Sushi the sheep, and the 9 awful days of brain worm

Well it finally happened, we got hit with Meningeal. Some of you may never experience it, but we are all afraid of it.  So I thought I would share our experience, and how I managed to save Sushi from this highly fatal parasite.

Meningeal Worm:

The dreaded "brain worm" - Parelaphostrongylus tenuis.  No one ever wants to hear this, see this, deal with this in their flock.  It is almost always fatal, especially in camelids, with only slightly more success for survival in ovines and caprines, and only with extremely aggressive treatment starting in the early stages. It's a very complicated and extremely difficult parasite to treat. I will do a brief outline of the whole meningeal worm cycle here, and then talk about my experience with it last week.
1. The parasite is carried by white-tailed deer, and adults live in the brain lining and spinal cord of the deer.
2. The adult worms lay their eggs in the deer, which circulate through their blood, get filtered by their lungs and turn into larvae in the lungs.
3. The larvae, still in the deer, then get coughed up and swallowed into the intestinal tract of the deer.
4. The deer deposit their larvae infested feces into the pasture.
5. Super tiny snails and slugs ingest the larvae and the larvae develop into an infectious parasite for your animals in this stage.
6. Your animals accidentally ingest these tiny snails/slugs while grazing, and upon ingestion, the parasite moves through the animals digestive tract and into the spinal cord and eventually to the brain.
7. Your animal can show symptoms within just a few days or up to an estimated 3 months or so.  Symptoms and course of infection vary greatly depending on the animal, thus making it very problematic to catch. The end result is often fatal and the only way to confirm presence of the parasite is through necropsy of the brain and spinal cord.
*there is almost no course of prevention, sans deer-proofing your pastures and/or consistent anthelmic treatments which in turn cause resistance which a whole other issue in itself and not recommended.
**cases are rather rare and are increased in wet seasons after the beginning of September here in Michigan. Most flocks will experience one or a couple infected animals, and not a systemic flock infection.

---

Sushi's Terrible, Horrible, No Good, Very Bad 9 days:

I took the photo of Sushi on the right, on Thursday afternoon about 4pm.  She is my most friendly girl and scampers and air jumps when running up to me every day when I head outside.  Thursday afternoon was no exception. No signs of anything wrong. Ate like crazy, running around, pets and kisses, posing for cute pics. 

​DAY 1, FRIDAY Jan 31: 
Friday morning I went out at 8am to feed - Just about 16hrs after the photo above , and she refused to come up to me in the field.  Her ears were back and she didn't 'look right'. Although I was immediately concerned something was amiss, I had an appt so I left her with the flock until the afternoon.  We have bully ewe that just lambed and pushes everyone around so I thought maybe she got whacked hard by her and she was being timid. At afternoon feeding when I got home, Sushi wouldn't come up to me again and I noticed she was kind of wobbly. Red flags went off and I immediately thought 'listeria', oh no!  I got her in the barn and separated her immediately into her own stall to monitor. No circling, no drooling, no bright red eyelids. I immediately gave her a high dose of penicillin, dexamethasone and thiamine since she showed neurologic signs, and b complex.  I also gave her a CDT shot since I didn't have any tetanus on hand.  I covered all my basic bases asap, or at least I thought.  I kept her in the pen for monitoring overnight.

---

DAY 2, SATURDAY Feb 1: 
She seemed weak and uninterested in food and slightly wobbly. Still no circling, no drooling, no facial paralysis, no basic signs of listeria. Her head and neck were up and strong, and ears were alert as you can see in the pic on the left, but her body was weak. I re-dosed with high dose Penicillin, Dex, B Complex, and Thiamine.  I expected to see some improvement by the afternoon, but she was very depressed. Still no blatant signs of listeria and I started to question if I just caught it early or if it was something else.  In the afternoon she got more Thiamine and B Complex, and had hopes her appetite would improve.  Dex often stimulates appetite, and Thiamine is necessary to prevent polio when sheep go off feed.  In milder cases, B complex can stimulate appetite. She was nibbling at feed but not eating and wanted to lay around a lot.

