INFORMATION ON EQUINE SHIVERS
FOR HORSE OWNERS AND VETERINARIANS
Brenda Bishop, VMD
1976 Graduate of the University of Pennsylvania School of Veterinary Medicine.
Brenda Bishop has spent many years researching equine immune mediated diseases.
She has included in this website a practical guide for horse owners as well as a guide
for veterinarians interested in a new thought process for dealing with Equine Shivers.
She answers questions that have gone un-answered for too long.
FOR MORE INFORMATION CONTACT:

Brenda Bishop, VMD
sporthorse@carolina.net
910-783-9740
EQUINE SHIVERS
Counter
"A new scientific truth does not triumph by convincing its opponents and
making them see the light. but rather because its opponents eventually die,
and a new generation grows up that is familiar with it".
                                                         
Maxwell Planck
The Leptospirosis Horse


Copyright 2012 by Brenda Bishop, VMD.  No portion of this publication may be without
prior written permission of the author.  Portions of this work have previously appeared in
Natural Horse magazine: volume 12 issue 2 (2010) “Demystifying Equine Shivers” by
Brenda Bishop, VMD and volume 5 issue 3 (2003) “Deciphering Equine Fibromyalgia
Syndrome (EFMS)” by Brenda Bishop, VMD.



The most common zoonotic bacterial infection in the world is Leptospirosis.  Due to its
number one status, much is known about its appearance in humans, dogs, cats, cattle,
sheep, pigs and goats.  Comparatively little is known about its existence in horses.  Of
the many different serovars (there are over two hundred known to date) the serovar L.
pomona is associated with two clinical entities in horses: equine recurrent uveitis (ERU)
and spontaneous abortion in mares.  ERU is considered to be an autoimmune problem
by many scientists; leptopirosis is suspected in mares that abort for no apparent reason.  
Both ERU and abortion represent consequences of previous (usually unrecognized)
exposure to one or more Leptospira serovars.  Whether the affected horse had a healthy
immune system or a compromised one at the time of exposure, these horses have won
the initial skirmish (acute infection) but lost the war, eventually suffering loss of one or
both eyes or a fetus.  

Bacteria that have a spiral shape, such as Leptospira and the Lyme disease spirochete
Borrelia, have a predictable course of action once established in their respective hosts.  
They characteristically elicit a biphasic response; the initial acute infection, which may or
may not provoke a fever and general malaise, lasts a short time (days); the second
phase takes weeks or months to manifest.  The symptoms of this second phase are a
reflection of an immune system struggling for control.  When immune system imbalance
goes on long enough, a certain threshold is reached wherein autoimmune conditions
(such as Shivers) can result.  Researchers have found that spirochete infections produce
the same clinical pictures in various animal species and humans, some of whom
develop ‘Persistent Human Leptospirosis’ (PHL).  Horses are thought to be a reservoir in
nature for certain Leptospira serovars; it is known that wild animals shed Leptospira in
their urine which can easily be ingested by grazing livestock.  If in fact some horses
embody a carrier state for the bacteria, these should not be confused with those
individuals whose immune systems are engaged in an ongoing active battle with chronic
infection.   

The easiest way to envision this second phase is in terms of a prolonged allergic
reaction.  Unlike the initial acute phase which can be life threatening (due to lung, kidney
and/or liver damage), this phase amounts to a progressive complex cascade of events
which leave the affected host with a wide array of complaints.  To further oversimplify the
picture of how specific problems are created, it is helpful to consider the role of mast
cells in the host horse’s body.  An important but poorly understood part of the immune
system, mast cells live abundantly in connective tissues (such as skin and ocular
conjunctiva) and mucosal linings (respiratory, reproductive and gastrointestinal tracts).  
They cluster around nerve endings, the smallest of blood vessels and lymphatics.
Another crucial part of the immune system, plasma cells, circulate freely and produce
antibodies (immunoglobulins) such as IgG, IgM and IgE.  Mast cells have an affinity for
IgE which attaches to their surface.  When leptospiral antigens make contact with this
IgE, the mast cell becomes activated and explodes like a bomb.  Among the many
substances released into the surrounding tissues are histamine, prostaglandins,
cytokines and leukotrienes. These in turn produce constriction of the airways, gastric acid
secretion, spasms of the gastrointestinal tract, itching, irritated nerve endings, swollen
blood vessels and lymphatics, and needless to say inflammatory pain.

