I’ve heard of this happening a lot. 60 days of GG and sometimes more, or needing to do GG and sucralfate, or miso/sucralfate instead. Depends on the type of ulcers. The regimen is intense, and difficult to schedule if you’re depending on barn workers or work away from home (lol ask me how I know).
I believe if you scope-treat-scope, the company will give a second 30 days of GG free if ulcers remain. But you have to have documentation.
Sucralfate is very cheap (well compared to misoprostal and ulcergard) at the human pharmacy with a good RX coupon. Pretty sure I paid like $60 for 300 last time. Might be worth calling your vet and asking if they would write a prescription for you.
No 2 horses are the same, so all I can do is relate my experiences. After 3 weeks of full dose ulcergard, we scoped. Horse responded to ulcergard positively within 2-3 days. Not much was found on scope, just mild irritation at pyloric area. We added sucralfate and tapered ulcergard. Horse continued to show signs of improvement. At end of bottle of sucralfate, horse started showing discomfort, so reinstated sucralfate. Right now tapering sucralfate with veterinary approval. Started horse on Excel a couple weeks ago. We are also doing daily PT, stretches to relieve the effects of long term effects of GI discomfort on entire horses body(shoulders, iliopsoas, etc) and groundwork.
I will add that last spring I empirically treated with full dose ulcergard. Horse did improve but I don’t think I treated long enough or perhaps with correct medicine.
Just something to think about, hopefully saving someone else time and grief😰
Brief update about a month out:
Things seem to still be the same with this horse, even after a month entirely off: tender when palpating behind the withers and hints of RH lameness. I have a couple of plans right now while she’s having time off:
I’ve just ordered sucralfate from Abler and am going to start her on at least 1 month of that. The RH issue may be something separate, but I know it can crop up as a symptom of hindgut ulcers - that, plus the ongoing wither tenderness, makes me worry we didn’t totally clear up the ulcers with 28 days of GG. I’m not going to scope or re-treat with omeprazole at this time; will try the sucralfate first. She’s also on slippery elm and yea-sacc at the moment.
Next step is a local vet that has a “lameness locator” system and specializes in lameness, which I’ll probably do in the spring time. Due to this horse being young (2020 born), a draft/WB cross and having some unfortunate inappropriate feeding as a baby, OCD could be a thing to look for. I’ll likely get some xrays and do some blocking at that time.
I’m not entirely convinced that my local, independent saddle fitter is correct that our current saddle is appropriate, so there’s someone in the next province over who is planning to come my way sometime this month and she has agreed to come take a look for us.
Edited to add: I am having her seen by an equine cranial sacral therapist later this month, in addition to her usual bodywork!
Sorry to read this is such a saga. I can totally relate to juggling different treatments when the cause of symptoms remains vague… Until I got my current horse I never experienced this foggy terrain (ulcers, saddle, riding style, hidden lameness?)
Please post on your experience with cranio-sacral, haven‘t thought of that yet!
I had a workup with a lameness locator done on my mare. It’s really quite fascinating. The vet told us that many of their Standardbred race clients are bringing their sound horses in to get baseline data to compare to when issues crop up. It also wasn’t overly expensive.
I had this lameness locator used on my other mare years ago and it was fascinating!
Just on the saddle fitting saga, my horse likes his saddle wider and then sheepskin directly on his back. He hates anything tight or restrictive. Fitting only standing still is the worst as he lifts his back a good 2” and totally different than his standstill.
If he is restricted in anyway via saddle or a breastplate, he looks off behind and short strides up front.
Ohhhh boy that sounds like a lot of not-fun to try and determine 
I still have intentions to try my barn manager’s western saddle on her to see if the spread out and padded-ness of it all is more comfortable.
I’m planning to start doing a consistent in-hand exercise plan with her in a few weeks to get her back built up again before I pursue further saddle things though. She’s pretty weak posturally (especially after all this time off) and her conformation lends itself to a dropped back and high head.
Small update!
I can’t remember if I had mentioned this before, but my usual vet said last month that she could see some mild RH lameness in recent videos I sent under saddle. My barn owner also watched her lunge and said she agreed, the RH seemed “stiff” more than truly lame.
The lameness specialist came today and did an assessment. Ironically, the lameness locator found nothing wrong 
She did flex mildly positive on that RH, and on a lunge assessment the vet pointed out how she steps under the midline more with that leg when going right - which indicates she doesn’t want to fully load it. She also struggles to bend to the right, which has been an ongoing issue but I chalked it up to “baby horse imbalance”.
