# Epm????



## MangoRoX87 (Oct 19, 2009)

So we had a vet come out today to look at my horse Rebel. He has slowly been losing weight and limping on his left front. They blocked his hoof and then the joint above that, and nothing really happened. Then they blindfolded him, and when he walked he would strut his legs out way infront of him. He has all of theses symptoms:
loss of coordination 
muscle atrophy 
difficultly swallowing 
sore back 
stumbling 
weakness

The vet pulled blood and is going to send it to Indiana to test for EPM, and she also sent another tube of blood to test for other things. Does anyone know about this disease or, perferably, have eny experience with it?
-Thanks, MangoRoX87


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## Ryle (Jul 13, 2007)

Yes, I know quite a lot about EPM. 

Here are some links for you to review. 
I would recommend that you check out these links:
http://www.thehorse.com/ViewArticle.aspx?ID=14177
http://www.thehorse.com/viewarticle.aspx?id=14649
http://www.thehorse.com/ViewArticle.aspx?ID=10416 


If you have specific questions, please ask them. It would take me way too long to just type out everything about EPM.


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## MangoRoX87 (Oct 19, 2009)

Thank you very much! Do you maybe know what the best treatment is for it? I have read up alot on Marquis..what do you think of that treatment?


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## Ryle (Jul 13, 2007)

Marquis is a great option because it is just as effective as the other treatment options but doesn't have the same risk of serious side effects that you have with Navigator and treats the problem much more quickly than the Rebalance (pyrimethamine/sulfadiazine). You MUST be very sure that you are not underdosing so if you can't put your horse on a set of scales it's often recommended that you use 1.5-2 times the labelled dose. (This is safe.) 

However, be sure you get a good diagnosis otherwise you could be treating for the wrong problem and leaving the real issue to continue to worsen.
Rather than Indiana, request that he send blood off to UCDavis for the IFAT test as it will give you a better indication of the likelihood that your horse does have active disease.

Also, since the issues seem to be more front-end you should consider that the issue is something other than EPM. If your horse has been trailered prior to the problems starting or has had any accidents then head/neck x-rays might be a good option.

You should also consider selenium deficiency if you are in an area of the country where the soil is selenium deficient. A simple blood test can determine if this is the problem.


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## MangoRoX87 (Oct 19, 2009)

Thank you very much! This is very informative. I will ask my mom about having the blood sent off to there instead of Indiana. When the blood comes back, the vet is coming to come out and discuss whats wrong and what we can do. In the meantime, how can I make him more confortable? And if it comes down to being EPM, is it cheaper to get Marquis from my vet or directly from Bayer?


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## Ryle (Jul 13, 2007)

In the meantime, you could talk to your vet about maybe trying a 3 day Bute trial. This would help to determine if it's a simple pain issue or actually a neurological deficit. If 3 days of Bute helps, it's not neurological. 

If Bute is not helping, then you should talk to your vet about putting him on banamine to go ahead and deal with whatever central nervous system inflammation is occuring. This will help to limit the permanent damage done to the CNS because part of the thing that causes damage is swelling inside a bony structure that kills nervous tissues due to the chronic pressure on it.

You can't by Marquis straight from Bayer so you will either have to get it from your vet or get him to write you a script so you can order online if you can find it cheaper. I believe you can still get it online for about $750.


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## MangoRoX87 (Oct 19, 2009)

Ok. I had him on bute for 3 days when his limping was really bad, and it didn't do anything for him. I could probably see about banamine.
Do I have to pay the whole price for Marquis all at once? The cheapest I have found is $759. I would think there is a way to pay it off.


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## sillybunny11486 (Oct 2, 2009)

Ive never herd of a manufacturer giving you payment options. I think you'd need to talk to a vet about that, or find a credit card with lower interest rates. 

Cindy, just curious as to why you suggest UCDavis instead of Indiana?


