Sarcoids, surgery and recurrence – any experience?

[Maximoose]

I’ve been reading the forum for a while but have finally decided to post (so ‘Hi’).

The ‘quick’ version of my question is:

Does anyone have experience of laser surgery in the treatment of sarcoids, generally but particularly with multiple and recurrent nodular variety?

Did they reoccur at the original site and/or elsewhere? If so, how long did this take?

I found a very useful talk (with case studies) by Jeremy Kemp-Symonds on You Tube, have looked up some of the studies in vet journals and also read a few of the previous threads but many mention the option of surgery without a follow up (and statistics are no substitute for actual experience).

Trying to decide on the best course of action, given what I’ve tried already.

Thanks in advance.


The back ground, (should anyone be interested)......

I’ve had Max for nearly 8 years and he’s a 15 year old Tbx (no idea what with as no passport when I bought him, but our best guess is sloth...) When he’s rideable (another story in itself!) we mainly hack but also occasionally do some schooling and pop the odd small fence.

Around 2006 he developed a couple of very small lumps on this ear which weren’t bothering him so I left alone. Eventually they started to grow so were examined by a vet, diagnosed as sarcoids and treated successfully with Liverpool cream. Around a year later another couple of small lumps appeared on the same ear, treated immediately this time, again with Liverpool cream. Unfortunately this time the vet was not as careful as he should have been and some of the surrounding tissue was damaged, however we did get rid of the sarcoids. I was particularly annoyed by this as had asked to apply the cream myself (I’m a research scientist so used to working with hazardous substances) and was not allowed due to licensing issues. I’d have done a much better job than he did but ho hum.

Another year passed, sarcoids on ear reappeared and again treated with Liverpool cream. Different vet was extremely careful and again successful removal. In each case he wasn’t particularly uncomfortable with Liverpool cream treatment (no painkillers needed etc.) and the sarcoids were mainly treated in order to stop them growing or because they were starting to weep and flies were a problem.

Over the next few years I has odd occurrences, both on his ear (always the same one, other is fine), stifle and under his belly. One set were banded (wish I’d discovered this was an option earlier as worked really well) and a couple actually fell off without treatment (one on ear, the other on stifle).

Fast forward to September last year. He’d had a mixed sarcoid on his ear for a while which hadn’t bothered him so had left well alone on vet’s advice, only treating with aluminium spray on the rare occasions it started to weep. However he also started to develop a lot of small growths on the inside of and between his back legs, which at this point were under the skin. Checked by vet and advised to leave well alone as not bothering him.

Fast forward again to March this year and noticed a significant growth on this sheath area. Not sure how I’d missed this however the lighting in the barn isn’t the best and was difficult to see unless really looking for it. So vet called again (had moved practice by this point as not happy with previous one but again another story). This time advised to treat with ExTerra cream (which I believe is a slightly less aggressive alternative to Liverpool cream?) that they had been seeing very good results with. Treatment was 5 days application, 5 days off followed by another 5 days application. Just treated sheath and between back legs, advised to leave well alone with ear.

First few applications not a problem. I should say at this point that Max is the softest creature I’ve ever had the pleasure of knowing, would happily sit underneath him if I had to (NOT that I’ve ever done or plan to do this....). Anyway you get the picture, treating between back legs didn’t worry me in the slightest. However despite 2 bute a day as a pain killer and to reduce swelling he was becoming more and more agitated when I tried to apply the cream and in general. Managed a couple of days with a twitch (even though I dislike using them) but even this was getting dangerous due to kicking out. Even changing his rugs was getting risky. Was advised to finish the treatment and used sedation for the last couple of applications which helped a lot and he seemed less stressed and not in pain when he came round. Bute kept him comfortable and the treatment was for the most part successful (sarcoids either shrivelled or shrivelled and dropped off) however it didn’t work on them all and some were missed as there were so many. One in particular was a problem as was catching every time he moved. Treating with silver spray (or anything else for that matter!) was not an option as couldn’t get near.

So decided to try a supplement to boost his immune system (vet said don’t expect it to work but shouldn’t do any harm). Went for Global Herbs Sarc Ex as swear by one of their other products for his pollen allergy. Fortunately he would eat it (as is a fussy so and so ) and actually seemed to help – main problem sarcoid dropped off.

