Raised CK levels

[Breagha]

Hi all,

My horse had blood tests in April this year when I knew she wasnt quite "right" at the time she had some sort of infection and we treated accordingly but her CK levels were slightly raised at 736. I had her over at the vets to get a lump checked and got them to take bloods and everything is normal apart from her CK level which is now 1600. obviously I have spoken to the vet about what it could be etc and she is going in to see a specialist on Friday to get the lump checked again and she is getting another blood test and she has to be ridden hard 4 hours prior to this for them to get a more accurate diagnosis.

I am really looking for your story on why your horses CK level was raised etc.

She has never shown any signs of tying up or anything like that. She is currently on Equerry conditioning mash and HiFi mollasses free so is low starch diet.

TIA

 

[Elf On A Shelf]

Normally it indicates that your horse has tied up. It might be worth asking your vets about this before you work them for the next blood test.

Not all horses shows the typical symptoms of tying up - ie muscles going rock solid and them being very reluctant to move. Some seem almost normal just maybe a wee bit off colour or quieter than usual but not enough to say what's wrong for sure.

 

[Breagha]

I've spoken to them about tying up and they don't think it is that as she doesn't show any other symptoms associated with it.

 

[MrsNorris]

What breed is she? Have you considered PSSM? Elevated Ck can be a symptom in type 2, not sure about other variations.

 

[Breagha]

She's a Heinz variety cob. She's 5 years old. Will def speak to the vet about that as I'm wanting any kind of issue to discuss with them cause I want to make sure she gets the right treatment.

 

[paddy555]

She's a Heinz variety cob. She's 5 years old. Will def speak to the vet about that as I'm wanting any kind of issue to discuss with them cause I want to make sure she gets the right treatment.

in my case PSSM.
https://cvm.msu.edu/research/facult...ratory/type-1-polysaccharide-storage-myopathy

there is also PSSM 2 on there


you can test for PSSM 1 yourself. It is simply a hair test around £30.

there is no vet treatment. It is controlled by diet and management. For most people the start of their symptoms are "not quite right" .

if you search for PSSM on here there are many threads about it.

treatment to start with is high dose natural vit E oil. Around 8,000iu per day.

 

[SEL]

My mare has type 1 PSSM. I took her to a new vet for a 2nd opinion on a hock issue and her resting CK level was around 1600 - that is not good!

I think it's an exercise tolerance test they want you to do. They take the CK level pre-exercise, lunge at trot / canter for 30 mins, rest in box for 4 hours and then take the CK level again when it's at its peak. Ideally you will only see a small rise. My mare post exercise was 4500.

If she'd been close to her resting levels then it would be less of an issue, but the rise from 1600 to 4500 showed exercise was damaging her muscles. Her target is about 500.

You can test for type 1 yourself for about £30 at animal genetics - so cheap it's worth doing.

ETA - she showed no signs of tying up during this work and the vet was shocked when the results came back. I was less surprised as I thought the hock issue was due to muscle tightness in the first place.

 

[Breagha]

Thanks for this reply.

D day is hopefully tomorrow. She is getting a lump checked tomorrow by a specialist (Patrick someone - information overload and can't remember his name). If she gets scanned and nothing needs done to The lump then I will hop on her at the vets to ride for the blood test.

Fingers crossed.

 

[Bertolie]

I had this with my last gelding. Vet thought he had tied up but CK levels were rising not decreasing as would be normal with tying up. He also had a lump at the top of his hind leg that vet said was if no significance. Had a different vet out and the lump was diagnosed as a haematoma (ultrasound confirmed). Once the haematoma started dispersing his CK levels returned to normal.

 

[Breagha]

I had this with my last gelding. Vet thought he had tied up but CK levels were rising not decreasing as would be normal with tying up. He also had a lump at the top of his hind leg that vet said was if no significance. Had a different vet out and the lump was diagnosed as a haematoma (ultrasound confirmed). Once the haematoma started dispersing his CK levels returned to normal.

