Site Menu:
| This is an archived Horseadvice.com Discussion. The parent article and menus are available on the navigation menu below: |
| HorseAdvice.com » Diseases of Horses » Skin Diseases, Wounds, and Swellings » Bumps / Nodules / Warts / Tumors » Melanomas » |
| Discussion on Trying unconventional treatment for melanoma | |
| Author | Message |
| Member: Corinne |
Posted on Wednesday, Oct 26, 2005 - 10:35 pm: Today after riding my 7 1/2 yr old grey Arabian,I was grooming him and checked on the two melanomas we had frozen near his anus six months ago. They are flat and have there is no sign of reoccurrence at those locations. Then I decided to do an inspection on the posterior side of his tail dock, because self admittedly in the year and a half since I have owned him I never checked with diligence in those spots. Unfortunately, I found a pea size melanoma on the proximal end of the posterior side of his tail, and one small 1mm melanoma next to it. If you lift his tail completely up they are two inches from the anus. I called the vet to ask if we should have those frozen as well and while I was waiting for his call back I had to run errands. I stopped in a drug store out of curiosity to check on those new wart removers that use refrigerant, because they advertise to be the same as the units we use in the clinics with liquid nitrogen, which is what the vet used last time. At that point the vet called back and we were discussing various treatments and I relayed the information I knew about melanomas from the bumps,nodules,warts,tumor's posting and asked him if he would recommend treatment now or should we wait until it becomes larger. He said it was owner preference but if I wanted to be proactive, he prefers therapy when they are small enough to manage. I asked him at that point if one could use the OTC cryotherapy. He said he was not sure if they worked but after reading the box to him we decided to go ahead and give it a try. He then added that some valuable treatments in medicine have been discovered through trial and error and it definitely would not hurt (meaning it wouldn’t be any worse that using a liquid nitrogen unit in the office and had the same plan of care for healing) I told him obviously if it doesn't work I will have assess him and recommend treatment either refreezing or excising the lesions out or leaving them alone. So to make a long story short he told me to try the product, cleaning the skin off first, applying Vaseline to the skin surrounding the lesion to protect it, and after freezing the lesion to try to keep it clean as I can. He told me to use some corona to ease with the friction because as frozen lesions ulcerate it might make him comfortable. I asked if some sort of dressing would work for comfort...he said it might make him more comfortable but be sure not to wrap anything around the tail that could cause tissue injury. He also said not to worry about antibiotics because freezing the tissue is going to cause necrosis so it's not really going to make a difference. Anyway, I decided to give it a go, so I bought some Ambesol (benzocaine) to topically numb the lesion so he wouldn't freak out, then I let it sit for minute, applied the Vaseline to surrounding tissue, froze the spot for 40 seconds like the directions said, and the I applied a duoderm (we used it for decubitus ulcers in people) with a little benzoin to help it adhere. Not sure if it needed a dressing at this point but I thought it might keep it from rubbing. He said I should notice this week whether it's working and I will call him back regardless to let him know if it did or if I need to make an appointment because it did not. Demetrius was an angel during the treatment but he did wiggle a bit like he did last time, as I am sure I would if someone where freezing anything on my bum. He does have some other pin point bumps under his tail....hopefully they won't cause much problems. Curious as to whether you think the OTC treatment might work? v/r Corinne |
| Member: Corinne |
Posted on Thursday, Oct 27, 2005 - 12:04 am: P.S. The product contained Dimethyl Ether; Propane; Isobutane. |
| Moderator: DrO |
Posted on Thursday, Oct 27, 2005 - 7:18 am: Yes, this could work Corinne. As a matter of fact Corinne we are in the process of experimenting with the over the counter freezing product on several horses next month, I will let you know how it works out. I think the large lesions may have to be done several times.DrO |
| Member: Corinne |
Posted on Thursday, Oct 27, 2005 - 10:13 am: Sir,I thought I was going to be laughed out of the pharmacy and off this site for this one....so glad to hear that it's not that ridiculous of an idea. The vet I spoke to sounded mildly intrigued and was interested if it was going to work, as well. If the tissue has not necrosed yet, and I am assuming it will take a few days, I will try to send photos of the progression of treatment. Also perhaps if you can visualize the lesion through the healing process you could guide me towards the decision for reapplication and when or if it did not work at all so I can trailer him to the vet. Pictures however depend on whether he lets me take photos and since I am up at the barn alone usually, it might be a challenge. I will keep you updated if it works for me, and likewise, I would definitely appreciate it if you let me know how it works for you...thanks for the offer. The one issue I did encounter is (I used the compound w version $26 for 10 applications, but after using it for the 40 seconds I don't see how there will be that many left in the can) the applicator tip dripped some refrigerant because it doesn’t create a tight seal like the hand held professional units. To fix that problem, in addition to the Vaseline, I held a kerlex roll under the lesion so it wouldn't burn him anywhere else on him. My thumb inadvertently got a little cold burned and as a person, I think 40 seconds would illicit pain if used on let's say a plantar wart. I got a little creative with the benzocaine (Ambesol) but where as last time he needed sedation, this time he really didn't protest. That’s not to say he did not protest with me messing with it after, so we did have to hand twitch his lip to dress it. If I am unable to keep a dressing on it, I don’t think there will too much of a problem with getting manure on it, even though when he clenches his tail, the frozen lesion is directly over the anus, because he lifts his tail high when he defecates and typically when ever we ride…he is after all an Arabian. If I can’t dress it I will keep it lubricated with corona. I am more concerned about his comfort as opposed to infection because the good doc said its dead tissue. I will still watch it closely regardless. Well, that’s it for now. It is very interesting to me, the more I read these sites, how human medicine and or treatments, can in some cases be used for horses. Have a great day! v/r Corinne |
| Member: Corinne |
Posted on Thursday, Oct 27, 2005 - 11:29 pm: All looks well so far. The skin has blistered and has peeled at the site. It looks exactly like the ones that were frozen by the vet. Couldn't get pics today as my camera card is full of honeymoon shots from last month in Italy. Husband would be rather miffed if I deleted some to take pictures of my horse's tail. Will get a new card this weekend.If repeat treatment is needed do we wait until this lesion has healed completely? v/r Corinne |
| Moderator: DrO |
Posted on Friday, Oct 28, 2005 - 7:31 am: I would wait until I was sure that it did not get all the melanoma.DrO |
| Member: Corinne |
Posted on Wednesday, Nov 2, 2005 - 4:08 pm: Sir,I looked at Demetrius melanomas today and it seems that the skin had pretty much healed...scab had fallen off. Nice pink skin. Melanoma's are still there....but I can't say for sure if they are smaller. His skin is black and they are black so they appear smaller because I can now see them under pink skin. Can't really tell much difference by palpating them because I am not sure if that's tissue inflammation I am feeling (the tissue under this last sights stayed thick as it scarred before it became smooth again) or melanoma. I do know for sure that It did not take nearly as much time to heal as when the vet froze them so I presume that I was not as aggressive and did not freeze them long enough (not knowing how he or the lesions would react) I had thought I froze them for the entire 40 seconds but counting on a watch today I realize I probably only did 1/4 of that...so I did another application of the Compound W. This time I twitched him (because we were alone) and he let me lift his tail high and stood still so I was really able to get a concentrated application right on the sites, none of it leaked to the surrounding tissue so I presume I am getting the hang of it. I will keep you informed about the progress. I expect it to start showing signs of necrosis in the next few days if this method is going to work. Hopefully second time is the charm. Will be in touch. v/r Corinne |
