Equine & Horse Advice: Information on MSM?

Discussion on Information on MSM?

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Chris Mills

Posted on Thursday, May 6, 1999 - 1:22 pm:

Beyond the marketing hype, when is MSM recommended (if ever), how much should be fed and are there any possible side effects?

Point me to an article, if one exists.

Thanks.

Lynn

Posted on Thursday, May 6, 1999 - 5:55 pm:

Hi Chris, Two horses in my barn are on MSM at the direction of our Vet. Both are sound working horses, But one (my Arabian) at the pre-purchase exam had alittle more change in the navicular bone than my vet would have liked to seem in a horse at age 9 and has a slight amount of fluid in the lft hock. The other is a 23 yr. old Morab gelding with ring bone and navicular changes on the lft front and arthitis in the hock and pastern on the back right. Simply said by my vet MSM is an excellent supplement for connectve tissues and internal workings of the hoof. It also seems to help the horse use more of the ingredients in certain supplements, we use Grand flex. Here is a website I found when researching the product: http://www.equineracing.com/vitaflex/msmreva.htm You should discuss this or any supplement fully with your Vet before added it to your horses diet. Hope this helped

The Advisor Vet, RN Oglesby DVM

Posted on Friday, May 7, 1999 - 7:36 am:

Hello Chris and Lynn,
MSM, methyl sulfonyl methane, is one of the various antioxidant products sold over the counter. Currently there is no rationale basis for the use of this product. I have probably searched for supportive information on this substance more than just about any other, it is a popular question, and it is not there. About the best the post-1996 texts will say is: No convincing evidence for its use (numerous equine medicine texts). Dr. Lewis in his Equine Clinical Nutrition states when referring to MSM specifically and 6 other commonly recommended supplements: "When they are evaluated in controlled studies, these and numerous other substances fail to demonstrate any benefit." There is also nothing supportive in the large medicine databases.

Lynn, if your veterinarian has supporting scientific evidence I would love to have the references. I went to the link you suggested and have no major beefs with any statements it makes. It makes no claim of medical efficacy and pretty much supports what is currently thought: MSM is an expensive source of dietary sulfur, a mineral whose deficiency that has never been reported in the horse.
DrO

Lynn

Posted on Friday, May 7, 1999 - 10:23 am:

Re: DrO, I will be seeing my vet today about a new horse in my barn with severe navicular (Updating exam) DrP is a real minimallist qoute "probably more for you then the horse" so I will question him further and try to get back to you by this weekend.

Chris Mills

Posted on Friday, May 7, 1999 - 11:12 am:

I did some research ... the vita-flex page for MSM pointed to some papers about it published in horse magazines and some work by a Dr. Metcalf on the left coast.

I searched on it using yahoo, too, and the iaep had a write up. All seemed more positive than I would have thought.

Here are my urls.

http://www.iaep.com/pages/nutrition/neutraceuticals/msm.html
http://horsenet.com/vita-flex/msm.html
http://www.equineracing.com/vitaflex/msmdmso2a.htm
http://www.equineracing.com/vitaflex/nusigmsma.htm
http://www.equineracing.com/vitaflex/msmdieta.htm
http://www.equineracing.com/vitaflex/msmbrua.htm
http://www.equineracing.com/vitaflex/msmreva.htm

Valley Vet is selling a 4lb tub that is supposed to be 180 days worth for $65 - not exceptionally expensive as far as horse stuff goes.

Chris Mills

Posted on Friday, May 7, 1999 - 11:17 am:

The Advisor Vet, RN Oglesby DVM

Posted on Friday, May 7, 1999 - 3:11 pm:

There all just ads Chris, including the iaep site. I would expect them to be all upbeat. I admit I got tired after looking at 5 of them. There is not a single scientific study sited in any of the ads I read and many of the statements are plain misleading. The worse being the implication that there is a known dietary need for MSM.

Chris if you will spend money on dietary supplements for which there is no known use which supplements are you not going to use, how do you decide? You know me Chris, I am not going to tell someone to quit using any product that they feel is doing them good as long as there is no harm in it for the horse. On the other hand 65$ flushed down the toilet is an expensive flush, it does not matter how often you do it.

DrO

Chris Mills

Posted on Friday, May 7, 1999 - 3:28 pm:

Heh, heh.

