Ulcer Experts Needed

[Kati7095]

Horse was acting ulcery at beginning of January so I started him on a full tube per day of UlcerGard and Equishure. Immediate improvement so decided to do the full month treatment. Ended up keeping him on it through a show at week 6. On week 4, I body clipped him and ulcer symptoms came back the next day. He continued with ulcer symptoms through show weekend so I decided to have him scoped when he came home. After 6 weeks of a full tube a day of UlcerGard, he had bleeding squamous ulcers plus pyloric ulcers. The vet had me add misoprostol and sucralfate.

Re-scoped 4 weeks later… still bleeding, but pyloric showed some improvement. Switched the UlcerGard to Ranitidine. Scoped 4 weeks later, no longer bleeding but still lots there. Added minocycline and probiotics. FDA took ranitidine off the market so went back to UlcerGard.

Scoped again 5 weeks later and the squamous were still not healed, although the pyloric were almost completely gone. Changed from UlcerGard to the injectable omeprazone from BET thinking that its better absorbed. Also did another round of minocycline. Still doing misoprostol and sucralfate. The injectable omeprazone would last about 4-5 days and then ulcer symptoms would come back. Also, the injection sites get VERY swollen, so we decided to go back to UlcerGard.

We’ve scoped 4 times now and the ulcers are still there. He’s currently on a full tube of UlcerGard, probiotcs, sucralfate, misoprostol and RiteTrac. I’ve also tried NeighLox, Ulcereraser, Outlast and probably other things that I’m not remembering right now. We had him allergy tested. He’s had a full work up, chiro and massage work. Feet are good. What am I missing?? Vets next idea is steroids in case there is some sort of inflammation going on.

Horse eats a cup of TC Senior 2x a day (mostly to mix all his meds into), HorseTech High Point vit/min, TriAmino, T&A hay at all times in small hole hay net, T&A cubes for lunch. He is very plump and never goes off his feed. Straight alfalfa makes him too bloated.

He lives in Florida and gets turned out from around 7-11 daily - anything more than that and he wants in. I know some of you are going to say he needs more turn out, but he doesn’t want to be out more than that. Gets ridden 5-6 days a week. Was doing the 1.45-1.50 when I bought him 2 years ago. Jan 2019 had colic surgery and had an uneventful recovery. I’ve been doing him in the AOs but haven’t been able to move up due to colic surgery and now ulcers. Any ideas??

[kashmere]

Not an expert - but a thought: when he is turned out, does he have buddies he gets to be with? I will go now and try to hunt down the actual source for this info, but I’ve read many times that solo turnout or constantly switching the groupings around can be a contributor to ulcers. Both of my horses are MUCH happier with friends. My gelding is at a training barn with mostly solo turnout, but he shares a larger paddock with a pal, and it makes a noticeable difference to his happiness vs solo turnout - even when they can see/touch others over a fenceline, it’s not really the same.

[beowulf]

Just because he is conditioned to want to go back inside, does not mean it is what is best for him. 7 to 11 … do you mean he only gets 4 hours…?

Squamous are very hard to resolve, can take a lot time and multiple $cope rechecks… My experience is, it is very hard to get a horse scoped with ulcers, permanently ulcer-free in a stalled environment.

This is my check-list, for a horse that has “had the works” (as yours has):

• increase to 24/7 turnout, access to roundbale
• incorporate alfalfa pellets into grain/sub for grain
• add a herd mate / pasture buddy
• critically look at the horse’s work, are they really sound?

None of the above is negotiable, IMHO, if you want to resolve the ulcers permanently. Ulcers are a management issue. You can treat the ulcers as you have done, but they will come back if you do not adjust his management permanently. That means changing his hours of turnout, forage, etc. Providing him a turnout buddy (Not someone through the fence, a horse that actually lives with him). Possibly investigating a physical cause for all the ulcers…

Another good thing for them when they’re ulcer prone, is to always have hay. I provide this by roundbale + grass during spring/summer. There is not an hour of the day that goes by that our horses do not have hay in front of them. How much hay is he actually getting? A lot of barns will claim their horses get “round the clock hay”, but it’s a buzzword, and when you define how much food it really is, it’s usually ~3-6 flakes of hay a day which is not sufficient for most horses in work. When you come to the barn, is there always hay in front of him…? How much? Has he ever not had hay in front of him?

I would push for more turnout, with buddies. Yes, the first two weeks he will pace or call or want to come in. Especially if he doesn’t have a herd mate. He’ll deal. He’ll be much happier out as much as he can be.

