Thursday, August 17, 2017

Cornell Visit: Only one like him. Literally.

Remember how I was all, "Cornell is an easy two hour drive" yada yada so easy?

LOLZ.

We almost died.

It was a really easy drive...for an hour and fifty minutes. Once we hit downtown and my directions failed me, we almost died. I somehow zigged left instead of right--I think--so I quickly turned on my phone's GPS and told it to get me to the vet hospital.

It took me to a dorm. On a mountain.

I drive a Dodge Ram 1500 with the biggest engine that model offers, and I have never once had a problem with it hauling. My trailer is pretty light, and there was only one horse on board. Dudes, every time I so much as paused I started rolling backwards. And almost shit myself, I think it goes without saying. Thank god for tight trailer brakes. I finally found a levelish alley type thing to pull into and park (e-brake engaged) while I called the office.

The wonderful front desk woman put on her headset and stayed on the line with me while my truck put its head down and somehow hauled us the rest of the way up the hill, moaning and groaning and warning me not to take my foot of the gas pedal for so much as a second until we reached our destination.

"this does not look like a horse show to me."

I nearly kissed the ground when I finally pulled into the parking lot. I was able to follow my directions on the way home, but still had to creep down a mile long 10% grade hill that was fortunately under construction so I was able to inch down it without any trouble. Holy fuck, I just really, really hate hills under all circumstances.

I got us checked in and then headed back out to the trailer to console Bobby who was in a bit of a rage about his circumstances while we waited for a student to come collect us.

ANGRY eating his hay. SO ANGRY. 

My student keeper for the day was great, and she had us settled into a stall with medical information written down in no time. My appointment was with the derm and ortho departments, but ortho was in the middle of looking at another case when we got there so derm got to work first.

Team Dermatology

Dr Derm has been working with us since the original diagnosis of sarcoidosis. He's one of the few in the country that has any first hand knowledge of the disease so I was looking forward to finally meeting him in person. He let his students and the other lead vet do most of the poking and prodding before ducking into the stall with a giant camera to get pictures. If Bobby appears in one of his books, do I get royalties?

Once he came back out, he asked me what I knew about sarcoidosis. I was like, "I know as much as you actually. I even read your one paragraph you published on it." The biggest problem with this fucking disease is that there is nothing known about it. If it's generalized, you euthanize. That's what we know. The end.

If it's localized? Dr Derm said, "I didn't actually believe there was such a thing as localized sarcoidosis. This is the only case in this country. Ever." Bobby. You do not need to work so hard to be a celebrity, bro. I can't afford it.

team derm and my student get to work

After everyone got their chance to poke him, Dr Derm pronounced he didn't think we were actually dealing with anything skin related from the sarcoidosis. He hypothesized that because the disease is basically the body trying to eat itself maybe there was some internal scarring that had blocked a vein and was causing the disruption of circulation and all the swelling. That didn't seem like a bad guess, and he went to go print the rads we took last Monday to look at and show the farrier and ortho who were finally ready for us.

Team Orthology

Since derm didn't think they had much to do with us, aside from wanting to play with the sarcoidosis, ortho became my lead doctor. Right off the bat they had Bobby hoof tested and jogged (and more pictures taken since the shape of his foot is almost as exciting as his sarcoidosis) as everyone unsurprisingly seemed blown out of the water that he was sound as a dime. Dr Ortho watched him go multiple times before shrugging. "Well, yes, he's very sound. Hmm."

He asked if I'd tried sweating it. I said I had once, but his leg couldn't handle it.

Dr Ortho: "What did the leg do?"
Me: "Um...well, the skin kind of fell off. He's very sensitive to topicals now."
Dr Derm: "LOL, no but really it did."

I was glad Dr Derm had stuck around because he's seen the entire progression from slime and pus and chunks of hair falling off and burnt skin to the relatively normal looking leg Bobby has now.

Dr Derm relayed his theory about the possibility of blocked circulation and Dr Ortho agreed that was a good guess so we'd roll with it. They scheduled an ultrasound and stuck Bobby back in his stall to wait.

he really wanted to eat his shavings even though
he had hay.

