Muscle disorders webinar may2012 final-7pm


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Learn how nutrition, supplements, exercise and other management practices can help with Tying Up, PSSM and HYPP in horses.

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  • Picture: Any active performance horse, any discipline
  • More content and organization to come, may not have room for picture
  • Picture: a trail rider (recreational or competitive, even an endurance rider) would work here
  • Picture: a trail rider (recreational or competitive, even an endurance rider) would work here
  • Picture: maybe a vet picture? Can be one of me or a different one
  • Picture: may not need one on this slide, if want one suggest one that speaks to one of bottom five suggestions
  • Picture: a racing TB would be ideal
  • Picture: another vet picture, drawing blood would be awesome (this one of me is okay)
  • Picture: may not have room for one here but if do, recommend speak to one of three suggestions at bottom Find Joe Pagan Chromium research (racing TBs)
  • Picture: horse in stall looking down aisle
  • Picture: QH, draft horse or warmblood Should this be separated into Type I and Type II (like SER and RER)? Want to mention the article in a recent Equus?
  • Picture: definitely a QH
  • Picture: draft horse or warmblood (doing dressage but nobody famous)
  • Picture: Newman in the paddock is a good example of the second to the last point; the picture of me lunging Newman is a good example of the last point
  • Picture: none needed for this slide (which I’m hoping Jno can reformat)
  • Picture: A picture of the halter stallion Impressive would be ideal
  • Consider adding video clips to this webinar to demonstrate an HYPP episode (and perhaps tying up, PSSM, shivers) Picture: may not have room for one, but if so, definitely a quarter horse (probably hard to get one of horse during an actual attack)
  • Picture: hay and/or grain would be best
  • The entire ration should contain less than 1.5% potassium, with each meal having less than 33 grams of potassium.
  • Picture: hay and/or grain would be best
  • Do we need a Summary slide? It seems to end rather abruptly.
  • Muscle disorders webinar may2012 final-7pm

    1. 1. Understanding Equine Muscle Disorders Lydia F. Gray, DVM, MA Medical Director/Staff Veterinarian Jessica Normand Senior Director – SmartSupplements™ May 16, 2012
    2. 2. Your Presenters 2
    3. 3. Agenda• Overview of Muscle Disorders• Tying Up• PSSM• HYPP• Questions & Answers 3
    4. 4. 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. HYPP 2. Type I PSSM 3. Malignant Hyperthermia (not discussed in this webinar) 4
    5. 5. Exertional Rhabdomyolysis aka “Tying Up” 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 5
    6. 6. Tying Up: Sporadic Exertional Rhabdomyolysis (SER)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 level o Injury from repetitive motion o Heat exhaustion o Dietary imbalances o Electrolyte imbalances 6
    7. 7. Tying Up:Sporadic Exertional Rhabdomyolysis (SER)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 signs o Blood work o Urinalysis 7
    8. 8. Tying Up:Sporadic Exertional Rhabdomyolysis (SER)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 intravenous o Dantrolene for muscle relaxant, methocarbamol o Do not administer diuretics (i.e. Lasix)• Management: o Stall rest and hay only for a few days o Gradually increase time and size of turnout, add hand walking o Resume training when blood work is within normal limits o Ensure diet is complete and balanced o Consider supplements: Electrolytes, Vitamin E, possibly Selenium 8
    9. 9. Tying Up:Recurrent Exertional Rhabdomyolysis (RER)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 9
    10. 10. Tying Up: Recurrent Exertional Rhabdomyolysis (RER)What does it look like?• Signs: o Muscle stiffness o Short strides o Shifting hind limb lameness o Elevated heart and respiratory rates o Sweating o Firm & painful hindquarter muscles o Reluctance to move that lasts for several hours• Diagnosis: • Additional tests o History, risk factors, classic clinical signs • Exercise challenge test o Blood work • Muscle biopsy o Urinalysis 10
    11. 11. Tying Up: Recurrent Exertional Rhabdomyolysis (RER)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 intravenous o Dantrolene for muscle relaxant, methocarbamol o 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 11
    12. 12. Tying Up: Recurrent Exertional Rhabdomyolysis (RER)• Additional Management Strategies for Racing Thoroughbreds o 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 12
    13. 13. Supplements to Consider for Tying Up Electrolytes Specialty Muscle Formulas Chromium Vitamin E, Selenium, Magnesium 13
    14. 14. Polysaccharide Storage Myopathy (PSSM) 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) 14
    15. 15. Polysaccharide Storage Myopathy (PSSM)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 15
    16. 16. Polysaccharide Storage Myopathy (PSSM) 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 16
    17. 17. Polysaccharide Storage Myopathy (PSSM)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 17
    18. 18. Polysaccharide Storage Myopathy (PSSM)   Credit: University of Minnesota Equine Center, College of Veterinary  Medicine, Neuromuscular Diagnostic Laboratory 18
    19. 19. Supplements to Consider for PSSM Pure Fat Vitamin E, Selenium, Magnesium Adaptogens 19
    20. 20. Hyperkalemic Periodic Paralysis (HYPP)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 20
    21. 21. Hyperkalemic Periodic Paralysis (HYPP)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 21
    22. 22. Hyperkalemic Periodic Paralysis (HYPP)How is it managed?• Limit Potassium (K) in the diet! o Aim for 0.6-1.5% of total diet o No more than 33g of K per meal• Dietary triggers to avoid: o Alfalfa o Molasses o Electrolyte supplements o 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 22
    23. 23. Hyperkalemic Periodic Paralysis (HYPP) High Potassium Feeds Medium Potassium Feeds Low Potassium Feeds (>2% K) (1-2% K) (<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 23
    24. 24. Hyperkalemic Periodic Paralysis (HYPP)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 24
    25. 25. Supplements to Consider for HYPP Pure Salt Antioxidants Adaptogens Appropriate Muscle Formulas 25
    26. 26. Questions & Answers 26
    27. 27. 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. Ive been using DMG for my HYPP N/H mare for a few months. Ive 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! 27
    28. 28. Questions1. Are muscle disorders genetic? What supplements support good muscle development if a horse has developed a problem around age 7?2. 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 horses life expectancy/quality of life if managed well? Is there any long-term damage?3. My recently purchased Arabian horse just tied up for the first time the other day. I didnt really know of this condition until it happened. I saw 5 supplements to help this. Wondering whats best to help prevent this from happening again?4. Is tying up chronic? or random?5. 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. 28
    29. 29. Questions1. 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.2. Can you please talk about EPSM and feeding to keep those horses safe that havent been tested but are prone to developing symptoms of this disease?3. Can you explain why an illness, particularly with a fever, causes PSSM which is otherwise well controlled, to flare up?4. How does the age of a horse relate to muscle disorder possibilities?5. 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 isnt lame but lacks muscle tone in this area.6. Is there a way to determine in advance if a horse is prone to a muscle disorder?7. 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? 29
    30. 30. 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? 30
    31. 31. Thank you for attending our Webinar! Have additional questions? Please visit us at Call us at 1-800-461-8898 or Email us at 31