Elliott with his mum

Elliott's Journey

The story of 17 months with osteosarcoma

The following is probably one of the more challenging narratives, I have engaged in. I´ve been staring at the heading and the empty page for almost an hour, realizing that I don´t really want to go to that place again, however, I’m also acutely aware, that I must share, to ensure that Elliott´s journey hasn´t been in vain.

Elliott was one of those special beings; he was the embodiment of everything I could ever ask for in a dog. He was intelligent, loving, gentle, confident, never needy, all toppled off with that special charm and sense of humor, which you can find in Wolfhounds. I don´t recall ever training - or correcting him: All I ever had to do was ask him nicely and he would trust me enough to do just about anything unquestioning. His trust was one of the key elements in a 17 months long battle with cancer. This trust allowed us to treat him, and take him through the ordeals as a day patient at the hospital, which are physically and emotionally taxing for anyone who has to go through the course. Although Elliott was a much loved dog, that in itself did not make him more eligible for the path in store; it was his general constitution, physical fitness and his mental stability which convinced me that he could manage, which he did really well until the end.

An experiment

Even in this day and age, cancer is a devastating disease, which is the most common cause of death in dogs, and the second most common cause of death in humans. I decided that I would undertake Elliott´s care as an experiment. I wanted to explore what could be done for a dog with such a life threatening diagnosis. Admittedly, it was a rather unscientific experiment in the sense, that I had too many feelings involved, and I included a wide variety of approaches simultaneously, to the point where I can´t clearly say which one had the most significant effect.

Long before Elliott was affected, I had decided that, should I ever encounter osteosarcoma again in any of my dogs, then I would try palliative radiation therapy. I have been working for a number of years, trying to find an applicable protocol for selectively breeding long lived and healthy dogs. The Elliott experiment had a completely different objective:  To explore what can be done for the dogs, who, are affected with a deadly disease like cancer, in spite of our best efforts. Elliott was young, well muscled and very fit. He was also a dog who did not stress easily. I would probably not have put one of our veteran dogs through this kind of ordeal, but for all practical purposes, he was a good candidate for the treatment I had chosen for him.  

Elliott - February 2015, we had no clue yet...

The subtle early signs

Early in 2015 we noticed that Elliott was “slightly off “ on his left hind leg, on our daily walk in the forest, the following day he would be sound again, so we thought nothing of it. A few weeks later the same thing happened, but seemed to fix itself without further ado. I took him to our veterinary chiropractor, thinking he had some issue in the lower loin. He was adjusted, and all was well for a while. As a precaution I took him for a second adjustment 3-4 weeks later, and all seemed well. Another few weeks went by, when he once again seemed a bit off on a morning walk, so we took him for a 3rd. appointment with the chiropractor, who commented, that she couldn´t find anything major with him, but we should have an x-ray taken of his left femur and knee. I got an appointment for an x-ray; it was as if there was a little bullet hole just above the condyle (distal femur). It did not have the typical sunburst pattern of an osteosarcoma, so my vet wanted to get an evaluation from an orthopedic veterinarian before any diagnosis was made. He said that we could be dealing with an osteomyelitis or possibly an osteosarcoma. It was a heart wrenching perspective; Elliott was just over 4 years. As a breeder of nearly 40 years, I had unfortunately had some previous encounters with osteosarcoma, but never in such a young dog, which is probably why, that I was so slow to pick up on that possibility.

Over the last 10 years or so, I have encountered periodic reports, from wolfhound owners who have opted palliative radiation therapy for their dogs with osteosarcoma, and the results were quite remarkable. I had only experienced survival times in my osteosarcoma cases, varying from 1 to 6 months at best. I learned that in several of the reported cases, where palliative radiation was given, they experienced survival times, which were often around one year post diagnosis.

Elliott scan

We made an appointment at the University Hospital for Companion Animals in Copenhagen, where I was allotted a spot for radiotherapy for Elliott in a Ph.D program. He had a CT scan (see above), and a biopsy was extracted and sent to a laboratory in the UK for histology. The final diagnosis confirmed: Elliott´s bone lesion was a medium-grade osteosarcoma. 

Report

 

 

 

 

Elliott CTThe biopsy

The biopsy caused him discomfort for about a month. The oncologists were getting increasingly concerned, they would like to see some improvement from the radiation (see photo on the left) sooner than was the case, or the prognosis would be bad. Finally he picked up and improved to the point where he completely stopped limping. We took him off all oral analgesics, but maintained him on natural anti-inflammatory supplements, details will follow. Elliott had an almost normal summer, where he was a happy well functioning dog. We were careful though, that he didn´t romp and play too wildly, for there is always the risk of pathological fractures, since the bone is weakened at the tumor site.

