# Raised CK levels



## Bertolie (28 November 2012)

Had the vet to my 19 year old cob 10 days ago as he was showing signs of being uncomfortable - shifting weight on back legs, fidgety and raising tail.  He had a previous 'episode' of same symptoms 3 weeks prior to this that was put down to having had a knock or possibly a kick in field (but no visible evidence).

Vet carried out full examination - heart, lungs, temperature, flexion tests, checked for laminitis, etc.  Horse was uncomfortable and uneven trotting up but no laminitis.  Bloods taken and results showed raised white blood cell count and also raised CK enzymes (normal range <380, horse tested at 578).  Gave antibiotics for 5 days to treat any infection and then retested bloods on Monday.  Results back yesterday showed that the white blood cell count now normal but his CK levels were still raised (559).

The vet said the most likely cause would be tying up but we were puzzled because she would have expected his CK levels to have returned to normal by the second blood test.  Horse is not exercised much at the moment (and not done any work since first blood test although is turned out 24/7) due to saddle problems and is fed a half ration of Spillers Lite balancer with joint supplement and biotin.

Does anyone have any other suggestions as to why his CK levels would still be raised?  Vets have said to monitor him, take him for a short hack in walk only this weekend and then see how he is.  Other than that, they seem to be a bit at a loss!

Any thoughts or suggestions would be appreciated.


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## dianchi (28 November 2012)

Has azortria been ruled out?


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## Bertolie (28 November 2012)

dianchi said:



			Has azortria been ruled out?
		
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Not ruled out completely but vet baffled why he would suddenly tie up with no change in diet or exercise.  Also, vet would have expected his CK levels to have returned to normal by the second blood test if it was azoturia. 

He also has a 'lump' on his near hind leg that vet thinks could be scar tissue - what from we dont know, and vet mentioned something in connection with his stifles but didn't go into detail. 

Options are:-
1.  Carry on as normal and monitor him
2.  Blood tests pre and post exercise
3.  Can try a muscle supplement
4.  Ultrasound scan of 'lump' on leg - not sure what this will achieve?
5.  X-rays of stifles - again not sure what to check?

I read somewhere that raised CK levels in older horses was normal but unsure how true this is.

I am just wondering if there were any other reasons for his muscle enzymes to be raised over an extended period of time.


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## flintfootfilly (28 November 2012)

One of my gang has had very elevated CK levels, which were picked up when doing a blood test when he had colitis about a year ago.  I was going to ask for a blood test in any case as he was showing a reluctance to work, regularly grinding to a halt from a trot.  A bit like a scaled down version of tying up.

Then I realised two others were doing similar, but to a lesser extent, and the others showed some reluctance to work, so I started thinking down the route of a herd problem.

Long and short is that I believe it was a selenium deficiency in the case of my gang.  However, in trying to address that deficiency (in accordance with published research) we tipped them into liver problems and that is now our biggest problem.

So what I would say is avoid making any dramatic changes in terms of muscle supplements/minerals etc, but DO ensure that he is receiving a full ration every day of a good quality vit/min supplement (like one of the Topspec range).

It's also easy enough to have your grass/hay/haylage tested to give an indication of its selenium content.  The NRC recommendation is a minimum of 1mg/500kg horse per day, which equates to 0.1mg selenium per kg dry matter in the diet.  (Mine came out as around 0.04mg/kg DM so it's no surprise they had problems).

Selenium deficiency will take at least 5 months to correct with daily vit/mins so do not expect a quick result if it's that.  But also that's worth knowing, as it's not worth chopping and changing what you do.

Even if it turns out it's not selenium deficiency, it has to be a good thing to provide a full daily ration of vits/mins.

Beyond that, some may suggest EPSM/PSSM/EPSM (all the same condition), but unless you see a reluctance to work cut in at around 15 to 20 mins after starting work, I probably wouldn't go down that route now (just based on my experience with my gang).

Worth making sure diet is low starch whatever.

My worst pony's CK is regularly over 3,000 - he's the one who shows the most dramatic grinding to a halt.  The other two who were grinding to a halt were at around the 800 mark.  And some others were only elevated by around 100 units or so.  Over the course of 5 months since starting the vits/mins, their CK has significantly reduced, with one pony having come within the lab's normal range for the first time ever, another coming below the "high normal" of 350 used by some of the world experts on muscle disease, one coming close to that level, and the two remaining other ponies both showing at least a halving of their previous levels.

