Possible EPM diagnoses via Orthopathy

Discussion in 'Horse Health' started by C4Roan, Jun 14, 2018.

  1. C4Roan

    C4Roan Full Member

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    I know that there are several posts concerning EPM, yet I did not see one that followed and answered the questions I have. Before I start, I want to state that we have contacted the Vet and have an appointment on Monday.

    Today my sister and I had a lady come out who practices Orthopathy on equine and canines. We had her work on two of our horses, a barrel horse and a trail / obstacle challenge horse. The barrel horse had been showing signs of discomfort and one hip looked higher than the other. The trail horse has had a mystery lameness that only presented itself at the walk when being ridden (Saddle fit was ruled out, x-rays on her front legs were done, a masseuse had worked on her). Turns out she had a shoulder out.

    When the Orthopathic specialist worked on the barrel horse, she started noticing symptoms of EPM. This mare has always been very sure footed and has never given us a reason to suspect EPM. One test that the lady did was apply pressure to the horse's poll. She immediately dropped her head. Supposedly this is a symptom, but I am not entirely convinced due to this mare being trained to drop her head to pressure. The next test was to apply pressure (quite a bit, if I may add) to the horse's back near her SI joint. She dipped her back, and that response and whatever the specialist might have felt (I'm not entirely sure if she felt something, this is simply my observations.) The third test was to push against the side of her hindquarters. The mare moved without resistance (again she was trained to yield) however she did stumble over herself a little bit. Her tail was then pulled first to one side and then the other. The mare was rock solid to one side, the other she struggled a little more to keep her balance. She then commented on the mare having muscle atrophy in her hindquarters and neck. I personally do not see it, but won't discount this. The mare had never packed much muscle, even when she is fit.

    The next horse, the trail horse, had obviously shown signs of needing chiropractic work done. My farrier (a rather experienced horseman) had previously tested the mare and thought her to be out in her poll and SI joint. We would have brought out a regular chiropractor but they all required 4-5 horses to make a farm call. Anyway, the Orthopathic specialist performed the same tests on this mare as the last. Again, this horse was trained to give to pressure on the poll. She lowered her head a little bit then shook it back and forth a little. She ducked her back when pressure was applied near her SI joint. She remained solid-footed when her tail was pulled, and her feet did not move when her hip was pushed, though her hip did shift with the pressure (I will draw pictures if this does not make sense). This mare has never had a great topline, she was in poor condition when I bought her as a yearling five years ago and even with my vet's help I could never get it to completely fill out. This mare has not been in regular work within the last several months, and has only been lunged maybe twelve times during that time frame, yet she is looking nice and is actually building muscle. She is a bit more on the klutzy side, usually have to get her attention before getting on or she may take a misstep. Always been like that, and I attributed it to her being rather narrow and ALL leg (no exaggeration, she is a literal t-post). She has never had an issue stumbling on the trail, in the pasture, or even in a deep sanded arena at any gate ( I have ridden her in each of these terrains in the past month, testing her lameness due to it only presenting when being ridden). Has no problems traveling out, performing lead changes, side-passing, or anything of the sort. Only had a light gimp at the walk.

    Now, I will end my novel with the addition that this specialist could not give an actual diagnoses due to her not being a veterinarian, but she did recommend that we either go ahead and treat them both for EPM or have the vet test them. I am somewhat skeptical, in all honesty, and would like to hear other's views on this. We are taking the horses to the vet, better be safe then sorry, but wouldn't the horses have given us some kind of symptom such as abnormal spookiness? Stumbling? Wouldn't the trail horse be exhibiting a decrease in muscle rather than an increase? And what are the chances that two horses present active EPM at the same time?
     
  2. manesntails

    manesntails Senior Member

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    Alright, I hadda stop reading, not going to even read the rest of the bull crap, about the horse immediately dropping it's head when pressure is applied to the poll.

    Is your horse wild, unbroke, and DOESN'T respond to, move away from, pressure?

    If not, then the horse is doing EXACTLY what it SHOULD do, drop it's head~!! This is what we train them to do, move away from pressure. All mine would've dropped their heads immediately.

    I can't even read the rest. Had she told me that the horse dropping it's head to pole pressure meant it may have EPM, I'd have not been able to contain myself, LMAO, then thrown her off the property.

    Go see a Vet, nevermind this idjit.
     
  3. slc

    slc Senior Member

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    Summary of my response - I don't think the Orthopathy lady makes any sense. The examinations she did of both horses were partial and the tests she chose to do (and did not do) and her explanations show no comprehension of how EPM affects horses or presents itself. Both horses need to be seen by a decent veterinarian. It may take several visits and various tests or a trip to a larger clinic with more equipment, to determine what their problems are.

    Common causes of lameness are arthritis in one or more joints, bruises to the sole of the foot, inappropriate or infrequent hoof trimming and shoeing, tendon and ligament injury. Often, 'the milder the lameness, the harder to diagnose.' However, the seriousness of the problem can't always be judged by how lame the horse looks visually.