Horses in the early stages of persistent leptospiral infections demonstrate chronic
fatigue, occasional toe dragging, itching body parts (mainly the head), depression and
poor appetite.  As time goes on, they might exhibit some of the following: urogenital
discomfort, biting at themselves, transient peripheral lymphadenopathy, cording of the
lymphatics, vasculitis in the hind legs, a mucoid nasal discharge, hyperventilation at rest,
asthma, insulin resistance, difficulty standing up, hind leg gait deficits, anxiety and/or
hallucinogenic behavior.  Both allergic and autoimmune states reflect alterations of the
immune system.  If an allergic response lasts over a long period of time (weeks), IgE
remains abundant and other immunoglobulins eventually enter the fray.  Both Myasthenia
Gravis and Lambert Eaton Myasthenic Syndrome involve antibodies of the IgG class,
acetylcholine receptor antibodies and calcium channel antibodies respectively.  (This is
why a percentage of babies born to mothers with MG or LEMS have ‘neonatal MG’ or
‘neonatal LEMS’ until the antibodies from the mother’s blood disappear within the first
week or two of life.)  Both pre-synaptic (LEMS) Shivers horses and post-synaptic (MG)
Shivers horses already have plenty of IgE; MG is characterized by high levels of mast cell
density in certain tissues and LEMS has been linked to mastocytosis (an excessive
number of mast cells) in humans.  Regardless of which came first, i.e., Leptospirosis or
Shivers, for a Shivers horse dealing with a leptospiral infection, the stage is set for all the
results of mast cell stimulation to escalate in intensity.  Small animal veterinarians have
observed that Leptospirosis vaccination appears to trigger mast cell tumors in some
dogs; there is no approved vaccine for horses.

Even though testing for up to seven serovars of Leptospirosis is available for horses,
results are subject to personal interpretation.  Another diagnostic challenge hinges on
spirochete biology, namely an adaptive ability to morph into ‘round bodies’ (a different
shape) when the local environment changes.  Clarification of spirochete round body
relationships with their vertebrate hosts will be lacking until sorely needed research
regardless of species is accomplished.  As with Fibromyalgia and systemic fungal
infections, not all Leptospirosis horses develop Shivers nor do all Shivers horses have
active Leptospirosis.  If a horse displays signs of massive mast cell stimulation, with or
without the presence of Shivers, Leptospirosis should be high on the list of possible
scenarios.  In the case of a horse with Shivers and a head that simply loves to be rubbed
with a soft towel after exercise, Leptospirosis should be considered.  Oral Doxycycline is
one of the antibiotics of choice for spirochete infections.  It has the added benefit of
having an anti-inflammatory effect on immune mediated neuritis. (Immune mediated
neuritis can manifest as mild itching, stringhalt, Shivers, head shaking, hypersensitivity to
hot and/or cold weather or any number of other syndromes such as EFMS and/or any
combination thereof.)  For a horse with Leptospirosis the dose should be 5 milligrams
per pound twice daily for up to sixty days.  Ideally a blood sample is tested at the start and
again after antibiotic therapy.  Short term benefits can be obtained with antihistamines,
aspirin and/or ibuprofen, however use of these drugs is like closing the barn door after
the horse is out; they have a place but are not practical for long term use.  

With the exception of autoimmune hemolytic anemia, one drug that IS useful for
maintenance of horses with a wide range of immune mediated problems such as
Leptospirosis is Pentosan.  Pentosan polysulfate sodium is gaining popularity in the
treatment of several human diseases, among them Crohn’s disease (an autoimmune
gastrointestinal disorder).  It stabilizes mast cells by inhibiting allergic mast cell
stimulation.  This powerful effect results in reduced histamine release, an effect more
potent than that of hydroxyzine, a drug that merely competes for histamine receptor sites
on target cells and is often prescribed for horses with Cushing’s syndrome.  An example
of symptom overlap that can be addressed with Pentosan is the skin hypersensitivity
common in Fibromyalgia horses.  People with Fibromyalgia have up to four times the
usual number of mast cells just below their skin surface.  Imagine how much discomfort
(itching and burning) such a horse would have upon being groomed with stiff brushes
and/or heavy hands.  Additionally Pentosan lowers intracellular calcium.  An essential
signaling molecule, calcium levels must be maintained in a precise balance, in a ratio of
about twenty thousand times more outside than inside individual cells.  When
intracellular calcium rises, cells die and different neurodegenerative diseases result.  
