DAN: "My horse recently had a keratoma scare
in her right hind foot.
My farrier noticed the growth and we
had the vet perform x-rays about a year and a half ago.
The vet saw a small growth in the x-rays,
but it was nowhere near the bone so she wasn't concerned.
She just said to keep an eye on it.
Since the x-rays, my vet has left her practice.
My horse is barefoot and sound, and we
have been documenting by taking pictures
every time we trim her.
My question is, what is a keratoma?
How are they treated?
And should we have more x-rays taken?
And if so, when?"
DR LYDIA GRAY: OK.
So whenever there's a hoof question, I turn to--
DAN: Danvers Child.
DR LYDIA GRAY: Danvers Child.
DAN: [LAUGHING]
DR LYDIA GRAY: He's the SmartPak Hoof Health Consultant and also
a certified journeyman farrier.
And he answered each of her questions.
What is a keratoma?
How are they treated?
And when should we have more x-rays taken?
DAN: He's awesome.
DR LYDIA GRAY: "If you look for the term
keratoma in the general medical literature,
you'll likely find that it's simply
categorized as a hardened area of skin,"
basically a callous or a corn.
"In the equine world however, the term
referred to something much more specific and much more
involved, unfortunately.
In our world, a keratoma is a benign tumor
that forms inside the keratin-producing epidermal
cells of the foot."
DAN: OK.
DR LYDIA GRAY: And she kind of described--
DAN: Yep.
DR LYDIA GRAY: --where hers is.
OK.
"In many cases, the keratoma is cylindrical in shape
and grows downwards towards the sole.
In other cases, it's more spherical, orb-like."
I would call it round--
DAN: [LAUGHING]
DR LYDIA GRAY: "--and tends to enlarge without descending."
So it stays where it is.
"While keratomas tend to be slow growing tumors,
they do grow and enlarge."
DAN: Mmm.
DR LYDIA GRAY: So she's right to be after it and taking
pictures and documenting it.
"Eventually as they grow and expand,
they impinge upon the laminar and bony structures
within the hoof, exerting pressure,
and that's what's causing the pain and lameness."
Now her-- she's not seeing that in her horse yet.
DAN: Correct.
DR LYDIA GRAY: OK.
DAN: We're sound.
DR LYDIA GRAY: All right, so then how are they treated?
"Since keratomas are abnormal, aberrant growth,
they can't really be treated.
Instead, they require removal, and that's by a veterinarian.
So in many, if not all cases, this
is done as a standing procedure under local anesthesia."
DAN: OK.
DR LYDIA GRAY: So that's great.
Anytime you don't have to lay the horse down--
DAN: Yeah.
DR LYDIA GRAY: --under general anethesia.
DAN: Not invasive.
DR LYDIA GRAY: Yeah.
So the vet-- well, it's invasive.
DAN: But--
DR LYDIA GRAY: But they don't have to lay the horse down.
DAN: Yes.
DR LYDIA GRAY: "The vet removes a section of hoof wall
to access the tumor and then remove it.
The prognosis for full recovery is generally good,
but a significant amount of aftercare
is required to ensure that the hoof is protected
until the new growth occurs," because you're opening it
up to the elements.
And so, until that tissue begins to grow from the inside out,
you have to protect it.
So the last question is, when should we
have more x-rays taken?
"Keratomas aren't always appreciable or seen
on radiographs."
DAN: Mmm.
DR LYDIA GRAY: "Often they don't evidence distinctly."
He has a phD in literature--
DAN: [LAUGHING]
DR LYDIA GRAY: --so you can tell.
I did not write this.
He wrote this.
"So other forms of diagnostic imaging like an MRI, CAT scan,
and bone scan or nuclear scintigraphy
will usually provide more productive diagnostics"
versus just like, I think she's photographing
from the outside--
DAN: Mm hmm.
DR LYDIA GRAY: --and not looking in.
"These approaches--" but they're more costly, as well.
DAN: Of course.
DR LYDIA GRAY: Yeah, but so make regular observation
more expensive than immediate treatment.
If you do the MRIs and the CAT scans and those ones.
DAN: So even though she isn't seeing any issues
with her horse currently--
DR LYDIA GRAY: Mm hmm.
DAN: --it is something that is going to continue to grow.
DR LYDIA GRAY: It sounds like it to me,
although it's been a year and a half.
So, you know, and he alluded to it's definitely slow growing.
DAN: Mm hmm.
DR LYDIA GRAY: But she's right to keep an eye on it.
And I guess somewhere in there, and I don't-- she
didn't mention working with the new vet since her vet left--
DAN: Correct.
DR LYDIA GRAY: Somewhere in there,
I would arrange for a regular internal imaging--
DAN: Mm hmm.
DR LYDIA GRAY: --like a radiograph or beyond,
besides just the documenting with pictures from the outside.
So that's after her vet -- maybe it's every year.
Maybe it's every six months.
But, and then, you know, measure it and see what it's doing.
DAN: Because like Danvers mentioned,
it's not something that's going to grow out
like an abscess or something.
DR LYDIA GRAY: No.
Nope.
Although there is a relationship.
They think there's a link between abscesses
and keratomas.
Like keratomas tend to form where
abscesses sort of injured the foot
and there's an area of not quite correct tissue development.
DAN: OK.
DR LYDIA GRAY: It might be like the nidus
or the starting point.
It's a thought.
DAN: So definitely, maybe get a new vet
to kind of come out and take a look at things since it's
been like a year and half.
DR LYDIA GRAY: Yeah.
DAN: It sounds like she's working
very closely with her farrier, which is awesome.
DR LYDIA GRAY: Yeah, that's-- that's great.
That's great.