Oroquin 10 - Day 5

I can't begin to say how much stronger and more balanced Blue is day over day. He nickered to us as we walked up to his stall this afternoon, and I put him in the arena and left him to see what he would do on his own.
With just a little urging, he picked up a trot and kept it up for more than a minute! Just happily trotting around the arena.

As I prepared his food and medicine, I left my 10-year-old daughter in the arena with Blue. This is the first time in a month that I have felt confident enough for her to be so close to him.

Even 2-year-old Clark got in on the fun by helping mix Blue's feed and adding treats on top:

No pic from behind tonight - Blue wasn't being overly cooperative about it and I had to keep an eye on Clark, who has not figured out that horses are bigger than he is.

I still don't know for sure if the Oroquin is the cause of this major turnaround, if the effects will last for Blue, or if he has any permanent central nervous system damage. But I do know that today was wonderful. It was absolutely wonderful to have my horse back - to play with and share him with my children.
This was the "Day 5" I dreamed of having.

Here are our Day 5 Horse Selfies:

Oroquin 10 - Day 4

AM: Happy Memorial Day! Blue decided to lead me on quite an adventure this morning. I'm exhausted just thinking about it.
First, I was super happy to see that he is FILTHY on one side - must have slept well!

Today Blue looks stronger and more certain of his feet. As you can see, he still stands with his right hind "kicked out," but that left hind is able to compensate for the most part.

Here his is walking. So far, he has had four doses of Oroquin 10.

Remember, though, that he also got a shot of Dex last night. On one hand, I am grateful for the Dex because if there is inflammation from the parasites dying, he isn't feeling it much. However, it makes you wonder - what is helping, the Oroquin or the Dex?

Because he was so excited about the three blades of grass he found growing in the indoor arena, I took him outside for some hand grazing. Blue has figured out that I absolutely hate to tug on his head. So I let him lead me this way and that way, and I try not to direct him too sharply for fear of unbalancing him.

HOWEVER, my horse is nobody's fool, and he figured out that if he puts his head down and turns a circle, I won't pull on his face. This often puts me in an awkward position. Today was no exception. He did this right up against the equipment barn, leaving me behind him and unable to reach around.

So I dropped the rope and went to move around AND BLUE RAN OFF!

That's right. Trotted right off without a look behind him, dragging his leadrope with him. I figured he would just go to the grass, but no. He trotted down the grassy lane and then BACK and finally let me catch him by the manure pile.

I didn't get a picture en chase, but here is a photo after I captured him.

He doesn't look sorry.

I thought I was having a heart attack. What a morning.

And he had the nerve to be mad at me when I caught him and stuck him back in his stall - here's a shot of him ignoring my offer of a cookie.

Worry not. His adventurous spirit is greater than his pride - it didn't take long for him to eat his cookie.

A list of EPM symptoms, and some advice from me to you

I had noticed something odd about Blue for awhile now, but never put two and two together until last night.
Very often when I walk up to Blue's stall, he has dropped from his sheath. I noticed several months ago that he was doing this more often, but if I couldn't find any information about sidewinders in horses, I certainly wasn't going to find anything about sidewinders in horses with the symptom of dropping out of his sheath.
I've always been pretty good about cleaning his sheath, but I haven't done it in awhile, mostly because of the mandate that no one be too "under" Blue for fear of him falling on us.
Yesterday when I walked up to his stall in the morning, he had dropped. I always leave him be when I see this, because when you gotta go, you gotta go.
Last night when I went to check on his hay, I noticed he had dropped again. And something clicked in my head. Could this be yet another neurological symptom?
I can't find much on it, but I think it's worth mentioning here, because this is something I noticed before he came in from the field crab walking last year. If it is a sign of neurological issues, I wish I had known about it then.
Here is my list of Blue's EPM/Sidewinders symptoms:
Crab walking
Turning circles
Non-directional, unable to move in the intended direction
ataxia/weakness in the hind end
depression/lethargy
misshapen hooves from unusual wear patterns
dropping from his sheath
tilted hind end
uneven muscle deterioration in the hind end
kicking out his right hind leg when resting
uncommonly bothered by flies
leaning on the hay feeder and his stall wall

Blue never lost his appetite, always drank his water, seemed mostly happy most of the time, and when not stressed, would even canter and trot with his buddies in the field.

