Rosemarie A. Niznik, DVM, CVA, CVFT, CVSMT

 

Lymphoma and TCVM of Neoplasia

Lymphoma is the most common malignancy of cats, accounting for as much as 30 percent of all feline cancers. Lymphoma is a cancer made of lymphocytes and these lymphocytes readily travel throughout the body via the lymph system. Renal lymphoma is lymphoma in the kidneys and is one of the worst forms of lymphoma for a cat to contend with. In most cases, the cat is brought to the veterinarian for symptoms related to insufficient kidney function: poor appetite, excessive water consumption, weight loss, and possibly vomiting. Unlike the more typical cases of kidney insufficiency where the kidneys are shrunken and small, the cat with renal lymphoma will have symmetrically large kidneys. A needle aspirate of the kidney usually reveals lymphoma cells.

With chemotherapy, the kidney enlargement reduces and often kidney

function improves until remission is lost. Median survival is only 3 to 6 months, though a recent case report highlighted a cat who lived many years, so long remission times are not impossible. Approximately 50 percent of cats with renal lymphoma are also positive for the feline leukemia virus, which carries the potential for other complicating issues. Unlike other forms of lymphoma, renal lymphoma has a strong association with tumor spread to the nervous system (brain or spinal cord). This makes for an unpleasant complication and, unfortunately, this occurs in up to 40 percent of renal lymphoma cats.¹ 

TCVM for Chemotherapy Patients

 

Modern chemotherapy drugs are less toxic and more effective, however, chemotherapy still has significant side effects such as fatigue, body aches, joint pain, anorexia, nausea, vomiting, fever, insomnia, low blood cell counts, dermatitis, kidney and liver organ damage, peripheral neuropathy, depression, decreased immune system function.

While the actual clinical signs vary, the effects of chemotherapy can be seen from a TCVM perspective as Spleen Qi and/or Liver Blood Deficiency with associated Qi and Blood Stasis, Stomach Yin Deficiency, Kidney Yin or Yang Deficiency, Liver Yin Deficiency, and local Toxic Heat from skin contact with chemotherapy drugs.

Immunosuppression is a common problem in patients receiving chemotherapeutic agents. Acupuncture can directly affect the immune system, and so it can be used to treat these adverse side effects. Human clinical trials have shown that electrical acupuncture can significantly enhance immune system function after chemotherapy.²

Appropriate acupuncture points for common issues in chemotherapy are listed in the following chart.

Problem	Acupuncture Points
Immunomodulation	LI-4, LI-10, LI-11, ST-36, GV-14, SP-10, PC-6, BL-20, GB-39
Immunosuppression	LI-11, SP-10, BL-23, BL-47, GB-20, LIV-3, CV-6
Neutropenia	LI-4, ST-36, SP-6, BL-17, BL-23, GB-31, GV-14

Lymphoma and leukemia patients often receive high doses of combination chemotherapy. They require foods to tonify Qi, nourish Blood, supplement the bones and generate marrow. Food items to supplement: Chinese dates, eggs, spinach, mushrooms, milk, walnuts, bone broth, and green tea. Research found significant improvement in the signs that accompany cancer in patients treated with epigallocatechin gallate, found in green tea. This extract has been shown to kill leukemia cells.³

Single herbs can be beneficial to prevent and minimize the side effects of chemotherapy. These herbs are listed in Chapter 8, Table 8.10 in book referenced.⁴

Jing Tang Herbal Formulas commonly recommended for Lymphoma patients are: Stasis Breaker, Max’s Formula, Wei Qi Booster.⁵

Case Report

Perseus, a 10 yr old MN Bengal cat, was seen as a housecall appointment for consultation for holistic support while undergoing chemotherapy at local Veterinary Specialty Center. He was referred to the specialty center for diagnostic work up for lethargy and anorexia. Blood tests at primary care DVM showed elevations in ALT, ALP, GGT, Total Bilirubin. Urinalysis showed hematuria, bilirubinuria, ad proteinuria.

