Talk to me about PSSM

[Miss_Millie]

I did for iron, copper, vitamin E. If I was doing it now I would add selenium. You need a Jan/Feb test for vitamin E because it's stored in and released from the liver so deficiency in the blood won't show until the liver has run out.
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Thank you! I've found myself down a rabbit hole and according to an older thread, the Forage Plus Winter Hoof Balancer which I used to feed routinely every Winter contains synthetic Vitamin E, in which case my horses would have only been getting 1000iu a day for several winters.

I switched to a different once this winter which is definitely all natural minerals as it worked out being slightly more affordable, but I'm annoyed that FP do not specify this on their website (just checked).

I have never worked out what horses on tracks do for vit E, how many get supplemented. I know the one you are referring to.

It is not just tracks we now keep horses very differently. In summer they are off the grass due to lami and in winter off the grass due to the wet not that the grass in winter is going to do much for vit E.
Then they are worked year round due to arenas and lights etc.
There used to be a lot of posts on earlier threads of my young horse has just started work and can't do it, (exactly the same as Sarah here)
I think we thought it was PSSM for many of them but then of course they coped as non worked youngsters with little vit E but once they started work they needed supplementing.

I have 4 on vit E so the "money diet" thread would be way beyond me.

Yes that's very true, I can see how the worry surrounding grass and lami could lead to a lot of horses becoming deficient in vitamin E.

Sorry to hijack your thread Sarah, I hope someone in the future will find reading through all of this to be helpful and spark some 'aha' moments, as have I since reading from the beginning

 

[ycbm]

but I'm annoyed that FP do not specify this on their website (just checked).

It's astonishing isn't it? They really went down in my estimation when I found that out. It's bad enough using synthetic but to declare it as 2000iu when they know full well only 1000iu is available to the horse is inexcusable.
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[Miss_Millie]

It's astonishing isn't it? They really went down in my estimation when I found that out. It's bad enough using synthetic but to declare it as 2000iu when they know full well only 1000iu is available to the horse is inexcusable.
.

I had been buying it for years up until recently, am now feeling ticked off as I thought I was giving my horses what they needed! It seems more likely now that my winter grump pony has a deficiency, as despite being out 24/7 the grazing is poor in Winter. They should most certainly declare on their website that the vitamin E is synthetic in their Winter balancer.

 

[quizzie]

It's astonishing isn't it? They really went down in my estimation when I found that out. It's bad enough using synthetic but to declare it as 2000iu when they know full well only 1000iu is available to the horse is inexcusable.
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I think all companies only declare what they have to, and it is safe in virtually all circumstances to assume that if nothing specific is said about "natural" vit E , it will inevitably be synthetic.
The same with minerals etc , if specific forms are not mentioned...assume it is the basic cheapest form.

 

[KatieDM]

Don’t apologise - its good to hear people’s stories and experiences as I’m so inexperienced with PSSM.

I have some vit e and he had his first 10,000IU dose yesterday and been kept warm and done light work Monday and yesterday. Tonight will be our first schooling session - not expecting many (if any) changes and I’ll stop if things still feel rocky.

May I ask which Vitamin E you’ve gone for? Considering it for my boy.

 

[I'm Dun]

Really hoping that's the easy answer for you.

My horse was healthy, but I decided to add vitamin e when the grass died and he'd be on hay only. He went bonkers on vitamin e. Which I don't think is common!

It is qute common. Too much made mine feellike a ticking time bomb

 

[J_sarahd]

May I ask which Vitamin E you’ve gone for? Considering it for my boy.

Forage Plus Natural Vit E

 

[ycbm]

I think all companies only declare what they have to, and it is safe in virtually all circumstances to assume that if nothing specific is said about "natural" vit E , it will inevitably be synthetic.
The same with minerals etc , if specific forms are not mentioned...assume it is the basic cheapest form.

Yes, but Forageplus were the pioneers in feed balancing to the horse and grazing, I was friends with Sarah Braithwaite when she started it. They educated us all that vitamin E is only half as able to be absorbed if it is synthetic.

