Rascal's CBC Results and request for help

Rascal:  10 years old, blonde/orange tabby.  He often goes outside in backyard only.  He sometimes ate the tall fescue grass, which at times would make him vomit.  Diet for the past 3-4 years has consisted mostly of wet food like Wellness, California Naturals?, Natural Balance, Tiki Cat, and dry food like Solid Gold.  Recently, I've added Purina Pro Plan since he's been so bored with just the other choices and he dislikes Wellness.  I need to know what dry food to give him because the Natural Balance low calorie food probably is not a good choice for him (although the overweight female needs it).  Anyway, Prior to the good diet, he was eating Fancy Feast, Purina, Friskies, etc.

History:   Last year Rascal weighed approximately 18 lbs, which for him was about 2 lbs. overweight.  Both he and younger female calico received annual Feline Leukemia shots in mid/late March.  In early April, female was sick with something and I got her treated with an antibiotic.  Male showed different signs of beginning to have issues.  Urine had strong odor, he began to lose weight.  Later that month, the city sent out a letter that we had a higher concentration of coloforms in the water supply than normal.  When asked, they of course denied that this could've been a problem for the pets and said no one else reported that there pets became ill.

By maybe June or July, Rascal had lost 3 lbs.  Later in the year, his throwing up had become more common place and he was losing weight, even though his appetite was as good as can be if not increased.  Okay, come February, he was throwing up much more often that I finally took him to the vet.  I know, I waited much too long and now I'm really sorry about that.  Well, unfortunately, I can't change the past, but I'm certainly wanting to do whatever I can possibly do within my means to improve the future for him.

He's been to the vet 3 times and after $800+ worth of lab work, an x-ray, antibiotics and Denamarin (milk thistle/SamE), he's now on Prednisone.  I'm surprised the vet took him off of the Denamarin because that was actually helping to reduce the liver enzymes, but the problem is he has an incredibly high amount of white blood cells, liver enzymes, and Absolute Lymphocytes.  Without doing a biopsy, my vet thinks he either has lymphoma/leukemia or some kind of Hepatitis. 

Here is the Clinical pathologist review:

There is a mild to moderate lymphocytosis which has increased in magnitude since the last 2 CBCs performed 3-2012.  The lymphocytes are small and mature.  This could be a reactive population secondary to immunostimulation but evolving chronic lymphocytic leukemia is also possible.  If there are changes of the lymphoreticular organs, biopsy recommended.  Recheck CBC at 2-4 week intervals to monitor lymphocyte numbers and morphology.

So, last we checked, WBC=33.7, Absolute Neutrophil Set=14491, Absolute Lymphocyte=17861, ALK Phospatase=177, ALT(SGPT)=551 and in a prior CBC AST(SGOT)=170, A/G Ratio=0.9,

After the first treatment of Denamarin/antibiotic, the liver enzymes can down, but the white blood cells increased.  We added Baytril to the mix and then being retested about a week after being off of everything, the numbers were all back up again.  So, now we're only treating with Prednisone.  Not sure why we stopped the Denamarin.

What I need from the community:   I want to know what is recommended for further troubleshooting (besides biopsy), treatment, and for helping Rascal be as comfortable as possible if these are his last days with us.  Right now, he's a spunky guy with a big appetite so you'd never know he had any problems, but his bloodwork shows otherwise.  And, Rascal's weight is now down to 10 lbs.  He's severly underweight!!

Thanks in advance!!

Randi (and Rascal)

Randi, I'm so sorry.

I have no experience with and know nothing about organ functions and related values. But I do know that those who do will want the lab's reference ranges, because each lab has different numbers. So to help the others help you, perhaps you can post the values for Rascal, but along with the reference ranges provided by the lab on the bloodwork data sheet?

