Chats with the Chatfields

Ep 21: Feeling a bit EPM-ish? No? Perhaps your horse is...

January 11, 2022 Dr. Jen the vet and Dr. Jason Chatfield Season 1 Episode 21
Ep 21: Feeling a bit EPM-ish? No? Perhaps your horse is...
Chats with the Chatfields
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Chats with the Chatfields
Ep 21: Feeling a bit EPM-ish? No? Perhaps your horse is...
Jan 11, 2022 Season 1 Episode 21
Dr. Jen the vet and Dr. Jason Chatfield

Calling all horse lovers!!

Equine protozoal myelitis (EPM) is a mystery to many in the horse industry - but not to Dr. Rob Franklin!  Dr. Franklin is a board-certified equine internal medicine specialist and has worked with the world's foremost experts on EPM.  Thank goodness he joins Dr. Jen the vet and Dr. Jason Chatfield in the Chat Room to talk all about EPM: the cause, what it looks like in your horse, and what you can do to prevent it! 

Don't worry companion animal friends - Dr. Jen brings in how this is similar to Toxoplasma gondii  (the causative agent of Toxoplasmosis), so there is something in it for everyone!

There's also a bit of V's View from Vet School tucked into this episode at the 12:35 mark! Should you take a break?!  V's got a view on that!

Want more EPM?  Dr. Franklin suggests checking this out:

Want to know more about Dr. Franklin?  Check him out here:

SUBSCRIBE to our show on Youtube or on our website:

Follow us on instagram @Chatfield_Show

Thanks to our sponsor, FullBucket Veterinary Strength Supplements - the leader in digestive health for horses, dogs, and cats!

V's View is brought to you by the AVMA Trust - Veterinarian inspired coverage protecting you through it all!

Share this episode with a friend who needs to hear it...or might be interested in the topic...or just to make their day brighter! :)

Show Notes Transcript

Calling all horse lovers!!

Equine protozoal myelitis (EPM) is a mystery to many in the horse industry - but not to Dr. Rob Franklin!  Dr. Franklin is a board-certified equine internal medicine specialist and has worked with the world's foremost experts on EPM.  Thank goodness he joins Dr. Jen the vet and Dr. Jason Chatfield in the Chat Room to talk all about EPM: the cause, what it looks like in your horse, and what you can do to prevent it! 

Don't worry companion animal friends - Dr. Jen brings in how this is similar to Toxoplasma gondii  (the causative agent of Toxoplasmosis), so there is something in it for everyone!

There's also a bit of V's View from Vet School tucked into this episode at the 12:35 mark! Should you take a break?!  V's got a view on that!

Want more EPM?  Dr. Franklin suggests checking this out:

Want to know more about Dr. Franklin?  Check him out here:

SUBSCRIBE to our show on Youtube or on our website:

Follow us on instagram @Chatfield_Show

Thanks to our sponsor, FullBucket Veterinary Strength Supplements - the leader in digestive health for horses, dogs, and cats!

V's View is brought to you by the AVMA Trust - Veterinarian inspired coverage protecting you through it all!

Share this episode with a friend who needs to hear it...or might be interested in the topic...or just to make their day brighter! :)


horse, epm, possum, parasite, people, called, immune system, disease, barn, muscle, animals, feed, jason, veterinarian, talk, protozoa, treat, signs, host, exposed


This episode is sponsored by full bucket veterinary strength supplements. Use promo code Chatfield to receive 20% off your first order from full bucket veterinary strength supplements.


Welcome to chats with the Chatfields. This is a podcast to expand your idea of what impacts veterinarians, pet owners and basically all animal lovers in the galaxy as humans. We are your hosts. I'm Dr. Jen the


vet. And I'm Dr. Jason.


And if you have not yet subscribed to our show, why not just go to and subscribe today. And if you want to reach us, and you've got a message that's full of love and positivity, you can find me at


But for all other questions that those of you guys that want to keep it real, you can reach me at I don't know why you roll your eyes every time I say that. Okay, cuz like the real message is it's not about fluffy unicorns and rainbows all the time. Okay, especially about today's topic.


It could be it could be I know, but today's topic is so fun. So we're gonna jump into it, folks. So this is for our horse loving friends, our infectious disease connesuers. Let's see who else is is really any. Anyone who lives in covers everybody


in the world, right? I think so. I think it does. 99.9% of people see a horse and go oh, that's so awesome, right?


I mean, yeah. Hello. So so we are gonna talk about a little bit of horse medicine today. But don't worry, don't worry, companion animal friends. I'm on bring you I'm gonna bring it to you. Don't worry. So our guests in the chat room today is none other than Dr. Rob Franklin. Now, I will say we have two facts about Dr. Franklin that we need to know need you to know before we get into it. Number one, he is a board certified equine internist. Right. That means he does Internal Medicine in horses, which I find to be one of the most challenging aspects of horse medicine. What do you think Jason? Internal medicine, surgery?


Internal Medicine followed by anything is challenging, right? For me, especially horses, right. I'm one of those guys. Yeah. Oh, so pretty nice and run around? I don't you know, yeah, we're great. As long as I'm looking at him, right. I know, completely lost.



