Question Details
Chronic Lymphocytic Leukemia In A Dog
by Pamela Page - July 31, 2017    View Case Report
Looking for treatment suggestions for Sophie, a 12-year-old Beagle mix who was incidentally diagnosed with presumed CLL when in for a meibomian gland growth removal. Lymphocytes increased from 9000 to 19,000 in about a month. Initially she had mild anemia and mild lethargy, both have resolved, and she does not have any real symptoms at this time. Does have moderate hip dysplasia radiographically, but not currently symptomatic. She tested negative for tick-borne diseases, and was treated with a 30-day course of Doxycycline. Does not like cold, is friendly, can be fearful/nervous. Tongue is pink, wet. Pulse rapid and slippery. Appreciate any suggestions. Current diet is Wysong dry, Also, fish oil, Arthrisoothe,and CAS options, (a non-specific cancer supplement with mushrooms.) Thanks for your ideas/experience with this condition..
Pam
Replies
by naturevet
August 3, 2017
Hi Pam,

Given the rapid slipper pulses, I'd be tempted to try Hoxsey-Like Combination, Si Miao San or both. Both of these formulas are Damp Heat formulas (signified by the pulse and wet tongue), as well as the time of year this all came about (assuming it's about now). Both formulas are also rich in berberine, which has an inhibitory effect on lymphocyte proliferation. It's the first thing I'd try.

This is a frequent problem, so let us know how things go!


Steve
by bannink
August 4, 2017
Pam,

Also, Cang Zhu (Black Atractylodes), which is in the Si Miao San Steve recommends, has shown activity in T-cell lymphomas/leukemias through its content of Atractylenolide-1.

I've, personally, had the most consistent luck with a modified version of Xiao Chai Hu Tang (add 10-15g Trichosanthes/Tian Hua Fen, 10-15g Coptis/Huang Lian and also 10-15g Indigo/Qing Das - if you can find it). Coptis clears toxic heat and drains Damp. Trichosanthes clears heat and transforms phlegm. So can support the dynamic you are seeing here as well as complement the SMS activity. The formula itself is heavy in Berberine, as Steve also mentioned to be important in LSA. Xiao Chai Hu Tang contains Bupleurum/Chai Hu, Ginseng/Ren Shen, Scutellaria/Hiang Qin and Licoric/Gan Can, which have all individually shown some activity against various lymphoid malignancies. Trichosanthes has shown activity against B and T cell malignancies. Indigo has activity against B cell malignancies. So if you've happened to phenotype the patient you can tweak the herbs to fit both the TCM and biomedicine diagnosis. With the mild presentation you are seeing now, you may have great luck with the formulas Steve has already recommended. But you can keep this idea in your back pocket if you are not seeing improvement with the SMS and Hoxsey. I typically use the modified XCHT in combination with other pattern appropriate formulas for the patient.

Yun Zhi or Coreolus mushroom also has shown anti-proliferative effects in B-cell lymphoma (an extract suppressed proliferation by more than 90%). PSKs from this mushroom also showed activity in other leukemia cell lines. So I usually add a Coreolus Mushroom supplement into the management protocol. (Not sure of the ideal dosing).

With the low lymphocyte count at this time, hopefully you can keep things stable or improved for a meaningful period of time. In CLL especially, I tend to see a slow steady action with the herbs, which can take a few months (3-4) to see the full effect. As long as you are not seeing worsening of the numbers or clinical signs, I'd stick with the protocol you choose. Many of these dogs can remain stable, with no treatment at all, for many months to sometimes even years. These are the patients for whom herbal therapies are especially interesting to me. Monthly CBC monitoring would be prudent, at least until you get a good feel of how this patient will respond.

Keep us posted.

Erin
by Pamela Page
October 24, 2017
Hi, I am sorry I did not see Erin's response until just now. Sophie's update is that we started Si Miao San herbs as the owner was nervous about Hoxsey Formula. After a month, her lymphocyte counts had jumped to 35K, up from 19K 2 months earlier. Neutrophils, monocytes and basophils were also moderately elevated. Otherwise, she was acting fine. I dispensed Hoxsey formula to use in addition to the Si Miao San. At her last visit, the owner informed me that she only gave 2 doses of the Hoxsey and then stopped because she read that the poke root in it was contraindicated for this cancer because it stimulates lymphocytes. Does anyone have any thoughts about this? She also decided to proceed with chemotherapy and the dog is now receiving prednisone and chloambucil. Would it still be advised to use herbs along with this chemotherapy? Also, any thoughts on vitamin supplementation? Tongue is now reddish and swollen, Pulses are choppy, slightly forceful and deep. Sophie is still feeling and acting well. Thanks a lot for any input. Where do you source the coreolus mushroom supplement?
Pam
by naturevet
October 30, 2017
Hi Pam,

