PSSM and blood test geeks please

[BBP]

Geeks in the nicest way, like me

I’ve finally had BBPs blood results sent to me. Vets reported them as normal over the phone but I can see there are some results that are out of range.

Vitamin E - he is deficient. Again. Or still. Despite supplementing with 5000 - 10,000iu Equimins vitamin E oil his blood serum is still low (consistently 1.5-1.7ug/ml where adequate is >2ug/ml and normal is >2.5ug/ml). This has gone on for at least 5 years now. Wondering if it’s worth raising with vets if this could be relevant to his hind end weakness?

CK was elevated. Not wildly so, but up at 520 from a top end normal reference range of 333. AST was normal though so not sure if this indicates muscle damage or not.

White blood cell count was a little low. I wondered if this could be linked to low vitamin E, as it is meant to protect them from oxidative stress?

I guess my question is, do you think I should query these results with the vet, in the face of the wider picture of hind end weakness, difficulty rising etc? And if the blood serum levels are low even at current level of supplementation, do I just whack it up a bit more?

 

[Dexter]

Are you treating the PSSM? I think its actually RER so PX isn't it? And if you are, how?

 

[BBP]

Are you treating the PSSM? I think its actually RER so PX isn't it? And if you are, how?

That’s right it’s RER (I’m not down with PX, it’s always RER to me!) but writing PSSM grabs more people’s attention. Management wise it’s always been mostly movement and stress minimisation, plus vitamin E. He has never needed dantroline or anything like that as although he gets muscle sore at times he doesn’t have major issues. I hadn’t checked his vit E levels for a few years but now see they are still pretty low even on a decent dose of vit E. I know vitamin E deficiency can cause Equine Motor Neurone Disease and I’m wondering if long term deficiency could be causing him his weakness issues.

 

[Roxylola]

If you're feeding a high dose and hes still deficient I'd be wondering about some sort of malabsorption issue, which would give me concerns there could be other deficiencies as well. I mean obviously you could just up the dose but I'd like to know why hes still low personally

 

[BBP]

If you're feeding a high dose and hes still deficient I'd be wondering about some sort of malabsorption issue, which would give me concerns there could be other deficiencies as well. I mean obviously you could just up the dose but I'd like to know why hes still low personally

It’s definitely a concern to me. I’m not sure how I’d figure that out. He gets a gut biome supplement but has only started on that about a month ago.

 

[SEL]

Is there adequate selenium in your soil / supplement? I also wonder if its worth trying a different brand of E.

I would definitely be talking through this with a vet given everything else you're seeing. I see the Equibiome team are looking into whether amino acids help 'fix' stomach lining to help with absorption issues.

 

[Dexter]

have you done the PSSM test to make sure its just the RER/PX? Lots of them have more than one variant sadly. If his muscles are sore then the PSSM isn't managed so something needs to change in terms of management. IT may well be that his need for vitamin e is very high if he's symptomatic all the time, just at a low level.

I'd also be checking selenium as above. Testing if you haven't and then doing a management overhaul.

 

[BBP]

Selenium is normal and was last time.

He hasn’t had the test, but the biopsy ruled out any sort of glycogen storage issue, the only abnormality was the location of the cell nuclei and it’s sensitivity to stimulus I think. From what I read, the PSSM variants all have visible polysaccharide storage abnormality and/or myofibrils, and that the difference between them is the genetic code enabling the fault. Equiseq appear to support the biopsy results. But I may be wrong and am certainly open to the testing in case I have misunderstood.

Currently I would say his muscles feel more weak than sore.

Management wise he is turned out on a mixture of hard standing, sand arena and grass track with hay stations of unfertilised old meadow hay. Rugged more than the others. Small feeds with Thunderbrooks chaff, and a little linseed to carry his supplements of equibiome stuff, vitamin E, equishure, boswellia, joint supplement and a Ron Fields ulcer supplement, plus danilon.

He’s been off work due to a suspensory injury and was plain dangerous to hand walk out, but he’s very active in turnout. He seems to be feeling good in his body at the moment, but had lost strength in this backend to get up. This has improved in the last 3 weeks. Not sure if that is the supplements or daily massage that has turned a corner.

I need to find a vet who will look at the whole picture with me. My vets are lovely and are trying hard, but had reported all the bloods as normal, whereas I have seen a pattern of depleted vitamin E over a number of years.

 

[paddy555]

you say you are giving him 5/10kiu vit e but is he eating that quantity? Is it mixed into the feed because if so it is very easy for a horse to open it's mouth during eating and to drop some. I feed my equimins vit E separately so there is no doubt it has gone down.
I think you have to closely monitor the vit E for say 3 months or so and test again. Feed equimins 10kiu, feed it separately and then retest. If still low then you could consider changing brand but I think I would be querying why on that dose he was still low.
I think you will have to look for a vet with a lot more specialist experience. Who read your muscle biopsy?

 

[BBP]

you say you are giving him 5/10kiu vit e but is he eating that quantity? Is it mixed into the feed because if so it is very easy for a horse to open it's mouth during eating and to drop some. I feed my equimins vit E separately so there is no doubt it has gone down.
I think you have to closely monitor the vit E for say 3 months or so and test again. Feed equimins 10kiu, feed it separately and then retest. If still low then you could consider changing brand but I think I would be querying why on that dose he was still low.
I think you will have to look for a vet with a lot more specialist experience. Who read your muscle biopsy?

I think biopsy was read at RVC, can’t remember which vet, and then my vets are a big teaching hospital, but those vets have all moved on now. I have a couple of the slides and report somewhere.