I know. So I'm really excited because also he's worked with some of the foremost authorities on this disease of interest today. It's called EPM. It's equine protozoal myelitis. I think you'll correct me if that's wrong. I just say EPM. The second fact about him that we need to know is that he actually is one of the founders of our sponsor, full bucket. But he's not going to be talking about that today, which is why it's not hinky. Right, we're going to be focused on NPM



was more of a full disclosure of situation that truly does affect full disclosure. Moving on.



We tried to be transparent and direct here in the chat room. Okay, so without any further carrying on and shenanigans. Let's welcome Dr. Franklin in the chat room. Dr. Franklin, welcome.



Thanks for having me. Dr. Jana, Dr. Jason.



Of course, of course,



we shouldn't go on like, like, you started the introduction, like 25 minutes ago, Jamie fine. Like, look, now is it my turn? Now? Is it my turn? It's really funny. Well, because it's gonna be his turn for most of this right? We gotta get we gotta get something in while we can. Right?



That's true. It's true point. It's true. So. So I actually got an I got an email from a friend of mine, because she had found out some information about her horse. Well, one of her horses and EPM. And she says to me, Hey, Jen, what what do you know about EPM? And I said, it's spelled with three letters. And I thought, Wait, but I know a guy. And I know a lot of horse owners struggle with EPM. So can you tell us what is EPM?



Yeah, and then, thanks for the lead up, Jen. And it's such a, it's such a wide open topic, because there is I'm gonna preface it, there's a lot that we don't know. And this disease was was first described back in sort of the late 60s 1970. It was reported at some scientific meetings in the mid 70s. And so it's, it's been around for a while, you know, 50 plus years that we've acknowledged it. But, you know, we've been doing a lot of research and we're, we still have, you know, many more questions than answers. So, it's quite easy for people to get on their stump and they and talk about EPM and be very anecdotal in their in their information. And I think a lot of horse owners get that to around the barn. Yeah.



around the barn Jason Are you on a stump around the barn?



Always I like to give out my stump and scream and holler out that that was the best thing so far good for people to get up on their stump and share stories of UPM on Saturday afternoons.



That's right. Okay, so but but but for for folks, for the uninitiated. So EPM equine protozoal myelitis affects horses, obviously because equine is in there and



produced even I was able to figure that out Dr. Jin, but I appreciate that.



Okay. protozoal that's parasite, right? Yeah, yeah. Okay,



that's right. Yeah. And then the myelitis are also referred to as Milo encephalitis it it has a predisposition for the spinal cord, but it does occasionally cause problems and the brain likes the brainstem. So it likes a central nervous system. It is a protozoa. So it's called sarcocystis neurona. That's the scientific name for the protozoa. There's also another protozoa that's probably responsible for a very small number of cases called the Osprey Usai. And those, those two affect a horse, the horses is, is is a dead end host that means it's not part of the normal life cycle for this protozoa. The normal life cycle oscillates with such distance neurona oscillates between the possum and that that's where the infectious part of the of the lifecycle comes out. So basically, the the intestine of the possum allows replication for this. And then it's eliminated in the feces and so to speak, or spread all around.



Okay, okay. Okay, so I heard a lot of stuff in there that that could be quite useful to me if I had a horse, right. So I hear sarcocystis neurona. And we don't need to say that anymore. Right. That's the parasite. That's the fancy name for the parasite. sarcocystis



I don't know. I like to say that sound like to say, I sound smart.



Yeah, you say it backwards. Right? Not trying that?



No. Okay, so So for our bird loving friends out there, you might be saying, wait a minute, wait a minute, I've heard of that. sarcocystis. neurona is also something that affects psittacine birds like parrots and macaws, and causes very similar things, right? sarcocystis can cause all kinds of neurological problems in birds. Okay, so now we have birds and horses affected by the same parasite. And you mentioned possums. So possums are the reservoir? Are they the source of it? What like, do we know



they're so they're the source of it? Definitely, there's in there several different sarcocystis in there was early days, you know, we weren't sure which one of the surfaces were causing the disease. So we started chasing down a lot of these what we call intermediate hosts, which you know, birds can be, and we, we were attributing disease related to those intermediate host and are they, you know, part of the problem that we need to address? It turns out that that many of the SOC assists that affect words, you know, aren't in the same lifecycle is the one that affects horses. So, for example, Falcon Tula was was a this species of one that resulted in the demise of many brown headed cowbirds, which are, you know, there's tons of those birds around but people thought they were part of the lifecycle, so they started languishing them around horse barns. Yeah, that turns out not to be the case. But so the definitive host is the possum. The intermediate hosts for for our parasites is going to include things like the armadillo, the skunk, the raccoon, and even the domestic cat. So what happens with those is they get exposed to the the feces from the possum that has the infectious organism in it. They ingest that and then it likes to go into their muscle and develop these cysts in their muscle. Ultimately, when they die, they're scavenged upon by guess who the the possum and here we go with the life cycle just sort of, you know, completing itself. The possum ingests the infected muscle, and then the cysts come alive and then they start replicating in the possum species. And the possum just goes spreading it around. Now the horse jumps into that lifecycle, again is kind of an aberrant host or dead and



dead on I like that phrase. I like that dead end. You're dead. There's



no There's no sexual replication of the protozoa in the horse. So the horse can't infect another horse. They can't cause infections to skunks, or possums or anybody else, it just ends with them. And sometimes that ends, you know, truly by the end of the horse's life, but in most cases not. So okay that horses is no normal life cycle.