So to find them selling a product quoting the iu as 2000 when actually only 1000 is bioavailable is a huge disappointment.
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[Fieldlife]

the link below gives limits re overdosing. I suspect overdosing may be pretty rare, due to the cost of it bankruptcy may be more common.

Vitamin E In Horses

Vitamin E In Horses Vitamin E functions as a biological antioxidant that serves to maintain normal neuromuscular function. Equine diseases that develop in the face of vitamin E deficiency in young animals include nutritional myodegeneration in conjunction with selenium deficiency, equine...

www.vetmed.ucdavis.edu

that link says “The NRC has set the upper safe diet concentration at 20 IU/kg BW based on biopotency of synthetic vitamin E (10,000 IU/500 kg horse).”

10,000 IU of synthetic limit would work out at 5,000 natural? So a lower limit than some people are feeding?

 

[SEL]

Really hoping that's the easy answer for you.

My horse was healthy, but I decided to add vitamin e when the grass died and he'd be on hay only. He went bonkers on vitamin e. Which I don't think is common!

My younger cob is only allowed a scoop of natural vitamin E if I'm not riding the next day. Hacking on our roads is bad enough without him prancing sideways doing dragon snorts!

 

[khalswitz]

Can a vitamin E deficiency present similarly to PSSM but just be a lack of vitamin E? I'm not speculating in OP's case, just musing. Horses probably don't get as much grass at this time of the year, especially with these wetter, muddier winters. I find myself wondering if this might be coming increasingly common.

How much vit E is a 'normal' horse meant to have? I think my balancer has 2000iu. Can a horse 'overdose' on it?

I'm happy for you J_sarahd that you're seeing some improvements, that is great news

Vitamin E deficiency can cause generalised myopathy (vitamin E responsive myopathy) that can look like the non-rhabdomyolysis clinical signs of PSSM (ie muscle atrophy and weakness), but it can also causes diseases such as equine motor neuron disease and equine neuroaxonal dystrophy/equine degenerative myeloencephalopathy. These look more like nervous system diseases.

It’s worth noting that for actual PSSM1, there is no scientific evidence that supplementation with Vit E does anything. But PSSM1 itself is nothing to do with vit E deficiency, it’s a glycogen storage disease and there’s no evidence of an oxidative stress role in the disease - most studies of PSSM1 I’ve read where vit E conc was measured showed no differences between cases and controls. The recommendation for Vit E supplementation in PSSM1 cases is primarily to balance the recommended high oil diet with sufficient antioxidant, not to relieve clinical signs - but due to the role of vitamin e deficiency in other neuromuscular disorders, it’s good to make sure the horse is receiving adequate vit e rather than battling two myopathies at once.

If you’re interested, Piercy & Rivero’s chapter in Equine Sports Medicine & Surgery, Valberg’s and Finno’s recent reviews on PSSM and Vit E responsive myopathy in Veterinary Clinics: Equine Practice and Harris & Rivero’s 2017 review in The Equine Veterinary Journal are useful overviews.

 

[I'm Dun]

Vitamin E deficiency can cause generalised myopathy (vitamin E responsive myopathy) that can look like the non-rhabdomyolysis clinical signs of PSSM (ie muscle atrophy and weakness), but it can also causes diseases such as equine motor neuron disease and equine neuroaxonal dystrophy/equine degenerative myeloencephalopathy. These look more like nervous system diseases.

It’s worth noting that for actual PSSM1, there is no scientific evidence that supplementation with Vit E does anything. But PSSM1 itself is nothing to do with vit E deficiency, it’s a glycogen storage disease and there’s no evidence of an oxidative stress role in the disease - most studies of PSSM1 I’ve read where vit E conc was measured showed no differences between cases and controls. The recommendation for Vit E supplementation in PSSM1 cases is primarily to balance the recommended high oil diet with sufficient antioxidant, not to relieve clinical signs - but due to the role of vitamin e deficiency in other neuromuscular disorders, it’s good to make sure the horse is receiving adequate vit e rather than battling two myopathies at once.

