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  Discussion on Is Releve alone sufficient?
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New Member:
ne900

Posted on Tuesday, Sep 16, 2008 - 8:12 am:

I have an 18 year old ~1100-1200 lb French Coach/TB cross mare that was diagnosed with EPSM through a muscle biopsy performed by Dr. Valberg. We had her tested after a tying up episode in August of that year. Recently, after reading some literature on Dr. Valberg's website, I began feeding her Releve. She had been doing well on it, but this past week, she had a tying up episode (her first since her original diagnosis).

After her diagnosis in 2006, we started her on a diet of low carb grain with vegetable oil and later began a controlled exercise program. She was not willing to consume the recommended amounts of oil (about 2 cups per day). We were eventually able to get her to tolerate Omegatin (20% fat) plus about ¼ cup of oil per meal. She was able to compete as an event horse at Training level in the summer of 2007.

In May of this year, I switched her to Releve concentrate with no added oil. She’s an easy keeper and so only gets ¾ quart AM and PM plus free choice grass hay. She is on 24-hour turnout in a good sized paddock with no grass. I let her graze on grass occasionally- no more than once a week for about 30 minutes, often not that frequently. In late July and August, she was in the best condition that any of us remember her being in since June of 2005. She was sleek, athletic looking with good muscle tone, and eager to work- enthusiastically conditioning, schooling and competing at Novice level eventing. We suspected that the Releve had a lot to do with her improved condition.

A week ago, on Sunday, we participated in a competition where I noticed her energy lagging compared to earlier this summer. She completed the competition, but without her usual vim and vigor. I gave her Monday off, had a great dressage school on Tuesday, gave her Wednesday off and then took her for a cross country school on Thursday (I purposefully kept her work lighter as she had another competition coming up and I wanted her to be fresh). During the cross country school she felt “heavy” and downhill. I began to get runouts at very small fences- not typical for this mare (and a symptom we noticed the summer that she was diagnosed). My trainer got on her to see how she felt- she jumped okay (my trainer gives her a much more confident ride than me), but when they stopped, the mare's shoulder muscle was spasming and continued to do so for 3-4 minutes.

I called my vet- he suspected that she was tying up and suggested steady work with no jumping, long warm-ups and long cooldowns. Friday, we exercised her for about 50 minutes- mostly at the walk, including some hills, with about 10 minutes of trotting and cantering on flat ground in the middle. She did not want to engage during the trot and canter work. As I walked her out, the shoulder muscle was spasming again, though not with as much amplitude as the day before. On Saturday, when I brought her in to tack her up- she stood in a somewhat parked out position- front feet slightly forward, hind feet slightly backward. I called the vet again and prescribed 3 days stall rest plus 5 ccs Banamine AM and PM. He also wanted me to cut her grain and add 1 cup of oil at each feeding.

She will not eat any of her feed when the oil is added and I am not sure that it is necessary given the composition of the Releve. My trainer and I are wondering if she just needs a larger ration of the Releve itself in order to provide enough energy to her muscles. I don’t think that my vet is familiar with Releve as he wanted me to feed her less to remove as much starch from her diet as possible and my understanding is that Releve is about as low in starch as you can get.

Nothing has really changed with this horse’s management the past two weeks- the primary thing that we can think of are that the event on Sunday was her first one day event this summer- she had to do all 3 phases, did not get a lot of warmup for each phase and spent a lot of time on the trailer- both traveling (2.5 hours each way on that same day) and while waiting for her time. She also spent the night before in a stall. The other things we can think of are that (1) I worked her lightly after the event and (2) the weather became suddenly cool for several days- also, just prior to the cool weather, I had body-clipped her because her winter coat had come in thickly and I didn’t want her to overheat at any competitions- making her perception of the coolness greater.

A concern I had was that maybe the Releve isn’t sufficient for her and that perhaps after being on it for several months without added fat, we are beginning to see muscle tissue damage. This doesn’t make seem to make sense though, given that on Dr. Valberg's website, 1.5 kg of Releve should be equivalent to 1.8 kg of alfalfa plus 2 cups of oil.

I am looking for feedback on whether Releve alone is appropriate for a horse with her condition. I am also looking for opinions on whether an increased amount of the feed may help her muscle condition. If anything, the horse is on the thin side right now, so additional feed won’t hurt her from that perspective.

As a side note, this horse had an episode of anhyDrOsis in June, and so is on One AC plus a daily (no sugar added) electrolyte.

Thanks for reading my long message!
Moderator:
DrO

Posted on Wednesday, Sep 17, 2008 - 8:51 am:

Welcome Nicole,
I agree with your assessment that it is not clear this was a tying up episode. This may be a horse returning to a higher level of performance and not use to it yet particularly if the environmental conditions a bit extreme. In order to rule out such mild signs of muscle problems may take sequential muscle enzyme levels pre and post exercise and a good understanding of the normal changes seen with exercise. In either case however the very least it does sound like her training level needs to be be taken back a step and then brought back up more slowly.

