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Talk to me about EPM: FINAL UPDATE

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    Talk to me about EPM: FINAL UPDATE

    Hello all. Some of you might've seen that my horse was just diagnosed with EPM, and I have loads of questions.

    Context: Thursday, 4/30, I noticed moderate RF and RH lameness. Pretty distinct lameness in each, thought double abscess.

    Friday, 5/1, about 4pm, worse lameness in RF and funky in back. Looked lame behind but couldn't pin it on one leg.

    Friday, 5/1, about 8pm, vet is out. Further worsened RF and severely ataxic. Could barely trot and swaying like crazy - not uncrossing legs, limp tail, and easily pulled off balance with tail pull. Vet dug an abscess out of RF, and made the EPM diagnosis on clinical signs. Did not do blood tests and gave decoquinate/levamisole at once with additional doses daily for 20 days. We were told we would see improvement in around a week.

    Saturday, 5/2, looks 10x better. Mild ataxia at most and some resistance to tail pull. Muscle wastage is slightly visible for the first time. Barely lame RF and only slightly funky behind.

    Today remains to be seen.

    My question - would EPM turn around that quickly? I thought it was a rapid descent, slow return, is it possible EPM is incorrect?

    They say when caught early, prognosis is good, but how is "early" defined? It was treated within 48 hours of symptoms, but symptoms were pretty severe so the disease must've been pretty progressed.

    Anybody in here with a similar experience? How did it work out?

    TIA! Jingles are appreciated too.
    Last edited by grandprixer; May. 27, 2020, 09:02 PM.
    When I die, I want to go peacefully like my grandfather did in his sleep. Not yelling and screaming like the passengers in his car.

    Official Secretary of Sass
    Original Poster

    #2
    Adding videos:

    4/18 for reference, no known symptoms at this time. Also notice the nice new dressage saddle I just bought and now can't use https://www.youtube.com/watch?v=qe38Y_aQfr0&t=1s


    5/1 this is the first real sign of neuro junk, and about 4 hours before the ataxia peaked. Abscess still present. https://www.youtube.com/watch?v=_dDpIH8xJ-4

    5/2 yesterday, massive improvement overnight - abscess popped but still sore here. https://www.youtube.com/watch?v=F3kSWFSpaQM

    I'll add videos of today when I get out there.
    When I die, I want to go peacefully like my grandfather did in his sleep. Not yelling and screaming like the passengers in his car.

    Official Secretary of Sass

    Comment


      #3
      Our "early" was grumpy, pulled a shoe backing up, rubbing hind legs together. For him, that was VERY peculiar behaviour. Vet said he never would have thought EPM was the issue, maybe blamed it on age with wear and tear. I insisted on an EPM test to rule it out. COTH had many stories of odd and peculiar symptoms that ended up being EPM. Vet did a simple blood test, found it in the blood.

      He never got as bad as what your horse showed. Husband said it could not be EPM because all the ones he saw or knew were the "sudden onset" type, going from normal to wobbling, falling, no body control, in a couple hours. Dangerous to be around, they were put down immediately.

      Vwt said try the Marquis for a week, he will be improved or it is not going to work, because Marquis was so expensive. We treated and saw improvement within 7 days. Hooray!! We did the full 28 day treatment. Horse recovered fully, did some strengthening exercises after treatment, to insure he was fully fit to work again. Never had any other issues with him or a relapse that some folks get. Horse was off work during treatment, no stress.

      Hope your horse continues improving.

      Comment


        #4
        OP, what part of the U.S. are you located? How/why did the vet call it for EPM? Specifically, not just a wonky horse because that could be EPM or a lot of other non-EPM things.

        I ask because EPM can be a tricky diagnosis even for vets. I had a horse misdiagnosed with EPM by an experienced vet when the blood test drawn the same day later turned out to be negative. Re-diagnosis with a second opinion from a chiro-vet (DVM also a chiro) was a sacroiliac problem, which was cleared up with appropriate rehab done by self according to chiro-vet's instructions. There are other physical and neuro issues with symptoms that can be misinterpreted as EPM.

