Diana B bought Liz, an ex-race horse, when Liz was just turning 6 years. A year later Liz was lame in a rear leg and when ridden it felt like her gait was wobbly. After the visit to a clinic and adjusting her shoes she was useful for three years. However, she showed the same lameness every fall and fell into a pattern: back to the clinic, change of shoes, 6 weeks walking, back to work.
Things changed in November of 2002 when Liz collapsed at the mounting block. The vet was called, a field neurological exam found nothing amiss. Diana noticed other things that made her feel uneasy so she took Liz to the clinic for another opinion. Liz’s demeanor had changed, her coat was dull and she was lethargic. The findings were unremarkable. A week later Liz tripped at the canter and almost went down. She was taken out of work.
Liz was diagnosed with EPM three months later when she couldn’t walk in from her paddock. At the time of her diagnosis at New Bolton, Liz displayed hind end ataxia and she would stand with all 4 legs crossed. She improved with Marquis, DMSO & Banamine, and continued multiple treatments for three months. In retrospect, Diana thought that Liz had been going through minor episode’s since she was 7.
Liz remained clinically normal for the following seven years, that was when she suddenly began spinning in her paddock, seemingly unable to stop. She was treated, but this episode presented very differently than her original “EPM”. She developed tilt of her hind end. She was unstable. Diana told us that she knew when Liz is going to have an issue because her behavior changed, she didn’t stand square/center on cross ties, her turns were choppy, she showed a very small twist in hind right foot and she stands parallel to wall and bends her neck to eat rather than standing straight in front of the corner feeders. She leaned her hind end on the window sill, water buckets or stall gate for support. The behavior clues start 2-3 days before she manifests the full signs.
We believe Liz had PNE, it is often a sequelae of EPM treatment. Her response to treatment and the absence of antibodies to S. neurona post treatment lead us to believe inflammation is the cause of the chronic/relapsing disease. Diana kept a close watch on Liz, she documented pollen counts, weather, and barometric pressure in addition to the obvious signs. Her Green Sheet included many of the early signs that predicted PNE.
A Green Sheet is Dr. Michael Riegger’s term for tracking changes in animals cases. It is a way to change a belief into evidence. A Green Sheet is a hard record, as opposed to a digital record, for keeping track of medications and the response to them, subtle health changes, and other factors that influence long term health.
The Green Sheet is an anecdotal report. Contemporaneously recording signs gives weight to the observations. Also, repeat observations yield patterns that are often forgotten. At one time we thought that an electronic Green Sheet would be useful for horse owners and their veterinarians. We developed a phone app thinking it would be popular. There was a section for uploading short videos along with a medical record section and other useful pages. Alas, the number of users didn’t justify the annual licensing costs on android and at the App store. Perhaps we will try again someday. Until then, set up a Green Sheet and we may reward you for your trouble!
To make your Green Sheet useful to us include an identification section including age, breed, weight and sex. Where you live is good, different things are expected in different regions of the country. A brief medical chronology is helpful. A quick check box for appetite and behavior, it is surprising how often behavior is noted by the owner as a premonition of later disease. How the horse behaves for the blacksmith, the farrier is often the one that says the horse has weakness in the hind limbs raising the specter of pending issues. If the horse is laying down more often, slow to come up for feed, or losing position in the herd pecking order are all things to record and monitor. Transient observations are useful. Especially when they start to recur or appear after some change, like vaccinations.
You can read about early signs and what to look for in the blog Predicting the severity of EPM is possible. Read our blog on how you can earn gift cards for case referrals.
As far as creating your own Green Sheets, we are looking for patterns and your observations may fit. If your Green Sheet is acceptable and if the case fits what we are looking for, we may give you rewards for your observations! For example, we are contacting veterinarians in certain cases and testing before and after treatment to monitor NfL values. Ask your veterinarian about this test and what it can tell you.