Letting nature take its course?

[Twiglet]

Buzz had a visit from the vet today, who has been off for two weeks, and she's found a substantial deterioration in his jaw, which is in constant spasm.
He now has no chewing ability, so food is basically sucked in and 'gummed' before being swallowed. He can only open his mouth around 4cm. He's lost all condition on the left side of his head, and the cheek has sunk in.
Neither the cancer vets nor the practice vet have ever seen this sort of spasm as a result of cancer or radiotherapy, and can find no medical cause for it.
The only treatment option at this stage is to have the jaw injected with methocarbamol (sp?) which is a muscle relaxant, and see if that can release any of the spasm. He's in pretty constant pain, which oral bute doesn't touch, but is relieved slightly with IV painkillers. His jugular has already collapsed as a result of catheters, so having to be careful with how injections are done.
The methocarbomal treatment is twice a day, every day for five days, via a needle directly into his face, and the cost is likely to be in the high hundreds (the insurance ran out weeks ago).

I'm really not sure where to go from here. He's been fighting this thing for three months, which I know isn't that long in the grand scheme of things, but it's a very long time for a horse who loves eating, and hasn't been able to eat properly in that time. I always said I would keep fighting and treating him while he had a quality of life, but I don't know at which stage I have to consider what that quality is.
At least one vet has said that as he can't eat, and is in pain, as far as they're concerned he should be put down, but the regular team (the cancer guys, and the practice vet) are still prepared to throw the kitchen sink at it in terms of treatment. I'm just not sure how long I can continue to consign a horse who has been so *******ing tough about the whole thing to yet more pain and horrendous treatments.

If the muscle relaxant works or makes any difference, I'm considering another option - a friend has offered the use of her field for him. It's got great grass, good shelter, and he'd have a companion. I'd have to find a groom who can stop by and check him in the mornings, and I'd try to get there myself 5-6 times a week (it's much further than the yard). I'd ask the vet to stop by weekly and inject painkillers, but otherwise he'd be on a diet of just grass.
Previously I didn't want to consider it, as he just wasn't strong enough to live out, but now it's getting warmer, and the grass is improving, I'm wondering whether to let nature take its course, and see if it does a better job than everything else we've tried.
The downside of it is that at the moment he has a team of really awesome, caring grooms and yard owner monitoring him on a near constant basis - they're going out after evening stables to top up his slop forage, and testing his bite and his weight. They have a good working relationship with the vet, and they really care about Buzz and how he is, which as far as I'm concerned is worth its weight in gold.

I don't expect anyone to have an answer, but just wanted to get it all down and see if there's anything I haven't thought of. It's just breaking my heart to feel like I can't do anything to help him.

 

[ihatework]

I want to give you an incredibly big hug.
What a horrible journey you have been on with a horse you so clearly adore.
Maybe it is time to consider if you have reached the end of that journey.

 

[mattydog]

Sorry to have nothing helpful for you and your brave, brave boy. Heart breaking but if the vets want to carry on maybe you should give him a it longer. Tough decision. You are the best one to decide when enough is enough. He will let you know.
But...if he can't chew how can he live out on a grass diet only? Sorry if I got hold of the wrong end of the stick with that one. x

 

[PorkChop]

Oh no, big hugs for you both, so sorry.

You will know in your heart when you feel enough is enough, a horrible situation to be in x

 

[catembi]

Oh no, how horrid for you both. I really sympathise with you as I went thru 6 months of hell with Catembi when he had protein losing enteropathy. It's so gutting to think that you might be winning, & then find out that you may not be.

I am so sorry for you. It's so hard to know when to let go, especially when it's been a hard-fought battle.

T x

 

[TarrSteps]

How awful for you both.

Okay, I'll ask the tough questions. . . What is the goal here? At this point is there a reasonable chance he will return to a relatively normal, pain free life? What is the potential cure rate for the cancer and what more might that entail? Can he get adequate nutrition from grass alone at this stage? How recently has he lived out? Even though we think it's 'better' it's still an adjustment. And while we think of summer as a lovely time of year heat and flies are very hard on horses.

Also, I love vets but they are scientists. They are hard wired and educated to solve problems. They are also supposed to do what the client wants or says they want. They are not, and should not be thought of, as spiritual advisors or ethics guides. I know what it's like to have vets invested and feel that somehow you owe them a certain decision, but at the end of the day they are hired guns. (As are trainers and grooms.) The ultimate responsibility is with the owner.

