So far so good with my horse. Midway through the 2 pill stage. I began giving him soaked alfafa cubes which he loves - figured the extra hind gut help will be good for him and he does need some weight - TB. He’s still not the biggest fan of grooming but there’s a lot less fidgeting and he’s happy to work.
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Thought I’d post my experience with Nexium with my horse for those of you who are interested in scoping results and in case anyone has had a similar experience and can help me out. Horse changed drastically over the winter from a level headed cuddler and fun ride, to a hot, agitated, biting machine. Girthy, irritable, miserable both under saddle and for all handling. Did 10 days of ranitidine and then decided to start on Nexium midway through January (3 capsules per day of the generic Walmart brand). He showed improvement within 5 days on Nexium, both under saddle and on the ground in general. I did a 28 days course and he was drastically improved, although not quite 100% back to his old pre-winter self, but there were many other changes to attribute the minor things left to. Began to wean him off, and within a few days of dropping to 2 pills, some of the negative behavior started to return. I stayed for several weeks at 2 pills due to a course of smzs that coincided with the weaning process, and then went to a week of 1 pill. He was clearly miserable again, so we went back up to 3 pills and I decided to have him scoped. Symptoms subsided again once back on 3 pills, and although not quite back to the summer horse I had, he only showed minor irritability occasionally. I scoped at the beginning of April and he was found to have hyperkeratosis (irritation/thickening) but no ulcers. Based on his response to Nexium the vet recommended trying gastrogard or injectable omeprazole. Due to cost, we discussed a less expensive option and he gave me two months of powdered cimetidine. I started the cimetidine, finished out the course of Nexium and weaned him off with 2 pills for a week and then 1 pill for a week. The cimetidine didn’t help at all and all the ulcery behavior returned. As soon as he gets anything less than 3 pills of Nexium, his ulcer symptoms return. I’m currently considering the injectable omeprazole. My vet says that the hyperkeratosis shouldn’t really be causing this degree of symptoms, but based on how he responds to Nexium, we have to assume it causes him pain. He can’t stay on the Nexium any longer, so I have to find another avenue. It’s been a frustrating few months, but figured I’d share with you guys since I was curious to know more scoping results after Nexium. If anyone has had a similar experience with trying to take their horse off Nexium and found a solution, please do tell!!
You mention he is miserable under-saddle and girthy… Are you positive the saddle fits? Positive the horse isn’t backsore or doesn’t have KS? I see it often enough with client horses, that are “ulcery” in the sense they have ulcer symptoms (girthy, irritable about saddle, tight, defensive) but the ulcers are secondary to their main issue, which is overwhelming body discomfort from either saddle, or KS. They usually have ulcers, but their defensiveness of their bodies was worsened by the ulcer pain, and usually tipped their comfort levels from “mildly annoying” to “painful”.
Something to consider… I agree with the vet that the symptoms don’t quite match with what you see on scope… It could be hind-gut ulcers too, but those can’t be scoped and you would have seen an improvement with ranitidine.
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I can’t say I’m positive as I haven’t had his back xrayed, but he doesn’t palpate sore in his back, the saddle fit has been checked twice and declared to be good in the last 6 months, and he had a full lameness/flexion work up at the same time as the scope and they found nothing. I’m pretty stumped! I think I just keep coming back to the ulcers because of the positive response to the Nexium. Unless there’s something else I’m missing that Nexium would improve?
I had a horse years ago who had a positive response to gastrogard and no ulcers (or maybe a pinhole) on the scope. We were perplexed, as her symptoms really pointed to her stomach, but what we saw on the scope just didn’t correlate to the severity of the symptoms. I just kept her on gastrogard, as that kept her happy. Once I retired her, she came off of it and was fine. Now she’s treated with nexium when we have big stressful things happen and tapers off of it with no difficulty.
Looking back, I think it was her hind gut. I’m guessing that stopping the PPI caused changes in the digesta traveling through the hind gut and those changes are uncomfortable. I might be waaaaaay off base, but were I in the same situation now, I’d taper the PPI, and treat the hind gut and see what happens.