So, and you skipped over one word there, because that becomes important. You said there's no sexual replication of the parasite while it's in the horse, which is why the horse is a dead end for the parasite, right? So parasite gets in the horse. And it doesn't replicate in such a way that it can be passed on by the horse. So you don't need to get rid of a horse that has it because he's no threat to anybody else. Right? So tell your horses not to not to discriminate. They can hang out with what were the words those who have who have EPM it's really okay. But then that, like calls into question, I guess. So this one thing, I think that's unique about sarcocystis is that it has sexual and asexual replication, right? So it can adapt to any circumstances it wants to. And it has so many of these opportunities with the intermediate hosts that can continue to pass it on, all of which seem to live in pastures and around barns. So that's a little bit scary. Yeah, so while everyone heads out to to start counting the raccoons and possums around their barn, we're going to take a quick break. And when we come back, we're going to talk about what does EPM look like in your horse? And what might you be able to do about it to prevent it? All right, hang on, we'll be right back. With all the fuss happening in the pet food industry, why not invest in something to help guard against digestive health arrangements in your pet? Full buckets probiotics are formulated by veterinarians to support your pets normal digestive health, your pets gut microbiome is integral to their immune system performance. Why not add full buckets daily dog or daily cat probiotic powder to your pets daily routine? to curate, protect, maintain and strengthen your pets microbiome. Visit full bucket Today to check out all of their veterinary strength supplements. Oh right quick, let's do this.



These view from that school brought to you by the AVMA trust, veterinarian inspired coverage protecting you through it all.



Greetings chatterboxes. And viewers, I am coming to you fresh off of finishing my first semester at best school. And let me tell you that after what seems like an eternity, and definitely the longest semester of my life, I am ready for a nice long break. It has been 22 weeks, 22 exams, 17 quizzes, six finals, and a partridge in a pear tree. Which brings us to the topic of this view. Take a breath and a break now and then whether you're in vet school, or any school, working hard or just managing your life and family. Take the time to take a break now. And now understand sometimes in life, we wind ourselves so tight that it may take a couple of days to fully decompress and relax. But it is worth it. Whether it's the long or the short term. Hell when I was working in law enforcement, I had to work Midnight's for a rotation, and it took me two years to sleep right again. That being said, it will probably take some time to adjust when returning to vet school. As it does most of us when we return from vacation to our normal everyday routine. But again, worth it. Do it. Everyone needs some decompression time. Thanks for listening. I'm V that's my view. I want to share your view. Are you seeing what I'm seeing or do you have a question about that school? Send it to me at info at Chatfield



These view from that school brought to you by the AVMA trust veterinarian inspired coverage protecting your three at all.



Okay, back in the chat room, we are going in hot and heavy with a bunch of science all about EPM in horses and for those of you listening circuses This is the infective agents and or ni Aspera can also be the cause. But these two parasites are similar to one that we see in In small animals, right, Dr. Franklin? Well, you have a small animal people. let you take over their Well, yeah, cuz aren't these similar to talk? So plasmosis Toxoplasma gondii i right. It's a it's a protozoa has the same. Yep.



Whole thing sounded super similar different different names but similar similar similar lifecycle similar stuff. Yeah. All that stuff.



Yeah, so for our audience who doesn't have horses, a lot of what we're talking about you can apply with talkshoe not all of it, but a lot of it can be applied to talk so and dogs, cats and humans as well. So okay, so we talked about the possum, you said skunks, raccoons?



I think I have one question. I have one question about that really quick before we delve even further. So So can you clarify that the opossum, the raccoon, all those things? They don't, they're not going to have signs, they just carry this this bad boy around? Is that what happens? So they don't they just kind of breed it internally. And it's send it on its way they don't they don't necessarily show any of the signs that you're going to see in horses, or clear



clearly not to Possum, who's going to be the one that's going to be the definitive post, but the intermediate host, you know that the circus is in the muscle could theoretically, you know, cause some demise of those animals but, but typically, those are just going to accumulate cysts in the muscle. And then of course, that muscle is going to be the thing that the possum feeds on whenever that animal dies. So not they don't get the neurological forms that we're seeing with the horse. I just



wonder I thought so. I just wanted to clarify that. No, that's good point.



But But, but it is a good idea to keep those pests environments out of your barn also, right? Like because they



can. It's crucial. It's crucial. I mean, we'll talk about prevention. Yeah, that's gonna be one of the most important things.



Yeah. 100% It's crucial. It's crucial. Okay, sure. Yeah. So, all right, so my horse gets it because they are exposed to infected possum feces. I mean, I guess a horse. Yeah, they have to be exposed. The only the that's why the possum is the definitive cause they're the only ones that can transmit the infection. Right? That's right. Yeah. So



while the skunks the pillows, and the cannons and the cats, I mean, they're part of the livestock, but they can't you know, cat poop. Can't can't cause an infection in the horse. But what they can do in the population when you have those animals is they're basically giving more opportunity for the possum to get a hold of the stark assist and to amplify the numbers of parasites in the environment.



Okay, so that's interesting.



Yeah. First, we should give a shout out to all the parasitologist for figuring this kind of stuff out. Oh, yeah. I'm always I'm always amazed by it. Right? It's just it's just really true.



