PSSM suspicion

[AWinter]

One of my client’s horses just isn’t quite right and I have been doing some research and some of the PSSM stuff I’ve read is ringing some alarm bells.

He is a young part bred draft horse. Presented very crabby suddenly overnight, unhappy to mount, curling his head round, he was always a little on the stuffy/nappy side in a green way but he is very laid back in nature, this was something different. He would work through a bit but when you got back on the next day be back to square one where he had previously been willing and progressing. He went from being a horse unbothered by anything to going to the back of his box and pinning his ears when I went to put his rug on. This was back in December.

Convinced owner to get the vet, took bloods and said his back was sore, there were some inflammation markers in the bloods, I can’t quite remember as I wasn’t heavily involved at this point. I know they wormed and tested for EMS etc. I strongly suspected ulcers due to his lifestyle of no turnout and rich hay but the owner was reluctant to scope at this point.

Fast forward months later horse moved to a new yard with more suitable hay and turnout, new saddle fitted and horse brought back into work. They told me he was better but when I went down to see him I found him the same. Unhappy to be saddled and unhappy to be mounted. Very crabby. He had a very weird lameness episode where he came in absolutely crippled one evening that I suspected looked a bit like tying up, he was fine the next day and it was put down to some sort of lami attack, which just didn’t fit for me. Eventually scoped for ulcers April/May time, horse had dropped a lot of weight and looked poor for his type, I believe they were quite significant, I wasn’t that involved again at this point.

Had a second scope a month later and they were improved and he continued treatment, this is where I got involved again. I was surprised to find him not much better, had put some weight on but not as much as I expected, still crabby to mount although better. Started some very light work with him, walking, hacking etc. Was concerned to find out he’d had horrendous loose droppings for weeks, he would eat his breakfast then not touch any hay, so he was essentially going out on short, stressed grass on an empty, ulcery stomach every day, then he would pick at the hay overnight, my little connemaras eat more. Not surprised he wasn’t gaining much weight. Still on his ulcer treatment, added a recommended hindgut supplement and he now stands in for a few hours to eat the hay every morning. Droppings still bad, vet out for 3rd scope and no improvement at all although I’m not surprised with how little he’s been eating, now on the injections instead.

I’ve been trying to read people experiences with PSSM, there’s just something about him that isn’t right to me, he’s very dull and uninterested, he is pretty perky out hacking once you get going but he is a willing sort. He sometimes just looks odd behind, he’s very big and weedy but he does look a bit wasted the more I’m thinking on it. His hoof quality is poor. Sorry for this ramble I’m just wondering how easy it is to test for or how people go about it or am I completely barking up the wrong tree. I just want to have some information because I don’t think the owner will be very interested/happy with this suggestion, I just have a feeling in my gut that we are missing something.

 

[ycbm]

He sounds very suspicious, and also like one who would show very quickly if he responded to a high dose of vitamin E which would be a good indicator. You could move on from there to hair testing or biopsy and/or other diet changes and supplements.

I would start him on 6 to 8,000iu of vitamin E a day but it must be natural or double the quantity if synthetic.

Be aware though that it is toxic at those levels long term if the horse doesn't need it.

 

[paddy555]

there is a lot in your post that would make me suspicious. I would also test for PSSM1. Animal Genetics around £35, just pull some hairs and send off. Your owner can spend a fortune on vets but nothing will work if this is the problem.


are you on thehorse.com
I think you have to sign up to it but it is free and sends articles to your e mail.

There is an article 17/5/21 "brushing up on tying up" well worth a read.

 

[Casey76]

You could try soaking the hay to remove sugars and add a Vit E supplement, but he sounds much more ulcer than PSSM to me.

Usually PSSM horses do much better when they are ridden (or exercised) day after day, unless you totally over do it one day. Also, if there is a tie-up episode, no way is he going to be fine the next day, it takes days to weeks to get back to normal after even a mild tie up.

