Sadly I must start this story with a warning...
IF your dog's "benign" histiocytoma does not resolve itself and returns after it has been surgically removed, you must assume it is this aggressive horrific cancer!!
Her name was Isabella and we called her Elly. She was the color of fawn - A BEAUTY inside and out! She was an English Mastiff and was born September 20, 2004 (the day we buried our "baby boy" mastiff Ripley who was almost 11 years of age). Elly was only 4 years old when she went to Rainbow Bridge on May 28
, 2009 only two days after a grandchild was born. When I went to "just look" at her litter, there were only 3 puppies left. She was the only one that came over to me to say Hi. It was love at first sight "...like the echoes of our souls on meeting..." and my heart was instantly melted! She was as soft as velvet and a very happy little girl. Of course, I brought her home and we were "joined at the hip" from the moment we met.
Elly was a LOVE, pure and simple. Our eyes would meet and she would wag her tail, as if to say I Love You! When she was not laying her head in my lap, her other favorite position was laying like a frog. She was such a soft sensitive cuddler. And although she was a registered English Mastiff, she reminded me so much of a Golden Retriever! She was so smart and picked up all sorts of talents mostly from watching her big sister, Emma! She wasn't thrilled about showing and was quite petite for a mastiff, but quickly became an AKC champion even in our novice hands. Her breeders gave her a good head start and were wonderful mentors. With very little coaching, she earned her Canine Good Citizen award as well!! Elly was also very vocal often reminding us of what she wanted more than anything – to be close to us! And all of her OFA health testing came back good/normal. So we had big dreams of breeding her and passing on her tremendous beauty...
To begin with, she was very healthy. However, around her first birthday, she developed a histiocytoma on the bottom of her front right foot directly below her dew claw. It did not resolve itself and continued to grow so we had it surgically removed in April 2006 when she was about 1 ½ years of age. What a relief when the biopsy report came back benign!
However, several months later in January 2007 we noticed that the same histiocytoma was beginning to grow back. Again we watched it and waited for it to resolve itself, but it did not.
Then in March 2008 - quite rapidly - she became gravely ill: she became uncoordinated, clumsy and very weak especially in her hind legs. She acted like she had forgotten how to eat and had little interest in eating. At times she would be trembling and shaking and would shudder with every breath. At other times, she was listless and lethargic not getting up in the morning to go outside to relieve herself and staying in bed for extended periods of time. Her vision looked impaired. She would cough, choke, gag and/or squeak while trying to eat. But the strangest behavior was making very primitive noises like she was roaring and seemingly she had forgotten how to bark! Her breathing was very rapid along with excessive panting, and she was drinking excessively. At times, her nights were very restless and agitated and she seemed uncomfortable. While sleeping, she would startle and awake with an intense jump! The left side of her face would draw up when she was excited. Her fur darkened around her legs and chest and she had crescent spots on her tongue for a time.
The list of her symptoms was very long and it was apparent that some of the vets actually thought we were over-reacting and imagining things... After 5 weeks of running back and forth to several vets, testing for everything under the sun, dealing with hypertension, pancreatitis, a possible UTI, giardia and hepatitis, it was finally determined through a blood test that she had a positive titer [1:40] for Neospora!
It is a protozoa that causes spontaneous abortion in cattle and is passed back and forth between canids and cattle. Neosporosis can also look like Coon Hound Paralysis.
Therefore, with the exception of cancer, everything else had been ruled out including pyometra, Addisons, torn cruciate, hip dysplasia, myasthenia gravis, all the tick borne and fungal diseases, so we went with neosporosis as being the cause of all of her ills. All of this craziness started March 12, 2008, the day we had our other mastiff, Emma, spayed. When we brought Emma home, she was understandably not feeling well and charged Elly over dinner.