| Member: Mariss |
Posted on Thursday, Nov 24, 2005 - 9:56 pm: Corinne, What ever happened to your treatments? I'm curious because I take care of a mare that melanomas upon melanomas on her tail and around her anus and down the back. |
| Member: Corinne |
Posted on Thursday, Nov 24, 2005 - 11:33 pm: Mariss,He needed a repeat treatment because the melanomas have not completely disappeared like they did with the vet cryotherapy but I am happy to say that there is no progression in the tumor size, in fact they have gotten smaller. I tried again with the OTC treatment this week and obviously will follow up with the vet when he comes out next. Currently the area is scabbed so we will have to wait until the scab falls off to see. Dr O...did you ever use the OTC treatment on those horses...if so...how long did you apply and did you have to repeat therapy? I will keep everyone updated. Have a good night. v/r Corinne |
| Moderator: DrO |
Posted on Friday, Nov 25, 2005 - 9:03 am: The jury is still out. I always used the longest recommended time (40 seconds with the product I was using) and on small lesions, 3 mms or less, the "bump" has gone away on those I have rechecked but there is still increased pigment in the skin. I am uncertain if this represents a dead melanoma or not. Anything larger than the tip of the device I still surgically remove.DrO |
| Member: Corinne |
Posted on Friday, Nov 25, 2005 - 11:01 am: Well in the one I had professionally frozen the increase in pigmentation of the melanoma stayed with the surrounding skin turning pick as the epidermis peeled away (it's normally black). And it took six months to turn back to black on the surface.I can still feel some thickness in the tissue but it's not just where the melanoma was, it's where the entire scab was so I think it's scar tissue. I don't feel that characteristic bump however.... In the two ones I did, they appear to be flatter and the top layer of skin has sloughed off but I can't be sure just yet because today there is a scab. One was 2mm and it might work on that one but the other one was 5mm so it just might need excision. I will have the vet look at it after the dressage clinic in two weeks. Thanks! v/r Corinne |
| Member: Corinne |
Posted on Tuesday, Jan 24, 2006 - 11:59 am: Just a quick update. The OTC treatment I tried in Oct didn't rid Demetrius of his melanoma. I think either it was too large (a little more than 3mms) or I never effectively froze it with the refridgerant. I had him seen by the vet two weeks ago (a friend took him while I was in finals the day before I left for vacation) and he froze it with the larger professional cryotherapy unit as he wanted to give that a try before surgical excision. The scab is really large and will probably take another few weeks before falling off so I will give an update then. If it didn't eradicate the bump we will have it surgically removed when the vet comes up in two months after Demetrius gets back from training.I still feel that the home units can help treat the smaller tumors. Dr O...did any of yours follow up? Take care, Corinne |
| Moderator: DrO |
Posted on Wednesday, Jan 25, 2006 - 7:38 am: Not since Nov but I hope to see it this spring and I will post after looking at i.DrO |
| Member: corinne |
Posted on Wednesday, May 2, 2007 - 9:17 am: Hey Dr O. Just back from the vet from his latest melanoma check. He had some small ones on his inner thighs and one in front of his sheath cranially as well as some on the tail dock that we treated with liquid nitrogen delivered by cotton tip applicator. But still nothing has responded quite like the cryotherapy gun which is much more powerful and delivers a constant stream of liquid nitrogen. The pea sized one that was originally treated that way back in Minot has never returned and although there is a scar, it's beautifully flat. The others have been treated with cotton tip applicators dipped in liquid nitrogen out of lack of equipment and have to be redone but still aren't as the vet states ready for excision. After he saw (the new vet in North Oklahoma) the results the cryo gun gave he is thinking in investing in a gun to use in his practice. The only worrisome area is a area where there seems to be a cluster that is in a 1 inch square area under his tail dock. They are very small but grouped together. As I always keep a watch on them they are not very raised but even if they were they would be hard to excise so the doc recommended cryotherpy with the gun (if he get's one) or perhaps laser ablation, which I was ready to jump on last evening although they pointed out lasers and rain don't mix LOL? If ablation is the correct word. Have you used lasers on malanomas? And if so with any success? He just doesn't like how there are so many and they are all grouped together and even small would like to watch and reevaluate in two months. I read in your article that doesn't mean the condition is turning dire.He did his best he could freezing those with the applicators. I don't think a picture would do justice as he has black skin and you have to palpate the area to know what we mean. Any suggestions? He and the other vet were scratching their heads and were open to any suggestions. I said I would write to you for advice (that's a first for me...a vet understanding the value of a vet forum). If he can't get something with the power of the gun (even the largest equine animal hospital here doesn't have one) what can we do? Since they are cropping up quickly but seem to go into remission (so to speak) after the cryo I think that is just what we might have to continue to do. Only perhaps more frequently since they aren't as effective as the gun. They had no idea cimetadine was used in any cases. I will send him your article related to melanoma's today. |
| Member: hwood |
Posted on Wednesday, May 2, 2007 - 9:41 am: It's great, Corinne, how you are helping to keep your OK vets informed. Often, vets in active practice just don't have the time to read up on all the latest information . . . for example, Cimetadine being used to treat melanoma, so we really do need to be informed consumers in the marketplace when it comes to our own health and that of our dependents. We can't always trust that the "experts" have practical knowledge of all the most current information. Good for you. |
| Moderator: DrO |
Posted on Thursday, May 3, 2007 - 7:38 am: On the large one, I would consider a scalpel blade and surgical excision to try and minimize the loss of healthy tissue, though careful use of a laser might be as discriminate, I don't have personal experience with one.Usually melanomas are pretty well encapsulated with well defined margins, though you may occasionally find "roots" you have to follow. The tissue at the margins of the lesion do seem to become "stained" with the melanin but if you stick to removing the solid black material you usually get all the melanoma. You don't have enough skin to close the defect but the tail will close a one inch defect with scar. I guess the question is how deep has the tumor penetrated so can it all be removed with simple surgery. DrO |
| Member: corinne |
Posted on Thursday, May 3, 2007 - 10:00 am: Dr. O,First to answer your question about how far the tumor has penetrated on the dock upon palpation the skin is two tight to feel if they are deep so we will have to wait to update you on that one. With the others you kind roll them between your fingers and it feels like an encapsulated pea or smaller etc etc. I guess excision or lazer are both options worth looking in to and will do the least invasive first and then progress etc according to need. If excision becomes an option I will let him know what you said about them being well encapsulated with defined margins with occasional roots. As your correct if we go the excision route there won't be enough skin to close the wound it will just be normal wound care and flushing per standard HA, although would duoderm (like we use on decubitus ulcers) held on with some vet wrap wrapped lighted around the tail dock (obviously loosely) keep it from manure contamination and irritation or would keeping it OTA be the best? I bet open to air is going to be your answer as a dressing might be just be impossible to keep on and it in itself can hold contamination in. As for the laser if we go that route, I will document with pictures and post or video and U Tube so we can add it to the HA library for possible treatments. Thanks! Will repost questions and progress as these are obviously going to be ongoing throughout my ownernship of Demetrius. |
