When Isis was diagnosed with Equine Protozoal Myeloencephalitis, one site provided answers and informative discussion about this disease, current treatment options, and tests: EPM Horse.org.
One of the keys to successfully treating EPM successfully is early detection. The more people know about EPM, the better chance they will have of recognizing the disease and treating it sooner. Fudge’s Mom, the owner/writer of EPM Horse.org, is taking an unconventional approach to promoting awareness by asking people to nominate the EPM Horse Blog for an Equine Social Media Award on Facebook:
I’m asking you to take one minute, go to Equestrian Social Media Awards, nominate app on the left, Category 13 Most Informative, put in http://epmhorse.org/WordPress/ and write one sentence about us. Please pass the link to your friends, it may save their horse. Nominations are accepted through 12/24/2011. Facebook and Chrome links are needed.
I’ve nominated this worthwhile site for an award. The information helped increase Isis’ quality of life during her last few weeks.
This post provides a table of contents and timeline for everything that happened with Isis while she had EPM in 2011. It’s not been an easy journey, but I am so glad that she had a few great days. I got my girl back before she left for good.
Previous EPM history
Isis was first diagnosed with EPM in June 2009. She had an acute onset with atypical symptoms: moderate ataxia (loss of coordination), blindness, and deafness. She didn’t know me, and I had had her since the day she was born. She was admitted to the hospital and seemed to recover on her own. After four days, she came home, sight and hearing in tact and most of her coordination back. We did a month treatment of Marquis and she responded very well.
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.)
I did something very difficult last night: I went to the Horsemasters meeting and talked about Isis’ death to a group of people who understand what it is like to lose a horse. I wanted to warn people about EPM and tell them that there is a new treatment available and that it made a world of difference for Isis. And some times, unfortunately, it can be too late, too, but it was still worth every penny to see Isis have such a good last week.
I’m going to the barn today for the first time since Isis passed. I finally started to cry today, to let go of the grief. I know I’ll see her every where out there. But I’ll be able to smile, finally, at her antics.
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.
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 was keeping her nose against the wall.
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.
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.
Isis showed no improvement. She was still wobbly and severely ataxic.
Isis did so well on the Oroquin. She was back to herself. I was so excited to have my girl back: to hear her nicker when I walked into the barn, pull a halter off the wall and toss it on the ground to get my attention, and to be riding again. I wasn’t posting here. I have a backlog of posts showing how much she improved on the Oroquin. She had an incredible week this past week. So much improvement, so much back to her mischeivious self.
And now she is gone: her life stolen by the same disease we had been treating. Something happened to her brain to cause the symptoms she had. Was it the EPM, brain trauma, or what? I don’t know. The only final kindness I could do was to let my dearest girl go. Isis died tonight at 9:00. Letting her go was the best option, as much as it broke my heart. (More details later.)
How do you say goodbye to a mare who has been the center of your life for 18 years?
You don’t say goodbye. You remember the intense joy of sharing your life with such an amazing mare. She was the center of my world and she knew it. She jealously protected me from other horses and gave her affections and nickers freely.
Sleep well, my sweet little girl. I will miss you so much.
Another shaky cam video, but it really shows just how far Isis has come. Over the past week, I’ve been putting Isis and Kasane into the big ring together with the hope of eventually turning them out into a pasture together. We’ve turned Isis and Prize out together so they could run the length of a field and really stretch. I thought it would be fun to have all three of my girls out in the big pasture, so I introduced Isis and Kasane in the ring. They have gotten along very well, even when Kasane nearly body slammed Isis.
I can’t get over how much better Isis looked this weekend. Such a great weekend for her. And for the first time, Isis and Kasane got their trot on and played in the big ring.
I got my mare back this weekend. Maybe not fully recovered, but her spirit and long strides are returning. She is not fully recovered from the EPM. She has a long way to go to regain her muscle, but she’s getting her strength back. She’s trotting with strong, floating strides up and down hills.
I started taking Isis on walks a few times per week just before she started Oroquin. We go on a “trail ride” around the perimeter of the farm. Once or twice around, up and down some small hills, along the pastures. At first, she walked slowly and was careful about where she put her feet. This weekend, she was all about strides. Big strides. The type that Juno, the 16+ HH Thoroughbred mare, had trouble keeping up with.
Here’s the regular video update of Isis moving. She’s pretty much back to normal. This video was taken Friday evening, October 7, 2011. We’re walking both on the gravel and the grass to show how her toe clearance stays the same (even if she is just a hair tentative on the gravel).
That’s my girl who was missing most of the summer. She seemed so happy this weekend. So full of herself and wanting to be the center of my world. She nickered at me and everyone else after weeks of being quiet. When I didn’t pay attention to her enough on Sunday, she demanded my attention. I had Isis’ stall door open with the stall guard across so I could pet her while I got her brushes out of the tack room (and stand next to her while talking with one of the ladies at the barn). When I wasn’t standing next to Isis adoring her, she would grab Prize’s halter and toss it on the floor. And then look at me. If I said, “No,” Isis’ mouth hovered just next to the halter until I turned my attention away and then the halter was on the ground again.
