EMS/PSSM/Grass affected... What is going on?!

[SWP]

Hi I wonder whether anyone with experience of the above could give me their advice or opinion on my mare?

She has just turned 5, I've had her a year, and I feel like I've spent the majority of our time together trying unpick her issues.

She has been treated for gastric ulcers and in December she had the facet joints of one of her vertebrae medicated. For some time she seemed miraculously better, then I felt that her ulcers had returned, I spoke to the vet and she was restarted on ulcer treatment. She still seems to be in a considerable amount of pain across her back and I think she is starting to resent working in the arena (this consists of lunging, ground work and poles). The vet has advised to give her a week off any ground work etc and perhaps just walk her out in hand and then see how she is.

My physio has suggested doing genetic testing for the pssm varients due to her muscle tightness and pain. Yesterday we noticed that she has swellings where there should be indents above her eyes, which I understand could be an indicator of metabolic troubles? I have also found that on days when they are able to be turned out to graze she has started coming in extremely wound up to the point where it is dangerous, and she is being very reactive and spooky to minor stressors. I'm planning to just leave her out for a couple of hours today in a very reduced sized paddock with hay to see whether less access to grass has a positive affect on her behaviour.

I don't really know anything about these conditions but I'm wondering whether there might be something going on with her which is connected to the troubles with her back and the ulcers? She saw the vet today who sounded a bit sceptical but she has taken some blood.

Any ideas or thoughts are much appreciated!

 

[paddy555]

first thing to do if you are considering PSSM is search on here for PSSM. There are so many threads on it.

PSSM horses start to show problems when they are young and start work. Your physio seems to be on the ball. You can test for PSSM1 by a hair test in the UK and for PSSM2 and variants by sending hair to Germany.

When your blood test comes back look for the results of CK and AST. Get an actual copy of the blood test results from your vet. Higher levels of those are not conclusive of PSSM (some PSSM horses have normal levels) but they may get you along the lines of a muscle problem

If you are on FB then there are several PSSM groups, there is one UK one but the more detailed info is on the US groups where they have a lot of experience of the problem. There is so much info in their "files" sections.

There is no treatment as in drugs, it is a management disease. So the things to do to start with are to rug your horse and always use an exercise sheet. PSSM horses need a lot more rugging. Mine lives in a 450g horsewear varilayer. Keep the horse moving as much as possible, stabling doesn't help they need to move. A shelter with a yard is good if you cannot put it in the field. Go with the vet's advice, cut out groundwork and riding and just walk in hand. If you are not already giving vit E then make a start on that. A natural vit E given at 10000iu per day.
All the previous threads will give you so much more info.

Grass may well not be helping so keep her in the small paddock for a few days until you can get more idea if this is PSSM. Grass caused mine a lot of problems but I couldn't quite make sense of them. Now he is sorted he is back out at grass and in summer that is out 24/7.

 

[SWP]

Thank you. You're right my physio is excellent!
Would you expect glucose and insulin levels to be abnormal in a pssm horse? Is there any link between EMS/IR and PSSM?
She came in relaxed and happy after two and a half hours in a little paddock, so my suspicions over the grass continue!

 

[Melody Grey]

Sorry, I know nothing of metabolic issues, but the pain across the back you’re describing would want me to go back to a lameness work up and x-raying the back and hocks. Ulcers are usually a result of chronic pain and I think I’d be wanting to rule out skeletal/ ligament issues first given that you’ve already had a joint break down- is there something else that hasn’t been spotted?

I don’t know whether metabolic conditions can cause ulcers? My experience here is extremely limited.

 

[Melody Grey]

If your grass is starting to come though, the sugars could be Creating excess acid and irritating an ulcery tummy, so might not be directly the grass causing the issue, rather that the ulcery tummy is irritated by it? I wondered if my big horse was grass sensitive....turns out he has ulcers.

