ABSTRACT: An eight year old spayed female Pug is successfully treated with traditional Chinese herbal medicines for cutaneous and subcutaneous Mast cell tumors which were previously unresponsive/sub-responsive to standard western medical approach (surgery and chemotherapy protocols).
"Mischief" an eight year old, 9.8 kg, spayed female Pug presented for multiple reoccurring subcutaneous soft tissue masses.
"Mischief" has been vaccinated yearly and is on heartworm prevention (Heartgaurd PlusÒ) and has had four surgeries to remove cutaneous and subcutaneous Mast cell tumors from three different sites between 2002 -2006. Following the last two surgeries conventional chemotherapy (Vinblastine, Prednisone, and Cimetidine) was performed.
Feb, 2007, "Mischief" returned with another Mast cell tumor just caudal to the previous site. Owner did not want to continue with the Western Medical approach.
"Mischief" is bright, alert, and responsive. She is moderately overweight. There is a soft 1cm round subcutaneous mass at the costochondral junction of the 10th rib. The mass was warm to the touch. She also has severe periodontal disease, mild kerato-conjunctivitis sicca, and constantly pants. A Mast cell tumor Grade II was diagnosed from a fine needle biopsy. There were several small lipomas also noted.
TRADITIONAL CHINESE MEDICAL EXAM:
- Personality: Earth when home. In the exam room, Earth/Fire personality
- Tongue: pale purple/ lavender, white coating.
- Shen: Excellent
- Body: Obese, graying around feet, eyes, ear and muzzle.
- Eyes: Bright with thick mucous film present
- Appetite: Excellent
- Diet: Commercial dry kibble.
- Pulse: Deep, weaker on L
- Respiratory: Panting.
- Temperature preference: Cool seeking.
Qi Deficiency and Blood Stasis with Phlegm.
TCVM TREATMENT PRINCPLE:
Clear Phlegm, tonify Qi and move Blood.
The two herbal medications selected to treat "Mischief" were Stasis Breaker1 and Wei Qi Booster. The dose for each medication was two 0.5g capsules given twice daily. Stasis Breaker was chosen for its ability to break Blood stasis, soften the hardness, and clear enlargements. Wei Qi Booster was selected to tonify Qi and Blood, boost Wei Qi, and inhibit mutations.
ACUPUNCTURE: Owner opted to use herbals only.
DIET: Owner is unable/unwilling to feed separately from other dogs, therefore; the diet is unchanged (dry kibble).
PROGRESS: Thirty days after the start of the herbal treatment, the mass was non palpable. Herbal treatment was continued for two months. The tumor was still non palpable at the three month recheck. Both the Wei Qi Booster and Stasis Breaker were decreased to once daily dosing.
The owner did not return for the six month recheck and discontinued all herbals when the medications ran out. "Mischief" returned on Oct 30, 2007 for a mass just caudal to the R ear. The fine needle aspirate revealed adipose tissue. On December 15, 2007, "Mischief" presented with a small 1 cm soft tissue mass on the lateral aspect of the L stifle. A fine needle aspirate confirmed another Grade II Mast cell tumor. She was put back on Stasis Breaker and Wei Qi Booster. The mass was not palpable at the two month recheck. Stasis Breaker was discontinued and Max Formula was dispensed.
The change in herbal medications was due to the patient’s age as the Max’s Formula is known to be a milder formula. "Mischief" was doing well with no new masses present on March 30th, 2009 and a few of her lipomas are visually smaller. "Mischief" is currently on Max Formula 0.5gm every other day. "Mischief’s" keratoconjuctivitis is no longer present although it is unknown when this change occurred.
DISCUSSION: Traditional veterinary medicine’s approach to Mast cell tumors may include any or all the following courses:
1. Surgical excision (with wide margins when able).2,3.
2. Chemotherapy (Vinblastine, prednisone, and Cimetidine) 2,3
3. Intralesional injections (triamcinolone 1mg for each cm diameter of tumor) 2,3
4. Radiotherapy (3,000-4,000 rads). 2,3
The side effects and possible adverse drug reactions range from mild to severe. These treatments can also impact negatively on the quality of life for the patient. Therefore; other forms of treatments for this condition must be considered.
The Traditional Chinese Veterinary Medical (TCVM) approach for treating masses/tumors is to give the animal a good quality of life while either slowing the growth, stopping the growth, or removing the growth. The Five Elements and the Eight Principles of TCVM are used to determine the disease pattern. 4, 5 The pathology of Mast cell tumor is the accumulation of Yin substance (Phlegm or Blood stasis).5 The treatment strategy of the disease is to treat the patterns and address the location of the mass. 5 The herbal formula Wei Qi Booster was selected for the ability to address the immune system’s role in this disease.1 Failure of the body’s defense system is a Wei Qi issue. Stasis Breaker was selected because it contains herbs that soften hardness, clear masses, break stasis, inhibit cell mutation, and tumor growth.1
Stasis Breaker was discontinued and Max Formula was used. The change was made because the animal was aging and not as strong as before. Max Formula’s indications are for lumps, fatty tumors, nodules, and skin masses in old or weak animals. 1 Later in the course of the disease in this animal and after a review of this case the formula Xue Fu Zhu Yu may be beneficial. 4,6
"Mischief" has been clinical free of Mast cell tumors for over one year. She still is a Fire/Earth animal and has an excellent quality of life to date.
1. Xie H, Preast V. Chinese Veterinary Herbal Handbook. Chi Institute of Chinese Medicine. Reddick, Fl. 2004.
2. AAHA Tampa 2008 Proceedings. American Animal Hospital Association. Lakewood CO. 2007. pg 269-271.
3. The Veterinary Clinics of North America. Small Animal Practice. Advances in Medical Oncology. W.B. Sauners Co. Philadelphia, Pa. 2003. pg 473-490.
4. Xie H, Preast V. Traditional Chinese Veterinary Medicine, Volume I Fundamental Principles. Beijing, China: Beijing University of Aeronautics and Astronautics Printing House, 2002.
5. Xie’s TCVM Clinical Charts-Cancer/skin/endocrine
Max’s Formula TM
In TCVM, tumor tissues and nodules are considered to be Blood stasis and stagnation. The key treatment strategy is to remove Blood stasis. Both Stasis Breaker and Max's Formula are designed for the treatment of neoplasia, tumors and nodules. Max's Formula is used for small enlargements in geriatric or deficient animals.
This herbal medication may induce diarrhea. Stop administration immediately if the patient develops diarrhea, vomiting or other unusual signs.
Horse: 15 g BID as top dressing on feed
Dog/Cat: 0.5 g per 10 to 20 lb body weight BID