Category Archives: EPM

Spotting Lameness: The Game Plan

Spotting Lameness: The Game Plan
— Read on horsenetwork.com/2018/10/spotting-lameness-game-plan/

I Loathe Ticks! 

Your horse comes in from being outside and is barely able to move.  His legs are swollen, he has a fever, is sensitive to the touch, and has a loss of appetite.  He has chills- intermittently shaking.  He wont touch his hay, his eyes are dull, and he looks depressed and tired.  You call the vet and they run hundreds of dollars worth of tests- CBC, x-ray his legs to ensure there is no fracture; they diagnose him with Lymphingitis.  You begin a course of antibiotics.  You cold hose.  You give him Banamine.  Your wrap his legs while he is on stall rest. A week later, the swelling has subsided, his fever has dissipated, and his appetite is back.

You get a text saying that your horse “ran away” when he had been let out earlier that day.  But when you get to the barn, you notice when he turns he looks like his hind end is falling out from under him..remember when you were little and someone would kick into the back of your knees and your legs would buckle?  That is what it looks like.  So you watch him.  You are holding your breath, hoping he is just weak from stall rest.  You decide, based on the vet’s recommendation, to let him stay outside for the evening.  You take extra measures- leaving his stall open, with the light on, wrapping his legs, etc- and go home.  Every time your mind goes to “what if..”, you reassure yourself that your horse is going to be okay and that you’re following the vet’s advice and after all, your horse had been running around earlier that day.

The next morning your horse comes inside and it takes him an hour to walk from the paddock to his stall.  All four legs are swollen.  He has a fever (101.5).  He is covered in sweat.  He won’t touch his food.  He has scrapes all over his body and looks like he fell.  You call the vet- again- and they come out to look at him.  They note his back sensitivity, his fever, the swelling at his joints (especially the front).  They note that his Lymphingitis seems to have come back.  The vet draws blood to check for Lyme.  They start him on SMZs and Prevacox.  You once again wrap his legs, ice his joints, give him a sponge bath with alcohol and cool water to bring down his fever.  You brush him, change his water, put extra fans directed at his stall.  You put down extra shavings.  And you watch him.

A few days go by and you get a call saying that your horse has tested positive for Lyme…and while your heart sinks, you are also relieved that there is an explanation for your horse’s recent symptoms. You plan to begin antibiotics and pretty much not breathe for the next 30+ days while your horse is pumped with antibiotics.  You pray that he doesn’t colic.  You pray that you have caught Lymes in time.  You pray that the damage is reversible.  You research everything you can on the disease.  And you sit and wait….

Below are resources on Lyme Disease in horses- treatments, symptoms, the course of the disease, and the prognosis.

epm-diagram

Lyme Disease in Horses | TheHorse.com

Lyme Disease, testing and treatment considerations | Best Horse Practices

Microsoft Word – Lyme Multiplex testing for horses at Cornell_2-12-14 –

Lyme_Disease_Multiplex_Testing_for_Horses.pdf

Recommended Equine Professionals and Services

 True North Equine Vets  www.truenorthequinevets.com   540-364-9111

Genesis Farriers: Dave Giza www.genesisfarriers.com   571-921-5822

Ken Pankow  www.horsedentistvirginia.com  540-675-3815

Full Circle Equine www.fullcircleequine.com  540-937-1754

Farriers Depot:  (Farrier related supplies) www.farriersdepot.com 352-840-0106

StemVet (Stem cell acquisition and storage) www.vet-stem.com

SmartPak Equine Supplements  www.smartpakequine.com

 

 

 

 

 

   

 

 

 

 

 

 

 

 

 

EPM Tilter. What Do The Numbers Mean?

During my horse’s recent Lymphingitis flare-up, the vet advised that we run labs to test for Lyme and EPM due to his presenting symptoms (hind weakness, twisting his back leg at the walk/walking sideways I refer to it as- “Chance’s swagger”).  As I noted previously, Chance’s Lyme test revealed that he was at the beginning stages of an acute infection…yay for the labs at Cornell University for their amazing ability to give you more than a positive or negative!

A little history before getting to the EPM Tilter results.

