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Hemangiosarcoma (splenic) In A Dog

by Tracey - November 8, 2018 View Case Report

Hi Steve ,

I have a very challenging HSA case. Tuppy had her splenic mass removed 6 weeks ago, confirmed HSA with mets to multiple spots in her omentum. Started her on HSA and Coriolus post-op and owner also opted to have metronomic cyclophosphamide therapy. Seemed to be doing well....until a major bleed 3 days ago. She was transfused and stabilized and now back home. Owner has opted for vincristine at oncologist's rec. as apparently it can help prevent bleeds.

I saw her today, her pulse has gone from a bit slippery, good width, to deep and extremely weak. Tonification of GV points (5 and 14) really helped as did tonifying BL 17. I didn't get much response to GB 30 but tonifying GB 39 helped.

I didn't do a lot of acupuncture on her today as she is still quite weak . I will see her again on Friday. I've got owner doing MOxa on GV points and St 40 daily. I have started her on high dose Yunnan Baiyao today and owner has withheld HSA for last 3 days as Tuppy also had diarrhea (started before bleed).

So...where to go. Do I stay on the HSA or, should I switch to XCHT or BZYQT to get Yang out to periphery and provide blood tonification.

I'm hoping, if Dr. Erin Banniink is lingering in the background, she could comment on the use of Vincristine in this case. I feel that it might be worth it if it is well tolerated (and so far so good) AND has a good chance of helping to prevent another bleed, and buy me time for herbs to work .

But, if it is more of a grasping at a chemotherapeutic straw kind of move, then i would rather not tax Tuppy's system with it as she is pretty qi deficient right now.

Just got vitamin D level back today and it is low, so starting supplementation tomorrow too.

As always, really appreciate your time and guidance,
Tracey

by naturevet

November 10, 2018

Hi Tracey,

First, regarding your vincristine question, I checked with Erin for you. She's never heard of vincristine being used alone for hemangiosarcoma, only as part of the VAC protocol, the other components of which are Adriamycin and Cytoxan. That protocol had a mean survival time of 6 months or so, with almost no dogs alive at one year. She would expect vincristine alone to perhaps give the dog 1 to 3 months.

Since HSA has produced longer survival times than anything else ever discovered, I would not stop it personally. The points suggest a need to tonify internal Yang and Blood, which the formula supports. Loose stools are not typically seen, so the Dang Gui should not automatically be presumed to be the cause of the diarrhea. If the diarrhea ceases off the herb, I'd advise re-starting it at a low dose at first, and then gradually find the maximum tolerated dose, up to 60 mg/k, with 1000 mg equaling 1/2 tsp of herb.

For Shao Yang dogs with internal Yang deficiency, you can also look at Chai Hu Gui Zhi Gan Jiang Tang, but it is drying, so you would still need to co-manage with a substantial amount of a Blood tonic like Dang Gui, which contributes a lot of anti-cancer effects as well. Natural Path can make the CHGZGJT up for you if you like, and you could pair it with Si Wu Tang to get the Blood tonification effect

These two might somewhat substitute for the HSA compound, although some anti-cancer components are missing. The missing components might tip the balance further towards the success of the tumor, but this latter combination might technically be a better fit right now. If an ultrasound detected only a small number of substantial mets, a second surgery could always be contemplated. That could certainly tip the scales in favour of the dog, buying much needed time and reducing the tumor mass that the herbs have to kill

Lastly, we've been using substantial doses of Yun Zhi instead of Im-Yunity, as well as Bilberry extract. You mentioned Coriolus extract but didn't mention which one. Large doses are needed of Coriolus to get decent survivals. The BIlberry extract is available from Natural Path as well.

Hopefully this information helps you out.

Steve

by Tracey

November 10, 2018

Hi Steve,

Thanks for your reply. right now I have the dog back on HSA at 1 tsp BID (the diarrhea was either from chemo, stress of being hospitalized or something she ate on the day she had her bleed) so I felt fine in putting her back on full dose . And I have had her at a >60mg/kg dose of NPHC Coriolus ( 1/2 tsp BId for a 30 kg dog) for 2 weeks.

