Category Archives: Medical

Cisplatin Beads to cure Squamous Cell Carcinoma in horses. A happy ending for Aponi!






I don’t have a light colored horse, so this type of skin cancer wasn’t even on my radar… I mean, I’d heard of it, but really didn’t take note because I thought it was rare.  It isn’t…

Squamous cell carcinoma came to my attention via my wonderful vet who has battled Tess’s canker cure, Aladdin’s rare disease, Norma’s severe laminitis/abscesses — and several other equine maladies — with me.  We were sitting in the barn observing Norma and chatting.  He said, “Y’know, I think I have a really great story for your blog…”

I get excited when THE VET says he has a great story… I know it is going to be good!  So, with excitement, I urged him on.

“OK, well, there is this really sweet, totally blind Appy mare that we know.  And…”

APONI’S STORY

Aponi is an 18 year old, totally blind Appy mare who was rescued 6 years ago by her devoted new owner, Veronica.  This mare was so sweet and so congenial, Veronica couldn’t help but take her in.  At that time, Aponi still had sight in one eye.  However, within two years, she lost sight in the other eye.  According to Veronica, Aponi is still the same happy mare.  She uses her nose and ears quite well and with the aid of her pasturemate Annie, Aponi didn’t miss a beat.  From all accounts, (including my vet and his tech) Aponi is just about the sweetest and most affable mare in the county.

Beautiful and blind, Aponi

BUT ONE DAY

This is the stuff that makes your scoobydar peak…  You notice something and you figure it is nothing but you call the vet out anyway.  When the vet arrives he cocks his head and says, “Hmmmmmmm”.

Ugh.  We’ve all been there.

“Wha?  Isn’t it just a little thing?”

No, it isn’t.

Here is the way Veronica told the story:

I originally had my vet out to check her in July for what I thought at the time was an abrasion/laceration from rubbing on the fence and/or trees that had gotten infected.  There was a thumb sized opening near the left side of her vulva and she’s such a butt scratcher that I assumed that must have been the cause.

However, when my vet came out to check her, the opening was actually deeper and larger than it had appeared.  When he examined the inside of the opening the tissue felt odd so he took a sample and sent it to the lab for testing.  When the test results came back, the diagnosis was cancer (squamous cell carcinoma.)  My vet indicated that due to advanced stage of the cancer, he was not sure that I had a lot of options other than trying to make her comfortable and he did offer to assist with what ever I needed.  However, he recommended that I check with UC Davis or other nearby Vet Hospitals to see if they thought it might be treatable.

The problem...

BUT SHE’S BLIND AND SHE CANNOT TRAILER

And then the thoughts that make owners bang their head against the wall…

“If you could get her to the Specialists…”

But she doesn’t trailer!  Arrgh.  What to do?!  Exasperation.

Here is how Veronica explained it:

The problem with taking her somewhere like UC Davis to be examined was that I had not trailered her since she lost her sight and wasn’t sure how well she would do.  She was blind in one eye when I adopted her six years ago, and had lost her sight completely in her other eye a couple of years later.  She has adjusted well to her lack of vision and gets around in her pasture using her nose and ears and her pasture mate, but I didn’t want to traumatize her by taking her away from her home if I could avoid it.

Up to this point, I wasn’t sure what to do. I wanted to do right by this 18 year old blind Appaloosa mare that I loved to pieces, but I wasn’t sure how I was going to make that happen.  About this time, she was due for her regular trimming from the farrier. When he came to see her, he noticed the S.W.A.T that I had applied around the affected area and asked what was wrong.  When I explained her situation, he almost cried.  I was not the only one that had a soft spot for this mare. After we spoke a bit more, he told me that I should contact Mario Dinucci and have him come out and do an exam.  He said that Mario had worked with some of his other clients in similar situations and that he might be able to help me as well.

IN COMES MARIO, MY VET

So, as Mario was relating this story, he filled in the medical blanks for me.  He said that these tumors grow rapidly and are nasty.  As a vet, he runs the risk of removing the tumor and in that process “angering it” (his words).  The tumor could come back with a vengeance.  But, sometimes tumors are removed and they don’t reappear.

This particular tumore was deep and large and scary.

But the mare was so nice…  Mario said that he decided that he wanted to try a new procedure on this sweet mare — as long as the owner understood the risks and agreed.

