Question Details
Hemangiosacroma In A Dog
by Dreudog - March 27, 2019    View Case Report
Steve and group,

This dog is a 9 yr. old Golden retriever. History of late summer/fall allergies, fairly mild symptoms. Nauseous on Cephalexin. Was 4DX + for Lyme @ rDVM- C6 Lyme @ 53 - treated Doxy.... reduced C6 to 16 (convalescent level per lab). Found weak and "not himself" by pet sitter 3/19 ; splenectomy @ referral center, uneventful recovery. Minor GI issues as younger dog (picky appetite) and 1 unexplained episode of anorexia and vomiting blood May 2017- resolved w/ supportive care.

On first exam 3-19:

- sweet, a little insecure per owner
- Tongue: sl pale, sl. wet
- Pulse: middle- deeper, thinnish
- 3 SQ masses (sebaceous cysts, lipomas, per previous FNA's)
- playful, fairly active for his age

I'm feeling he is spleen and blood deficient, somewhat damp. I started him on Dang gui shao yao san @ 3 tabs TID (65 # dog), Yunnan bai yao, IP6, Vit A & D, Coreolus mushroom, enzymes and changed his diet from kibble to cooked commercial raw + veggies 25%. (he's tolerating that transition so far).

Do you have thoughts on this herb choice? Other?


thanks,


Cathy L
Replies
by bannink
March 28, 2019
Hi Cathy,

I'll share how I usually approach cases like this. Steve can chime in with his experience and whether he's had success with anything new, or different opinion.

Dang Gui Shao Yao San is one I often use for Damp, Blood deficient patients with stasis post splenectomy for HSA, along with a XCHT-based formula to address Shao Yang disharmony and the lack of mixing Yin/Yang in these patients with aggressive cancer. XCHT also contains a number of herbs which have biomedical rationale in the sense that they have demonstrated the potential to block tumor progression pathways recognized in canine HSA. To this, we have been adding Dang Gui (Angelica sinensis Root). This is a Blood tonic and will additionally help with blood deficiency along with having VEGF-inhibiting potential (anti-angiogenic). I'd probably add around 10-15g/100g base if you are using along with DGSYS which also contains Dang Gui. I've heard some people have had trouble with this being too moistening and causing diarrhea, but I haven't personally seen this problem. (The high dose Coreolus, though, I have seen cause diarrhea.) Steve also adds a robust amount of San Qi (as he doesn't usually also use Yunnan Pai Yao - unless this has changed recently). I usually also use Yunnan Pai Yao 2 caps BID for a dog this size.

For dogs with deeper pulses that may be weak, I usually opt for Chai Hu Jia Long Gu Mu Li Tang as the base formula (based on Steve's recommendations with the rationale of mobilizing Yang - and I agree that I've had some very deficient looking patients with deep weak pulses that do well on this formula), over Xiao Chai Hu Tang (which I use as a base in patients without heat signs who have more overtly wiry pulses).

I don't use a lot of tablet formulas because, in my hands, my patients tend to not do as well when I'm not robustly dosing and the Natural Path granular are relatively more potent...so maybe someone else could comment on dosing for you. I'd be concerned you may need to increase that, and would probably double your dose. For the granular formula I would usually use 3/4 tsp BID of each formula for a dog this size.

I typically also test vitamin D levels (I use the VDI test kit) and dose to achieve 100-120ng/mL. Rationale: In a 2016 veterinary study, low serum vitamin D3 levels were shown to be associated with an increased risk of developing splenic hemangiosarcoma in canine patients. The optimal serum vitamin D3 level was determined to be 100 -120 ng/mL based on iPTH and c-CRP variations plateauing at this level.
Reference: Selting KA, Sharp CR, Ringold R, et al. Serum 25-hydroxyvitamin D concentrations in dogs - correlation with health and cancer risk. Vet Comp Oncol. 2016 Sep;14(3):295-305.