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## MyBoyPuck (Mar 27, 2009)

I see Ryle mentioned Selenium. I'm not sure where you are located, but if you're in the northeast US, your horse is most likely low in Selenium. My horse was "loosely" diagnosed with EPM last year. No concrete or severe symptoms. Not so much as a blood test. I was a new horse owner and didn't know any better. We did the Marquis. While he was recovering from his loss of muscle and incoordination, I had him on SE-Mag from Smartpak. It's a vitamin E, Selenium and Magnesium supplement. I cannot tell you how much muscle that horse put on just walking around in the two months I was giving it to him. I stopped because I was afraid of overdosing him on Selenium, but it was very obvious to me that the combo of Vitamin E and Selenium assisted the healing process.


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## tealamutt (Aug 21, 2009)

Map of Selenium Status in US

here is a map of selenium deficient areas. Remember that even if you don't live in one of these areas, your hay may come from one so you should have it checked if you truck it in. Posted mostly for those who might be reading the post and curious about Se deficient areas.


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## AlmagroN (Jul 19, 2009)

if money is an issue and youre not 100% sure if its EPM, you may want to have a vet drench your horse with Baycox first. we use baycox to help with our EPM horses. we drench with baycox about once a month. and if your horse has to have any injections or such, do NOT use ANYTHING with cortizone. cortizone is a HUGE no no with EPM horses. 

anyway the baycox is a lot cheaper and does work


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## Ryle (Jul 13, 2007)

Baycox is not an approved treatment and there are no good studies on the dosage or time that would be necessary to effect actual treatment of the diseae. Baycox is the parent drug of Marquis and the body turns it into the same product, however I haven't seen any good evidence of what dose would be necessary to affect the same results as with Marquis. 

You would need to discuss payment options with your vet or look for one of the online pharmacies that will sell marquis by the tube so that you can spread the payments out a bit. But really most equine vets simply can't afford to take payments because they have bills to pay themselves. 

As for why I would recommend using the lab at UCDavis, it is because they run the IFAT test which gives a quantitative answer that has been correlated through studies to a % chance that the horse actually has EPM rather than just being exposed to the parasite. It isn't foolproof, but it is better than a simple "yes he has been exposed" or "no he hasn't been exposed" that you get from the Western Blot test which really leaves you little better off in a positive horse. This is because exposure only leads to active disease in about 1% of exposed horses.


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## AlmagroN (Jul 19, 2009)

Ryle said:


> Baycox is not an approved treatment and there are no good studies on the dosage or time that would be necessary to effect actual treatment of the diseae. Baycox is the parent drug of Marquis and the body turns it into the same product, however I haven't seen any good evidence of what dose would be necessary to affect the same results as with Marquis.


actually there was a test done by bayer. nothing in it says marquis is any better than baycox. its just much more expencive


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## Ryle (Jul 13, 2007)

The problem is that Baycox doesn't work but that we don't have reliable dosing and safety studies with Baycox.


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## AlmagroN (Jul 19, 2009)

all im going to say is thats what the vets use here, and there has never been a problem. and ive seen first hand improvement.


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## Ryle (Jul 13, 2007)

Yes, but how accurate was the diagnosis? EPM is very over-diagnosed. Many times the cause is another condition and the horse improves due to time off, anti-inflammatories and/or it's body fighting off the infectious organism. I've seen multiple horses that were diagnosed with EPM that turned out to be something else. Several of them even seemed to respond to treatment for EPM because treatment and time off were instituted at the same time. 

Dr. Bruce Kilmer of Bayercorp explained that bolus dosing of Baycox isn't going to be effective because you do not reach a steady state of drug in the central nervous system and that steady state of drug is required to actually effectively treat EPM. Thus the need for 28 day dosing with Marquis.


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## MangoRoX87 (Oct 19, 2009)

Ok, so last night my horse Sassy colicked and I got a tube of banamine (paste) from the vet. I am in central Oklahoma, and we buy our hay from folks in the state nearby. I really doubt its selenium deficiency. We have made payments with our vet before.
When the vet came out, we tried several things. He is very uncordinated, has no muscle mass on his shoulders (you can feel the whole bone), is weak, and his back is kind sore. We have tried everything imaginable with this horse. We are not 100% sure if it is EPM, but we are getting his blood tested for other things.


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## MangoRoX87 (Oct 19, 2009)

Ok so Rebel is indeed borderline EPM. We are getting a shipment soon of medice (the vet choose something else, not Marquis, and alot cheaper). Thank you guys for all your answers!


