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(the author has asked me to apologize in advance to the readers that this text tends to ramble a bit, but it is an accumulation of notes over time.  Some info may be dated and she also wants to remind the readers that she is not a vet.)
 

Now, take into account that this is rather old so there may be new approaches, and I'm not a vet.  I have been meaning to do an update with someone I know who's a vet student but neither of us has had much time.  Anyway, here's a bunch of stuff I put together long ago.

People always ask about the salt; once there's known cardiomyopathy as with your ferret it's NOT going to make any difference. It had just been HYPOTHESIZED that it MIGHT make a difference for some forms of heart disease OTHER than cardiomyopathy.

Be sure to discuss with your vet: ultrasound, Enacard, Digoxin once compressions are compromised (ultrasound will tell) or if an arrhythmia develops. A person has to be very careful to not overdo Digoxin and the amounts for one ferret may not be right for another so your vet will need to do the math.

Doses described apply only to our ferrets' individual situations; back when first written the vet kept contacting us to find out the doses, weights, disease stage, etc. because this stuff was new way back then.

Upper limits for Furosemide (Lasix) now are merely by what ferret will tolerate. We have exceeded "max" many times will all three who had it. Ruffle was more limited in her personal tolerance, but Meltdown and 'Chopper the Organic Helicopter had huge amounts in their last months.

'Choppie had hypertrophic, the rare form which tends to not be found till it's very advanced, or even not found till after death. It can also be hard to diagnose since the changes are hidden within the heart (thickening of the muscle rather than enlarging of the heart). Her only symptom was failure to maintain weight. Have since heard about four others whose only symptom was the same one.

Forgive it being disjointed. Things get tacked on now and then.

Remember that cardiomyopathy is NOT the only cause of ascites (liver disease is possible the second most common cause) so a CBC by your vet also makes sense. Also remember that Digoxin is a powerful medicine but a very helpful one so treat it with both appreciation but with the caution of proper testing to know the appropriate levels. I have never personally read of a ferret with too high a blood level of it or with toxic effects, but it has happened in other mammals so just use common sense and testing.

Several people have run into unexplained wasting which turned out to be connected to a not common form of cardiomyopathy for ferrets: hypertrophic cardiomyopathy which can be harder to diagnose.

Coenzyme 10 Q can be a useful ADDITION to the standard cardiomyopathy meds. Since it is supposed to be given with C&E you can do this by mixing it with a bit of Furovite and some vitamin E oil from a capsule into some Hills A/D. (We used to use Efa-Z but have since read that ferrets get zinc poisoning easily so are avoiding it for the most part now, though not completely since we've never run into the poisoning ourselves.) into some Hills A/D. When this was added to the routine for 'Chopper, a seven year old with hypertrophic cardiomyopathy it seemed to help improve her quality of life. Her cardiomyopathy gave her only a handful of days of discomfort despite her living to the point where she needed regular massages each day to aid with peripheral edema. She insisted on being active and climbed right up to four days before her death and kissed to the very end.

IMPORTANT NOTE: having read in the new James Fox ferret veterinary text how easily acquired and bad zinc toxicity is in ferrets we would NOT use the Efa-Z as a source now!!!!!!!!!!!!!! We'd use vitamin E capsules. (Problems is no one really knows how much zinc is safe -- some is going to be essential -- but what is safe?

Remember to get the cardiomyopathy FAQs from Pam Greene at pgreene@optics.rochester.edu or http://www.ferretcentral.org, and the AFIP FAQs at http://www.afip.org/ferrets/index.html

You'll be grateful for them, and so will your vet!

The other medical FAQs are wonderful, too! Everyone should have them and share them with their vets!

We gave lasix and furosemide for many months with Ruffle and Meltdown and only saw two negative effects (if memory serves): decreased sense of smell (so we gave more soft and warmed foods), and dehydration in Ruffle since she had the opposite of the usual reaction and lost her thirst. By the time she was ready to go Meltdown was on doses over 50% higher than those mentioned by Quesenberry and Rosenthal in their book, which are themselves about double what had previously been thought to be the maximum dose so the running wisdom among ferret vets now, I gather, is that ferrets can be given ANY size dose which is tolerated by that individual.

Here is an overview of some of the things we learned SINCE the below write-up:

The amount of Lasix given is dependent only on the tolerance of the individual receiving it. Meltdown finally got to the point where she was having around three times as much as we had originally (as in the below) thought the maximum and not having any problems.