 

[Melody Grey]

I wonder if the hindgut needs medicating rather than just a supplement? Sounds like something’s still amiss re: digestive system. Have antibiotics been tried with the ulcers?

 

[AWinter]

there is a lot in your post that would make me suspicious. I would also test for PSSM1. Animal Genetics around £35, just pull some hairs and send off. Your owner can spend a fortune on vets but nothing will work if this is the problem.


are you on thehorse.com
I think you have to sign up to it but it is free and sends articles to your e mail.

There is an article 17/5/21 "brushing up on tying up" well worth a read.

Thank you, I know there are a few different types which I’m finding confusing. I have also read that a lot of vets don’t know much about it at all. I will look at the website.

You could try soaking the hay to remove sugars and add a Vit E supplement, but he sounds much more ulcer than PSSM to me.

Usually PSSM horses do much better when they are ridden (or exercised) day after day, unless you totally over do it one day. Also, if there is a tie-up episode, no way is he going to be fine the next day, it takes days to weeks to get back to normal after even a mild tie up.

Thank you, I hear you. The vet had mentioned that she thinks there may be a pain issue with them not clearing up, I’d read during my research that PSSM horses are prone to ulcers due to ongoing muscle pain so I was thinking along those lines.

I don’t have much experience of horses tying up but the one horse I knew was always much better the next day that is my mistake. I didn’t see the horse in person during this episode I just saw videos and he went from struggling to walk to happy.

I don’t think he would touch the hay at all if it were soaked, he’s barely eating it as it is, it is tested low sugar/starch.

I wonder if the hindgut needs medicating rather than just a supplement? Sounds like something’s still amiss re: digestive system. Have antibiotics been tried with the ulcers?

Thank you. He has had 2 months of oral omeprazole and sulcrafate and is now onto the IM injections instead. The vet mentioned there may be an ongoing pain issue to look into if they still weren’t clearing up and that’s when I started to think. Vet didn’t seem concerned about the hind gut just said it was the grass and to try to get him to eat more hay before he goes out which I’d already suggested. Not saying she’s correct so any experiences/suggestions welcome.

 

[Nudibranch]

Don't forget the big draught types can be ideal candidates for multiple issues, many of which can manifest along pssm lines. So hock/SI/back pain which then contribute to ulcers for example. And probably more likely than pssm too.

 

[paddy555]

Thank you, I hear you. The vet had mentioned that she thinks there may be a pain issue with them not clearing up, I’d read during my research that PSSM horses are prone to ulcers due to ongoing muscle pain so I was thinking along those lines.


this. Mine has hind gut problems and is on equishure for these. PSSM causes pain and stress.

The chart below I tried to copy has not come out well but you will see in bold with a draft you are looking at PSSM1 therefore I would PSSM 1 test first job to get this eliminated. You are right a lot of vets are not very familiar with it.





Myopathies By Breed
Here is a summary of the diagnostic process of classifying the type of exertional forms of muscle disease. Note the importance of considering breed when navigating this process.

BREEDMOST COMMON FORM OF EXERTIONAL MYOPATHYOTHER FORMS OF EXERTIONAL MYOPATHYRECOMMENDED DIAGNOSTICSThoroughbredsRERPSSM2 (very rare)
PSSM1 does not occur!CK, AST (elevated)StandardbredsRERPSSM1 does not occur!CK, AST (elevated)Quarter Horses racehorsesRERPSSM2,
PSSM 1 only rarelyCK, AST (elevated)Quarter Horses (halter, reining, cutting, working cow, pleasure)
Appaloosas
PaintsPSSM1PSSM2, RER
(and malignant hyperthermia not addressed in this article)CK, AST (elevated)
GYS1 testing first, then response to diet/training
modifications and/or muscle biopsy if negativeArabian racehorsesRERPSSM1 does not occur!CK, AST (elevated)Arabians and Arab crosses in enduranceRER, PSSM2, MFMPSSM1 does not occur!CK, AST (elevated)
Response to diet/training modifications then muscle
biopsy if no improvementDraft horses (e.g. Belgians, Percherons)PSSM1
“Monday morning disease” CK, AST (elevated)
GYS1 testing first, then muscle biopsy if negativeWarmbloodsPSSM2RER, MFM, PSSM1CK, AST (usually normal). If elevated then perform GYS1 testing. Response to diet/training modifications then muscle biopsy if no improvement

