Ferret Shivers

Question
QUESTION: Hi Jacquie,
I HAD EMAILED YOU ABOUT 2 WEEKS AGO ABOUT MY LITTLE FERRET
TEDDY THAT HAS ADRENAL TUMORS ON BOTH SIDES , I HAD TOLD YOU
ABOUT HIS CONSTANT OFF AND ON SHIVERING,HOWEVER I FORGOT TO MENTION THAT THEY FOUND OUT FROM THE ULTRSOUND THAT HIS HEART IS SLIGHTLY ENLARGED ON  ONE SIDE SO THEY PUT HIM ON ATENOL,( BLOOD PRESSURE MED.) BECAUSE HIS LITTLE HEART WAS BEATING FAST , HAVE YOU EVER COME ACROSS FERRETS THAT WERE PUT ON THIS MED?  
DO YOU THINK SOME OF HIS SHIVERING IS BECAUSE OF THE HEART ? IT'S VERY STRANGE , SOMETIMES HE SHIVERS ALOT SOMETIMES NOT THAT MUCH ?? HE'S HANGING IN THERE, HE IS EATING PRETTY GOOD , BUT I HAVE TO FEED HIM BY HAND OR SHRINGE, HE STOPPED EATING HIS FOOD 2 MONTHS AGO, HE USED TO EAT THE ULTIMATE 8 & 1 FERRET FOOD , NOW HE WON'T TOUCH IT, I HAD NOTICED HIS GUMS WERE A LITTLE RED SO MAYBE THEY ARE IRRITATED FROM SOMETHING ?? I NOW FEED HIM CANIVORE CARE
SOFT FOOD, HE LOVES IT BUT I HAVE TO FEED HIM , HE WON'T EAT OUT OF A BOWL, MAYBE HE DON'T LIKE TO GET HIS MOUTH DIRTY?? DO YOU HAVE ANY SUGGESTIONS AS TO WHAT I CAN PUT THE FOOD IN? IT'S A POWDER I MIX WITH WATER. SOMETHING THAT WON'T DRY IT OUT? ALSO I READ SOMETHING YOU HAD ANSWERED BACK TO SOMEONE REGUARDING A PROCEEDURE OF A SHOT OF GRAIN ALCOHOL IN THE RIGHT ADRENAL TUMOR TO SRINK IT, DID YOU HAPPEN TO KNOW
WHAT VET THAT DOES THIS PROCEEDURE?? AND IF THEIR IS ONE IN MY AREA , DELAWARE COUNTY " HAVE YOU HEARD MUCH ABOUT THIS PROCEEDURE? ALSO WHEN FERRETS HAVE ADRENAL TUMORS, IF THEIR
CANCEROUS , DOES IT PROGRESS VERY FAST ?? I TRY TO ASK QUESTIONS TO PEOPLE WHO HAVE HAD FERRETS TO HEAR THEIR EXPERENCES, TO SEE IF ANYONE HAD A FERRET THAT HAS THE SAME SYMTOMS AS MY LITTLE BABY, IT HELPS. AGAIN I THANK YOU FOR YOUR TIME AND GREATLY APPRECIATE YOUR ADVISE.

ANSWER: Hi again Connie:

So sorry to hear that Teddy is still shivering. That must be frustrating as a ferret mommy to watch him and feel that he's probably uncomfortable when he is shivering. When the doctors don't seem to know what causes it, that makes mommy's worry even more, of course.

Atenolol is a beta blocker, blood pressure 'normalizer' used specifically in ferrets who have hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy is (in simple-to-understand terms) is when the heart enlarges because it has to work extra hard (like any muscle that exercises hard) to compensate for the parts of the heart that are no longer working (the hardened parts of the heart). Since the heart is a 'muscle' that is responsible for pumping blood through our bodies, anything that slows or affects circulation can cause the shivering you're describing because the newly warmed blood isn't getting circulated quickly enough. Since ferrets are so tiny, their hearts are also teeny tiny, so it must be super-efficient to pump blood through every part of their body.

