PSSM and a
Quarter Horse Named Doc
by Claire C. Cox-Wilson
Did you ever wonder how you could just overlook little signs and symptoms for years? Then, suddenly one event makes you sit up and take notice. That is exactly what happened to me.
One morning in November of last year, my husband David noticed Doc our QH gelding lying down in the back pasture. We watched him get up, take a couple of steps, turn around and lie down again. The other three horses were peacefully grazing close by. David turned to me and said, “He’s not right--- he’s just not right”. On the off chance he had an upset stomach, I grabbed some probiotic. We walked down to the pasture together, our handsome buckskin didn’t stir. When Doc finally did get up, David observed that unlike our other horses Doc never shakes when he gets up. He was right…why had I never noticed? I did a quick physical assessment. Doc had good gut sounds, respiratory and heart rates were within normal limits. He was not sweating. Colic didn’t seem to be the problem, but I gave him the probiotic anyway. It couldn’t hurt. I tried to rub and scratch his withers, as he usually enjoys a good scratch and rub. Surprisingly, he wasn’t interested. I watched him as he walked away. Theoretically, he wasn’t lame, but I noticed his hindquarters seemed extremely stiff. I approached him again. Doc made it very clear that he did not want to be touched. His golden eyes were sad and clearly told me--- just leave me alone. I recalled our massage therapist’s comments about Doc’s massive build and unusually hard muscles. Our trimmer had also commented on his musculature on several occasions. Was Doc experiencing severe muscle pain? On the other hand, did Doc’s legs hurt? Worse yet, had Doc’s navicular symptoms returned? So many things could be wrong with him and I wasn't quite sure what to think. It was then that I took on the mission of finding the root of Doc's discomfort. Because as David had said.... Doc just wasn’t right.
Doc
was obviously uncomfortable
and finding the source of his discomfort was not going to be easy.
According to
our massage therapist, Doc had chronic muscle pain and soreness in his
hindquarters
and shoulders. I knew from our experience with navicular
syndrome/disease that
hoof and leg pain can cause all kinds of compensatory soreness and
pain. I
contacted our veterinarian and scheduled her to come out and run some
blood work
and perform a thorough lameness exam. She watched me longe Doc and
agreed that
his hindquarters were very stiff. She started out with flexion tests
that
showed definite problems in Doc’s fetlocks. The nerve blocks further
confirmed
discomfort in the fetlock region. We took X-rays. Doc
had mild fetlock arthritis and pastern
ringbone in his right front and moderate to severe arthritis and
pastern
ringbone in his left front. We decided to try the Hyaluronic Acid (HA)
&
methylprednisone joint injections and see if these would offer Doc some
relief.
Within
three days of the joint
injections, I saw a marked improvement in Doc’s front-end movement, but
there
was still something wrong with his hindquarters. It was becoming clear
to me
that his hind-end stiffness was not entirely a compensatory mechanism
for front
leg pain. Many of the symptoms of PSSM/EPSM can also be a symptom
of
certain mineral deficiencies; magnesium comes to mind, as it can cause
weakness
and cramping. We have our hay analyzed and then mineral balanced by Dr.
Eleanor
Kellon, so we knew a mineral imbalance was not the case with Doc.
Both
insulin resistance and hypothyroidism cause exercise intolerance and
low
functioning thyroid can also cause tying up; therefore, a thyroid
panel, an insulin and glucose
should
also be drawn when dealing with muscle pain and cramping. Although
Doc’s muscle
enzymes came back slightly elevated, our veterinarian placed little
value on
them as a diagnosis for PSSM as many conditions can cause a rise in
muscle
enzymes. We had ruled out a
mineral deficiency,
thyroid problems and his joint pain was under control. The only
accurate test
for PSSM/ EPSM is a muscle biopsy. It was clear that a muscle biopsy
was the
next step.
The
muscle biopsy is a
relatively simple procedure. Fortunately, we didn’t have to add to
Doc’s stress level with a trip to the
veterinary
clinic. The
biopsy was done right here at home. Doc was administered a mild
sedative and
the area was infiltrated with a local anesthetic. The whole procedure
including
preparation time probably took less than thirty minutes. Our
veterinarian fedexed the muscle sample
to Dr. Stephanie Valberg at the
While his biopsy site healed and we waited
for the results of the muscle
biopsy, I started hand-walking Doc. Unfortunately; to complicate
matters I
discovered Doc was having hoof issues. To make a long story short,
through some
miss-communication our trimmer had been over-trimming Doc. His soles
were very thin
and extremely tender.
