The End

Someone once told me that I would "just know" when it was time to say goodbye to Blue. I thought they were insane.

Never would I ever be ready. Never would I ever give up on him. Never would I ever say goodbye.

One day in February, I looked at Blue and I knew - deep in my heart I knew that he was only here for me. And that deep feeling didn't have anything to do with him leaning against his stall wall, or standing crooked in the field, or having to have a shot in the neck every day. It was the way he looked at me. He didn't feel well. He looked tired and weak and sad. He looked ready.

I buried my face in his long shaggy mane and cried. I told him I wasn't ready, but I promised him "no more winters." We would have a fantastic summer together, enjoy the early fall, and say goodbye before the trees lost their leaves. I made this promise as a compromise for my heart. Surely a few more months wasn't too much to ask.

Our days together became more meaningful. I took more time with his grooming. I led him outside to hand graze. He got more treats and more hugs. He left more slobber in my hair. I relished in watching him trot in the field on the first day of pasture. I loved that he didn't want to come in at night.

I knew our time was limited, but I had no idea just how limited our days would be. A few weeks ago, I noticed Blue's hindquarters were oddly marked. Like kick marks, but not. More than just "stall rub" from leaning against the wall. He had begun to stand with his front feet splayed out to make up for his weak hind end. And he would not shed out - no matter how much I brushed.

We increased his dex. I tried giving the NeuroQuel every day instead of every other day. He perked up, but physically he was still failing. One night I went to brush his hind legs and noticed blood. His hind chestnut had been rubbed off from his hocks touching when he moved. I gave him the first bath of the year and was terrified he was going to fall on me. I could not pick his feet anymore.

Just like that, my "never would I ever" turned into "just knowing." Blue wasn't just suffering. He was suffering FOR ME. Solely for me. Solely because of my resolve and my love. After all the years he gave me, it just wasn't fair to him. And I knew it.

Dr. Miller came out and the look on her face was crushing. She saw it too. I told her that I had made a decision and I dared her to talk me out of it. I wanted her to talk me out of it. I wanted her to say that there were things we could do to make his quality of life 100 times better and I didn't care what it cost.

"I respect your decision," she said.

I spent the next four days crying and feeding Blue apples. I talked to him. I told him how much he means to me. I sang to him like I used to do when we were learning to jump and I had to keep his attention on me and not the scary green box he had to jump over. I sat on the floor of his stall and let him slobber in my hair. I let him rub his big face all over my back any time he wanted.

And then it was time.

It went like all events like this should go: peacefully and quickly. Blue was entirely intent on me through the whole thing. He was looking at me. He was looking at me.

As soul crushing as it has been to lose such a big part of my life, I know in my heart that I did the right thing for Blue. It's true. One day you'll look at the animal that shares your heart and you'll know. The decision makes itself in a lot of ways. In a lot of ways, Blue made the decision for me.

I am so fortunate to have Dr. Miller to walk me through this entire journey. It is her willingness to travel treatment roads uncertain, her understanding of heart horses and their elevated life status, and her big hugs that got us through a year of uncertainty. She is a short lady with an incredibly big heart.

Dr. Ellison at Pathogenes Inc. and her passion for a deeper understanding of EPM, sidewinders, and chronic neurological diseases in horses is incredible. When you call the Pathogenes lab full of questions and scared of the answers, you talk directly with Dr. Ellison herself. She's no-nonsense, but she lets you cry a little before she gives you instructions on care and medication. She doesn't care if your horse is Grand Prix or pasture perfect: they all matter to Dr. Ellison. If you even suspect your horse may have EPM, run, don't walk, to email her. It is your horse's best chance at recovery/treatment/management. Time matters. Don't wait.

I have to say thank you to the Debs in my life. My two good friends Deb and Debby saw me through - and in some cases literally held me up - as I struggled and grappled and cried. They were there to help me measure medicines, scoop supplements, fill syringes, and dry my tears. Thank you, my dear friends.

Big thanks to my husband, who I think developed a healthy fear of me in this last year and never balked, complained or questioned the many (many) checks I wrote for the many (many) supplements, medications, vet calls, blood work, feed changes, stronger fly spray, apples, peppermints, syringes, etc. etc. etc. Your silence on the matter (and constant support) is deeply appreciated. I know you loved Big Blue in your own (from across the pasture) sort of way.