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## AlmagroN (Jul 19, 2009)

MangoRoX87 said:


> Ok so Rebel is indeed borderline EPM. We are getting a shipment soon of medice (the vet choose something else, not Marquis, and alot cheaper). Thank you guys for all your answers!


let me know what the stuff is he ordered. im interested to know.


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## Ryle (Jul 13, 2007)

Exactly what does "borderline EPM" mean? You should ask your vet if that is what he said, because that makes no sense. If they did a Western Blot on blood there is simply a "yes" or no" to exposure. If they did an IFAT then the results are reported with a % chance that you are dealing with active disease.


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## MangoRoX87 (Oct 19, 2009)

Yeah I was a little myphed on the "borderline" part also.


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## sillybunny11486 (Oct 2, 2009)

when my gelding was tested the vet told me: low grade positive. did that mean he was exposed but the chances are low he had it?? I never really asked because we had already decided to put him down t that point. Selenium is great, but its toxic if fed too much.


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## Ryle (Jul 13, 2007)

It's likely that "low grade positive" was used to describe a weak positive on the WB test, which would indicate that he had antibodies to S. neurona circulating in the blood but not a high number of them. That would likely indicate that exposure occured sometime in the past.


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## sillybunny11486 (Oct 2, 2009)

we had him tested for epm at 5 and at 8.


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## DaysofThunder (Apr 24, 2009)

I like to use Baycox 5% twice a week until I get the EPM under control. I buy the Toltrazuril powder from Stop EPM with Baycox & Toltrazuril and just put it on the horses food. Once you get about two weeks worth of treatments into them you notice a huge difference in there gait. I highly recommend this treatment because it's much cheaper than marquis and more effective in my opinion.


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## AlmagroN (Jul 19, 2009)

DaysofThunder said:


> I like to use Baycox 5% twice a week until I get the EPM under control. I buy the Toltrazuril powder from Stop EPM with Baycox & Toltrazuril and just put it on the horses food. Once you get about two weeks worth of treatments into them you notice a huge difference in there gait. I highly recommend this treatment because it's much cheaper than marquis and more effective in my opinion.


ive never seen the tolrazuril powder. ill have to keep a link to that!!


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## Ryle (Jul 13, 2007)

sillybunny11486 said:


> we had him tested for epm at 5 and at 8.


Ok, I'm really not sure what you mean by this....5 o'clock and 8 o'clock? 5 days and 8 days? 

You don't diagnose EPM by testing twice on blood a certain length of time apart.


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## Ryle (Jul 13, 2007)

DaysofThunder said:


> I like to use Baycox 5% twice a week until I get the EPM under control. I buy the Toltrazuril powder from Stop EPM with Baycox & Toltrazuril and just put it on the horses food. Once you get about two weeks worth of treatments into them you notice a huge difference in there gait. I highly recommend this treatment because it's much cheaper than marquis and more effective in my opinion.


This treatment is no more effective than Marquis because toltrazuril is the parent drug of ponazuril (Marquis). The body turns toltrazuril into ponazuril and thus treatment of EPM occurs if dosed correctly. However, as there are FDA approved drugs for the treatment of EPM and Baycox is not one of them most vets do not use this product because there are not as many studies on it's correct dosing. It also can lead to a vet being fined for prescribing a non-proven drug for treatment of a disease when their are approved drugs available.


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## DaysofThunder (Apr 24, 2009)

Ryle said:


> This treatment is no more effective than Marquis because toltrazuril is the parent drug of ponazuril (Marquis). The body turns toltrazuril into ponazuril and thus treatment of EPM occurs if dosed correctly. However, as there are FDA approved drugs for the treatment of EPM and Baycox is not one of them most vets do not use this product because there are not as many studies on it's correct dosing. It also can lead to a vet being fined for prescribing a non-proven drug for treatment of a disease when their are approved drugs available.


How is "Baycox" not proven? It was the first thing out that was used for treatment of EPM. Marquis is nothing more than a bunch of hype. We have used marquis and seen absolutely no good results and for the money is costs it's definitly not worth the time or the headache. If you use the Toltrazuril Powder every five days you see great results. I like the powder because you don't have to have a vet run the nasogastric tube to give it. The biggest reason the vets like Marquis is they make a lot more $$$$$ selling it.