I know I'm supposed to tell you to keep going, that it's worth everything. I think very highly of your vet, although partly for her relatively 'agricultural' outlook. But if you are genuinely wavering, seeing B every day and knowing him well, don't deny your instincts because you feel you have to keep going, having done so much. And certainly don't let what you think other people might think impact on making the right decision for you and B.

 

[PolarSkye]

Buzz had a visit from the vet today, who has been off for two weeks, and she's found a substantial deterioration in his jaw, which is in constant spasm.
He now has no chewing ability, so food is basically sucked in and 'gummed' before being swallowed. He can only open his mouth around 4cm. He's lost all condition on the left side of his head, and the cheek has sunk in.
Neither the cancer vets nor the practice vet have ever seen this sort of spasm as a result of cancer or radiotherapy, and can find no medical cause for it.
The only treatment option at this stage is to have the jaw injected with methocarbamol (sp?) which is a muscle relaxant, and see if that can release any of the spasm. He's in pretty constant pain, which oral bute doesn't touch, but is relieved slightly with IV painkillers. His jugular has already collapsed as a result of catheters, so having to be careful with how injections are done.
The methocarbomal treatment is twice a day, every day for five days, via a needle directly into his face, and the cost is likely to be in the high hundreds (the insurance ran out weeks ago).

I'm really not sure where to go from here. He's been fighting this thing for three months, which I know isn't that long in the grand scheme of things, but it's a very long time for a horse who loves eating, and hasn't been able to eat properly in that time. I always said I would keep fighting and treating him while he had a quality of life, but I don't know at which stage I have to consider what that quality is.
At least one vet has said that as he can't eat, and is in pain, as far as they're concerned he should be put down, but the regular team (the cancer guys, and the practice vet) are still prepared to throw the kitchen sink at it in terms of treatment. I'm just not sure how long I can continue to consign a horse who has been so *******ing tough about the whole thing to yet more pain and horrendous treatments.

If the muscle relaxant works or makes any difference, I'm considering another option - a friend has offered the use of her field for him. It's got great grass, good shelter, and he'd have a companion. I'd have to find a groom who can stop by and check him in the mornings, and I'd try to get there myself 5-6 times a week (it's much further than the yard). I'd ask the vet to stop by weekly and inject painkillers, but otherwise he'd be on a diet of just grass.
Previously I didn't want to consider it, as he just wasn't strong enough to live out, but now it's getting warmer, and the grass is improving, I'm wondering whether to let nature take its course, and see if it does a better job than everything else we've tried.
The downside of it is that at the moment he has a team of really awesome, caring grooms and yard owner monitoring him on a near constant basis - they're going out after evening stables to top up his slop forage, and testing his bite and his weight. They have a good working relationship with the vet, and they really care about Buzz and how he is, which as far as I'm concerned is worth its weight in gold.

I don't expect anyone to have an answer, but just wanted to get it all down and see if there's anything I haven't thought of. It's just breaking my heart to feel like I can't do anything to help him.

Hugs Hon . . . this is the update I so didn't want to see. Are you asking if it's time? Honestly, I don't want to tell you what I think if that's not the case . . . but I do think you will know, in your heart of hearts, when it IS time to call it a day.

I know how lucky you feel to have Buzz . . . but Buzz is very lucky to have you.

Big hugs.

P

 

[stencilface]

Oh no poor buzz and poor you

If he would be happy enough and enjoy the grass space and freedom I would see if that would work. Could you hold his stable at the yard if he doesn't enjoy being out?

 

[Ditchjumper2]

I think you know the anwser to the question. You have done everything and more for your boy and no one could accuse you of not doing your best, and for all the right reasons. However, I am with TarrSteps on this one. Vets like the new challenge and the opportunity to achieve the end goal....at whatever cost, and I do not just mean the money.

Look at your boy, look at his eyes......and you will have your answer. Big hugs to you x

 

[Twiglet]

Thanks all. Mattydog, the turning away would be post muscle relaxant treatment, providing it worked to the extent he was back to where he was a few weeks ago - able to graze and eat hard feed but not hay.
In reality that treatment starts tomorrow and I'll be going ahead with it - I'm not near ready to make a decision in the next 24 hours.

