Question Details
Anal Gland Adenocarcinoma
by CIVTdvm - May 26, 2021
10 yr old M,N German Shepherd dog was diagnosed with Right side anal gland adenocarcinoma (incomplete margins) in Dec 2019. He was monitored with X rays and ultrasounds throughout 2020. He did well until it recurred in Mar 2021. Radiation therapy (4 weeks total, once per week) was done April-May 2021. He just finished radiation therapy May 12, 2021. Radiation decreased the mass size from 5cm--> 1.4cm
(no presence of pulmonary metastasis thankfully)

History - I started seeing him back in Jan 2019 for dermatitis and otitis. I started him on Chu Shi Wei Lin Tang for seasonal allergic dermatitis (and then started having anal gland issues in Oct 2019). It did not seem to work enough so switched him to Si Miao San + Dang Gui (15g) - he has been on this combination from Nov2019 --> May 2021 (I have been on maternity leave this whole time and it was not changed). He had maintenance acupuncture for allergies which owner reports helps a lot; the main points used were: GV -14, 20, ST-36, ST-40 and ashi points mainly on lumbar epaxial muscles; tongue is typically pink--> pale lavender and pulse is typically strong and steady.

Notes from owner:
diet: Big Country raw
He has been about the same energy level wise, though with the heat he is normally a bit more lazy and he does drink more water. I have also noticed for about 2 days after his radiation he does drink more water. No skin flare ups as of yet and no gastrointestinal flare ups, after a radiation treatment it was a bit more soft but that normally went away in about a day or two.

dx:
anal gland adenocarcinoma - blood stasis
otitis - damp heat
shoulder cyst - blood stagnation (surgically excised in 2020)
benign hypoechoic splenic nodules (dx on aspirate) - dampness in upper jiao
dermatitis - damp heat
otitis - damp heat

He started Oncosupport (Rx Vitamins) and homeopathic (Silicea) April 4, 2021

I am consulting on this case as the other vet is out of country (and I am only working remotely right now). I would like to switch him to
Xiao Chai Hu Tang + Curcuma

Xiao Chai Hu Tang is desired for antineoplastic effects but being a Shepherd who has very reactive lumbar acupoints and likely underlying hip dysplasia as well. XCHT will also help Qi flow between upper and lower burner.

Questions:
1. Would you agree starting XCHT + curcuma?
2. What dose of curcuma do you recommend (and what source) - 100mg TID of plain curcumin/tumeric powder?
3. Would you continue SMS too in this case?
4. Would you agree to continue Oncosupport and Silicea?

Thank you so much in advance!

Christiane
Replies
by naturevet
May 29, 2021
Hi there!

It's been my sense that anal gland adenocarcinoma is an upper burner issue (even though it is located in the nether regions). In theory, the Nan Jing said anything on the body periphery is potentially upper burner in nature, since its health is dependent upon excellent circulation, which is a function of the upper burner. As with most mast cell tumors and with breast cancer in women, I see anal gland adenocarcinoma as taking advantage of peripheral under-perfusion, causing the immune system to not detect the tumor cells.

Peripheral perfusion in Chinese medicine is dependent upon having enough Blood and that Blood being in motion. Most Chinese medical trained veterinarians understand that Qi guides the flow of Blood as well as fosters its synthesis. In other words, Qi is the driver of the bus of Blood. Yang, however, is the internal combustion engine of the bus. The chief determinant of how well Yang flows to the surface, pushing Blood before it in the process, is the health of the Shao Yang. Shao Yang disharmony thus potentially underpins many peripheral and cutaneous problems including, in my experience, anal gland adenocarcinoma.

Xiao Chai Hu Tang is the main formula to address Shao Yang disharmony, so I am in full agreement with you wanting to use it in this case. To add in Curcuma, and address the other aspects of poor peripheral perfusion, I would use it in tandem with Xue Fu Zhu Yu Tang. If you use the 'Modified' version of the latter, then you have your Curcuma on board. You can get both formulas - Modified XFZYT and XCHT - pre-made from Natural Path

As for SMS, even with the Dang Gui added, it's effect is probably to drive circulation deep, away from the periphery, potentially aggravating the current situation. I understand its use was for the skin issues. Note, though, that if any skin problems flare up while an animal is getting a raw diet, Damp Heat is not likely to be the cause from a Chinese medical perspective. I talk about this in a series of webinars that you should be able to access via the AHVMA. I presented them at their 2020 fall virtual conference. In those lectures, I talk about how many allergic dogs likely have Shao Yang disharmony, making the above protocol potentially helpful with this patient's skin problems, too.

As to the Oncosupport and Silicea, I don't see them posing any problems

A note for future reference: Xue Fu Zhu Yu Tang has been shown to help sensitize tumors to radiation, making them more responsive. If more radiation treatments are contemplated in the future, prior treatment with Modified Xue Fu Zhu Yu Tang may well ratchet up the response to them.

Hopefully this helps you out. Let us know how it goes!

Steve
by CIVTdvm
May 29, 2021
Thank you so much Steve.
Shao yang disharmony makes sense - likely why the tumor recurred too, since the tumor was present prior to SMS administration.
I have XCHT in stock but the XFZYT will take a week or so for delivery, so can I start with XCHT and then add the second in or should both be started simultaneously?
Also, am I doing full dose of each: 3/4 tsp + 3/4 tsp BID? or different combination?
Other than GI signs, any reasons I should be aware of to discontinue these herbs?
If radiation is repeated, can I use the XCHT too or just the XFZYT - and for future reference, are herbs typically safe with chemo and radiation because my colleague had them discontinue herbs two weeks prior to radiation therapy...
Do you agree with my curcuma dose?
by naturevet
May 29, 2021
Hi again,

I seldom use turmeric/curcuma on its own, but rather in a formula like mXFZYT. No problem to use it on its own, though. What you suggested is fine, but use it in addition to the herbs, not instead of it.

