Post by katt on Nov 22, 2014 17:35:26 GMT -5
Okay let's give this a go....
MY credentials: I am a second year medical student. I have my Bachelor of Science in Biology and I am 3/4 of the way through the book phase of our learning (3rd and 4th year are all clinical rotations). I am not a vet, nor am I am expert Yet in reading labs, however I have been taught quite a bit, and by some of the leading physicians in their fields. I also have a lot of first-hand experience with IBD/allergies as both of my boys have been diagnosed with IBD and Koda has food allergies; I have also helped switch several people's ferrets with IBD or allergies on the forum. I also used UpToDate when going through Pearl's labs to double check and confirm things where applicable before posting them as I would hate to give you any inaccurate information. UpToDate is THE medical resource for human medical practice - docs even get CE credits for using it. Ferrets are NOT humans, however they ARE the model organism of the human immune system - which is why they are used so much as research animals, particularly for the testing of vaccines.
Glucose - a bit low, but not below 90 so not particularly concerning RE Insulinoma - 90 and above is considered a normal fasting BG, 70-80 is borderline, below 70 is insulinoma.
Creatinine is low - low creatinine isn't alarming, it's when it is high that it's an issue. Creatinine is a molecule generated by the muscles. It's generated at a fairly constant rate in an individual, and filtered out by the kidneys. A high creatinine would indicate that the kidneys aren't doing their job of eliminating creatinine (so there's more "stuck" in the body bc it can't get out via the kineys, thus the higher amount in the blood). Every individual has a different baseline normal creatinine level and this normal value can vary quite widely. Creatinine on its own usually is not the best indicator as a result - it's the Creatinine to BUN ratio that is most important, as well as if there are any acute or chronic Changes in creatinine. Every individuals creatinine normal can be so different from any other person. Things that contribute to higher creatinine include age, gender, muscle mass, etc etc. As a fairly small, female ferret with lower muscle mass it would be totally normal for her to have a lower creatinine. The more muscle mass you have, the higher your creatinine. And again - LOW creatinine isn't really an issue, HIGH creatinine, particularly elevated from normal values (you have to have something to compare it to in order to indicate any changes - this is why doing regular blood work while they are healthy is so important) is more concerning. Creatinine and BUN are often higher NORMALLY in raw fed ferrets as, like Heather explained, the normal ranges labs used are all based off of kibble fed ferrets.
Albumin is on the low end of normal. Notice that the Normal range is 2.6-3.8, and hers is 2.6. So she is technically still in the normal range and usually you don't start worrying about abnormals until they are significantly abnormal, not just barely on the verge of abrnomal. That said, it is still part of the overall big clinical picture. Albumin is a protein made in the liver that transports things in the blood. Low albumin can be a result of many different processes in the body. It can be a sign of liver disease, kidney disease, heart disease, gastrointestinal disease, infections, just about any acute or chronic inflammatory process, certain meds....I mean I could go on for hours. I would like to also importantly point out that it can be low in IBD (a GI disease). It by itself is not a very specific indicator of any particular thing though.
Her liver values look good - so we can assume at this point that the other values being off are not related to liver disease.
Potassium (K+) is low. Honestly, this is to be expected with her chronic diarrhea. K, Na, and Cl (potassium, sodium, chloride) are the three primary electrolytes that we look at to determine the body's electrolyte and volume status. They can be off due to kidney disease, diarrhea, vomiting, and other conditions. When the diarrhea is controlled, her K should return to normal levels. If it doesn't, then that would be an indication that there is something else going on beyond what we are seeing.
MCH and MCHC MCH is the amount of hemoglobin, MCHC is the concentration of hemoglobin. So you can think of them as sort of total number vs relative percent. I don't know as much about these values. I do know that high MCH and/or MCHC can be indicative of Macrocytic Anemia, low Vit B and/or low folate (red meat is a great source of these things). Can also be related to cancers, suck as leukemias.
WBC high - that's an easy one. Anything that revs up the immune system can cause high WBC, most commonly infections, inflammation. She clearly has some sort of inflammatory process happening here - whether that is from an infection OR something like IBD. WBC can also be elevated in some cancers.