This gives me some hope that it may be attached to the lump. I'm hoping that is what it is but vet said if it is the likes of PSSM, not to worry as it could be that it will never get worse.

 

[Breagha]

Latest update:

So the lump is nothing more than a muscle mass - thank goodness.

But we are still testing to find out why her CK levels have been raised.

When we were at the vet getting the lump checked, they did baseline bloods and then I rode for half hour and then they took the bloods after 4 hours. Interestingly her baseline bloods were back to normal but her bloods after exercise were 1060. Then we took a blood test for PSSM type 1 which was negative and a week last Thursday she was back in for a muscle biopsy (which I am agonisingly awaiting results) So vets are confused why her bloods have been so different.

We had TopSpec at the yard yesterday which was good for Breagha as I got more advice on best feed for her.

Horses - who'd have em.

 

[Breagha]

Muscle biopsy came back negative and ruled out other issues too. So even more confused. Havent spoken to the vet properly as she left a message last night.

 

[SEL]

When mine did the exercise tolerance test her post exercise results were more than 4 x her pre exercise results. I know that was bad (she is type 1), but did the vet expect them to completely return to normal? I think if you're horse isn't very fit then it can stay elevated for a while, but I don't know the 'norms'

Be interested in what the vet says.

 

[Breagha]

When mine did the exercise tolerance test her post exercise results were more than 4 x her pre exercise results. I know that was bad (she is type 1), but did the vet expect them to completely return to normal? I think if you're horse isn't very fit then it can stay elevated for a while, but I don't know the 'norms'

Be interested in what the vet says.

At the time when she was tested back in April she was really fit, hacking most days etc. they were 736 or something back then. When they came back as 1600 she was in regular work but then after that she was only allowed to be walked "just in case" until we found out what she had. The vets were really suprised that they were normal on baseline but expected them to be lower post excerise. She now hasnt been ridden in over 2 weeks as she still has the stitches in her from the biopsy.

I am waiting for the vet to come back in from call out to discuss further. As if she doesnt have PSSM type 1 or 2, what is causing the raised CK.

I will update as soon as I hear from the vets as it would be interesting if anyone else has gone through similiar.

Out of interest, how do you "treat" her PSSM?

 

[SEL]

I will update as soon as I hear from the vets as it would be interesting if anyone else has gone through similiar.

Out of interest, how do you "treat" her PSSM?

Having a bit of a google and apparently thyroid and kidney issues can sometimes cause CK levels to rise in humans (as can alcohol abuse - so might want to watch her beer intake!).

I manage my mare through a low sugar, starch diet with high oil and daily exercise. Its very, very rare that she gets a day off at all. She also has a tonne of supplements, although some are because she is susceptible to ulcers. High dose vitamin E, amino acids, l-glutamine and l-carnitine. She used to have a balancer, but seems better off it. She's much better out 24:7, but that's not possible over winter where I am. Rugged up warm. She usually crashes heading into winter, so I'm waiting for the inevitable!

 

[MrsNorris]

Just a thought and probably not relevant, but what’s her diet like? You mention she’s a cob, if she’s been on restricted grass and on soaked hay to control weight, is there a chance her vit E levels could be too low? Or maybe her electrolytes out of whack, because soaking hay leeches out some minerals?

 

[Breagha]

Having a bit of a google and apparently thyroid and kidney issues can sometimes cause CK levels to rise in humans (as can alcohol abuse - so might want to watch her beer intake!).

I manage my mare through a low sugar, starch diet with high oil and daily exercise. Its very, very rare that she gets a day off at all. She also has a tonne of supplements, although some are because she is susceptible to ulcers. High dose vitamin E, amino acids, l-glutamine and l-carnitine. She used to have a balancer, but seems better off it. She's much better out 24:7, but that's not possible over winter where I am. Rugged up warm. She usually crashes heading into winter, so I'm waiting for the inevitable!

