Treating for EPM, without confirming its EPM (or Lymes)

[Empressive_Award]

Recently saw a FB post, and have had this same discussion with other long time, knowledgeable horse people regarding treating a horse who seems mildly “not right” for Lyme or EPM, and success stories.

Some background. I have a 14 year TB I have had for 11 years that I adopted as a neglect case. I know her VERY well. She has always been an easy keeper and fat, and often has lived in a grazing muzzle when the pasture has been excellent.
This spring we struggled with her not being in front of the leg, lacking energy, etc. We switched diet and changed out exercise routine and that seemed to help. We started our dressage season with very decent scores 66-68% at 1st level- first time at the level). Around May she started looking ROUGH, meaning balding patches of hair, shedding out unevenly, bleached out in spots, much slimmer, not really well muscled and lacking topline. I chalked this up to missing something in her diet, and immediately switched her to a higher fat/protein grain and RB. Things seemed to get better, but then the objecting to work started, back soreness, unwillingness to move back in a rein back, topline not developing. We did saddle fit check 3 times, Magna Wave, massage, SI injection, literally everything to treat body pain. Her feet are great. Full vet evaluation revealed no other areas of concern with her body other than SI pain and slight soreness in her back. He did not feel she was underweight, and was at a good weight, just lack topline.

So now, here we are moving to September and done with our dressage season which saw our scores drop into the low 60s, and our tests became dull, utterly lacking connection and throughness. When I am riding at the trot, every once in a while she will take a weird step with her hind that feels like a stumble, or a foot landing in awkward footing, still no effort in the rein back, tightness in her back. At one point in our test last weekend, across the diagnoal during a lengthening, she stumbled with her hind end quickly recovered.

She has previously been tested for EPM and Lymes a few years back and on multiple occasions was negative. I don’t know if these signs I am seeing the past few months are a milder symptom of either disease and I should have the vet do bloodwork and treat regardless of outcome, or if I need to refocus my energy on basics and conditioning to rebuild proper muscle and balance for her and I both, and hopefully alleviate these things( I’m an amateur rider on a self-made horse taking lessons weekly, so I have some concept of “correct” as far as how she should be going vs how she is going). This mare is so STOIC its hard to figure out anything thats going on.

The article I read on FB was about a rider who’s endurance horse was treated with EPM meds without an official diagnosis, and dramatically improved and resolved his back pain (not sure which meds were used). Much of his symptoms were related to his back, lack of energy/forwardness, soreness etc. I have also heard other stories of people doing a 30 day cycle of doxy when their horse starts showing symptoms similiarly.

Has anyone had experience in this “alternative” preventative medicating with a horse who seems to have a decline in performance and loss of topline and overall muscle soreness, but isnt positive for EPM or Lyme? or just treating without confirmation? Which did you use, and did you skip vet confirmation/bloodwork etc?

Teeth are done
saddle fit checked 3 times in the last 6 months
different saddle used, same results
on ulcer supplement and vitamin E + multi vitamin

TIA!

[candyappy]

Is there a reason you won’t have her vetted and confirm EPM or Lyme disease first before treating?

Has she been checked by a vet at all during this period you describe? If she has , sorry I missed it in your post.

[Empressive_Award]

Yes her regular bloodwork was normal, vet did full lameness/ full body check and diagnostics. We injected her SI. Each time I have done the testing for Lyme and EPM it was negative. I have already spent well over $1000 in the last 4 months on managing her body soreness, I am just a bit hesitant to do the labs again for $400+ and get negatives and be back to square one, so I was more or less looking for stories of those who maybe also had negative results, but still treated and saw an improvement in similar symptoms.

I am also looking at Vitamin E deficiency as the pasture she is on right now is much more poor quality than our previous boarding situation, and my only option to to supplement with additional hay and supplements. Moving her to another facility isnt an option right now, as there arent any available.

[OverandOnward]

Right now is the only time to test and know for sure if she has EPM right now.

If you treat first, and in a few months either test or try to judge by any change in condition, you will still not know if you treated EPM, or wasted the EPM treatment on something else.

