Jump to bottom for latest updates - last update on October 11, 2016. Information about Lyme starts on September 25, 2012.
This page contains links to a couple of sites that have good information about EPM, a couple of posts I've done about my own experiences with EPM, and regular updates about Pie's and Drifter's EPM treatment and status. Three of my horses have had infections with EPM, one horse with two different phenotypes on two different occasions, and that same horse also tested positive for chronic Lyme. I am fortunate that my horses' symptoms so far have been not been as serious as those many horses experience - we caught things relatively early in the disease process and that the treatments were effective.
Here is a site with a lot of good information about EPM.
Here's the site with information about the new ELISA antigen test for specific strains of EPM that infect the horse, and with information about the new treatment protocol that is in clinical trials. This test is designed to distinguish between the different strains of EPM that infect horses, and to distinguish between active infection and simple exposure to the infectious organisms - many horses have been exposed but fewer develop an active infection or symptoms. The test also facilitates distinguishing between EPM and other conditions or diseases that may present with neurological symptoms, such as Wobbler's. The hope is also that, with this test, it will be possible to detect and treat EPM at its earliest stages rather than having to wait until a horse develops more severe symptoms and possibly permanent nervous system damage. The treatment uses a combination of older drugs, with low toxicity, that are believed to be effective against all strains of EPM that infect horses. The hope is that treated horses will have lasting immunity to at least the strains they have been exposed to.
Here is my first post about EPM. Here's the second post.
Pie's symptoms (as of October 27, 2011) before treatment:
Stiffness in movement and reluctance to move out.
Unusual sensitivity to heat, with excessive sweating.
One episode of severe sweating and mild tying up with mild exercise under hot, humid conditions.
Some abnormal cranial nerve and spinal nerve reflex responses.
Poor response with hind foot placement test, first with one hind foot and then later with both.
Period of acute, short-term chronic colic attacks that started immediately after fall vaccinations - appears to be a reaction to immune system stimulation. Examined at U. Wisc. veterinary hospital - lumps in abdomen outside digestive tract which may be enlarged lymph nodes, moderately elevated GGT liver enzymes. Lymphosarcoma not ruled out.
Difficulty holding feet up for picking or farrier - started with right hind, that got a bit better and then holding up right front became a problem.
General crabbiness - actually bit someone which is very unusual behavior.
Lots of yawning/gaping, which is continuing and some unusual gulping noises a while ago. Some head rubbing - on me and solid objects, although less of that now. Occasional odd upwards stretching with neck.
Some difficulty walking down hills - hesitant, which is a change for him.
Has recently started being picked on in the pas|ure and not moving as fast at liberty - still walks, trots and canters in pasture.
Sound under saddle in walk and trot in both directions, although short-strided. Not attempting canter under saddle right now.
Drifter's symptoms (as of October 27, 2011) before treatment:
Before symptoms, very sound at walk, trot and canter, although has always tended to place left hind more towards centerline of body.
Started feeling a bit "weird" at trot - push and impulsion reduced and very slight unevenness. No sign of any physical problem in hooves, legs or body that would cause this. Sound at the walk. On observation at liberty, very slight lack of push with left hind could be just barely observed.
Over next week, trot got worse - on lunge could see short-striding and toe dragging with left hind, although comfortable moving out. With more effort - longer, faster strides - gait improved substantially but more noticeable unevenness returned at slower pace. Still sound at walk under saddle, and will walk, trot and canter in the pasture. No evidence of any joint, muscle or soft tissue problems.
Abnormal responses on hind foot placement tests.
Pie's ELISA test results:
September 28, 2001 blood draw:
SAG 1 - 20 - just above cut off (which is 16) for active infection.
SAG 5 - 20 - just above cut off for active infection.
SAG 6 - 40
October 18, 2011 blood draw:
SAG 1 - 8 - unclear what this means - it may mean that infection with this strain is resolving.
SAG 5 - 40 - doubling from last test likely indicates active infection.
SAG 6 - 40
Drifter's ELISA test results:
October 18, 2011 blood draw:
SAG 1 - 4
SAG 5 - 40 - likely indicates active infection.
SAG 6 - 40
Treatment plan for both horses: 10 days of Oroquin-10 paste (decoquinate and levamisole) followed by 90 days of feed top dressing (decoquinate). Periodic ELISA antigen retests.
Feed and stabling:
Pie: 1/2 pound Equi-Balancer pellets (protein plus vitamin/mineral supplement tailored to our low-selenium area), U-Gard pellets and magnesium/chromium/selenium/vitamin E supplement a.m. and p.m.
