Thursday, August 24, 2017

WWYD: Telling the vet no

As you guys know, the only tangible results of my Cornell visit were two giant bottles of prednisone to experimentally treat the sarcoidosis.

ENTER MUCH DRAMA.

listen, tim gunn knows. 

Let's do a quick recap of our timeline:

  • Dr Derm looks at Bobby's leg. Dr Derm has been on Bobby's case from initial diagnosis. He does not think anything with the hoof is related to the sarcoidosis. He also says anything going on in the leg is too deep for our current medication--pentoxyfilline--to be making any difference and there's no reason I should continue it.  
  • Cornell Farrier is in and out all day. He sees the rads. He sees the ultrasound. I know he's spoken to Dr Derm and Dr Ortho. He says that Bobby's coffin bone has had rotation as seen in a laminitic episode, albeit a very bizarre presentation. He recommends glue on shoes and a frog support pad.
  • Dr Internal Medicine comes in without me knowing and goes gaga over the sarcoidosis. I do not know if she's had any consult with the farrier or Dr Derm or anyone else for that matter. We've been at Cornell for seven hours at that point and Bobby is trying to eat vet students. Dr IM recommends the prednisone--the one drug that has shown to sometimes prolong generalized sarcoidosis. Bobby does not have generalized sarcoidosis, his is localized. My local vet had mentioned wanting to try steroids previously so I agree and clean out their supply of prednisone without thinking about anything besides getting the fuck out of there. 
  • I call Farrier and tell her Cornell Farrier's findings and that I was given steroids. Farrier says, hold the phone, bad idea
  • I call Vet and tell her Farrier said she didn't think treating a laminitic horse with steroids was a good idea. Vet says she'll call Cornell and Farrier and chat. 
I think that's where I last left you guys.

trying to do right by the moose, even if all that means is taking him on adventures
before i accidentally founder him. #letsnot

Enter a weekend of ranting and raging to poor Hubby and working myself up to not even wanting to talk a vet again. Ever. Any vet. Really anyone in any medical profession. Farrier arrives bright and early Monday morning to put new shoes on Bobby. I ask her how her chat with Vet went, and Farrier shoots me the look of death that says she's been having the same thoughts.

Vet told her the laminitis episode was a "misunderstanding" to which Farrier wanted to know why she was then having Bobby shod like a laminitic horse, and I wanted to know why my fucking discharge papers said "evidence of laminitic episode". Vet was also concerned that a frog support pad would put too much pressure on the navicular bone which to her credit we all kind of forgot about BECAUSE BOBBY HAS TOO MANY FUCKING ISSUES TO KEEP TRACK OF.

bobby's all, tell me about it.

In the end we changed the whole shebang. He still has his standby aluminium wedge on the left foot because it hasn't seemed to have caused any adverse affects, and it helps his worse navicular foot stay sound. On the right she did aluminum and a leather pad with his little froggy cut out so there was no pressure there. She dug out and patched the giant crack at the top of his foot and stuck a felt wick in there so I could feed it white lightning to prevent infection. She reiterated that she didn't think steroids were the right choice in this scenario.

they shaved his leg for the ultrasound and made
his skin angry again. fortunately liberal krudzapper
has calmed it down.

So here's where I stand:

Sarcoidosis is really, really, really rare and the biggest study on it came out of the Netherlands. All of those horses had generalized sarcoidosis. Prednisone was given to some of them. It prolonged the disease in some cases, in some it didn't. In the end they all had to be euthanized anyway. Sarcoidosis is not curable. Any treatment plan at this point to address the sarcoidosis specifically is going to be experimental. I understand that the vets don't have anything to go on and are having to make this up as they go. That's frustrating for them and it's frustrating for me.

HOWEVER.

Right now Bobby is sound and happy. We have visual evidence of a problem in his foot, and a solid plan to address that problem. There's no guessing going on in that department. We're not in a lot of danger of making him worse by attacking that problem head on.

