Blood loss, oral

Question
QUESTION: I have had 10 ferrets over the years.  We now have a male and female originally from Marshall's.  They just turned 3 yrs old.
No recent health issues but got their annual check up and rabies shot just 3 weeks ago.
Thursday morning the male had blood on his paws and belly with diarrhea on his tail.  Gave him a bath and looked for injury, he seemed fine in all aspects.  Friday morning repeat with black stool, believed rectal bleeding.. called vet for emergency.  Spent 6 hours there, blood tests ok, but red blood cell count very low.  Fluid in his abdomen.  Vet put him on Amoxicillin and Prednisone with Carnivore Care food.  All night family took shifts to care for the poor guy.  Saturday morning identified the bright red blood was oral.. happy little guy, eating and drinking and taking his meds..  Now Monday and no more bleeding but has me and vet stumped.  Possible ulcer or ingested something hard???
No possibility of poison, home is ferret proofed.
Ideas.. thoughts..???

ANSWER: Hi Kevin:

Interesting question!  First I have heard of this.  I am wondering if 1: could he have bit his tongue while being restrained during his vaccine? ( due to the timing); OR, 2: he could have a loose tooth?  3: Possibly a lesion (cut, gum disease, or even a tumor or open sore in his mouth?  He could possiblpy even have a bleeding ulcer. Often blood in the stomach will cause people or animals to vomit the blood up,  and that may be what you were seeing when there was so much of it.  Do remember though, that it takes a fairly small amount of blood to look like a lot, but conversely, ferrets bodies don't have a lot of blood and definitely not enough to spare so much that his blood count came back low! (I promise I am not trying to panic you...just thinking of all possibilities).

Hopefully your vet did a very very thorough oral exam, even if he needs to give him a little snort of anesthesia to get in there and get a good look.  Any mouth wound tends to bleed more than other parts of our body because the mouth/nose are so rich with blood vessels.  He has, apparently, lost a fair amount of blood, tho, to have his hematocrit come back low. If the cause is not found, he could continue to bleed and end up with much more serious problems, so it definitely needs checked out very thoroughly.  I'm surprised your vet sent you home without finding the source of the bleeding.  There is always the possibility, if the blood is not coming from his mouth, that he has a bleeding ulcer, which could be life threatening.....anothe reason to check that mouth thoroughly, under tongue, all teeth, under lips, throat, etc.

If he did not exam him that thoroughly, I would return to the vet ASAP and request a thorough exam while ferret is sleepy/somewhat drugged to allow a very thorough exam.  HOPEFULLY it is a bit tongue, loose tooth, or small cut of some kind, but because there is always the potential if a tumor or other lesion that may require treatment, I would definitely not just drop the concern.  If nothing is found in his mouth, gums, terth, throat or lip underneath sides, I would think the next step would be to have a barium upper gastro exam, which would reveal any ulcer.  Ulcers can be treated, but if not treated, they can be lethal, so it is a valid concern. I would be sure to let the vet know you want a definitive answer.  Three years old is too young to die from a treatable ulcer.  On the flip side, he could even have a cancer in his digestive tract (esophagus, stomach).  The favt that the blood in his stool is black indicates that it has been digested, so it is coming from somewhere in his upper digestive tract - mouth to stomach somewhere.  If it were a vowel problem, blood i  the stool would be bright red....so it is definitely from the upper end of his digestive tract somewhere, not the intestines.

You may even be able to do a cursory inspection of his mouth, gums, lips and teeth by scruffing him firnly, gently trying to wiggle each tooth one by one, checking for loose ones as you go, as you also watch for any cuts or lumps, bumps or open sores of any kind.

I hope you will follow up as soon as possible. With a low blood count, he could go downhill very fast, as ferrets are so famous for doing.  I concur with feeding ONLY the soft food for now...Carnivore Care is excellent, as is Hills A/D Feline (canned) thinned with water and warmed. It is especially for sick and recovering carnivores, containing extra vitamins and easily digested as well as being gentle in case his mouth is sore.   I would remove access to kibble until you know what is going on. No sense in aggravating the problem.  I recommend serving the 'soup'  warm, introducing it by having him lick it from your fingers till he gets used to it, then moving to a spoon he can lick from.  I find my kids eat "soup" better if its nice and warm and I hold them to feed them. Its really important to get good nutrition down him right now and at leadt three to four times a day as much as he will eat. He may be reluctant at first since he's not used to it, but it won't take long for him to look forward to that one-on-one time with you and his warm, soft food. I like to make it about gravy consistency. If he acts like he doesn't want it, try thinning it just a bit more. Sometimes its the texture thry just aren't used to. The extra fluids won't hurt with his blood count being low too. Eventually you will determine how thick or thin he prefers it....and a bit more than lukewarm is good. Remember their normal body temperature is about 103-degrees, so lukewarm to us is cold to them.  Also, there is an iron supplement for small animals (I can't remember the name of it right nowm but it comes in a small brown dropper bottle and smells like iron and is not expensive. Your vet can best  advise on dosage.. You can add it to his soup or feed a few drops as a treat....ferrets like it, at least all I've given it to. Ask your vet about giving him that till his blood count is back up to normal. Small things can quickly turn into big problems with ferrets, as I am sure you know as an experienced ferret owner. I would approach this problem  from several angles for best results and nutrition and iron supplement would be important until this gets properly diagnosed and under control.

Thanks for an interesting question. Please write back and let me know what this turns out to be?  This is an interesting case and I am curious about what has caused this much bleeding.   Kudos to you for being an observant owner and getting him to the vet ASAP!  Hope to hear from you soon and that it turns out to be something simple and easily fixed.

Sincerely,

Jacquie Rodgers
"MAY GOD PROTECT THOSE PRECIOUS LITTLE ONES WHO CANNOT SPEAK FOR THEMSELVES"

---------- FOLLOW-UP ----------

QUESTION: Thanks for the fast reply and insight you provided.
The vet did sedate him to take blood and xrays.  She checked him orally as far as she could and everything was fine.  Doctors at Cornell reviewed the Xrays (can't wait for that bill) and determined that other than the fluid in his abdomen it looked ok.  
He was so bad that the vet offered to euthanize him Saturday, I declined as he was not suffering.
I am going with the ulcer or possible a piece of plastic ingested.
He loves his Amoxicillin and Carnivore Care, Prednisone is a different story.  
Since Sunday night no more blood and his weight is starting to go up again.  His nose and gums are still a bit pale but I am guessing it will take a bit for his red cell count climb back up, he was at 17 and the vet said 30 is critically low.
I am setting up follow-up appointments.  Would really like to know what happened to the little guy since there was no warnings and I have never seen something like this before.

Thanks again
Kevin

Answer
Hi again Kevin:

Thank you so much for the follow up. Glad to hear he is doing better. I agree, if he is not suffering, no need to euthanize. You know your ferret and even tho he will likely not be quite as active with low blood count, hopefully his full energy  will come back up soon..  If you do see the vet again soon, it would be a good idea to ask for a liquid iron supplement to help get that blood count back up. You are obviously a great ferret dad, getting an opinion from Cornell (!) :-)  God bless you for loving him so much, giving him such great care, and being willing to get him nothing but the best.  

If I can ever be of any help, please don't hesitate to write again.  I want to invite you to join my online Facebook ferret group called THUNDERING FERRET PAWS. You could even post a picture of your little guy - I'd love to see him!  We have a great group of around 200 folks with many rescue moms, a vet or two and years and years of combined ferret experience and we all try to help each other. There is usually someone there 24/7 because we have owners from all over the world. It is quite interesting too.  Hope to see you there!

Sincerely,
Jacquie Rodgers