Tag Archives: protazil

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

Another Try

Yesterday, while at the farm, Chance’s medications arrived at my house instead of the farm.  I drove home, grabbed the meds, and began my drive back to the farm.  A winter storm was just beginning.  4 hours later, I dropped off the medication and turned back around to head home.

Thankfully, Chance began his second round of EPM treatment this morning.

I decided to try a different type of treatment this time around- round one: Protazil and round two: Marquis.  Marquis has been around longer and has similar potential side effects and outcomes as Protazil.

Rebalance recently was linked to the death of 4 horses in 2014.

Or

Oraquin-10 which is a 10 day treatment that is more cost effective.  However, it is a newer medication and the vets that I have spoken to were not as comfortable with the outcomes in the horses with EPM.

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A Month Later

Luckily, after about one week of stall rest and hand walking, along with a stronger anti-inflammatory, Chance has begun to show improvements over the last couple weeks of treatment.

Chance has almost completed his first 30 days of EPM treatment and has about a day or so left of the Protazil. He is going to continue his other medications and supplements:

1. SmartPak: senior flex and immune boost
2. Vitamin E
3. MicroLactin (amazing) to help with regrowth of his cells, inflammation, and pain.

As I’m doing research, and trying to come up with a plan of action, once again I am inundated with opinions…medication, exercise, holistic, massage, acupuncture, chiropractic, organic, shoeing, etc.

I know I need to continue therapy, or start a new therapy. But which one do I choose?

Do I go the holistic approach and work with an acupuncturist, chiropractor, massage therapist, and vitamins such as Vita Royals? Do I go organic? Or do I try Marquis? Another month of Protazil? Oraquin-10? Rebalance has been linked to a number of recent deaths in the past handful of months. If I go the organic or holistic approach do I run the risk of the disease progressing? If I go with the medication do I run the risk of yet another “treatment crisis”?

I contacted Vet4 and he suggested doing another round of the Protazil or Marquis.  I decided on trying Marquis and waited for it to arrive.

Chance after a month on Protazil 

Our Regiment


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Chance receives the following:



AM:

1. Protazil 50mls

2. Vitamin E 4 scoops (Watch for loose stools.  This would indicate that his VitE should be cut down)

PM:

1. SmartPak: Immune Boost

2. SmartPak: Senior Flex

3. Equinyl 2 scoops first two weeks, 1 scoop after

OTHER:

If Chance’s symptoms are worse, he can receive Equinox and UlcerGuard.

How to we get there?

As I said previously, the idea of Chance collapsing and no one being there terrifies me. Vet4 is shipping me the Protazil and I am trying to find another vet to come and administer the DMSO before beginning treatment.  DMSO typically helps the Protazil adhere better, thus making the treatment more effective.

EPM: Is DMSO the Cure for Treatment Issues?

By Stacey Oke, DVM, MSc Aug 3, 2009

New research on treating horses with equine protozoal myeloencephalitis (EPM) has found dissolving toltrazuril sulfone, commercially known as ponazuril, in dimethylsulfoxide (DMSO) instead of water prior to oral administration in horses increases the bioavailability by three times and achieves therapeutic levels in both the blood and cerebrospinal fluid.
Ponazuril and related triazine-based antiprotozoal agents used to treat horses with EPM are highly lipid (fat) soluble. As a result, these agents dissolve poorly in the gastrointestinal systemand are therefore poorly absorbed.
Poor drug absorption results in variable drug concentrations in the bloodstream, which translates into a variable therapeutic effect in the treated horse, explained Levent Dirikolu, DVM, PhD, from the Department of Veterinary Biosciences at the University of Illinois, and co-researchers from the University of Kentucky Gluck Equine Research Center and the United States Department of Agriculture (USDA) Animal and Natural resources Institute.

I finally found a vet who was able to come to the farm to meet Chance and administer other medications.

Vet6 felt that DMSO wasn’t necessary and that Chance would be fine. I called Vet4, explained the situation, and he advised beginning Chance on 1/2 a dose of Protazil for the first couple days in conjunction with a mild anti-inflammatory.

So, that is what we did. I had also read that Vit E (only in its all natural form) was helpful during treatment, along with Ulcer Guard to keep his stomach safe from the medications.

I called 5 different vets and no one has what I was looking for in stock. I finally found it in Chantilly!