I can’t comment re: Pathogenes–I used compounded Diclazuril–but I can comment on the Immubiome. I saw no difference, and had a hell of a time getting my horse to eat it. Finally gave up about 3/4 through the container because it was a daily battle to get him to finish even with it slathered in molasses, peppermint syrup, mixed in two POUNDS of chopped alfalfa and molasses, etc. He just straight up stopped eating any sort of grain with even a quarter of the dose in it. I saw no improvement and decided the sheer quantity of sugar needed to get him to eat it couldn’t be good for him, either.
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Lol I also ended up throwing out a full container when I started my EPM journey. Horse is one of the least picky eaters I have ever had and I could not for the life of me get him to eat it. At the end of the day I have a hard time believing any unproven supplement will be a miracle cure anyway. Just keep loading them up on vitamin E.
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I have a friend whose mare is on daily levamisole for polyneuritis after having the most success with dec/lev for EPM. Her mare had been on the levamisole it for quite some time now, months, and anytime she tapers back, symptoms come right back.
There is a Facebook group I’m in with a vet that is not Dr Ellison…maybe they are colleagues or something. But has a lot of experience with EPM, and he pushes Dec/lev as basically the only treatment worth doing. A lot of people seem to have success but when I was deciding on treatment, the reason I started with Marquis was because it had testing done and had the best safety profile.
I feel like Protazil is very effective. My vet recommends doing a round once a year.
But honestly I put them all on Vitamin E regardless of if I’ve tested them, even if it’s just like 500 IUD.
I did the dec/lev for twice the recommended time which seemed to help the most. My mare also had polyneuritis in addition to her EPM. What’s seemed to help the most was treating her for Lyme and Anaplasmosis this spring along with adding a liquid vitamin E supplement.
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Do you remember what you treated her with for the Lyme and Anaplasnosis? So glad to hear she’s doing well!
9 days of iv doxycycline I believe. The protocol called for 7-10 but her catheter and her patience wore out at day 9.
I’m not super familiar with polyneuritis, but it looks like treatment is usually steroids. Given that steroids suppress the immune system, maybe they’re using the immune suppressive effects of long term levamisole to accomplish the same thing? But that doesn’t mean it’s safe or a good idea to use long term in every horse.
Yeah, there are certainly all sorts of places online where vets or doctors practice and tout medicine that is not evidence based. It’s always so tough to sift through because those groups either tend to be self selective toward supporters, or outright block/ban those that have a different viewpoint. All the groups believing ivermectin is the one true answer to covid come to mind.
There are a few things that stand out for me about the whole EPM drug thing:
The newer drugs that we do have data on–Marquis and Protazil–required blinded review of rechecks after treatment, and those blinded reviewers reported less improvement than the non blinded reviewers. Isn’t that amazing, how easily bias could impact the non blinded reviewers? These are vets that have specific training in neuro exams, presumably trying their best to be impartial, and they still thought the treated horses improved more than the blinded reviewers.
If blinding impacts the report of results so much, how on earth can we expect generalist vets who may or may not have specific expertise or interest in neuro exams to be unbiased, and even moreso if we’re expecting owners to report back on outcomes??
We just have no idea how decoquinate/levamisole compares to those trials, because it’s never been measured by the same yardstick. Dose and duration is apparently all over the map, and we really don’t even know what long term adverse effects might exist.
I think it’s … curious … that no vet grad student has run a well designed study to investigate. Ellison and this treatment option seems to be pretty much ignored by the main stream EPM literature, although that hasn’t always been the case.
Ellison has also published (most/all?) her work in a single journal. I’m not savvy enough to understand if it’s a pay for play journal, or if it’s really peer reviewed…but it’s certainly not where the other EPM work gets published, and that just raises more questions (esp along side the FDA letter that calls her entire study designs and conclusions not adequate.) That journal also isn’t picked up by pubmed, which…not all are…but just adds to the hmmmmmm level, ykwim?
To be clear, I am not saying that decoquinate/levamisole doesn’t work. I obviously don’t know. But we have just no data on it…on how well it works, or what dose should be used, or for how long, or what the risks are, or how it compares to our other treatments. It’s all just flying so blind, relying on anecdote that has such a heady risk of being very influenced by just a huge amount of confirmation bias.
I also think a lot about how my mare was knuckling over and clearly neurologic, but improved over 2-3 days entirely on her own (while we were waiting for the vet–she did get testing & treatment.) It freaks me out that if I’d skipped picking out her feet for a couple days, I very likely would not have seen anything wrong. And it makes me wonder, at least a little, if there’s an ebb and flow to symptoms, and if that might make identifying treatment “success” a little harder.
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I don’t disagree with anything you’ve shared! If it weren’t for my friend being between a rock and a hard place (basically put the horse down or try those meds) I wouldn’t have thought twice about cruising right past that group. Anything to me that’s THIS IS THE ONLY WAY is highly suspicious, and that is how that group in particular comes off. Having stuck around, it does seem a lot of horses do have pretty good success with that combo, but I’d feel a lot better making that decision to try it if it had thorough research backing it up. Why no one is doing to research is beyond me 
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Yes, totally! I just wish there was more data. Like goddamn, EPM is such a bitch, and this is a possible tool, can’t we at least actually study it so we can all make educated decisions on when and how to use it?? Why is that not happening?
And no shade to your friend, it’s fab she found something that worked for her horse. It’s not what I would try first either but after no success with other therapies? Sure, throw it at the wall and see if it sticks. When you’ve run through the more known entities, take that shot in the dark.
Ugh, one day we’ll know more. Hopefully!
Completely agree. I don’t know how many months they did of both Marquis and Rebalance but they did several rounds of each and it wasn’t until they did the Dec/lev did they finally start seeing improvements.
If I knew what I know know, I would have pursued a different career path 
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