Insisting upon tests becomes easier the more you do it. Especially for X-rays - I happily pay on time, every time, and they don’t argue anymore 
. I usually just say “I need the X-ray on the truck, I want to take films of his feet/hocks/whatever” and leave it at that! I’ll let them do a lameness appointment and any tests they suggest, but always simply say “and I want his feet imaged/Lyme tested/pull for EPM”. No mention of the internet, no reasons, just asking for testing. Easy peasy!
3 Likes
When I had hind feet films done it was because I asked for them—there was no major bullnosing visible from the outside/nothing to indicate that my horse was as negative as he was, so our vet never recommended them. I told her that I wanted them for peace of mind. As soon as she took them and looked at the screen, she went “You wanted these to see if he was negative, didn’t you?” I said yes and that was that. The farrier was there that day so we called him over to look at the films, they made a plan, and two weeks later he was shod with his new setup.
It’s always great to have a vet who doesn’t want to make you spend any more money than necessary, but when you’re asking for it (and it’s as non-invasive as films), there’s no reason that they should refuse.
3 Likes
I will see what they say-I never explicitly asked for hind feet rads previously but rather more so asked “do you think we should look at his hind feet?” which they didn’t think so, so I think at this point they will take the rads for me now that I explicitly said I’d like to schedule the appt for them to be taken. It’s just a little nerve-wracking. I don’t want anyone to think I don’t trust their expertise! haha.
Getting hind rads next week-I suspect he’s negative NPA but I’m actually nervous that he won’t be and then I’ll have to go back to the drawing board lol.
1 Like
It’s funny how sometimes we are hoping to find something wrong!
It’s worth doing a little reading up on what normal hoof X-rays look like. (Broad generalization coming up, that is sourced from my personal experience). Vets often get a week, maybe two, of study of the hooves in school. Outside of major rotation/rotting coffin bone/huge abscess track/sloughing, some vets can be remarkably unconcerned about abnormal findings. I have been told by a practice that I generally respect that 0 degrees is “fine”.
0 degrees is NOT fine - 2-7 degrees is the more modern range. Generally you’re aiming for bony column alignment, so having the X-rays taken with BOTH hinds on blocks and the horse as square as possible is important. This may be obvious, but ask for digital copies of the X-rays sent to you so you can share them with your farrier (and COTH, if you like 
).
Anyway, do a little reading if you can. Trust your vet team, but they’re also human and have their biases - ultimately you have to advocate for your horse! The effect of hoof angles and health on the rest of the horse is something that we are just starting to understand.
3 Likes
Alright, while I wait for hind feet rads to be taken, I am looking into the other possibilities-EPM or PSSM. IF (and that’s a big if), I wanted to try and treat either of these without testing, is that possible?
I understand that for PSSM I can change his diet, which I am considering doing-however with the two different types of PSSM I don’t even know where to start with that.
For the possibility of EPM, I am assuming that you need a prescription for any medication to treat it? Or if that’s not the case, what would I give and is it safe to administer if they don’t have EPM? I don’t want to give him anything without testing if it could harm him to take without having the disease in the first place-but it may be easier to just treat and see what happens.
He is currently on grain, cocosoya, a large amount of vitamin E, along with a hoof supplement and probiotic.
I’ll wait for someone to chime in more, but a friend is dealing with EPM and there is no quick/easy fix or things to try. Medication is quite costly, treatment is lengthy, and unfortunately makes no guarantees.
@FjordBCRF is correct that EPM treatment is costly, lengthy, and may or may not totally clear the protozoa.
The good news is that I am unaware of any negative side effects from the meds! In fact, since the titer is not always a reliable indicator of an active infection (like lyme, a low but positive titer can simply mean the horse was exposed in the past and cleared the infection on its own, or it can mean there’s an active infection but the immune system is not raising a robust response), vets often choose to go ahead and treat a low titer and if the horse responds to the meds, it’s assumed that there was indeed active EPM.
The two meds used most often for treatment are Protazil (diclazuril) and Marquis (ponazuril). The brands of both are quite expensive (~$800-$1000/month in my experience) and I’ve been told that to really give your horse the best shot at clearing the infection, you should treat for 90 days (though the official recommendation for both of the above drugs is 30). The protozoa have a slow lifecycle and a 90-day treatment essentially ensures that the medicine hits all of them. If you don’t successfully get them all the first time around, the ones that made it through will just reproduce and start the cycle again. Some vets are willing to prescribe compounded (generic) diclazuril and ponazuril which is much cheaper but some vets insist on the brand.
There’s also a newer med that’s not FDA approved called Orogin (levamisole/decoquinate). It’s only a 2 weeks treatment period and a lot of people seem to have success with it. I don’t totally understand why it claims to be able to wipe out the population in only two weeks where ponazuril takes longer (ponazuril is also intended to kill the protozoa, where diclazuril just inhibits reproduction), but 
Toltrazuril is an older, cheaper drug in the same family as diclazuril that is also used, though anecdotally it seems to be less effective. I tried it with my horse for the first month of treatment, saw no change and switched to Marquis, which he had a pretty immediate response to.
2 Likes
That is super helpful, thank you! I am just going to add a blood test for EPM to our schedule when he gets the hoof rads done-obviously a blood test and radiographs are cheaper than a bone scan, so whatever. One last hurrah before I give up.
4 Likes
Hang in there. This stuff sucks but you’re not alone.
