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  1. #1
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    May. 10, 2010
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    Default EPM Shake didn't work...on to Marquis...any advice??

    Well, 2012 just wasn't a good year for my boy. Most recently, he's developed neurological symptoms that appear to be "EPM-like," so we ran a blood test. He tested mid-range, so we treated him first with the EPM shake (I was so hoping that the cheapest medicine would work). After three months, there's been no improvement, so my vet suggested I order Marquis. I'm keeping my fingers crossed that this actually works, but I'm SOOOO NERVOUS!!!

    He fell recently when he accidentally stepped on his lead rope. I wasn't there when it happened, but it breaks my heart to see him so fragile. Have any of you had success with Marquis? How quickly did you see an improvement?

    If this doesn't work, my vet said that may indicate it's not EPM at all, but rather neck arthritis. I cringe to think that it could be something we can't do anything about...



  2. #2
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    Just wondering if you ruled out other neurologic diseases. It could be lyme, rabies... I would be very aggressive about testing now, not after you try Marquis. Since tick borne diseases cause arthritic symptoms I would at least start him on doxy and if you see any improvement become more aggressive with IV oxytet.

    I have a mare who was very neurologic and she was going down so quickly I insisted we put her on iv oxytet while we ruled out other diseases, including epm. She responded to oxytet even though her lyme titers were only mildly elevated, however there is another tick borne disease that responds to oxytet but does not test (it has been identified in humans. I can't remember what it's called). I suspect she had that because she responded so well to oxytet. We thought we were going to lose her but did not only because we acted quickly and aggressively. We did test for epm but I can't remember what her titers were except that they were so low we stopped treatment (we had started Marquis also).



  3. #3
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    Why not shoot a few x-rays now to see if you've got arthritis? It's cheap and can be done in the barn as long as your vet has a good machine. A couple shots each of the neck and back now seems better than potentially two months of Marquis for no reason.


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  4. #4
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    Jun. 15, 2002
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    ^^This. Get the neck rads done. Why wait another month and throw $$$ down the drain on Marquis if that may not be the issue at all??? You could save that money to get the articular facets of the cervical vertebrae injected which would make him comfortable if arthritis is the culprit. Why wait and risk another potential accident??



  5. #5
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    Well, I asked my vet about the neck x-rays, and he said that while they may show something, it really wouldn't be conclusive without an MRI, which is pretty $$$ and requires anethesia. I'm concerned about giving him anethesia given his age. The horse's blood was already tested for other diseases that may present neurological symptoms, but I will ask again.

    I've already ordered the Marquis, so I'm in for at least a month. My vet is fairly certain this is EPM as he was treated for a tendon injury with a steroid injection, which reduces a horse's immunity to EPM. Shortly thereafter, he began presenting these symptoms. Also, two other horses at the barn were recently diagnosed with EPM, and a possum family was found living under the tack room. They have since been moved to a national park.



  6. #6
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    Default

    [QUOTE=PrinceSheik325;6744676]Well, I asked my vet about the neck x-rays, and he said that while they may show something, it really wouldn't be conclusive without an MRI, which is pretty $$$ and requires anethesia. I'm concerned about giving him anethesia given his age. The horse's blood was already tested for other diseases that may present neurological symptoms, but I will ask again.

    Well, no worries about the $ for an MRI - there is no clinic/university etc. is able to do MRIs on a horses neck (not alive anyway).

    Xrays of the neck could also rule out trauma - chip or fracture (if he had an accident or something)

    I'm surprised your vet hasn't done a spinal tap though. That would give you an answer on the EPM before you spend all the money on treatment. It also could rule out other possibilities.



  7. #7
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    It was my understanding that a spinal tap would be used to test cerebrospinal fluid, which may show more than a blood test, but not necessarily. Also, the risks associated with a spinal tap...increased ataxia, possibility of paralysis, etc. seem to outweigh the advantages. Additionally, a spinal tap would be around $800.

    Perhaps I'm mixing up the name of what my vet said would be used to diagnose arthritis of the neck. He told me that the procedure involves injecting a fluorescent liquid into the neck and taking images of the neck while the horse is under anesthesia. I thought that was an MRI, but perhaps it's something else. At any rate, he recommended ruling out EPM before going down this route.