[RichardX]

I had a horse with EPM (almost certain) 3 years ago. A few things about EPM:

1. I’ve never heard of EPM causing hair loss or uneven shedding, but that doesn’t mean much.
2. My TWH showed ataxia (lack of coordination) in hind legs. That was the final give-away to call out my vet on an emergency basis.
3. She was 4-1/2 years old, and seemed to stop developing - especially glutes and top line.
4. I had had the impression - for 6 months - that something was “wrong” with her. She did all I asked her to do, learned what I taught her, and minded me well. But with every horse I had ever bonded with before, as I told my vet, I could peg them within a week or so as: lazy, feisty, happy, sassy, wild, stubborn, irritable, sensitive… whatever. With my mare, I couldn’t peg her personality - at all. It was like nobody was home. My vet told me, “that’s a symptom of EPM. It depresses the horse’s entire CNS.”
5. The only way to be 100% sure of EPM is to perform a spinal tap. Expensive and risky. But there’s an easier “quick check”. Give her twice daily doses of about 10 cc’s of oral (not IM) banamine, to alleviate pressure and inflammation on the brain and spinal cord. If you see improvement in under a week, it could be either Lyme OR EPM (I think). But a vet should be able to diagnoise EPM with: 1) tail pull tests, 2) circle pulls, 3) palpitation and limb manipulation, 4) putting a hand near her “naughty parts” to see if she “tucks under” in reaction, as EPM often causes lack of sensation in the hind quarters, and 5) a “fake fly” test: take a stiff piece of straw and poke her all over, especially hindquarters, to see if the skin flinches as it normally would when a fly lands on her.
6. There’s good news on EPM treatment: The product “Marquis” works wonders. A one month supply is around $800 (I did it for 2 months with my mare). Once daily oral administration, along with banamine, in the beginning.
7. With my TWH mare, I was overseas when she was diagnosed. I returned a week later, after my vet (and friends) had started her on Marquis and Banamine. When I got home (a week later), she was a completely different horse: sassy, bratty, vocal, spoiled, etc. I almost cried. The vet told me that was the effect of the banamine, as the Marquis was only beginning to kill the protozoa that were attacking her.
8. In the beginning, my vet gave her a neurological grade of 3 (0 is perfectly healthy, 5 is unable to stand or walk). She said to expect a “1-grade” improvement with the Marquis. After 2 months, my vet said she was a neurological grade 0 to 1.
9. Forgot to mention: if it’s EPM, she needs about 4,000 IU of Vitamin E daily (no selenium) in the beginning of treatment. Then, as further care and prophylaxis, 2,000 IU per day is good.
10. A friend of mine at my stable had a horse diagnosed with EPM several years earlier. He opted for another treatment: Karbo Combo. KC is a great product for overall horse health, including gut / colic, blood diseases, and even parasites. But his horse would never canter again. On the other hand, my TWH mare went on to become a not-too-shabby barrel racer, jumper, pole bender, and cow sorter as well as having a lovely canter, gallop, and running walk.

That’s my experience with EPM. I have no experience with Lyme disease. Maybe other forum members can shed light there.

Get your vet to do a neuro exam fast! Good luck!

[AKB]

I would have the vet do a neuro exam and send blood to Pathogenes in Florida. Their SAG labs labs are inexpensive. If she tests positive, you can treat with their, inexpensive med, Orogin or treat with Marquis or Protazil. My horse was not right 3 years ago. Vet number 1 found nothing. Vet number 2 saw his very crooked tail and sent blood to Pathogenes. He was very positive for EPM. A few days after starting meds, his tail was straight. His behavior was normal. He has remained healthy during the past 3 years.

[OneTwoMany]

@RichardX

I had a horse with EPM (almost certain) 3 years ago. A few things about EPM:

1. I’ve never heard of EPM causing hair loss or uneven shedding, but that doesn’t mean much.
2. My TWH showed ataxia (lack of coordination) in hind legs. That was the final give-away to call out my vet on an emergency basis.
3. She was 4-1/2 years old, and seemed to stop developing - especially glutes and top line.
4. I had had the impression - for 6 months - that something was “wrong” with her. She did all I asked her to do, learned what I taught her, and minded me well. But with every horse I had ever bonded with before, as I told my vet, I could peg them within a week or so as: lazy, feisty, happy, sassy, wild, stubborn, irritable, sensitive… whatever. With my mare, I couldn’t peg her personality - at all. It was like nobody was home. My vet told me, “that’s a symptom of EPM. It depresses the horse’s entire CNS.”
5. The only way to be 100% sure of EPM is to perform a spinal tap. Expensive and risky. But there’s an easier “quick check”. Give her twice daily doses of about 10 cc’s of oral (not IM) banamine, to alleviate pressure and inflammation on the brain and spinal cord. If you see improvement in under a week, it could be either Lyme OR EPM (I think). But a vet should be able to diagnoise EPM with: 1) tail pull tests, 2) circle pulls, 3) palpitation and limb manipulation, 4) putting a hand near her “naughty parts” to see if she “tucks under” in reaction, as EPM often causes lack of sensation in the hind quarters, and 5) a “fake fly” test: take a stiff piece of straw and poke her all over, especially hindquarters, to see if the skin flinches as it normally would when a fly lands on her.
6. There’s good news on EPM treatment: The product “Marquis” works wonders. A one month supply is around $800 (I did it for 2 months with my mare). Once daily oral administration, along with banamine, in the beginning.
7. With my TWH mare, I was overseas when she was diagnosed. I returned a week later, after my vet (and friends) had started her on Marquis and Banamine. When I got home (a week later), she was a completely different horse: sassy, bratty, vocal, spoiled, etc. I almost cried. The vet told me that was the effect of the banamine, as the Marquis was only beginning to kill the protozoa that were attacking her.
8. In the beginning, my vet gave her a neurological grade of 3 (0 is perfectly healthy, 5 is unable to stand or walk). She said to expect a “1-grade” improvement with the Marquis. After 2 months, my vet said she was a neurological grade 0 to 1.
9. Forgot to mention: if it’s EPM, she needs about 4,000 IU of Vitamin E daily (no selenium) in the beginning of treatment. Then, as further care and prophylaxis, 2,000 IU per day is good.
10. A friend of mine at my stable had a horse diagnosed with EPM several years earlier. He opted for another treatment: Karbo Combo. KC is a great product for overall horse health, including gut / colic, blood diseases, and even parasites. But his horse would never canter again. On the other hand, my TWH mare went on to become a not-too-shabby barrel racer, jumper, pole bender, and cow sorter as well as having a lovely canter, gallop, and running walk.

That’s my experience with EPM. I have no experience with Lyme disease. Maybe other forum members can shed light there.

Get your vet to do a neuro exam fast! Good luck!

Yikes!

[Dutchmare433]

I PMed you more specifics. But basically my vets would not treat without a positive titer. They were correct and at least saved my from having to pay for unneeded treatments. After a second opinion from a specialist in another practice, we got a diagnosis and treatment plan.

[OneTwoMany]

@Empressive Award

Recently saw a FB post, and have had this same discussion with other long time, knowledgeable horse people regarding treating a horse who seems mildly “not right” for Lyme or EPM, and success stories.

Some background. I have a 14 year TB I have had for 11 years that I adopted as a neglect case. I know her VERY well. She has always been an easy keeper and fat, and often has lived in a grazing muzzle when the pasture has been excellent.
This spring we struggled with her not being in front of the leg, lacking energy, etc. We switched diet and changed out exercise routine and that seemed to help. We started our dressage season with very decent scores 66-68% at 1st level- first time at the level). Around May she started looking ROUGH, meaning balding patches of hair, shedding out unevenly, bleached out in spots, much slimmer, not really well muscled and lacking topline. I chalked this up to missing something in her diet, and immediately switched her to a higher fat/protein grain and RB. Things seemed to get better, but then the objecting to work started, back soreness, unwillingness to move back in a rein back, topline not developing. We did saddle fit check 3 times, Magna Wave, massage, SI injection, literally everything to treat body pain. Her feet are great. Full vet evaluation revealed no other areas of concern with her body other than SI pain and slight soreness in her back. He did not feel she was underweight, and was at a good weight, just lack topline.

When I am riding at the trot, every once in a while she will take a weird step with her hind that feels like a stumble, or a foot landing in awkward footing, still no effort in the rein back, tightness in her back. At one point in our test last weekend, across the diagnoal during a lengthening, she stumbled with her hind end quickly recovered.

She has previously been tested for EPM and Lymes a few years back and on multiple occasions was negative. I don’t know if these signs I am seeing the past few months are a milder symptom of either disease and I should have the vet do bloodwork and treat regardless of outcome, or if I need to refocus my energy on basics and conditioning to rebuild proper muscle and balance for her and I both, and hopefully alleviate these things( I’m an amateur rider on a self-made horse taking lessons weekly, so I have some concept of “correct” as far as how she should be going vs how she is going). This mare is so STOIC its hard to figure out anything thats going on.

