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Bringing back the EPM horse? Experiences?

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  • Bringing back the EPM horse? Experiences?

    My most lovely mare, Lina, is being treated for EPM. Her symptoms were always slight, weird lameness and failed the neuro tests. She's been treated for almost 2 months. I have ridden her about 10 times, cantered some yesterday. One time yesterday she tripped, not very badly. that is about all she has done.
    What are your experiences of bringing a horse back into low level eventing?
    I know how to rehab an injury, I want to know specifically experiences with EPM, what signs to look for that I am over doing it. I just want to do BN if possible.
    thanks for any ideas.

  • #2
    I'm surprised your vet didn't have you ride her during treatment, but opinions do differ. My horse had mild EPM in 2008 and made a full recovery. I did ride him at the walk and trot during treatment to keep hi stifles strong, but I didn't do it enough. He came out of the EPM with weak stifles, but that s easily corrected with lots of walk trot on the flat and with ground poles and cavilettis and walks uphill.

    The tripping will go away with time. My horse did it also and, unrelated, did it again later that year when he strained his SI ligament. At the end of the day work and fitness will help him avoid injuries.

    Oddly enough we also treated him for ulcers following the EPM and that made a huge difference in attitude and ability! Good luck and keep after the flat work.


    • #3
      Don't know anything about rehabbing from it as I've never had to, but good luck to you and your mare!
      Trying a life outside of FEI tents and hotel rooms.


      • #4
        My horse was diagnosed/treated for EPM in 2005. His primary symptoms were extreme weight/muscle loss and fatigue following a stressful week at an away show. Vet sent us to Univ Florida, so I was lucky enough to have one of the world's top EPM vets to get us through this. We treated w/ 2 rounds of Marquis and five months of the sulfa drug compound, which was the 'gold standard' at the time.

        Did not ride for 4+ months. He had a big paddock off his stall, so he could go in and out at will. For several months we did a lot of grazing handwalks. When he made clear that he was bored with that, I put him in long lines and we ground drove all over the farm in walk. Around 4 months I started adding little bits of trot and canter in long lines following the rail of the dressage arena. When we got the vet's okay, started walking under saddle, then gradually added trot and later canter. At about 6 months post diagnosis we were up to about 45 min riding, w/t/c, focusing on getting him to stretch and use his topline which was where most of the EPM damage occurred.

        I was told to consider the whole first year after diagnosis as the healing period. He actually made gradual bits of progress for two years. During the third year we reintroduced little jumps. Due to age and soundness issues I'd decided to retire him from competition over fences, so we just jumped for fun at home. Got him back to where he was happy and safe over 2'6" about 3.5 yrs post diagnosis. That was his peak, and at that point I'd say he was at 90-95% of his pre-EPM abilities. A couple years later arthritis started to really catch up with him (he's now 22 and as retired as he'll tolerate being).

        The frustrating thing about EPM rehab is there's no set timeline to follow, and no ultrasound or x-ray to tell how far along you are. We had several setbacks when what I thought he was ready for turned out to be too much. My best suggestion is to err on the side of going too slowly, ask for less than you think the horse can handle, and allow time for the nerves to heal.

        The lasting effect of EPM that most limits this horse's work is heat intolerance. From my research this is a common problem for post-EPM horses. He stumbles more in hot weather, fatigues faster, and has to be kept at a much lower intensity of work than he can handle in winter.

        There's an EPM support group on Yahoo that's worth joining--lots of people on there who have been through the treatment/rehab process, with the whole range of possible outcomes. If you have specific questions feel free to PM me, though I can't say I'll have answers as every EPM horse is different. Good luck!


