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  Discussion on Epsm-again
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Member:
Gwen

Posted on Monday, Sep 5, 2005 - 6:44 am:

As I posted, my QH was diagnosed with EPSM in the spring. We put him on Purina Ultium with corn oil and he is still showing all of the symptoms. He is also fat now to boot! I have two questions: one is does someone have a SIMPLE diet that has worked for them? And also, how much does excercise affect their improvement? He does not tie up, but has many of the more subtle signs-stretching hind legs, very sensitive to touch, no but muscles, stiff, horrible for farrier, etc. Thanks!
Moderator:
DrO

Posted on Monday, Sep 5, 2005 - 9:30 am:

Gwen, we have a diet and other management suggestions including exercise for EPSM at Equine Diseases » Lameness » Muscle & Tendon Diseases » Tying Up, Rhabdomyolysis, and Shivers (EPSM).
DrO
Member:
Gwen

Posted on Monday, Sep 5, 2005 - 8:35 pm:

Thanks Dr. O, I have read that article and read it again. It is just a bit daunting to me with all of the numbers and big words. Sorry to sound like a simpleton. I was hoping for someone to tell me something that was tried and true. Like specific grain brands and supplements. It was helpful to read the sections about excercise though. Thanks!
Member:
Fpony

Posted on Monday, Sep 5, 2005 - 9:56 pm:

Hi Gwen,
My horse was also dx with EPMS 5 years ago. It was mild on muscle biopsy. The high fat diet seemed to help at first but it never really controlled it. (I was very careful and followed it to the tee for 4 years.) My horse was fat and out of condition as i could never ride him very hard but was riding him 5 to 6 days a week. I started looking into other nutritional routes thinking there must be something else as his EPMS surely didn't seem mild!

Since he was very "sugar" sensitive i checked out the Yahoo IR and cushings site. My horse fit the insulin resistant profile to the tee. I have stopped oil altogether and have done what they call mineral balancing by analyzing my hay and adding minerals to timothy cubes and beet bulp.Not anymore work than trying to get them to eat oil and he likes this! He looks so much better and has tons more energy. We haven't had a tie up since! Fall is when he would have the worse issues. He isn't perfect but doing so much better this fall. He is metabolically different but I can manage it now. After 5 years, he is finally able to work on canter transitions!

You might want to check out the Cushings yahoo site for nutritional info. The site is run by a vet named Dr. Eleanor Kellon.

I guess what I'm trying to say is if you are really following the EPMS diet strictly and things are still not improving then you need to look for more answers. Did you have a muscle biopsy done? Blood work to check insulin, glucose and ATCH.Taking Dante off the oil was scarey at first but it has really worked out for him.
Kim
Moderator:
DrO

Posted on Tuesday, Sep 6, 2005 - 8:38 am:

Gwen, assuming the diagnosis is correct your post suggest you may are overfeeding your horse and misunderstand how the diet works and perhaps you still have too much carbohydrate in the diet.

Many think that the diet for EPSM is dependent on the fat in the diet, that the fat is therapeutic. That is not the case, the diet works by lowering the carbohydrate from the diet. The fat is used to make up the energy deficit that removing the carbohydrate adds. If your horse is obese you should not be feeding extra energy in the form of fat and you should double check all sources of carbohydrate to be sure you have removed all that is possible.

Kim's case sounds like she was in a similar position early on that you are now. She was adding fat when the horse was already in a positive energy balance. Though there certainly is nothing wrong with taking a detailed look at the mineral composition of your feedstuffs I have never seen a case where good quality forage and trace mineral salts as outlined in our articles on nutrition (see Overview) did not provide adequate minerals for optimum health. Nor have I seen where the experimental depletion of these minerals in the diet resulted in tying up or insulin resistance as a symptom with the possible exception of selenium, but that really is a little different type of degenerative myopathy than classic tying up.
DrO
Member:
Fpony

Posted on Tuesday, Sep 6, 2005 - 12:35 pm:

Hi Dr.O
I'm not suggesting that this horse is mis dx, but that if she is following the diet as prescribed and not getting the results she should that there maybe something else going on.

