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Discussion on Myositis or back problems? | |
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Posted on Wednesday, Jul 25, 2001 - 4:08 pm: Dear Dr.O.:Our 6 year old Selle-Français mare had what the vet then diagnosed as a locked stifle when she was 4 years old. After a long period out of work, she recovered, and was gradually put back into training. She progressed steadily along the months, with no sign of the old problem, and was even jumping ( like an angel, actually ! ), so we were all very happy, including the vet. A couple of months ago, she had what the vet called a brief episode of myositis: her croup muscles started to twitch, and she would press her rear to the wall as if she were trying to get rid of a cramp. A few hours later she was absolutely fine, but the vet advised us to put her on a supplement with vitamin E, selenium and lysine, for her muscles. She was already on another supplement called Glycan ( by Equipur ) for her joints and cartilage, which the vet said not to stop. Anyway, she recovered quickly, as I said, and went back to work. She was again going like a dream, until, a couple of days ago, something weird happened: In the morning, when the trainer was getting her out of the box to exercise her, he noticed that she was very stiff, and appeared to "drag" her hindlegs, specially the right one ( where she'd had the locked stifle ).He asked me to have a look while he briefly trotted her on the lunge, and in fact the tension was all over her croup muscles, causing that "leg-dragging" effect. The weirdest thing, though, was that her tail was "shivering" so much, one would think it was switched to electricity! Of course we stopped any work immediately. The vet was away, so he only came to look at her this afternoon. She is a little better, and her tail isn't "electrified" anymore, but there's still a noticeable tension on her back ( croup ). The vet said that now he doesn't think that what she had in the past was a locked stifle after all. He's now inclined to think that she has a muscular problem which affects her back ( croup )and that the "leg-dragging" was in fact an effect of this. There may be also a tendency for myositis, he says, so he took a blood sample to check her CPK and other muscle enzymes. In the meantime he prescribed a course of Bexamol ( methocarbamol )and advised we stopped all exercise for a while ( just turn her out everyday ). He wouldn't want to advance any prognosis. In the meantime ( I forgot to mention this to the vet ) there was something I wonder if it might have had anything to do with this: The mare was "heavily" in season when this happened ( still is ) and she gets very bossy and even "stallion-like" at these times. She was staying in a paddock next to another mare ( with a fence separating them )who was also in season, and also gets a bit silly at these times. On the day the first mare appeared with that problem, the second mare had a bad tendon sprain, and - I only noticed this later - the first mare has the marks of a bite on her chest! I know they nip at each other across the fence... could they possibly have been fighting and injured themselves in the process ( one in her back, the other in her tendon? )? Needless to say, I'm very unhappy about this, specially with the lack of prognosis ( and the vet admitted he wasn't very sure about the diagnosis, either ), so, with my apologies for the terribly long post, I wonder if you could give me any advise. Thank you very much in advance. |
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Posted on Thursday, Jul 26, 2001 - 6:58 am: Hello Maria,Using your description and without seeing the horse I cannot differentiate between the various problems you hypothesize and other possible diseases. I hope the blood work will also look at the electrolytes including calcium considering the muscle twitching. I certainly think you need to consider Tying Up / EPSM particularly if your muscle enzymes come back high. See Equine Diseases: Lameness: Problems of Muscles, Tendons, Ligaments, and Bones: Tying Up, Rhabdomyolysis, and Shivers (EPSM) for more information. DrO |
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Posted on Thursday, Jul 26, 2001 - 11:19 am: DrO ~ I came over here to suggest that she check for hypocalcemia too, having just gone through this with DJ. DJ's muscle enzymes were normal however. Maria, this is well worth checking out, even if you have to run another blood panel.Suzy |
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Posted on Thursday, Jul 26, 2001 - 2:31 pm: Thank you for your suggestion, Dr. O., and thank you too, Suzy. I've already asked the vet to check that too. It's true we live in a calcium deficient area, and our horses feed is supplemented with calcium in the form of tricalcic-phosphate ( I don't think the spelling is correct,sorry!... ).In some cases, we've also given the horses calcitonin (once again, not sure about the spelling!). However, what they're taking now maybe insufficient, and only the blood test will, in fact, tell.So, thank you again! And Suzy, I hope DJ is fine, now. All the best! |