He is definitely eating it all, he gets fed on a piece of yard that is always clean before I feed so I can keep an eye on him. He used to be quite fussy and would spit out a lot but now is polishing off every last morsel, which is a relief given how much money goes in to his feed as supplements!

Thinking back I went for a while without feeding it, as he had seemed ok, we ran out and I had a period of maybe a year before I restarted. So I think I only restarted it properly this spring maybe. So if he’s this low on current dose I wonder what he was like last year.

I’ve got a slot booked at vet clinic this Friday, it would be interesting to run the bloods again now he is on the equibiome stuff and see if his absorption has improved.

 

[paddy555]

I think biopsy was read at RVC, can’t remember which vet, and then my vets are a big teaching hospital, but those vets have all moved on now. I have a couple of the slides and report somewhere.

He is definitely eating it all, he gets fed on a piece of yard that is always clean before I feed so I can keep an eye on him. He used to be quite fussy and would spit out a lot but now is polishing off every last morsel, which is a relief given how much money goes in to his feed as supplements!

Thinking back I went for a while without feeding it, as he had seemed ok, we ran out and I had a period of maybe a year before I restarted. So I think I only restarted it properly this spring maybe. So if he’s this low on current dose I wonder what he was like last year.

I’ve got a slot booked at vet clinic this Friday, it would be interesting to run the bloods again now he is on the equibiome stuff and see if his absorption has improved.

re your final para, look forward to seeing the results. Hope the levels have raised.

 

[SEL]

If you do get stuck vet-wise you could cheekily email the vet heading up the myopathy study at the university of Minnesota. I'm supposed to be putting both my horses into their trial but need a kick up the backside to do the paperwork.

 

[BBP]

If you do get stuck vet-wise you could cheekily email the vet heading up the myopathy study at the university of Minnesota. I'm supposed to be putting both my horses into their trial but need a kick up the backside to do the paperwork.

Thanks. I’ve just been reading about Vitamin E myopathy, which appears to possibly be a precursor to EMND. Could explain the hind end weakness and elevated CK.

 

[paddy555]

Thanks. I’ve just been reading about Vitamin E myopathy, which appears to possibly be a precursor to EMND. Could explain the hind end weakness and elevated CK.

I have often wondered how many of the horses we describe as PSSM as in fact VEM horses.

 

[Dexter]

If you do get stuck vet-wise you could cheekily email the vet heading up the myopathy study at the university of Minnesota. I'm supposed to be putting both my horses into their trial but need a kick up the backside to do the paperwork.

2 of mine are in. Its worth it and the initial survey doesn't take long

 

[Dexter]

I have often wondered how many of the horses we describe as PSSM as in fact VEM horses.

If people tested then none, with the small exception of P8 and K1, which is coming soon and anything we cant yet test for, although these are very definitely in the minority

 

[paddy555]

If people tested then none, with the small exception of P8 and K1, which is coming soon and anything we cant yet test for, although these are very definitely in the minority

true but many people do not have a muscle biopsy done to confirm PSSM2 so diagnosis is based on the accuracy or otherwise of the equi seq test or the horse's reaction to PSSM management.

 

[Dexter]

Anyone who suspects PSSM 2 should be testing. Management varies quite a lot between the types. All I ever see on here is recommendations to feed vitamin e, but its really not that simple, and in some of the type 2 variants will do nothing significant to help.

With a horse with RER/PX there's other things you can do management wise. I dont think vitamin e is considered a huge essential, but obviously that's massively complicated if the horse is low in vitamin e and not absorbing it. I dont have a PX but this has some more information on management, which suggests IM injections

https://aaep.org/sites/default/files/issues/proceedings-06proceedings-z9100106000365.PDF

 

[BBP]

Thanks for that article, been a while since I read that one.

I was geeking out and found this article on intestinal inflammation and the absorption of vitamin E in a study of PRE’s.

https://www.horsetalk.co.nz/2016/03/28/study-andalusian-horses-light-equine-motor-neuron-disease/

Certainly a few things to chat to my vet about.

I’ve also realise I’ve been giving my horse less vitamin E than I thought, so have upped it. Will see what happens.

 

[Dexter]

I'd be interested to know what the outcome is. I only know a handful of people who actually blood test for vitamin e. I'm going to get mine done now.

 

[BBP]

I'd be interested to know what the outcome is. I only know a handful of people who actually blood test for vitamin e. I'm going to get mine done now.

I wish I had done it more to get more of a pattern. I did several times in 2015/2016 but then nothing til now.

 

[paddy555]

Anyone who suspects PSSM 2 should be testing. Management varies quite a lot between the types. All I ever see on here is recommendations to feed vitamin e, but its really not that simple, and in some of the type 2 variants will do nothing significant to help.

I agree they should be testing however currently the only test is a muscle biopsy which many prefer not to do for what will be a management disease.
I see from Valberg (whose paper you quoted earlier) there is currently no scientifically validated genetic test.

 

[SEL]

I agree they should be testing however currently the only test is a muscle biopsy which many prefer not to do for what will be a management disease.
I see from Valberg (whose paper you quoted earlier) there is currently no scientifically validated genetic test.

I do wish Equiseq would get those type 2 tests peer reviewed and properly identified - they don't appear to be glycogen storage myopathies from the descriptions on FB. I have thought about testing my type 1 to see if there is a reason she is so symptomatic but even if she came back as positive on one or more I'm not sure what they are telling me.