If you’re interested, Piercy & Rivero’s chapter in Equine Sports Medicine & Surgery, Valberg’s and Finno’s recent reviews on PSSM and Vit E responsive myopathy in Veterinary Clinics: Equine Practice and Harris & Rivero’s 2017 review in The Equine Veterinary Journal are useful overviews.

So why does it work? I understand bias etc but people were coming up to me asking what had happened to make my pony totally different. Her body shape changed. I'll try and find the photos later, it was really, really dramatic. There is so much anecdotal evidence we cant all be wrong. Obviously most people don't blood test for vitamin e levels to get a base level, so that wont help, but surely it has to be working?

And in my case, my pony was always a degree or 2 colder than everything else, something else I've heard people say. Is there any scientific reason for that?

Sorry, I know I should do my own research but I know its an area you are familiar with and I should be writing my dissertation so I darent go down a PSSM rabbit hole!

 

[Fransurrey]

If you have a deficiency it will take time for the levels to build up. No doubt someone will come on and say their horse was cured and jumping cross country courses after 3 days but I would give a high dose for a month and then evaluate ridden work. Schooling suggests circles and frames. If you really have to ride I would stick to straight lines at his speed to give him the best chance.

I agree with this. My lad has been on Vit E (Forage Plus) and ALCAR for 5 days today. I did ride him yesterday and he was pretty forward for it (for him!), but we do get the odd ride like that, so I'm giving him until the packet is used up for both. I started him off on 6000 IU Vit E and the standard 10 mL scoop of ALCAR (he's very usefully the standard 500 Kg!). He's back on linseed, too (previously he was reactive on it, which is why I stopped it a couple of years ago). If I don't see any improvement at the end of the Vit E packet (should be about 2 months), we'll start just doing walks and I'll ride someone else's horse as and when.

 

[Fransurrey]

It's astonishing isn't it? They really went down in my estimation when I found that out. It's bad enough using synthetic but to declare it as 2000iu when they know full well only 1000iu is available to the horse is inexcusable.
.

I didn't know, either. I have commented elsewhere that I used to feed extra Vit E as part of a supplement. I checked back in my emails and it was indeed the FP winter hoof balancer.

 

[Fieldlife]

that link says “The NRC has set the upper safe diet concentration at 20 IU/kg BW based on biopotency of synthetic vitamin E (10,000 IU/500 kg horse).”

10,000 IU of synthetic limit would work out at 5,000 natural? So a lower limit than some people are feeding?

Bump, @paddy555 interested if you read it this way too? Thanks

 

[khalswitz]

So why does it work? I understand bias etc but people were coming up to me asking what had happened to make my pony totally different. Her body shape changed. I'll try and find the photos later, it was really, really dramatic. There is so much anecdotal evidence we cant all be wrong. Obviously most people don't blood test for vitamin e levels to get a base level, so that wont help, but surely it has to be working?

And in my case, my pony was always a degree or 2 colder than everything else, something else I've heard people say. Is there any scientific reason for that?

Sorry, I know I should do my own research but I know its an area you are familiar with and I should be writing my dissertation so I darent go down a PSSM rabbit hole!

I have no idea. Several potential answers, but without more research I can’t tell you which it is:

1) It’s a placebo. Yes, the placebo effect still works on animals when humans think they are being treated. Without comparison against a placebo showing a stronger effect, we won’t know for sure that it does actually do anything. And the placebo effect is really strong!

I’m not aware of any RCTs of Vit E in PSSM horses, as there hasn’t been evidence of reduced serum Vit E in published papers so it probably hasn’t been seen as fruitful research (equally research in rhabdomyolysis cases in dogs showed no effect beyond placebo).

2) If it does actually have a stronger effect than placebo, then possibly this is in a subset of cases where there was also a Vit E deficiency. Without blood testing for Vit E first and finding no deficiency we wouldn’t know if Vit E is addressing a deficiency rather than PSSM itself. We’re not really sure how widespread Vit E deficiency is in the UK, or whether also having a Vit E deficiency makes PSSM signs worse.

