Fudge’s EPM Rehabilitation

In the same vein as “You don’t know what you’ve got ’til its gone,” you don’t know how UNHEALTHY your horse is until you’ve seen him get better.  It took six months for me to realize how sick the horse had been when we bought him.  It has now been one year since he completed treatment for EPM, and I think we might be about topped out. 

The natural trimmer, Dawn Willoughby commented on him when she was out in February.  The vet and the dentist commented on him when they were out earlier in March.  WOW! This horse looks great.  His coat is exceptionally glossy without oil or silicone.  His eyes are bright.  He trots out with a twinkle in his eye (and mischief in his head).

FUDGE is feeling better!

It has taken one full year for this horse to turn around.  Good nutrition, no stall time, low stress, and trimming his feet.  I am not as worried about a relapse now.

If you are dealing with EPM, you need to realize how low your horse’s immune system is.  Your horse is broken.  Take the time to fix him before you plan your next outing/show/hunt.  It will take longer than you believe.  It will take longer than your vet is willing to tell you.  It takes more than one month of FDA drugs, nutrition, trimming, and money.  It takes time.

Fudge came to us with a set of front shoes on.  It didn’t take a rocket scientist to figure out that one shoe was 1/4″ too long, and the other was 3/4″ too long.  The right front was rasped at a different angle across the sole.  His left front heels were contracted, and all soles were flat.

Paula Derby had told me that she took her horses to a farrier service that pulls, rasps, and reshoes all four in about 20 minutes.  The person making the shoes is not the same person that nails them on.  They must take the attitude that if the shoe doesn’t quite fit, it’s OK, they’ll get new ones the next time.

My farrier was out shortly after we brought Fudge home.  He had a few choice words to describe drive-in, assembly line farrier services.  I’d had two rides on Fudge by that time, and knew there were problems with his stability, but did not yet know he had EPM.  I had the farrier pull the shoes, and leave him barefoot.  This accidental decision - some might say gut feeling - was the best thing I could have done for Fudge.  It took me 8 months to learn this.

As some of you may have guessed from the last blog entry, Fudge was tripping - in part - from toes that were too long.  Before you jump on my case or my farrier’s about the pre-trim photos, consider the problems associated with trimming a horse that is unstable on three legs. 

Fudge didn’t have a leg to stand on, at least one that he could feel.  He is still somewhat unstable when one foot is lifted.  He places his rear feet at odd angles, and is sometimes parked out.  He does not know where his rear feet are, or how they are positioned.  I asked the farrier to skip a trim on him once, and only trim the front once, because he was so unstable.  The farrier was also scheduling trims at intervals for shod feet - every 8 weeks.

Fudge's Front Feet before trim. Note stance

Front right. Note toe drag, contracted heels, and broken thumb.

 After viewing the videos of a test ride, I read up on natural hoof care, and called in Dawn Willoughby to teach me and my farrier how to trim for the ‘Wild Horse Model’.  Because all three horses have been barefoot for some time (Fudge 9 months, TWH 1.5 years, and Mustang her whole life), we did not need to boot the horses after the trim.  It is a work in progress, moving from a pasture trim to the wild horse model.

If you are not familiar with the work of Jamie Jackson or Pete Ramey, please start here:  http://www.hoofrehab.com/

A friend and knowledgeable horseperson stopped by the other day.  We went out to look at the horses, and she was concerned over the muscle atrophy on Fudge’s rump.  She said, “You’re letting this horse go to waste!  He has no muscle on the rear.  You need to get on and ride, ride, RIDE.  Build that muscle back up.”

I tried to gently suggest otherwise, but she wouldn’t hear of it.  Fudge looks like he is in good health, he feels good, and isn’t in pain.  Why would I not ride him?  My friend was trying to help with what she thought was a simple problem; muscle atrophy caused by non-use.  

Fudge’s atrophy is caused by a lack of connection between the brain and the muscle.  The nerve damage limits the ability of the muscles to move correctly, or for the horse to know when to move the muscle.  This is a very different issue than loosing muscle from lack of use.  Understanding this difference is important to rehabilitating the horse.

Rehabilitation must first work on the connection between the brain and muscle, until the horse has control of that body part.  Giving the horse 24-hour turnout to gently exercise allows him to use the muscles as he is ready, and for longer periods of time.  Slow ground work exercises will also help the horse activate muscles in a safe way.  Until there is connection between the brain and the muscle, building muscle mass may not even be possible.

One article suggests that nerve damage can be repaired at a rate of 1″ per month, up to one year.  After that time, the window of opportunity to reactivate the muscle is lost, and remaining damage will be permanent.  If the horse had EPM for a length of time, the extent of the nerve damage may be too wide, and the window too short, for the body to repair.  There are also anecdotal stories of spontaneous resumption of muscle awareness two years after EPM.  The key is realizing that recovery is a slow process.

During the horse’s time-off, muscle atrophy will certainly occur due to lack of exercise.  The safety of both horse and rider must be taken into account when deciding to resume riding, even at a walk.  Don’t let someone pressure you into ridding the horse if they don’t understand the reason for the muscle loss.  If you begin riding the horse before he is able to comply with commands, you set the stage for stress and relapse.  A horse that has relapased will have a much longer rehabilitation time than one that is given time off.

I have only ridden Fudge once since his diagnosis in January.  I was on him for five minutes in early April to test for deficits after two months of treatment.  At a slow walk he just seemed out-of-shape.  Slow trotting a wide turn, his rear end fell out and he stumbled badly.  Since then we have only hand walked him, and given plenty of turnout.

We are trying to engage his mind without stressing his body, through gentle ground training and desensitizing.  We have found that Fudge has had little exposure to bicycles, objects like tarps, or loud noises.  He seems more balanced at this point, so we loaded Fudge and the Mustang on the trailer for a very slow, 5-minute drive to the local park.  We were able to work  on stream crossing, standing for a sponge bath, and wooden bridge crossing.

It became very obvious stepping down from the bridge that Fudge does not know where his rear right hoof is, in relation to his body.  He hung half off the bridge, searching for the ground with that leg.  It may only have been a second in length, but it was enough to tell us that Fudge is not yet safe to ride.

On the way home we heard him take a misstep into the side of the in the trailer when we made a slow turn after a stop.  Fudge’s rehab is going to be much like the trip home…very slow, listening to the horse, a few mis-steps, and a lot time caring for, but not riding the horse.

Yesterday Fudge had the last of the vaccines in the refrigerator, for West Nile Virus.  It has caused a clear runny nose, slightly worse impairment of the hind legs, and general malaise.  A worsening of symptoms is typical for EPM horses, but you never know which vaccine may cause problems.

I have Fudge on the supplement MicroLactin (Duralactin) for help in reduing the inflammation in his central nervous system caused by EPM.   It helps to control neutrophils, a type of white blood cell that is the first defender to arrive at the scene of infection or trauma to the skin.  Neutrophils are closely tied to the process of inflammation, so limiting them limits inflammation.

MicroLactin has been studied in humans for reduction of inflammation, and has one horse trial by Dr. Bello, involving 58 horses.  Links to the study abstracts are below.  This over-the-counter supplement is worth a try for EPM horses - especially during vaccine season.

“The Use of MicroLactin for Inflammatory Conditions in Equine Veterinary Practice“, Bello, Thomas.

“Effects of a Milk-Based Bioactive Micronutrient…“, Colker, Carlon.