Unfortunately there are multiple mets throughout her omentum (seen at time of splenectomy but morenow) and one retroperitoneal 9 cm mass.

Pulse was much stronger on Friday's recheck (48 hrs after initial post above), nowhere near as deep. Tongue is still pale lavender and dry though. GV points weren't as helpful this time at improving pulse, but tonification did help a bit. Still some Shao Yang/TBO going on as pulse was responsive to tonification of GB 39. And improvement to SP6 tonification (Yin deficient)

Given I have had her on such a high dose of HSA (closer to 100 mg/kg BID now that i calculate it)...could I use a 60mg/kg dose of HSA instead and add in the CHGZJT + SWT at 60mg/kg BId ?

Must admit, I'm reluctant to take HSA out of the picture but, on the other hand, I'm worried that she grew a 9cm mass in the 6 weeks post surgery, has multiple new mets and had a substantial bleed while on HSA and Coriolus. Will get her on Bilberry too.

Hoping to talk to the oncologist next week as I want a better sense of chance of success given failure on metronomic cyclophosphamide and aggressiveness of this cancer. On closer questioning of owner, it sounds like the Vincristine is the first step in a multiple chemo protocol..... which they will only continue if she tolerates Vincristine. It made her pretty inappetant and might have been responsible for that extremely weak and deep pulse I felt....but she had just had a big bleed and transfusion.

I would love to get her off chemo but, owner has to make this decision, with data in hand. Neither herbs nor chemo to date has seemingly helped and, if she stops chemo, against oncologists recommendations, don't want her beating herself up forever more thinking her decision shortened her dogs life.

Kind of between a rock and a hard place, but very thankful you are there to provide a little light!

Tracey

by naturevet

November 10, 2018

Sure, you can try the reduction in HSA and sub in the other two. We're closed on Monday but they can zip it out to you on Tuesday if you want

S

by Tracey

February 7, 2019

Thought I just submitted an update to this case but....no sign of it, nor of the post for the Forum so here it is again with apologies if first attempt shows up as well.

This dog has had quite and eventful 3 months since the last post. Several chemo protocols have been used but she had 1 bleed in December and 2 in January (which both required transfulsions after she clotted). Repeat ultrasounds at the referral centre has shown increase in number of mets to abdomen although previously noted large met (9cm) has shrunk to 6 cm. Also 2 suspicious nodules noted on lungs and mulitple presumed mets all along splenectomy incision line.

I have kept her on HSA, Yun Zhi, Chai Hu Gui Zhi Jiang Tang + Si Wu Tang, Yunnan Bai Yao, Vitamin D, and Bilberry when she will take it. She has done well, other than the bleeds, with only mild transient soft stools and inappetance post chemo. I did add in Shen Ling Bai Zhu San for these post chemo symptoms...which has worked well until lately (currently has soft stool post Palladia admin)

TCVM rechecks show spleen qi deficiency (pale moist tongue, deep soft pulse, BL 20 tonification). Stimulating GV points continue to help pulse and, lately, sedating SP 4 helped normalize the pulse. So, am thinking of using BZYQT instead of Shen Ling BAi Zhu San to support GI tract and overall QI, but have also wondered about adding GXZYT given increasing size and number of abdominal mets (but this won't help GI signs). We are logistically at a limit of how many formulas to give this dog. Feeling like I should do something else given ongoing bleeding events or maybe I should hold the course because, frankly, all are amazed she is still with us.

Would love your thoughts on this complex case Steve.

Thanks,
Tracey

by naturevet

February 7, 2019

Hi Tracey,

I'm glad to hear of your success with such a tough case. Bu Zhong Yi Qi Tang does sound like the best fit for the case, so I'd implement it instead of the SLBZS. It has a hemostatic effect as well, so that should help!

Thanks so much for keeping us posted

Steve

Bu Zhong Yi Qi Tang

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