        If I were you I'd get the blood test done (about $100 in this area) just to have that positive/negative information. If it's positive, it may not mean much, but if it is negative that is important to know right now. There is no second chance to get the blood for this moment in time.

        I'd also get a second opinion from the most experienced, BTDT vet available, especially one who has handled a lot of EPM diagnosis explorations, and more especially if they have chiro experience as well. Just me, but after my own experience I would not go by one vet's opinion with no testing.

        Making it more complicated, in the southeastern U.S. many vets actually discourage the standard EPM blood test because so many horses in this area will have a "sort of" positive for a barely-there "sort of" EPM that never affects the horse. Vets don't want clients galloping off down the EPM trail when that is not actually the problem. The positive test can be widespread because opossums are widespread, and the urine/feces of opossums will sooner or later find its way into hay and grain pastures, before harvesting, but not infect to a degree that many horses ever actually have active symptoms. (I had to insist on having the test run, promising that I wouldn't over-react to a positive. And then it was negative, so back to the drawing board.)

        https://equusmagazine.com/uncategorized/eqepmtest310

        https://kppusa.com/2018/05/09/epm-sy...and-treatment/


        On the other hand, crazily, under-testing for EPM also sometimes means that EPM is missed. And the owner is trying to correct for everything else, and none of it really works and the horse doesn't significantly improve, because an active EPM is unidentified and unaddressed.

        In my case, my horse blood tested negative. It wasn't EPM. I won't post the video of the vet exam where the initial diagnosis was made, because I am not looking to embarrass anyone who might be recognized. But the video looked a lot like your second video, although not as pronounced. My horse just couldn't seem to get his hind legs sorted out and comfortable. Off balance on the tail pull. As explained in 1st para, it was sacroiliac.

        As I understand it, there is a spinal-tap that is fairly horrifying in pain and expense, rarely done, but has a more definitive result for EPM. Rarely ever recommended due to the pain, but mentioning it just for the record.

        There are a lot of things, and combinations of things, that can look a little or a lot like EPM. Physical and neuro. It's possible that your journey to a diagnosis has just begun.

        Here's a video "what sacroiliac looks like" -- I know nothing about the source, hope it is credible. But just an example to compare with your horse.
        https://www.youtube.com/watch?v=gE0g...oHhtpFaod7JrCc

        Comment

          Original Poster

          #5
          Originally posted by OverandOnward View Post
          OP, what part of the U.S. are you located? How/why did the vet call it for EPM? Specifically, not just a wonky horse because that could be EPM or a lot of other non-EPM things.

          I ask because EPM can be a tricky diagnosis even for vets. I had a horse misdiagnosed with EPM by an experienced vet when the blood test drawn the same day later turned out to be negative. Re-diagnosis with a second opinion from a chiro-vet (DVM also a chiro) was a sacroiliac problem, which was cleared up with appropriate rehab done by self according to chiro-vet's instructions. There are other physical and neuro issues with symptoms that can be misinterpreted as EPM.

          If I were you I'd get the blood test done (about $100 in this area) just to have that positive/negative information. If it's positive, it may not mean much, but if it is negative that is important to know right now. There is no second chance to get the blood for this moment in time.

          I'd also get a second opinion from the most experienced, BTDT vet available, especially one who has handled a lot of EPM diagnosis explorations, and more especially if they have chiro experience as well. Just me, but after my own experience I would not go by one vet's opinion with no testing.

