Sky is a bay tovero American Paint Horse mare, born in 1999. She presented to me originally in May of 2013, as a referral. Sky had severe BPV infection, with 25 tumors when I first saw her. Most of my knowledge and sarcoid experience have come from working on this mare, and I am incredibly grateful to her owner for giving me the opportunity to undertake this project. Sky's treatment is still ongoing, but she is down to under 10 tumors as of May 2014, her one year anniversary, and I will continue to post updates with subsequent visits.
In 2008, Sky developed a small mass in the girth area behind her right elbow, which was initially dismissed as a bug bite. While that mass remained fairly stable, additional masses began to develop, mostly on her face, head, and neck. Her owner sought the help of several local veterinarians, early in the course of the disease. By this time, a fibroblastic tumor had begun to develop on her left shoulder. One veterinarian declined to treat, telling the owner to just get another horse, as these tumors have a deep root and you'd never get it all. As her disease progressed, another joked that she would need a 55 gallon drum of Xxterra to treat the horse. She had hopes to ride this mare again, and stubbornly pursued her options while putting away money in her "Sky Fund." She felt mocked and judged first for owning a horse with this problem, that had grown so out of hand through no fault of her own, and then again for seeking treatment.
When I met Sky and her owner, she told me the entire back story. She also warned me that Sky was a bit needle shy and could be somewhat difficult to handle. We discussed options, and my limited experience with these types of tumors. I had recently gotten a cryotherapy unit, and was pleased with some of the results I had been seeing, and we elected to give it a go. I explained that our odds of completely curing Sky were poor, but her owner defined success merely as improving her quality of life, getting rid of the large bleeding tumors. An added bonus would be if Sky could be comfortably ridden again. She was very realistic about things.
On that first visit, I examined her, and identified 25 tumors, ranging from small flat sarcoids to a fibroblastic sarcoid larger than a softball present on her left shoulder which constantly oozed and bled. In spite of the tumors, Sky was in excellent body condition (actually somewhat obese) and other than being irritated by flies on the ulcerated tumors, she appeared to be in no significant distress. The plan was to remove only the large shoulder tumor, and use cryotherapy to treat the surgical site when it was removed. It would be left open, as closure would not be possible due to the size. This would give me an idea of how well her immune system could deal with healing such a large wound. I discovered on this day that Sky is profoundly needle shy, pushy, and a bit of a brat! The surgery was performed with Sky standing and sedated, and went extremely well. The tumor weighed 7lbs.
After 6 weeks, I returned for the next surgery. The surgical site at the left shoulder was 90% healed and looked fantastic. Both her owner and I were cautiously optimistic about the future, but knew Sky had a long road ahead. I had done some research, and talked to a soft tissue surgeon who has published several papers on Equine Sarcoids in preparation of the next surgery. The next tumors that I wanted to remove were in locations where cryotherapy would have been unwise: at the base of the ear, near the eye, and on the back of the left carpus. Under general anesthesia, a fibroblastic tumor the size of a ping pong ball was removed from the back of her left knee, and cisplatin beads were implanted prior to closing the incision. Next, a nodular/verrucous tumor at the base of the left ear (that had recently undergone malignant transformation) was removed, and 80% was able to be closed. Cisplatin beads were also implanted where the tumor had been removed. Beads were implanted under the two nodular tumors near her right eye. Several other tumors were treated with cryotherapy.
Sky has had multiple other surgeries, but overall is improving with each one. Probably half of her tumors have had some degree of recurrence. Her owner is sold on the cisplatin beads, as they have been my go to on any sites of recurrence. On a good day, Sky is not a great patient, and has also taught me a fair bit about how to deal with difficult horses. She is at the point now where all tumors that would inhibit her ability to be ridden are gone. I will continue to post updates with subsequent visits.