Team Imaging

Bobby was already in the stocks and "sedated" when my student came to get me for the ultrasound. She said they'd given him xylazine which I was kind of annoyed that they'd done without asking me. Bobby doesn't react to xylazine--I mean, he sweats a lot and it makes him pee, but it doesn't sedate him. That was a charge on my bill I didn't need as Bobby hung out being annoyed about the sweat dripping down his butt and gnawing on his lead rope, but otherwise quiet and not sedated in the slightest. If sedation is a mandatory procedure, they could have given him dorm and actually knocked him out.

The ultrasound doctor admitted right off the bat she didn't usually work on the coronary band area, but she spent a good half an hour trying her best to get some good imaging. Dr Ortho joined us towards the end to discuss findings.

Veins and blood vessels looked great, no problem there. She did the suspensory and DDFT as well and said those also looked great. She found a small pocket of fluid on the outside side of the heel bulb, but she didn't think it was anything of concern. His lymphatics were slightly swollen which was what they were expecting with the leg being swollen.

Overall though, we didn't get much. Dr Ortho wanted to focus on the foot itself and asked to do a venogram--where the veins in the foot are highlighted and viewed via xray. Yeah, sure, whatever, Dr Ortho. Just give me an answer.

I haven't heard yet what they found on the venogram as I wasn't called back for it. They're supposed to email me the report at some point today. I can probably give you a summation though: nothing.

parked next to me with the most gorgeous dapplely warmblood gelding. later to be
stalled next to us was a giant equally gorgeous warmblood owned by the maddens.
bobby was the celebrity for the day, but he did not look the part in comparison. 

Team Farrier

Throughout the day the farrier popped in and out. I liked him because he was alone so he talked directly to me instead of to a team of students trailing around him. He'd looked at the rads and had watched the ultrasound. I don't know if he was there for the venogram, but I'm sure they passed that along to him as well. He was very interested in Bobby's case because Bobby. Everyone was very interested in Bobby's case.

He thought my farrier was doing a good job with the shoeing, but agreed it was time for the wedges to go. I told him Farrier wanted to do glue ons with a rocker toe and he said he'd do that as well, but he need a pour-in pad or a frog support pad. Anyone ever dealt with laminits? That's a classic laminitis shoeing package.

Why? Because the farrier thought that Bobby had had a laminitic episode. He was practically giddy over the rads. In most laminitic cases, the coffin bone falls forward, right? Bobby's was pointed upwards, pushing through the back of the foot instead of the front. Not unheard of, but very rare.

My farrier has frog support pads on-hand so we'll be doing that set up on Monday. She's been sent the rads as well and promised to get in touch with Cornell farrier to discuss.

back at home and gorging himself, unconcerned
about the state of his falling apart body.

Team Internal Medicine

Almost done!

Do you feel like we've cycled through the entire vet school yet? Because I did. It was 4:00 by this point and Bobby and I were both done with the whole thing. While at the beginning of the day Bobby was mugging everyone for snuggles, when my student took me to the back to talk to IM, his ears were pinned and he was trying to bite them. Having teams of five to seven students poking and groping him all day had lost its appeal, and he was pissed. It didn't wear off when we got home either. He unloaded with his ears back and wanted nothing to do with talking to anyone. He seems to have forgiven me this morning, but I gave him extra cookies and the day off anyway.

I didn't know IM had been called in to consult, and was kind of annoyed to find that charge on my bill. If you want to take a look at his leg because sarcoidosis is rare and Bobby's is even rarer, fine. But don't charge me for it.

They asked all the standard sarcoidosis questions: How's his weight? Is he eating normally? Breathing normally? Have you had his lungs checked? Temperature stays normal? Yes, yes, yes, all things my vet and I discuss on an almost weekly basis. We're old pros at this by now.

Finally Dr IM came out of the stall and gravely told me, "Sarcoidosis isn't cured. We can manage it, maybe, but once it spreads..."

I was like, "Uh, yeah. I know. I KNOW EVERYTHING ABOUT SARCOIDOSIS ON THE PLANET." We've had the euthanasia talk. A couple times, actually! At the first sign it has spread to his organs, I will put him down. I'm not going to rush him back to Cornell and hope they can stop his lungs from eating themselves while his fucking flesh falls off.

