baited breath, Equine Protozoal Myeloencephalitis

A nearly full moon hung in the light blue evening sky.  I could not see the mountain in the background, just the trees of the riparian border of the big back creek beginning to turn, and the sky, and the gentle sway of the holler that runs on up to that hidden mountain, the mountain that feeds the creek, the creek that makes the holler, and me in it.

This is his last dose of medicine.  If you missed the beginning of this story, it is here. He'd gotten his teeth floated and had a somewhat abnormal response to the sedative.  The next day we found him down and unable to get up, his feet uphill.  After a long struggle and me being sure he was dead, he got up and seemed, actually, pretty darn normal.  But not quite.  Just a little off-ness.  It somewhat came and went but was there.

I was thinking EPM.  It was now one week after he went down.  I called the vet and we talked.  He was thinking EPM too.  If you don't know EPM, it is a protozoal thing that, it would seem, most horses are exposed to (or at least a LOT of horses are exposed to) and for most it is dispatched by their immune systems.  However, when it isn't, there are central nervous system symptoms.  Like his being off balance in his hind end.  I described his "not quite right" "just a little off-ness" as being "canted" -- he was canted to the right; standing with his right hind under him and his left hind out to the side a bit.  If he got badly off balance, his hind end circled to the right, where the weight was going.

We listed and discussed options.  There aren't really good, clear ones.  No definitive test (even a spinal tap isn't really a good test for this).  No obviously hugely effective treatment.  Expensive treatments, treatments with high rates of relapse.  We basically looked at ReBalance, the oldest and cheapest treatment (per month) but one that requires 4 to 8 months, really.  It's a sulfa and a pyrethric.  Marquis, most used now, VERY expensive, and often recommended that to be effective it be given at twice the dose and my horse is already twice the horse so you can figure that out pretty quickly.  BayCox, not approved in the US, drug used not approved for horses, and now, sadly, being used in the high end racing and dressage industry as "preventative"--which really means they are doing their damndest to create a drug resistant protozoa.  It's drug (toltrazuril) and the one in Marquis (ponazuril) are similar antibiotics (triazine group) (and if you look up triazines you will actually find them under herbicides).  And Oroquin 10, a 10 day treatment now in clinical trials that features a former cow wormer that seems to boost the equine immune system and a common anticoccicial.  Our vet, knowing we're poor humble hillbillies, recommended the ReBalance.  "We've been using it a long time.  Lots of horses respond in a month."  But from the research, lots of horses relapse if treatment isn't continued too.

So, admittedly without knowing relapse rates, after much research and soul searching, we decided to order the compounded form of Oraquin, levamisole and decoquinate, supplement vitamin E, bute for a bit for inflamation.  By the time this was started, it was two weeks from the initial episode.

And now, today, is his last dose of medicine.  He's on 5000 IU of vitamin E which I will continue until I decide to start cutting it down, and for now, still some bute that will likely quit after tomorrow or the next day.

After his down episode, he was canted, as I said; canted right.  As soon as we ordered the medicine, he was square.  And he stayed square until day 3 of the medicine, when he canted left.  Just a bit at first, and never as bad as the Friday he'd circled just standing, before I'd called the vet.  But he'd stayed canted left from day three through, well, today even, although lessening every day I think.  Almost square. 

And now we hold our breath.

UPDATE 10/20/16:  He continues to do well.  Bute discontinued, turmeric (1TBS BID) added (I should have researched that and added it earlier).  Also still on 5K IU vitamin E/day.  He's been in a separate flatter field with a couple goats and a donkey since the down episode -- away from the little mare who likes to move his feet.  Put her in with him today.

UPDATE 10/28/16  Inky was too much for him.  Last Saturday he was canted right and circling again.  He'll likely be in that pasture without her for the rest of the winter.  Will complicate hay some.  Having looked at everything again, I have so far decided against re-treatment.  We upped his tumeric and doubled his E.  He's improving.  Still canted but not circling, and cantered to his hay today.

UPDATE 11/22/16  Straight and has been most of the month.  Also, lively in demeanor.  He is still on 10,000 IU Vit E/day, and 4 TBS turmeric/day.  Will likely begin reducing Vit E in December.  Now adding beet pulp to rations to increase caloric content again as body condition isn't bad but I'd like it better.  Tomorrow plan to start hand walking hills for additional exercise.  Why did I decide against additional treatment?  There are FDA approved treatments that are all expensive and long but no double blind studies.  There seems to be about an 80% response rate to treatment, and about a 60% relapse rate.  Theories include that this is something that the immune system takes care of . . . or doesn't, and that "treatments" just hold it in check until that happens, or doesn't.  So turmeric to control/reduce inflammation (which is what seems to cause symptoms), and Vit. E to support the CNS, reduce stress (flat field, no pushy mare to deal with, water not in rocky creek), and time to heal.  Hopeful but also resigned.  My usual life stance I think.