Intense ulcer treatment - no improvement

[KelseyK]

2019 Oldenburg gelding. I’ve had him for a year. In hindsight, I believe ulcers were always present even before he came to me. So a year+ of undiagnosed/untreated. Recently scoped and confirmed grade 2 ulcers and suspected hind gut ulcers/inflammation.

Treated him with omeprazole, sucralfate and misoprostyl for 60 days, rescoped and saw no improvement. His behavior while grooming/tacking up improved.

I’m 6 months into building a business and can’t financially sustain this whole process again especially if it does nothing. My vet advised me to keep him on the miso and wean him off the others which did not behaviorally have a negative impact. Recently, while waiting for his miso prescription, he went 5 days without the miso and immediately became sensitive to grooming and tacking up. I’m taking this as the miso is having the most impactful effects.

Any insight as to what underlying problems this could be pointing towards?

He only gets a small amount of ration balancer, flax seed, vitamin E, salt. Recently started adding aloe juice, slippery elm and dried cabbage. Free choice hay and has access to his paddock 24/7

[Demerara_Stables]

How long ago was he in a herd with young horses? Was he in herd turnout with the person that owned him before you? How big is his paddock? 24/7 forage doesn’t always prevent ulcers. If he’s stressed (from lack of turnout or lack of friends because he’s used to those things, or maybe where he lives has too much activity for him - or not enough) or has undiagnosed pain, the ulcers will keep coming back.

[KelseyK]

@Demerara_Stables

How long ago was he in a herd with young horses? Was he in herd turnout with the person that owned him before you? How big is his paddock? 24/7 forage doesn’t always prevent ulcers. If he’s stressed (from lack of turnout or lack of friends because he’s used to those things, or maybe where he lives has too much activity for him - or not enough) or has undiagnosed pain, the ulcers will keep coming back.

For sure, this has been a thought. He moved from TN to MA. Big changes in scenery. I think he was with 1-2 horses at his breeders, in a large field. Now he lives on the coast in MA, turnout is always limited. We are pretty lucky to have a 24/7 option. He has a big run 24/7 and then a pod that he gets access to during the day. Unfortunately group t/o will likely never be an option. He needs hindshoes and is a very very big horse. When I went to try him in TN, his breeder mentioned that after going away for 60 days of training, he came back VERY girthy. I believe the ulcers started way back then. His girthyness improved 90% since being medicated, even though his scope showed no improvement.

He has had extensive lameness exams in the last year also, trying to pinpoint some of the behaviors he was displaying. Full body X-rays and exams have come back with nothing out of the ordinary. Ulcers and hindshoes helped majority of those displayed behaviors.

I just don’t know long term how to solve the ulcer issue or where to go from here besides keeping him on the miso.

[Demerara_Stables]

The lifestyle he is living now might not be the right one for him, he may need to be out with other friends. Putting composites on his hind feet is an option to allow him to be out with others as they are as soft as or softer than a hoof.

It’s possible when he was started that he was done so in a rushed way or with a poorly fitting saddle and the concept of being ridden or saddled is stressful to him. If he was mine I was talk to the horse communicator with him.

[KelseyK]

Totally! I’ll definitely look into that. Thank you!

[hillary_again]

@KelseyK: what a disappointment How confident are you that the Omeprazole was given correctly? Administration has to be very precise.

[KelseyK]

@hillary_again

@KelseyK: what a disappointment How confident are you that the Omeprazole was given correctly? Administration has to be very precise.

It was a huge gut punch. One because I want him to feel better but also because it was so much money that I really should have used elsewhere.

I paid extra to make sure everything was administered to a tee. And I truly believe it was. They were sooo good and precise about it. 🥲

[mmeqcenter]

Personally, I think less symptomatic behaviors indicate improvement, whether or not it was seen on camera.

IME some of them can take 6-12+ months to fully heal. I’d probably continue the miso for a few more months, since that’s what appears to have caused the biggest effect. And dig through some of the many threads in her for more affordable treatment options and give those a go for a few more months. Some also just respond better to some meds over others. Ranitidine was considerably better for my mare than omeprazole, I’m pretty angry that it’s permanently discontinued. But you could try famotidine, esomeprazole, cimetidine, etc.

