Question Details
Probable Osteosarcoma
by mikemesley - September 6, 2009
Dog with Hx of relatively acute onset lameness, mildly responsive to NSAIDs. Rads showed relatively small combo lytic/proliferative change in proximal humerus.

This was what I wrote when I first saw it a few weeks ago and recommended rads... it had recently lost a lot of weight after I had recommended a diet. It has put on weight in past few weeks with slight increase in food. Other great concern for the owners was the dog's increasingly uncontrollable anxiety. Valium had helped a lot with this - prescribed so she wouldn't do her forelimb more damage initially.

TCM Assessment:
Tongue purple. Pulse weak, difficult to say slippery or wiry - maybe a bit of both. Much fewer damp signs than previously - coat a bit better and obviously less fat - so blood deficiency with some stasis still present - and maybe more SP deficiency (or ST/SP disharmony?) signs being shown.
Herbal Prescription:
Found this one a bit tougher. Will move some blood stasis with NSAIDs so if lameness goes well on NSAIDs and we reassess then (maybe with acupuncture even?) we might get a clearer picture. Certainly a tonify blood, move blood and qi and perhaps tonify SP or harmonise middle jiao formula might be best. XYS springs to mind.

My question -
Hoxsey and Boneset should clear heat, phlegm, drain damp and move enough - but I really feel this dog might need some blood tonification as well (is extremely anxious and has huge fear of noise and thunderstorms). Is there an obvious choice for formula or additive single herbs to achieve this extra blood tonification (more water in the river = less stasis?). Si Wu Tang simply perhaps?? How about XYS?

A bit rambling but hope you get the point!
Replies
by mikemesley
September 6, 2009
Also - colleague has her started on piroxicam, amantidine and tramadol. I feel this should be a good combo for this dog in terms of settling anxiety associated with pain (esp tramadol), but will this affect the choice of herbs?
What do each of these drugs do from a TCM perspective??
Thanks...
by naturevet
September 7, 2009
Hi Mike,

I haven't looked into amantadine. I think of Tramadol as most effective when treating neuralgic pain or spasm associated with Yin deficiency. Piroxicam, as an NSAID, is a blood mover. Pain with anxiety is a good indication for Tramadol.

If the pulse is weak and the tongue purple, there could well be some Qi or Blood deficiency causing or caused by the Stasis. If there is anorexia or cachexia, I'd try a Qi tonic like Liu Jun Zi Tang (Six Gentlemen). I decide how to treat these cases (which tonics to use) through active points. Both Blood and Qi deficiency can create anxiety, so that's no help. So, in the absence of further point data or any help from the past history or a review of systems, I guess you can just start trying things. Or you can start Hoxsey and see what comes up. If Qi deficiency symptoms materialize, use a Qi tonic. If dryness materializes, use a Blood tonic. I guess that's how I'd handle it.

Steve

by mikemesley
September 9, 2009
Great advice - thanks Steve.
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