Monday, January 31, 2011

When It Pays to Pay to Play (UPDATE)

Day Two and All is Well

My biggest concern with this latest attempt to rid my mare of her squamous cell nastiness was that there would be unexpected side-effects of the implanted cisplatin.  Having done my time with cisplatin IV and IP, I could readily imagine that Pokey would be somehow miserable and craving Mickey D's Fillay Oh Fish with Fryes and Choco Milk-type Shake (though I've been assure that that was the Dexamethasone talking and not the cisplat, which has better taste).  So far, however, aside from an unexpectedly kindly turn with the one-eyed Appy whose mere existence offends her, there have been no changes.  None.  Nada.  Could be the Bute, but I'm thinking it's more likely that any break from the crummy weather is welcome and likely to result in an attitude improvement toward those in her vicinity.

Here is Pokey's Nethers on Day Two:

The photo had to be enhanced because it was a very dark, dreary morning and the flash on my cell phone was insufficient to overcome the gloom.  She's not really purple.  Most  notable here is that the swelling from the blocks and incisions has reduced entirely.  Always a good thing.   There's no sign of infection, and Pokey didn't try to behead me for touching her tail.  Yay for that.  

This photo is even more enhanced as the closer I got, the darker that place under her tail became.  Sorry.

Next update will hopefully show some reduction in the visible lesion and the tumors below it. 
The main lesion is just below her anal orifice and visible here as a very dark, reddish-brown blotch.   The subcutaneous tumors are almost impossible to see in a photo.  Though they may reach inside, they appear on the surface only as a slightly raised area notable for it's lack of notability.                                            

Of course the greatest score of all would be a total disappearance of all the cancer.  That would add this case to the growing list of successful resolutions of a problem that used to be a death sentence for light-colored horses who tend to be prone to this sort of nastiness.  Fingers crossed.

Paying to Play

Missleading (aka: "Pokey") 
A short while ago, the Horse and Man blog (thanks, Dawn Diovera, for your excellent research!) ran an article about a mare with a squamous cell carcinoma on her vulva that was successfully treated with cisplatin beads implanted around the tumors.  My eyes couldn’t have gotten any bigger with toothpicks, I’m sure, as the photo of the tumor could just as easily have been of my darling mare, Pokey’s, nether region.  I saw the identical tumor, presenting identically externally, in the identical location.  Wah-hoo!  For those of you not following me (or my blog, you slackers), Pokey (aka:  Missleading), my OTTB x Paint mare and the mother of none other than the ignominious Zips Money Pit (aka: Zips Memory), developed a tumor back around 2005.  It was surgically removed, and the successful removal remained successful until 2009, when the nasty bugger returned in all its gory glory.  Pokey is currently 24 and holding.

On the second round, we (meaning me, my amazing vets, and the lucky lint ball in my pocket that I often consult on these things) decided to go full-bore and try laser surgery.   There is only one veterinary facility in NJ that owns a surgical laser, so Pokey and the SS and I were off to Freehold to the New Jersey Equine Clinic run by Dr. Scott Palmer and his excellent staff.  The 5-hour round-trip (don’t you just love that drivers absolutely must cut off a horse trailer on the highway?  Apparently, it's the law.) was interrupted by about an hour of actual prep, surgery, and recovery.

Dillon checking Pokey's breathing skills
One credit-card-melting trip to Rite Aid for a tube of 5-FU chemotherapy ointment and a box of gloves later, Poke and I settled into our twice-daily routine of debriding and ointment-ing until her whimpering got the better of me and I quit.  Part of the tumor was determined to be inoperable due to location, and there was no way of knowing whether or not the cancer had spread internally, though it appeared not.  I opted to let the chemo work, let the mare heal, and watch the situation unfurl over time.

Six months later, the tumor was back, so another two weeks of 5-FU, whimpering (hers), whining (mine), and twice-daily chases around the pasture ensued.  Again the tumor shrank, and this time I happened on a supplement by Figuerola Laboratories called 2-Mor Saver.  Figuring “WTF” applied nicely here, I bought beginner-level jar and gave it a two-week trial.  It didn’t kill her, and the tumor wasn’t any larger, so I sent for the mega jar.  Happily, the stuff worked enough to keep the superficial tumor (can’t see anything under the skin of course, but I’m hopeful about that area) from progressing while I waited for either Pokey to tell me she was done and needed to go to the big pasture in the sky, or for veterinary science to come up with something else.

Fortunately, something else came first.  My fingers couldn’t wait to send a message to my vet Christopher Fazio, VMD, to gauge his response to the idea of yet another attempt to salvage what’s left of my mare’s lady parts.  He took the idea under advisement, did his research, and came back with a big “sure, why not?” 

Now, I’m not a horse owner on the edge.  I can well afford to experiment and to keep horses that have little left other than their pleasant appearance as lawn ornaments.  And I can afford to play with lasers and $100 jars of herbs and cisplatin pearls.  To my way of thinking, maintenance is cheaper than repair, and anything I can do to further veterinary science by way of making my horses guinea pigs (which are, I hear, considerably cheaper to feed and easier to clean up after, so the change might be welcome) is okay in my book.  

On Thursday, January 06, 2011, Dr. Fazio peeked under Pokey’s tail, did a head count, and determined that four packages of 3 beads each would suffice to cover all the ground currently being made lumpy with tumors.  Today, January 31, the deed was done.  The most obvious lesion in the photos is the same now as it was almost two years ago, but the lumpiness under the skin is the area of greater concern.  This first photo was taken just after Dr. Fazio blocked the area, so some of the lumpiness and all of the drippy redness are related to that part of the procedure.  

Pokey's nether region pre-impant
A full view with Betadine, not blood
The implanting was fairly straightforward.  Due to the size of the tumors, Dr. Fazio opted to implant three beads into each of four locations surrounding them.  That’s a total of 12 beads.  The process involved small incisions, beads poked under the skin then manipulated into position, and a stitch to close the incision.  Five small punctures, a few days on Bute and SMZ’s, then wait to see what happens. 

To her credit, and at Dr. Fazio's request, Pokey did manage not to pee on the vet during the procedure.  Kudos on a job well done! 

The ultimate outcome is up for grabs.  There’s a 60% chance of the tumors reoccurring but this process can be repeated annually for an indefinite number of treatments, so even if the tumor return, Pokey’s quality of life can be maintained at “super-duper” until one of her other ailments or something unexpected simply drops her in her tracks.  Meanwhile, it’s all good for this lovely mare who is living out her post-partum days (“partum” was 14 years ago, so it’s been a loooooong recovery) on the sunny chunk of grass outside my window.   I’ll post a follow-up when there is something more to report.  I am pleased to say that the reports of other horses’ outcomes under the care of various vets including Dr. Mike Fugaro at Centenary College who used this treatment on a squamous cell carcinoma near a horse’s eye with great success, suggest that this may be the treatment to look at for your crusty old horse’s sarcoids and SCC’s until the Next Big Thing comes along.  

Wait for it.


Zoe said...

This is fascinating, Jo. Sending my best vibes that it will do the trick for your Pokey. Chris Fazio is a fabulous vet. He used to be at Staller's, and we all loved and miss him.

Anonymous said...

So glad you found a treatment that may help, and that your vet was so cooperative. Hope she does well, and good for you for trying to improve her quality of life at what many would consider an advanced age.