Hind gut ulcers?

[GPjumper]

Hey all,
A friend asked me to ask the gurus here for her about her horse. He has episodes where he seems to just collapse on her.
What does that mean?
Insane anxiety. Over the top spooky, can’t even hold it together to graze or eat hay in the stall. Stall walking/fence walking.
Tight/sore back/SI area. We aren’t sure if it is caused by being tight from anxiety or the anxiety is from back pain.
Doesn’t want to eat hay or grain very well.
What has been done:
Clean bone scan and rads of the back.
Nothing on muscle biopsy
Nothing on spinal tap.
Cold intolerance. If he gets cold, his topline seized up.
Negative PSSM/HYPP
Was great for three days after shockwave but pain came back horrifically as if he had tied up.

Vet originally thought axial back pain, but there is no reason for the pain.
What started this latest episode?
He was taken off sucralfate for a week and a half or the dewormer.
Horse is NOT in work. He hasn’t been ridden since.December.
Diet:
1 quart TC senior 2xs a day
Vermont Blend balancer
8g sucralfate with breakfast and dinner (restarted 4 days ago)
Uckele GUT
Positude (not sure if it is working)
Free choice Timothy hay
Muzzled for turnout. (Treating him as if he has a PSSM2 variant even though tests are negative)

Vet has suggested a course of misoprostol thinking this could be ulcers. He started that tonight for the two week trial.
When the back is 100% (as it was after shockwave, the horse is quiet as a mouse, it just doesn’t last)

Is there anything else we could be missing?
TIA if you’ve made it this far.

[joiedevie99]

Has she done any diagnostics for ulcers? Scope of stomach, ultrasound of colon, fecal occult blood test?

[GPjumper]

Scope was clean. No ultrasound. No occult test.
She’s basing this on improvement with sucralfate.
She’s also thinking this because he does much better on a softer hay. He is definitely not as happy on the stalkier bay of the most recent load.

[DannyBoysMom]

EPM test done?

[GPjumper]

Yes. Clear spinal tap.

[KMC96]

Sounds very ulcery, I would try treating with omeprazole and Misoprostol. Also have to remember how long the intestines are in a horse and that the scope only goes into a fraction of that. So even though nothing showed on the scope, that doesn’t mean its not there. Biggest thing is to try and keep him constantly eating so there’s something to soak up the acid. Chopped hay is very easy for them to digest so could try that or some alfalfa/alfalfa mix. Does he go out with a friend? Horses are herd animals so many he doesn’t like to be by himself? Lastly, I had one that was pretty body sore with no explanation and 30 days of hemp really seemed to get him over that hump.

[joiedevie99]

@KMC96

So even though nothing showed on the scope, that doesn’t mean its not there.

A proper scope should show the entire stomach (including the pylorus). I’m not aware of anyone scoping for hind gut ulcers. If it’s clean - the horse doesn’t have stomach ulcers, and no need for omeprazole. Quite a few people think omeprazole is bad for hind gut ulcers, so I wouldn’t give it unless indicated.

Hind gut ulcers are hard. We can ultrasound the colon for thickening, and test for blood in stool but neither is dispositive. You can do misoprostol and sucralfate and look for behavior improvements. For serious hind gut horses, my vet prefers a more intensive treatment period where all long stem forage is removed for 60+ days to allow time for healing. You’ll need the advice of an experienced vet if you think this is the route you want to go.

[JB]

the cold intolerance really screams PSSM2. BUT, there could definitely be other things that are causing muscle issues which are then just exacerbated by cold.

@GPjumper

Treating him as if he has a PSSM2 variant even though tests are negative

What test was done? PSSM2 doesn’t have the sugar issues that type 1 has, so the muzzling isn’t necessary unless he’s an easy keeper

Vitamin E and selenium tested? If no, I’d do that asap.

@GPjumper

1 quart TC senior 2xs a day

That’s barely over 2lb, for a feed that needs 5-6lb per 1100lb. Is that because he gets fat on more? If so, I’d switch to the Balancer at 1-1.5lb per 900-1100lb, or even the Lite at 1-2lb per 900-1100lb

[KMC96]

What I meant by this is Scopes are like 10ft long so they can only see the very beginning of the small intestine, which is almost 70ft long. But no cant scope for hind guts. I have had a lot of vets say not to bother with the fecal occult test as it is very unreliable and will most likely only be positive if it is a bleeding ulcer back there. That for hind gut stuff you almost have to just treat the symptoms.

[GPjumper]

He is muzzled because he is sugar sensitive ulcer wise and is an air fern.
Scopes clean
Vermont Blend is a balancer so he is covered there.
PSSmlM 1 and 2 were negative as was muscle biopsy.

[Amy3996]

Have you had hoof rads done? My TB presented very similarly - our local vet thought SI ligament tear. I ended up bringing him to New Bolton for a full lameness workup and scope. He had thin soles all around and flat/almost negative palmar angle behind. He also had raging ulcers.

Treated the ulcers and fixed the trim/shoeing. Huge improvement.

[E.Equestrian]

This horse sounds similar to mine who is allergic to corn or any distiller grain/corn by product. He’s usually calm but if he gets corn he turns into a raving lunatic. He’s spooky, sore all over can’t really be touched and pretty much isn’t comfortable in his own skin. I have to check every ingredient in all products he eats down to treats and supplements.

[GPjumper]

Yes! This is this guy to a T. The anxiety is through the roof with him. The vet comes Tuesday to run a food allergy panel. She agreed something is wrong and we need to find the source.