EPM treatment & itching?

[sparkygrace]

Those are high numbers! My vet suggested one month on Protazil, but I treated for two months. He seemed better, but some symptoms returned when treatment ended. I treated for another month with success doing 1/2 dose daily and then my vet said to try one dose per week. That didn’t work, so I’m back to 1/2 dose daily.

EPM causes ulcers, which are often the first indication of EPM. Treating for ulcers is essential. Before I finally got a diagnosis, my vet tried a number of things, including treating for ulcers. I saw a big improvement with ulcer meds.

Don’t be afraid to make suggestions to your trainer’s vet. Not all vets are up on EPM. My regular vet, who is really good, missed it. Only when another vet came out did I get a diagnosis. She saw it right away. Neither knew about the ulcer connection.

[sparkygrace]

Forgot to mention I retested after two months on Protazil. Results were 1:1600, still high.

[deweydee]

After an exam, my mare tested 1:2000 on the SAG 2, 4/3 and the vet recommended 2 months Marquis then 1 month Protazil.

[sparkygrace]

Marquis was hard to find, so my vet ordered Protazil.

[Critter]

Yeah…his titers for both shocked the vet as she expected everything to be negative (or just the typical EPM exposure level).

Interesting with the ulcer connection…last year we found severe ulcers (he was actually seen by a top neuro vet who said not to test for EPM then, even though he was grade 1+/5 ataxic in all 4)…we found ulcers then (but we also found 2 broken ribs). After I sent him to the trainer he was showing ulcer symptoms (despite being on sucralfate and treating with UG before and after shipping) and again had severe bleeding ulcers. We got those healed up but he still had some odd stuff going on. I was the one that asked the vet to test for Lyme and EPM…she thought I was crazy testing for Lyme because they really don’t have it there…but we have it really bad where I live so I insisted on testing. We are keeping him on the UG while doing the doxy and Protazil, because I don’t want the ulcers coming back. I did have them stop the sucralfate for now, as that can interfere with absorption of other meds…and I don’t want to risk that with the the meds he definitely needs to get!

I will ask them to run another EPM titer as we near the end of the month. The vet there wanted to only treat 10 days on doxy…my vet said minimum 21 days, and we already got the additional meds for that. Thanks!

[sparkygrace]

When I was researching EPM, I found this article from a vet practice in Nova Scotia. It explains how EPM causes ulcers. @pony_baloney, this article also mentions herbal support, so thanks for yor suggestion!

https://sunnycoastvet.com/ca/equine-disease-breaking-the-epm-stereotype/#:~:text=One%20of%20the%20first%20signs,despite%20several%20rounds%20of%20treatment.

[joiedevie99]

@Simkie

Joie is nearish to me. I was wondering why it was popping in the horses that travel vs the ones that stay home, because there’s certainly plenty of EPM here to infect horses. Curious, no?

Yeah. We’re not totally sure. In at least two instances, it seems to have been in the environment/water at barns we rented in FL. Although it’s still possible that the travel made them more susceptible. Symptoms started to show up 4-6 weeks after arrival in Florida; no horse up north ever showed any. In another instance, a horse tested positive only 10 days after shipping south - so likely something the horse was already carrying. We tested everyone down south and up north, and treated anyone who came back positive, although no one else ever showed any signs.

[Simkie]

That’s so interesting! Thinking about stressors, I wonder if this high heat & humidity could be the trigger, since symptoms really popped when that started. This horse has no other stress :-/

I’m treating another with an overall low titer but there’s just been something … weird about him. Thankfully he’s not been itchy.

I need to test the third horse, ugh.

I’m a bit bitter because I feel like improving my pastures has led to this. For the first time, they’re good enough to not have to feed hay. Guessing all that grazing upped their exposure. Siiiiigh.

[sparkygrace]

Maybe not. The parasite can be in feed and hay. I have no idea when my horse got infected. He may have had it when I bought him.