    A few other comments - 1.) most horses - even many sound, painfree horses, 'flinch' and hollow out their backs when pressure is put on the SI joint or hands or a pen or other instrument are drawn along the back 2.) most horses will drop their heads when pressure is applied to the poll as they are trained to do so 3.) if sudden firm pressure is put on a hip, many horses will stumble while moving away from the pressure 4.) many horses will react in a surprised or alarmed fashion of their tail is pulled to the side and you won't get a real picture of what's going on.

    Without a logical, sensible, step by step procedure from a good quality veterinarian, an accurate diagnosis is very unlikely. There are ethical issues with practitioners who do 1-2 types of therapy, doing diagnostics('to a hammer everything looks like a nail', as the old saying goes - conflict of interest). A better approach could be that a chiropractor be called if the veterinarian's treatment plan recommends that form of therapy. Some vets also have chiropractic training. As long as they are equally open to all forms of therapy and diagnose without bias to therapy, that can work too.

    Without an accurate diagnosis no one can divine what the correct treatment might be. A vet who specializes in lameness is the best bet.


    Summary of information from OP:

    Neither horse has been seen by a vet recently, but unknown when they were last seen or what was done. There are plans to take the horses to a vet and chiropractor.

    Barrel horse mare - age, breed and history unknown. One hip 'looks higher than the other' and shows signs of discomfort(unspecified). Orthopath cites pressing on horse's head, back, reaction to pushing on hip(stumbled a little), pulling on its tail on one side, muscle atrophy not visible to others, as signs of EPM.

    Trail obstacle horse - age, breed and history unknown. 'Mystery lameness'
    only at walk and only under saddle*, some xray views, were taken of her forelegs, OP did not mention if the vet taking those xrays arrived at a diagnosis or recommended additional tests, not known which views or when this was done. Unknown how long the lameness has been there.

    Had some massage at some point in time. OP feels she 'had a shoulder out.' Father said she was 'out at poll and sacro-iliac joint.' Poor muscling but improving. 'Gimp'(unknown what type of lameness or how it presents) at walk. Ridden(not known how often, for how long, or how intensely), longed 12 times in last few months. Must 'get her attention' before you get on, or she will stumble (not explained how her 'attention is gotten.'). Ridden in canter, flying lead changes, side passing, trail ridden on different surfaces without OP noticing any problems. Narrow chest.

    Orthopathic practitioner (vet? tech?) diagnosed both with EPM.


    Questions: somewhat skeptical, in all honesty, and would like to hear other's views on this. We are taking the horses to the vet, better be safe then sorry, but wouldn't the horses have given us some kind of symptom such as abnormal spookiness?

    "Abnormal spookiness" is not a core symptom of EPM. In fact many horses with EPM damage seem rather unreactive and unlikely to spook, they seem depressed, resigned. SOME horses (I saw one recently) was spooky because he was so anxious about losing his balance, but he also was very green and just generally a nervous type of horse. By no means are all or even most or many EPM affected horses spooky.

    Stumbling?

    Not necessarily. The way EPM changes the gaits is not usually characterized as 'stumbling'. It's called 'Ataxia.' Ataxia means a loss of balance and coordination. Some may call this as 'stumbling' and indeed that may happen, but what's most important to look for is if the animal can control its balance - if the body sways abnormally or it seems the animal cannot control its balance. The animal may seem to 'hunt' with the hind legs when backing up, too, holding each hind leg up uncertainly for a moment as he steps back, as if he's unsure of his ability to place his hind feet safely. But the chief thing is incoordination, loss of balance, the body appearing to slightly - or more severely - sway, lurch or fall to one side. This is especially noticeable when turning.

    'Stumbling' is the term generally used when the lower limbs don't flex or lift properly due to mild arthritis or tendon injuries or hoof damage. The foot fails to 'get out of the way' when the leg is brought forward, or the joint flexes the wrong way. The body doesn't usually sway - or sway in the same way it would with EPM.

    Keep in mind that many horses with EPM also have other chronic issues like mild arthritis or ligament/tendon injuries which also affect their gaits. The veterinarian has to distinguish each issue and understand what each issue contributes to the picture he or she sees.

    A response to a tail pull, a push on the hip, is not done to detect stumbling but to detect the animal's inability to retain its balance. This is not so simple to see and people have to be trained and practice looking at many horses before they understand the difference.

    Further, other neurological tests are given, such as stepping up and down a step or curb, turning sharply and backing up - key tests the orthopath did not perform. The exam is not complete without these tests. Of course the practitioner has to understand what to look for in each test.

    And of course, there are MANY different disorders which affect a horse's gaits. There are many different neurological conditions that non-veterinarians confuse with EPM, and there are many orthopedic(bone, tendon, ligament) disorders of the legs and hooves that make a horse appear as if it has a neurological condition. It is often not simple or a one-visit thing to determine a diagnosis. But without a diagnosis no one can choose the appropriate treatment.