Dr. Valentine believes that fat is necessary at the rate of 2 cups of oil per 1000 lb horse. (I think this is a lb of fat per 1000 lb horse and it takes 6 months for the horse's body to adapt to using the fat calories as energy)Low starch intake is also a key to the diet, but many of the folks of Rural Heritage posting board don't have issues with grass intake or letting their horses have a few days off if the high fat diet is working. My horse needed constant exercise to control things and couldn't eat sugar of any kind in any great amounts. Grazing by mid August also caused him issues. I agree the low starch and sugar intake is why the high fat diet seemed to help my horse in the beginning but the high fat part was killing him.

I'm no vet or a researcher but it seems there is a lot more to learn about some of these metabolic issues as not all horses are responding the same way to intervention.

I do get a bit wound up about this as I wasted 4 years on the high fat diet killing myself to exercise my horse snow or rain 6 days a week, with my vet just insisting that EPSM was my horse's only issue and he would never be right as he must have it so severely. (oh yes she also said well he is just out of shape.-Geesh!)The muscle biopsy taken 3 years after his dx proofed that EPSM couldn't be the only issue in my eye but all they had to say is "Dante must not have read the book".

Sorry, I'll get down off my box that i probably have no right to be on anyway! Kim
Moderator:
DrO

Posted on Tuesday, Sep 6, 2005 - 10:11 pm:

No, the input is appreciated Kim, after all you have been around awhile now.

If a low carb diet does not fix the problem, in all liklyhood the horse is misdiagnosed. Kim you may be making the same mistake that those people who were advising you were making: instead of trying to educate you are suggesting therapy only knowing what is in the post above. And there is direct evidence that the diet may has too much energy and we don't know how much starch is in it. I don't think anyone would prescribe that a horse be fed to the point of obesity Kim, including Dr. Valentine.

You have seen me argue many times about the misdiagnosis of EPSM from vague symptomology and mild changes on the muscle biopsy, maybe I cautioned you. But you don't throw out the baby with the bath water. There are many horses with real EPSM who have benefited greatly from low carb diets. It is important that Gwen learn and understand what is known about these conditions and explore her diet and options.
DrO
Member:
Gwen

Posted on Wednesday, Sep 7, 2005 - 8:29 am:

Thanks guys. My horse was diagnosed from elevated enzymes in his blood work. We did not do a muscle biopsy because we thought that he showed several symptoms and that the diet would tell us either way. From what I have learned so far about this condition, each horse is very different and therefore there is a lot of trial and error in terms of treatment. This system is fine (if it is the only option), but as many of you know I have been trying to get my horse comfortable for A WHILE now and am impatient. Dr. O, am I wrong about this being trial and error? Of course I have a lot to learn, but the thought of making up myown feeding program is overwhelming and frustrating. i thought that I could try something that another experienced horse person had success with rather than reinventing the wheel!
Member:
Fpony

Posted on Thursday, Sep 8, 2005 - 7:47 am:

Hi Dr. O and Gwen,
Dr. Valentiune does believe that high fat is the key. She advises to decrease hay to safe low levels to get off the extra unwanted weight gain before decreasing fat, as well as continous turnout. (My horses really like turn out 24 hrs even in the winter) As I understand it EPSM horses are actually insulin sensitive thus their cells are flooded by glucose that they can't use. Although when asked if a horse could be both IR and EPSM (which seems contradictory to me) she said it could be possible.

No I'm not throwing the baby out with the bath water as i do believe that there are some horses out there with EPSM and the diet is a live saver for them but I also think there are a lot of frustrated owners who are following the diet and exercise regimes to the tee and are still having problems. I'm not saying these horse must be IR but they might have something else going on-even just orthopedically. I just wish my vet had taken me seriously.

