Tag Archives: Diagnosis

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:

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epm-test-results-8-31-16

EPM results 9-8-16 copy.jpg

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I have a limp!

Resources on how to diagnose, treat, prevent, and handle lameness in horses

Your Horse Has a Swollen Leg – Why and What To Do | EquiMed – Horse Health Matters

All About the Fetlock

Fetlock Lameness – It’s importance… | The Horse Magazine – Australia’s Leading Equestrian Magazine

Causes of Equine Lameness | EquiMed – Horse Health Matters

 

Common Causes of Lameness in the Fetlock

fetlock lame

 

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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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


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Final Product: Hind


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 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.

If You Experience Worsening Depression…

Chance began another round of Excede to get his scratches under control- it is a never ending battle.  A while back, I had a skin scrape of Chance’s scratches due to their chronic nature.  The scrape results showed a number of bacteria, all commonly seen with this type of infection, that were resistant to most antibiotics.  Thus why we decided to try Excede.

Administering Excede is pretty straight forward- 1 shot IM every 4 days for about a month.  Easy enough….or so I thought.  The first shot was administered by the vet when I was not present.  The second shot the vet also administered while I was there.  Thirty minutes after the shot was given to Chance I noticed he seemed off but not in his “normal” post-acupuncture relaxed state. He suddenly became lethargic, he wouldn’t eat his dinner, and the gut noises became almost nonexistent. I commented to the vet my concerns and she came over and reexamined him.  Sure enough something was wrong.  She proceeded to administer 10cc of Banamine (just in case it was colic) and told me to walk him around outside for about 20-30 minutes.  Then see if he would eat 2 cups of feed only.  We walked and Chance began to act like his normal happy go lucky self.  Once inside he started to eat!

Part of me felt that his reaction was a fluke.  However, the third dose proved me wrong.  Four days later, Chance received his shot and went outside to enjoy the first beautiful, warm day.  I sat in the field watching him.  He was sluggish, lethargic, stiff..he looked 10 years older and barely moved from one spot under a tree.  He wasn’t eating grass nor did he run around and play- he didn’t even run up to me like he normally would. I decided to bring him inside and give him a warm bath since it was in the high 70’s.  He was non responsive to his bath- no playing with the hose or even accepting peppermints.  I placed a cooler on him to ensure he stayed warm until he was out in the sunshine.  I figured after a bath he would perk up- again, I was wrong.  At dinner time I went to bring him in and typically I will open up the gait and he will canter into his stall- he slowly walked instead. He wouldn’t eat his feed (he normally whinnies and makes a fuss until he gets his feed and devours it) or his hay…I stayed and watched him for a while and he just slept.  I spoke to John, the guy who helps me with Chance and Lucky, and he confirmed that Chance hadn’t been finishing his feed and wasn’t running when he brought him in for dinner.

My concerns grew and I decided to do some research on Excede. That strange thing is I usually do extensive research before changing or administering anything with my animals.  But, for some reason I did not do so this time and I wish I had.

According to a number of reputable websites, Excede can cause significant and dangerous side-effects such as; diarrhea, severe acid reflux, blood coming from mouth, loss of appetite, lethargy, muscle and gait stiffness, and more.

The most troubling of everything that I read wasn’t what was posted on the Pfizer (the manufacturer) website but from the countless statements given by horse owners and the studies done by outside companies.

According to drugs.com, “in the PK study, several horses developed clinical signs consistent with foot pain (stiff in the front limbs when turned in tight circles, and increased pulses and heat to the front feet). One horse in the NAXCEL group and one horse in the 6.0 mg/lb (2X) EXCEDE group were euthanized due to laminitis. Clinical signs of foot pain (stiff front limbs and increased heat and pulses in feet) affected more horses, for a longer period of time, in all EXCEDE-treated groups as compared to the NAXCEL-treated group. The study housing (multi-horse pens on concrete slabs) and diet (free choice alfalfa/grass mix and once a day pellets) may have contributed to the development of foot pain. The prevalence and severity of injection site reactions in EXCEDE-treated horses may also have contributed to the development of a stiff gait. A causal relationship between ceftiofur and foot pain could not be definitively determined.”