Erin
by naturevet
March 30, 2019
Hi Cathy,

I agree that a Shao Yang harmonizing formula is probably indicated here. Shao Yang disharmonies correlate with tendencies to Spleen deficiency and its sequelae; the build up of Heat in the Yang Ming that could cause hematemesis; the late summer allergies; and the splenomegaly.

As to which one to use, I think all my HSA cases have eventually had to move to Chai Hu Jia Long Gu Mu Li Tang, so you could start there. You can continue the DGSYS, YBY, and Coriolus. It's not the protocol we are using for the clinic trial, but it is close

Hopefully this helps you out. Please let us know how this case goes

Steve
by Dreudog
April 1, 2019
Steve and Erin,

I'm feeling that the DGSYS will address his blood deficient state. Not used to seeing that in Goldens, but his pale tongue, thinnish pulse and tendency to be a bit nervous under stress make me feel that he is blood def, but also damp (fatty lumps, drooling recently , snoring). I'm biased, as my longest- lived HSA case (1.5 yrs) was on DGSYS only. I see the need for a shao yang formula, esp. having been dx this time of year and for the Yang ming evidence.

Would I need to add Dang gui to the CHJLGMLT, if I kept him on the DGSYS SID? Shouldn't need to San ji since he is on Yunnan bai yao, right?

This dog looks pretty strong for his age and post- op, but his tongue and pulse were definitely deficient.

Erin mentions the VDI VIt D level test - I usually do run those on cancer cases (and older Goldens!). Erin, I'm curious if you've used their In Case or Cancel panel w/ any success to predict a tumor, catch it earlier.


Thnx,


Cathy L
by naturevet
April 2, 2019
Hi Cathy,

You can see if the Dang Gui in DGSYS is enough. The concentration is fairly low, which is why it is so well tolerated even in Damp dogs. I guess start there and see what happens to the Blood deficiency traits

Steve
by bannink
April 5, 2019
Hi Cathy,

We are evaluating the VDI Cancer Panel as part of the HSA clinical trial. So far we don't have enough data for me to comment objectively. This will be something we will be reporting, however.

Erin
by Dreudog
April 5, 2019
OK, thanks for your input. I know that some researchers are feeling that low Vit D levels are associated w/ some cancers. The other markers are interesting (CRP, TK1, etc.). Is there any similar testing being done in humans?


:)Cathy
by Dreudog
April 29, 2019
This dog's tongue and pulse are not improving much. Initially, owner had been giving lower herbs doses, so we lost some time to catching up on dose and a 2nd recheck.

She elected to start chemo (Lomusitne) w/ a boarded oncologist also. As Ben was getting a proper herb dose about the time he started chemo, I can't say whether chemo is affecting his tongue and pulse. He has been somewhat reluctant to eat since the start of chemo.

So on 4/23 exam, his PE was basically the same as first exam, with T: sl. pale (maybe a little more pink), lavendar center, some moisture but not excessive. P: Deeper, thinnish esp. left, toned, normal rate.

He was playful and seeking attention in the room.

So I'm wondering about herb changes. Add LJZT? Nauseous on (cold) chemo and historically on Cephalexin.

I'm worried about him, even tho' by Western standards he looks great!


Thanks,


Cathy
by naturevet
April 30, 2019
Hi Cathy,

I'm not sure what he wound up taking, but for sure you can add Liu Jun Zi Tang in there to counter any tendencies to cachexia. It does seem to potentiate some chemo in my clinical experience, which may lead to better outcomes

Steve
by Dreudog
May 1, 2019
Sorry- he is on CHJLGMLT 1.0 tsp. BID + DGSYS 4 BID + Yunnan Bai Yao 2 BID (plus the suppl. and diet listed initially). I'll do a case update also.

Maybe it's reasonable to start the LJZT and then just recheck T: and P: in a couple weeks?


Thnx,


Cathy
by naturevet
May 1, 2019
Sounds good

S
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