Tarrsteps - thank you, I hear where you're coming from. In reality there is no precedent here - it's an incredibly rare cancer with a very uncertain outcome with this treatment.
Best case scenario, he'll improve day to day and in 5 months time I'll take him back to the RVC for a CT and he'll be clear of cancer, requiring only ongoing check ups, but be otherwise a normal horse with every chance of a normal life.

Otherwise, I'm going to spend the next 5 months treating all these set backs, asking more and more of his poor battered body, and having to let him go at the end of it when the CT shows the cancer hasn't responded to it.
If I had a crystal ball and it showed that he was still going to poorly, I'd make the decision today.

But in the meantime he is SO chirpy and happy in himself. He schooled himself over trotting poles on Friday night for his own entertainment. I brought him from the field on Sunday and he emptied a bucket over me, smashed a grooming kit, untied himself and walked off (not all at the same time). To look at him, other than his poor face and his ribs, you'd think he was a relatively healthy happy horse. At no point has he spent a sustained period looking blue or sorry for himself.

 

[Jane_Lou]

I am so sorry you have got to this position. Only you can know what is best for him and no one will judge you, if you decide enough is enough as frankly you have gone above and beyond for him already.

I have not commented before as I went through a similar yet different situation. I was there 10 years ago with my precious and very special little dressage horse. There were two difference though, he was 23 and it was November. I also had no insurance cover at all due to his age but was happy to fund (within reason) any treatment he needed. You don't have to read below but it might give you some comfort in the fact that others have been through similar decisions with this horrid disease.




I noticed a lump to the side of my horses throat and after various biopsies and blood tests the vets had identified a large tumour on his Thyroid and then he developed altered behaviours suggesting another in his brain. He had all but stopped eating he was dropping off rapidly. A week in the RVC brought us no further forward as did consults with many other vets around the country. There was no surgical option offered due to the position of the tumour so the plan was to see how he went over a period of time and manage him with pain relief. His weight was dropping, he stopped eating any form of long fibre, not even chopped fibre like redigrass which he always loved and when he refused haylage I knew things were bad. We found he would eat Spillers High Fibre Nuts soaked into a mash so there was a constant supply made available to him, then he would only eat them if hand fed so all the staff and liveries would pop into his stable on and off all day to feeds him as much as he would eat but he still dropped more as his appetite was clearly compromised. He was on IV painkillers twice a week as this was really all the vets could offer at that time. Had it been spring I would happily have turned him away and seen what magic Dr Green could perform but it wasn't, it was late October and the weather was already bad. He hated winter, he hated wind and rain and being out in bad weather, he hated the cold, he just hated everything about winter and always had. I made the decision and had him put down on the 5th November. In reality I know myself that I would have been making the same decision within a matter of weeks of turning him away as it wouldn't have changed the fact he wasn't eating.

Many I think thought I had not given him enough time or chances as it all happened over a 3 month period, but I knew my horse and my lovely and brilliant vet knew my horse and we both knew we were doing the right thing.

 

[TableDancer]

I want to give you an incredibly big hug.
What a horrible journey you have been on with a horse you so clearly adore.
Maybe it is time to consider if you have reached the end of that journey.

^^^^Beautifullly put.

 

[DonkeyClub]

Is he only just starting the methocarbonal treatment? I would definately give that the 5 days to see what effects it has.
& sounds corny but would an Arc Equine machine help? Could someone lend you one?

What about a decent osteopath ? My Osteo does plenty of work on relieving jaws & making the jaw more mobile, I will Pm you his details.

& if the grass is really lush and long in this field, I would definately try it. Constant grazing really would go someway to relieving that spasm. Muscles can't work again unless they're forced into use& exercised.
Silly analogy but I would perhaps compare this to the story of the guy who was paralysed in an accident, doctors told him there was nothing he could do& he'd never walk again, after 5 years in a wheelchair, one day he met this yoga instructor who started doing gentle exercises with him & some months later he was walking and running! So you can make the body do amazing things, if pushed in the right direction.

 

[kerilli]

Poor you and poor poor Buzz. I know this is horrible but if he were mine I would 100% be on the phone to the vet now and have him pts tonight, before he suffers any more. You tried your absolute best, you did everything you could (more than many people would have done) but if he cannot eat and is in constant pain, that is really no quality of life at all.

Fwiw I have had horses a long time and have had to have quite a few put down over the years. Invariably the indecision and the wait is the absolute worst thing. They are indescribably awful. Once you have had it done, a bit of relief honestly help the grief. You should have no guilt at all. You did everything you could.