One way you can SEE Teddy's circulation and know if circulation problems are so bad they could be affecting body temperature - look at Teddy's gums, tongue, even the pads on his feet and in between the pads - do they have a bluish gray tint to them, or are they a nice pink color? In a ferret with cardiomyopathy that is advanced, it is common to see bluish tongue, gums and even cold, bluish-colored toes - the blue color indicates that enough blood just is not getting to that area to keep it warm.  You mentioned that Teddy's mouth looks "red" - is that all the time? If so, you may want to mention that to the vet who put her on the atenolol. She may need a lower dose. It *should* help blood circulate better - enough to keep the mouth and gums from having a blue tint to them - but not to the point that her gums actually look *red*.

The only solution to Teddy's shivering is to provide enough warmth from an external source that it takes the chill away. A ferret's normal body temperature is 101-103 degrees F...so it's a bit higher than ours. Teddy's skin should always feel very warm when you touch it. Even if he's chilled, it still may feel warm to you, so don't judge by that. He *probably* would appreciate an independent source of warmth to help him stay warm. **(can't stress this enough)WARNING: You must be very very careful with things like heating pads because ferrets can become overheated really quickly. With impaired circulation, Teddy would also have great difficulty cooling his body down if he gets overheated. Sometimes the best idea is a hot water bottle (not too hot) or even one of those tube-style rice-filled neck-warmers that you heat in the microwave oven. Just be sure it's not too hot. They can stay warm for an hour or so. You can put it under a blanket and it will provide warmth without being directly against him....but please don't *assume* he won't be curious and find the source of the warmth - and end up getting burned OR biting into whatever it is you have in the cage (so be SURE it's something ferret-safe too).  Hopefully an external source of heat will only be necessary on the coolest of nights and he will be okay in the daytime if you keep him in the warmest room in your house. Sleeping with other ferrets is another great way to keep him warm...if you have other ferrets :-)

If you have no other options, you may want to try using a heating pad on the lowest setting possible, but with the following safety precautions:

- be SURE there is a nice thick fabric cover on the pad that has been SEWN on (or zippered, then the zipper sewn so it cannot be unzipped) so he absolutely cannot get the cover off. Double stitch it if you have to - just be SURE he cannot get to the wires to chew them.

- be SURE the pad is right next to the edge of the cage and the electric cord goes directly out of the cage - and CANNOT be pulled into the cage (put a brick on it if you must, so it cannot be pulled in and/or chewed on).

- Placement of the pad:
    *DO NOT put it anywhere near water or where anything wet can possibly get on it
    *BE SURE there is another place the ferret can sleep if he chooses; just in case he feels the pad is too warm, he should have another comfy choice to sleep in
    *Consider putting a hard plastic (PVC) tube over any part of the electric cord that is inside the cage so the ferret absolutely cannot chew on it

ABSOLUTELY BEST IDEA OF ALL:........an even safer way to give your ferret a warm place to sleep that removes ANY possibility of your ferret chewing cords, digging the electric pad, digging or chewing a bag of rice, etc....Place the electric heating pad UNDER THE CAGE ON THE OUTSIDE OF THE CAGE (make sure the cage sits down flat onto the heating pad - not up on wheels) and your ferret will have a nice "warm floor" in his cage. The only thing that is awkward about this is that most folks have the litterbox and food/water on the lowest level of the cage - if you can rearrange your cage and put the sleeping area on the bottom floor (keeping 'underneath blankies' to a minimum for best use of heat), this will work perfectly and be SAFEST. If you just have a stack of blankies, your ferret will decide where is the most comfortable for him and will figure out that he can go down low for added external source of warmth or up on top if he would rather get away from the heat for a while.

I have not heard nor seen anything more about the injection of grain alcohol into diseased adrenal glands since I mentioned it about a year ago here on this website. I believe if it had been the monumental success it was expected to be, we would have all heard of it by now - it would definitely be earth-shaking news within the ferret community. Here is a great website that talks specifically about hypertrophic cardiomyopathy that you may find helpful:  http://www.miamiferret.org/fhc/cardiomyopathy.htm .   The best source of information is a Yahoo group online that concentrates its efforts on ferrets with adrenal disease, insulinoma and other serious ferret illnesses. There are some VERY experienced ferret owners, shelter operators and even ferret vets who are very active on this list.  You can read/join that group here:

http://pets.groups.yahoo.com/group/ferrethealth/

Another excellent information resource is Dr Charles Weiss, who will do telephone consultation fees with veterinarians for a fee and will answer all kinds of questions, give second opinions, review test results, etc. He can be contacted at Bradley Hills Animal Hospital by calling 301-365-5448 Mon-Fri 8am-6pm and Sat 8am-12pm. You will need a credit card to arrange payment, then he will speak directly with your vet. It's really quite simple and not that expensive either. Dr Weiss knows just about all there is to know about ferrets - has ferrets of his own - and his heart is truly in his work.