At this point, given the pulses, it looks like you're dealing with a Blood stasis condition, if things are truly choppy. If there is no internal organomegaly, try Qing Ying Tang, which has Coptis in it to combat leukemia, as well as cooling herbs and Blood movers

Going forward, Hoxsey is fine in leukemia, despite the Poke root content, just as it is in lymphoma. It's believed the plant will combat leukemia, despite it's natural ability to boost normal lymphocyte populations

Steve
by Dr. Krisi Erwin
March 1, 2021
Hello everyone! I know this is an old thread but wanted to post a question about a current case I am treating similarly to this patient. If that's not ok, please let me know and I will make a new thread for it. Recce is a 9.5 yo M intact Chesapeake Bay Retriever who was diagnosed with T cell Chronic Lymphocytic Leukemia 12/19. I have him on a home made diet with additional Liposomal Vitamin C and fish oil added. He is on herbs and is currently taking:

Hoxsey-Like formula (100mL) 1.5mL PO BID. (peak dose can be 2mL PO BID if needed).
Si Miao San (100g) powder: 1 tsp PO BID
Xiao Chai Hu Tang 100g + Tian Hua Fen 15g + Huang Lian 15g (130g x 2 bottles) 2 tsp PO BID

I started with the XCHT- WBC returned to normal. Then came up again- added SMS. Came back to normal then went up again a few months alter. Added Hoxsey. Last exam was in January and he looks really great to me. The only issue the owner can see is slightly sparse hair coat around his ventral neck (what prompted her to have him checked to begin with) and difficulty maintaining his weight. Calorically his intake is good and his appetite is very good. I made these notes on the most recent exam:

TCVM: Tongue: Pinker red with some lavender, moist
Pulse: strong but soft, not compressible but does get narrow with deeper palpation. Does seem toned but maybe that the blood doesn’t fill the whole pulse.

I am reaching out to see how I might modify things as his most recent CBC in 2/16/21 had a WBC of 40,000 (18800 neuts, 19600 lymphs) and he also had 2 small melanomas completely excised from his mouth in December. The immunihistochemistry for Ki67 showed low nuclear atypia. The oncologist doesn't feel any of the diet or herbs/vitamins are making a difference and said to the owner that they should just expect this far in that the WBC and lymphocyte count will start to vary more widely. She still doesn't recommend any chemo for him. I feel for being more than a year in he looks great but that's just me. I'm also glad he hasn't needed chemo yet but not sure how long dogs typically go without needing it.

I see the notes in the case above about using Qing Ying Tang but is that in place of something? I would appreciate any insight anyone can offer!

Sincerely,
Krisi
by naturevet
March 4, 2021
Hi Krisi,

I'm not sure whether that WBC count of 40K represents an increase or stability. If stability, then I would not take anything away, but consider adding something, as you suggested. The reddening of the ventral neck represents Heat in the Yang Ming. Given that you have lots of Cold bitter herbs on board, that must represent Yin deficiency. All three formulas have a drying effect over time, suggesting Yin deficiency is quite possible.

My favourite formula for restoring Yin in the Yang Ming is Yi Guan Jian. There's nothing in there I would anticipate to raise the lymphocyte count, so I would give it a try, and then check again in a month or so.

The oncologist's comments are not unanticipated. At least s/he has the same reservations about what s/he has to offer that this point!

Steve
by Dr. Krisi Erwin
March 5, 2021
Hello! Thank you so much! So, 40K is an increase. I believe I started on the XCHT mix initially- WBC were normal for several months. Then they increased again (and if memory serves I felt he had more heat signs)- added SMS went back to normal for several months. Increased again, added in the Hoxsey. So prior to this 40K number, he would have been normal or just above normal. Oncology says that this far in he will likely have fluctuations and that is to be expected. Still no chemo until 60K or more. I imagine the difficulty maintaining his weight may also be Yin Def? Would the Yi Guan Jian be in addition to what I'm doing then? I will say the family doctor has been floored how the WBC goes down into normal and stays there for a while with the herbs. I think he expected them to stay high and just gradually increase and need chemo. This is an A+ client so she'll gladly add in anything recommended to see how it helps! I know he may need chemo eventually but it's great to stave it off as long as possible. Also, I'm not acupucnturing him at all right now- largely in part b/c of plague- o prefers to just bring him in for periodic check ups as opposed to a more regular acupuncture schedule but she would probably be amenable if that would be an indicated next step!