Gwen,
The simplest diet for EPSM ,as that is what I did, was as little alfalfa pellets as need soaked with some water to make them soft so the oil will soak into the pellets then add selenium and vit e to that mixture. In the beginning, i needed to use cocosoy oil to get him to eat it. I had blood work done to tell me if he was deficient in Se (we live in the NE which is low in Selenium) then retested in 3 months after adding the amount of se my vet prescribed. Good luck Kim
Moderator:
DrO

Posted on Thursday, Sep 8, 2005 - 7:52 am:

Yes, without a muscle biopsy the cause of your EPSM is unknown. Muscle enzyme elevation while it supports myopathy does not tell us the cause.

That said, I think a very low starch diet, along with evaluation of the total diet, as described in our article is the place I would start and I don't think it is very complicated. Perhaps if you will detail your horses current feeding regimen we could make suggestions.
DrO
Member:
Gwen

Posted on Wednesday, Sep 14, 2005 - 10:41 am:

So if I am understanding this correctly, I need to decrease his fat intake if I am not riding him... He does live outside 24/7, but is not being worked. Maybe the lack of exercise and high fat intake is part of the problem?
Moderator:
DrO

Posted on Wednesday, Sep 14, 2005 - 11:05 pm:

Perhaps Kim, but if you are saying she recommends feeding to the point of obesity, you know that is not right and if you don't cut the fat how do you reduce the calories in a high fat diet? Fat as a replacement for starch that is supplying required energy for exercise and maintenance is the key. The problem with EPSM horses is not IR but that they form abnormal glycogen that cannot be mobilized rapidly resulting in muscle dysfunction. I have not noticed IR horses are prone to tying up and have not noticed that the horses that tie-up are particularly easy keepers, but there may be some horses that have both.

Gwen, while adjusting feed intake in response to changing work conditions to anticipate changing caloric needs is sensible (see article on Overview of Nutrition for guidelines), you make feed adjustments primarily based on the condition of the horse.
DrO
Member:
Gwen

Posted on Thursday, Sep 15, 2005 - 8:43 am:

I know that many articles mention the necessity for exercise with this condition. How crucial is it?
Member:
Fpony

Posted on Thursday, Sep 15, 2005 - 8:09 pm:

"The problem with EPSM horses is not IR but that they form abnormal glycogen that cannot be mobilized rapidly resulting in muscle dysfunction. I have not noticed IR horses are prone to tying up and have not noticed that the horses that tie-up are particularly easy keepers, but there may be some horses that have both. "

That is exactly the confusing issue as my horse who had a mildly positive muscle biopsy and who had terrible episodes of tying up in the fall was an easy keeper and extremely sensitive to sugar. At this point, the no fat diet is working with low starch (tymothy cubes and beet pulp with minerals added)and limited grazing. It seems some EPSM horses aren't as sensitive to grass as others.

As for exercise, I think once the horse has adapted completely to the fat in his diet then each horse is different as to how much exercise is necessary.My horse needed constant exercise even if all he could tolerate was 20 min of walking. You have to listen to your horse as to how much is too much. Even 20 mins of hand walking is great exercise if your horse has had a minor tie up as this helps the blood flow and gets the needed energy to the muscles to stop the spasms. If left in a paddock they might not move around enough if their muscles are sore.

The other really important thing is to check Selenium if you are in a low selenium region. Selenium and vit E work together and if your horse isn't eating green grass than he may need vit E also. They both help with muscle function.

I would stress getting a muscle biopsy so that you know for sure. It is a simple surgery that your vet can do right at the barn. There is an infomation sheet on the procedure at
https://www.ruralheritage.com/vet_clinic/index.htm
The virtual vet is where everyone posts questions most of it is about EPSM.You can get lots of feed back from many folks that own EPSM horses as well as from Dr. Valentine.
Moderator:
DrO

Posted on Friday, Sep 16, 2005 - 8:52 am:

With your last post we come around and are on the exact same page Kim. You would only need extra fat in your diet if you could not maintain condition on a low starch (which is a sugar) diet (see my first post). Timothy provides a large part on its energy through the bacterial formation of fatty acids from its long chain carbohydrates (that the horse cannot digest in the small boweil) in the cecum.