I kind of feel like the vets are so excited to get their hands on a case of sarcoidosis that they're not looking at the bigger picture. To me, the bigger picture is having that sound and happy horse first and foremost. I don't want to mess with that by trying something that might seriously fuck his body up. Laminitis isn't the only potential side effect of steroids, you know?

could we play in water all the time if he had bleeding ulcers and foundering feet?
PROBABLY NOT. #unacceptable

Have you guys ever had to say no to your vet or farrier before? Is there are point where the line has to be drawn and you put your foot down? Or am I being completely absurd here and subjecting my horse to a slow death instead of a fast one? OR AM I DENYING HIM LIFE SAVING TREATMENT I DON'T KNOW.

As an aside, Dr IM also said I should also do at least another month to six weeks of pentoxyfilline. I told her Dr Derm said he didn't think it was effective, and she agreed it's probably not, but it's a pretty benign drug so might as well. Or....might as well not? I'm using up the four bottles I already had, but I'm not buying more "just because". That I'm not budging on. I didn't think it did anything after the first couple of weeks we first started it (he was on it for six weeks), and I didn't think it was going to do anything this time. It doesn't seem as if it has.

I can't even with vets anymore.

also again. can we remember that this is what ONE
dose of SMZs did to his leg? everything makes poor
cancer leg incredibly angry all the time

54 comments:

  1. Christ what a nightmare. I'm so sorry. Fwiw I think you're making the right choices for Bobby. Good luck :(

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    1. I'm being such a child and giving everyone the silent treatment and I don't even care anymore.

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  2. My friend's going through this now. Vet thinks the mare is laminitic, but won't take xrays, and was wishy washy about having shoes put on her (currently barefoot). They're going to call Farrier and then maybe a new vet.

    I don't think you're being absurd at all. The most important thing is a healthy, happy Bobby and if the steroids are going to change that, and maybe not help cancer let, then why do it?

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    1. Ughh, I wish farriers and vets could work together better sometimes instead of it being a war on who's right.

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  3. Holy shit what a mess! :( Glad that he is happy and sound now (and I agree that is the most important thing!)

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    1. How is it I spent MOAR money to get MOAR problems?!

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  4. You are doing the right thing - thinking of your horse's comfort and happiness first. I'm sorry the vets are making this rather frustrating and confusing. But stick to your guns and do what you think is right.

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    1. Thank you! I just wish I didn't have to put up a fight about it in the first place. Grrr.

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  5. There is absolutely a time and a place to say no, especially when SO MANY people are coming at it with so many theories. You may not know the medicine as well as they do, but you do probably know your horse better than anyone.

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    1. I'm definitely pretty clueless when it comes to the vet stuff which makes me feel like an idiot for even arguing with them. But at the same time I see the horse every day and I know what he can and can't deal with it so I feel like I have a little bit of ground to stand on. Kind of?

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  6. I'm going to validate your choices here. You're your horses best and only advocate, and you gotta listen to your gut here. He looks great and is sound/happy now, so don't rock the boat unless that changes.

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    1. Thanks, boo. In so much need of validation right now!

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  7. As a pharmacist it is part of my job to say no to doctors on a regular basis. It is fine, and sometimes the right call, to do so for Bobby. use up the pentoxifylline you have and be done. Less treatment can be good as long as he stays sound.

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    1. I'm willing to try some things if he does come up lame, but I think you're right--less is more right now.

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  8. I get it from both sides. As a veterinary student, I can understand the excitement over seeing something in person that is the only known example in the world of that issue and wanting to Try All The Things. As a horse owner I understand wanting to just enjoy your horse as long as possible, keeping him sound and otherwise healthy.

    If what you're doing is keeping him sound and otherwise healthy, as a vet I'd have no issue with an owner who didn't want to experiment with unknown treatments, because that's what I would want for my own horse. And with The Only One In The World nothing is going to be guaranteed to work. The vets are all just making the best suggestions they can think of, and every specialist is going to have a different perspective on the problem, but at the end of the day no one can make you do anything with your horse that you don't want to do or that you don't think is in the best interest of your horse.

