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Discussion Starter #1
My vet has just diagnosed Tyra with RER, a form of PSSM. It seems like her colic last month ended up being a severe tie up episode from too many electrolytes. We were told to pull her off of all alfalfa, no electrolytes (only salt). This came to us after Tyra colicked (ended up being Tying Up) every day last week.



I really need support and advice from people who have experience with this disorder... I thought I was doing the right thing by giving her 'lytes, but now she can only have plain salt... I feel so bad.
 

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What's she eating right now? Diet is a big part of managing it.
Not RER, but I'm feeding my horse for PSSM right now, in case it solves our problems.

High fat, high protein, low NSC and starches. Why no alfalfa? Myopathys are typically glycogen imbalances. Alf is usually g good choice for the high protein and low nsc content.

She doesn't get much turnout now, right? They need to move as much as possible, be it turnout or riding.

This may also be the source of her soundness troubles.
 

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@ApuetsoT - I never considered her soundness issues related to RER, but now that you say so you could be very well right. it's never been in her feet, it's always been hind end. Always seemed musculature but never could be sure...



Vet says her calcium levels are too high and not balanced. She wants her completely off of alfalfa and was very, very adamant about that. I am supplementing with tri-Amino. Vet says this is OK.



After she came home from the vets (she wasnt officially diagnosed yet), I put her on this feed program:


1 lb soaked beet pulp
20lbs double hay netted orchard grass hay fed twice a day (10 lbs each serving) - this lasts her all day
5 lbs TC senior
1 lb soaked timothy pellets
3 scoops pro bios
3 scoops electrolytes
1 cup oil.


Now that we have the diagnosis we are taking her off of beep and electrolytes and replacing with salt. She has been tying up/colicking every single day last week (still on lytes and beep). We turn her out with a young mare who loves to play and they non stop run for 20 minutes. I had no idea this was wreaking such havoc on her. 7 days in a row she "colicked" but i found poop/pee and by the time i came to the barn she was eating and drinking. I only knew because of the HUGE sweat patches on neck and multiple bite marks on belly.


I'm absolutely side-lined by this and I did not expect this diagnosis or disease at all. She is n/Rx and apparently a late-symptom developer...
 

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Discussion Starter #4
I do ride her every day. She had a huge episode last monday after a very hard 2-day clinic. She could barely move and passed dark brown urine. She had spontaneous sweating. I felt her hind end was very tense but I wasn't sure because colic was still my only thought. I called the vet and that's when we realized what was happening, and suddenly everything made sense. They have a blood panel at the hospital as well and her results are on file. ;_; my poor sweet girl...
 

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I'm following this and trying to learn...sadly through your bad experience...


I would like to ask some questions if you would allow?
They are NOT digs at you but because I do not understand her diet as you had it and are now changing it to...


So...
Why was she getting so much electrolytes daily?
When I've given them we fed 1 scoop per day, then watched carefully for enough water intake to warrant and keep that amount of reduce it as much as we could?
Why are you taking away her beet pulp?
Its fiber and calories...
Thought to soak this in plain water it would help to keep that intestine working smoothly...
With the tying-up she then has lower levels of certain vitamins and minerals...yes?
My friends horse when she was campaigning her, riding in all kinds of weather and stress conditions her horse needed extra Vit E/Selenium and one of the B vitamins...but which one I no longer remember clearly...
With blood panels already on file for base line maybe you will also see those numbers being slightly off and rectify offering her faster recovery...


I wish you only the best in recovery...
Although it took this to find it, it is found and now a plan to do a successful recovery for your girl now happens...
:runninghorse2:...
 

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Subtle hind end lameness and NQR, moving lameness is common with myopathys, even if they don't have it so severe as to tie up. But you think about what the disorder is, muscles not having the right fuel. You're going to end up with muscle damage over time if its unmanaged.

Calcium and electrolytes are integral to muscle health, so it would make sense that a nutritional imbalance would worsen an episode. I'm also not sure if calcium is released during an episode. Might be something to research. Once you get the electrolytes under control, you may be able to add alf or bp back in. TC Senior is 11% NSC, so that is good. The extra aminos are good. You may even want to bump up the oil once she is used to it. I think 3 cups is a point some people with PSSM try to feed at.

