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Lymphoma

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Hello,
I am seeing a 10 year old DSH that has been diagnosed (by another DVM) with lymphoma. The original complaint was a mass on the metatarsus, aspirate suggested that the mass and popliteal LN cotaintained round cell neoplasia. The other DVM removed the leg. Tissues sent to the pathologist revealed lymphoma in the mass and popliteal LN. The cat is now receiving Modified Wisconsin Protocol (just received second treatment) and is on prednisone. The cat is coming to me for a "second opinion"/ nutritional and possible herbal support. The cat has a strong but compressable pulse, with a dry, slightly red tongue. I am considering (and the owner is very keen on trying) herbal treatment: Hoxsey like Formula, Si Mao San, and Xiao Chai Hu Tang. I am not sure how to go about this along with the chemotherapy. I am going to consult with the onconlogist too to see if he is willing to cooperate. How will the herbs effect the chemotherapy?

Thank you! Leslie

by naturevet

June 8, 2009

Hi Leslie,

Your protocol seems a good place to start. In general terms, we find herbs rarely interfere with chemo and, if anything, have the opposite effect. That is, they tend to enable or improve conventional treatment outcomes. Undoubtedly there are several possible mechanisms that might explain this. One that has been confirmed is the ability of Phellodendron and, most likely, Oregon Grape, to inhibit multi-drug resistant pumps in tumor cell walls, making them more susceptible to chemo. It also appears, however, that normal cells are also more sensitive to chemo when using herbs simultaneously, so it would be ideal for the oncologist to be willing to alter their regimen according to the incidence of side effects in the patient. If the patient is more affected by the chemo, it would be more prudent for the oncologist to back off on their drug doses than for you to stop herbs, so you can continue to take advantage of any synergies.

Hopefully this will go well for you. Please update us as things unfold. Good luck!

Steve

by bannink

June 8, 2009

Hi Leslie,

I commonly use herbal treatments with chemotherapy in many of my cancer cases, including those receiving CHOP for LSA, and have no major concerns in doing so. As Steve said, there is the possibility for increased side effects in some patients, although I really have found that the incidence is pretty rare and dose adjustments are not commonly necessary. I have had a handful of patients (although mostly dogs) who have become profoundly myelosuppressed but, in hind sight, they appear to mostly be dogs who have been blood deficient - which we might be able to predict from a TCM standpoint. I am hoping to be able to gather enough data that we might be able to predict which patients this is most likely with. I am guessing that I have not really seen that in cats because it is very rare for me to see a blood deficient cat with cancer and blood deficient dogs are more common. So that is my hypothesis based on the cases I have had so far. I really haven't seen increased GI side effects, although I do try to be careful with my herbs in patients who require a lot of antibiotic therapy during chemo because both are cooling and can increase risk of diarrhea. So I try to watch herbal choices in patients prone to cold GI issues.

Some food for thought. Good luck with the case. Let us know how it goes.

Erin

by

June 9, 2009

Thank you so much for the guidance! I am going to speak with the oncologist today to see if he is agreeable to my plan.
Leslie

by

June 9, 2009

Hi- I talked to the oncologist. He was very nice and said "I can use all the help I can get!". So I am starting the cat on 1/8 tsp BID of the Si Mao San and the Xiao Chai Hu Tang, 0.4 ml BID Hoxsey-Like Formula. The cat is 8 pounds. Hope my dosing is okay- please advise if it seems incorrect.
Thank you! Leslie

by naturevet

June 9, 2009

The doses seem fine. Good luck!

S

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