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  Discussion on Treatment of Potential Liver Failure from Melanomas
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New Member:
moserls

Posted on Sunday, Feb 7, 2010 - 3:48 pm:

My 28 yr old grey arab Crystal has been loosing weight and listless for a couple of months. She has large melanomas in her rectal area, her lip and throat, and small bumps in several other places. A little over a month ago she had a tumor in her rectal area break open so we put her on Tucoprim. She was still feeling poorly and running a fever so the vet came out again about a week later, and subsequent to that and many blood test, IV treament for dehydration, doxycyline for two weeks, and some inconclusive ultrasounds and abdomen tap, the vet concluded that the only reasonable explanation was that the melanomas had spread to Crystal organs and that there was nothing to be done. I had a second vet examine Crystal and review the blood work, and he agreed that the tumors most likely have spread internally and that the most likely organ in question was the liver. There were no elevated liver readings...in fact no issues on any values..... on the first tests on Jan. 5, but tests two weeks later had evelated liver values and elevated WBC. This was after a round of tucoprim and subsequently doxycycline.

Crystal's respiratory rate has been elevated all along, and I truly think she has a respiratory infection also. We ultrasounded her lungs and saw some "suspicious" masses, but the vet was unable to conclude whether this might be tumors or old damage/infection.

So I am struggling with what to do next. Both vets have said it is only a matter of time. However, there is not a definitive diagnosis in my opinion, and I'm very concerned about the respiratory issues. Crystal makes a strange coughing sound now when she nickers at me. She became very depressed and weak when at the vets before, and I don't think she could handle another round of in patient work.

My other issue is fever control. She continues to run a low grade fever. She was on Banamine, but because she had taken it for almost a month, and it appeared to be killing her already fragile appetite, I changed her to devil's claw, but only when her fever spikes. She is up and down now on the fever, but never below about 101.5 and as high as 103.2.

My vet is unavailable until Wednesday, and has little opinion one way or the other as he feels she is dying, so I need more insight into the appropriate usage of Banamine or devils claw. Should whichever I am using be given for a certain number of days and then stopped? Or only when her fever climbs?
What is the danger of long term use with Banamine, or devils claw for that matter? Has anyone else had appetite suppression issues with Banamine?

Secondly, how does a vet typically diagnose and treat a respiratory infection? Is it a problem to do yet another round of antibiotics (and will they even have a chance of helping), especially if her liver is compromised?

Thanks for any knowledge you might be able to impart.
Member:
vickiann

Posted on Sunday, Feb 7, 2010 - 4:20 pm:

Sorry that you are having such challenging difficulties and I really am not qualified to give any advice but wanted to say that I did recently have appetite problems with both Banamine or Bute use in a horse who was having ulcer problems. This continued until I had him on Gastro Guard long enough for it to begin to make his stomach feel better.

Also, a good friend of mine had a very aged gray Arab with various, visible large melanomas, some in the same locations as your horse, which were thought to have spread to the internal organs.

The horse lived comfortably and happily for quite a long period of time after the Veterinarian thought this happened, though eventually the time came when my friend knew that it was time to end things for her beloved horse.

Hoping that things will improve for your horse.
New Member:
moserls

Posted on Sunday, Feb 7, 2010 - 4:58 pm:

Thank you for your information. Crystal was on Ulcerguard until she finished the doxycycline, and we have had her on cimetidine for a little over a month. However, I do believe her tummy is upset quite a bit. Her feed intake varies quite a bit. She still eats a lot of hay, free choice, but not as much as she used to.
Member:
vickiann

Posted on Sunday, Feb 7, 2010 - 6:05 pm:

It seems to me that my Vet told me that Cimetidine is not effective when used in horses for more than a consecutive week.

We were doing cimetidine injections whenever my Vet could get by and it wasn't even working that great though we didn't use it for very long.

Glad she is still eating as my guy was really off his hay, though he always ate his small portion of pellets.

All best wishes.
Moderator:
DrO

Posted on Sunday, Feb 7, 2010 - 7:28 pm:

Welcome moserls,
I am sorry to hear about your mare. There is no scientific work with Devil's Claw in horses so I will not comment on it here however we have discussed it's use before so using the form above if you run a search on it you will read about their experiences and past comments I have made about it's use.