One of the key regulators of intracellular calcium is the voltage gated calcium channel,
which is dysfunctional in LEMS.  Pentosan’s effects are dose dependent, appear quickly
(24 hours) and last long after it has washed out of the body (weeks).  

The little known herb Butterbur is a perfect therapeutic partner for Pentosan, useful
because it is complementary at worst and synergistic at best.  It is a natural beta blocker,
i.e., it reduces spasms of capillary muscles and lowers blood pressure.  Improved
arterial blood flow results and is probably amplified in the presence of Pentosan which is
heparin like. (It has been shown that Pentosan improves blood supply to subchondral
bone in horses’ joints.)  Butterbur gives dramatic relief to most sufferers of migraine
headaches, one of many human diseases now viewed as ‘calcium channelopathies’.  
That a simple herb could give relief to throbbing blood vessels within the central nervous
system suggests an exciting possibility for controlling spasms in the peripheral nervous
system, an overlapping symptom of Leptospirosis, MG, LEMS and FMS.  While Pentosan
stabilizes mast cells, Butterbur lowers the effects of leukotrienes and prostaglandins
which leak into tissues when mast cells do explode.  Pain relief is the end result.  For a
thousand pound horse a dose of 300 milligrams Butterbur root extract added twice daily
to the feed can be used until results are seen.  Herbs can take weeks to garner
improvement but provide a horse friendly alternative to aspirin or ibuprofen and like
Pentosan can be pulse dosed over the long term.  Horses allergic to daisies,
chrysanthemums or marigolds should not be fed Butterbur, which belongs to the daisy
family.  Both Pentosan and Butterbur, used alone or together, appear to yield impressive
clinical improvement by working at both the central (CNS) and peripheral (PNS) nervous
system levels, a fact which lends excitement to this rapidly expanding field of twenty-first
century research known as ‘autoimmune channelopathies’.  
MULTIDIMENSIONAL MEDICINE
Copyright March 1, 2020 by Brenda Bishop, VMD
All rights reserved.
No portion of this publication may be used without prior written permission of the author.
The author asserts her moral right to be identified with this work.
“When we know better we do better.” - Maya Angelou
Shining the light of our awareness into historically dark corners is a metaphor for the shifting paradigms we as
horse owners face in this new year of 2020. Traditional linear thinking has served us up to a point and now it is time to take
an accounting and ponder the gaps in our knowledge regarding horse health care. Prevailing mindsets have become
comfortable with using drugs for anything and everything that amounts to a problem. This approach chooses “better living
through modern chemistry” over broader mindfulness of deeper implications and fails to serve the whole horse. All the
humans in horses' lives have become drug buyers and/or drug sellers. Equine supplements alone have become a
multimillion dollar industry in a relatively short time. A small minority of horse people outside this grid fall into the
network called healers. “Healers don't heal anyone. They re-balance.” (Abraham Hicks) Re-balancing centers around three
principles: the principle of contraction, the principle of expansion and the principle of plurality.
Horses are by nature peaceful grazing prey animals. They are born equipped to run away from predators. When
this ability is hampered by unsoundness of limb or limbs they become fearful and naturally prone to panic. Shortened
forward phase of stride, delayed forward extension, flexors restricted by inflammatory agents, delayed over-extension (for
example clicking heels), hypermetric gaits with spasms in abductor muscles (for example stringhalt, shivers), postural
tremors, contracted heels, etc. are examples of contraction leading to tendon sheath rupture, suspensory strain and untold
anxiety. The mental stress alone contributes to multisystem dysfunction such as gastrointestional ulcers, adrenal
exhaustion
syndrome, and increased permeability of the blood brain barrier. The principle of contraction is (from the horse's point of
view) characterized by fear and potentially self destructive behavior. In order to re-balance it is necessary to get the horse's
body and mind back to a natural neutral state of well-being.