The research has revealed that Excede should be used with caution and the horse receiving the medication must be monitored. Make sure to weigh the benefits and risks before starting Excede.  This drug can be lifesaving for many horses but for others, it can be life-threatening.


Excede Resources


Straight from the Horse’s Mouth: Antibiotics, Antifungals, Antivirals

Excede Study

Equine Product Catalog: In depth understanding of equine medications

FINALNewMexicoEIBPetitionExhibits2908-1407_pdf

 

“Let Me Clear My Throat..”

My poor guy was eating the other night and began to choke.  Scary doesn’t even begin to cover it.  I immediately removed his feed and began to rub his neck to feel for any lumps (feed stuck in his esophagus).  I administered 10cc of Banamine into his butt cheek, which helps the horse’s muscles to relax, thus allowing the food to move through.  I called my vet who said to call her back in 20 min (once the Banamine had time to take effect) if I felt that he was still having issues.  Well, me being the overprotective person I am, I called and asked her to come out to check on Chance and make sure he was okay. The vet came out and flushed his mouth twice with water and said that she felt that he was okay and had passed whatever feed had been stuck.  Thank God!

(Below is a picture of Chance drugged up and waiting for the vet).

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Resources on Choke


How To Tell If Your Horse Is Choking and How You Can Help

When Horses Choke

 

Gator Rubs

Chance was not acting like himself near the end of the snow storm.  He seemed lethargic and gloomy…his appetite was good but the light in his eyes was not as strong.

I called the vet and asked her to please come out. She came out that day and ran a CBC along with going some acupuncture and chiropractic adjustments.  The vet also gave Chance B12 (or as our previous vet called “the old man shot”).

She contacted me after seeing Chance and informed me that she was diagnosing him with an ulcer and thinks that he may have either slipped on the snow and hurt (bruised) his hip or hurt it while rolling.

I asked about the diagnostics that lead to the ulcer diagnosis.  She explained that with horses there are 7 “acupuncture points”.  When they are all reactive 85% of the time the horse has a gastric ulcer. She also went on to explain that with the lethargy and the change in patterns due to the snow a gastric ulcer would be plausible.   They are apparently common when there are changes in the horse’s routine and fairly easy to cure.   She prescribed “Nux” (give 1 teaspoon until gone) and Ranitidine.

I am suppose to let her know if he stops eating or becomes more lethargic.  She felt that he was not at risk for colic because he is eating well and on a high quality feed.  Fingers crossed.

hc-gastric-ulcers


Resources on Gastric Ulcers and Prescribed Medications



Gastric Ulcers in Horses

Ranitidine

Nux Vomica Herbal Medicine

Horses in Virginia are at risk of Liver failure due to Panicgrass or Panicum.

Horses in Virginia are at risk of Liver failure due to Panicgrass or Panicum.

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According to Haymarket Vet (http://haymarketvet.com/fall-panicum-grass-and-liver-disease/) Panicgrass is causing Fall Panicum Toxicosis in horses.

“In 2004, our practice was involved in documenting an important toxin for horses—fall Panicum (Panicum dichotomiflorum) grass.  This common native grass has been fed to horses in hay and in pasture probably since the Europeans first brought horses to our area.  But, while we know that it doesn’t cause illness all the time, certain growing conditions can cause it to become toxic, as it did in Nokesville, VA in 2004.  We don’t know what triggers the grass to become toxic, but we do know that it sometimes does become toxic, and the conditions are right this year. This study proved the hepatotoxicity: http://www.ncbi.nlm.nih.gov/m/pubmed/17186859/

Currently, there are several cases of liver disease in Fauquier, Clark and Loudon counties that appear to be from grazing Panicum grass in the pasture. Some signs of toxicity from eating the grasses includes: decreased appetite, lethargy, somnolence (unusual periods of sleepiness), mild colic, or neurological signs. Some horses have no symptoms at all.

If you have this plant in your pasture or if you find it in your hay cut this year, you may want to have your horses tested for liver disease; this involves a simple blood draw.”

Below is a link on more information about Liver Disease, symptoms, and treatment options.

http://www.tsln.com/agliving/equine/7614069-111/liver-horse-says-disease

Chance’s Face Lift

I brought Chance in from his turn out this evening and immediately noticed this flap of skin hanging off of his forehead.  Another emergency vet visit…yay!  Unfortunately, due to the skin flap being to the side and not hanging downward from the top, Chance needed staples…I believe it was 14 staples in the end and two cuts.

