I’m using Nexium 24 hr 20 mg mini capsules. I give my horse 3 caps 1xday = 60 mgs total.
IPEsq is using a totally different, much higher, dose based on something other than the paper in the original post that demonstrates 40 mg is an effective dose to raise the pH of the stomach to “healing” levels. The rest of us are using that paper as our guideline with a treatment dose of 3 pills a day.
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I feel like i just hit the jackpot finding and reading this thread!
@Simkie - thanks for your contribution and advice. Same with everyone else who chimed in.
I have a young 3 yr OTTB i purchased middle of the summer. We suspected he became ulcery after I got him straight from the track as he started some mild cribbing and minor weight loss. He was picky with grass hay, but not grain at all. I think it was just because he had awesome alfalfa and was being a diva. I gave him a tube of UG but not a full treatment as he was adjusting to 24/7 turnout. I would say things went fine.
Fast forward a couple months, and sadly my boy got kicked right above his knee! He has been stall bound with little hand walking (per vets orders). He luckily has not had to have too much bute and banamine while on his stall rest (just dealing with proud flesh and closing the wound and luckily minimal pain). He was a little picky with his grain while he was getting SMZ’s but again, i dont think that was necessarily ulcer related more so taste related. We are now a little over two months of being and stall rest and he is totally losing his mind. I know a lot has to do with pent up energy but hes always had a kind demeanor and anyone who sees him can tell how miserable he is. Bucking in his stall etc. Does NOT enjoy blanket changing at all. I have had his cribbing collar on for the duration of stall rest and thats very effective for him so I cant say if its caused his crib to get worse or not.
We are seeing some light at the end of the tunnel and turn out/riding may be in the (knock on wood) not to far future. I am going to try getting him some nexium for the remainder of his stall rest and his transition back into the “real world”! Fingers crossed for us, I would love it if I can make him happier. I will update with findings!
I’m using only one clear mini Nexium per day. Drop it in his feed. He also gets a short scoop of Equishure once per day, in his feed. My ulcery horse is doing great on this routine. Not sure I will ever quit it.
:applause::applause::applause:
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There have been at least two studies of esomeprazole. One used 40-80mg per day and the other used 250mg to 2g (100 pills). Given that range, you can take a WAG at how much to give your horse and probably not go wrong. The first study found no difference between the horses given 40mg and those given 80 but the medication was delivered by tube directly into the stomach. Given the relatively low cost, many people are throwing in some extra pills in case the horse crunches a few while eating. OTC esomeprazole pills are 20mg.
Peggy and I had a discussion in this thread about the 2 papers. The recommendation from paper 2 is 0.5mg/kg. Both delivered Nexium via NG tube. The second study looked at pH for more hours post administration than the first as well because the first study noted that as a limitation and that pH may have reduced overnight. On the advice of CSU, I followed the 0.5 mg/kg dose guidelines. However, huge caveat—I did the 30 days of treatment with a full tube of Ulcergard except for a few days where I used 0.5mg/kg Nexium (~14 or 15 pills). I switched to Nexium when it was time to taper, and so that meant starting the taper at 7 pills.
This protocol was agreed upon after lengthy discussion with my vet. Given the severity of my horse’s symptoms (rearing and not eating), I decided to take my vet’s advice and go with this and not experiment with the 3 pills dose.
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So…
After several months on 3 capsules a day, then 4, then 5, then finally 6, and not being able to wean off at all, I scheduled a scope. He still has ulcers. Not huge ones, but still definitely there and angry looking. This is also after 2+ months of Ulcergard. So we have switched back to Ulcergard just because the vet was more familiar with the dosing and protocol with it and added sucralfate 3x/day and will also add Outlast as a supplement. Cross your fingers for me. My guy must be an absolute saint to work as nicely as he does with the amount of discomfort he must be in.
Bummer 
Any evidence of something else happening, like delayed gastric emptying?
Um yes, as a matter of fact. He had very little water/none overnight and still he had a lot in his stomach today making the scoping pretty difficult. She didn’t seem to have a good answer for that one and it was even weirder since the other horse they needed to scope had the same situation.
Do you know how the protocol would differ in this situation?
Oh dear. I really hope this isn’t it. My barn would not be able to handle that kind of treatment. The vet didn’t see any substantial food in the scope, just water, so I hope it was just because of decreased gut motility given the very cold day we had yesterday. I made that up- I don’t know if that’s even a thing but given that 2 horses of completely different breeding and gastric symptoms both had a lot of water in their guts today then maybe I’m right.
Hmmm…I wonder if the scope had a leak? (There is a way to spray water from it so you can wash away any debris on the stomach wall). I don’t know if that’s a thing, but it seems weird.