A friend recommended hoofwings by HorseSneaker Hoofwear, located right
here in Arizona (http://www.horsesneaker.com/).
In addition, I used trax pads as inserts.
Doc in his Hoofwings
I couldn’t hand walk Doc much less longe
him
without the boots.
He was very uncomfortable without his hoofwings. It took approximately
two months for his soles to heal. In
the midst of all this, we received the
results of his muscle biopsy. Doc had moderate PSSM.
What
is PSSM?
Polysaccharide Storage Myopathy (PSSM) is
a condition in horses where there
is abnormal glycogen storage occurring in muscles resulting in the
accumulation
of excessive amounts of glycogen and an unusable polysaccharide. The
Equine Polysaccharide Storage
Myopathy (EPSM) is another form of PSSM
that occurs in Draft, Draft crossbreds and warmbloods. The book Draft Horses-An Owner’s Manual by Dr.
Beth Valentine covers this condition.
Classic
Symptoms of PSSM
Horses
with PSSM typically have
signs of tying-up. Most commonly these signs of muscle stiffness,
sweating and
reluctance to move are first noticed in horses when they are put into
training
or after a lay-up period when they receive little active turn-out.
Episodes
usually begin after very light exercise such as 10-20 min of walking
and
trotting. During an episode horses seem lazy, have a shifting lameness,
tense
up their abdomen, and develop tremors in their flank area. When horses
stop
moving they often stretch out as if to urinate. They are painful,
stiff, sweat
profusely and have firm hard muscles, particularly over their
hindquarters.
Some horses will show signs of pawing and rolling immediately after
exercise.
Most horses with PSSM have a history of numerous episodes of muscle
stiffness
beginning with the commencement of training; however, mildly affected
horses
may have only one or two episodes/year.
Per Dr. Karen J. Wolfsheimer's article on PSSM, depending on the severity of involvement, symptoms can include any of the following:
- all around stiffness
- difficulty rising
- reluctance to “move out”
- tires easily
- saddle issues (sore back)
- bucking
- resistance to holding up the hind feet for shoeing or cleaning
- subtle lameness episodes
- abnormal gaits
- cranky attitude
- muscle tremors or sensitivity
- kicking at flies that aren’t there (muscle cramps)
- excessive tail swishing (muscle pain)
- looking at belly or flanks as if colicky (muscle pain)
- having a preference for rubbing or rolling a lot, or in some cases the opposite with resistance to brushing/grooming, especially over the back and rump
- affected horses may show a stiff, tense gait with difficulty getting that nice relaxed rhythmic swing that is so desirable in the dressage horse or any other athletic, sport horse
- symptoms of “shivers” where there is an abnormal hind leg action and muscle quivering has been described in draft breeds
If left
unmanaged, over time, the muscles can atrophy and
the horse can show severe muscle wasting.
Doc's
Symptoms
Doc has always displayed symptoms of PSSM but we never tied it all together.
While
trying to decide whether
to do a muscle biopsy on Doc, I made a list of his symptoms.
- cranky when asked to canter both under saddle and on a line. When he was young he would buck, as he matured he would swish his tail angrily
- extremely hard muscles even when out of shape
- backs up very slowly and reluctantly
- seems uncomfortable when asked to pick up his back legs
- difficulty picking up his right lead
- unexplained episodes of back soreness
- stiff, choppy gaits, he was never relaxed and rhythmical
- tripping, which we attributed entirely to his Navicular Disease/Syndrome
- quivering chest muscles, especially when waiting for his feed
- at times Doc did not want to be groomed, acting as if he was going to bite
- a history of tying-up
Looking back, I suspect that this may be exactly why his first owners sold him. I think he started tying-up on them and rather than deal with it...they sold him. This horse was a beautiful heeler; very well trained (I loved to watch him come out of box because the raw power would make the ground tremble). When David bought him he was the envy of the ropers at our boarding stable but David never really had the time to learn to rope so he became a pleasure horse. We did a little team penning on him but mostly trail rides. We never worked him very hard. In our younger days, we warmed him up little in the round pen and just rode around. I still remember the first time he tied up on me. That day he had so much energy that I let him run it off in the round pen...when we finished he was dripping with sweat. So, to cool him off I decided to saddle him and go for a walk around the block, but before we got back to the barn he stopped and wouldn't move. I got off and saw that his hind end muscles were rock hard and quivering---I didn’t understand what I was seeing. All I knew was that Doc was in pain. Slowly, and with frequent stops I managed to lead him back to the barn.