I would say that if you even suspect EPM or a neurological issue in your horse, call your vet and ask for the ELISA test and Oroquin prescription. For under $300 you can definitively know BEFORE your horse suffers permanent damage to its Central Nervous System. Had I been educated on any of this in Nov. 2015, I could have prevented so much of Blue's suffering and sidestepped some of the bigger hurdles I think we might encounter in his rehabilitation.
Oroquin 10 is affordable, accessible, has no side effects, and easy to feed if your horse isn't Blue :(
If I could take the time machine back to Nov. 2015, I would have done all of these things immediately and saved us both a lot of heartache.
As I write this, I still don't know if Oroquin 10 will save my horse, but I am hopeful. I am grateful to Dr. Ellison and my vet for giving me this last-ditch option for him. I read blog posts and articles about "returning a horse to work" after EPM, and "getting your whole horse back in 10 days." But the truth of the matter is that so many people are like me - with an elderly heart horse who means the world, a horse that will never be ridden again, will never show. A horse that holds their world right-side-up just by being healthy and happy in the pasture. I know there are people like me who happily write the monthly board check for a horse who is the cornerstone of their lives - no saddles needed.
How amazing that this drug is available for the performance horses and the heart horses alike.
If you are reading this because you suspect your horse is having a neurological issue, stop reading and call your vet. You have so much to gain and so little to lose.

Oroquin 10 - Day 3

AM: Blue spooked a little as I walked up to his stall this morning. His hair showed a sweat pattern at his chest and flanks - even though he had a cool bath in the evening, it had cooled down significantly due to thunderstorms rolling through the area, and his box fan was on all night.

He was done eating breakfast, so I slid on his halter and took him out to the field to graze a little. He was head-in-the-air interested in getting out there and even jigged a little. At first he was more interested in moving around and looking at everything, but eventually decided the clover should be his priority.

Again the flies were relentless. Blue was more bothered by them than usual, even though he was well sprayed down before we went out.

I decided to stick him in the arena to walk a little, just because he seemed so on edge. He immediately trotted over to the open door, and had a little trot and then rolled. He got down right away to roll, and then looked like he was going to roll on the other side, went down to his knees and decided against it. This is something I have NEVER seen him do in the 20 years we have been together.

There is a feeling deep inside me that says this is go time. I think something is starting to happen inside my horse. I'm grateful that we put him on the Dex (get gets another shot tonight) to help control the inflammation as the parasites die and his body works to expel them.

Here is an AM video. As you can see, lots more energy and while his gait is pretty wild, he has no problem moving forward. The "tilt" is better and he seems a lot less crooked.

PM: Blue was much calmer this afternoon. I spent about 45 minutes brushing him with a soft brush and feeding him treats. He was almost hyper-focused on me. The rest of the barn was quiet. He whiffled in my hair and turned his neck to watch everything I was doing. He nuzzled my pockets for treats and licked my hands. I decided not to take him out of his stall after that. He seemed content and calm, and I didn't want to disturb that.

Also a note: I think he laid down to rest today. He had several stains on his side and rump that suggest that he slept in his stall in the late morning or early afternoon. This is significant because my vet believes Blue was suffering from sleep deprivation from not being able to get down. Little victories.

Oroquin 10 - Day 2

AM: Major change in mood today for Bluehorse. He nickered at me as soon as I came into the barn and wanted his treats. I slipped his halter on and took him out to hand graze.

Shock of my life - he trotted past me to get to the clover. He was moving around quite a bit on his own out there, and he looked... Happy.

The flies and gnats are out in full force at 9 am here, and while I of course remembered to spritz him, the bugs were eating me alive, so we came back in.

I have holiday weekend plans this afternoon, but I intend to come out this evening to give Blue a nice bath and some more hand grazing after the sun goes down.

No video this morning - I was just trying to keep up!

PM: Blue was full of himself tonight, dragging me around and being contrary. But he was alert and happy, and I gave him a bath that I don't think he fully appreciates :)
I notice that he still stands very tilted in the hind, but he no longer looks quite as precarious. He walks with purpose and he can get where he wants to go.
The flies here are horrible already, and I am using an incredible amount of flyspray. I'm going to put the spot fly treatment on tomorrow. (hence the bath)
Blue does seem to get tired quickly. He was filthy dirty, and by the time I had sufficiently sudsed him up and rinsed him off, he was showing signs of exhaustion. He returned to his stall and box fan happily.

OH - and note on the Oroquin today. Tonight was Dose 3. I still had the maple syrup covered feed that he had objected to on Dose 1, and I wanted to see if I could convince him of its deliciousness. Today, without coercion or violence, he happily ate every single grain of it.