 

[SWP]

Thanks, that's interesting. This time of year is a nightmare! She is still on a reducing dose of omeprazole so I would be surprised if she was showing further signs whilst still being treated? Although it is a lower dose so I suppose it is possible?
Before treating the back problem she was admitted to horsepital for a very thorough lameness work up, bone scans, X-rays, ultrasound scans, bloods... I really think they did every diagnostic they could and this was only in December. I thought once we had discovered it that this must have been the cause of the ulcers, but obviously we still haven't solved all the issues!
My theory now is that she has always had an underlying metabolic problem, which caused pain and stiffness, which in turn caused ulcers, and both together could have caused the damage to the vertabrae if she was moving wrongly as a result?
At this stage I'm getting a bit desperate to make sense of it all and this feels like it could be the thing that ties it all together...

 

[Melody Grey]

Sounds like you need someone like Sue Dyson to look at the ‘whole horse’.
Re: the ulcers- very persistent cases can require more than one round of treatment, so unless you’ve scoped with evidence to the contrary, they may still be present. Are you using Sucralfate as well or just Omeprazole?

 

[SWP]

Good point, I think we might need to think about rescoping she has only been on omeprazole during both rounds of treatment... The vets have never offered sucralfate? She is on a half portion of pink mash and protexin to try and help her hind gut.

 

[Melody Grey]

Good point, I think we might need to think about rescoping she has only been on omeprazole during both rounds of treatment... The vets have never offered sucralfate? She is on a half portion of pink mash and protexin to try and help her hind gut.

Pink mash contains protexin (that’s why I feed it because it’s a cheaper way of giving protexin) so you might not need to add it additionally?

my current ulcer horse is on GG and Sucralfate, but his ulcers were particularly bad (grade 4 in two places). Other horses I’ve had treated have only had omeprazole, so perhaps it’s dependent on severity/ budget?

This time round, my vet recommended a supplement called Pronutrin (expensive!) and 200ml/ day corn oil to help line and calm the stomach.

 

[SWP]

I started feeding half a scoop of protexin to make up for what we were loosing by only feeding half the recommended amount of pink mash if that makes sense?!

 

[paddy555]

My theory now is that she has always had an underlying metabolic problem, which caused pain and stiffness, which in turn caused ulcers, and both together could have caused the damage to the vertabrae if she was moving wrongly as a result?
.

I used to think that way for a long time. Then I started realising it was the other way round. It was the muscle pain that was the primary cause and that produced the stress, gut problems and the stiffness etc. Mine was in horsehospital for a week. No one mentioned PSSM.

To deal with the hind gut problem I use equishure. I have found that is by far the most effective. PSSM horses are worse in winter. Problems usually start around mid Oct if winter starts early otherwise Nov if there is an Indian summer.
If the vet has eliminated the obvious then I would be going along with your physio who is the person who has seen the horse and examined the muscles.

 

[SWP]

It's amazing I had never heard of it before! I have sent off for the genetic tests now though I will be interesting to see the results.

 

[paddy555]

It's amazing I had never heard of it before! I have sent off for the genetic tests now though I will be interesting to see the results.

neither have many people and sadly neither have some vets. Mine hadn't. I had to do all the research myself as have most people on here. It is really great that your physio has.

 

[TheSpottyCobby]

Recent PSSM type one diagnosis here. Vets have little/no awareness to speak of so you are definitely best off testing and looking into this yourself. The FB groups have been an absolute saviour. I will be interested to see when the spring grass comes through good and proper how mine is affected, so far we have had no issues on grass, it was a period of box rest which lead to our issues so mine is out as much as possible. Lots of type one are really affected by grass and athough wet, it has been mild so grass has still been growing. Your physio sounds fab, mine is also fully on board with PSSM and with her help has got back to feeling as good as he did before pretty quickly.

 

[Feral]

Hi SWP,

I was just wondering if you had getting any further forward with your mare? My mare is similar in the fact she is just not right- hs on/off hind end lameness - very work intolerent and shut down at times. Really struggles with canter but then can snap out of it within seconds and canter very normally?
We have had a muscle biopsy, xrays of spine/hoofs and nerve blocks. The muscle biopsy did show she does have a muscle myopathy (not pssm) but this is my 3rd year with her now and I am only just starting to figure out patterns.
I am now convinced it is linked to the grass or her seasons! - she is better over the winter than she is in the summer and can lie down alot when brought in during the summer and really struggle to move when first standing up.

