Cash’s Journey with EPM, Part 1

For those of you with four legged equine friends, have you heard of EPM? Do you know what causes this disease and what it looks like? Although I have grown up around horses, I wasn’t personally familiar with EPM until recently. My best friend had an incident with her horse that had caused concern for possible EPM. Fortunately for her, it turned out to be an isolated event and her horse is doing great! I didn’t truly know what it was, and I didn’t bother to research it at the time. 

There are many great articles out there that go much more in depth and explain it better, but here’s a quick summary. EPM, equine protozoal myeloencephalitis, is carried by opossums. It is usually transferred when a horse eats hay that has been contaminated by opossum feces. Many horses are exposed to this, but only a few develop EPM. It can lay dormant in the horse’s system for up to 6 months before symptoms arise. The protozoa burrow holes into the central nervous system and damage the nerves. This causes horses to begin to lose feeling and function in their hind limbs. It can progress up further, causing even more damage. 

A few months after moving to a new barn, I noticed Cash was just off. I couldn’t put my finger on it, so I chalked it up to being the winter blues from lack of turn out. I noticed him dragging his hind hooves and hanging his head lower. One Saturday while riding with a friend, she noticed that his hind legs were moving pretty stiffly. Immediately, I dismounted and walked backwards while leading Cash in an attempt to see what she was seeing. He had some warmth in both hind fetlocks. I assumed it was arthritis and began applying liniment and taking him for short hand walks. By Monday there was no major improvement, so I called multiple vets to see who would be available for a farm call. I made an appointment for that Friday with a vet I was not familiar with, but had heard good things about. I was advised to put Cash on Bute twice a day until my appointment. Cash showed no signs of pain, and I knew that may put him at risk for stomach ulcers. I shared my concerns with the veterinary assistant on the phone, who replied, “Well I’ve owned horses all my life and that’s what I would do.” I felt insulted, as I have also spent a large portion of my life around horses. Instead of letting it bother me too much I picked up a bottle of Bute and started the medication. Within a day or so Cash had diarrhea. On the third day I stopped the Bute. I started to consider other things that could be wrong, and decided to research EPM.

I read about the tail sway test, altered proprioception, and decreased tail strength. I would pick up one of his hind legs and place it down across his other, and he would not fight it or correct it immediately (altered proprioception). I read how EPM horses often scuff or step on their own feet. I thought back to all the times he stumbled and I called him clumsy, and how he would at times step on his own feet when we were doing tight circles. I began to fear the worst. 

My farrier was out the day before my vet appointment. He is extremely knowledgeable and has a lifetime of horse experience. I shared my concerns about EPM. He had me walk Cash down the barn aisle while he pulled his tail towards him and then pushed his hip away. Cash did not fight to correct this. My farrier agreed with me that it was EPM and recommended a great vet in Michigan. I told him that since I already had a vet booked for the following evening, I would see what he had to say. The vet in Michigan required all horses be trailered in, which is an issue when you don’t have a trailer. My farrier offered to haul Cash up there for me because he knew the care would be the best. I called the Michigan vet the next morning and scheduled an appointment a week out. 

The following day I had Cash evaluated by the vet that was able to make a farm call. Immediately, he dismissed my concerns of EPM. Because my horse wasn’t falling over and walking like a “drunk”, he couldn’t possibly have EPM. Being a nurse, I advocated for my horse over and over, insisting he evaluate further so he could see the failed results of the neuro exams I performed. He disagreed and refused to do EPM bloodwork. I asked what else it could be, desperate for some answers. I suggested arthritis, but informed him that Cash was already on joint and antiinflammatory supplements. The vet said that could be the case, and went on and on about the cost and risks of hock injections when I suggested them. I felt so frustrated, and he sensed that. Ultimately, he told me he knew that he was not going to make me happy, and suggested I go to another vet. I bit my tongue rather than spitting back that I already had another appointment scheduled. 

There were more things I was unhappy with during this appointment, but I’ll refrain from typing a whole book. I will also not share the name of this vet, as that is unfair. I would rather have people form their own, unbiased opinions. 

A week later my dad, myself, my horse, and a borrowed trailer spent an hour driving to Michigan. I had already informed the office of my concerns for EPM. This vet observed me unloading my horse, and chuckled a bit when he saw the red pool noodle tied to the top of his halter. I laughed and explained how Cash has been raising his head while unloading, coming within inches of hitting his poll on the top of the trailer. It wasn’t until later in the appointment that the vet informed me that this was caused by the EPM. Cash was unable to feel exactly where to put his feet while unloading, causing a falling sensation. In reaction to this, he raises his head to keep his balance. Yet another sign that went unnoticed. 

This vet did a much more in depth neuro assessment; including walking him up and down a slope, having Cash turn in circles, checking tail strength, pulling/pushing hind end to look for resistance. It wasn’t that I wanted my horse to have EPM, but I was relieved that this vet listened to me. EPM is a progressive disease that can ultimately lead to paralysis for horses left untreated, and I just wanted treatment. I remember the vet explaining everything he was testing. He told my dad that he had a smart girl and that he absolutely agreed that Cash had developed EPM. He got his first treatment that day. I’ll go into detail regarding his treatment and progress in a later post. 

I am so thankful that I spent four years in nursing school learning how to advocate for my patients, because this helped me advocate for my horse. I understand that there isn’t a perfect way to diagnose EPM, which is part of the reason the first vet was so hesitant to agree with me. Treatment is also VERY expensive. Marquis, which is the most popular treatment currently, is around $1000-$1500. I personally felt the way the first vet focused on the cost of everything was his way of saying my 24yr old horse wasn’t worth the money. At first, I tried to see the positive, which is that he was conservative. Most horse owners will appreciate this because horses are not cheap! However, I knew in my gut that this was not something I could ignore. Luckily, the treatment the vet in Michigan uses is his own combination and was a little more affordable. 

I want to encourage horse owners not to settle if you disagree with a vet. Not to say you should all go out and argue with your equine veterinarians…please do not do that! But, if you truly believe that something is wrong, trust your gut. If you spend a lot of time with your horse, you know your four legged friend best. I could have let it go, and there’s a chance that a year from now Cash wouldn’t be able to walk safely. Advocate for your horse, because he cannot speak up for himself.

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