How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 27961
Experience:  University of California at Davis graduate veterinarian with 45 years of experience
55012488
Type Your Dog Veterinary Question Here...
Dr. Michael Salkin is online now
A new question is answered every 9 seconds

Urinary issues, recent biopsy of mammary tissue. I have

Customer Question

Urinary issues, recent biopsy of mammary tissue. I have questioned her vet more than I should, but the latest lab work has me concerned; although the vet said her labs were normal.
JA: What sort of animal are we talking about?
Customer: Cat. Age 14, almost 15. Spayed female.
JA: OK. I'll do all I can to help. What is the matter with the cat?
Customer: We took her to the ER two weeks ago, because she urinated right in front of us on the floor. ER vet treated her for UTI; suggested we follow up with regular vet. Just got her labs back as well as biopsy. Vet said if it is cancer, we dont treat breast cancer aggressively. Rudy is urinating WAY WAY more than normal. Vet said her blood work was unremarkable. SAid the SDMA was normal. I asked for a copy, and her Bun, Creatine Kinase, TCO2 were all elevated. Chloride low, lymphocytes low. Labs from last week are drastically different from her labs in October... Suggested removing mammary glands. I sent a message back asking about the chem panel. She didnt show us the xrays in the office, but said they were fine. I asked for copies, to take to our oncologist for our other cat. I don't know if surgery is advisable based on what I am seeing on the labs.
JA: Strange behavior is often perplexing. I'm sure the Veterinarian can help you. Is there anything else important you think the Veterinarian should know about the cat?
Customer: My concern is that she either has advanced cancer, and how do we determine if it has metastasized or whether she is even a candidate for surgery.
Submitted: 2 months ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 2 months ago.

You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

Expert:  Dr. Michael Salkin replied 2 months ago.

I would be pleased to review the lab work for you. Can you upload a copy of all of her test results to our conversation? I understand that you might not have a copy at home but her vet can give you one which you can scan into your computer and then give me the file link or you can photograph the pages and upload them by using the paperclip icon (if you can see that icon) or by using an external app such as dropbox.com/

I not only review the test results but also note which tests should have been performed but weren't. Candidates for surgery have nothing exciting in the lab work, have negative chest X-rays and a negative abdominal ultrasound and their heart is functioning normally.

Customer: replied 2 months ago.
I think the page jumped ahead, because I had to fill out a form as well. hopefully you receive it. Attached is her blood work and urinalysis from October as well as last week. The vet has not provided copies of Rudy's xrays to me. She was having breathing issues last year, and the doctor began treating her for asthma with Theophylline. She has not had any type of cardio work up, and the vet didn't listen check her lungs or heart sounds. Not sure what changed but she used to do 98% of the work in front of the owners, as well as show xrays when they were taken. She has not done that the last two times that we went in. She has brought up the fact that Rudy is "old"; however, Rudy doesn't act remotely like an elderly cat. (My eldest cat is 19, and she still plays like a maniac. Age is not a good judge of whether a human or animal should receive extraordinary care.) We have only been seeing this vet for a year, and during the process my two 13 year old males died, and regarding Rudy we ask in October if they pinched her with the clippers, or if it was a rash (because they shaved her belly for a urinalysis). Rudy is eating well, drinking quite a bit more than normal and urinating more.
Expert:  Dr. Michael Salkin replied 2 months ago.

Thank you. Give me a moment to take a look, please...

Customer: replied 2 months ago.
sorry for grammatical errors, trying to type with the cat leaning all over the keyboard.
Expert:  Dr. Michael Salkin replied 2 months ago.

Yes, my cat must be lying on the keyboard...it's a rule.

OCT 2016 - creatinine, BUN, SDMA normal - remarkable for her age; T4 of 2.9 in grey area for hyperthryoidism but subsequent T4 in APRIL 2017 normal; specific gravity of urine dilute (1.015) and expected at her age - it presages renal insufficiency as demonstrated in APRIL 2017 test results; lymphopenia is due to stress - just the visit and having blood drawn can cause lymphopenia

APRIL 2017 - creatinine now in high normal range; BUN elevated out of range; SDMA still normal but a smidge higher as renal insufficiency progresses; specific gravity of urine essentially unchanged; T4 now normal; lymphopenia once again; the elevated TCO2 indicates metabolic acidosis caused by the decreased chloride - there may be an abnormal loss of chloride through the kidneys at this time - this isn't a significant finding but should be monitored in subsequent testing; creatinine kinase can elevate just from being restrained for the blood draw

BIOPSY - a good finding in that it wasn't a mammary adenocarcinoma; removing it and biopsying it will allow the pathologist to assess it better

Please continue our conversation if you wish.

Customer: replied 2 months ago.
While it did not declare adenocarcinoma, FNA's can be tricky (been there myself and with other pets). The vet said she is almost completely positive it is cancer, but is unsure of what kind. I would like to know if there additional tests we should request before moving on to surgery, and/or to determine whether there are mets. Also, could the prednisone injection from 3 weeks ago have altered the lab or biopsy results?
Expert:  Dr. Michael Salkin replied 2 months ago.

Methylprednisolone could alter test results after this length of time but not regular prednisone. Abdominal ultrasound is the next diagnostic of choice after chest X-rays when looking for mets from a mammary tumor of 3rd or 4th mammary glands.