Sincerely,
Krisi
by naturevet
March 8, 2021
Hi there,

If he has trouble holding his weight, then let's definitely try Yi Guan Jian. In order not to pull the rug out from under him, let's use it in addition to what you're doing for now

Steve
by Dr. Krisi Erwin
March 23, 2021
Thank you!! I'll report back!!

Krisi
by Dr. Krisi Erwin
June 28, 2021
Hello again! I think this will need to become a new case or question but wanted to share here as I wasn't sure how to move the old information over? Recce continues to do very well clinically. His weight is still a bit lower than his typical but holding pretty steady since January (92lbs in Jan, 91.5lbs in June). His hair has grown back since starting the Yi Guan Jian. His physical examination was otherwise very good. He has some tightness in the muscles around the hips and reluctant hip extension bilaterally.
Tongue: Reddish lavender (not brick red), moist
Pulse: soft in general but stronger on the right than the left. Left is easily compressed. On left it felt like I could feel the blood fill and run under my fingers. Right side seems more consistent throughout the pulse and more normal on width/strength.

His labs are as follows:
2/21: WBC 40K with 18,800 Neuts and 19,600 lymphocytes
6/21: WBC 46.7K with lymphocytes 35,492. No marked change on pathologist review re: the nature of the lymphocytes.

The only other clinical change is that he started with diarrhea when boarding at a kennel where he has stayed in the past. Since then, he has had increased urge for BM and intermittent loose stools. In my notes, this has been going on for about 6 months. I do need to verify with her if that correlates to starting the Yi Guan Jian. I also didn't make a note if a fecal had been checked after boarding at the kennel in case this is a more logical issue like giardiasis or something?

He is on a ton of supplements, here is the list:

Twice a day
About 12oz double strength organic green tea
1.5 ml Hoxey Like Formula
1 Tablespoons Grapeseed or Corn Oil (alternating weekly)
4 scoops Dr Harvey’s Paradigm (feeding instructs attached)
2 tsp Xiao Chai Hu Tang
1 tsp Si Miao San
2 pills Yi Guan Jian BID
1 tsp Animal Mushroom Blend
¼ tsp Nature’s Farmacy Super C
2 tsp Nature’s Farmacy Complete
1 Tbsp Nature’s Farmacy Gain and Shine (just to add calories, I’m out of this now and won’t reorder until we speak)
8 oz of meat
Once a day
2 Omega 3 Pet Soft Gels
1 Zesty Paws Turmeric Curcumin Bites
½ teasp Caniotic Probiotic a couple of times a week – Switching to Proviable daily

I still hold that to see him, he doesn't appear sick. He is energetic, active and happy. Keeps up with the puppy in their house. Still doing a lot of field work. I wasn't sure if you had any other suggestions on the herbs for him? Please let me know if you need any additional information!

Sincerely,
Krisi
by naturevet
July 1, 2021
Hi Krisi,

You could try pulling back on the YGJ and seeing if the stool improves. If so, then he is getting a bit Damp from it.

One option if that is the case is to use Zhi Bai Di Huang Wan instead, to continue supporting Yin while you clear Heat.

Another idea is to use Qing Ying Tang. It has Huang Lian in it, which has been shown effective against leukemia in laboratory studies, and likewise cools while protecting Yin and drying Damp. I guess I would be inclined to try this instead of the YGJ and see what happens

Congratulations on your success thus far, at the very least in keeping the dog relatively stable. It's better than just waiting until he's finally sick enough to justify chemo - in my book, anyway. Keep up the good work!

Steve
by Dr. Krisi Erwin
July 1, 2021
Thanks, Dr. Marsden! I will switch him to the Qing Ying Tang when he is due for his next refill of the Yi Guan Jian and see how it goes. It's hard to know if he would look worse if we weren't doing anything but boy he does look really good. I'll report back in a bit so others can learn from him to. Thanks again!

Krisi
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