Possible EPM?

[frugalannie]

Have a 9 yo OTTB mare with confounding signs and symptoms. EPM is our “Hail Mary” diagnosis. If that isn’t the cause, we will have to euthanize. So I’d love to hear EPM stories to keep me optimistic until we get teat results back Weds or Thurs. Sorry for the length of this

Mare came from the mid-Atlantic, now in New England. Raced until late in her 8th year when I was lucky to get her. Sound, sensible and a love bug. I gave her the winter off, then started gentle legging up and introducing non-racing concepts. She’s an apt student, and was going along nicely.

In Feb, while being tacked up, she did something weird: kind of like a cat stretch, but her forelegs under her, knees bent. I slapped her belly, she got up and we had a nice ride. Then 3 weeks ago, I was tacking her up again, turned to get her bridle and she chested the stall guard (I wasn’t using crossties) and then crumpled. There’s no other word for it. She rocked back on her hind legs, knees bent and all four legs crumpled such that her sternum hit the ground in slow motion. I got her up, and she stood there shaking for 5 min and then seemed fine. Vet came a day or so later, and could find nothing but a couple of cardiac blocks lasting 30 seconds or longer, but inconsistent. During these episodes, no pain response noted: ears up, no tail swishing, eyes open, not sleepy. Decided on a cardio consult, but vet #1 came back the day before the consult and heard the block again. (And a dear friend vet (#2) who has a post doc in equine internal med, but retired, also came for a listen and heard nothing notable).

All blood panels normal and Lyme panel negative.

Cardio vet (#3) came, did EKG, tested her pre and post exercise and said her heart was like a Swiss clock it was so regular. Said no need for an Echo because there was nothing wrong on the day, so longe her for two weeks and then have vet #1 come and recheck her. During the longeing I was to listen to her heart pre, post and halfway through. Mostly I heard normal rhythm, maybe once a little racing but that was it. During the two weeks another vet was in the barn for vaccinations and examined her (vet #4). All normal.

At two week visit, vet #1 came, noted mare’s muscle tone was elevated, and she was antsy, but heart perfect. Trotted her in hand and heart perfect, so I was given the go ahead to ride. Vet left and I decided to longe her one more day instead and was getting her ready when she crumpled again. I got her up and she did it a second time, and then almost went all the way down a third time, the last witnessed by two barn mates who heard me yelling. This was within 20 min of the vet leaving, so I called her back and hustled the mare outside where she seemed fine. Vet returned within the hour, drew a cardio tropinin (which was negative) and re-examined mare. Heart rate was disorganized (which I had picked up after fall number 1 that day), otherwise horse not as antsy, neuro exam normal but she was headshaking, which she had never done before.

I called the vet who had checked her over for me prior to my getting her to see if she had any insight (yes, advice from a 5th vet). Her recommendation was to test for EPM and initiate treatment with Marquis because that’s quite common where the mare came from. So next day vet #6 came out, examined her, couldn’t appreciate any cardiac abnormality, drew EPM test and provided a tube of Marquis. This vet even put a surcingle on and tightened it up to se if there was any effect and there wasn’t.

I believe the mare has gone down unwitnessed because at least twice she’s come in from turnout with knees and fronts of fetlocks scraped, which is what happened when she did it witnessed.

As she is, mare is unsafe. We are being very, very careful bringing her in and turning her out, but other than that everyone is to stay clear lest they get pinned. I am absolutely heartbroken but hoping for EPM because at least we can treat that and give her a chance.

If you’ve made it this far, thank you for reading my booklet. If you have any ideas they will be appreciated. And please keep your fingers crossed and curb chains jingling. I don’t want to euthanize this lovely horse but may have to for safety’s sake.

[jherold]

My mare had epm and poly neuritis. Symptoms were weird. Crabby, girthy, sensitive to grooming (worse on the left side), and would stand like on a tight rope behind. Looked and felt sound. Did all the usual, saddle fit, ulcers etc. Most if it was behaviorial, but was very sore for chiro and body worker. Did saddle fit, ulcers, etc. Did epm and lyme tests as last thing to try too. Came back positive for epm. My vet used Pathogenes Lab for diagnosis and medication, Orogen and lavamasol. She got completely better for about 6 weeks, than the polyneuritis started up. Got better but it came back again. Finally retreated with both orogen and lavamasol again over the winter. Got better, but it wasn’t until recently when I added bodywork that she is finally back to my sweet mare. The working theory is that the epm and inflammation created restrictions and overall muscle soreness.