Concerning the amount of concentrate needed I would not use the horse's energy level during and following intensive exercise to evaluate this but instead the horse's overall condition should be used.

I don't exactly get the questions between muscle damage caused by the Re-leve's composition. Are you concerned about your horse not getting enough protein? The primary sign of insufficient protein is weight loss. As to whether it is enough the forage in the horses diet are an important part of the diet also.
DrO
New Member:
ne900

Posted on Monday, Oct 13, 2008 - 11:14 am:

Some updates:
My vet drew blood 5 days after the tying up episode while my horse was on stall rest. Her CK and AST levels were normal, but Potassium was below normal.

After about 10 days on stall rest, we began 1/3 to 1/2 day turnout- we also added light salt to her diet- all under the direction of my vet.

About 2 weeks after she was off stall rest I rode her at the walk for about 30 minutes with 2 short hills. She had another episode- high respiration, muscle tremors in the flank and shoulder. The next day, I rode her again, but this time only for 20 minutes at the walk on flat ground.

The following day, my vet exercised her on the lunge line at the walk trot and canter for 5-10 minutes and then drew blood about 45 minutes later. Her Potassium was normal, but CK was 8350 and AST was 3980.

While waiting for the bloodwork results, we transitioned her to full day turnout and I continued the program of walking her for 20 minutes each day with about 2 minutes of trotting. She was fine with this except for one day where she had a high respiratory rate and slow respiratory recovery after walking up the very slight incline from the outdoor ring to the barn after her 20 minutes of exercise.

Now that we have the bloodwork back, I am going to scale her back to just 15-20 minutes of walking on the flat (no trotting at all).

Regarding my concerns about Releve- I did not mean to imply that I thought it was causing muscle damage. My concern is whether feeding the Releve without any added fat is sufficient for maintaining an EPSM horse.

Dr. Valberg's site suggests Releve without added fat is sufficient, but Dr. Valentine believes that higher fat is required, even when feeding Releve.

My horse does not find oil or powders palatable- so I was hoping I could use the Releve alone, without added fat. The fact that she tied up for the first time in 2 years after 4 months on Releve has me concerned that I am doing something wrong.

Before switching to Releve, I was feeding 1 quart Omegatin with 1/2 cup oil daily (split into 2 feedings)- she often left the oil or did not finish the pellets because of the oil.

This summer, she got 1.5 quarts of Releve per day. She maintained an athletic condition, while working hard- a little slim, but not terribly underweight.

Now she is up to 3 quarts of Releve per day, she is more fleshy, but not overweight and has been working very lightly for the past 7 days.

She has always gotten free choice good quality hay, but does not have access to grass in her paddock.

I'm not sure what to do next to try to manage her. At 19, should she be retired? She still seems to relish being worked- she's much happier working than she is being a pasture pet.
Moderator:
DrO

Posted on Tuesday, Oct 14, 2008 - 9:17 am:

I have had discussions with Dr Valberg and Dr Valentine on this very subject, and one prolonged discussion on this with ummmm ...enthusisatic... Dr Valentine disciple on this board. First it is important to realize that different horses seem to have different sensitivities to the carbohydrate levels on their diets. But I have not seen the horse that needs to have fats "pushed" to them beyond the needs to maintain condition, so I agree with Dr Valberg on this issue with the caveat that perhaps Dr Valentine sees a different population. I do think these horses do better with a moderate as opposed to fleshy condition. Remember it may take 6 months or more after going to a low carb diet before the horse responds well. Our article on EPSM has instructions on how to proceed but I suspect Dr Valberg has given you complete instructions.

The age alone is not a reason to retire a horse but it may be a reason to back off a bit on expectations of the amount of work the horse can do.
DrO
New Member:
ne900

Posted on Tuesday, Oct 14, 2008 - 12:15 pm:

I actually didn't get instructions from Dr. Valberg directly. I got instructions from my vet who recommended reducing grain intake as much as possible and getting her to eat 2 cups of oil per day. However, we have never been able to successfully get her to eat more than 1/2 cup per day (and sometimes she turns her nose up at even this).

I've tried to do as much research as possible on my own and in doing so, found Releve. I was hoping that this could eliminate the need for the added oil that my mare finds unpalatable.

I have tried to keep my expectations for her in line with her condition- I don't intend to compete her at training level any more- but she loves to event so I am still trying to keep her in sufficient condition for a few Novice level events each year.

I guess the question I meant to ask by referring to the question of retirement was: Does EPSM become more difficult to manage with age? Is it reasonable to expect to be able to manage an older horse successfully?

The only thing I haven't tried is a more absorbent base feed- like soaked beet pulp, alfalfa pellets or hay stretcher. I'm wondering if I should switch from Releve to one (or a combination) of these.

Thanks!
Moderator:
DrO

Posted on Thursday, Oct 16, 2008 - 7:47 am:

No, Nicole I have not noticed that EPSM worsens with age, in fact somewhat the opposite. This may have to do with decreased expectations or better adhered to treatment plans, but many cases of chronic tying up do to various causes seem to improve with age.
DrO
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