Especially with that intermediate host thrown in there. I feel like that's a little bit of cheating on the part of the



super cheating, right? It's not Yeah,



I mean, here you go. So okay, so so if you see your horse eating possum, feces, like we should look out for signs, what like, what is a horse? And I think this is probably one of the biggest questions that I hear from my friends that have horses. Because while I might play one on a podcast, I'm not an equine vet. Why What are we looking out for? Like, what will my horse do or look like if they have EPM?



Right and, and just to clarify, so that the possum feces may get may enter into that, that animals system by contaminated water, contaminated feed, contaminated hay, any of those things allow that opportunity now once that horse takes it in, like we talked about, it has a predisposition to go into the central nervous system. So you know, there are typical signs and then there's a whole cadre of signs that, you know, we just say could be EPI, the most classic.



Like, again, like taco and some other animals. It's kind of



like, is it like mad cow? Like, remember Denny crane on Boston Legal? Like he did? He was just like, I've got the Mad Cow. Anything that went wrong is like okay. Yeah,



I mean, it can it has some very classic signs, but it also Yeah, I mean, you could a lot of people will say their horse looks EPM ish. And that that can mean anything. Is that



sort of thing. EPM ish.



Oh, is it a bad and many other similar contrived words to describe a horse that's not performing exactly how the owner wishes. So



Oh, it's a performance issue.



It can be and I'm not discounting the fact that it doesn't occur. But but in its classic presentation when it was first described and how we always think about it is a unit Don't mean one side, it'll affect one side of the body. And that typically will result in a loss of a muscle. So a classic would be the gluteal muscle in the in the right hind limb, and the horse just begins to evaporate, so they get atrophy of that muscle. And they, they may also get some coordination issues on that side as well. So when we talk about one sided coordination, coordination issues, lack of muscle muscle atrophy, that is, you know, you you put EPM really high on your list. Now, when it affects the brainstem, it affects some of those nerves that go into and around the head. And we may see some focal atrophy of the muscle, the chewing muscles, could be the temporalis muscles, we may even see some facial nerve issues in there. And so those, again, unilateral signs are, are very classic for EPM. When we start looking at bilateral signs or things that are equal, whether it be coordination, or lack of muscle, inability to chew on both sides, that brings in a whole nother list of differential diagnoses, but the unilateral or or, you know, problems are classic EPO. So that's like a dent in your horse can't be very similar to a dent in your



horse. I mean, that's what muscle atrophy looks like, to me, especially if it's perfectly well like with a giant, I like horse with a giant back end, because that's what they use for stuffing. So I like him be able to stop really well. And if there's a dent in the back end, man, that's EPS,



right is EPM is in it, you know it all. It all matters where that where that pozole goes in that spinal cord. And if it gets close to a nerve root that that basically goes out to innervate a muscle. And that's where you get that muscle atrophy if it just occurs in the long tracks that that relay the signal of where our feet are, and how hard to push and everything. And those just result in coordination issues. So it can be both can be one can be the other. Okay, and that's why EPM can look like a whole host of things. And when that those signs are really subtle. That's when we get performance issues. So when we're doing sports medicine exams on performance horses, you know, we're typically looking at lameness issues in the joints, we're looking at wind issues and the throat or the lungs, we're looking at heart issues. But oftentimes, we'll get these really subtle performance issues where the horse just for barrel horse, it just kicks out around a turn or or a dressage horse just makes it an occasional stumble or something. That's when we say, well, it could be something neurologic and EPM is going to be high on that list.



So that's a clumsy horse, right? Like, if they trip, if you know if they trip pretty often, like if you just like, oh, that horse trips, like his cadence is, is. It's got a regular trip in it, then we're thinking, and it's the same foot every time. Hey, maybe maybe a little EPM ish, maybe



DPMS. There you go. Yeah. You can't be you know, and they can do that you made fun of reasons. But it certainly comes on to our list when we see weird things like that. But the classic ones are the classic ones. And I think we have recognized those for a long time. But it's there has been sort of a line that I think we crossed off and that is throwing everything in to be EPM. And I think that can be a catch all for the horse just doesn't perform very well. It really is not that good of an athlete or the trainings not that good or the riders not that good. And so sometimes before the horse gets retired or re homed or put into a new trainers barn, they get treated for EPM.



So, okay, so that then we get to so we get to the thing here. I'm like, so I know like for other protozoal infections, right, like talkshoe, and a lot of different animals, macro pods, lemurs, people, cats, testing is, like, equivocal at best, right? Like we can do all kinds of tests. And what do we know? We know we did all kinds of tests, like we don't necessarily have an answer. Is it the same situation for EPM? And horses? Is there a definitive test that says yes, your horse has it or no, they don't?



Short answer is no. There is not a definitive test and testing is a quagmire at best.



It's a quagmire. If you're playing bingo, there's quagmire.



Was that was that one of your buzzwords, someone get a prize?



No, but sometimes we try to work in some interesting phrases. So So EPM is a testing quagmire. Okay, but what are the options because what that usually means to me is that there's like 10 different choices.



