Sounds like they were very thorough!
The EPM med is probably Toltrazuril. It’s being recommended for EPM more and more. I’ve used it in two different horses and had excellent results with it. It’s also only like $300 for the whole treatment which is much nicer than what EPM meds used to cost. Also, the horses think it tastes good so that’s a bonus 
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They were there a little over two hours! Definitely thorough. I’m glad there are some treatments that don’t cost a fortune to try out if the gate.
I’m just glad our new vet is taking the tripping far more seriously. No one has seemed to. Heck, I text our trainer tonight and her response was along the lines of “high titers can happen but that doesn’t mean he is showing symptoms” 
. I was like, we HAVE symptoms, the tripping which is the entire reason I’m exploring this with the new vet. This is why I handle my own vet stuff and always will.
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I’m in the camp of if the horse even has a chance of having EPM treat it. The symptoms can be SO weird. One of mine was stumbling and started refusing jumps. The other kept getting lost and couldn’t find his stall. A friend of mine had one with EPM who basically lost all hind end control (he improved a lot but sometimes would just fall over in the pasture.)
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A very good friend of mine just went through the wringer with EPM and after over a year, her mare is finally seeming like she is in some kind of remission. It started with tripping and trouble bending in one direction years ago. It wasn’t until she seemed to literally lose her mind and body that EPM was suspected. I don’t know if you can catch it early, but I’m of the same thought you are in regards to treatment.
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Something that looks like buckling and neck symptoms make me think of my gelding. He was retired at 9.5 due to bony changes at C6/7 and C7/T1. It all started as a pretty subtle short on the left that became a knee buckle that became retired because the stumble became pretty consistent under saddle. If the titre comes back low, looking at the neck down low might be worth finding a very experienced vet.
Mine has bony changes on the left and a knee buckle on the left that is worse on a circle than a straight line. FWIW we got 18 months out of the first round of IRAP after getting no benefits from HA injection. The second round of IRAP only bought us a couple of months so I retired him.
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Really appreciate the post. Pulling in this thread about our neck issues earlier in February since it seems like its got a good chance of being relevant Soft Tissue Injuries - Neck/Shoulder *May Update*
I don’t have the rads back yet, but I can share when I do. The X-ray quality decreased as they went down the neck due to Fjord Neck Mass, but Im not sure at which process it became harder to get a good view. I’ll read up more on the IRAP and HA injections, a quick google says they are non-steroidal. Our vet mentioned injecting but having to weigh the risk with the metabolic profile he has.
I started keeping a more detailed Trip Log after the vet visit. Im sticking to groundwork/ground driving/liberty/free lunging again for the moment and am starting to wrap my head around not being able to ride much if at all a lot sooner than hoped. DH and I plan to buy property and build our our forever home, which also will have a small barn and paddock paradise type set up and to rescue another fjord or two. The hope was stay where we are for another 15-20 years and continue to board, but if were looking into more of a retirement situation, it makes sense to push that up to 5-10 years out if we can.
@UrbanHennery - any other details you can share? Did footing or shoeing matter? Was he more prone to the buckle/stumble at any particular gaits?
We have an equine specialty hospital nearby in addition to the two vet clinics, and are a couple hours north of OSU so were in a good spot for whatever he needs vet care/expertise wise. I need to decide how much money makes sense to throw at this depending on what it seems to be the problem.
In the meantime is his learning to do his moves when I’m further away for him 
ead1d4a280a649828ad7ef28f2fdf62f
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It is my understanding radiographs of C6/C7 and C7/T1 must be taken at a very specific angle to see changes or deformities, which all vets are not well versed in.
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Very good to know. I just looked up the anatomy and the sheer amount of mass he has around the C6/C7 area definitely is not helping a good view.
If the EPM comes back as not a concern, I will discuss how we can get a better view of this area. I believe he said in addition to the mineralization at C1, he had some slight degeneration in a spot but he didn’t seem to think it would cause what we’re seeing.
I just called the clinic and they like to send everything over together so I probably won’t have the full picture until next week.
In the department of good news, I just got the teff analysis back from the hay farmer and it’s perfect. Just need to coordinate pickup and payment and NO MORE HAY SOAKING
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Here’s the recommended x-ray protocol for ECVM (that’s the C6-T1 malformation you and NaturallyHappy have been discussing). These generally have to be taken at a hospital because most field x-ray machines are not strong enough to penetrate that low down the neck.