In regards to Teddy's refusal to eat his kibble, this is very very common in ferrets who are chronically ill. It seems that once they are handfed for some period of time, they become dependent upon being handfed and just almost 'forget' how to eat on their own. I've personally had to hand feed two ferrets for multiple years after they had extended illnesses and I was unable to get them to go back on hard kibble again. Carnivore Care is 'okay' as far as meeting a ferret's nutritional needs.  Personally I prefer Hill's A/D Feline canned prescription diet. You scoop out a couple tablespoonsful, add water, microwave a few seconds, stir to consistency of gravy. Dip your finger in it, then let the ferret lick it from your finger; OR you can touch your finger behind his canine teeth (the long ones) until he gets a few good tastes of it. Ferrets NEVER like new food - and sometimes even gag - but once they get a good taste of it, will come running when they hear that A/D soup being stirred. It is chicken - meat AND organ based; HIGHLY digestible and added nutrients made especially for sick and/or recovering carnivores - PERFECT for ferrets. It has high calorie count and will quickly put weight on ferrets...sometimes hard to do when ferrets are sick.

If your ferret doesn't need to gain any extra weight, you can get Hill's I/D canned feline prescription diet, some food but less fat. (NOTE: A/D or I/D MUST be covered and refrigerated after opened - take out what you need and return the rest to the fridge. A can will last a day or two depending on how much your ferret eats. Costs about $1.50 per can)  In my opinion, both of these are far preferable to Carnivore Care, especially in the long term. Unfortunately, once ferrets get *spoiled* to being handfed, they can be very very difficult to return to eating on their own. Unlike other animals, it's not a matter of "if they get hungry enough, they will eat" - it doesn't work that way with ferrets unfortunately.  That's one of the things that makes ferrets so very delicate and require such specialized care.  Owners must recognize things like this - ferrets just are different than other animals and this is one of those ways where they do differ.  As a result, you most likely will join a long list of ferret moms and dads who feed their sick kids for a long time. The only consolation I can give you is that the time spent feeding these little ones is precious time and it's a great bonding experience. When that day finally came that the first ferret I had handfed for years passed away, instead of the great freedom and extra time I expected to have....intead I felt this incredible, horrible sense of loss. I've found over the years that the little sick ones, the ones I have ended up handfeeding for years, are usually the ones that I mourn the most when they are gone. They are the ones who take a big chunk of your  heart when they go - so my best advice is to enjoy every single minute of those hand feedings.  Consider it an honor and a pleasure that your little one trusts you with his life to the point that if you don't feed him, he simply won't eat.

My thoughts and prayers are with you and your precious little Teddy. Looking back, I *think* I got all of your questions answered. Please don't hesitate to write again if I missed any, or if you have other questions now or in the future - I love updates, just with the news was happier. And give that precious little 'chow hound' a hug from me, k?

Sincerely,

Jacquie Rodgers




    


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

QUESTION: THANK YOU JACQUIE , ONCE AGAIN FOR YOUR CARING ADVISE.
TO ANSWER YOUR QUESTION, TEDDY'S GUMS NEAR HIS K9 TEETH
ARE RED AND WERE THAT WAY BEFORE HE WAS PUT ON THE ATENOLOL,
THE VET SAID HE HAS TATAR ON HIS TEETH, COULD THAT BE THE REASON? OTHER THEN THAT HIS GUMS ARE NOT GRAY NOR IS HIS TOUNGE OR PAWS, WE BROUGHT HIM TO THE VET YESTERDAY AND HE
PUT HIM ON THE ATENONOL 1X A DAY NOW, INSTEAD OF EVERY OTHER,
YESTERDAY HE DID NOT HARDLY SHIVER AT ALL, I WILL MONITOR
HIM AND SEE , MAYBE IT'S HELPING , I HOPE !! ANYWAY IF YOU HEAR OF ANYTHING ABOUT THE GRAIN ALCOHOL OR ANY OTHER PROCEEDURE WOULD YOU PLEASE KEEP ME POSTED ? ONLY ONE OTHER
QUESTION,IF THE RIGHT TUMOR IS INVADING THE VENA CAVA DOES THAT DEFINATELY MEAN CANCER ?? THATS WHAT SHOWED ON THE ULTRA SOUND,THE RIGHT TUMOR INVADING THE VENA CAVA.. DO YOU THINK THIS IS WHATS CAUSES THE HEART TO OVERWORK ? IF IT IS CANCER, DOES IT PROGRESS FAST? HE'S NOT LOSING WEIGHT, ACCUALLY HE GAINED ALITTLE WHEN HE WAS WEIGHTED YESTERDAY.
HE STILL WANTS TO PLAY , OF CORSE NOT LIKE HE USED TO.
BUT THE INTERSEST IS THERE. DO SICKLY FERRETS STILL WANT TO PLAY ?