After an amazing 5½ pain free months, Elliott started limping again, ever so slightly. He was given a single dose of radiation, which did not have the same degree of pain management as the initial course of radiotherapy. Before the treatment he was scanned again, and according to his oncologist, Pernille Holst, there was visible activity, but the tumor had not grown significantly since the initial scan. 

The importance of a stress free environment

It had become quite clear, that Elliott needed a very routine like, and completely stress free environment. Whenever he got stressed – or if I did, he would get poorly. If I had to go away for a few days, I would return to a lame dog. If the bitches were in season, he would get lame, so we decided to chemically castrate him, to reduce this stress factor. It was a continuous learning process, in which I had to stay constantly observant and alert. We found a good balance; through the autumn he was doing remarkably well. He was sound on the walk and just slightly off on the trot. He was eating and acting like the normal happy dog, he has always been.

One important point, which this journey has taught me, is to accept that your dog will not be able to exercise like a normal dog ever again. There is a risk of pathological fractures at the tumor site.

Just before Christmas he got sick with gastro enteritis, and it was as if it started a domino effect of other problems. His tumor got warm, and I knew there was new activity. I managed to get him back in balance, but wanted to know how things looked. In January 2016 Elliott had the second entire body scan, which revealed metastases of the lungs. In my confused emotional state, I thought I would have to let go then and there, but regaining composure; I realized that the scan was merely a picture of the status quo for the cancer, and that I should look at the dog to make the assessment. He was still the ever present, happy, loving Elliott who ate his food and had not resigned from daily life in any way. I added Ginger to the vast array of supplements he was already getting. He had it in his food and I rubbed it on the tumor-site along with Traumeel gel. It had an amazing local anti inflammatory effect.

Elliott - May 2015Pain management in Osteosarcoma patients

Osteosarcoma is an extremely painful condition; thus, pain management is one of the great challenges in caring for these patients. Many veterinarians happily prescribe Non Steroid Anti-inflammatory Drugs (NSAIDS) for long term use in dogs. I am sure that some breeds tolerate long term treatment with this type of drug better than others. There are also individual differences, with regards to how well the drug is tolerated.

It is, however, extremely important, to understand that the majority of Irish wolfhounds have a very low tolerance to treatment with any of the NSAIDs. Most Wolfhounds will manage fine up to about 3 days on NSAIDs, after that they will begin to lose appetite, become listless and finally develop gastric ulcers. Elliott was no exception, he would develop bloody diarrhea after 3-4 days on NSAIDs, so when his initial pain-relief from the radiotherapy stopped working, we had to think constructively, knowing that if we could not manage his pain, then the only other option would be euthanasia. His oncologist prescribed a drug called Cytotec, an anti acid /gastric ulcer medicine which is also recommended for long term usage of NSAID treatment. He was then able to tolerate daily treatment of Metacam without adverse effects. He got this in injectible form, as this seems to cause less gastric upset than with oral administration.

One of the causes of pain in osteosarcoma, are the micro fractures in the porous bone at the tumor site. In order to minimize the bone weakness, Elliott received a monthly zoledronic acid drip, which is a drug in the bisphosphonate family, which aims at strengthening the bone at the tumor site, by packing calcium back into the porosity of the diseased bone. Even with this treatment, the dog will still be prone to pathological fractures, so extra care is needed in the form of controlled exercise.

Diet and supplements as important elements of the cancer protocol

I am neither in favor nor against the use of either conventional or alternative treatments. I have basically tried to harvest the best possible elements from both worlds.

As soon as I discovered that Elliott had cancer, I switched him to a high protein diet, rich in fat, omega oil, vitamins and minerals, but pretty much void of carbohydrates, as these are known to “feed” the cancer.

All through Elliott´s course I would discuss the various approaches with his oncologist. As soon as he was done with radiation and chemotherapy, I started supplementing his diet with significant doses of turmeric (we have gradually increased his dose to about 100 ml of the paste morning and evening). Turmeric has been used in alternative treatments for a long time and is also gaining a growing interest within the scientific community. Elliott benefitted tremendously from the turmeric supplementation: It has remarkable anti inflammatory properties. It was obvious that if we could keep inflammation down in the tumor site, there also seemed to be little or no activity in terms of tumor growth. I treated the tumor site topically with Traumeel Gel. The University hospital was unable to get any of the osteosarcoma vaccines, which have been developed in a couple of American universities to Denmark. Instead I opted to give him an immunomodulator, Rimulanas a weekly shot.

