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Blood work questions about suspected PSSM horse

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  • Blood work questions about suspected PSSM horse

    Questions about bloodwork: just received Bella's lab report, it's the weekend so I don't want to call the vet until Monday, but wondering what it all means?

    Glucose 25 should be 60-125 LOW
    CPK 350 should be 100-350 HIGH
    LDH 654 should be 150-450 HIGH

    Is this standard in a PSSM horse to see these abnormalities? Does anybody have experience with this?

    I sent off the mane DNA test to confirm PSSM but that won't be back for over a week. Bella is on a special low starch/high fat diet. She is just recovering for an undiagnosed left front lameness of 4 weeks duration which came on suddenly after a diet change to lower her NSC consumption.

  • #2
    I don't know about the test results, but what breed is she? I was told (and the U-Minn website seems to confirm) that only certain breeds can be diagnosed via hair testing. Other breeds (TBs for sure) have to have a muscle biopsy.


    • #3
      Depends on when the blood work was pulled. I think 4 to 6 hours after an "incident" is when you would expect the CPK to be over 1000 on some EPSM horses. Some never have abnormal blood work, but can still have EPSM discovered via muscle biopsy. And yes, the hair test seems to apply only to certain breeds/type of EPSM.


      • Original Poster

        She is a Belgian/QH x, so we started with the DNA test, if that is negative, we go from there to the muscle biopsy.

        There was no "incident" before this blood work, just a normal non working day.


        • #5
          Then a bit on the high side, but not terribly so. Any other symptoms?


          • Original Poster

            Sorry this is long, but I figured you wanted to know everything so here it is:
            Overall goal: I suspect PSSM and feel Bella’s long term health is at stake, I need guidance with her diet. I bought her as a performance horse prospect for low level jumping and eventing, and we are having trouble getting to that goal. She needs to lose weight, and iron out all these physical problems she is having. This is a young vibrant mare that I love and I REALLY want her to be my performance horse but at this point until I get her diet straightened out she physically CANNOT do it. I keep trying different things hoping to hit on the right combination. When she came to me 2 years ago she was on Purina Healthy Edge. I have tried to take her off this feed which is 17% NSC twice now, each time I switched to a lower NSC feed she developed different alarming symptoms, once she began cross cantering constantly (Seminole Feeds product that was low in Selenium), back on HE, everything OK again; tried to cut down NSC by switching her to Purina Enrich 32, she began having joint popping noises so bad she sounded like an orchestra! Back to HE, everything normal for her again but she still can’t canter well, and still I know that feed is not right for her. So now for the 3rd try dropping the HE and trying Timothy pellets and Barn Bag . Within 2 weeks of that diet change, she mysteriously pulled up front end lame showing severe lameness on front left, also seemed to have dimpling on shoulder area, when I pressed into her shoulder that 1st day her knee would quake; in following days she exhibited swelling to above fetlock, soreness to hoof testers, pointing to relieve pressure. Trainer & I agreed abscess, launched soaking and Ichthamol wrap nightly for 5 days but it went on for over 3 weeks with only slight protrusion ¾ way up hoof wall with no clear expulsion of the “abscess”. Although getting slightly better, called in a vet, Dr. Malone for lameness exam by the time he arrived (4 weeks into lameness) she was trotting sound again. Nutritionist feels she may have been getting too much selenium so we pulled blood test for that plus general blood profile with CBC/Diff, and are sending in a hair sample for PSSM testing.

            Bella’s symptoms:
            Hard muscles across the back and hindquarters
            Very girthy
            Dislikes being groomed
            Difficulty holding up hind feet for cleaning, farrier, especially right hind
            Has displayed serious spasming in the front opposite shoulder while farrier works on front feet
            Hits lip of stall with hind feet on entry
            Doesn’t want to go forward under saddle/balky
            Holds her nose to the ground during lounging
            Unable to hold canter consistently, breaks canter around turns
            When she breaks at canter it is due to an odd “hop” in the back end, like something has locked up
            (I will add more as they come to mind)
            These symptoms come and go on a daily basis, and are not consistent except for canter problems

            Current corrected diet fed 2x daily: Began this diet appx 4/25/13
            5 heaping spoons of beet pulp soaked with water
            1 cup canola oil (8 pumps)
            2# Timothy Hay pellets
            1 scoop Quiessence
            ¼ cup Barn Bag
            3-4 flakes of coastal hay outside PM, pack as much coastal in black haynet as will fit for inside while locked in AM.
            Out on poor pasture without muzzle 12-15 hours daily

            BIG changes in relaxation of muscles within a week of change to this diet. Left front lameness occurred on 5/11/13, vet agrees possible PSSM and pulled the blood work and DNA test sent in 6/5/13.


            • #7
              Certainly sounds like an EPSM horse! I think the front leg issue is unrelated. The Friesian we had actually lost weight once he was up to 2.5 cups of oil. Since it is early, you could try ALCAR as I would love for it to be the better alternative.

              We have found a course of Gabapentin can help some of the chronic muscle soreness that doesn't resolve with just the diet change.
              Last edited by candico; Jun. 10, 2013, 12:15 PM. Reason: .


              • Original Poster

                Bumping up: concerned about the glucose level of 25, per nurse friend glucose below 40 would indicate immediate IV glucose supplement due to the fact that the brain may not be getting enough glucose to function?

                Horse looks fine and normal for HER. What do you guys think about this? Test came from vet's office via mail with no phone call indicating this was a problem? I guess it is possible his admin staff received it and never showed or discussed it with him? I rode the mare Friday night with no problems showing except her usual sporadic hind end "hitch" which really wasn't even bad at all. Gave her yesterday off, back to the barn now for leisurly quick trail. More info later.

