Histiocytosis in the Bernese Mountain Dog   

The following article is a summary of a presentation made at the BERNER UNIVERSITY PORTLAND OREGON APRIL 2009

Marlene Smith – Schalkwijk DVM
Tree of Life Veterinary Care
1777 Riverside Lane, Courtenay BC Canada
ph: 1-250-338-2316  fax: 1-250-338-8814
treeoflifevet@shaw.ca

Introduction.
The diagnosis of cancer is in most people’s mind a death sentence. It is one of those areas in Western Medicine where the cause of the disease is mostly speculative and poorly understood. Western medicine approach to cancer is surgery (if applicable), prednisone, chemotherapy or a combination. This can buy some time and yet rarely “cures” cancer. “Spontaneous remissions” are being reported in human as well as in veterinary medicine and as poorly understood as cancer itself. Over the last 10 years we have seen a dramatic increase in cancer in our pet population. It is now the leading cause of death in dogs over 10 years of age. The very first question we all ask is; “what is the cause of my animals cancer?” At this point there is no answer to this question. Genetic predisposition, environmental pollution, diet, damage to the immune system due to repeated vaccinations or excessive antibiotic use, thinning of the ozone layer, herbicide and pesticide use are all components showing up in the various research articles as possible contributors to this new epidemic.
Research shows that patients treated with immune suppressive therapy have a higher incidence of developing tumors then those not treated with immune suppressive agents. Also patients with immune mediated diseases and acquired immune deficiency syndrome (Feline leukemia, Feline Immune Deficiency syndrome, Aids) have a higher incidence of cancer. (1) Use of herbicides/pesticides as T4D are quoted as increasing cancer especially lymphoma type cancers.

Summary.
This article will focus on the number 1 cancer diagnosed in the Bernese Mountain Dog Histiocytosis/ Malignant Histiocytic Carcinoma/ Cuteaneous Histiocytosis or Disseminated Histiocytosis. Of all the Malignant Histiocytosis diagnosed in dogs, 80% is diagnosed in the Berner. This is a great tragedy that could potentially destroy this lovely breed! It is the author’s belief that bone cancer so prevalent in the Rottweiler has a similar genetic background and development as histiocytosis in the Bernese.

Immune system in cancer.
Cancer can develop in many different organs or cells and are named after the cells they develop in. Most of them have a common origin; chronic stimulation of specific (inflammatory) immune cells.
 
Cancer specifically involving immune cells.
The following are classical immune cell type of cancers:

Is every tumor cancer?
There are benign and malignant tumors. Cancer normally relates to malignant tumors.
A benign tumor is characterized by a limited multiplication of cells, surrounded by a capsule. There are no rapid multiplying cells and the mitotic index (rate of cell multiplication) is zero or very low. There is an absence of malignant cells extending into the surrounding tissue. There is no chance of metastasis to surrounding tissues or elsewhere in the body.
The tumor is limited to the site and does not go anywhere. Surgical excision is curative.
Examples are lipoma’s, sebaceous gland cysts, warts, Histiocytoma in young dogs.
Malignant tumors/cancer.  These are characterized by rapid growth and cell division (high mitotic index), infiltration into surrounding tissue (no clear tumor margins) local or distance metastasis and reoccurrence or metastasis after surgical removal.

The immune system.
As cancer is basically a failure of the immune system to eliminate the cancer cells, it is important to look at the immune system first if we want to try and understand the cause and subsequently treatment of cancer.
The immune system evolved to protect the body from outside pathogens as well to recognize abnormal cells and cancer cells within the system.
The immune system can be divided into two parts, each of them carrying specific cells.
a) Innate cells (we are born with it) which fight bacteria and viruses. The Natural Killer cells belong to this family and destroy cancer cells. Dendritic cells and macrophages are also classified in this group. These last cells kill invaders and tumor cells through lyses (digestive granules). Macrophages come from the bone marrow/blood monocytes and are also called Kupfer’s cells or Histiocytes depending on their location.
b) Adaptive cells. These are obtained during live and acquired. Their response and development is slower. B & T lymphocytes belong to this group. These cells recognize specific antigen through their antigen receptors.