I will tell her to cut back on the alcohol lol.

All her other bloods came back normal, which makes for a difficult diagnosis.

I was worried about if she did have PSSM as she would have also needed daily exercise and our school floods and is boggy and freezes, so was wondering how I was going to keep her going.

Just a thought and probably not relevant, but what’s her diet like? You mention she’s a cob, if she’s been on restricted grass and on soaked hay to control weight, is there a chance her vit E levels could be too low? Or maybe her electrolytes out of whack, because soaking hay leeches out some minerals?

I have an acre sized paddock and she was grazing in half of it until my mare was put to sleep at the end of August. She then had it to herself and let herself into the lush side plenty of times. She doesnt need restricted grazing, although she is a good doer, she doesnt need managed.

Topspec have advised me to put her on the Top chop zero (love saying that), anti lam and I also have the spillers fibre mash.

 

[Casey76]

Increased CK can come from any kind of muscle damage, not just tying up. So if she had been exercising hard, or had had a good hooley around the field, or had sustained a kick injury (on the bottom for example), or has gone splat in the field, all of this could be reflected with an increase in CK.

Was AST also increased at the same time? Any other hepatic or renal marker?

 

[Breagha]

Increased CK can come from any kind of muscle damage, not just tying up. So if she had been exercising hard, or had had a good hooley around the field, or had sustained a kick injury (on the bottom for example), or has gone splat in the field, all of this could be reflected with an increase in CK.

Was AST also increased at the same time? Any other hepatic or renal marker?

The AST was not raised in any of her blood tests. I think they are more concerned as this has been going on since April. She has very really been exercised hard with her being only 5, gets plenty down time.

Only other thing that was raised back in April was her WBC which was at 10.7.

One thing that I have noticed and other people have noticed at the livery is that she can sometimes stand looking a bit "down" in the field.

 

[Breagha]

Spoken to the vet and in true Breagha style she hasnt made it easy.

They have ruled out a whole heap of things from the muscle biopsy but they say that there is something "abnormal" but not sure what it causing it. They have said it could be multifocal myofibre atrophy and degeneration or the other thing to test for would be cushings but vet is convinced it wouldnt be that as she is only 5 and is not got any symptoms. So they will be speaking to a muscle expert in Edinburgh to see where to go from here and keep her on a high fibre diet and they are putting her on a supplement cant remember the name something to help with repairing the muscle that they would put horses on box rest on. She said it wont hurt her giving it a try.

 

[SEL]

Have they also recommended high dose vitamin E? It's worth a try. Expensive but won't cause harm to your horse if she doesn't need it. Dr Valberg the muscle expert in the US often recommends it as a starting point. Around 10000iU per day.

 

[Breagha]

No they havent mentioned vitamin E at all. Vet out tomorrow so will ask. Thanks

 

[paddy555]

Have they also recommended high dose vitamin E? It's worth a try. Expensive but won't cause harm to your horse if she doesn't need it. Dr Valberg the muscle expert in the US often recommends it as a starting point. Around 10000iU per day.

if you read the link I gave you in post number 6 you will see the importance of vit e and the problems of deficiency. Where is your horse getting vit e from ATM. None in grass at this time of the year and little in hay. I would ask vet to blood test current levels of vit E to at least rule this out. I would also give high dose natural vit E per Dr V's findings at around 10000iu per day. You can see a difference quickly with high dose vit e.

 

[Breagha]

if you read the link I gave you in post number 6 you will see the importance of vit e and the problems of deficiency. Where is your horse getting vit e from ATM. None in grass at this time of the year and little in hay. I would ask vet to blood test current levels of vit E to at least rule this out. I would also give high dose natural vit E per Dr V's findings at around 10000iu per day. You can see a difference quickly with high dose vit e.

I will speak to the vet today about it. Because it seems to be unusual I am wanting to try anything but havent got round to asking it yet as it has been alot of information to take in along the way.

