Muscle disorders webinar may2012 final-7pm

Understanding EquineMuscle Disorders

Lydia F. Gray, DVM, MAMedical Director/Staff Veterinarian

Jessica NormandSenior Director – SmartSupplements™

May 16, 2012

Your Presenters

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Agenda• Overview of Muscle Disorders• Tying Up• PSSM• HYPP• Questions & Answers

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Overview of Muscle Disorders• According to the AAEP, as of February 2012 tests for mutations in

single genes are currently available for 12 diseases in horses. Three of them are muscle-related:

1. HYPP2. Type I PSSM3. Malignant Hyperthermia (not discussed in this webinar)

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Exertional Rhabdomyolysis aka “Tying Up”

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What Is It?• Muscle stiffness and pain after exercise• Two types:

o Sporadic Tying Up Due to a temporary problem in muscle cells caused by fatigue, heat

exhaustion or electrolyte imbalance Can occur in any breed

o Recurrent Tying Up An inherited problem with the way muscle cells use calcium Is mainly seen in Thoroughbreds, Arabians and Standardbreds

Tying Up: Sporadic Exertional Rhabdomyolysis (SER)

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What Is It?• First-time or occasional episodes of tying up• No age, breed, gender or discipline predilection• Temporary imbalance, no intrinsic muscle defect• Triggers include:

o Exercise beyond fitness levelo Injury from repetitive motiono Heat exhaustiono Dietary imbalanceso Electrolyte imbalances


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What does it look like?• Signs:

• Muscle stiffness• Short strides• Shifting hind limb lameness• Elevated heart and respiratory rates• Sweating• Firm & painful hindquarter muscles• Reluctance to move that lasts for several hours

• Diagnosis:o History, risk factors, classic signso Blood worko Urinalysis


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How is it treated/managed?• Medical Treatment:

o DO NOT MOVE HORSE!o Pain relievers: bute, Banamine®o Tranquilizers (for anxiety)o Fluids: oral or intravenouso Dantrolene for muscle relaxant, methocarbamolo Do not administer diuretics (i.e. Lasix)

• Management:o Stall rest and hay only for a few dayso Gradually increase time and size of turnout, add hand walkingo Resume training when blood work is within normal limitso Ensure diet is complete and balancedo Consider supplements: Electrolytes, Vitamin E, possibly Selenium

Tying Up: Recurrent Exertional Rhabdomyolysis (RER)

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What is it?• Tying up that occurs repeatedly• Primarily seen in Thoroughbreds, Standardbreds and Arabians

o Classic example is two-year-old nervous filly in race training• Caused by inherited abnormal regulation of intracellular calcium• Can be triggered by exercise, stress or combination of both


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What does it look like?• Signs:

o Muscle stiffnesso Short strideso Shifting hind limb lamenesso Elevated heart and respiratory rateso Sweatingo Firm & painful hindquarter muscleso Reluctance to move that lasts for several hours

• Diagnosis:o History, risk factors, classic clinical signso Blood worko Urinalysis

• Additional tests• Exercise challenge test• Muscle biopsy


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How is it treated/managed?• Medical Treatment:

o DO NOT MOVE HORSE!o Pain relievers: bute, Banamine®o Tranquilizers (for anxiety)o Fluids: oral or intravenouso Dantrolene for muscle relaxant, methocarbamolo DO NOT ADMINISTER DIURETICS (i.e. Lasix)

• Management:o Resume training gradually but immediately (no stall rest)o Diet change: decrease sugars/starches and increase fat o Consider supplements: Electrolytes, Vitamin E, Chromium, possibly Selenium


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• Additional Management Strategies for Racing Thoroughbredso Avoid excess stress, if possible

Stall in quiet area of barn Train when facility least busy Avoid “exciting” training regimens Tranquilize before training Give dantrolene before exercise

o Consistent exercise program Provide daily turnout Exercise daily (no days off) Avoid stall rest and lay-ups

Supplements to Consider for Tying Up

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Electrolytes

Chromium

Specialty Muscle Formulas

Vitamin E, Selenium, Magnesium

Polysaccharide Storage Myopathy (PSSM)

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What is it?• aka EPSM or EPSSM (Equine Polysaccharide Storage Myopathy)• A dysfunction in the way muscles store glycogen, the storage form of glucose

(sugar)• An inherited condition found primarily in Quarter Horses, draft horses,

warmbloods and warmblood crosses• Two types now recognized (Type I and Type II)


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What does it look like?In Quarter Horses (usually Type I)Typically occur a few minutes after the onset of exercise:•Stiffness, reluctance to move•Firm, painful muscles•Elevated heart and respiratory rates•Anxiety and excessive sweating•Posturing to urinate, stretching out•Muscle twitches•Pawing, rolling


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What does it look like?In draft horses and warmbloods (usually Type II):•Difficulty picking up feet, holding up limbs and backing•A “shivers-like” gait•Loss of muscle mass•Tucked up abdomen•Difficulty collecting•Reluctance to engage the hindquarters


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How is it treated/managed?• Treat the acute episode as exertional rhabdomyolysis then:

o Diet: Reduce sugars and starches Increase fat Provide appropriate Vitamin E and possibly Selenium

o Exercise: Turnout as much as possible – no more than 12 hours in stall Provide daily, controlled exercise


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Credit: University of Minnesota Equine Center, College of Veterinary

Medicine, Neuromuscular Diagnostic Laboratory

Supplements to Consider for PSSM

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Pure Fat Vitamin E, Selenium, Magnesium

Adaptogens

Hyperkalemic Periodic Paralysis (HYPP)

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What is it?• Dominant inherited trait affecting Quarter Horses, Paints, Appaloosas and