          Making it more complicated, in the southeastern U.S. many vets actually discourage the standard EPM blood test because so many horses in this area will have a "sort of" positive for a barely-there "sort of" EPM that never affects the horse. Vets don't want clients galloping off down the EPM trail when that is not actually the problem. The positive test can be widespread because opossums are widespread, and the urine/feces of opossums will sooner or later find its way into hay and grain pastures, before harvesting, but not infect to a degree that many horses ever actually have active symptoms. (I had to insist on having the test run, promising that I wouldn't over-react to a positive. And then it was negative, so back to the drawing board.)

          https://equusmagazine.com/uncategorized/eqepmtest310

          https://kppusa.com/2018/05/09/epm-sy...and-treatment/


          On the other hand, crazily, under-testing for EPM also sometimes means that EPM is missed. And the owner is trying to correct for everything else, and none of it really works and the horse doesn't significantly improve, because an active EPM is unidentified and unaddressed.

          In my case, my horse blood tested negative. It wasn't EPM. I won't post the video of the vet exam where the initial diagnosis was made, because I am not looking to embarrass anyone who might be recognized. But the video looked a lot like your second video, although not as pronounced. My horse just couldn't seem to get his hind legs sorted out and comfortable. Off balance on the tail pull. As explained in 1st para, it was sacroiliac.

          As I understand it, there is a spinal-tap that is fairly horrifying in pain and expense, rarely done, but has a more definitive result for EPM. Rarely ever recommended due to the pain, but mentioning it just for the record.

          There are a lot of things, and combinations of things, that can look a little or a lot like EPM. Physical and neuro. It's possible that your journey to a diagnosis has just begun.

          Here's a video "what sacroiliac looks like" -- I know nothing about the source, hope it is credible. But just an example to compare with your horse.
          https://www.youtube.com/watch?v=gE0g...oHhtpFaod7JrCc
          Thanks for the detailed response.

          Diagnosis was made on a few things:

          1. Location. I am in central Arkansas. I recently moved barns, the old one had a possum problem and had at least one case confirmed by spinal tap and several others with positive blood tests/symptoms.

          2. His symptoms were rapid onset and semi one-sided. Beyond the ataxia he was dull and listless. Today I also noticed some pretty significant muscle wastage, mostly in the right side - where the other symptoms started.

          3. He "responded" overnight to the meds. This one I'm least convinced of, if it was some sort of ischemic attack he would've seemed to responded to whatever we gave him.

          4. With all this put together, we decided to treat without testing. The blood test would likely be positive whether it was causing symptoms or not, and a spinal tap is just as expensive as the treatment and much easier on him. I'm still a little concerned that we're treating something that isn't there and in the meantime irreversible damage is happening, but the 2 best vets in the area agree on EPM and he seems to be improving for now.

          ​​​​​
          When I die, I want to go peacefully like my grandfather did in his sleep. Not yelling and screaming like the passengers in his car.

          Official Secretary of Sass

          Comment


            #6
            Without seeing the neuro tests, I think at least the lameness improvement looks to be very likely from having that abscess addressed. I think pain can skew things like the tail pull test. My horse had such a weird change all of a sudden I called the vets thinking it was EPM. He had ulcers. You could just about pull him over. 2 weeks on Gastrogard and tail pull was normal. Now we also were suspecting neck issues at that time and he wound up going through a very thorough neuro exam once the ulcers were under control and some of the behavior didn't improve, and he passed. Of course, the crossing legs and other stuff is not normal, and I think you are doing the right thing. But I just wouldn't put so much stock in the tail pull test since he had that major abscess going on too.

            Comment


              #7
              Originally posted by grandprixer View Post
              .......

              5/1 this is the first real sign of neuro junk, and about 4 hours before the ataxia peaked. Abscess still present. https://www.youtube.com/watch?v=_dDpIH8xJ-4

              ..........
              With an active abscess, I dunno, not sure I'm seeing neuro. I'm seeing a horse in a lot of pain who is on hard, stony ground.

              But I'm not a DVM and would defer to the experts.

              I think the abscess in all of its stages significantly clouds the situation. Those can be so painful that as it clears up, the horse seems to get a lot better overall. Definitely better balanced.


