The spinal tap and subsequent testing for EPM for my gelding was much less expensive than Marquis. That being said, he did have bad neck pain for a few days afterwards, even with a very clean stick.
Why would they not go straight to the most common, most likely reason for the symptoms?
Why go-to some strange, convoluted reason such as: mare gets arthritis in joint, bone breaks and fluid builds up pinching nerves in neck and fluid/infection around inner ear throwing off balance? Why go there? Online research (done by local vet that evening…he called me to tell me what he had found…online) pointed toward this broken bone thing… Well, i scrubbed the interwebs after his call and what it seemed to me to be the main difference between the two sets of symptoms (for EPM vs bone break) was the direction and synchronicity of vestibular movement and most online sets of diagnosis claim central nervous system disabilities should be observable. Not ALL papers agree with the CNS involvement though.
We are a farm…opossums everywhere. I went-to the most simple explanation first. I think they should also.
Quoting from: https://pathogenes.com/w/epm-treat-for-the-treatable/
" A rapid response to treatment and return to use in suspect EPM cases is our goal. Our goal is facilitated by an early recognition of central vestibular signs. No doubt EPM is a difficult disease to identify, treat, and manage. Our view is based on available literature, experiment, and clinical observations made by veterinarians. The optimistic view is that EPM is treatable because a large part of the disease syndrome is inflammation. Until scientific evidence shows us an alternative, defensible view, we will continue suggesting treating neuroinflammation as a practical approach to treating EPM."
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I can’t speak for your vet. I can’t speak for my vet. I can relay my experience with my vet. And that experience is vet makes diagnosis based on what he sees. What I see and what the vet sees are often different. The majority of my horse experience is with healthy horses. The vet has far more experience with unhealthy horses. I speculate that’s the cause of why he sees things I don’t see and vice versa. And why vet may put more emphasis on certain symptoms than I would.
Vets are humans too though. Humans aren’t perfect. It’s entirely possible your vet made a mistake. That doesn’t mean vet didn’t listen to you or that he’s full of mumbo jumbo.
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“Outraged”…not quite there yet. If she were to die i would be outraged though. As of now, i’m seeking a new equine vet. My experiences with MIZZOU are about 50/50. This particular intern was nutty.
Same mare, about three years ago, right after i got her… I witnessed her step into deep fresh limestone screenings that i was putting into a dugout swale by their gate that was filled with water. I’d dump a bucket (frontloader bucket…so a LOT) and press it down and get another bucket. Horses decided it would be a good idea to run through and come into the barn as i was loading a new bucket… I saw her step in and turn and step out of it and step off her left hind leg immediately and not be able to put any weight on it>>>>(YIKES!!!) … so, i jumped off the tractor, grabbed a halter and led her into a stall and called the vet. (same local vet). He came out, no broken bone. Stall rest, banamine followed by bute. After about a week she was still lame so upon his recommendation i hauled her to MIZZOU. They did all these tests…holding up her poor leg and making her trot…lots of students grouped for confab after each go-round. Then began a series of joint blocks to try to identify which joint. I TOLD THEM STIFLE>>>>>>I SAW IT! but noooohoooo. they had to go through their process. Took two hours and i am sure it was painful. Ultrasound. Finally radiographs. Know what they found? “shallow sole on her hoof”. and still to this day, i think: “Okaaay…great but that does NOT explain what i saw and how she acted.” Have not radiographed her hoof since, but my farrier says they are thick now. (My herd goes over a rocky creek many times a day)
I understand your frustration. It is so hard to see a beloved friend suffering and it sounds like you have a strong gut-instinct. I don’t think you should view all vets as fundamentally flawed, though. I really appreciate a vet who listens to me and then begins to systematically rule things out, regardless of what I said! The students at Mizzou who went systematically through the process of determining your mare’s lameness were doing their due diligence and that’s exactly how they should be taught. And it is a painfully slow process, that honestly, a lot of vets skip these days but I think it is invaluable. Good luck with your new farm vet and treating your sweet mare-I hope she makes a full recovery!
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i had a wonderful vet several years ago. Older guy, intuitive diagnostician. Opinion sought by many other vets in the region. Even after he sold out and retired, he was still willing to tap-in on my horses. And i suppose i got spoiled… He’s old OLD now, no longer driving, poor health 
So i’m relegated to local guy with support from University of Missouri teaching veterinary hosp. And usually you end up with an intern and a gaggle of students. I have 19 horses, i need better. There are very few horses in my town… actually, i only know of three others! Vet is good with cattle, but not very experienced with horses. Good with blood on the ground and broken bones too…but not all the strange and awful things that are pure-horse. Like EPM.
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Diagnosing neuro stuff is soooo difficult. In your case, it sounds pretty clearly like EPM.