3) It does have some effect on PSSM, although there isn’t a good candidate mechanism for how it would do that.

If I was researching this, I’d want to do a RCT of PSSM horses with known no deficiency in Vit E to find out. But even then it’s not easy as you’d need a good objective measurement of improvement to compare, and you’d need to control for diet, turnout and exercise etc as well ideally as age and breed. It would also need a Hone Office license as well for taking blood etc. And would therefore need a good whack of funding!

Edit: regarding temperature, again no published evidence on this, but also I’m not sure it’s even been looked at. In theory, horses with subclinical signs of muscle disease you’d expect to be warmer due to inflammation, but I have an unpublished study that looked at a small number of PSSM horses using thermal imaging of the typically affected muscles and we didn’t see any difference in temperature. However it wasn’t a big enough study to really draw a conclusion either way. So no scientific answers for that one!

 

[I'm Dun]

I have no idea. Several potential answers, but without more research I can’t tell you which it is:

1) It’s a placebo. Yes, the placebo effect still works on animals when humans think they are being treated. Without comparison against a placebo showing a stronger effect, we won’t know for sure that it does actually do anything. And the placebo effect is really strong!

I’m not aware of any RCTs of Vit E in PSSM horses, as there hasn’t been evidence of reduced serum Vit E in published papers so it probably hasn’t been seen as fruitful research (equally research in rhabdomyolysis cases in dogs showed no effect beyond placebo).

2) If it does actually have a stronger effect than placebo, then possibly this is in a subset of cases where there was also a Vit E deficiency. Without blood testing for Vit E first and finding no deficiency we wouldn’t know if Vit E is addressing a deficiency rather than PSSM itself. We’re not really sure how widespread Vit E deficiency is in the UK, or whether also having a Vit E deficiency makes PSSM signs worse.

3) It does have some effect on PSSM, although there isn’t a good candidate mechanism for how it would do that.

If I was researching this, I’d want to do a RCT of PSSM horses with known no deficiency in Vit E to find out. But even then it’s not easy as you’d need a good objective measurement of improvement to compare, and you’d need to control for diet, turnout and exercise etc as well ideally as age and breed. It would also need a Hone Office license as well for taking blood etc. And would therefore need a good whack of funding!

Edit: regarding temperature, again no published evidence on this, but also I’m not sure it’s even been looked at. In theory, horses with subclinical signs of muscle disease you’d expect to be warmer due to inflammation, but I have an unpublished study that looked at a small number of PSSM horses using thermal imaging of the typically affected muscles and we didn’t see any difference in temperature. However it wasn’t a big enough study to really draw a conclusion either way. So no scientific answers for that one!

Thank you. I understand placebo, but I'm convinced its not that, as I would be if it was placebo mind

 

[khalswitz]

Thank you. I understand placebo, but I'm convinced its not that, as I would be if it was placebo mind

We instinctively seek to recognise patterns as humans - sometimes we think things are causal when they aren’t. I don’t doubt a massive change in your horse - it’s just whether it’s definitely caused by the vit e, and if so whether the vit e was addressing the PSSM.

In animals, there’s evidence that the placebo effect can be strong. 80% of epileptic dogs in one study showed decreased seizure rates on a placebo. Another showed saline injections could replicate the effect of insulin in diabetic animals for an extended period. It’s crazy.

On a personal and practical note though rather than a scientific one, I’d 100% keep feeding vit e in your scenario. Even if it’s a placebo, if I was seeing an improvement, I’d keep it going as long as it’s doing no harm to anything but my pocket - and it’s very possible it’s not a placebo. It’s just that using it as a diagnostic indicator for PSSM is fairly flawed logic with current evidence.

 

[ycbm]

I would guess because having PSSM causes horses enormous amounts of stress and vitamin E reduces the physical effects of stress and the horse will feel less unwell. Also there is some suggestion in humans that vitamin E acts as an antidepressant. There is no reason why this shouldn't also happen in horses.