Drifter: 1/2 pound Equi-Balancer pellets and U-Gard pellets a.m. and p.m. Magnesium oxide supplement a.m. One cup Omega Horseshine p.m. A small amount of cocosoya oil.
Pie on grass pasture in a.m., Drifter on a very skimpy pasture a.m. (he gets Omega Horseshine due to limited access to grass). Both horses get grass hay in p.m. and evening.
Pie outside 24/7, either in a paddock with shelter or pasture. Drifter out at least 10 hours a day in pasture or paddock, stalled at night.
Record of treatment and any observations:
October 28, 2011 - Dose one Oroquin-10 paste a.m. In p.m., Drifter worse at trot on lunge - really dragging left hind and not that good with right hind. Felt wobbly at walk under saddle. Tripped once on way out to paddock. Pie sound at walk and trot, but reluctant to move out, somewhat crabby. Had a pretty serious colic attack in the evening - out flat in paddock groaning - resolved quickly with walking and he was back to normal and eating again within about 30 minutes.
October 29, 2011 - Dose two Oroquin-10 paste a.m. Pie had a brief, fairly painful, colic attack in paddock after bring in from pasture in the late morning - laying flat and groaning. (This was Pie's last colic attack - it is possible that the treatment was beginning to reduce the inflamed lymph nodes in his abdomen.) Got him up and hand-walked - got better very quickly. P.m. - 500-lb. dose Banamine (vet's recommendation to deal with inflammation on days 3, 4 and 5). P.m. - Pie looking "punky" about an hour after dinner and eating two flakes hay, but recovered after walking around for a bit. Will reduce hay somewhat during 10-day treatment period.
October 30, 2011 - Dose three Oroquin-10 paste a.m. 500-lb. dose Banamine a.m. and 500-lb. dose p.m. Both Pie and Drifter moving well at liberty at all gaits, and Drifter appears to be sounder behind.
October 31, 2011 - Dose four Oroquin-10 paste a.m. 500-lb. dose Banamine a.m. and 500-lb. dose p.m. Pie was less crabby and particularly lively at feeding time and on turnout this morning - rolled all the way over twice, and got up and trotted off to the far pasture - he hasn't trotted off (which was his usual behavior on turnout) in quite a while. Less crabby in the afternoon, in fact quite friendly, and laid down in paddock and took a nap - sternal for a while, then flat, but very responsive when I went up to him, didn't seem to be colic this time. Pie slightly short-striding with left hind. Drifter using left hind much better in pasture and not resting it as often.
November 1, 2011 - Dose five Oroquin-10 paste a.m. 500-lb. dose Banamine p.m. Pie still cheerful, even whinnying to me, which he hasn't done in a while, but somewhat tentative when walking although willing to move out - took a brief hand walk in the arena. Drifter no longer toe dragging behind, but leaning heavily on me when I pick hinds and still noticeably not right in left hind - also very reluctant to move out on lunge. Got on very briefly and walked him around.
November 2, 2011 - Dose six Oroquin-10 paste a.m. Drifter calmer than normal today but not depressed. Still leaning when pick right hind. No longer dragging toe of left hind at walk. In tight circles, does not drag left hind when circling left and crosses over well with left hind. When circling in a tight circle right, drags left hind but does cross over with right hind. Rode at walk for a bit - still a bit of a "wallowing" feeling but he was glad to extend the walk. Pie very friendly and interactive, walking easily but without much length of stride. In tight circles, wants to sidestep or cross behind instead of step over, particularly with left hind. Rode at walk in arena and a bit on the trail - was walking out nicely by the end although not much push going up a slight hill.
November 3, 2011 - Dose seven Oroquin-10 paste a.m. Pie very cheerful and friendly in p.m. Drifter no longer dragging left hind in tight circles to right, not leaning as much with left hind when picking, has been stretching right hind out behind him sometimes when I pick it up.
November 4, 2011 - Dose eight Oroquin-10 paste a.m. Drifter and Pie both no longer dropping feet to ground when I let go after picking - they place them down, much more comfortable with all four being picked. Pie did a very nice sound right lead canter for several hundred yards when coming in from pasture, moved well going uphill. Drifter's walk much better under saddle - less "wallowing", and able to lengthen nicely. Turns in hand - no dragging of left hind and good crossing over. Pie under saddle - still stiff and has a "stilted" feeling to the walk - no push or engagement behind. When backing under saddle, hindquarters tend to go to the left - left hind not stepping back as fully - but was able to back straight with effort if I worked to get left hind energized with some left leg. Pie turns in hand - won't cross over with left hind - just side steps around, with right hind will cross over although reluctantly. Pie still very friendly, engaged and alert.
