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.

Take a look at this

I wasn't going to post a video today (though I took one out of habit) but I simply had to share this: my EPM horse, off Oroquin by one day, off to join his herd in the back pasture:

Oroquin 10 - Day 10

I'm looking at a different horse than I had 10 days ago.

10 days ago I stood in the barn and cried, certain that I was going to lose my Blue, my "once in a lifetime horse" to EPM. Today he goes out with his herd at night, he gets down to roll with no problems, he trots after my kids and nickers for the apples he knows are in their pockets. He gets sassy when he doesn't want to do something. He's interested in life again.

What we have here is nothing short of a miracle.

But that leaves us with many questions still unanswered - how much damage was done to his Central Nervous System? How much of that damage is permanent? What can we do to help the healing of those nerve passageways? When can we start, and how can we start, helping him gain his strength back in his hind end?

And *gulp* what about possible relapse?

Putting all those questions aside for just one more day, we can look at the overwhelming benefits of the Oroquin and see success. Blue is no longer walking "death circles." He is straighter, for sure. He is still awkward in his hind end, but certainly no longer "tilted." He trots.

While he was never really depressed, his mood is elevated again. He is happy to see me and the children. He calls for his friends in the field. He looks through his stall door with clear, interested eyes. I texted my vet on Day 5 - "I have Blue back!"

He is bright and alert and seems happy. He is also so much "straighter" than he was. There was a time before the Oroquin when we could barely get Blue into his still because he was so crooked that his shoulder and hip had to fit through the door at the same time.

And I mean that with my whole heart.

Of course, all is not perfect. He seems to still not know exactly where his hind feet are. I catch him standing awkwardly all the time, one foot crossed over the other, standing almost clubfooted at times. And he still stands with his right hind leg "kicked out," though it is much less dramatic than it had been. The toe-dragging has not resolved, to the point where we are going to have to do something to help his hooves if it continues. He was dropped from his sheath when I walked up to his stall today.
Here are his Day 10 hind end pic:

My 10-year-old daughter and I were talking about Blue this morning. She has been anxious about his condition, and wanted to know if I thought she would ever be able to ride him bareback at the walk again.

My words caught in my throat when I told her how sick Blue has been, and how I know we almost lost him. It gives me a healthy dose of perspective. If this is our final result, I am overwhelmingly grateful.

Here is our Day 10 video:

And for reference, here is the video of Blue doing circles the day before treatment started. What a difference!