<Deep sigh> Ideas for medicating -- definite "outside the box" thinking required

[twelvegates]

Horse has EMS, Cushing disease and laminitis. Requires daily Bute @ 1gm AM and PM. Horse is under veterinary care and veterinarian has been contacted regularly about issues. Horse is too painful to take off the Bute, injectable Bute is not recommended after 5 days, and I should add that said horse is also needle-phobic.

The only thing that has worked was the enteric coated Abler Bute granules, which they no longer make, and even then, she always left some in the bottom of her feed bucket.

What I’ve tried (and yes, I’m well aware that some of these efforts are ill-advised for an EMS horse, but everything has been done under a vet’s supervision, with regular blood work):

1. Bute forms: flavored paste, oils, tablets, powders. Have tried various flavors that she usually loves, and some that she has never tried before.
2. If I dose the medication directly in her mouth, she refuses to eat for 4-5 hours and basically drools out all of it. I’ve watched her on the camera, and you’ve never seen a more stubborn mess. I swear that horse is part donkey.
3. I’ve tried a dosing syringe with apple sauce, molasses, agave syrup, simple syrup, maple syrup, low sugar peppermint flavoring. All versions bring on the drooling.
4. Without the Bute in her meal (which is a bit of soaked beet pulp with her supplements and Thyro-L and Prascend), she eats her food willingly. Add the Bute and it’s a “no-go.” I’ve tried vastly increasing the amount of soaked beet pulp and adding various other ingredients, such as sweet feed, and once she tastes the Bute, she leaves the rest of the food untouched. I’ve added ground carrots, carrot chunks, apple chunks, and the “crumbs” from the bottom of bags of “Nicker Maker” treats – NOPE. I’ve added the low-sugar flavorings to the feed to mask the smell – NOPE.
5. I have kept the powdered Bute in the freezer, having heard that this helps. NOPE. Not with her.
6. Again, I know she has EMS, but with the vet’s blessing, I’ve tried those wonderful German Horse Muffins. This actually worked one time. She has refused even undoctored muffins since then, and it has been 6 weeks since I tricked her. I even stuck undoctored versions in her mouth, and she spits it out as soon as I release her muzzle.
7. Hollowed out carrots and apples and bananas-- NOPE. Spits the whole thing out once she crunches down on the medication.
8. Tried hiding Bute in Fig Newtons and bread – NOPE.
9. Tried adding to warm bran mash – NOPE.

I haven’t tried capsules yet and am considering buying some and filling them with the flavored powder, but I’m pretty sure that she will either sift them out of her food, spit them out, or stop eating once the dreaded Bute flavor presents itself.

I’ve asked the vet about other types of medications, but she believes that Bute is best for her, although she was willing to give acetaminophen a try, which worked as “well” as Bute and was vastly more expensive. No to firocoxib. Vet suggested injectable Ketamine, but we both agreed that this wasn’t a good solution, given her mental status when needles are present. (Said horse is 12 years old and I and three other vets have done the desensitizing training, and it hasn’t worked for her. Tried clicker training with yummy treats years BEFORE this whole Bute problem started, and she always fought the needle. I do have Dormosedan to sedate her in case I have an emergency and she needs to get some shots, but I can’t do that in this situation. I even took her to a clinic with a horse whisperer, and shots did not happen that day.)

Perhaps this combination of horse and medication was simply not meant to be.

In sympathy with horse, I’ve tried the medicines myself and I agree that all of them, with the exception of the paste, are absolutely horrible. “Bitter” doesn’t begin to describe the taste. The paste isn’t nearly as bad, but it doesn’t seem to matter to her–she won’t eat it if I add it to her food and she drools for hours and hours if I paste her.

And yes, I’ve alternated these efforts so that she isn’t always presented with a medicated treat, but she is suspicious of everything. And I’m in a bit of a quandary, because this is a regular medication that she is supposed to get AM and PM.

I’m at a loss. Has anyone figured out anything else that I haven’t tried?

[Scribbler]

@twelvegates

Horse has EMS, Cushing disease and laminitis. Requires daily Bute @ 1gm AM and PM. Horse is under veterinary care and veterinarian has been contacted regularly about issues. Horse is too painful to take off the Bute, injectable Bute is not recommended after 5 days, and I should add that said horse is also needle-phobic.

The only thing that has worked was the enteric coated Abler Bute granules, which they no longer make, and even then, she always left some in the bottom of her feed bucket.