  8. #8
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    Jun. 15, 2002
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    That's a myelogram. That will show compression of the spinal cord. But plain radiographs (no general anesthesia) will definitely show changes in the vertebrae/arthritis; I have no idea why your vet would suggest that they are not useful. Ultrasound is very useful also (if your vet knows how to use it). Your vet may not feel comfortable reading neck rads and maybe that's why he said that.

    You might save a lot of time, effort and money if you ship him in to a university or large clinic.



  9. #9
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    Quote Originally Posted by Meadow36 View Post
    That's a myelogram. That will show compression of the spinal cord. But plain radiographs (no general anesthesia) will definitely show changes in the vertebrae/arthritis; I have no idea why your vet would suggest that they are not useful. Ultrasound is very useful also (if your vet knows how to use it). Your vet may not feel comfortable reading neck rads and maybe that's why he said that.

    You might save a lot of time, effort and money if you ship him in to a university or large clinic.
    I certainly appreciate these comments, and now, I guess I'm at a loss as to what to do. My vet is generally viewed as one of the best in the region and is often referred the difficult cases that other vets are unable to handle. I've been working with him for 20 years, and I trust him. But, what you all have said is making me question his recommendations. I've called and left word for him and will raise the concerns mentioned in this thread once he calls me back.



  10. #10
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    Often times when you try to go the cheap route you end up spending way more money. You throw things at the horse hoping it will fix whatever the problem is rather than figuring out what the problem is and going straight to the appropriate treatment. It is up to you if you want to keep throwing things or find out what the problem is. That would probably be best handled at a clinic or hospital that can do it all.


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  11. #11
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    Jul. 29, 2001
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    mmm... I wouldn't be so quick to condemn the vet. You haven't mentioned where you are located. If it's an area with a high instance of EPM cases, and you're already in for a month of Marquis, well... don't go looking for zebras when there is a donkey standing in front of you. (or in your case, 2 OTHER cases in your barn already and a positive opossum connection)

    You can mention the things that have been brought up here, but the bottom line is your vet is the one on the scene, hands on the horse, not us.
    The ninja monkeys are plotting my demise as we speak....


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  12. #12
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    Laurie - that is very true. I wasn't necessarily trying to go the "cheap" route. I was just trying to be smart with his treatment as he's a 22 year old horse. I had concerns about invasive testing and since my vet recommended treating for EPM, went that route. As my vet described, there are three main treatments for EPM, which all are about 75% effective in 75% of horses. Of course, that 75% of horses is different for each medication. As a result, it seems logical to try Marquis for a month and see. I've talked with several vets who have all said I should see improvement with Marquis within a month if it's EPM. While Marquis is $760, taking him to a hospital would be just as costly. It seems to me that trying the Marquis seems like a logical way to go. If that doesn't work, then I'll just have to deal with more invasive testing.



  13. #13
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    Quote Originally Posted by propspony View Post
    mmm... I wouldn't be so quick to condemn the vet. You haven't mentioned where you are located. If it's an area with a high instance of EPM cases, and you're already in for a month of Marquis, well... don't go looking for zebras when there is a donkey standing in front of you. (or in your case, 2 OTHER cases in your barn already and a positive opossum connection)

    You can mention the things that have been brought up here, but the bottom line is your vet is the one on the scene, hands on the horse, not us.
    Thanks - I needed this. It's easy to second guess yourself (and your vet) when everyone seems to think your course of treatment is absurd. I would imagine EPM is pretty prevalent in my area as there are possums everywhere. In fact, one even lives under my deck (not to worry - I live in the city...away from horses).



  14. #14
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    Now that I know about the other two horses and the possom I think your vet is following the most logical path.



  15. #15
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    Quote Originally Posted by Laurierace View Post
    That would probably be best handled at a clinic or hospital that can do it all.
    Yeeessss.... but... sometimes a vet, familiar with the horse itself can be worth more than an entire vet clinic.