    And as a client I get so overwhelmed wheb I go to the vet that I forget to ask all the important questions, or any questions at all, or even why I'm there. So I would not be a good resource when it comes to talking to vets which is ironic. But just be completely honest, that currently your horse is sound and wants to play in the water and you don't want to try a treatment with detrimental side effects and I like to think that your vets might be understanding of that. It's easy to lose sight of the entire animal when you look at one problem.

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    1. So much yes! I don't feel like the vets are trying to take advantage of me or anything, but it does feel like they're so excited that they want to do SOMETHING. And I don't know that just SOMETHING is the right answer right now.

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  9. I'm so sorry all the options suck. FWIW I'm with you on skipping the steroids. He's sound and that's important.

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    1. Thanks! His comfort is definitely top priority right now.

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  10. What AnEnglishRider said. Yes. I've worked in veterinary teaching hospitals and share her point of view re: some vets are so excited over a unique/strange case that they sometimes lose perspective. Steroids are tricky because some vets are almost too comfortable with using them for just about anything (while others are extra cautious)...and I am 100% validating you too here because in your shoes, I would be making the same decisions you are. Given what you know about pred + generalized sarcoidosis and pred's effect on laminitic horses, I'm in complete agreement with you. It is absolutely fine to draw a line and say no.

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    1. I've never even had a problem with steroids before, but I'm so paranoid now knowing his feet are not in the best shape.

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  11. I'm no help, but wanted to say you got my feels. Wishing you the best.

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  12. Yeah I mean we are the best advocates for our horses so we need to have their best interest in mind. Like you said all the horses eventually had to be put down, so there is no magic cure for this. Just keep enjoying him as sound and healthy.

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    1. That's the thing, is I know I'm going to have to put him down eventually--and it's probably not going to be a few good, long years eventually--that I don't want to try something and speed the process along if he feels so good now.

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  13. I think you're making the right call. From what I gather (which may be off, correct me if so) but you currently have cancer leg under control with the exception of crazy hoof problem, right? And farrier is addressing crazy hoof problem which seems not to have much to do with cancer leg, yes? So I would say unless cancer leg decides to act up, don't mess with it!
    Hopefully farrier can get that foot under control so you can Bobby can keep having great adventures.

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    1. Well we don't actually know what the crazy weird swelling along the coronary band is, but no one can give me an answer for what it even MIGHT be. But we do have the other issue of the rotation in the foot that there's visual evidence so we're tackling that head on because it's something that is for sure there and treatable. So treat the treatable thing first and don't fuck with the rest until it's broken, right?

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  14. You are your horse's advocate- you want him happy, sound, and as healthy as he can be. I think you've done the right thing- if it's not broke, why fix it? Your farrier thinks she can get the hoof under control without irritating cancer leg. That sounds fantastic :)

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    1. She was even able to glue on a giant patch without irritating cancer leg which is impressive because cancer leg gets irritated by EVERYTHING.

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  15. Just one sec while I tell a story: I too have a horse with too many fucking problems. More recently he came up lame and I figured it was an abscess. But then he got a really weird lump on the bottom of his foot. Vet cant' come out because she's pregnant (hey I'll hold the foot and you can look) but figures I should soak and x-ray. Enter much ranting at hubby when I realize that I don't want to x-ray because I don't want to know. This horse is held together with baling twine and duct tape at this point and one more thing just might be the tipping point so could we fucking not identify that he has yet another weird and wonderful issue? Enter farrier (love my farrier). Makes a special trip out, looks, agrees it's weird. Could just be a bit of sole that was chipped and then grew back too much he does a pour in pad thingy and says let it sit for a couple days. So okay then. He seems happier so whatever it is might just heal up on his own.

    So now that I've ranted with you and feel better (thanks) I agree with you to keep doing what you are doing and forget the experimental treatments. Also, if they want to experiment then, frankly, they shouldn't be charging you because it's adding to their knowledge. Why should you pay for it? Steroids have so many side effects - I wouldn't try them on my horse either without a high probability of success.

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    1. I so feel you on the not wanting to know any more problems! Just "fix" it and carry on. Or look the other way completely sometimes!