I've not flushed. Just curious about non-invasive ways to make my aging mare a little more comfortable.

The hype seems no different than the chondroitin sulfate, yucca, kelp, whatever stuff to me.

As far as flushing - I'd save time if I just fed the horse money. Sort of like that old daffy-nition that a boat is a hole in the water in which you pour money. "Equine" is just like anything labeled "marine" - twice as expensive.

Wish I had a happy face icon, too. Happy weekend. GRIN

Emily French

Posted on Sunday, May 9, 1999 - 4:57 pm:

Now this may be and isolated "case study" But both
my self and my husband take an occasional dose of
MSM and it appeared to help our related
aches-n-pains. But it certainnly wasent a true
scientific trial by any means and the mind can
play a powerful role. Anyhow, I do give it to a
couple of my aged horses when the weather turns
damp and cold and it appears to make them more
comfortable with their assorted achy bones. I can
unnderstand that it might make the absorbtion of
nutrients better as I was told by a people doctor
that DMSO is what MSM is derived from and that
pure DMSO is the only chemical know to pass
through the Skin barrier emmediatly, easly seen by
sticking your finger in DMSO and you almost
instantly taste rotten egg in your mouth! YUCK!! I
was also told that if you mix DMSO with somthing
that it will also carry that directly into the
blood stream so it might stand to reason that MSM
might help in the absorbtion of nutrients that it
is feed with... but I ain't no scientist! :)

The Advisor Vet, RN Oglesby DVM

Posted on Monday, May 10, 1999 - 7:50 am:

Hi Emily,
Well this is the problem with products like this. Even though there is no scientific work to support the use of such a substance we can conjecture a possible mechanism of action and find folks who have testimonials of efficacy. You find this sort of anecdotal support for dozens (hundreds) of products for which there is no scientific support and it just is not lay people, veterinarians and doctors are susceptible to this problem also.

You are correct that the placebo force is a powerful and measurable force that improves outcome of just about any treatment.

Your doctors comments are interesting and partially true. MSM and DMSO are related compounds However I do not think MSM shares the incredible solubility that DMSO does. DMSO has this property of binding with polar and nonpolar substances because it's unique molecular structure allows the oxygen's electron cloud to move around the molecule. MSM does not have this structure and does not display a lot of the properties associated with DMSO. A second point is there has been no benefit shown from feeding DMSO and several of its other metabolites either.

Will MSM prove to be the next wonder drug? I don't know, you would think so from the claims to improve everything from arthritis to skin tumors. How do we separate the wheat from the chaff? The total lack of support for the use of MSM in not only this countries literature, but the body of world scientific literature, does make me skeptical. If the people you sold MSM had proof of its efficacy do you not think you would find it plastered all over the net? I think it is important that people understand what is fact and conjecture because ultimately you must make up your mind yourself.
DrO

Emily French

Posted on Wednesday, May 12, 1999 - 12:05 pm:

So true Dr. O. I would love to see this popular additive (MSM) proved or disproved in a place other than the barn. I suppose at this point I have heard of no ill effects of moderate use and I will continue to use it for my horse if only to make me feel better that I am doing something that "appears" to help him. ;0)
I wish that there were more testing on alot of the "wonder products" out ther for horses, but I guess untill there is equal economic impact to that of food animals, large companion animals will take second chair in the research department.

Chris Mills

Posted on Tuesday, May 18, 1999 - 2:27 pm:

Dr. O,

So I went surfing for MSM info and this is the best I could do for science ...

http://www.dancingwolf-inc.com/medical.html
http://www.equineracing.com/vitaflex/msmreva.htm
http://www.nfm-online.com/nfm_backs/Dec_98/msm.html

Sounds to me like there is a lot of anecdoetal stuff, little double blind testing and the jury is still out.

Most of the stuff I could find related to people supplementing themselves with MSM for arthritis and other (many) things. I guess, if they thought it worked, then they got their money's worth.

Too bad a critter can't tell us if they are feeling better.

Lynn Strand

Posted on Wednesday, May 19, 1999 - 10:33 am:

DrO, Sorry it's taken me so long to get back to you. DrP and I talked yesterday about MSM he agrees with you that there are no actually scientific tests about it. He has been going on his own research and reports back from his cliental *which has been very positive* and I should make it clear on his behalf that he does not prescribe MSM but suggests that they try it and see if they get some improvement.

