The chicken & the egg - calling on the collective experience of the coth peeps

[rcy]

So my mare has ulcers and for the life of us, we can’t get them to go away and stay away.

I had suspected them when I purchased her a year ago, but didn’t have her scoped as part of the PPE and just acted under the assumption she had them and I would have to treat. She is a hot horse - this I have no issue with - however I’m starting to wonder if her anxiety is the root cause of the ulcers? Or the ulcers are causing the anxiety?

She’s been scoped several times, and was diagnosed with both kinds. She’s been on GG and sucralfate, and every time I try to wean her down off of the GG they seem to flare up. But when her stomach feels good, she is lovely and calm. She obviously had films and flexions during the PPE, then I’ve had a lameness vet look at her twice since then to see if there’s anything they could pick on that would be causing underlying pain. She never flexed lame, but they thought if I wanted to try injecting stifles or SI. So I did one first, then the other, with a couple months in between to see if the first would cause any improvement. No significant change in performance after either, and the ulcers are still there.

She’s currently on Nupafeed (magnesium), Mare Magic and is about a week or two into SmartGI Ultra, but given she is in the midst of a flare up, I don’t think it’s helping much.

She won’t eat Platinum Performance. GutX didn’t work, ulcers came back. There was another supplement in there that the name is escaping me at the moment but it will come back to me.

She lives in a stall with attached run at a very low key barn, with daily turnout on grass where she can also kick up her heels. Gets hay 4x day, with alfalfa in two of those meals. I’ve also been giving a bit of alfalfa before I ride to buffer her stomach. On Purina (I think this is the right name) Strategy Healthy Edge - the one with Outlast in it.

I don’t mind hot - that’s actually one of the reasons I like her so much. She is a sensitive soul, wears her heart on her sleeve and I believe she is entitled to her opinion but needs to be open to negotiations. She works 5 days a week with two of those being lessons or my trainer riding her. But I worry that if she’s got anxiety, that’s what’s causing the ulcers. I don’t want to drug her to calm her, and I really don’t want to keep her on GG into perpetuity. Her tells when she’s getting a flare up are that she’s against the left leg, girthy, and spooky. At the worst she’s kicked out on mounting, double barrel kicking under saddle, etc.

Any ideas from the collective experience of the COTH? TIA!

[IPEsq]

Has she ever been on misoprostol?

[Halternatively]

Ahhh, I feel your frustration. I’ll throw out a few ideas:

Have you tried Succeed? Platinum & Succeed are similar in texture, so not sure if your horse will eat it.

Have you tried a forage-based diet of hay, senior feed and no processed grain while the gut heals?

Have you tried adding aloe Vera juice to meals?

My go-to is a daily mash of alfalfa cubes or pellets, beet pulp, aloe, omega 3 & 6 oil, and platinum GI. I do this with light work, lots of turnout, free choice hay, and a forage-based senior feed.

Good luck!

[blob99]

she sounds like my horse who also is a sensitive soul very prone to ulcers.

He still needs medication any time we’re trailering somewhere off property and I give a treatment dose, not a maintenance dose. But two things have helped inbetween:

1. he has constant access to forage–either grass or hay or both. But there’s never a time of day when he doesn’t have access to as much as he wants of either. I know you mentioned your mare gets hay 4x a day–but are there periods where she is without? Can you use a slow feeder or hay net to extend how long the hay lasts? It’s less about the calories and more about the stomach never goes empty.

2. I’m not saying this is right for your mare, but I had to pull my guy off of grain. I don’t know what ingredient it is, but something in basically every fortified or pelleted feed bothers his stomach. So now he is on a forage only diet–hay/grass hay; alfalfa; beet pulp; and a vit/mineral supplement (currently on horse tech highpoint, but was also on vermont blend earlier)

[rcy]

Sorry I don’t know how to quote and reply to those -

No, we haven’t tried misoprostol - I will ask my vet!

Yes, we’ve tried Succeed (they still came back; that was the other one I couldn’t remember yesterday!)

Is senior feed not considered processed grain? Taking her off grain is an interesting idea - so do you find that horses can still maintain the work/build muscle without?