I’m now a couple of months down the line and have still got a couple of problem sarcoids – one on the inside of hind leg that is raw (but doesn’t actually seem to be bothering him, have stopped bute and he will let me know if he’s in pain) and another between back legs that is still under the skin but growing quickly and worried it will rub. Trying to continue Sarcex but struggling to persuade him to eat it when he’s full of grass. The dosage is quite high (4 scoops a day) and he won’t eat sloppy or wet feeds so a bit dusty, even if I try to damp down a little.

So I’m now considering laser surgery as an option to try and control them. Being a pre-existing condition he isn’t covered for vet bills but I can just about afford 1 course (i.e. complete removal + necessary general anaesthetic once but not again if they reoccur). I’ve already paid a 4 figure sum in vet bills over the years for topical treatments but I’m worried if I don’t treat I could end up losing him and will kick myself if I don’t try everything I can. I won’t use Ex Terra again as it upset him too much and will need several months to see if supplement will really help. Banding may help short term.

Hence surgery. I’ve done a fair amount of background reading and know success rates are pretty high with single sarcoids but less so with multiple and if they have reoccurred. I’d be interested to hear any experiences. Also would ideally like to do the surgery (should I go ahead) in the autumn when he’s in and flies are no longer a problem (and I’ve had time to put some money aside!), but worried leaving it a few months may cause more problems.

As you can probably tell this horse means a lot to me (God knows why, he causes me no end of stress!) The treatment is going to cost more than he’s worth but that isn’t really an issue. Retiring him is not a problem if necessary, I just want him to be comfortable.

Sorry for the essay!

 

[Jules19]

Unsure how much help I'll be as mine was for a single sarcoid, nodular, under the skin and eventually erupted,inside the hind leg. First lasered 6 years ago, followed by Liverpool cream treatment, all good, takes a decent amount of time to heal as they are trying to get all possible affected cells so it is not a delicate little hole!

It then recurred about 4 years ago, apparently thinking had now moved on and they weren't using Liverpool cream post op anymore, so just straight laser. Again, took a while to heal, but zero complications. He was operated on with standing sedation and I was able to get him in and out in a day (also no insurance!). Since then have had no issues whatsoever and fingers crossed, no sign of recurrence. I'm afraid I've had no experience with multiple lesions though.

Good luck.

 

[onemoretime]

Have a read up on here about people who have used Crest toothpaste. It makes interesting reading. I have had no personal experience of any of this though myself. Good luck

 

[Goldenstar]

Fatty has/had nodular sarcoids when we got him he was given to us because he had a heart issue due to this we had more pressing issues than sarcoids when got over this he had six nodular sarcoids removed five by laser one surgically ( this was on his stifle this not a good place to laser.) aftercare was fine just a question of bute for few days and barrier creams to keep flys off and lots of for repellant and keeping any wounds on out other horses well covered in barrier cream .
Wounds took just over three weeks to heal .
About a year later something started to grow on the edge of the scar of the biggest area treated it was lasered again treated as before nine months after that one popped up on the inside of his thigh it was lasered two days later and he's been clear a year now.
Fatty had all his done under sedation I know some vet what a GA but this approach has worked well for us.
I am careful to keep fatty stress free and chilled its easy as he's very very laid back , I check him all the time I obsessed its been an expensive exercise but he's a great horse who does a fab job for us.
He's never had them appear anywhere Else except the insides of the hind leg but I keep a close eye all over.

 

[Goldenstar]

Ps on tooth paste I put high flouride professional toothpaste on a tiny lump I found on fatty in January it disappeared but I am not convinced it was a sarcoid , your horses sounds too serious for a DIY approach.

 

[Maximoose]

Thanks for your reply Jules, that’s very helpful and much appreciated. Glad you seem to have got them sorted second time around.

I’m hoping most of the wounds wouldn’t be huge (most of the sarcoids are pea sized) but am prepared for the fact that larger ones may take ages to heal, particularly given where they are. He could cope with box rest if necessary. Not even sure if ear and stifle would be suitable for surgery but need to have a detailed discussion with my vet. I just thought I’d try and make a firm decision first as don’t want to mess them around (hence this post to research it a bit more).

Sadly I think standing sedation wouldn’t be an option in this case due to their number and location but would rather avoid GA if at all possible (risk and cost!) so will double check.

