Exertional Rhabdomyolysis Syndrome

Tr0uble

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Hi...I’m looking for some experiences/advice/hints/tips/anything really. My horse has recently been diagnosed with this, after 3 years of exploring and lots of red herrings and symptoms that we thought were the main problem (like stomach ulcers)

The biopsy results showed that he had considerable muscle damage, and blood tests showed enzyme levels that support this, so he’s pretty much had this year off so far. We had started to do a little, very low level work – all in hand, ride and lead from my other mare/some long lining.

He was starting to build some muscle tone again, paces were becoming expressive again, he stopped stressing and panicking, coat condition picked up etc....then he went and had an accident in the stable and ripped his leg to shreds – he’s been on 3 weeks of antibiotics/box rest and pressure bandages and it looks like it’ll be another fortnight before he can start walking out again...least he’s back on turnout now!

Anyway, I am going off topic! What I’m after, really, is some input from others who have experienced this condition, how you managed it.....hoping for lots of success stories of course, but failures would be useful too. I’m determined to get my boy through this and allow him to have a useful working life...I’ve accepted that I will always need to manage this, and that he will likely not be my top competition horse, but it would be nice to ride him at least.

A bit about him...he’s now 7, 17.hh WBxISH. His behaviour started to show as strange/problematic when he was about 4, always worse in the winter months....he would buck, rear, spin, panic, nap, stop dead, kick at the riders leg, throw his head in the air, ears back, eyes rolling – has even dropped to his knees in pain before now (having been walking fine just a second before) There were other things like difficulty lifting hind legs for the Farrier, excessive sweating and itching after sudden bursts of activity, excessive rolling to name a few.

He’s had numerous vets and specialists checking his back, legs, feet, eyes, ears, liver, kidneys, general internals...we’ve blood tested for pretty much everything, he was scoped and did have ulcers (now clear for over 18 months)

He’s generally such a loving horse, really loves people, thrived on work....then suddenly it would change and he’d display the behaviour as described above....totally out of character, always sudden, such turn around that it was clear there HAD to be a ‘real’ issue....we’ve had behaviourists out to help with various things and although there’s always room for improvement with my leadership and handling skills, it’s always been clear that he’s most definitely not ‘taking the Mickey’

I’m working with a nutritionist/scientist on getting the supplementation right for muscle repair and support, various nutritionists on his diet (but I’m always keen to hear actual experiences f things as the theory is not always what works!) he has regular Bowen Therapy which has shown a massive improvement in him, he’s kept warm at all times, fed high oil, given as much turnout as possible (balancing the turnout vs. cold wet weather implications)

He’s currently a completely different horse than a few months ago when at his worst, he’s now calm, rational, nice and normal....but we haven’t yet started ridden work, that will be the real test!!

For anyone who has read this far...thank you! I did ramble on a bit there, it’s just such a long and complicated history. So, anyone able to input any further advice for me??
 
You say you are working with a Nutritionist/Scientist which has helped.

I do not know of course who this is but I do believe in a chap called Roger Hatch of "Trinity Consultants" this is the website.

www.justbespoke.com

I find him very very good. has helped my lot deal with the problems they have had.
 
My horse was also diagnosed when he was 4. His symptoms were more along the lines of general tying up/muscle damage. He is maintained on a high fibre, high oil, low starch diet, always kept warm and I always make sure he is warmed up/cooled down to the extreme! He has done really well on this and enjoyed a career eventing and SJing til he had an accident in the field and fractured his pelvis when he was 9. I didnt push him to do anything really competative after that but he still enjoys life as a general allrounder, consistantly scoring in the 60-70%s unaff dressage, winning local level showing classes and generally having fun :) Oh, and he'll be 20 in April! He is the dark bay SJing in my sig (pic taken when he was about 12).
Once we knew what we were dealing with my boys case was perfectly manageable. Yes we have had the odd episode (although touch wood not had one in about 8 years!) but I know how to deal with it. Wishing you all the best with your boy, hopefully you have many years of enjoyment ahead :)
 
Thanks all! I'll have a read of that link when I get home from work....and nice to hear a success story....that gives me some real hope!