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  16. This is such a hard situation to be in -- being an advocate for your horse is complicated. But ultimately you know Bobby best, and if he's comfortable and happy for the moment, I'd go with your gut. You know there's no "curing" this, and if he's already comfortable, are the steroids going to do anything better?

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    1. I think (???) the steroids were to help with the swelling in the coronary band and the leg, but...I don't know. It just seems like that can't be the ONLY option to reduce swelling out there. And maybe there's one that doesn't involve such crazy side effects?

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  17. Having been a human medical freak, I do think the analytical minds get so overwhelmed because something is finally EXCITING that they definitely overlook the bigger picture. I've been lucky; my only horsey adventures have been in lameness, and my vet was very straightforward when giving me my spectrum of options. Way to be an advocate for Bobby, and I hope that your vets start behaving. Seriously, drugs "just because?!". BAH HUMBUG.

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    1. I couldn't believe the "Oh, they're pretty benign so you might as well give them to him." Uhh, whut.

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  18. Tim Gunn is always the answer. Always.

    I've had it out many times with my Farrier, but I frankly told him EFF NO when he wanted to put hind shoes on Roger "so he'd stop pulling the front shoes." Um, no. The horse shows absolutely zero sign of needing any hind-end support whatsoever. He hasn't had hind shoes in the almost 3 years I've had him. He pulls his shoes bc he's a 7-year old OTTB who sometimes plays in turnout, and also sometimes is a dumb-dumb about where his feet go. Also, Roger naturally tracks up behind in his normal trot, which sometimes pulls shoes by catching the front shoe. So no, Farrier. I will not make it rain dolla dolla bills and satisfy your wallet putting completely unnecessary hind shoes on my perfectly sound horse. Thank you very much, eff off.

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    1. I feel like I need Tim Gunn as my vet.

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  19. Oh Carly! I think you are doing right by Bobby and listen to your gut when it comes to these decisions. It's not like you've decided to donate him to a medical study so they can "try" therapies on him. You want him happy and as sound as he can be so you two can enjoy your time together, not a pin cushion! Steroids are so rough -- I'd be very skeptical too.

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    1. I've never paid attention to meds side effects before and now I'm officially that crazy horse person reading all the labels.

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  20. Love your common sense approach and think your decisions are good ones. Again, I'm sorry you're even having to deal with all this in the first place.

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    1. I wish the vets would get a little less excited and use a little more common sense. ;)

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  21. I think you should take comfort in the fact that you know your horse best - and you are making choices in his interest! Huge kudos to you for doing what you believe is right.

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  22. All you can do is make the best choice today with the information you have IN THIS MOMENT. None of them last forever, and IMHO you should make the most of your time with Bobby. <3 <3 <3

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  24. It is so easy for vets to get sucked into the treating of the problem that they don't look at the bigger picture of horse is happy and sound and you want to do right by him. They want to take a (long) shot at fixing things and don't necessarily think about maintaining quality of life. Listen to what Bobby tells you. Plus you are the one that lives with the decisions. For what it is worth this internet stranger thinks you are doing the right thing telling them to take their steroids and shove it.

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    1. I appreciate them wanting to be proactive, but at the same time I want them to slow their roll, ya know?

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  25. I just came back to read the comments.

    Maybe you SHOULD call Dr. Hope 😂

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    1. Maybe he could cure Bobby's syphilis while he was at it? Gotta love spam!

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  26. Yeah, unfortunately I've had to make the call to stop treating or stop trying treatments. Sometimes enough is enough and you don't want to tip the delicate balance of where things are. As others have said, you are your horse's best advocate, so don't feel guilty about making those tough decisions for Bobby's welfare. His quality of life is 100% the most important thing, and unfortunately some vets can lose sight of that. Hugs, and keep on doing what you're doing.

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    1. So frustrating when you want to put it in someone else's hands to fix it, but you're not sure they're really doing what's best in the long run.

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  27. Keep doing what you're doing. I saw your XC pictures on FB and Bobby looks perfectly happy. How frustrating.

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    1. He seems like he's enjoying himself just fine for the moment!

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  28. I don't know how you are dealing with all that...Bobby is lucky to have you.

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