Thanks

 

[Maximoose]

Thanks Goldenstar, very helpful and glad you also seem to be winning! Wasn’t even considering toothpaste – as you say this has gone too far for home cures, effective as they may be in many cases.

Trying to keep them covered is a problem (couldn’t even bathe when initially treating with Exterra) but if I can find something gloopy that doesn’t sting he should let me apply a cream. He’s a wimp with fly spray but we get there eventually. Fortunately I haven’t had a problem with transmission to other horses in the years he’s had them, but I’d rather keep them covered if I can.

It also seems that I may need to budget for more than 1 treatment which isn’t ideal but worth thinking about. With general anaesthetic I was initially quoted £1000 (£800 treatment, £200 GA), which was actually less that I’d thought. I hadn’t even considered surgery previously as I was convinced I’d need a second mortgage and when he first had them treated the laser approach only just seemed to be taking off, but still. I’d also need transport and probably an overnight stay which all adds to the cost.

If I could do any subsequent treatments under standing sedation it may be OK. My yearly vet bills are often at least £500 (he’s usually done something to hurt himself or need attention, bloomin’ thoroughbreds! ) so may manage if I wrap in cotton wool for 12 months.....

If you don’t mind me asking, roughly how much did your laser treatment cost per session (i.e. not sedations, extra drugs etc.)? Would be useful to have something to compare with (PM would be fine if you’d rather not say online).

RE stress, he’s generally very chilled (read as half asleep/horizontal) but can have a tendency to panic in certain situations (usually short lived). He’s been on the same yard for the last 6 years, out 24/7 in summer and during the day in winter with ridden work where possible (when he’s sound) so shouldn’t have a great deal to be stressed about.

Thanks.

 

[Goldenstar]

My memory tells me about £ 800 the first two times and £400 for the last small one .
The bill so far is just over £3000 in total but my guts tell me we got the little b on the run now.
He's a lovely horse and was given to me because of his health problems so we are still up on the deal ( just).
I can recommend filta bacc cream as a barrier excellent it really works. It's gloppy and I had splat in on quick when they where sore .
You can get a tub from eBay cheaper than the vets, I also think its runnier in a tub and easyier to splat I had a tube at first.

 

[Maximoose]

Thanks, that's very helpful. I'll check the cream this evening - got to run for a train now.

 

[Darremi]

My old horse got a rally aggressive sarcoid on his tummy and this got surgically removed and treated with Cisplatin being injected into the wound. Because this chemical was dangerous to humans we had to avoid touching the area for quite some time. He never got another one. But I think this kind of treatment is for really bad ones only.

 

[Passtheshampoo]

Can't help on the laser treatment as my mare had Liverpool cream on her module and mixed sarcoids. The vet never got them all with thec ream but they did all go. Not sure if you've thought about giving your Echinacea but I think this helped build ur my mares immune system. The tablets are cheap enough to buy from most chemists.

 

[YasandCrystal]

I feed my mare a herbal sarcoid supplement I bought from Folklore Herbs. I was recommended this by someone whose horse was cleared of sarcoids after a2 years on this. I also feed Aloe Vera juice in her feed.

 

[Maximoose]

Thanks for all your replies.

I'm going to check with my vet about the barrier cream before using, just to be sure. If I understand your post correctly Goldenstar you used it post surgery to protect the open wounds and allow healing for which it sounds ideal. From reading the manufacturer's description it does seem to be a permeable barrier rather than actually promote healing so should be fine in my case too (and gloopy is good, if I can splat from a distance even better!)

However I've got weeping sarcoids rather than wounds and I believe that anything that encourages cell growth can be a problem, which is why I'm going to double check first. I understand this is why something like Camrosa is apparently a bad idea?

With regards to Cisplatin really glad it worked for your horse Darremi. However I think this is quite a rare approach and not sure how it would work with multiple growths, particularly being carcinogenic itself? However I wouldn't rule it out if I could cover the cost.

RE supplements he's currently on Global Herbs Sarc Ex, which I'd heard good things about. It doesn't contain Echinacea so this could be something I could try either as an addition or at a later date. A lot depends on whether he will eat the tablets (he's very fussy) but I'll look into it.

Thanks again for all the suggestions.

