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Parathryoid Tumor In G. Ret

by Michelle1 - May 3, 2009

Hi Steve,
Am seeing a 13 y.o. G. ret with elevated Ca+ for ovwer a year,and a PTH that supports neoplasia. He is weak in hte rear limbs and now losing his "voice" as well. What would you do for this dog if he were at your clinic? Er Chin tang was one I considered for hte stasis in the TB, but would suregry be a better option for this guy?
Thanks!
Michelle

by naturevet

May 4, 2009

Hi Michelle,

Another challenging case I see. Pretty soon we'll be looking to you for all the answers on the tough patients.

I have one recent case of hypercalcemia due to possible malignancy that has normalized on Xiao Chai Hu Tang. I've had another case that did not. So, maybe a 50:50 chance of success? Since Xiao Chai Hu Tang is a potent anti-cancer formula, that would be another reason to favor it over Er Chen Tang. I'd try that first. You can use the two together, if in doubt, given that Er Chen Tang is an anti-phlegm herb, and given that the main obstruction to the Triple Burner is Phlegm.

Please let us all know how it goes. Also feel free to update your other cases. You can just search for your own posts and reply to them with your updates if you like.

All the best!

Steve

by Michelle1

May 6, 2009

Thanks Steve,

The owner is really uncomfortable with the idea that there would be any cancer mass in her dog as she has lost several Goldens to neoplasia. She has decided to go ahead and have the gland removed- would XCHT be recommended afterwards as help for preventing this pattern from getting worse?
Take care,
Michelle

by bannink

May 8, 2009

Hi Michelle,

I will let Steve comment on your specific question but thought it might be helpful to chime in about the concern for malignancy in this patient as this might help steer your treatment choices and maybe alleviate some worries on the part of the owner until we get the biopsy back. (My specialty is oncology so I can't resist these cases!) Also, does this patient have any evidence of renal damage? A year is a long time and I would be worried about the possibility of nephrocalcinosis, unless the calcium has been only mildly elevated.

90% of dogs have a solitary parathyroid mass and only 5% of them are malignant. Most dogs get parathyroid hyperplasia or adenomas and metastasis has not been reported. Although a biopsy is always needed to be sure. After surgical removal, there is only a 10% rate of recurrence of clinical signs in patients with uncomplicated hyperparathyroidism. The biggest thing from a conventional standpoint will be managing any renal disease (which may not reverse after surgery) and any postoperative reflex hypocalcemia (the risk of that is relatively low in patients with pre-op calcium levels below 14mg/dl.)

Addressing the underlying cause from a TCM standpoint post-operatively would still be indicated in my opinion, as it could obviously lead to other imbalances or potentially malignancy as this dogs is already forming nodules (although likely benign at this time). I would usually check tongue, pulse and active point status in determining which formula to use post-op.

Steve?

Erin

by naturevet

May 8, 2009

Hi Michelle,

Why not have a look at the dog post-op and see if it still fits the picture for Xiao Chai Hu Tang? Surgical removal of a lesion can have a major impact on TCM diagnosis. Essentially, it's 'pruning branches to expose the root', which means that when you see the dog next, you'll have a better idea of where exactly the tumor came from in TCM terms.

It's nice to have Erin weigh in on your case. She's a board-certified oncologist and an excellent resource. Thanks, Erin, for your input. I take it, Michelle, you've already evaluated for renal issues? If the 'root' diagnosis involves use of a treatment that protects or reverses renal damage, then hopefully hypercalcemic nephrosis won't be a liability for the dog in the future. I guess that was Erin's point - worry more about protecting the kidneys than protecting against the recurrence of this tumor. We'll see what you think post-op in the way of a TCM diagnosis, and what formula might treat that while protecting the kidneys.

All the best going forward!

Steve

by Michelle1

May 22, 2009

hi Steve and Erin,

There were two benign masses on histopath and his serum calcium is still elevated a week post-op. His renal function has been fine except for the dilute urine. he was also very weak in his rear limbs adn his bark was weak as well- post-op seemed to be much strong legs and voice, but then yesterday, weak again, though not as much deficiency. These seem like eenrgetic signs of renal weakness- have not seen him for tongue adn pulse yet post-op. thoughts about the pesistant hypercalcemia (iCa= 1.41) and the weak rear limbs?

Thanks for your help!
Michelle

by naturevet

May 22, 2009

Hi Michelle,

I'm still thinking of XCHT here. Is the dog already on it? If it's been on it a few weeks and no response, then it's fine to try Rehmannia Eight. Again, though, we've had good luck in hypercalcemia with XCHT.

Steve

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