Eosinophils - normal values were not given by the lab, so I looked them up and found 2.5% (links below). Also when you look at the value further down, you can see that hers are high. Okay so this is where the "meat" of the diagnosis debate comes in in her case. Elevated eosinophils CAN be due to parasitic infection. When you see elevated eosinophils you think of a differential diagnosis (potential diagnoses) list of: parasites, connective tissue disease, cancer, or allergies. You absolutely can NOT diagnose ANY of these (including parasites without further testing. You can NOT see elevated eosinophils and just automatically diagnose parasites. Yes, she has diarrhea, but you need to do a fecal to rule parasites in or out - and you specifically said that her fecal was normal - that rules OUT parasites. It doesn't hurt to do the antiparasitic meds in case something was missed on the fecal, but there were NO parasites seen and you (you not you specifically just generalized "you" as in anyone evaluating Pearl's condition) can't just ignore all of the other things that could be causing this. I'm a bit blown away that your vet would do that - particularly because you do say he is knowledgeable and experienced. Eosinophils can be elevated in allergies. They can also be elevated in cancers, such as leukemia.
wildpro.twycrosszoo.org/S/00dis/Miscellaneous/EosinophilicGastroenteritisFerrets.htm
miamiferret.org/physiology.htm
Neutrophils are high - this can be seen in infection, particularly bacterial infections, chronic inflammation, congenital diseases, some drugs (e.g. glucocorticoids, beta agonists), and some solid tumors.
Platelets are low. This can be due to autoimmune disease, infection (bacterial or parasite), certain drugs - including antibiotics (particularly sulfonamides, ampicillin, piperacillin, vancomycin, rifampin), Vit B12 or folate deficiency, bone marrow disorders (e.g. leukemia), among other conditions.
Parasites ARE killed by freezing. Freezing the meat solid in your freezer for a Minimum of 3 days should be more than sufficient to kill ANY parasites present with the single exception of Trichinella spiralis. So even if the meat you got DID have parasites, if the meat was frozen all parasites would be dead. That is straight from the mouth of one of the nation's leading experts in parasitology FYI. Now the exception is trichinella, which can be resistant to freezing. Trich USED to be an issue in US pork, however after a big outbreak the FDA has seriously cracked down on pork production and pork meat is very, very tightly regulated and very thoroughly inspected before being approved for sale for human consumption. If anything pork is one of the safer meats now as a result of the very tight regulation. Pork should be just fine to feed - BUT I typically only recommend feeding pork from a US FDA regulated meat source sold as fit for human consumption. Wild pork is a no-go and locally raised pork is certainly a risk. I have never heard of any issues with HareToday, but if you emailed or called them you could easily ask how often their pigs are tested for trich. Other potential sources of trich include any wild boar/pork, wild rodents, and carnivore meat (e.g. bear meat).
Does it hurt to give Pearl some anti-parasitic meds? No, though if parasites are truly a concern, Bea should be on them too. I think it is a good idea to cover your bases. Do I think that Pearl HAS parasites? Probably not. Unless you don't freeze the meat, the odds of them getting a parasite from raw food is absurdly, ridiculously low. So what is our differential diagnosis?
- Parasites (being treated)
- Bacterial Infection (unlikely, has already been treated)
- IBD and/or food allergies
- Leukemia
I think it is a good idea to have covered your bases with antibiotics and now antiparasitics. When you hear hoofbeats think horses, not zebras right. That said, IBD, food allergies, and cancer are all very common in ferrets unfortunately. The diarrhea really points me away from leukemia just because it aligns better with the other things on the list, but I don't think it can really be ruled out either. Also, while cancers in general are very common in ferrets, leukemia is not typically one of the commonly seen ones. In all of these cases, raw diet is honestly the best thing you can possibly do for her as it will keep her body at its strongest. If she does have IBD or an allergy (or both), raw diet will help keep her properly hydrated (in fact, it's probably the only reason she isn't dehydrated at this point with all of that diarrhea honestly) AND it allows you to have maximal control over what goes into her system. With a kibble you never know which ingredient she is or could be react to, you can't just remove a certain ingredient, you can't even assure that the ingredients are of any quality. With raw you know exactly what is going in. If you suspect a certain allergy, it is so easy to avoid entirely. My vet specifically told me that the only reason my boys' IBD is as under control as it is is, the only reason they are not on a chronic dose of pred, is because of the raw diet.
I would really recommend doing a protein trial with Pearl to see what proteins she is or isn't reacting to. I would suggest starting with lamb or goat if you can - as a red meat it is high in iron and B vitamins (see above), and considered to be the most "hypoallergenic" of meats. Get her diarrhea under control, and then start testing one protein at a time to see how she reacts. You might also ask your vet about putting her on pred, particularly if the meds don't help - if she has IBD or leukemia the pred should help. If the meds and putting her on novel protein diet doesn't get the diarrhea under control I would really consider the possibility of other diagnoses and ask what further testing can be done.