About 2ish years ago, Chance was diagnosed with EPM (and one of the reasons opossums and I are not friends since they host the disease as do a few other culprits).  Chance immediately began EPM treatment- he received Protazil in his feed for one month. After hours of research I chose Protazil, although extremely expensive (if you order from http://www.drfosterandsmith.com they sometimes have promotions where you receive store credit for every $100.00 you spend…they did when I ordered and I got a “free” dog bed that my dogs adore), due to the decreased likelihood of Chance experiencing a “Treatment Crisis” (worsening of symptoms) and the ease of administration (other brands require the drug being administered 1 hour before eating or an hour after and so on).  Typically, EPM treatment is done for 30 days and, depending on the residual symptoms, some may require subsequent treatments.  While Chance’s symptoms improved, I wanted to ensure that we annihilated the disease and did another round of treatment but this time with Marquis.  At the end of two months, Chance’s ataxia was gone!

Fast forward to September 2016…Chance, just having a Lymphingitis flare-up, has been tested for Lyme and EPM. Lyme came back positive.  And….so did the EPM test..well, kind of.  Wonderful.  (See why I loathe opossums?)

Chance’s EPM test #2 on 8/30/16 (the 1st one was 2ish years ago) showed the following:

“Combined SAG 2,3,4 Tilter on serum= 1:2000”

So, what does this mean?

The test revealed that Chance had “positive, specific antibodies” detected in the blood work.  This means that he had EXPOSURE to S. Neurona, a causative agent of EPM.   Serum tilters range from <1:250 (negative) to >1:4000 (high positive).  S. Neurona (SarcoFluor) is one of two protozoa found in EPM infected horses, the other protazoa is N. Hughesil (NeoFluor). S. Neurona is most frequently seen, whereas N. Hughesil is not as common.

The vet ran another EPM test to confirm the findings in the 8/30/16 test.  The results showed that Chance had “Combined SAG 2,3,4 Tilter on serum= 1:1000.  Again, Chance showed EPM protozoa in the positive-ish range.

I initially had not seen the results but was told by the vet that he was EPM negative.  So when I asked for the test results to be emailed to me and saw the numbers I sort of freaked out…I emailed the vet to ask for clarification.  She explained,

“The EPM test shows that he was exposed to the organism in the first test we did which is why we did a follow-up test. Since his exposure level dropped from 1:2000 to 1:1000 this shows that he does not have the disease. There is no good one time test for EPM once they are exposed which is why we had to do the repeat to compare the two.”

While this explanation offered me comfort, I was confused…why does he have any protozoa in his blood if he doesn’t have EPM?

I spoke to another vet and she explained it in a bit more detail…I am hoping I am summarizing what she said correctly..

When a horse tests positive for EPM they either have an active disease or they may not.  However, when the test does from 1:2000 down to 1:1000 this typically means that the horse’s immune system is working correctly to fight the disease off- active or not.  EPM testing typically provides you with a % of the chance your horse has an active EPM infection, or at least if you send it to Cornell University.  For instance, lets say a horse gets the results back and it shows that they are “positive” or have been exposed to S. Neurona (one of the two EPM protozoa)…their results are  1:647.  This means that, after doing a bunch of adding and multiplying that this vet kindly did for me, the horse has a 60-70% chance of having ACTIVE EPM.  Meaning, he most likely would be symptomatic (ie: behavioral changes, ataxia, weight loss, difficulty eating, changes in soundness, and a bunch of other neurological symptoms).

My hunch is that Chance’s immune system was boosted because I started him on Transfer Factor (amazing stuff… more information can be found in some of my older posts) again as soon as his results came back positive for Lyme.

Here are the 3 EPM tilters that were run on Chance (oldest to most recent) along with his Lyme test results:

epm-2014

epm-test-results-8-31-16

EPM results 9-8-16 copy.jpg

lyme-titer-8-30-16

Equine Podiatry

Medical History


  1. DDFT Lesion on right hind
  2. Cervical Spine Arthritis
  3. Hip discomfort due to past fall

Past Treatments Tried


  1. Stem Cell Injections: Healed the DDFT lesion in right hind until recently the lesion began to reappear
  2. Ozone Therapy: Assists in the healing of tissues
  3. Shock Wave Therapy: Assists in the healing of tissue
  4. Chriopractic adjustments
  5. Acupuncture
  6. Supplements

Initial Consultation


Chance showed decreased movement in his right hip and a audible cracking noise at the suspensory joint.  He has edema of both hind fetlocks, Pastern, and Pastern Dermatitis.  Chance was unshawed on both hinds due to his inability to stand for long periods of time and his decreased mobility.  However, his front adorned clips.