This been said, she can then go and do a 10 mile pleasure ride and be absolutely fine by the end of it - actually got better mile on mile???

Various physios have said she is flexible and a normal 6 year old with regards to how she feels with no signs of any discomfort.

She is going to be turned out from next week in a woodchip pen with soaked hay for a few weeks to see if we can link it further to seasons or grass.

 

[SWP]

Hi Feral

Yes so things are looking up for us now thankfully (fingers crossed it continues!).
It's been a huge and rather confusing learning curve to get to this point, so apologies in advance for the long and rambling reply!

So the genetic tests came back and revealed that she has pssm2, n/p2 to be prescise. It may be worth sending off a hair sample for your horse for testing? If you already know they have some muscle abnormality it may give you more information about the best ways to manage it? The Facebook groups as mentioned above are also a wealth of information and support for any muscular issues.

I've found that too much of the wrong sort of grass does seem to have a major impact on her behaviour. She can change over night if she has access to it. If you haven't already discovered it the calm healthy horses website has some really interesting ideas on horses who are grass affected. They are really helpful if you contact them as well.

I still have concerns that she is metabolically abnormal, she still has the puffiness above her eyes and it's really hard to keep the weight off her despite some major changes to her management.

I now think for Purdey that the pssm2 has been at the heart of all her issues. I think living with severe pain, as she was before we got the pssm2 under control, has had a lasting affect on the rest of her body and how it functions. For example, the stress hormone cortisol is released as a response to pain, and it's been shown in horses that cortisol also contributes to insulin disregulation. It's also a factor in developing gastric ulcers.

She is also very grumpy when her seasons are worse in Spring and Autumn, but I think this is just another way in which she doesn't cope well with things that other horses are OK with.

The things that I've found have helped have been feeding the pssm2 diet, feeding a good quality (and horribly expensive!) gastric supplement all the time as a maintenance, increasing exercise really slowly and gently, moving to a track livery where she can live out all year round in a big herd without much access to grass but with plenty of hay, and rugging in poor weather. I don't think any of those components would have been enough on their own to get her right, but combined they seem to do the trick.

I hope you get to the bottom of what is going on with your horse. It's so hard when you know there's something wrong but other people don't believe you!

 

[Feral]

Hi I wonder whether anyone with experience of the above could give me their advice or opinion on my mare?

She has just turned 5, I've had her a year, and I feel like I've spent the majority of our time together trying unpick her issues.

She has been treated for gastric ulcers and in December she had the facet joints of one of her vertebrae medicated. For some time she seemed miraculously better, then I felt that her ulcers had returned, I spoke to the vet and she was restarted on ulcer treatment. She still seems to be in a considerable amount of pain across her back and I think she is starting to resent working in the arena (this consists of lunging, ground work and poles). The vet has advised to give her a week off any ground work etc and perhaps just walk her out in hand and then see how she is.

My physio has suggested doing genetic testing for the pssm varients due to her muscle tightness and pain. Yesterday we noticed that she has swellings where there should be indents above her eyes, which I understand could be an indicator of metabolic troubles? I have also found that on days when they are able to be turned out to graze she has started coming in extremely wound up to the point where it is dangerous, and she is being very reactive and spooky to minor stressors. I'm planning to just leave her out for a couple of hours today in a very reduced sized paddock with hay to see whether less access to grass has a positive affect on her behaviour.

I don't really know anything about these conditions but I'm wondering whether there might be something going on with her which is connected to the troubles with her back and the ulcers? She saw the vet today who sounded a bit sceptical but she has taken some blood.

Any ideas or thoughts are much appreciated!