MY credentials: I am a second year medical student. I have my Bachelor of Science in Biology and I am 3/4 of the way through the book phase of our learning (3rd and 4th year are all clinical rotations). I am not a vet, nor am I am expert Yet in reading labs, however I have been taught quite a bit, and by some of the leading physicians in their fields. I also have a lot of first-hand experience with IBD/allergies as both of my boys have been diagnosed with IBD and Koda has food allergies; I have also helped switch several people's ferrets with IBD or allergies on the forum. I also used UpToDate when going through Pearl's labs to double check and confirm things where applicable before posting them as I would hate to give you any inaccurate information. UpToDate is THE medical resource for human medical practice - docs even get CE credits for using it. Ferrets are NOT humans, however they ARE the model organism of the human immune system - which is why they are used so much as research animals, particularly for the testing of vaccines.
Glucose - a bit low, but not below 90 so not particularly concerning RE Insulinoma - 90 and above is considered a normal fasting BG, 70-80 is borderline, below 70 is insulinoma.
Creatinine is low - low creatinine isn't alarming, it's when it is high that it's an issue. Creatinine is a molecule generated by the muscles. It's generated at a fairly constant rate in an individual, and filtered out by the kidneys. A high creatinine would indicate that the kidneys aren't doing their job of eliminating creatinine (so there's more "stuck" in the body bc it can't get out via the kineys, thus the higher amount in the blood). Every individual has a different baseline normal creatinine level and this normal value can vary quite widely. Creatinine on its own usually is not the best indicator as a result - it's the Creatinine to BUN ratio that is most important, as well as if there are any acute or chronic Changes in creatinine. Every individuals creatinine normal can be so different from any other person. Things that contribute to higher creatinine include age, gender, muscle mass, etc etc. As a fairly small, female ferret with lower muscle mass it would be totally normal for her to have a lower creatinine. The more muscle mass you have, the higher your creatinine. And again - LOW creatinine isn't really an issue, HIGH creatinine, particularly elevated from normal values (you have to have something to compare it to in order to indicate any changes - this is why doing regular blood work while they are healthy is so important) is more concerning. Creatinine and BUN are often higher NORMALLY in raw fed ferrets as, like Heather explained, the normal ranges labs used are all based off of kibble fed ferrets.
Albumin is on the low end of normal. Notice that the Normal range is 2.6-3.8, and hers is 2.6. So she is technically still in the normal range and usually you don't start worrying about abnormals until they are significantly abnormal, not just barely on the verge of abrnomal. That said, it is still part of the overall big clinical picture. Albumin is a protein made in the liver that transports things in the blood. Low albumin can be a result of many different processes in the body. It can be a sign of liver disease, kidney disease, heart disease, gastrointestinal disease, infections, just about any acute or chronic inflammatory process, certain meds....I mean I could go on for hours. I would like to also importantly point out that it can be low in IBD (a GI disease). It by itself is not a very specific indicator of any particular thing though.
Her liver values look good - so we can assume at this point that the other values being off are not related to liver disease.
Potassium (K+) is low. Honestly, this is to be expected with her chronic diarrhea. K, Na, and Cl (potassium, sodium, chloride) are the three primary electrolytes that we look at to determine the body's electrolyte and volume status. They can be off due to kidney disease, diarrhea, vomiting, and other conditions. When the diarrhea is controlled, her K should return to normal levels. If it doesn't, then that would be an indication that there is something else going on beyond what we are seeing.
MCH and MCHC MCH is the amount of hemoglobin, MCHC is the concentration of hemoglobin. So you can think of them as sort of total number vs relative percent. I don't know as much about these values. I do know that high MCH and/or MCHC can be indicative of Macrocytic Anemia, low Vit B and/or low folate (red meat is a great source of these things). Can also be related to cancers, suck as leukemias.
WBC high - that's an easy one. Anything that revs up the immune system can cause high WBC, most commonly infections, inflammation. She clearly has some sort of inflammatory process happening here - whether that is from an infection OR something like IBD. WBC can also be elevated in some cancers.
