Sarcoid Treatment

Before Ben was mine, I didn't want to write anything about this. But now? Kid is all mine, for better or worse. And Emma's post about blogging and reading got me thinking about what else I had to share that could be semi-useful or at least visually entertaining (if you're into gross things). 

Turn back now if you don't want to see some gnarly pictures of a giant sarcoid on a sheath. 

 

Arrival in January. Large, nasty thing hanging out there. 

Treatment options offered included surgery, immunocidin injections, or a combo of both. Surgery ran the risk of incomplete removal, angry sarcoid tissue left behind, and wound dehiscence. He also would need a month of recovery time if we went that route. So his owner elected to go with immunocidin injections. Immunocidin is mycobacterial cell wall fractions. The idea is to inject the sarcoid and get an immune response. The pictures that follow are testament to that. 

Looking kind of angry, but more on a stalk after the first injection

Then the center started to get necrotic, yay! At one point it was oozing pretty steady drips of puss out of the center. 

I won't compare this to food... I won't compare this to food... 

It went through several bleeding phases too 

This was a few days before our Majestic show. His doctor had managed to put a band used for castrating sheep around the base of it. It was hanging on by a thread and smelling very, very like a dead animal. Poor buddy also had a lot of swelling above it. 

JT and I joked about trotting down centerline and then flinging this sideways at the judge as we turned at C. The morning of the show, I put a ring of suture around the base to make sure it wasn't going to bleed or hurt him, and then snipped this off. I promptly threw it in the trash because the other thing JT and I had talked about was it falling off in the pasture and a dog eating it. Also LOL at my lack of gloves, bad vet.  

Large wound left, but nice healthy granulation bed. There's another sarcoid above it. We treated the wound bed with Vetricyn Plus, which I had never used before. I've since recommended it for a number of wounds I've seen at my job. This made me a believer in it. 

Closing up so quick. But... that sarcoid brewing above became the next thing. 

I apparently got bored of photographing Ben's sheath at this point, about 2 months ago. The sarcoid above was the next target of immunocidin injections. It's almost done at this point, then we get to stop poking the poor kid in an incredibly sensitive/personal area. He has been SUCH a good boy for all of this. He picks up his hind leg in protest when I go to check or remove the scabbing to be able to get ointment on it, but he has never actually threatened to kick. His whole team at Peterson and Smith where we did the injections just loved him as well. 

I think all together we did... 4 immunocidin injections, 2-3 weeks apart. 2 injections got us to the point of banding the larger one, the last 2 injections were on the one above it that never did form a nice stalk. I did another injection myself after his dual farrier/vet appointment on Tuesday. Just trying to finish off that (non-photographed) one above it. He did tend to get sore and swollen in his sheath after the injections, sometimes to the point of not really bringing that right hind forward under saddle. We would give him some easy days with just a light hack when that was happening. Seems like motion was good for it, but obviously wanted to be kind to him. 

He has a sarcoid on his leg (that I have never taken a picture of...???) that he has had since his owner got him as a 5 year old. It's just above his chestnut on the inside of his left front leg. Also about the size of a chestnut, but raised. The one on his sheath cropped up between age 10-12 while he was on lease. He had plaques in his ears as well, I'm not sure of the time frame on those. Since we've been treating the sheath, we also did treat ones in his ears and the one on his leg. 

The ones in his ears responded to a single treatment of topical Imiquimod. They did get pretty angry and painful, so I wouldn't use that same medication again in the ears. He's SUCH a kind and forgiving horse that he has gone right back to letting me handle his ears, no problem, but I can definitely see how a less forgiving horse might very easily have become head shy/ear shy after the process because they ulcerated and kind of peeled off, leaving his ears very raw for a time. Applying or spraying anything on those was a no go, so we just put ointment on when he was sedated at the next injection appointment and then kept him covered up with a fly mask with ears. 

The one on his leg has been responding to weekly Imiquimod and then daily Sarcoid Stopper. There is a Sarcoid Stopper product that probably would have been better for his ears than the Imiquimod because it contains a steroid to try to decrease inflammation associated with treatment. His vet at Peterson and Smith said the ones in the ear can usually just be ignored as well, but occasionally as a surgeon she sees one that has grown out of control and wishes it had been treated earlier. This reminds me of lipomas in dogs. Mostly they never become a problem, but sometimes they are the type that weave intramuscularly, or they just get so big in such a bad spot that they are a problem. And then once they're that size and a problem, they're pretty hard to deal with. 

I'll snap some pictures of his leg as well as where we're at with the sheath and share those if others are interested in this journey.