Right? So in its most basic form, we might do serology, which basically says, we're going to pull blood sample and has your or develop antibodies to this protozoa this parasite. And if it has, you know, sometimes we'll say, well, that's supportive of a diagnosis. But a diagnosis for EPM is a clinical diagnosis supported with adjunctive laboratory testing. And sometimes it's a process of elimination as well, because it can look like so many different things. It can look like musculoskeletal problems related to lameness, it can look like several other infectious or noninfectious neurological problems. So, sometimes those are easier to rule out. And what you're left with is EPM. Especially in those more subtle cases, again, those those more classical cases, oftentimes, we're not even running the test. So if you if you need to go down the testing pathway, sort of the best test and not a gold standard, the only gold standard is is a post mortem, which that's not a good,



that's an ideal,



a good go to test, no



good to test. But if you're if you're trying to do a pre mortem diagnosis, then probably the best thing is to look at both a blood and a cerebrospinal fluid or CSF fluid sample and comparing those and there you're looking for antibody differences in the spinal fluid. And sometimes even you're looking for the the antigen itself with the PCR tests. But again, those can be very hit or miss, you know, up to 90% of the horses in North America have seroprevalence are our seropositive for EPM. So



yeah, that's yeah, that's what I was just gonna ask though, because most horses are pastured or they're even if they're in a barn, the barn has can have possums in it. And so, don't they all have an antibody? titer because they've been exposed. Right?



Right. I mean, it's it's anywhere from 15 to 90%. So yeah, and we're people really go in getting misled is whenever they want to do a screening, so So you're doing a pre purchase exam, right? Yeah, you're doing all these things to make sure you're getting a healthy horseman people say well, I wanted to EPM test to not really, because that's not going to give you any information that this is going to be useful. In fact, it could it's kind of like doing a live test. You know, it can just, it can make the situation very, very



muddy, muddy, muddy, muddy, muddy, muddy. Right, so it's money.



Is this a progressive disease? We have gone over this is this disease does a horse is it going to get progressively



no worse? Jason? It's conservative.



Oh, very good. I just want I just wanted to make sure



it's more of a green problem



No, I kidding. That's a great question. Jason.



It is in the answer is yes. And yes. And yes. So it can be acute you can have a horse that is just chewing eating his food normally and then the next day it's literally got one side of his face. Oh wow. Overnight, you can get more subtle you know I'll say escalating problems so they and then you can get some chronic problems it just sort of are low grade but they don't tend to escalate so the answer your question Jason is yes.



Very helpful. So many ways.



That it can't come on overnight. It can knock a horse down that make it where it can't stand up overnight. Wow.



Why not helpful at all? Oh, I






for some helpful answers. Yeah,



I know. So here because then I guess so the the testing I understand, right, like because it's it's possums that are going to bring it to my horse. Basically. I can't You can't eliminate possums. Right? You mean? Well, you can try it.



Yeah, I mean, you should, you should try. Leave it to, you know, live trap. It may live traps, let's just leave it at that. But trying to get those possums trying to secure your feed storage area. Yeah, keep your water source clean. And then yeah, if you've got a barn, you need to be trapping those buggers. A lot of times people are putting out cat food feed and you know Barn Cats and stuff. You know, you're calling in all possums when you do that. So yeah, you've got to be you've got to try to mitigate that risk. Because it is it is the number one thing that you can do to try to prevent your horse from getting EPM is to control the apostle,



but it's a fool's errand to think that you're going to keep your horse from being exposed by keeping all the possums out you should you should make great effort for many other reasons, including EPM to keep varmints out of your feed, and out of your horse stall and whatever. But if you put that horse on a pasture, depending on the size of the pasture, I guess it's a fool's errand to think that they're not going to potentially be exposed at some point, right? It's like, it's like saying that you're keeping your dog from being exposed to Parvo. No So it's everywhere, right? Or, or your, you know, your your macro pod your kangaroo from being exposed to talk. So it's definitely Dr.



Chin, you're correct, it's everywhere, but let's not throw our hands up and go, Oh my gosh, don't even you got to mitigate it



everywhere. But I mean, really, when we start feeding animals in a concentrated source, that's when we we amplify the amount of protozoa in the environment. And that's what we get most of these horses are developing that are in barns not out on on big pastures, or ranches or something like that. You know, it's just a delusional issue whenever you're out on those big properties. But when you're in a barn, and there's there's a feed tub and that possums in there pooping in the feed tub.



I mean, you've just that's the problem.



A whole bunch of parasite in that horses environment.



Right? Well, I mean, but feeding, putting just leaving food out is never a good plan anyway, right? Like, that creates an unnatural population density of all kinds of things. Yep. So and if you're, if your horse is going to eat it, then you should protect it like you protect your food, right? Keep the lid on, you know, preserve it appropriately. So we don't get robbed, all those sorts of things. So now, if I think my horse has it, we do a test. Which doesn't really tell me to we may or



may not do a test. Yeah. Right. But But oftentimes, we'll do a test to support a clinical diagnosis. Yeah, I will say this. I mean, I've had some some horses that it this is few and far between, but it's definitely happened that have been cero negative. So negative two antibodies on a blood test with her acute infection, right. So they, they just probably hadn't had the chance to get those circulating antibodies yet. But but they, you know, responded in classic, classic symptoms, and they responded well to treatment.



