Severe cases of Tying up/rhabdomyolysis

[Putter]

Situation: Horse with severe tying up episode, currently hospitalized and receiving treatment. Responding very, very slowly.

I am looking for stories and data on horses with severe episodes. What were their muscle enzyme and kidney function trends during recovery? Were they able to recover? How long did it take? Complications?Were causes ever definitively identified?

Looking also for legitimate article recommendations, and accepting all forms of jingles, prayers, crossing of eyes, fingers, toes, etc.

Feel free to post or PM.
Thank you.

[jetsmom]

Sending you jingles and prayers that your horse makes a complete recovery, and you can figure out what caused it.

[Cowgirl]

Mine had a severe tie up episode and was hospitalized for two days in 2012 to have her kidneys flushed. I went on, several months later, to show Intermediare 2, win my regionals and win a national championship and has since shown at the Grand Prix level. I did have blood tests and a muscle biopsy done and my horse did NOT have any indication of a genetic anomaly or a muscle disease that would indicate recurrent episodes. I recommend the biopsy so you know how to approach it. It was not terribly expensive (maybe $500?) and it healed quickly. My horse did have a vitamin e deficiency (which took six months to normalize) and the hay at that time was drought hay (very high in sugar) which also, around the same time, caused another tie up in the boarding barn and a founder case. I do give her branch chain aminos and l-glutamine supplements and continue to supplement vitamin e. I did test the hay, but it’s tough in a boarding situation where the supply constantly changes (even if they buy from the same broker or field, no guarantee that the hay will be the same). I feed about half alfalfa to lower the sugar content of the grass hay and made some other changes with her diet (i.e. removed the ration balancer because she doesn’t need that protein, and exchanged it for a flax/rice bran based complete supplement). For a while, I did try ALCAR (instead of a high fat diet) but when the results came back negative for any type of muscle disease, I dropped the ALCAR and just upped her alfalfa (a low sugar hay). I continued the BCAAs and L-Glutamine because it seems to help her muscles develop in training.

Any horse can tie up on a high sugar diet. I didn’t realize at the time that hay could be high enough in sugar to trigger tie up, but it was no coincidence that within the same week, another horse in the barn tied up and one foundered. It was a super tough hay year here.

[walkinthewalk]

I have one of my horses on MgRestore for the typical indicators and it is working.

When Performamce Equine Nutrition sent my latest order, they included a paper written by Melyni Worrh, PhD PAS.

She talked about magnesium and RER in the article.

Following is an excerpt, I PM’d to someone else dealing RER:

[B] Within the muscle cell, mg and Ca have antagonistic functions. The Ca ion is released during muscle contraction and binds to the actin-myosin complex, ‘locking’ it in the shortened or contracted state.

When relaxation of the muscle is required, Mg ions are released and ‘knock’ the Ca from the binding site allowing the actin-myosin complex to relax back to the inactive or non-contracted state.

Hence, low muscle levels of Mg are associated with titanic muscle states, e.g., muscle spasms or muscles that cannot relax or return to normal state. An excess of Ca or a deficiency of Mg can both cause a temporary muscle tetany in horses called tying-up or Recurrent exertional Rhabdomyolosis (RER). [/B]

There is more regarding, magnesium and RER. I am sure the article is online, if you have time to search for it.

Sending healing thoughts your way:)

[Chestnut_Mare1]

I recently read that a selenium and/or Vit E deficiency can cause tying up. Not sure if it is of any help, but sending many jingles your way. Keep us updated.

[2enduraceriders]

I did bllod testing for SE/E levels over a years time. Found i had to feed 4X the recommended dose to get blood levels into the normal range.

[Putter]

Thanks for all of the good information so far. I have a lot of reading to do.
For those with Vit E/Se Deficiencies, do you live in a certain area? We are in MD with good grass, and have been told that it shouldn’t be a problem, but I guess you never really know without testing. That will be added to the list of items to address down the road.

Her ck level is still trending down (initially 350,000 on 11/27, 300,000 on 11/28 and 150,000 on 12/1. Creatinine has been stable. Good urine output, passing manure.
She had been down since Sunday evening 11/27. 12/1 she was able to stand on her own for 30 seconds. 12/2 she was able to stand for a full hour in the morning and then shorter times throughout the rest of the day. She is now also able to urinate standing up, and has some water from a bucket. Yay!!!

She has a good appetite for hay, but was a little too ambitious and had a choke episode which has resolved. Still getting 30-40L of fluids daily, vit E, IV Lidocaine, banamine and antibiotics.

For once I am looking forward to the morning update, and as always, I can’t wait to see her again this morning to give her a kiss.

[gypsymare]

Melyni Worth also wrote Storey’s Guide to Feeding Horses. In that book she talks about magnesium to great lengths, cites a study conducted on the east coast that indicated most horses on pasture or hay were deficient and strongly advocates for supplementation for most active horses and those showing IR symptoms.

[M_O_Connor]

I recently posted about this- management is certainly possible; my RER horse trained and competed for years (he was a 4’ jumper) till his retirement and has been fine since as well.

I’ll just copy/paste so you won’t have to search: the Dr. Valberg referred to is Dr. Stephanie Valberg of U Minn, one of the true experts in the field of equine nutritional research and the one who developed the genetic tests that can tell you which metabolic muscle disorder is responsible in the event you do the biopsy (btw, I didn’t). (Also btw, $500 seems like a VERY high price tag for that procedure-- I had not heard it was that expensive!)

[QUOTE=M. O’Connor;8950233]
Dr. Valberg was very helpful to me years ago when I consulted her about my TB jumper with RER. I ended up working with her and with nutritionists at Kentucky Equine Research to find a solution that would allow me to keep him in training and competing for several years till his retirement.

While PSSM and ESPM are not exactly the same syndromes as RER at the molecular level and the genetics are slightly different, the solution to keeping these horses in work require pretty much the same approach.

No matter which of the syndromes is responsible, the key is that both the horse’s work load and nutrition must be managed closely to prevent the tying up symptoms from occurring.

The nutrition is actually much easier to manage than the work. High fat / low starch feeds are not uncommon, although not every feed that claims to be “high fat” is high ENOUGH fat…

Re-Leve from Kentucky Equine Research is the high fat feed formulated by Dr. Valberg and is what my horse gets to this day (though he is long since retired). Alfalfa is sometimes a trigger for the tying up; this seemed to be the case for my horse, so we stick to timothy or orchard grass for him.

The exercise factor is much more difficult because it takes a lot more care to get right. These horses can be trained and competed, but the level of their exercise and fitness has to be kept constant. The horse has to be brought into fitness very gradually, and kept fit, with a consistent level of work each day. No days off, EVER (these syndromes used to be known broadly as “Monday morning disease” or azturia). Since muscles make no distinction between work under saddle and turnout exertion, turnout has to be monitored closely so that enzymes that circulate through the blood after exercise aren’t increased beyond safe levels after a too lively turnout session followed by a hard workout.

For my horse, being in work was an all or nothing affair, and still is. He’s an easy guy to ride, and would make a perfect ‘guest horse,’ except that he either needs to be fit and working all the time, or let totally down and turned out. He never could be the horse to ride a few times during the week and then have a lesson with on Saturday. He had to work at just the same level, every single day (even on Monday). Under a consistent work plan, and on the high fat ReLeve, he was able to train and compete with no problems, although I would give him Robaxin after competing (not before, as it’s not permitted) to keep his back muscles relaxed.

Hope this helps…![/QUOTE]