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## Ryle (Jul 13, 2007)

DaysofThunder said:


> How is "Baycox" not proven? It was the first thing out that was used for treatment of EPM. Marquis is nothing more than a bunch of hype. We have used marquis and seen absolutely no good results and for the money is costs it's definitly not worth the time or the headache. If you use the Toltrazuril Powder every five days you see great results. I like the powder because you don't have to have a vet run the nasogastric tube to give it. The biggest reason the vets like Marquis is they make a lot more $$$$$ selling it.


Truthfully, I question the quality of diagnosis you are basing results on. Unfortunately EPM was WAY over diagnosed for years....and still is to some extent though more vets know what constitutes appropriate diagnostic protocols now. Lots of horses who are diagnosed with EPM don't have EPM....I know several cases where this is what occured. 
The fact that you expect a horse's gait to be improved in 2 weeks time is proof that you don't really understand the treatment of the disease because ponazuril (what toltrazuril is turned into by the body) requires 2 weeks treatment to get up to a steady lethal dose for the parasites in the central nervous system. That is the point where it really starts effecting a good kill of the parasites, but that doesn't mean that it's going to make your horse better in 2 weeks time because when the parasites die they emit toxins that cause inflammation in the central nervous system and often leads to a worsening of symptoms.

Baycox has never been an FDA approved treatment for EPM. It has been used off-label for many years without sufficient studies to prove effectiveness, required dosing, etc. Marquis was the first PROVEN effective treatment marketed. 

So your vets run a nasogastric tube to give Marquis? 

In carefully controlled studies over several years Marquis has been proven effective at treating EPM. I know many many owners who have successfully used Marquis to treat their horses. And again, the toltrazuril you are recommended is turned into pontazuril (the active ingredient in Marquis) by the body....so if Marquis didn't work toltrazuril wouldn't work.


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## Cat (Jul 26, 2008)

Toby was diagnosed with EPM when he was 4 years old. It was horrible. He lost almost all control of his hind end and was staggering and falling down. His front end was fine, but his back was completely whacky. He also ended up with some muscle atrophy - especially on the left hind which was the one that was effected the worst.

My vet suspected EPM - he said almost classic case. But while we waited for the results to come back he had him up at the clinic with a DMSO drip given to him several times over a couple days and some sort of pill to go in his feed - not sure what it was. But once the results came back - a very strong positive - we went with marquis paste. Gave him corn oil w/ it as well in some feed which was suppose to help with absorption. He was also on a vitamin E supplement during this time as well.

The first month was up and down. He looked a little better - but then at 2 weeks seemed to get worse, which was explained to me to be a common thing due to "die off" of the protozoa about that time. Then after that he just continued to improve. We did very slow rehab with him - light walking (at his pace) and letting him move in the dry lot as he wished. After a while as he felt better we started having him walk over poles and such so he could relearn how to place his hind feet. It was about 8 months before I first got on him again and that was just at a short walk. Almost a year before I did any actual riding.

My boy is now 8, and doing very well. I use him on trails and he started cantering for me again recently. If I ever have a horse come down with EPM again - I wouldn't hesitate to use Marquis. Its safe, its proven, I've seen it work, and I'm not guessing at dosage. Plus my vet calculated out the estimated cost of baycox vs marquis - and if you use baycox at what is supposed to be an effective level it comes out at about the same cost as Marquis.


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## MangoRoX87 (Oct 19, 2009)

Ryle and Cat. I like what you two are saying! Very imformative. So around 2 weeks, the little parasites will die, hu? Thats good too know. The medicine should be here tomorrow or Tuesday, so I will give you guys the name when it comes. While he is on the treatment, should I keep him stalled with a turnout? (he will flip out if he is locked in a stall without one). We have him on vitamin E pills right now. If we weren't already using this, I think I would deffinatly go with Marquis, based on what Ryle and Cat have to say.