What I’ve tried (and yes, I’m well aware that some of these efforts are ill-advised for an EMS horse, but everything has been done under a vet’s supervision, with regular blood work):

1. Bute forms: flavored paste, oils, tablets, powders. Have tried various flavors that she usually loves, and some that she has never tried before.
2. If I dose the medication directly in her mouth, she refuses to eat for 4-5 hours and basically drools out all of it. I’ve watched her on the camera, and you’ve never seen a more stubborn mess. I swear that horse is part donkey.
3. I’ve tried a dosing syringe with apple sauce, molasses, agave syrup, simple syrup, maple syrup, low sugar peppermint flavoring. All versions bring on the drooling.
4. Without the Bute in her meal (which is a bit of soaked beet pulp with her supplements and Thyro-L and Prascend), she eats her food willingly. Add the Bute and it’s a “no-go.” I’ve tried vastly increasing the amount of soaked beet pulp and adding various other ingredients, such as sweet feed, and once she tastes the Bute, she leaves the rest of the food untouched. I’ve added ground carrots, carrot chucks, apple chunks, and the “crumbs” from the bottom of bags of “Nicker Maker” treats – NOPE. I’ve added the low=sugar flavorings to the feed to mask the smell – NOPE.
5. I have kept the powdered Bute in the freezer, having heard that this helps. NOPE. Not with her.
6. Again, I know she has EMS, but with the vet’s blessing, I’ve tried those wonderful German Horse Muffins. This actually worked one time. She has refused even undoctored muffins since then, and it has been 6 weeks since I tricked her. I even stuck undoctored versions in her mouth, and she spits it out as soon as I release her muzzle.
7. Hollowed out carrots and apples and bananas-- NOPE. Spits the whole thing out once she crunches down on the medication.
8. Tried hiding Bute in Fig Newtons and bread – NOPE.
9. Tried adding to warm bran mash – NOPE.

I haven’t tried capsules yet and am considering buying some and filling them with the flavored powder, but I’m pretty sure that she will either sift them out of her food, spit them out, or stop eating once the dreaded Bute flavor presents itself.

I’ve asked the vet about other types of medications, but she believes that Bute is best for her, although she was willing to give acetaminophen a try, which worked as “well” as Bute and was vastly more expensive. No to firocoxib. Vet suggested injectable Ketamine, but we both agreed that this wasn’t a good solution, given her mental status when needles are present. (Said horse is 12 years old and I and three other vets have done the desensitizing training, and it hasn’t worked for her. Tried clicker training with yummy treats years BEFORE this whole Bute problem started, and she always fought the needle. I do have Dormosedan to sedate her in case I have an emergency and she needs to get some shots, but I can’t do that in this situation. I even took her to a clinic to with a horse whisperer, and shots did not happen that day.)

Perhaps this combination of horse and medication was simply not meant to be.

In sympathy with horse, I’ve tried the medicines myself and I agree that all of them, with the exception of the paste, are absolutely horrible. “Bitter” doesn’t begin to describe the taste. The paste isn’t nearly as bad, but it doesn’t seem to matter to her–she won’t eat it if I add it to her food and she drools for hours and hours if I paste her.

And yes, I’ve alternated these efforts so that she isn’t always presented with a medicated treat, but she is suspicious of everything. And I’m in a bit of a quandary, because this is a regular medication that she is supposed to get AM and PM.

I’m at a loss. Has anyone figured out anything else that I haven’t tried?

Bute is toxic or carcinogenic to people.

Laminitis is the acute inflammation while founder is the long term structural changes to the hoof. Both can be painful. You can have one without the other.

If the horse is in acute laminitis that needs to be halted. Painkillers aren’t enough. Are you trying soft boots and ice? If the horse has founder that’s this painful going forward you need to think about what’s going on inside the hoof capsule and whether it’s reversible.

[starsandsun]

That’s a real challenge. Only things that come to mind are Banamine instead, or trying a white willow bark supplement for pain. I have no idea if there are any more holistic things available that work on pain. ETA - are you sure you’re getting the syringe far enough back in her mouth?

[BayMoose]

How long do you think she will need the bute? If short term, can the vet put an IV catheter in? They are a total PITA to maintain of course and require some skill to use, but I have used them when my horse needed antibiotics and was so dangerous with IM injections that we all feared for our lives.

When you say you vastly increased the beet pulp, how much are we talking? I’ve never had a horse, even a very picky one, refuse a small amount of any medication if placed in a kg or so of soaked cubes. You could add something to hide the smell.

[twelvegates]

Scribbler – I’ve been working with the vet since the laminitis started. That’s a whole other thread of frustration. This is a weird one for sure, as blood work from onset was perfect, except for low thyroid. We’ve tried glue on shoes, glue on clogs and boots. She is x-rayed monthly. She is actually more comfortable without the shoes, clogs and boots. Vet and farrier are both against putting her down at this time, and I’ve worked with both of them long enough to believe they have her best interests at heart. Her diet is well-controlled and her hay tested at 7.8% NSC. Her weight is good.

When I say I have “tasted” the Bute, I’m saying that I touched my tongue to the tip of the paste or a grain of the powder, then spit out everything. I don’t make a habit of eating horse medicine.

Starsandsun – I’ve got her on white willow and on meadow sweet, but they aren’t strong enough. Banamine is just as unpleasant for her, taste-wise. I get the syringe as far back as I can on her tongue – syringe is pretty long and I’m certain I’m getting it back as far as possible. I was wondering about a balling-gun and a Bute tablet?

[twelvegates]

BayMoose – I’m putting a teaspoon of Bute powder, or a single Bute tablet (a little larger than a dime in circumference and about 1/3rd inch tall), into 3 quarts of soaked beet pulp and she won’t eat it. Even with flavoring and additives that she normally loves. And I break up the tablet. She’s just a very suspicious horse. She doesn’t like soaked cubes without anything added.

