Vets, therapists and PSSM

[Indefatigable]

Interested to know peoples' views on this. I've asked the vet, the physio and various other therapists what they thought about the prevalence/impact of PSSM. Each and every one of them were reluctant to engage in the subject. A couple said it was 'just another fashionable thing' these days, much like kissing spine'. I can't help wondering if a formal acknowledgment and/or confirmation of PSSM would lose vets and therapists quite a bit of income e.g. x-rays, MRIs, scintography, joint injections, Bute trials, physio sessions ..the list goes on.

 

[SEL]

I think it's unfortunate Equiseq decided to sell their genetic tests before they had been robustly peer reviewed.

A friend has undiagnosed "lameness" issues with a coloured cob. Always showing elevated muscle enzymes but negative for P1. She came back as P8 on the Equiseq tests but the vets don't want to know even though every blood report back from the lab says a myopathy should be considered.

I'm not sure what the answer is tbh. I've struggled enough with a P1 mare. I'm always surprised at how many therapists who specialise in muscles have minimal knowledge of diseases of the muscles they treat

 

[ycbm]

IMO, there is not yet enough awareness among the professionals of muscle myopathy, it is very widespread.
.

 

[ycbm]

I'm also not sure how kissing spines can be written off as a fashion when the unmistakable bone damage from it is repeatedly being found on x ray.

 

[SEL]

I'm also not sure how kissing spines can be written off as a fashion when the unmistakable bone damage from it is repeatedly being found on x ray.

This!

We just have better diagnostics now. I'm pretty sure my old warmblood had it but I learnt to work with his quirks and within his limitations

 

[TPO]

Interested to know peoples' views on this. I've asked the vet, the physio and various other therapists what they thought about the prevalence/impact of PSSM. Each and every one of them were reluctant to engage in the subject. A couple said it was 'just another fashionable thing' these days, much like kissing spine'. I can't help wondering if a formal acknowledgment and/or confirmation of PSSM would lose vets and therapists quite a bit of income e.g. x-rays, MRIs, scintography, joint injections, Bute trials, physio sessions ..the list goes on.

You need a new vet and physio because that certainly isn't the attitude of the professionals that I know/use.

Your insinuation that vets would purposely neglect to diagnose and treat an animal accordingly so that they can make money doing unnecessary treatments is very bad form.

 

[tristar]

i have met vets who just look confused or blank when asked to test for pssm

if you get xrays for K spines you can see for yourself

horses, so much mystery, so much to know, so much yet to understand

 

[tristar]

Interested to know peoples' views on this. I've asked the vet, the physio and various other therapists what they thought about the prevalence/impact of PSSM. Each and every one of them were reluctant to engage in the subject. A couple said it was 'just another fashionable thing' these days, much like kissing spine'. I can't help wondering if a formal acknowledgment and/or confirmation of PSSM would lose vets and therapists quite a bit of income e.g. x-rays, MRIs, scintography, joint injections, Bute trials, physio sessions ..the list goes on.

look at the stats of kissing spines in racehorses at retirement and post mortem

might be an element of not wanting to acknowledge being involved with and supporting industries damaging such young horses which might be called er, abuse and cruelty

i think you are right to question, its a big part of seeking the truth

 

[catembi]

I see what you're saying. My first affected horse, 16 years ago, went to Rossdales as a 4 yo for 10 days & had every test under the sun, xrayed head to tail, scintigraphy etc etc etc until they had well & truly maxed out my insurance & then some. Verdict? They couldn't find anything wrong so if he's not doing what I want, then get him PTS. This was before the Type 2 test, but I stumbled across PSSM, he tested -ve for type 1 & then I had a very strong reaction to the high oil diet so I had my answer.

With subsequent horses, I have recognised where we're heading straight away & done the test, so have spent £200 on the CAG test rather than £6k on utterly futile diagnostic tests. Afaik, there are no veterinary interventions for PSSM & all you can really do is manage it by keeping them warm & dry & tinkering about with diet & supplements, so there is no money in it for the vets. But unless someone comes up with a gene therapy type cure, I don't think vets can do anything.

 

[paddy555]

I think PSSM is easier to get some idea of if you live with the horse and care for it. Then you get a complete picture of the problems many of which in isolation can indicate lots of different problems. A vet only sees a horse for a short time.

However I think vets are extremely keen on tests and insurance and using their equipment to provide income. I am currently in this situation with small animal vets.. I know little about dogs and have had to rely on them. They have relied on the insurance company. How much is he covered for? off we go!
They didn't carry out my instructions which where at the first sign of trouble PTS immediately (he was in their hospital) they didn't, the bill for that one night was £1000. I knew nothing until the nurse rang me at 7.30am the following day to say the dog was still with us. Erm, why wouldn't he be?. I have ended up with a dog, that because of that failure, I now simply cannot take to a vet. I'm afraid I feel very cynical about vets ATM.