        • #5
          I had a horse I was eventing at BN when he was diagnosed with EPM, I had him treated and honestly the only problem resulting was that it was harder for him to gain fitness and he lost fitness quickly if he wasn't worked. Though that always could have been something else, I am by no means an expert and this was when I was a wee-munchkin
          Come to the Dark Side, We Have Cross Country



          • #6
            My mare was diagnosed with EPM 1 month after I bought her. She lost a lot of topline muscle and was very, very short behind. She also did this weird neurological thing where she would curl her neck up at an awkward angle and violently shake her head for a few seconds. I picked up on the shortness behind and kept a close eye on it; eventually calling my vet up to do a full lameness work-up. Thankfully I used the same vet for my prepurchase as well as the lameness work up, so he was able to pick up on everything that was wrong. He point blank told me I had a completely different horse than the one he did the pre-purchase on. We started her right away on Marquis. After that, she had the winter off (diagnosed in early september) and I slowly brought her back into work in Feb or March (I honestly cant remember, its been a while!) We started just hand walking for like 30 minutes a day, then some very light lounging. Eventually I started walking her under saddle (over poles and stuff, working on figure 8s and changes of direction.) My vet came back after we had finished the 2nd round of Marquis and did another neurological exam on her. He gave us the green light, and I started increasing the work-load daily.

            I was extremely nervous putting her back into work. I purchased her as a future upper level eventer and I was told by many, many people that she would forever be considered unsafe and dangerous. I was told to retire her as a pasture pet or do strictly ring work and the chances of relapse, especially for a horse that is actively competing is a huge risk. Despite all the nay-sayers, I worked very closely with my vet and trainer and we monitored her progress. Any signs of relapse and I stopped training and gave her time off. Luckily we only had one relapse scare, and it actually turned out to be a poorly fitting saddle. About 6 months after she was diagnosed, we entered our first event, and never looked back.

            She later went to to compete very successfully at Prelim and Intermediate, including completing a long format CCI*, clean XC at NAJYRC, and several top placings at Intermediate. So, despite what people will tell you, stick with it! It is possible to make a full "recovery"


            • #7
              Hi OP - there's a lot of confusion about EPM in the horse world, and I speak as an equine vet who specializes in internal medicine. First, you cannot truly, truly diagnose EPM without a post-mortem exam. If a horse has consistent clinical signs (neurologic abnormalities) plus positive results on a couple of specific tests, and responds weel to treatment, then you can conclude that it was likely the horse had the disease. But the only was to know for sure is to see the protozoa in the spinal cord/brain. But not to panic...

              There are good tests and bad tests on the market for EPM. In my area (mid-atlantic), the IFAT and the SAG-2,3,4 tests work well, but are most accurate when combined with a CSF (spinal) tap. The SAG-1 and Western blot tests are a lot less accurate, and I no longer rely on them. Horses with EPM are often graded on a scale of 1-5 for neurologic disease with 1 being very mild, and 5 being recumbent (down and unable to rise). About 60-70% of horses improve with treatment by 1-2 grades, so if your horse is a grade 1-2 in severity, there is a fair-to-good chance she will normalize. If your horse has grade 3 or 4 signs, it is less likely she will be improved enough to ride. And if your horse doesn't actually have EPM, then treatment won't help!

              So to answer your question, how was your horse tested for EPM, and what was the grade of the deficit. Meanwhile, DO NOT RIDE A HORSE THAT IS NOT NEUROLOGICALLY NORMAL. It would be horrible if you or anyone else got hurt, and 1200lbs of muscle that doesn't know where its feet are is a dangerous, dangerous thing.


              • Original Poster

                I think hers was pretty mild. She was slightly positive to the neuro tests, pulling on the tail,turning in a circle etc. otherwise, she was just not right.
                She has improved on the tests after the sulfa drugs and Vit E, Folic Acid.
                We did not do any tests, though we debated endlessly.
                She nows seems normal. She has been fine under saddle, we're not doing much.


                • #9
                  I had a horse who tested positive, and he lost a lot of muscle, and got very spooky/stumbly. Post meds (two rounds of marquis), we did a lot of long and low at the walk and trot. A LOT.

                  He'd been going BN/N before he got sick.

                  He's doing T now, and just did a T3D.

                  Good luck with your mare!
                  --Becky in TX
                  Clinic Blogs and Rolex Blogs
                  She who throws dirt is losing ground.