| Moderator: DrO |
Posted on Friday, May 4, 2007 - 8:21 am: Having just removed one about this size we were hosing until well granulated in then just hosing to keep it clean. It is healing well at this time.DrO |
| Member: corinne |
Posted on Friday, May 4, 2007 - 9:06 am: Great....I will keep it open if we go that route and per the course cold hose to keep open and clean until granulation. Thanks Dr. O. |
| Member: corinne |
Posted on Thursday, Jul 12, 2007 - 12:26 pm: Dr O. we were going to take Demetrius to OSU to have his melanoma's treated this month. Which ever treatment they choose, cryotherpy, laser ablation, excision, it will leave an open wound that I know will heal with water lavage etc. but I have seen horses with cellulitis at barns this season from secondary infections from bugs and bites from insects because of the flooding. Should I wait until we get cooler weather and the bugs are gone to prevent contamination from insects? I am not so much worried about the underside of the tail dock as he keeps his tail pretty much stuck to him, but the few on his perineum and the two on his thighs I worry about. They are not increasing in size or changing drastically. Do you recommend we wait a few months until a cooler season with less chance for insectal contamination etc?Thanks! v/r Corinne |
| Moderator: DrO |
Posted on Friday, Jul 13, 2007 - 8:22 am: Hello CorinneIf you can wait, I would. DrO |
| Member: corinne |
Posted on Friday, Jul 13, 2007 - 8:37 am: Dr O. We will do just that. Like I said I have seen infections secondary to bugs from the northern part of the state to the southern in friends horses (even with automatic fly spray systems) and since I am so far away from the barn it really would make me more comfortable to not have to risk bug contamination. Thanks for seconding my opinion.v/r Corinne |
| Member: corinne |
Posted on Monday, Sep 17, 2007 - 10:15 pm: Ok, bug season is just about over in our neck of the woods so after my last schooling show and clinic in Oct Demetrius will have his current melanomas frozen. Since the beginning of this post 1.5 yrs ago he has developed some small melanomas under his tail dock and around his anus, one cranial to his sheath and one on his the inside of his thigh and we have tried the cryo with both liquid nitrogen delivered to these melanomas with a cotton tip applicator twice and the over the counter products by Dr. Scholl's with zero results as the liquid nitrogen delivered by the cryo gun often used to treat warts on humans had a higher rate of cold nitrogen being delivered and that was the only cryo therapy that has worked.. That first lesion (I showed Holly recently) has never returned and while a small scar was left the skin is very smooth with no evidence of the melanoma.Because I like the less invasive approach and it has been working, we found a vet in Wichita at a Equine Surgical hospital who is willing to come out and freeze the existing lesions because he has one of the cryo gun but he initially said he doesn't treat melanomas because they come back with a vengeance. I wonder if perhaps he has had similar experiences as the article states that they may come back rapidly and perhaps this happens and I only hypothesize because excised lesions are disturbed and encapsulated cells are left to develop again. I know the article associated with lumps, bumps, warts and nodules etc states that this might be the case however there was no evidence with the cryo so I asked if I requested this treatment would he perform the procedure. He agreed. In our horse and I can only speak for him, the one that was properly frozen for at least 30-60 seconds with the cryo gun was completely eradicated so he was more than willing at my request to give it the old college try. He will not take my word for it that Demetrius just stands there when his melanomas are frozen and I can not blame him for not wanting to risk his safety, so he will lie him down with some Ketamine. Prior to his arrival I will get some DrOp cloths (per Holly's suggestion as it will done in the indoor) and I will use the formula that takes the square root of the heart girth and measurements from the point of his shoulder to his buttocks to determine his weight to ensure the Ketamine is an accurate dose. I don't mean to insinuate that the vet doesn't know dosing but I am not about to take any risks with Ketamine with an eye balling for weight. Since I am nervous about him lying him down, Holly will be there for moral support. Demetrius is very much a light weight with sedation. Is there an antidote should he develop apnea? Should I request the doc bring it? Also since he is getting older, he was 9 in March should we add cimetidine? All the opinions I get on that one vary from vet to vet and from research article to research article, Dr. O, I very much value yours and would love your opinion on that one. If we start is it a life long treatment? Should we only use it for a specific duration? Also as for the Ketamine, the lying down, anything you want to add there? Don't know why I am nervous about that...perhaps it's the hundreds of conscious sedations I have done with humans and I know all the things that can go wrong. Additionally this is one vet who seems to have better relationships with his clients if you are advocating for your horse by educating yourself prior to calling him out so I want to be able to speak from a scientific based research point of view. Thanks Dr. O. As always I go right to the horse's mouth or shall we say horse advice's mouth (so to speak) prior to speaking with any vet. Write back when you get a chance. v/r Corinne P.S. Off to my internship for the next week, just back from a show, will catch up on everyone else's posts soon. Holly has been keeping me up to date. Hope all is well. Sending my well wishes. |
| Moderator: DrO |
Posted on Tuesday, Sep 18, 2007 - 1:10 pm: I would remove the melanomas if that is an option before I would go with the cimetidine Corinne. Though an accurate weight to start from is a good idea, I would allow the veterinarian to do the final decision on dosages. I don't find published dosages for xylazine/ketamine anesthesia reliable for many nervous and young individuals and premature waking before the procedure is done the biggest problem. Note that the ketamine is actually a cv stimulant, it is the xylazine that is the depressant but together they generally cause a moderate heart rate rise, moderate rise in blood pressure. Yes initially breaths may come with long pauses between them but they will improve. This is a very safe regimen.I think it is likely the tarps may make the horse nervous so would discourage their use before the horse is laid down unless you are sure he will not be effected by them. DrO |
| Member: corinne |
Posted on Saturday, Sep 22, 2007 - 11:41 am: Dr O thanks! I will keep you updated on the procedure. As for the tarps we were going to use a soft sheet if possible to keep the area clean but I have an Arab who just might think a tarp will kill him so it wouldn't be anything bright or krinkly, so thanks for the warming, will have to wait and see on the day how he behaves. I was just worried about the take down having images that the vet had to physically lie the horse down with lead ropes etc but I know gather the horse lies down himself. Thanks! |
| Member: corinne |