              Originally posted by grandprixer View Post

              Thanks for the detailed response.

              Diagnosis was made on a few things:

              1. Location. I am in central Arkansas. I recently moved barns, the old one had a possum problem and had at least one case confirmed by spinal tap and several others with positive blood tests/symptoms.

              2. His symptoms were rapid onset and semi one-sided. Beyond the ataxia he was dull and listless. Today I also noticed some pretty significant muscle wastage, mostly in the right side - where the other symptoms started.

              3. He "responded" overnight to the meds. This one I'm least convinced of, if it was some sort of ischemic attack he would've seemed to responded to whatever we gave him.

              4. With all this put together, we decided to treat without testing. The blood test would likely be positive whether it was causing symptoms or not, and a spinal tap is just as expensive as the treatment and much easier on him. I'm still a little concerned that we're treating something that isn't there and in the meantime irreversible damage is happening, but the 2 best vets in the area agree on EPM and he seems to be improving for now.

              ​​​​​
              Sounds like you are covering all the bases. If you've got the 2 best vets in the area on the case, then I think you are doing the right thing to go with their opinion.

              Very glad he is improving!


              If the vet were not the 2 best in the area, I'd proceed carefully with an EPM diagnosis also because there are some unscrupulous practioners who use "EPM" to sell a lot of vet services and treatment. Precisely because EPM symptoms can be so variable and hard to define. Here in possum country it can be fairly easy to tag "EPM" on horses who are just tired and sore, or who have some other less lucrative lameness or set of lamenesses. But going with the reputation of the vet will hopefully put you on the right path.

              Comment

                Original Poster

                #8
                Update on the off chance anyone cares. (and for my own future reference)

                I can't tell if he's improving based on the last 2 days.

                Yesterday, 5/3, he looks more sound up front but I can't tell in back. He was really listless, almost lethargic, and just very dull. I noticed the first signs of muscle wastage - he lost a ridiculous amount of condition in just a few days. His tail was really limp (almost like a pregnant mare). https://www.youtube.com/watch?v=At2plsnjmwE

                Today, 5/4, he looks better in terms of energy, but still duller than normal. More obvious muscle loss. His tail is still limp and he's still easily pulled around by his tail. If anything the ataxia looks more pronounced, but I can't tell for certain. I can spot lameness easy but ataxia is a new one for me. https://www.youtube.com/watch?v=9NJ51YdkdcA
                When I die, I want to go peacefully like my grandfather did in his sleep. Not yelling and screaming like the passengers in his car.

                Official Secretary of Sass

                Comment


                  #9
                  I'm sure many readers are very interested in your journey, and how this works out. I know that I am!

                  Your case is likely to be instructive re EPM and diagnosing EPM. And distinguishing it from other types of lameness.

                  It might be hard to read to much into a day-by-day watch. I understand it's supposed to act quickly and you certainly want your horse to be better. But it might not realistically happen that smoothly.

                  Wishing all the best for your horse and you. Will be following along supporting both of you.

                  Comment


                    #10
                    I've had several EPM cases (all caught early). All confirmed with blood work. All showed a marked improvement between weeks 1 and 2 on Marquis.

                    In terms of caught early - only one showed any deficit on a manual neuro test. All were suspected and tested due to under saddle symptoms: sudden onset of spookiness, spooking in response to nothing, sudden loss of coordination in end change, interference in lateral work with no shoeing/lameness explanation.

                    The abscess certainly complicates things. Sorry OP!

                    Comment


                      #11
                      Epm will definitely wax and wane during early treatment and nsaid use can sometimes temporarily make a big difference in level of ataxia.

                      Trotting around the roundpen isn’t a great way to assess ataxia. Walking away in a straight line to look at level of circumduction and turning in tight circles to see how the horse crossed over were the videos my vet had me take to track progress.

                      I did take lots of pictures of my horse from the same hind end angle to track atrophy.