    Wouldn't the trail horse be exhibiting a decrease in muscle rather than an increase?

    Changes in musculature are not so easy to see and are often misidentified. Online, you will see many 'before' and 'after' photos of horses that are declared by one and all to 'have more muscle' when they have only put on fat or there are insignificant changes to musculature. And in fact it's not so easy to tell what's what (muscle or fat) from a photo or even the average blurry video. Having hands on the horse is better.

    To assess the horse's condition, it is better to use a more systematic approach. Get a good estimate of the horse's weight by using a weight tape every week(apply it the same way each time to get a good estimate). Except in malnourished horses, which fail to develop muscles due to a deprived diet, horses will muscle up according to body type(some horses are built slender and slim and will never 'bulk up' like a stock horse breed, for example). The type of work also matters.

    A program that consists of occasional rides is unlikely to cause any change in muscle development. It takes a real 'program' of consistent, carefully structured work and frequent work over months, to develop muscle; changes do not occur quickly or easily. Unless the horse is 'in a program' changes one sees are not likely to be due to muscle development.


    And what are the chances that two horses present active EPM at the same time?

    Very good, in fact. The cause of EPM is a parasite transmitted by smaller animals like opossums. These animals contaminate feed or environment with their feces. So because of how EPM is spread, it is not unheard of that several horses in one stable could be infected.

    On the other hand, it's also not unusual to see one horse in a stable of six or seven be the only horse that has EPM. However, with horses moving around to different owners, stables, shows, events, it often isn't known when or where the EPM infection was picked up.


    * It's unlikely that the horse is only lame at a walk. There are some conditions that could cause this, but it's more likely that the horse's lameness just is not so obvious at the trot and canter.
     
    Last edited: Jun 15, 2018
  4. C4Roan

    C4Roan Full Member

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    Definitely going to see a vet, and glad I'm not the only one that thought this was a bunch of nonsense. XD
     
  5. C4Roan

    C4Roan Full Member

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    Thank you for replying, you sound much more experienced in this sort of thing than I am! Here are hopefully some clarifications. :)

    The vet saw both of them last week for their coggins.

    Barrel horse : 7 years old, QH, owned for 5 years, lightly started as a three year old and thrown out to pasture for the winter before being finished as a four year old. Has only been actively competing as a barrel horse since last July. Other then one hip looking higher, she has started to run past the first barrel and resisting pivoting to the right.
    Trail Horse : 6 years old, QH, owned for five years, same training schedule, not competing in obstacle challenges at the moment though has in the past. Lameness presented itself three months ago. Farrier recommended x-rays (both front and side view) and thought the mare to be out in her poll and SI joint as well. Horse was then seen by the vet, had clean x-rays that did not present any arthritis or abnormality, horse was then seen by the masseuse the week after. Since then we had been attempting to get a chiropractor out to no avail.

    The horses are half sisters through their sire, and were in poor condition (malnourished and extremely wormy) when purchased as one and two year olds. There is a chance that the trail mare is inbred (her dam may be a full sister to the barrel mare, but we are not completely certain.) We worked alongside a vet to rehab the mares, though the trail mare never grew much in width. I feel this is due to both her original neglect and poor breeding. The other mare matured much better and is now a 3D barrel horse.

    The Orthopathic specialist is the one that determined her shoulder was out. My farrier, not my father, examined the mare's poll and SI joint. Gimp presents as slight short striding on the right front leg at the walk. When I rode her it was for no more than thirty minutes at a relatively light intensity. Mostly walking, various turns, a short trot and a short lope.

    I suppose that the mare could have been lame at a jog or a lope, but I did not notice any short-striding or head bobbing.
     
  6. slc

    slc Senior Member

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    I'm really bupkiss compared to a good 'leg man' (male or female, lol, specialist vet in lameness).

    Thanks for all the detail. I'll mull it over after I get done fixing the gate. The key is really getting the horses to a good leg man.

    They may have EPM but I kind of doubt it. I'd never treat a horse for an illness without getting a diagnosis or a situation like 'it costs 5 bucks to try treatment, which, if correct guess, would start improving the symptoms in a few days, and it's $500 for the test to diagnose it....' That's not the case with epm(improvement is by no means sure even with the right medication and it might be necessary to wait a long time before improvement can be seen).

     
  7. Garfield70

    Garfield70 Senior Member

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    How about tea leaf reading to diagnose rare diseases...

    That woman is in no way, shape or form qualified to do neurological diangostics. I would go so far as saying, if she gives you a diagnosis like this she is practicing veterinary medicine without a license. I would notify the authorities that regulate who is allowed to practice veterinary medicine. They may be interested in because it's their job to shut down quacks.
     
    ~tiffy~ and manesntails like this.
  8. Garfield70

    Garfield70 Senior Member

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    Definitely not a specialist in anything.
     
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  9. ginster

    ginster Senior Member

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    I am glad you have the vet out because this "specialist" doesn't make much, if any, sense.
     
  10. slc

    slc Senior Member

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