Posted on Friday, Oct 19, 2007 - 6:22 pm: Well, I visited with the vet who is freezing Demetrius’ melanomas the other day and we immediately agreed to disagree that treating melanomas is appropriate since he wished all the melanomas he had treated weren't treated since they came back "with a vengeance". I am not sure what his definition of vengeance was.He is a qualified equine surgeon however I am unaware of how many melanoma cases he has treated since he doesn’t believe in treating. I must preface this post with the fact that he is the only one in the area with the liquid nitrogen gun and using him would prevent a four hour rode trip for me and he is used by a lot of others at the barn who stand behind his veterinary skills in treating their horses. Interestingly he said that regardless of the fact that he doesn’t believe in treating melanomas however, since I requested this service, he would be more than willing to come out to freeze them on my horse so I gather he doesn't ethically think that cryotherapy will harm my horse and I am appreciative of his willingness to help. And as Holly suggested perhaps Demetrius can be a case study for him. But just to ensure he was comfortable with the procedure, which is important to me, when he came to change a dressing on another horse on Thursday, I decided to show him the results we had with the cryotherapy liquid nitrogen gun treatment used on the primary lesion three years ago as well as the small lesions that need freezing now, that are distal to the primary lesion, so I believe they are not secondary but would have occurred regardless (although I could be wrong). The current lesions are all very small 2-5 mm over the span of three years since the appearance of additional tumor so they are not very progressive. After he looked at the scar where the frozen lesion was (which is completely eradicated and there is no evidence of it and it was the size of a pea) he no longer seemed to be un-receptive to the treatment request. My question is I guess I am just not sure why some vets don't want to treat melanomas at all? Especially when I have seen them grow to baseball size leaking necrotic fluid down the tail and actually pushing the anus laterally? How uncomfortable for the horse! Why would a vet subscribe to no treatment at all? Do you know any that hold this belief and have they explained their reason to not trest other than the explanation I have received? If as the some posts state they become so hard to manage when they grow to massive tumors at which point some horses are humanely euthanized due to secondary infections etc I am not sure why you wouldn’t treat them while they are still manageable? Can you provide me with a better understanding of this theory amongst some vets in current practice. Is this a new standard of practice? Additionally while speaking about the melanomas this DVM said cimetadine (although we weren't speaking of this as a treatment for my horse) was only used to prevent itching and scratching the existing lesions not that they slow the growth or treat them in any way. I am going to print off the journal article associated with in vitro effect of histamine on proliferation of human malignant melanoma cell lines because it’s an interesting read and perhaps he may feel “further investigation is indeed warranted” as for it’s use in treating melanomas with horses. |
| Moderator: DrO |
Posted on Monday, Oct 22, 2007 - 11:00 am: Hello Corrine,I went to the article and it looked like it needed a good updating that includes the answers to your questions in a very complete form, check it out. Be sure to follow the link to the article on cimetidine which has the latest information on the action of cimetidine as a antitumor medicine. I would like to see more large scale scientifically rigorous reports on its use in horses. But clinically I have felt I have seen response in many cases. DrO |
| Member: corinne |
Posted on Monday, Oct 22, 2007 - 7:33 pm: Thank you Dr. O. After posting I am updating my folder with the new article. The treatment went well today. The vet was terrific. The take down with the Ketamine was not nearly as traumatic as I thought but after the lesions were frozen I had to walk away because it was a little disconcerting to watch my horse so vulnerable and unconscious, recumbent, (from the stand point of someone who loves him), so I would just come back every few moments to check on respirations from the gate and after 15 minutes he brought his head up and rested on his nose then 10 minutes later he was up and standing without assistance, although he was ataxic for quite a while so we stayed out of his way. After 30 minutes on his feet we caught him and walked him back to his stall.He is urinating and stooling as normal and his appetite is good. He had on a cooler on and a light sheet on over it because it was 45 in the barn with a windchill of 35 as the doors were open and I didn't have anything warmer but I just got a report that he is slightly damp so they won’t be adding any layers tonight since he will be inside (I initially thought oh my malignant hyperthermia, but I am not sure if that even happens in horses like it does in humans under general anesthesia (and this was not) but I will stop over thinking and worrying and have them take off a layer and dress accordingly. He gets the PM turnout rotation so he will be blanketed as necessary when he goes out Tuesday night. As for the tumors, now comes the waiting game for the ulcerations and the wound care per HA, hosing etc. but I have high hopes that cryotherapy with the high pressure liquid nitrogen will work like it did the last time we had the equipment which was many vets ago because the units are so expensive. The cost of the treatments has also gone up in the last three years as it now cost $80 to fill the gun once (liquid nitrogen now has a new hazardous material rating) but I budgeted for increases etc. As for other variations in treatment, we will make other adjustments and or add different therapies if we need to. This is obviously a process we are going to have to deal with for the life of my horse so every update you have on research or studies I so appreciate your sharing. Thanks! |
| Member: lilo |
Posted on Tuesday, Oct 23, 2007 - 10:20 am: Corinne - Good luck, I hope all heals up well. Lilo |
| Member: corinne |
Posted on Tuesday, Oct 23, 2007 - 11:52 am: Here is one for your Dr. O, since the studies, while there are few, seem promising about cell line proliferation and possible tumor shrinking of melanomas with Cimetidine do you think it would be beneficial to use in conjunction with the cryotherapy to not only perhaps potentiate that treatment, but to inhibit the grwoth of other tumors that are have yet to be identified by me? Please let me know what you think. As well as if you think it might be a complementative therapy would the 1.6 mg/k dosing be the best since we don't have any existing tumors that have not been frozen and the progression of those have been slow? I would like your opinion. Then of course treatment time, 3 months or one year? Obviously this is uncharted. But I would love to be one more statistic to be used at least in any personal experience you have even if it's anecdotal through HA.The vet actually complimented me and my diligence because he has never seen anyone find tumors that small. I have all the knowledge I have gained here to Thank for that. |
| Member: sonoita |
Posted on Wednesday, Oct 24, 2007 - 7:25 pm: I saw in Eqqus that a type of toothpaste was used on melanomas. A vet I know here in Colorado also tried this method. Sorry I do not know what became of this. Just wondering if anybody else heard this. |
| Member: corinne |
Posted on Wednesday, Oct 24, 2007 - 7:54 pm: Hello everyone! Things are going well. To my surprise, the skin has already ulcerated and the treated melanomas near the sheath and the ones on the inner gaskin have caused lots of edema. I cool hosed like I would any other wounds. He is getting 2GM of Bute for pain as I assume he has got to be uncomfortable. We did not ride as usual in lessons but walked which I thought would help the edema and listened to dressage theory.I spoke with his vet and we have decided to try and slow the progression of newer melanomas that are not yet discernable so we are going to try Cimetidine and I am going to get the apple flavored powder from Smartpak. We will then reevaluate in three months. I would be so miserable if I were this horse right now however......poor thing! But no where near as miserable as his friend who has one the size of a baseball on his tail dock I imagine! |
| Member: mrose |
Posted on Wednesday, Oct 24, 2007 - 10:40 pm: Wanda, I remember reading that article also. I wonder if you did a search at Equus.com if you could find it? |
| Member: paul303 |
Posted on Thursday, Oct 25, 2007 - 1:05 am: We did have some very interesting discussions on Crest Toothpaste a number of years back. |
| Moderator: DrO |
Posted on Thursday, Oct 25, 2007 - 8:32 am: As for the cimetidine recommendation Corrine I really do not have more to add than the pros and cons, dosage recommendations, and length of treatment suggested in the article. It may have a place but considering the uncertainties and the long term frequent dosage recommendation, I would not use it if surgery remains effective and practical.Wanda wasn't the toothpaste used on sarcoids? We have had success on the boards with Crest in years past. I am sure a search will turn it up. DrO |