                      I wouldn’t force exercise at this point but allow free movement to the extent that they are safe doing it.

                      Finally, it can be a long haul. Trying to assess every single day will probably drive you crazy...I know from experience .

                      Comment


                        #12
                        Could he have eaten oak? My mare displayed similar symptoms two years ago and it was from eating oak leaves off a downed limb. FWIW....my vet also diagnosed EPM at the time.

                        Comment

                          Original Poster

                          #13
                          Originally posted by knic13 View Post
                          Epm will definitely wax and wane during early treatment and nsaid use can sometimes temporarily make a big difference in level of ataxia.

                          Trotting around the roundpen isn’t a great way to assess ataxia. Walking away in a straight line to look at level of circumduction and turning in tight circles to see how the horse crossed over were the videos my vet had me take to track progress.

                          I did take lots of pictures of my horse from the same hind end angle to track atrophy.

                          I wouldn’t force exercise at this point but allow free movement to the extent that they are safe doing it.

                          Finally, it can be a long haul. Trying to assess every single day will probably drive you crazy...I know from experience .
                          Thank you for your response, made me feel a little better.

                          If nsaid use changes ataxia, does it make it worse or better? I have him bute twice - the first two days he had symptoms, and I haven't since. Could the bute have made him worse and then better once I stopped it?

                          I'm definitely tracking condition with pictures. I'll add some tonight if I get motivated enough.

                          I know there's better ways to see ataxia, but it's hard to video them by yourself 😅.

                          Sdel, it's possible. There's plain old oak in the pasture he's been in the last few months. And he's certainly dumb enough. What other things did you see in your horse? How did you figure out the cause?
                          When I die, I want to go peacefully like my grandfather did in his sleep. Not yelling and screaming like the passengers in his car.

                          Official Secretary of Sass

                          Comment


                            #14
                            Originally posted by grandprixer View Post

                            Thank you for your response, made me feel a little better.

                            If nsaid use changes ataxia, does it make it worse or better? I have him bute twice - the first two days he had symptoms, and I haven't since. Could the bute have made him worse and then better once I stopped it?

                            I'm definitely tracking condition with pictures. I'll add some tonight if I get motivated enough.

                            I know there's better ways to see ataxia, but it's hard to video them by yourself 😅.

                            Sdel, it's possible. There's plain old oak in the pasture he's been in the last few months. And he's certainly dumb enough. What other things did you see in your horse? How did you figure out the cause?
                            No problem. I totally get how frustrating neuro issues are to monitor.

                            NSAIDs would improve ataxia by decreasing inflammation.

                            There is also a well known phenomenon of increased symptoms during the die off of the protozoa which can come in waves.

                            If I didn’t have someone to video I would set my phone on something (fence post or whatever) to record. But again, be mindful that their bodies are already very stressed and sometimes it is better to let them be than to force movement for the sake of monitoring every day. I would once a week or once every couple weeks, depending on where we were in the recovery process.

                            Comment


                              #15
                              Originally posted by grandprixer View Post
                              Sdel, it's possible. There's plain old oak in the pasture he's been in the last few months. And he's certainly dumb enough. What other things did you see in your horse? How did you figure out the cause?
                              I had two eat it at the same time. The TB had other issues so she really got it bad, the QH was mild.

                              Both had swelling along the brisket area. The QH’s was barely noticeable unless you were looking. The QH had a few muscle tics and mildly ouch feet but was otherwise fine.

                              The TB was swollen everywhere (I could press in up to middle of my finger), even up into the throat area. Poop was small, black, mucous covered....but we had been battling ventral edema from a bute overdose so her gut was already pretty ulcerated. After a few days of swelling the TB she started tripping and had problems on small circles. Failed the tail pull test spectacularly. She didn’t pee much for a couple of days. Her tail was limp like a mare that was going to foal any minute. I wound up cutting it because she was ripping it out. Once the swelling started going down it was like she just melted. Went from a BCS of around a 6 to barely a 3. She couldn’t walk straight and listed side to side. If you touched her to move her hind end she’d practically fall over. She had obvious difficulty getting up and kind of bunny-hopped around on the hind until she could get her balance. She also became unusually aggressive to the QH for a couple of months.