 

[I'm Dun]

Don't forget the big draught types can be ideal candidates for multiple issues, many of which can manifest along pssm lines. So hock/SI/back pain which then contribute to ulcers for example. And probably more likely than pssm too.

Sadly not the case at all. Its far more likely to be PSSM than anything else, it just goes un diagnosed in many cases, and will also cause things like hock/SI/back pain which then get the blame.

I'd test for PSSM, all variants. There are some question marks over the type 2 test, but a positive type 2 test along with symptoms is usually pretty clear cut that there is a muscle myopathy. There are lots of draft crosses with type 2 PSSM.

Before diagnosis mine has definitely had tying up episodes like you describe then been "fine" the next day.

 

[ycbm]

I don’t have much experience of horses tying up but the one horse I knew was always much better the next day that is my mistake. I didn’t see the horse in person during this episode I just saw videos and he went from struggling to walk to happy.

I had one tie up quite badly, very stiff to walk home in hand, admittedly due to fluid loss from a wound and not from PSSM, and she was fine to event 2 weeks later. I had another who felt like he was tying up on the way back from a ride who seemed absolutely fine next day.
.

 

[Micky]

Prob not related but has he had his teeth checked too?

 

[Clueless]

Please get this horse tested. My lean, beautiful cob had a series of issues, leading to a massive off the scale tying up incident. Vets were involved multiple times, including eye tests… just in case… and I ended up speaking to previous owners. It was a very sad history of difficulties and passing them on. I actually asked if he might have a brain tumour, he was just so erratic and inconsistent, but occasionally perfect. This was the lightbulb moment that led my vet testing him for pssm and came back positive for type 1. It all made sense, he had so many of the classic symptoms. People say it can be managed. It always seems to involve working through pain. Very sadly, he was pts.

 

[rextherobber]

PSSM is a horrible condition, I'd certainly test, as management can be very effective

 

[I'm Dun]

People say it can be managed. It always seems to involve working through pain. Very sadly, he was pts.

Type 1 can be managed and has never involved working through pain. Type 2 is a different matter. However most vets are clueless and often give terrible advice, so a lot of people struggle.

 

[SEL]

Type 1 can be managed and has never involved working through pain. Type 2 is a different matter. However most vets are clueless and often give terrible advice, so a lot of people struggle.

I'd debate type 1 can always be managed given the condition of one of mine.

OP for a draft I'd always start with type 1 tests which is cheap at Animal Genetics UK, so hopefully something the owner would consider. I second getting a decent amount of natural vitamin E into the horse.

Is the horse on a decent vitamin and mineral balancer? My draft needs more protein to keep his muscle tone than the part bred (both have pssm type 1). Ulcer wise I found with the part bred getting on top of her PSSM and managing her pain helped with the stomach, but I was having to feed 250ml of oil and 'forget her weight' per the specialist vet. She is now retired because we couldn't get her symptoms under control but the oil broke the cycle of pain / gut / more pain

 

[I'm Dun]

I'd debate type 1 can always be managed given the condition of one of mine.

It can if its caught and managed early and if no other myopathies are involved. Sadly lots seem to have 1 and 2 and its next to impossible to manage.

 

[AWinter]

Thank you for all of the replies, I have touched on the subject with the owner but the horse is going well the last few weeks and I think they are reluctant to look into it too much at this point. I have convinced them to add the vitamin E.

If you were to get a positive test for type 1, what would be the next steps? Would a vet know what to do? Or are there specialist vets who are experienced with this you could consult?