November 5, 2011 - Dose nine Oroquin-10 paste a.m. Pie trotted away from gate on turn out - he hasn't done this in quite a while. At bring-in, Pie galloped from far pasture, did some bucking as he ran and even jumped a large puddle at a gate between pastures.
November 6, 2011 - Dose ten Oroquin-10 paste a.m. Drifter's tight circles in hand now completely normal - good crossing over with both hind feet and no toe dragging. Pie's turning improved - with effort, can get slight crossing over with right hind and left hind now, with effort, can be placed just in front of right hind - no big crossing over but side stepping reduced. Here is a video of them doing the tight turns test - Drifter has no white on legs and Pie has one white hind leg - ignore the brief clip of Drifter feeling (too) good at the beginning:
Pie standing, walking and even trotting well in pea gravel in paddock. Pie no longer yawning/gaping his mouth. Since Pie is not 100% yet, Dr. Ellison is recommending that he get liquid levamisole (for the continued anti-inflamatory effect) by mouth for a further period, in addition to the decoquinate feed top dressing, and we're in the process of getting that ordered.
November 7, 2011 - starting daily decoquinate feed top dressing. Drifter able to gradually start back to full work. Pie can do some light exercise to help him with hind end - some hand walking on trails and some walking under saddle, with walking over poles and some work on backing straight. Under saddle today, Drifter really walking well so tried a little bit of trot and it was good - and there was no balking! Pie did much better on turning test today - immediately did a little bit of crossing over in both directions - and walked out better under saddle.
November 11, 2011 - day 5 of decoquinate feed top dressing. Neurological exams of both horses show substantial improvements, even in the past week. Drifter now has no impairments other than a very slight delay in moving right hind in crossing test, and in general somewhat reduced spinal nerve responses - the responses are there just not as large as would be expected. Drifter's backing also much improved - lifts legs equally and puts toes down first, whereas before he was pulling legs back. Pie also much improved - turning test in both directions almost normal, with very slightly less reach with left hind. Pie's spinal nerve responses dramatically increased on both sides all the way back - some hypersensitivity in left hind quarter. Pie now uses both hinds equally in backing and can easily back straight. Both horses also had normal responses when the vet tried to put one hind foot behind the other - both horses resisted and wouldn't put their hinds in that abnormal position, whereas both had had abnormal responses before - Pie had left his left hind behind his right hind indefinitely, and Drifter had difficulty correcting his hind foot placement. They both clearly know where their hind feet are and are able to control where the feet go.
November 14, 2011 - day 8 of decoquinate feed top dressing. Drifter no longer reluctant to trot, although trot does not feel completely normal under saddle yet. Pie walking out well under saddle.
November 15, 2011 - great progress with both horses - see this post for details.
November 24, 2011 - Charisma - 22yo Morgan mare - also diagnosed by ELIZA test to be infected with strain 5 (same as Pie and Drifter). Not on pasturm or round bales, so source of infection for all three likely to be square bale hay. Symptoms: impaired spinal reflexes on right side, some difficulty on turning and foot placement tests with right hind. Notable lurchiness going downhill - not using hind end and keeping legs very straight. Started Oroquin-10 this morning.
November 25, 2011 - Drifter somewhat balky in walk/trot transitions, and in slower trot doesn't move as well as in lengthened trot. Able to work well once he got going, but dragging left hind toe a little bit afterwards - tired?
November 26, 2011 - Drifter no longer dragging left hind toe, but still very balky in walk/trot transitions. He may be sore, or have tweaked his stifle when he was feeling so much better. Next time I ride him, I may try a bit of Banamine in the morning to see if that improves his comfort - that would indicate that it's soreness.
December 17, 2011 - Day 51 of treatment - day 41 of decoquinate feed top dressing. Drifter and Pie both pretty much completely back to normal both in terms of gait/movement and also personality/demeanor. Here's a link to a post by someone else at our barn whose horse has also been diagnosed with EPM - a good description of how the movement issues came on:
December 29, 2011 - Day 63 of treatment - day 53 of decoquinate feed top dressing. Drifter perfectly fine. Over past several weeks, although neurological symptoms seems to be completely gone, Pie increasingly crabby, uncomfortable being groomed and "mopey" from time to time, although no real colic. Could be lumps in abdomen reappearing (perhaps levamisole caused them to shrink), could be sensitivity due to re-enervation, particularly of skin. Also seems stiff and muscles seem tight - generalized inflammation? May try 500-lb. dose of Banamine every 3rd day at vet's recommendation to see if that makes a difference - may damp down any inflammation.