The article I read on FB was about a rider who’s endurance horse was treated with EPM meds without an official diagnosis, and dramatically improved and resolved his back pain (not sure which meds were used). Much of his symptoms were related to his back, lack of energy/forwardness, soreness etc. I have also heard other stories of people doing a 30 day cycle of doxy when their horse starts showing symptoms similiarly.

Has anyone had experience in this “alternative” preventative medicating with a horse who seems to have a decline in performance and loss of topline and overall muscle soreness, but isnt positive for EPM or Lyme? or just treating without confirmation? Which did you use, and did you skip vet confirmation/bloodwork etc?

Teeth are done
saddle fit checked 3 times in the last 6 months
different saddle used, same results
on ulcer supplement and vitamin E + multi vitamin

TIA!

We recently had a horse that has many of the symptoms you describe. He was a relatively young horse that we had since he was green broke. He was in a normal work program, but he wasn’t developing a hind end like most horses would. We increased the work load and that helped, but his hind end continued to lack the ideal musculature development and he would stumble occasionally. We had our lameness specialist look at him more than once and eventually the lameness specialist referred us to an internist. The internist conducted a variety of tests to rule out; vitamin E deficiency, EPM, Lyme, spinal compression and a few other things. All the tests came back negative. Finally he underwent a muscle biopsy. The biopsy came back positive for a muscle condition which needs to be managed with diet and exercise

The morale of the story is, there are a lot of things that could be causing the symptoms you describe. I would suggest it may be beneficial to get a specialist (not a generalist) involved and allow them to start ruling things out. A negative Lyme titer or EPM titer isn’t putting the horse back at “square one”. The negative tests are simply ruling out possibilities or likely possibilities. Ruling out possibilities is a step forward toward identifying the underlying cause of your horse’s symptoms.

More specific to your question of treating with Marquis or doxy without a “positive” diagnosis, we have worked with vets that have suggested a course of Marquis to “rule out” EPM or a course of minocycline (our vets prefer it to doxy) to rule out Lyme, when the lab tests have been inconclusive. We have never had a vet suggest medicating a horse with Marquis or doxy/minocycline for possible EPM/Lyme without having lab work done first.

[Guilherme]

Treating a disease that may not exist is a very questionable practice. It’s a “shot in the dark” method that carries it’s own serious risks, some of which are noted above.

I’d not heard of the Banamine dosing regime before but if the vet. thinks it’s OK then it might be worth a shot as a “confirmatory test” that carries a relatively low risk.

Still, the SOAP system requires an Assessment (which would include a diagnosis) before a Plan can be formulated and put into motion.

G.

[Janet]

Purely anecdotal.

Some years ago, my sister had a horse who appeared, to the vet, to have EPM. They started her on EPM medication (probably Marquis in those days) and she immediately began to approve. Then the EPM test results came back - Negative.

Apparently there is/was ANOTHER protozoal disease (I forget the name) which presents similar symptoms, and responds to Marquis but is not detected by the (then) standard lab test for EPM.

Then continued with the EPM treatment, and the horse returned to full health.

[fordtraktor]

I just finished treating for EPM. I personally would run the labs again. My vet is scheduled out to do another lab so we can compare and see how effective the treatment was. good to have a baseline and Marquis is very expensive if not needed.

FWIW, my horse looked to be to be very very mildly neurological at times and just NQR lame at others. When the vet came out he was sound and passed the neuro tests 100%, but based on what I had seen earlier in the day I asked for the EPM test to be sent off, and the titer was in the 95%tile. my vet was, in his words, “shocked.” He says it is a weird disease and can show up in many different ways.

[SonnysMom]

My husband had been treated multiple times for Lyme. Every time he tests negative yet responds to the doxy and feels better for years. So either he has never had Lyme and whatever he did have still responds to doxy or he tests as a false positive.
Has your vet tested for the other tick borne diseases such as anaplasmosis?

[Obsidian_Fire]

Following. Just got a negative/negative EPM test back, but my mare has many of the same symptoms as OP.

