Just me chiming in with the reminder that treating gastric upset with omeprazole/esomeprazole is what likely started our descent into hell. You can’t just adjust the pH level in stomach without consequence.
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I’m sorry that it triggered issues in your horse; unfortunately all medications come with possible side effects. However gastroguard has been given to likely millions of horses; many times preemptively for things like trailering or shows, with no adverse consequences. It’s recommended by vets before long trailer rides, stress, major feed changes. In the majority of horses it cases no side effects.
I suggested it because horses just like humans can get hiatal hernias and one of the ways humans (and equines) will relieve the pain from it is stretching. The triggers in people can be nonsensical; for me it was garlic and starches, for my cousin it’s spicy foods and meat products. I’d assume it’s similar in horses. There is only two things you can do for it which is surgery or taking acid reducing medication to see if it helps. The hernia is also difficult to diagnose unless you are specifically looking for it.
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And the horse is already on Zyrtec which also suppresses stomach acid production.
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Zyrtec? that’s an allergy med. Are you thinking of Zantac?
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Nope. Zyrtec is an H2 antihistamine and they suppress acid production from the parietal cells in the stomach.
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A radiograph won’t show anything but bone, unless you’re adding contrast. Ultrasound may be useful, but what you want to see is awfully deep in the body, so it might be tough to get a good look.
A barium swallowing study is probably your best bet, and a scope with particular attention to the esophagus and upper airway.
Dysphagia can apparently be caused by a whole raft of things, including gutteral pouch mycosis. Here’s a paper that discusses a few different things you could look for:
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I understand that it is often recommended by vets, and I also understand that it is used extensively in the day to day of horse care (unfortunately). As a self-admitted abuser of gastroguard, I get it.
If it was a vet recommendation from a vet with extensive experience in horses with severe digestive problems, as part of a comprehensive plan … okay.
But my POV is that I do not think it prudent to add medication that specifically alters the gut biome to a horse that is in chronic distress without a broader understanding of impact. It does not come without the potential for severe consequences.
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Have you tested for PSSM?
What I can find says that cetirizine is an H1 receptor antagonist, not H2.
“Cetirizine is a fast-acting, highly selective peripheral histamine H1-receptor antagonist.”
From
https://www.ncbi.nlm.nih.gov/books/NBK549776/
H1 receptor antagonists don’t do the same thing in the stomach as the H2 receptor antagonists
“The H1-receptor drives cellular migration, nociception, vasodilatation, and bronchoconstriction, whereas the H2-receptor modifies gastric acid secretion, airway mucus production, and vascular permeability.”
From
Do you have any info about cetirizine acting on H2? If it does that, I’d love to know. I’ve missed ranitidine.
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“Cetirizine, the carboxylated metabolite of hydroxyzine, is a specific and long-acting histamine H1-receptor antagonist.”
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Thank you, this is supremely interesting. I wonder, too, about what I thought was a run-of-the-mill devil’s thumbprint on her…but it seemed in an odd spot. Might be nothing, might be something. I always kind of wrote the dent in her neck off as congenital, but I might ask vet to confirm rather than assume.
The thing I keep coming back to is, if it does have something to do with “front end” piping, why why why does she keep getting glandular ulcers and why did they not see anything on her multiple scopes…
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We’d be looking for PSSM 2, not PSSM 1. And the PSSM 2 requires a pretty deep punch into the muscle for biopsy, and must be done at the hospital. That seemed a bit too traumatic to put her through, considering her symptoms don’t seem to line up.
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Whereabouts in the horse are you referring to for possible areas prone to hernias?
I do not believe gastroguard harmed my horse, for what it’s worth.
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If only we knew.
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It’s essentially the diaphragm. I’ll attach a photo showing it in humans. It’s genetic in my family. Unless doctors (or vets) are looking for one it’s hard to diagnose. Even in human medicine, I was told I did not have one but they went in surgically to check. The surgeon said it was one of the larger ones he’s operated on. Couldn’t even see it on scans. I was MRI’ed, Ultrasounded, imaged with contrast and got to swallow barium. Nothing showed it.
If you look up ‘hiatal hernia horse’ you can see cases of it. Unfortunately it seems to mostly be diagnosed after the horse has been euthanized.
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So what I see when I look at the megaesophagus stuff is that can lead to problems with the pylorus as well…which could maybe be contributory to glandular ulcers? It doesn’t seem to be a stretch that if there’s a problem in the esophagus, there can be a problem in the stomach.
And while I’m 100% with you that if there’s something amiss in the esophagus, it should have been picked up in your exams…the reality is that vets (and doctors) very often miss stuff they’re not actively looking for. Which is a shit answer but unfortunately pretty common :-/
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Why not PSSM1? That’s just a hair test and not expensive. She looks a little drafty, and PSSM1 could be a possibility. She has a lot of the symptoms. https://www.youtube.com/watch?v=Sp223pUYBRE
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Sorry to derail, but I knew an older mare who went through some unexplained weight loss for a period, so she got some extra soaked senior meals, and she would totally submerge herself in the bucket. Gave herself a sinus infection. Definitely need a shallow pan for those critters!
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We had one last year who randomly started colicking - so we thought. It was pretty violent when it would happen, start with yoga and curling the lip but it could progress to rolling and thrashing. Never, ever coughing or anything coming out the nose. One time he did it 3 times in one week, the last episode was so bad we were trying to get a backhoe there thinking it was time to euthanize. By the time the emergency vet showed up he was doing better.
Scoped, biopsies with the scope, ultrasounded, bloodwork, oral exams, everything and anything there was to do in the field to find the cause we did. Could not figure it out.
We stopped feeding him hay. He eats sloppy senior feed and sloppy hay pellets, and grass in season. He does not get 1 mouthful of hay, ever, and it stopped. He lives on a low dose gabapentin for pain, and we did a pretty hefty steroid taper to bring down any inflammation when we originally stopped the hay.
I don’t know what caused it. It’s linked to the hay - if he gets any hay it will start again. It must be somehow related to the esophagus entrance into the stomach but the scope always looks fine. Really a mystery. Horse is in its 20’s and has eaten hay his whole life.
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Hay is the one common denominator I can think of for my mare; this is across different kinds of hay at different barns. I think I might have to convert to hay pellets, just to say I tried it. Here’s the thing, though: I moved my horse to the only barn that I felt could reasonably care for her (she inspired a lot of compassion fatigue, as you might imagine). Which is 40 minutes away from my house. Barn staff is really great about doing whatever I ask, but how would that even work, feed schedule wise? She chokes if the pellets aren’t soaked; moreover, she’s supposed to have food in front of her 24/7 to prevent ulcers. And supposedly if you soak hay or hay product for more than 9 hours (as would happen if the barn staff started a soak the night before for breakfast), you run the risk of too much bacteria? Barn staff is GREAT, but I can’t ask them to soak her food a full two hours before feeding. They’d have to leave and come back.