At the Specialty Center, Perseus was diagnosed with renal lymphoma and hepatopathy: combination of hepatic lipidosis, possible lymphoma. He has been receiving weekly chemotherapy CHOP protocol. He was very stressed with travel to the Specialty Center and agitated for his diagnostic

testing and chemotherapy that he required light sedation and anti-nausea medications for the chemotherapy appointments. Currently, he has an PEG tube to assist with feedings. He originally had an esophagostomy tube but that was removed as it was causing excessive drooling and potential nausea. Owners are feeding him 75 ml three times a day through the PEG tube. He is also offered small amount of cooked chicken, turkey, and salmon at meal times and will take a few bites of food at each meal.

Activities of daily living are normal and he is comfortable in his home environment with his housemate, Orion, another Bengal cat.

Current medications are: Prednisolone 5 mg SID, Cereniaa16 mg SID, Buprenex 0.6ml(0.3mg/ml) TID or as needed, Ursidiol 250 mg 1/4 tablet SID, Hepato TruBenefitsb 1 capsule SID, Zoftran 8 mg 1/4 tablet BID/TID dissolved in water (alternative to Cerenia).

Supplements administered: Fortiflorac PRN for diarrhea, Liver Tonic 3 drops BID, Artenisinin 1 capsule SID.

Diet: Hill’s A/Dd, Hill’s I/Dd, Fancy Feaste.

Herbal Formulas: The owner had purchased herbal formulas on line but was not current administering them: Si Maio San, Modified Hoxsey, Bu Zhong Yi Qi Tong, Xiao Chai Hu Tang.

TCVM Examination

Personality: Water Cat; Shen: Good; Tongue:Pink with a pale center, moist, no coating; Pulses: weak and deep bilaterally; Appetite: decreased but attempting to eat; Skin/Coat: Dry; Urine and feces: Normal, Temperature: Normal

TCVM Diagnosis

Spleen and Kidney Qi Deficiency, Liver Blood Deficiency, Liver Qi Stagnation, Liver-Spleen Disharmony, Qi/Blood Stagnation in Kidney, Shen Disturbance

Treatment Principles

Tonify Kidney and Spleen Qi, Tonify Spleen, Tonify Liver Blood, Move Liver Qi, Pacify Shen

Acupuncture Treatment⁶

Dry Needle: GB-30, ST-36, BL-60 to KID-3, LI-10, PC-6R, SP-6L, GB-21 GV-14, Bai Hui, GV-17

Jing Tang 36 x 1/2 inch for 10 minutes while siting on owner’s lap

Aqua-acupucture: Diluted B-12 0.1 ml at GV-14, GB-21, SP-10R, ST-36L Note: Unable to access Bladder channel in thoracic and lumbar area due to PEG tube wrap.

Acupressure: Shan gen with demonstration for owner to perform daily

Owners perception

They were surprised and happy to see Perseus sit still for the acupuncture treatment and he seemed to be very relaxed during the treatment.

Herbal Consultation with Jing Tang Herbal

Owner did good with picking herbal formulas but recommended the following Jing T formulas with known sourcing and ingredients:

• JT Wei Qi Boosterg - Tonifies Qi and Blood, boosts Wei Qi, and inhibits mutation
• Max’s formulag - Soften the hardness and clear nodules
• Six Gentlemeng - Tonify Qi, strengthen Spleen, transform phlegm, and dry up Damp
• Six Gentle Petsh - Strengthen Spleen and Lung Qi, transform phlegm

Food Therapy

Recommend recipe formulation with Balance-Ii, Green Tea, reshi and shiitake mushroom blend

TCVM Diet: Food to Support Qi and Blood - beef, chicken, rabbit, beef bone broth, eggs, pumpkin, squash, shiitake mushrooms, kidney beans.

Owner feedback: Perseus looked great at his oncology appointment the next day. His ALT liver test was only mildly elevated and the total bilirubin value was WNL on repeat blood test the next day to the surprise of the oncologist.