February 4, 2011 - Day 100 of treatment - day 90 of decoquinate feed top dressing. All done with treatment, and both horses seem in perfect health and have no residual neurological symptoms. Also Pie no longer having any signs of digestive upset or discomfort, although he remains crabby when eating.
February 28, 2011 - Blood draws for ELISA retests - very good news:
SAG 1 - 2
SAG 5 - 2
SAG 6 - 8
SAG 1 - 2
SAG 5 - 2
SAG 6 - 2
April 3, 2012 - It seems that there's more, concerning Dawn - see this post.
April 4, 2012 - Dawn seems worse - almost stumbling, walking like an old horse. May be having some difficulty chewing and swallowing. Stance on cross-ties with feet somewhat splayed. Clearly does not feel well.
April 5, 2012 - Neurological exam by our vet exam - abnormal left hind placement test, difficulty with left hind on turning test, abnormal stance and also not walking with as much assurance, seemed a little mopey and chewing hay with great care. 500-lb dose oral banamine, plus levamisole. Felt better almost immediately; eating hay well at 9 p.m. when I checked on her. Meds ordered for delivery tomorrow.
April 6, 2012 - Dawn Dose one Oroquin-10 paste. Still mopey and eating carefully.
April 7, 2012 - Dawn Dose two Oroquin-10 paste. Also 500-lb. dose Banamine. Wallowy enough at walk under saddle that I got off almost immediately.
April 8, 2012 - Dawn Dose three Oroquin-10 paste. Also 500-lb. dose Banamine. Seemed a bit better in hand, foot placement still abnormal. Lunged briefly at walk and trot - not too bad and willing to move forward. Slightly dragging left hind toe, and tripped with that foot once. Rode at walk on a loose rein for about 15 minutes, working on active walk - still felt wallowy but slightly better than yesterday. Seemed to be eating slightly better.
April 9, 2012 - Dawn Dose four Oroquin-10 paste. Walking a bit better. Had 500-lb. dose Banamine due to strenous dental visit - had parts of two broken teeth removed.
April 10, 2012 - Dawn Dose five Oroquin-10 paste. Got blood test results:
SAG 1 - 32
SAG 5 - 2
SAG 6 - 2
April 11, 2012 - Dawn Dose six Oroquin-10 paste.
April 12, 2012 - Dawn Dose seven Oroquin-10 paste. Dawn is already shoing signs of improvement - in foot placement test, only left front was left in the awkward position. She moved right front back quickly, and also moved both hinds fairly quickly - not 100% but improved. Lunged at walk and trot, and improved - more lift and evenness and no signs of short-striding or dragging left hind.
April 13, 2012 - Dawn Dose eight Oroquin-10 paste. Lunged in outdoor. Was very willing to move, but did seem to be slightly dragging left hind, and was dragging it a bit when backing.
April 14, 2012 - Dawn Dose nine Oroquin-10 paste. Lunged in outdoor - looked good, no toe-dragging and willing to move. Rode at walk and trot - gaits very good, no unevenness, toe-dragging or tripping, but a little careful when going down slight downhill slope and pretty braced in general - hind end must feel a bit weak.
April 15, 2012 - Dawn Dose ten Oroquin-10 paste. Lunged and rode in indoor - very sound and no signs of unevenness or toe-dragging. Saw three easy flying lead changes when she galloped off to turnout.
April 16, 2012 - Dawn dose one decoquinate powder.
April 17, 2012 - Dawn dose two decoquinate powder. Dawn able to do good walk and trot work, also able to do some shortening/softening work at the trot.
April 21, 2012 - Dawn dose six decoquinate powder. Dawn backing much better, leg placement tests better - fronts normal, backs still not quite although placed them back fairly quickly.
April 23, 2012 - Dawn dose eight decoquinate powder. First day Dawn has refused to put fronts in wrong position on leg placement test, and resisted with backs and moved them back very quickly.
April 26, 2012 - Pie has been slightly not right since about 10 days after his 4-way vaccination. Slightly swollen glands in the throat, fails rear foot placement test on both sides, although fronts are OK. Backs well and does turning test well. When riding, occasional misteps behind, and occasional tripping. Back feet sometimes "hover" as he puts them down on a level surface. Not mopey or sore-bodied and eating well. Drew blood for another EPM test - either just an inflammatory response to the vacinnation (apparently this can happen with former EPM horses) or else he may have picked up a new strain (1?) at the new barn.
April 30, 2012 - Dawn: dose 15 decoquinate powder (day 25 of treatment); now completely normal neurologically - passes all ground tests and trots and canters freely and soundly on the lunge in both directions. Pie showing signs of improvement - strongly resisted on front foot placement test, and resisted slightly with right hind and corrected foot position quickly, still resisting less with left hind but did correct position - but only after a few moments and by moving other hind. Pie did walk and trot well under saddle.