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## DaysofThunder (Apr 24, 2009)

Ryle said:


> Truthfully, I question the quality of diagnosis you are basing results on. Unfortunately EPM was WAY over diagnosed for years....and still is to some extent though more vets know what constitutes appropriate diagnostic protocols now. Lots of horses who are diagnosed with EPM don't have EPM....I know several cases where this is what occured.
> The fact that you expect a horse's gait to be improved in 2 weeks time is proof that you don't really understand the treatment of the disease because ponazuril (what toltrazuril is turned into by the body) requires 2 weeks treatment to get up to a steady lethal dose for the parasites in the central nervous system. That is the point where it really starts effecting a good kill of the parasites, but that doesn't mean that it's going to make your horse better in 2 weeks time because when the parasites die they emit toxins that cause inflammation in the central nervous system and often leads to a worsening of symptoms.
> 
> Baycox has never been an FDA approved treatment for EPM. It has been used off-label for many years without sufficient studies to prove effectiveness, required dosing, etc. Marquis was the first PROVEN effective treatment marketed.
> ...


I don't necessarily agree with what your saying in the fact you say you can't help a horse in two weeks. You give me a racehorse that you have diagnosed with EPM and give me two weeks and I'll for sure have it better than it was before. I have never had one go worse from giving Baycox because of toxins. If Marquis is same as why wouldn't you go with the one for less money? The vets around here charge $400 for two weeks of Marquis and you can get Baycox for $40-50$ a treatment. I think if you use a little DMSO and then some Baycox you will see great results.

What is your take on Diclazaril? I like that treatment also but only in bad cases and I always use Baycox first to calm the EPM down so as to not hurt the horse.


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## AlmagroN (Jul 19, 2009)

DaysOfThunder- i have never used anything for EPM but baycox. ive never even seen a vet use marquis. they all still use baycox. and i highly believe baycox works great.

as far as marquis goes, personally i think ... as with most companies... it was just another way to make more money. but thats just what i think. if baycox is the parent drug in marquis, how could baycox not work or be bad for the horse, and marquis be fine. i just dont get that. plus if baycox has been used for a long time already to treat EPM, then where is all the proof that it is harmful or doesnt work? all i have seen is proof that it DOES work.

to me this is like when dog food companies change a lable on food. they take crap *** dog food like purina or something, slap holistic on the bag and sell it for more. its not better than the other, but the lable insists its more costly.


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## qtrhrsecrazy (Aug 2, 2009)

Ok.. if I'm understanding everything I've read, Baycox has to turn in to what Marquis already is, once in the body.

There is not a determined dose approved of Baycox and it's a guessing game what to actually administer. 

Right?


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## Ryle (Jul 13, 2007)

Days of Thunder, if you are seeing great results in 2 weeks time you aren't dealing with EPM. Killing the parasite actually causes more inflammation in the CNS so you are going to see continued or even worsening of symptoms during treatment just because you are causing inflammation by killing the parasites. 

Lots of those racehorses diagnosed with EPM likely don't have EPM. Both from what I know from dealing with horse owners treating EPM for the past 8 years and from talking to the EPM researchers from the big universities about the serious problem of over-diagnosis of this disease that was prevelant for more than 10 years.

MangoRox87, whether or not you will see a worsening of symptoms at 2 weeks depends on what drug your vet has ordered. With Marquis, yes...it's possible. But if you are using pyrimethamine/sulfadiazine you aren't going to have big die-offs because that drug combination doesn't KILL the parasites but rather just prevents it's reproduction. You continue treatment with that combination long enough to prevent the parasites that are there from reproducing until they die off naturally.


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## DaysofThunder (Apr 24, 2009)

AlmagroN said:


> DaysOfThunder- i have never used anything for EPM but baycox. ive never even seen a vet use marquis. they all still use baycox. and i highly believe baycox works great.
> 
> as far as marquis goes, personally i think ... as with most companies... it was just another way to make more money. but thats just what i think. if baycox is the parent drug in marquis, how could baycox not work or be bad for the horse, and marquis be fine. i just dont get that. plus if baycox has been used for a long time already to treat EPM, then where is all the proof that it is harmful or doesnt work? all i have seen is proof that it DOES work.
> 
> to me this is like when dog food companies change a lable on food. they take crap *** dog food like purina or something, slap holistic on the bag and sell it for more. its not better than the other, but the lable insists its more costly.