However looking back, one of the internal medicine vets who saw Elly was concerned about an "occult neoplastic process or a primary immune-mediated disease." Another internal medicine vet also noted a "slightly irregular patch" on her spleen. This particular vet diagnosed hypertension, hepatopathy, anorexia, toxicity [possibly to flagyl] and lethargy. Had we not all been totally exhausted at the end of 5 weeks, we should have pursued these two concerns. But the apparent "infection" from the neospora blinded us to the possibility of cancer. A year later, the oncologist would call Histiocytic Sarcoma, Cancer of the Immune System...
Finally, as we started treating her with 1200 mg. of Clindamycin (the drug of choice for neosporosis) twice per day, she gradually began to improve and her symptoms subsided. However, it was a very slow process and she initially had to be hand-fed roasted market chicken to get her appetite going. She had lost a great deal of weight from 150+ pounds down to 126 pounds. Eventually she began to eat on her own again and it appeared that she fully recovered from the neosporosis (although it is never "cured" but just managed - apparently the protozoa are never totally eliminated from the body).
We had been strongly advised to have her spayed since heat seasons are very stressful and the stress was likely to allow the neospora to multiply again. She appeared strong enough for surgery in September 2008 and we went ahead with plans for spaying her when she started her last season! So it was the following month, October 2008, when she was actually spayed and at the same time had the 2nd histiocytoma removed from her front right paw. The biopsy from the 2nd histiocytoma surgery came back benign
... More relief... The tumor was troublesome but not to worry because it was benign...
Then early in February 2009 we started noticing more "histiocytomas" emerging on other parts of her body, and the ones in her front right foot also began to re-emerge with one actually coming up right through her pad... The multiple histios were growing with a vengeance! We were becoming very concerned and took her to our local vet on March 31, 2009. He wanted to "cut them all off" and biopsy all of them. We were still in deep denial [hadn't they always been benign?] and thought this was a terribly radical approach! When the vet said he would have to remove her pad and re-attach it - that it would be a difficult recovery - we were in shock!! We just kept thinking the tumors are BENIGN!
What is happening??? Although by this time, there was also a "lump" forming under the skin behind her front right foot pad along with multiple other tumors emerging on this same poor foot which had been so traumatized. The vast majority of her tumors were on her right side!
Then, on April 4, 2009, while we were sitting on the couch, I felt a lump in Elly’s right hind leg (what I would call the back side of her thigh). My heart sank depths, and I instantly sensed she was in trouble. The lump was about the size of a golf ball and very hard. It was also directly above the tumor that had been growing since early February on the top of her right hind foot. So now, the tumors were definitely spreading and no longer localized... We wanted her breeder to see what Elly was struggling with before we allowed our vet to go knife crazy...
So on April 7, 2009, we took Elly to her breeder's vet who did a fine needle aspirate of 4 tumor sites with the following results: 1) right hind leg popliteal lymph node: possible histiocytic lymphadenitis, 2) right chest/abdomen: probable discrete cell neoplasia, 3) right cranial elbow: possible histiocytoma, and 4) palmar aspect of the right front foot: probable histiocytic neoplasia. The report noted concern for systemic histiocytosis and histiocytic proliferative disorder, and strongly recommended surgical excision and histopathology. We were then referred to an oncologist and made an oncology appt for April 16, 2009... not realizing the extreme aggression of this disease. All along we are being lulled into thinking it is benign
... On April 10, 2009 the tumor on the top of her right hind foot became infected. The vet cleaned it and gave us cephalexin to administer orally – more antiobiotics...
Our first consultation with the oncologist was on April 16, 2009. In spite of the above cytology report, the oncologist did only two "real" biopsies: 1) a small sample from her front right foot, and 2) the right hind leg (popliteal) lymph node. On the same day, he also did an ultrasound, chest x-rays, and a bone marrow aspiration. He said that all internal tests came back clear – that everything on the inside looked good. At this point in time, the oncologist was leaning towards Cutaneous Histiocytosis which gave us all tons of - what turned out to be false - hope. The oncologist sent her tissue samples to Colorado State University and on April 24, 2009 we got back the following results: the front right foot was again thou
ght to be a benign histiocytoma
. However, her right hind leg lymph node was described as Histiocytic Sarcoma!