Ros et al_2023-.pdf (12.8 MB)
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Update and I’ll preface by saying Im glad we have some things to target.
Possible causes of tripping could be any or a combination of:
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EPM - Our titer came back as 1:2000 which is smack in the middle of low and high. The clinic is going to send me over the med options. Doc said we could do Marquis, Rebalance, or the one they have compounded. Plan is to treat for 30 days and see what we notice.
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Mineral deposits at base of skull and C1 - Doc consulted with one of the OSU vets on his neck rads and its entirely within the realm of possibility that this deposit is interfering with the nuchal ligament and causing joint/nerve pain as we’ve seen intermittently or something like nuchal bursitis. The OSU vet mentioned blocking but my vet (and I) agree with how intermittent the tripping is, it’s prob not worth it. Im of the thought that it might be worth ultra sounding which we could do in clinic, but I think hauling to OSU for a bone scan is where I will prob draw the line for now.
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Bony/arthritic changes in the lower neck. The images of the lower vertebrae were clear enough for them to conclude this could also be contributing.
Vet thinks that both instances we thought were laminitis could have reasonably been issues with his neck flaring up. Both times he had a harder ride than normal; first was our first lesson in spring of 2021. He was being wonderful and we did more cantering and intro type dressage patterns that day. In that instance, he was also much more comfortable walking on concrete than arena footing. This year, we got in a boggy spot in the woods as mentioned previously that could have torqued the neck. Im sending over all my hoof rads today and he is going to go over them with a fine tooth comb but is pretty convinced there is nothing to be seen laminitis wise.
Like person like pony! I have disc degeneration disease myself. My takeaways here are that this is going to largely boil down to keeping it managed. We could consider injections but would need to weigh the risk with his metabolic predisposition even though wer’re thinking laminitis may not be in play. With that said, no changes to his lifestyle of dry lot/weighed hay bags etc, keeping him trim is even more important to help that front end.
I don’t plant to continue his training. If I can have a horse that I can toodle around with on trails with good footing and drive some, I’ll be thrilled. Im tickled I can ride him bareback and bridle-less and am going to do more in the liberty space since we both seem to enjoy that too.
Going back to the comments on him looking sounder in the driving video upthread, is it reasonable to think that could cause less neck pain since its pretty much straight lines vs riding in circles?
I have also been tracking his instances of tripping since the vet was out. I started using my BEMER on his neck and we haven’t had a trip since. The vet found that interesting and said to keep all that up. Once he is through the EPM treatment, I am going to start some acupuncture which the vet highly recommended. I told him thats what helps my neck the most LOL.
I think we’re just going to have to be careful about terrain and intensity of rides and take things one day at a time, but I can totally work with that.
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EPM treatment options:
1 month of Marquis $1552
2-4 months of liquid suspension Sulfadiazzine trimethoprim pyrimethamine $132/month. I believe this is very similar to ReBalance but is more cost effective…maybe not FDA approved? They said this needs to be administered about 30 minutes before his meal once a day which I can accommodate.
Any inputs? Is one harder on their system vs the other or anything of that nature? The vet said he doesn’t really recommend one over the other which makes me inclined to go the less expensive route unless there are other big considerations.
Edit to add - as I am reading Marquis seems to be a little better tolerated and has less side effects. Marquis it is.
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I suspect the circles vs. straight is less significant than carrying a relatively unstable rider vs carrying a relatively stable harness. Our body weight and how it’s positioned on a horse affects their balance and movement no matter how good a rider one is. Any time your horse needs to make a quick balance shift to compensate for the human’s movement, he will automatically be using his neck in an abrupt, sharp move.
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No doubt, very good point.
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I’m late back to this thread. My horse is and was worse on uneven footing such as arena than he is on hard ground. It is worse going downhill than on the flat. He is more likely to stumble with a rider on board; bareback was better than saddle.
Shoeing didn’t really matter, though it did turn out that because we originally thought we had a foot problem we had overcorrected his low heels and having them higher was NOT helping. We diagnosed his changes with x-rays at the vet hospital and then ultrasound by a highly regarded sport horse vet.
He’s been fully retired for 6 years (he’s now 15). His deterioration has definitely stabilized and pulling his shoes and letting his feet find their way back to baseline has helped. He’s probably sound enough to sit on and walk around the pasture / laneways but he’s reactive and my life is busy enough that I don’t bother.