                Do you think it was a false reading? Or do the PSSM horses always show this low a glucose level?


                • #9
                  I'm not sure on the glucose level, but I would definitely call the vet first thing Monday to get their take.

                  Your horse does sound like an EPSM horse to me, and the fact that a high fat diet is improving the situation is a big indicator. I'd think you would want to work up to more oil and also supplement vitamin E (I give 5000 IU in the human gel capsules - just make sure it is the natural kind (a-tocopherol instead of al-tocopherol)).


                  • Original Poster

                    Vet says regarding glucose level: "They all come back like that"

                    Seriously? Is this a false reading or something? Or is it NORMAL for a horse to have a reading that low (even though test guidelines say NOT)?

                    Very confused!


                    • Original Poster

                      Blood sugar reading explanation: After pulling blood from the horse, normal bodily functions continue inside the blood. If the blood is not put through a centrifuge immediately, the red blood cells consume the glucose in the blood; hence the super low reading, the longer the blood stays unseperated or unrefridgerated, the lower the reading will go.


                      • #12
                        Originally posted by outfoxem View Post
                        Blood sugar reading explanation: After pulling blood from the horse, normal bodily functions continue inside the blood. If the blood is not put through a centrifuge immediately, the red blood cells consume the glucose in the blood; hence the super low reading, the longer the blood stays unseperated or unrefridgerated, the lower the reading will go.
                        Thanks, that is great information to know. Keep us updated!


                        • #13
                          The cross-cantering and hitch could be unrelated to the EPSM as those can be symptoms of a stifle problem such as intermittent upward patella fixation. Perhaps your vet should watch your horse canter on the lunge line to watch for the stifle locking?


                          • Original Poster

                            Originally posted by sweetiemcdee View Post
                            The cross-cantering and hitch could be unrelated to the EPSM as those can be symptoms of a stifle problem such as intermittent upward patella fixation. Perhaps your vet should watch your horse canter on the lunge line to watch for the stifle locking?
                            I agree. However, the EPSM mimics this stifle problem. When the mare is in regular work, this goes away. Is that also a stifle symptom?


                            • #15
                              Originally posted by outfoxem View Post
                              I agree. However, the EPSM mimics this stifle problem. When the mare is in regular work, this goes away. Is that also a stifle symptom?
                              Can certainly be, usually once they are more fit=less locking/catching. How'd the DNA test come back?


                              • Original Poster

                                DNA test for PSSM type one came back N/N. This is NOT conclusive however, next step muscle biopsy.

                                Rode my mare last night, she was forward (for her) at the trot, willing to canter but unable to hold it for me longer than about 150 feet, ending in a weird hop/kick that is preceded by a whole body bend/stiffening that is hard to describe.

                                I guess it is possible that she has BOTH PSSM and stifle problems as well. I am a firm believer in taking ONE step at a time when attempting to fix a problem, otherwise it's nearly impossible to tell which treatment fixed the problem.

                                This is just SO discouraging. With over 35 years horse experience I am relegated to walk/trot work when I could be....well, you name it. I do love this horse and she is SO steady in so many other respects I am just not ready to give up on her but this is a TOUGH journey.


                                • #17
                                  Originally posted by outfoxem View Post
                                  Vet says regarding glucose level: "They all come back like that"
                                  Because he probably doesn't separate the serum from the whole blood for many hours. The RBCs (red blood cells) in whole blood continue to consume glucose. Low glucose values are common when blood is drawn by ambulatory vets unless they have a centrifuge on their truck (few do).

                                  The CPK isn't very high and apparently is within normal parameters for the lab you used.

                                  Has your horse been tested for HYPP? Any foot films (x-rays)?


                                  • #18
                                    This sounds very familiar - I have an upper level dressage horse we suspect has EPSM - first to sweat in heat, tied up twice and started out with a hitchy, uneven gait, losing hind end muscle, etc. My vet recommended changing the diet prior to a muscle biopsy to see if there was a change. I talked to several experts and ended up creating a feed program that guarantees 25% of calories from fat and as little sugar/starch as possible. If you want to try it - I think it ended up being 4-5 lbs of Omegatin per day (this is 25% fat and very low starch but you can only feed up to 5 lbs), 4-5 lbs of Wellsolve LS - this is low starch but doesn't have enough fat and cocosoya oil (can't remember - maybe 1 cup?). Noticed a difference after a couple weeks but was told it would take 4-6 months for the damaged muscles to regenerate. It's been about 7 months for me and my horse has put on the muscle again and regained strength. We haven't had anymore issues and he doesn't start out hitchy or uneven anymore. It's amazing to me what a difference the diet has made - would keep playing with this if I were you.


                                    • Original Poster

                                      Originally posted by rcloisonne View Post

                                      Has your horse been tested for HYPP? Any foot films (x-rays)?
                                      Sire was QH, dam was Belgian/Paint cross. I guess the HYPP could be on the dam's side. I wouldn't think AQHA would allow a stallion with HYPP to breed, right? What makes you question this, curious.

                                      What would we be looking for on hoof xrays?


                                      • #20
                                        I have a horse who we suspected pssm or Epsm due to most of the symptoms you listed. She had an episode like tying up, I had the blood pulled and also said to check for IR, and she is IR.

                                        i eliminated all extra fat, upped her Thyro l, found a way to make her accept a grazing muzzle. Which was cutting out the area covering her nostrils, and she feels much better. She is also at least 100 lbs lighter.