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Needless to say, the vet did a phenomenal job stapling his poor forehead.

Pump, Pump, Pump It Up!

The vet came out to give Chance and Lucky their fall shots and do some follow up acupuncture on Chance.  The vet said that Chance has increased flexibility especially in his cervical spine and has gained weight and muscle mass!!!!!!

His feeding regiment is as follows:

AM:

  1. 6 quarts of Nutrina Safe Choice Senior Feed
  2. 3 quarts hay stretcher
  3. Alfalfa hay mix (as much as he wants through out the day)

PM:

  1. 6 quarts of Nutrina Safe Choice Senior Feed
  2. 3 quarts hay stretcher
  3. Alfalfa hay mix (as much as he wants through out the day)
  4. 1 Scoops of DuraLactin (Natural anti-inflammatory and pain supplement)
  5. 1 SmartPak (Senior Flex, Immune Boost)

He is out all day when it is cool and all night when it is hot during the day. So he has tons of green grass to eat.  He walks constantly- up and down the hills- and runs around with Lucky.  We also walk ground poles and do stretches and massage every time I come out to the barn.

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We still need to continue upping his weight and muscle mass preferably before winter.  Fingers crossed.

Save

And They’re Back….Scratches, Scratches EVERYWHERE!

Over the last couple weeks the rain has been unrelenting.  And with rain comes scratches (Pastern Dermatitis).  In a previous entry I spoke about an amazing treatment for scratches that actually worked…however, when it rains like it has recently, once again the scratches got out of control.

A handful of months ago I got a skin scrape on Chance’s hind legs to determine the bacteria that was causing the scratches.  Sure enough there were three types of bacteria growing which was why I was having so much difficulty getting them under control.

Below are the results:

Version 2

As you can see above, the bacteria shows resistance or no interpretation to all but 7 antibiotics.  I spoke to my vet and she suggested beginning with Gentamicin and go from there if he does not respond to the medication.  Chance has been receiving an injection of 30 mls of Gentamicin in his muscle once a day for about a week now.  He obviously does not enjoy this, nor do I for that matter, but his scratches are showing improvements!  He is also on the topical cream, Silver Sulfadiazine, once a day.

Fingers crossed that I will get ahead of the scratches and they will go away forever!

 

 

What He Has Taught Me Through Our Journey

It is amazing to me that it is coming up on a year from the day that I received a phone call about Chance’s health! As I think back over the many months of diagnostics, research, hyper vigilance, wishes, decisions, stressors, and connection- I am truly amazed.

I am amazed at Chance’s strength.  He never gave up; he kept on fighting.  No matter how sore, tired, or sick Chance was there was ONE thing that remained- his gentle and determined soul.  He never seemed deterred by the obstacles in front of him whether the obstacle was a hill, walking a straight line, or walking in general; he just kept trying each and every day.  He showed kindness to the numerous vets who poked and prodded him; never once trying to bite or kick at them. Chance did not give up throughout this tiresome and seemingly, never ending journey.  He persevered.  We persevered.

Every single day I am grateful that I have been able to spend this time by Chance’s side; to reconnect and go through this journey together.  We have made up for the time lost while he was in Forest, VA. If today was Chance’s last day, I can honestly say that I would be at peace.  I wouldn’t have been able to say this a year ago.

Over the last year, while the journey was overwhelming, sad, tiresome, and at times, heart wrenching, I was able to witness Chance become a horse.  That may sound strange, but after enduring the many years of pain medications and intermittent bouts of lameness and Lymphangitis, I saw a horse that was not able to 100% enjoy his life.

And for the first time, I have seen him doing the very opposite, I have seen him enjoying life. Life as a horse. I’ve seen him running in the pastures, laying in the sunshine, rolling in the snow. I’ve seen him make friends, eat warm bran mash, and devour his hay. I’ve heard him whinny and I’ve seen the light come back into his eyes.

For that, I am truly grateful.  I can say without a shed of a doubt, I have no regrets about the decision I made a year ago, no matter how difficult it may have been.

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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.

Update!