Sam - yeah I've been discussing Dantrolene with my vet, we aim to use the remainder of my insurance claim to get Dantrolene into him for as many months as possible whilst i fitten him up, in hopes that it will offer the extra he needs until he's fit and strong enough by himself...and then use it adhoc when needed (seeing as it's so expensive!)

But we've put that plan on hold for now as he's injured his leg to a point where he can't be worked at all, so no point in spending the money until we're ready to start.

Thanks for the replies!
 
Oh another thing, Saz5083....what do you do when he does have an episode now? What's your immediate reponse?

I guess I'm lucky that my boy has necer tied up to the extreme where he can't move at all, his seems to be move extreme discomfort/stiffness. Unfortunately I didn't know it was what it is so I tried to work him through it and have contributed to prolonged muscle damage.

I'm hoping now I have all the info and all the element right, that I will be successful in managing it.
 
Hi Tr0uble,

Having read your thread I am hoping you may be able to help me. I've had my horse for 13 years and have pretty much always had the sort of behaviour that you describe - everyone vets and back people who have seen him had said likely to be behavioural because its not been consistent - would go for months like an angel then turns into some sort of monster then eventually back again. I have always thought it was pain related behaviour but never been confirmed by vet... anyway I moved yards last year and he changed in the space of a month from being not quite relaxed and a bit edgy to being very happy relaxed etc etc which made me think it might be something else possibly diet. I have put him on the high oil diet and manage his excercise the best I can with as much turn out as the yard will allow and then riding. Interestingly over the past 10 days 2 weeks he has become a monster to both handle and ride - really spooky, bargy, very tense and just not happy in himself....am thinking at the moment it could be down to a flush of grass as that is pretty much all that has changed... are you experiencing anything like this? looking back over the years the change in his behaviour has always been very quick and for as long as I can remember September has rarely been a good month for him....

Just interested to hear what other symptoms you have seen etc etc and what may have caused them such as season grass growth or change in hay / management / use of rugs....sorry fr such a list but would like to know more..

Many thanks.
 
Diet is the most important thing, high oil low starch/sugar. Mine also ties up on haylage, so has to have hay.

We keep a stock of "Dantrium" (dantrolene sodium) for when he has an episode. He gets 10 emptied & mixed with water then syringed down his throat.

Mine also lives out 24/7 with access to his stable, the key is to keep them moving as much as possible, so I put out multiple piles of hay to try & keep him wandering. IMO I would take my chance with an extra rug in the cold weather rather than have him in, being able to wander will also keep him warmer.

Most vets seem to recommend a Selenium & Vitamin E supplement.

if you Google either Drs Stephanie Valberg or Beth Valentine, you will find a lot of interesting reading on the subject.

You might also like take a look at http://www.silverliningherbs.co.uk/

Good Luck
 
When Tango was diagnosed nearly 10 years ago at Liphhook hospital, they just recommended she has a heaped tablespoon of good old table salt added to her feeds. Seems to have done the trick as she never suffered from it again. May be worth checking with your vet?
 
Hi TrOuble

My mare was diagnosed a couple of years ago now but her symptoms were nothing like you describe. She would just stop and refuse to move, usually just as I finished working her and if it rained.

We do similar things to Saz. She now lives out 24x7, is always rugged up - rain sheet in the summer and nice warm rugs in winter. She didnt like oil based feed - wouldnt even sniff it so I use Stamm 30 which is recommended by Dr. Stephanie Valbert as someone else has said. She has Selenevite E but otherwise no special measures. She has only ever tied up twice a year and never causing permanent muscle damage - its seems to be one in November and one in March which makes me think it is something to do with changing coat/hormones. We went as far as getting Dantrolene but I have never given it to her as her attacks were never relating to stress but more through lack of fitness and time of year.