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Posted on Friday, Jul 27, 2001 - 1:19 am: Thank you, Maria ~ DJ is fine now, but it took weeks of huge amounts of calcium supplements to get him there. He too was on a diet that should have been providing plenty of calcium.Good luck and keep us posted on what the blood work shows Suzy |
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Posted on Friday, Jul 27, 2001 - 6:28 am: Hello All,Maria, though the blood calcium will be low if the muscles symptoms are due to acute hypocalcemia, in general chronic hypocalcemia cannot be diagnosed with blood work and has different clinical signs. Diagnosis is best done by evaluating the diet carefully. For more on this see Care for Horses: Nutrition: Calcium, Phosphorus in the Diet. DrO |
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Posted on Tuesday, Jul 31, 2001 - 8:29 am: Hello again, Dr.O. (and Suzy):The blood test results are back, but unfortunately there's no ionogram ( spell.?), so I don't know the electrolyte levels! I suppose I'll have to ask for another swab to determine these values. In the meantime, the mare has finished the methocarbamol course the vet had prescribed, and... she looked "wobblier" than before on the day she had the last injection! :0( - She's still holding her tail up as well, while she's moving, so I'm reading your article on "Lower back Pain in Horses" ( I've also read the one on "Tying up" very attentively, as you suggested ), to try and gather as much information as I can that might be helpful. As for the blood test results, here they are: CPK - 292 U/L ( reference values : at rest 12 to 60 UI/L or under 150 UI/L , after well tolerated exercise lower than 250 UI/L ) LDH ( LACTIC DEHYDrOGENASE - spell.? ) - 524 U/L ( ref. values : 151 - 322 ) I've also got her hemogram, which the vet didn't find anything wrong with. If you think it would be interesting to have a look at, I'll be glad to post it too. Thank you in advance for any further help. |
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Posted on Tuesday, Jul 31, 2001 - 12:02 pm: So what does your veterinarian say about all this? Does he find the elevation of the muscle enzymes significant?DrO |
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Posted on Saturday, Aug 4, 2001 - 6:16 am: Dear Dr.O.,I had a problem with my internet connection after a thunderstorm, this is the reason of this delay in getting back to you. I'm afraid the vet's opinion isn't conclusive at all. He says that although the enzymes are high, they're not that terribly high, and this could be due to the additional effort spent in her movements, as, he thought, all wasn't well with her back. Anyway, she's better now, her croup muscles don't twitch, her tail is relaxed, but there's still a slight stiffness in her back train, which still makes the "leg dragging" effect visible, although considerably less than it was in the beginning. We have not resumed her training, however, because, frankly, we are afraid to do so. She's being turned out everyday, and it is true that, if she gets excited by the sight of other horses coming and going, she starts galloping around, and gets all sweaty! I must say that, although she's terribly sweet, being out of a Thoroughbred mare, who was very highly strung herself, makes this filly quite highly strung, too. It makes me wonder if all this episode wasn't, in fact, the result of over exertion, when she was in season! I suppose I'll have to be patient and wait to see how she progresses. In the meantime, would you like to comment on this? Thank you in advance. |
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Posted on Saturday, Aug 4, 2001 - 9:32 am: Well he is right, it takes very little to raise these enzymes, and your values are not very high. Usually we take 4 times the normal as the play in the normals and you do exceed this in one of your enzymes. Is your vet sure the dragging is not caused by upward fixation of the medial patellar ligament (locked stifle)?While not conclusive the rise is muscle enzymes appear to be the best indication of the problem at the time and after getting the other values discussed above and ruling out problems with them you should consider experimenting with the treatment for Tying Up/EPSM with the increased fat diet described in the article. DrO |
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Posted on Sunday, Aug 5, 2001 - 6:38 am: Hello, Dr.O., thank you for your reply. Regarding the possibility you advance (upward fixation of the patella), this was the issue our vet believed we were dealing with two years ago (my post of July the 25th, above)and from which the mare seemed to have recovered completely until this episode occurred. Now he doesn't think a locked stifle is the issue, he's more inclined to a back problem, as I said earlier, due to her conformation and to a genetic tendency to a back train unbalance ( I'm sure this is a very un-scientific description of mine, I apologize ! ).In the meantime, we've actually started her on the high fat diet, which she's accepting very well, and although it's very early days, we are more optimistic now. Let's wait and see... and keep trying! Thank you again for your help. |
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