I can try aloe vera, but she is a VERY picky eater…

I would like to try a slow feeder, but given GG is supposed to be fed on an empty stomach - it seems as though I can only do one or the other?

[beowulf]

The two leading factors in ulcer occurrence are pain and management(isolation). Other factors include grain or very rarely, delayed gastric emptying. One or the other being present does not exclude the rest - it’s very common for a horse with ulcers to have several grievances going on at once from physical to management.

Well-meaning owners tend to treat ulcers, but ulcers are almost always a symptom of a bigger problem, which is usually a combination of management practices and pain/discomfort. If you[g] don’t address the management, you may as well be throwing your money away (as with all things horses).

Try getting her a low key paddock buddy, and push for more time outside. Isolation is a major contributor of stress in a horse and being adjacent to a horse in a different paddock or stall is not enough. Stalling is another problem as a major contributor to ulcer development in horses for two reasons: one, prolonged isolation with no ability to move leading to general inflammation all over the body – for two, prolonged periods of time with no forage in front of them.

What management is included in her stall time? Does she have hay in front of her from when she is brought in, to when she is turned back out? A hay bag? If she were my horse I’d be looking for ways to ensure she does not spend a single moment without forage in front of her while she’s stalled. For the average boarding barn that does 8hrs out, 16 hrs in a stall, factor in that a healthy horse can eat 1 flake in 30m and then figure out how much hay she would need in front of her to still have some left over in the AM. For an average horse that’s probably close to 40lb of hay, which most boarding barns are not equipped to do.

I am not a fan of Purina Strategy H/E, but if that is your only option I guess it is your only option. For an ulcer prone horse I’d be looking to reduce starch and NSC, up alfalfa and forage, and possibly even consider a grain-free option if she can keep condition well.

Consider that she may have an undiagnosed pain issue that has not been found yet. Your symptoms are pretty extreme.

When she was scoped, was there still food in her stomach after fasting?

[blob99]

@rcy

I would like to try a slow feeder, but given GG is supposed to be fed on an empty stomach - it seems as though I can only do one or the other?

GG does not need to be fed on empty stomach. Sucralfate is ideally given on empty stomach, but omeprazole does not need to be.

[Simkie]

Have you ever had a clean scope?

[walkinthewalk]

Here’s my two cents since I have dealt with fore and hind gut ulcers in three horses but they were/are geldings.

One Arab. One Tennessee Walker (RIP Streeter & Joker)

One now 26 yr old Dutch Warmblood, a retired show jumper.

Then there’s my remaining 28 yr old TWH whose picture should be beside the word “angst”

1. If your mare were my horse, I would clean house on the feed pan stuff (NOT your forages) and start over.

Find a grain-free ration balancer she will eat and since you have a mare, hopefully something that uses alfalfa as the protein source instead of soy.

I’m not that big of a fan of Nutrena Safe Choice Senior but it’s the best I can find my area for the Warmblood, who recently came to retire on my farm:). It does not have added iron, it DOES have the three essential amino acids.

2. MagRestore is magnesium malate which is supposed to be the most bioavailable of the magnesiums. I have my 28 yr old Tennessee Walker on it for the second time in several years, because he lost “it” after TWH Joker passed; he would be Bi-Polar were he human. The difference in his demeanor and the softness in his eyes is unbelievable, and I will keep him on the MagRestore until???

2.1. The caveat with MagRestore is on their website and says”

**Precautions: Due to magnesium content, your veterinarian should monitor animals with renal insufficiency. If animals’ condition worsens or does not improve, stop administration and consult your vet. Avoid feeding MagRestore® simultaneously with ulcer medications, slippery elm, or over the counter ulcer products: these may inhibit absorption of magnesium. Feed MagRestore® separately if you use these supplements“**

I point this out to say, I am a staunch believer in “Succeed” but feed the magnesium at a different feeding from the Succeed”. It may be some of the mare’s problem; we all want to throw everything in the feed pan at once and be done with it but that isn’t always a good thing, as pointed out on the MagRestore website

I hope this helps​:cowboy_hat_face:

[JB]

@rcy

was diagnosed with both kinds

There are 3 kinds - from top to bottom they are squamous, glandular, and pyloric

I assume you mean squamous and glandular?