I don't know enough about leukemia and it's impact on the body to have thoughts on that. I do have experience with lymphoma - and it often isn't even detectable in blood work. Our Lazlo completed six months of chemotherapy in January. But the only reason we found his was because he had bleeding ulcers due to a large mass in his stomach. Those ulcers caused him to be anemic, and when the anemia didn't respond to traditional treatment (steroids and antibiotics), we found the mass on an x-ray. We were fortunate, in that he tolerated the medicating and vet visits well, and the chemo worked for him. Have x-rays been done to see if there are any masses to detect? I take it he doesn't test positive for FeLV? There is an expensive bone marrow aspirate that can be done to see if the leukemia is "hiding" in the marrow. Another TCS member, Momofmany, is dealing with this in her Koko right now. :heart2:

But with Rascal's liver enzymes being out of whack... :dk: Seems to me there's more going on here.

Vibes you can get this figured out - and treated! :rub:

I feel your pain.

I've been going thru a similar story with my 9 year old. She was gradually losing weight and her blood work was off in February. When her blood work got seriously worse (her counts were low rather than high), we did do a bone marrow aspiration, as we suspected bone marrow leukemia. Turns out she has been harboring the feline leukemia virus in her bone marrow since before she was born and it never showed up on any blood test in 9 years. Fortunately she's not contagious.

She was put on pred for a couple of reasons, and I suspect your vet did the same for you. First to stimulate appetite. Secondly, in her case, pred is known to help anemia (which was the major symptom of my girls leukemia). Pred is a great anti-inflamatory drug and it can generally make them feel better. The pred wasn't entirely helping, so I asked that she be put on doxycycline. She has perked up tremendously after she got over the nausea from that medication, so I think she had a blood based infection and the doxy knocked it out. I haven't had her blood checked since the doxy, but I suspect her anemia will be much better now.

You get into oddities with blood and it frankly could be a number of things. High white blood cell count usually indicates an infection of some type, but I'm certainly not a vet and would be remiss if I tried to analyze Rascal's for you. Sometimes you can narrow down the problem by a combination of things going on with the blood, and it appears that is what your vet did for you. In my cat's case, her red blood cells dropped, then her platelet count dropped to dangerous levels, then her white blood cell count dropped. All three pointed to leukemia. We chose to do the biopsy because I wanted to know what I was up against.

Sometimes a biopsy is the only thing you can do to isolate a problem, but I would ask your vet - what exactly are you going to biopsy? Leukemia typically affects blood, and a bone marrow aspiration is a relatively easy procedure (mine didn't even need pain meds afterwards). I had a cat with lymphoma and they weren't certain at first what to biopsy, as lymphoma can spread to all parts of a body. Xrays showed nothing. An ultrasound narrowed the search down to a couple of organs. Sorry I can't remember which organ they ultimately biopsied (that was over 20 years ago), but nothing else would have told us what was actually wrong.

What you are going thru is difficult. If Rascal has a terminal illness, what would you do about it? But if it isn't terminal and you don't go the extra steps to find out what is wrong, are you letting a treatable disease take his life? I hate these decisions, and frankly, if in doubt, I always take the next step to find out what is actually wrong. Blood work won't be conclusive, nor will xrays. Ultrasounds can help somewhat, but it will ultimately take a biopsy to prove what is going on.

If your vet is convinced that what he has is terminal, and you chose to let nature take its course, simply give him ever darn thing in the world that will make him happy. I've got a very old cat and my feline leukemia girl that probably won't make it through the year. If they want to eat the ice cream from my bowl, why not? If they want a slice of deli ham, what harm is it at this time? As long as you don't let them do anything that will seriously harm them, keep them happy. I was able to keep a cancer dog going for 18 months after she was given 30 days to live. She was given cheese danish off a plate while lounging on the sofa (which she was never allowed on previously). I call this treatment plan "Love and Cheese Danish". There are threads on the site that talk more about it.

LDG said:

There is an expensive bone marrow aspirate that can be done to see if the leukemia is "hiding" in the marrow. Another TCS member, Momofmany, is dealing with this in her Koko right now. :heart2:

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I must have started posting when you responded!

The bone marrow aspirate cost me about $500. It wasn't entirely outrageous, and it did include the test for cancer as well as a test for feline leuk virus (an IFA type test). Once a cat is a senior (past 8), they typically need to do a blood monitoring panel any time they put them under anesthesia. It's always an extra $100 or so because of their age. The incision didn't even need stitches, they just insert a very large needle through their hip joint into the femur bone marrow.