Did you use cimetidine or ranitidine, @Emerson? IIRC, cimetidine has a very short duration of effect and must be dosed something like four times a day? That’s why we don’t use it for ulcers in equines. Ranitidine is a better choice as it can be administered twice daily.
Interesting! I gave ranitidine for a brief period in January but switched to the Nexium pretty quickly. After his scope, my vet gave me cimetidine, which was dosed twice a day for two months and had zero effect. So you would taper off the Nexium and put him on ranitidine instead? He’s also on SmartGI Ultra for hind gut support.
Yep, although I’d start ranitidine first and then taper nexium, so you hopefully avoid a painful period. I’d also add sucralfate if the vet is willing and finances allow.
@Emerson My story is the same as yours to the T. Same behavior, same scope results. My vet recommended Platinum Performance Gastric Support. However he is on this and on 1 pill of Nexium and still has horrific behavior while grooming. He is better under saddle, but was hot just like yours. He would run at fences etc. I feed the gastric support at half dose because of the price. And because he is on both nexium and the new supplement I can’t tell how effective the new one is. Especially since his behavior sucks even still. Threatening to bite, head tossing, threatening to kick. It’s a mystery. We have been on a saddle fit journey and now I have saddles that fit so it’s too soon to tell if that is the cause. My vet confirmed he is absolutely not back sore even with his saddles that didn’t fit well. I bought new HAAS brushes specifically for Greys and maybe it’s the brushes. 
He also does NOT have hindgut ulcers.
I would lose the gastric supplement and put him on a full round of Nexium.
Just to repeat what that is…
3, 20mg capsules once a day for 30 days
2, 20mg capsules once a day for 2 weeks,
1, 20mg capsule once a day for 2 weeks
Then use the gastric supplement daily as maintenance. You would probably see better results.
He IS on the Nexium protocol currently AND the gastric support that my vet told me to put him on.
If you’ve had no luck treating the belly, and the scope is clean, why do you think the problem is his stomach?
If you know you have saddles that don’t fit, why do you keep using them? Just because he doesn’t palpate back sore doesn’t mean that he’s not unhappy about the saddle.
”‹”‹”‹”‹”‹”‹How have you ruled out the hind gut? It’s generally very difficult to say with certainty that it is or is not a problem.
”‹”‹”‹”‹”‹”‹Gabapentin might be an interesting trial for you, and would address neuro pain.
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How can you know if he doesn’t have hind gut ulcers? I thought you can’t scope for that?
Ulcers boil down to a management issue most of the time. Increase time outside, increase as much forage as possible, make 100% positive it is not the saddle fit, be positive he is 100% sound, and continue the Nexium/gastric support.
How are his teeth? Is he masticating all of his hay correctly? I have had horses show ulcery symptoms (but not have ulcers – actually, they had irritable bowels) from not being able to fully masticate the coarser hay and it irritated their bowels during digestion.
Re: saddle… I have spoken at length about this on the forum but… take it in your own hands to educate yourself on proper saddle fit. I had a gelding about a decade ago that was really talented but started being wildly misbehaved after fences… and gradually, his misbehaviors devolved to full-out bronc sessions when I asked for a canter. We chalked it up for a long time to just being a difficult horse. He had his saddle fitted at every 6 months for at least four years… multiple fitters… all said his tack fit… his behavior kept getting worse and worse and we brought him to a top lameness specialist who took one look at him going over fences and said it was the saddle. We were all quite insistent it was not, as we had several different pros look at it… but the vet was right.
It fit on paper, for the most part… but for whatever reason, the horse did not like it. We did a round of mesotherapy (break the pain cycle) and SI injection (addressing physical trauma from saddle) and found a saddle that fit a little outside of the box and all of his bad behaviors went away and the undersaddle stuff we had been struggling with (like collection and straightness) were suddenly quite easy… Just goes to show you horses put up with a lot before they throw in the towel.
