Nothing Can Ever Be Simple

There’s a meme that’s been floating around, and it truly speaks to my soul.

I’ve had the honor and privilege of being around horses for the majority of my life. Particularly in the past ten years, I’ve seen many major injuries and even more simple cuts, scrapes, and bruises. I’ve been involved in the care and rehabilitation of many equines and more than once have brought Goose back from his latest disaster. I have changed enough of his wound dressings that I truly believe his greatest feature is the fact that he is a near-perfect patient. While I’ve gained an incredible amount of medical knowledge, I am not, nor will I ever be, a veterinarian. These magical people heal, cure, and save our animals' lives every single day. This is a task that I can only imagine to be draining on many levels as they toil away for hours on end while simultaneously trying to chip away at their own seemingly endless student loans, not to mention having dealing with crazy animals owners who usually only half know what they’re talking about. We all rely on these hardworking people to take care of our animals when they are in need because we cannot always do so ourselves. I’ve been lucky enough to have close relationships with my vets in NJ and I never hesitated to go to them for advice or ask about a problem. Here, too, I’ve been lucky to have forged a relationship with a vet who has been so supportive and willing to put in extra effort to help me set a course of action for Goose’s melanoma. Vets are people we turn to for something as small as a splinter or an abscess, all the way up to unthinkable injuries that can take our horses’ lives. Through it all, they are there for us and I don’t know what we’d do without them.

However magical they are, vets are not perfect. What do you do when your vet calls you and says they can’t help you? That their boss won’t let them call the contacts you’ve so dutifully provided to make their lives easier, contacts that are willing and able to sell the drug that could potentially fix all your horse’s problems? What then, when the wonderful people you put all your faith and trust in simply won’t, or can't, help you?

Here are the steps I have taken since that awful phone call this past Tuesday.

• Slowly realize what my vet is telling me. Try to mention the lovely people who said they could help me get the vaccine, if only she would call them
• Refrain from calling her boss horrible names when she explains her hands are tied
• Try REALLY HARD to not cry angry tears while on the phone (I have not cried in front of this vet yet, trying to keep this track record)
• Ask a few questions about Tryon again
• Hide my hyperventilation after she tells me it’s actually going to be over $3,000 and not the $2,200 she had originally been quoted it would cost going to Tryon
•  Keep holding it together while she reminds me that it is a lot of money, and Goose could still be part of the 20% that the vaccine doesn’t work for
• Hang up the phone, get through the last hour of work and only run to the bathroom once to have a mini breakdown
• Get home, completely lose my shit because turns out, no, not even ONE thing can be easy in this God-awful process

To put it simply, Dr. N’s hands are tied and there is nothing more she can do for me other than recommend continuing the cimetidine and point me in the direction of Tryon. I am not convinced the cimetidine will do anything, at least not long-term. I’ve heard such mixed things about Tryon and wish I had a closer, maybe even just slightly more affordable option. She told me that she’s been in touch with Tryon again and that they misquoted her the first time regarding their initial cost of treatment: it is actually $2,600 NOT including call/clinic fee or administration fees. I could also look into a different local vet, but she suspects no one would want to go through this process because it’s too many hoops to jump through.

My disclaimer is that I do not blame Dr. N at all. She has gone above and beyond for me by researching this vaccine and trying to convince her boss. It’s not her fault that he won’t play along, and I’m sure there’s a lot more reasoning behind his decision to say no than to just personally smite me (even though that’s what it feels like, because sometimes I’m an emotional trainwreck and blaming someone helps).

I’ve done some more networking and between me and my barn manager we’ve talked to a few other vets whose first reactions have been “It’s so expensive to do the vaccine, do you know that? And it’s so hard to get… Your horse will probably be fine and melanoma is very common. Have you thought about cimetidine? It doesn’t always work though.” We’ve also had a vet comment on what a bad idea a melanoma removal was, and that I shouldn’t let anyone else cut into him as it will only make it worse.

I’m not saying any of these professionals were wrong, I’m just confused why everyone is willing to jump down my throat but no one is willing to help me. Melanoma is such a common problem, and this drug has the potential to save or improve so many lives. I’m willing to bet there’s a lot of people out there, most of them at the top of the sport with horses who are actually worth a lot of money (looking at you, bottom dollar Goose) who would be willing to pay for this treatment if they knew about it and had access to it. Pleading ignorance here, because perhaps there is actually a really great reason that I’m completely missing. I do understand that it is still considered an experimental treatment and that it's above their heads that it's so difficult to obtain. I just don’t understand why they all seem to be trying to talk me out of it when I’m telling them I’m willing to pay for it, that this is NOT a regular case of myhorsewillgrowtobeoldandjustlumpy melanoma, and that I need someone to care about this situation even half as much as I do. I feel like I’m waving money in front of their face begging for help, and they’re laughing at the crazy woman while ignoring my pleas. They all seem to be more than willing to shoot me down, but they’re not willing to give me a better alternative. Likely because there is no better solution.