I agree 100% - The only reason these "Vets" want to push Marquis on you is the money. They buy it for 100-200mo. and turn around and get you for 800mo. Total scam - I look at EPM like a broken nose. You never X-Ray a broken nose. Can you breath? Dose is look the same as before? If both yes leave alone. If one is no it's obviously broken and needs fixed.

Point is....if horses acts like EPM and I give him Byacox and he's better then do I really need to spend money on spinal tap to get confirmation? What if it comes back negative but horse raced great on Baycox? I agree EPM is over diagnosed but wasting money on spinal tap and other diagnosis is waste of money. If horse acts like it -treat it and see if better!


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## MangoRoX87 (Oct 19, 2009)

"Point is....if horses acts like EPM and I give him Byacox and he's better then do I really need to spend money on spinal tap to get confirmation? What if it comes back negative but horse raced great on Baycox? I agree EPM is over diagnosed but wasting money on spinal tap and other diagnosis is waste of money. If horse acts like it -treat it and see if better!"

I think I have to disagree. I am no vet, but couldn't that poison a horse if you use medicine that they may not need? It wouldn't have anything to fix or kill so it would just kinda..sit there in a way or do more harm then good.


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## Ryle (Jul 13, 2007)

The point is that you may be seeing results that have nothing to do with the Baycox but rather with time off and any supplemental care you are giving such as Banamine. 

I know a woman who had 3 horses diagnosed with EPM by her local vet.....she treated with Marquis 3 times and horses appeared to get better. But each time they again started showing symptoms after the Marquis was discontinued. She was finally talked into having diagnostic testing done on her horses and none of them had even been exposed to the parasite that causes EPM. But they were all low in selenium. Selenium supplementation was started and all 3 horses' symptoms disappeared and never returned.

Lamess from pain is often confused for neurological deficits and a couple of weeks off can make a huge difference. 

A horse with a fractured vertebrae in the neck can show neurological symptoms and can appear normal in a couple of weeks with just time off an Banamine or Bute. But if this horse was diagnosed as EPM off symptoms alone and started on ANY treatment for EPM it would have looked like the medication did the job. (Again, from experience--horse with no outward signs of trauma but with a fractured vertebrae. He was initially diagnosed as having EPM on symptoms alone but owner was convinced to get diagnostic testing and found the vertebrae fracture with x-rays. The horse recovered well and quickly with time off and anti-inflammatories.)

So without a good diagnosis, response to treatment isn't necessarily proof that you are treating the correct thing. And a single Western Blot test on blood simply isn't diagnostic----of all the horses that test positive on a WB on blood, less than 1% actually contract EPM. A positive WB just means that EPM is still on the list of possibilities. It's value isn't in the result being positive because that just shows exposure. It's value is in being negative which means that EPM is highly unlikely.


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## tealamutt (Aug 21, 2009)

Ryle is absolutely right here. EPM, while being diagnosed more frequently is still extremely rare. If you take the time to read some of the links she posted (all from very credible, peer reviewed sources) you will see that EPM is diagnosed very infrequently and is almost never at the top of a differential diagnosis list. Vets don't make very much money on pharmaceuticals and the figures posted above are completely incorrect (I checked today at the hospital to see what our cost is vs what we charge). A spinal tap is not a very expensive proceedure and with all neurological diseases, time is of the essence. You could waste very valuable time doing the "treat and see" approach, not to mention risking losing the horse all together.

Additionally, treating something which you didn't diagnose properly and seeing it resolve doesn't "prove" that the treatment worked. Only controlled studies can prove efficacy. Since EPM cannot be reliably reproduced in a research setting, nothing has yet been proven. I would be very careful making statements like that. I am also suspicious of any clinic that claims to have seen more than a handful of EPM cases, it is just too rare for them all to have been actual EPM.


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## AlmagroN (Jul 19, 2009)

tealamutt said:


> Only controlled studies can prove efficacy. Since EPM cannot be reliably reproduced in a research setting, nothing has yet been proven.


there ya go. so who says marquis is better are works better than baycox if you just said yourself that nothing has been proven?