Because clearly Bluehorse runs the show around here :)

Not much of a video today. Blue was more interested in following me around than walking out like a good boy. But I think this shows the increased balance I'm noticing:

Oroquin 10 - Day 1

AM: We gave Blue his dose on Thursday night, and I went to the barn Friday morning (today) to lay eyes on him. I know in my heart and in my head that we won't see any improvement until Day 5. But I peeped in on him and he perked up to see me.

I grabbed a brush and dusted him off. I did not try to pick his hooves because he is so very, very off balance. I brushed his long mane and tail (when we were showing, that mane was so short! I love it long in his retirement, though). I sprayed him with more flyspray, and fed him his favorite peppermints. He nuzzled at me, and though his movements weren't any better or any more stable, he was super interested in what I was doing and seemed happier and perkier.

I'm betting it was the Dex that helped most.

PM: He was an even happier horse this evening. He is walking no better, but he isn't doing circles and he actually got down and rolled and had only a little trouble getting back up. I credit the Dex. He also drank two buckets of water today.

Here is a photo of his "tilted" stance:

 Here is a video of him walking crooked :

And here he is rolling and getting up. As tilted and weak as he is in his hind end, I'm stunned that he could do it:

The Oroquin has arrived

One look at these huge pills and I knew Blue was going to, as we say in the horse world, Have None Of It.

20 years with a horse will give you this kind of insight and foreshadowing.

We crushed up the pills and stuck it in some feed. I poured some syrup over it and mixed it well, letting it soak up the powder. And I fed it to Blue.

And he sniffed it, and looked at it, and stepped in it. He flipped over the feed tub. I put treats in it, so he picked all those out and flipped the tub again.

Thanks, Blue.

Eventually we gave up on the camouflaged powder in the feed trick and dissolved another two pills in some water (ground up first, not water soluble) and put it in a dose syringe. And Brad the Barn Owner (or Cowboy Brad, as my kids call him) did the deed.

I scooped up the refused feed and I hope to put it in his regular feed little by little so he gets the dose. If he still refuses, I'll ask my vet about the possibility of getting just one dose.

Nothing about EPM is easy! Ugh!

This is the face of an old, spoiled horse who refuses to eat his life-saving medicine:

Lost in the mail - sort of

My vet ordered the Oroquin the day we found out he was positive for Sarcocystis Neurona. But SEVERAL snafus delayed getting the Oroquin to me.

And Blue went downhill fast.

He was still eating and drinking, but he looks dangerously tilted. His hind end sways precariously. He is so crooked that he barely fits in his stall door between his shoulder and hip. Finally, I decided he could not go out with the other horses - one bump and he'd fall. I also requested that he be put in the indoor arena while his stall is cleaned, because I am so afraid he might fall on the girl who mucks the stalls. I do not let my children around him, which breaks our hearts. He is just too off-balance. He wanted to be in his stall so he could lean up against the wall.

It looked pretty bad:

Little did I know it was about to get MUCH worse.

The next day I went out to the barn and I was putting away his supplements when I saw him turn. It looked like he wanted to roll. But when I looked up a few minutes later, he was still turning circles in the same spot. He couldn't walk forward. He was stuck doing circles and he couldn't get to the water trough. It was incredibly heartbreaking.

I'm going to put on my honesty hat here. If the Oroquin wasn't on the way, I would have put him down on this night. This is exactly what I was trying to prevent for him. I love him too much to put him through this low quality of life. I felt huge guilt for keeping him alive through it.

But the package of Oroquin was on the way, so I switched into "hospice mode." The question on everything was "how can I make him most comfortable?"

We did a few things:

1. Dexamethazone shots to relieve inflammation. This is a short term fix, and I'm not convinced it worked, but he got one shot for two days, a rest for two days, and then a shot for the next two days.
2. Flyspray. I doused him. I didn't want him kicking and stamping at flies when he is already so off balance. I also purchased Equi Spot from Smart Pak. 
3. We put a box fan up on his stall door to blow constant air to keep air circulating and to cut down on flies and heat.
4. We doubled up on the bedding in his stall
5. I added U Gard Pellets (pellets!) to help his stomach and esophagus while he is on so much medication.
6. I bought a coffee grinder to turn the Oroquin tabs into powder and I bought maple syrup to help hide the powder in his food.
7. We left Blue and his girlfriend, Sunny, both in all the time. This kept them cooler, without the flies, and they got out when their stalls were being cleaned. He had a buddy, and that reduced his stress. 
8. I also made a point to be at the barn in the mornings to brush him and at night to give his meds, fuss over him, feed him treats, etc.