I don’t buy the “my horse hates turnout” argument - I’ve converted every horse that has come to our farm to 24/7 turnout and not one has failed to adjust to the new norm. There have been plenty that were show horses too, and came with the caveat “they hated turnout” and “they couldnt be turned out with other horses”. That is purely an owner restriction - either they don’t want their horses out more often, or, they’re misconstruing the horse’s anticipation of coming in as the horse’s preference. Most horses only want to come in because they know they get grained once they’re in a stall… and most horses are on an empty stomach at the end of their turnout, which is why they want to come in so badly. Trust me, it’s not because they enjoy being locked in a stall for 16 hrs of the day.

[mmeqcenter]

@beowulf

Just because he is conditioned to want to go back inside, does not mean it is what is best for him. 7 to 11 … do you mean he only gets 4 hours…?

Squamous are very hard to resolve, can take a lot time and multiple $cope rechecks… My experience is, it is very hard to get a horse scoped with ulcers, permanently ulcer-free in a stalled environment.

This is my check-list, for a horse that has “had the works” (as yours has):

• increase to 24/7 turnout, access to roundbale
• incorporate alfalfa pellets into grain/sub for grain
• add a herd mate / pasture buddy
• critically look at the horse’s work, are they really sound?

None of the above is negotiable, IMHO, if you want to resolve the ulcers permanently. Ulcers are a management issue. You can treat the ulcers as you have done, but they will come back if you do not adjust his management permanently. That means changing his hours of turnout, forage, etc. Providing him a turnout buddy (Not someone through the fence, a horse that actually lives with him). Possibly investigating a physical cause for all the ulcers…

Another good thing for them when they’re ulcer prone, is to always have hay. I provide this by roundbale + grass during spring/summer. There is not an hour of the day that goes by that our horses do not have hay in front of them. How much hay is he actually getting? A lot of barns will claim their horses get “round the clock hay”, but it’s a buzzword, and when you define how much food it really is, it’s usually ~3-6 flakes of hay a day which is not sufficient for most horses in work. When you come to the barn, is there always hay in front of him…? How much? Has he ever not had hay in front of him?

I would push for more turnout, with buddies. Yes, the first two weeks he will pace or call or want to come in. Especially if he doesn’t have a herd mate. He’ll deal. He’ll be much happier out as much as he can be.

I don’t buy the “my horse hates turnout” argument - I’ve converted every horse that has come to our farm to 24/7 turnout and not one has failed to adjust to the new norm. There have been plenty that were show horses too, and came with the caveat “they hated turnout” and “they couldnt be turned out with other horses”. That is purely an owner restriction - either they don’t want their horses out more often, or, they’re misconstruing the horse’s anticipation of coming in as the horse’s preference. Most horses only want to come in because they know they get grained once they’re in a stall… and most horses are on an empty stomach at the end of their turnout, which is why they want to come in so badly. Trust me, it’s not because they enjoy being locked in a stall for 16 hrs of the day.

[Marla_100]

Beauwolf Nailed it Again!!!

[kashmere]

@beowulf has nailed it, as usual. I initially read the “7-11” as “7-11 hours” which is not ideal but certainly better than if it is truly “7am to 11am” - which is really not an acceptable amount of turnout.

And the point about “hating” turnout is an excellent - and extremely worthwhile thing to really consider. Asking to come in can be a conditioned behaviour, and breaking that creates temporary discomfort, as Beowulf noted. It can also be that they don’t want to be “in” but that something about being in fulfills a need that they can’t get in their current “out” set up. Things to consider: Is there shade in his turnout? Is he comfy urinating on the footing he’s turned out on? (my gelding will NOT pee anywhere it might splash him, many are similar), Does he have fresh water outside? Is he only given hay inside? Is there a nice spot he can doze and rest? etc. etc.

Here is a very interesting 2015 paper that references turnout buddies (not in great detail), but overall is an excellent read for managing ulcers:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858038/

[kaya842]

@kashmere What do you do for your gelding who does not like to be splashed by his pee? I’ve a got a mare who is very similar - She will BEG to come inside just to pee because the fluffy shavings absorb it all and it doesn’t splash her. Her turnout is a dry lot half the time and grass paddock + access to her dry lot the other half.

[kashmere]

@kaya842 - I bought a small load of sand for his paddock so if the pasture is closed for weather he has somewhere that won’t be splashy. He will happily pee out on the grass 😊

[joiedevie99]

If you want to commiserate, read my old thread Drug Resistant Ulcers. My problem ulcers were pyloric, but we tried everything under the sun. I signed a photo release for my horse’s stomach to be in a text book

Besides different turnout options, I’d consider the following:

1. Ranitidine and Ulcergard at the same time
2. Two tubes of Gastrogard per day. If you read the label, there is a weight limit per tube, and more horses than you’d think are over it.
3. Allergy test him. If he’s allergic to corn or alfalfa (as mine were), it’s hard to heal the stomach without removing the culprit.
4. A serious lameness exam or a bone scan. IMHO, chronic low level pain is responsible for more ulcers than people think.