ANSWER: Hi Connie:

I'm so glad the more frequent dose of atenolol seems to be helping Teddy's shivering. That pretty well confirms my suspicion that the shivering was because his circulation just wasn't enough to keep him warm. No doubt he will be a lot more comfortable if he isn't shivering all the time and it will be a lot safer if you don't need to supply an external source of heat to keep his little body warm. It sounds to me that your vet is really on top of Teddy's situation; and your little one is in very good hands. :-)

If Teddy does have tartar on his teeth, yes that could definitely cause the gums to be red and irritated. Since he's eating soft food instead of crunching on hard food, it will be hard to remove the tartar. There are little rubber toothbrush-like cleaners you can get at any good pet store (PetCo has them) that slip over your finger (or you can get a tiny brush at the same place and also some pet toothpaste that's meaty flavored) and then you can actually remove the tartar yourself OR you can have your vet remove it if it is problematic. Especially with a pet with heart problems, it's important to keep any possibility of gum disease under control. I think ferret toothbrushing is like anything else - you must start just a little at a time and he will probably only tolerate a little bit; then  the next day do a little; then each day continue until he gets used to it and it doesn't bother him anymore. I know of some people whose ferrets let them brush their teeth all the time with no problem. It's just a matter of what they are used to. Especially since Teddy is on soft food, it would be a good idea to start getting him used to a tiny soft pet toothbrush and special toothpaste for small carnivores.

I'm sorry to hear that Teddy's ultrasound outcome showed that his right adrenal gland is surrounding his vena cava. I assume your vet explained to you that the vena cava is the largest blood vessel coming out of the heart, so if it gets cut off by the ever-growing tumor, it will kill Teddy.

HOWEVER, hopefully your vet also explained to you that many vets DO right-side adrenal surgeries. If not to remove them completely, then at least to "de-bulk" them, in other words, to take all the insides out of the tumor, which makes it just an empty shell again, which could buy Teddy YEARS of life back.  If your vet did not explain this to you, please please take the results of the ultrasound and go to another ferret vet for a second opinion. Unless your vet explained some other reason that surgery cannot be done on Teddy's right adrenal gland, it may well save Teddy's life to get a second opinion.

I think from what I understand from what you are writing is that this vet feels the tumor that is on the right adrenal gland is ALREADY impeding the blood flow to Teddy's heart. Did he give you any idea how long he feels Teddy has? Every tumor is different and grows at a different rate, whether it is cancerous or not - and it won't matter if this is cancerous or not if it cuts off the blood supply to Teddy's heart, it will be just as deadly even if it's not cancerous.  

Connie, reading your note again, I'm beginning to feel that Teddy may not have long for you to decide what to do. Did your vet give you a time he thought Teddy might have?  Will your vet consider doing a 'de-bulking' surgery to remove most of the tumor, or does he not even want to touch it because of where it is?  There ARE other vets who WILL do surgery if he won't.  Possibly it would be a good idea to get a second opinion AS SOON AS POSSIBLE or you could lose Teddy, as he is already having some serious symptoms, such as the shivering, which was apparently caused by the lessened blood flow from the vena cava that is being affected by the right adrenal tumor. As all the symptoms really come together in my head, it is becoming obvious that your little Teddy is one very very sick little fellow who is going to need adrenal surgery very soon or you are going to lose him. The atenolol will help him for a while, but there is no way to know how long - it could be only days or weeks. PLEASE - don't wait to get a second opinion. If you did not understand what your vet told you, please do call him or go back in and make sure you understand everything he told you. It's very very important that you ask him the questions you asked me about 'how long does Teddy have?' and 'What other options for treatment does Teddy have?' Do also ask him if he knows ANYONE in your area who might be able to do the right sided adrenal surgery if your vet will not or cannot do it.