T lymphocytes are involved in cell-mediated immunity. They originate in the bone marrow and migrate to the Thymus where they mature (hence the “T” of T Lymphocytes). There are several types of T-cells; one of them has the function of a Memory cell. Other Tcells are;  Cytotoxic Tcells (CTL), these destroy tumor cells through lyses. Helper Tcells help the immune system to perform its function through the release of lymphokines. Suppressor cells protect the immune system from over reacting and creating auto-immunity. NK T cells (Natural Killer) are the immune surveillance. They recognize metastasis and are responsible to prevent it. They have the characteristics of the innate NK cells, T lymphocytes and cytotoxic cells, The cytotoxic T cells fight of cancer. Antigen Presenting Cells (APC) trap antigens or part cells/protein, digest them and then present them to the immune system. Dendritic cells are professional antigen presenting cells. They are essential to help recognize abnormal cells like cancer cells (9).
B-lymphocytes are a part of the humeral immune system and come from the bone marrow. Once these cells find an antigen they absorb it via special receptors on their surface. This antigen or parts of it is displayed on the surface of the B cell, which activates the Lymphocytes to bind and secret lymphokines, which matures the Bcell. It then divides in the antigen producing plasma cells, which binds to the antigen and destroys it through lyses, using cytokines.
Cytokines are proteins secreted by immune cells to signal other cells of the immune system. Different cells secrete different cytokines as interleukine 2, 4 and 8 and interferon 8 ά and β, TN Factor (which stimulates the growth factor for the macrophages) Transforming Growth Factor, which moderates macrophages and lymphocytes proliferation (the  “turn of key”!).

Immune response to cancer
In an immune response to cancer, there is a cascade of activity involving lymphocytes, macrophages (histiocytes are differentiated macrophages), interleucine, interferon, tumor necrosis factor and Natural Killer cells etc. This is a similar chain of reaction to infection! In summary it works like this: if a tumor cell presents itself as an abnormal cell, dendritic cells or other immune cells will recognize this. These cells will absorb the introdudor or abnormal cell and place a specific signal on its surface. The cell will release lymphokines & cytokines, which will attract specific lymphocytes. Two bindings have to take place between the Dendritic cell and the Tcell, in order for the Tcell to become activated and to release cytotoxic enzymes. This activates the macrophages, which then will continue the job and destroy the abnormal cell. The release of cytokines/lymphokines or histamine creates the inflammation we can see in blood work or in the patient as fever, pain, itching, swelling etc.

How can this fail?
Tumor cells can resemble normal tissue cells and the immune system may not recognize that these cells are abnormal. Tumor cells are poorly immunogenic.
Tumors can also be immune evasive. This can happen through dysfunction of the immune system.
The earlier described binding process can be inhibited by immune suppression, tumor blocking antibodies, and some tumors producing a protein on the surface of their cells mimicking embryonic protein! (2). Some tumors (prostate is an example) will produce arginase, an enzyme which deactivates arginine, necessary for the immune system to function properly. Interestingly enough the bacteria Helicobacter, involved in chronic gastritis and gastric ulcers and IBD also produces arginase; so does Mycobacteria! It is amazing how sophisticated some of these tumors are in avoiding recognition and destruction by the immune system!
There can be a defect in the Antigen Presenting Cells as the Dendritic cells, Macrophages or Histiocytes. Tumors can produce hydrogen peroxide or nitric oxide, which kills the dendritic cells.

Causes of cancer

From the above it is clear that from a Western (medicine) scientific perspective the causes of cancer are complex and are mutifactoral. It is not a process that happens overnight; it is a slowly developing time bomb waiting to go off in an opportune moment.
Specific forms of cancer have a high incidence in specific breeds or family lines, which points towards a genetic predisposition.
The question is here, if the cancer is encoded on the gene’s, why does it not express itself in the first stages of development or during the rapid growth spurt, when the DNA is duplicated many times?
Most researchers agree that a trigger seems to be needed to set of a cascade of immune failure resulting into cancer.