Her recommendation was that we try a steroid--what my vet had wanted to do if I didn't take him to Cornell. In generalized sarcoidosis, that's the one and only treatment option. Like Dr IM said, it won't cure it, but it might prolong the inevitable. Not a single horse treated has ever not been euathanized though. Not. One.

no organ eating going on here for the moment.
just cookies and grass.

All of Bobby's emergency vet savings completely emptied, we headed home with a thousand prednisone tabs and no more answers than what we'd arrived with.

I called my farrier and relayed all the information. About an hour later she called me back again. "I'm not going to tell you how to medicate your horse, and I haven't seen the rads yet, but with the state of his foot and Cornell Farrier thinking he's had a laminitic episode, I don't think you should give him the steroids. At all."

Ughhhhhhhh.

Steroids, of course, run the chance of foundering a horse. If Bobby's already vulnerable, he runs an even higher chance. Right now this horse is sound as shit. If you didn't look at his foot, you would never know there was a thing wrong with him. If we chance the steroids on the chance it does something to the sarcoidosis, we could very well bring on full blown laminitis, and then he's definitely going to be lame and now we have EVEN MOAR problems.

So I put in a call to my vet (and am waiting to hear back from her) to get her opinion. I don't know what IM was doing there, so I don't know if they knew anything about what was going on with the foot, or if they were focused entirely on the sarcoidosis. It certainly seems like the latter. If that's the case, then I'm assuming they didn't realize his foot is not up to steroids.

I should have known that, and I should have said something, but at that point I was so done with the day and ready to grasp on to any type of answer or solution that I was just like, whatever. Give me the meds. Now I have two giant bottles of prednisone sitting in my kitchen that I don't know what I'm supposed to do with. Is there a black market for 'roids? Someone get in touch with me.

So there you go. My takeaway? I'm going to keep doing whatever the fuck I want with him so long as he stays sound. I'll let Farrier do whatever she thinks needs to be done with the shoeing as we go along. If he comes up lame, we'll take it from there.

Thanks, Cornell. For nuthin.

58 comments:

  1. So fucking frustrating 🙁 I know they're not miracle workers but to spend all that time and money with no more answers than you started with blows. Ughhhhhh. Oh well. Fingers crossed that Bobby keeps on confounding and confusing everyone with his soundness and ability to be a medical marvel for a long time to come! Thinking of you guys <3

    ReplyDelete
    Replies
    1. As far as I'm concerned, Bobby's happy so I'm happy!

      Delete
  2. i'm sorry girl. this is incredibly frustrating on basically every front. i'm sorry that cornell didn't seem to have their ducks in a row, the right hand not knowing what the left hand is doing. what a waste of time and money. i'm also sorry that you don't have any new answers or insights. except maybe it's marginally reassuring to know that you've already been doing the absolute best for bobby that can be done? good luck :/

    ReplyDelete
    Replies
    1. I'm definitely doing the absolute most expensive things for him! Fuckers.

      Delete
  3. So frustrating! Leave it to Bobby to be so bizarre and such a damn mystery.

    ReplyDelete
  4. I've been able to return medicine to the vet that isn't used or opened. Maybe they'll take the prednisone back? Worth a phone call - I know every penny not spent helps.

    ReplyDelete
    Replies
    1. Good point! Give them a call and see if they'll refund you!

      Delete
    2. I'm hoping they will, even if that means I have to drive back down there--though that won't be so bad in my car!

      Delete
  5. Ugh, WTF Cornell? I'm sorry you weren't given any answers, just additional charges for shit you didn't need. How ridiculous.

    ReplyDelete
    Replies
    1. It was an expensive learning experience, that's for sure.

      Delete
  6. I think Cornell owed you money for that one...

    ReplyDelete
    Replies
    1. Still think they should have done it for free for Science.

      Delete
  7. What a fucking whirlwind and agree.. I don't think you need to pay a dime

    ReplyDelete
    Replies
    1. I told Emma I needed to start charging people every time they took a picture.