Quarter Horse crosses worldwide• Caused by a defect in the skeletal muscle sodium channel• 1992: It was publicly linked to a popular Quarter Horse sire named

Impressive• 1996: AQHA officially recognized HYPP as a genetic defect or undesirable

trait• 1998: Mandatory testing began for foals descending from Impressive• 2007: Foals born this year or later that test homozygous will not be eligible

for registration


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What does it look like?• Intermittent signs first appear at 2-3 years of age• Episodes begin with muscle rigidity and possible third eyelid prolapse• Horse then develops sweating and muscle tremors, especially in the flanks,

neck and shoulders; may spread throughout body• Horse may develop severe cramping or muscular weakness• Horses generally remain standing during mild attacks• During severe attacks, horse may sway, stagger, dog sit or lie down• Horse may have elevated heart and respiratory rates, anxiety • Episodes usually last between 15-60 minutes• Death may occur due to respiratory distress


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How is it managed?• Limit Potassium (K) in the diet!

o Aim for 0.6-1.5% of total dieto No more than 33g of K per meal

• Dietary triggers to avoid:o Alfalfao Molasseso Electrolyte supplementso Kelp supplements

• Pasture turnout is ideal because of high water content in grass (and exercise)• Feed later cuts of Timothy or Coastal Bermuda Hay (least amount of potassium)• Beet pulp and cereal grains like oats are also a good choice• Have grass and hay analyzed for potassium content • Or, provide a commercially available complete feed


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High Potassium Feeds (>2% K)

Medium Potassium Feeds (1-2% K)

Low Potassium Feeds (<1% K)

Electrolyte Supplements Rice Bran Pure Fats, Oils

Molasses Timothy Hay Beet Pulp

Kelp Supplements Coastal Bermuda Hay Corn, Oats, Barley

Alfalfa Hay Kentucky Bluegrass Hay Wheat

Canary Grass Hay Oat Hay Wheat Bran

Orchard Grass Hay Fescue Hay Soybean Hulls

Soybean Meal -- (Flax Seed)

Credit: Dr. Sharon Spier, AAEP Annual Convention


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How is it treated?• Administer acetazolamide orally every 8-12 hours as a

preventative• Immediate treatment during an episode may include:

o Owner Options: Light exercise Grain or corn syrup

o Veterinary Options: Acetazolamide Calcium Gluconate Dextrose Epinephrine

Supplements to Consider for HYPP

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Pure Salt Antioxidants

Adaptogens Appropriate Muscle Formulas

Questions & Answers

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Questions1. What type of feed/supplements are good for horses with PSSM? 2. What are the breeding concerns when contemplating breeding a EPSM horse? 3. A client believes these to be signs of PSSM in her horse: Droopy lip, glazed

eyes, frequent urination. These are new signs to me. Can you please confirm? No other typical weakness is evident. Thank you!

4. My QH gelding is HYPP N/H. What is the best feed and exercise regimen to keep him healthy?

5. Can you please suggest management best practices for horses with PSSM that are also overweight?

6. I've been using DMG for my HYPP N/H mare for a few months. I've seen a significant difference in her comfort, especially in her sensitivity to touch/being cold backed. Is it safe to give my mare DMG long-term?

7. Is SmartBug Off safe to use for my HYPP horse? Currently he is on MSM, Cosequin, SmartGut & Quietex. Thanks!

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Questions8. Are muscle disorders genetic? What supplements support good muscle

development if a horse has developed a problem around age 7? 9. Are certain horse stretches helpful for horses with PSSM? Is there harm in

feeding a PSSM horse a high protein diet? How does a diagnosis of mild PSSM (in 5 year old warmblood) affect the horse's life expectancy/quality of life if managed well? Is there any long-term damage?

10. My recently purchased Arabian horse just tied up for the first time the other day. I didn't really know of this condition until it happened. I saw 5 supplements to help this. Wondering what's best to help prevent this from happening again?

11. Is tying up chronic? or random?12. My horse tied up this past spring. I am still trying to determine why. She is

not the nervous type. I feed Omolene 100. I do not use supplements. Could it come from the extra protein in the spring grass? Bloodwork showed enzyme level of 6000.

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Questions13. Could you please explain any muscle changes that occur in older horses and

how to work with those changes in my riding? My horse is 19 years old. 14. Can you please talk about EPSM and feeding to keep those horses safe that

haven't been tested but are prone to developing symptoms of this disease?15. Can you explain why an illness, particularly with a fever, causes PSSM which is

otherwise well controlled, to flare up? 16. How does the age of a horse relate to muscle disorder possibilities? 17. My horse has a lack of muscle tone on either side of his hip in the thigh area.

Can this be due purely from a lack of work? He moves great and isn't lame but lacks muscle tone in this area.

18. Is there a way to determine in advance if a horse is prone to a muscle disorder? 19. I have a 9 yr old mare that ties up (seems to be more stress related). She has

been tested for PSSM and was negative. I have changed her diet to no alfalfa, low carb/sugar, I add vit e and se, but still see this happening. Any advice?

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Questions20. I have 4 yo Perch/Paint cross that is 17hh. He has developed a upward fixating

patella. Is this a result of his large size and a growing spurt? or is it an early sign of PSSM (since he is a draftx). Should I change his diet?

21. How to treat a horse that is tying up on the road. How long do you need to keep the horse stalled after the incident?

22. Does PSSM have significant varying degrees of severity and does it wax and wane in an individual horse?

23. How does this correlate with Cushings?

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Thank you for attending our Webinar!Have additional questions?

Please visit us at SmartPak.com

Call us at 1-800-461-8898or

Email us at [email protected]

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Muscle disorders webinar may2012 final-7pm

Lifestyle

o exercise

methocarbamol o

days o

balanced o

o sporadic tying

o stall rest

classic signs o blood

intravenous o dantrolene