---

DAY 3, SUNDAY Feb 2:
I should note that from the very beginning, Sushi never had a temp, no diarrhea, no coughing, no upper respiratory discharge, good FAMACHA score, no clinical signs except weakness, increased staggering, and loss of appetite.  
​Today it was game on!  She hadn't eaten or drank fluids for almost 24hrs on her own at this point.  I had Lactated Ringers but no IV equipment remaining in stock, so in the morning, I manually drenched her with 1000ml of warm water and molasses. I re-dosed with the same meds as the last 2 days, but added a shot of Nuflor to the protocol just to cover the lungs, and propylene glycol (PPG) to help stave off ketosis. I began to ponder my next steps. She didn't want to stand or walk at all by this time, and she just wanted to cuddle cuddle cuddle. In the afternoon, I took a trip up to the local market and got a 6-pack of Guinness. Beer is a hard and fast go-to when my sheep go off feed for more than 24hrs.  I don't drench beer cold, let get room temp or slightly warm. Normally 1 beer over the course of 24hrs does the trick in milder cases - even some really worrisome scenarios, but I was really starting to get very concerned. Besides not eating, she was not moving around. She got a whole beer first time up. If anything, it would help relieve the stress a bit. I drenched her with another 1000ml of fluids in the evening and hoped she would get some energy overnight.  I began to wonder if this might be the end of the road for her, but I don't give up easy. Tonight was the first night I went to bed thinking she might not be with us for much longer.  About midnight I had an epiphany - OMG it's Meningeal!, It has to be - she would be dead by now with listeria, and she had no clear signs of listeria, but what she is experiencing is clearly neurological. I decided if she was with us in the morning, I would begin the protocol.

---

DAY 4, MONDAY Feb 3:
She is still here!! But still not eating. I started the MW protocol first thing - I continued the Dex, thiamine, PPG, and B complex.  Poor girl was becoming a pin cushion at this point.  I added banamine orally, and gave her another 1/2 beer.  A bit later I added high dose ivermectin and high dose albendazole.  She still wasn't eating so I made her a 'sheep smoothie' (minced up hay, a tea made from catnip, fennel, and mint, molasses, vitamins, and some warm beer blended in the nutribullet) and drenched her with about 800ml of that - she hated it!  By late in the afternoon, she still couldn't stand but I gave her a handsome flake of pure alfalfa and she tore it up!  I was so excited. Before bed I gave a second high dose of ivermectin and fenbendazole.  I expected great things in the morning.

---

DAY 5, TUESDAY Feb 4:
My hope for great things didn't come to fruition...not even close.  Sushi had gone downhill overnight in a bad way. During my morning check I found her on her side, flailing wildly not able to stand or even right herself.  I grabbed her and stood her up but she just kept falling over. She had no strength and no coordination to function. I thought, well, my diagnosis was wrong for MG, or I was too late and I have lost her.  I tried everything in the play book at this point.  I was still regularly drenching her with fluids. But she had stopped eating again.  I knew she had eaten the day before so at least her rumen wasn't totally shut down. In the afternoon the circling started. Round and round and round, fall, flail, I pick her up, round and round and round, fall, flail, I pick her up. She literally dug a hole in the floor of her pen with the circling.  Every 1/2 hour minimum I went to the barn to pick her up off the floor, and I would stand over her, holding her between my legs.  I drenched her with fluids, and her pain and anthelmic protocol and tried everything to get her back interested in the alfalfa, or anything, but no luck.  I did this literally for hours...18hrs!!.  About 1am I was sitting with her on my lap just rubbing her neck and head and talking to her. I decided that if she wasn't stable by the next morning I would put her down. I was convinced she would not live much more than a few more hours. I gave her a dose of morphine to ease her nerves and help her relax a bit since she was very stressed by all the circling and falling down.  I propped her against some straw bales and called it. We had been fighting this 'thing' for 5 days now. I finally had to go to bed, I was exhausted, and I shed a couple tears with her and said thank you and goodbye, just in case. We planned for her passing and I was going to send her to the MSU labs to get tested after her death to confirm diagnosis. I didn't get any pics or videos this day.

DAY 6, WED, Feb 5
Oh but the strong will survive!  Lo and behold when I checked the barn cam in the morning, there she was just sitting there, ears up! I was flabbergasted. When there is a problem child, I always check the barn cam before heading down so I can prepare myself before opening the barn door.  I ran to the barn so happy!  There she was, just looking at me like, "what?"!. I grabbed her and stood her up fast, but she face-planted.  She had lost most of the use of her front legs, and her back legs were so weak and shaky.  We tried over and over, but down she would go!  I thought, well great, she is alive, but now she can't walk, what am I going to do with this!. When she could stand for a minute, she would circle but not aggressively like she had the day before.  I was still tempting her with alfalfa and she was nibbling a little but nothing major.  She began to take small sips of water on her own, but again nothing major.  I dosed her with the MW protocol and checked on her hourly, giving pets and motivations and standing her up regularly. She had clearly made some progress and the fact that she clearly wanted to be alive meant that I wouldn't put her down this day. But she wasn't out of the woods. I didn't get any pics or videos this day.  