The principle of expansion is essentially a one way street. “The mind, once stretched by a new idea, never returns
to its original dimensions.” (Ralph Waldo Emerson) Healing takes place from the inside out when any and all impediments,
restrictions, obstacles are removed. If the horse's garbage cans (lymphatics, liver, kidneys) are brimming with toxic debris,
infection, parasites, etc. a cleansing is required to open (expand) the channels. If the lungs are not able to expand after
contraction with each breath, the stress level is exponential. The interconnectedness of all things dictates that multiple
systems will come into play on the path to well-being. The brain and central nervous system can compensate for small
neuronal deficits but eventually imbalance will create downstream issues. Questionable integrity of the blood brain barrier
is something healers tend to think about and factor into their protocols because it is so fundamental and necessary for
promoting good health going forward.
The principle of plurality incorporates aspects of expansion and contraction from a higher perspective. Linear
thinking is useful but it falls short when the rubber meets the road on the path to lasting balance; an expanded paradigm is
required. Standing at the bottom of a mountain we can only see a short distance up; standing at the top allows us to see
everything below. This higher view organizes horse keeping into more obvious groups of choices. If we simply focus of
three areas of healthcare (nutrition, chronic infection status and parasite status) the convoluted puzzle pieces will fall into
place. When the inside of the horse is right the outside takes care of itself. Horse nutrition has been very well researched
and can be learned by anyone taking the online course given by Eleanor Kellon, VMD, a pioneer in this field. Chronic
stealth infections such as Borrelia (Lyme) and Bartonella operate in relative darkness due to lack of funding for needed
research. (See Frequently Asked Questions on the Bartonella page of this website.)
Plurality is analogous to a modern Physics term for explaining the inter-relatedness of the distant parts of a
phenomenon, 'entanglement'. Linear thinking cannot get there from here. Entanglement deals with answers which generate
whole new lines of questions. We know that chronic bacterial stealth infections are synonymous with multiple system
overlap. But we frequently fail to realize that chronic zoonotic parasitic infections are usually part of the total picture we
label immune system compromise. Layers of infection are inevitable the longer a body is out of balance. Healers like to
think of their work as 'peeling the onion'. One layer that grows more omnipresent over time is that of worms with a filarial
stage in their life cycle. Examples are Onchocerca cervicalis, Oxyuris equi and Setaria equina. Because these worms live
under the skin conventional “fecal exams are not worth the paper they are printed on” (Marvin Cain, DVM) when it comes
to these parasites. Additional concerns arise by virtue of the fact that systemic filariasis is perpetuated courtesy of a
symbiotic bacteria (Wolbachia) belonging to the same phylogenetic class as Bartonella spp., an avenue currently being
explored by the World Health Organization.
New questions we should be asking ourselves go something like this: are frequent draining foot abscesses and/or
subsolar abscesses bacterial, microfilarial or both? Are ill defined (dormant) cysts seen on diagnostic imaging of stifles,
hocks, fetlocks, navicular areas microfilarial? Are horses diagnosed with COPD harboring millions of microfilaria in their
lungs? Are seasonal skin pruritis problems linked to microfilarial populations positioning themselves to be siphoned off by
blood sucking insects? Are club feet associated with small vessels clogged with microfilaria acquired through the
placenta?
Are microfilarial parasites inhabiting the pituitary in IR and/or Cushings horses? Are a horse's “Lyme/Bart” symptoms
worse during a full moon because unrecognized microfilaria become active during certain lunar cycles? Are my horse's
symptoms consistent with 'nocturnal periodicity' typical of microfilariasis? Is there a symbiotic relationship between this
group of parasites and chronic stealth bacteria? What role do microfilaria play in acute onset co-infections such as tetanus,
neurologic herpes and so-called protozoal myelitis? What are the inter-relationships between chronic Lyme disease, brain
fog and filariasis? A review of the Symptom Check List under Bartonellosis will spark a plethora of additional questions for
the reader.
Parasite resistance to chemical dewormers (drugs) is a well documented phenomenon in horses. Traditional
deworming plans almost never take into account the possibility of worms with microfilarial stages. Fortunately there are a
number of effective options that should be considered on a case by case basis. These include but are not limited to the
following: resveratrol, arnica, Para-X (Omega Alpha), silicia, Silver Lining Maintenance, BVC (Advanced Biological
Concepts), Source Micronutrients, dandelion root, white sage, prebiotics (garlic, bananas, custard apples, watermelon),
and
custom herbal Parasite Blends made specifically for addressing filariasis. Deworming strategies such as custom blends
paired with nutritional balancers maximize blood brain barrier integrity by incorporating vitamins B6, B9, B12, resveratrol,
curcumin, vitamin C, and anti-oxidants (green tea, raw barley, raw oats, Colloidal Silver, vitamin E). Stress reduction can
be achieved with balanced targeted nutrition, chronic stealth infection and parasite elimination, and by limiting exposure to
electromagnetic fields. Ideally we should remove anything electronic from our horses' immediate environment. This
requires a return to natural environments far away from high voltage power lines and turning off the barn radio.