 

[JulesRules]

Just out of interest have u tried combining the sarc ex cream with the herbs? A combination of both worked on my mare although hers were small nodular ones and nowhere near as severe as yours

 

[Goldenstar]

Thanks for all your replies.

I'm going to check with my vet about the barrier cream before using, just to be sure. If I understand your post correctly Goldenstar you used it post surgery to protect the open wounds and allow healing for which it sounds ideal. From reading the manufacturer's description it does seem to be a permeable barrier rather than actually promote healing so should be fine in my case too (and gloopy is good, if I can splat from a distance even better!)

However I've got weeping sarcoids rather than wounds and I believe that anything that encourages cell growth can be a problem, which is why I'm going to double check first. I understand this is why something like Camrosa is apparently a bad idea?

With regards to Cisplatin really glad it worked for your horse Darremi. However I think this is quite a rare approach and not sure how it would work with multiple growths, particularly being carcinogenic itself? However I wouldn't rule it out if I could cover the cost.

RE supplements he's currently on Global Herbs Sarc Ex, which I'd heard good things about. It doesn't contain Echinacea so this could be something I could try either as an addition or at a later date. A lot depends on whether he will eat the tablets (he's very fussy) but I'll look into it.

Thanks again for all the suggestions.

I also used this cream when nodular ones dropped off before he was treated
and summer fly cream both recommended by the vet.
You can get liquid echinacea from Hilton herbs ( I think that's where I bought mine) .
Your wise to check with your vet they are not things to experiment with.

 

[neddymad]

My 3yr old had surgery at Easter for a large sarcoid on his tummy and one on his penis. It was extensive surgery where they removed the lumps and used a lazor and was done under a GA. IT has taken time to heal and he had lots of stitches but he was fine. I have however noticed another one (much smaller) come up on the outside of his sheath. The vet did say to me that lazor surgery is supposed to help stop them coming back in the same place but as you probably already know they can appear anywhere on the body.

Not sure if this helps but wish you all the best.

 

[Maximoose]

I haven't tried a combined herbs/cream approach (I did cream then supplement) but interesting that it helped. I think (though may be mistaken) that Sarc Ex cream comes in various strengths, some available commercially and the more potent forms from a vet? The version I used was pretty nasty and I really don't want to go that route again if I can help it. In order to do another course I'd need to sedate him for 5 consecutive days (twice) which aside from the cost I'm not sure would do him any good. It's too risky to apply the cream without.

Useful to know that echinacea is available as a liquid, will look into that. His feed already has more ingredients than a Michelin starred dish so why not add another for good measure.

Going to ring my vet next week to discuss options further.

I'll also try to upload some photos from various stages - no help to me but may be interesting for others.

 

[Rebels]

Hi, maybe worth asking your vet about cryospraying some off? My lad had several that didn't respond to bloodroot so next step was Liverpool cream. Vet tried the freeze spray first and Im pleased to say that was it after 2 treatments. 1 was banded then frozen, rest just frozen. All were starting to escalate. That was 3 years ago. Just had a youngster have some appear, had one banded and i tried the sarc ex. Not allowed to put bloodroot on until its healed, the lump dropped off immediately (very surprised ) and has left a sore plaque which i think the sarc ex is keeping 'awake' and should hopefully drop off soon.

 

[lannerch]

My horse had multiple removal of nodular sarcoids in his sheath area in December , do not over worry about the wounds, they were open but healed very quickly, the vet came to clean once , and he was on antibiotics for a few days after.
Cannot comment on whether they return and how long it will take if they do, but the whole laser removal costs about £500 a time ( sometimes with multiple sarcoids they are unable to remove them all in one session.
My own horse has a few left they could not remove due to the sheet number and position and will go backin the autumn to have these removed also.

 

[R.A.H]

Hi, I had a horse with a very aggressive sarcoid on his ear. Had it removed twice then third time went for laser surgery. Used Jeremy kemp Symonds brilliant bloke. Couldn't fault him. If you have a look through my previous threads you will find some photos.

Also I wouldn't put anything on his sarcoids that the vet hasn't recommended.

 

[SusieT]

have you contacted liverpool (Prof. Knottenbelt I believe) to ask their advice as they are the experts?

 

[leflynn]

have you contacted liverpool (Prof. Knottenbelt I believe) to ask their advice as they are the experts?