I worry about the IV catheter. She needed one before and she rubbed the hell out of her neck and dislodged it. Fortunately, this happened in a veterinary hospital, so she didn’t bleed out.

ETA: Length of time Bute will be needed is unknown. She has been on it for 8-ish months already.

[Rackonteur]

@twelvegates

said horse is also needle-phobic.

Is she needle-phobic only when she sees the needle?
Have you tried blinkers?

[twelvegates]

Rackonteur - yes – we’ve tried the blinkers or me blocking her vision from the needle. Once she feels that thing in her neck she will shake her neck until it’s out.

She’s a lovely horse otherwise. Just a strange one. Vet tries to give her a treat and she won’t eat it. Vet hands treat to me, and she eats it as soon as it’s in my hand. Well, not at the moment, as she thinks all treats are loaded with poison.

[cayuse]

Regular aspirin might work better than willow maybe, just a thought. It comes in different flavors. I had my pony who foundered on it for awhile.
My pony was better without clogs and shoes too.

[PushersBlue]

@twelvegates

No to firocoxib.

I’d ask the vet why not to firecoxib? You’ve tried everything under the sun with no luck so right now the mare is still getting nothing. I have a mare here as a companion horse who is head bobbing sad to watch lame due to a mystery issue in her hoof. Not even pasture sound on my flat land. Pill in cookie muffin and she’s near perfect now so it is fairly strong (and better than the nothing you’re able to get on board now).

Alternatively - when I had to medicate my cat with a ton of medications, the capsules were a lifesaver. They’re pretty tough so hold up to some chewing without letting the bitter whatever you’re hiding out and you can hide in the crack muffins. I had a local pharmacy compound for me.

[starsandsun]

So just to clarify - she has been on bute 8 months already? So this is chronic pain? What was the rotation? Has it stopped?

[4horses]

You could possibly try sodium naproxen tablets rather than bute. My old mare was on them the last year of her life when firocoxib no longer worked to control her pain.

I once had a horse on ranitidine. That stuff was terribly bitter. I tried mixing it with maple syrup thinking it would help the taste. If anything it made it even worse! Yes I tried it as well, trying to figure out why the horse resented that medication so much.

Anything in capsules is a good idea. Or I would probably make stocks and do an injectable.

[Highflyer1]

She is 12, has been on twice daily bute for eight months and is still that unsound? If you don’t mind my asking, is the vet optimistic that she will be pasture sound without medication at some point? It sounds like you are doing everything you can but it may be a losing battle unfortunately.

[twelvegates]

Hope I’m answering everything.

cayuse – I haven’t tried aspirin but will speak with vet about it. I’ll go taste it first.

PushersBlue - I’ll ask again about the firocoxib and as I recall, it was a small pill which should help. I’m glad capsules sound like a possibility.

starsandsun - Yes – she’s been on bute 8 months. There was rotation but it has stopped. She has gas pockets between her laminae and her hoof walls that haven’t completely grown out.

4horses - Will look into the sodium naproxen.

[twelvegates]

Highflyer1 – I worry about that as well, and I have a heart-to-heart talk with my vet every month about it. Horse is eating (when she isn’t drooling) well, is bright and interested in what goes on around her. She lays down to sleep at night but is up throughout the day and in and out of her stall (she has a big run). When she is medicated, she goes for walks around the barn where she looks sound. When unmedicated, she is sore. Vet is optimistic that we are winning the battle and will eventually win the war. I’m not as sanguine about her chances, but both the vet and farrier see improvement every month.

[carman_liz]

Without reading thru everything, what about banamine paste? Tube a good way inserted before injection and then hold her head up and rub her throat OR offer a small treat or handful of senior right after so she swallows it with the leftover banamine? How big is she?
ETA: when was she last xrayed?

[seabreeze]

Have you tried dosing tablets with a balling gun?

You might try making a warm mash with her feed and plenty of starlight mints. See if that entices her after the paste.

[twelvegates]

carman_liz: I don’t recall why we chose not to use banamine paste or firocoxib and will ask vet again. She’s a funny thing, and won’t eat anything immediately after medicating, because that’s just her. She is 16’2" and about 1350 pounds. She is x-rayed monthly, and we are watching the laminae grown back to her hoof walls. She had a lot of distortion at the beginning and it’s been a long process.

[twelvegates]

seabreeze – I like those ideas. I have been thinking about a balling gun. I was worried that I might not operate it appropriately, but will look into it. As for the warm mash – sounds like a great idea, but this mare is the type that would send food back to the chef at a 4-star restaurant, so we will see!

[No1]

I would insist on trying fircoxib a try. For a variety of reasons. For one, your horse had been one bite for a long time. While we know that firocoxib does still have an effect on the gi tract, it’s definitely less than bute. Second, it’s a smaller pill and may make your life much easier.

If you do determine to continue down the road you’re on, try rinsing her mouth a couple of times right after you give dose her with the bute.