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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 24432
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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Salkin, We spoke on November 19th about my male, 3-year old

Customer Question

Hi Dr. Salkin, We spoke on November 19th about my male, 3-year old American Shorthair, Shelby who has a low WBC and Neutrophil count. The labs done on 11/19/15 revealed a WB of 3.7 (Lab ranges: 3.9 to 19.0 K/uL) and Neutrophil level was 1765 (Lab ranges:
2620-15170/uL). The Labs were repeated 11/25/15 and his WBC count is now 3.5 and the Neutrophils: 1593. Both have decreased further. Dr. Quel, our vet, called and said she spoke with an internist and he recommended waiting one more month, re-checking the bloods
and if they are still low, send him to a specialist for a bone marrow biopsy and scanning. They would appear to be looking for a tumor.... He is eating well and happy, but he is meowing with great frequency and it isn't a playful meow. Last night to comfort
him, I picked him up, as I do and kissed him. I then tilted him back in my arms, he let out a howl as if in pain and bit my ear. He did not mean any harm, but clearly something was painful when I touched him. I'm worried, of course, but also don't want my
cat to suffer or linger for our selfish desire to have him with us. If it is cancer, isn't everything just palliative? Thanks Dr. Salkin, I welcome your insight and advice.
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you for the update. Yes, myeloproliferative disease (bone marrow disease/cancer crowding out normal cell producing precursor cells) must be considered although we do see rare autoimmune disease affecting just the white blood cell line. Hence, the need for a biopsy to better understand what's going on. A cancer is treated with chemotherapeutic agents. An autoimmune disease, however, is treated with immunosuppressive agents. The prognosis for a cancer is very poor but can be good-guarded for autoimmune diseases.

Yes, his vocalizing and reaction to handling does suggest pain. I understand your concern at this time. It's not unreasonable to see how prednisone affects Shelby. That steroid can increase the WBC and act as an immunosuppressive agent.

Customer: replied 1 year ago.
Thank you for your reply. If we go ahead and get him on Prednisone, that would be done now before a consideration of the bone biopsy correct? And if the WBC/Neutrophils increase, would that be an indicator of it not being cancer and more likely an autoimmune disease? The costs involved in the diagnostics are unknown to us at the moment, but that too is of concern in the long run.
Expert:  Dr. Michael Salkin replied 1 year ago.

You're welcome. A bone marrow biopsy should be performed prior to prednisone administration. I mentioned the prednisone if you elected to waive the biopsy. Yes, an increase in WBC is more likely if cancer weren't present. Be sure to ask for written estimate prior to anything being done. This kind of work can become pricey fast.

Customer: replied 1 year ago.
If he has the bone marrow biopsy, and it is cancer, we will not put him through this. Isn't the probability higher that this is indeed cancer as opposed to the autoimmune disease?
Customer: replied 1 year ago.
I think I'm opting for the Prednisone...if the WBC goes up, what then? Prednisone indefinitely?
Expert:  Dr. Michael Salkin replied 1 year ago.

Yes, cancer is more likely than autoimmune disease but perhaps the WBC is depressed due to an unknown virus instead of either of those possibilities. If that were the case, prednisone might be contraindicated - at least at an immunosuppressive dose which could worsen a viral infection. There are a lot of ifs and buts when we treat presumptively but if the alternative is doing nothing or euthanasia, I'm all for seeing how it affects Shelby. If you saw a nice response to prednisone, the dose is tapered as far down as possible while a reasonable WBC is seen.

Customer: replied 1 year ago.
Last question, any idea, ball park what the cost of a bone biopsy is? Is a scan required as well post biopsy.
Thanks Dr. Salkin for everything.
Expert:  Dr. Michael Salkin replied 1 year ago.

I regret that I can't know what you'd be charged. $1000 including the pathologist report? A scan=abdominal ultrasound? X-ray? Such imaging is performed in a search for a focus of disorder and guided by other symptoms that might be present. For example, an increased respiratory rate might peak my interest in X-raying his chest and gastrointestinal symptoms might peak my interest in ultrasounding his abdomen. It's my pleasure. I can't set a follow-up in this venue and so would appreciate your returning to our conversation with an update - even after rating - at a time of your choosing.

Customer: replied 1 year ago.
I was happy to pay again today and grateful for your time. If the testing is in the 1,000.00 or so range, we will go ahead and do it to see what's going on. At least if it is cancer, and we choose to not put him through this, we will know our decision was made for the right reason. We will be heartbroken regardless.
Expert:  Dr. Michael Salkin replied 1 year ago.

I understand. Please keep me posted.

Customer: replied 1 year ago.
I will. Happy holidays Dr. Salkin!
Expert:  Dr. Michael Salkin replied 1 year ago.

I appreciate it! Happy holidays to you and Shelby too!