Then, nobody I know introduces vitamin E alone. They add extra rugs, more consistent exercise, low sugar diet, super keen attention to the horse"s moods, what the grass and the weather are doing, and all of that together produces a good result in horses with PSSM.

I also think a lot of PSSM2 diagnosed is not muscle myopathy but vitamin E myopathy, for which vitamin E is obviously going to be effective.
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[paddy555]

. We’re not really sure how widespread Vit E deficiency is in the UK,

I also think a lot of PSSM2 diagnosed is not muscle myopathy but vitamin E myopathy,
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both of these. It would be interesting to have some idea as to how many are aware of vit e def/myopathy. Many seem to arrive (on here) on threads such as this.

 

[Slightlyconfused]

both of these. It would be interesting to have some idea as to how many are aware of vit e def/myopathy. Many seem to arrive (on here) on threads such as this.

We had a lovely Irish vet about 8 years ago who came to see mine after his second tye up.

He is type one neg as parents are and she didnt want to so the biopsy as apart from two tye ups about 10 months apart he only had slight symptoms which included tight muscles and feeling the cold more. She said try on high Vit E and if he improves keep him on it as he may just be Vit E deficient rather than pssm.

It worked so we went with it.

 

[SEL]

We instinctively seek to recognise patterns as humans - sometimes we think things are causal when they aren’t. I don’t doubt a massive change in your horse - it’s just whether it’s definitely caused by the vit e, and if so whether the vit e was addressing the PSSM.

In animals, there’s evidence that the placebo effect can be strong. 80% of epileptic dogs in one study showed decreased seizure rates on a placebo. Another showed saline injections could replicate the effect of insulin in diabetic animals for an extended period. It’s crazy.

On a personal and practical note though rather than a scientific one, I’d 100% keep feeding vit e in your scenario. Even if it’s a placebo, if I was seeing an improvement, I’d keep it going as long as it’s doing no harm to anything but my pocket - and it’s very possible it’s not a placebo. It’s just that using it as a diagnostic indicator for PSSM is fairly flawed logic with current evidence.

I seem to collect PSSM horses (type 1) & with my very symptomatic Appy I haven't found that increasing or decreasing her vitamin E intake makes any difference. I suspect because she's had it supplemented relatively consistently for 10 years she has good stores so when I run out she doesn't become deficient. I now only supplement in winter.

For rugs I tend to think that when we have sore muscles we like heat. It helps to relax muscles so I've always assumed it's as simple as that with the extra rugs.

 

[Fieldlife]

Or is it that some horses on limited fresh grass are Vitamin E deficient especially in winter. They show PPSM symptoms and improve on vitamin E? And never really had PPSM?

Advice now is that all horses that dont have access to fresh grass should have omega 3 and Vit E added to diet.

 

[J_sarahd]

I’m feeling a bit overwhelmed and not knowing where to go or what to do. Physio came out today for Shadow and I spoke through all my concerns, everything I’ve mentioned on here. Whilst she was doing her thing, he was quite aggressive, trying to bite her but because it wasn’t a specific spot that made him aggressive, she said it was confusing and complicated. She tried to back him up and he tried to bite her. But then she took him out of the stable and he backed up so sweetly.

Physio thinks he’s hungry and therefore getting a bit frustrated in his stable when others are in there (even though he was allowed to eat his hay whilst she was doing her thing). She also did suggest ulcers and scoping may be a necessity if simply adding an extra meal doesn’t work. She said both could be reasons for the “not quite right” feeling I’m getting - I know someone did mention ulcers previously.

But when she’d gone, I went into his stable to put his rugs back on and he lunged at me, biting my back and breaking the skin through my equidry and hoodie. I am glad it was me he hurt and not someone else but equally, I just feel so confused. He has been nice as anything the past few days. Is it likely he’s just got frustrated and it’s tipped him over the edge?

