Maestro Part Two

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I’ve got to get to the bottom of this!  Maestro’s muscles are slowly melting away and he’s lethargic. I need to know WHY.  The vet and the blood tests say he’s fine.

Studying Maestro one evening, “EPSM” comes to mind.  Equine Polysaccharide Storage Myopathy is a genetic, progressive, neuromuscular disease. There are two types. Type II is what applies here.  Type II manifests later in life than Type I. Maestro is thirteen, which seems to be the sweet-spot for most Type II horses (average age at diagnosis is between eight and early teens).   Dutch Warmbloods (when compared to other warmblood breeds) are well-represented in the Type II category but rarely with Type I.

Maestro before any MAJOR symptoms, albeit overweight…

In veterinary technician school we were taught about equine neuromuscular disorders, briefly.  EPSM was just a mysterious acronym for my classmates. Thankfully, I’d been out in the horse world my whole life and had managed Type I horses.

Type I affects many breeds especially drafts and Quarter horses.

Both Type I, and Type II symptoms can include muscle wasting. Type I usually occurs earlier in life and often manifests by the horse “tying up,” in the most severe form.  Here, the horse stands camped out, outstretched with a tense back and painfully hard hindquarter muscles. The horse is unwilling to move. During an episode, the horse’s urine may be coffee-colored.  This is from the muscle pigment, myoglobin, being released from the dying muscle fibers after being filtered by the kidneys.  There are more subtle symptoms of Type I as well and it’s easy to diagnose with an inexpensive genetic hair test.

My local vet and her colleague had no awareness of the second type of this syndrome and little experience with the first.  One acquaintance, a board-certified equine surgeon, had only diagnosed a couple of horses with EPSM.

Although everyone who saw Maestro believed he looked “fine,” he’s shown consistent symptoms of Type II recently.

Recalling a severe stent of kidney colic and tying up eleven months ago, everything added up.  He recovered brilliantly with the help of intensive supportive care, homeopathy, a gifted holistic vet and energy medicine. Maestro’s main symptoms after this acute episode have been:

  • progressive muscle wasting throughout body
  • exercise & heat intolerance
  • occasional mild tying up episodes
  • standing camped out (outstretched)
  • unwillingness to move forward when working
  • “stickiness” in the hindquarters
  • lethargy & lying down often
  • occasional cough

Recalling other horses in my life, I started to see that this is not an uncommon disease.

In fact, I’ve likely worked with many “problem” horses who have been undiagnosed but symptomatic of EPSM.  Discomfort caused by this disease may have been the reason for much of their behavior challenges and physical symptoms.  These signs sound familiar to many horse owners.  The problem is that they’re generalized and could mean MANY things.  It takes time and persistence to put the puzzle together and discover what may be the cause.  Of course, horses never lie…

Studying his bloodlines, his records and talking with his previous owner revealed that Maestro has had seemingly random symptoms during the time she had him.

Top veterinarians never suggested EPSM as a possibility.  They did their absolute best to help Maestro.  Vets attributed each problem to a variety of lameness issues, hoof pain, chronic colic, compensatory pain, etc. His owner lovingly treated him to the very best veterinary care and holistic management, but to no avail.

Given his multiple soundness issues and lack of suitability for upper level dressage, my dear friend could no longer keep him. He had a different purpose in life.  Since I love rehabilitating horses and could care less about riding, she gifted him to me.  The teacher had appeared; quite literally.  I decided to learn from “The Maestro.”  To understand his his lineage, I talk with warmblood breeders and learn about his bloodlines.  Learning of the possibility of genetic proclivity to EPSM made me want to dig deeper.

The journey begins by going straight to the horse’s mouth.

I find one of the world’s experts on EPSM.  Dr. Stephanie Valberg, DVM, PhD is a researcher at Michigan State University’s College of Veterinary Medicine and is also board certified in internal medicine.   She’s been a respected pioneer in equine neuromuscular diseases for many years the Equine Neuromuscular Disease Laboratory.

During our conversation, she agreed based on my description of Maestro’s history, breed, age and symptoms, that he may have Type II.  She requested that he have small muscle biopsy from his hamstring.   That sample would be sent to her team in Michigan for microscopic evaluation and diagnosis.

Considering that his surgical site would have several stitches, he’d need to be confined to a smaller turnout area for a couple of days.  No big deal for most horses.  However, Maestro becomes stressed in any kind of confinement and his body becomes acutely painful.  Taking him out of his herd creates tremendous distress on top of it. For now, it’s not worth it.

Recognizing how nice it would be to have a definitive diagnosis, I feel confident it’s not in Maestro’s best interest at this time. 

Plus, I am not excited about having Maestro undergo a minor, but nonetheless invasive standing surgery at this point.  His condition is in a precarious state and it doesn’t feel right to proceed.  If we need more clarity at any point, it’ll be done. Trusting that the time will be right and Maestro will be well-prepared leaves me feeling relieved.