I find horse vets very different probably because I know a lot more about horses and keep them absolutely under control.


utterly futile diagnostic tests.

A lot of money is spent on horse's feet/laminitis etc and I once said to my vet this is when the cash tills start rolling. The insurance pay out lots for these sort of problems, the horse has endless treatments, vets make money and at the end of the day when the insurance has run out something finally realises they have to get the shoes off and start rehabbing the feet. That however doesn't make a great deal of money for anyone.

 

[Hormonal Filly]

I can’t believe the amount of breeders, especially Welsh D stud yards that have proven PSSM in their lines (owners testing symptomatic horses bred by them) yet they still believe the testing is rubbish!

Second to that, there is one breeder that had her stallions and mares tested for P1 and P2. Her best stallion was positive so she removed him from stud and has had him cut, as well as a few mares. One colt tested negative. Huge respect to her.

 

[hock]

IMO, there is not yet enough awareness among the professionals of muscle myopathy, it is very widespread.
.

Yep this!

KS a fad? Sheeesh I know not your words but the words of a muppet.

 

[Birker2020]

I'm also not sure how kissing spines can be written off as a fashion when the unmistakable bone damage from it is repeatedly being found on x ray.

The trouble is just because something is seen on x-ray it doesn't mean that the animal is encountering pain from it. If its used as part of a clinical diagnosis because there are other symptoms that might lead to that conclusion then I agree. Probably not explaining myself well but I know what I mean

 

[palo1]

On the other hand though at least there are not a million and 1 supplement/alternative therapies companies and therapists promising unrealistic outcomes for these horses as they do with other issues. I think vets are aware of PSSM; 12 years ago when I bought a youngster we discussed testing for him even though I had very carefully checked his bloodlines for problems. In the end his breeding meant that he looked very low risk so I purchased without testing but my vet was completely aware of PSSM and discussed it perfectly sensibly!! If a vet isn't acknowledging a problem that IS fairly well recognised more generally now then change vets I say!

 

[paddy555]

On the other hand though at least there are not a million and 1 supplement/alternative therapies companies and therapists promising unrealistic outcomes for these horses as they do with other issues. I think vets are aware of PSSM; 12 years ago when I bought a youngster we discussed testing for him even though I had very carefully checked his bloodlines for problems. In the end his breeding meant that he looked very low risk so I purchased without testing but my vet was completely aware of PSSM and discussed it perfectly sensibly!! If a vet isn't acknowledging a problem that IS fairly well recognised more generally now then change vets I say!

well 10 years ago my vet certainly wasn't aware of PSSM. She only became aware of it when I had strange symptoms and asked her to ring the vet schools for an explanation of the blood test results. I didn't know which area to start investigating and Leahurst came back suggesting PSSM.

Whilst you may be aware of PSSM that doesn't mean a novice owner is. If someone was buying a QH and asked for it to be vetted would all vets suggest PSSM1 testing and advise the owner that PSSM2 was prevalent in that breed as they were vetting it.
If the horse becomes ill and the owner doesn't know about PSSM and neither does the vet then how do they know to change vets? The owner just presumes the vet knows everything.

 

[Hormonal Filly]

On the other hand though at least there are not a million and 1 supplement/alternative therapies companies and therapists promising unrealistic outcomes for these horses as they do with other issues. I think vets are aware of PSSM; 12 years ago when I bought a youngster we discussed testing for him even though I had very carefully checked his bloodlines for problems. In the end his breeding meant that he looked very low risk so I purchased without testing but my vet was completely aware of PSSM and discussed it perfectly sensibly!! If a vet isn't acknowledging a problem that IS fairly well recognised more generally now then change vets I say!

Most vets are aware of it but in my experience, 2 independent vets believed it was only found in TBs and Warmbloods when we spoken about it.

One said we could test my Welsh D for P2 but he highly doubted he would have it as he’s a native. This was in 2020, he was negative for P2 but muscle enzymes showed significant muscle damage. This was a top lameness vet as well.

It’s good to see a database for all Welshies has started to be created though! They’re always known for quirkiness and there are now so many suspects in the pedigree.

 

[SEL]

well 10 years ago my vet certainly wasn't aware of PSSM. She only became aware of it when I had strange symptoms and asked her to ring the vet schools for an explanation of the blood test results. I didn't know which area to start investigating and Leahurst came back suggesting PSSM.