I started this blog in hopes of creating a search term for "sidewinders" as a way to help others find Dr. Ellison and as a guide for all the big and little things we managed and life hacked in the treatment of EPM and sidewinders. It worked. More and more people find this blog every day as they search for answers. If you're in that search now, I hope your find what you're looking for, and I hope all the best for you and for your heart horse. Know that every single thing you do, every dollar you spend, every treatment option that doesn't work, every treatment option that does work, every time they decide they aren't going to eat the supplement you just bought, every time they wobble as they walk away from you, every video you send to your incredibly patient vet, every sleepless night you spend searching the internet for answers, every hard decision you make - you are doing the right thing. Every part of the journey is worth it for them. Hug them tight. Feed them extra apples. Let them rub their big faces on your back. Buy a lot of maple syrup. It's worth it. I promise.

Trot on

It's still snowing here, but somehow also muddy in a way that only happens here in Ohio. Blue is itching to stretch his legs, and I'm in love with how much he wants to move. He only has our little indoor arena, but he bucks and runs every time I let him out.

In fact, the old fart RAN ME OVER last week! Legitimately ran me over. I took the opportunity to take this video of him as he trotted off. Not. Too. Shabby.

Trot on, Old Blue.

Sideways, but still here

I'm happy to report that while we are still living a bit of a sideways life at Blue Nile Farm, we are all still here.
There have been a few medication changes, but life in muddy, sometimes snowy, sometimes balmy northeast Ohio continues.
First, we tried playing with Blue's medications. The dex is great and it works, but it isn't meant for long-term use. Can we cut it? We gave him half doses every day for a week and a half and he started walking sideways and leaning on his stall wall for support at night.
Ok, So instead of 2.5 and instead of 1.5, let's do 2 and see how that goes.
And it worked. Not our goal of cutting it in half, but you have to live life. I will not cut the NeuroQuel. Going from four days a week to three has Old Blue walking sideways. We are dependent on it, and that's ok.
We did make a few dietary changes in the last month. He was picking out the senior feed from the sweet feed in his bin every day, so we removed the sweet feed altogether. I added an Omega 3 supplement to take the place of the corn oil he hated.
He still gets plenty of Walmart brand maple syrup (family size bottle!) over every dinner, because it makes the medicine go down.
Blue LOVES his beet pulp (properly soaked to prevent choking). He gets this once a day always and sometimes twice if he's begging. We can tell when he wants it, because he'll stand in front of his hay rack and just look at the hay. His teeth as they are, he can't quite chew it up like he used to. The beet pulp lets him munch on something filling and takes the place of some of the roughage.
Speaking of roughage: Cowboy Brad (who owns the barn) has taken up the business of re-baling round bales into square bales. This makes me chuckle a little, as I remember my teenage summer days (always the hottest freaking days of the year) helping my dad bale squares and rounds in the fields. Never could you ever convince me that hay should be baled twice. Lol.
Anyway, the most tender bits of the hay fall through the re-baler. We gather these nutrient-rich bits up like thieves in the night and fill a big feed tub in Blue's stall. It's like pre-munched hay.
As for his attitude, Blue goes out in the arena with his band of geriatric oldies but goodies every day, and they run and chase each other like grandpas with walkers. He gets down to roll (and back up!) with no problem. That back hind leg is still "kicked out" in that sidewinders way, but it doesn't seem weaker. When he trots off, he looks good. His beloved horse cookies are officially too hard for him to chew, though.
He's happy to see the kids, and he nearly went through his stall door yesterday when he saw me giving a barnmate a half an apple (I'm Blue's mother and I belong to Blue. That apparently goes for all the apples I bring with me, too).
Life plods on, however sideways. Blue is still here with me, and I am forever grateful.
Here's a very shaky video taken my my 10-year-old daughter. At the very, very, very end, you can see Blue trot off a bit.

Where to even begin?

My brain is so full of everything that has happened in the last few months that I hardly know where to begin this blog post.

About a month after our successful Oroquin treatment, Blue began showing signs of illness again. He was standing sideways at the hay feeder again, and started slipping from he sheath off and on. He also started leaning on his stall wall at night, and standing with that "kicked out" hind leg.

Dr. Ellison at Pathogens gave me a stern talking to over the phone. Blue is not "cured," no matter how successful to Oroquin treatment. A course of Levamisole (NeuroQuel) was prescribed to help shore him up. After the two week dose was over, he needed another round, then a round to every other day. Every time we tried to wean him off of it, he would relapse. I resigned myself (quite happily) to the idea that he would just have to be on an every-other-day dose for the rest of forever. At $60 a month, NeuroQuel is affordable into the forever, and it worked.