Strokes and temporarily blocked vessels from thrown clots are not always terrible. Meltdown had several before the ones which ended her life on her 8 and 1/2 year birthday. Anticoagulants and massage ( for something like 14 hours straight when it was one lodged in the femoral artery) did the trick for a long time. Meltdown eventually had a thrown clot in a kidney which was not clearing up and then a massive stroke the morning she was already going to have to get a mercy shot since the kidney clot form the day before had not worked out well despite time and treatment.

Meltie had problems with aspirin so had a couple of intestinal bleeding episodes. We began putting a lot of vitamin E in her food then since that would possibly reduce the effects of vitamin K and so reduce thrown clots. Whether it actually helped or not we don't know.

Those TINY furry "mousies" were light weight enough that she could take out her frustration on them without being stressed.

Meltdown LOVED having carnations (more than the other smell options given) to sniff while she was ill.

Her attitude was great pretty much throughout. Meltie was someone who looked at her options and made the most of them and Steve and I were always trying to make her life interesting throughout her illness.

Heart Disease in Ferrets from the Owners' Point of View

Until the last few days of March 1996 Steve and I knew virtually nothing about heart disease. Then within a week Ruffle was barely saved from a sudden, severe bout of ascites (fluid build-up) and Meltdown almost was lost to cardiomyopathy with ventricular bigemini (doubled contractions from the rhythm being off due to the pacemaker section of the ventricle being stretched), only to be followed within weeks by an elderly uncle having first a heart attack and then congestive heart failure. Sometimes you have to learn fast.

As with humans there are a variety of heart diseases, variations, and treatments, but most common in ferrets is cardiomyopathy, a painless (if there is not fluid in the lungs) but terminal condition which fortunately often progresses slowly if treated. The ferret's heart enlarges, sometimes thickens, and become less efficient. Some cases are due to long taurine deprivation, such as when a ferret has been given dog food, others are genetically linked, or age related, but most happen for unknown reasons.

In Ruffle's case she was going on six years old, multiply handicapped, multiply deformed, and retarded so many organs began to fail on her or acquire tumors or lesions at the same time. That presented the challenge of dealing with heart disease (first caught as a pre-cardiomyopathic condition), a cystic and diseased liver, a benign adrenal tumor, Insulinomas, a faulty spleen, lesions of the lungs and kidneys, grande mal convulsions, and major simultaneous surgeries. Yes, you can balance treatment for such conditions, and a ferret with heart disease can survive surgery if luck is with you, you have a very skilled veterinarian, and the treatments are not too badly in conflict. Ruffle's most common large problem involved her ascites which was from both the heart and liver. Unlike most ferrets which are given diuretics she did not get thirsty; instead she over-responded to her medication, plus had a reduction in both thirst and hunger so that we were constantly having to monitor swings between too much fluid preventing her diaphragm from functioning well enough to survive and dehydration. This meant checking her no less regularly than every two hours around the clock for water balloon belly, or loose neck skin and flat eyes. On her bad nights she slept in a large carry cage placed on exercise platforms next to the bed.

Lest you think we were cruel, Ruffie still enjoyed life and we did everything possible to help her do so until she gave up on it herself a few months later at which point we got her a mercy shot. In fact, she greatly enjoyed being able to act like the world's most spoiled ferret, and got off on bossing us around.

Both our sick ferrets have enjoyed most of their time with cardiomyopathy. For the first two months they were an incredible drain on a person's time, sleep, patience, and humor. After a while being able to get their own way constantly lost its charm and they let us have a some of the rest of our lives back. Ruffle went from wanting to play till she dropped or until we put her in (and put down a cover to signify that she needed to rest, a trick we've used for years which does work once they get used to it), to being awake less but happy when she was up, to having little energy but loving being carried for walks, being given herbs to smell (especially mints and basils), having the sun on her belly for short periods, listening to music (especially if we wove her name into a song), hugs and kisses, and other peaceful entertainments. Meltdown, meanwhile, has added muscle mass since she has learned to pace herself. In weight lifting she would be called a hard-gainer, someone who needs extra rest time for adding muscle.

Meltie, who will be 8 years old in early October, was not expected to survive even a few weeks, let alone thrive. No one had ever before caught a case of ventricular arrhythmia in a ferret early enough to treat it. Usually it is only seen while it is killing the critter. There ensued a mad scramble involving veterinarians around the world: practicing vets, veterinary research vets, and university and medical center vets who handle research animals, plus human cardiologists in case any had run into a research ferret with the problem and to narrow down treatment options by looking at those used for other species. She even was brought up as a topic of conversation during a cardiologist's conference which happened to conveniently be going on at the same time. People in several ferret organizations and the Ferret Mailing List were tracking every lead, all of the vets at Basking Ridge Animal Hospital (especially Hanan Caine) spent considerable amounts of time on the phone, and we tripled our standard phone costs for the two weeks when each lead was being followed, sometimes having to stay on hold for as long as a half hour to question one more expert. No one ever refused to help or withheld information, or was even gruff with us. There are some wonderful folks out there.