Whilst you may be aware of PSSM that doesn't mean a novice owner is. If someone was buying a QH and asked for it to be vetted would all vets suggest PSSM1 testing and advise the owner that PSSM2 was prevalent in that breed as they were vetting it.
If the horse becomes ill and the owner doesn't know about PSSM and neither does the vet then how do they know to change vets? The owner just presumes the vet knows everything.

I've said before on here it was a chance reading of night blindness genetics and appaloosas that brought me to the Animal Genetics page and PSSM. Vet had never mentioned it.

Therapists are interesting where PSSM is concerned. There are some well known names which get mentioned on this forum at times who have looked at me blankly when I have presented them with the Appy and said she is a highly symptomatic PSSM horse. I can only think of 1 who asked me how that presented. There is an extremely talented bodyworker in this area who after working on the Appy said she could feel the difference in her muscles and has encouraged other owners to test based on what she has felt under her hands. In some respects I find it more frustrating with bodyworkers who are supposed to be muscular experts than vets who are general practitioners!

 

[palo1]

I've said before on here it was a chance reading of night blindness genetics and appaloosas that brought me to the Animal Genetics page and PSSM. Vet had never mentioned it.

Therapists are interesting where PSSM is concerned. There are some well known names which get mentioned on this forum at times who have looked at me blankly when I have presented them with the Appy and said she is a highly symptomatic PSSM horse. I can only think of 1 who asked me how that presented. There is an extremely talented bodyworker in this area who after working on the Appy said she could feel the difference in her muscles and has encouraged other owners to test based on what she has felt under her hands. In some respects I find it more frustrating with bodyworkers who are supposed to be muscular experts than vets who are general practitioners!

I can't see any reason for a decent equine bodyworker/physio/soft tissue expert not to know about at least the most common/most easily tested variants of PSSM these days and it is disappointing to hear of vets treating horses with strange symptoms not to consider it. I understand why though if PSSM presents as lameness or other really obvious physical symptom and some less experienced owners might not join up behaviours with physical issues. Sadly there are still many people who see physical issues as naughtiness/training problems so I can see how vets would not get a full picture of a horse's issues from some owners.

 

[I'm Dun]

I can't see any reason for a decent equine bodyworker/physio/soft tissue expert not to know about at least the most common/most easily tested variants of PSSM these days and it is disappointing to hear of vets treating horses with strange symptoms not to consider it.

They really don't. I didn't have a single person pick up on it, despite me mentioning a few times that I thought something just wasn't quite right. Any vets I mentioned it to were always interested to hear about it and how I managed it as it was something they said they rarely came across. Given how many horses I know with it, I highly doubt they don't come across it, they just don't recognise it.

A friend just bought a HW cob, before she bought him I said he looked to me to have symptoms of PSSM and to make sure he was tested before buying. She asked the vet doing the vetting about it and was advised not to bother. If he doesn't have type 1 I will eat my hat. The problem with type 1 is it can sit under the radar. Lots of people want "lazy" "backwards" thinking horses and the amount of people who say cobs don't have a good canter and its to be expected that they struggle make me want to bang my head off the desk.

 

[palo1]

They really don't. I didn't have a single person pick up on it, despite me mentioning a few times that I thought something just wasn't quite right. Any vets I mentioned it to were always interested to hear about it and how I managed it as it was something they said they rarely came across. Given how many horses I know with it, I highly doubt they don't come across it, they just don't recognise it.

A friend just bought a HW cob, before she bought him I said he looked to me to have symptoms of PSSM and to make sure he was tested before buying. She asked the vet doing the vetting about it and was advised not to bother. If he doesn't have type 1 I will eat my hat. The problem with type 1 is it can sit under the radar. Lots of people want "lazy" "backwards" thinking horses and the amount of people who say cobs don't have a good canter and its to be expected that they struggle make me want to bang my head off the desk.

That is so disappointing to hear. I must have just been lucky in the conversations I have had (tbf just with 1 vet, my saddle fitter and a bodyworker). Perhaps I attract alternative types lol!! Still it is frustrating that there isn't the recognition that is clearly needed.

 

[Inda]

The reality is we can’t use a test that isn’t peer reviewed as a diagnostic tool. If we use it and the review shows it’s not predicative we will be facing lawsuits. So we’re stuck with muscle biopsies and CK levels.

However I’m the pain management small animal vet who happens to have a horse, so sorting out pain is what I do on a day to day basis. I stumbled onto PSSM2, it wasn’t discovered when I was a student. I think both variants are more common than we think they are, but diagnosis isn’t there yet and we generally see them at crisis point, called out for a possible colic. I have an emergency treatment protocol for these guys.

I can’t recommend the CAG test but the physio I’ll recommend them to for myofascial release, to help with the tight muscles, can. She’s gotten really good at clocking these horses herself now, and the students she teaches.