Some will have regular recurrences no matter how “perfect” their life is. My mare has been corn and molasses free with 24-7 turnout and free-choice hay for years, but since she’s an anxious spooky type, would almost always have a flare-up when we’d go to a show, so she got ranitidine before, during, and after a show. For her, she must be corn and molasses free to stay happy outside of showing (which we no longer do).
The aloe juice should help. Alfalfa helps as well. You’ll probably need to play with his diet and supplements until you find what works for him.

[KelseyK]

@mmeqcenter

Personally, I think less symptomatic behaviors indicate improvement, whether or not it was seen on camera.

IME some of them can take 6-12+ months to fully heal. I’d probably continue the miso for a few more months, since that’s what appears to have caused the biggest effect. And dig through some of the many threads in her for more affordable treatment options and give those a go for a few more months. Some also just respond better to some meds over others. Ranitidine was considerably better for my mare than omeprazole, I’m pretty angry that it’s permanently discontinued. But you could try famotidine, esomeprazole, cimetidine, etc.

Some will have regular recurrences no matter how “perfect” their life is. My mare has been corn and molasses free with 24-7 turnout and free-choice hay for years, but since she’s an anxious spooky type, would almost always have a flare-up when we’d go to a show, so she got ranitidine before, during, and after a show. For her, she must be corn and molasses free to stay happy outside of showing (which we no longer do).
The aloe juice should help. Alfalfa helps as well. You’ll probably need to play with his diet and supplements until you find what works for him

Thank you! This is encouraging! He has been quite lovely on the ground and really improving under saddle. Definitely going to continue the miso and keep an open mind. I just started doing soaked alfalfa pellets!

In a way I felt like I was failing him by not being able to financially do the $2500+ a month process again but I need to just take one day at a time and focus on the horse in front of me.

[mmeqcenter]

Absolutely not! Search the forum, there’s several lengthy discussions of the exact same concerns. It’s expensive. But there’s other options. I hope you see more progress soon!

[starsandsun]

I would definitely check his insulin resistance regardless - I had repeated ulcers and colics and some of that may have been related to an insulin disregulation. Treating for that, for me, has resulted in a happier, thinner horse with no gut problems at all, and it also resolved a nagging NQR that was probably subclinical laminitis. Treating with Steglatro, pergolide and he just turned 13 - this was probably a thorny issue for the past few years tbh.

If you’re not open to that route, maybe try feeding only chopped forage (Safe Starch would do it) for 30 days to give his gut a break. Or, consider adding as 25% of his hay compressed Standlee alfalfa (I use it as it is tested and is low NSC).

For us, it was definitely a combined problem but calming his gut down with less demanding hay product, medicating to get insulin under control, resulted in no ulcers and no colics. We actually started this whole thing years and years ago with unresolving ulcers so I hope you can get off that train as soon as possible.

[KelseyK]

Thank you so much! I’ll definitely keep all of this in mind going forward!

[frugalannie]

A couple of years ago I got an OTTB who either came with ulcers or developed them upon arrival. I was pretty much oblivious until he was kicking and biting when being tacked or blanketed. He was just getting a ration balancer and hay with 8 hours (+/-) of turnout in a group. My vet put him on Ulcergard (which you can find on sale sometimes), Platinum GI* and free choice alfalfa cubes when he was in. It took three rounds of Ugard: starting full tube then tapering, but he’s much better and a scope last spring showed one tiny ulcer that was healing.

The thing my vet insisted on was feeding the cubes dry. She said that maximizes saliva production, and saliva helps prevent ulcers. I had no idea! You may want to check with your vet.

*I have no relationship with this company except as a customer. I’m pleased with the way my horse looks, he’s happy and it comes with Colicare. It’s more expensive for sure, but cheaper than keeping him on Ugard!

[jvanrens]

@frugalannie

The thing my vet insisted on was feeding the cubes dry. She said that maximizes saliva production, and saliva helps prevent ulcers. I had no idea! You may want to check with your vet.

After seeing a horse choke badly on a dry alfalfa cube I’ve soaked them ever since. I’d prefer to feed straight alfalfa hay to maximize saliva.