Well, that's what I was getting at, like what how to blood tests can be



nothing, it can go both ways. But oftentimes, we will do it just to help support our clinical suspicion. And if it is negative, that will more more than likely rule out the disease. But I always keep it on my list, especially if the signs are classical.



Okay, so then what are we going to do? What are we looking at for treatment? Because



respond to treatment? You did? You're telling me there's a chance?



I got out of that. One of a million?



No, no, no, not that bad.



So yeah, so So what are we? What are we treating with? Because I think there's a few choices on the market, right? How long do we treat? And if it was subtle, changes, like a tripping horse with negative test results? How do I know when I've treated enough? I guess, so all that



you know how to tee up some good questions.



There's like nine questions in that one little, but



they're all perfect. And they're, I mean, they're ones that we wrestle with. So let's talk first about what's available. And I'll say there's a bunch of stuff available. And anytime there's a bunch of stuff available, that means that nothing is, is the gold standard works all the time right



now. Otherwise, that would be a third treat. Right?



People throw a lot of a lot of, you know, quasi treatments in there. And again, you know, half the time, say half the time that maybe that's not accurate, but a lot of the time, you know, we don't even have the right diagnosis, or people are just treating as a people even lay people just go out and my my horse looks at you pm ish. And so they'll just start using stuff or the horse gets better. And the horse really had a foot bruise. You know, and that's the reason he was tripping. And they gave some, you know, XYZ and then they said that worked. And that's how a lot of that stuff gets going. Yeah, but let's talk about the barn.



Horse with this and it saved the dairy. Yeah. Oh, man.



Oh, man. And I added in some DMSO so I know it worked.



We know. We call that veterinary ketchup, right? Yeah, everything. Yeah. Okay. Okay, so



go ahead. Yeah.



Okay, so the real the real deal. So the FDA stuff that means it's gone through some rigor, and then approved by the FDA. There are three options that are out there, and two of them are in the same class of drug and one's called marquee and that's Penang Israel. And then you've also got its cousin which is di Plaza real and that comes in a pellet version called proto ZIL



What about told trouser real because I'm seeing that now to like a compounded told trouser real



well, and then you can open up that whole Pandora's box of all the compounded stuff that's available, right? So those are all trying derivative, anti pros. And they all work the same way. And quite honestly, they're all about equally effective in treatment. So the thing with you know, always put a caution out there with the compounding is that it doesn't have the same rigor in terms of making sure that you've got the right concentration in every batch like an FTE. A approved product I



mean live recommend people. Let's remember the Polo horses with Frank's pharmacy and the compounding error and dead horses. Right. So be cautious Yeah, get a credible compounding pharmacy that's going to create even,



you're exactly right with that Frank's pharmacy. I remember that. But but even since then there's there's been EGM meds that have gotten screwed up and yeah, of course has died. So, and I'm not saying that that's not appropriate, some cases, time some nice combinations are put together. But just to save money is not the right reason to use a compounded drug. But so those trading derivatives pun Azrael dot class real toll traps are real, they're all metabolized in the same active thing. And so, and they all work on the same way, so, okay, and they're all pretty bioavailable, meaning when you give it to them, they get absorbed pretty readily through the intestinal tract. So it's not a difficult, difficult type of treatment, where some of those treatments, you know, you just can't get good enough



cost is there? Is there something that we should feed the horse at the same time? I mean, you know, when you're feeding a horse medication, like we like people like me, I like mix it with sugar, molasses, whatever. But is there something different better? Or what should we How should we do that?



Add some full bucket in there, I guess.



We can say that now, because we had a full disclaimer otherwise, right? Like, oh,



yeah, well, in all round, the third, the third one in the thing that we started using the earliest was a sulfur dyes, the impure methylene combination, and that is that was used in the compact version forever, because we didn't have an FDA approved product. And now that's called rebalance. And so that's an oral liquid that you that you give to those horses. If the same time to, there are some things that can help. And that, you know, there's a thought that there there Well, when we do research, so when I was a resident University of Florida, I did my research, looking at this particular protozoa and looking at it in that in a specific type of mouse model, because we were looking for a prevention, something you could feed daily on these horses that were high risk, and that would knock down those chances of getting an infection. So we were feeding them Penang, Israel, to these mice, and they're called gamma interferon knockout mice, you're probably familiar with those but they basically they they've taken out a gene in their immune system. And so their immune system can't fight off these type of disease. Now, if you don't take out that that gene in a mouse, they they won't become infected. And so there's clear that there's an immuno compromised situation. Now, there have been some studies done looking at older horses and horses under physiologic stress that do show that maybe they're a little more prone to infection. But there are also some studies where we tried to suppress the immune system with things like cortisone, exogenous cortisone, and it didn't really change their their likelihood of getting infected. But all that to say that there probably is something to do with the immune system that's gone arrived, that allows some horses to become infected when 90% of the horses don't get infected. And we need to go back to that is the incidence of disease is 1% or less in terms of the total population. So 90% have been exposed less than 1% actually get the disease. So there's a huge disparity,



you got to be really a special horse. Special horse.



Yeah, but there's horses that some of them are gonna be special.



That's true. That's your physiological stress. So I mean, I don't know like, what horse? Is that? Like the horse that scared the Bohemians around the bush? Because that's physiological stress? Or do you mean like, physiological stress, like getting them in a trailer in Holland? And somewhere or, I mean, what are you talking about?



