The first thing I learned about putting 5% Fluorouracil on my horse was that I was never allowed to get it on myself. 5-FU is a chemotherapy medication, so it’s basically a hazardous material. It comes in two plastic “transport bags” with yellow warnings that say “Caution: Chemotherapy Material” and “observe safety precautions for handling and administration.” My vet told me to wear gloves on both hands when administering it.
The second thing I learned about putting 5% Fluorouracil on my horse is that I never should have told my mother about it. She wants me to wear double gloves on both hands and long sleeves. I’m just waiting for her to suggest a gas mask and a hazmat suit. I honestly think she’d prefer if I just had my hands amputated and replaced with metal tongs.
(Pro-tip: if you’re lost right now and have no idea why we’re discussing equine skin cancer instead of some ineffective natural deodorant powder, I suggest you go back to the beginning for a recap.)
The 5FU comes in a small tube and looks like lotion…except for the warnings all over the front. Other than that, just like lotion. It works by attacking cancerous and pre-cancerous cells in the skin. This form of chemotherapy is unique in that it is supposed to only attack diseased cells, leaving healthy cells unaffected. You can determine which areas of tissue are cancerous by how they react when the 5-FU is applied; healthy skin should have no reaction, while cancerous tissue should become irritated.
I began using 5-FU to treat the lesion on Hawk’s nose on November 26, 2016. The Fluorouracil works in cycles. To begin, my vet instructed that I apply a small amount (think dime-sized) to Hawk’s lesion once a day until the area becomes too irritated to continue. I asked how I would know when that was, and my vet replied, “oh, he’ll let you know.” Surprisingly, though, Hawk is pretty good about it. I’d like to think this is because he’s so well trained and really likes me, but he’s probably just gotten used to me antagonizing his nose by now. That’s not to say that he loves getting the medicine, and although he doesn’t typically act up, I usually can tell when he’s had enough. Once, he actually ran in the opposite direction when he saw me coming with the tube – no signals were mixed that day.
After stopping treatment, I allow the lesion to rest for a few weeks, and I apply an antiseptic – usually Neosporin. Once a scab forms and then falls off, I let the lesion rest for just a few more days before beginning again with the 5-FU. Each cycle typically takes between four and six weeks. The treatment is to continue in these “on”/”off” cycles until the cancer is hopefully eradicated. We have completed 10 rounds so far, and I am about to begin the eleventh in the next few days. As an example, this is a photo progression of Round 1. In this 38-day cycle, Hawk spent 12 days on chemotherapy, and the scab fell off on Day 29. Photos are labeled “CHEMO” and “REST” to indicate days on and off of the 5-FU.
People often ask me if Hawk’s nose is getting any better. Well, it’s definitely changing, but I don’t know that I would describe it as “better.” Before we started treatment, the sore was a raw and lumpy mass of hard, leathery tissue. Now, it’s gotten smaller, and it’s opened up into what I call a “crater,” which has a nasty odor and drains constantly. The vet tells me however, that this “eating away” of the flesh is likely a good sign that the chemotherapy is working. Here’s a comparison of what the sore looked like when we first began and what it looks like now. That dark area in the second picture is the opening that I call the “crater.”
Sometimes I feel like we’ll never be done treatment. What if the FU just keeps eating away at diseased flesh for eternity? Will the sore ever go away? Will his nose ever be normal again? In the beginning, these moments of frustration would have me in tears. I’d leave the barn so disheartened, smelling the rotting smell of whatever drainage Hawk had wiped on my jacket, and I’d just cry. I’d cry because he looked worse than yesterday, because he’d ripped a scab off, because it was bleeding, because it was draining, because it was discolored, because it was always one step forward and two steps back. I’d cry because even though I’d gone through cycle after cycle, I didn’t feel like I was looking at progress. Sure, his nose looked different, but was this weeping, rotten-smelling hole really progress?
Eventually, I realized that I can’t live and die with Hawk’s nose every day. The reality is that his nose changes all the time. Due to the nature of the treatment, it routinely goes from blistered and aggravated to soft and pink in the space of a a few days – in the space of a night sometimes. That’s quite an emotional roller coaster if you’re hanging your happiness every day on a glimmer of hope that maybe you’ll see some progress this time.
Progress in this challenge is a lot more “big picture.” Do I still get disheartened? Of course. Do I still cry sometimes? Maybe…he is my baby after all. But I try to trust that it will get worse before it gets better. And, most importantly, I try to trust that it will get better. If it doesn’t, then Hawk will spend the rest of his life with a nose that smells like a skunk laid its rotten eggs inside of it. And I’m betting God’s nicer than that.