And then...

It stopped working. Well, I mean that the NeuroQuel was not nearly as effective. I don't know if it stopped working because I am too terrified to take him off of it. I called Dr. Ellison again (Blue's mom on line 2 again!) Again, she talked me down off the wall. It's chronic, sure, but manageable. Let's try dexamethasone orally and see how it goes.

Orally, the dex is not really working, either.

In the middle of all this fun and games, Blue got kicked in a pretty real way. The inside of his right hind was in bad shape - pretty swollen and with a big superficial wound. Dr. Miller (always on speed dial) set us up with SMZ and bute to get him through it, as he was injured in the leg that is already an issue. Also, dexamethasone can hinder healing in immune-deficient animals. And I'm pretty terrified of what an infection would mean for Old Blue.

So we became a hospital once again, devising a clever system of jelly jars, dry erase markers, maple syrup and a coffee grinder to get Blue to eat everything. The meds schedule was like quantum mathematics - every other day on alternating days for the levamisole and dex, every day for bute and U-guard, twice a day for SMZ and vitamin E.

After his wound had healed and he was back to walking better (yet still tilted), Dr. Miller suggested we switch to dexamethasone shots for better absorption, and I agreed.

Also, as a fun aside, dex causes gastro issues including ulcers and can cause a horse to lose weight pretty dramatically. Convinced of the worst, I bought another tub of U-Guard and ran to the feed store to get some beet pulp with molasses.

And so, here it is - Blue's medication schedule (don't tell my husband how much this all costs).
1. Levamisole tablet (NeuroQuel) every other day.
2. 2.5 ml (That's 10 mg) of dexamethasone by injection every alternating day.
3. Two scoops of U-Guard every day
4. Two scoops (10,000 IU) of vitamin E every day.
maple syrup to make the medicine go down.
5. 1 pound (building up to 2 pounds) of soaked beet pulp every day.
6. 1/2 cup corn oil once a day to maintain weight (may go up to 1 cup and may switch to an oil lower in Omega 6 and higher in Omega 3).

I also learned how to give a horse a shot and Blue, to his credit, was a very good patient about it.

He got his first dex shot last night. I am not brave enough to ask Dr, Miller what happens if the dex simply does not work. Part of me just doesn't want to know.

Signs of trouble

It's been a pretty blissful month at Blue Nile Farm. Blue gained strength and weight following the levamisole treatment, and began enjoying his summer days dozing in his stall and the warm nights outside with his herd. Lots of treats, lots of love, lots of flyspray.

But then...

We noticed Blue was standing sideways at the hay feeder again. And that right hind leg was kicked out again. And maybe he's more tilted than he was just a week ago.

My heart sank into my stomach and I felt sick. There is only one reason for all of this, and it's neurological.

My vet gave me some Dex shots and I'm simply beside myself. I always knew relapse was possible, but I did not know it was possible within a little more than a month of end of treatment.

Troubles linger

I decided that Blue would do well with some focused exercise, and so I let Emily ride him at the walk yesterday. I don't know what I was hoping for.

Blue was very stiff - and we didn't do anything but walk, but he seemed to get very tired, very fast. His feet were trimmed the day before, and that seemed to help with the toe dragging until he got tired at the end. I would say that Emily rode at the walk (In big figure 8's) for about 15 minutes:

Waiting on Levamisole

Post-Oroquin, we are waiting on the delivery of Levamisole.

Levamisole is sort of an old-school drug, used years ago by sheep ranchers to deworm the flock. So how does it help Bluehorse?

Dr. Ellison writes:
"The anti-protozoal drug deciquinate was effective as shown by a reduction in titer post treatment in this study. The marked improvement in clinical signs may be partially due to the effects of levamisole as an immune midulator or effects on other neurobiological mechanisms. One such effect is the possiblity that S. neurona or the immune response to the organism damages some upper motor neuron function that is responsive to levamisole therapy."

You can read the full paper here: http://www.jarvm.com/articles/Vol10Iss1/Ellison.pdf

So basically this support medication could potentially help Blue even more. Like I said before, no complaints about Blue's incredible improvement - but there are lingering issues that I would love to see resolved. My fears about relapse are very real. If the levamisole can clear up just a few of Blue's issues - stiffness, ongoing weakness, awkward rear-end stance - then let's do it.

We are waiting on the drug now, then it will be 14 days of trying to get Blue to eat it.