Clinton Vet Service: Week 4

Another week filled with more interesting cases has come and gone at Clinton Vet.  I would have to write a small novel in order to encompass all of the unique cases that I have had the chance to be a part of during my time with Clinton.  I have chosen two of my favorites to review in this weeks post.  Thank you all for following along this month, enjoy!

Eye ulcers can be a frustrating and drawn out battle for horse owners.  They can have multiple causes, including abrasions, foreign body, and neoplasia.  This particular gelding has been battling ulcers on and off for almost two years.  In the past he has gotten them in the winter time, this being the first time he got one in the summer.  A week prior to our first encounter, one of the associate veterinarians had performed a corneal scraping and sent it into MSU for evaluation.  Surprisingly the sample came back positive for squamous cell carcinoma, with a note that a full thickness biopsy would be needed to confirm.  The owner was extremely worried that a positive cancer diagnosis would result in the loss of his eye.  After looking at the eye we did not suspect that it was squamous cell, as there was no appearance of outer eye involvement or cancer-like behavior. 

Ulcer taking up stain
on our first visit

No stain uptake after
biopsy and treatment

        We began our exam by looking at the eye with an opthalamascope and light.  Then we stained the eye fluorescein, a dye that is taken up by damaged or inflamed cells in the eye. So we put him back on daily ulcer treatment, in this case a triple antibiotic, atropine, and an anti-fungal just in case.  The owner was willing to bring him into MSU for an ophthalmology consultation and biopsy so we got him in as fast as possible.  MSU took a biopsy and instructed her to continue treatments.  All of the tests came back negative; which was both encouraging and frustrating.  We were back the drawing board as there was not evidence of bacteria, fungus, a virus, or cancer.  Two weeks later we returned to the farm to a welcome sight.  The eye no longer took up stain and the biopsied portion was healing well.  For now we are discontinuing treatment and crossing our fingers that we have cleared his ulcer woes once and for all.

Cytology showing abnormal lymphocytes

The next mare that we visited was on the schedule for "bumps on her body" and weight loss.  A long time client of Dr. Cynthia's, the owner just wanted to trouble shoot what could be causing her problems.  The mare is older and has been struggling with weight loss for some time.  Dr. Cynthia palpated the area, near the mares right flank, and noted that it was well attached to the underlying tissue, a sign that it might be neoplastic in origin.  We took a fine needle aspirate of the area and brought it back to the clinic for cytology.  Unfortunately, we noted a number of abnormal lymphocytes.  Our most likely diagnosis was cutaneous lymphoma.

Taking a punch biopsy

The "lumps", more on underbelly

When you hear the word lymphoma you immediately think the worst, as we did at first.  But, after substantial research we found a few recorded cases of cutaneous lymphoma in horses that received treatment.  The owner did not express interest in treating the horse with chemotherapy, the most common treatment for lymphoma.  With the horses age and condition we agreed that this wasn't a feasible option.  Instead, we found positive evidence of remission with intralesional steroid treatment and oral administration of progesterone.  As this treatment was cost effective and easy to execute (the steroids were a one time treatment and the progesterone is given once daily on top of grain) we chose to give it a shot.  So we visited again, took a punch biopsy, and administered the steroids diffusely around the tumor areas.  That evening the owner messaged to say that the areas had softened up throughout the day and seemed to be getting smaller already.  We are awaiting biopsy results and typing of the lymphoma, but for now we are optimistic that we can keep the mare comfortable for a good long while.

Injecting dexamethasone into region

It is hard to believe that I am heading into my last week with Clinton Vet.  I have seen so many unique cases and met some fantastic clients.  I am so fortunate to have gotten this opportunity and I cannot wait to see what my final days have in store.  Thank you for following along!