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.