Anyway, I always take the time to type out that spiel because no matter how many times I type it, it’ll never be enough – saddle fit is incredibly important and sometimes when looking at a horse with behavioral and physical issues, it pays to suspect everything even if a professional has already ruled XYZ out. It taught me something extremely valuable, besides thinking outside of the box - always listen to the horse. I had a lot of professionals tell me these were behavioral and not physical… I am so glad I went with my gut and kept pursuing it… and I wish I knew then what I know now. I did him a tremendous disservice for years thinking he was just difficult…
I have also come to learn that back palpitations are absolutely useless for diagnosing just how sore the horse actually is over his back, and are worthless for ruling out SI issues or Kissing Spine. A better indication of if they are backsore is how they react to: placing the saddle on their backs, moving/adjusting the saddle, how they move freely vs undersaddle…
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1: His first round of Nexium in February really alleviated all symptoms until he weaned from it. His scope showed yellowing/keratinization and his vet suggested PP Gastric Support until we could get him happy.
2: I learned his saddles didn’t fit in March. By the last week of April he had a new dressage saddle and as of now he has a new jump saddle that fits. I did the best I could and have been trying saddles left and right as well as working with a saddle fitter.
3: I tested the pH of his stool and it was 7.6. I then treated him with equishure with no difference in symptoms. He has had no high risk experiences that would lead to hindgut ulcers. He doesn’t eat grain. He hasn’t been on anti inflammatory drugs of any kind. Or any drugs for that matter. He is on pasture and has access to hay at all times. He is not kept in a stall at all, ever.
4: I am not accepting this as a behavior issue and I have been and will continue to pursue this until I can make him happy.
Treating with a PPI can cause hind gut ulcers. It may be interesting to run him through 60 days of ranitidine, as that will address his stomach and hind gut both.
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Thank you for brainstorming with me and sharing your experience. Saddle fit has become super important to me and I have learned quite a bit! I just want him to feel better.
I am open to trying ranitidine. However he is only fed his supplements once daily so I don’t know the dose or how to incorporate it into his current feeding regimen.
He needs ranitdine at least twice a day, using 4.5mg/lb. Otherwise it’s 3x/day at 3mg/lb. Is there a reason he can’t be fed a handful of something, enough to hide potentially 30 of the 150mg pills (do your own math based on his weight), roughly 12 hours after his regular meal? You could start with just a week or 10 days of this and see if symptoms improve, then decide how to go forward.
Musing about this cleaning stalls this morning, and I really wonder if the missing link in horses like this is the microbiome. We’re JUST on the cusp of even beginning to understand how important it is, but we know it plays a role in mood and pain.
So, the microbiome is probably disturbed by the stomach ulcers, then we disturb it again, likely pretty significantly, with a PPI. Most horses bounce right back, but some have a different bacterial and fungal balance and get too out of whack and we wind up with a puzzling painful horse.
I don’t know what the answer is at all. Our understanding of using probiotics is so nascent, it’s really throwing darts at a board in a dark room. It would be interesting to take a horse like this and do a fecal transplant from a healthy, especially resilient horse (you know, the horse in the barn that can handle bute without flinching and shows every weekend without any gastrogard) and see if that changes anything.
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You said he’s on 1 pill of the Nexium daily with the gastric supplement… that’s not the full Nexium treatment.
eta: okay re-read and see you did Nexium in February…
He has been on Nexium again Since early April. I am on one pill because he is weaning off of it. So he has had 2 full treatments with prolonged weaning. The gastric support is pretty much just probiotics.
That’s a boatload of money for a probiotic. And it’s only two different strains, wow. :eek:
This might be a great product, but if it doesn’t have the microbes YOUR horse needs, it’s money down the tubes…and we don’t know enough about the microbiome and probiotics to really have any idea how to supplement them or what ulcers + a PPI might do to the gut bacteria. Someday we’ll know, but we’re a ways off.
If you’re not seeing a change with it, I’d stop spending the cash and try a different approach. Either a different probiotic with other microbes, or ranitidine, or something like sucralfate, or switch approach entirely and try gabapentin. Or a NSAID trial to try to rule out non neuro pain.
Feed out the rest of the bucket at a full dose, so you’re giving it an honest try and ditch it if nothing changes.
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