His daily supplements consisted of:

Turmeric paste with coconut oil and black peber. It is anti inflammatory, antibacterial, and some research shows that cucurmin, which is an extract of turmeric, has cytotoxic properties. We have gradually increased his dose to about 100 ml of the paste morning and evening.

Dried ginger powder has similar properties as turmeric, seemed to work really well in conjunction with the turmeric.

Astragalus root powder which is an anti bacterial, immune boosting and supposedly a telemorase enhancer. It was mixed in his food morning and evening.

Blueberry powder 50 ml is labeled  a superfood , which is full of phytonutrients such as flavonoids and antioxidants).

Rosehip powder, which has anti-inflammatory properties, contains a variety of antioxidants; carotenoids, flavonoids, polyphenols, leucoanthocyanins and catechins and is rich in minerals, calcium and vitamine c.

Devils claw powder, which is another anti-inflammatory plant, a heaping teaspoon was mixed in his food twice daily.

Omegaoil 25 ml twice a day, it is a combination of hempoil, linseed oil and rapeseed-oil.

 Milkthistle seed powder and artichoke powder for liver detox and health.

I added a general vitamine/mineral powder,

a time release vitamin B-complex, 3000 IU of vitamin D, extra vitamine C.

Both of Elliott´s daily meals consisted of raw beef with all the supplements.

I am aware that  it is a crazy amount of things, but I couldn´t be purely scientific about it. Elliott was my much loved dog and not a lab. rat;  hence the sawed off shotgun approach. In January 2016, I added the ginger and the artemesian (which is reported to be an angiogenesis inhibitor) – this  brought on the most significant change  in the following  3½ months.

I gave him the equivalent of a heaping teaspoon full of dried ground ginger X 4 daily, plus I rubbed his tumor-site with concentrated ginger tincture and Traumeel gel.

If I am to sum up what I think has made the most significant difference: I would say the radiation, the bisphosphonate, ginger and the turmeric. I think a general high quality diet, no carbs, but good quality Omega oil is extremely important as is the vitamine D.

Food supplements

The subtle decline

 In December 2015 we had to return to the analgesics. We put him on Tramadol retard, twice daily, we have later incorporated Gabapentin and one injection of Metacam daily, because we have added a drug called Cytotec, which protects against gastro-intestinal ulceration; he was able to tolerate NSAIDS, something which was completely unthinkable previously.

At some point in the palliative course, it will not be possible to manage the pain from osteosarcoma without NSAIDs such as Metacam, or any drug in this family. It is of the utmost importance to understand that, Wolfhounds are extremely sensitive to all drugs in the NSAID family, and will develop gastric ulcers after as little as 3 – 5 days on this drug. Therefore adding the Cytotec is a must for any long term treatment.

The personal investment

My journey with Elliott lasted 17 months. He became the record holder for survival time for non amputated osteosarcoma patients at the Veterinary Hospital. I must say beyond our wildest expectations;  he did remarkably well. There were ups and downs along the way, but I gradually learned how to bring him back in balance, should he fail. Elliott´s journey was meant to be an experiment; I wanted to see how much could be done for the quality of life of the dog, when faced with a deadly disease such as osteosarcoma. I opted to bombard him with an array of phytotherapeutic extracts with anti inflammatory, anti bacterial and cytotoxic properties. I read about cancer for the entire 17 months. I tried to concentrate on plants and extracts of plants, which had at least some degree of scientific backing. It should by no means be perceived as a manual for dealing with osteosarcoma, but rather a description of the path I explored, which combines conventional with alternative treatment.

But be sure of one thing; it is a path which will drain you emotionally and in every other way. Caring for a terminally ill patient requires your attention 24/7. It will inevitably become an emotional roller-coaster for the caregiver. The bond becomes incredibly strong, as does the grief when the patient departs. It is not for everyone, I couldn´t do it again anytime soon. – It is important to understand, that choosing euthanasia immediately upon diagnosis does not make you a bad dog owner; that is another choice of  responsible ownership. Our job as owners and caregivers is first and foremost to provide quality of life for however long or short it may be.

Elliott chewingDuring the 17 months we took a few videos to document how Elliott fared:

Elliott - September 2015                              - 9 months with osteosarcoma

Elliott - February 2016                                - 14 months with osteosarcoma

Elliott - March 2016                                    - 15 months with osteosarcoma

 

 

 

Elliott pictured the day before he was put to sleep at the very end of May 2016

 

 

 

Pernille Monberg