I unsaddled him and instinctively threw a sheet over him. Someone mentioned the words “tying up” and one of my friends produced some bute paste. This was my first experience with this condition. It simply broke my heart to see Doc in such pain --- I put my arms around his neck and cried.
In the 1990's tying up was linked to Monday Morning Disease/ Azoturia. I did some research and started him on Vitamin E & Selenium. I was also very careful not to over work him. In those days, they attributed tying-up to continuing the grain ration on days of rest, hence the name Monday Morning Disease. However, that was not the issue here, as we have never grained our horses except for the handful of oats for psyllium palatability.
Doc during a Cowboy Dressage class in May 2001...note the swishing tail.
Managing Doc’s PSSM
As soon as I had started to suspect PSSM, I started reading about the management of this disease. Management of PSSM mainly consists of a low carbohydrate- high fat diet, as well as regular exercise. Bottom line… we needed to train Doc’s muscles to use fat for energy instead of carbohydrates.
The recommendation was one pound of
fat per 1000 lbs of horse per day, which if using straight oil would
mean two
cups of oil for a 1000 lb horse. The consensus was that any type of oil
was
acceptable. There are some high fat feeds available but I had some
concerns about
high iron content and the preservatives needed to keep these feeds from
going
rancid. There were so many things to consider and I wanted to play it
as safe
as I could. I really became concerned when I talked to two horse owners
who had
followed the oil recommendations, with a diagnosis based totally on
symptoms I
might add. Both of these horses had laminitis and were displaying
symptoms of
insulin resistance. As it turned out one horse did not even have PSSM
but a
mineral imbalance…..I was glad we had decided to get a muscle biopsy. I
felt
very strongly that Doc had been through enough; I was not willing to
take the
risk of him coming down with laminitis and/or insulin resistance. The
more I
read the more concerned I became. This fat and carbohydrate stuff was
way over
my head, what I needed was an expert in equine nutrition, someone I
could
trust.
I sent Dr.Eleanor Kellon an emotional email asking for her guidance with Doc’s new diet…who better to guide us through this diet change but an expert on equine nutrition?
“We need a game plan here, with goals for Doc rather than goals for fat intake,” Dr. Kellon said in her response to me. I felt better already. Dr. Kellon was looking at Doc as an individual.
Adding fat to a horse’s diet seems simple enough, however a horse’s natural diet of fresh grass is very low in fat, and the only actual “requirement” they have is for fatty acids they cannot manufacture themselves, these are the omega-3 and omega-6 fatty acids. These are referred to as the Essential Fatty Acids (EFAs). Dr. Kellon explained that if we were going to supplement fat, we might as well do it in as healthful a way as possible and make sure we were feeding Doc “good” fats.
Stabilized fats are oils you buy on a store shelf,
and oils
added to feeds, weight gain products, added rice brans are all
stabilized and
have the EFAs destroyed. Stabilization can also change the structure of
fats,
producing hydrogenated or partially hydrogenated forms, and trans fats. Stabilized/trans
fats have been recognized as a health risk in
Dr.
Kellon suggested either cocosoya or straight coconut oil. Coconut
oil and cocosoya (a blend of coconut and soy oils) are highly palatable
and
high in medium chain triglycerides (MCTs), a form of saturated fat.
This isn’t
the same as other forms of saturated fat that people are instructed to
avoid
(i.e. palm oil, meats). MCTs are different because they can be utilized
directly as energy sources by the cells---at least the cells of other
mammals.
Unfortunately, no equine specific data is available on this subject.
This last
comment did not deter me. In January 2000, we had plunged into the
barefoot
world to cure Doc’s navicular against the advice of friends, vets and
our
farrier. It had made perfect sense to me. We have never regretted
pulling those
egg bar shoes. Dr. Kellon’s diet for Doc
also made perfect sense to me. We would balance the high omega-6 fatty
acids in
these oils with ground flax; an excellent source of omega-3s. I was
starting to
feel better about this high fat diet.
However,
that was not the entire plan. Dr. Kellon had me start Doc on L-Carnitine.