Dr. Valberg generously shares other strategies that may help him.  She suggests a feeding trial including a very high protein commercial feed, moderate-low starch and whey protein for amino acids.  The objective is to provide ample building blocks for muscle repair and development.  Stopping the muscle wasting is the main target.   Should he need to gain weight, he could have additional calories from fiber and fat but not from starch.   She stressed progressive walking exercise to help his muscles. Depending on his response, we’d have a better idea of his status.

Talking with EPSM researcher, Dr. Beth Valentine, DVM, PhD at Oregon State University’s College of Veterinary Medicine gave me more information.

She’s been studying the disease for 25 years.  Her recommendation for all types of EPSM is a high fat, low starch and high protein diet.  Exercise and full-time turnout without rich grass is critical.  Maestro’s response to this diet could take four months.  Dr. Valentine cautioned me there would be good days and bad days during his metabolic shift and to focus on the good ones. Feeding fat from a vegetable source was absolutely key, regardless of type, in her experience.  Calculating 20-25% of Maestro’s daily calories coming from fat meant feeding him well over two cups of oil per day!  I feel apprehensive about feeding that much of any oil to Maestro.

Everyone has a strategy to manage this disease, but it’s defined as incurable.

In talking with other people with Type II horses, it seems that these horses are a challenge.  The idea of treating the horse who is manifesting symptoms of the disease on a more “constitutional” level hasn’t yet come up, except with my holistic vet. What Maestro is expressing is actually a collection of symptoms that could be labeled as EPSM.  The diagnosis is not the answer.

Homeopathy is something we are using in Maestro’s case to help the whole horse recover.  Regardless of a diagnosis, he needs the right foods, exercise, low-stress and unlimited turnout.  My intention is for the “Whole Maestro” to bounce back into a state of health

Meanwhile, Maestro’s genetic hair test is negative for Type I.

That’s no surprise.  I insisted we check muscle enzymes (AST and CK), vitamin E and Selenium.  All were normal. Muscle enzymes are often normal in Type II horses.  Low vitamin E and Selenium can cause muscle pain and tying up in any horse and are an easy fix.

I sent more mane samples off for a brand new Type II genetic test.  It’s not yet recognized by many vets, as it just became available.  The science behind it makes sense and others have obtained consistently accurate results.  It will at least tell me if he has the genes for EPSM and which type. It’s something I can do.

I have nothing to lose in changing his diet.

Carefully preparing Maestro’s dinner gives me hope!  Not relying on a bag of pellets means I can see that what he eats and feel it with my hands.  He’s always eaten a whole food diet but this one is further customized to support his healing efforts.  Feeding the whole horse, not managing a disease, is my mantra.  No processed foods, no soy, no GMOs, nothing artificial and no pro-inflammatory food will EVER cross his lips.

To reduce starch, I eliminated the tiny amount of oats he was eating. Adding just a cup per day of organic coconut oil gives him medium chain triglycerides, one of the most rapidly used muscle fuels.  I’m not using the typical vet recommended vegetable oils such as corn, canola and soy.  The majority are GMO, hexane (a carcinogen) extracted, deodorized and are high in pro-inflammatory omega-6.  I add chia seeds into his recipe for critical omega-3 and other nutrients.  I’ll add a bit of hemp oil and camelina oil for their specific properties soon.  Doubling his organic alfalfa pellets raises the protein.   Tossing in a small amount of un-denatured, grass-fed whey gives him a full spectrum of amino acids for muscle repair.  His low starch hay is always free choice along with grazing on sparse native pasture.  A variety of super green foods like AFA algae, spirulina, kelp, and nutritive herbs provide his vitamins and minerals.

The King LOVES his Green Mash!

Green Mash is food for health, not disease. Watching Maestro savor his dinner feels amazing and lowers my stress. Within twenty-four hours, I’m shocked!  His eyes are soft and he’s moving well.  Each day I make notes on his condition, attitude, any changes and whatever we did that day.

 The physical shifts are slight at this stage, but everything else is clear!


Here are the changes I’ve noticed in about four weeks since implementing his new diet & exercise program:

  • standing more square (happened in 48 hours of new diet)
  • improving condition
  • not urinating just before feeding time
  • playing with herd mates
  • more energetic & napping less
  • eager to walk in hand
  • no “stickiness” or hesitation when asked to move forward
  • not grumpy
  • overall calmness
  • loves to be touched & groomed
  • stands quietly for hoof trimming
  • muscle development behind withers and between hip and stifle
  • soft muscles along lower back and hindquarters

Stay tuned to learn about his progress, what I learn about this dis-ease and my conclusions/opinion about this all too common but often under-considered syndrome.  As always, your feedback is welcome.  Please respond in the comments section of the blog or send a note to


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  1. Betsy Longoria says:

    Is EPSM considered an auto-immune disease?

    • No it’s not Betsy, not in the literature at least. I think that term autoimmune could go so many different ways! Some people compare the discomfort (they’re suggesting based on their own experience) that it may feel similarly to fibromyalgia….

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