Odd symptoms and tests - ideas needed

So, my mare was scheduled to have her second gastroscope on Monday to make sure her ulcer problem is resolved. She has been improving in both her body condition and attitude towards work. On Wednesday, all of the sudden, she threw a fit with my trainer: wouldn't move, started kicking and wanting to lay down while ridden. We immediately saw something was wrong and took her in. I called the vet and we had some bloodwork done.

Her liver and kidneys are normal. She does have increased levels of creatine phosphokinase (CPK) and AST (I have no idea of what that stands for). I've sent the results to the best vet I know (who unfortunately is too far away to take a look at her himself) and I'm waiting for his feedback.

She is clearly uncomfortable, and I am worried about her. I had the terrible idea of googling CPK and apparently it can indicate heart issues.

Has anyone ever experience anything like this?

Jingles needed.

I had a horse that had high cpk, creatine levels. It was just normal for him to run higher. He lived to be 36 and i had to put him down for other reasons but he lived q full great life. Don't scare yourself with google. I tend to do that sometimes to lol. Just wait for the vet and see what they think. Have you tried to ride her again? Is it just under saddle? Or is she uncomfortable all the time? If just under saddle did you check the girth?

AST is aspartate aminotransferase, and it is found in several different tissues.
Elevations in both CPK and AST frequently indicate muscle damage, as in tying up to one degree or another.

I was going to say the same thing as Ghazzu, sounded like tying up to me. Many different reasons for it, some to do with diet and interrelated genetic predispositions. The Australians have a study that indicates some fairly interesting indications of mineral deficiencies. I would not bother speaking to the vet about that because for the most part they are not interested in anything but the US literature unless they are particularly well rounded and well read in current literature internationally.

Right. Best not to even inquire--simply assume your veterinarian isn't interested...that's a productive approach.

Usually they are not, in my experience, unless they are as I stated before. A handful even want to try new hypothesis, surely you must have experienced this, it is not just relative to the veterinary profession, I find it fairly across the board in all professions. Once that sheepskin is obtained, (with considerable faulty types of conceptual education) the "brot gehlerten" (bread learners) are usually not interested in a previously unthought of thought.

Years ago, I worked at what is now Hagyard Equine Institute in the lab, and these results point toward a horse that is tying up, aka muscular damage. I would worry more about her back and trunk muscles than her heart.

Jingles sent. Keep us posted.

Still waiting for the vet to give me a call. He sent me a text earlier telling he's handling and emergency but will call as soon as he has the chance to look at the results.

Other than the reluctance to move, her only other symptom is discomfort in the abdominal area (as in, don't groom me or touch me or I'll bite and kick). But she is by herself a bit skittish so it can e completely unrelated.


Thanks for the support. I'll post as soon as we know more.

Absolutely consider that your mare has EPSM. If this is the one with lack of muscle and ulcers, both common in EPSM horses, this could solve your conditioning issues.

http://ruralheritage.com/vet_clinic/epsm_summary.htm

Yep, it's the same horse. And the description actually fits her 100%.

Just googled Epsm (yep, did it again) and it sounds bad...

Not great, but have heard of a few Grand Prix horses with EPSM. Just a PITA as far as management - messy oil in feed and daily exercise, 24/7 turnout is best. I think the Grand Prix horses do okay because they are vigilant with exercise and diet. Vets tend to know little as there really isn't any "pharmaceutical" that can be prescribed for it.

Great that you caught it fairly early - most people just go through a lifetime thinking they have a "difficult" horse and just try to beat the bad behavior out of them. I think many get bred because they show enough moments of brilliant potential, but difficult to progress in the training hence go into the breeding shed.

Just got off the phone with the vet, he's pretty sure it's EPSM. I'm sending her to his clinic on Monday so he can figure out the recipe for her well being. His daughter is one of our top Grand Prix riders and she'll be riding her meanwhile.

I'm hoping this will be the end of our issues. It's been a real rollercoaster.

And that's the thing. Lorraine is one of the most talented horses I've seen in a while, and my trainer agrees. I'm hoping I won't have to retire her to breeding, it would be a waste of a great horse.

Currently, the consensus is that it is 100% inherited from the mare, I believe. Some offspring might have less symptoms/degree of muscle damage, but quite the risk in the delivery as well as many mares tie up with the muscle strength needed to deliver a baby. My EPSM mare is a gorgeous flaxen chestnut roan that is a dream to ride and just floats around the ring when her symptoms are managed, but I won't breed her unless they find a better "cure".

Hope the added fat to her diet will turn her around. A search here should help you find ingredients to work with. And don't be afraid of the oil - mine need up to three cups a day for third level dressage work. Seems like a lot, but if you find the right medium to soak it up, it's not sooo messy... I use two pounds presoaked hay pellets which then fluff up, then add oil, twice a day, plus Vit E, magnesium, and Tri Amino seems to help as well. Also, careful slow, patient warm up, incrementally increased exercise, lots of turnout, and careful with days off though mine do fine with a few days lost due to weather if I'm careful not to overdo it the first day back.