Do this, they have referral service, my boy was referred there a couple of years ago and recieved iridium wire treatment for an agressive sarcoid over his eyelid and *touches wood* none have come back since and the suspected one under his chin went along with the original one.

I'm another who wouldn't dabble with tootpaste I'm afraid and would go to a vet/liverpool referral, good luck!

 

[Maximoose]

Thanks again to others who have replied. I have read some of the previous threads, including yours R.A.H, and they have been very helpful. Glad to hear the surgery seems to be working so far.

His ear isn’t as aggressive as the one your horse had but it is starting to cover a larger area. He has two nodules on the front at the base (which are pink but not bleeding if that makes sense) and the whole base (and starting to work up the sides) is becoming covered with smaller nodules and is scaly. This one was classed as a mixed sarcoid. I need to take a recent photo but this isn’t actually bothering him at the moment so less of a worry short term (considering the others anyway).

Iridium wire seems to be a good choice for eyes, where other treatments aren’t an option and glad it worked for you leflynn. However I think it could be cost prohibitive for the sheer number that he has. I know radiotherapy routes can cost a fortune.

Again cryosurgery could be an option Rebels, I need a detailed chat with my vet.

R.e. Liverpool I’d be happy to talk to them. His early treatment did use the cream so they were involved, however the latest course didn’t. We decided using Liverpool cream in his sheath area may cause him too much discomfort. My vet actually trained with Prof. Knottenbelt so I’m sure she would get in touch for me if I asked her to.

I also need to find out how much experience my practice has had if I go the laser route – I think they have treated several cases but not certain. If it’s not something they do regularly I may be better getting a referral.

If I had thousands in insurance to play with I may have more options available, especially with a referral. However I simply can’t afford to pay for multiple surgeries, additional expensive drugs on an ongoing basis (I've spent a fortune over the years as it is). I could possibly do 1 surgery/treatment now and another if they recurred in 12 months but can’t cope with a bill that runs into the thousands (and it easily could with some of the treatments available.) I'll do everything I can to help him but without a lottery win there are obviously limits.

Will see what the vets say. All the advice/options/experience are much appreciated.

 

[Goldenstar]

If you are near to a vet training uni it might worth asking for a quote from them I did a great deal with my nearest one for my TB's tooth surgery saved a fortune verses my vets.

 

[Maximoose]

I’m in the north east (Teesside) so I’m guessing Liverpool or Edinburgh would be closest? It’s a possibility but looking at a hell of a journey for him if I did (Liverpool took me 3 ½ h in a car last year).

 

[leflynn]

I’m in the north east (Teesside) so I’m guessing Liverpool or Edinburgh would be closest? It’s a possibility but looking at a hell of a journey for him if I did (Liverpool took me 3 ½ h in a car last year).

I'm Newcastle ish and mine travelled well both ways thankfully (even had a little doze), if they travel okay it shouldn't be too far for them I know Bearl near me do some sarcoid laser surgery (Northumberland) so maybe worth a look locally to you as it would involve less travel? (Haven't used Bearl so won't comment on them)

 

[Goldenstar]

I’m in the north east (Teesside) so I’m guessing Liverpool or Edinburgh would be closest? It’s a possibility but looking at a hell of a journey for him if I did (Liverpool took me 3 ½ h in a car last year).

Yes the travel would absord any saving it was just a thought.

 

[Maximoose]

I’d be looking at the Rainbow Centre in Malton as my practice use their facilities. According to their website (and my vet) they do laser surgery but not sure if sarcoid removal is something they specialise in?

He travels OK but have only ever travelled for up to an hour. Should be OK to go further if I needed to for medical reasons but the cost of diesel would, as pointed out, probably negate any savings for treatment.

 

[Renvers]

I have (unfortunately) had experience of both Liverpool Cream and Laser Surgery. Personally I prefer the Laser Surgery, as Liverpool Cream application is much less precise and if missapplied the pain/skin damage is awful. Liverpool Cream is cheaper but I have had it miss cells and result in further agressive growth where the sarcoid has been irritated.

Like RAH I used Jeremy Kemp Symonds( http://sarcoidsurgery.com ) and was really impressed with the work he did, one was right by the eye which has healed wonderfully. He also prescribes a post op cream developed by University of Vienna with a wonderful record for stopping regrowth at that site.

Good luck with whatever option you decide, I hope the much feted vaccine gets licenced soon