The scramble was worth it. We found two possible treatment options: The first was Enacard and Propranolol (Inderol), the latter of which is used quite a bit now in hypertrophic cardiomyopathy in ferrets, but was mostly experimental for them just a short while ago. In Meltdown's case this resulted in a marked reduction in the episodes of bigemini, but since there was the second option suggested by Dr. Bruce Williams we decided to not let well enough alone, and tested that one, also. It involved a combination of Enacard and the pediatric digitalis elixir, Lanoxin, at 0.05 mg/mL concentration. In her case this turned out to be pretty much a miracle. Now it is possible to monitor Meltie's heart for 3 minutes and not find even one episode of bigemini even though she had been throwing many extra contractions (including occasional trigeminis) each minute before. In two weeks the veterinary world knew there were two treatments which can work.

The question of diet of course arose. It turns out that fat does not present a problem for ferrets with heart disease as far as anyone has so far seen, but in some cases of non-cardiomyopathic or pre-cardiomyopathic heart disease salt might pose difficulties. We had to find out from the extremely kind veterinary nutritionists at Totally Ferret what levels were being considered as possible contributors to existing heart disease, then call all the manufacturers, and finally do the math on a sodium per protein basis. We'll save you time. There are NO ferret or cat foods with levels low enough; the ones with the lowest levels also have the least nutrition so ferrets would have had to eat more of the food and therefore more salt. Baby foods found locally also turned out to have too much salt for Ruffle. The upshot is that Dr. Willard at Totally Ferret designed a special diet. It's simple and straight forward: cook a plain meat from your grocer without adding salt, puree it, add a few hard boiled egg yolks, and some Nu-Salt salt substitute to ferret's taste. Nu-Salt is potassium chloride so it is also useful when diuretics or dehydration cause electrolyte problems for ferrets with ascites. For storage purposes you can make convenient cubes by freezing most of it in ice trays and later transferring them to a sealed container or wrap.

Never give a ferret with heart disease any treats, herbs, or foods which can upset the careful balance you have achieved. Some of these include licorice, caffeinated or depressant containing beverages, fibrous treats which can impair the uptake of Lanoxin, and perhaps chocolate since these animals are more sensitive to even slight perturbations.

As you can imagine, we wound up with quite a pharmacy sitting on our counter, and it (as well as doses) change according to alterations in health. We can not stress strongly enough how very important it is that you keep charts. Put down the ferret's name in one column, note how medicines must given, then whenever you give medicines write them down and note the time. Keep information on side effects, when to skip doses, how to deal with missed doses or accidentally doubled doses, which medicines should not be given close together, dose levels and frequencies, which must be shielded form light, and all other related information. Do NOT keep them in a room which gets too hot, too cold, or too humid. Never give a laxative close to when you give a medicine. Be aware that some medicines increase the chance of problems such as sun burn; we had to limit Ruffie's belly sun periods. Here is an idea of what we wound up dealing with:

Meltdown (easy): 12 hours apart she gets 0.2 ML of Lanoxin given with a tuberculin syringe because it has small enough measurements. Once a day she also gets 1/8 tablet of Enacard. We bought a pill cutter when they got sick and it has already seen more use than most probably go through in a year; it works better than any other method we have tried, including a scalpel with a fine vascular blade. Shift the sections carefully so that they don't break; the side of a dental scraper or the side of a pair of tweezers work well. We get less breakage by keeping the pieces in tiny, swallow, covered bowls rather than pill bottles. If the medicine is light sensitive you must cover it with something opaque.

