Weekend Wellness: Not Today, EPM, Not Today

Laura Reiman shares her side of an incredibly difficult journey with EPM.

Photo courtesy of Laura Reiman.

Last year, at my very first event, I was hand-grazing my leased horse by the volunteer table eagerly waiting for scores to be tallied. The girl next to me mentioned she was just happy to be out competing at elementary level after her horse had been diagnosed with EPM. I immediately pulled my horse back, wracking my brain to try and recall if EPM was contagious and what it entailed.

It seems like there are always a handful of scary-sounding equine infections floating around Area 2, so I was concerned not for her horse, but my own. Had I known then what I know now about the devastation and cost of EPM, I would have given that girl a giant hug and her horse a pat on the nose, because it is a brutal diagnosis.

A few months later, I found myself buying what I thought was the perfect young event horse project, and my first horse as an adult without parental financial help. I was all in, getting a truck, trailer, and fitted cross-country and dressage saddles. I was hungry to jump right into low level events, clinics, schoolings and hunter paces. You might remember a fun clinic I did just weeks after buying my horse, called Wine & Ride Summer Camps.

My new mount had been off the track for only a few months but had been restarted by a well-known pro and was already prepping for recognized novice events. I was fully committed to creating a strong foundation for our partnership with two lessons a week, lunging, and trainer rides when I could swing them. But something was never right.

He wasn’t building a topline or working with his back well. He was desperately trying to please, but started hitting rails and moving poorly. He had never tracked up in his hind, which I figured was a weakness/fitness issue, but now he was tripping a lot and dropping consistently in his stifles. He had shown issues with back soreness in his PPE but no other indications of illness, and I believed a chiropractic adjustment had helped his back and had forgotten about it. During my first vet visit, with let’s say “Vet 1,” I was told he had weak stifles and to work him on hills and get him moving.

Next, I hired a bodyworker who specializes in Ttouch and Masterson Method work, who believed he had a pulled groin muscle and needed rest. My trainer, who I stayed with despite her saying after roughly a month of work that he would never amount to much past novice level eventing, kept pushing that he seemed in pain. I agreed, but couldn’t pinpoint the issue.

About four months after buying my new, precious horse, I put him on full training board. Perhaps my amateur riding wasn’t doing my horse any favors and he needed some better workouts. I was out of town when I got videos and messages that my trainer did not feel comfortable ever jumping my horse again. She had tried riding him over small cross rails on a circle and he had plowed them as if he didn’t know how to jump.

When I got back and had a lesson we tried again and he was trying his heart out, but was obviously having issues. From then on, my trainer started tell me I had to come to terms with the fact that I was either keeping my horse for trail riding, or moving on – which I refused to believe were my only options. I was committed to finding out what was going on with my guy.

By this time, I was also on my second round of cellulitis. When Vet 1 came out to treat him, I asked her if we could run tests for EPM based on a forum post I read. Vet 1 said she didn’t run EPM tests in Maryland without absolute certain clinical signs because there are too many false positives. I said ok, and forgot about it. After the cellulitis was gone, I called a lameness specialist.

“Vet 2,” a well-regarded FEI vet in the area, came out and used lameness sensors to try and pinpoint the issue. She noticed the horse had back soreness and clearly had something wrong, but couldn’t figure out exactly what. We tested him for Lyme and ran some bloodwork to check levels for anemia etc., and gave him back injections. She told me to ride him and keep working to see how he went. The back injections didn’t work, so she recommended I take him to a clinic for a bone scan – even she was curious to get a definitive diagnosis.

Thankful I had my own trailer, I left for the clinic and “Vet 3.” Bone scans didn’t show much out of the ordinary other than somewhat severe back pain due to a sore ligament that ran the length of the spine. The vet recommended I simply give him a lot of time off in a field somewhere to be a horse, and then once he was ready I could work him back up with physical therapy exercises and some alternative treatments like shockwave.

Meanwhile, I continued to keep my horse at an eventer competition barn and take lessons on other horses because I didn’t want to give up the feeling of being part of a team. I was hopeful that if I kept my horse in that atmosphere, I’d be able to work back up and manifest a recovery. If I put him in a rehabilitation barn, I was worried he would just naturally end up in retirement.

So I went all in again. I went to the barn six days a week and did carrot stretches, hand walks, lunging, and everything the vet recommended aside from leaving him out in a field. I became an expert on ground core conditioning work. I called “Vet 4” to give shockwave treatments to my horse’s back in order to break the cycle of pain. When she looked at his scans, she said his back looked better than a lot she had seen and I should get back on him and work him from the saddle. I started riding again with light work, feeling relieved to have an advocate on my side.

The shockwave had helped with back soreness and we were cantering, doing some lateral work, and even getting a nice frame. But there was still some foot drag and tripping. On a follow-up shockwave treatment, the vet mentioned EPM. I wanted to cover all my bases, so we took bloodwork just to be safe. The bloodwork came back highly positive. According to the lab, he had most likely been infected for at minimum six months prior to testing (which was six and a half months after I got him).

EPM, or Equine Protozoal Myeloencephalitis, is a neurological disease horses can get when they’ve ingested the protozoa Sarcocystis neurona. This is likely caused by possum feces infecting their food or water. The protozoa attack the brain and spinal cord, creating different degrees of neurological deficiencies as it kills nerves.

According to vets, the internet, and popular opinion, about 85% of horses in my area (Area 2) have had contact with the disease but most can naturally create antibodies. Only about 1% actually get sick and show symptoms. I call foul on this since every random person I come into contact now seems to have had some experience with EPM. How is this possible??