Some examples of genetic predisposition of cancer:
A specific line of English Cocker Spaniels developed immune mediated glomerulo nephritis. They all developed anal gland adeno-carcinoma with metastasis to the regional lymph nodes. Over 80% of this family was affected. Western oncologist have no explanation for this phenomena.
Some lines of Golden Retrievers show a very high incident of Lymphosarcoma or hemangiosarcoma (almost 80%), with the majority of the members of these lines dying of this specific type of cancer. The interesting part of this is that almost all animals would show cancer at the same age!
The Rottweiler has a very high incidence of Osteo-sarcoma.
The Bernese Mountain Dog, Flatcoat and Golden Retriever have an above average of Histiocytosis (Malignant Histio/ Disseminated) in their breed, with the Berner topping it with 80% of all cases of Histiocytosis.
.
Histiocytosis is an interesting form of cancer as it is clearly an immune induced disease.
Understanding what sets of the cascade of events in Histiocytosis may help us to understand better how cancer starts and how we can treat it in a more specific and directed way then the current chemotherapy approach.

Histiocytosis in Bernese Mountain Dogs

Histiocytosis is characterized by an abnormal multiplication of histiocytes.
What are Histiocytes?
Histiocytes have different names depending on their location.
Macrophages (in blood and bone marrow)
Dendritic cells (skin, mucosa, connective tissue)
Kupfer cells in liver
Microglia in the brain
Osteoclasts in the bone (marrow)
Langerhan’s cells in the skin (dermis)
Type A synovial cells in the joints

They all come from the monocytes (watch the monocytes count in the CBC) and differentiate in the phagocytotic cells.

What is their function?
The macrophages/histiocytes have as main purpose in life to ingest, breakdown and digest (phagocytosis) of microorganism, cell debris, damaged cells and abnormal (cancer) cells. This includes phagocytosis of red blood cells (erythrocytes) and platelets. We can see the result of this in the blood work of dogs affected with Histiocytosis in that we will see a regenerative anemia and decreased platelets count (thrombocytopenia), which can result into the bleeding we often see in Histiocytosis.
Histiocytes and dendritic cells are also antigen-presenting cells (APC). As discussed earlier the antigen binds to the APC, which releases cytokines (inflammation = fever), which attracts T lymphocytes. This will activate the T cell and macrophages, which then destroy the cancer cell.
Resent research at UC Davis by Peter Moore & all seems to indicate that in Malignant Histiocytosis there is a problem with the binding mechanism between the APC and the T cell. The continuous release of cytokines creates the inflammation and fever we see in dogs with Malignant Histiocytosis. These cytokines activates the histiocytes and macrophages, which then will phagocytose the (damaged) erythrocytes (causing anemia) and platelets (causing bleeding). The tumors we see (multiple) are a proliferation of the Histiocytes in the spleen, liver, lung and lymph nodes. (10). Multiplication likely occurs via the stimulation of cell surface growth hormone.
Most chemotherapies Cyclophosphamide (Cytoxin) or Cyclosporin, Doxyrubricine etc will inhibit cell reproduction as well inhibit T cell production. The absence of T cells could stimulate the APC to produce more cytoxin and stimulate their own growth hormone leading to more APC cells as histiocytes and dendritic cells. The use of chemotherapy is the treatment of Malignant & Disseminated Histiocytosis is questionable at this point. It seems the only treatment available in Western/Allopathic medicine. The inability to form the second link in the immune complex is likely genetic and we can expect it will re-occur as soon as immune suppressive treatment stops.
 
The language of the Histiocytic Sarcoma Complex.

Histiocytic Sarcoma. This name is reserved for a single site Histiocytic tumor. They present most of the time on the extremities and can be treated successfully with surgical excision or limb amputation.
When it spreads to the regional lymph node or beyond it is called  Disseminated Histiocytic Sarcoma. This spread is often to the spleen, lung and bone marrow and often goes unnoticed. It is then called Malignant Histiocytosis. Names changed as research and pathology defines better which cells are involved. Malignant Histiocytosis develops very aggressive at multiple sites in the body. It is the author’s believe that this is not a “classical metastasis”, rather a cell-chemo (of histiocytes elsewhere in the body) response to the activation of histiocytes and the release of cytokines. Presentation can be anorexia, enlarged spleen, joint capsule swelling/inflammation and/or enlarged lymphnode(s)
Since histiocytes are normal inflammatory cells in the body, initial diagnoses may be difficult, vague or frustrating.