It's hard to say if Teddy will lose or gain weight because of the growing tumor that is feeding on the main blood supply in his body. It could grow large fairly quickly and become heavy. I would go more by how Teddy "looks" - does he look skinnier than he did last week? Or does he look like he is gaining weight? Is he just bigger in the middle (because that could be tumor)?

I need to talk to you really honestly, Connie. As long as he feels well, Teddy will play and be fairly active and he will seem okay. As long as he is active and will eat and play, you still have the chance to find a different vet who might be willing to do surgery on Teddy. However, please understand that because of the nature of the adrenal tumor that Teddy has, he could very quickly go from feeling okay to being very uncomfortable as his heart struggles for blood, or the vena cava could even possibly rupture and Teddy could die quickly. You must be emotionally ready to handle this if it happens and you are there with him. You will need to stay strong, to hold him, to keep your voice calm and reassuring, to hold him close to you and talk to him. You MUST be the mommy - the strong one your baby. He will need you to be strong so much more at this time than ever before. Do be sure to make up your mind NOW that if anything goes wrong with Teddy at any time, that you will remain calm and hold him close to you; with Teddy's problem being vena cava / heart, there is no way you will be able to get him to vet care quickly enough for help. Your time will be best spent stopping whatever you are doing, sitting or laying with him, speaking lovingly, slowly, calmly to him so he KNOWS his mommy is right there with him as he passes to the Rainbow Bridge. Okay?  That's a hard thing to do, but as ferret parents, it's something we almost always have to do for our kids.

After he takes his last breath and you are positive his little spirit has passed on, then you can cry; you can mourn and sob and weep and moan. But, while he is here, please make up your mind to be strong for him. I've sat with each of my kids while they have passed to the Rainbow Bridge and it just never gets easier. I wish I had the forethought the first time to *know* and to have been prepared - instead I panicked the first time and I still feel bad about that. And so, it's that I am trying to help you avoid. I hope I can make you feel just a little more comfortable with the idea of death; that we will all go to that eternal sleep when our time is over, and the best we can wish for is for the person with us to be calm, loving and spiritual as we make our journey.

I don't like discussing those last moments, but I like even less thinking of any ferret mom or dad being as unprepared as I was when it happened to me the first time. My first ferret died in my arms at 4 a.m. with my vet on the phone and me frantic because he was having seizures and I had never seen an animal have seizures before. My vet later told me that it is not uncommon for ferrets to have seizures when they die - but that they are not usually aware when they happen. I'm still not so sure of that, so IF I feel my ferrets are getting close to *that* time in their lives, I usually choose to *help* them cross the Bridge at the vet's office and go gently in my arms with no pain at all except a tiny stick of a needle in their little butt for that last shot that puts them asleep.

I really want to encourage you to talk very frankly to your vet about Teddy's future - if your vet won't do surgery, does he think ANY vet could do a successful surgery?? If not, how long does Teddy have?  Hopefully a few answers will help make life a little less stressful for you. If there are some signs you could watch for to know when Teddy is starting to get in trouble, so you can get him in to the vet to HELP him to the Bridge so you KNOW it will go smoothly - please don't forget to ask those questions.

Here's an awesome place to light a candle for Teddy and just put in a little prayer request IF you would like to. I found it very comforting when my kids were sick and hope you do too.