      Delete
  8. I'm with Shauna. They should take the meds back if you aren't going to use them. While you're talking to them about that, complain about the unauthorized charges on your account (IM and the sedation). That's what I'd do... Stay very calm and don't suggest you didn't give authorization to treat him, but instead that these were not discussed with you and added significant charges to your bill which were unnecessary. See if they'll pull those off, too.

    Jesus, though. What a cluster. If I were you I wouldn't give the steroids. He doesn't even have the same type of that variety of cancer they usually give steroids to. Wtf. I've noticed vets like to leave people with something to give their animals to treat, like it makes us feel better when shit is wrong and there's nothing we can really do. Sounds like what the IM vet was doing. Fuck that noise. All you really needed was a beer and some time without people for Bobby, amirite?

    ReplyDelete
    Replies
    1. It physically pains me to think about talking to more vets and vet offices at this point. PAAAINNNN. Like I know I should because that sounds like a really logical, sound plan, but I am so fucking done with dealing with the veterinary profession as a whole.

      I completely agree that I was probably just given something to make me feel better. And it did. I walked out with something to show for my $1k vet bill...until I got home and processed wtf had just happened.

      Delete
    2. Plus side they're not too crazy expensive?

      Delete
    3. Maybe a big bottle of wine would have been better at this point.

      Delete
    4. Only $1k!!! For all the vets he saw I imagined a much, much higher number. Cornell needs to take this on probono. This is rare and asking you to pay for their research is shit. Definitely dispute the xylazine charge and probably IM too. Your vet and farrier seem to be just as knowledgeable so follow there advice. I'd probably give the steroids but I don't you should. Listen to your vet and farrier for Bobby's sake. Good luck. I wish the best for both of you. Xoxo

      Delete
  9. I agree with Austen's first paragraph - I can't comment on the secondary tho because I know nothing about steriods and horses haha.

    ReplyDelete
    Replies
    1. Would you like to purchase 1,000 pills and do some research? ;)

      Delete
  10. I'm so sorry they didn't have better answers for you. Hopefully the venogram will get you some info. It sucks that you spent all that money for no new information. It sounds like they did try their best to get to the bottom of it though. I mean EVERYONE got involved. I'm sure they will be teaching his case in the future. I knew a kid going to Cornell not too long ago and she said they studied my horse and his epm.

    ReplyDelete
    Replies
    1. Rio would have fit right in with our fancy company. They definitely didn't get me no answers for lack of trying, it's just so frustrating that after all the fancy diagnostics we're not any further ahead.

      Delete
  11. Well that's beyond frustrating. Wish I had something useful to say other than that sucks and at least it's going to keep sucking for a while?

    ReplyDelete
    Replies
    1. I'm just happy he's sound so I can keep doing fun things with him. I don't know how long that's going to last so I'm embracing it to its fullest extent while I can!

      Delete
  12. It certainly is a fascinating case... which sucks for you. Bummed you don't have more answers, but glad he continues to be sound.

    ReplyDelete
    Replies
    1. As the ten millionth person stopped by to take pictures, Dr Derm was like, "You don't want interesting. You want the most boring case here." Preach, Dr Derm.

      Delete
  13. What a hell in a handbasket day. With no real answers. I am sorry, it sucks so badly. I agree with Austen, if you tell them the services were not authorized, they should be removed or significantly reduced. Stupid Bobby, stop trying to be a celebrity!

    ReplyDelete
    Replies
    1. Right? Like, you have a blog, bro. What else do you need?

      Delete
  14. Sounds like a very frustrating day at the clinic. Sorry you didn't get concrete answers. My vet practice does take meds back - that may be worth a try. Every little bit helps...

    Hoping Bobby stays sound!

    ReplyDelete
    Replies
    1. We're now entrenched in a battle of farriers vs vets on the prednisone so it's sitting here waiting for the victor to emerge.

      Delete
    2. After reading your post I was curious, and did a little cursory Dr Googling re steroids + laminitis - there were data and opinions on both sides...��

      Delete
    3. I know prednisone is a pretty "mild" steroid as far as side effects go, but because they think he's already had a laminitic episode, I'm more paranoid than I already would be. Possibly going to try a really low dose though. Going to bounce some more thoughts off Farrier tomorrow now that she's had a chance to talk to everyone herself.