I beat a path to the mailbox every day for nearly a week, and watched Blue go from sidewalking to circling. Turns out, the medicine was waylaid at the vet's office. It was never sent. I met the vet at another farm to get it, and on Thursday night, we were able to give him his first dose of Oroquin. But Blue certainly wasn't going to make it easy on me.

Back to Blue

So we sent Blue's blood samples to Florida. And got some results:

To break it down, Blue is positive for EPM. Like the EPM survival guide says, he is low titer (8) for SAG 5 with a high CRP (30). My vet says that while the CRP is three times the normal, this does NOT indicate the severity of this infection. When we test him after the Oroquin treatment, we hope the CRP will go down. That will show that what we are doing is working. Fingers crossed.

OH! and his Vitamin E levels are elevated! Absorption! Yay! I'm keeping this going. I know his Vitamin E is high, but I want to keep it up because so many people say it helps.

An EPM survival guide

A sincere thanks to the wonderful people at Pathogenes lab for putting out so much information (and slideshows!) about EPM. I'm a content manager by trade, and I can appreciate the effort of putting out consistent content. (Shout out to Dr. Ellison: if you need a content manager to further the message, I'm totally available for freelance).

Sorry. Back to reality.

Other than the fact that the word Sidewinders isn't on anything, anywhere, the word EPM is on EVERYTHING! One of my favorite treasure troves of information is this EPM survival guide. It's so aptly named. (Is it dorky to admit that I have a screenshot of slide 16 on my phone for comfort?)

So many nuggets of hope all wrapped up in one slideshow. Read the whole thing and screenshot your own security blanket slide.

I think I found what I was looking for.

If only Vitamin E could solve this problem alone. We again added the shots for hind end strength (not expensive) and it seemed to work. He was trotting out in the field, moving around, and while still "crooked" he wasn't "tilting dangerously."

I'll take it.

But I was troubled by the fact that while I hoped the E would support his health and while the shots supported his hind end, nothing was being done to address the neurological symptoms that keep coming and going.

In a late night internet search using the word "Sidewinders," I came across a blog post that got me excited.

Dr. Ellison at the Pathogenes lab in Florida used the term Sidewinders to describe a horse named Dusty-Pal. The breakdown is that EPM may be part of a larger equine ataxic syndrome that includes SIDEWINDERS!

Read the blog post here: http://pathogenes.com/blog/page/3/

I think the post uses the word Sidewinders ONCE, but that's how I found it. Dr. Ellison believes she can help these horses who have ataxia and that crooked gait with EPM treatment. Her signature treatment - Oroquin 10 - has HUGE (or should I say YUGE in this election cycle? Sorry) success rate for horses with mild to severe EPM.

So what if sidewinders is just a version of EPM? Can it be treated like EPM? What is this magical drug Oroquin?

This was especially mind blowing to me because 20 years ago when I bought Blue, if I horse got EPM, it died. End of story. I did not really think to search for EPM because Blue was still very much alive. So I called my vet and she came out to do another neuro exam on Blue (stop pulling my tail!) and take some blood. Ironically, this was at the time when he was doing much better and had just started the Vitamin E. We pulled his tail anyway and shipped the blood samples to Dr. Ellison for the ELISA test. This tests for the three parasites known to cause EPM.

A positive test (and C-Reactive Protein) supports the diagnosis of EPM and puts us on the path to Oroquin 10.

What is Oroquin 10?
Oroquin-10 (10 day therapy, consisting of 0.5mG/kG decoquinate and 1.0 mG/kG levamisole) is compounded exclusively by Francks Veterinary Compounding Lab for the treatment of protozoal disease in horses. Oroquin-10 or Oroquin-10E (with 8000 u of Vitamin E) is part of an effective strategy to eliminate the risk of severe neurological disease in horses.

1. Oroquin-10 is rapidly absorbed 
2. Kills the Sarcocystis neurona and Neospora stages that reside in cells.
3. Superior killing at lower concentrations of anti-protozoal agents.
4. Elimination of triazine resistant SAG 1 and SAG 5 phenotypes.
5. Levamisole is a non-specific immune modulator that may facilitate recovery.
6. Oroquin-10 was used in 172 horses with no adverse effects.
7. 93.3% of horses treated with Oroquin-10 resolve clinical signs within treatment period. 
8. Less virulent strains are treated with a daily prevention dose that induces immunity.
9. Decoquinate at 0.05 mG/kG for 28 days prevents intestinal infections in most species when fed for at least 28 days when development of coccidiosis is likely.
10. Use of Oroquin-10 distinguishes horses with inflammatory disease or triazine resistant sarcocystosis. These cases require alternate therapy. 