Cutaneous Histiocytoma is a single site benign tumor in young dogs of all breeds. They normally regress without any treatment and are responsive to topical antibiotic and steroid (or anti-inflammatory) treatment.
Systemic Histiocytosis is predominantly seen in the Bernese Mountain Dog and sporadically in other breeds. It presents with skin manifestation as in Cutaneous Histiocytosis, but other organs as mucous membranes of nose and eyes are involved as well as lymph nodes, lungs and bone marrow.
Histiocytic Sarcoma. These can be presented as a Histiocytic Mast cell tumor or Histiocytic mixed Sarcoma. As mentioned earlier these can be removed and follow up treatment should be aimed at avoiding any immune stimulation.
In Malignant/Disseminated Histiocytosis lesions/tumors can be present in spleen, lymph nodes, lung, bone marrow, skin, sub- cutis, brain, spinal cord, peri articular tissue or joints of the limbs. The tumor(s) can stay in one organ for a period of time and then suddenly rapidly disseminate into other tissue all over the body. Response to chemotherapy is limited and at best brief.

Histiocytic mast cell tumor in Bernese Mountain Dog

Recognition of Histiocytosis
Early recognition is difficult, but not impossible. A lot of Berner owners report “no previous illness”. Below are some signs I see as early warning signs (often missed or ignored) for possible development of Histiocytosis. Early recognition can help in preventive treatment by supporting the immune system and supporting its fight to eliminate “Heat Patterns”.
Any lump is suspicious! Send biopsies to Histovet (Canada), University of Pennsylvania, Colorado State University or P Moore at UC Davis. An accurate description and history and specific request for possible Histiocytosis should accompany the biopsy. Remember that histiocytes, Dendritic cells, monocytes, macrophages etc are NORMAL cells in the body associated with immune activity. Biopsies and post mortems are crucial to identify type and extend of the disease. Registration via Bernergarde will help to identify the genetic background and help to identify lines with high incidence. Avoiding breeding these lines (with high incidence) helps to reduce the genetic aspect of the disease.

The following are some symptoms owners have identified in dogs with Disseminated Histiocytosis.
Over-reactive immune system during life.
A reactive immune system will show as repeated hotspots, urinary tract infections, otitis, conjunctivitis and meningitis. Reactions to surgery with increased inflammation or to shaving for blood collection, surgery etc, repeated ACL surgeries are all indicators we may see throughout the dog’s life years prior to the expression of the disease.
Excessive /chronic inflammation.
If histiocytes, dendritic cells are unable to bind and activate Tcells, they will continue to release cytokines, which will show up as fever, panting, restlessness and pain. Damaged erythrocytes will be seen as needing destruction by the phagocytic cells (Tcells), which will lead to anemia and also thrombocytopenia. Cytokine release will also activate the bone marrow to produce more precursors for the histiocytes, the monocytes. This will show an increase in monocytes (monocytosis) in the blood.
Changes in blood work:
The blood work could look like this:  Neutrophils: increased or normal, lymphocytes decreased, monocytes increased, red blood cell count decreased, platelets decreased to very low. Abnormalities in chemistry panel in Malignant (Disseminated) Histiocytosis): increased Alkaline phosphatase (tissue damage) ALT (liver enzymes) increased, kidney enzymes increased, sometimes T4 decreased.

The following patient showed the “classic” development of Malignant Histiocytosis.
A 5 year spayed female BMD was presented with the following complaint:
Anorexia (not eating), panting, restless and sore joints/legs without any obvious limping. Onset was slow over about 1-3 weeks.
On examination the pulse was weak and the tongue was pale. The spleen was enlarged and the temperature was 39.8 degrees Celsius. Blood work showed a regenerative anemia, increased Neutrophils and monocytes, decreased lymphocytes, and platelets, increased alkaline phosphatase (indicates tissue destruction) and low T4. Histiocytosis was diagnosed on the above symptoms. Inspite of treatment attempts the dog’s health declined in 14 days and she was euthanized. Autopsy showed an enlarged and mottled spleen and spongy liver. All other organs looked normal. Biopsy samples were obtained from spleen, kidneys (looked normal) liver, heart; lung and internal lymph nodes (normal in size and appearance). Histiocytic leasion and tumors were seen in all submitted organ samples.