| Member: corinne |
Posted on Sunday, Oct 28, 2007 - 10:46 pm: Thanks Dr O. Acutely, the tail dock lesions have ulcerated and are scabbed nicely without so much as any indication that they are bothering him. They seem to be healing like every other melanoma we have treated in that general area. The poor boy, however, where the melanoma on his lateral gaskin was frozen and where the lesion proximal to his penis was frozen had moderate swelling within two days. I called the vet at Equine Surgery when I noticed the swelling on Wed, and he said he expected the swelling to be the worst on Thursday and to proceed with 2GM of PO Bute per day but there were no restrictions on his activity. I did not see Demetrius on Thursday or Friday but he was dosed with Bute 2gm PO QD by the barn. He was urinating normally, alert and happy and wasn't lame at the walk or the trot on Sat morning (slightly at the canter on the right lead as he departs of that left hind where the worst swelling is) so we took him to KS to look for saddles as we had planned this trip for months and had another depending us for a ride. Demetrius seemed fine but upon arrival to KS (a three hour trailer ride) I noticed that the gaskin ulceration which is scabbed and hard to touch (and literally four inches long and at least 2.5 inches wide) was now swollen the size of a small baseball (do they come in one size) making him lame at every gate except the walk and cranial to his sheath there was severe swelling but it had an odd pattern. Needless to say my friend went saddle shopping and we were unable to. He continued to eat and act normal.The areas of swelling have always the same temp as the rest of his skin, he is bright eyed and eating well, urinating and having normal bowel movements. His vitals are normal. Today the swelling in front of the sheath is almost gone. This afternoon when we got home, I tried to aspirate the gaskin lesion to see if there was something other than soft tissue trauma going on as it is a bit worrisome. I used sterile technique and he was only cross tied but could care less as there was no feeling in the tissue obviously since it's necrotic at least superficially. I didn't get any purulent aspirate back but in another spot I got about 3 ccs of blood but it was a 21 g needle and I think it developed a clot so I just withdrew (I doubt I hit a vein, although it was possible). When I removed the needle, the lesion drained on it’s own without my adding pressure with my hand about 5-10 ccs of blood onto the floor and seemed to shrink in size and felt smaller on palpation after the drainage stopped. I had an MT (lab scientist) with me and she said she thought it was smaller after the blood had drained as well and neither of us thinks it's an abscess as it has more characteristics of a hematoma and or just general soft tissue trauma. Neither of us knows the actual process skin in a sensitive area goes through when its frost bitten or how much swelling to expect as we have not seen actual patients human or animal with cold injury. In the tail dock and the rectal area there are no areas to swell. We proceeded to cold hose all the lesions for 15 minutes and he stood quietly and I then put a Telfa pad on the gaskin lesion as it was rubbing his other thigh and causing irritation, with the thought that at least he would be more comfortable. The telfa when I went out to check prior to leaving to head home did not have any bloody drainage on it but was primarly adhered to the lesion by sero sanguineous fluid. So I guess my questions are, if vital signs remain normal, we are cold hosing and buting, his behavior is normal considering, his appetite is not decreased and he can run and buck around in turnout with the baby (I sware he made me look silly with all my talk about his lameness once turned out). Is there any reason to think this is not par for the course? The vet did use a substantial about of liquid nitrogen and it was from an older gun so alot dripped onto otherwise healthy tissue. I should have thought about protecting the surrounding skin with vaseline etc but then again I have not seen this vets technique and he really couldn't help the gun leaking but I was watching respirations with bated breath since he was out cold on the ketamine….a first for me. In my experience these lesions get worse before better. Can you add anything on my acute issues? I am going back up on Tuesday and will stay with him for the week and sleep in the horse trailer. We will call the vet out if need be but at this point I don’t think there is anything he can do other than bring me more bute as I will have run out by then. About the Cimetidine I plan on following the recommendations in the article if we decide to use that as an adjunct. I know this round of cryo was particularly hard on the horse and on me!  I just feel bad for him…..he could probably, as I said, care less, as long as I don’t saddle him but I just love him dearly and to think he is any pain or is sick in any way always makes me uneasy. Gosh…..I know you are all going to say wait until you have children….LOL. Thanks in advance for anything you might add. Corinne |
| Moderator: DrO |
Posted on Monday, Oct 29, 2007 - 8:00 am: Yes, swelling is normal in tissues that are loose enough to allow it following cryosurgical removal of tumors. I would be watching the local signs which normally stabilized by about day 3 after the surgery. For a detailed description of symptoms of worsening infection in a wound see the infection subtopic of Diseases of Horses » Skin Diseases, Wounds, and Swellings » Wounds / Burns » Long Term Deep Wound Care.DrO |
| Member: corinne |
Posted on Monday, Oct 29, 2007 - 11:05 am: Thanks Dr. O. On that note we will have the vet come and take a look to be on the safe side. He will also bring more Bute. He will be out in the AM and I will update you all when I get back on Thursday night as I don't have access while staying in the living quarters of the trailer.This time I won't forget my camera as it is a rather remarkable lesion. |
| Member: sonoita |
Posted on Monday, Oct 29, 2007 - 8:22 pm: Sorry, I thought she used it on melanomas. |
| Member: corinne |
Posted on Sunday, Nov 4, 2007 - 11:36 am: Dr O. The primary lesion, which I mistakenly identified as lateral but meant medial gaskin is not going down in swelling but we are still cold hosing, and the periphery of the lesion remains open as the scab disconnects from the skin at that point, so any drainage is allowed to escape.I asked the vet at the horse trails yest who is a partner of the vet I used what we could do to keep it moist between cold hosing etc because I will be gone for internship next week and he gave me Kenalog. Luckily I have a vet tech as a fellow friend and boarder who is going to provide daily wound care while I am gone. I am not worried about proud flesh or scarring....primary concern is melanoma eradication and prevention of secondary complications. He can run and gallop and leap and fly his changes in his paddock with the baby or when the baby is taken away because he can protect himself but under saddle is lame as the lesion hits his sheath and inner gaskin on the off right and surely is irritating. The vet tech said Bute won't work on any existing pitting edema cranially to the sheath as banamine is a better product for that but he I won't be able to get up there and it cost $108 to have the vet bring me the Bute in the first place. If he is not lame and swelling is not increasing and he is off his grain when we sneak it in, can we D/c the Bute? Thanks, Corinne |
| Member: corinne |
Posted on Sunday, Nov 4, 2007 - 11:38 am: P.S. Sorry I thought I gave an update on the surgical vet's reevaluation but he said the swelling cranial to the sheath is pitting edema and not abcessing and nothing to be concerned about and the lesion on the medial gaskin is swollen due to localized tissue trauma. He said to Bute 2 GM QD for pain and agreed treatment that I was providing (per HA wound care) was appropriate.v.r Corinne |
| Moderator: DrO |
Posted on Monday, Nov 5, 2007 - 7:15 am: Sounds logical to me.DrO |
| Member: corinne |