 

[paddy555]

PSSM isn't straightforward. The best source of info is on the FB group "PSSM forum" as you will see from there they have progressed beyond types 1 and 2. Number one thing is high dose vit E. It is something that most owners are way ahead of vets as owners are finding out what works to keep their horses healthy (there is no vet treatment) and getting results whilst science is still trying to find out why.

I think you will be lucky if the vet comes up with something very definite ie X is causing this and give him Y and it will resolve it. These muscle diseases seem to be ones where the owner has to work out the best way of managing their horse. I do more or less the same as SEL which works and many others do something similar. I got to the stage with the vet when I was asking why won't CK go down. They didn't have an answer. Like many I had to work on my own to find the management regime that worked.

Even without PSSM the question of vitamin e deficiency still remains. If you have a look at t he links you will see vitamin e deficiency on there. Unless you are supplementing the question still arises as to where your horse is getting vit e from in winter.
Since I started down the PSSM/muscle route about 5 years ago I have supplemented all my horses with vit E through the winter not just the PSSM one.

 

[Breagha]

Hi,

She def does not have PSSM and the question is "what does she have". I am trying to do best by my horse and go with what the vet is instructing me but as I feed her the spillers fibre mash which has vitamin e in it, it is not like she isnt getting any.

Thanks

 

[Leo Walker]

Shes getting very, very little. There is only 200iu/kg of Vitamin E so even at the recommended feeding rate of 1.5kgs a day she would only be getting 300iu

 

[Breagha]

I am going by what the vet is telling me to do, they are putting her on a supplement but I am not sure exactly what is in it but will find out today.

I am not saying you are not right but I will discuss with vet in the first instance.

 

[SEL]

https://cvm.msu.edu/directory/valberg

I know this is going to sound a bit odd, but many of the owners of horses with myopathies are much better educated on the subject than the vast majority of vets. I've always put this down to the fact that we only have 1 or 2 specialist subjects to educate ourselves on, whereas vets are more 'general practitioners'. I've even had a disagreement with a vet who told me myopathies were one of their specialist subjects. He definitely wasn't expecting to have his arguments picked as part quite as thoroughly as I did - but then I'd read more papers on the subject that he had!

It might be myoplast that your vet is recommending. I struggle with why they recommend that particular product (cynic in me wonders if there is a financial incentive) because there are alternatives with less sugar available. I understand why you wouldn't want to supplement vitamin E without speaking to your vet, but if they tell you that you shouldn't or it isn't required then they immediately lose credibility in my eyes.

At the top of this post I have put the link for Dr Valberg's email address at Michigan. There is no other vet in the world who has done as much research as she has - no matter what any of the UK based vets might say. I have emailed her speculatively at the address on there and she responded within 24 hours. I don't know who your local vet is referring to, but if you can get a copy of the results then there is no harm in asking for her advice. This is a subject that she is passionate about and if you have something unusual then 1) if she's come across it before there is no better person to advise and 2) if she hasn't seen it before then I suspect she'll be interested.

Let us know how you get on.

 

[Christmas Crumpet]

I think SEL has totally hit the nail on the head with this... vets are "General Practitioners". My vet didn't have a clue what was wrong with my horse and it was only on here that I managed to fit all the pieces together. The diet my vet suggested was totally wrong for my horse, again I got the right diet through trial and error and suggestions on here. My vet said my horse tied up because he was selenium deficient.

Needless to say, it is worth keeping an open mind and perhaps trying some of the things suggested on here. Vitamin E is essential. I feed my horse 10,000 iu every day of Equimins Vit E oil. I also feed essential amino acids, salt, a bespoke calmer with mg in it and micronised linseed, speedibeet & top chop zero. My horse is muzzled out on grass. This works for him. But it has taken me nearly 3 years to get here!! My vet was as useful as a chocolate teapot.

The good thing is that none of the "supplements" are prescription - you can buy them yourself and try them with no vets permission. So very easy to do.