My mare had some mild neuro symptoms back in 2013 or 2014. Based on her history, we started with neck injections (don’t remember the details, which joint, etc.). That didn’t change things. Senior vet from the practice came to have a look at her, said “looks like mild EPM, let’s treat her for that and see what happens.” Her blood titer was marginal – and like someone else said, it only indicates exposure, not active disease. He did not like to do spinal taps unless the owner really wanted it, and this was right after a friend’s horse died immediately after a spinal tap and some other diagnostics.
He prefers Orogin and an antiprotozoal for our area. In his opinion, some EPM responds better to Marquis, some to this. He also said that typical improvement was “1 grade” on the neuro scale. My mare was grade 1 1/2. I actually never stopped riding her, which was kind of stupid on my part. By the end of treatment, her symptoms were so mild that you wouldn’t see them unless you knew to look for them. So, grade 1/2. Basically, she stumbles a bit at the walk before she’s warmed up, and sometimes “rope walks” going down hills.
This vet is not huge on supplements, but likes all horses with a neuro history to be on 8000 to 10000 IU of Vitamin E per day for the rest of their lives (it can be cut way back if the horse is on pasture, but mine is not. He likes all horses not on pasture to get 1000 to 2000 IU at least.) So I’ve been doing that. When I run out of Vitamin E, I see more neuro stuff, but that might be confirmation bias.
So you might want to supplement with Vitamin E. I use the UltraCruz natural Vitamin E.
But … very tricky. She will not ever be sold, and I’d disclose the neuro issues to anyone who would lease her (not that it’s likely to happen as she’s old and not entirely sound, plus I’m a bit selfish about her!)
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My horse that did have EPM had a spinal tap ( supposedly). I don’t know why I spent the money - at that point he was really bad living at the vet clinic leaning on the walls to stay up. There were not very many options to treat and I really just wanted to euthanize him at that point. I asked if it was a PCR test or something else ( I forget). The vet said yes so that really told me nothing. ( Not my regular vet).
Even a spinal tap is not 100%. I have read if they do the tap in an area that the protozoa is not present you can get a false negative. So maybe it is best to just treat with the drugs they have available these days and see if you have improvement to diagnose.
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oh man. That must have been so rough. I can’t imagine… I am sorry about your horse.
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Thanks for the advice on Vit E QuietAnn. My mare is on pasture 24/7. (except for now…now i have her in the front yard so i can give her meds). I’ll start working on a way to get a vitamin E into her. I could pair it with something and deliver it daily as a treat. I think??
I saw online that there had been a vaccine for EPM several years ago. Anyone know anything about it? IS it still a thing? Anyone giving it to their horses?
Vaccine was taken off the market.
Where did you find Marquis? Everywhere I looked said “long term backorder”.
My vet, who i am complaining about ironically, sourced it at MIZZOU for me. The intern there that examined my mare when i hauled in was a schoolmate of his, and because she had actually examined my mare, she was able to make the script directly to me.
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Ultra Cruz Vitamin E is available as an alfalfa-based pellet, if you want to try that. It actually may be slightly more economical than the powdered form.
If your horse is on pasture, a half-dose may be enough.
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My EPM horse got 10,000 IU of Natural Vit E daily. Not synthetic-something about the way it metabolizes.
Also dexamethasone and banamine during initial outbreak. We went with the cocktail rather than Marquis. Luckily he liked the vit E gelcaps. Easy to see if they were eaten.
A month in, expect a ‘treatment crisis’ as the protozoa die off and cause more inflammation.
He did relapse twice over 12 years before he passed at 30.
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Actually, I’ve seen several THO horses. Your vet’s initial diagnosis makes total sense. I’ve also seen many, many horses with EPM and a variety of symptoms and never seen the symptoms your horse had.
Good on the vet for making a reasonable initial differential list and recommending follow up diagnostics.
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If the vet who examined your horse at the university went to vet school with your vet at home, she was not an intern.
She was likely an internist with the normal 8 years of school, plus an internship, and residency.
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you’re right. She is a resident. I got that wrong.
There is a water-soluble liquid version of natural vitamin E that is rapidly absorbed and raises blood levels quickly, as in within hours. You give it orally, or put it on feed. Strong alcohol smell, though.
The other forms of natural vitamin E take much longer to establish therapeutic levels, days to weeks.
thank you! My issue will be getting it into her. If it’s not really simple and quickly edible then she’ll have too much competition. She lives in a herd in pasture. They do come into the barn occasionally, but not every day, and not reliably. If i go out to give meds, she’s going to very soon learn that me coming means me sticking something unpleasant in her mouth. I have her in a pen right now…for the 28 days of Marquis. But that will not be lasting her lifetime. I will need a way to get something into her that makes her happy. I’m thinking capsules squeezed onto a piece of alfalfa cube…that might work