I also ditto her exercise comments: the amount of exercise that is optimum is variable from horse to horse and you will have to explore this question with your horse. What does apply to every horse is that the exercise needs to be regular and consistently at the same level.
DrO
Member:
Fpony

Posted on Friday, Sep 16, 2005 - 9:39 am:

LOL!

What I was trying to say all a long! There is must be an art to communicating what you really mean!

I do believe that folks who follow on Rural heritage feel that the fat energy is most important and just a low starch diet won't do the trick if your horse has EPSM. I'm not saying that is what I necessarily believe(as it didn't do the trick fo my horse).
Member:
Gwen

Posted on Friday, Sep 16, 2005 - 12:38 pm:

Yikes. I so appreciate both of your input. I have been on Rural Heritage before, but did not stumble upon areas in which to correspond. I will check there again. Dr. O, I know that you have said that this is not too difficult. I don't know what sort of deficits I have but it is so overwhelming to try to understand and follow the details of starch/fats/sugar, etc. I am trying! My next steps will be to acquire a selenium/vit e supplement (I too live in the northeast) and get him into a STRICK routine. This has been so tough with the craziness in my lifestyle. I am realizing that I need to make this a priority however..
Moderator:
DrO

Posted on Saturday, Sep 17, 2005 - 9:52 am:

All right, let's see if we can walk you through this. Let's start with the assumption your vet has the diagnosis right and we are trying to correct the diet:
1) What is your horse's size and weight (with a tape please)?
2) What is your horse's condition? (See Care for Horses » Particular Situations & Procedures » Weight, Condition, and Eventual Height Estimation)
3) What exactly do you feed and supplement your horse by weight and frequency?
4) How long a day does your horse have access to pasture and what is in the pasture and what is it's condition?
DrO
Member:
Gwen

Posted on Sunday, Sep 18, 2005 - 6:18 am:

Thanks, Dr. O. Before I drive you any crazier, I was thinking that I would try to add vit e and selenium to his diet. Apparently this can be an integral part of the program that I haven't given a shot. I also think that exercising him will help. I actually rode him yesterday and he started out very stiff, but worked out of it so well. Hopefully I won't need a personal tutorial! Thanks again, though.
Member:
Gwen

Posted on Sunday, Sep 18, 2005 - 8:08 am:

Kim, do you have any recommendations for low carb/sugar treats?
Member:
Gwen

Posted on Sunday, Sep 18, 2005 - 5:51 pm:

How does liniment tie into an exercise program? Do EPSM horses benefit from a liniment bath after work anymore than a typical horse?
Member:
Fpony

Posted on Monday, Sep 19, 2005 - 8:27 am:

Hi Gwen,
I use Hunter by Blue Seals is relatively low in starch and high in fat and i can use this as a treat with tiny handfuls or even a few pellets at a time if I'm using it as positive reinforcement for a reward system while training. Crackilin Oat Bran (human cereal)is recommended on the Rural heritage site as it is high in fat but this is too much sugar for my horse if I'm using as a reward and I will notice issues after a session that needed a lot of reinforcing. Brocolli heads are well liked by my horses.
I feed occasional apples or carrots but this too is chopped into small bites so it will last longer than one treat. For example if you are at the barn all day one carrot could be given out as 3 or four treats though out the day. I really have stopped using treats much, just as treats. I tend to use them for reward when learning something new or doing something I've asked that is normally difficult for them to behave (positive reinforcement) Sheath cleaning always deserves a treat as does a bath as these are truly difficult things for my water fearing horse.

Hope this helps. There are flax treats by Omega
https://www.omegafields.com/productDetail.asp_Q_catID_E_2_A_subCatID_E_1_A_produ ctID_E_2_A_flax_for_horses_E_flax_for_horses

They would be good as they don't have much else in them and flax is suppose to be good for us and our animals. I haven't tried them as they are a bit pricey.
Kim
Moderator:
DrO

Posted on Tuesday, Sep 20, 2005 - 7:45 am:

Gwen I don't believe linimint would be helpful towards the EPSM but massage might be. However the amount of force and time it would take to really increase blood flow to the muscles might be quite a bit.
DrO
Member:
Fpony

Posted on Tuesday, Sep 20, 2005 - 8:21 am:

Gwen, My horse couldn't tolerate massage when he had muscle spasms but I got results if I used ice massage. (I'm A PT-ice can relax muscle spasms and when the ice treatment is done there is an increase of blood flow to the area) Ice massage means you use ice cubes (or freeze water in paper cup and peal paper away so you can hold the cup while icing) And you continuously move the ice over the area being treated for approximately 5 to 10 min. I would keep each treatment area a size of 4 to 6 inches.Try to follow the muscle that is in spasm if it is obvious to you.Also, using percussion (cupped hands) was also one of his favorites. (he is a very sensitive Arab) Percussion can decrease pain and will vibrate tissue causing some increase in blood flow. This really helped my guy get relieve. Keeping them moving also helps.
Member:
Aannk

Posted on Thursday, Sep 29, 2005 - 10:19 am:

Dr. O.,
I have a strange question. Can you use artificial sweeteners for horses? I was thinking that adding equal or something similar to grain of horses who aren't allowed to have sugar might make the feeds more palatable. I know we humans do it.
I finally got Lilly a biopsy, and she does have EPSM. She is 16.1 hh, and probably weighs 1000 lbs. She should weigh 1200 pounds. She is about a 4 on the condition scale. She has always been a picky eater, and we are trying several things to get her to eat. I can't make my barn manager understand that oil is more important than grain, but I did print some stuff out today that might help her realize that.
Anyway, just wondering if I could use splenda or something in her grain, or to make treats.
Alicia
Member:
Gwen

Posted on Thursday, Sep 29, 2005 - 6:52 pm:

Holy cow. My horse is going SO well. He literally is like a different horse than I have had. He is absolutely better the more I work him. I am looking forward to putting a picture of him in that picture thread-as soon as I can get someone to take pictures while I am riding! I am working him about 3-4 times a week now. Really, it has only been a few weeks, but the results are so impressive! Not sure if it is cutting back on the grain, working him, or the selenium/e supplement. Unfortunately they all started right around each other so it is hard to tell. I am liking thinking that it is a combo!
Member:
Fpony

Posted on Friday, Sep 30, 2005 - 11:56 am:

Gwen!
So glad to hear things are improving for you! Kim
Member:
Canter

Posted on Friday, Sep 30, 2005 - 8:32 pm:

Great question, Alicia. I've wondered about the artificial sweetners as well (I asked my husband to pick up some peppermints and he picked up the ones with the new "splenda" in them). I haven't dared to give them to my mare.
Moderator:
DrO

Posted on Saturday, Oct 1, 2005 - 7:06 pm:

I am uncertain about the safety of sugarless or sugar modified sweetners in horse, my guess would be they are OK but it is only a guess. Horses fairly dependably like small amounts of apple cider vinegar.
DrO
Member:
Aannk

Posted on Monday, Oct 3, 2005 - 1:36 pm:

Fran,
I was hoping that Dr O would say what he did. Dr Valentine says she can't say it would hurt but can't say it wouldn't. She says she would prefer a little bit of real sugar. I think I will at least see if Lilly likes the taste of a treat made with Splenda, and go from there.
Dr. O.,
I use Apple Cidar Vinegar a lot at my house with my dogs and birds and find it seems to make them all healthier. However, you have to refrigerate the raw unprocessed stuff, and that won't work at our barn. I at one point did try that in Lil's water, and she did drink it, but seemed not to care it was there at all.
I have a nutrition question for you regarding Lil. She is getting as close to the EPSM diet as I can, considering how picky she is and how skinny she is. Dr Valentine gave me some ideas, and I want to see what you think.
I am feeding her Blue Seal Vintage Victory. It has a lot of oats in it, but high fiber (11%) and high fat (10%) and a somewhat lower protein than I would like (10%). It also has .5% lysine, .2% methionine, .6 to 1.1 calcium, .6 phosphorus, .65% potassium, .3% magnesium, .8% salt, 120 ppm maganese, 140ppm zinc, 42ppm copper, .5ppm selenium, 5000 IU/lb Vit A, 800 IU/Lb Vit D, and 85 IU/lb vit e. I am not sure how much she is getting, but I am using for reference 4 pounds a day. That would provide 6252 calories. She also gets free choice alfalfa while in, but she is only in for about 2 hours a day, so probably only eats about 4 pounds. That is another 4000 calories. To get the rest of the pound of oil in her, we divide a cup into her two feeding using alfalfa pellets to soak it up. I would imagine the pellets can't weigh more than 2 pounds, so would provide no more than 1000 calories. Then we have the 1/2 pound oil, or 1000 more calories. I don't know how much she eats outside, but it is regular timothy. If you don't add any for the timothy, that is only 12252 calories a day. Is that enough?
So, I guess my most important question is do I have my calcium phosphorus ratio correct? If not, what can I do about it? Also, since I am not feeding the recommended amount of grain, should I add a vitamin supplement? They recommend 9 pounds, believe it or not, for her eventual weight (when adding weight I usually just feed the amount the horse should weigh).
She also gets tractguard (Calcium carbonate, sodium sesquiscarbonate, potassium chloride, magnesium sulfate, distillers grains, diamond V yeast, linseed meal) and vitamin e and selenium crumbles.
Thanks!
Alicia
Member:
Gwen

Posted on Monday, Oct 10, 2005 - 10:02 am:

Two things: one is that my EPSM/QH and I did our first ever dressage show yesterday. Forget the scores, he did great! The second thing is about feeding low carb feed to "regular" horses. I am thinking of changing over my appendix to eat Ultium also. Mainly because they are turned out 24/7 together and my qh has figured out that his food doesn't taste as good as his buddy's. Unfortunately, the EPSM horse is the boss so he can chase the other away and eat his yummy stuff. From what I have read, it seems that low carb can be good for every horse. Especially one who is not doing a ton of work. But again, this is SO not something I understand very well, so any advice would be appreciated!
Moderator:
DrO

Posted on Tuesday, Oct 11, 2005 - 6:51 am:

Alicia I remember answering your post, did you have it posted somewhere else in your own discussion or did it not get posted here?

Gwen, I think as long as you follow our basic nutrition advice (Overview of Nutrition) using Ultium would be fine for a concentrate.
DrO
Member:
Aannk

Posted on Tuesday, Oct 11, 2005 - 12:05 pm:

Dr O,
I think I may have posted a while ago (a few months maybe) about her diet too. This is a new diet, however, so the last post wouldn't be relevant. I will do a search. Did it, and I can't find anything recent, just a question from 2003.
I don't remember receiving anything recently from you concerning this. Is there enough information here? She is doing well now, and on the diet I mentioned above. We have her out as close to 24 7 as you can get without a run in.
I just started riding her again yesterday after a month off from the surgery to repair her urethra, and it was wonderful, especially since I hadn't ridden since before Guin died.
Alicia
Moderator:
DrO

Posted on Wednesday, Oct 12, 2005 - 7:37 am:

Well let's see, I think the first thing I wrote was, you do not decide if you are feeding enough by counting up the calories, this does not take into account environmental and exercise conditions and even when that and breed and size and age are accounted for there can a large range in caloric requirements in what maintains horses in a particular condition. You have to look at the horse to know if their caloric intake is suitable.

I do think it looks like the Ca/P is OK however as each of your foodstuffs is acceptable except for the straight oil but I don't think this is enough to prevent adequate consumption from all the other sources.
DrO
Member:
Aannk

Posted on Wednesday, Oct 12, 2005 - 12:41 pm:

Dr O.,
I am a little confused by your last sentence. What do you mean by "I don't think this is enough to prevent adequate consumption from all the other sources."? You mean that the amount of oil I am feeding isn't enough to change the ratio from the other stuff she is eating?
If so, then I am OK?
Thanks,
Alicia
Moderator:
DrO

Posted on Wednesday, Oct 12, 2005 - 7:09 pm:

Yes.
DrO
Member:
Aannk

Posted on Thursday, Oct 13, 2005 - 9:52 am:

Thanks, Dr O, you are awesome :-)
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