Posted on Wednesday, Oct 29, 2008 - 8:29 am: Hello everyone. It's now the fall of 2008, about three years since my original post. Demetrius has been on 2GMs of Cimetidine for nine months. He has developed several small melanomas proximal to his rectum. We were waiting for the bug population to DrOp once again before using the liquid nitrogen from the vet (Here it's still 70 during the day and even when the temps DrOp drastically at night there are still mosquitoes and some flies (although we have the best bug control I have ever seen and the barn doesn't use overhead sprayers). Anyway, I was going to wait until Feb or so to have the vet freeze but I wanted to freeze two of them 2mm in size with the OTC Dr Scholl's refridgerent. I thought it might at least halt the progression until the vet could freeze. To my surprise it's almost two weeks later, the scab has fallen off and the skin surface is smooth. That's rather surprising since it has not worked in the past. I wonder if the addition of the Cimetidine made them more suseptable to even lower grades of cryo? Either way we are very happy with the combination.The original lesions in 2004 have never come back, nor have any of the other lesions that we have used a cryo gun on. Some of the small ones the vet used cotton tip applicators dipped in liquid nitrogen did and were retreated with the gun...gone, but now, even the OTC is effective. AWESOME! We may not need the liquid nitrogen this year, knock on wood. Will continue with the cimetadine! Great news for my boy! Worth the $30 per month (we need the apple flavored as the regular crushed tabs are NASTY!). Corinne |
| Moderator: DrO |
Posted on Friday, Oct 31, 2008 - 8:23 am: Another explanation is that folks tend to get better at a procedure with experience, even simple procedures seem to work better when practiced. However there is also support for the idea that melanomas are less aggressive when exposed to cimetidine. Thanks for the update Corinne it should help others with their decision on treatment of melanomas.DrO |
| Member: corinne |
Posted on Tuesday, Nov 4, 2008 - 8:45 am: Thanks Dr O...I think it's a combination of both and will keep you all updated as time goes on.Corinne |
| Member: corinne |
Posted on Friday, May 14, 2010 - 10:38 pm: Hey Dr O. It's summer of 2010 right now. I can't believe it's been five years since I started this post on Demetrius' melanomas. Anyway, when I was bathing Demetrius tonight I found a grape sized melanoma on the lose skin of his inner gaskin or perhaps it's the lose skin of the perineum. It feels very mobile. You can literally roll the entire tumor between your fingers so you can feel all the borders. I am afraid this one got away from me during the six months I lived in NJ and the time back here after having had the baby. I feel bad that I never froze this one as all the others are still well below the excision stage. The horse still remains on Cimetidine but is 12 yrs old this week I am not really surprised that he still has growth.A few questions I have for you are, should we have it excised out now or wait until the winter? The heat in the south is a bear as you know (we live near VA Beach) as well as the insect population but we are at a barn where he will be monitored very closely, there are very few flies and manure is picked up four to five times daily. If we don't remove it now we can remove it in Nov when the insect population has died down. As far as removal, when we do remove the melanoma, what is your experience with excised melanomas? Do they tend to go neoplastic if disturbed or is it of no real consequence that you could tell? Also since I am not sure the rate of growth for these sized lesions since I have always managed them with cryo at 2-5 mm would waiting until the winter, after bug season, if that's your recommendation, be likely to cause the tumor to grow to the point of irritation and thus lameness or to a point that it would need a more invasive procedure? This tumor literally feels isolated in the skin and there is no external irritation. I gather if they remove it we can let it heal via secondary intention and will follow the wound care per HA. Any information you could provide would be greatly appreciated! Thanks! |
| Member: corinne |
Posted on Saturday, May 15, 2010 - 8:47 am: Dr O....Have you tried Cisplatin for non malignant melanoma yourself? Is it injected into the tumor itself or given IV? I was certified as a Chemo nurse and for some reason I don't think this is available in our area. Have you heard about giving Transfer Factor Colostrum for immune support? |
| Member: corinne |
Posted on Saturday, May 15, 2010 - 8:51 am: https://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=46984 |
| Member: corinne |
Posted on Sunday, May 16, 2010 - 7:46 am: Dr O after further inspection the melanoma is very high in the space between where the inside of the leg ends and the perineum begins. If we excise it now, I am afraid it would take a rather long time to heal because of friction from walking and with the insect population we would risk infection. I think it's best we wait until the Winter and I will just have to hope for the best in relation to continued growth. If you wouldn't mind weighing in on my other questions that would be great! Thanks! |
| Moderator: DrO |
Posted on Sunday, May 16, 2010 - 11:09 am: Hello Corrine,We answer your questions on surgical treatment and malignancy pretty well in the article. Is there some particular point you need clarified? As to removal of this tumor I do not see a reason to wait and I would consider suturing it. It is a tough place to work however and some horses may have to be laid down to safely do surgery. I do not use Cisplatin as the substances requires specialized handling procedures. It I felt it the best choice I would refer it to our University Hospital. DrO |
| Member: corinne |
Posted on Sunday, May 16, 2010 - 1:18 pm: Thanks Dr O. Yes we are going to remove. I guess I am just nervous as you hear all of these probably unsubstantiated stories from those in the horse community who say if you remove then they will grow back with a vengance. No clarification needed as I know the pros of removing now probably outweigh either not removing or removing later. He is out of showing after Raliegh the first weekend in June and won't show again until August so we have time now and if sutured I gather there will be less chance for infection. Personally I am surprised it was missed on his very expensive HMO exam. I think you are somewhere within a five hour drive.....if I didn't have the baby I would take him down to you so you could remove it. Either way I will start getting on the horn to find a place who could excise. He would have to be laid down for sure, I mean it could be cut out without having to lie him down but to suture effectively it's not at a good angle. I read again on the Colostrum supplement reversing these tumors from an immunity perspective. Have you heard of it? I bet it's use is anecdotal at this point. Anyway, Thanks so much. |
| Moderator: DrO |
Posted on Monday, May 17, 2010 - 6:56 pm: I have removed many single melanomas and never seen an explosion following removal. Yes they continue to get new melanomas but this is expected behavior. Such behavior is commonly reported with sarcoids so I wonder if they are confusing sarcoids on grey horses with melanomas. I have not seen any information on colostrum supplement and treating melanomas.DrO |
| Member: corinne |
Posted on Saturday, Oct 16, 2010 - 1:13 pm: Dr. O. Still vigilant with D's melanoma monitoring and treatment. We are having a few surgically removed in Nov after our last show. These melanomas are in areas where cryo is not an option. The rest will be frozen and he will remain on his cimetadine. I have noticed however that his sheath has quite a few of them, although his penis seems be tumor free. What's the best approach for treatment of the tumors in this area? I don't want them to grow to the point he can't DrOp his penis...they are somewhat small. What would your recommend due to the complex nature of the area? If we remove or freeze would the incisions or area of necrosis from the cryo cause the horse to fear DrOpping his penis to urinate? How would you keep that area clean? I guess I am just unsure as to how to treat these. Demetrius is 12 now.Thanks! Corinne |
| Moderator: DrO |
Posted on Monday, Oct 18, 2010 - 4:27 am: The problem with the sheath is the swelling following any procedure which causes inflammation. The least inflammatory way to deal with these would be surgical excision but it may require general anesthesia.DrO |
| Member: corinne |