                              As for why I suspected oak....the symptoms matched better than EPM. Her blood test was positive for EPM, so we did 45 days of Rebalance. After 45 days, while she still failed the tail pull test, the vet was now sure she knew where her feet were and we were looking at weakness. We confirmed oak a few months later when I caught her actually eating off a limb and had a minor recurrence of the swelling/peeing/weight loss a few days later.



                              Comment

                                Original Poster

                                #16
                                Another update.

                                I'm having a hard time tracing progress. I just don't know enough about neuro presentation to tell, and Google only helps so much.

                                Today 5/7 he seems better, maybe. More resistance to tail pull, not stumbling anymore. Uncrosses his legs right away and stood well for the farrier. Hopefully good signs, I'll add video below. Feel free to help me on whether he still looks ataxic or neurological.

                                https://youtu.be/xR6Nn2TLYgU

                                https://youtu.be/JQQr5UEls00
                                When I die, I want to go peacefully like my grandfather did in his sleep. Not yelling and screaming like the passengers in his car.

                                Official Secretary of Sass

                                Comment


                                  #17
                                  Hard to tell from those videos. Better video would be someone walking him in straight lines away from the camera, turning around sharply where he has to cross his legs over to turn, things like that. Not easy to create with 1 person.

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                                    #18
                                    Neuro stuff is so frustrating, could lots of things. A lot of horses will test + for EPM with no symptoms so if your vet thinks EPM off symptoms/exam then I think that's good enough. My horse was very mild, limp tail, if you crossed her back legs she wouldn't adjust, and was very cinchy. The cinchiness improved within 2 days, went from ears pinned trying to bite me to nothing. And she isn't a mean horse so she was just telling me something wasn't right. She was a bit lethargic, that improved within about 2 weeks. The limp tail and leg crossing took a good 4 weeks of treatment before they went away. Made me nervous but she has zero symptoms now, it just took the full round of treatment to go away. Treatment started in February, gave Protazil on Saturday and Tuesday for 4 weeks. I rode my horse every day since she never mis-stepped, she was safe to ride. Competed in barrel racing the whole time, and we even kept getting faster times. Vet told me to keep riding/competing. If you are comfortable with your vet I say just keep with the course, call him/her with any questions/concerns. If you are good with that, then just trust the process. I think every horse will be different, some symptoms will improve quickly, some won't. Maybe it depends on where in the spinal cord the disease started.

                                    Good luck!

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                                      #19
                                      When we were treating one w EPM w Marquis, our vet also had us give Elevate liquid vitamin E. We purchased it at Kentucky Equine. We gave it by mouth w a dose syringe- maybe 10 cc a day? I don’t remember the dose but I bet someone will.

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                                        Original Poster

                                        #20
                                        FINAL UPDATE:

                                        unless something big changes lol.

                                        Today we saw the vet for a follow-up visit. It couldn't have give better! Normal neurological responses, no ataxia, no signs of EPM.

                                        He was very very sightly off on flexions in both fronts and RH, but with his previous injuries and age I'm not surprised or concerned. We decided to do 30 days of previcox just in case, as he starts being ridden under saddle again.

                                        He's good to go under saddle now, taking it very slow obviously. No jumping for at least 30 days or until he gets seen again.

                                        Thank you all so much for supporting me through this! I learned a lot from y'all, was talked off a cliff, and generally felt better from this thread. I'll leave it up for educational purposes but unless something changes I won't update again.

                                        Thanks again y'all!
                                        When I die, I want to go peacefully like my grandfather did in his sleep. Not yelling and screaming like the passengers in his car.

                                        Official Secretary of Sass

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