Anyway, the positive thing is she has been competing normally this year, and provided you have rugs available and a stable to put him into straight away it is manageable. The first time it happened she had only just been broken in and I thought she was being nappy so I caused more damage by trying to work her through it. I now know straight away if she is starting to change stride or not snapping off my leg it is best to stop.

I would highly recommend Stephaine Valbergs website for info and I am sure you will be able to sort him out.
Good luck
 
Thank you all....some really useful info....he's on low starch/sugar/carb diet with added oil...he gets Alfa A Oil, Speedibeet and 300 ml of oil added in liquid form (more when he's in work but he's getting fat whilst on rest with his leg!) He's on a high vit E & Selenium supplement which also covers amny other aspects of muscle support and repair.

He gets hay, soaked when needed, and the odd handful of haylage as a treat. He's never fed carrrots, apples, polos or anything like that.....I am obsessively cautious about the treats I buy for him!

He's out 24/7 for as long as possible, but once nights drop to a certain temperature he begs to come in....I've tried keeping him out but it stresses him too much. I even moved yards to have the turnout I needed, and now he loves his stable too much!

Puddles: It all started very mildly, he would nap a bit. Be a bit reluctant to go forwards in trot, but he just felt lazy. He would get very hot and sweaty (was always around mid to end of October when it started) so I woul clip him...and suddenly it would get worse - he'd nap, rear if pushed, buck on the spot, kick up at my leg etc. I would lunge him to let myself see him move to see if there was any obvious issues....we would call him the 'cut and shut' horse because it looked like his back end was not quite related to the front end....not lame, never ever lame, but just uncoordinated.

He has had problems backing up, but not currently.

He's always had trouble with his back legs being lifted, ranging from a slight snatch when asked to lift (not behavioral as he is perfectly mannered with his legs and lifts them for me from voice command) right through to thrashing so hard the trimmer was thrown across the yard (this was in winter when at his worst)

His canter has always been weak, and for a big athletic horse he cannot coordinate himself over jumps.

He toes drags at times, yet naturally he has big expressive paces.

He is a very well built horse, but seems unable to put on any topline even when he's fat enough to look pregnant (good doer, hard to keep weight off when you can't work him!)

He is almost OCD abut some things, or at least he used to be....weird stuff like poking himself in the eye (VERY strange and upsetting to watch)

He stresses about other horses being taken away from him - this is also massively improved.

I knew all along that my horse wasn't just 'a bad one' as many people would tell me...'get rid of him and buy something nice!' I got told! I knew it had to be a physical problem because my hrse loves people, he follows me around like a puppy, he is so tuned into me when I'm in his space that people comment on it a lot. His riden work is exceptiona when he's well, he is willing and trainable and enjoys learning and working.

We went from doing well out competing after a summer of hacking alone and in company, with jumping and stubble field galloping etc, to immediate inability to even walk forwards under saddle, and violent rearing if pushed even a little bit.

I had ALL physical checks done, plus a few I'd never thought of before and everyone said he was absoutely fine for tack, back, teeth, eyes etc....brain tumours were discussed, ulcers were found and cured, but still the pattern of behaviour kept coming back, worse each time.

It even took 2 goes at diagnosing the muscle biopsy sample to get a real answer too, first time came back inconclusive!

This is us ealy this year during our last recovery period....a week after this was taken it all went wrong again and that was when I turned him away and we began the biopsy route...
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This is us at our first ever competition...please ignore the fact I appear to be pulling his teeth out, I'm not norally that heavy handed! I was nervous!
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Things starting to go wrong
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Thanks Lucy, yeah it was actually EPSM that we were looking to confirm with the biopsy! He seemed to be a text book case.
 