[Dutchmare433]

@beowulf has it right above. Treatment without management changes won’t work long term.

The only other treatment option would be compounded omeprazole/fenbendazole paste. My vet uses it on some horses who do not respond to omeprazole.

ETA: My fatty who has had 2 bouts of ulcers over the 5 years I’ve had him can’t do free choice hay—he would be beyond obese. We weigh his hay and put it in super small hole nets so he has hay reliably all day and he usually runs out around 3-4am or so—and gets breakfast hay at 6-6:30

[Equkelly]

Ouch this is making my wallet hurt.

I know he wants to come in but honestly that shouldn’t matter, his management clearly isn’t working. Also people always like to say “oh my horse loves his stall”. They don’t. That’s just where their food is, his friends are, and where he sleeps. Just take all that and put it outside. Horses aren’t meant to live in a box for 20 hours a day. I get that it’s normalized and some horses really do fine with that life, but yours clearly doesn’t.

I would move him to somewhere where he can live outside with free feeding. I did 28 days of gastroguard plus wean off plus scoping in January for my mare and there’s no way in hell I’d spend all that money and still keep my horse in a stall where she would just get them again.

[Incantation]

In addition to the management changes mentioned above, you may want to try injectable omeprazole. My friend had a horse with bleeding ulcers, and it healed them with one shot a week for 2 weeks. My guy’s ulcers weren’t nearly as bad and it took about 6 weeks of Gastro guard and sulcrafate to heal them, that was after trying ulcerguard at 1/4 dose for 6 weeks.

For the horse that won’t pee outside without a soft spot, I put a pile of old hay out. I have to change it out at times, but both my boys prefer to pee in the hay pile, so there is no splash.

[No1]

Some horses really do hate turnout, no matter what you do. Some horses will bring themselves in when they’re done if you don’t go get them. Luckily, those ones are usually good jumpers anyway. Please, DO NOT give your horse a coastal round bale unless you already feed your horse coastal. Especially a horse with a history of colic.

Things to consider: The timing of your meds. Omeprazole is supposed to be given on an empty stomach. Sucralfate and ratinidine are supposed to be given at different times and with more frequency than they are often given. Sucralfate should be given every 8 hours and on an empty stomach. Alfalfa is good to feed as it coats the stomach and provides protection from acid. As someone else mentioned, maybe you could give your horse a handful of soaked alfalfa cubes instead of grain. Also, adding some hand grazing in the afternoons may be good.

[beowulf]

@No1@all

Some horses really do hate turnout, no matter what you do. Some horses will bring themselves in when they’re done if you don’t go get them. Luckily, those ones are usually good jumpers anyway. Please, DO NOT give your horse a coastal round bale unless you already feed your horse coastal. Especially a horse with a history of colic.

Things to consider: The timing of your meds. Omeprazole is supposed to be given on an empty stomach. Sucralfate and ratinidine are supposed to be given at different times and with more frequency than they are often given. Sucralfate should be given every 8 hours and on an empty stomach. Alfalfa is good to feed as it coats the stomach and provides protection from acid. As someone else mentioned, maybe you could give your horse a handful of soaked alfalfa cubes instead of grain. Also, adding some hand grazing in the afternoons may be good.

A horse should never have an empty stomach, even if that’s optimal time for dosing. Empty stomachs are part of the reason ulcers develop in the first place.

I’m not with you that some horses really hate turnout.

Some horses really hate being out alone. (industry standard)
Some horses really don’t do well with being turned out in a dry lot with nothing to eat for hours (industry standard)
Some horses really hate being attacked by bugs or without shelter from sun/rain/snow.

If a horse is pacing the fence-line, it is telling you something - and it’s not usually related to wanting to get back to the stall. It’s usually related to:

• I want to be with a herd
• I want food
• I want to get away from the bugs/sun/rain

I’ve never had a horse fail to adapt to 24/7 turnout. Several of the horses we’ve had have been show animals their entire life and came with the warning “they hated turnout”. They didn’t hate turnout. They hated their management.

The key is providing them with: herdmates, round the clock hay, and adequate shelter from bugs, sun, and inclement weather. Most people don’t do that, which is why they think their horses hate turnout – the answer is usually in providing a good turnout buddy, unfettered access to hay and/or grass, and a shelter.

