Cannot figure out what is wrong with 4 yo horse

[led18]

WE ARE STRUGGLING TO FIGURE OUT WHAT IS WRONG WITH HIM (Sorry for the long post, but there is so much to relay)

• I have an imported (from Ireland) 4 yo ISH. He was briefly in PA (June), then moved to SC (July) to be in a training board program with an upper level eventer given I lived out of state. At this farm, I discovered that he did not have access to any grass due to overgrazing, so I had him on 5,000 IUs of Vitamin E (powder to start, per vet recommendation).

• He was immediately struggling to put on some weight/muscle, but I think that was likely tied to the nutrition program at the barn (not getting enough calories or roughage). He also had occasional loose stool and constant fecal water.

• As time went on, he would have periods where he was going really great and then periods where he was simply not wanting to move forward/work, would kick out under saddle, and was very girthy. Without scoping, I just assumed ulcers and treated with omeprazole and sucralfate (per vet guidance).

• He continued to struggle to come through his back, release his neck and had some serious knots in the muscles where his neck meets his shoulders/body. He was getting regular body work (massage and chiro) to work through this, but didn’t seem to be getting much better.

• He was indicating that something might be wrong: poor topline development, poor muscling of neck where meets body, lack of energy (after all he’s 4!), tripping, girthiness, loose stool/fecal water, kicking out/bucking during canter and more. The signs have progressively gotten worse over time.

• Given his age, the trainer thought it might help him to have some time off. So he went from roughly 5-6 days of work per week (July-mid November) to getting thrown out in a pasture (with no good grass) with another young horse for 6 weeks to grow (mid-November-late December).

• Due to concerns around the nutrition program and lack of access to grass and enough forage, I moved him to a new barn in late December that offers free-choice, high-quality hay and ample turnout (although the grass is dormant down here right now).

• He was brought back into light work for a few sessions… and then he had a “minor” tie-up episode in early January.

• I immediately wanted to look at his Vit E and Selenium levels after the tie-up, as that was the first time I knew of that happening to him. His Vitamin E was VERY low (202), but Selenium was normal. Working alongside my vet, we added in Nano-E (10,000 IUs/day given his levels were so low) in hopes of getting his levels up. I assumed it was so low due to no access to grass and limited forage at former barn. Out of caution around a muscle issue, we have kept him on the dormant grass (vs. rye), even though the green, rye grass would likely help his Vit E levels.

• I switched him to KER Re-Leve after his tie-up, as a precaution and per consultation with my vet. Robaxin (muscle relaxer) was also added into his regime 2x/day, per vet guidance.

• We tested for PSSM1 and Lyme… both came back clear/negative.

• For added fat, I added in KER EO-3. He is already starting to put more weight on, but the palatability of Re-Leve or EO-3 doesn’t seem great as he is less interested in his grain.

• We also started focusing on ensuring he gets as much time turned out (14+ hrs/day) and keeps moving. That has involved mostly tack walking, hacking and a little bit of trot/canter here and there (NO JUMPING since one time in December w/other trainer).

• Instead of getting better with the diet/nutrition changes and exercise changes, he has progressively been getting worse over the last two weeks. Now, he is stumbling over a single pole (when he was jumping in December), trips when walking, and struggles to keep the canter or bucks/kicks out. I am not even riding him anymore beyond tack walking to keep him moving. He does not appear lame. He has went from a horse with crazy hind legs (great hock action), to one that drags his toes and trips.

• I had him scoped last week and he has a few bleeding ulcers, and we are treating that, per vet guidance with Gastrogard and Sucralfate. Vet does not believe this is the primary cause of his issues (nor do I). Also worth noting he drinks a lot of water and pees a lot.

• We have ruled out poor fitting tack, as I have consulted with many saddle fitters. We ruled out teeth issues, as he was just done.

• Vet and my trainers (FEI level dressage and 5* eventer) do not believe this is training/behavior related, nor do I. He is the sweetest horse.

PLEASE HELP. We are planning to do a full neurological and lameness exam on Thursday. From my understanding Vit E deficiency, especially at his level, wrecks havoc on their body and can cause things like tie-ups, neurologic behavior, but getting those levels up will take a lot of time. My thinking is to rule out: EPM, PSSM2, or a Trauma possibly while in the pasture for 6 weeks, as his extensive PPE (including neck, back, joint, leg, etc. x-rays) was clean upon importing.

[IPEsq]

How long was he in PA? Maybe add Lyme to your tests too?

[led18]

@led18

He was in PA about a month. Tested for Lyme and that was negative.

He was in PA about a month. Tested for Lyme and that was negative.

[Highflyer1]

EPM and EDM would be my first thoughts.