Is there any hope for the future of the Bernese Mountain dog?

With the genetic information being present in a large amount of all the breed lines of the Bernese world wide, we have to look at a multiple prong approach to save this lovely breed!

Pale tongue and muscle atrophy in a Bernese with Histiocytosis

Looking at cancer from a Traditional Chinese Medicine perspective.

Traditional Chinese Medicine looks at the causes of the disease as a disharmony in the normal body balance of health. Their goal is to restore that balance.
In Traditional Chinese Medicine cancer is seen as a stagnation of Qi and Blood. As cause we often see Heat (=inflammation) and Latent Heat (=”unresolved previous inflammatory reactions”). In oriental medicine treatment is very specific as to the cause and presentation of the disease. Since we are still in the dark to what really causes the immune system failure, which leads to cancer, it is difficult to be specific enough in a TCM approach to treat cancer; let alone cure it! However we most certainly can use oriental medicine to add to our cancer protocols and to provide better and longer quality of life. It also may help us to understand better how cancer develops. Once we understand how and why cancer develops, we can treat it in a more specific and better way. We should encouraging more research into the TCM understanding of cancer rather then dismissing TCM as “non scientific”.
Cancer is the end result of a long and slowly developing disharmony. If we can recognize early (potential) developing cancer; we may be able to support the bodies own defense system to clear the cancer. We could call this a preventative approach.
If we look at cancer from a western scientific approach, we see immune cell and organ cell cancers. Most cancers are marked in their early phases with an inflammatory pattern. In Western Medicine, inflammatory bowel disease is now seen as a precursor to cancer (3). Do certain bacteria as Helicobacter have a hand in this?
If the immune system recognizes the abnormal tumor cells we see that the AP cells release cytokines, which causes inflammation. Inflammation would translate into Heat in TCM. We see this specifically in mast cell tumors, fibrosarcoma, histiocytosis (histiocytic sarcoma), leukemia, lymphoma and malignant lymphoma. This Heat pattern can be caused by external pathogenic factors such as a virus (Feline, Bovine leukemia), vaccine induced (some fibrosarcoma’s), chronic inflammation (mast cell tumors) or unknown causes. A longer standing Heat pattern will result into drying of the fluids the Qi needs for its movement. This will lead to stagnation of Qi and the end result will be Stagnation of Blood or a solid mass. So we can see here that we have to observe our dogs for signs of unreasonably excessive or unexplainable inflammatory reactions. Such as re-occurring “itis” as cystitis, dermatitis, otitis, arthritis etc. And we have to address these from the perspective that the immune system needs help and not suppression!
Internal factors (emotions, personality) would predispose individuals to being more prone to get stagnation in specific organs. Is it just coincidental that the Golden Retriever with its Earth personality (loving, caring, nurturing, worrying) is more prone to splenic hemangiosarcoma and Lymphosarcoma? “Earth” relates to the digestive system and more specific to the spleen/pancreas, stomach and lymphatic tissue. Does the emotion of excessive worry combined with an Earth personality predispose an individual to contract Blood Stagnation/cancer in the organs related to Earth?
Is it just coincidental that in our high stress world and lifestyle (also for our pets that feel responsible for us!) that we see more and more Cushing’s disease and adrenal tumors (the organ designated to deal with stress)?
Are immune cell types of cancers a result of an ongoing battle of the Immune System (Wei Qi) fighting an external pathogenic factor and a weakening of the Wei  (Defense) Qi as a result of internal factors? Has the pathogenic factor successfully entered the next level past the Wei Qi and is now presenting in the “layers in between the outside and the inside” or even entered the level of the Blood?
It is remarkable to observe how many (malignant) lymphomas start in the submandibular lymphnodes prior to progressing to the other nodes. This coincides with the respiratory or digestive tract, an obvious place for external pathogens to enter. A small percentage of lymphomas start in the popliteal lymphnodes, one of the internal connecting points in the TCM meridian system.
Cuteaneous lymphoma and intestinal lymphoma are both related to the first contact of the Immune system located just under the skin or intestinal system. This relates to the cell mediated immunity.