That function seemed to be working fine. She just couldn’t see a lot of the stomach because it had a lot of water in it. She was able to see he had several ulcers around the margo plicatus, but beyond that there was too much water in the stomach to see any more.
Bumping up. Basic question is “might Nexium help this horse?”
She’s a 19 YO Morgan who has always been, um, very enthusiastic about her food, and it’s getting worse. When it’s “hay time,” she talks a lot, trots around and occasionally rears when turned out, quiets down when she gets her hay, eats it fairly quickly and often starts fussing again. Hay is not free choice (she would explode!) and she attacks hay nets so they barely slow her down, and she ends up with a hurt neck from yanking on them. I think she gets 7-8 flakes; it’s first-cut grass hay in your typical 45 pound New England bale – so maybe 25-28 pounds a day – in 6 feedings. Also gets Magnesium 5000, a previcox tablet, and 8000 IU Vitamin E (for neuro history) in the a.m., and a Smart Pak joint supplement in the evening – supps are mixed with 1/2 pound Poulin Etec ration balancer at each feeding. She is slightly fat, probably because she’s out of work other than hand walking due to me being hurt. (Etec was cut when it became clear I wouldn’t be riding for a while.) Unlike a lot of Morgans, she’s not a super-easy keeper.
Right she’s now getting ~7 hours individual turnout (she has rear shoes, and kicks like a demon if another horse gets close to her hay.) Her turnout paddock had just enough grass to keep her busy nibbling, but that’s gone now that it’s winter – and that could be part of the problem, she was constantly eating tiny amounts of grass, and now has nothing else to do! She had been out 24/7 for a few years, but was failing to cope mentally – she stopped sleeping, basically. Now she loves her stall and her buddies, is sleeping well, and is more energetic.
The obsession with getting fed is her only ‘classic’ ulcer symptom. She’s obviously not skinny, and she’s eating well. Not ticklish or girthy, no diarrhea, well-behaved for hand-walking as long as I keep my standards very consistent. She’s a bit high-strung by nature.
So…
@quietann you kind of lost me in all that with what the actual problem is. If you are saying that the mare is food aggressive and becoming more so, that is not a symptom of ulcers. Horses with severe ulcers don’t eat.
That’s not true. Plenty will have ulcers but still want to eat. I’m assuming that she has been shown to have ulcers in the past when she acts like that?
Sorry for the novel! Basic issue is, she’s fat, has a good appetite and no general signs of ulcers, doesn’t have a “staring coat”… but I would call her “food anxious” more than “food aggressive.” She won’t go through a fence to get to food, she doesn’t kick the stall walls or anything, but when she is hungry she makes a ruckus! Mostly “talks” but will also paw, pace the fence or front of stall, etc. So i am wondering if she’s building up acid during the times she doesn’t have hay in front of her.
Obviously she has trained barn staff to feed her when she's noisy, which doesn't help. They keep to a regular schedule when she's out, but if she's late for a hay feeding because of my being there to groom or walk her, they rush out with more hay as soon as I turn her out... even if she already has hay in her paddock.
She spent the first 9 years of her life in a herd and AFAIK always had *something* to nibble on, whether pasture or hay. I know she wasn't starved or going hungry during that time. I've had her 10 years and she's adjusted to the typical New England quality boarding barn where hay is fed 3 to 5 times a day and at night check, and there are 2 grain meals, horses are out for 5-10 hours per day depending on the barn, etc. - except for this food anxiety.
The *only* time she has not been anxious about hay is when it has been fed free choice -- but in all but very cold weather, she fattens up a lot on free choice hay. She lived outside with a shed during our awful 2015 winter, had free choice hay, and spent the entire winter standing on a huge pile of hay and nibbling rather than hoovering. She got a LOT calmer about food and didn't gain weight during the winter. But the free choice hay continued into the spring when things warmed up, and by the start of May she was very fat and had to be on a diet for a while.See above response, but she’s been anxious about her food since I got her almost 10 years ago. So is she building up a lot of acid during the times she doesn’t have hay in front of her? Unless the hay is bad, she eats up every little scrap. She has a nervous, alert nature to start with.
She’s never been scoped, but was treated for hind gut ulcers last spring, based on some symptoms that sort of fit, and a “Succeed” poop test which showed no evidence of foregut issues, but did for hindgut (though as a skeptic I’m inclined to think that the Succeed company is really trying to get more people to feed their $$$ product by providing the test.) Treatment (sucralfate and Equishure) helped only a little.
A couple of years ago, I started giving her Ulcerguard for a couple days before I took her anywhere, then kept her on it until a day or 2 after we got back. I would say she became slightly calmer about food while on Ulcerguard.
With the additional info, it doesn’t really sound like ulcers. Just that she likes her food!