Additional treatments

Perseus was treated with Dry Needle Acupuncture and Aqua-acupuncture with B12 for three additional weekly appointments. Additional Acupuncture points treated: Shen Shu, HT-7, SP-10, LIV-3, Shen Gen.

Perseus did well with his acupuncture treatments and the Shen improved. He was more interactive with the family and was eating some more bites of canned food at meal times.

Unfortunately, after receiving Doxorubicin as a chemotherapy, Perseus took a turn for the worse. He was lethargic and nauseous. He developed facial swelling on his chin. He was becoming more difficult to handle during oncology appointments and heavy sedation was now a requirement for future appointments. Shen was depressed. One last acupuncture treatment was administered to help with nausea and support Spleen and Kidney Qi, tonify Liver Blood, and calm the Shen.

One week later, Perseus was still lethargic and mentally depressed. He was being fed small meals and was still nauseous after meals. Blood tests showed improvement in liver enzymes. He started to exhibit normal behaviors and interact with pet owners. However, the owners made the difficult decision to discontinue chemotherapy treatments especially doxorubicin treatments. They spent quality time with Perseus before humanely euthanizing him two weeks later.

Summary

 

This case illustrates that acupuncture can be utilized to tonify Spleen and Kidney Qi, Liver Blood, Shen, and improve comfort in cancer patients. The veterinary acupuncturist can be of assistance as a liaison between the oncologist and pet owners and a valuable member of the treatment team. Housecall visits were a wonderful option for Perseus as he was able to be treated in the comfort of his home in his owner’s arms.

Perseus - More than a Cat - A Part of the Family

 

About the Author

Dr. Rosemarie Niznik received her Bachelor of Science Degree with Honors from the Pennsylvania State University and her DVM degree from the University of Georgia. Dr. Niznik is certified in Mixed Animal Veterinary Acupuncture and Food Therapy from the Chi University and Veterinary Spinal Manipulative Therapy from the Healing Oasis Wellness Center. She founded Harmony Rose Animal Wellness, a housecall integrative practice in 2015 that serves clients in Illinois and Wisconsin. She currently is a Chi University MS-TCVM student and Acupuncture Lab Teaching Associate and President-Elect of AHVMA. She goes by the nickname of “Dr. Rose” and lives on a 5-acre farm in Wisconsin with Chip, her husband, Grace, a Bernese Mountain Dog, and Wendy and Willa, two rescue cats.

Footnotes

1. Cerenia, Zoetis United States, Parsippany, NJ
2. Hepato Tru Benefits, Veterinary Recommended Solutions, Blue Bell, PA
3. Fortiflora, Purina ProPlan Veterinary Supplements
4. Hill’s Fortiflora, Purina ProPlan Veterinary Supplements, Louis, MO
5. Fancy Feast, Nestle Global, Vevey, Switzerland
6. Kingdom of Basil Healing Herbs for Animals, Seattle, WA
7. Jing Tang Herbal, Ocala, FL
8. Kan Herbal, Santa Cruz, CA
9. BalanceIT, balanceIT.com

References

1. Brooks, , Lymphoma in Cats, www.veterinarypartner.com

2. Ye F, Chen S, Liu W, Effects of electro-acupuncture on immune function after chemotherapy in 28 cases. J Trad Chin Med 2002; 22(1): 21-3.

3. Hazawa M, Takahasha K, Sugar S et al. ( - ) Epigallocatechin-3-O- gallate induces nonpoptotic cell death in leukemia cells independent of the 67 kDa Laminin receptor. J Nat Prod 2011; 74(4): 695-700.

4. Xie, , Wedemeyer, L., Christman, C., Trevisanello, L., Practical Quide to Traditional Chinese Veterinary Medicine - Small Animal Practice, Chi Institute Press, Reddick, FL 2014, 610-612.

5. Ma, , Clinical Manual of Chinese veterinary Herbal Medicine, Fifth Edition, Ancient Art Press, Florida, 2020

6. Xie, , Preast V., Xie’s Veterinary Acupuncture, Blackwell Publishing, Iowa, 2007, p 143-234