Sally Ann Maas

Posted on Sunday, Jun 6, 1999 - 3:03 pm:

Isn't scientific testing extremely expensive and only worth the trouble if someone has a patent on the product? Lots of companies sell MSM so what would be the motivation to spend all the money on research?

Sally Ann Maas

Posted on Sunday, Jun 6, 1999 - 3:04 pm:

The Advisor Vet, RN Oglesby DVM

Posted on Monday, Jun 7, 1999 - 7:22 am:

While that is partially true of the pharmacy companies, much research is carried on by the universities and private organizations. It would be highly valuable information however to a pharmacy company to know any physiological actions of any drug that might improve health, whether they could patent MSM or not.
DrO

Chris Mills

Posted on Monday, Jun 7, 1999 - 3:19 pm:

Actually, MSM is patented.

Here is a partial list.

http://sulfurnet.com/sulfur/msm_patents.htm

Most of the patents are owned by Herschler.

The Advisor Vet, RN Oglesby DVM

Posted on Wednesday, Jun 9, 1999 - 7:06 am:

Thanks Chris,
DrO

John Wilder

Posted on Wednesday, Apr 19, 2000 - 8:02 pm:

Has anyone had even minimal sucess in using MSM in the care of a COPD horse?

Nada J. Woodworth

Posted on Monday, Apr 24, 2000 - 5:43 pm:

Hello John: I have clients who have tried MSM for COPD on their horses, because they wanted to see what it would do, not because I recommended it to them, and the results were that it did not help the condition. It did not harm the horses, but it did not improve them either. Sorry, I can not be more positive about its' use for the condition. Dr. Woodworth

Pamela Korsmeyer

Posted on Friday, May 5, 2000 - 5:10 pm:

Dear Dr. O and horseadvice correspondents,
I am new to the site and am thrilled with the professionalism and dedication to equine well being that I have found here. With respect to the supplement discussion, it is great to find some "horse sense" applied to this issue. Too many people are obsessed with doing MORE for their horses and cannot look dispassionately at what, in fact, they are doing--or not doing. I am convinced that a complete nutritional program is the very best thing you can give to your horse. I suspect that at least some of the supplement craze has to do with the deficient diets that many horses get at many boarding facilities, which are trying to save money on feed and haven't enough acreage for pasture. The clients are then persuaded that their horses need all sorts of stuff to make up for what they should be getting in their food. The spiel that goes with supplements for specific conditions such as DJD are a little different but just as flimsy. (I have been trying to get information on Cosequin, which I understand has been tested at Auburn University, for ages, so far with only limited success.) I found an article on the World Equine Health Network (www.wehn.com) some time ago that I highly recommend to anyone interested in how anecdotal evidence and personal experience can never replace good science. It is called "Why Therapies May Seem to Work (Even When They Don't).
As for me, I am about to decide on what care/treatment to begin with my 10 year old warmblood gelding as he is showing some pretty classic signs of DJD in his hocks. I feel much more capable of going into my discussions with veterinarians (first and second opinions) as a result of having found the Horseman's Advisor. Many thanks. Pam K.

Pam Jorgensen (Mouseyen)

Posted on Saturday, May 19, 2001 - 7:16 pm:

Hi everyone, I have read with great interest the submissions you all have made. My mare has an obscure stifle problem and so I have been researching MSM. Serendipity! The Canadian Horse Journal (May-June issue) has an article on tests done on 30 racing standardbreds by Dr. Ron Riegal. The results were unveiled at the Equine Research Center in Guelph, Ontario in March. This article should be available at www.horsejournals.com. If you can't access it there contact me at equitred@island.net and I will forward the article to you.

Regards, PamJ

Robert N. Oglesby DVM (Dro)

Posted on Sunday, May 20, 2001 - 12:41 pm:

Pam I went to the site and did not find a easy way to locate the article but would be interested in reviewing it. If you forward me a copy, roglesby@horseadvice.com, I would like to review it.
DrO

Penner (Penner)

Posted on Tuesday, Aug 21, 2001 - 7:52 pm:

Dr "O",
I'm in the (human) medical field & here is a link I use regarding alternative medicine:
http://www.quackwatch.com/

Granted, its for humans, but what I've read here is that its only been tested in rats anyway:
http://www.quackwatch.com/01QuackeryRelatedTopics/DSH/msm.html

The biggest problem I find with alternative medicine, is that there are no Evidence Based Medicine studies supporting most of it. The next problem is the lay public doesn't understand statistics, & falls for the advertising.

