Am I grasping? Wanting a second opinion but rationally doesn't make sense..

[Tif_Ann]

OK, I need some rational listening ears here. :) I've posted a few times about some of the medical issues my family has dealt with with our animals. I've also posted about the bad year I'm having - I've lost three animals this year, 2 from very old age (20+ yr old cat, 13.5 yr old Siberian Husky) and a 24 yr old TB from complications from melanomas (Rocky's story is pretty well covered on the board. I lost the cat in January, Rocky in March after 4 months of dealing with multiple medical issues, and my husky in April. I am currently dealing with my 13.5 yr old German Shepherd showing signs of late stage degenerative myelopathy and know I will lose him before the end of the year. AND... In May, my baby ... my 12 yr old half-blind mustang ... was diagnosed with squamous cell carcinoma on the eyelid of his good eye.

This post is about him. I am lucky to live in an area that has a very good Large Animal Clinic - and three very good vets that specialize in horses. All three of them have been involved in Pirate's treatment. We discovered a cataract at the same time as the SCC and have realized that Pi is probably 70-80% blind in his "good" eye as well. My main vet spent a few days consulting with several vet associates around the country regarding Pi too - friends at the University of Missouri vet school, where we would have taken him for cataract surgery, people at the University of Minnesota vet school ... others I don't know for sure. The Minnesota people recommended trying Aldara as they had been having a lot of success with the treatment. The location and size of the tumor makes surgery a last resort as my vet doesn't believe he can get good margins and there is a high likelihood that he will lose the eye. So our goal is to get rid of the cancer without losing the eye - though I am prepared to lose the eye if that's what it takes. As blind as he is the adjustment to full blindness will not be a big deal, and he's a beautiful dressage horse. We would have to see if we could still do simple trails, though I have already started training him to verbal commands such as "up" to step up hills, "down" etc. It's beneficial already given his vision.

The reason I'm posting is for the first time ever I'm wanting a second opinion. I realize it'll be the fourth ... fifth... tenth ... I don't know. Fourth vet that will actually see him. We have done three rounds of the Aldara already. It causes a massive amount of pain and is very difficult to put him through. Our vet clinic has only treated one other horse with Aldara and that family ended up having him stay at the clinic because they couldn't handle the emotional stress of putting their horse through so much pain. However, the treatment does no harm to the eye itself, just causes massive swelling and scabbing and makes the body's immune system attack the tumor.

The first two treatments seemed to work. The three small tumors on his upper eyelid are gone. The bottom one is being more difficult. He's had that tumor for about a year, I just didn't realize it was anything to worry about. After the second round of treatment that tumor seemed to be gone too, and I was very happy.

However ... about a month ago I had his teeth done, and the vet checked his eye automatically. Anytime the vets stop out to our stables Pi ends up getting looked at *rolls eyes* ... truly, my vets are amazing. BUT she noticed that the tumor was back. She believed that it was latent tumor that had been deep under the skin that had come to the surface. Given his extreme reaction to the Aldara before, we decided to do three more treatments and see if that took care of it.

Well, it didn't. The tumor is still there, and now it's red and looks like a pimple. I spoke with two of my vets at great length earlier this week about it, and both of them are wanting to be very aggressive about the treatment. I am having some financial troubles because of moving, and had wanted to wait a month (when I expect my finances to be back on track) and both vets stressed that waiting even a month is not an option, we need to be on this now. My main vet doesn't think the Aldara is going to do anything but we are going to try six more treatments (two weeks) and evaluate at that point. Next step is attempting cryotherapy. He also told me the other horse that had been treated with Aldara has now been sent to Missouri and is undergoing radiation. So there isnt' a lot of optimism at the clinic about the Aldara.

Maybe it's my fear ... I don't know ... but all of a sudden I want another opinion. My rational brain is telling me it's stupid because I've had three separate vets see him and they all agree on what it is and the need for treatment. My brain is also telling me that this need I have is all fear, fear of losing my baby, fear of what will happen to me if I lose ANOTHER animal (my family in total has lost 5 this year - my mom just lost a horse to colic last week and my sister lost a morgan to bladder cancer in January, both very young). I can barely afford the treatment right now, yet I'm sitting here starting at my professional flute thinking I could sell that to get the gas money and fees to haul him to Missouri to be seen. I'm THAT irrational about this.

