After spending several days reading COTH stories about drug resistant ulcers, people scoping 5+ times, and months on months of treatment, I need some silver lining.
Who had a successful treatment journey? What were the right components for your horse?
I’m 36 hours into diagnosis, building a treatment plan, navigating a very picky sensitive palette that also is nervy about oral syringes, etc.
I need some happy stories to keep me patient while we give her body time to start the healing process.
I was one of those people last year!! Didn’t ride for probably 5-6 months. Squamous, glandular/pyloric and months of omeprazole (injections), misoprostol and sucralfate. 4 scopes, some would heal and new ones would start.
Once a vet finally suggested PSSM2 and we started addressing that she was a different horse within a week- no more ulcer meds, didn’t even scope again bc she never had another symptom! I rode all summer and she was great. After a surgery in the fall to remove an OCD chip the pssm got out of control again and resulted in more ulcer symptoms ….but now I know what’s causing the ulcers and that to actually get them to heal I need to get the pssm symptoms under control and then they seem to heal on their own.
Most horses do fine with a straightforward treatment of a PPI. It’s so normalized that people don’t really talk about it. We hear about the persistent, stubborn cases that are head scratchers or frustrating instead.
My picky picky picky princess horse loves the taste of gastrogard. She’ll outright refuse to swallow other oral meds.
But if you want something you can top dress, abler granules (“blue pop rocks”) have a faithful following, or you could give Nexium a whack. Lots of us have had success with that.
I just finished up gastrogard with one horse who was very severely ill and on a bucket of other meds. No problem there.
A few months before I treated everyone with Nexium after a move. Also no problems there.
Truly, it’s more often than not that you treat, ulcers are resolved, and you move on. Identifying the cause is important to prevent reoccurrence.
I agree that treatment has become so normalized over the past 10-20 years that most of the time all you hear anymore are the horror stories.
Most ulcer meds are pretty palatable. Gastrogard/Ulcergard has never been an issue for my picky horses. Abler’s granules “pop rocks” have never been an issue. Nexium has never been an issue. The only palatability problems I had were with some of the OTC foreign, unregulated omeprazole pastes. But I generally don’t use those unless I’m dealing with long term issues and my funds are tapped out.
We also know now about the importance of tapering PPIs. Once upon a time we’d treat for 4 weeks then stop the meds cold turkey, now we know to gradually step down.
Hi, so what do you do to take pssm symptoms under control? Thank you
One of those old threads is probably mine. I will say that I’ve treated three others since, and had them fully heal on a 28 day course of gastrogard. Most aren’t the behemoth that my little guy was 
Did you find the omeprazole injections worth the money vs Gastrogard?
I never had any success for 3 years healing ulcers - did months and months of full tubes of gastroguard, weaned off and ulcers would come back.
Finally broke the cycle by using gastroguard, getting a clean scope, then keeping him on misoprostol, and finding out where he hurt. It took awhile to locate tight muscles in his back, but myofascial release and surefoot pads have been a godsend. We are now back in full work and he feels better than he has in years and years.
Oh that opens up a whole can of worms!
It can only be managed with diet, exercise, 24/7 turnout and heavily blanketing to keep them warm. She was already on free choice hay/ timothy and alfalfa pellets with some supplements but I raised her to 10,000 ius of Vitamin E and added acetyl-l-carnitine or “ALCAR” and she was back to normal in a week. This is a typical response when the ALCAR helps, I was told it would be within a few days to a week. She got worse in the fall and and then subsequently had ulcer symptoms again, I’ve since added whey protein and am getting her back to work and seems much better.
Yes! For me it made more since than having the barn staff have to give it prior to breakfast in the morning and since they now recommend giving gastroguard on an empty stomach. Once a week shot, and I had read that it can be more effective for some (that may have been for glandular- but in that case I think the misoprostol was more effective anyway!) and I think they were actually a little cheaper! (Like 800-900 vs 1200)
I somehow missed this thread and just posted on the Nexium thread. After a year of ulcer hell with my young TB… multiple scopes, 3 months of GG, 4 months of Misoprostol and Sucralfate… I think we’re finally on the right track.
An unexpected barn switch may have been a blessing in disguise for us. Transitioning to a different facility seems to have made all the difference. He’s still on a maintenance dose of Abler, but we’re seeing progress that we didn’t even when he was on that whole cocktail of meds, turned out 24/7 with friends and out of work for most of last spring/summer (aka the best management we could offer at our previous facility). We’re hopeful that we might be able to wean him off completely over the next couple of months. He’s back in full work and getting better and better week by week
My horse had chronic ulcers—both glandular and non-glandular (pyloric). Four months of the bug guns: GG, sucralfate, and misoprostol all at once weren’t clearing them up. Turns out, he has inflammatory bowel disease—this causes delayed gastric emptying, so the food sits there and the acid splashes the parts it shouldn’t. Treating the IBD (plus diet and management changes) is what will stop the ulcers from recurring. It’s been a process…
My nervous nellie of a gelding came to me with bad ulcers. I tried treating with the abler pop rocks first and while I did see some relief while he was on it, He was on it for 90 days without the ulcers actually clearing up. I tried sucralfate (again abler) as well and again–relief while he was on it, but no healing. Though I was not really able to do the sucralfate on an empty stomach as is considered best practice since he had access to forage at all times. Finally tried the nexium and he healed within 45 days on 3 pills per day (might have been sooner, but that’s when I checked). My take is that the abler products might not as potent or effective as they claim to be.
After his ulcers healed I had to do another round of nexium about a year later for 30 days. Since then I’ve also learned that he doesn’t do great with grain (including pelleted ration balancers), so he’s on a forage only diet with vermont blend + vit e (I use wet alfalfa pellets as vehicle for his supplements. I also go ahead and give a preventative dose of nexium when we go to shows or if anything else unusually stressful is going to take place. With this protocol we haven’t had another flare up.
One was definitely yours. You had quite an experience.
What symptoms lead to the suggestion and what testing did you end up doing?
I love your before and after. His before does not look awful but the after definitely shows you the difference between okay and really blossoming. Was he on 24/7 turnout at the prior barn as well?
Was that discovered by scope or through other diagnostics? We are dealing with glandular and pyloric so delayed gastric emptying was high on my list but at least for now my vet was pretty unconcerned about that possibility.
He was on 24/7 turnout at the prior barn - he is not at the new barn. Winter weather and lack of shelters in turnout here mean that he’s out during the day and stalled at night at the new barn.
He was out 24/7 with friends at the old barn May-September 2021 while being treated with GG, misoprostol and Sucralfate. He was on no grain and only in very light work at that time. He was clearly improving compared to where he started, but he wasn’t blooming like he is now.
He’s on 3lbs of Purina Ultium a day, still free choice forage, daytime turnout, and far less medication now. He’s filling out, eating well, happy to work 4-5 days per week w/t/c and starting over low fences.
You’d think the “24/7 turnout on excellent pasture/no grain/all the ulcer meds/very little work” would’ve made the biggest difference, but he didn’t seem to turn the corner until after we moved barns in December. Vet, bodyworker, and saddle fitter are all both thrilled with his progress and also just as perplexed as I am.
I really wonder if something about the environment at the old barn was bothering him.
@grace, the IBD was dx by scope and small intestine biopsy, plus ultrasound of the small intestine showed thickening.
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