I’ve seen some similar posts but nothing quite what I’m looking for. So my horse was diagnosed with EPM about 1 year ago based on clinical signs. He was never severely affected. I actually took him in for his 6 month stifle injection and mentioned that he felt worse under saddle than usual, so the vet did a thorough exam and found neurological impairment.
A couple weeks into treatment with Rebalance he got much worse for about 10 days, which my vet said means he definitely had EPM as killing off the organisms can cause inflammation and worsening symptoms. After 2 months he was better but still not great, so we added Ponazuril (compounded Marquis) and Levamisole. He was better by month 3 but hating the taste of the Rebalance, so we stopped it and continued Ponazuril and Levamisole for a total of 6 months. The vet actually said we could stop treating earlier, but I kept treating just in case. So he got his last treatment in early July.
Then in November, only 3 months after stopping treatment, he seemed a little funny again. Again, mild symptoms like difficulty with balance in the canter or trouble negotiating steep downhill slopes on the trail, and lack of impulsion under saddle. Some of this attributed to him not getting the Cortisone injections in the stifles that we originally went to the vet for in January, and which he’d been relying on for the last 3 years to treat mild arthritis. His neurological exam was positive, worse than his last exam in the spring, but not as bad as when originally diagnosed.
So since my horse relapsed, we treated again with Ponazuril starting in November and continuing to today. He seems better again, not 100% but we know that EPM horses almost never are 100% normal again. Between the 1st treatment and relapse he moved twice and got leased out, so there was some serious stress (long story, I was in the hospital and had my own health crisis to worry about).
My vet said there is a ton of reinfection in this area, and she thinks reinfection is probably more accurate than to say he relapsed. He probably has a somewhat weak immune system and is susceptible to reinfection, so she wants him treated for the rest of his life. She only recommends Protazil as it has research showing that twice a week treatment long-term prevents reinfection. She actually only recommends Protazil for treatment, but as it was my previous vet who started me on the compounded Ponazuril (Marquis) she’s been ok with that so far. But she says there is no research on using Ponazuril for long-term maintenance or prevention so I need to switch to Protazil long-term. I can’t afford Protazil which is around $800 for a container. It would be cheaper to do the full treatment dose of Ponazuril (Marquis) forever than to do the twice weekly dose of Protazil.
Also, neither my current vet nor my previous vet had anything good to say about Orogin and told me that at veterinary conferences where they talk to the top experts in the EPM field, nobody has anything good to say about it. I’ve decided to trust these experts and stay away from that drug. I get my compounded meds through Rood & Riddle’s equine pharmacy, which is a very reputable place. It’s not like I’m importing sketchy generic drugs from overseas. Ideas? Anyone tried using a maintenance dose of any EPM meds for life? I’d love to hear what has or hasn’t worked for others. I love this horse and want to continue riding him, but I’m also not made of money and can’t just keep charging his expensive meds to my credit cards indefinitely.