Got Pie's EPM test results:
SAG 1 - 32
SAG 5 - 16
SAG 6 - 4
Looks as though he has a new infection with strain one, strain 5 results may be a cross-reaction.
May 1, 2012 - Pie worse. Somewhat mopey, almost fell when I was picking his feet, front foot placement normal, turning test normal, back foot placement abnormal in both, backing very tentative and having trouble placing hind feet. Did not ride. Will start treatment tomorrow when medicine arrives.
A post I did on the effect of geography and moving barns on the development of EPM.
May 2, 2012 - Pie: dose one Oroquin-10 paste. Dawn: first ridden work at canter - cantered well on left lead, had a harder time on right lead - left hind may need more strengthening.
May 3, 2012 - Pie: dose two Oroquin-10 paste. Loose manure, so have added probiotics to his feed. Is cheerful and eating well - stressed by heat so kept him in his cooler stall for a good part of the day.
May 4, 2012 - Pie: dose three Oroquin-10 paste. Manure OK again. A little better on foot placement test - fronts still normal and gave me some resistance with right hind, although did leave it in odd position. Left hind still abnormal.
May 5, 2012 - Dawn: day 19 decoquinate powder (day 29 treatment); doing very well. Pie: dose four Oroquin-10 paste, also 500-lb. dose Banamine. Somewhat mopey, neck sore and slightly swollen on left side, glands in throat still swollen. Foot placement the same as yesterday.
May 6, 2012 - Pie: dose five Oroquin-10 paste, also 500-lb. dose Banamine. Brighter attitude. Backing greatly improved - picks feet up and moves them in pairs toe-first - no "searching" with back feet. Did not drag hinds when backing under saddle in the arena - no drag marks. Right hind somewhat improved on foot placement test - resisted putting it in the wrong position although did eventually. Left hind still abnormal. Neck still somewhat sore and swollen. Rode at walk and walk was forward and regular.
May 7, 2012 - Dawn - took a few bad steps in front today, but otherwise worked very well, including some left lead canter work - her easier direction. Had rabies vaccination on inside of right hind - will keep an eye on how she does. Pie: dose six Oroquin-10 paste. Rode 20 minutes at vigorous walk, also did some nice backing.
Here's a post I did with a short summary of the various symptoms my horses experienced in their four cases so far.
May 8, 2012 - Dawn - had rabies vaccination yesterday. Seemed fine today except for some stocking up in hind legs, particularly left hind. Walked and trotted sound on lunge, so rode for about 30 minutes at walk and trot. Filling a bit better when done. Pie: dose seven Oroquin-10. Backing almost completely normal, turning very good with big crossover in both directions, foot placement test improving - resisting with both hinds and put them back in place after a few seconds.
May 9, 2012 - Dawn's legs back to normal. Lunged at walk, trot and canter - completely sound, does still have trouble sustaining right lead canter, probably due to continuing bend to outside (this is unrelated to EPM). Pie: dose eight Oroquin-10. Short lunge session at walk and trot - completely sound in both directions at both gaits, all transitions normal and moving well and using himself.
May 10, 2012 - Pie: dose nine Oroquin-10. 20-minute ride with 10 minutes walk and then walk/trot work, avoiding tight turns. Did very well.
May 11, 2012 - Dawn did very well at trot and canter on uneven ground. Pie: dose ten Oroquin-10. 30-minute ride in outdoor - uneven ground and fairly deep footing. Did well going up and down steep hill to the outdoor - moving freely and no attempts to move sideways. Did "scuff" a bit with fronts in deepest footing. Very good softening work at the walk, and forward, engaged trot - only did level ground and uphill, no downhill.
May 13, 2012 - Pie: dose two decoquinate powder. Rode at walk and trot, one very big trip/collapse behind at walk after transition down from trot, otherwise OK at walk and trot.
May 14, 2012 - Pie: day three decoquinate powder (day 13 of treatment) - very good walk/trot session, no problems.
A published study of early clinical trial results from Dr. Ellison.
