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.