Get an account at FeedXL.com. You put in all of what you are feeding, your horses stats, and it will run an analysis on the nutritional content. You can specify you need a diet for tying up too and it will set those limits. A month membership is $20 for one horse, or $60 for a year. I used this for my horse and was shocked what his old diet was like. Not what I was expecting.

What is the feeding directions on the lytes? 3 seems like a lot, but I don't feed lytes.

When did these episodes start? I don't remember reading about them before, just her subtle NQR lameness. Maybe look at what changed at the time she started tying up more. Was it when you moved barns? It might be a turn out situation. The more low intensity turnout she gets the better. Being out with the mare who makes her run for 20 minutes might not be the best. Any way you can get barn staff to hand walk or gently lunge in the morning, then you ride in the evening?
 

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Here's a good article on RER:
Managing RER (a Form of Tying-up) With Dietary Changes | KPP

These horses benefit from a low sugar/starch diet (because anything that makes them overly excitable like grain can make the issue worse). Your horse is already on that type of diet, assuming her grass hay is not high sugar/starch.

I put your diet into Feed XL, using a basic orchard grass template (may vary slightly in nutrient content from what you are using), the 5 lbs of TC Senior, 1 lb Timothy pellets, 1 c. oil, probios. The only thing I didn't add was the salt. As you can see, your horse would probably benefit from a multivitamin, as there are some basic deficiencies in this diet.



On this current diet, your horse is getting about 1,700 IU of Vitamin E. You may want to supplement this, as you can read in the article above and I've read in other sources, horses with muscle myopathies are usually recommended to get at least 3,000 IU. Also half of the Vitamin E is coming from the TC Senior, which uses synthetic E rather than natural. Horses only absorb about half of synthetic E, so you need to feed twice as much if you give synthetic.

Magnesium is also VERY important for nerve and muscle function, so it is often recommended that horses with muscle issues are given a combo of Magnesium, Vitamin E and Selenium (but check to make sure your hay is not grown in a Selenium rich area, or else have the hay tested). I give my TB all three.

On the chart the sodium and chloride deficiency will not be accurate if you are feeding salt, I just didn't know how much to add.

It's true that RER horses are not supposed to have straight alfalfa because of the high calcium content.
 

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Yea, vitamin E is also important. Forgot about that one. I've ordered the 500iu vit e from horsetech. Since you had bloodwork done, did her vit e and selenium get tested? She doesn't get to graze so supplemental vit e is even more important. You can safely megadose vit e too.

What's the minimum feed rate on tsc senior? I didnt look yesterday. If you are feeding enough you shouldn't need an additional vit supplement in theory.
 

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It's much too involved to write here, but please get yourself educated on the role calcium plays in the pathophysiology of your horse. Your Vet is right, the blood calcium levels MUST be reduced, it can have fatal consequences otherwise. Wishing you well on this one...
 

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What's the minimum feed rate on tsc senior? I didnt look yesterday. If you are feeding enough you shouldn't need an additional vit supplement in theory.
It must be a few pounds more than five since if you look at the graph chart using the TC senior there are deficiencies.
 

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Discussion Starter #13 (Edited)
I'm following this and trying to learn...sadly through your bad experience...


I would like to ask some questions if you would allow?
They are NOT digs at you but because I do not understand her diet as you had it and are now changing it to...


So...
Why was she getting so much electrolytes daily?
When I've given them we fed 1 scoop per day, then watched carefully for enough water intake to warrant and keep that amount of reduce it as much as we could?

Originally I was feeding electrolytes because we thought her colic was due to her not drinking, but it happened immediately after extremely strenuous exercise (turnout). The vet was positive she was going to die (well, the first aid vet at least) so we rushed her to the local hospital. By the time she arrived, the high blood pressure/heart rate had gone back down. Although we have no evidence, just hindsight, we believe the heartrate is due to her being overdosed with electrolytes that the vet gave her. Now that I know this specific myopathy is sensitive to potassium she is off e's and added onto salt.
Why are you taking away her beet pulp?
Its fiber and calories...
Thought to soak this in plain water it would help to keep that intestine working smoothly...
This specific myopathy is sensitive to calcium and beet pulp has high calcium, so I was thinking perhaps the rest of her episodes last week were due to that? The vet has already instructed we take her off of alfalfa after seeing her bloodwork. Could I add extra water to her TC senior?
With the tying-up she then has lower levels of certain vitamins and minerals...yes?
Her tying up is due to overuse of blood proteins, as I understand it. It is the muscles being overworked and she is unable to stabilize her calcium levels.
My friends horse when she was campaigning her, riding in all kinds of weather and stress conditions her horse needed extra Vit E/Selenium and one of the B vitamins...but which one I no longer remember clearly...
Yes, vet also told me more vitamin e. I guess looking at feedxl her selenium needs to be upped as well.
With blood panels already on file for base line maybe you will also see those numbers being slightly off and rectify offering her faster recovery...
Exactly, which is why I am so happy they pulled blood for me.