Genetic predisposition. Certain types of cancer are seen more often in specific breeds, such as malignant histiocytic sarcoma’s (malignant/ disseminated histiocytosis) in the Bernese mountain Dog, Flatcoat Retriever and Golden Retriever.

How does this translate into TCM?
In case of a genetic predisposition in TCM this is seen as a Jing deficiency, causing a Wei Qi (= immune deficiency) Deficiency. This can result in pathogenic factors, including tumors, having a greater opportunity to escape the immune system and causing problems on a deeper level. This points towards the incredible responsibility of the breeder(s)!
In Histiocytosis in the Berner we see a very clear link between specific breed lines and Histiocytosis occurrence. TCM also warns against “too much sex”, which translates into inbreeding (or line breeding) and overuse of a breeding male or female. We even have to investigate if freezing and preserving sperm could damage the DNA of the sperm and this could translate into damaged DNA of the offspring!
If we have animals with an unbalanced immune system, we may want to be a bit more careful regarding how we challenge their immune systems with early spay and neuter, vaccinations, exposure to chemicals, artificial insemination (?) etc. We may want to support these animals by nourishing their postnatal Qi and Wei Qi through diet, supplements and acupuncture.
This nourishment is also important when we treat animals with cancer especially if they receive chemotherapy.

Acupuncture and herbal medicine in the treatment of cancer.
In a Chinese medical assessment, the pulse and tongue diagnosis are essential to find the pattern of disharmony in the body. We treat the entire patient, not the cancer alone.
The tongue and pulse will show a deficiency in blood before we have a clinical anemia. Blood in TCM also includes the white blood cells, the macrophages, dendritic cells etc. Using specific acupuncture points we can address these deficiencies. Specific herbal formulas would support these treatments. Medicinal mushrooms are high in polysaccharides, stimulating the formation and differentiation into macrophages. This would be very helpful to support the immune system to fight of cancer cells, especially post surgery when the immune system is already hyper alert.
In Histiocytosis we see excessive inflammation from the cytokine release. This translates into Heat in TCM, so we can use herbs to cool the heat (reduce inflammation). Also we see that there is a binding problem in Histiocytosis. This may be due to a deficiency of a specific amino acid needed in this process. Specific research into finding the possible cause of this linking problem may help us to supplement the animal with specific amino acids. Amino acids are building blocks in proteins. They can be destroyed or inactivated in the heating process as in dried commercial kibble.
In Qi and or Blood stagnation a more “wiry pulse” and a purple or violet tongue with possible red spots may be present. Here we would focus on the movement and dispersing of the stagnant Qi and Blood, using again acupuncture and herbal supplements.
In an early phase, when the vitality is still strong, Chinese medicine advocates the strong expulsion of the toxins, using herbs and acupuncture. The stagnation of Qi often will lead to a deficiency of Qi, sometimes called vacuity of Qi (Bob Flawes). The tongue will be paler and the pulse more deficient and soft. In this case we also have to nourish the Qi.

Heat.(=”itis”)
Heat can come from an excess as a result of the battle between the immune system and the pathogen (cytokine release) and also from a deficiency of blood and Yin.  Pulse and Tongue diagnosis will show us what we are dealing with. In most cases and most certainly in Histiocytosis we see both. Prolonged battle and Heat will damage the Yin and Blood. Here we are entering preventive medicine. In early detection and treatment of the Heat syndrome, before it damages the blood, we can cool the heat and support the blood and thus preventing the expression of the disease. In Blood deficiency syndrome” the pulse will be thin and possibly rapid and the tongue will be pale.
Heat toxin from chemotherapy can sometimes be seen as a yellow coating. When you see that, it is time to back of on your chemotherapy real quick or you will lose your patient!
Blood Deficiency: This is a continuation of the Yin deficiency and continuation of the battle. This can also be a result of treatment with bone marrow suppressive agents. Herbal supplements are definitely indicated here and work more powerfully than acupuncture.
 We often use blood-nourishing herbs in patients with anemia caused by bone marrow suppression from chemotherapy.

