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Gastric Adenocarcinoma

by marneemadsen - June 17, 2009

Hola,

12 yr old mix breed with hx of poor hair growth post shaving, dermatitis with summer and fall, runs hot. Vet went in for what they thought was FB sx and found mass with severe ulceration - removed what they could. Put him on pred post op.

He is six weeks post op - I started seeing him 3 weeks ago. He is really blood deficient, pulses were very weak and hard to find, tongue purple/red with phlegm. They were reluctant to do much, but were feeding raw since sx (he has had diarrhea since sx) so I just did LJZT and encouraged high dose Vit A and to cook the food and get off the pred as it seemed contraindicated in many ways with this dog.

Came back today, BUN 64, still diarrhea, still on pred eod. His pulse is better - deep, choppy, still weak for his size.
Active pts both times BL 20/21 which are super sensitive and which improve his pulse tremendously with sedating. Now lots of active GB pts as well. I sent home Ge Xia Zhu Yu Tang with Chai Hu and Yu Jin added, Yunnan Baiyao.

Are these gastric adenocarcinomas typically driven by poor blood supply to the epithelium, or does that appear just to be this dog?

Would pred not worsen that? One of the other palliative tx I found on VIN was piroxicam, which also seems like it would do the same thing.

IN the "pulse diagnosis made crazy easy" model, this dog seems to fit perfectly with needing tonifying and aromatic herbs to get the blood to the epithelial surfaces...am I on the right track? Is the formula appropriate with all the ulceration?

Thanks and thanks,
Marnee

by naturevet

June 17, 2009

Hi Marnee,

Your formula choice seems a great place to start. I would wonder if a Phlegm accumulation (which firsts starts in the Stomach) is the cause of the Blood stasis. So Er Chen Tang and derivatives may come in handy at some point.

GXZYT decentralizes Blood outwards to the periphery, which includes mucosal and epithelial surfaces. So its use is fine here. And yes, I agree, NSAIDs and prednisone would have the opposite effect. The deep pulse suggests we need blood mobilized outward, so I agree that pred and NSAIDs would be potentially contraindicated. If the dog has not benefited clinically from the drugs, they should probably be discontinued (prednisone gradually, of course). If there have been benefits, then we should entertain the notion that Stevie's logic isn't always sound and use them anyway until you've taken the dog beyond what the drugs accomplished.

As for typical gastric tumor behaviour, I have found most of them to be Qi deficient, but there's no question with the tongue appearance that a moving influence is needed.

I'm sure you'll see some benefits here. Please keep us posted. Good luck,

Steve

by bannink

June 20, 2009

Marnee,

If you haven't already, I would take the dog off pred. There is no western med rational for its use here as far as the cancer goes - at least not based on what you have said and the biopsy report. I am assuming they put the dog on it post-op due to concern for LSA. Since this is not what we have based on biopsy and prednisone is only going to aggravate GI bleeding, which we already have, discontinuation of pred should be recommended in my opinion. It has no anti-tumor action with adenocarcinomas. If they have the dog on it for dermatitis issues, I would still recommend stopping if there is another way to manage this patient because of the GI bleeding. I have found that L-Glutamine is helpful in resolving and then decreasing occurrence of GI bleeding. There was a study showing Glutamine to be as effective as Carafate in people with gastric ulcers. Obviously the bleeding here is originating from tumor, but it might be worth adding to the food.

Gastric adenocarcinoma also has a high rate of metastasis. Median survival time is short - usually only 2 months - with rare cases living longer than 3 years. I wonder if adding something like Bilberry and Vaccinium formula would be indicated for its anti-angiogenic properties? Thoughts about that Steve? I am not clear on the formula's TCM actions.

Erin

by marneemadsen

June 21, 2009

Thanks Erin,

I had strongly encouraged them to taper off when I saw the dog initally - they are getting a lot of opinions and it's helpful to be able to pass this on from you - Thanks!

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