# EPM! Help



## hrsecrzie (Feb 1, 2010)

My horse was diagnosed with EPM over a month ago, and has been on treatment since then. In about another week the vet said I could start gently riding (working) him again. I'm worried about how he was affected by this, and how that will impact him while I'm in the saddle. And what the possible damage could be. I'm not sure how I should start out with him again. Please any advice would be a huge help to both me and him.


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## Speed Racer (Oct 21, 2009)

You mean EPM, not EMP. *E*quine *P*rotozoal *M*yelitis. 

What you have to remember is that even though you can get it under control, it's never really gone. Your horse will never be 'cured'.

Your horse may or may not have relapses, depending on the severity of the disease and how far along it was prior to diagnosis.

If your vet said you can work your horse, albeit slowly, then believe him. EPM, unfortunately, is pretty common and vets deal with it quite a bit.

I wouldn't ride a horse knowing it had EPM, but that's just me. You never know when they're going to have a relapse, and I wouldn't want to chance riding the animal.


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## MyBoyPuck (Mar 27, 2009)

If you access to gentle sloping hills, start hand walking your horse up and down hills to start building up his muscles again. Once he's doing that like he's bored with it, move onto riding him at the walk up and down the same hills. Once that's boring for your horse, move onto trotting, etc. You know your horse, so you'll be able to see what might be difficult for him. EPM affects every horse a little differently. Mine recovered completely in terms of motor function. I just brought him back to work systematically one step at a time so I would be able to identify any problems. I also use a selenium/magnesium/vitamin E supplement for the first few months back to work to help his body heal itself. If you caught it early, he'll probably recover very well.


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## EPMhorse (Jun 14, 2009)

hrsecrzie,
Please give your horse some time off. The horse can't build muscle where he has nerve damage. I would not work the horse in a lunge circle until you are sure that he can handle this. Tight circles are very tough for the EPM horse to negotiate. I highly suggest the TTouch Rehabilitation for Horses with Neurological Deficits. The exercises will help you to more fully understand the depth of the horse's deficits.
Horses - Tellington TTouch Training

Please visit this site for more rehab information and ideas:
www.EPMhorse.org No Sales.

Rehabilitation of neurological deficits takes a lot of time. Think in terms of a year, not weeks. If you push the horse, you risk a relapse. I disagree with Speed Racer. The horse either has an infection, or it doesn't. You want to treat the infection long enough to kill all of the protozoa. Relapses within a few years are generally thought to be reactivation of the infection that was never fully cleared. Many vets recommend at least two months of treatment with Marquis or diclazuril. 3 to 7 months with ReBalance.


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## Speed Racer (Oct 21, 2009)

EPMhorse said:


> I disagree with Speed Racer. The horse either has an infection, or it doesn't. You want to treat the infection long enough to kill all of the protozoa.


Killing off the protozoa is only the first step. If the horse has irreversible neurological and nerve cell damage they will _never_ recover fully, thus they're not able to be cured.

Early detection and therapy may increase the _*chance*_ of sucessful treatment, but response to treatment is highly variable.

Some horses do return to their original level of function, while others remain compromised. There are also those animals who will require medication indefinitely.

So your cut and dried statement, "either the horse has an infection or it doesn't", doesn't work for EPM. It's an extremely frustrating and expensive disease to treat, and many do not recover to their pre-EPM levels.

Even the treatments and medications aren't without risks. Anemia, diarrhea, abortion, and low white blood cell counts are some of the side effects.

Hrsecrzie, I'm sorry about your gelding. EPM is a very serious condition, and I hope your boy can return to his normal work. Your vet is the one who knows the horse, so if he says you can work him lightly, go ahead. 

Regardless of the advice you get from a bunch of strangers over the internet, your vet is still your best source of information and direction.


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## Ryle (Jul 13, 2007)

I'm with EPM Horse, it is possible to CURE EPM--*EPM is the actual infection with the protozoa in the central nervous system.* That doesn't mean that a horse won't have permanent neurological deficits from the damage those parasites caused before they were killed, though. But a horse doesn't always have EPM. But it is very possible to cure the disease itself. 

As for going back to work immediately, I'm afraid your vet really hasn't done his research on EPM. Dr. Reed stressed (at a veterinary symposium lecture on EPM that I attended--so first hand advice from an EPM expert) the point that recovery is slow and that horses recovering from EPM horses recovering from EPM need lots of time off with no forced work and definitely no riding. Neurological deficits from EPM are much like those from head and neck trauma suffered in a car accident, they take lots of time for the body to learn to work around. Rehab should be taken slow so as to not overwork the horse because even very short periods of physical activity (and I mean waking across the paddock) can be extremely tiring because the horse is having to work extra hard to perform normal motions because the nerves that used to perform these tasks no longer function correctly. Pushing a recovering EPM patient too much leads to increased risk of traumatic accident to the horse or the handler. It is best to allow them a few months of turnout and self exercise in a safe environment so that they can move around as they have the energy and not end up over-worked. You will find that these recovering horses may look pretty good one day, but if they are tired, stressed, nervous or even distracted they may show an increase in neurological deficits. This same sort of thing happens with human and other animal patients recovering from central nervous system disease or damage.


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## hrsecrzie (Feb 1, 2010)

Thanks so much everyone. I haven't delt with many serious issues, so I really apperciate all of your input. I've been to vist him alomost every day since his diagnoses, and he's doing much better.  I wasn't talking about getting on and pushing him at all. he's been on turn out for a bit... he can run around the pasture just like he did before. He's not tired, or lathargic. The vet drew blood, and we got the results back and it was positive for EPM. I know that there can be false positives and I'm starting to believe that this could be the actual truth because he's acting so much like himself. Like i said, I really appreciate all of inout, and I take it to heart.