Omeprazole doesn’t tend to work very well on glandular ulcers, even combined with sucralfate, but does work well on squamous

Misoprostol works well on glandular ulcers though.
Misoprostol is superior to combined omeprazole-sucralfate for the treatment of equine gastric glandular disease - PubMed (nih.gov)

Squamous ulcers have biggest risk factors in diet and exercise.
Glandular ulcers have biggest risk factors in NSAID use and stress.

Here’s a really good read
Squamous vs Glandular Ulcers in Horses: What’s the Difference? | Mad Barn

Living in a stall may be her biggest source of stress, but how many hours is she turned out, and is it solitary turnout?

I’d say you need to get misoprostol a try, but also consider that omeprazole may have caused some hind gut issues.

I’m not a big fan of corn for horses, so don’t really like most Purina and Nutrena products for that reason. So, that’s one change I’d make - remove all corn. Triple Crown Sr is a good low NSC, no-corn feed, and the Gold has hind gut support (like the regular) AND gastric support

If it’s the HE, or nothing at all, I’d go with dropping the HE, going with some alfalfa pellets and pelleted California Trace (as I assume soaking isn’t an option) and seeing how that goes.

[pompeiii]

My thoroughbred has a very difficult to manage stomach. He’s often ulcery and ulcergard triggers severe hindgut issues. Or his hind gut issues trigger ulcers? We’re not entirely sure. But ultimately things got so bad this winter that he went off all feed/hay.

What I found works for him as he’s NOT one that can be on ulcergard (or similar products like nexium) long term is a diet rich in digestible forage plus plenty of hay and alfalfa. For us, fibre beet has been a miracle feed. My horse, who won’t touch soaked anything, is obsessed. It’s pricey, but it was the only thing he ate when he stopped eating. He gets 3lbs/night. That plus TC alfalfa forage blanch chopped hay. He’s down to about 5lbs/night (from 15), but I won’t cut it completely. He does get grain now (tribute wholesome blends Senior —we have soy issues) plus free choice grass hay and alfalfa. And, the key for him is succeed. He gets the paste so I know he eats it (I had stopped 2 months pre-flare up…).

While my guy gets grain now, he put on a ton with just the Fibre beet and chopped hay because they were so easy to digest. His stomach was able to heal and he felt better about eating (even if I cried when my vet encouraged mostly chopped for a month).

[rcy]

I appreciate everyone’s thoughts here and will try to answer as much as possible given that I don’t know how to quote

She was diagnosed with both glandular and non-glandular. No, we haven’t tried misoprostol; I’ve got a message into my vet to ask about this.

I’ll also ask about pulling her grain, at least temporarily. It took me a year to get her weight and muscle where I’m starting to be happy with it, so I just want to make sure I’m giving her what she needs to maintain that and the work.

She’s never been on bute since I got her, so I can’t imagine anything was caused by NSAIDs (or if it was prior to her purchase, that they would have been cleared up by now given the GG/sucralfate protocol?). But with regards to the ulcers being a result of low grade or chronic pain - I was also going to ask if I should try putting her on Equioxx for a little while to see if there’s any change in her work - but I want to make sure that THAT wouldn’t contribute to the ulcers!

I’m going to bite the bullet and get her a slow feeder… to heck with timing meds on an empty stomach.

But then back to the root of my question - if anxiety is a contributing factor to the ulcers, and I don’t want to drug her, are there nutritional/supplements that I should be looking at (food sensitivities, lack of/too much of something in her diet) that could be contributing to the anxiety? I know I bought the horse I bought and I knew she was hyper aware and always on point, and I’m fine with this personality type - but is there a way to rule out if the anxiety as a cause?

TIA for anyone who’s getting through these questions… as I know there are a million threads on ulcers already!

[JB]

@rcy

I was also going to ask if I should try putting her on Equioxx for a little while to see if there’s any change in her work - but I want to make sure that THAT wouldn’t contribute to the ulcers!

One thing you don’t want to do is an NSAID, while using omeprazole, as that has shown to cause issues in the hind gut.
Here’s What To Keep In Mind When Giving Your Horse Omeprazole For Gastric Ulcers - Horse Racing News | Paulick Report

“A recent study showed, however, that while omeprazole helps prevent gastric ulcers potentially caused by NSAIDs, this drug combination appears to cause hind gut issues such as small colon impactions and diarrhea that can potentially be fatal, especially when high doses of phenylbutazone are used,” said Sykes.