I wish you only the best in recovery...
Although it took this to find it, it is found and now a plan to do a successful recovery for your girl now happens...
:runninghorse2:...



@ApuetsoT - This is RER, that's the only myopathy that has been confirmed. There could be others. She doesn't have PSSM 1 (which can be fatal), but very well could have PSSM 2(a bit more manageble), and RER is genetic as well. This specific myopathy is an inability to regulate calcium levels so she must be on a low-calcium diet. I had added the beep because without alf she is at nearly 0, but she was experiencing tie up episodes every day last week... so now I trying to figure out if it was the e's or the beep...

@gottatrot - yes, i was trying to keep her low NSC anyway due to her susceptibility to laminitis. What I didn't know is the alfalfa. At our last barn she was not receiving as much alfalfa as she was at this barn (maybe 5 lbs). But to be safe, vet wants her off of all alfalfa. It is also apparently a developmental disorder and can be slow to progress or appear. Might explain why I haven't seen this before for her. I was shocked the vet was pushing us so hard to remove the alfalfa, especially since she is ulcer-prone as well. She might need to be on long-term omeprazole in this case.

She's on late-cut orchard, so I would assume the sugars would be lower. We have a lot of IR horses on this property so the barn does a wholesome cutting that will work for everyone and not upset those with sugar sensitivities.

I'm definitely going to get FeedXL and more vitamin e. I keep thinking this horse can do OK without a lot of additives but I continue to be wrong. Thank you so much gottatrot <3 i pride myself in being the barn guru but i didn't even see this diagnosis coming...
 

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Azoturia (ERS) comes under the same umbrella of disorders and used to be known as Monday Morning Disease because it almost always occurred after a horse that was worked hard all week (especially in the days before they were replaced by motorized transport) spent to weekend in a stable doing nothing.
With modern and science and more research they've isolated things like stress and sudden changes in routine and diet to be triggers.
Horses prone to it should be kept on a high fibre/low starch/low sugar diet and have as much access to turnout as possible - going from standing in a stable for long hours to sudden intensive work sessions or galloping around a field to release pent up energy isn't good for them and neither is going from a lower NSC hay to high sugar lush grass
High does Vit E has been shown to help and so has selenium but that has to be kept within that fine toxicity line.
Any horse that's reliant on hay as its main feed source needs supplemental Vits E and A
Any horse that spends most of its time in a stable needs a low sugar/low starch diet - an hour of work and an hour in a small paddock isn't enough exercise. You can spend that hour just warming them up and then cooling them down. The real work is what comes in between.
I wouldn't give any pelleted feed at all, you can add vitamins and minerals as needed. A good chopped forage that's got no added molasses and sugar beet, also no added molasses with some quality oil added to the feed is more than enough for a stabled horse in light work. Sugar beets got good pectin levels so makes a natural buffer against acid and chopped forage helps soak up acid and encourages chewing which produces essential saliva that will also reduce acidity.
If the ulcers are caused by stress and stress also a factor in things like RER then this horse would likely be better suited to a different lifestyle


Most articles I've read advise to use electrolytes.
 

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Ok...so now that I understand a tiny bit more questions...


You make reference to her having a reaction/episode after any hard exercise whether ridden or self-inflicted running or such in t/o...
So, follow me here...
Racehorses...Thoroughbreds after a workout are walked for 45 minutes minimum so the body is offered the opportunity to have the muscle acids by-products of work minimized, absorbed and neutralized by the body before they are allowed to return to their stall, get a bath or anything where they stand and stay put.
They walk, they are offered sips of water not long thirst quenching drinks...and walk more...and more.