Due to the length of Chance’s front toes and the height of his heels he was unable to evenly distribute his weight (60/40) to his front and hind ends.  This would most likely cause increased tension on the DDFT tendons and corresponding ligaments resulting in an increased likelihood of tendon and ligament related injuries.  The uneven distribution of weight could also inhibit the horse’s range of motion through his hips resulting in his body compensating for this injury and causing ataxia (balance issues), pain, arthritic changes, and cervical spine misalignment.

By shortening the toe of both front feet, the heel will rise allowing a more even distribution of his weight.


Front


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IMG_3196


Final Product: Front


Trimmed feet to corrected to the following specifications:

Foot   Beginning Angle & Toe       Corrected Angles & Toe   Total P.C.

L/F    47 Degrees at  3 7/8 inches   53 Degrees at 3 inches         6 Degrees

R/F    45 Degrees at 3 3/4 inches    54 Degrees at 3 inches         9 Degrees


Hind


20160604_160438


Final Product: Hind


20160609_153622

 Return visit to trim and shoe Chance’s hind feet with #2 OBRHB Wedge shoes.Trimmed hind feet and corrected to the following specifications:

Foot   Beginning Angle & Toe       Corrected Angles & Toe   Total P.C.

L/H   48 Degrees at 3 7/8 inches    54 Degrees at 3 1/4 inches    6 Degrees

R/H  46 Degrees at 4 1/4 inches     55 Degrees at 3 1/4 inches     9 Degrees

Note: Chance needed to be sedated by veterinarian to complete the trim and shoe his hind feet due to preexisting hip and DDFT issues.

Pain in the Neck

My old guy has always had issues with his cervical spine/neck.  Throughout the years he has developed arthritis which has caused symptoms which mirror EPM such as; ataxia, difficulty bending, hind end weakness, difficulty going up hills, lethargy, difficulty balancing when foot is lifted, muscle atrophy, sore back…you get the picture.

When his symptoms first came on I had the vet test for EPM.  The test was positive.  I did my research and found out that about 50% of horses will test positive for EPM but only 1% show actual impairment from the virus.  I went ahead and completed two rounds of EPM medication therapy and still his symptoms continued.  So, I sought out another vet who practiced eastern and western medicine.

After some chiropractic adjustments and acupuncture she felt that his issues were actually due to the cervical spine and not EPM. The vet also showed me how, when looking at Chance straight on, one of his eyes was lower then the other- a classic sign of cervical and jaw issues. We continued with the chiropractic and acupuncture therapy and have continued for over a year and the change has been remarkable.  Along with these therapies, we upped his feed, added supplements, began stretches and different exercises, and had him walking and running up and down hills whenever he was outside.  The dentist has also been of great help by floating Chance’s teeth every few months instead of once a year.  This helps with the alignment of his teeth because he tends to ware one side of his teeth down more then the other; ultimately straining his jaw and neck.

He has rebuilt the muscle on his hind end, put on around 100 lbs, and is able to do stretches while someone is holding his foot up.  He runs when he is outside and is no longer on pain medications (except on the rare occasion).

Here is some useful information on a horse’s back and cervical spine.

Diagnosing A Horse’s Neck Problems

Main Causes of Ataxia in Horses

Arthritis of the Spine in Horses

Back Stretches

Exercises for Spinal Issues in Horses

Trust Your Instincts

Chance being lunged after many years of not being lunged due to a DDFT injury and possible EPM treatments.  He is still stiff and needs to build up the muscle in his hind end thus why he is being lunged.  In addition to his chiropractic adjustments, acupuncture, stretches and massages, and all natural pain medication (MicroLactin), he is also doing physical therapy- walking over poles, walking serpentines, and walking up and down hills.

New Concerns Have Sprung

image

Chance greeting me as I drive up

The days are finally feeling like spring!  The grass is green, the blankets put away, the sun is shining, and the horses are shedding.

Chance is continuing to gain weight, although as I said in the previous post, he still needs to put on a good 50-75 lbs.  As the days continue to get warmer, Chance’s arthritis seems to become more manageable for him; his stride is longer and he runs around (mostly after Lucky) more frequently.

Unfortunately, when the farrier came out about two weeks ago Chance was too stiff to get his back right shoe on. The farrier decided to come back out to try and re-shoe him and, during that time in between, Chance must have tweaked it…AGAIN! 

 While Chance did not have a shoe on his back right I kept it wrapped to provide some protection and also even out all of his hooves.  However, when I arrived I noticed that Chance was significantly twisting his back right leg inward at the walk & it had some swelling.  The swelling was not horrible but it was noticeable. I cold hosed his leg for about 45 minutes while I groomed him & gave him a dose of Equinox (pain medication) and Ulcer Guard.  I put on his back leg wrap to help with reducing the swelling and provide some extra support.  Chance did his neck stretches effortlessly and was baring weight on his back hind. 