THE TREATMENT

Mario said that he read that Cisplatin beads had worked in a clinical trial of several horses, donkeys, and a zebra.  Cisplatin beads are tiny beads that contain the cancer medicine, Cisplatin.  The idea is that these beads can be placed exactly in the hot area and do their work with minimal intrusion upon the rest of the animal.  These concentrated measures of medicine are fixed and don’t spread around the rest of the body as Cisplatin liquid can when used orally.  So, less stress on the animal and more directed intervention.

The HOPE, Cisplatin Beads

CISPLATIN BEADS

I found this article that gives a bird’s eye view on the beads.

Click to enlarge

THE STUDY

There are several articles written on Cisplatin beads. However, I wanted to show you the study so you could read about it from a clinical standpoint:

At the Marion duPont Scott Equine Medical Center in Leesburg, Va., 40 of 48 horses (83%) treated with this approach were relapse-free two years later. Hewes reported the following success rates from an article published in the Nov. 15, 2006, issue of the Journal of the American Veterinary Medical Association:

Use of cisplatin-containing biodegradable beads for treatment of cutaneous neoplasia in equidae: 59 cases (2000–2004)

Christina A. Hewes, DVM, Kenneth E. Sullins, DVM, MS, DACVS
Marion DuPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Leesburg, VA 20177. (Hewes, Sullins)
Dr. Hewes’ present address is Peninsula Equine, PO Box 7297, Menlo Park, CA 94028.
The authors thank Lea Ann Hansen of the Virginia Commonwealth University School of Pharmacy for technical assistance.
Address correspondence to Dr. Hewes.
Objective—To determine outcome for equids with cutaneous neoplasms treated with cisplatin-containing biodegradable beads, alone or in conjunction with debulking.
Design—Retrospective case series.
Animals—56 horses, 1 zebra, 1 donkey, and 1 mule.
Procedures—Medical records were reviewed. Follow-up information was obtained through telephone conversations with owners and trainers of the animals.
Results—22 tumors were sarcoids, 6 were fibrosarcomas, 1 was a fibroma, 2 were peripheral nerve sheath tumors, 11 were squamous cell carcinomas, 14 were melanomas (13 gray horses and 1 bay horse), 1 was a lymphosarcoma, 1 was an adenocarcinoma, and 1 was a basal cell tumor. Forty-five (76%) animals underwent conventional or laser debulking of the tumor prior to bead implantation. Forty of 48 (83%) animals for which long-term follow-up information was available were relapse free 2 years after treatment. This included 20 of 22 animals with spindle cell tumors (including 11/13 horses with sarcoids), 6 of 10 animals with squamous cell carcinomas, 13 of 14 animals with melanomas, and 2 of 3 animals with other tumor types. Adverse effects were minimal.
Conclusions and Clinical Relevance—Results suggest that implantation of cisplatin-containing biodegradable beads, with or without tumor debulking, may be an effective treatment for equidae with various cutaneous neoplasms.

•                91% (20/22) of cases with spindle cell tumors (sarcoids and fibrosarcomas) were relapse-free after two years. Three cases with regrowth at one, two, and three years resolved after one additional treatment.

•                Squamous cell carcinomas had the greatest tendency to recur (60% success rate), likely due to the duration of these cases and the increased metastatic (spreading) potential of this tumor type.

•                93% (13/14) of melanoma cases were relapse-free after two years, including all affected gray horses. The one failure was a bay horse with malignant melanoma.

•                The sole cases of basal cell sarcoma and adenocarcinoma were relapse-free after two years.

•                One horse with lymphosarcoma showed metastasis after nine months.

•                Flat sarcoids don’t respond well to this treatment; growth stops, but the tumor doesn’t regress.

Complications included swelling, erythema (capillary congestion), wound drainage, subtle scarring, and a corneal ulcer requiring eye removal in one horse (following treatment of an upper eyelid tumor).

“Cisplatin beads are a simple and effective cutaneous (skin) neoplasia treatment,” Hewes concluded. The beads are affordable for the average horse owner and are sold in three-packs.

HOW VERONICA SAW THE OPTION OF SURGERY

As an owner, we have to make difficult decisions… Here is what Veronica said:

I contacted Sierra Equine that same day and requested a ranch call.  Mario came out the following week and conducted the exam and commented on Aponi’s good nature about the whole thing.  I told him that was why I adopted her in the first place.  After he finished the exam he told me that he couldn’t guarantee the cancer would be cured, but he did think that Aponi was a good candidate for the procedure and cisplatin beads and most importantly that he could do the procedure on site.