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## EPMhorse (Jun 14, 2009)

hrsecrzie,
Many recovering EPM horses do go out and play in the field. Some get hurt when they fall. The TTouch book I recommended is less than $20, and is a series of ground work exercises. They have you log your observations, and the exercises get progressively more complex. I can't tell you that they will absolutely help the horse to get better. I can tell you that they will give you a much better understanding of what deficits the horse has. The logs are very good for reference during the first year. Knowing what deficits the horse has will help you to make the decision of when to ride, and what to look for when you do start to ride again.

The horse may have deficits anywhere in the body, lips to tail. He may reject a bit that he has always taken, if he can't feel parts of his mouth. He may not pick up his feet, causing tripping. He may only have problems going downhill. He may have skin sensitivity....And on and on. You won't know until you are able to groundwork him. Good luck with the rehab. Please give it time.


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## Ryle (Jul 13, 2007)

hrsecrzie said:


> The vet drew blood, and we got the results back and it was positive for EPM. I know that there can be false positives and I'm starting to believe that this could be the actual truth because he's acting so much like himself. Like i said, I really appreciate all of inout, and I take it to heart.


What blood test was run? What signs was your horse showing that led your vet to expect EPM?


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## hrsecrzie (Feb 1, 2010)

his eyes were glazed over, one side of his body wa less corrdinated, his gait was stiff. he kept bupping into things. All of this is very unusual for him. I'm not sure what exact blood test was done. But I'm not crazy for thinking that, right? it could be a false possitive.


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## Ryle (Jul 13, 2007)

Was the eyelid on that side of the body not working correctly or was it swollen? The eye being "glazed" really is something that would be associated more with trauma to the eye which would mean that he could have had trauma to the head as a whole.


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## maura (Nov 21, 2009)

My understanding is that the only readily available definitive diagnosis for EPM is response to treatment. I'll defer to EPMhorse and Ryle on that as I haven't done research recently and that may have changed. 

Your horse has some pretty serious sounding neurological symptoms, in the face of those symptoms, EPM would be good news to me as a horse owner, as it's treatable and there's a chance the horse will return to useful soundness, if not his previous level of function. I can't think of anything else that would cause the symptoms (Wobbler's syndrome, stroke, severe concussion) you're describing that has as good a prognosis. 

In your shoes, I would be following the prescribed treatment regimen to the letter. 

Good luck, and let us know how the horse progresses.


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## hrsecrzie (Feb 1, 2010)

His eye lids weren't swollen and they were working properly. He has repsonded wll to treatment, but before we started it he seemed to be getting better. I think with EPM that its more back or front thats affected more, but with him it was left or the right. I'm not sure if this is true. I will deffinatly keep everyone updated. thank you.


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## Ryle (Jul 13, 2007)

maura said:


> My understanding is that the only readily available definitive diagnosis for EPM is response to treatment. I'll defer to EPMhorse and Ryle on that as I haven't done research recently and that may have changed.


Actually, response to treatment isn't considered a solid diagnosis or even "best medicine". This is because there are any number of issues that can cause very similar neurological deficits and resolve with supportive care or no treatment at all. Having a positive test on blood and CSF from a horse showing neurological symptoms is still considered the gold standard for diagnosis.


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## Ryle (Jul 13, 2007)

hrsecrzie said:


> His eye lids weren't swollen and they were working properly. He has repsonded wll to treatment, but before we started it he seemed to be getting better. I think with EPM that its more back or front thats affected more, but with him it was left or the right. I'm not sure if this is true. I will deffinatly keep everyone updated. thank you.


With the discoloration in the eye, I would be much more inclined to believe that head trauma might have been the cause of the symptoms. But you won't know because you never got a FIRM diagnosis or other diagnostic testing.

A positive blood test has little value, this is because of all the horses that get exposed to the parasite less than 1% will actually contract the disease. Now, the IFAT _may_ be of more benefit because it actually gives you a number value so you know how many antibodies to the parasite there were in the blood sample and the researchers have taken the time to figure out the percentage chance that a horse with x number of antibodies MIGHT have active disease. But again, it's still only testing blood and repeat exposures or very recent exposure can still lead to a high antibody count. So any positive result just means that you need to keep EPM on the list of possible causes. Where blood testing has the most value is in being negative. 

So a positive blood test is only a part of getting a diagnosis. Along with that, an initial workup should include head/neck x-rays and bloodwork to rule out EEE, WEE and WNV.


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## maura (Nov 21, 2009)

Great info, Ryle, thanks. But does it make sense, from a practical point of view or cost effectiveness, to treat for the EPM and gauge the horse's response before doing the head/neck xrays and the other blood tests? 




> I think with EPM that its more back or front thats affected more, but with him it was left or the right.


I'll defer to some other folks on this one, but I believe one of the reasons that it's so hard to diagnose EPM from symptoms alone is that the symptoms depend on the number, location and size of the lesions. Some horses may present with general ataxia, and others may present with pronounced with symptoms in one part of the body, one side or one limb


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## Ryle (Jul 13, 2007)

Diagnostic testing is WAY WAY less expensive than treating for EPM. And it's always better to know what you are treating and treat appropriately right off the bat rather than waste a month or more treating a "might be the cause".


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## hrsecrzie (Feb 1, 2010)

k thanks


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## 5cuetrain (Dec 11, 2009)

If I remember right there are two types of treatment--one by Bayer and one by someone else. I've used the Bayer and it worked well. Unfrtunately it was lots more expensive than the other. Some of my buds used the other and did not seem to get as good of a result.


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