Elly's front right foot was clogged with histios of various shapes, sizes and appearances, but the report came back benign!?! How could this be??? I believe this is because just a small area of the multiple tumors on her front right foot had been sampled and the malignant ones were missed... I cannot believe that all the tumors on her front right foot were benign... We were all hoping for the best and in the process missed the gravity of this horrific disease! With this disease we must assume the worst! There is no time to be wasted hoping for a lesser form of histiocytosis.
Getting back to the angry lesion/tumor/histio – whatever it was - on the top of her right hind foot: I mentioned to the oncologist that I had read that localized histiocytic sarcomas (LHS)
should be removed referring to the huge one that had been growing on the top of her right hind foot, probably "feeding" the local lymph node. The oncologist did not want to remove this lesion. He wanted to use it as a "marker" to determine if she was responding to chemo. He was at a loss for words to recommend any effective treatment but did say he would try doxorubicin, prednisone and CCNU if she were his dog. He also said that even the experts can't agree on this dizzying array of histiocytic diseases and that there really wasn't much that could be done. For some reason, he did not seem to hear me when I spoke of amputating the affected limb (not an option for us) and/or surgical removal of the offending lesion. This was a grave lack of communication about a very confusing and little understood set of diseases. Click here for more photo's of Elly's histio's.
We never imagined that our precious, beautiful, sweet little girl would have the horrendous cancer that strikes Bernese Mt. Dogs. So when he hesitatingly said he would do doxorubicin and CCNU [Lomustine] and Prednisone if she were his dog, we were reluctant and resisted being aggressive... (CCNU is a "pill" that is given every 3 weeks as opposed to the toxic doxorubicin which must be given via IV). At that point we really did not know that we were dealing with such a horrific disease!! It still had not dawned on us that she was going to die!?! We knew that a sarcoma was serious business but still had high hopes of a cure...
Her first chemo treatment was on Thursday, April 30, 2009. We went with chemo because we had to trust his expertise. We hoped the CCNU/prednisone combo would help with what we were still thinking was a mild case and really had no clue about this cancer's aggression!!! So the CCNU/prednisone was a compromise although prednisone was taboo for dogs with neospora as it suppresses the immune system. She was on the prednisone 2 days and immediately started regressing back to the rapid breathing which she had with the neospora. I am still thinking and focused on “neosporosis” and thinking it is coming back and thus cut the prednisone back to zero in 5 days. And now kicking myself: if I had stayed with the pred, would she have survived???
We painfully discovered, Histiocytic Sarcoma is a FIRESTORM!!!
By Saturday, May 16, 2009, her front right chest had also become extremely swollen. We took her to our local vet thinking she may have been bitten the night before by a bat or snake. My husband had let her out back without his glasses on and saw her "jump" after touching her nose to the ground. Our local vet said it was not a bite but that her lymph node in her shoulder was causing the swelling. Due to this swelling, she also had difficulty lifting her right leg to climb up on the couch. The oncologist's associate (2 hours away) wanted us to bring her in for evaluation but we had just been down there on Thursday and didn't have the energy to drive another 4 hours... and in our hearts something told us it was futile to continue running...
On Thursday, May 21, 2009 (one week before she passed), she had her 2nd CCNU treatment. Her stomach was already looking swollen and red but the oncologist did not think it remarkable. I agreed to once again try the prednisone along with the antibiotic Bactrim (in case the neospora might again multiply). We were becoming alarmed at the look of her swollen and inflamed abdomen which we had initially noticed and mentioned to the oncologist clear back on May 14. On Saturday, May 23, I panicked and called the oncologist and again mentioned her inflamed and swollen abdomen to him and also emailed photos of it to him. He said he would call me if he saw anything remarkable - he never called.