Additional Reading
http://
www.copperfieldequinetherapy.com/
biodiversity-and-what-lies-beneath-theconnection-
to-equine-diseases-2-2-2/
https://www.sciencedirect.com/topics/
agricultural-and-biological-sciences/
onchocercidae
Microbial population analysis of the midgut of Melophagus ovinus via high-throughput sequencing
Parasites and Vectors 2017 PMID 28793927
https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC106837/ Zoonotic Filariasis
https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC4893572 A Rare Case of Ovarian Filariasis
Filariasis Symptom Check List

(updated 09/01/2020)
“Good observation is your best tool.” - Elaine Hammel, VMD
“Birds of a feather flock together” as do Chronic Stealth Infections. Decades of routine
chemical deworming delivered orally in paste form have contributed both directly (pastes and gels
damage the immune system) and indirectly (drug resistant strains have had plenty of time to adjust and
ultimately thrive) to the current state of affairs: horses carrying a wide array of opportunistic CSI's.
These infections can even be transmitted to foals via the placenta in utero. Where one or two stealth
pathogens are present, there are many more hiding under the radar. Tape worms for example are next
to impossible to test for, rarely seen in manure and survive in all kinds of weather. Worms with a
microscopic filarial stage in their life cycle can reach epidemic proportions over a horse's lifespan.
Examples are Onchocerca spp, Oxyuris spp and Setaria spp. Like birds, blood sucking insects are
ubiquitous team players. Mosquitos transmit Dirofilaria immitis (heartworm); sheep keds (blood
sucking insects) are known to harbor both Bartonella and Wolbachia stealth bacteria. This fact alone
links filarial worm populations with Bartonella presence. Wolbachia bacteria are distributed worldwide
and promote fertility (production of microfilaria) from within adult heartworms, pinworms,
threadworms, etc. The consummate team players, endosymbiotic Wolbachia strains modulate lipid
metabolism and lurk in the background overshadowed by an assortment of protein aggregate
myopathies. Layers of symbiotic (mutually enhancing) relationships among a wide range of zoonotic
stealth pathogens cannot be fully appreciated overnight. Knowing that 'the horse will always tell you',
it falls on us to observe and decipher clues implicating CSI's. Inevitably the Filariasis Symptom Check
List and the Bartonellosis Symptom Check List will share a number of possible undesirable findings.
Chronic Protein Deficiency
thin sparse short mane / hair loss / short wispy tail
thin walls and/or thin soles (chronic foot soreness)
chronic toe cracks and/or quarter cracks
chronic fatigue syndrome (CFS)
neurotransmitter imbalances (delayed reactions / over reactions / anxiety / brain fog)
leaky gut syndrome (LGS) / low serotonin levels / protein losing enteropathy
cold feet (feet should always be warm to the touch)
skeletal muscle wasting (predominantly topline)
edema / fluid retention
fatty liver / oxidative stress
periodontal disease
bone fractures / hairline cracks
Drainage Deficits
swollen painful inguinal lymphatics (groin area)
swollen painful axillary lymphatics (arm pit area)
chronic progressive lymph edema (CPL)
swollen painful parotid salivary glands (throat area)
swollen painful submandibular lymph nodes (lower jaw area)
choke / slow to swallow food and water / epiglottis dysfunction
dorsal displacement of the soft palate (DDSP)
patchy sweating / excessive sweating / anhidrosis
exercise induced pulmonary hemorrhage (EIPH)
transient ischemic attacks (TIA's) (cardiac and/or pulmonary artery occlusion)
belching / burping (lower GI tract / liver)
lymphatic channel pooling and/or dehiscence / leaking
poll evil
fistulous withers
hygroma of the elbow (olecranon)
tender girth area (channel between the withers and elbow)
swollen udder with or without discharge (mares)
swollen painful sheath (geldings and stallions)
swollen scrotum (stallions)
scratches (lower legs)
'rain rot' (predominantly topline, lower hind legs)
wind galls / wind puffs (suspensory and/or flexor tendons)
chronic lacrimation (tearing) (one or both eyes)
Gravity Dependent Edema / Weakened Weight Bearing Posture