Ben Sykes is a leading ulcer researcher

[rcy]

ohhhh, thank you @JB! never mind that idea then…

[Turntable]

Yes- this is important. Omeprazole is a proton pump inhibitor which reduces the secretion of stomach acid and also some other things and there are many, many side effects of longer term use including rebound gastritis, reduced digestion of protein and many minerals and vitamins (especially iron, calcium and magnesium and B12) and a generally negative shift in gut bacteria (too much to get into) which is obviously a problem in horses. It is not indicated for long term use and is carelessly way over prescribed for that in both humans and animals.

[JB]

One thing I’d say differently is in regards to B12.

People has to consume B12, which means our stomach has to have the acid to break the protein apart, to release the B12, to be bound with other things, which then allow it to be digested further down

Horses synthesize their own B12 in the hind gut, so it doesn’t require an acidic enough stomach environment. But, using a PPI at all could impact how well supplemental B12 is digested.

[blob99]

re: stress:

some horses are just going to be more prone to anxiety than others. I have one that is phased by nothing and the other that gets worried about everything. So you have to manage the best you can with the nervous types and limit/mange things that are known stress triggers as much as reason.

Does she get turnout alone or with a buddy? I know some nervous/easily stressed horses really, really benefit from a calm buddy. Horses are heard animals the nervous ones are also often the insecure ones and they are hoping someone else can tell them when and how to react to things. So having a good leader buddy can make a world of difference. I know others might disagree but I actually prefer horses in groups of 3-4 rather than in 2 because sometimes when there are just 2 horses together they can get very dependent on each other. A slightly larger group, usually creates less dependence but still provides reassurance for the nervous types. But even getting just 1 buddy could help.

I don’t really believe in any of the daily ‘calming supplements’ you can find. Some people swear by magnesium but that only helps if there is an actual deficiency. I do think there is value in giving something when encountering an especially stressful situation. I have used confidence EQ with success with some horses. It’s not a daily thing but can be used for an out of the usual routine, stressful situation.

re: removing grain:

Mine also was very underweight and so not giving him grain made me nervous. But with beet pulp or alfalfa pellets you can still get calories in and I found that once his stomach was in better shape, keeping weight on was also easier. So while he’s definitely not a chunky horse, he is pretty good at maintaining on a forage only diet. And there is always the option to add fat if you need a bit more something. I give flax, but there are also others that have had very good experience with oil or coolstance.

[clanter]

@rcy

Strategy Healthy Edge - the one with Outlast in it.

there is a Purina horse treat with Outlast … Purina® Outlast® Horse Treats (https://www.purinamills.com/horse-feed/products/detail/purina-outlast-horse-treats)

My wife won a door prize at the opening of a new feed store, in that package was package of these Outlast horse treats

Nothing scientific but the one old mare we have that had gastric issues everything cleared up once she was offered these treats (she has also is on the Strategy Healthy Edge as her feed)

But since offering these to her she is basically a calmer different horse… and No Horse we have has ever turned one of these treats down, all are searching for more.

as always…check for manufacturer’s coupons …the is a $5 off on the Purina web site (it is emailed to you) but five dollars is five dollars… coupon is good for any Purina product that has Outlast in it including the treats

Take a Test RIDE with Outlast Gastric Support Supplement | Purina

[EmilyM]

Misoprostol helped my horse in three weeks when seven weeks of GG did nothing. Confirmed w scoped.

[Feldspar21]

The rider that I work for has a few horses that just seem to be more sensitive to developing ulcers. It seems to be specific line of Dutch horses (she has a few brothers). She has them on a diet of alfalfa pellets, speedi beet, and rice bran. They all get free choice hay in a haynet, and 12ish hours of turnout. They also all get Succeed and live on a scoop of misoprostol twice a day. One gets sucralfate before every ride. They also get a full tube of Ulcerguard before, during and after shows, tapering off in the days following a show. I know she’s really struggled with these horses, but this program seems to be working really well for them.