[Ziggy793]

I dont have any helpful insight but just want to say that I commiserate (as so many do)! It’s a bizarre and frustrating disease and if I’ve learned anything over the course of treating my gelding, it’s that the symptoms can be all over the place. Rebuilding them (nerve health, muscling, gut, immune system) is frustratingly slow.

[JB]

For those who are trying to beat EPM and struggling, and relying on Marquis or ReBalance, if you haven’t considered compounded levamisole/decoquinate, I would.

The other products only prevent reproduction in the hopes that the horse’s immune system will take care of the adult protozoa themselves. But even the FDA-approved Marquis only “guarantees” an improvement of 1 score. That’s fine if you’re at a 1-2, not fine if you’re 5-6.

The levamisole/dec combo actually kills protozoa.

[ASB_Stars]

The short story on EPM is that you need a drug that can cross the blood/brain barrier, get into the cord, and kill the protozoans. Diclazuril does that. There is no useful data on the lifecycle of the protozoa. Therefore, what you need to do is give the horse enough of the drug (which isn’t harmful to mammalian tissue) to get them to steady state (which can take 10-14 days) and keep them there for as long as your wallet allows. Realistically, I’d do 120 days. I personally believe that the little buggers encyst in the cord, and wait until the coast is clear, and come out and start again, which readily explains relapses.

Marquis is a metabolite of a drug that Bayer originally released for EPM called Baycox. I have zero confidence in the drug, as it doesn’t actually kill the bugs, nor does it cross the blood brain barrier. If you get lucky, and it works for you, that’s great, but I really believe that it’s popularity is more due to the drug reps selling it to the Vets as the thing, and the poor tired Vets not having the time to do a deep dive into all of the possibilities. It’s convenient, and they can make a few bucks on it.

Adding 10K IU high quality vitamin E is a must, and using your choice of immune boosters isn’t a bad idea.

[JB]

@ASB_Stars

Adding 10K IU high quality vitamin E is a must

this is outdated I agree with everything else in your post, but this part

Dr Carrie Finno actually presented on this at an AAEP convention within the last couple of years.

How much to supplement, an in what form (regular natural E, or a water-soluble/nano-dispersed version) needs to be based on blood work

Not all EPM horses need 10KIU, not even close. Many don’t need more than 3-5kIU of a water-soluble form

If a horse is already eating a lot of fresh grass, and has normal to high-normal levels, just adding 10kIU could become toxic and start interfering with Vit A and K absorption and cause bone density issues.

The nice thing about using levamisole is that it’s a very good immune “booster” drug.

[ASB_Stars]

@JB

The nice thing about using levamisole is that it’s a very good immune “booster” drug.

This is true. It used to be labeled only for sheep, and it doesn’t cross the blood brin barrier, but for the money, it isn’t a bad option.

[sparkygrace]

@ASB_Stars

The short story on EPM is that you need a drug that can cross the blood/brain barrier, get into the cord, and kill the protozoans. Diclazuril does that.

My vet concurs. He said Protazil does kill the parasite. The problem is how encysted they are in the spine and if the drug can get into the cyst. The mystery is why some horse’s immune system can’t fight off the parasite. Most horses have the ability to successfully fight the infection.

[bktl]

100% agree. The vets REALLY push Marquis as the “gold standard”, and wanted me to get the brand name. Makes me wonder… I am glad I got the generic as it worked after 10 days and then horse relapsed on day 29! An expert in our area said she has seen the same thing happen with Marquis, but not with Diclazuril. Also read in a forum recently someone say every horse they put on Marquis relapsed. I have Diclazuril on order; wish I had started with that. I read a study today from 2000! that show that 37% of horses relapsed on standard treatment and 5% did on Diclazuril. And I 100% agree that the vets must not have time to keep up with all the studies, info, and owner experiences available otherwise we would not all be told to get Marquis. It would be great to have specialists like infectious disease, orthopedist, etc.