 

[Patterdale]

Hugs to you.

Not so long ago I had a fantastic self produced 2* eventer. He had an horrific accident in the field and spent 4 months in vet hospital and another 3 on box rest at home.
Then, after deteriorations, he was PTS.

Throughout, there were fantastic vets working on his case, from all over the country. They were all so positive about each new treatment that I just got carried away along with them, and felt like I had no option but to say yes.

I now see that the vets (and this is not supposed to be a slight on them as such), were so keen to keep him going as they just 'had' to solve it. TarrSteps says it very well -

Also, I love vets but they are scientists. They are hard wired and educated to solve problems. They are also supposed to do what the client wants or says they want. They are not, and should not be thought of, as spiritual advisors or ethics guides. I know what it's like to have vets invested and feel that somehow you owe them a certain decision, but at the end of the day they are hired guns. (As are trainers and grooms.) The ultimate responsibility is with the owner.

Part of my reasoning for putting him through all the treatments was that I thought I would feel guilty if I had him PTS without throwing everything I could at it. But actually, afterwards, I just felt do guilty for putting him through it at all

In the end I dosed him up on everything i could and chucked him out in the field after half a year in, bandaged to above his hock and too fed up to even run around. He stayed out in a lush field for a few days (it was summer by then) and was then PTS with his head in a bucket. That week was one of the kindest things I feel I did for him.

The point I'm trying to make is.....it's easy to get carried away with what the vets are telling you.
What do YOU think? Truthfully?

Xx

 

[be positive]

I am with TarrSteps on this, what is the end goal and is there a future of a quality life for him to make going through any more worth it, the only suggestion I can make regarding his current issues with the spasm is has osteo been considered, I used one recently on my horse who has had some problems in his mouth and jaw, she was able to really help with relaxing his far more minor issues but it could be worth considering, vets do not always want to involve alternative therapists but they do offer a different approach.

Whatever you do now remember Buzz has had the best of everything available and is a very lucky boy xxx

 

[Gamebird]

I want to give you an incredibly big hug.
What a horrible journey you have been on with a horse you so clearly adore.
Maybe it is time to consider if you have reached the end of that journey.

This. 100% this.

In reality that treatment starts tomorrow and I'll be going ahead with it - I'm not near ready to make a decision in the next 24 hours.

I'm going to be horribly blunt here... you may never be ready. Sometimes these decisions are not about what's best for the owner but what's best for the animal. I have put many hundreds of cats, dogs and horses to sleep in the last 15 years and have been many times presented with an animal (often a dog) who has gone on too long because the owners didn't feel ready to make a decision and were tentatively hoping that the animal would slip away in its sleep. I have often gone home in tears and have vowed never, ever to let one of my own animals get to the same stage.

You may well still be doing the right thing by your horse - I can't tell you whether you are or not - but you are describing to me a horse in intractable pain who can no longer eat in any meaningful way. I would let him go. Having seen the things that I've seen over many years, often by highly caring, emotionally invested, intelligent owners with their animals' best interests at heart, I strongly believe in the old maxim 'better a week too soon than a day too late'.

I am really, really, really sorry for you. I send you my deepest sympathies. Sometimes though it's time to let go. It's not 'giving up', it's not 'letting the horse down', it's just taking a deep breath and being really, really brave and having the strength to say that you did your best but now it's time to let him go.

Whatever you decide I wish you strength and courage.

 

[Twiglet]

Thank you for your replies. I do appreciate people sharing their experiences. I think perhaps that there's no 'right' answer here

I hope I've been open to the idea of euthanasia from the start - the first diagnosis I got was followed by 'let me know when you're ready for me to come out and put him to sleep', and I've always said I'll fight it as long as he'll fight it, but I'm not willing to keep him alive for me.

If he wasn't so bloody happy and cheerful all the time I think it'd have made the decision easier.

I posted this before but this was him on Friday...he'd only been turned out in the school to stretch his legs, and chose to demolish the trotting poles for his own entertainment....he's just so full of energy and life most of the time, it's hard to believe there's anything actually wrong with him.

http://youtu.be/1saRCEt02P8

http://youtu.be/R2smNs5CsAk

 

[Twiglet]

Just had a reply from the vet agreeing we should try the field for a few weeks. She ended with 'I promise I'll tell you when I think we're not winning anymore'...