[Dbliron]

PSSM2. MIM or RER or a combination of both.

[Amberley]

Definitely test for EPM. Do the full neuro and talk to the vet and go from there. Perhaps neck x-rays are on the table, or checking wolf teeth or ? Also Robaxin is a CNS and some horses (and people) are a lot more sensitive to it, ask your vet.

As far as not thriving: if he’s from Ireland he likely grew up on grass year round or maybe some haylage + grass in the winter. He was likely backed and VERY lightly worked but had no real fitness and didn’t spend much time in an arena. He’s likely never seen a day or 80 degree weather in his life or had hard feed other than ration balancer. Moving to the south in July, with their hay and no grass and being ridden 5 days a week has likely been a huge shock to his system. If he’s got draft he’s going to be slow maturing, I wouldn’t expect much from a 4yo TIH. It’s a lot of change for a young one.

[Sarah616]

EPM would have been my first go to, with a horse coming from Europe to the East Coast, especially the mid-Atlantic region, where mild cases of EPM are so prevalent. Horses in Europe aren’t exposed to it, so it has a tendency to hit them when they come over.

[Posting_Trot]

PSSM (either version) was what I was initially thinking as I read your first post, then saw that you’d ruled one version out. But it still makes sense to test for the other version. The Vitamin E level would also concern me, especially after you’ve tried aggressively to bring it up. I know you said that you tested for Selenium deficiency, but it might be worthwhile to try adding a little selenium to the diet (not a crazy amount, just add 1 or 2 mg) and see if that helps.

And what about magnesium? Adding 10,000 mg wouldn’t hurt him and might be useful. Your vet might tell you that few horses have a magnesium deficiency, but there’s a ton of anecdotal evidence that suggests that it can be helpful with muscle issues. Again, it won’t hurt and it might help.

Good luck!

[led18]

I have not yet added in additional magnesium. Was planning to add that + some amino acid support after the PSSM2 muscle biopsy.

[SBrentnall]

Do the x-rays for ECVM. These are typical symptoms.

[Critter]

The neuro stuff to rule out is ECVM (or SI nerve compression), MFM, Lyme, EPM and EDM. You already ruled out Lyme.

My one guy that had EDM had a lot of urination…apparently that is one sign (not super common, but enough that it has been seen in many cases)…my guy had kidney issues secondary to the EDM stuff on necropsy…we had attributed the excess urination to other stuff until we had the necropsy.

My current gelding has recurrent ulcers…but they’ve always been secondary to something else. He did have very high Lyme and EPM titers and has been a totally different horse since treating for those. He is now on the once a week dose of EPM medication based on the study that came out.

[vxf111]

That’s what I was thinking too.

OP are you feeing a PSSM 2 diet or a PSSM 1 diet? They’re pretty different.

[ala359]

Sounds just like pssm2/MFM

[joiedevie99]

To me this screams EPM. So much so that I’d probably do that test first and wait for the results before going whole hog on the neuro exam, lameness exam, x-rays, etc.

[2tempe]

I agree re the EPM test, but I would also still do full neuro evaluation and skip for now the lameness thing,

[tbchick84]

Cushings? Would explain the difficulty keeping weight, lethargy and lack of muscle.

[led18]

PSSM1 I’d say. Diet is:

• KER Re-Leve
• KER Nano-E
• KER EO-3 (fat)
• Orchard Grass mix (waiting on hay analysis)
• Grass is mostly dormant down here, so moved off rye onto dormant grass after tie up.

I had plans to move him onto amino acid support and more protein, but was waiting until after muscle biopsy.

[jvanrens]

Why wait. You already know he isn’t PSSM1. Neither could hurt.

[vxf111]

If PSSM 1 is ruled out and PSSM 2 remains a possibility you could try that diet instead

[sparkygrace]

Ulcers are one of the first signs of EPM. I treated my horse for ulcers at the same time as EPM.

One of the first signs of EPM is gastric ulcers, and many patients that we see with EPM present with recurrent gastric ulceration or gastric ulcers that will not heal despite several rounds of treatment. This is because the disease causes multiple receptor sites for IL-6 (an important inflammatory modulator) to open up on the stomach and duodenum, causing excess stomach acid. The gastrointestinal tract is the main source of the body’s immune protection, so keeping it functioning optimally is essential. Gastric ulceration also causes pain, which perpetuates the cycle with EPM. We use a combination of gastric and hind gut acid reducing Western medicines, acupuncture, and probiotics to heal gastric ulcers and improve gut health.

https://sunnycoastvet.com/ca/equine-disease-breaking-the-epm-stereotype/#:~:text=One%20of%20the%20first%20signs,despite%20several%20rounds%20of%20treatment.