I’ve hesitated to post because I much prefer the lurker life on COTH but pulling myself out of the bellows to offer a working theory that I have. First a bit of background to give context: I’m a peds occupational therapist with training in neurodevelopmental technique, John Barnes myofascial release, and extensive experience treating biomechanical and neurological disorders in humans. I also practice JB MFR on horses, mostly TBs transitioning from the track following rehab from various injuries and beginning their retraining prior to adoption. Previous experience working at an equine rehab facility with a pool and water tread that allowed me to observe pelvic dysfunction in UL dressage, eventers, and SJers. The water treadmill was especially cool aa it allowed for overhead viewing and comparison to performance in the pool on a curve. And as a special interest I’ve reviewed countless hours of dressage in person and through live-streaming to study gait abnormalities across the lower and upper levels.
On to the theory! Humans have a righting reflex that has the body want to maintain midline for maximal protection, balance, stability, and mobility. You see this all the way from infancy into adulthood, as motor skills develop the eyes, the hands, and the trunk come to midline until you have the core strength to stabilize your core while mobilizing your limbs. My grad school professors drilled into us, “proximal stability, distal mobility”. Despite the best case scenario of maintaining symmetry starting at midline, our brain and our body adapts and allows for stability through compensatory positioning.
In doing bodywork with horses and observing many horses in action, I believe that horses also have this innate desire to be at midline. If there is deviation from midline it most often presents as asymmetry in the pelvis which travels up the spine to the poll. The horse’s body when on circle going to the right should make a C shape. Due to the asymmetry of the pelvis, say the pelvis is shifted forward on the right side, the hip is pointed to the right with the left shoulder bulging to the left and the poll towards the right. This makes the horse able to maintain a C shape to the right and an S shape when traveling to the left due to the large muscles of the hindquarter holding the pelvis in a stuck position.
Some signs I look for that can be assessed on the ground:
-ratcheting between the point of hip and stifle
-asymmetry in ROM with turn on the forehand
-short striding on one side (above example right hind will be short when going to the left)
-dropping the head and bucking into the non-preferred canter lead
-asymmetry in the shoulders (in the above example the left shoulder would be larger)
-discomfort in the ribs, pecs, shoulders with palpation
Disclaimer that I am not a vet and would continue to rule out NPA and other medical abnormalities. I’m happy to review video of your horse that could point out if this MIGHT be contributing to your horse’s lameness.
4 Likes
This is awesome, thank you! I appreciate you taking the time to get these thoughts down. So, if there is asymmetry in the pelvis-would a chiropractor be able to tell this? How would it be fixed (if it can be fixed)?
1 Like
Alright! New update-
Took rads of the hind feet this morning. Waiting on the official degree (vet has to measure once she gets back to clinic) but it is negative. We had tried putting frog pads on his hinds this last shoeing which I think is contributing to why he has gotten even worse, since every other change should only have made him better (ie his injections). My vet had initially before the other injections thought that the NPA wouldn’t be an issue-they said most ottbs do have NPA but it doesn’t typically cause problems as severe as this. After trying frog pads and noticing his behavioral changes and seeing the injections didn’t work, they are all for trying to change the angle and see if that will help him. Luckily he has good sole depth, so we are hopeful that will help us make the changes. I understand this isn’t a quick fix and will take a while to get right.
I had asked to draw blood for EPM, and my vet did, however in speaking with them on the phone they mentioned they also took some hair samples to test for PSSM if I want to. I have never mentioned this possibility to them before, so I am glad that they mentioned this on their own and that it coincides with a few others on here bringing it up. Vet thinks it is more likely PSSM than EPM, so because this is all getting pretty expensive I opted not to test for EPM yet and instead test for PSSM.
Also going to change his feed for the time being while we wait on results.
4 Likes
-4 and -5 degrees in his hinds. wow!
WOW! So what do you do going forward?
I’m not going to say wow because my horse was -4 in his right hind so I am unfortunately way too familiar with the consequences of that lol, but I really think you’ll see a big difference if this can be addressed!
Our farrier stays up to date on continuing education and he said right now there’s some debate on whether you actually do need to be totally positive with the angles if the horse’s conformation dictates otherwise, but he’s talking 0 or -1 degree, not -4 or -5.
I hope your farrier and vet are willing to work together on this. We put my horse in wedge pads with frog support (you need it to grow heel effectively) and it helped him almost immediately. The most difficult part was honestly just getting him used to the new way of going—he’d feel lame every time I picked up the trot til he did a few laps and realized he could actually push from behind, and then he’d lift his back and get comfortable. It took a few weeks to really settle but it’s done wonders for him (and so has our farrier).
Sending you good vibes for a little bit of magic on this, it’s such a simple thing but it can truly change everything for them!
2 Likes
Well, it’s going to take a while but my farrier was actually at the barn while my vet was so they were able to chat. My vet is a little wary of doing wedge pads right off the bat and the frog pads seemed to make him much worse, so we’re going to use that sole depth that we have to hopefully just slowly trim him up differently. If that doesn’t do the trick then we’ll start trying different pads.
What did you put under the frog pads? Pour in? DIM? Magic cushion? A lot of horses can’t handle the sole pressure of pour in or some of the sole packing materials, and they need something softer. Even the softest equipak was too much for one of mine. Sometimes you have to experiment a bit to find what works, with the packing and the pad material itself.
Also, -4 and -5 is BAD - no wonder he’s so uncomfortable!! That’s like walking around with your high heels on backwards 24/7 and being asked to workout. Good luck!
2 Likes
I’m honestly not sure-I haven’t had a chat with my farrier yet. I should know, but I didn’t realize there were different things you could put under the frog pad so I never thought to ask!
Oh yes! I had to haul one back 3 days later when he got so much worse with a harder packing. Now we just default to the softest option the farrier has that day - usually DIM.