Concerning dosages and use of Banamine (flunixin) we have a whole article on this and you will find it at Treatments and Medications for Horses » Anti-inflammatories (NSAIDs, Steroids, Arthritis Rx) » Flunixin (Banamine). If you are using it to control fever it makes sense to me to just use it as indicated as long as you do not exceed recommended dosages.

As to the diagnosis of pneumonia see the "Clinical Signs" and "Diagnosis" subtopics in the article Diseases of Horses » Respiratory System » Pneumonia & Pleuropneumonia.
DrO
Member:
npo33901

Posted on Monday, Feb 8, 2010 - 4:37 am:

Moserls, I had a gelding of 38 years .
Riding him into the forrest and stretching him in the arena
He enjoyed it all BUT eventually we have to take the hard decision for the good of the horse. Consider Him and evaluate the quality of HIS Life.
The diagnoses has been made a time ago - cancer - most likely it's all over inside of him - he is not comfortable . And more treatment he only will suffer more .
I had a bad cancer myself horrible treatment . That is maybe why I am so outspoken
Member:
kpaint

Posted on Monday, Feb 8, 2010 - 10:50 am:

Before it sticks, HAers, her name is Moser-ls not Morsels...

So sorry to hear of you situation Moserls. Never an easy situation.
New Member:
moserls

Posted on Monday, Feb 8, 2010 - 12:40 pm:

Actually, Anna Marie, my mare is not suffering. The vet and I are on the same page about that. We will not keep her here for a moment longer than she wants to be here.

My issue is that the diagnosis is based on not being able to find another cause for her issues. So she has not been diagnosed with cancer, she is suspected to have cancer because other potential causes have been eliminated.

My primary reason for coming here was to determine whether giving banamine in consistently repeated doses has a better cumulative impact than individual doses only when needed. I apparently didn't ask that question very clearly. I had read the articles Dr. O refers to except the one on pneumonia before asking my questions. I am still confused about whether antibiotics work for respiratory problems which don't appear to be pneumonia.

Anna Marie, I am sorry that you had cancer.
Moderator:
DrO

Posted on Monday, Feb 8, 2010 - 1:54 pm:

moserls, maybe my reply was not clear: when using it for fever control use it as only as often as necessary (what I meant above by as indicated) and the lowest dosage needed to control the fever.
DrO
PS Sorry for misspelling your name, I will correct it above.
New Member:
moserls

Posted on Monday, Feb 8, 2010 - 2:14 pm:

Thanks Dr O. That is very helpful. I will continue to use banamine only when needed at the lowest dose possible. That is what I needed to know.
Member:
npo33901

Posted on Monday, Feb 8, 2010 - 5:32 pm:

Moserls, glad to hear that you consider the well being of your mare and let her go when the time comes for her .
Thank you for taking my "hint' kindly.
Hope Crystal will soon recover from her illness .
Member:
mrose

Posted on Monday, Feb 8, 2010 - 6:50 pm:

Moserls, I feel for you. I lost my lovely 28 yr.old mare due to renal disease a couple of months ago.She too, was an Arabian. Like your mare, she wasn't in pain, thankfully, but just started to go "down hill." It is so difficult to watch these old girls slowly slip away.

I'm glad you are doing all you can for her. No one an ask more. Best wishes.
Member:
rtrotter

Posted on Monday, Feb 8, 2010 - 7:05 pm:

Moserls,

Just curious, did you have available base bloodwork for your mare to know what her normal liver values were before her antibiotic treatment.

I had a mare a few years ago that had liver values that reacted to anything given to her, antibiotics, wormers, certain supplements, vaccines. etc. I took blood several times a month and sometimes several times a week. Her high liver enzymes affected her performance. Both the vet and I were at our wits end, we did a bile assay on her that came back normal. The next step was going to be a liver biopsy. As a last resort my vet told me to change her feed. Lower the protein and raise the fat ( I went to 11% protein, from a 14% protein and went from 6% to 11% fat). We took blood before the feed change and then three weeks later. I did not change what I was doing with her. At the end of 3 weeks, her blood came back normal for the first time in 2 years and stayed there. She did have fluctuations but they correlated to wormings/ vaccines etc. If you think about it ( and also the way it was explained to me) The liver is the organ that cleans everything, so it makes sense that when there is something foreign in a horses system the liver values are affected. Most people only take blood when they think something is wrong, so they don't know what a normal blood for their horse is.