For the average show horse, or jumper since you specifically mentioned it – these needs are rarely met. Show horses are rarely turned out with buddies. They’re rarely turned out with access to absolutely unfettered hay. Usually they’re given 1-3 flakes in AM and sometimes around lunch - this is not unfettered access to hay. Most show barns don’t have shelters attached to their turnouts, so horses can’t escape the bugs or heat.

I do not believe coastal roundbales were suggested anywhere on this thread. My roundbales are a timothy/orchard mix. No one in my region has coastal roundbales, so I assume your interpretation of the bales being “coastal” must be a regional bias.

[Tackpud]

@beowulf

A horse should never have an empty stomach, even if that’s optimal time for dosing. Empty stomachs are part of the reason ulcers develop in the first place.

I’m not with you that some horses really hate turnout.

Some horses really hate being out alone. (industry standard)
Some horses really don’t do well with being turned out in a dry lot with nothing to eat for hours (industry standard)
Some horses really hate being attacked by bugs or without shelter from sun/rain/snow.

If a horse is pacing the fence-line, it is telling you something - and it’s not usually related to wanting to get back to the stall. It’s usually related to:

• I want to be with a herd
• I want food
• I want to get away from the bugs/sun/rain

I’ve never had a horse fail to adapt to 24/7 turnout. Several of the horses we’ve had have been show animals their entire life and came with the warning “they hated turnout”. They didn’t hate turnout. They hated their management.

The key is providing them with: herdmates, round the clock hay, and adequate shelter from bugs, sun, and inclement weather. Most people don’t do that, which is why they think their horses hate turnout – the answer is usually in providing a good turnout buddy, unfettered access to hay and/or grass, and a shelter.

For the average show horse, or jumper since you specifically mentioned it – these needs are rarely met. Show horses are rarely turned out with buddies. They’re rarely turned out with access to absolutely unfettered hay. Usually they’re given 1-3 flakes in AM and sometimes around lunch - this is not unfettered access to hay. Most show barns don’t have shelters attached to their turnouts, so horses can’t escape the bugs or heat.

I do not believe coastal roundbales were suggested anywhere on this thread. My roundbales are a timothy/orchard mix. No one in my region has coastal roundbales, so I assume your interpretation of the bales being “coastal” must be a regional bias.

I’m all about turn out - 24/7 if possible. I’ve gotten a lot of show horses that people have said “they can’t be turned out” and they end up loving it. Changed their mental outlook on being worked and totally changed their happiness level.

But I had one horse who absolutely would not enjoy turn out no matter what I did. Large field, grass, friends, round bales - nope. Beat you back to the barn. Paddock with just a buddy (tried different one so he was high man and low man), grass, hay - nope. Dry lot with hay - nope. Tried for 5 years to get him to be happier outside than in the barn - nope. He just didn’t like being outside of his stall. I never gave up and we came to a compromise - a paddock behind the barn where I’d leave the door open to his stall and he would stay inside all the time with the option to go out if he wanted. Never went out - but it made me feel better that he had access to the paddock all the time. Only horse I’ve ever had that truly loved his stall and hated turn out.

[joiedevie99]

@beowulf

A horse should never have an empty stomach, even if that’s optimal time for dosing. Empty stomachs are part of the reason ulcers develop in the first place.

While I agree with the general principle, it really does make a difference for some difficult cases for the first few weeks of treatment. We tried to give enough hay so that it ran out at 5 am, Gastrogard is given at 6 am, and then breakfast hay is fed at 6:30am. The horse isn’t without food for much longer than he would be if he were tacked up, ridden, and cooled out.

[Equkelly]

@beowulf

I’m not with you that some horses really hate turnout.

Some horses really hate being out alone. (industry standard)
Some horses really don’t do well with being turned out in a dry lot with nothing to eat for hours (industry standard)
Some horses really hate being attacked by bugs or without shelter from sun/rain/snow.

If a horse is pacing the fence-line, it is telling you something - and it’s not usually related to wanting to get back to the stall. It’s usually related to:

• I want to be with a herd
• I want food
• I want to get away from the bugs/sun/rain

I’ve never had a horse fail to adapt to 24/7 turnout. Several of the horses we’ve had have been show animals their entire life and came with the warning “they hated turnout”. They didn’t hate turnout. They hated their management.

The .

This times a thousand! It drives me nuts when people assume that 24/7 turnout means just throwing your horse in some field where they’re meant to just fend for themselves. You can still provide quality care for your horse when they’re in a field, it can just be a little harder. My horse is on 24/7 turnout and she still has a shelter, she still gets grain and supplements, she still gets blanketed and unblanketed, she still gets fly sprayed, and she still has crystal clean water. I think people assume when you throw them out in the field that means you’re sacrificing things like that, when you don’t have to.

