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Hemaniosarcoma/Lymphoma

by todd - December 7, 2009

Dear Steve and Erin and anyone else,
Am seeing a most interesting patient with something that happened during the treatment/evaluation that I would like to run by you. Dog has Hsa of Spleen and Heart--were found when pericardial sac filled with blood.Blood was drained . Also has enlarged Pop' and Periscap' Lymph nodes that cytologically showed Lymphoma, "not too advanced". On Hx and exam the dog had a mix of Dampness and Blood Def. with the Blood def. somewhat more prominent. The Pulses were very weak,;very thin and deep. BYHWT came to mind,but when I was palpating around radiant points in the B15,16,17 area trying to find what point was hottest and which point it was, I placed a needle guide tube on B16 and reached for the Pulse only to find it had tremendously dilated and seemed a normal strength. I went ahead and put the needle in at B16 and Pulse did not alter. B20 made a bit more improvement in the Pulse.
I re-counted from B11 caudally , and needle was at B16 position. I do wonder, though , if B17 palpation,or B15 played a part, or if dogs' points may be not so reliably at the assigned position. I guess I will see on next exam perhaps.
I put dog on DGSYS,XCHT 1/4 dose,Bilberry, and dog was already on DGBXT that was dispensed 2 days before I could see him. I've noticed from the FORUM that you may be developing some preference for BYHWT ,perhaps???, with Hsa.
Any thoughts/insights? I was thinking of going to XFZYT if there is Liver Blood involvement(dog has mild sep'anxiety and Dreams 20-30 min. nightly, B17 ???) and the bleeding coming from the Heart...if I do find B17 active would you advise such a thing or has it been your experience otherwise. I've gotta keep in mind the Dampness element with lymphoma, too, I presume? Last question: Have you ever cranked up the dosage on any of the supplements,e.g. Bilberry(what is there to lose?).

by naturevet

December 7, 2009

Hi Todd,

BL 16, like its neighbors, can have a big impact on improving peripheral blood flow and reducing chest stasis in the process. So it would push me towards considering XFZYT, if your response to current treatment wasn't satisfactory. I think you're fine, though, to see what happens, as your treatment protocol is already roughly on the track of tonifying and moving Blood and encouraging peripheral circulation.

No problem really using lots of bilberry. The worst that can happen is the dog develops spectacular vision.

As for lymphoma, I do look at it as a Damp/Phlegm problem, but not in a very wet sense. So XFZYT would not be inappropriate to use.

Interesting that it has two tumors! My own belief is that the Nan Jing addressed tumor development rather cryptically many centuries ago when it was published. It looked at Blood stasis tumors as a tendency for Yang not integrate with Yin, and I believe it looked at lymphoma as Yin failing to integrate with Yang. So you could see how the two conditions could co-exist, although it's still a little startling to see both disorders in the same patient from a western perspective.

Good luck!

Steve

by bannink

December 8, 2009

Hi Todd,

I am intrigued by the lymphoma "not too advanced" diagnosis. I wonder what that means. It either is lymphoma or it isn't. Are these maybe reactive nodes? Diagnosis of low grade lymphoma requires a biopsy. So it is possible maybe we don't actually have lymphoma? Are the nodes getting bigger?

I'd focus on the hemangiosarcoma as you are doing and consider another FNA of the lymph nodes if the owners are up for that given the bicavitary HSA. If this is truly LSA, it could take him before the HSA does, provided we can control the HSA bleeding tendencies.

I would certainly always consider XFZYT with added E Zhu and San Leng for the upper burner affinity with pericardial bleeding. However, Bu Yang Huan Wu Tang also has upper burner affinity as well with all four of the main herbs in XFZYT that address blood stagnation in the chest (Chi Shao, Tao Ren, Hong Hua, and Chuan Xiong). I normally think of BYHWT in patients with more of a weak pulse and XFZYT with more of a wiry or taut pulse. With E zhu and San Leng added to the XFZTY you can address more of the abdominal mass location as well....I wonder if you could add E Zhu and San Leng to the BYHWT? I have not done that yet. Steve, can you comment?

I have used fairly high doses of Bilberry with no problem. With the atrial HSA and pericardial effusion this dog is begging for some Yunnan Pai Yao, which might be your biggest life saver by helping prevent pericardial bleeding and cardiac tamponade. I believe Steve's preference for BYHWT over DGSYS for HSA at least partially also stems from the inclusion of Huang Qi (Astragalus) which has hemostatic properties (tonifies Spleen Qi which keeps blood in vessels). You have that covered with the Dang Gui Bu Xue Tang.

Hope that helps a little.

Erin

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