Homotoxicology.
In homotoxicology it is accepted that diseases enter the body from the outside. The immune system fights it of, which may result into discharges, diarrhea or skin rashes. If successful, the body will recover. If not successful the disease will penetrate deeper into the body creating chronic illness. Eventually the body cells are unable to properly conduct their function, which leads to cancer. Homotoxicology is based on the principle that we can re-activate tissue cells to eliminate the offending agent, assist the lymphatic system in clearing the tissue and bring it to the excreting/detoxifying organs as the liver and kidney, to rid the body of the pathogen or cancer cell. In homotoxicology treatment there would be an alternating treatment with homeopathic carcinosum and lymphatic drainage. Details of homotoxicology are beyond the scoop of this presentation.

Pituitary/ Adrenal/ Thyroid involvement
The thyroid and adrenals both get their signals from the pituitary gland, when and how much hormones to release. The pituitary also picks up information from the hypothalamus, which picks its signals up from the internal (body) and external environment. The thyroid regulates the metabolism and is often suppressed in chronic illness, included cancer. This is often referred to as “sick-euthyroid”. This suppression may come from concurrent or previous episodes of immune mediated thyroiditis or from the high demand of the metabolism of the cancer itself. Caution with supplementing the thyroid as it may also increase the tumor’s metabolism with an increase in growth as result.
The adrenals are our stress regulators and also they regulate the thyroid. Poor adrenal function can result with the individual having problems dealing with stress. This can be expressed in diarrhea, meningitis or any disease following any stress challenge (as in dog shows, traveling, kenneling, vaccinations, spaying, neutering, shedding, teething, season change etc).
In Chinese Medicine the thyroid function and activity are related to the Qi production. The general Qi provides for the Wei Qi, the defense Qi or immune system. So we most certainly have to address this deficiency in Qi or thyroid function. This can be done with acupuncture, herbal medicine, diet, glandular therapy or western (low dose) thyroid medication.
The adrenal function is covert under the activity of the Kidney in TCM as well as an illusive system called the Triple Heater or Triple Burner or San Jiao. Herbs and acupuncture can activate or regulate these organs.

Dietary considerations.
In TCM Damp Heat accumulation is often one of the causes of cancer. Damp Heat can be created in the digestive system with refined and easily digested carbohydrates. This is even more important in the carnivores (cats) or mostly carnivores (dogs) as they are deficient or lack amylase to properly digest carbohydrates. This finding correlates with Dr Graig Oglivi from Colorado State University, finding an increase of lactate acid and insulin in the blood of cancer patients. His recommended diet, based on his research, eliminates or minimizes grain carbohydrates; especially the easily digestible ones found in most commercial kibbled foods. His recommendations are a diet consisting out of meat, fish, vegetables, fish oils and mineral and vitamin supplements (6). We may also want to take a look at these recommendations for prevention of the accumulation of Damp-Heat in the intestines! Raw food is better as it does not alter or destroy amino acids. In immune suppressed animals we may want to consider cooking the food to reduce or minimize the possibility of bacterial infections from the food.

Anti-oxidants. The use of antioxidants is sometimes controversial especially when chemotherapy is used. The increased metabolism of rapid growing cancers creates more oxidative byproducts (free radicals). These products have an inflammatory effect on the surrounding tissues, which stimulates and maintains cancer growth and production. Chemotherapy treatment produces even more free radicals. While initial research suggested a negative effect from the use of antioxidants during chemotherapy, more recent research shows that the use of these nutraceuticals are not contra-indicated during chemotherapy. We advice anti-oxidants use in between chemotherapy treatments. Vitamin C (100mg / 10 lbs 2X per day), vitamin E (100.IU per 15 lbs twice daily), Hoxey Formula, fish oils, grapeseed extract etc is the most commonly used anti-oxidants.