Horses don’t hate turnout, but some people just do because it’s more of a pain and it’s harder work. We think our horses must love sleeping in a cozy stall with lots of comfy shavings because that’s what WE would like, but they’re not like us.

[No1]

@beowulf

A horse should never have an empty stomach, even if that’s optimal time for dosing. Empty stomachs are part of the reason ulcers develop in the first place.

I’m not with you that some horses really hate turnout.

Some horses really hate being out alone. (industry standard)
Some horses really don’t do well with being turned out in a dry lot with nothing to eat for hours (industry standard)
Some horses really hate being attacked by bugs or without shelter from sun/rain/snow.

If a horse is pacing the fence-line, it is telling you something - and it’s not usually related to wanting to get back to the stall. It’s usually related to:

• I want to be with a herd
• I want food
• I want to get away from the bugs/sun/rain

I’ve never had a horse fail to adapt to 24/7 turnout. Several of the horses we’ve had have been show animals their entire life and came with the warning “they hated turnout”. They didn’t hate turnout. They hated their management.

The key is providing them with: herdmates, round the clock hay, and adequate shelter from bugs, sun, and inclement weather. Most people don’t do that, which is why they think their horses hate turnout – the answer is usually in providing a good turnout buddy, unfettered access to hay and/or grass, and a shelter.

For the average show horse, or jumper since you specifically mentioned it – these needs are rarely met. Show horses are rarely turned out with buddies. They’re rarely turned out with access to absolutely unfettered hay. Usually they’re given 1-3 flakes in AM and sometimes around lunch - this is not unfettered access to hay. Most show barns don’t have shelters attached to their turnouts, so horses can’t escape the bugs or heat.

I do not believe coastal roundbales were suggested anywhere on this thread. My roundbales are a timothy/orchard mix. No one in my region has coastal roundbales, so I assume your interpretation of the bales being “coastal” must be a regional bias.

If you have never had a horse did not want to be in turn out, with or without any combination of those things, count yourself lucky. I can assure you, they exist. I’ve had maybe 4 that wanted nothing to do with it, no matter what combination of friends/no friends/hay/grass/shelter/fly sheet you tried. And one that would only turn out in a very small run attached directly to his stall, which isn’t possible for everyone. All but one of those would jump out and bring themselves in if they weren’t brought in promptly. Which is less than ideal for a lot of reasons.

It’s true that the coastal round bale is regional. I believe the OP is in Florida, as am I. It is possible to get the random Orchard round bale here, but not common or regularly available. Coastal is notorious for causing ileal impactions.

I’m with you on the empty stomach. That said, you can time it so the meds are given when the horse likely has the least volume of feed in their stomach. Such as first thing in the morning rather than directly after their morning meal, which I see so many people do. Or at lates, or whenever.

[beowulf]

@No1@all

If you have never had a horse did not want to be in turn out, with or without any combination of those things, count yourself lucky. I can assure you, they exist…

To be fair, I don’t believe it’s fair to attest success in acclimating a horse to turnout as sheer luck.

It just takes the right management. I’ve had those horses that let themselves in by going through a gate or jumping (and usually pulling down) the fence. Yes, it’s a huge PITA, but don’t give up. They will be healthier and happier in the long run.

What you do, is put them right back out again (sometimes in a different location or with a different friend…). They learn when they bust gates and go through fencing, that they go back to their stall where the grain and food is. Most people just bring the horse in at that point, which reaffirms the behavior. Everyone who handles a horse, trains that horse… For better or worse.

Some tough love from me, but it’s old hearing horses don’t like turnout. They’re meant to be outside moving around, eating constantly, they’re meant to be in a herd. I feel genuinely sorry for horses who do not have turnout and turnout buddies. The older I get, the more cruel I think it is, and it’s no wonder so many working horses are unhappy.

[SporthorseFun]

The pyloric were ulcers were healing, and it sounds like the misoprostol and sulcrafate combination were successful there. However, you have indicated that the squamous are still a problem with healing and staying healed. It is noteworthy that the omeprazole injection site gets very swollen. Isn’t UlcerGard omeprazole in a paste form? That to me says a reaction to the medication, but I am not a vet or pharmacist. What happened with the allergy testing?

If the horse doesn’t appear to have pain anywhere else, and the horse is used to and comfortable with his herd arrangement, it seems like he is ingesting something that is really upsetting his system, or he may need more turnout than he is used to to keep him moving as he has been worked or is working at a pretty high level. Could he have some arthritic changes?