Question Details
Multiple Myeloma Case
by Pamela77 - September 30, 2009
Case consult

Kevin Masui
11 year old aussie neutered male

Originally seen 7/07 for chronic diarrhea and elevated protein/creatinine ratio
Ultrasound showed glomerulonephropathy

Diagnosed clostridium, treated for it with Clavamox, tested negative, and the protein creatinine ratio became normal

He continued to have a sensitive gi tract and was on a homemade limited ingredient diet of mostly pork and sweet potatoe.

Tongue was pink with a slippery phlegmy coat, and pulses were full.

Treated with si maio san, still soft stool, resolved on Tylan.

Added shen ling bai zu san as well .

12/07 Episode of severe coughing, see by Emerg clinic, treated with AB’s, took 3 weeks to resolve. NOTE Stool was very good (very firm) on AB’s., so it seemed like the colitis was more DH, so I stopped shen ling and started Bai tu wen dan briefly, but the owner stopped it thinking the stool got softer.

6/08 – still in sms and Tylan, added ah zhen sang – less gas and gi gurgling

12/08 – coughed up a bit of mucus and blood one time
Complete lab done all normal
Slight weight loss
1/09 watery stool – tried Flagy
2/09 water stool agastache
3/09 Exercise intolerance – complete lab work up showed albumen 2.5%, globulin 5.2%, otherwise normal
chest rads – broncho pneumonia and some bullae
Rx – Baytril 3 weeks
4/09 Improved but not as much as expected, tongue slightly pale and lavender, pulse slightly thin and wiry
4/09 – saw an internist who took off ab’s, rechecked rads 3 weeks later, residual pneumonia and multi thin walled bullae, started doxy

6/09 Improved some on doxy, less cough but still very exercise intolerant, panting a lot, unable to walk far – Pulse strong yet thin yet wiry, tongue pale and lavender with a little phlegm
RX – xue fu zhu yu tang starting at ¼ t BID ( to move stagnant blood) and su zi jiang qi tan 1/8 t BID ( to direct qi down, dispel cold phlegm and stop cough)

6/09 Improved, breathing easier, less cough, still can’t walk far
Radiology consult concern that pneumonia not full cleared, concern FB (foxtail?)

Trial Baytril, Clav and doxy, continue herbs

7/09 Rads – pneumonia improving AND likely discospondylitis (migrating foxtail?) – cont abs and herbs , AP

7/09 Improving, energy better, cough less, still panting, stool perfect, pulse slightly weak and small, tongue sl pale

8/09 tongue slightly red

8/09 coughed many times, some with blood, panting constantly – to UCD for CT scan

After repeat lab work, chest and abd US, CT scan – suspect mulitiple myloma.
Anesthetized, did bronchial lavage, aspirated mass in lungs – carcinoma or adenocarcinoma - slow growing
CT showed multifocal aggressive lytic lesions in left scapula and several in thoracic and lumbar veterbra.\
We did ua and found Bence Jones protein in urine, lab showed monoclonal gammopathy in blood.

The oncologist started him on melphalan 2 mg SID, prednisone 10 mg SID, Clavamox62.5 mg BID, Baytril 136 mg SID, Tramadol 50 mg TID

He feels better, less panting,
If you didn’t know he was so sick you would not believe it when you walk into the room – bright eyes, happy, hungry. But he has looked this way all along, except when the breathing was really distressed.
Pulse is small, then full, not compressible, not wiry
Tongue is slightly pale, slightly lavender

Now, what herbs can we use to support this process? To help quality of life, fight the myeloma, relieve pain, tonify the immune system, slow down the growth of the lung cancer?

Replies
by naturevet
October 2, 2009
We've certainly had some good luck with Xue Fu Zhu Yu Tang, even in dogs who did not receive chemo. I'd continue that. SZJQT can work at cross purposes with XFZYT by directing blood into the lungs, while XFZYT is directing it out.

To increase anti-cancer effects further, have San Leng and E Zhu added to the formula. Dr. Boudreaux can do that, or K'an makes a liquid form.

Once we see hemoptysis and tongue redness, formulas that address Lung Yin deficiency, Blood stasis and Empty fire can be helpful. There are several - Bu Fei E Jiao Tang, Bai He Gu Jing Tang, Shun Jing Tang, and others. You can read up on them to see if any match the dog currently. Or you can just persevere with the XFZYT plus SL and EZ, without the SZJQT.

Good luck, either way. You probably have a good chance of achieving some decent longevity.

Steve
by Pamela77
October 4, 2009
Thank you for your help. I had thought about xfzyt but I was afraid that it would not be enough since he had already been on it at 1/2 tsp. BID since 6/9/09 and yet all these symptoms progressed and worsenend. Granted it did not have SL and EZ added. I will stop the SZJQT and add the 2 herbs and see. I just would have hoped that it would have made more difference already.

for the other herb I had looked at bai fei E Jiao tang but it is so yin I was concerned that it might cause loose stool, sinces almost anything in Kevin seemed to cause loose stool except antibioitics. He seemd so deficient yet with damp heat clearing antibiotics his stool improved. It was hard to understand.

The bu fei E Jiao Tang looks interesting - I have never used it...Any specifics on choosing that one? I can't find shun jing tang in my herbs books - does it go by any other name? I will see Kevin tomorrow and check tongue and pulse and points.

Again, thank you so much for your help with dear little Kevin.
by naturevet
October 6, 2009
Hi Pamela,

All of those new formulas I cited are Yin tonics, so if the animal has Damp signs, they may not go down to well. If you have Dagmar Ehling's Chinese Herbalist Handbook, you'll find them all in there.


If the dog is worse on XFZYT, then it may have the wrong hemodynamic, in which case you'd switch it out for SZJQT instead. You just need to know which way to play the circulation. Overall, the case struck me as a pretty classic presentation of XFZYT (pulse, tongue, prior response of cough to formula, worsening on drying formulas like Bai Tou Wen Tang).

Good luck and stay in touch so we can be sure to figure this out!

Steve
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