                  • Original Poster

                    Gosh, these stories all really vary don't they? I figured as much. thanks for all the input. My fear is that she will trip and get badly hurt.
                    She tells me she wants to jump, though


                    • #11
                      Originally posted by shea'smom View Post
                      Gosh, these stories all really vary don't they? I figured as much. thanks for all the input. My fear is that she will trip and get badly hurt.
                      She tells me she wants to jump, though
                      Jumping would be overdoing it at this point in her recovery. At best you'll set her back, at worst both of you will get badly hurt. Much better to occupy her brain with things that help her improve her compensation ability--TTEAM ground exercises are great for that.

                      I'll defer to Dr. Notsureyet, but from memory of my research when my horse was ill, the sulfa drug combo is very slow acting, as in 3+ months before it actually reduces the protozoa population. If you're seeing a significant improvement in less than two months of that treatment, I'd have to seriously wonder if EPM is the correct diagnosis.


                      • #12
                        Ti was diagnosed with EPM last May. He had some subtle signs right before things went really bad. He would be a little off behind randomly, seemed to be tripping slightly more than usual, and his hind end had lost a little muscle. In hindsight, our rides 1-2 months prior were definitely not as good (but then we also had some great rides so it wasn't totally obvious). His dressage wasn't as good the last month before the diagnosis. He tested weak positive which we were told was common, and my vet recommended that I compete at Maydaze the next weekend. We did dressage and cross country on Saturday without problems, but then Sunday things went badly as he was eating his breakfast in the stall. I don't really want to describe in detail what happened in detail here, but it was scary. (I hope I never see anything like it again. I was scared for months afterward that it would happen again. Every twitch freaked me out!) It almost looked like a seizure, but he didn't fall down, thank goodness. We were able to get him loaded up and to Rood and Riddle within 30-40 minutes. When we got there 15 minutes later, he couldn't use his left hind leg. Dr. Morrissey began treatment for EPM right away with an IV. He was getting fluids, Vitamin E, and Marquis. Dr. Newton came by a few days later and had them examine his neck, but they didn't find anything. They retested him, and he was "more" positive, and he definitely responded to treatment. We're 100% sure it was EPM.

                        He spent 2 weeks at Rood and Riddle, and then moved to a nearby place that rehabs injured TBs a lot. He got Marquis for a 1.5 months as well as plenty of Vitamin E, and we also had him on UlcerGuard. His case was pretty severe, and we were told the Marquis can really take a lot out of them so definitely no riding. He definitely lost some weight and muscle during the whole ordeal.

                        He came home, and I started slowly riding him again. I was doing simple W/T/C flatwork for 20-30 minutes (mostly walking) after 6 weeks. Then he started showing some signs of relapse (failed the tail pull, would be a bit off behind, stumbling), and we put him on another month of Marquis (no riding). Then a month of Navigator (started riding again on that). From there, he has been fine. He came back much stronger after the second time around with Marquis and Navigator. He did about 2 months of just flatwork, and then by the 3rd month we sent him to my trainer's farm to be started back over fences and more intense flatwork again.

                        He has come back great since the EPM! 100%. His stifles are still a bit weak, but they are slowly getting better. The last time the chiropractor/acupuncturist looked at him he said his stifles were the least sore yet. That was on our measly hills so I'm excited to see how much muscle he builds since he has come with me to a MUCH hillier area (KY). He has been on Vitamin E since then which was strongly recommended by Rood and Riddle. Make sure you get the natural Vitamin E and not the Vitamin + Selenium (which is only good for the Selenium part we learned!).

                        Dr. Newton recently did an examine on him, and he recommended 4x a year Marquis treatments (2 days each time, 1/2 a tube each day) and also after stressful times (like how he just made a big move to a new state, barn, program, etc). And he wants him on Vitamin E AND Lysine.

