Re Do 2- Third Times a Charm?

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Karen Gehringer mgehringer@dmenet.com
I have spent the last seven months treating my horse for EPM.
  We should be done with treatment in two days.  Anna looks
 really good now but I have a strong urge to knock on wood as I
 type that because relapse is always a possibility.


I would like to share with you what I have learned through this
 process because, chances are, more than a few of you will have
 to deal with EPM at some point. Maybe my experience can be of
 some benefit to you and your horse.


I would like to divide this up into several parts.  The first
 would be “diagnosis”, the second “treatment”,  the third “food
 for thought” and the fourth “resources”.


Part 1: Diagnosis


In mid March of 1999, Anna and I completed our first one day 50
 mile ride at the Florida Endurance Classic.  We went slow but I
 was so pleased that she came through with one B and the rest
 A’s.  I was thrilled as this was a big step for my mare and I.
  The vets were excellent and since there was an FEI part to the
 ride, no doubt very qualified.


After a  week or so of time off, it was back to work.  Anna
 wasn’t quite right.  Soon she was intermittently traveling
 crooked, with her hind end traveling several inches off to the
 left of her front end.  After checking to see if the heart rate
 monitor was bothering her, then checking for saddle problems, I
 called my vet, Dr. Suzan Oakley.  She came out the first part
 of April and made the diagnosis of EPM.  The diagnosis was made
 due to muscle atrophy in the right shoulder and mild atrophy
 over the gluteals.  Anna had proprioceptive deficits in all
 four legs (moderate delay in the front, extended delay in the
 hind).  Tail pull was weak and she had a distressed facial
 expression.  Should be noted that I rode her hard for 45
 minutes (turns on the haunches, forehand, tight circles,
 backing etc) before I could get her to travel crooked prior to
 the  vet’s arrival.


My vet started Anna on pyrimethamine/sulfadiazine 30 ml a day.
  She also gave her the rabies shot she was due which may or may
 not have been such a great idea at that point, but more on that
 later.


A month later she showed mild improvement  to my vet.  But to
 me, she was worse as it took no effort at all to get her to
 travel crooked.  Although I believed my vet’s diagnosis because
 she is a skilled diagnostician and I had a gut feeling she was
 right, I decided at this point to get a second opinion.


My neighbor’s horse had just been diagnosed with EPM also so we
 took them both up to the University of Florida vet school.  Dr.
 Maureen Long, a neurologist, saw Anna.  She did a spinal tap on
 her,  x-rayed her neck and did a neurological exam.  The
 results were that Anna has some arthritis in her neck which may
 or may not  be effecting her (although I bet that’s why she
 couldn’t do dressage)plus she had mild weakness in the RF,LH and RH and mild proprioceptive deficits.  The spinal came back
 as a strong positive for EPM.  Dr.Long recommended continuing
 the treatment my vet started.  As a side note, Dr. Bryant who
 vets alot of rides checked on my mare several times while we
 were at UF and I really appreciated that courtesy.  Although both vets felt they had enough to go on to diagnosis EPM, there
 is no definitive way to prove a horse has it.  Some horses with
 positive spinal taps show no symptoms at all.  No one really
 even knows what causes EPM.  Recent controlled studies at UF
 failed to induce EPM in healthy horses.


My next post will cover a comparison of tx options (including
 cost), supplements,  rehab and other tx considerations.





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