Ahhh, this makes sense. I was thinking some backwards physical ripple effect, but it just comes down to a pain/discomfort/stress response. Thanks, that makes sense.
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Dutchman, where are you located? Iād love to reach out to your vet
Can you pm me more info? Where and who did the trial? Thanks!
Weāre in the thick of it with my gelding right now. Heās a 6yo OTTB. I bought him from FL in December and he shipped up to NY. He had multiple casting episodes in the first 3 months I had him, so we ended up sending him to New Bolton for a full lameness workup and a scope.
Scope showed grade 4 pyloric ulcers. Vet at NB prescribed 30 days of misoprostol at 2600mcg/2x a day. In hindsight, I should have pushed for a course of GG too. First rescope at 30 days showed almost no improvement. My local vet did the rescope and pulled a sample of the gastric fluid for PH testing. Therein laid part of our problem. His gastric PH was 1.6 - normal is somewhere around 5. The miso couldnāt be effective when his stomach was so extremely acidic.
New protocol was 1 month GG, and 1400mcg of miso 2x a day. He was put on 24/7 pasture turnout, and offered as much alfalfa as he wanted when he did come inside. Sucralfate before any work. 2nd rescope showed improvement from Grade 4 to Grade 1. Continued with same protocol for a second month.
3rd rescope (last week) showed little improvement in the pyloric region and some Grade 2 squamous ulcers. Continuing with a 3rd month of GG, and increasing his misoprostol dose back to the 2600mcg 2x a day. Also got in touch with the leaser who had him for about 6 months before I bought him. She said heād never been scoped or treated for ulcers despite obvious symptoms - said she couldnāt afford it for a lease horse on her own and his previous owners wouldnāt pitch in. So heās likely had these ulcers to some degree for over a year, which might explain why itās taking so long to get a handle on them.
Long story very short - pyloric ulcers are an absolute bitch and Iām sorry youāre in this boat too.
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Amy,
This has been going on for years! Years! She was on Miso for 8 months-no improvement. Double dose GG years ago when symptoms first appeared. I think it was triggered by PHF (we never tested her but all the sx were there and she was vaccinated. We treated the PHF and she never foundered but I think it really screwed her up.
We have one that has been treated for ulcers for years, with all the usual suspects of treatment - ulcergard (made them worse), sucralfate, ranitidine (no longer manufactured), no grain, different types of grain, oat hay (didnāt like it), alfalfa, Famitidine (to replace the Ranitidine), Outlast, etc. The one thing that has consistently helped him is actually Doxycycline. The vet explained that there was some sort of bacteria that was contributing to the horseās lack of appetite and ulcers. As long as he is getting a low dose of Doxy everyday, he is happy. But when we have tried to take him off of it, he goes back to being unhappy.
We have a different horse right now that is starting on ulcer treatment, and the vets actually said to stop giving him the Outlast, because it has molasses in it. Not that he was eating it well anyways. This horse is the pickiest eater I have ever seen, which also makes any feed through ulcer support difficult to give him. He seems to be happy on Purina Ultium, fed in 5 or 6 small meals a day instead of 3 big meals, with constant hay and chopped alfalfa before meals. In addition to his actual treatment medications. Thus far it seems to be helping. Still canāt get him to be happy turned out for extended periods of time, but thatās for a different topic.
Has this horse been tested for lyme or some other infection?
Thereās a lot of out there treatments for ulcers, but doxycycline is a headscratcher for me. You typically want to avoid ABX with ulcers, because there is a proven link between ABX administration and ulcer presence.
I said it up thread but people are willing to change everything in feed/supplements, but unwilling to change the physical management: turnout/roughage 24/7 with friends. It is the first ā not the last ā thing someone should do when dealing with ulcers in a horse.
Keep the horse outside (with a herd mate turned out with him). The acclimation will come. Most of mine take 2 weeks but some take longer. Never had a horse not thrive after acclimation period.
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Maude, I sent you a PM.
I think we might still be in the same boat. My guy got rescoped on Tuesday. 8 weeks off GG, but still on misoprostol and Sucralfate. Zero ulcer symptoms. Not girthy, not back sore. Eating well, finishing his grain, putting on weight and muscle. Great coat and attitude. Behaving beautifully under saddle and his chiro/massage appointments were continuing to get better and better. I really thought we were home free.
His pyloric region looks great still. Inflammation is gone, no ulceration. But his squamous region is now a mess of ulcers and his pH is back down to 1.75 (fasted roughly 16hrs before scope).
Heās on 24/7 turnout with two consistent buddies that he loves. Constant access to grass + round bale in turnout. Alfalfa and Sucralfate before he works. 5lbs of Purina Ultium Gastric Care split into two meals, top dressed with additional Outlast. He had a thorough lameness workup at New Bolton in the spring and nothing significant was found except the ulcers and a shoeing adjustment which has long since been addressed.
So either we had rebound ulcers despite a 2 week taper when he initially came off the GG in August, or heās internalized something, or heās stoic enough that heās asymptomatic even with squamous ulcers now that the more painful pyloric ulcers were healed.
