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Chronic Lymphocytic Leukemia Patient

by amymatthews - September 25, 2009

Hello again!

I have a 15 year old FS golden retriever, previous successful show dog, no previous medical issues, who was diagnosed with CLL 3 months ago. Her primary sign was ADR (a little quieter). Her WBC isn't high enough to warrant chemo (only 16-19,000) per our local oncologist. Her tongue is what I would call black, seems like a black coat (I've only seen it once before, in a dog who was on chronic pred; that tongue improved markedly just by stopping the pred) and dry, with a dark dark red body. Her pulse is superficial and slightly rapid. I'm wondering if I should support yin or drain heat here (or both?). She is definitely asking for some TCM! I have not done acupuncture on her (staff member's dog), will do that today.

Thanks,
Amy

by naturevet

September 25, 2009

Black tongues to me are associated with extreme Heat, and the pulse and tongue echo that. Leukemia is generally an extreme Heat state, so that fits. If the pulse is superficial, then the Heat is more likely to be a pure excess. If it was wiry and rapid or thin and thready and rapid, then Yin deficiency would be my first suspicion. So I would start with a Hoxsey and Si Miao San combination, and recheck counts in the next few weeks. The last leukemia case I had responded to Hoxsey alone.

Erin Bannink is a boarded oncologist who uses a lot of herbs, so she may have some other advice for you if she happens to check your post.

Good luck!

Steve

by amymatthews

September 25, 2009

ERg, I keep posting responses when it looks like I'm logged in up above, and then it doesn't post ANd doesn't inform me that it doesn't think I'm logged in (BUT still lets me review the forum). But, to try again:

When I first checked her pulse, she was lying down. Now I'm wondering if that was wise, since once she got up and walked into the room her pulse was weak, thready, and difficult to maintain contact with. Her pulse responded only briefly to the points I picked up for her, incl CV6, KI6, BL23, and LI11, like a flutter of energy and then back down deep again. Does this change the recommendation?

Thanks, she's a great dog.

by naturevet

September 26, 2009

The ideal time to check the pulse is while the animal is lying down, so no problem there. Given that you were trying to improve her with tonics, and not successful, it makes the idea of using a draining formula even more feasible.

Regarding posting replies, your connection to the site may time out if you leave your desk for too long. To make sure you're still logged in, just click the Forum tab, or any other, and see if your name still appears at the top of the page. If it does, your reply will work.

Good luck!

Steve

by amymatthews

October 23, 2009

Thanks, Steve. I forgot to mention that she was on Rehmannia Eight. We stopped that and put her on Hoxsey (full dose, d'arcy formula) while waiting for Si Miao San, but the owner noticed that she seemed more lethargic so we put her back on Rehmannia Eight. Currently she is on Rehmannia Eight, Hoxsey, and Si Miao San...and her tongue is still red-black and dry, pulse still superficial when lying down. Do I need to get her off the Rehmannia for the Damp-Heat draining herbs to work?

Her pulse is most responsive to SP9 and LI11.

To my eyes, she pretty much unchanged - tongue/pulse the same, great attitude, really benefits from chiro adjustments - but she's obviously lower in energy per the owner. Her last CBC (about two weeks ago) was also unchanged from previous work.

thanks,
Amy

by naturevet

October 23, 2009

I guess I'm wondering if the severe Heat has damaged her Yin. In that case, Zhi Bai Di Huang Wan plus Si Miao San might be a better combo. I don't know if D'Arcy Naturals Hoxsey is quite the right blend for this, though, and may be too weak for your purposes. Anyway, see how it goes,

Steve

by amymatthews

October 27, 2009

I was wondering about D'Arcy's Hoxsey. I've seen it improve other "hot" dogs, but none had the extreme presentation that this dog has. As long as her signs continue to be fairly mild, I'm inclined to try the Natural Path version and see if we can get a shift.

by amymatthews

October 27, 2009

I only see the tincture version of Hoxsey-like at A Time to Heal - do you make the granules, too?

by naturevet

October 27, 2009

Currently we make just a tincture version, so if it has to be powder, then you may have to keep going with the version you have.

