Eosinophilic Peritonitis – Milo’s Story

On Wednesday, 31 August, 2005, I noticed Milo, my 22-month old boy, wasn’t himself – he didn’t do his weasel war dance, seemed quiet and just kind of ‘flat’.

Nothing seemed suspicious enough to warrant an urgent trip to the vet so I decided to see how he was the next day. Well, he didn’t improve and as I followed him around, I realised that he wasn’t eating during the day.

I thought, “Uh oh! Please not a blockage!”

However, as we are almost neurotically careful about not having anything the ferrets can chew and swallow lying around the house (since my experience with Snoopy’s blockage with the olive pit), I really couldn’t imagine how that could happen.

But, as all ferret owners know, ferrets can get into all kinds of trouble no matter how careful you think you are around the house.

Vague symptoms

Friday, September 2 — I checked his poop before taking him to the vet but it didn’t look unusual. She checked his abdomen and noticed that he started to paw at his mouth as if in pain.

I left him there so that she could x-ray him. Nothing showed up but Milopooped while at her surgery and it was greenish, so she thought he might have a touch of gastro.

She gave me Baytril to give him over the weekend but he didn’t improve.

Monday, September 5 — Back to the vet and she checked his abdomen again. This time he didn’t paw at his mouth so she changed his medication to Amoxicillin, in case the problem was caused by helicobacter mustelae.

Again there was no improvement.

Milo was totally disinterested in food so I had to syringe-feed him his smoothy on an hourly basis. To make sure he got as much goodness as possible, I put a whole egg in, together with a squirt of Nutrigel and some Herbalife protein powder which I had and mixed it all with 1/2 cup of Whiskas Pet Milk.

I was getting anywhere between 6mls – 12mls down his throat before he had enough. And there was no chance of tempting him with solids! I would stick my finger in the A/D Formula and put it against his nose for him to lick. but he got so fed up with this that he bit my finger.

Dark, gassy, sticky poop

By this stage his poop was almost ‘bubbly’ (when I showed it to the vet she said the bubbles were from the gases in his stomach) and very, very dark and sticky. But when I checked it, there was no evidence of blood in it.

Friday, September 9 — Back again to the vet and when he was palpitated, he still didn’t show any signs of pain.

I took samples of Milo’s poop and she confirmed there was no blood so ulcers were ruled out.

Continuing weight loss

By this stage his weight was fluctuating from a high of 1.25kg to 1.19kg, and I was still hand-feeding him on an hourly basis.

These were the symptoms so far:

Total lack of appetite

Lethargy

Abdominal pain

Green sticky poop

Dark, gassy, sticky poop

Monday, September 12 — To the vet again and this time when he was examined, he started pawing at his mouth and grinding his teeth so my vet said she’d give him a barium to see if he might have swallowed foam which didn’t show up in the first x-ray.

I got a call later that day. The x-ray didn’t show anything specific but there was a darker colored circle in his stomach which the vet thought should be examined surgically.

I took him home and fed him up before he had to start fasting the next day at 1pm. At that stage, I was getting to the point where I was worried every morning when I let the boys out of the bathroom that I would still find him breathing.

Exploratory surgery

Tuesday, September 13 — I took him for his operation and the vet promised to ring as soon as it was finished.

She called us around 5:15 that afternoon to say that there was no blockage but she found a 2cm x 3cm fatty, necrotic, nicotine-coloured blob between his stomach and his pancreas, also 2 raisin-sized growths elsewhere. She also said his liver and spleen looked knobbly and not very healthy.

She said Milo had weathered the operation pretty well, considering, but she would be taking him home with her that night to make sure he was looked after.

She called me the next morning and said he was looking bright and so I could come around noon to pick him up, which I did. She gave me 10 days supply of Flagyl and told me to keep giving him the Amoxicillin as well.

Milo’s post-op stomach!

We got home and all the other ferrets came out of the ‘Chest of Drawers Hilton’ to sniff all the strange smells which were on him and so I put him in the bathroom alone to get some peace and quiet.

I had a dish of his special smoothy there and for the first time in 2 weeks, he went and licked it on his own.

Once the gang quietened down, I opened the door, he came out and after wandering about the house a bit, he jumped into the drawers and joined the others.

For the first time in weeks, I felt optimistic about him pulling through. However that soon fizzled out because he still was reluctant to eat by himself.

Still no appetite

He absolutely refused the A/D Formula, wouldn’t look at Hills Science Diet turkey cat food, eyed me balefully when I put baby food down and turned his nose up at my home made chicken ‘soup’ (which I made with everything good thrown in, then pureed so that I could syringe it into his mouth). The only thing he’d take was the special smoothy he’d been eating for these past couple of weeks.

Thursday, September 15 — the vet rang to say she’d got the pathology results back and it was peritonitis but because it was ‘idiopathic’, they couldn’t tell her which bacteria were causing the problem so she didn’t have a specific antibiotic she could prescribe.

The details of the reports were as follows:

HISTORY: Inappetence, weight loss two weeks. Exploratory laparotomy revealed 2 : 3cm mass between stomach and pancreas (pot 1), two other in omentum. Liver and spleen biospies (pot 2). Histo on pot 1, hold pot 2 for now.

GROSS DESCRIPTION: 3 x 1.8cm tissue biopsy with a soft cut surface.