It may be worth pursuing really good x-rays and ultrasound. I never did a bonescan as I got definitive enough answers without it and nothing we found that way would have changed the prognosis or outcome.
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Thank you for sharing, it sounds very similar to everything we’ve got going on. The block I quoted is about where I’m at. I know spots on his neck that aren’t going to get any better no matter how much I throw at more diagnostics so it will be a matter ongoing management/PT and seeing what activities he finds comfortable or not. We do have a rehab clinic a 20 minute haul with everything from a water treadmill to salt room and they also do acupuncture. Our chiro person also does acupuncture so we’ve got some options there.
I’m glad we caught the EPM, but my gut says the tripping is from the neck stuff and not EPM. I’ll be happy to be wrong about that, but we will know in an about a month.
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I just wanted to say I’m sorry for what you’re dealing with - it’s nice to have some answers but it’s also a big ??? on what he can do. Luckily y’all already drive so that’s something fun that seems to agree with the neck/spine horses more than riding!
The EPM might actually be your main issue - we don’t really know what necks and spines do to horses. EPM + neck issues = uncomfy horse though. Hopefully some management and treatment will see a huge improvement for him!
I’ve seen good results with B12 acupuncture on the bodysore/NQR ones!
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I forgot if you’ve already tried adequan, but if not once the EPM treatment is done I’d try that. You could also try legend.
If those don’t help, and he was mine, I’d do the cervical injections. You can do HA only (no steroid) injections, but personally I’d do the steroid injections. You have to weigh benefit vs risk, and with proper precautions id think getting him comfy would be worth it.
You could try shockwave therapy.
IIRC they can surgically remove the deposits; but that seems a little overkill for intermittent tripping.
Lastly, equioxx can be a game changer and horses can stay on it for a very long time.
(This is totally my perspective so take that for what you will): If he was mine, I’d ride him/drive him/whatever you like to do with him. Horses like jobs. The exercise is good for him, physically and mentally. Yes, he might have a few ‘ouch!’ Moments when he turns his head a little weird, but it’s not continuous, and he looks happy when working. He hasn’t fallen on his face, he knows how to catch himself when he trips. I wouldn’t aim for a elite dressage or jumper career, but with proper maintenance, good fitness, and being mindful of his neck there’s no reason he cant have a fulfilling riding career; no matter if that means trail rides or some crossrail hunters.
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I hope youre right!!
Unfortunetly not the case. He went down on his knees with me in November last year, and had a close call a couple months before that 
. Poor guy went down, popped back up and stood like a statue.
Im doing a lot of free lunging with him now so he can move how he likes. We went 5 days with no trips so I think my plan for now is to always free lunge first to gauge his comfort level. If I don’t get any trips, then we can proceed from there. Yesterday had a big stumble/buckle; hopefully he will be more solid today. We have one more HOT day tomorrow in the forecast but Im hoping to take him for a drive over the weekend if he seems good for it.
I completely agree about keeping him in work, he likes to work and seems much more comfortable in my treeless saddle than our previous one. He LOVES to drive and I am beyond thankful I have that option. I just need to keep everyones safety in mind.
Editing to add - I think I might get serious about showmanship with him. I did really well in that as a teen with Quarter Horses and our local showgrounds is like 20 mins away. That would be fun and low risk and we already do all sorts of groundwork and liberty.
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Just got my very expensive box of Marquis today.
I’m paranoid about monitoring his after his loading dose. Could I give him his first dose tomorrow with breakfast and then come Monday, start his daily doses at dinner time?
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I would think switching from breakfast to dinner should be fine. Are you doing loading doses with him (i.e. higher doses for the first couple days to get things going)?
Horses often seem to get worse in the first couple weeks of treatment. The meds cause a big initial die-off of the protozoa that causes a big burst of inflammation. When I treated my EPM gelding the first time he had a period of about a week where he was straight up rearing when being led (being extra spooky was one of his initial EPM symptoms). Then he got a little lethargic. Then he starting coming back to normal.
I know this sucks to hear but I would also seriously consider doing more than a month of the marquis. Or do a month of the marquis and then see if your vet is willing to prescribe compounded ponazuril or diclazuril for another couple of months. Better to really knock the protozoa out the first time than have to go back and start again.
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