Robert N. Oglesby DVM (Dro)

Posted on Wednesday, Aug 22, 2001 - 7:30 am:

A wonderful link Penner. Have you visited our section on Alternative Medicine yet? It is at, BULLETIN BOARD members only: The Lounge: Kick back and relax.: Alternative Medicine and Epistomology.
DrO

Mandy
Member
Username: Bucky

Post Number: 29
Registered: 6-2004

Posted on Friday, Apr 1, 2005 - 2:15 pm:

Hello,

I found this article on www.thehorse.com. Thought you might find interesting.

MSM Helps Sore Muscles
by: Karen Briggs
June 2001 Article # 959

A recent study performed by Ron Riegel, DVM, on 30 racing Standardbreds confirms that the popular nutraceutical supplement MSM (methylsulfonylmethane) can have far-reaching effects on the ability of equine muscle tissue to rebound from exercise stress.

The data, unveiled at the second annual Nutraceutical Alliance conference in Guelph, Ontario, on March 23-24, was gathered, using 30 three- and four-year-old Standardbreds in full race training at an Ohio county fair track. To eliminate other variables in the study, Riegel persuaded trainers to discontinue the use of all injectable and topical medications three weeks prior to beginning the study. This was a tough sell, but necessary because his primary diagnostic technique in assessing each horse's level of soundness and comfort was full-body thermography--a method which scans the horse's body for differences in temperature. Thermography cannot diagnose specific problems--it cannot, for instance, differentiate between a hoof abscess and a fractured coffin bone--but it is a very sensitive method of identifying sites of inflammation (the greater the irritation, the hotter the tissue and the brighter the color on the thermograph).

Riegel separated the horses into three test groups. Group one received no treatment. Group two received 10 grams of MSM daily, and group three received 20 grams of MSM a day (both doses by oral syringe). The horses were examined regularly by thermography for about eight weeks. Riegel also drew blood samples that underwent CBC (complete blood count) and serum chemistry analysis, and tracked their training progress.

The results showed that all of the horses receiving MSM had dramatic improvement in three ways. Thermography showed less inflammation and soreness, particularly through the back and hind end. (The change was faster and more dramatic for the horses on the higher dose.) Additionally, their serum chemistry demonstrated significant drops in two crucial parameters: AST (aspartate aminotransferase) and CK (creatine kinase), tests that indicate metabolites from muscle damage. Finally, all treated horses improved their average training time--group two (the lower dose) by two seconds, and group three by 2.62 seconds.

Riegel concluded that MSM provides significant anti-inflammatory and analgesic effects for horses in hard training. MSM has good palatability and no known side effects. "None of the 30 horses experienced any problems with it--no diarrhea, no allergic reactions, no abnormal blood chemistry," Riegel says. "And while we weren't able to quantify it, the trainers reported that the group three horses had better hair coats, faster, and healthier hoof growth, and quicker recoveries after exercise."

Why does MSM have this impact? While the details aren't yet clear, it is known that MSM is an excellent source of dietary sulfur, a mineral involved in the integrity of collagen, cartilage, hooves, and hair, as well as joint fluid and many important enzymes. Medicinally, organic sulfur inhibits the proliferation of scar tissue and slows neurotransmitters, triggering muscle relaxation. Sulfur is abundant in many feeds, but it's quite unstable, breaking down during most forms of processing (such as drying hay), so MSM may be a handy way of delivering it in a stable, absorbable form.

Debbie E
Member
Username: Deggert

Post Number: 172
Registered: 7-2003

Posted on Friday, Apr 1, 2005 - 4:21 pm:

I feed MSM and have for 6-7 years. I use to only feed it to the geriatric mare but now everyone takes it, even the weanlings when they start a creep feed. I agree it is one of the least expensive supplements to feed. I think I became interested from other breeders or trainers who saw improvement in many areas, feet particularly, and it is antioxidant and antiinflammatory with no side effects that we know of. Our vet practices in southern Calif. have used DMSO IV for years in relation to founder, retained placentas (part of the founder prevention) and cervial trauma. In reading, MSM is the oxidized state of DMSO, but I am no chemist or doctor. I am sure one side of the "supplement" arguement will never agree with the other.
I know people who use DMSO on their sore backs and msm gel on their arthritic hands and the pain in reduced.