[Lusoluv]

This is such a conundrum! There are 2 owners at my stable treating their horses with Orijen as they suspect their horses have mild EPM. Vet agrees. Their thinking is that Orijen is only $200. Which is cheaper and safer than a spinal tap - the only reliable diagnostic for EPM. Other tests have too many false negs and pos to be trusted. People tend to do the same thing for ulcers. Instead of fasting and stressing their horse with a $$ scope, they go ahead and treat with Omeprazole (very cheap if you do generic Nexium caps) and figure if it helps - all good. If not, then pursue something else…

I’m not sure what I’d do in this case. If I had unlimited funds, I’d like to do the spinal to be sure. But since I don’t, I can see why folks do treatment first over diagnosis.

[Gainer]

Maybe get a second opinion from another well-respected vet in your area to see how he/she feels about the symptoms/cause. Two head are sometimes better than one.

[Empressive_Award]

@RichardX “But a vet should be able to diagnoise EPM with: 1) tail pull tests, 2) circle pulls, 3) palpitation and limb manipulation, 4) putting a hand near her “naughty parts” to see if she “tucks under” in reaction, as EPM often causes lack of sensation in the hind quarters, and 5) a “fake fly” test: take a stiff piece of straw and poke her all over, especially hindquarters, to see if the skin flinches as it normally would when a fly lands on her.”
My vet actually did this exact thing during her full lameness eval in July and she reacted normally.

Farrier recently did her feet (Monday) and had no negative feed back about her balance or doing her hind feet. She was tripping mildly before and after the trim, so I do not think its related to needing feet done either.

Thanks for your input and experience!

[Empressive_Award]

The preliminary plan is to start by adding natural vitamin E into her diet for 30 days at 4,000IUs to see if we notice an improvement, along with Omega Horse shine for the added fat, which she could use in addition to her Senior grain diet, and in order for the Vitamin E to really absorb and be used.

Also getting a fecal test done to test worm load as I received feedback from someone else who had multiple horses of the years with similar issues that ended up having a high worm count and symptoms resolved after fecal, PowerPac, followed by Quest 10 days later. We haven’t done a fecal since early spring so its time anyways.

If things still persist after 30 days, then I will look again at EPM and Lymes, as well as other tick borne diseases, but I am really hoping this is a dietary issue that is evolving into a potentially dangerous condition if not addressed since it seems to happen we she is on restricted or poor quality pasture versus when she was on excellent 24/7 pasture.

Still interested in hearing other’s experiences, I’m not sold on spending $800 to treat for EPM without the diagnosis, but how accurate is the testing anyways…it seems not by much

[Guilherme]

@Empressive Award

The preliminary plan is to start by adding natural vitamin E into her diet for 30 days at 4,000IUs to see if we notice an improvement, along with Omega Horse shine for the added fat, which she could use in addition to her Senior grain diet, and in order for the Vitamin E to really absorb and be used.

Also getting a fecal test done to test worm load as I received feedback from someone else who had multiple horses of the years with similar issues that ended up having a high worm count and symptoms resolved after fecal, PowerPac, followed by Quest 10 days later. We haven’t done a fecal since early spring so its time anyways.

If things still persist after 30 days, then I will look again at EPM and Lymes, as well as other tick borne diseases, but I am really hoping this is a dietary issue that is evolving into a potentially dangerous condition if not addressed since it seems to happen we she is on restricted or poor quality pasture versus when she was on excellent 24/7 pasture.

Still interested in hearing other’s experiences, I’m not sold on spending $800 to treat for EPM without the diagnosis, but how accurate is the testing anyways…it seems not by much

The Merck Vet. Manual is on line. Here is the relevant section. https://www.merckvetmanual.com/nervous-system/equine-protozoal-myeloencephalitis/overview-of-equine-protozoal-myeloencephalitis This IS The Horse’s Mouth. Much better info there than from the “rail birds” that hang around barns…or websites!!!

If the definitive test for EPM is a spinal tap then that’s what should be done if the clinical signs point that way.

G.

[HJdaydream]

I notice that no one has mentioned the generic form of Marquis- I believe it is called Toltrazuril. I have had a vet on the side of the “treat if you suspect” for EPM and the generic was recommended to me as it is significantly cheaper. Approx $300 I believe versus close to $1000. Something to ask your vet about if you do decide to go down the treatment route.

I have heard of some barns in heavy EPM areas treating all their horses once a year ‘just to be safe’. This is hearsay, and I am not saying I approve of this practice, just something I have heard related to treating undiagnosed EPM.