So... I'm posting here for advice ... what would you do? I respond well to tough talk too :) so don't be afraid to be the rational voice and tell me to trust my very good vets. It's hard to listen to the rational brain when your heart is screaming so loudly!! :)

[BuddyRoo]

If it were me, I'd remove the eye.

Critters aren't emotional about the loss of appendages or functionality in the way that people are. Most are quite resilient and find ways to cope--as long as today is a good day, life is good. They live in the here and now.

I personally would not spend another dime or another day with a treatment that is not working and is causing pain. We can ask them to suffer a little (or a lot) when the prognosis is pretty good...but in this case, it ISN'T good and therefore, IMHO is unnecessary pain.

You can still ride and show a blind horse. I know a handful of people who are doing that. I think that if I were in your shoes (and please know that I am not a vet nor do I play one on TV) I would probably remove the eye.

Once you start going down the path, it can be hard to put a $$ amount on it...a stopping point if you will. I think you've let it run away with you.

What are your goals?

1) Keep horse alive and as pain free as possible.
2) Avoid bankruptcy.

Those would be mine.

I think it's doable...but again, I think that if I were in your shoes, I would discuss with your vets the possiblity of just removing the eye.

Buying a *little* time isn't the same financially or emotionally as knowing the cancer is GONE.

[sdlbredfan]

I agree with BuddyRoo. ("If it were me, I'd remove the eye. Critters aren't emotional about the loss of appendages or functionality in the way that people are. Most are quite resilient and find ways to cope--as long as today is a good day, life is good. They live in the here and now. I personally would not spend another dime or another day with a treatment that is not working and is causing pain. We can ask them to suffer a little (or a lot) when the prognosis is pretty good...but in this case, it ISN'T good and therefore, IMHO is unnecessary pain.")

[BuddyRoo]

I forgot to say... (((hugs))) and lots of jingles coming your way from MI.

I have not been in this position with my horses (yet...knocks on wood), but I have with my dog. I had to sit down and have an honest conversation..."Dr....I have X funds. What is our best bang for the buck?" And care credit might be an option for you too.

I was looking at having to euth my dog about 2 mos ago....I just couldn't afford any more. Bless her heart, my vet said, "I'm not letting this sweet boy die and we'll work it out." BUT, I still had a limit...and I had to stick to it. I can't be living in a cardboard box or go overboard and risk the health/well being of my other critters and myself.

[Mach Two]

Here's a hug for your losses, and your pain. And here's the voice of reason from an outsider who is not emotionally attached to the situation. If I knew you personally, I would give you this "tough talk" along with hugs.

If you are determined to keep this horse alive, remove the eye. Your love and pain of the past will not render a cure. Vets are trained to offer all the options for cure, and to make enough money themselves to make a living and pay off student loans. So removing an eye, or euthanasia, are not options that give them an opportinity to do what they are trained, and have taken an oath, to do. This is not at ALL a criticism of the vets you have seen so far. But I get the feeling you are hoping one of them will give you the answer and make a decision for you...and only you, as the owner can make that decision.
Yes, you lost some good friends, but given the circumstances you described, the friends were all at advanced ages, and had been loved by you and your family for a long time. So there was nothing that was going to be different, nothing attached to bad luck, unless you could having a group of aged animals as bad luck.

Say no to expensive treatments, say NO to selling your best flute. You won't replace it. Yes, it's just a thing, and the horse is your friend, but selling a treasured instrument is not going to give you extra points in the miracle book. You are not going to fix that eye by going deeper into debt and furthering your personal pain.
You will grieve the loss of the horse's eye, but the horse will not. It will just adjust, and will hopefully be cancer free.
Be at peace....you will make the right decision.

[Hampton Bay]

I too would remove the eye. Horses can adapt pretty well to being blind, and as you say he is already mostly blind. He is probably pretty darned well adapted already.

If the vets are not hopeful about the drug treatment, then likely he will lose the eye anyway? If that is the case, why not just go ahead and do it and skip the emotional and financial stress of the other treatments that might just be putting off the inevitable.