He provided me with worst and best case scenarios where the worst case would be to perform the procedure and cancer would come back but at least her quality of life would improve greatly while she was still around to enjoy it and of course the best case scenario where the cancer is cured completely.

MARIO’S TAKE ON THE SURGERY

Mario was very excited and nervous to do the surgery.  Clinically, he wanted to find something that worked, of course.  But, he was also frightened that he might exacerbate the problem and contribute to the decline of this lovely mare.

Bottom line, she was such a good mare, Mario felt that he could perform the surgery in the field and it was worth it.

He said that he only used local anesthetic and the mare was a dream…  The tumor was even larger than he thought and very deep.  Getting it all was a challenge.  As he went along, he inserted the tiny beads and stitched them in place.  5 in all.  He sewed it all up and prayed a bit.

THE RESULT

Mario was so enthusiastic about this because it worked (so far so good) and also because he really felt a pang of “gotta fix her” for this very sweet, blind mare.  it has been almost 5 months now and there is no regrowth.  Mario felt that there would be regrowth by now if he had aggravated the tumor or hadn’t removed it all.

Mario smiled and said that the mare helped him do his job because she was such a good girl throughout the entire ordeal…

His tech nodded her head in agreement, “She is an awesome mare!”

Here is Veronica’s conclusion:

As of today, it has been almost 4 months since her surgery and she seems to be doing great.  In fact, I rode her recently for the first time since the cancer was discovered and we both enjoyed it tremendously.  That would not have been possible without Mario and Sierra Equine’s innovative approach.

4 months later... still gone!

Up close...

A HAPPY ENDING

So, a happy ending for this mare!  Please pass this onward to any owners of light colored horses!

A happy ending! A cancer-free Aponi receives some lovin'!

MARIO AT SIERRA EQUINE

If you want to learn more about Mario Dinucci and Sierra Equine, please see the Sierra Equine FaceBook Page or go to the Sierra Equine website.

DOGS AND CATS

The beads are just starting being used for small animals with squamous cell carcinoma.  They are also being used to help with bone cancer.  Evidently, in some cases, no amputation has to occur after using these beads.  Good to know.  I’ve attached a story:

Apparently, there has been a large study in California; 80-100 small animals (mostly dogs, cats) that have received the treatment with tumor removal. They have had a 90-95 percent success rate, with only one case of tumor regrowth. In general, these are results that are typically not seen in clinical trials, so with that said, it is a very viable option.
While the Cisplatin is a very potent anti-tumor drug, the delivery system places it right on the tumor site and thus requires a fraction of the medication that would be given through more traditional methods (by mouth or through injection).
To put it in perspective, if every bead released every drop of medication at once, it would be less than *one* oral/intravenous dose of cisplatin previously used in treatment for animals. The rel
Last summer, our friend Jami told us about about “cisplatin biodegradeable beads,” an experimental type of chemotherapy treatment being tested in dogs with bone cancer, who are undergoing limb-sparing procedures instead of amputation.
These biodegradeable beads are being implanted at the time of the limb-sparing surgery, with the goal of preventing tumor regrowth in the leg, through a gradual release of cisplatin, a chemotherapy drug. This type of treatment can possibly reduce the recurrence of tumors in dogs who have had limb-sparing surgery instead of an amputation.


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Hoof Abscesses.


Monday, December 13th, 2010 | Filed under Medical




Of course I know what abscesses are… They are nasty migrations of infection that open up and drain.

Norma has one on her coronet band.

I also know that abscesses are often associated with laminitis and wet weather.  I know that you soak an abscess and that they are really painful.

But, when I had to think about abscesses since I was now dealing with one, I realized that there was so much I didn’t know…

What creates an abscess in a hoof?  Why does wet weather make more?  Why does laminitis promote them?

I never bothered to find out about abscesses because I had never known one before.

But, now I had met Mr. Nasty, head-on.  So, I needed to educate myself.  I asked my vet and Mr. Google to kindly explain ‘abscess’  to me.