If your mare is positive for epm and doesn’t get better on Marquis, try the Pathogen protocol. It is my understanding that there are 3 types of the protozoan that cause the disease and marquis only treats one type. Plus Oragen and lavamasol are a lot cheaper! Fingers crossed that this is her problem.

[No1]

She could be narcoleptic.

24 hour surveillance with a video camera might be helpful to see what she’s doing when no one is around. You can send her in to a clinic for it to be done.

There are ways to manage narcolepsy, if that is what is going on. If I remember correctly, there was an upper level event horse who was narcoleptic.

[Pezanos]

Agree on the camera suggestion. If you have wifi, a Blink or similar camera is super cheap and the video footage is valuable. I had a horse with a recumbent sleep disorder and he also collapsed. He also had very bad kissing spines- we don’t know if it caused the sleep disorder because it hurt to lie down or whether the constant collapsing jammed his spine. If EPM test is negative, maybe xray the spine to see if there is some devastating impingement that’s causing her to go down.

I’m really sorry you have to go through this. It sounds terrible for everyone involved.

[Spud_amp_Saf]

My TB with EPM started doing this exact thing in the cross ties. At first, I thought it was narcolepsy/sleep deprivation/vagus nerve issue with the girth. Looking back, this was one of what I would say was the earliest of his neuro symptoms, combined with having difficulty with having his back feet trimmed.

[frugalannie]

Thank you all for your suggestions. Working on setting up a camera (mo wifi at the barn, so I’ve got to figure that out first). And @Spud_amp_Saf, your horse had the same presentation? How did he do with treatment?

[mfglickman]

Both of my horses had EPM and I am in New England, horses had been with me 2 and 6 years. Lots of opossums up here too.

Younger horse 4 yo was nqr, kicking out and bucking and sucking back and crow hopping when asked to canter, vet suspected stifle and attitude, trainer agreed, daughter (rider) insisted she was trying to tell us something and that she felt A TON worse than the video showed. One day in a lesson she kicked out when asked to canter, went down on her knees, my daughter fell and 2 years later is still dealing with effects from the concussion. (She didn’t even hit her head - doctor said it was the shock of the brain hitting the inside of her skull, ouch…)

We treated 60 days with Marquis, used Elevate liquid vitamin E 8,000 iu/day (she’s small, 13.3-14.0) and Eclipse PM. Slow and easy return to work after treatment, during treatment vet suggested light riding but mare was definitely not safe so we just let her chill, with normal turnout.

The older mare was complicated since she also had chronic Lyme. She was resistant to picking up her feet and seemed wobbly sometimes just standing or walking. Treated 60 days with Marquis, Emcelle 8,000 iu (same product as Elevate, much cheaper), and Immubiome Spine & Nerve. She also got Banamine for the first 2 weeks, lesson learned after poor younger mare clearly suffered from the die off of the Protozoa, which I wasn’t aware of.

Both mares lost hind end muscling seemingly overnight. Older mare is now retired after all this, and had to be treated for Lyme too, but my daughter was able to hop on bareback and walk around the fields with her last week, for the first time since early last Summer. It was so nice for them - mare is her first pony and forever best friend, and I think it did the mare a world of good to still have some “work” to do.

So far, so good. I won’t ever have them somewhere that doesn’t religiously keep grain sealed and stored, and I won’t ever put hay on the ground outside again. Their water is inside and they have walkout access to paddock/field. That’s just me. I realize they could have gotten it from a possum that walked through the hay field or one that wanders through the field at night; I just try to control what I can.

Join the EPM group on Facebook if your mare has it; there’s an equine nutritionist who consults for free to help develop supplement / supportive plans for EPM horses.

[Spud_amp_Saf]

Unfortunately, my horse was not a candidate for treatment. He was essentially too far gone before we got to the diagnosis and had other factors such as being unable to be stalled (so accomplishing treatment would have been extremely difficult), and had become dangerous to handle even on the ground. EPM is not prevalent in my area, so it was further down the list of diagnostics and took a while to get there.

If I ever had another horse exhibit neuro symptoms of any kind again, I will insist EPM be on the testing list right away.

[Pezanos]

If no wifi in the barn, you can buy a wifi hotspot and use that for internet. That’s what I did. It was pay as you go and I did use about $100 worth of data for the month that I was filming overnight but I considered it money well spent. Now they have pay as you go cameras but I liked having the flexibility of the separate wifi hotspot.