May 17, 2012 - Dawn: day 32 decoquinate powder (day 42 of treatment) - strength rebuilt after about two weeks back in work - work going very well, as shown in these videos. Pie: day six decoquinate powder (day 16 of treatment) - moving very well, able to go up and down hill much more easily. Starting to work to rebuild strength in under saddle work. And here's an e-mail I sent to Dr. Ellison on May 18:
Just an update - please use as you see fit. Both my horses - Dawn and Pie - who came down with antigen strain one this spring are doing well. Both horses were showing significant improvement and rideable at the walk by the end of the Oroquin-10 treatment, and one (Dawn, who was more symptomatic) was completely normal and back in full work by day 25, and the other (Pie, the horse who had strain 5 last fall, was treated and recovered) was back in full work by day 15 of treatment and is now quickly rebuilding strength. In both cases, I think it helped that both horses were very fit when they became infected, and that they were in almost daily strenuous work - it made it a lot easier to notice when very small things weren't right - and I had the experience of two prior cases so was clued in to the diverse symptoms and caught them as soon as they began to show. Thank you again for all your great work - now if there was a good way to get owners, chiropractors (who get called in when things aren't quite right) and vets doing annual health checks, to recognize the earliest symptoms so horses could be tested and treated quickly before symptoms worsen - I expect often the vets aren't usually called in before symptoms are much more advanced.June 2, 2012 - Dawn: day 48 decoquinate powder (day 58 of treatment); Pie: day 22 decoquinate powder (day 32 of treatment): both horses working very well in all three gaits - completely sound and willing.
July 9, 2012 - all horses continue to do very well. Dawn has finished 100 days of treatment and remains completely sound with no other symptoms. Pie is still on decoquinate powder - he's about 4 weeks behind Dawn in treatment - and is completely sound. Red has been on preventative powder since early June and has shown no symptoms.
September 12, 2012 - follow-up blood tests for Dawn and Pie - very good news - both are:
SAG 1 - 2
SAG 5 - 2
SAG 6 - 2.
Now it looks like Red (formerly named Drifter) may have another strain of EPM - here's a post about it.
September 15, 2012 - Red: blood draw for EPM and Lyme. Neuro test showed abnormalities in LH on placement, crossing and backing - slight dragging. Some abnormalities on pen tests, both hinds, also some slight muscle atropy left hind.
September 16, 2012 - Red: slightly depressed; adopted "tripod" stance while grooming - front legs close together but directly under shoulder, hind legs spread apart and camped out to the back - he did this on first EPM infection.
September 17, 2012 - Red: right hind also seems affected - tends not to put it down flat when picking other feet; still somewhat mopey. Meds on the way and should have first dose tomorrow.
September 18, 2012 - An update on Red and some early symptoms of EPM that I've observed. Red dose one Oroquin-10 paste.
September 19, 2012 - Red: dose two Oroquin-10 paste.
September 20, 2012 - Red: dose three Oroquin-10 paste. Got results from 9/15 blood draw - 2/2/2. This could mean a number of things, since he has clear neurological signs: one - that he doesn't have an EPM infection but rather an inflammatory response to something due to his prior EPM infection; two - that he has an active EPM infection but his immune response has been surpressed due to being on the low-dose decoquinate medicine; three - he has a recent EPM infection - within the past three weeks, and has not yet mustered an immune response; four - he doesn't have EPM at all but some other neurological problem like Lyme disease.
September 21, 2012 - a post on the possible meanings of the low titer. Red: dose four Oroquin-10 paste. Red's symptoms are improved - would put LH behind RH but immediately take it back; backing improved - now picking up both hinds and putting them down toe first; turning test much better - crossing over well with both hind legs.
September 22, 2012 - Red: dose five Oroquin-10 paste.
September 23, 2012 - Red: dose six Oroquin-10 paste. Didn't do a full neuro check, but significant improvement in foot placement test - didn't want to put LH behind RH, and also standing more square on cross ties. Have been riding at walk all along - rode bareback today again.
September 24, 2012 - Red: dose seven Oroquin-10 paste. Neuro signs improved - would not put LH behind RH at all, but still lame on lunge at trot.
September 25, 2012 - Red: dose eight Oroquin-10 paste. Got results of Pie's Lyme test, which was the more accurate Cornell test. Antigen levels:
Antigen A - Negative.
Antigen C - Negative.
Antigen F - 1,726 (cut off for active infection is 1,250). This is a positive result, although many horses with Lyme have much higher titers. This indicates an active, chronic Lyme infection that is more than 5 months old. Our vet believes that some of the acute symptoms Pie experienced in the summer and fall of 2011, including an episode of laminitis, severe muscle pain/soreness, acute sensitivity to touch, severe grumpiness - to the point of biting, and his continuing muscle tightness and unusual visual reactivity to movement may have been/be Lyme related.
September 26, 2012 - Red: dose nine Oroquin-10 paste. Walking down steep hill in hand much better - very little LH dragging, although still some. Getting feisty - think he feels pretty good.
September 27, 2012 - Red: dose ten Oroquin-10 paste. Excellent walk ride - very feisty and forward, would have trotted if I asked - want to see him on the lunge first.
