Dear Debbie:
 
>I have two sick ferrets that are not getting better.  Pywacket is six years
>old and Hooter is about 5 years.  My vet thinks that it is ECE and ulcers
>caused by the ECE.  Hooter is still eating, but has severe diarrhea.  Py
>is totally out of it.  I am sub-qing him three times a day....
>schedule that I would like to post here to see if anyone can give me any
>suggestions...
>
>8am- Carafate -Py sub-q
>9am food, Clavamox .5 ml, chloramphenical 1 cc and
>   pepto 1 cc mixed with food.
>1pm food & water
>3pm carafate
>5pm food & water, Py sub-q
>7pm carafate
>9pm same as 9am. plus- Biaxin 1/2 cc.
>11pm carafate, Py sub-q
>4.am food and water
 
It would certainly be helpful to know why your vet is suspecting ECE -
while the clinical signs do fit, has there been any recent introductions
of new ferrets, a trip to the pet store, etc?
 
First off, ECE and ulcers are both treatable with good nursing care.  It
may be rough going for a while, but there is no reason to asuume that Py
won't make it - euthanasia at this point would be a bit hasty I believe.
 
Looking at your treatment protocol, I am seeing treatment for three and
possibly four diseases (ECE, ulcers, Helicobacter, and proliferative
colitis).  I think that this apporach is a bit too all-encompassing and
that we should focus on the two most important.
 
First off, I would discontinue the chloramphenicol - this antibiotic is
useful only for proliferative colitis, an uncommon disease of young
animals.  Otherwise it is not a useful antibiotic in ferrets.
 
Also, I think at this point I would hold off on treating for Helicobacter -
it is obvious that this is not the cause of the problems, or we would have
seen GI symptoms prior to the onset of vomiting and diarrhea.  Not to say
that it may not be contributing to the problem, but its contribution
probably does not warrant the stress involved with giving the extra meds,
especially the Pepto.  Sometimes the stress of trying to get pepto into a
ferret cuases more damage to the ulcers than it helps.
 
At this point, I think that I would go strictly with the subq fluids,
Carafate, and continue the Clavamox for a week after the onset of clinical
signs, then discontinue.
 
Regarding the administration of the Carafate, Carafate is an inert
substance that really serves only to patch ulcers, rather than to have any
anti-inflammatory effect.  For this reason, it should be given 10 minutes
prior to feeding.  When an animal eats, the stomach secretes acid, and when
the acid hits the ulcer it hurs, the animal grinds itsteeth,a nd stops
eating.  With Carafate plugging the holes, it will be able to eat without
discomfort.  So I would rearrange the Carafate schedule here to coincide
with feeding.
 
Finally, you don't mention what you are feeding - if it contains kibble,
the diarrhea will continue as long as kibble (even if ground) is being
fed.  You should swtich to a bland diet (chicken baby food is an excellent
substitute for ECE patients), and feed every four hours with water offered
every two hours (in addition to the subcutaneous fluids.)  The ferrets
should receive a minimum of 60 cc's per day SQ initially, then taper it
as they start taking more orally on their own.
 
Sometimes we can overdo it with ministrations to the detriment of the
ferret.  If we can concentrate onthe ECE and the ulcers first, then we
can always treat the Helicobacter later.
 
With kindest regards,
Bruce Williams, dVM
[Posted in FML issue 3328]