WHAT MY VET SAID

My vet is young and sharp and fresh and willing and wonderful.  He also has a very clinical mind that speaks from a place of booksmart that eludes me.  Luckily, he is able to translate for a simple lay person like myself.  So, after we found the abscess and did our Hallelujah dance, I asked him WHY.  Why does an abscess usually follow laminitis?  What creates an abscess of the coronet band?

(We are not addressing any other kind of abscess.  For example, pigeon fever creates horrible abscesses…  Or any foreign object that impales and enters a horse may come out in an abscess.  We are only speaking of the hoof kind of abscess.)

OK, so my vet said that when a horse has laminitis, the laminae separates, ever so slightly, from the hoof wall.  During this process, bacteria can migrate up into the hoof.  If one is lucky, the bacteria is battled by the horse’s immune system.  The immune system sends out a bunch of white blood cells to encapsulate the bad things in a nice river of fluid (pus – OK, I said it) which protects the body from the invader.  This nasty boat of gunk now knows it needs to exit the body so it migrates around until it finds an ‘out’ point.

The laminae separating from the hoof wall which allows bacteria to enter

If the horse is lucky, that out point is his sole.  With gravity in its favor, the nasty boat flows down the junk river and escapes out the bottom of the foot.

But, if you aren’t as lucky, the nasty boat takes a turn up river and pushes itself up the hoof wall until it reaches the sensitive coronet band where it explodes out the side like an angry boil.

The reason this is so painful, well, as my vet explained it, goes something like this:  (in his words)  Imagine that you have sunburned the bottoms of both of your feet (laminitis) and then you grow a huge blood blister under your toenail beds.  Between the blistering pain of the soles of your feet and the huge pressure of the “blood blister” (abscess), the pain is almost unbearable.

Yikes.

An example of an abscess in the hoof wall

OTHER CAUSES OF HOOF ABSCESSES

Another way a horse can get an abscess is if he steps on a stone and either cuts his sole (hence opening another area for infection) or if he causes bruising.  Sometimes a stone bruise can turn into an abscess as it heals.  However, stone bruised abscesses usually come out the sole.

Another cause is wet ground.  It isn’t the wet ground, but more that continuous wet ground softens the hoof.  That softened hoof is more easily penetrated.  And, as we all know, that soft hoof is mucking around in not-so-clean mud.  The bacteria in the not-so-clean mud enters the soft hoof and you get abscesses.  This is why Fall is called Abscess Season.

Another obvious cause of an abscess would be a nail or any other type of puncture.  Ouch.  Hopefully your horse had his tetanus vaccine.

It is smart to clean out hooves often, especially in wet weather…  And, of course, it is smart to clean out hooves often anyway because then you can watch for bruises and cuts and softening or whatever else might go wrong with the hoof.  I know, I know, who wants to clean out a mucky, gucky hoof in rainstormy weather?  I know I don’t.  But, it is better to catch bad stuff like thrush or (heaven forbid) canker, laminitis or an abscess EARLY.

Imagine if that hole was created in your foot pad...

LAMINITIS IS VERY COMPLICATED.  ABSCESSES AREN’T

Laminitis is very complicated.  It could be caused by any number of factors and the complications can be numerous and from all sides.  Abscesses are abscesses.  They are very painful but once you know what you are dealing with, you can most often fix them.

We were doing a Hallelujah dance when Norma blew the nasty boat through her coronet band channel locks because we couldn’t understand why she was still so painful in her left front.  Since laminitis is so complicated, yet her foot wasn’t showing signs of sinking, we couldn’t come to a solution.  Once we found the abscess, all became clear.  Now we had an explanation and a process.

DIAGNOSING AN ABSCESS

According to my vet and Mr. Google, usually one can test the hoof by applying pressure with hoof testers or by just using strong fingers.  Imagine if you had a blood blister under a toenail.  Someone could push on all the other toes and foot – you’d be fine – but press on the bad one and you would jump and slap the person, maybe.  Well, that is what it is like for a horse when you use hoof testers.  “Does it hurt here?”  no.  “OK, does it hurt here?”  nope.  “Here?” nada.  “How about…?  AAAAGHHHHHH!    You get my drift…

Once you know, kind-of, where the abscess lies, you can treat it.

Sometimes you can even see the abscess in the form of a blood spot or black spot (dark blood) on the sole.

But with Norma, she didn’t show any more pain with the hoof testers.  Her entire hoof was sensitive, but no one spot was really painful.  We didn’t see any bruising or dark spots on her sole.  We had no idea that she had a huge abscess brewing deep inside.