 

[mavandkaz]

Oh, I really do feel for you. Followed your story with your previous horse, and we conversed a couple of times on here and on Facebook (PSD group)..and we were both looking for new ones around the same time.
I think it might be 'easier' to just run a full blood panel? Rather then trying to eliminate things yourself. Did you have a 'wellness' check done at the vetting and pull bloods?
The lethargy and aggression when being touched sounds similar to how my boy was before I retired him. I never tried to work out exactly what it was as decided to just retire instead. But in the prior months I had found he was struggling with forwardness so ran bloods and he returned raised liver enzymes. He looked well in himself. I managed to reduce them, but then he started not wanting to be touched so ran them again, and they'd gone back up.
Another pony on the yard would get very aggressive when his liver issues flared up. But could change from day to day.
I'm not saying it is liver, but a full blood panel can rule out/in quite a lot in one go.

 

[J_sarahd]

Oh, I really do feel for you. Followed your story with your previous horse, and we conversed a couple of times on here and on Facebook (PSD group)..and we were both looking for new ones around the same time.
I think it might be 'easier' to just run a full blood panel? Rather then trying to eliminate things yourself. Did you have a 'wellness' check done at the vetting and pull bloods?
The lethargy and aggression when being touched sounds similar to how my boy was before I retired him. I never tried to work out exactly what it was as decided to just retire instead. But in the prior months I had found he was struggling with forwardness so ran bloods and he returned raised liver enzymes. He looked well in himself. I managed to reduce them, but then he started not wanting to be touched so ran them again, and they'd gone back up.
Another pony on the yard would get very aggressive when his liver issues flared up. But could change from day to day.
I'm not saying it is liver, but a full blood panel can rule out/in quite a lot in one go.

Thank you - I was just so ready for a simple horse to enjoy but it just seems to have fallen down the pan a bit the last few weeks. Possibly because I notice little things a bit more now.

I am going to get his bloods done. Like you said, it takes the guess work out for me and potentially saves me £££ on trying different supplements etc. He’s fine for me to touch, groom etc but it was as if it all just got too much for him today.

 

[SEL]

Thank you - I was just so ready for a simple horse to enjoy but it just seems to have fallen down the pan a bit the last few weeks. Possibly because I notice little things a bit more now.

I am going to get his bloods done. Like you said, it takes the guess work out for me and potentially saves me £££ on trying different supplements etc. He’s fine for me to touch, groom etc but it was as if it all just got too much for him today.

I remember my pssm mare being really horrible and I got bloods pulled expecting raised muscle enzymes only to find her liver enzymes were out of whack. She also had a couple of cycles of ulcer drugs. It's hard often to know what to do and where to start when they're in pain but a set of bloods is always a good starting point

I'm sorry you haven't got an easy one. FB has kindly reminded me of having 3 out of work a few years back and it was a very miserable time.

 

[J_sarahd]

I remember my pssm mare being really horrible and I got bloods pulled expecting raised muscle enzymes only to find her liver enzymes were out of whack. She also had a couple of cycles of ulcer drugs. It's hard often to know what to do and where to start when they're in pain but a set of bloods is always a good starting point

I'm sorry you haven't got an easy one. FB has kindly reminded me of having 3 out of work a few years back and it was a very miserable time.

I’m going to ring the vets tomorrow and get them to come out asap. Does anyone know how much it costs to get their bloods done? I’ve never had to do it before (about one of the only things at this point )

Thank you - I think once I find and fix/manage whatever’s going on, he will be a really fun little pony as he is so sweet, eager to please and is already fun (or was before all of this kicked off).

 

[Miss_Millie]

Sorry to hear this Sarah. How long is he stabled for per day?

 

[SEL]

I’m going to ring the vets tomorrow and get them to come out asap. Does anyone know how much it costs to get their bloods done? I’ve never had to do it before (about one of the only things at this point )

Thank you - I think once I find and fix/manage whatever’s going on, he will be a really fun little pony as he is so sweet, eager to please and is already fun (or was before all of this kicked off).

Winter won't be helping - I've got 3 fed up horses (& 1 human!) at the moment.

You'll have the usual call out fee then a charge for taking the blood plus the lab fees. I think I paid £150 last time but can't remember if it was a free call out day