Posted on Saturday, Jun 4, 2011 - 4:33 pm: Dr O,Not sure if you want a new post on Demetrius' melanoma questions or if you would like me to continue here so you can have a history. Just let me know. Anyway, as I stated in my last post we had three tumors excised on the inside of his right hind leg in Nov. They were being rubbed by the other leg and were open and leaking necrotic fluid. The vet, knowing I was a nurse allowed me to assist. After IV sedation he held the leg and had me inject local around the tumors. Of course I was wearing a helmet. He then had me use a hemestat of sorts to pull the tumor down and then I cut the skin proximal or behind the tumor with a pair of surgical sizzors to remove it all of the lesion. This was simple as there was a lot of redundant skin. After that he had me freeze the area where the lesions had been. After care was Bute for a few days and cold hosing twice daily until healed. Seven months later no new tumors have appeared and the skin looks beautiful. With that being said that gave me an idea on treating the small lesions around the rectum that I was using the OTC cryo on. First I froze the area, then a few days later debulked or debrided the scabs which left a small open area in the melanoma and froze again. That process instead of just the singular freezing and letting it heal caused alot of the tumor to be reduced in size, more so than just the freezing alone. What started as an eraser head size melanoma is now almost flat. Do you think applying the salicylic acid you would apply to a wart after it's debulked would help further? Once again these are small tumors in an area where it would be hard to remove. As for the sheath tumors, he has his HMO exam on Thursday. We are going to sedate and document size and location. His sheath is riddled with them but his penis doesn't have any. Most are small but some are larger. Not sure how we are ever going to treat those. With excision you have swelling and infection risk and without if they are rapidly growing you have obstruction issues. If we have to excise in the winter (already bug season) we plan on sending him in patient so they can do aftercare and monitor for infection and swelling. The vet we are using now also thinks he is on too small of a dose of cimetidine and it should be given three times daily as opposed to two so we are going to increase that. When would you excise sheath tumors? Have you had any patients you have done the procedure on? I sincerely hope my beautiful talented horse doesn't have a life limiting problem with the sheath tumors. It would break my heart. Well that's it for now. Will update as needed. v/r Corinne |
| Member: lilo |
Posted on Saturday, Jun 4, 2011 - 10:17 pm: Hi Corinne - no advice, just letting you know that I am happy to hear from you, and hope that you will be able to find a way to get rid of those tumors on the sheath.Lilo |
| Moderator: DrO |
Posted on Sunday, Jun 5, 2011 - 12:09 pm: Hello Corinne,Keep posting here for the reasons you state. I don't know what the effect of the topical wart medication would be. I can see the logic of chemically burning away more neoplastic tissue and other than the ulcer it might form cannot see much downside. I would excise the sheath tumors as early as possible but if they are not growing rapidly waiting till after fly season is logical. DrO |
| Moderator: DrO |
Posted on Sunday, Jun 5, 2011 - 12:13 pm: Corinne one other thing. Have you considered immunotherapy it may help with the existing tumors and prevent the formation of new ones. There is a piece in the article on this.DrO |
| Member: corinne |
Posted on Sunday, Jun 5, 2011 - 5:27 pm: Thanks Dr O. I can't say I have measured them before on the sheath so I am not sure at their progression rate. Our exam Friday will give us a good base line and we can check monthly. I will also read up on immunotherapy. We are moving to DC in a month as Herb will be stationed at the Pentagon and D will stay in VA until after the baby is born in Nov. Any avenue I choose if we do it now will require care while I am not present. Not an easy situation. When he joins us I will have more hands on time. Either way I am sure the best decision will be made, now or waiting until then. Will let you know what the vet says about immunotherapy and whether to wait or not. |
| Member: corinne |
Posted on Sunday, Jun 5, 2011 - 5:45 pm: Dr O...how do I contact the point of contact listed for the immunotherapy? Have you known of horses that have benefitted from the vaccine? Any idea of the associated costs? |
| Moderator: DrO |
Posted on Tuesday, Jun 7, 2011 - 11:52 am: Other than the contact information and the results of the study that are in the article I have no other information. When you get moved I would contact the nearest veterinary hospital with an oncologist and see what they can do. From Washington DC that might be the Virginia-Maryland Regional College of Veterinary Medicine.DrO |
| Member: corinne |
Posted on Wednesday, Jun 8, 2011 - 8:34 am: Will do Dr. O. I am also giving this research article to our vet here to reference.Thanks! Corinne |
| Member: corinne |
Posted on Thursday, Jun 9, 2011 - 6:19 pm: Hey Dr O. Was with the vet today for a good hour today while she assessed the tumors on D's sheath. We also got some great photos I will post once she emails them to me.There are two large lesions and lots of smaller lesions but the two large lesions that are more concerning are on the right and left side of the sheath are 1.5 X 1 at it's widest and one is 1.5 X 1.5 at it's widest. But it seems to be clustered melanomas that have grown together as opposed to two single lesions. They are located very high up on the sheath. As far as treatment first we are going to increase the cimetidine to 1GM TID from 1GM BID. Second we are going to reevaluate in 60-90 days to see if and how much growth has developed. If no growth then will continue to reevaluate. If growth we will do one of three things although no one seems to know which would be the best course of treatment. 1. Place cisplatin Beads 2. Inject cisplatin instead of the beads due to the location so no sutures would be required. 3. Excise and freeze and allow to close by secondary intention with aftercare daily by the vet so they can monitor for adhesions/infection etc. Where to do the treatment is also in question. My vet consulted with a vet at an equine surgery center (Woodside) in Richmond however that vet was underwhelmed about treating at all. She is going to check to see if her colleague would do it at our barn. (We have a VERY CLEAN barn) and also will contact NC state. We also spoke about immunotherapy but apparently the woman in PA doesn't do the vaccines anymore as my vet was aware of who she was. One thing is for sure, there doesn't seem to be a concensus on how to treat these sheath tumors. Once I post pictures would you please advise as to what you would do? A friend had her horse's fist sized melanoma removed from his sheath at OK State with a laser and three years later there has been no regrowth. Thanks! |
| Moderator: DrO |
Posted on Sunday, Jun 12, 2011 - 8:47 am: I would be glad to comment.DrO |
| Member: corinne |
Posted on Wednesday, Jun 15, 2011 - 8:42 pm: Thanks Dr O. Still waiting on the vet to email me the pictures. In the mean time I have found contact information for the contact mentioned for vaccine prep in the associated article. I will write and see if that is still an offered service. This is what I found...If you are an owner or a practictioner interest in our vaccine, plese contact our research lab at vosrcrearch@hotmail.com, or call (610) 692-6272. Tumor prep is done with only advanced notice, please call for schedule, costs, and shipping specifics. |
| Member: corinne |
Posted on Wednesday, Jun 15, 2011 - 8:46 pm: Dr O I found the information below when I googled the immunotherapy. It is the contact number and email for the person you have listed for vaccine prep. I will be emailing tomorrow to get more information. Also, will post the pictures as soon as the vet emails me! Thanks.If you are an owner or a practictioner interest in our vaccine, plese contact our research lab at vosrcrearch@hotmail.com, or call (610) 692-6272. Tumor prep is done with only advanced notice, please call for schedule, costs, and shipping specifics. |
| Member: corinne |
Posted on Wednesday, Jun 15, 2011 - 8:48 pm: (sorry for the double post I thought i lost it and tried again) |
| Moderator: DrO |
Posted on Friday, Jun 17, 2011 - 8:03 am: Thanks for the information, be sure to let us know what you find out.DrO |
| Member: corinne |
Posted on Friday, Jun 24, 2011 - 9:03 am: Dr O....Here is the pictures of D's sheath tumors on one side. It seems to be clustered tumors as opposed to large single tumors. We would have the tumors proximal to his belly treated. Please advise as to what you would do if he was your patient. Thank you!