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## tealamutt (Aug 21, 2009)

AlmagroN said:


> there ya go. so who says marquis is better are works better than baycox if you just said yourself that nothing has been proven?


precisely. I'm not saying one is better than the other. I'm saying response to treatment should never be touted as "proof" of efficacy. My point was more toward the importance of proper diagnosis (which is the cheap part here). Treat as you wish, just make sure you're actually dealing with the disease you think you are.


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## Ryle (Jul 13, 2007)

Actually, there has been a model developed for producing EPM in a research setting and it has been in use for several years. And many studies have been performed to PROVE the effectiveness of Marquis, Navigator and Rebalance. 
http://www.sciencedirect.com/scienc...serid=10&md5=1ead6b44017717e6da923ad6f796f401

The Horse | EPM: Still an Enigma or Under Control?

The Horse | Twelve Years of EPM Research: Are We Any Smarter?

http://74.125.95.132/search?q=cache:T-Cu_PrmYPgJ:ecommons.cornell.edu/bitstream/1813/13331/4/Sandoval-Claudia-ppt2007.pdf+saville+%26+EPM+model&cd=15&hl=en&ct=clnk&gl=us

Years of studies have shown that all 3 of those treatment options provide about 70% chance of recovery from the disease.


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## AlmagroN (Jul 19, 2009)

the first link i cant use because i would have to pay money to be a member of that site.

the second and third links you have to be a member so i have to go back and do all that before i can read those.

the last link is a paper a student wrote. how is that proof of anything? plus after 6 days that horse was put down....


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## sillybunny11486 (Oct 2, 2009)

I feel like EPM is undiagnosed around here. My horse could have been carrying it for years (if thats even possible) and a vet never even thought to test him for it until he was dangerously uncordinated. (We have alot of the typical carriers were I live.)

Most vets here just start treatment then wait for lab results. Most people want to start their horse on something asap, instead of waiting, if it could progress.


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## MangoRoX87 (Oct 19, 2009)

Rebel's medicine came in. Its called Karbo. It came with about a half or so gallon, then a flour like substance. I feed him 2 ounces of each daily. Anyone ever heard of this treatment?


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## EPMhorse (Jun 14, 2009)

MangoRoX87,
I agree with what Cindy is saying, but there is a little more to the FDA drugs. Diclazuril has been approved by the FDA for two years as 'Protazil.' This drug is not yet on the market, but you can get diclazuril compounded for about $150 per month. It has gone through the same clinical trials as Marquis and Navagator. 

As for Karbo....any substance used to treat EPM must do two things. first, it must pass the blood brain barrier to treat the central nervous system (CNS). Second, it must be able to enter individual cells to kill the protozoa that are within other cells in the CNS. If the treatment that you are using does not do these two things, it won't kill the protozoa.

Karbo is not an FDA approved drug. It has no formal clinical studies to prove it's effectiveness. If your horse has a nutritional deficiency, the Karbo may improve the deficiency just enough to make it look like there is improvement. BUT, it won't kill the protozoa. Do not rely on Karbo to treat for EPM.

Please, have your vet consult with a teaching hospital. Your horses health is at stake. There is another site where you can find more information on FDA drugs and protocols for free:
www.EPMhorse.org 

Go to the treatment page. The FDA 'Freedom of Information' sheets for each of the four FDA approved drugs are at the bottom. It talks about costs, side effects, and efficacy of each drug. Several clinical studies are available for free on different pages.

And, like Cindy, I would highly suggest an IFAT test through UC Davis. This test will give you better information about the chances of your horse having EPM.

EPMhorse


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## MangoRoX87 (Oct 19, 2009)

"Karbo Flour is our original Karbo formula product. The primary function of this flour form supplement is to bind and inactivate bacteria, viruses, protozoa, fungi and toxins in animals and birds. Karbo Flour has proven effective in alleviating multiple disease challenges and symptoms, and in boosting immunity."
Ok so I believe EPMhorse's statement, as it sounds like she knows what she is talking about. But, I got this statement from the people who make Karbo. And, if it does "inactivate", not so much kill, like Ryle seemed to say, then he would just need to be on something to keep them from multiplying and/or doing further damange until they just die off?