Yep, and all the above. So you take a really hard bound horse and you isolate them, that is only going to be a lot of stress. But I am, I am largely talking about holding a horse to horse shows or horse races, or the the physiologic stress that occurs and intense training situation. So any of those things can increase circulating cortisol, which suppresses the immune system. And you know, people think stress is just mental stress that we get from from our work. But you know, stress is real. Stress is real. In the end, it has consequences in the animal. So what we're trying to do with some of these ancillary things is support the immune system. Okay. All right. So you said What else can I feed? Oh,



that's why you made probiotics, right? Like, that's why you. That's why



you mentioned MOBOTIX. And prebiotics are two things that really do support the immune system, over 70% of our immune system is in our gut. Yes, it is. It's the big pool filter that that that collects things and tells the body what to fight off and not fight off. So probiotics and prebiotics, definitely keep that in tip top shape. So that would be something there's also some, some medications that have been used To help stimulate the immune system, things like levamisole, which is a de wormer, that's been shown to increase the immune system. We also have some, some some things that stimulate the immune system that are parenteral shots. So equistone equimi. And those are those are injections that veterinarians will give to try to stimulate the immune system. So we'll, we'll try to do that. But in large part, those things are, those are the key medications that we use. And then it's notable that, you know, you said, How long do you treat them for there's not a prescribed dose, we treat them until they're, they're no longer have clinical signs. Now, sometimes that never changes. So their signs, just make it static at a point, and then I may stop treatment at that point. But if I am getting an improvement, I'm going to treat until those patients are completely as good as they're going to get. And typically I'm gonna give it 30 days, you know, of static before I say it's, it's not getting better. And so a lot of times like a marquee, which is the natural pace that typically is given for 30 days. And now if the patient is halfway better and improving, I'm going to continue to give that the the older drug, the self dies in pure math mean, that works in a different way. And we typically have to give that longer three to six months. Yeah. And so you have to, and sometimes I'll combine those because they work in different ways. And if one horse isn't responding, I may, I may put them on both to try to attack that parasite in two different ways.



So you're saying it's not the end of the world if your veterinarian comes and says, yeah, so not only is your horse EPM ish, I actually think that might be the issue here, you're saying it's hopefully it's not necessarily it's a bad diagnosis, but it's not going to be hopefully not going to be the end of the world because you do see some improvement.



Right. And just generically speaking, most of the studies show about two thirds of the horses are gone are going to respond positively. And that means a third of them are not going to respond. And that can be a third may not respond to Markey. But that third does show some response to rebalance. And so, again, we'll we'll try different approaches. But out of those two thirds that that that respond, that doesn't mean that they're all cured. That means that 100% may return to normal, right. But that also could mean that positive would be them, stopping the disease where it is, and realizing that sometimes the nervous system just gets damaged, where those where those things were asexually multiplying, they create damage in there, and that it sometimes doesn't



recover from that. Yep, yeah. Or it takes longer. I mean, it can take a long time for the nervous system to repair it. So. So if I have a horse, though, like what, you know, what if I'm a high performance horse, right, what if I'm a barrel racer, and you know, it's rodeo season? And and we're, you know, hauling that horse all over the place? Or what if I'm a polo player, or foxhunter, you know, I'm doing stuff? Because that's one reason people have horses, right? Because they like to go do stuff with them. So how can I mean, can I prevent? Can I decrease the likelihood? That might, because people are always asking me like, What can you put what can you give them when you're trailer and, um, to sort of mitigate that physiological stress? And I think you've already touched on some of it with the pre and probiotics and other immune support items. But it's, you know, can we give one of these as rules while we're tailoring them? Or is that not helpful?



No, no, that it is in and so, you know, again, 20 years ago, the research that I did, did show a positive effects whenever you gave low dose daily bananas real to these gamma interferon knockout mice, and that's been iterated, improved, and expanded upon into some true clinical studies in which do show a reduction of disease incidence whenever we keep these animals on low dose, die class real pellets, for example. And so it can work now you would want to have a fairly high risk animal to do that. It's not expensive. Yeah. To do.



Yeah, cuz I'm pretty sure I'm pretty sure all of these are laced with gold man. I mean, they're very expensive to treat a 1200 pound creature



in you know, gym, you know, sometimes, you know, I talked about how difficult the testing is, but sometimes we use treatment as a test. And I know you guys are familiar with that and other species, but will will oftentimes say, okay, look, we've tried to rule out the other things. Let's treat repeat them and see if we get some resolution and especially those more subtle performance related things. That can be a very useful tool. Looking for that, that improvement there. But yeah, I mean, you bet it's expensive and a lot of times, that's why people go to compounding and unrightfully. So and, but in good horses. Yes. To answer your question, I would be protecting my immune system. Again, I'm going to go back to reduce Seeing the number of varmints in the vicinity. So securing your feed and your water and making sure they're they're kept clean keeping, you know, where you're feeding the Barn Cats making sure possums aren't getting in there. And just trying to reduce that, I just always think it's a bad idea to say, well, we're going to try to stimulate the immune system, but I'm not going to try to reduce the dose because EPM you know, we say, Why are 1% clinical and 90% are exposed? It's probably dose related as much as anything. So yeah,



overwhelming exposure. Right, like, right,



right. So so how do you reduce the dose? I mean, it's, it's not by keeping the immune system tip top, it's about reducing the exposure to the parasite. I mean, so can



you not just disinfect your pastures monthly? Come on, people?