Eosinophils - normal values were not given by the lab, so I looked them up and found 2.5% (links below). Also when you look at the value further down, you can see that hers are high. Okay so this is where the "meat" of the diagnosis debate comes in in her case. Elevated eosinophils CAN be due to parasitic infection. When you see elevated eosinophils you think of a differential diagnosis (potential diagnoses) list of: parasites, connective tissue disease, cancer, or allergies. You absolutely can NOT diagnose ANY of these (including parasites without further testing. You can NOT see elevated eosinophils and just automatically diagnose parasites. Yes, she has diarrhea, but you need to do a fecal to rule parasites in or out - and you specifically said that her fecal was normal - that rules OUT parasites. It doesn't hurt to do the antiparasitic meds in case something was missed on the fecal, but there were NO parasites seen and you (you not you specifically just generalized "you" as in anyone evaluating Pearl's condition) can't just ignore all of the other things that could be causing this. I'm a bit blown away that your vet would do that - particularly because you do say he is knowledgeable and experienced. Eosinophils can be elevated in allergies. They can also be elevated in cancers, such as leukemia.
wildpro.twycrosszoo.org/S/00dis/Miscellaneous/EosinophilicGastroenteritisFerrets.htm
miamiferret.org/physiology.htm
Neutrophils are high - this can be seen in infection, particularly bacterial infections, chronic inflammation, congenital diseases, some drugs (e.g. glucocorticoids, beta agonists), and some solid tumors.
Platelets are low. This can be due to autoimmune disease, infection (bacterial or parasite), certain drugs - including antibiotics (particularly sulfonamides, ampicillin, piperacillin, vancomycin, rifampin), Vit B12 or folate deficiency, bone marrow disorders (e.g. leukemia), among other conditions.
Parasites ARE killed by freezing. Freezing the meat solid in your freezer for a Minimum of 3 days should be more than sufficient to kill ANY parasites present with the single exception of Trichinella spiralis. So even if the meat you got DID have parasites, if the meat was frozen all parasites would be dead. That is straight from the mouth of one of the nation's leading experts in parasitology FYI. Now the exception is trichinella, which can be resistant to freezing. Trich USED to be an issue in US pork, however after a big outbreak the FDA has seriously cracked down on pork production and pork meat is very, very tightly regulated and very thoroughly inspected before being approved for sale for human consumption. If anything pork is one of the safer meats now as a result of the very tight regulation. Pork should be just fine to feed - BUT I typically only recommend feeding pork from a US FDA regulated meat source sold as fit for human consumption. Wild pork is a no-go and locally raised pork is certainly a risk. I have never heard of any issues with HareToday, but if you emailed or called them you could easily ask how often their pigs are tested for trich. Other potential sources of trich include any wild boar/pork, wild rodents, and carnivore meat (e.g. bear meat).
Does it hurt to give Pearl some anti-parasitic meds? No, though if parasites are truly a concern, Bea should be on them too. I think it is a good idea to cover your bases. Do I think that Pearl HAS parasites? Probably not. Unless you don't freeze the meat, the odds of them getting a parasite from raw food is absurdly, ridiculously low. So what is our differential diagnosis?
- Parasites (being treated)
- Bacterial Infection (unlikely, has already been treated)
- IBD and/or food allergies
- Leukemia
I think it is a good idea to have covered your bases with antibiotics and now antiparasitics. When you hear hoofbeats think horses, not zebras right. That said, IBD, food allergies, and cancer are all very common in ferrets unfortunately. The diarrhea really points me away from leukemia just because it aligns better with the other things on the list, but I don't think it can really be ruled out either. Also, while cancers in general are very common in ferrets, leukemia is not typically one of the commonly seen ones. In all of these cases, raw diet is honestly the best thing you can possibly do for her as it will keep her body at its strongest. If she does have IBD or an allergy (or both), raw diet will help keep her properly hydrated (in fact, it's probably the only reason she isn't dehydrated at this point with all of that diarrhea honestly) AND it allows you to have maximal control over what goes into her system. With a kibble you never know which ingredient she is or could be react to, you can't just remove a certain ingredient, you can't even assure that the ingredients are of any quality. With raw you know exactly what is going in. If you suspect a certain allergy, it is so easy to avoid entirely. My vet specifically told me that the only reason my boys' IBD is as under control as it is is, the only reason they are not on a chronic dose of pred, is because of the raw diet.
I would really recommend doing a protein trial with Pearl to see what proteins she is or isn't reacting to. I would suggest starting with lamb or goat if you can - as a red meat it is high in iron and B vitamins (see above), and considered to be the most "hypoallergenic" of meats. Get her diarrhea under control, and then start testing one protein at a time to see how she reacts. You might also ask your vet about putting her on pred, particularly if the meds don't help - if she has IBD or leukemia the pred should help. If the meds and putting her on novel protein diet doesn't get the diarrhea under control I would really consider the possibility of other diagnoses and ask what further testing can be done.