   LIGHT A CANDLE IN MEMORY OR IN PRAYER:  
   * http://www.gratefulness.org/candles/enter.cfm?l=eng

    I will keep your little Teddy in my thoughts and prayers and trust that you will keep me updated. Hoping for the very best news possible -

Sincerely,

Jacquie Rodgers





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

QUESTION: JACQUIE,
JUST WANTED TO LET YOU KNOW, TEDDY'S SHIVERING IS BACK .
JUST THAT ONE DAY HE HARDLY SHIVERED .. I JUST DON'T GET IT,
SOMETIMES HE hardly SHIVERS AND SOMETIME HE SHIVERS ALOT???
YOUR RIGHT IT'S VERY FRUSTRATING !! IT MAKES ME SAD, BUT WHEN HE IS SHIVERING I LAY HIM ON ME STOMACH AND COVER HIM WITH A BLANKET AND RUB HIM A WHILE & AFTER A WHILE HE STOPS SHIVERING?? WHY?
I JUST DON'T KNOW, THEM WHEN I PICK HIM BACK UP TO PUT HIM TO BED HE STARTS SHIVERING AGAIN !! THEN I RUB HIM WHEN HE'S IN HIS BED THEN AFTER A WHILE HE STOPS SHIVERING AGAIN.. DOES THIS TELL YOU ANYTHING ?? IT'S STRANGE , JUST DON'T KNOW IT MAKES ME CRAZY NOT KNOWING !!I'M SORRY TO ASK A MILLION QUESTIONS BUT IT REALLY HELPS TALKING TO YOU, AND KNOWING THAT YOU HAVE BEEN THERE AND HAVE DEALT WITH SIMILAR SITUATIONS IN WHICH ALOT OF VETS HAVE NOT. P.S. DO YOU THINK THE ATENTENOL HOWEVER YOU SPELL IT "" IS HELPING OR HURTING THE SITUATION WITH HIS HEART ?? DO YOU THINK IT MAY BE MESSING UP THE FLOW OF THE BLOOD ?? SLOWING IT DOWN TO MUCH ?? SO MANY WHAT IF'S , YOU KNOW ? ANYWAY THANK YOU ALSO FOR THE CANDLE LIGHTING , THAT WAS SOOOOO SPECIAL I THANK YOU FROM THE BOTTOM OF MY HEART !!! AND THANK YOU FOR YOUR PRAYERS !

Answer
Hi Connie & Teddy:

So very sorry to hear the shivering is back :-(  I'm thinking he had that one good day of not shivering when the vet increased his atenolol dosage. Yes, it is very frustrating - I do understand that. Unfortunately, this is how it is when these little ones get sick.  Just wondering - did you call your vet and let him know that Teddy is back to shivering again?  He *may* want to increase his atenolol dosage again - or maybe he is already on the highest dose he can be on - either way, at least it's worth asking, especially if there is a possibility that it could help him. It seems like the increased dosage did help him for that one day.

No, I don't think the atenolol is making the situation with Teddy's heart or his blood flow worse - I think that Teddy is having a very serious illness is all.  Once I put all the pieces together in my head, it was then that I saw what I *think* your vet is hoping to accomplish for Teddy. I think he is trying to just keep Teddy comfortable and feeling the best that he can feel.  Since your vet didn't recommend surgery, I'm thinking that maybe surgery was not an option for Teddy - that possibly it is already too late for that. That just happens sometimes, and there is just nothing we can do except keep them as comfortable as possible, love them lots and lots and be there for them.

The first thing I would say is to call the vet and let him know the shivering is back and ask if increasing the atenolol dose might help him to stop shivering again.

Then, it might be a good idea to get a nice hot water bottle or heating pad - with lots of coverings on them so he doesn't get burned - and help Teddy stay warm from the outside, since he doesn't seem to be able to stay warm from the inside. See if the hot water bottle or heating pad or rice bag (warmed in microwave oven) helps him stop shivering while you are holding him. If he doesn't mess with the electrical cords and stuff, then keep him closeby where you can keep an eye on him AND keep the settings down on the lowest possible numbers so he can't get burned.

His shivering sounds like he is definitely feeling a chill - his body isn't doing a very good job of warming itself up.  So, till you can get an answer back from the doctor, go ahead and try some kind of SAFE ways to keep something warm around Teddy to help keep him warm. Remember Teddy's body temperature is 101-103 degrees (warmer than ours), so just holding him against your skin won't be warm enough. You can put him on your tummy, then a heating pad on LOW on top of him, or between him and your belly, whichever you prefer. It definitely sounds like he would rather have mommy holding him :-)

Just hold him lots and love him lots.  I will keep your little man in my thoughts and prayers. Give him lots of snuggles and warm hugs.

(((hugs)))
Jacquie Rodgers