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Polycythemia Vera In A Dog

by Dreudog - January 31, 2018 View Case Report

Hi Steve and group,

This dog is a 3.5 year old Collie. Historically, he had intermittent colitis, nausea, vomiting and inappetence as a puppy and into his first year or so. He has late summer allergies as well. I treated him for a short while w/ Xiao Yao San (no change), then he saw a homeopath. Over time w/ the remedies and raw diet, these symptoms have become moderately better- he still is prone to reflux type symptoms on occasion. He groans some and runs hot.

Last July he was seen by his rDVM and then the U for lethargy and was dx w/ Polycythemia vera (PCV 79%, required phlebotomy). I saw him next 10/3/17 and found:

- BAR, sweet
- mm pink, sl. tacky
- Pulse: middle- deeper, thinnish
- underweight (which improved w/ ^ calories later)
- PCV 67% TP 7.8 g/dl

He was, and remains on commercial raw diet + slurried veggies. No meds.

I started Bentley on Mod. XFZYT and he started acupuncture w/ a local; practitioner (sorry- do not have the points). Enzymes seemed to help his reflux.

By 12/27 at 2nd recheck he had not needed a phlebotomy since the initial one (the U said he would beed them ~ monthly). His reflux was the same or somewhat worse, so I switched him to Yi guan jian (wish now I had kept the XFZYT SID) on 1/3. He tolerated the herb fine but then became more lethargic (PCV 74%) and required another phlebotomy 1/18. He had missed acupuncture X 2 weeks (PCV 68... 71), but then after acupuncture still ran 74%. At his 12/27 exam, his gums were sl. dusky pink, tongue sl. lavender, so I guess one might have predicted the ^ PCV.

On 1/17 his cholesterol was ^ at 419, albumin ^ at 4.1.

The owner felt that his reflux may be better on the YGJ, so we kept that BID at lowest effective dose, and restarted the Mod. XFZYT at 1.5 tsp. BID.

I've not seen a PCV since the 17th (probably should check on that and get back to you!). But wanted to start up some discussion on his case - I've never treated this dz herbally.

I'll check on the most recent PCV and let you know.

Thanks !

Cathy

by Dreudog

February 1, 2018

So Bentley's PCV just post- phlebotomy 1/18 was 65%/TP 6.0. Then 1/23 63% /7.0 and 1/30 60% /8.0 (on the latter she had limited his water some to try and reduce his reflux). Mom says that his PCV typically continues to drop some post- phlebotomy (have you seen that? what would be the mechanism?), and so its probably more difficult to measure the success of Mod. XFZYT until we are down the road a bit.

I'm happy to sit tight for a while and see what the Mod. XFZYT can do, but wondered about also using QYT or other immune- modulating herbs. He has to be sedated for the phlebotomy, since his blood is so thick and hence a very slow draw, so I'm motivated to try and minimize those for Bentley !

Thnx,

Cathy

by naturevet

February 3, 2018

Hi Cathy,

I interpret the reduction in HCT following phlebotomy as being due to fluid redistribution. That is, fluid is mobilized from tissues to restore circulating blood volume, until the bone marrow kicks in. If that's the case, it implies a pathogenesis and a potential solution: Dampness accumulation in the tissues that needs to be mobilized into the circulation (and thence to the Kidneys).

There are several traits that suggest Spleen deficiency and Dampness, including:

Digestive problems as a youngster

Tendencies to regurgitation, potentially worse on Blood tonics

Worsening of HCT on Blood tonics (although the bone marrow stimulating effects of YGJ provides the scientific explanation for this)

Improvement on a raw (non-Dampening) diet

Improvement with digestive enzymes

Thin pulse

Lavender tongue and gums, which can signal Spleen Yang deficiency

If you're intrigued to explore this idea, I'd try something like Wei Ling Tang or Wu Ling San (especially the latter).

Up until now, my assumption is that PCV (which we measure using the PCV - ironic!) represents damage to the Ying Qi. We've had two other cases reported here that were at least stable if not slowly better on the Qing Ying Tang (or QYT plus SMS) approach. But the behaviour of your case in response to the blood-letting and the success of hydroxyurea (which I interpret as an overall tonic) makes me think of the Spleen, for the reasons outlined above.

Lastly, another line of approach would be to vasodilate the patient, and pull more fluid into the blood from the tissues. Nitric oxide inducing herbs would be good for stimulating NO (and hydroxyurea partly works this way). In that instance, the Blood moving approach you've got going on right now would be expected to help.

So, three avenues to pursue. Please let us know what happens here

Steve

Wu Ling San

by Dreudog

February 5, 2018

A wealth of information, as always!!
I think we'll keep him in the Mod. XFZYT (since he had gone such a long tome w/o phlebotomy, until I traded for the YGJ), and substitute Wu ling san for the YGJ.

Thanks :)

by Dreudog

May 4, 2018

Steve,

This dog is doing really well on the above herbs, but his pulse will not correct- remains sl. feeble, thinnish, middle position. Tongue is sl. lavendar/pink, dry.

Thanks !

Cathy

by Dreudog

August 2, 2018

Hi Steve,

This dog's Polycythema vera has stabilized beautifully on the Mod. XFZYT and then Wu ling san (per your advice) added in Feb. I'm tempted to reduce his herb dose for long term maintenance (he's a 63 lb dog and is taking 1.25 tsp. of Mod. XFZYT and .50 tsp. of WLS BID), but as it is have not corrected his tongue and pulse. And in any form of cancer, might that be risky?

Thanks much,

Cathy L

by Dreudog

January 19, 2019

Steve,

This dog has had stable PCV/TP since returning to Mod. XFZYT and adding Wu ling san 1 year ago, per your suggestion. I'm wondering if he might be able to get by with less herb over time, or not worth the risk in this dz?

Thanks,

Cathy

by naturevet

January 25, 2019

Hi Cathy,

I think it's fine to go ahead and try reduced doses, given the 1 1/2 years of stability

Steve

by Dreudog

March 10, 2019

Hi Steve and group,

This do's Polycythemia vera is very stable on Mod. XFZYT (1.25 tsp. BID) and Wu ling San (1/2 tsp. BID) @ 60 lbs. . PCV's always 55-60. Tongue and pulse most normal I've seen for him. He still has an occ. bout of reflux/nausea, mild pruritis. So I'm wondering a couple things: is there any chance we will cure this dz? Is there reason to try and drop his herb dose even further? He was so chronically sick (mostly GI) as a younger dog, I'm assuming his constitution is weak, and he'll need herb support lifelong.

Any thoughts on the remaining reflux/nausea? It is SO much better than a couple years ago, but I wonder if we can just straighten it out.

Thanks,

Cathy

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