    Case in point: My mare was off in front. Short stepping, uncomfortable,miserable in fact, but not really pin-pointable. My regular vet was out of town for a month. So I was sent by the local clinic to the clinic at San Luis Rey. The first thing I said upon arriving at the clinic was: "I think she might be presenting with EPM" and was told REPEATEDLY over the weekend, that that was simply not possible. After running what seemed like every test at the office, (short of the one that would turn her radioactive) and a vet bill of over a thousand, I was given a diagnosis of navicular. (which didn't seem right to me at all, but they were the experts...)

    My vet came home, took one look at the horse trotting and before I said one word, said: "you guys are originally from Pittsburgh right? I'm going to test her for Lyme and EPM"

    The mare's EPM titer came back off the charts. (This was so long ago I can't remember which test was used...) We treated and my mare recovered to about 75-80% of "normal."

    All because this vet knew our history, how the horse moved normally, and what her risk factors had been.

    I have nothing against San Luis Rey by the way, they treated us like rock stars while we were there, and I think my mare still dreams about their "All you can eat" hay buffet and turn out paddocks...
    Last edited by propspony; Dec. 28, 2012 at 03:19 PM.
    The ninja monkeys are plotting my demise as we speak....



  16. #16
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    Nov. 5, 2000
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    What's in the EPM shake?

    I used Oroquin-10 from Pathogenes on my EPM horse, as I did not want to subject him to the heightened risk of side effects from Marquis, plus it was MUCH more affordable. That was just over a year ago, and he is doing really, really well - staying sound and in work, progressing very nicely in his training, and laying in muscle on his topline for the first time in years.
    http://pathogenes.com/



  17. #17
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    Nov. 13, 2009
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    I don't have time to read all of the comments, as I just popped on here quickly, but a few things:

    1. They don't really do spinal taps for EPM anymore - they do a blood titer that is sent to UC Davis and is quite accurate as to exposure levels. Treatment is often based on the results of this test. The test is around $100, I believe, and is well worth doing.

    2. They can do a similar test for Lyme (titer that shows range of exposure). That one has a similar cost, but the blood is sent to Cornell rather than UC Davis.

    3. The other tick bourne disease someone was thinking of is anaplasmosis (also sometimes called ehrlicia). It cases a high fever (104ish) and stocking up. The horse would be sick in a way that isn't very similar to EPM.

    4. If the horse had rabies, it would be dead by now, so I would not worry about that.

    I would get the blood titers pulled for EPM and Lyme IMMEDIATELY and sent to UC Davis and Cornell. If those came back with little to no exposure, I would then proceed to neck x-rays.

    I would never treat with Marquis without at least testing for EPM first.



  18. #18
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    Quote Originally Posted by PrinceSheik325 View Post
    Well, 2012 just wasn't a good year for my boy. Most recently, he's developed neurological symptoms that appear to be "EPM-like," so we ran a blood test. He tested mid-range, so we treated him first with the EPM shake
    First thing the vet did was get a titer count... well, probably second after looking at the horse... ;-) lol
    The ninja monkeys are plotting my demise as we speak....



  19. #19
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    Quote Originally Posted by propspony View Post
    First thing the vet did was get a titer count... well, probably second after looking at the horse... ;-) lol
    D'oh! I even went back and re-read the OP and somehow didn't catch this because I was reading so quickly!

    Given that he tested mid-range, I would totally treat for EPM with Marquis.



  20. #20
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    Jun. 15, 2002
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    Actually the UC Davis IFAT titer is NOT accurate; it is potentially useful as a screen but that's about it. Unless it is extremely negative or extremely positive, all other values are "equivocal".

    The SAG 2/3/4 ELISA (which compares titers from the blood to that of the CSF and comes up with a ratio) is considered the most accurate test available at the moment: http://www.edslabky.com/education/13...-bulletin.html

    I was not intentionally questioning your vet; but a horse that has been neurological for 3+ months, non-responsive to the first round of treatment, and dangerous/falling, NEEDS NECK RADS. That's just the proper standard of care. You are retreating for a neurologic disease based on an equivocal blood test that is known to have many false positives without doing any diagnostics for the handful of other causes of neurological dysfunction. Maybe you and your vet are miscommunicating?

    Call your local university and ask for a phone consult. You don't have to take the word of people on the internet, but I definitely think a second opinion is appropriate. (preferably with someone boarded in medicine).



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