[NaturallyHappy]

Can you share more about the Immubiome Spine and Nerve? Thank you.

[mfglickman]

It was recommended to me by the nutritionist on the EPM forum on FB. It is aimed at repairing normal nerve function and response that are damaged with EPM. I did feel that she improved with it, and I had her on it for about 6 months.

It’s a small quantity of a very fine powder; I usually dampen grain anyway (older mare was choking as a neuro symptom) and that also made it stick. She didn’t seem to mind the taste or consistency mixed in like that.

[greywithchrome]

I’ve heard of this kind of thing before. Horses that essentially faint when the girth is done up. Some end up having no issues if it’s done up very very slowly and carefully, or if a sheepskin cover is used, etc.

Obviously, rule out neurological issues. The fact that it seems like she may have gone down at times when tack was not involved suggests it could be neurologic or narcolepsy.

[Paint_Party]

What you wrote is very informative and detailed. I’m so sorry that you are faced with such a puzzling and troubling issue.

@frugalannie

This vet even put a surcingle on and tightened it up to se if there was any effect and there wasn’t.

Have these acute “crumpling” symptoms only occurred when she’s in the process of being tacked up or saddled? The distribution of weight and pressure on the spine/back is so much different with a surcingle vs. an actual saddle. Wondering if this could be a spine/back issue rather than EPM.

[frugalannie]

Paint_Party, that’s a good question. Two crumples with saddle on, separated by a month. Three crumples in one day with surcingle on three weeks later. In neither case was the tack tightened all the way and no incidents despite surcingle being put on every day in between. Neither has been reproducible. I strongly suspect that there have been at least 2 unwitnessed episodes because she came in from turnout with the exact lacerations on her fetlocks and knees as she had a result of the witnessed falls.

Chiro/ acupuncture vet can’t find any issues with her spine and neuro exam has been normal, even immediately after the three fall incident.

Trying to find a path to clarity re: safety for horse and humans. I’ll be traveling through the weekend, and I hope it’ll give me the perspective to work this out.

[frugalannie]

And thanks to all of you for your thoughts and suggestions. They really have been more helpful than you know.

[2tempe]

You mentioned that spine and neuro exam were normal, but I would suggest a good set of xrays of the neck and back. Cervical arthritis comes to mind, and there could be nerve impingement. And perhaps, given her long career, some injury may show up.
I’m also puzzled by the inconsistency of the heart evaluations, and a heart ultrasound may be worth the time and money. Can you take her to a good clinic/vet school and have a full workout done?

I had a TB some years back who had both A-fib and a murmur; it did not bother him for a good number of years but ultimately it caught up with him. Ultrasound took measurements of the heart and there was mild enlargement. He also had cervical arthritis starting around 21. Neuro symptoms but different than your mare. Injections helped for a couple years, then I quit riding him.
good luck, these things pretty well suck…
edited to add: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1939-1676.2010.0610.x Not trying to scare you but this is worth reading.

[Victorious]

I don’t know much about EPM, thankfully, but what do you mean about the protazoal die-off? Is that a painful process? Adds toxicity to the blood? Your experience sounds so awful, I’m sorry you had to go through that twice and same to you, OP. I’m really jingling for you

[Sdel]

I don’t know if this helps but we had a horse put down at my barn this week that was starting to just randomly crumple to the ground. He had S. neurona titers that were off the charts high.

[IPEsq]

The Protozoa are in the spinal fluid when the horse is symptomatic (not all ingested EPM Protozoa likely make it there, but they is the location of the infection the drugs target). If you have a lot of them and start killing them quickly and effectively, it can worsen symptoms until the body clears them. Not that unlike treating parasites in a high worm load horse, but with most of those, you are only dealing with organisms in the GI tract.

[frugalannie]

Mare’s titer came back 1:500. Not unusually high, and still unclear if that would cause her to fall. She will start her second tube of Marquis tonight, but there has been no change in her for better or worse. She has retained her topline and her haunches are decently muscled (no loss of muscle at all.)

Two of the vets have suggested a gastroscopy as a last ditch effort, so one has been scheduled for May 18 (soonest date). If mare keeps looking happy and healthy, we will do it. If she looks ill or falls become more frequent other decisions will have to be made.

I truly thank you all for your kind thoughts and suggestions. Only horse people really understand this kind of situation!