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Equine Protozoal Myeloencephalitis (EPM) is a serious equine neurological disease caused by an infestation of protozoans–either Sarcocystis neurona or Neospora hughesi. (The web site, EPM horse, has an excellent explanation of what EPM is, the life cycle of the protozoans involved, and the symptoms horses with EPM can exhibit.)

The Pathogenes’ webinar, “A Novel Strategy for Treatment and Protection against EPM,” provides a good overview of EPM, existing treatments, and the new treatment Pathogenes is making available, Oroquin-10.

Isis responded very well to Pathogene’s Oroquin-10 treatment. I never would have learned about Pathogenes and Oroquin-10 from the EPM Horse web site.

This series of pictures shows how she looked over the course of the summer:

This is a post I never thought I would write: the details of the passing of my beloved mare, Isis Bint Sirdar. You always know you’ll have to write this type of post, but you never want to think about it, and you never want to actually do it. I’m doing both because I am hoping that the details of what happened with Isis will help someone else avoid what we went through.

The vets at Carolina Equine Hospital have provided some of the best care for Isis since she has been in North Carolina. Both Dr. Stinson, my regular vet, and Dr. King, the on-call vet who came out for Isis, were honest with me about what Isis’ treatment options might be (and might not be). I appreciate their honesty, compassion, and integrity.

The following information is a transcript of Isis’ medical notes from her log book. I have a composition book that I started when Isis was first diagnosed with laminitis in 2003. I have notes on everything that happened to her. I cope with medical emergencies by documenting them. Any errors are my fault.

Update 8 Nov 2011: Dr. Stinson noted that she thought Isis’ death was probably caused by some brain trauma. What happened to Isis was atypical of EPM. Because no necropsy was performed, there is no way to know what actually happened to Isis.

5:45 PM

Jon from the barn called me and said that Isis wasn’t having a good day: she was wobbly and standing in one of the stalls in her paddock (her paddock has a run-in shelter with two stalls). She was reluctant to turn around or move. Jon left Isis in the paddock and I headed to the barn.

He also said that Isis as keeping her nose against the wall.

6:15 PM

By the time I arrived at the barn, Isis had managed to walk out of the stall and was at the corner of her paddock. She nickered at me when I approached, but didn’t lift her head off of the ground much. She knew I was there, and her ears followed the sounds of where I was, but she didn’t lift her head very far from the ground. Putting my hand on her made her wobble. The lymph nodes around her neck were swollen.

6:30 to 6:45

Left a message with the emergency service and waited for a call back from the on-call vet. Meanwhile, called Dr. Stinson, my regular vet and told her what was happening. While I was on the phone with Dr. Stinson, Isis collapsed to the ground and was unable to get back up.

Isis’ eyes moved in an odd manner: they looked down towards her cheekbone and then back and forth involuntarily. The movement lasted for 30-60 seconds, and then she would come out of it. She would recognize me and nicker, and then her eyes would return to the strange movement.

I confirmed with Dr. Stinson that Isis should have a dose of banamine at 1000 pounds. I gave it to Isis just after Dr. Stinson and I ended the conversation. Dr. Stinson called Dr. King to fill her in on what was happening.

Isis did manage to return to a move upright position, but her head was in a very strange angle. It just didn’t look right (you can also see how her eye looks odd too).

We left Isis where she was and didn’t try to put a halter on her. I stayed with Isis so she could hear me, but not so close that she could move around and hit me.

7:00 to 7:30 PM

Isis tried several times to get up. At one point, she was up on her front legs and her rear legs kinda passed up and she collapsed into the fence. Luckily, facing into the paddock and not into the fence. She succeeded in standing finally at 7:25 PM. All of her weight was balanced on her left legs. Her right front leg was out to the side. Her nose was firmly planted on the ground.

Jon put up some lights so we could see in the back without moving Isis.

7:30 to 8:00 PM

Dr. King arrived and was glad to see Isis was standing. Isis wobbled from the slightest touch, so Dr. King did was careful with the exam and told us that there were a few things that might be causing Isis’ symptoms. We knew it was the EPM, but it might be swelling on her nerves or brain damage.

Dr. King summarized three possible treatment options:

• Try to get Isis to NCSU vet school. It would be very difficult to get her onto the trailer and she could injure herself on the drive there. The vet school might be able to offer additional options, depending upon exactly what was wrong with Isis.
• Give Isis a shot of dexmethizone (a strong steroid) and see if she improves in 45-60 minutes. If she did, then her symptoms might be caused by swelling on the nerves. Treatment options, while still not optimistic, might be there. Dex is generally avoided in insulin resistant horses because it increases the chances of the horse getting laminitis as a side effect.
• Put Isis down.

7:54 PM

Isis was given 40 mg of dex. Dr. King said that if Isis didn’t show marked improvement, may end up taking her to the vet school or may end up putting her down. If Isis did improve, then the best case scenario might be that Isis might eventually learn how to compensate for whatever nerve or brain damage she had. She probably would never be able to go out with other horses again.

Isis’ nose firmly planted on the ground was a sign of cerebellar problems: Isis couldn’t tell where the ground was (extreme case of vertigo).

The lymph node swelling around Isis’ jowls was from having her head down for such a long period of time.

8:51 PM

Isis showed no improvement. She was still wobbly and severely ataxic.

9:00

Made the decision to put Isis down.