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The Big C

Cancer sucks. I've procrastinated writing this entry because it's a very personal subject, as I'm sure it will be to many readers. My grandmother died at a very young age from colon cancer. I lost a dog to liver cancer a few short years ago, and of course have lost many wonderful patients to cancer over my career. But it's an important subject, and I felt it would be good to blog about since it affects so many people and animals, so here goes:

Theory

Traditional Chinese medicine looks at cancer in an interesting way. In a healthy body, qi and blood circulate through the meridians and imbue movement, nourishment, strength, and vitality to an animal. (For more on Chinese theory, please see the articles in the Services section on
acupuncture and herbal medicine) Cancer begins with the accummulaion of an abnormal substance roughly translated as "phlegm" in English. Phlegm can be thought of as energetic fly-paper: sticky, goopy stuff that accumulates within the body and interrupts normal function. It can be carried through the body, lodge in a meridian and block the flow of energy, causing heart attacks and strokes, or it can act in a more subtle way. As qi and blood course through the body they can be grabbed by phlegm, like fly-paper or a spiderweb ensnares a passing fly. As qi and blood continue pass by more of these energies are trapped and accumulate, eventually tangling together. I envision it like a snarled fishing line; the more line you feed it, the bigger it gets. (Yes, I am the King of Simile). This tangle grows until we appreciate it as a mass, and just like fishing line is a bear to undo once started.

So what creates this phlegm in the first place? If I knew the answer to that in every case, the rest would be easy. Certainly things that damage normal function, like toxins and viruses, are culprits. Aging animals also create phlegm as the body becomes less efficient and waste products build up. Food plays a big role. We know that certain foods are likely to produce more phlegm in the body than others. In carnivores like dogs and cats high carbohydrate loads, commonly found in processed kibble and grains are factors that lead to phlegm. Dairy is another. Herbivores are another matter, they have a higher tolerance for grains and carbohydrates, though excessive sugars like molasses can lead to problems in them as well. Perhaps a better way to look at food is that the feeding of a
species-inappropriate diet leads to phlegm accumulation. With this perspective, maybe we can look at high cancer rates in dogs and cats as opposed to the relatively low occurence in horses as being correlated to the types of food we put into their bodies. Which species is being fed closer to their optimal evolutionary diet? Dogs? Hardly. How often would a wild canine come across, and eat, any grains? Horses, especially those being fed high levels of hay and grass and little grain at least approximate a wild equine diet. And yet, there are dogs out there (I know, I see them all the time) fed fantastic raw food or home-cooked diets and still get cancer. Why?

Part of the answer lies in an individual's constitution, or genetics, to put a more modern spin on it. Hang around dogs long enough, you'll find certain breeds have a much higher predilection for cancer: Golden Retrievers and Boxers are two that come to mind. One thing that most of the individuals of these breeds have in common would be their constitution, as defined in Chinese medicine. We consider these animals a Fire constitution, and they are characterized by their exuberent friendliness, energy, and overall joyful and happy personalities.

With Fire we think of heat, and indeed, these breeds are prone to many other diseases with heat at their core: allergies, inflammatory bowel disease, and ear infections, to name a few. Chronic heat may also lead to cancer. Think of it this way: if you want to reduce a sauce to something thicker, you leave the pan on the heat for longer, right? Phlegm can manifest in the same fashion: heat, over time, thickens normal fluids in the body until they become a more dense, stickier substance which eventually transforms into phlegm, which in turn has potential to start the cancer-tangle. Of course, not every Fire individual will get cancer, but in some individuals, this constitution is so strong that they may overcome one type of cancer only to succumb to a wholly different tumor down the road.

Treatment

The first bit of advice I give to people who have an animal with cancer is
"Get Ye to an oncologist". This is not to say that I have nothing to offer, simply that in most cases Western medicine has a better answer, and when time is of the essence better is, well, better. Chemotherapy, radiation, and even surgery offer faster and more aggressive treatments, an approach more likely to garner results in the short term. There has been great advancement in veterinary oncology in the last couple of decades, to the great benefit of patients. The down side to these therapies is that they can be expensive, they may not gain as much additional time as we would like, and they sometimes result in side effects that make you wonder if the time gained is of worthwhile quality. So where does Chinese medicine fit in?

Personally, I like the integrative approach. Now "integrative" may be the latest catch phrase, along with complimentary, comprehensive, and mixed medicine; all ways of saying "let's throw everything at this case and hope something sticks." Actually, that's not as bad as it sounds, because often something
does stick, leading both oncologists and alternative practitioners to claim credit, in spite of all that other nonsense that was tried. When chemo, radiation, or surgery is opted for I'm more than happy to sit on the bench and use herbs to treat side effects like nausea, diarrhea, or loss of energy. Herbs can treat the anemia that results from many chemotherapy regimens or help with healing and pain relief after surgery. Once patients are through their primary treatment, additional herbs can be used for fighting cancer and keeping it in remission.

What if an animal is too fragile for aggressive treatment, or the treatment is too expensive, or a patient has severe enough side effects that treatment needs to be discontinued? Well, in these cases herbs can be used alone. This is done in a stepwise approach. First we spend time, sometimes weeks, using herbs that "untangle" blood and qi, get phlegm out of the body, and break down the mass. This might include herbs like
San Qi (pseudoginseng), Tian Nan Xing (arisaema), Qing Dai (indigo), or Hong Hua (safflower). After a time, the herb mixture is changed to do less untangling and more breaking; this is when tumors might actually shrink. It is also the time when acupuncture might come into the mix. There are different views on using acupuncture to treating cancer patients. My own is that it should be avoided in the initial stages of treatment, because acupuncture can strongly move qi and blood, and if the tangle is tight there is a good chance of feeding into the tumor and accelerating the disease. In my mind, once a formula has changed to focus more on breaking down a mass, then acupuncture is more appropriate. Herbs used to fight cancer are strong, and can cause side effects similar to chemotherapy, though not usually as severe, so delicate patients are less likely to be at risk of harm.

There are, of course, cases that are impossible to cure, or even slow the progress of, the disease. In these patients, herbs are chosen to help make whatever time is left as comfortable as possible. A real-life example is a dog I saw about ten years ago, an older German Shepherd riddled with lung cancer. Now, as is often the case, this dog showed no outward sign of being ill until he had only a few weeks to live. All of a sudden he was lethargic, anorexic, and generally miserable. His owners were a bit shell-shocked and not ready to say goodbye. We came up with a mixture of herbs that perked him up, allowing him to resume the nightly walks he so enjoyed, and got his appetite back on track. He didn't live but another two weeks, but in that time he was happy, and it allowed his family to come to grips with his passing and spoil him rotten in the meantime, and it allowed this dog to enjoy himself for a while longer. It felt really good to be able to do this for both the dog and his people.

Yes, cancer sucks, and there is no magic in Chinese medicine, just as there is no magic in Western medicine. We do what we can, hope for the best, and pray that in the end we did right by our patients.

In Memory Of Barclay

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