S

by amymatthews

November 3, 2009

This dog has been on the Si Miao San + Natural Path Hoxsey now for about 4 days. She had a mild grand mal seizure this morning. She had a mild partial seizure about 5-6 years ago, and none since then. Any evidence that these herbs can lower seizure threshholds?

Otherwise, her pulse has normalized quite a bit; her tongue is still dark red, black coat, dry. At the moment, I'm inclined to give the herbs more time. We're also rechecking her CBC, and checking her chem in light of the seizure activity.

Thanks as always for your perspective.

Amy

by naturevet

November 3, 2009

In general, we use SMS to clear up seizures and don't expect it to cause them. So I wouldn't have thought either of those would precipitate seizures. The exception would be potentially if the animal were overtly Yin deficient. If that's the case, Tian Ma Gou Teng Yin would help control the seizures and Zhi Bai Di Huang Wan might be better for the CLL.

Steve

by amymatthews

November 3, 2009

Interesting, her tongue has always been dry, today her gums were dry, too (but her skin turgor was normal; and it sounds like she wasn't drinking well post-seizure). And it was when we stopped the Zhi Bai Di Huang Wan earlier that she seemed to lose some of her zip (even though it didn't seem to affect her tongue and pulse much, may have normalized her pulse a bit). Nothing much is touching this toxic tongue, though!

by naturevet

November 3, 2009

Perhaps we can modify it to increase its Heart Fire cooling effects. Or, more easily, use Qing Ying Tang simultaneously. It also nourishes Yin, is anti-leukemic, and cools Heart Fire. The Heart is said to open into the tongue, so perhaps it will only be once we cool Heart Fire that we see the tongue change color.

Try to take a digital photo next time. I'd love to see it.

S

by amymatthews

November 5, 2009

Arg, forgot to take the photo Tuesday!

Just FYI: Her bloodwork came back and, if anything, the WBC is on her lower range (16,400, has been up to 19,000). However, she has had borderline azotemia and her BUN is now 45 (6-25), Cr 1.6 (0.5-1.6) - no urine checked, so this could be pre-renal.

by amymatthews

November 5, 2009

Arg, forgot to take the photo Tuesday!

Just FYI: Her bloodwork came back and, if anything, the WBC is on her lower range (16,400, has been up to 19,000). However, she has had borderline azotemia and her BUN is now 45 (6-25), Cr 1.6 (0.5-1.6) - no urine checked, so this could be pre-renal.

by amymatthews

December 10, 2009

Followup: no seizure-like activity on QYT, but no change in tongue or general well-being per owner.

by amymatthews

December 11, 2009

Here's her tongue today:

http://www.flickr.com/photos/14066462@N06/4176853640/

You can see the black coat at the back. She does NOT have pigment on her tongue.

and without flash:

http://www.flickr.com/photos/14066462@N06/4176093953/

Her tongue is not dry today.

Still no acupuncture points that really shift her with lasting effect, thought GB25 was active today.

by naturevet

December 11, 2009

Hi Amy,

That's a very creative way of sharing the photos. Soon we'll be able to upload them here, but nice idea in the meantime.

There's a lot of stasis in that tongue. Our formula definitely must be moving. It's pretty wild how black the root of the tongue is. I've never seen it that pronounced in a dog before. So the tongue definitely says Stasis and Kidney weakness, which QYT can conceivably help. How are we doing with Blood counts and general clinical progress?

Steve

by mikemesley

December 14, 2009

Any chance this dog is running out of Essence or Yuan Qi? That is a wild tongue!
Extreme stasis in lower burner - might something bupleurum be useful? Or too powerful given my first question?

Wow
Mike

by mikemesley

December 14, 2009

also Amy how did you share photos like that?

by naturevet

December 15, 2009

Hi Mike,

It looks like Amy used Flickr, a free photo-sharing site.

As for Bupleurum, it's a thought. Given the heat in the tongue and also the black color, I felt like recommending something more directly tonifying to the Kidneys, such as a Yin tonic, rather than something indirectly acting, such as something that just opens the TB.

