I have a 6 year, 11 month old male Marshall ferret which is believed to
be have mild insulinoma, some gastrointestinal distress/bleeding, and
aggressive malignant lymphoma. I do not question the first two things.
I want to be as sure as reasonable that he actually has malignant
lymphoma. Key vets and other being out of town this week, combined
with limited tests, is making clarification difficult. I think some
here, particularly Dr. Williams if he is still on list, may be able to
provide valuable insight. I'll keep this as short as possible, thanks
in advance for any comments (email is welcome).

Test Results
------------
The abdominal ultrasound showed four (substantially, IIRC) enlarged
mixed echogenic lymph nodes (one vet said mesenteric), splenomegaly
(note: an enlarged spleen was noticed prior to removal of left
adrenal in Sept 2007), cyst in pancreas and right kidney, fine
suspended sludge in gall bladder:
http://www.geocities.com/grapeferret/FerretReports/Ultrasound.jpg

Cytology Report: Masses, possible lymph nodes, consistent with lymph
node aspirate... predominance of immature intermediate-sized to large
lymphoid cells occurring singly or in monomorphic aggregates... points
to malignant lymphoma:
http://www.geocities.com/grapeferret/FerretReports/Cytology.jpg
Note: lab says it appears pretty aggressive but they say they can't
identify the type or grade unless they receive an actual biopsy sample.

A recent blood test and urine cysto:
http://www.geocities.com/grapeferret/FerretReports/BloodTest.jpg
http://www.geocities.com/grapeferret/FerretReports/UrineTest.jpg

Full body and thoracic xrays taken to check for other lymph node
involvement or problems... none seen.

Recent History
--------------
05/21/2008: Early checkup with exotic vet due to mild hind leg weakness
after outdoor walks. Blood work (probably four hours after his last
meal) reveals low blood glucose level (65 I believe). Insulinoma
suspected, no treatment for now, follow up in three months unless
something changes. Note: outdoor walks cut back.

06/XX/2008: Lethargy and hind leg weakness somewhat worse, wobbly when
he first wakes up. Touched base with vet, no change in plan unless
symptoms worsen. Note: outdoor walks eliminated.

07/27/2008: Lack of energy/strength and wobbling raising more concern.
Mild teeth gnashing while eating. Mild hiccups. Eating, but may not be
eating enough.

07/30/2008: Largely unresponsive ferret laying in his own urine
episode. An hour after Nutrical he was up and wandering around
relatively well. All food (Marshall Senior + Totally Ferret Older +
Ferretone) immediately replaced, chicken baby food added, treats
(bandit treats, and infrequently a few licks of milk) eliminated,
major effort to assure adequate food intake. Note: For whatever reason,
his energy/strength not only improved immediately but continued to
improve going forward.

08/01/2008: Exam, blood test (probably 3 hours after eating), and urine
cysto. Some off-nominal values spurred additional testing:
http://www.geocities.com/grapeferret/FerretReports/BloodTest.jpg
http://www.geocities.com/grapeferret/FerretReports/UrineTest.jpg

08/05/2008: Fasting blood glucose test (confusion over duration,
figure 8 hours but it might have been 10 hours) was low (62 I believe).

08/06/2008: Abdominal ultrasound performed. Summary: four
(substantially, IIRC) enlarged mixed echogenic lymph nodes (one vet
said mesenteric), splenomegaly (note: an enlarged spleen was noticed
prior to removal of left adrenal in Sept 2007), cyst in pancreas and
right kidney, fine suspended sludge in gall bladder:
http://www.geocities.com/grapeferret/FerretReports/Ultrasound.jpg

08/07/2008: Put on Clavamox to cover bases (not sure of dose, just
following directions)

08/08/2008: Cytology Report: Masses, possible lymph nodes, consistent
with lymph node aspirate... predominance of immature intermediate-sized
to large lymphoid cells occurring singly or in monomorphic
aggregates... points to malignant lymphoma:
http://www.geocities.com/grapeferret/FerretReports/Cytology.jpg

Note: lab says it appears pretty aggressive but they say they can't
identify the type or grade unless they receive an actual biopsy sample.

08/10/2008: His energy, strength, and food intake have been rather good
since 07/30 episode. However, black tarry stools just cropped up and
there has been ongoing mild teeth gnashing when eating and one or two
recent episodes of hiccupping. Food intake just dropped off too...
voluntarily eating soft foods from finger, but not eating enough.

08/11/2008: Exam (with fill-in vet), full body and thoracic xrays
performed, said to show no issues other than those previously mentioned
(no evidence of thoracic or peripheral lymph node involvement). Weight
at 996 grams, down from 1009 on 08/01/2008. Both vet and tech agree
that he looks and acts surprisingly well and normal. Started on
carafate (not sure of dose, just following directions). Note: later
that night he was rather active but getting wobbly again. Given a
little Nutrical just in case.

08/12/2008: In PM started on Pepcid AC (1/4 of 10mg tablet once a day)
and Pediapred generic (0.5 mls twice a day of "Prednisolone 5mg/5ml
solnhit"). Still taking soft foods off finger, but probably not eating
enough. Black tarry stools starting to clear up.

08/13/2008: Back to hitting food bowls on his own, wandering around a
little bit. All stools from today look normal.

[Posted in FML 6062]