Pie - heard back that Cornell thinks we should treat his Lyme - need to obtain sufficient doxy pills for treatment - vet/chiro working on that.
September 28, 2012 - Red: started low-dose decoquinate powder. Picks up all four feet for picking easily - no problem lifting LF. Also walked down fairly steep hill from above barn to lower parking lot without dragging or scuffing LH. Seems to be feeling good - couldn't lunge to check soundness because arena footing being redone.
September 29, 2012 - Pie: extremely grumpy and sour. Red: walked up and down fairly steep hill with ease.
September 30, 2012 - Red: lunged completely sound to left, much improved although not 100% to right. Left hind still seems to fatigue very quickly. Rode him at walk in arena, hand walked in outdoor and rode in pasture - able to go down hills well, although LH tired by end of session.
October 1, 2012 - Red: no problems after yesterday. Did a lot of massage before riding - walked and trotted sound in indoor under saddle - LH tired quickly. Pie did good work outdoors in pasture, still visually spooky.
October 3, 2012 - Red: put him on the lunge for the vet/chiro to evaluate. All I can say is wow! his trot was amazing - big, engaged and floating and he was delighted to move out - his amazing gaits are back! Greatly improved even from 3 days ago. To the left, 100% sound, and almost as sound to the right - for the first time in a long time - trotted out beautifully, although would occasionally take a shorter step with the left hind. She had brought her ultrasound - we were planning to lunge him before and after therapeutic ultrasound of the tendon area, but she said he looked so good there was no point in doing that. She also did neuro tests on him - he's now 100% normal again and his affect is bright and eager - and drew blood for a follow-up EPM titer and C reactive protein (to test for inflammation). He's completed the Oroquin-10 and is on day 6 of the low-dose decoquinate powder. She agrees that he likely had an original mechanical injury - the Achilles tendon area and related muscles above as the primary site of injury - compounded by a neurological flare-up (we may find out whether this was a new infection with a different phenotype from the blood test) that compromised his ability to extend and lift the LH forward - mainly affecting the biceps femoralis muscles, which interfered with his rehab. The rehab plan for the next couple of weeks is to alternate days, with some trot work, building up slowly, with icing of the tendon area afterwards, alternating with a walking day, both under saddle and some hill work in hand. The goal is to gently continue to break any remaining adhesions without triggering extra inflammation, and to slowly rebuild muscle strength in the front of the leg. If he gets sore, we'll back off, if he continues to improve, we'll continue to build his work. When we let him back into the pasture, he galloped off up the hill, on the right lead, no less, and pushing fully with the left hind. He was still careful in the downwards transition to trot - she says the downwards transitions will remain imperfect until he's 100% back to normal. I'm delighted with his progress!
October 4, 2012 - Red walking ride, doing well. Pie - good w/t ride - see Ride Log - started doxy treatment with 10 (100 mg) pills. When grooming, crabby and somewhat sore, but rode well.
October 5, 2012 - Red started trot work again, doing well. Pie - extremely crabby and sore in neck and shoulders to the touch, but rode well in a short ride. 20 pills - used cocosoya, which he loves.
October 6, 2012 - Red: hand walk around barn. Pie - extremely crabby, day off. Ate 30 pills well.
October 7, 2012 - Red: w/t work, very sound, did 10 arena lengths in two sets of five. Pie - much happier and very sweet, although very alert and even a bit fidgety. Much less muscle sore for grooming, and muscles seem somewhat softer to the touch, except in his neck. Sore in sternal area. W/t ride in indoor, extremely forward, engaged and soft. Very awake, and looking at everything as if he were seeing it for the first time, but not spooky. Ate 40 pills well - manure softer and less formed but not loose.
October 8, 2012 - Pie: up to 50 pills. Riding very well, alert and engaged, but somewhat crabby, mostly relating to having to leave his hay.
October 9, 2012 - Pie: 60 pills, manure holding at soft not loose. Good ride w/t.
October 10, 2012 - Pie: 70 pills. Seems to be coming out of his shell - more interactive, friendly and alert. Very good w/t ride - forward and soft.
October 11, 2012 - Pie: 80 pills. Attitude alert and sweet, very good w/t ride in pasture. Manure firmer than yesterday, although still soft and bulky.
October 12, 2012 - Pie: 90 pills, manure still OK. Rode very well - forward and very energetic. Got Red's second EPM test results - still 2/2/2, so whatever was causing the neurological episode was probably an inflammatory event - CRP being tested as well, don't have that result yet.
October 13, 2012 - Pie: 100 pills, all is well at this point.
October 14, 2012 - Pie: 110 pills, all is well for now.