But as I was grooming him I noticed, on the left side his chest, he had patches of hair loss and dandruff.  The area did not look red or inflamed, nor did it seem itchy or painful.  So I continued grooming him and decided to put a call into the vet to come and check his leg and the hair loss.

Of course, I turned to Google to try and find out what exactly could be the cause of the patches of hair loss.

image

According to a handful of sources, there are a few possibilities for hair loss- mites or Lice, a vitamin deficiency, rain rot or crud, or even just his natural shedding tendency. A skin scrape would help to confirm what may be the cause. 

 As for the swelling of Chance’s back right leg, I decided to call our previous vet who collected and injected Chance’s DDFT with stem cells to heal the hole in his tendon. We have some stem cells left over and I wanted to see if injecting his leg again would be of any benefit.  I also would like to get an ultrasound recheck to ensure that there is not another injury to his DDFT tendon sheath again.

The twisting of his back hind leg is worrisome as well.  

Everything I have read about EPM states that horses can have a relapse in symptoms after treatment is complete. My concern is that the twisting are due to the neurological symptoms coming back since Chance’s EPM treatment has been finished for a little over two weeks…. 

 Our current vet believes that Chance’s ataxia and twisting is not due to EPM but his cervical spine instead.  Could the twisting be worse due to the swelling of his hind leg?  Or is the swelling and the twisting two separate issues all together?

Progress

Chance BEFORE tendon injury diagnosis (I need to find the video where he was at his worse)

Chance AFTER Stem Cell Treatments

After 1 round of EPM Treatment

 Chance AFTER 2 rounds of EPM Treatments (Need to get a better video) Before there was no way he would have been able to get up that hill.

Wobbler Syndrome in Older Horses

Wobbler Syndrome in Older Horses

By Erica Larson, News Editor

Mar 28, 2013

Wobbler Syndrome in Older HorsesThe gold standard for diagnosing CVSM is the meylogram (seen here), a procedure that involves injecting dye into the spinal canal before taking a set of radiographs to evaluate the spinal column’s width and to identify possible sites of compression.

Photo: University of Kentucky Gluck Equine Research Center

The neurologic condition cervical vertebral stenotic myopathy (CVSM, commonly known as wobbler syndrome) is much less common in older horses than it is in young, growing animals. But according to one clinician, this condition should be on all veterinarians’ differential diagnoses list when evaluating an aged horse presenting with neurologic signs and/or neck pain.

At the 2013 Western Veterinary Conference, held Feb. 17-21 in Las Vegas, Nev., Laurie Beard, DVM, MS, Dipl. ACVIM, associate clinical professor at Kansas State University’s College of Veterinary Medicine, presented a review of CVSM in aged horses.

Horses affected by CVSM essentially have a damaged spinal cord. The major causes of spinal cord damage include cervical (neck) vertebrae malformation or trauma.

“The exact pathogenesis of CVSM in older horses is unknown and likely different than younger horses,” Beard said. She said older horses are more likely to have lesions located in the caudal cervical vertebral column (near the base of the neck), between the vertebrae C5 and C6 or C6 and C7. She noted that some studies suggest biomechanical loading related to “wear and tear” could contribute to lesions. Additionally, she said, articular process osteophytosis (bony remodeling) is a common finding in older horses with CVSM.

Beard said common clinical signs associated with CVSM in older horses include:

  • Spinal ataxia (incoordination), generally symmetric with the hind limbs affected more than the front limbs. Beard noted that in some cases, however, mature horses with CVSM might appear more lame than ataxic;
  • Neck pain or stiffness;
  • Neck arthritis; and
  • Decreased appetite.

Beard said veterinarian frequently use standing cervical radiographs to diagnose CVSM in mature horses. However, if cervical radiograph results are inconclusive, a myelogram, considered the gold standard CVSM test, might be required. This procedure involves injecting dye into the spinal canal before taking a set of radiographs to evaluate the spinal column’s width and to identify possible sites of compression.