Nancy S. Kaplan
Member
Username: Redalert

Post Number: 76
Registered: 10-2004

Posted on Friday, Apr 1, 2005 - 5:45 pm:

Back to John Wilder's question on anyone having had success with the use of MSM on a horse with COPD. I have had what seems to be success with MSM(and management) with my COPD horse. Like everyone has noted, this "success" may have been accomplished without the MSM, but it is part of a regimine I use when this particular horse is having problems! I also use "cough free", and, I myself cannot believe I am admitting to this, but they seem to work for him. He also has had to be on Ventipulmin and inhalers in the past(when he had to travel for training or horse shows). He is now retired, and is doing well with nothing at the moment, except wet feed, hay, and shavings dust free environment! Good luck with your COPD management, John!
Nancy

Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 12453
Registered: 1-1997

Posted on Friday, Apr 1, 2005 - 7:10 pm:

Concerning the possible mechanism by which MSM may work, this is not sensible. Sulfur is an element and so unless it undergoes nuclear fission or fusion can not be broken down further. Sulfur deficiencies are not reported in horses and as stated above is in abundance in the horses diet.

Though the study above is interesting there is no supporting studies in the refereed scientific, medical, or veterinary literature in any specie. There has been one research project with MSM and horses with COPD in which no effect was found:
Am J Vet Res. 1992 Oct;53(10):1908-16.
Evaluation of clinical signs of disease, bronchoalveolar and tracheal wash analysis, and arterial blood gas tensions in 13 horses with chronic obstructive pulmonary disease treated with prednisone, methyl sulfonmethane, and clenbuterol hydrochloride.

I have had good luck with just good management alone in all cases of COPD, for more on this see the article on Heaves.
DrO

Nancy S. Kaplan
Member
Username: Redalert

Post Number: 77
Registered: 10-2004

Posted on Friday, Apr 1, 2005 - 7:38 pm:

Man, that was quick, DrO !
I was thinking about you when I made that post, having read what you had stated earlier in HA about MSM, and having done some reading further on the site about studies done cc MSM and other "remedies". I just had to say it, as it seems to have an effect on the recovery of this horse, though, as stated, it could be that he was going to recover whether he was on MSM and "cough free" any way. Just could not rule out the MSM helping... just another anecdotal testimony that I knew you would jump on!
Nancy

Sara Wolff
Member
Username: Mrose

Post Number: 541
Registered: 1-2000

Posted on Friday, Apr 1, 2005 - 7:56 pm:

I don't understand MSM at all; however, I do use it. I have a friend with an older stallion who just seemed to be "going down hill" for now special reason. She started him on MSM and after a week he was so perky she had to cut his dosage back. This was several years ago, and is what got me interested in using it. I use it on a chronically lame mare (old knee injury) and on any horse with an injury. It seems to me there is quite a bit of improvement usually when I use it. I can definitly tell the difference in the mare when I leave it out of her feed for a few days.

I read an article about MSM being good for asthma and arthritis in humans. Since I have both, I started stealing a little from the horses and mixing it in my juice. After about a week of doing so, I could tell a real difference in the asthma and not quite as much with the arthritis, though it did seem better. Placebo? I don't know. From what I read when I first started using MSM years ago, it acts on the circulatory system.

Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 12462
Registered: 1-1997

Posted on Saturday, Apr 2, 2005 - 11:27 am:

I cannot find anything in the scientific literature where there is a well defined action on the circulatory system or any other system in vivo, but I will continue to look.
DrO

Angie Judson
Member
Username: Ajudson1

Post Number: 176
Registered: 6-2003

Posted on Saturday, Apr 2, 2005 - 1:30 pm:

Sara and everyone,

I have just started reading about inflammation in our bodies, (after a dr visit and $100's worth of tests) and how it causes many diseases; usually the ones ending with "tis". A great website with alot of information is www.stopinflammation.com. In our case (humans) we need to add fish oil to our diets, cut way back on anything that causes us to have extra AA (some kind of acid) in our systems. I am just learning this myself, but I thought concerning MSM, if it reduces inflammation in our horses, it may very well be helpful for many things which have some kind of inflammation as a base.