To learn the basics for understanding your bloodwork I use the Macgregor Veterinary clinic website.

https://www.gateway.net.au/~mcvc/index.html

How they explain it may be worded a bit differently, but I found it interesting because it gave me more of an understanding of what I was looking at when reading the blood results on all my horses. Just because a reading says high or low, there may be more to it than that.

I hope your horse is ok, I know its tough when you are dealing with illness and older age in your horses.

Rachelle
Member:
vickiann

Posted on Monday, Feb 8, 2010 - 7:45 pm:

Rachelle makes such a very good point.

The medications that we give can cause liver fluctuations.

A human doctor of mine told me to avoid Cimetidine in favor or Omeprazole for esophigitis because Cimetidine is not good for the liver, but there is a lot of conflicting information about this.

Diet and drugs, especially at advanced age, can all have an effect on liver function numbers.
New Member:
moserls

Posted on Tuesday, Feb 9, 2010 - 3:04 pm:

Rachelle, thanks for your insight. One of my concerns with the leap to liver problems has been that the tests in early January showed normal liver readings. Crystal started antibiotics right before these tests. The tests which showed abnormally high liver values were done after she had been on antibiotics for almost three weeks.

I am going to have bloodwork done again this week. She has been off of all medication except banamine for almost three weeks now.
Moderator:
DrO

Posted on Tuesday, Feb 9, 2010 - 6:07 pm:

moserls,
What abnormal and normal liver values do you have?
DrO
Member:
moserls

Posted on Tuesday, Feb 9, 2010 - 9:12 pm:

January 5 - AST - 252, GGT - 24
January 19 - AST - 373, GGT - 83
January 22 - AST - 371, GGT - 89

During this time frame, our main focus was PCV, which went from 37 to 49 to 56. 49 and 56 were after hospitalization and two sessions of IV fluids for dehydration.
Member:
rtrotter

Posted on Wednesday, Feb 10, 2010 - 6:32 am:

Moserls,

If the lab reference range was 1-35, than her January 5 reading for GGT were well with in normal ranges. The GGT on the Jan 19 and 22 are high.

My mares normal was 17, before the feed changes she was as high as 126 and for two years never went below 52, no matter what we tried.

I'm curious to know what the values are now. Since she's been off her medication for a while.

Rachelle
Moderator:
DrO

Posted on Wednesday, Feb 10, 2010 - 7:46 am:

It is important to note moserls that high liver enzyme values are not indicative of liver failure and may not even be do to significant liver disease. Some drugs for instance cause rises. For more on this and the diagnosis of liver disease see the article.

I certainly think the hemoconcentration indicated by the lab work is worrisome. What is the believed cause of it?

Rereading your posts above it strikes me that the two veterinarians you have had see the horse do not have the same goals as you do. I figure that this may be do to information they have to strongly suggest the grave prognosis you present. I do not see such information presented here. If there is no such information you need to find a veterinarian that has the same goals as you do: to diagnose the problem, deliver a prognosis based on factual evidence, and possibly institute targeted therapy.

In the meantime you need to reverse the weight loss if possible. For more on this see Diseases of Horses » Colic, Diarrhea, GI Tract » Weight Loss in Horses » Overview of Chronic Weight Loss.
DrO
Member:
moserls

Posted on Wednesday, Feb 10, 2010 - 1:29 pm:

Thank you, Dr. O for saying so eloquently what I have been trying to express. Other than the hemoconcentration issue, I have not been given factual evidence that would cause me to give up on Crystal. The lack of success in reversing the high PCV% caused the first vet to diagnose eminent renal failure and she recommended immediate euthanasia. That is when I sought a second opinion, where liver failure was diagnosed based on the lab tests. I am in the process of finding another vet who will work on a diagnosis that isn't colored by the fact that Crystal has melanomas. Meanwhile, I will read the Chronic Weight Loss overview.
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