sway back / hollow back / high head carriage (any age horse)
loss of topline
pot belly (with or without bloating)
ewe neck
dropped sternum
dropped head syndrome / collapse of ligamentum nuchae
tendon laxity (foals, young horses)
digital suspensory ligament desmitis (DSLD) (old horses)
sheared heels (usually in one or both front feet bearing 60% total body weight)
pleural effusion
Behavior Abnormalities (frequently worse around a full moon)
intense itching/ scratching (with or without nocturnal periodicity)
head, especially around poll, eyes, sinuses and facial crest
rectal, tail head area
upper ribs
lower back / sacroiliac area
ventral midline
chest area / ventral lower neck
udder / sheath area
groin area (between hind legs)
dribbling urine and/or straining to urinate and/or hematuria
sporadic explosive outbursts / running straight backwards violently / bolting
violent spasmotic dorsiflexion of lower back (bucking)
jittery, nervous habits (usually wax and wane)
holding one deep breath while running
ear pinning flat back against poll area (anger)
ear sensitivity (tinnitis)
head pressing (headaches)
head shaking (photic and/or nonphotic)
bruxism (teeth grinding)
depth perception deficits / 'my space - your space' issues
altered / sporadic estrus cycles
failure to thrive (foals) / depression
adverse IV drug reactions
adverse vaccination reactions
hypersensitivity to sedatives with or without hematuria
biting insect allergies
hypersensitivity to light / moon blindness (ERU)
hypersensitivity to electromagnetic fields
excessive shivering / sensitivity to freezing weather, rain, snow
balance problems and/or falling down in a moving horse trailer
rearing and falling over backwards / pulling back violently while tied
Co-infections
Wolbachia (thousands of strains in nature)
Bartonella (discovery of new species is ongoing)
Borrelia (at least 50 species in nature)
maggots (dark low oxygen locations such as feet, inner sheath, tail bone)
Leptospira (discovery of new species is ongoing)
Toxoplasma (an intracellular protozoal parasite)
Corynebacterium pseudotuberculosis (“Pigeon Fever”)
Localized filarial cysts / nests / dormant abscesses / nodules / protein aggregates
cystic ovaries / ovarian pain
adrenal glands / adrenal exhaustion syndrome
lungs (coughing, small amounts of mucous) / COPD
upper airway obstruction / recurrent airway disease (RAD) / wheezing
nasal polyps
gutteral pouch infections / abscesses (usually unilateral)
sinusitis (exacerbated on exercise)
lower legs
collagenous tissue disruption (tendons, ligaments, suspensory apparatus)
carpal tunnel and/or check ligament deficits
extensor rigidity (shortened forward phase of stride)
flexor contraction and/or rupture (ex: curb) / displacement (ex: Achilles tendon)
chronic foot abscesses / subsolar abscesses / false soles
navicular abnormalities / digital cushion abnormalities
contracted heels (usually in front feet)
club feet (one or both front feet)
pituitary gland dysfunction (Cushing's syndrome) / pituitary 'tumor'
thyroid gland dysfunction (goiter)
vitreous floaters (detached collagen fibers) with or without ERU (eyes)
parasitic keratitis and/or immune mediated keratitis (IMMK)
carbuncles 1 to 2 centimeters in diameter with central bulls eye (sheath area)
acquired white spots / multiple polka dots ('birdcatcher spots') / 'skunk tail'
disseminated granulomatosis (SLE)

Systemic Lupus Erythematosus (SLE) Symptom Check List
Copyright September 1, 2020 by Brenda Bishop, V.M.D.
All rights reserved.
No portion of this publication may be used without prior written permission of the author.
The author asserts her moral right to be identified with this work.
Simultaneously as filarial parasites infiltrate horses' bodies via the circulation into every
available nook and cranny within soft tissues (preferentially tissues built upon a collagen matrix), a
certain percentage of horses escalate from chronic immune suppression to self destructive overdrive;
their immune systems start attacking themselves. Consequently autoimmune conditions tend to coexist; some examples
are autoimmune hemolytic anemia, pemphigus, immune mediated keratitis,
inflammatory bowel disease (IBD), cutaneous lupus and systemic lupus erythematosus (SLE).