October 15, 2012 - Pie: 120 pills, all is well for now, day one of 30 days at this dose.
October 28, 2012 - Pie: day 14 of full dose - doing very well.
November 13, 2012 - Pie: finished 30 days of treatment at full dose. Doing very well - much more alert and interactive, and less sore and grouchy. Moving and working well at all three gaits.
April 5, 2013 - Pie: possible inflammatory flare-up 7 days after vaccination with E/W/tetanus - not standing well when picking right front - did neuro tests, right hind failed foot placement test. Gave him 1000 lb. dose banamine, will watch carefully. Good ride w/t.
April 6, 2013 - Pie: somewhat improved - more reluctant to place right hind incorrectly, gave him another 1000 dose banamine. Day off. If still improving tomorrow, will tail down to 500 lb. dose.
April 15, 2013 - Pie: now completely normal.
May 28, 2013 - Pie has been blood tested at 8-8-8, C reactive very low - does not seem to have an active infection but rather is responding to reexposure - will treat with new protocol designed by Dr. Ellison. Dawn significantly neurological in front - see today's post for details - will be blood tested Thursday as well as Red.
May 30, 2013 - Dawn and Red: blood draws for EPM test and C reactive protein. Pie: dose one of decoquinate tablet.
June 8, 2013 - Pie finished 10th dose of decoquinate and remains symptom free. Dawn and Red both tested 2-2-2 for EPM - negative - although Dawn's C reactive protein was slightly elevated, probably due to a kick injury to a hind leg - all three horses continue to be symptom free.
July 23, 2013 - results of EPM retest for Pie: 2-2-2 with slightly elevated CRP (7) - he'd been stung badly by bees/wasps on the face the day before, so that likely explains the CRP. Lyme results - all three antigens below cut-off: A: 623 (up from 141 last test but cut-off is 2,000); C: 277 (up from 105 on the last test but cut-off is 1,000); F: 801 (down from 1,726 last test, cut-off is 1,250). He remains Lyme symptom free. See September 25, 2012 entry for more information about Lyme testing.
February 15, 2014 - results of Pie's retest for Lyme (due to several ticks found on him in November) - all three antigens well below cut-off: A: 282 (down from 623 last test); C: 244 (down from 277 on last test); F: 540 (down from 801 last test). He remains symptom free. See September 25, 2012 entry for more information about Lyme testing.
April 23, 2014 - Dawn: minor EPM symptoms when I rode yesterday - just a little bit "fumbly" but not off. Left front and left hind failed foot placement tests. Probably due to rabies vaccination two weeks ago. This morning, "sprawly" on cross ties and other front foot now failed placement test, turning tests pretty OK. Gave her 500-lb. dose ban amine. In afternoon, all foot placement tests were normal, she was walking with more assurance, and galloped off when I turned her out, with several lead changes.
April 24, 2014 - a post on symptom flare ups in horses who have had EPM.
April 25, 2014 - Dawn improved but not 100%, left front still failed placement test. Another 500-lb. dose Banamine, galloped off to turnout.
April 26, 2014 - Dawn: all four feet tested normal, good ride with much better more even gaits.
May 15, 2014 - Pie has been very sore to touch and extremely crabby for grooming and has been showing some unusual spookiness - had a blood draw for a Lyme retest.
May 21, 2014 - Pie's Lyme test negative. Subsequently figured out that the crabbiness/spookiness was due to ulcers. Treated with UlcerGard paste and doing very well.
September 27, 2014 - Red apparently has an infection with phenotype 5 - see this post.
August 23, 2015 - Red getting a two-week treatment with Levamisole - slightly neurological behind - a flare of symptoms due to who knows what - blood test 2-2-2 so perhaps a re-exposure.
September 3, 2016 - Another case of EPM - Red this time. Titer 8-4-4, very earliest stages of infection. Post with details here.
September 12, 2016 - an update on Red after starting treatment is here.
September 14, 2016 - an update on Red day three. Pie and Missy both tested 2-2-2 and are doing well under saddle so nothing needed there for now. And here's a post on day four, and how EPM symptoms can be exacerbated during treatment.
September 16, 2016 - another update on Red - he's still having symptom exacerbation and is doing the "J scrape" with one hind when turning.
Another update - things are returning to normal.
September 17, 2016 - an update on Red, with an assessment ride - he's better but we've got a ways to go.
September 19, 2016 - As of yesterday, Red has had 8 days of treatment with Orogin-10 and is much better. Not at all spooky and walking without toe scuffs. In hand was able to walk over poles and low cavelettis without tripping or stumbling.
September 20, 2016 - vet reevaluated Red - a pretty good report.
October 11, 2016 - a good update on Red.