Just throw it all out? No, but I mean, useful, right? I mean, those are useful things to be doing. And then, you know, consult with your veterinarian about low dose, you know, daily feeding, or intermittent feeding of these Panozzo, classical type of medications, because they they can be effective. And let's face it, you've got a horse that is going places, and you've invested in time and money. It even though it's expensive, it's not that expensive compared to the debilitation that can occur if the horse gets



dizzy, that well, yeah, the loss. I mean, you just gotta weigh that that cost benefit. balance out. So I guess, I guess that's where part of me also starts to wonder about root parasite resistance. So do we run the risk of developing that? Or is that not, you know, a large issue with these protozoa? Or? I mean, it could



be it's not documented right now. But



that's good to know.



We've only been dealing with this for, you know, a treatment for 30 years, right? Yeah. And anytime you do, you know, they didn't see a lot of resistance to penicillin when it first came out, either. But you give things enough time, nature has this way. And yeah, I mean, that's, that is the, you know, cost is one thing, but you're right. I mean, just putting a horse on a daily pair. You know, it's kind of like stringency, you know, where we we fed that daily de wormer to horses. Versus or pretty. Most horse parasites don't respond to that, that drug anymore. That's right. So that can occur. It hasn't right now, but it is a concern. And I think any of us veterinarians just always feel that onus to not flood the the environment with anti anything, because there's a natural balance there.



Wow. So we just blew through a whole lot of stuff about like a really, really complex, right ap komplexen That's the kind it is but it really complex parasite. Dr. Jason, what do you what are you doing over there? What do you think and



I'm contemplating EPM EPA emission all kinds of mice without gamma interferon that's just some really cool stuff.



It is it is I can't believe that,



that all that kind of stuff. We covered we cover arm, you know, not everything. But all the important stuff for everyone, everyone to know and be aware of, sort of touching on the resistance situation, because that sort of needs to be in the back of everyone's mind about everything, not just Yeah. But you give something enough times to enough enough animals the body's gonna fight back a little bit.



I mean, shameless plug for our episode with the very brainy Dr. LAUREL reading where we talk about antimicrobial resistance and the mechanisms by which it develops. So check that out. If you want to know more, but yeah, I mean, I we just got through an entire Convo about horses and we didn't mention the word gut or colic or a single die.



That's like, mentioned gut we did. We did mention colic though we did mention gut and how good it is for the immune system. So



Oh, that's true. That's true. I just did Correct.



I was listening, I may not have been participating because I was enthralled in John's discussion, but I was absolutely listening.



There are a host of things I would be remiss not to mention, you know that that there are a host of things that people are going to find out there you know, and even some sound very scientifically credible. I really encourage people to trust their their general practitioner. Oftentimes the EPM will go into a into an internal medicine specialists like myself and into into value there. There are some complementary treatments that I think you know, a lot of times these are neurological rehabilitation cases and they have that rehabilitation mindset. I think using some traditional Chinese medicine and acupuncture you know, Those can be ancillary things that can be beneficial whenever you have nerve damage, damage to the central nervous system. So, though those should be keyed on, I would also like to mention that these antiprotozoal medications do have a natural sort of growth promoting what we call a blooming effect on horses. And they have gotten very popular to use in horses that are thought to have these very mild cases that EPM I don't think that they have mild cases of EPM at all, but you will you will hear around the barns, you will see with certain trainers, they will, in certain areas I've been I mean, an entire barn of horses will go through a month of these medications before a big show. And in order to kind of clean them out. But they do have a you know, when they're using cattle, you see their daily gain go up, you see some other effects that are not related to them, killing sarcocystis neurona. So these horses do look better after going on treatment, but just realize that that is likely a drug effect that is not germane to kill. Yeah,



well, I'm sure like all of those are effective against other gastrointestinal parasites that may be at a low level and totally subclinical, but they are kind of hampering the horses over all condition. And so sure, if you eliminate those, okay, everyone looks better. Right?



They do they look a lot better. And you know, a lot of times people go see I told you that thing had EPM Well, you know, to your point, Jim, they they can have some other benefits. So just just good optics on that when people people see see or hear that around the barn that Yeah, that's very common.



That's a very good point. That's a very good point. And we'll take in, so yeah. Jason, anything else?



No, I think I'm an EPM. Expert. Now I'm ready to roll.



All right now if we can just figure out how to clean better to the horse when riding it. Dr. Franklin, thank you so much for joining us. This has been wonderful. Do you have any places that you'd like to send folks that are credible and reliable? You share those with us. And we'll throw those into the show notes if you'd like so that people can get more information, you know, on this disease itself,



or they can just watch this podcast, listen to it over and over and over again. Much right. That's



right. That's right. I mean, we wouldn't hate that. That's for sure.



But so many people love to go places. So we'll put those in the show notes for sure.



Yeah. Yeah. Okay. Well, I think that's all we have on our equine episode today. Yeah, so I'm Dr. Jenn the vet. And I'm Dr. Jason. And we'll see you guys on the next episode.



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