L-Carnitine is made in the body from the amino acids lysine and
methionine, and
is needed to release energy from fat. It transports fatty acids into
mitochondria, the powerhouses of cells, "furnaces" where these fuels
are burned. With the exception of medium chain triglycerides such as
those
found in high concentration in coconut oil, all fatty acids require
L-Carnitine
to carry them into the mitochondria. The
idea was to give Doc both a supply of the MCTs and supplemental
L-Carnitine to
help him utilize other fatty acids so that we could achieve the desired
results
with a minimal amount of actual oil.
I ordered the L-Carnitine and started Doc on an ounce of Cocosoya oil
twice a
day. I was up to 4 ounces of Cocosoya oil a day when the L-Carnitine
arrived.
Within three days of
starting
the L-Carnitine I could feel a difference in Doc's muscles...they were
actually
relaxed. That night David and I went around feeling all our other
horses'
buttocks, we giggled, hoping our neighbors weren’t peeking out their
windows at
us. Surely, they would have thought we had lost our minds.
However, this was scientific
research
and we needed a basis of comparison. David confirmed my thoughts. I
wasn't
imagining it, Doc’s muscles were just as relaxed as our other three
horses. Elatedly,
I sent Dr. Kellon an email and made sure she knew that David had agreed
with my
findings. She informed me that it was
indeed possible to see improvement so soon. David and I were ecstatic.
We
didn't expect to see results within three days.
Today, Doc's daily
diet
consists of bermuda hay (anywhere between 10 to 20 pounds depending on
the condition
of our pastures) , about ½ pound of rinsed and soaked beet pulp,
a pound and a half
of alfalfa/bermuda pellets. He also gets 2000 IU of Vitamin E, a cup of
stabilized flax, 1-2 ounces of iodized salt,
and his
glucosamine preparation. Even though we have a custom mineral mix
(balanced to our bermuda hay) which includes magnesium, Dr. Kellon put
Doc on extra magnesium
oxide as
well. Doc's PSSM symptoms are
totally controlled with 3 ounces of oil a day. I use a
combination of straight coconut oil and cocosoya oil, and of course his
L-Carnitine.
For exercise, he is either longed (for 20 minutes) or ridden five times
a week.
His gaits and transitions are smoother than ever before and he picks up
both
leads equally well and consistently. The big bonus is that he is only
grumpy
when the pastures are closed off because of irrigation.
Not too long ago I was talking to my neighbor, not a horse owner but definitely a nice person since he allows our horses to have 24/7 access to his back pasture. Doc who sometimes prefers human company to his equine friends had joined our discussion. He looked intelligently and appropriately at each of us as we spoke. We discussed the usual topics in our neighborhood, the gophers that chewed up the roots to my orange tree and the fact that our irrigation water always seems to arrive at two or three in the morning and of course, the inevitable advent of our Arizona summer. I propped my foot on the bottom rail of our fence as we talked. Quick as a wink and slicker than you know what, Doc reached down and untied my shoelace. “How did you teach him to do that?” My neighbor asked, laughing. I assured him that Doc didn’t need me to teach him any tricks. I gave Doc a stern look and bent over to tie my shoelace. Doc promptly pulled the scrunchee out of my hair and my ponytail collapsed around my face. I looked up as Doc walked away with long, smooth strides, front and back-end…just the way a healthy horse should walk. He stopped, turned around, my red scrunchee still in his mouth and looked at me as if to say “Gotcha!”
I smiled at my
neighbor and
said, “Yep! That’s my Doc.”
Eleanor Kellon (Equine Nutritional Solutions,
References:
- PSSM....Could
my horse
have it? By Karen J. Wolfsheimer DVM
- http://academic-server.cvm.umn.edu/neuromuscularlab/PSSM.htm
- http://f2.grp.yahoofs.com/v1/AIt7RHBoweL1OG7H_q1SW-5FTGpKcdkDD5u01ooLl-NLJyJuU7wp
- 3UMnOWXyS570_mG3xfjqNsHPHLfB178y0kY8OlnFLjmIyA/Bad%20fats
- http://www.ppsrx.com/ppsrx/hn/Supp/Carnitine.htm
- http://www.ruralheritage.com/vet_clinic/epsm.htm
- Quarter Horses Have Particular Muscular Worries; Horse Journal, June 2006,Vol.13, No.6
06-01-06 Doc......no worries now.