Omg you sound so much like me ..... I’m constantly saying that people don’t believe me and keep thinking I’m crazy!
My mare has been tested for pssm1 and 2 and is confirmed as n/px (the muscle biopsy was done afterwards as vet would not believe the hair test was conclusive)
N/px is not as straight forward as pssm and not much known about it.
She does not seem to be affected by weather and yesterday and she has been out in the field now for 48 hours and was fine tonight?? She has just finished her season so hard to tell what is affecting her.
She can be such a forward, fun, happy pony when she is feeling ok and she has never struck me as been a lazy pony. She is only 6 (I’ve had her since she was an unbroken 4 year old)
When she is on form she is so so supple and absolutely beautiful to ride, so easy and acts much less green than she actually is.

most of the time you would think she was a just backed 3 year old with no balance, coordination or forwardness.

i will see what next week brings when I have access to a woodchip pen and soaked hay for a few weeks! Stripping her to total basics and will wait to see if in 2-3 weeks time she goes down hill again when season happens

xx

 

[Scarlett]

Hi SWP,

I was just wondering if you had getting any further forward with your mare? My mare is similar in the fact she is just not right- hs on/off hind end lameness - very work intolerent and shut down at times. Really struggles with canter but then can snap out of it within seconds and canter very normally?
We have had a muscle biopsy, xrays of spine/hoofs and nerve blocks. The muscle biopsy did show she does have a muscle myopathy (not pssm) but this is my 3rd year with her now and I am only just starting to figure out patterns.
I am now convinced it is linked to the grass or her seasons! - she is better over the winter than she is in the summer and can lie down alot when brought in during the summer and really struggle to move when first standing up.

This been said, she can then go and do a 10 mile pleasure ride and be absolutely fine by the end of it - actually got better mile on mile???

Various physios have said she is flexible and a normal 6 year old with regards to how she feels with no signs of any discomfort.

She is going to be turned out from next week in a woodchip pen with soaked hay for a few weeks to see if we can link it further to seasons or grass.

I would genuinely recommend speaking to Calm Healthy Horses. I spent thousands trying to pin down what was wrong with my boy. I thought I was going crazy. I could see a pattern emerging that seemed to be grass related but nothing we tested for was conclusive.

He had crazy symptoms - lami, hind end lameness, tying up, wood chewing, became unrideble, weight loss, gastric issues, excessive urination,regular abcessing and cellulitis - he tested positive for ibd and had hind gut issues for a while. Scoped positive for ulcers once, and was treate. Otherwise EMS, Pssm etc all negative.

Decided to try CHH supps 4 years ago and he's better than ever. He was off grass for a year, but has returned to the herd and is currently out 24/7 in his herd with no reoccurrence of his issues in 3 years, other than when I tried to turn him away for 6 weeks at another yard and stopped his CHH supplements - within a week he was lame, and had a cellulitis/abcessing attack.

Hes off all other supplements, Inc the expensive gastric ones, and now lives on fresh air. Never seen a Tb that is as easy to keep!

My own vet has recommended CHH to other people having gone through this journey with us.

I have seen varying improvements in all my other horses, a headshaker in particular. I feed the supps spring and autumn flushes, and when they are moving fields onto fresh grass. The one who had all the issues just gets a bit more than the others.

 

[Feral]

I would genuinely recommend speaking to Calm Healthy Horses. I spent thousands trying to pin down what was wrong with my boy. I thought I was going crazy. I could see a pattern emerging that seemed to be grass related but nothing we tested for was conclusive.

He had crazy symptoms - lami, hind end lameness, tying up, wood chewing, became unrideble, weight loss, gastric issues, excessive urination,regular abcessing and cellulitis - he tested positive for ibd and had hind gut issues for a while. Scoped positive for ulcers once, and was treate. Otherwise EMS, Pssm etc all negative.

Decided to try CHH supps 4 years ago and he's better than ever. He was off grass for a year, but has returned to the herd and is currently out 24/7 in his herd with no reoccurrence of his issues in 3 years, other than when I tried to turn him away for 6 weeks at another yard and stopped his CHH supplements - within a week he was lame, and had a cellulitis/abcessing attack.

Hes off all other supplements, Inc the expensive gastric ones, and now lives on fresh air. Never seen a Tb that is as easy to keep!

My own vet has recommended CHH to other people having gone through this journey with us.

I have seen varying improvements in all my other horses, a headshaker in particular. I feed the supps spring and autumn flushes, and when they are moving fields onto fresh grass. The one who had all the issues just gets a bit more than the others.

Thanks for this! I have emailed Calm Healthy Horses with some details to see if they could help!!!