Be warned that most vets don't have a clue on the significance of selenium (although they are rightly cautious about avoiding using excessive amounts as it can be very damaging and sometimes fatal), so they would probably send you round different routes first.  But my reckoning is that if you sort the vits/mins then that's something that needs doing whatever, and it may or may not solve the problems.

Sarah


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## flintfootfilly (28 November 2012)

Forgot to ask but what are his saddle problems?  I'm wondering whether there's a chance that they are related to the elevated CK, and therefore whether the discomfort with a saddle actually relates to underlying muscle problems?

S


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## flintfootfilly (28 November 2012)

Sorry, just one other thought.

The weight-shifting with the hind legs is something I've not generally seen with my gang.  The only time I saw it was when one had laminitis, so although the vet didn't think your boy has laminitis, I'd definitely keep checking pulses in all 4 feet and watch him like a hawk in that respect, and obviously make sure his diet is low sugar.  Better safe than sorry.

The CK levels may or may not be related to his apparent discomfort, so worth thinking from all angles.

S


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## Bertolie (28 November 2012)

Flintfootfilly - thank you, that makes very interesting reading.

His saddle problems started about 3 months ago when he started short striding and a reluctance to pick up his front foot and opposite back foot.  A friend on my yard is a qualified horse physio and had a look at him and said he had a small amount of muscle wastage on his shoulder and a sore back on the opposite side.  He is hard to fit a saddle to as he has the classic cob wide, flat back but he has withers! Saddle fitter adjusted saddle and told to try it out for a few weeks in walk only.  I still don't think it fits him properly and am getting another saddle fitter out to fit a new saddle.  

Could this be the cause of his raised CK levels and his discomfort?

The vet did check for laminitis when he came out and there was no heat or pulses.  The rocking on his back end was more a case of trying to get comfortable I think?


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## Chocy (28 November 2012)

If horse had had mild tying up episode & was still turned out that could b enough 2 keep the CK levels high- as muscles still being used & working so CK can't lower properly

My horse tyed up (medium episode) box rested & CK levels stayed high for 3 weeks eventually she had 2 be kept on sedalin for a week 2 minimise movement & get her CK down 2 acceptable levels


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## flintfootfilly (29 November 2012)

Bertolie said:



			he started short striding and a reluctance to pick up his front foot and opposite back foot.  A friend on my yard is a qualified horse physio and had a look at him and said he had a small amount of muscle wastage on his shoulder and a sore back on the opposite side. 

Could this be the cause of his raised CK levels and his discomfort?
		
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At least two muscle diseases (EPSM and nutritional myopathy) seem to affect the hindquarter muscles more obviously than anywhere else.  I'm guessing this is because they are such big powerful muscles, and so important in movement that they show up problems soonest.  Was your boy's short striding in the front end or the back end?  Not that that would definitively say anything, but if it's a stilted hind limb action, then that ties in with my worst boy (and also with what can be seen with EPSM, but I'm not suggesting it is EPSM, just that muscle problems can cause that stilted hind limb action).  If it's the front end that looks choppy, I'd still be really on my guard for laminitis.

CK is present in the highest concentrations within muscle cells, so any damage to muscle cells results in CK leaking out and getting into the blood, so elevated CK reflects some form of muscle damage.  But muscle damage can be caused by strenuous exercise or travelling or apparently even from an injection just damaging a small amount of muscle, so it doesn't always reflect more serious muscle problems.  But the more times the CK is elevated, the more you'd suspect something underlying it.

Not sure if that really answers your question, but it's the best I can do.  

Sarah


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## Bertolie (29 November 2012)

flintfootfilly said:



			At least two muscle diseases (EPSM and nutritional myopathy) seem to affect the hindquarter muscles more obviously than anywhere else.  I'm guessing this is because they are such big powerful muscles, and so important in movement that they show up problems soonest.  Was your boy's short striding in the front end or the back end?  Not that that would definitively say anything, but if it's a stilted hind limb action, then that ties in with my worst boy (and also with what can be seen with EPSM, but I'm not suggesting it is EPSM, just that muscle problems can cause that stilted hind limb action).  If it's the front end that looks choppy, I'd still be really on my guard for laminitis.

CK is present in the highest concentrations within muscle cells, so any damage to muscle cells results in CK leaking out and getting into the blood, so elevated CK reflects some form of muscle damage.  But muscle damage can be caused by strenuous exercise or travelling or apparently even from an injection just damaging a small amount of muscle, so it doesn't always reflect more serious muscle problems.  But the more times the CK is elevated, the more you'd suspect something underlying it.