HISTOPATHOLOGY: The section planes of the submitted tissue reveal portions of a regional lymph node. These reveal extensive areas of mixed inflammation and necrosis with haemorrhage. The inflammation is dominated by eosinophils and these are distributed throughout the node and the surrounding tissues. Clusters of Splendore-Hoeppli material can be seen in the medulla, the foci of necrosis and in the peripheral sinus. These have typical peripheral eosinophilic clubs but no distinct bacteria were identified in routinely stained sections. There are numerous eosinophils and activated macrophages with large areas of necrosis and haemorrhage. The lymphoid tissues are often appear [sic] relatively intact with some lymphoid follicles present and markedly dilated sinusoids and fairly prominent medullary cords. The surrounding omental tissues reveal a diffuse inflammatory reaction including lymphocytes, plasma cells, macrophages and large numbers of eosinophils with far fewer neutrophils.

DIAGNOSIS: Eosinophilic necrotising to granulomatous lymphadenitis and peritonitis.

COMMENT: The histological examination of the submitted tissues reveals a chronic active inflammatory response within the omental tissues and involving the regional lymph node. This appears to include areas of necrosis and haemorrhage. Eosinophilic inflammation is a prominent component and there are clusters of Splendore-Hoeppli material present. These features are suggestive of the eosinophilic granulomatous enteritis/peritonitis complex. Examination of the GI is consistent with this idiopathic disease in ferrets. The possibility of deep bacterial infection needs consideration. Further special stains will be undertaken to try and investigate this lesion further.

Friday, September 16 — Took him to the vet for a check up and his weight was still 1.19kg. The amount he pooped was small (the size of a grain of rice) and almost the color of egg yolk, so it was obviously going straight through his gut. But it didn’t seem sticky or gassy any more.

I told her he still wasn’t keen to eat solids and I was still coaxing him to take his smoothy. The only difference was that he was licking it on his own, without any syringing required.

She told me to keep going and see how he was over the weekend.

On cortisone now

Monday, September 19 — The vet weighed Milo and found he’d lost a bit more weight. Now he was 1.13kg, so the vet decided it was time to try prednisone/cortisone on him. She had been reluctant to do it earlier as she didn’t want to compromise his immune system.

Rather than giving me a bottle of prednisone, she gave him a 3-day injection of cortisone to see how it would affect him and if the results were good, she’d put him on prednisone when she saw him again.

When we got home and I let him out of his cat carrier, he wandered around and actually grabbed an empty loo roll (his favorite toy) and ran to the wardrobe to stash it with the rest of his collection. That was an excellent sign!

Then that evening he came into the kitchen and headed to the food dish. I was too nervous to open the door and see if he was actually eating, in case he got put off, but it certainly sounded like he had his head in the trough and seems a whole lot brighter.

Finally acting more like himself

Wednesday, September 21 — He’s still the same. Licks a complete dish of his special smoothy when lying on my lap without any urging from me, seems more like himself and has been playing with the rest of the gang this morning. Another first since he got sick!

Thursday, September 22 — Bruce Williams replied to my email. I had sent him all the information on Milo and he said as far as he was concerned, the problem was Eosinophilic Enteritis and we would need to change his diet — no more chicken but feed him turkey-based food and put him on 1 mg prednisone daily.

He said we need to get Milo’s gut back to normal before we worry about the lymph nodes.

I had found an old FML message from 2001 where someone wrote about her ferret with EGE and she said she put him on Pro Plan’s turkey and barley cat food and he thrived on it.

I went down to City Farmers last Sunday and looked for that particular flavor — they had everything but! However they had turkey and barley dog food.

When I got back home, I checked on the Pro Plan website to make sure they still made that flavor and they do, so I rang City Farmers and asked if they could get it in. Haven’t heard back from them yet.

Milo’s stitches come out tomorrow and he’ll start on his daily prednisone course.

From what I understand, he has to have that forever and if he goes off it for whatever reason, he could have a relapse.

Friday, September 23 — Milo’s stitches came out. The vet was very pleased at how bright he appeared but he’s still losing weight. He’s down to 1.10kg.

I drove down to City Farmers and was told it’s not possible to get either the turkey & barley or turkey & rice cat formula in Perth. The only turkey in the Pro Plan range was the “Indoor Cat” packet but that’s a furball formula and has 8% fiber so absolutely not suitable for a ferret.

I took the salmon & rice cat food for him to try out, but I don’t fancy my chances.

I also bought fresh minced turkey from Coles but when I gave it to him, he looked at me as if to say, “Surely you don’t think I’m going to eat this, do you?”

The vet suggested roo meat but none of our ferrets will eat red meat so ….

* sigh *

Well, I’ll just keep giving him his smoothy and try and tempt him with solids. I will certainly put down any successes I have here if and when they happen.

However, if there is anyone out there with a ferret who has the same problem, please contact me and perhaps we can figure out how to beat this disease together!

Hooray! It’s looking good!!

Tuesday, April 4 — Over 6 months since Milo’s illness and I’m happy to say he’s absolutely fine. (Touch wood!)

There was one time when our vet thought we should see how he went after his first course of prednisone finished. It took 5 days before Milostarted to droop so she put him back on his medication and he’s been his old self since then. It really is like a miracle drug!

Back to his old weight, back to weasel wardancing, back to stashing the dog’s kong and loo rolls in my wardrobe, and back to being my sweet, silly Milo!

Fingers crossed!

Update: I am sorry to have to say that Milo lost his fight with this disease and passed over to the Bridge on October 30, 2009. He was only 5 years old

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