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Portal Vein Neoplasia

by mikemesley - August 2, 2009

Just finished removing a grapefruit sized neoplasm from a medium sized dog's portal vein (or was it caudal vena cava - not 100% sure).

If the dog doesn't bleed to death after damaging my intricately placed vascular sutures in the next day or so - I am looking for some form of herbal formula to encourage long trem survival.

Full Hx - I removed a tumour from the caudal aspect of one of its liver lobes over two years ago now. Histopath at that stage said sarcoma of unknown origin but maybe something like leiomyosarcoma - and suggested looking in GIT or portal vascular bed for primaries...

Has never (including first time around) had any liver enzyme elevations. Not anaemic yet although is in low end of normal limits.

Signs noted by owner are waxing/waning lethargy, vomiting, inappetance, occasionally diarrhoea. Scoots and has problem with anal glands. Can be a bit territorial, and a bit timid, but not really noise/thunder phobic, generally gets on very well with other people and dogs after being timid initially.

PE findings - mixed bag from TCm stand point.
Tongue purple, slightly pale. Pulse wiry, thin, not deep, not overly rapid. Sebaceous cysts present. AGs full. Skin flaky (large flakes).

Assessment -
Blood stasis. Dampness signs also present. Didn't feel TB blockage really present as not the agitated type, and pulse not typical in my limited experience.

Acupuncture: BL18 far more useful than GB 34 or BL 20 in improving pulse. BL 18 bilaterally really removed wiry and almost superficial quality to pulse.

So - neoplasia, blood stasis, presume Qi stasis, presume Damp/Phlegm also involved, and we can also presume some SP Qi deficiency underlying (and overwhelming of SP with purely commercial high carb diet). I have been surprised by relative lack of HEAT signs - almost nowhere to be seen - but dampness is present.

My feeling was initially GXZYT, and maybe SMS for its antidampness and SP tonifying effects. Have since had more of a look and thought perhaps CHGST might be appropriate - and was worried about SMS being too cooling in dog with no real signs of heat. Certainly I feel the overall look of the formula needs to be primarily blood moving, then dampness leaching as well as Sp tonifying - and possibly have some harmonising effects between liver and SP/ST. Maybe too much to ask of one formula??
Also, given blood loss in Sx today was significant - PCV dropped from 34 to 26 through operation - maybe something to tonify blood in the short term might also be nice.

I hope this is as interesting for you all as it is for me - what is the best presciption for an Earth-type veterinarian who tends towards dampness and heat but has had a severe overdose of adrenalin through surgery today! I could do with some!

Hoping you are all well.
Regards,
Mike

by mikemesley

August 2, 2009

having a further look was wondering what you thought about a combination of Xue Yu Tang and 6 Gentlemen for this dog. i note that XYT has some heat clearing properties and both are appropriate for abdominal neoplasia. Certainly this dog looks like the initial issue will have been a SP and/or KID yang/Qi issue so maybe this combo will go to the heart of the issue?
Also might be useful in the anemia post-op too?

by Nate Heilman

August 2, 2009

Mike,

That sounded like a harrowing surgery. You adrenals have a right to be spent.

One thing to consider in a fragile anemic cancer patient is the use of atragalus (Huang Qi) added to Blood moving, Blood tonic formula. Astragalus can raise the PCV well, and will address the Spleen Qi deficiency signs that you mention. It can also raise appetite, which is important in getting these creatures stabilized. I have some good success rolling this into Blood tonic formulas such as Xue Fu Zhu Yu Tang, or Ge Xia Zhu Yu Tang in patients such as yours; perhaps to the tune of 20 - 30 g per 100 g of the base formula.

Perhaps the Dampness signs may make a comeback, once the PCV climbs.

I have found Xue Yu Tang to be insufficienty nourishing for these cases; very moving but not enough tonic effect.

Nate Heilman

by naturevet

August 3, 2009

Hi Mike,

I agree with Nate's and your take. GXZYT is good for abdominal blood stasis lesions, especially of the cranial abdomen. It's a safe place to start while we assess how important it is to have an anti-Damp formula on board. The pulse and its response to acupuncture certainly suggests that Blood stasis is the main concern right now.