There is a woman in Iowa with a blind horse who is showing at first level (with respectable scores) and schooling second. I have seen videos of her showing him, and you would not know the horse is blind from watching the video. I am sure it took her some time to develop that kind of working relationship after the horse went blind, but she seems to have no big issues with it now. She has said that he tends to not grow his winter coat until he gets cold (because the light cues that seeing horses use to grow the coat are not there, so his body responds to temperature instead). But overall the horse is doing just fine.

Good luck, and sorry for your losses this year :(

[BuddyRoo]

Hampton, I thought about putting her in touch w/ Tracy too! I might PM Tracy today just in case. Fessor is an amazing horse! (We have to be talking about the same person)

She has blogged a lot about working w/ him and his blindness.

[FatPalomino]

Will removing the eye be able to eliminate the cancer altogether?

There was a horse I heard of that had aggressive treatment for a similar issue. It worked for a short time, but not in the long run :(

Don't feel you have to treat him. You've done much more than most could afford to do for a mustang. Letting him go, as tragic as it with a younger horse who's so kind and talented, isn't something you should feel guilty about.

You probably know how inexpensive mustangs are, how trainable and tough they are. I am sure there is a mustang in a holding pen who would be thrilled with the opportunities you could provide. At least for me, getting a new project and keeping busy if the only way to deal with losses of our good friends.

(Hugs)

[Penthilisea]

Just another chiming in, jingles for you and your guy. I think BuddyRoo is on the money too. Causing pain sucks. Blindness doesn't.

[jen-s]

Tif_Ann,
I'm so sorry about Pirate. I've read your threads this year and I can't even imagine what you've been through. (((hugs))) BuddyRoo is right that about removing an eye and how horses adjust, but FatPalomino has a very valid question about whether removing the eye will eliminate the cancer. If the answer to that is yes, then remove the eye. If it's not, then it might be time to consider putting him to sleep. I know that's the last thing you want to do, but better a week too soon than a moment too late.

And no, I don't think you should sell your flute. If it's a professional flute, then in theory, you use it to make $ to feed not only yourself, but your critters. Unless you have a professional flute collection with duplicates, I think you'd want to hold onto this.

Please keep us posted on how things go and what you decide. Pirate knows how much you love him and will understand that you did your best and that whatever decision you make, "This it be right."

[EqTrainer]

I am not sure I could sign my horse up for numerous more extremely painful treatments, that he does not understand - no matter what the outcome.

When MSU started doing hip replacement surgery in dogs, my GSD was 7 years old. They did not usually do them on dogs that old, but the surgeon agreed to meet me and my dog to discuss it, informally. At the end of our talk he agreed to do the surgery.. but then he said to me "look.. between you and I... the rehab is horrendous. And the dog has *no idea why* he is in so much pain and is being forced to walk... please think about this long and hard. If you want me to do it, I will.."

I opted out of the surgery. IMO it's not really fair to ask animals to suffer terrible pain that goes on and on that they cannot understand. And the effects it has on a horses body, to be in terrible pain.. it's not just as simple as it being local. Horses can develop IR from chronic pain situations, they can become laminitic, they develop ulcers.

Lots to think about. And I wouldn't sell the flute, unless you look at it and it has no meaning to you - been there, done that, no regrets. Hugs to you, it's tough either way :(

[Tif_Ann]

Thank you everyone - it's surprising how much of an "a ha" moment there can be when just reading some words can put into focus what I'm really feeling. :) Buddyroo nailed it right away - it's the Aldara and putting him through it that had me so unsettled and upset. As soon as I decided not to do the Aldara again I was able to calm down and start looking at other options.

So that's where we are - no Aldara. There's more reasons than I posted - including that the treatment would affect my other horse, because he'd have to go to pasture and lose his stall while Pi was being treated. Tommy is a hard keeper, at a good weight right now but not "fat" for winter like most, and needs vitamin E every day. He's also an anxious horse who has never done well in pasture - he likes his routine of turnout, etc. Putting him on pasture for a month or two at the beginning of winter was going to be very difficult.