DAY 7, THURS, Feb 6
What a morning! I went to the barn with the assumption she would be with us, but not convinced her condition would be improved, but....

​Tah Dah!
There she was standing at the pen divider clearly wanting to get to the other sheep. She was wobbly but up! I had been leaving her pen door open because I had been using straw bales to prop her up, and she was so immobile, she wasn't going anywhere.  I gave her all her meds and went to feed all the outside critters. Once done, I came back in to feed her and the mama's in the barn. 
​Then...!
I opened her pen door to give her some goodies, and she bolted out as fast as she could - straight through the open barn door and outside!  She face-planted about 15 times in the process but she was D.O.N.E. with the barn! And wouldn't let me help her!  She even baa'd for the first time in days!  She wanted the flock and wanted to be outside, and nothing else mattered! 

She made her way straight to the pasture gate, so I decided I would just pen her up there for a couple hours, feed everyone at the gate so she could visit, and let her enjoy it.  She worked hard to stand and it didn't take her long to get it, but she had completely lost the use of her left front leg and was dragging it around.  Regardless of her eagerness, she still wasn't eating. ​ Because she was face-planting so much and dragging her legs around, she quickly got raw spots on her knees. I made her some knee-pads with vet-wrap and gauze pad which seemed to help her stability too.  In the afternoon she very reluctantly and with plenty of squirming, let me put her back in her pen in the barn.  I enticed her with everything and she nibbled a little - enough for me to say she was trying, but not enough to keep her from shutting down again.  However, she had begun to drink water, so I decided to be patient.

---

---

DAY 8, FRIDAY, Feb 7
Another morning of improvement.  The water bucket clearly showed signs of her drinking but no signs of having eaten anything.  She desperately wanted outside again so I let her out with the mamas.  She was clearly more stable than the day before and was no longer face-planting. She was still dragging the leg as you can see in the video below, but there was healing for sure. She was taking it slow and was not yet sure footed but was really enjoying the sunny day.  Gave her another round of the MW protocol and watched her sniff at things and nibble at snow.  By the afternoon I had decided that if she hadn't eaten anything by dark, I would do a cud transfer on her.  (I will be posting a page with pics on how to do this soon).  

In the evening I separated my cud donors into the neighboring stall and got down to business with that fun procedure.  I gave her a 1/2 a warm beer before the transfer and then did the transfer with about 300ml of water.  Gave her some food choices and called it a night. After one week of this, we knew we were pretty well out of the woods.

DAY 9, SATURDAY, Feb 8
Last day of MW protocol, and this morning she bolted out of her pen and was even able to trot a bit.   There were clear signs in her feed piles that she had eaten over night and drank plenty of water.  We were back in business!  Since she wasn't falling face-first anymore, I took her knee-pads off and let her do her thing.  First thing she did was go outside and forage some feed from under the snow!  We did it!!  Sushi has earned the right to retire and be our nana sheep.  We only allow one nana and one wether on the farm at a time, and she is replacing our previous nana Afton who passed away in October.  Since nerve damage is permanent with Meningeal worm, she most likely will always have a limp, but at least she isn't fully paralyzed in that leg, like I thought she might be. Most importantly she is social and happy and back to being a sheep.  

---

I am happy to direct you to the information to assist you with treating meningeal worm, and the recommended protocol. Feel free to contact me.

QUICK NOTE ON MY CHOICE TO TREAT SUSHI - 
I cull fairly aggressively in my flock, primarily for attitude, feet, and parasites.  Normally I would have probably culled Sushi on about day 4 at the latest, and in all honesty if I hadn't caught her when I did, she would have been dead anyway.  However, I like a challenge.  In over a decade I have never known a fellow shepherd or client to save a sheep from meningeal.  I have never had it personally in my flock. So when I realized what it was, I wanted to test the protocol and see if I could actually do it, and if it would work.  It did, but with more work than most would put into it, and had I not been at home for the week, it most likely would have failed.  I had the liberty to attend to her all day every day.  This is not something most can do, nor something I can always do.  This might be something I do again should I ever have another case, but I can't promise it would be as aggressive as I had the opportunity to do so in this instance. When their bodies struggle this hard to recoup, it makes no sense to me to enter them back into the breeding program, so unless you are willing to let that animal retire, my recommendation is to cull the animal.  Had she resulted in any paralysis, I would have culled her regardless of my efforts, because simply it would not offer her a quality of life. Sheep are not carriers of meningeal worm and therefore she does not pose a risk to my other animals.