Is there any specific genetic test you can do?

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Originally Posted by Calamber

Usually they are not, in my experience, unless they are as I stated before. A handful even want to try new hypothesis, surely you must have experienced this, it is not just relative to the veterinary profession, I find it fairly across the board in all professions. Once that sheepskin is obtained, (with considerable faulty types of conceptual education) the "brot gehlerten" (bread learners) are usually not interested in a previously unthought of thought.

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Funny--the CE meetings I attend are usually packed.
At the state VMA meeting this past winter, we kept the speaker in the large animal track for an hour past when she was supposed to be finished.

When I attend one of the larger meetings, I feel like a kid in a candy store--there are so many options, I don't know how to choose.

Oddly enough, there are a large number of other veterinarians there...

Not sure about genetic testing per se, but since she is already going to the clinic a muscle biopsy is best as the hair test only catches one type. Be sure to never send your mare to a hospital in the midst of a tying up episode as the trailering can be extremely hard on them - a recent study in Spain, perhaps? showed some gruesome pictures of horses and ponies at clinics with the conclusion that it is better to treat them at home. It wouldn't hurt to start some fat supplementation right away and hopefully the clinic is not too far. Many horses have their first major episode after a super long trip or after a plane ride across the "pond". I have heard so many people complain that their horse was never the same as when they tried them out in Europe, etc where generally they have much more turnout/exercise which keeps the symptoms to a minimum.

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Originally Posted by candico

Currently, the consensus is that it is 100% inherited from the mare, I believe.

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Can you point me to a reference for this?

100% maternal inheritance is possible in only a very limited set of genetic circumstances - such as a mitochondrial disorder.

Even if it were an autosomal dominant gene on the X chromosome, the condition would be likely to present only in male offspring (unless female offspring also carried the EPSM-affected gene via the sire's X chromosome). So the odds of inheritance would vary, but would likely be much lower than 100%.

In any case, my understanding is that they've actually identified a causal variant in a gene in nuclear DNA (not mitochondrial DNA) that is responsible for ~80% of cases. This would mean that it is inherited in a straightforward, Mendelian fashion (ie, not 100% maternal inheritance).

I won't even pretend to be knowledgeable in genetics, but I think it was either a question posed to Dr. Valentine or a study done on a breeding farm by Valberg. This was probably more than a few years ago that I read this so they might think otherwise now, but my own vet seems to believe the same.

I know of the three offspring out of my mare, who only got diagnosed as she tied up during her third delivery, all three had EPSM although different sires, vastly different types of symptoms, and one mare, two geldings. Unfortunately, I had no idea as the first offspring only got diagnosed after I bred the third and never saw major symptoms in the mother. Just slightly finicky to shoe behind, and some bucking early on if not warmed up slowly. Sounds like it was passed down in the maternal line as the offspring via my mare's sire have never come up as having these type of issues nor when I look at the paternal siblings of the ones I bred. The maternal grandmother did have odd hind end issues and bucking fits.

If the sire does need to carry it as well, I think we are a long way away from stallion owners testing for it. Seems to affect pretty much every breed with some at a much higher percentage, so not sure breeding is worth the risk yet with 1 of 3 light breed horses and 2 of 3 draft with it, I don't think it will ever be eradicated. Those who are only mildly affected will probably go through a lifetime undiagnosed and unhindered by it. Perhaps someone will chime in with a mare biopsied with and offspring biopsied without. Unfortunately, most wouldn't do the biopsy unless the offspring showed the more limiting symptoms and I found most to be older before diagnosis so often out of the hands of the breeder.

From a quick read on some recent articles, the blood-hair genetic test can tell you whether your horse is pos/pos, pos/neg, neg/neg for type 1 EPSM. Sounds like warmbloods could be either type 1 or 2. It is a dominant autosomal trait, and if your horse has it, there is a minimum of 50% of the offspring inheriting it. To be clear, as far as type 1, only one parent has to carry the gene, and if they are homozygous you are 100% passing it down. Sounds like they do not know yet the gene which causes type 2... Please correct me if you find I misread, as I swear Valberg and Valentine do seem to have different statistics, etc. especially on the reliability of the genetic test. Too bad warmbloods aren't all type 1, as you could "steal" 20 hairs off the stallion that interests you - not suggesting you do this, but hypothetically???

To the OP, EPSM is challenging, but not typically career ending. Career shortening perhaps, but not ending. It takes intensive and consistent management, and it sounds like you're the right kind of person to be faced with that. (meaning that you con across very on the ball, proactive, and intelligent)

The few horses I have known with EPSM returned to their full potential once their diet was appropriately adjusted. In both cases, their careers were shortened, but they were happily retired and remained sound and happy for flat work for many, many years after the fact.