Treatment options for mature horses diagnosed with CVSM include:

  • Anti-inflammatory drugs (both steroidal and non-steroidal, depending on disease severity);
  • Natural vitamin E supplementation (Beard explained that vitamin E is an antioxidant that could act as an anti-inflammatory in horses with CVSM);
  • Cervical facet steroid injections (this procedure must be repeated every six months or so, but can reduce pain and soft tissue swelling); and
  • Surgical correction (which typically consists of fusing the affected vertebrae–the movement of which causes the spinal cord compression–together using a metal implement called a “basket” in a surgical procedure called cervical stabilization).

The prognosis for for return to work in mature horses with CVSM is variable and depends on the degree of ataxia present, Beard said.

“A horse with mild clinical disease that is a trail riding horse (or low-level performance horse) probably does have a reasonable chance of still performing,” she said. “However, higher level performance horses probably will not be able to perform at the level they were.”

Additionally, horses used for pleasure riding are more likely to have a good prognosis for full return to athletic function than higher performance athletes, she said.

Take-Home Message

Although it’s commonly thought of as a young horse disorder, Beard stressed that veterinarians should consider CVSM as a differential diagnosis in any horse with spinal ataxia. Prognosis for return to work depends on the degree of ataxia present, but many horses show improvement with medical management, she said.

I pray that gentle hands may guide my feet; I ask for kind commands from voices sweet; At night a stable warm with scented hay, Where, safe from every harm, I’ll sleep til day. -Author Unknown.

Today I met with a “new” vet, Vet7, who was Chance’s very first vet over 15 years ago, when he was vetted at purchase. She came out to do a chiropractic and acupuncture consultation, along with a general check-up. Vet7, while she has a more holistic approach to vetrinary medicinw, she also practices Western medicine.

Vet7 looked at Chance from head to hoof and took a thorough medical history, and ran some tests. She mostly did some balancing and acupressure type diagnostics, and declared that while Chance may have had EPM, she felt that his ataxia was due to his cervical spine….

She explained her reasoning:

1. EPM diagnostics are sub par at best. Even the spinal fluid testing. And, like I previously posted, about 50% of horses in the USA are EPM positive while only 1% are symptomatic.

2. Vet7 did a stretch test with Chance’s neck- to the left, while he compensated by bending at the top instead of the bottom, he showed little flexibility and increased ataxia while doing so. The right side bend was easier. Typically, horses with Cervical issues have issues with the hind-end on the opposite side. Chance has issues with his right leg.

3. Typically horses with EPM respond to treatment. Chance is on his second round of EPM treatment and while his symptoms have had moments where they are less noticeable, there are other moments when his symptoms are prominent; mostly at times of stress. (ie: trailering, new donkey friends, etc).

4. Vet7 put a needle in one of the points in Chance’s tail. He responded immediately showing that he has feeling and strength in his tail, which is something most EPM horses do not exhibit. Typically, an EPM horse will have weakness in his tail, and a times their tail is too weak to lift when they goto the bathroom resulting in having dried manure along their backside.

Vet7 made some adjustments and stuck Chance with a handful of needles. At one point he fell asleep with his head in my arms. She proceeded to inject different points along his cervical spine and hips with B-12.  She taught me some stretches and massage techniques, exercises he and I could do together to increase his hind-end and neck muscles, and gave me some weight gaining instructions.

Chance will have Rice Bran added to his feed beginning with 1 cup for a week and slowly increasing to 2 cups. This will aid in getting his weight up. Apparently, horses are able to tolerate up to 30% fat in their daily diets.

She also suggested adding a Probiotic to increase his Immune system since the gut is the control center. There were other supplements that she felt maybe helpful as well, Cervical Formula, to help with his neck flexibility and overall health.

As for the exercises, in conjunction with turning him out daily, he and I will do stretches to help increase his neck flexion and balance, and I will hand walk him. We will walk on flat land, up and down small hills, and do serpentines. Eventually, increasing to twice a day and adding ground poles and lunging. This will help to develop the muscles, increase his flexion, decrease the ataxia, and aid in his overall health.

acupuncture

Vet7 will come back out in two weeks to see how he is doing…I’m hoping that we have finally found some answers and are closer to a solution.

Weight Gain- The Good Kind

While Chance’s hind-end is still sunken, especially on the right side, he is looking much better than he did almost a year ago.  In the last year, he has gained a significant amount of weight (and still needs to keep gaining) and muscle mass.  This was achieved by upping his feed to 4 quarts and adding hay stretcher with each meal, along with Chance walking up and down small hills during the day.

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Chance 6 months ago (August 2014) Pre-EPM diagnosis or treatment.

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February 2015: Second round of EPM treatment and 6 months of upped feed with higher fat and protein content.

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