      Delete
  15. Holy F, that's ridiculous. If it makes you feel any better, that sounds cheaper than Tufts. I've come out of there with a $1500+ bill, plus they wanted to charge an additional $800 for a CT scan. When I asked what that would help diagnose the vet said "your cat only has a 50% chance of surviving the anesthesia & it won't help us with treatment, but it could help us treat future cases." They were shocked when I said no thanks.
    Glad Bobby is feeling good regardless!

    ReplyDelete
    Replies
    1. Omg that is fucking ridiculous! I kind of feel like the vets have a sarcoidosis boner and they want to play with it on my dime. Sorry, NO.

      Delete
  16. Dang girl. You made those vets' day, and they just thanked you and Bobby with a big ass bill.

    Fingers crossed for him. Because Bobby. <3

    ReplyDelete
  17. Jeez, what a hot mess! I hope you're able to return the meds and haggle the bill down a bit. And, of course, I hope Bobert keeps on trucking for a while yet!

    ReplyDelete
    Replies
    1. I kind of just want to turn into a hermit and never talk to a vet again tbh.

      Delete
  18. Oh man, that sucks. I'm glad he's still sound, but I'm sorry you wasted all that time and money on Cornell.

    ReplyDelete
    Replies
    1. Him being sound is definitely the highlight.

      Delete
  19. So here's the thing with vet teaching hospitals, as 2 Punk Dogs suggested: They're going to throw anything at you/your horse that they can in order to give their students exposure to different diagnostic methods and treatments, as well as pay for all that fancy equipment they're using to do the former. You've gotta self-advocate because otherwise they WILL try to steamroll you into more than is actually necessary or helpful, and mostly in consideration of profit first, then education. Be that PITA owner who is on their case about what they can and cannot do to your animal. The kids (especially the small animal folks doing their mandatory sentencing to large animal rotations) will say you're a typical crazy horse owner, but at least you're not getting totally screwed out of potentially thousands of dollars. I may or may not be absurdly bitter about the way vet schools operate as I sit here watching my significant other, a fourth year vet student, pay a fuckton of money to serve as free labor to his school's teaching hospital.

    ReplyDelete
    Replies
    1. I am for sure at that point as I feel like the vets just really want to do ALL THE THINGS with the sarcoidosis because oh my gosh so rare and exciting, while the farriers are like, "Here is an actual problem to address, let's stay focused." Vets, sit down. Take a time out. I can't even with you right now.

      Delete
  20. As I learned all too well last year, you can spend a shit ton of money and have all the diagnostics done and still not have an answer, or be able to do anything once you have it. It's a shitty, shitty situation and I'm so very sorry you're in it. :(

    ReplyDelete
    Replies
    1. It's so frustrating because I know Bobby is not going to live a long and fulfilling life with all this going on, and I kind of feel like the vets want us to be a walking science experiment--which I don't want for him or me.

      Delete
  21. Sounds frustrating and I can relate somewhat to the financial sting with my recent vet adventures though with very different issues... still reeling that your adventure was 1k... if I take my horse to the clinic I have to assume bare min is 1k most of the time. My last vet bill was 4K.... thanks Annie.

    I am glad they discovered the possible laminitis episode because that was good to know before you dosed with roids. Hoping the showing changes help. :)

    You might be able to discuss some of the charges with them. I certainly did when I saw the bill for my recent adventure. Doesn't hurt to ask at least.

    ReplyDelete
    Replies
    1. Yikes, I wouldn't be able to do anything with my vet if that was the going rate! I don't remember, is Annie at least insured?

      Delete
    2. I agree, seems like pushing back on at least the IM billing part would make sense. I doubt they have any sort of sign off from you that that group was going to see you.

      Delete
  22. My god, what a day from hell. I would return the pills and argue the charges. On the plus side you can be sure that no stone was left unturned. Hugs.

    ReplyDelete
    Replies
    1. There was no one feeling left out by the time we were discharged, that's for sure.

      Delete
  23. I can totally relate, nothing runs fast at a teaching hospital from either side of the stall. Sorry they weren't able to give you any great solutions. =-((((

    ReplyDelete

If you can't say anything nice, fuck off.