Is your horse not being walked sufficiently that her body is then poisoning itself with muscle work by-products that create tying-up and worse scenarios?
I don't know all the technical terms as others do but know if your horse is strenuously working then made to stand to soon she is going to have serious side-effects.
"Cooling out" and she is not really cooled...

Could this be part of the reason she is tying up...there sure is a activity line to document here.
:runninghorse2:...
 

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Discussion Starter #17 (Edited)
@jaydee - this is not ERS, this is RER - Recurrent exertional rhabdomyolysis. RER can't have potassium. We do not KNOW if she has ulcers. I am ASSUMING she can get ulcers. In my opinion, ulcers can be treated with medicine. She is not a high strung horse, just a cribber and her cribbing has gone down 50% since moving to this new barn. In turnout she will NOT move. In a large dirt lot or arena (what we have access to, so please respect my limitations and work off of what I have when you offer advice), she stands and cribs. She ties up when she is turned out with another horse who makes her RUN. Every time she's had an episode it has been under these conditions, the last one where she ran for over 20 minutes straight with another horse sent her to the hospital. So forgive me if I choose a stall for her, because too much exercise makes her sick.

@horselovinguy - only when she is turned out and made to gallop/race around. Then she ties up. This last time I caught was after my friend, not knowing, turned her out with her extremely aggressive and hyper mare and they went around and around at full tilt for over 5 minutes. I come to the barn and she's breaking out into spontaneous sweating. Not full tie-up but she was breathing heavy and wouldn't move. I agree, after turnout she should be walked or cooled off. I am brand new to this disorder... I did not know. I am doing everything I can now to recognize what can trigger one of these episodes.



She is in very light work under saddle, and we do light dressage. She doesn't experience episodes after being ridden, just after being turned out with the horses who like to zoom. She is not a zoomer. She is a stagnant being who would rather stand and sleep than move about. Whether this is due to pain in her body from the RER or her personality is not clear yet, but for the past three years this is constant across the board. She does NOT like to run.


@rambo99 - this is why the vet suggested we soak it, to remove any sugar that possibly could be in there.


OMG! The management for this is insane!!! I am so thankful I am at a barn that will adjust their standard practices for me...


I would also like to note that yes I do believe in pasture turnout and I am not someone who is against it... but not for this horse. With all of her issues, she needs constant monitoring 24/7 which we would not get if she was in a pasture. If this were ANY OTHER horse she'd be out there frolicking about, but Tyra has too many issues, too many health concerns and needs too much supervision for me to feel safe with her in an area with other horses where she cannot be seen at all times.


AS A COMPROMISE we are moving her to the "large stalls" which have 50 x 60 enclosed area and a 14x14 indoor box stall leading out. I am on the waitlist. Just waiting to get the call that they have a stall for us.
 

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@ApuetsoT - This is RER, that's the only myopathy that has been confirmed. There could be others. She doesn't have PSSM 1 (which can be fatal), but very well could have PSSM 2(a bit more manageble), and RER is genetic as well. This specific myopathy is an inability to regulate calcium levels so she must be on a low-calcium diet. I had added the beep because without alf she is at nearly 0, but she was experiencing tie up episodes every day last week... so now I trying to figure out if it was the e's or the beep...
I realize it's RER, but they all kind of fall into the myopthy umbrella. The advice is still to limit NSC and starches and feed a high fat diet with regular, low intensity exercise.

If you can find any articles by Dr. Valburg, read those. She's the industry expert on all things myopathy
https://thehorse.com/115247/exertional-rhabdomyolysis-not-just-tying-up-anymore/
 

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Discussion Starter #20
I realize it's RER, but they all kind of fall into the myopthy umbrella. The advice is still to limit NSC and starches and feed a high fat diet with regular, low intensity exercise.

If you can find any articles by Dr. Valburg, read those. She's the industry expert on all things myopathy
https://thehorse.com/115247/exertional-rhabdomyolysis-not-just-tying-up-anymore/

This is what she states for exercise:


It is quite possible that exercise exerts beneficial effects on horses with chronic exertional rhabdomyolysis that are separate from the impact of reduction in dietary starch and/or fat supplementation. Failure to implement an appropriate exercise routine will likely lead to failure to control rhabdomyolysis.

These episodes only happened at speed and at great exertion. I do not think what I do with her has triggered any episodes. The racing around the arena for minutes on end surely did and this is not even close to the amount of work she would experience under saddle.
 
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