EPM story #2 – Scotty (June, 1998)

This is a continuing saga, written partly for my own benefit and partly with the hope that it might help others.  See also Sam's EPM story.

Scotty is a 5 yr old Standardbred gelding purchased 7 months before this started. (See pictures) For 2 weeks before symptoms appeared, he had been confined to a stall with a hock injury, getting out twice a day to graze in hand.

Day 1, Wed. June 3, 1998
The first sign of a problem, though I did not recognize it as such, was small scrapes on both knees. In retrospect, these are probably because he tripped and fell.

Day 2, Thurs. evening
He seemed very lethargic (NOT normal) while grazing, almost as though he were tranquilized. He dragged toes on all 4 feet, sometimes tripping, and also had his legs buckle under him. He did not fall, but was definitely not right.

Day 3 Fri.
Still lethargic, toes still dragging, legs still buckling. Vet says this is definitely neurological, probably EPM. He does not have the typical signs of rhino, has had no fall that could have injured his neck and he is on the high side of the typical age for wobbler syndrome. She rates him as a Grade 3-3.5 on a scale of 0 (normal) to 5 (down and unable to rise).  Injected Banamine for inflammation, started him on SMZ (sulfamethoxazole-trimethaprim, 20 pills twice a day) and Bute. He stumbles and comes close to falling while walking in his stall and paddock.

Day 4 Sat.
No longer lethargic, in fact, rather agitated. (It is a cold, windy day.)  Still catching his toes, even saw him place one hind foot on top of the other, clear sign that he is not aware of where his feet are. Vet treated with 3 liters of 12% DMSO solution IV, to combat inflammation. The hope is, given the sudden and severe onset of symptoms, that a lot of the symptoms are due to inflammation, and we need to treat aggressively. Started treating with Daraprim (25 pills, once per day).  While walking in hand, he trips or his legs buckle every 2-3 steps.  He seems to do this more with his right fore than left fore.

 Day 5 Sun
He seems better.  He is quiet, though not as lethargic as Thurs and Fri.  Loose in a small field, he can walk the width of the field (100 ft) in a rhythmic walk without stumbling.  He does still stumble and his legs buckle, but it is much less frequent.   Even saw him trot briefly without obvious problems.  Saw him take several consecutive steps hitting his left hind fetlock with his right foot.
I have not seen him lean and tip over, as Sam did.  Even tranquilized on Sat, he was very stable, no indication that he might fall over.

Day 6 Mon
He is lethargic, but stumbling is less frequent.  He still drags his toes much of the time, but I see very few instances of his legs buckling.  He moves around his paddock, in and out of his stall, without tripping.
He is getting 20 SMZ twice a day, 25 Daraprim once a day (on an empty stomach) and 1.5 g Bute twice a day.

Day 7 Tues
Scotty seems better today, less frequent stumbling. I saw him trip only 2-3 times as he grazed.  He was out for almost 3 hrs this morning with his buddies in the adjacent pasture, and seemed happy to graze quietly.
He woke me at 3:30am, kicking the paddock fence. He was really antsy, wouldn't be distracted with hay, pacing the paddock and kicking. (He does that when he's frustrated.) He was actually trembling all over for a few min. Don't know what that was all about. He finally lay down, got up after 10 min or so, did a few circuits of the paddock and lay down again. He seemed to be falling asleep, then got startled by something and stood up. But he did not resume the pacing and kicking, so I went back to bed.

Day 8 Wed June 10
I am beginning to feel optimistic.  Stumbling, toe dragging, etc. are very infrequent.  He is spending several hours in pasture, which has greatly improved his outlook on life.

Day 15 Wed June 17
He has seemed fine for the last few days, haven't seen any toe dragging or tripping.   He is now out with his buddies about 16 hrs/day and is regaining his normal playfulness.

Day 18 Sat June 20
Stopped giving Bute, after 2 weeks.  Watching carefully...  Got on him and went for a walk down the road.  He is high and spooks at the slightest excuse, but feels solid, no stumbling.

Day 22 Wed June 24
Vet's comment: "He looks great!"  She puts his neurological symptoms at grade 1, meaning the only signs are seen when deliberately manipulating him.  Turning in a tight circle, he swings his outside hind leg too wide.  She sees no hint of problems in his front legs.  He may or may not get better than this, but is not likely to get worse, and he is safe and rideable.  I can breathe again!  We will continue meds for a full 3 months, then do a spinal tap, hoping it is negative.

Update 3/12/00:

He has shown no signs since the above episode.  I ride and drive him with no problem.  We never did a spinal tap, as the results are not definitive.  I credit prompt treatment for his recovery, and will be ever grateful to Dr. Lisa Laurie for her decisive action.

Last updated: 01/22/03