Hi Again Tr0uble,

Thanks for the info - as I have mentioned I have had my horse a long time and he had displayed symptoms very similar to those you describe - reluctance to flat refusal to go forwards and then if pushed very very violent reactions. Always worst in the school, out hacking never quite so bad. His personality changes too he is usually a very sweet cuddly horse - can be a bit of a thug but not nasty. Every year since I have had him Spring is usually stressful as he gets a bit mad - had always put this down to spring grass and then September. Again he has not let me down and this year he has gone from nice to monster to handle and ride and he just doesn't look happy (sounds mad I know).
He was already on the high oil diet but must confess this had added apples! Now starting to think along EPSM and sugar intolerance routes the only thing that had changed was the addition of apples to his feed and also the grass coming through. Three days ago I moved him to a different paddock with less new grass and stopped the apples - he is beginning to change back to nice. I realise that his behaviour could be caused by other issues however he has shown nearly all EPSM symptoms at some point in his life and Kissing spine, SI or PSD I would have thought would have been more consistent? Could new grass and apples be enough to set off an episode?

Have been looking at other posts ref EPSM which I gather is similar - certainly in management and I note always rug, out as much as possible, high oil feed with vit E and selenium and soaked hay. Is there anything else? what about clipping - I would guess better not too or at least a little as you can get away with but if clipped out are they easier to rug and not over heat?? So many questions....

Thanks, P
 
Snip has shown text book EPSM symptoms, hence why we were looking for that. He's always been worse in the school too.

As for the diet, I was already avoiding sugars and high starch because he' had stomach ulcers so I was already obsessive about what he ate, but was just slightly off from what is ideal, and that was enough.

Clipping, I thin, is a nono for Snip...when I look back at his history, clipping him is what has always sent him over the edge. I may one day manage a neck and belly or something small, but never again a full clip. Not worth it.
 
Puddles - my horse has EPSM and is so sugar/starch intolerant that even feeds which are designed to be low sugar and lami safe are too much for her. My affectionate snuggly chocolate lady becomes a fire breathing dragon with double fire cannon behind.

Can't turn her out at the moment because don't have access to a grass free turnout area and even 45 minutes is too much. It's not easy, we have to exercise 2 or 3 times a day to make sure she gets enough to manage the EPSM
 
Hi Lucy - My God you have your work cut out!

What sort of routine do you have to keep her as stable as possible. Rugs / clip / type of excercise - when can she be turned out?

So much to learn!

Thanks,

P
 
Hi Puddles.

Yes, I am a bit tired right now. Hopefully it won't be forever.

diet is simple (looks complicated but its not really)

split into two equal feeds

200g Kwik Beet
200g Micronised Linseed
500ml Sunflower oil
2000IU Vit E (holland and barratt online)
NAF Pink Powder
Ginormous Himalayn Salt Lick
Handfuls of mixed herbs suitable for laminitics (think nettles, hawthorn, rosehips, milk thistle, burdock)
Probiotic (YeaSacc)
Cal mag

AM turn out in school for roll and stretch. Then either loose school or walk in hand

Lunch time - hired help when I can afford it

PM ride out or lunge or walk in hand if worked hard lunchtime

Bedded on cardboard. a bit pricey, but it soaks up pee brilliantly so her feet (bare) stay dry and free of thrush (also sloosh them with salt water when I pick them out - works a treat)

I do not rug or clip. She eats about 3% of her body weight (ish) in hay which keeps her toasty warm. The hay is soaked for 12 hours in lots and lots of water and then rinsed thoroughly in more fresh water.

I think doing the hay nets is the hardest thing, they are soooo heavy when wet. So I use two each time to split the load.

I know rugging is recommended for EPSM, to keep the muscles warm. But to be honest I find feeding enough forage is a better way of keeping a horse warm and then they can regulate their own temperature.

I am not sure Grace has ever worn a rug. Her mane is in mint condition all the way to her withers.

She can go out in winter, post Autumn flush, before the spring grass comes through. I love the snow - no grass! :-)
 
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