After two rounds of EPM treatments, stem cell injections, acupuncture, chiropractic adjustments, testing, antibiotics, ultrasounds, blood work, adding DuraLactin….Here is a video of Chance yesterday!  He has gained a lot of weight back and hopefully, with the addition of the Rice Bran in his feed, he will continue to gain weight!

Creaking Bones: Information on Equine Arthritis & Prevention

STUdy: Start Measures to Prevent Equine Arthritis Early

“Arthritis is one of the most common reasons we retire horses, and this study shows that prevention of joint damage in early training may be possible through diet,” Coverdale said.

A series of studies by researchers in the department of animal science at Texas A&M University suggest prevention is the best solution to prevent arthritis in young horses.

Josie Coverdale, MS, PhD, associate professor in equine science, and Jessica Lucia, MS, PhD, a former graduate student under Coverdale and now a professor at Sam Houston State University, found that using anti-inflammatory aids mixed with daily feed rations can help decrease joint inflammation in young horses.

“Arthritis is one of the most common reasons we retire horses, and this study shows that prevention of joint damage in early training may be possible through diet,” Coverdale said. “It’s pretty clear the damage comes during early training and that damage often leads to arthritis later in life. A lot of pharmaceuticals are given to treat pain, but few actually help repair the cartilage. We went with the premise that prevention is the best approach rather than trying to treat an existing condition.”

Coverdale said they used the horse production herd at Texas A&M to develop the model and test several diet additives. Lucia read through numerous journals and read a study that used LPS (lipopolysaccharide) injected into the joint for induction of localized inflammation in horses.

“We came across LPS, which has been used in older horses, but not younger horses,” she said. “LPS is the inflammatory part of E. coli, which can be injected using a sterile solution. The beauty of that method is you inject it in the knee and in 24 hours you get pretty quick swelling that is associated with cartilage turnover and related pain.”

This allowed researchers to study the inflammation and breakdown of cartilage over time and mimic the progression of inflammation and cartilage changes associated with intense exercise.

“This initial model study showed us the pattern of inflammation and isolated appropriate markers to measure cartilage breakdown using joint fluid removed from the knee at various time points,” Coverdale said.

Once the LPS model was established to predictably cause joint inflammation, Coverdale said, different dietary strategies were used to try to decrease the amount of inflammation, which included anti-inflammatory dietary supplements such as glucosamine—commonly used by humans to aid in building back damaged cartilage in arthritic joints.

Coverdale said previous data with glucosamine supplementation was “hit or miss with adult horses,” but they wanted to see for themselves and test the theory that prevention in young horses was easier than treating arthritis in the adult.

“We found that it tended to increase new cartilage production and decrease the breakdown of existing cartilage, which was good,” she said.

Study horses received 30 milligrams of glucosamine per kilogram of body weight, Coverdale said.

“We certainly got a positive response, which was what we wanted,” she said.

Another component of Coverdale’s research has been studying conjugated linoleic acid, or CLA, which “is fairly similar to glucosamine in that there are documented anti-inflammatory effects, which may be used to remediate and repair cartilage in joints.”

“Horses receiving supplemental CLA tended to exhibit greater repair of their cartilage when injected with LPS rather than break it down,” she said. “Two percent of the diet was given in the CLA and that can be economically feasible for horse owners.”

The research group has also evaluated horses at varying ages to determine the response to LPS based on age. They concluded that young horses were more likely to synthesize new cartilage in response to inflammation while older horses were more likely to experience cartilage degradation or damage.

“This further illustrates that dietary intervention provided to young horses in training to prevent joint damage may yield the best results,” she said. “With all four of these projects it confirmed that intervening during times of early growth and training with some of these dietary additives is worth it.

“Waiting on down the line as the horse ages is probably too late,” she continued. “Most people are waiting until they see symptoms in these adult horses and by then it is too late. It’s more cost effective and beneficial to do this early. Using it as a prevention method is much better.”

“The initial project to develop the LPS model was funded by the H. Patricia Link Quasi-Endowment funds in the department of animal science,” she said. “This funding was pivotal in furthering the research efforts and helped generate interest from other funding sources such as Cargill Animal Nutrition and the American Quarter Horse Association. The whole premise of the Link funds is to help researchers develop a model or provide preliminary research data to support further funding efforts. This was a perfect example of how this can work.”

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For more information select the below link:

Equine Arthritis Information