Unfortunately for affected horses, SLE is rarely recognized for two reasons; every case is uniquely
different symptom-wise (NO TWO CASES ARE ALIKE), and repeated exposure to specific high risk
factors is commonplace. Many possible indicators of autoimmunity, convoluted in and of themselves,
are challenging to appreciate due to layering of systemic stealth bacteria, filarial worm loads,
mycoplasmas, biofilms, viruses, and so on. The following list of diagnostic criteria reflects a
considerable amount of symptom overlap with Filariasis and Bartonellosis. Helping a compromised
immune system is akin to closing the barn door after the horse is out. For veterinarians trained in
developing a linear differential diagnosis list it doesn't help matters that autoimmune states tend to
cluster, more or less superimposed upon each other reflecting multidimensional dysfunction.
Indices of Suspicion
age of onset (early adulthood, 5 to 10 years)
breed predilection (none however larger individuals are at higher risk)
sex predilection (mares appear to be at higher risk due to presence of estrogen)
history of malnutrition and/or repeated vaccinations early in life
history of months or years living in tropical / subtropical climates
history of stress followed by sudden hair loss (around eyes / total head / total body)
history of repeated exposure to high risk factors
feeds containing soy (soy is estrogenic and estrogen makes lupus worse)
supplements containing garlic (many insect control products)
alfalfa products (hays / cubes / pellets / sprouts / powder)
sulfamethoxazole / trimethoprim (antibiotics)
Lupus Flares
hypersensitivity to strong UV light (consider face masks in summer)
livedo reticularis (plain zinc oxide paste is the ideal sunscreen for faces)
rapid shallow breathing / fluttering nostrils at rest
spontaneous periodic deep hyperventilation at rest (5 to 20 minute episodes)
depression / eyes half closed / ocular pain
hypersensitivity reactions to vaccines / drugs (sulfamethoxazole / trimethoprim)
hypersensitivity reactions to alfalfa (organic and GMO)
hypersensitivity reactions to garlic
deterioration on feeds containing soy
lupus nephritis / frothy urine / blood in urine (hemoglobinuria)
Neuromuscular Predilections (that wax and wane randomly)
non-specific muscle spasms tetanic in nature
recurrent exertional rhabdomyolysis (RER) (commonly in young nervous mares)
lower back / sacroiliac area chronic regional pain (CRPS)
postural tremors (difficulty holding legs up against gravity)
proximal suspensory desmitis (PSD) / suspensory strain
cold hind legs / cold feet
swollen joints (hocks, stifles)
spasms of diaphragm (thumps aka hiccups)
cardiac conduction disturbances (dropped beats / atrial fibrillation)
pericarditis / transient ischemic attacks / sudden collapse / chest pain
chronic fatigue (CFS) / fibromyalgia (EFMS) / poor exercise tolerance
Dysbiosis
ulcers (gastric, hind gut and frequently both)
leaky gut syndrome (LGS) (manure can be normal, tight or loose) / IBS / IBD
improvement on resistant starches (oats / barley / coconut meal)
oxidative stress / improvement on antioxidants such as astaxanthin, vitamin E
biofilms / fungal overgrowth / Candida overgrowth
'protein losing enteropathy' (poor haircoat, poor hoof quality)
sensitivity to glyphosate contaminated feeds (soy / alfalfa / corn / beet pulp)
chronic protein deficiency (microfilaria live on glutamine, required for gut integrity)
Central Nervous System / Cranial Nerve anomalies
'lupus psychosis' / immune mediated neuritis (multiple expressions)
sporadic hallucinations
brain fog that waxes and wanes
optic neuropathy / uveitis (ERU) / keratitis (IMMK)
hypersensitivity to sound
dry mouth and/or dry eyes
seizures
dizziness (during and after transport and/or repetitive forced exercise)
Multiple Co-infections
excessive Wolbachia / filarial worm loads (see Filariasis Symptom Check List)
unusual skin changes / chronic 'rain rot'
disseminated granulomatosis
semicircular white hair spots (shoulders / torso / thighs)
sweet itch (face, chest, ventral midline, neck, groin, tail head, lower legs
chronic stealth infections
Bartonellosis (see Bartonellosis Symptom Check List)
Babesiosis
Borreliosis
Mycoplasmas, Biofilms and many more