But it's the same idea.....all inflammation causes health problems.

Just because "scientifically" horses don't need sulfur, if it reduces inflammation, it would have benefits. and for many differnent things. if it's not toxic, it's more helpful than harmful, so I'd say use it.

To compare again, we don't eat the way we did years ago, and our horses don't eat the same way either. Maybe when we changed them from grazing animals to stalled pets and added grain, we changed their systems (not for the good) and now they do benefit from something (sulfur) that they "shouldn't" need, but it works now.

Far fetched maybe, but in the case of alot of ideas, 10 yrs from now it may be that MSM is indeed proven to be a wonder supplement and you won't find a horse feed without it, who knows??

I hate that word "Scientifically", but it's been proven Scientifically that inflammation is the root of many of our modern diseases.

Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 12463
Registered: 1-1997

Posted on Saturday, Apr 2, 2005 - 5:38 pm:

It is not true Angie that all inflammation causes disease or is bad from a health standpoint. Inflammation is an important component of healing wounds, preventing infection, and in a loose sense is responsible for such regular body functions as replacing the cells in some mucous membranes like your stomach. That is why antiinflammatories sometimes cause gastrointestinal ulcers.

The problem with MSM is they have been making the possible wonder claims for at least the past 20 years and no one has as of yet demonstrated that wonder effect, dare I say it, scientifically.
DrO

CJ
Member
Username: Marroon

Post Number: 18
Registered: 3-2005

Posted on Saturday, Apr 2, 2005 - 6:43 pm:

Not trying to butt in but how are they able to identify that the gastorintestinal ulcers are caused by aniinflamatories? Since MSM is not scientifically proven are there test studies that link it to the ulcers also? I better do a search....excuse me.

CJ
Member
Username: Marroon

Post Number: 19
Registered: 3-2005

Posted on Saturday, Apr 2, 2005 - 6:53 pm:

Emily, was there ever any discussion with your doctor in regards to a combination mix such at MSM, Chondroitin & Gluclosimines? (splg herendous sorry) Just curious.

Shirley A. Johnson
Member
Username: Shirl

Post Number: 187
Registered: 2-2002

Posted on Saturday, Apr 2, 2005 - 10:33 pm:

I don't want to add fuel to the fire, but I know MSM is NOT advised if your horse has Cushings or Insulin Resistance. I agree with Pamela and Dr. O's thinking.

When Sierra was alive I went overboard with the supplements trying to help her with feet/leg problems. (Laminitis eventually killed her). If I had it to do over again, I'd have the hay analized and feed any missing minerals, or a complete pellet. I've learned a lot since she left me. No, the 'extras' didn't hurt her, but I did a lot of "flushing" as Dr. O quotes. Best to all, Shirl

Angie Judson
Member
Username: Ajudson1

Post Number: 177
Registered: 6-2003

Posted on Sunday, Apr 3, 2005 - 9:13 am:

Dr.O.,

I am corrected; that was a bad choice of words to say "ALL INFLAMMATION CAUSES DISEASES" You are correct in pointing out all the benefits from inflammation. Thank you for setting me straight.

A better way of putting it, would be to say "the root cause of many diseases is unbridled inflammation." This is where the "scientific studies" have been awesome, on people.

I don't really think MSM will ever be proven to be a "wonder" drug, but I wouldn't rule out that it has some health benefits, in some cases. Personally, I can't take it but thats me.

Debbie Green
Member
Username: Green007

Post Number: 63
Registered: 7-2004

Posted on Monday, Apr 4, 2005 - 9:34 am:

Anyone know how MSM stacks up against Devils Claw? I have tried both with my senior gelding and see better results with Devils Claw. Anyone else tried both and seen a difference?

Sara Wolff
Member
Username: Mrose

Post Number: 543
Registered: 1-2000

Posted on Monday, Apr 4, 2005 - 9:56 am:

Devil's Claw is more of an anti-imflamatory and pain reliever as I understand it. I use it on my mare that had knee surgery as I understand it to be easier on her stomach than bute. ( She only needs something when the weather changes or she overdoes it.)