Vets are stumped. Iām beyond frustrated. All the signs heās given us over the last 8 weeks are that his stomach was no longer bothering him. He may be one that needs to live on a little omeprazole to keep the ulcers at bay (along with maintaining the slew of management changes). Itās been 6 months of hell chasing this.
Serious question: If the horse has zero symptoms and appears to be comfortable and happy in work, do the clinical findings matter?
Of course I understand that after everything youāve been through, the clinical findings from the latest scope are frustrating.
But think of it this way, if it were not for his history, you wouldnāt have fasted for the 16 hours and scoped. How many horses are out there, working well, with similar or worse guts that will never be scoped because theyāre asymtomatic?
Thatās pretty much the same conversation I had with my vet. Sort of in the same vein as ātreat the horse, not the X-raysā. Her thought is that itās likely that the constant access to forage, Outlast (which he gets 3x a day), and Sucralfate buffer is keeping his pH at an acceptable level when heās not fasted. As long as heās asymptomatic, the plan is to put him back on some omeprazole to hopefully keep his pH and get the squamous ulcers healed.
At this point we donāt think another scope is necessary unless he becomes symptomatic. I just needed a minute to vent to someone who gets it.
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I hear you, loud and clear. But donāt lose sight of the fact that youāre a success story, and youāve solved your horseās issues and are keeping him happy and useful.
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PS -
Abler Equine is the cheapest source for Omeprazole (and Sucralfate) that I could find.
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I think this question is difficult to answer and it boils down to how intuitive ā truly ā a person is at reading āsilent painā in a horse.
For example, I see a lot of quality horses for sale with findings on x-rays that scare buyers. To use a recent example, thereās a Prelim packer being listed near me for 15k which is a steal. Itās a nice horse too. Buyers found significant KS on PPE, seller is priced him down to reflect the bad x-rays.
The seller says he is asymptomatic and they never had any idea. I believe the seller didnāt know. There are videos and photos provided. Itās a damn nice horse. The comments are overwhelmingly positive, with people being shocked, loving him, thinking he is wonderful, saying how asymptomatic he is despite the findingsā¦
The thing is, he wasnāt asymptomatic at all in the video. He had all of the āsilent painā symptoms I associate with KS in a horse. Dull expression, ātightā ears, stilted tail, subtle bilateral lameness, toe dragging behind, tense neck, stiff back, walked off from mounting block the second there was rider weightā¦ But he went W/T/C in a frame with all legs moving evenly, jumped nicely, and was clearly well behaved. A generous horse.
I am not saying this is the case with you, or the OP, but itās been my experience so many people think only misbehaviors or lameness are symptoms of an issue and they describe the horse as āasymptomaticā because the horse isnāt obvious about his pain. They donāt recognize the small things that might point to an uncomfortable horse.
I donāt, personally, think in the case of ulcers that the findings are irrelevant. I do think generally, ulcers tend to reoccur at some level when thereās a physical component at play. They are usually a better symptom that something is bothering a horse than their behavior is. It really sucks this has to be your journey to unravel OP.
Do you have photos of the hooves, and a video of the horse moving around?
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Thatās true. For my horse, however, weāre quite confident that pain is not the issue here. I handed him over to the sports medicine team at New Bolton and said ādo whatever you feel is necessary.ā They did - and came back with no clinical findings beyond a trim issue we have since addressed, and the ulcers. Their exam included objective diagnostics (lameness locator machine), radiographs, nerve blocks (lameness blocked to the feet which led us to the trim issue).
Since the NB visit, heās been under the care of two vets at our usual practice and our chiropractor, who is also a DVM. Unanimously they have said that they donāt believe there is any indication of pain to trigger the ulcers, and that he may just need continuous Omeprazole.
With all due respect, Iāll defer to their expertise.
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Occamās Razor.
You said your team discovered a physical issue. A trim issue. By the time there is any pathological findings in a lameness work up, the damageās been done and takes several months to revert.
My assumption would be if the ulcers persist, that physical issue is not wholly resolved.
Something a vet told me a long time ago:
You cannot rule out pain. You can only diagnose it.
I hear you. At this point, I have sought out the best veterinary care I have access to and given those veterinarians carte Blanche to do any and all diagnostics they deemed necessary. They have done so. They do not feel based on their examinations of the horse that there is anything further for them to pursue at this point, and yet the ulcers persist.
Our hope is that the continued absence of the previous pyloric ulcers means that whatever may have been bothering him physically is resolving with time. If we can resolve the squamous ulcers with another round of treatment and keep them at bay beyond that, we might very well be on the other side of this.
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My vet uses a compounded omeprazole/fenbendazole paste to treat tough cases with some really great results. Might be worth asking about, either for now or in the future.
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I feel for you OP, the ulcer journey is not fun. Iāve been present for many disappointing re-scopes where owners have done everything right in their power to try to treat the ulcers.
It does take a long time to heal and in my experience squamous are the worst in heal times. Try the compounded version of omeprazole/fenbendazole if itās an option for you. My vet does it as well - it is not cheap but worth treatment if all others are failing.
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Iām not familiar with the Omeprazole/fenbendazole combo. Can you explain the purpose of the fenbendazole? We have our supply of meds for now but I can definitely ask our vets about it pending results of his next rescope.