Sometimes you don’t know they are there until they burst.

How it looks while healing

WHAT TO DO WITH AN ABSCESS

Soak it.  Draw it out.  Help the body get rid of it.

Mr. Google had a billion recipes for poultices and soaks.  I’ll get to those in a minute.

My vet told me (I called him when I discovered the abscess exit point) to help it drain as best I could… the first thing I should do was to  soak her foot in warm water, Epsom Salts and Betadine.  Easy.  Except she wouldn’t let me soak her foot.  And, if a donkey doesn’t want to do something, she won’t.  (Remember, the donkey put the ‘stubborn’ in the mule…).  So, I called him back.  He then told me to make a poultice out of the Epsom Salts and Betadine.  Put that on a clean cotton swab and wrap that.  I did.  But the abscess was very stubborn and was not draining rapidly.

So, my vet came out and gave me Animalintex pads.  These are so cool!  First of all, they are inexpensive (Yay!) and fairly easy to apply.  The idea is that they are prepared with the drawing agents already embedded into the cotton.  They have a plastic face that helps create heat (helps create more draw) and a plastic bottom that protects the ingredients.  All you have to remember is “shiny side down”.  It is easy.  First you cut the pad according to the type of abscess you have (sole or coronet band).  Then, you soak the pad and squeeze out the excess water.  Finally, you position the pad (we put ours on the coronet band and longways down her hoof wall and then under her sole to hopefully draw out the abscess through the sole as well).  If you are lucky, the equine will allow you to affix the pad with adhesive, elastic vet wrap.

You should have seen my vet apply the poultice pad…  One, two, three DONE!  I felt like I was watching calf roping… Grab, pull, wrap, tie and Ole!

You should have seen me do it.  The wrap looked like the rodeo clown applied it.  Yeesh.  But, it was on there.  Norma was much more obliging to the vet than to me…

Anyway, you change the pad every 24 hours even though the pack says every 48.  Fun.  But, better than watching your horse suffer laminitis and not know why…

Imagine the pressure of an abscess slowly traveling up the laminae

DIGGING IT OUT

OY.  I cannot even imagine the pain associated with digging out an abscess.  Maybe a better term would be “puncturing” the abscess to help it drain.

I know farriers do this often and I’m sure that is fine… but I’d rather have my vet do it so that pain could be addressed and infection could be watched.   In any event, puncturing the abscess does relieve the pressure and allows the infection to drain.  The sooner it is gone, the better.

POULTICES

Oh my word… When I asked Google about poultices, I read so many recipes, I felt like Julia Child.  I learned about every drawing agent under the sun from Linseed and Wintergreen Oil to Slippery Elm — the homeopathic remedies abounded.  Dr. O’Grady (a known vet specializing in hooves) said:

“Another useful form of poultice is a combination of wheat bran and Epsom Salts (2 parts bran and 1 part salts). This poultice is cumbersome but has certainly withstood the test of time. Packing the foot with Ichthammol or a combination of Ichthammol and glycerin is also used frequently with good results reported.”

He also suggests using disposable diapers as a foot covering and then wrapping the diapers.  I liked that.  Easy, Clean and they already have sticky tabs!

THOUGHTS

My parting thoughts are to keep the horses feet healthy and hard.  Hard feet help prevent any cracks in the soles/hoof wall that would let in bacteria.  Watch for stone bruises or injuries.  Keep betadine, Epsom Salts, elastic wrap and diapers on hand.

But, my biggest and best advise would be to practice wrapping the hoof with a slippery something.  I swear, trying to get a very sore hoof wrapped in a slippery poulticed pad with an elastic wrap in the works is like trying to keep kittens in a basket.  So tough.  I swear I must have dropped the poultice pad in the shaving half a dozen times.  When I’d grab for the pad, I’d invariably drop the starter part of the elastic in the shavings as well, which rendered that piece useless.  So, I’d wet and clean the pad, again, re-start the elastic and try again while Norma was pulling her foot away from the very weird sensation she had never felt before – over her incredibly painful spot that I was pressing against.  It was like a three ring circus.  When it was finally done I almost cried.  Norma almost cried.  But, we ended the event with a treat so she almost forgave me.  Of course, she is a donkey so she will never forget… and that makes me so eager to do it all over again in 24 hours.  Not.

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