I've got a suspect lymphoma case on my hands which appears to have ocular involvement. Loki is an 8 years old 24# NM mixed breed with severe lymphadenopathy - all lymph nodes are extremely enlarged. The SM and pre-scap LN are a bit bigger than a golf ball. The poplitea LN are the size of a big grape and he developed a limp this morning which I think is due to increased axillary lymph node size on the right side.
The owners do not want to pursue chemotherapy and wish to treat this with a holistic approach only, which is putting a lot of pressure on me considering how advanced I think it is...
Traditional Chinese exam:
Pulse: Thin, very fast, floating (feels a little eratic?)
Tongue: Red/lavender, wet
Body temperature: hot
Decreased appetite in the morning
Cool seeking, pants, lays in front of a fan all the time at home
Suspect lymphoma w/ ocular involvement ddx cannot rule out leukemia
Weight loss, muscle atrophy temporal muscles
Uveitis, Glaucoma, hyphema in R eye.
Dry coat, hair thinning on dorsum
Not exactly sure how lymphoma translates as far a TCVM specific diagnosis goes, but so far I have this:
Significant Qi Def
Wei Qi Deficiency
Spleen Qi Deficiency
Blood Stasis & blood def ?
Yin Deficiency/ Excess Heat
BW on this patient reveals very elevated lymphocytes, with bands present. RBC WNL and platelets WNL. Although this BW is from 05.2023 so quite dated.
The cytology report from lymph node FNA said : These findings of a persistent marked lymphocytosis are consistent with lymphoproliferative disease (either lymphocytic leukemia or an intermediate size lymphoma with circulating neoplastic cells).
O did not pursue further work up.
I started this patient (20#) on
Si Miao San: ½ teaspoon BID and Hoxsey-like formula (tincture): ½ mL BID
We also started 5 mg pred BID because the patient had a couple episodes where he seemed to gasp for air while resting.
Wondering what to add for the ocular involvement/dyspnea ? XCHT or Bupleurum, Dragon Bone and Oyster Shell Combination (CHJLGMLT)? I read in other lymphoma cases about CHJLGMLT being useful for ocular lymphoma, but since this P is already on 2 herbals, if we could add one more formula which do you think would help best?
Many thanks in advance !