See what I put in bold? Yeah. That's the moneymaker statistic. That's what had me writing the check before the vet handed me the bill.

I had a million questions:
Side effects? Few to none.
Is his age an issue? No.
And most cases in Blue's category show major improvement by day 5 of the 10 day treatment.

We ordered the ELISA test. This tests for SAG 1, SAG 5 and SAG 6. Remembering that most horses will have a low but measurable result that does not indicate a positive EPM diagnosis. We also tested his C-reactive protein (which measure inflammation) and (because I was curious) we tested for his Vitamin E level, just to make sure he was absorbing the Smart Pak supplement.

The wait was on.

Vitamin E? Yes, Please!

So with nothing but the truly ineffective search term "Sidewinders," I started scouring the internet for any information. I knew that it is a neurological disorder, so I started looking into equine neurology.

Regardless of the specific neurological diagnosis, almost everyone I spoke to, stalked online, read about or contacted, recommended a huge dose of Vitamin E. How MUCH E?

A usual dose found in an overall multi supplement is about 1,000 IU
An increased dose for a performance horse is 2,500 IU
Want to get serious about E because you are riding in the Olympics? Give 5,000 IU
The recommended dose for Bluehorse? 10,000 IU A DAY.

That's a lot of E.

So I bought Elevate because I heard good things. But this is a powder, and each scoop is 1,000 IU. So he needs 10 scoops a day.

Did I mention Blue is like a drug sniffing dog? There was NO WAY he was going to even consider eating that. I didn't want to throw him off his feed in addition to all the other problems we were having, so....

I found that Smart Pak (which I had never used before) has not only a natural E supplement, but that it comes in pellets! PELLETS! (Someone please kiss the person who came up with this). It is important to note that not all Vitamin E supplements are created equal. Synthetic E is hard for horses to absorb, which makes it much less effective. Natural E, on the other hand, is made for absorption. My vet confirmed - Smart Pak Vitamin E pellets are all natural E.

Get it here: https://www.smartpakequine.com/ps/vitamin-e-pellets-by-smartpak-8917

I give 5,000 IU twice a day and mixed in with his sweet feed/senior pellet mix, he never even sees it coming.

Smart Paks come pre-measured in little plastic containers. They even sent me a two-drawer storage system which I kind of pooh-poohed until I realized that raccoons, cats and other horses can't get into it, it keeps the dust off of everything, and it keeps me organized, which is a real bonus.

AND (really I promise Smart Pak isn't paying me for this) they write the BEST emails ever (very cute and funny) and they save all Blue's information in the system so changes can be made pronto. Everything comes with Blue's name on it and mine so no searching for a Sharpie at the barn. We are on the subscription plan, so the stuff just ships out to me every month and I don't even think about it.

BOOM. Vitamin E for neurological health. Done.

Sidewinders or EPM? How about both

I'd like to start this blog by thanking the Blogosphere and all the other bloggers out there who wrote about their troubles with EPM. Your blogs got me through the long nights of frantic and weary searching for answers and resources. You all know what it's like to have a heart horse who is suffering, and you know how hard it is to get answers fast.

Your journeys helped me along mine, and this blog is my "pay it forward."

This is Blue.

We have been life partners for about 20 years. That makes us both pretty old. He's 28 years old, and up until about 8 months ago, he was doing just fine with exactly no intervention whatsoever. In fact, my husband would joke that he'd be saving for retirement, but he has to pay board on Blue for another 20 years.
But in November 2015, Blue went out in the field in the morning with no trouble and by dinnertime he was walking sideways.
We gave him some bute and let him rest in his stall. He had started to stand oddly as well, with his right hind leg "kicked out" in an awkward resting position. He didn't seem to be in any pain, and he was still eating plenty and drinking, and he loves my children (ages 10 and 2) and would nicker to them for his treats.
We called the vet and got the diagnosis of "Sidewinders." As it was described to me initially, Sidewinders is a rare neurological disorder mostly found in elderly horses with a prevalence in geldings.
Not much you can do, but the hind end weakness was remedied with some steroid shots to strengthen him up. And it pretty much worked. He was "crooked" but not "tilted" if that makes sense. We would put him in the arena with his much younger buddy and they would run and buck. He loved to roll, and would get up and down with no problem.
Since he's totally retired except for the occasional pony ride, I was thrilled with this progress.
Just before Easter, my daughter even took him out for some "low speed" fun bareback.

Just a week later, he was back to "crab walking." His occasional crookedness turned into a full tilt, and he looked as though a stiff wind could knock him right over.

Something had to be done, and I was no longer satisfied with the "not much we can do" treatment plan.