The PSSM1 test, recommend it to cob owners, not a great response tbh.

 

[Nudibranch]

I do wonder if some of the problem lies within the attitude you see on some of the pssm groups on FB, etc. In that some people think every little thing their horse does or suffers must be pssm, even when they haven't even been tested, because they're been reading about it and convinced themselves. Vets must come across this day to day. I've seen a few examples where there's been a video of a very clearly lame horse. Now it could be pssm related but they haven't even had a basic workup, and yet people are feeding the poster by declaring it must be. Meanwhile the poor horse is going without veterinary attention. There are still many other factors at play; arthritis, orthopaedic problems, soft tissue injuries, whatever.

My previous vet (he'd still be my vet if we hadn't moved!) always said the worst part of the job wasn't the horses, it was the owners. Given some of the tales he shared, I can see why.

 

[TPO]

I do wonder if some of the problem lies within the attitude you see on some of the pssm groups on FB, etc. In that some people think every little thing their horse does or suffers must be pssm, even when they haven't even been tested, because they're been reading about it and convinced themselves. Vets must come across this day to day. I've seen a few examples where there's been a video of a very clearly lame horse. Now it could be pssm related but they haven't even had a basic workup, and yet people are feeding the poster by declaring it must be. Meanwhile the poor horse is going without veterinary attention. There are still many other factors at play; arthritis, orthopaedic problems, soft tissue injuries, whatever.

My previous vet (he'd still be my vet if we hadn't moved!) always said the worst part of the job wasn't the horses, it was the owners. Given some of the tales he shared, I can see why.

???

 

[flying_high]

The trouble is just because something is seen on x-ray it doesn't mean that the animal is encountering pain from it. If its used as part of a clinical diagnosis because there are other symptoms that might lead to that conclusion then I agree. Probably not explaining myself well but I know what I mean

This kissing spine is not diagnosed from x-rays alone. It also needs another factor such as an improvement if relevant area is nerve blocked. Some spine changes never cause pain.
Similar with hock x-rays. You generally need to triangulate to get a meaningful diagnosis.

 

[flying_high]

The trouble is just because something is seen on x-ray it doesn't mean that the animal is encountering pain from it. If its used as part of a clinical diagnosis because there are other symptoms that might lead to that conclusion then I agree. Probably not explaining myself well but I know what I mean

This kissing spine is not diagnosed from x-rays alone. It also needs another factor such as an improvement if relevant area is nerve blocked. Some spine changes never cause pain.
Similar with hock x-rays. You generally need to triangulate to get a meaningful diagnosis.

 

[SEL]

I do wonder if some of the problem lies within the attitude you see on some of the pssm groups on FB, etc. In that some people think every little thing their horse does or suffers must be pssm, even when they haven't even been tested, because they're been reading about it and convinced themselves. Vets must come across this day to day. I've seen a few examples where there's been a video of a very clearly lame horse. Now it could be pssm related but they haven't even had a basic workup, and yet people are feeding the poster by declaring it must be. Meanwhile the poor horse is going without veterinary attention. There are still many other factors at play; arthritis, orthopaedic problems, soft tissue injuries, whatever.

My previous vet (he'd still be my vet if we hadn't moved!) always said the worst part of the job wasn't the horses, it was the owners. Given some of the tales he shared, I can see why.

Before the Equiseq tests then I would have agreed. Everyone seemed to be self declaring their horse with PSSM 2. Nowadays though I see encouragement to test so people know what they are dealing with on every forum I'm on (albeit people often recommend diet change while they get results). I do agree its very frustrating when people talk about their PSSM horse and haven't tested - one of those is a friend of mine

I also see a lot more encouragement to get vets involved and case studies about 'normal' lameness on those forums, although some are better than others. The trouble is until you get the myopathy under control its very hard to do a decent lameness work-up and I speak from 5 years of trying.

But then I think every FB forum assumes that what is wrong with your horse is what they are 'selling'. Join the Ulcer forum and every horse will be FB diagnosed with ulcers, ditto arthritis, Kissing Spine, etc etc etc.

 

[ycbm]

This kissing spine is not diagnosed from x-rays alone. It also needs another factor such as an improvement if relevant area is nerve blocked. Some spine changes never cause pain.

Pain from kissing spines can't be diagnosed without behaviour change, but the presence of kissing spines is seen on x ray. Also, I believe that if the horse is stoic and isn't reacting to pain doesn't necessarily mean there is none. If the horse is both stoic and not a big mover, then I think it's probably possible for it to have some level of pain from kissing spines which doesn't obviously alter the behaviour when the processes are anaesthetised. But that's just a personal theory after seeing 3 confirmed kissing spines cases up close.
.