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  Discussion on New low grade epm diagnosis
Author Message
Member:
jackiew

Posted on Tuesday, Jul 14, 2009 - 12:03 am:

Hi Dr. O,

I have a 5 year TB G. Today I took him to the vet to ease my mind on some things I'd been noticing...He last raced in Sept 09. My father had him as a race horse for part of 08 and until I took him Oct 09. Typical young off the track TB, seemed to catch his toes often last Oct when I took him. I chalked it up to green-ness. I'd say some of it resolved, but he remained a horse that made me say often "when is he going to learn to pick up his feet!!" In May, I noticed him slipping out on the right hind. I had moved barns, and the footing at the new ring was terribly inconsistent and very deep. I attributed it to that, although over time I realized that it only occured on the right hind (as well as hacking through fields, mostly downhill). Mid May I had a ride where I couldn't get the left lead--he wouldn't hold his quarters in to strike off with the right hind. Afterwords, he was sensitive to palpating over the muscles of the right hip, so I gave him 2 weeks off. He seemed to come back fine, but I was more aware of, or the frequency of the right hind slipping out went up. Typically it was when going down hill or turning to the right. Often it was significant, hip DrOpping out and head shooting up as back DrOpped on right side.

Although he continued to do well overall schooling and jumping, this would happen 1-6 times a ride. Bright alert, no other issues, no muscle atrophy--auto changes and an overall progress in balance, straightness, and lightness on the flat. Intermittent issue of missing the left lead, which I couldn't tell if it was just a straightness/weakness issue or soundness.

He's also had a tendency to hit himself behind. It appears given the number of cuts he comes in with lately to have increased. He wears boots when working, but not when turned out. He is shod behind, but I am planning on pulling the shoes now. Vet felt the farrier had him shod well and that that was not an issue or contributing factor.

So we went to the vet today. Flexed fine, no apparent hock or stifle issues. Sore in sacroiliac (spelling?) joint area upon palpating, slightly more on right. With the tail pull test, I could see he easily could be pulled on both sides.

Vet felt it was mild epm given history of my notes and tail test. Said to do the combo pyrimethamine/smz/? for 30 days. It is 30 ccs oral paste/thick liquid once per day. He said could get worse in 2 wks, but should be much better in 30.

Dr. O, what is your preference on the above meds vs. the others you describe in the article (ie Navigator)? Is it true that what I am giving does not kill the protozoa? Your article also mentions a much longer treatment than 30 days. I'm not sure when the article was written, is that still the recommendation for duration?

This is a well known lameness vet in our area, though I've not used him as I just moved here from 45 min away. Is it worth a second opinion? Right now, I'm planning on giving the horse 3 weeks off, giving meds as prescribed, and pulling hind shoes.

Thanks in advance for your thoughts!
Moderator:
DrO

Posted on Tuesday, Jul 14, 2009 - 9:40 am:

Hello jacqueline,
The above article is current with the research that was published in the last week. Our articles are not written and put up. They are daily edited as new information is gleaned from research and experience.

I don't have a general preference as each medication has strengths and weaknesses. Also local availability must enter into your decision. The article outlines them and compare and contrast the medications, so carefully study these to make the best decision for you. The treatment times are based on many clinical studies and explains what happens if given a shorter length of time.

As to a second opinion, you should seek one if you have significant doubts about the current diagnosis or treatment plan.
DrO
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