The vet found some swelling in her right medial stifle area on palpation.
We x-rayed the stifle, totally clean. Ultrasound showed some synovitis but nothing indicated meniscus or ligament issues.
We injected with Legend/steroid as a one-off treatment to help reduce the inflammation and see if that makes any difference to her comfort. I’ll check her in a few days and start doing some light work and see what we have.
Lameness specialist feels that there was no indications towards OCD or anything of that genre, so we won’t pursue that for now. It was tempting to just get baseline rads of all her joints but the recent scope + GG really wiped me out so I have to be a little bit conservative!
My saddle is definitely too wide at the front for her; an independent fitter from the next province over is coming in 2 weeks to assess and hopefully help us. I’m disappointed that the local independent fitter didn’t catch this, even on multiple visits through the summer, but no one is infallible so I’m not going to dwell on it.
So at least I have some clarity that the joints themselves are doing well physiologically, and I don’t have to lose sleep over wondering 🫠 Unfortunately it doesn’t give us a definitive answer. Will just keep trying things.
Cross your digits for us!
Fingers and toes crossed for you that you found your problem! Please keep us updated.
Oh my gosh, this sounds almost exactly like my mare, although we did find “lameness” with the lameness locater. She also struggles more to bend to the right and steps under the midline more with the right hind. We had some inflammation but nothing else indicated via x-ray and treated the inflammation. I’m not riding regularly right now (weather and my job), but I’m hopeful the downtime will help contribute to improved performance in the late winter/early spring.
I swear, stifles can cause so many weird symptoms. I hope the injections help.
For those of you following our saga!
Cranial sacral therapist visit today found right pelvic damage causing muscle wastage and major weakness. I’ll try and upload a video of the “wobble” in her fetlock and hock on the right hind - the CST said she’s never seen one this aggressive before. She’s certain it was caused by an injury - likely a slip and fall in her pasture, as the discomfort under saddle initially started happening late August 2024 when she was in her hilly field daily.
You can see the before photo (blacked myself out so you can see the muscle wastage more accurately) and then after she did her magical work. I amplified the colours/contrast so you can see it better in the low light.
She feels it should be a successful rehab case, and we will just have to “protect” it throughout her life; which is no different to my own sports injuries that require ongoing attention!
She will see us again in 3 weeks to assess if her adjustments “took”, and if she feels that the case is more complex than she can help with, she will refer us to the local specialist.
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Did your mare look that uneven from behind when she was at the vet’s for the scope, or when she was evaluated by the lameness vet?
I’d be shocked if they didn’t notice that. It’s quite marked.
@skydy She sure was, although I was not aware of it 
Disappointed that it wasn’t caught! But that’s pretty par for the course with our vets, I’ve found.
She does look to be standing on uneven ground in your photos, not hard level ground where most lameness evaluations takes place.
It’s difficult to imagine, if anyone had evaluated her on level ground, they would have missed that asymmetry .
Keep us posted! Your horse’s symptoms and your journey with it sounds similar to mine. I never quite nailed what was wrong with her but through process of elimination (and lots of money spent) I narrowed it down to something going on in the pelvic/SI region.
Right, update time. We’ve been seeing the cranial sacral therapist every 2-3 weeks for bodywork, although it has not provided The Magic Fix that I really hoped for. I started going down the paths of DSLD, neck arthritis, among many other possibilities I haven’t decided yet what kind of diagnostics to pursue at our spring vet appointment coming up.
Last week I had an extremely knowledgeable independent saddle fitter come out, and she told me that my dressage saddle wasn’t remotely a good fit for the horse (and she showed me how and why on each part of the saddle). This is the saddle that was checked 3x in the summer by a different independent fitter, who told me it fit almost perfectly. I just… don’t have words at the moment.
Anyway. I’ve got a jump saddle borrowed from the recent fitter, whose tree is just right for my mare; it’s not a saddle I would choose for myself, but in a couple of days she’s coming back with some more options for me to try.
I’m going to take a deep breath, pull on my Brave panties and share some video that I took today, in the hopes that everyone will be polite about my riding; the last time I shared a public video to get opinions on the horse’s movement, my equitation got completely dismantled. I’ll try and upload it in another response as it keeps getting stuck here.
Here is some video of her lunging, which was today’s warm up, so you can see her movement without a rider:
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Blast, the video won’t upload. I’ll try getting it up tomorrow!
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