But ultimately - it's the Aldara treatment itself. Pi is so trusting and forgiving it's very hard to put him through it. First treatment he accepts just fine, even after the other rounds. Second treatment usually requires an ear and/or nose twitch and two people fighting him, third usually requires sedation and a twitch. He becomes extremely head shy - we keep a halter on him during treatment so he can be lead and turned out at night. He loses weight - though my BO is very quick to watch that and bumps up his grain. He doesn't normally get grain, maybe a handful after we ride - but while on Aldara gets about 1.5 scoops a day just to maintain the weight (in addition to nearly free choice alfalfa/hay). It's also very stressful to him and he loses his ability to use his other senses to find his way around - his blindness shows as he will walk into things, trip and stumble, etc. The first round of treatment he actually bruised his hooves (not his soles, just hoof wall bruises) from hitting things and walking into things. The pain has him so internally focused he's unable to even navigate his surroundings. Putting him through all that when the treatment no longer appears to be working just doesn't seem worth it.

So... I'm going to set up an appointment with two of the three vets and take him in to evaluate and discuss options. I'm also going to call the Univ of Missouri vet school and talk with them, and see if it's worth bringing him down for a consult. All my research shows that surgical removal is the best option for this kind of cancer. And while there is a high risk of losing the eye with the surgery, it's not a guarantee - he could keep the eye. The biggest fear is there will be damage to the muscle of the lower eye - the tumor is on the skin on the lower eye on the inside of the lash line - which would leave him unable to close his eye properly. That would require removal of the eye.

Then there is the possibility of just doing nothing. SCC is one of those things that it could sit there dormant for years, or it could go crazy tomorrow. If it stays dormant ... it's not a huge deal. When it goes active, though, it tends to be very fast and aggressive. We are nowhere near the put to sleep stage right now, as by all appearances he is a very happy, sassy, and healthy horse. Even though I haven't been out to the stables in several days and it was dark, when I called him last night he came running up to the gate and was very playful and fun. His trust and love is overwhelming - along with his ability to forgive. He doesn't hold grudges :) I would expect any horse to become very headshy with what he's gone through, the twitching and pain, etc., but he gets over it very quickly. He still kind of flinches when I reach for his ear or pet around his eye but lets me touch and is getting over it. It feels like such a betrayal of his trust to put him through the treatments.

Anyway ... thank you again ... posting and reading your responses has really helped to focus what I was feeling.

[AKB]

Really consider doing nothing. I always have trouble inflicting painful treatments on an animal if there is a low likelihood of success. I would really want good data about the success of any treatment before I would put him through it. If you do nothing, he should have some time with a good quality of life. When he is uncomfortable, you will put him down so he does not suffer.

[blackstallion2]

Jingles for Pirate .. you are doing your best for him.
I agree with the above and have known many that spent 5 figures on cancer treatments (all dogs) only for a few months more time. They said it was worth it. I on the other hand appreciate the old fashioned vet who says there's nothing he can do. Like you mention, it's not as much about the money as it is what you are putting him through, without any more guarantee that he'll get better than if you do nothing.

[TracyA]

I just wanted to jump in. I'm Tracy, Fessor's owner mentioned above. Or maybe he owns me, I'm not sure...

Fessor was first diagnosed with uveitis about four years ago. In time, he went fully blind. Fortunately, the blindness came over time and we had time to adapt and adjust to the idea. We've had a few nervous moments early on in the transition into blindness. But he's been fully blind in both eyes for a few years now and has adapted beautifully. I don't know if we'll make it that far, but Fessor shows signs that he will be a decent third level dressage horse.

I had a blog detailing our early experiences in the journey into blindness. I cannot find it now, but will recreate it later this afternoon from old posts on the yahoo blind horses group. http://pets.groups.yahoo.com/group/Blind-Horses2/

I will look and see if I can find a link to an article on horsecity from a few years ago, shortly after Fessor went blind. If I find it, I'll either post it here or send you the link in a PT. Good luck with Pirate!

Tracy

edited to add: I cannot find the article I was looking for -- it's either too old or got lost in the site conversion. Once I get the blog recreated, I'll send you a link.

[TracyA]

Here is the video from Sunday. Fessor and I competed in first level tests three and four. We scored 69.41% and 67.41%. Though we still have a few things to work on, I am happy with how our tests went. Now I just need to lose the weight I've gained since the last time I wore my coat. Oops! We competed in First level tests three and four.


http://www.youtube.com/watch?v=VFG6j_vHpHk


http://www.youtube.com/watch?v=oSlslcI00lQ


Tracy