 

[CBAnglo]

Poor you and poor poor Buzz. I know this is horrible but if he were mine I would 100% be on the phone to the vet now and have him pts tonight, before he suffers any more. You tried your absolute best, you did everything you could (more than many people would have done) but if he cannot eat and is in constant pain, that is really no quality of life at all.

Fwiw I have had horses a long time and have had to have quite a few put down over the years. Invariably the indecision and the wait is the absolute worst thing. They are indescribably awful. Once you have had it done, a bit of relief honestly help the grief. You should have no guilt at all. You did everything you could.

I completely agree with this; quality of life for me would be that he can eat/play/be "normal" and not in constant pain. No-one could have done more in your place, he is really lucky to have you.

 

[dianchi]

I didn't want to read and run, I think you have your final treatment you can try, and I would be doing the same, but as an outsider this for me would be the last roll of the dice.

All the vibes in the world that this course of treatment works and you can get to the final CT scan and have it be clear.

XxXxX

 

[TarrSteps]

I just have to add, I think you do have to keep in mind, too, that prey animals are not like cats and dogs and well, us. They are hard wired to show a healthy face to the world. The ability to move and eat continuously is essential to life, they simply cannot curl up somewhere and lick their wounds. They have incredible pain thresholds and will literally go until they drop. This is not will, it's instinct.

I don't mean to sound harsh and I don't mean this fact is even germane at this point, but it's something to keep in mind on a general level.

 

[Twiglet]

I just have to add, I think you do have to keep in mind, too, that prey animals are not like cats and dogs and well, us. They are hard wired to show a healthy face to the world. The ability to move and eat continuously is essential to life, they simply cannot curl up somewhere and lick their wounds. They have incredible pain thresholds and will literally go until they drop. This is not will, it's instinct.

I don't mean to sound harsh and I don't mean this fact is even germane at this point, but it's something to keep in mind on a general level.

I've said for quite a while that I think buzz's demeanour has had more to do with his attitude than his pain. He is this great big brute of a horse...and if it had been my old boy going through the same thing I would have made different decisions I think. Not because of quality of life but just because of physical strength and general ability to be relaxed and take things in his stride.
Which at the moment is counting both for and against him I think

 

[Gamebird]

Just had a reply from the vet agreeing we should try the field for a few weeks. She ended with 'I promise I'll tell you when I think we're not winning anymore'...

I think therein lies the difference between your vet and me. I don't think of it as 'winning' or 'losing'.

 

[Sandstone1]

So sorry you are having to go through this. Whatever anyone else thinks, only you know your horse. You will know when its time.

 

[Twiglet]

I think therein lies the difference between your vet and me. I don't think of it as 'winning' or 'losing'.

Ah to be fair it's me that named them Team Buzz and keeps calling him Rocky, I can't blame her for the turn of phrase!

 

[khalswitz]

I know what I would do, but tbh I think that's irrelevant. It's what YOU are thinking that matters. But this:

a horse who loves eating, and hasn't been able to eat properly in that time

If my foodie couldn't eat, and it wasn't being relieved, he would be suffering more than he would be from a lameness.

I know I very much regret the 'summer in the field' I gave my boy before being PTS. He was sore, and despite galloping about and being a nutter he was still noticeably lame even in the field, and he got much less patient to handle as I got more frustrated with the fact he just didn't improve. I miss him SO MUCH, and whilst 'if I knew then what I did now' there are other things I might have tried rather than purely the vet, at least I know that he went peacefully and didn't fight, which for him was saying something. And he won't regret anything - especially considering the lovely groom and loads of apples, carrots and polos that he got the night before, and lots of cuddles and attention.

Ultimately, only you can make this decision. It could all be worth it and him come right. But quality of life has to be good - he doesn't know that you're trying to save him and make it better, only that he's sore.

 

[Shrimp]

Oh twiglet i don't know what to add, you've both been through so much with all of this and i really really hoped all would come good. big hugs for whatever you decide to do x

 

[teapot]

So sorry H All I can say is given how much of a foodie he is I'd start questioning whether whilst he appears good in himself, he actually isn't... And it's not about winning or losing I don't think, it's about quality of life today and tomorrow, not in 6 months time...

Sending a massive hug x

 

[Fools Motto]

Nothing to add, but didn't want to read and run. Thinking of you and Buzz, all so brave. x