I refuse to accept that I’m supposed to just let this run its course and “see what happens”. I don’t have time for that, and my gut is telling me that Goose doesn’t either. This doesn’t mean that he’s dying tomorrow, or even a year from now, but I’m not prepared to sit around and wait until the situation gets so bad that there really is nothing we can do. If I have a chance, I am going to take it.

After I reached out to Caitlin this week, she posted on a local Facebook group simply asking if anyone had any experience with melanoma treatments. One woman posted about her experience with Oncept (the vaccine) and that it had been successful in her horse along with three others that also did the vaccine through her vet at the same time she did. I messaged her to learn more, and it was incredibly comforting to talk to someone who had been through the same situation that I now find myself stuck in. I’m taking it as a sign that another person with a Perch/TB cross, similar age and melanoma type to Goose, reached out to me with her story to offer advice and kinship. She explained much of what I already half-understood and gave me a broader picture of what this treatment protocol will entail.

My current plan is to continue pursuing a local lead on a vet who may be willing to help me. I’ve taken new pictures of his melanoma and since I last took pictures February 14^th, within these two weeks they’ve already become larger. My goal tomorrow is to start taking better pictures and labeling and numbering the melanoma and documenting sizes. I figure if I do this bi-weekly, I’ll be able to determine some semblance of a growth pattern and will have physical documentation so when he gets the vaccine, I’ll know if it’s working based on his previous growth. If this local lead doesn’t work out, I’ll pursue treatment with Tryon. This is not a terrible scenario, but I’m still holding out hope that I can save even a few hundred dollars by sourcing the treatment locally.

When it rains, it pours. This has been a lonely road to wander down, not for lack of support, but for lack of information. At this point, I seem to know more about this vaccine than many vets do, and I’ve had very limited resources. To any of you reading my blog and following this journey, I ask two things of you.

First, please don’t offer unsolicited advice, and if you do, please do so gently. If I hear even one more person tell me “Don’t worry, my trainer’s horse is 35 and has melanoma so bad you can’t find his anus, but he’s totally fine!” I might actually hit someone. While I appreciate success stories like this, it is not always well received depending on how it was delivered because I have every right to worry. My horse’s melanoma case is not typical, no cancer case is ever typical, and it is highly unlikely he will even live to even 20 at this point unless he is treated. This is not a comment on many of you who have reached out with your own melanoma experience – I just mean to please take a moment to listen to people’s issues and don’t shove your own experience down their throat. If they’re telling you it’s different, just listen to them. We are all entitled to our worry and our feelings and we shouldn’t have to justify them.

Second, please share my story with anyone who mentions their horses are battling melanoma and are interested in treatment options. I’m no expert, but would love to be a resource or sounding board for someone else. My whole world shifted when I was able to find someone with real-life Oncept experience. I had resources before, including someone who had seen it work wonders, but to talk to someone who went through exactly what I’m feeling now… It turned my horrible week around and I’m so grateful she reached out. There is so little out there on this vaccine and those who know about it think it’s as simple as a needle and syringe, one-and-done type of deal. It’s not. It’s insanely expensive and damn near impossible to find. If I could do for someone else what this woman did for me, give me hope and an outlet to ask all my questions, I would be glad to do it. It’s amazing what one simple connection did for my mindset. All my friends and family have been incredibly supportive and I count my lucky stars I have them in my life, but none had experience with this exact situation and treatment option like she did. Thank you, Facebook, for connecting me with this person. This week my faith is restored in social media.

Here is the information I have gathered thus far regarding the Oncept melanoma vaccine in horses: 

• There is roughly a 75-80% success rate in horses
• ~60% of horses saw no further growth or development 
• ~20% of horses saw reduced size or eradication of existing melanoma and no new growth
• ~20% of horses had no reaction to the vaccine
• The vaccine is given through a transdermal device, not a normal needle and syringe
• The only major reaction I have heard of is some swelling and tenderness at the injection location which receded quickly and without complication
• Dosing
• Loading Doses
• 4 total loading doses given at 2-week intervals over the total course of 8 weeks
• Boosters
• If the loading doses show positive effect on the melanoma, the horse will need a booster every 6 months for 3 years, or as long as it continues to work
• After 3 years, the horse requires an annual booster
• Cost
• Roughly $2500-$3500 for the loading doses including call fees, administration fees, etc. (I'll keep you posted)
• Anywhere from $450-$800 per booster (again, I'll let you know)

I’ll continue to post updates on the situation both for my records and in hopes of helping someone else wind their way down this bumpy backroad from hell. In the meantime, here is a picture of a Very Good Goose hacking out with Zu after an excellent dressage school.