Ruffle: During Ruffle's last months we had to give her assorted combinations of the following around the clock (depending on the state of her health) and needed a number of lines daily on her chart: Proglycem for her reoccurring insulinomas (50 mg/ mL), Lasix tabs to control ascites (This varied from 1/8 tab every other day to 1/4 of a tablet three time a day if memory serves. I still can't bring myself to review her chart.), Furosemide 10 mg/mL oral solution (a liquid form of Lasix which is more easily given as two squirts each dosing period since a lot may have to be given and which has a flavor they hate, but which finally became easier than the pill form, 1/3 mL three times per day) also to control ascites, Phenobarbital elixir 20mg/5mL before her surgery brought the convulsions to a safer level, extra Nu-Salt and banana puree to help maintain safe potassium levels, 1/8 tablet of Enacard once a day, Winstrol-V in her last weeks to increase her appetite and thirst (1/4 tablet twice daily), Amoxicillin post-surgically, and when needed a bit of Pepto Bismol (for digestive problems) or Pediatric Benadryl elixir (for her asthma). Whew! Oh, yes, like all our ferrets she also got a bit of Schiff powdered Brewers Yeast in water daily, and in her last weeks we had to make rice water by boiling sticky rice in excess water to treat her runs.

In her last month and a half Ruffle could not swallow solids any longer so we went to very diluted meat purees, and to Sustical and Ensure which she dearly loved. Whenever she went off those liquids despite cuddles and songs we found it paid to have one of our healthy ones raid her bowl in front of her. Sometimes there is nothing like competition to get a ferret to eat. We also learned some things about Sustical and Ensure. They don't have taurine so they should never be given long term to a non-terminal ferret. Ensure had the preferred flavors, but was also more likely to cause the runs. The best solution seemed to be combinations such as Strawberry Sustical with Butter Pecan Ensure, and Eggnog Ensure with Vanilla Sustical.

How can you give medicines most easily and effectively with the least dangerous stress? It depends on the medicine. Some, like Enacard or Lysodren must be given in ways which minimize the exposure to water or saliva. They are most easily given with a narrow pill gun such as your vet will probably carry, or mixed with a fatty gel like Nutrical. Liquids are pretty straight forward, but some ferrets get good at bring those up or spitting them out. If your vet or the manufacturer's research pharmacists say they may be given with fats try putting some Linatone or Nutrical on the ferret's nose and while it is licking that off squirting in the dose at the posterior side of the mouth. (Do not use a laxative such as Petromalt for these.) Meltdown is excellent at understanding conditional statements such as "First medicine, then treat." so will sigh and put up with it all.

Stress may be fatal to a ferret with heart disease. Give the individual her or his own cage or space such as a bathroom with a barrier across the portal (sanctuary) and allow play or sleep periods with good friends only while you supervise. If your ferret has a reduction in smell try moistening a cotton puff or swab with a bit of perfume and putting it on the lower back above the tail, and behind the ears. That will keep it from sensitive areas but let the ferret enjoy the comforting status of having a ferret-proper level of smell. Use folded towels to make ramps. Never let the ferret have a tantrum; pick it up immediately. Keep heat below 80' F and try to not let the temperature vary widely in your home. If at all possible cancel your trips away. If not possible have a familiar, friendly, knowledgeable pet sitter such as a vet tech. Have a schedule, with some minor variations for interest, so that your pet knows what to expect and does not become agitated. When your ferret has to be at the vet's office bring along a favorite toy or blanket which smells like home. Remove very large or heavy toys your ferret is in the habit of moving and substitute small, light ones. Because the litter pan is used often look into some of the ones with shallow ramps or lower entry ways which can be found in ferret catalogs. Punishment is never a good training tool for ferrets anyway since they learn better by striving to do the things which earn them praise; for a ferret with cardiomyopathy it can be extremely dangerous. Let your sick one get away with things you would not normally have tolerated. Since your ferret will very likely eventually have to use a piece of newspaper set on the floor of the cage when he or she can no longer deal comfortably with a litter pan add shredded newspaper to your litter to get it used to the concept while saving money you'll need for vet bills and pharmacy payments. (Our $80 shredder paid for itself in six months through reduced litter costs.)

Do NOT accept ANY risk of exposure to ECE. The strain of going through that major illness very likely will kill your heart patient.

There are several ways to diagnose heart disease and then look carefully enough at each case so that the medical treatments can be optimized. The first is to listen to the heart with a good stethoscope, the second is to x-ray and look for enlargement, and the third is to monitor the heart with an EKG. If heart disease is probably present you will most likely find that an ultrasound (sometimes repeated if enough time has passed or there has been a health change) is also needed by your vet to design the best treatment program for your pet. These are expensive, but worthwhile.

Major illnesses in ferrets tend to be roller coasters. You will be hopeful one day and strung out the next. Plus, you will have to check the ferret often according to your vet's recommendations, so your sleep will be interrupted. Don't forget to do something for yourself. Gripe to understanding friends and owners over the phone or internet. Give yourself the luxury of a bubble bath, or a present to yourself, or even a movie when health and schedules permit. Be kind to yourself, too.