Saturday, September 05, 2009

When is Enough?


This pretty white horse with the black head is Pokey. Her registered name is "Missleading", which is also an accurate description of her. She is a Paint horse off the track in Oklahoma and Florida. She's Zip's mom. She has a huge spirit that she shares readily with anyone in need of comforting. She's my friend.

I pretty much make a rule of taking the best possible care of my horses, and Pokey has definitely been a beneficiary of my compulsive nature. But into even the best lives some rain must fall. In her case, there's been ample rain to qualify as a flood.

Foundered and pregnant when I bought her, she popped out a terrific colt and has gone on to live another 13 years with barely a lame step. Then Pasture Heaves happened. About ten years ago, she tested positive to 22 plants in her environment, testimony to what happens when you move a horse from one side of the country to the other. When I couldn't bring myself to tighten her girth anymore (and she is not a bareback horse!), I gave her my blessings to live forever in my care in semi-retirement. Her job is to make sure the geldings don't get out of hand, and to make everyone crazy with her occasional bursts of insanity that seem to take her by surprise as much as the rest of us. Her job is also to make people feel good. I don't know how she does it, but she can send out waves of peacefulness that are nearly palpable.

Then a few years ago I noticed blood on her hindquarters. The vet diagnosed a squamous cell carcinoma, and the surgeon removed it right in my barn. There was no chemo or other advanced techniques readily available at that time, so a couple of weeks after surgery, I removed the stitches, and she went about her life happy and healthy...until recently.

With a re-occurrence of the carcinoma, she and I ventured into a brave new world of veterinary medicine. I'm delighted to report that laser surgery is not just for humans anymore. With a five-hour round-trip visit to the only clinic in the state to sport a surgical laser and an hour of treatment by a surgeon versed in its use, Pokey was once again free of the growth on her barely-used private parts. We rejoiced with carrots and wine.

But now that we are over a week into the after-care for this particular treatment, which consists of rather painful cleanings of the surgical site (to permit healing from the inside out, it was left un-sutured) followed by the application of a chemo ointment called 5-FU, a chemical in common use in humans to stem the growth of various cancers. On days when the surgical site and the nubbins of additional tiny lesions that were lasered off at the same time are "weepy" from the intrusive quality of the chemo ointment, the cleaning is followed by smearing with another ointment. I've opted for Triple Antibiotic over the silver sulfadiazine that the vet recommended only because I know it works on her and I have tons of the stuff. Then there's the antibiotic Tri-meth and Bute for the pain.

I have no problem with playing nurse to my mare. I've diligently followed instructions, and the area appears to be healing. But with the recommended course of Bute doses finished, the pain in that area has increased exponentially. I can see it when I clean the site and she shifts her hindquarters as far away as possible. I can see it in the way she carries her tail straight out away from her painful area. I can see it in her eyes.

I will continue with the treatment as ordered for the prescribed 14 days. We've come so far that it seems a shame not to give her every chance for a longer, healthy life. But the pain is bothering me, and it has caused me to question: Just because we can, does that mean we should?

Pokey is 21. The tumor caused her no discomfort, but the treatment is causing plenty. In another week she is supposed to reappear at the vet clinic for a "touch-up" and a reassessment of a small tumor discovered during the first procedure. A "touch-up" means another round of laser cutting with the same after-care. I'm not so sure this falls into the "we should" class of actions.

At what point does it make sense to let nature take its course? I'm guessing on behalf of this mare that we're at that point. To take away the joy she exhibits in her daily romps in the pasture in order to ensure another chunk of time without guaranteeing that it will be longer than otherwise seems unfair. As much as I appreciate the additional years I've gotten from my own surgery and chemo treatments, I lost a lot as well. Maybe I'm more sensitive to the possible losses as a result.

I will wait it out this time. Pokey will heal (hopefully well) from her surgery, and I'll let time pass. If it takes another four years for the cancer to re-occur, we've done well. If it takes longer, better still. If it comes back quickly, then a new approach may be in order. But for now I'm passing on the "touch-up". This time I will temper my fascination with technology and my desire to wring every possible breath out of this lovely animal with patience and the knowledge that a life lived in pain isn't the goal.

For us, for now, "now" is "when".

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