Absolutely, start with just the XCHT while you are waiting for the Modified Xue Fu Zhu Yu Tang. I would use full doses of each, twice daily, to begin with.

I wouldn't expect any backlash from discontinuing the SMS. If there was some GI inflammation it was somehow controlling, XCHT will likely take up that mantle, with its content of Huang Qin.

Go ahead and use both formulas through any future radiation treatments. They will only help, not hinder. I don't discontinue them, because several meta-analyses of clinical trials in humans show absolutely no adverse effects of using Chinese herbs with conventional cancer treatments of any kind. The only effect seen is that the patients have fewer side effects from chemo and radiation; and that outcomes are better, with remission rates higher. I know Erin Bannink finds a middle ground by starting chemo before herbs (so the herbs can't be blamed for new symptoms); and by stopping herbs just one day before conventional treatment, and re-starting them one day after. In my opinion, the research suggests removing herbs for two weeks is more likely to be detrimental, based on those meta-analyses which in total cover 150K patients.

Hope this helps you out!

Steve
by CIVTdvm
June 3, 2021
Hi Steve,
Thank you for your reply. How do I upload a picture to this conversation? The client sent me an excellent photo of her dog's tongue; if I were to describe it, it is thin at the distal third but very wide and flopping over the teeth edges; there appears to be a central notch at the hip (HT deficiency?); overall it is a pale - lavender colour with slightly scalloped edges and longitudinal crevices midline; overall tongue is quite moist
interpretation; Qi deficiency/BL stagnation (pale/lavender) with dampness (moist/wet), swollen at the LIVER/GB edges but then thins out distally; central crevices in region of SP/ST indicating deficiencies in these organ systems; distal notch - HT deficiency

Client is starting on XCHT and then next week (when it's delivered) XFZYT - are these okay to mix in the same meals or should they be given separately for better absorption?

I just discovered that the client has her dog on several supplements from Feed-Sentiels. I am assuming Rocky's been on these the entire time as he was initially when I was seeing him in clinics and I recommended discontinuing while on the herbs but I guess this never happened.

Overall they appear safe. To me, it just seems like a LOT and some crossover with the Chinese herbals (tumeric, etc) and I feel that these supplements may counteract the balance of the Chinese herbal formulas. I am concerned about the interaction of the following: dandelion root, burdock, root, ginger, marshmallow, slippery elm, cinnamon, stinging nettle, garlic, tumeric and cayenne.

Are these okay to give concurrently or should I have the client discontinue these while on the new herbs?

Thanks in advance - see ingredient lists below:

Carob powder, ground sunflower seed, dried parsley leaf, kelp flakes, alfalfa greens, ground almond, hulled oil rich hemp seeds, hemp seed flour, dried red and green pepper, dry celery leaf, dried blueberry, dried cranberry, dry dandelion leaf, ground pumpkin seed, powdered carrot, stinging nettle, barley grass powder, dried mint leaf, powdered rose hip, paprika, burdock root powder, garlic powder, sesame seed, digestive enzyme blend (protease, lipase, cellulase, amylase), glucosamine, MSM, dill weed, coriander, anise, fennel, goat milk whey powder, powdered marshmallow root, blue Hawaii spirulina, rosemary, oregano, ginger, cumin, marjoram, thyme, savory, basil, sage, cayenne, powdered yucca, turmeric, fenugreek, bilberry, vegetal silica

Organic Red Raspberry powder, Apple fibre, Organic coconut flour, Apple pectin, Sweet Red Beet powder, Burdock Powder, Wheat grass powder, Meeker red raspberry seed flour, 16-strain digestive enzyme blend, 14-strain probiotic blend, Goat protein powder (with naturally occurring probiotics), Goat whey powder (electrolytes, minerals, and digestive enzymes), Bee pollen powder, Acerola powder, Rosehip powder, Cranberry powder, Carrot powder, MSM, Marshmallow Root powder, Slippery Elm powder, Cinnamon Powder, Amla powder (Indian gooseberry), Bromelain powder, Papain powder

Split cell chlorella, Hawaiian spirulina, wheatgrass, barley grass, nettle leaf powder, oat grass, alfalfa powder, dandelion leaf powder, rosehip powder, turmeric, hemp flour, bee pollen, burdock root powder, dulse, shave grass, milk thistle seed powder, noni fruit powder, ginger root powder, reishi mushroom powder, matcha-green tea leaf powder

Camelina oil (certified organic, cold pressed), African red palm oil, Unrefined Rice Bran Oil
by naturevet
June 4, 2021
Hi Christiane,

I think those supplements are okay. The more ingredients there are, the less impact any one ingredient has. Particularly if these supplements are not concentrated extracts, they will not interfere with the Chinese herbs.

No problem to use XCHT and XFZYT together. I do that all the time.

As for uploading an image, you would be able to do that if you had independently started a case report (using the Cases link, above). If you get around to that, I will link this discussion with your case report, so you can switch back and forth between them.

Good luck!

Steve
by CIVTdvm
June 4, 2021
Great, thank you so much Steve!
by CIVTdvm
June 4, 2021
Great, thank you so much Steve!
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