Astragalus plus Dang Gui will do a fine job of replenishing the Blood count post-op and is anti-neoplastic. It can be used with the GXZYT if desired, as Nate suggested.

Good luck. For you, a little dose of Six Gentlemen should recover your frazzled nerves!

S

by mikemesley

August 4, 2009

Thanks Nate and Steve for your help.
She is still going well - PCV dropped to 18 at one stage the morning after Sx but has rebounded nicely to 26 again this morning. Maybe her marrow doesn't need the slug of Dang Gui after all! Will begin on GXZYT and Astragalus - and monitor her closely over next few weeks to see if DGui is necessary.

Thanks and regards
Mike

by mikemesley

October 26, 2009

Update on our miraculous friend mentioned above.

She has gone extremely well, and O reports her to be pretty much her normal self. However in the past few weeks her Dampness signs seem to have come back with a vengence - even to the point of diarrhoea in the house, and seems skin also back to very seb oleosa appearance. These seem better when she doesn't receive the herbs.
I have her booked for a recheck, but any ideas re alterations to formula based on above info and re-emergence od Damp as an issue. Unfortunately the Os are keen on diet change in the consult room, but I don't think it is translating into real change in the dog's bowl - dry food is too convenient I think.

Mike

by naturevet

October 26, 2009

I'm not sure what you settled on using, but GXZYT is not dampening. So unless you used Astragalus and Dang Gui, then the problem is the diet. If you did add in the latter two, you could try to cut back on that component of the protocol. If her hematocrit is back up, she won't need them anyway.

S

by mikemesley

October 26, 2009

Hi Steve,

Some findings from today's examination.

Current herbal formula - GXZYT with NO additions.
Current Diet - as mentioned above - trying raw food diet predominantly but occasionally gets Hills Science Dry. Seems currently to be having diarrhoea related to eating lamb meat - often cooked.
Tongue - pale lavender, similar underside, slight and generalised solid white coating. Looks a bit dry in general.
Pulse - L side full and a bit slippery. R side weaker, more wiry, deeper. Particularly "short" on R side - ie position 3 (most distal) is difficult to feel. Is this KID Yang deficiency?
Points that seem active on palpation = SP6, BL17, CV12 (but maybe it's CV14?).
Other signs - generally very well. Behaviour still Blood Deficient it seems. Anal Glands full of pale paste today. Only diarrhoea occasionally in the evenings, O has related this to meat in diet. One potentially relevant thing I have failed to mention is that this dog is tiny for her breed - presume a bit of a runt - suggesting underlying KID issues?

Unsure if this is of use?

Any interpretations of these findings that anyone can make to help tweak her treatment. Generally O and I are both happy with her progress, and I feel we might be getting closer to her root issues. Would I be silly to suggest even BWDHW in a slightly damp, still Blood deficient, Qi deficient (and maybe KID +/- SP Yang deficient - although no "cold" signs seen)animal? If GXZYT is not dampening really, then maybe the tonification of Yang and diet change may be the keys?

Mike

by naturevet

October 27, 2009

Hi Mike,

Any lab or imaging findings to tell you how you're doing?

I agree the dog is looking more 'deficient'. If the diarrhea is not colitis, but more small bowel, then we can say the dog lacks both Qi and Blood. What time exactly is the diarrhea? Whatever organs are at 'high and low tide' can give you a clue as to its source. For example, the Lung, Large Intestine, Stomach and Spleen are at low tide from 3 to 11 p.m. The Bladder, Kidney and Pericardium, and Triple Burner are all at high tide. I'm wondering, then, if this is a case of a 'lack of fire under the cooking pot' causing the diarrhea. So a warming Blood tonifying formula that is anti-cancer is still called for. If you've seen definite improvements on GXZYT, and not just a maintenance of the status quo, one way to meet these new criteria while not upsetting the apple cart is a formula called Wu Yao Tang (Lindera Decoction). It warms the abdomen (the fire) and tonifies Blood, and is a component of GXZYT. You'd just be ramping it up. Especially if there was any abdominal pain, it's a consideration.

Otherwise, more overtly tonifying formulas are candidates. Bu Zhong Yi Qi Tang especially springs to mind, but so does Xiao Yao San.

So those are some ideas for you to play with. Glad you're having some success.

Steve

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