Not sure if that really answers your question, but it's the best I can do.  

Sarah
		
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Thank you, that is really helpful.  

The short striding was on the back end and when checked my friend said that the back muscle where the back of the saddle sits had gone into spasm.  I didn't ride him for approx 3 weeks until the saddle fitter had been, and the back was vastly improved and he was no longer short striding.  I am beginning to wonder now if the saddle issue and the CK levels are in some way connected.

I am going to try him on a short hack in walk only at the weekend and then monitor him.  The reason I and the vets are veering away from tying up is because he is fine whilst hacking and the rest of that day, his symptoms are showing up the next day.  He had the farrier out last sunday and was displaying signs of discomfort after he had been shod (seemed fine before and during) but hadn't been hacked out that weekend.  

Will be having a conversation with vets after this weekend and see where we go from there.

Thank you for your input - it has been most helpful


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## Bertolie (29 November 2012)

Chocy said:



			If horse had had mild tying up episode & was still turned out that could b enough 2 keep the CK levels high- as muscles still being used & working so CK can't lower properly

My horse tyed up (medium episode) box rested & CK levels stayed high for 3 weeks eventually she had 2 be kept on sedalin for a week 2 minimise movement & get her CK down 2 acceptable levels
		
Click to expand...

Vet advised to turn out, rugged to keep his muscles warm, and to keep him gently moving.  

He was stabled at night during the torrential rain, but seems happier out.  He shows more signs of discomfort when standing still than moving around.  I will double check with the vets as to the best routine.

Thank you for your thoughts tho, any little bit of advice or information is greatly appreciated.


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## ILuvCowparsely (29 November 2012)

dianchi said:



			Has azortria been ruled out?
		
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Can also be Myopathy which is a lesser form and not as serious as azutoria.

Creatine is leaked out the muscles which causes them to cramp.

 Sweating   cramping    bucking .  vet care is a must and if it is this.  My mare had 3 months off to recover


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## Bertolie (29 November 2012)

Leviathan said:



			Can also be Myopathy which is a lesser form and not as serious as azutoria.

Creatine is leaked out the muscles which causes them to cramp.

 Sweating   cramping    bucking .  vet care is a must and if it is this.  My mare had 3 months off to recover
		
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No sweating or bucking just uncomfortable on back end.  

Thank you for the suggestion, I will speak to vets about all these possibilities.


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## harrietSJ (4 December 2012)

Is the AST raised at all?

I am not saying it is EPSM at all but I would definitely speak to your vets about the possibility of a myopathy -  and if they say myopathies are 'rare' then get them to contact Dr Richard Piercy at the RVC for an update!  There is a simple genetic test that can be done for 1 type of this (type 1), and the other type is still biopsy unfortunately.  

(My cobby type has EPSM and was diagnosed as his muscle enzymes went up high after a week off, then remained high while was off 'resting' but then decreased when started walking him)


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## paulineh (5 December 2012)

As well as other things ,the land could be sort of Magnesium. 

I have a mare that has in the past presented with hind quarter stiffness (mild tying up as well as full blown tying up). This caused her to be uncomfortable in the trailer, making her unbalanced. I was advised to give her a magnesium supplement, used to help the nerves in the muscles and not as a calmer.

After having the land checked I now give all mine a maintance dose daily.

Lack of Magnesium can also cause other problems too.

Just to say that my mares problem was never caused by diet or exercise.

Another thing could your horse have slipped in the field and pulled a muscle.

I would also not allow a Physio to give the horse a massage /treatment if the CK is high, as a high CK indicates muscle damage.


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## Bertolie (5 December 2012)

I had the vet out yesterday to do an ultrasound scan on a lump/swelling that he has at the top of his near hind leg - this was pointed out to vet at original visit but was not thought to be of significance.

The ultrasound showed that he has a large haematoma and some scar tissue - probably from a kick as first thought.  The vet that attended yesterday said that this would cause the discomfort as it is in the large muscle situated over his 'thigh' bone.  It would cause his CK levels to be raised as obviously there will be some muscle damage.

I am so relieved to have gotten to the bottom of the problem, and although the vet said that it will probably take up to 3 months to disperse, at least I know whats wrong with him


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## flintfootfilly (5 December 2012)

Thanks for posting an update.  Hope it heals well and that things are soon back to normal - it sounds very encouraging.

Sarah


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## FairyLights (5 December 2012)

Could it be the start of cushings.?


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