And here is the liquid that I also have for it: http://www.gomersinc.com/k_epic.asp


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## EPMhorse (Jun 14, 2009)

MangoRoX87,
First, 'inactivate' is not a clinical term. It could mean just about anything. Second, a 'flour' is going to stay in the digestive tract. It will not treat the CNS. Karbo is not a prescription drug.

The Western Blot test performed shows only exposure to EPM, it is not definative of active disease. IF your horse has an active case, and the neurological symptoms you see are from EPM, then the protozoa are causing damage to the CNS. Karbo will not kill it there.



> MangoRox87, whether or not you will see a worsening of symptoms at 2 weeks depends on what drug your vet has ordered. With Marquis, yes...it's possible. But if you are using pyrimethamine/sulfadiazine you aren't going to have big die-offs because that drug combination doesn't KILL the parasites but rather just prevents it's reproduction. You continue treatment with that combination long enough to prevent the parasites that are there from reproducing until they die off naturally.


I believe Cindy was simply pointing out the differences between Marquis and ReBalance (pyrimeth./sulpha.). The 'zuril' drugs (ponazuril and diclazuril) kill the protozoa faster, and only need to be given for one or two months. (Some vets are now suggesting a minimum of 2 months of Marquis) The pyrimeth./sulpha combination must be given for a minimum of 3 months, and up to 7 months. Both diclazuril and pyrimeth/sulpha must be compounded from a pharmacy that handles veterinary prescriptions. If your horse has EPM, you need a prescription drug to treat it.

In this case, I would recommend one of three things. Either insist that your vet consult with a university hospital, or get a second opinion from a vet that has treated many cases of EPM. You can also call a university vet hospital, and ask for some basic information over the phone. Most university vets are very good about helping. Cindy gave links to some articles on TheHorse.com. This disease can get much worse overnight. Don't wait to see if improvement happens with Karbo.

If your horse does have EPM, you are in for the long haul. He could have setbacks, bad days, treatment crises, and not be rideable for several months. There is a Yahoo group that is specific to EPM, and has the experience of many EPM horse owners to help you through the treatment and rehab: 
EPM : Equine Protozoal Myeloencephalitis.


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## Ryle (Jul 13, 2007)

Definitely, if your vet is choosing to use an unproven product to treat a serious disease in your horse when there are several FDA approved, proven effective products on the market then you need to get a second opinion. The simple fact that your vet prescribed a non-FDA approved product when there are FDA approved products on the market and didn't TELL YOU that he was doing so is a big flashing warning sign. They are required to tell you if they are using a non-FDA approved treatment in your animal.


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## MangoRoX87 (Oct 19, 2009)

Ok so I was just thinking. My friend had told me about this thing that a college in our state, OSU (Oklahoma State University), does. They use your horse for their classes, and they run tests and stuff for free. Then after they are done you get your horse back. Now I'm not %100 sure if she had her info right. But, how do you go about doing that? And what if it wasn't EPM? What diseases are easily confused with it?


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## EPMhorse (Jun 14, 2009)

You can Google the OSU vet school for a number. Other diseases that look like EPM are listed on www.EPMhorse.org Diagnosis pages. Please read throuh the pages, they may answer many of your questions, and make you better prepared to discuss things with both your vet and OSU. EPM is not a disease for non-reading owners. It takes a lot of research and time.


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## Ryle (Jul 13, 2007)

Universities may actually look for horses with specific conditions for studies, but they don't give away free services on a day-to-day basis. You can have your horse examined and treated at veterinary teaching hospitals where students will be involved in the examination, diagnosis and treatment, but you still have to pay for the services. However, the cost at a teaching hospital may be quite reasonable.


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## Cat (Jul 26, 2008)

MangoRoX87 said:


> And what if it wasn't EPM? What diseases are easily confused with it?


I forget everything my vet looked at, but here are a few of the things I remember he was working to rule out while we waited for the EPM test results:

WNV, Wobblers, Lyme Disease, Braken Fern poisoning (and a few other plants we looked in the pasture & hay for), selenium deficiency, back injury, EPSM (PSSM), etc.


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