Steve

by amymatthews

January 18, 2010

Would you recommend a yin tonic other than Rehmannia Eight? That seems to have benefited her energy a bit, without changing the tongue. Her WBC counts continue to show only mild changes (between 13,000 and 19,000, at the lower end currently) without significant changes in morphology. She has been stable with that tongue now for 6 months!

Tried GV4 for her during acupuncture last time, it was a little active, no dramatic shift.

And yes, I uploaded my pictures to a free account on flickr so y'all could see them. :)

by naturevet

January 20, 2010

Hi Amy,

I'd be reluctant to rock the boat if things are going well. Given that she's stable on tonics, we've noticed that Xue Fu Zhu Yu Tang will help some deficient leukemia cases. So you could try that alone or with Rehmannia Eight. But I'm also a fan of 'if it ain't broke, don't fix it'.

S

by amymatthews

February 11, 2010

Should've listened to you...2 weeks on XFZYT and she had mini-seizure AND developed a moderate mastitis at her mammary mass. Will stop the XFZHT and see what happens.

by amymatthews

February 12, 2010

Bloodwork came in - she's in early renal failure (BUN 48, Cr 2.9, urine SG 1.016) with mild anemia (HCT 30%) (makes me even happier that we've had her on zhi bai di huang), her neutrophils are up (suspect this is due to the mastitis), BUT her lymphocyte numbers continue to treck towards the normal line (a mere 8000 this time!).

Her thyroid value was also low (0.8,range 1-4), though that could be due to the mastitis, too (it's the first time we've checked it recently). Will recheck it in a few weeks.

Her tongue and pulse remain unchanged. She was showing signs of fatigue one week into XFZYT - hm, obviously worth paying attention to!

Thanks as always.

by naturevet

February 12, 2010

Hi again,

As soon as I see azotemia and seizures in the same patient, I think of a Shao Yang pathogen. I'd be curious to see what happens with the use of Xiao Chai Hu Tang plus ZBDHW. The former used in lymphoma and leukemia in China for humans.

Just a thought.

Steve

by amymatthews

April 2, 2010

She just had a mammary mass removed which turned out to be an adenocarcinoma - it has been detectable since 2 months after her diagnosis of CLL. Strangely enough, today (4 days post-surgery) her tongue is MUCH more normal looking! It's lavender with a mildly undulated surface, slt sticky surface. Pulse feels deeper and weaker than previously, though.

She doesn't look nearly as hot today (I was thinking of XFHMY, but not after seeing her). Do you still think XCHT might be indicated (sorry I missed seeing that reply earlier).

Thanks!

Amy

by naturevet

April 3, 2010

Hi Amy,

I'm pleased to see the dog is stil around:-)

Xian Fang Huo Ming Yin is my favourite mover for the mammary channel, even if the dog is not too, too hot. I think it's fine to try.

Steve

by amymatthews

May 24, 2010

Hey again,

Marlo has done great for a while since her mammary mass was removed, tongue was lavender-pink (a marked change!). I was going to start XFHMY, but then I recalled that when I tried her on SMS, she developed seizure activity (had had a few similar incidents very spaced apart when younger) that resolved when we stopped SMS. Given the general similarities, I was reluctant to try XFHMY - any thoughts on distinguishing points between SMS and XFHMY that might account for seizuring? I'm starting to wonder if she might have a pituitary adenoma, as she is panting more, developing a pot belly, and losing muscle mass (all of which could be geriatric signs, too).

Over the past few days, her tongue has turned black again, even more markedly than before. Her pulse is no longer superficial, but is deep and difficult to find. KI27 was active today.

For now, she's staying on Eight Rehmannia.

Amy

by naturevet

May 24, 2010

Hmmm. If the dog is Cushingoid, then SMS is a good call. The seizure may have been coincidental.

Xian Fang Huo Ming Yin is not nearly as drying as SMS, and promotes peripheral (and cerebral) circulation. So it's almost opposite to SMS in the respects that pertain to the Chinese medical etiology of seizures. I wouldn't expect XFHMY to aggravate an internal Wind by being too drying; or to cause seizures by being too downbearing. So I still think it's safe to try, even with the Rehmannia Eight on board.

S

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