She was possessive of me again. Sounds silly, but I missed her threatening Prize whenever I was around. How dare any mare in a stall next to Isis get close to HER human. (The picture below shows Isis pinning her ears against Kasane, not Prize, but it’s the same general expression.)
It is so nice to see her back. We even went on our first trail ride (bareback and only at a walk) around the perimeter of the farm. Rooster and Isis, the two recovered EPM horses, out for a stroll bareback (with their owners really hoping they didn’t come off).
This is the first video of Isis after she completed the Oroquin-10 trial. I took this video in the ring and she was very reluctant to move. More of a “Ah, mom, do I gotta? I just wanna eat my hay…” She is moving better and picking up her toes (although definitely lacking enthusiasm).
The Bay Wonder Mare is showing her amazing recovery powers again. She’s picking up her toes and moving out with style. It’s amazing that she’s been on the Oroquin-10 for a week and she is already almost back to normal. Some of the people at the barn have commented that Isis looks like she has gained more weight. Her muscling over her shoulders seems to be coming back, slowly but surely.
I’m amazed at the difference that Oroquin-10 has made for her. I’m very glad that we took a chance on the study meds instead of starting with Marquis immediately.
It’s Isis’ fifth day of treatment on Oroquin-10. Every day when I go out, I start looking for little improvements — and I’m often rewarded with a lot more than I expected. Today, Isis’ toe dragging was much improved, when walked in the ring. When Isis is more interested in what is going on, then she drags her toes a lot less. When I had her in the paddock today, she seemed to be dragging her toes and not wanting to move on very much.
So, we went into the big ring, and she immediately started moving out a little more (and tried to get some grass).
First, Isis. She has had two doses of the Oroquin-10. From what I read about the drug, some horses improve as early as 3-5 days after treatment starts. We went for a walk up and down the lane near the barn. A reasonable walk in hand with some grazing, for about 15-20 minutes.
The first thing I noticed is that she isn’t dragging her toes in the dirt like she was before. She was picking up her toes and maybe skimming the top of the grass, but not leaving trails like she did before. Is this the Oroquin having an effect or Isis just being more alert since she was out of her paddock? Could be either or a combination. When I put her back in the paddock and asked her to walk a little, she did drag her toes a little. Not like she had been before.
When I asked her to pivot around me, she still had trouble placing her back feet. I was asking her to move around me on the lane, so there may have been some uneven ground between the center aisle of the road and the lane itself. She stepped underneath herself a few times but other times she paused like she had to think about where her feet were being placed.
It’s early to be looking for signs of improvement. I feel like I have a better baseline so when she does improve, I’ll be able to spot it immediately.
At least with Isis, we are sure about what we are dealing with and have a treatment plan. Kasane is another (far less severe) story. She’s covered in hives again: small raised lumps every where. Running your hands over her feels like you could read an entire braille book. She has been in flaming heat for the past four days. (No, Kasane, the lovely Hanoverian mare can not help you. Keep moving, girl.) Kasane has been flinching from the slightest touch over her loin, about where her ovaries are. Poor kid. I’ve never seen her be this sensitive. I’m hoping it’s just from the combination of allergic reaction and her heat cycle.
The barn manager may have found a culprit for the hives on Kasane and four of the other horses in the pasture. The wet weather we’ve had apparently has created ideal conditions for black flies. Think of these flies as a cross between mosquitoes and small horse flies. They look like little black flies and suck some blood for their meals. Like mosquitoes, they use an anticoagulant, which can cause an allergic reaction in some horses. Our best guess is that all of the horses with hives are having allergic reactions to the fly bites.
Kasane was given a dose of antihistamines tonight (first time giving diphenhydramine to a horse). We’re also using a fly wipe that has some mineral oil in it now. (NCSU has a good article on black flies.)
The vet is coming out for spring shots tomorrow afternoon. Great timing. If the girls are going to have issues, might as well have them when the vet is scheduled to come out.
Isis’ medicine arrived today via shipment. (I love it how a “morning” shipment arrives at 11:30 AM.) The medicine is an apple-flavored powder that can be fed in Isis’ grain: one scoop, once per day for 10 days. That’s it.
She ate her first dose in some beet pulp and licked the bucket clean. Seems like this is going to go very well for her eating the meds.
Good news for Isis. Unfortunately, Kasane has broken out in hives from something in her pasture. Several other horses are also having hives. We’re not sure from what exactly. I treated her bumps and scabs and then put her back out. Poor girl was very sore over her croup.
Friday, the vet called me back with an update on Isis’ meds: they should arrive Saturday morning via overnight, morning delivery. Yay! I should have had them on Wednesday, but at least they will be here tomorrow. With any luck, Isis will eat the meds in her food.
My vet also said that we should have the results of Isis’ EPM ELISA titer results today or Monday. The Peptide-ELISA test is different from the regular EPM titer test. The Peptide-ELISA test determines which phenotype of protozoan is active. These test results can provide a hint about which treatment will be most effective against the phenotype(s) found in the current infection.
Very cutting edge stuff. It’s exciting to have this option.
Isis’ meds should be here shortly, so I took some baseline pictures of Isis. Her muscling has changed even from the last set of pictures I took two weeks ago. She has lost more muscle over her back. Her ribs are more prominent below her spine. There is a dip there now, where there never has been before.