On Tuesday, May 26, a grandchild was born. The next day, Elly was seen by our local vet to determine if there was anything he could do her for her fully distended, painful and inflamed abdomen. He said he could feel numerous tumors and that there was nothing he could give her to relieve her suffering. She was also having great difficulty stooping to go to the bathroom which by this time had become projectile diarrhea. She was also leaking urine all over. She had also been crying several nights in a row and had great difficulty getting up to go outside to attempt to relieve herself. Her hind leg was swollen and baggy and she was limping on it. She was also limping on her front foot as it was clogged with various tumors that were obviously painful. (With her first two foot surgeries, she did not limp one bit). She could barely get around... Her last few nights, I had my hand on her all night long... She could barely move... She was telling us it was time...
We could no longer watch her suffer and should have ended her suffering perhaps a couple of days sooner, but I had to be at the birthing... My heart was torn and broken... The following day, Thursday, May 28, 2009 our local vet was off, but we had one of his associates come to our home along with two of our favorite vet techs. They gently placed Elly in our van and gave her the pink injection that would end her suffering and send her to Rainbow Bridge. She went down very quickly as if in a very deep slow-motion sleep. I pray she awoke in a beautiful meadow where Millie and Ripley were already there waiting for her. It was so painful for us, and I pray so quickly for Elly. Who knows how quickly we go from life to death – hopefully it is instantaneous - a heart-beat away? It is said that death is not the end but just the beginning.
She declined so rapidly... When we looked up, she was gone... We took her to our pet cemetery to be buried next to our first two mastiffs, Millie and Ripley. She was such a loving gift and such an angel!! ... Elly helped us heal from losing Millie... We miss her terribly and will never be the same... Although our time with Elly was a very brief 4 years, our lives have been forever enriched with her love and joy and she will always be in our hearts... The lesson we learned from Elly is this:
Act aggressively immediately!! Had I not been lulled into thinking she was okay due to the first two benign biopsies, and had I known she had this awful hideous disease that steals souls away in the night, I would have taken a RADICAL approach! Or... perhaps I should have done nothing knowing she would die anyway giving her a small measure of peace while she was still here and not running her all over the country-side poking and prodding her for the sake of tests... Perhaps I should have done nothing more than sit by her side with her head in my lap and just stayed with her until her time had come. It is a very personal decision and looking back I with hindsight, in our situation, I believe the latter choice would have been best for Elly.
But I didn't know she was dying. I had false hope! Not just from my own denial but also from the oncologist’s initial thoughts. I regret he did not say these words to me: "Look! We potentially have an extremely aggressive cancer on our hands and we must act aggressively!" But he didn't. We had to let her go less than 5 weeks after her diagnosis of Histiocytic Sarcoma...
Looking forward, I wonder about following as either irritating and/or aggravating factors with her immune system or actually causative agents in the process of developing histiocytosis:
1) maitake mushroom for "immune system support" may have been a factor in this cancer of the immune system...A vet suggested we give this to combat the histiocytomas,
2) the microchip irritating her immune system,
3) the possible melamine in the kibble,
4) the bordatella vaccinations every 6 months while we were showing her,
5) the massive doses of antibiotics she was given to combat the neospora.
6) Like Bernese Mt. Dogs, did she have the genetic form of histiocytosis and was she predisposed to it?
7) If she truly had neosporosis in 2008, could the neospora have driven her immune system crazy?
8) Or did a somehow weakened immune system allow the neospora to take hold and multiply?
9) Or did she ever even have neosporosis?
10) The more I think about it, the more her illness in 2008 looks like it could have been just the beginning of the histiocytosis?
So many questions and so many tears. With selective breeding, why can we not breed healthy dogs? When breeding or buying puppies we must insist on a full disclosure of the health and temperament issues that might be encountered. That will be our gift to our loved-ones who give so much and ask for so little.
With Much Hope, Love and Prayers,
Roxanne, Jack + Emma (Elly’s sissy)