Vaccinations.
Vaccinations are a “Toxic Heat” from TCM perspectives. It is probably more the adjuvant that causes the damage then the viral particles itself. Some vaccines have a higher immuno-genecity then others (stimulates the immune system stronger). Research done by Dr. Jean Dodds (13) showed that repeated vaccinations in sensitive animals could lead to immune mediated thyroiditis. Her recommendations, supported by Ron Schultz, Immunologist at Wisconsin University (14) supports a longer immune response to vaccine then 1 year. The options of testing blood levels for antibodies for distemper and parvo helps us to make decisions about the need for booster vaccinations. The author does not support a “No vaccine” protocol as many veterinarians have experienced losing entire litters or individual dogs/ puppies to parvo in the no vaccine protocol. However, I also believe that vaccines need to be addressed for their safety in immune sensitive animals and the duration of immunity.
Dr Dodds “Rabies Challenge” research is most worth while supporting (13).

Summary.

In summary TCM has a lot to offer in the treatment of cancer. Using the pulse and tongue diagnosis, listening and a careful history intake, palpation of the acupoints, a patient’s individual TCM diagnosis and pattern of disharmony can be established. The correct diagnosis will indicate what to do to help the patient.
At present an integrative approach is the most successful, using surgery, western cancer Tx, diets, acupuncture, and herbal supplements and nutraceuticals where indicated.
In closing I would like to urge you all to please publish your successes so we can all learn form them and help to unraveling the puzzle of what causes cancer in the first place. In This way we can increase our understanding in how to effectively treat this devastating disease in the best way. Beyond treatment, let us continue to attend to what contributes to cancer growth and to unravel its puzzle as to its genesis.

For Holistic approaches to cancer see: “A Holistic Approach for the Treatment of Cancer “ Joe Demers DVM, CVA, CVH  Journal of the American Holistic veterinary Medical Association January 2005 Vol. 23 number 4 page 31

And Tree of Life Veterinary care website at: www.treeoflifevet.ca

References:

1. Cancer and the Immune System, Marlene Smith-Schalkwijk DVM AVAC Calgary July 28 1999
2. Veterinary Immunology, Ian R Tizard.
3. A Holistic Approach to Cancer with Traditional Chinese Medicine, Cheryl Schwartz DVM Galgary AVAC July 28 1999
4. Biology of Belief, Bruce Lipton www.brucelipton.com
5. Treating cancer with Chinese Herbs, Hong-Yen Hsu, PH, D, Oriental healing Art Institute. (Translation of Chronic and Recalcitrant diseases by Dr. Hong-Yen Hsu. Printed in Taiwan)
6. Nutrition and Cancer: Frontiers for Cure! Gregory K Ogilvie, DVM, Dipl. ACVIM American Holistic Veterinary Medical Association 1998 New Orleans
7. Controversies in  Veterinary Oncology: Complementary/ holistic Cancer Therapy- Fact or Fiction? Gregory K Ogilvie D.V.M, Dipl. ACVIM ; American Holistic Veterinary Medical Association New Orleans 1998
8. Managing the Veterinary Cancer Patient. Gregory K Ogilvie, Antony S Moore. Veterinary learning Systems 1995.
9. Cancer vaccines Preeti, Gokal & Kochar www.csa.com/discoveryguides/cancer/abstract/
10. www.histiocytosis.ucdavis.edu/sarcoma.html
11. Canine Hemophagocytic Histiocytic Sarcoma. P.F. Moor, V.K Affoter & W. Vernon U.C. Davis Vet. Pathology 43:632-645 (2006)
12. Dr Candace Pert, Molecules of Emotions www.candacepert.com
13. Jean Dodds DVM Hemopet (rabies challenge fund)
14. Vet. Therapeutics vol 5 no 3 Fall 2004

All three dogs of the same litter of English Cockers were affected with anal gland adenoma carcinoma

Two year old Flatcoat retriever was presented with a “Histiocytoma” in the ear, which progressed to generalized Histiocytosis in all internal organs.

Family of Bernese, mother in middle, two litter- mates brother on top and single pup from same breeding. All 4 dogs died of Histiocytosis. Brothers died on same day!

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