Ironically, I felt relief that we had a diagnosis. I called Vet 2 to let her know, and her response was to not forget that there are many false positives in this area. But that didn’t deter me. Vet 4 recommended I try a medicine called Orogin. She believed it was effective, and since I’d spent…a lot of money… on diagnosis, this would be kinder to my pocket. I actually didn’t know at the time that it wasn’t FDA approved, but I did know that people either love or hate the medicine.

Within a few days, the drug was clearly working because the protozoa were dying off and causing a “crisis of treatment,” which caused my horse to move like he was drunk. Terrified, I called Vet 4, who told me to give him Banamine for a few days because the die-off was creating inflammation. I called Vet 1 for confirmation, and she agreed that the die-off was a common occurrence. I was thrilled the medicine was working.

Orogin is a 10-day treatment that encourages the immune system to kill the protozoa. It is controversial because the gold standard of treatment is 30-90 days (in order to kill all life cycles of the parasite) of another drug that can cost roughly $1000 a month, but I wanted to follow vet recommendation. She also had us add large amounts of Vitamin E to help boost immunities. Throughout the entire ordeal, the vet recommended riding to keep my horse’s muscles from deteriorating and to keep working his brain. My trainer and barn owner felt he needed rest, but I was listening to my vet and proceeding on what I thought was the cautious side.

As I started to ramp up work, my horse started lightly tripping again. My vet mentioned that it was common to do a second round of Orogin, which I planned to do until I realized my horse had undeniable ulcers. He showed symptoms like aggression during meal times, crankiness with pasturenmates and excess, although solid, poops.

We gave him some Omeprazole paste, but he got a nose bleed the following day. I was terrified I’d misdiagnosed his ulcers so took him in for scoping. With confirmed ulcers, we did a month of ulcer medication and waited on the EPM treatment. I continued to lightly work my horse with hand walks on trails and lunging for 10-20 minutes. We had also dropped his feed down because he was getting a bulbous belly and wasn’t in work.

I started to get texts from my trainer about strange behaviors like digging holes in the field, chewing on wood in the field, cloudy eyes and my horse acting like he didn’t know where he was occasionally. Several people at the barn continued to mention perhaps he didn’t have EPM, or perhaps I should start thinking about euthanasia. I continued on, because I had bought this horse and he was my responsibility. If I didn’t think my horse had the slightest chance at rehabilitation or was in pain, I would certainly consider euthanasia but there was never a point the vet said he was untreatable.

The second round of Orogin I made sure to personally hand feed my horse to make sure he was getting every bit of the pills. I could tell my trainer had written me off for not following her advice to rest him or give up on him. I was getting charged an extra $100 for double shavings because my horse was going to the bathroom excessively and when I asked my trainer to give me an easy, 20 minute walking lesson to help me with walking muscle-building exercises, she set up an intricate gridwork exercise that both my horse and I struggled with. While I sat on him, both of us trying our hardest and failing, she told me my horse was lazy…. that my horse recovering from a neurologic disease, was lazy. I got off and we called it a day.

It was clear the second round of Orogin hadn’t worked, so I was waiting for Vet 5 to come check him out. By this time, my trainer had banned Vet 3 from returning to the barn because she did not agree with her methods or advice. Vet 5 cancelled due to an emergency so I was forced to wait a few more days, but before we could reschedule, I got texts from the barn that my horse had bit the girl who feeds him and then proceeded to fall head-over-tail down the hill when he got turned out.

She said he was dangerous, he needed rest that I refused to give him, and that I had to leave immediately. She told me to take him to “Vet 6” barn where he could get the help he needed and until I did, I was not allowed to have him anywhere but the field or his stall, and probably just his stall because he was a danger to other horses.

I have never been anything but an advocate for the well-being of my horse. I have poured my heart and my money into this horse not to prolong his life for my sake. I would LOVE to cut my losses and get a horse I could actually ride. No. I do this because it is what I have been dealt. This animal’s life is in my hands and if there is a chance, and I’ve always believed there to be a chance, I owe it to him to give him that time.

I took him my own vet’s clinics to ride out the time between getting kicked out, and moving to a new boarding barn. I swallowed a daily fee and started him on ulcer prevention to minimize the stress of moving. They were horrified at how much weight he had lost and immediately switched him to a higher quality feed and double his rations. For two weeks of constant supervision he never once exhibited aggression, digging, chewing on wood or any behaviors mentioned at the previous barn. Maybe it was the energy, maybe it was the nutrition, it could be anything.

After an examination by Vet 5, we agreed to put my horse on Protazil. This is one of those $900+ month-long medicines that’s a bit more aggressive than Orogin, and more widely accepted as a treatment. He is now on the other side of treatment and we have been given the green light to start working again. I’ve moved to a new barn and have even started taking dressage lessons. He is moving beautifully and as of now, looks like a normal, healthy 6-year-old horse. After my first lesson, my new trainer said my horse was lovely and I went home and cried. There is always the fear of relapse, but for now we are doing well.

I have my horse on all sorts of immune-boosting and ulcer-fighting supplements, and even hired a nutritionist to help create an inflammation-fighting diet. I can tell that other boarders think I’m high maintenance and crazy. I can tell I confuse my trainer when I ask to call it a day early. But that is EPM. It’s a rollercoaster. Emotions, health, time, money, opinions. Medicines are only increasing in price, and people reach out to each other in forums desperate for support and advice. I’ve become an obsessive advocate for the health of my horse, which is why getting asked to leave for “over-working” and “abusing” him at my last barn was so painful.