                        Hope that helps!
                        T3DE Pact


                        • #13
                          My horse, All Purpose Brown was diagnosed with EPM in May of 2009. We treated him with Baycox, because the reoccurance rate with Marquis is actually quite high. With the Baycox the horses reaction is strong, due to the massive die off of protozoa, but he has not had a single relapse. We turned him out for a month after the treatment and then brought him back into work like normal, as I would with any horse that had time off. He is running Intermediate, moving up to Advanced the end of the year. I dont have any issues with him except, when he isnt in steady work or has time off (more than a week) he has trouble with his right stifle until he gets back into work. So I try to not give him too many days off in a row. When I shipped him to Australia he had 7 weeks off in quarantine and it took about 3 weeks until he was back to normal in the right lead canter. He has never had tripping or front end issues, mostly just the right stifle and ulcers.
                          When he gets tense, his right lead canter gets almost 4 beat. He has no trouble jumping what so ever. Basically, I am very careful about vaccines and worming, no steroids and he is on 5,000 IU of Vit E a day. Otherwise he gets treated like any other horse.
                          I think that treating with Baycox instead of Marquis, was the key to my horse's full recovery and being able to compete normally.



                          • #14
                            Originally posted by FlamingoRider View Post

                            I'll defer to Dr. Notsureyet, but from memory of my research when my horse was ill, the sulfa drug combo is very slow acting, as in 3+ months before it actually reduces the protozoa population. If you're seeing a significant improvement in less than two months of that treatment, I'd have to seriously wonder if EPM is the correct diagnosis.
                            That's true, but if the horse is negative on the EPM blood test, it doesn't have EPM, so you're wasting money and losing time diagnosing what's really wrong. )If it's positive on the blood tests, the horse may or may not have EPM)I guess would have a hard time spending hundreds on treatments without doing a $75 test to make sure there was even a chance the horse has EPM.


                            • #15
                              If memory serves me , Hannah Sue Burnett brought St Barths back from EPM, very successfully. Hope that gives you some encouragement!


                              • Original Poster

                                In our area, there is lots of exposure to EPM, so the blood test could be meaningless. I talked to three vets and read many articles and they all said treat if you suspect.
                                Her symptoms have decreased so that is what we are basing things on.
                                Christian, you keep your guy on the Vit E? I have some left, could keep giving that.
                                thanks for the info, everyone.


                                • #17
                                  Originally posted by shea'smom View Post
                                  In our area, there is lots of exposure to EPM, so the blood test could be meaningless. I talked to three vets and read many articles and they all said treat if you suspect.
                                  Her symptoms have decreased so that is what we are basing things on.
                                  Christian, you keep your guy on the Vit E? I have some left, could keep giving that.
                                  thanks for the info, everyone.
                                  . I know you weren't asking me, but FWIW, I have kept my horse on Vitamin E at the recommendation of 3 different vets! They think he should just stay on it for good.
                                  T3DE Pact


                                  • #18
                                    I highly recommend this: "Rehabilitation of Horses with Neurological Deficits Book"

                                    Available here:

                                    Good luck!


                                    • #19
                                      My first horse was diagnosed with EPM as a 5 year old (over a decade ago). I'm sure lots has changed in the treatment/understanding of EPM since then. But, we worked closely with our vet to create a program of bringing him back into work after treatment. Hind end weakness was the biggest problem, and once he was sure footed again (i.e. no tripping, stumbling or other neuro signs) we slowly brought him into work and began to work in hills, trot poles, low jumps etc to get strength.

                                      I agree with others that you should err on the side of going slowly, but at least with my guy, it was pretty clear when you were pushing too hard. He would start to get very easily frustrated (this was especially true with lateral work). I kept a riding journal during the time, which helped me to track our progress, and plan out reasonable goals so I felt confident I wasn't pushing too hard too fast.

                                      We spent probably 1 year-1.5 years working up to being ready for BN (when he was diagnosed he was probably only about 6 months away from being BN ready). He is now 18 years old, and has competed successfully at Prelim and schooled Intermediate.

                                      Good luck with your mare!


                                      • Original Poster

                                        I am glad to hear all the happy endings. I have personally known three horses with EPM and two died within the first week. One went back to Training level eventing.
                                        I'm going back on the Vit. E today.