|
| Moderator: DrO |
Posted on Sunday, Jun 26, 2011 - 9:06 am: Corrine, the above photo gives a good impression of shape but is so close I am not getting a good impression of size and extent.With that caveat, I think there is too much tissue involved to remove surgically and close or even to rely on extensive second intention healing as would occur with freezing. That leaves you with either attacking the masses a few at a time, say with freezing if they are not too large, or using techniques that don't cause extensive necrosis, cisplatin, immunotherapy, or possibly both. I think cisplatin injections might be the way to go. I have not personally handled cisplatin, until the pellets came along it required special licensing and techniques. However the irregular appearance with coalescing nodules argues against use of the pellets. I would refer this to NC State and assuming they do not disagree with my assessment expect them, under general anesthesia, treat the tumors with injections of cisplatin and consider the use of a autologous vaccine during or following treatment. DrO |
| Member: corinne |
Posted on Sunday, Jun 26, 2011 - 9:28 am: Thanks Dr O. There is still quite a bit of redundant skin, the vet was holding his sheath at the bottom pulling it taut so she could get a good view of the tumors to document. That U shaped lesion (the primary one in the photo) is about 1.5 by 1 inch at it's widest. The large lesion on the other is 1.5 by 1.5 at it's widest. Our vet is going to speak to NC state as Woodside in Richmond doesn't agree with treating these because of the horrible location. If NC state says there is something that can be done there, we will have to work transport down there (I will be about to deliver our second baby come late fall). He will have whatever is recommended and he will come back to the farm he lives at now where my current vet will come out daily for wound care after discharge. If that's doesn't work out I will speak to the Vet school you recommended in VA/MD and have it done once we move him up there after the baby is born.Either way we are deep into bug season so the current plan it to reevaluate in two months after the increase in cimetidine. We are praying for shrinkage although realistic it may not happen. In the mean time everyone is doing the research. I appreciate your opinion! Will continue to update. |
| Member: corinne |
Posted on Sunday, Jun 26, 2011 - 5:26 pm: Dr O I found some promising information on Cimetidine on Pubmed. Hopefully we will get better results now that Demetrius is on the 2.5mg/kg/TID dose he should have been on...Since we can't do anything (with the move and insectal issues) hopefully that will give us some time to see if the proper dose gives shrinkage and then we can progress on to chemotherapeutics, vaccinations, and or excision this fall.Cimetidine an H2 histamine antagonist, was used in the clinical management of progressive, multifocal melanomatosis in 3 adult gray horses. Prior to treatment, the tumors had increased rapidly in size and number in 2 horses (duration of 6 and 27 months, respectively) and slowly in the third horse (duration of 48 months). All 3 horses were treated with cimetidine (2.5 mg/kg of body weight, PO, q 8 h) for 2 months to 1 year. During treatment, the number and size of the melanomas decreased substantially (50 to 90%). The progression of the disease was halted in 2 horses and controlled in the third horse, which is still being treated with cimetidine (1.6 mg/kg, PO, q 24 h). The horses in which treatment was terminated have not been treated for 31 and 41 months, respectively, during which time the melanomas have not increased in number or size. |
| Moderator: DrO |
Posted on Monday, Jun 27, 2011 - 7:33 am: Keep us informed Corinne. What is that dosage rate going to cost you a day?DrO |
| Member: corinne |
Posted on Monday, Jun 27, 2011 - 8:28 am: Dr O. We use Smartpak because they flavor it apple. They also have cimetidine powder that comes in a canister but I tasted it and it was horrible. I imagined it would not take long to put him off of it all together. Via smartpak if you get one gm three times daily it's $14.50 a dose. If we were to purchase three gms but not divided it would be slightly cheaper, less prep time. We pay under $50 a month to include shipping. It's auto shipped for a year under one prescription. From the research I have read going higher on the dosing like you would for gastric benefits is not likely to further supress the T Cell supressor cells (I hope I said that right) the 2.5 mg/kg Q8 seems to be the magic number. Will let you know how we do on recheck! Bummed the initial vet in KS, who only gave me the scrip to placate me (which he admitted to) dosed lower (we were giving 2GMs BID) but I didn't check until recently so partly my fault. The one thing about these tumors is it's hard to find one school of thought on treatment. I gather because each horse responds differently. We have lived in five states and in each place every vet has a different belief on treatment and some don't treat. Hopefully with all of the experience I have had in being my horses advocate we are on the right path! Thanks as always for consulting. You have been the one vet with us since the beginning! |
| Member: corinne |
Posted on Monday, Jan 2, 2012 - 9:26 am: Well Dr O it's been a long time coming but the vet who was going to treat D's sheath tumors was not comfortable doing the surgery during the unseasonably warm weather so we had to wait until temps DrOpped and then of course for Christmas to pass....He finally had the surgery on the 27th. Interestingly enough he took enough sedation to DrOp a 2-3 draught horses, which the vet said can happen as a horse ages. Anyway, the higher dose cimetidine seems to have kept the tumors from getting any larger. They were excised but there were two large bleeders that couldn't be stopped with conventional dissolvable sutures, apparently only a thicker guage would stop the bleeding. The vet did some cryo before sewing him up at least that is what I think (I am in DC). After the surgery she came out the next day and then on Friday, she will come out every other day until the sutures come out. He hasn't needed to be sedated to be cleaned which is surprising since he usually won't DrOp and his swelling has stayed manageable with hand walking. He even DrOpped to urinate which she said would prevent urine scald which is something I didn't even consider. Anyway, all in all everything went well and on Sat his trainer was able to walk trot while up. If there is no infection we will move him to MD three days after the sutures are removed and then for the sixth time we will have to find a vet who is willing to treat his tumors as needed because so many that we have met just won't. Will keep you posted. Thank you for being a mainstay for the last six years in regards to Demetrius' tumors. |
| Moderator: DrO |
Posted on Wednesday, Jan 4, 2012 - 5:24 pm: Thank you Corinne, here is hoping this goes along way toward reversing the problem.DrO |
| Member: corinne |
Posted on Friday, Jan 6, 2012 - 9:55 am: I hope it does as well. Good news they just removed the three layers of sutures and so far we haven't had any complications. I hope this goes along way towards proving to future vets that melanoma can be managed surgically, with cryo, and perhaps just even with H2 Antagonists! Will post pictures when I reunite with the horse. |
Horseadvice.com
is The Horseman's Advisor
Helping Thousands of Equestrians, Farriers, and Veterinarians Every Day
All rights reserved, © 1997 -
is The Horseman's Advisor
Helping Thousands of Equestrians, Farriers, and Veterinarians Every Day
All rights reserved, © 1997 -
