Ulcers in foal

[EventerLS]

Hi COTHers,

Sorry in advance for the long post, I’m trying to include all details in case they are relevant- I’ve had a very frustrating first 3 months with my new filly and I’m looking for potential advice or pointers toward experts I might want to contact or even a little bit of optimism.
My filly was born somewhat prematurely with no signs of labor from the dam (not her maiden foal, had a healthy colt last year perfectly on time with very obvious signs of labor for 2 days before giving birth) so she foaled out unattended in a field. The filly failed to stand and nurse and after a couple hours of consultation with vets we got her into the hospital. She was dehydrated and colicky when she got in and stayed for 6 days on the full works- oxygen, fluids, feeding tube, antibiotics, etc. Vets treated very aggressively and were amazed how quickly she improved in the first 24 hours. They released her on the 6th or 7th day with a catheter to a rehab farm with a very positive prognosis.
3 weeks later she was taken back to the hospital colicking fairly aggressively. Colic resolved quickly but vets ran full battery of tests- abdominal ultrasound, xrays, gastroscope, barium study- which revealed she had a large stomach, small pylorus, and esophageal ulcers. Long story short we have had her on every ulcer med- omeprazole, alamag, ranitidine, sucralfate, bethanechol, probiotics- and she periodically continues to colic every 1-3 weeks. Vets redid barium study 3 weeks after the first and were very pleased with the improvement in the pylorus and stomach size. Performed another endoscopy at the same time which revealed healing ulcers. When she colicked and was taken in about 3 weeks ago the xrays showed sand in her stomach so they started giving her psyllium and she now has restricted turnout in a muzzle). However, she colicked early this week (hard to keep track without looking up all the records but I believe this is the 5th time, she is 3 months old today) and gastroscopy shows her ulcers are worsening even on all her ulcer meds. They increased the dosages since she has gained weight.
Every time she goes to the hospital she recovers from her colic episodes fairly quickly with minimal medical intervention (sometimes they oil her but that’s about it with the exception of adjusting dosages of the ulcer meds) so they are hesitant to risk exploratory surgery. They’ve told me that’s an option if she gets worse but she does so well between episodes that they aren’t encouraging that route yet.
I have absolutely the utmost faith in my vets, and I know they are doing their absolute best, I’m really just throwing my story out there to see if anyone has any experience with an unusual situation that has them a bit stumped or any ideas for therapies they might not have considered. I want to point out that she is growing and behaving completely normally, her coat is shiny and she seems very healthy except when she colics; this is not a case of a foal thats overall a poor-doer. The vets have assured me that this is the main reason they’re not pushing to do surgery as normally if there are more significant intestinal issues the foals don’t thrive like she is.
The only part of her management that I don’t think is ideal for the ulcers is having her muzzled during turnout but she had the ulcers prior to that and I don’t think we can avoid that with the risk of sand colic (there aren’t many options for sand-free turnout in the area).

Not overly hopeful for a ton of ideas that haven’t been tried yet but any thoughts would be appreciated. We’ve obviously invested a lot of money and emotion into this girl and I’d like to give her the best chance I can.

TIA!

[Rooty]

Oh my. I had a foal with duodenal ulcers which she developed as a result of the stress from needing antibiotic injections for the first few weeks of her life to save her from an umbilical cord infection, but happily we were able to manage her with cimetidine. A side note is that as an adult she has to go on omeprazole if she needs NSAIDs but other than that she is ulcer-free.
I don’t have anything to offer you except my sympathy and heartfelt wishes that you are able to get your little girl fixed up.

[JB]

Have you tried Equisure?

Is she still nursing? Do you purposefully feed her something of her own, and does she get into whatever mom eats (which is what)?

Is there ANY way you can find a barn with grass turnout, even if it’s out of state, at least for a few months?

[EventerLS]

JB,

I have not tried Equisure yet- I use it on my competition horse and have noticed a change, so maybe I will try that for her next.

She is nursing and creep feeding from mom’s bucket, she gets a beautiful orchard grass hay with a little alfalfa but not a ton. The mare gets SafeChoice Mare & Foal- I know there are more ideal grains for ulcer-prone horses but the mare was diagnosed potentially PSSM (about 10 years ago…) and we switched her onto the SafeChoice and never had another problem so I’ve just been hesitant to change and honestly don’t know what’s ideal to switch to. I know the Buckeye EQ8 is good for ulcers, is that the best and would it be ideal for a foal/weanling? I have tons of experience with competition horses but very limited with foals so I never know if my instincts are correct in this case.

I do have the option of sending her to my parents’ farm… They have other horses and beautiful big grassy fields where she wouldn’t have problems with sand. My concern, and the reason I’ve kept her here, is that she would not be watched round the clock and the closest hospital would be about 45 minutes away, as opposed to here where she’s checked on several times through the night and the hospital is 10 minutes away. I’ve been very tempted to try her there but I am just so concerned if it didn’t help and she had a problem that it wouldn’t be noticed quickly enough.

Thanks so much for the suggestions, at the very least I will definitely look into the Equisure and grain changes and if the problem persists then maybe risk trying her on full grassy turnout with less supervision.

[JB]

M&F is relatively high in NSC (22%) so not something I would let this foal have. At her age she really can’t digest many of those ingredients anyway. I would make it so she can’t get any of that, and if she needs some help, use a milk-based pellet, either Progressive Foal’s First, or I think Seminole and/or Buckeye have a similar one.

Once she’s 4 months, you can transition her to a ration balancer.

I might also consider putting the dam on Ultium Growth, which is 18% NSC, and higher fat than the M&F, at 9.5% vs 7%.

[EventerLS]

Thank you so much! Will look into milk-based pellets. Are there better or worse ration balancers for ulcer-prone horses? I haven’t used them much in the past.

I’m happy to switch the mare to another feed, but actually wouldn’t look higher fat. I don’t believe she has lost a pound since giving birth, and is actually an absolute WHALE right now… looks like she’s ready to give birth again on only a couple pounds of grain a day.

[JB]

Most RBs are grain-free, and low NSC, so not counterproductive for ulcers. TC 30 is a good one and one I’d chose over Nutrena or Purina given the choice. Progressive is excellent. But it’s really about what you can easily get.

If she’s only getting a couple pounds of the M&F, then I’d switch her to a RB as well. Fewer calories and definitely lower NSC. She’d get 2-3lb of most any of them.

[DressageChic2]

have the vets cultured the ulcers to check for a bacterial element?

i have a 5yo stallion with grade 4 bleeding pyloric ulcers that WILL NOT heal (despite being on GG, sucralfate, and doxy)

vets think they have been there since a foal and he is now on steroids to try and reduce inflammation and thus hopefully the doxy can then do its stuff.

could there be any parasite issue (sorry i dont know much about foals, never had one that young) as my vet is pretty sure my boys issues stems from a heavy parasite burden at a young age.

[JB]

Foals should be dewormed about monthly starting at about 8 weeks. That’s just how long it takes for parasites to mature to a stage that can be killed.

[EventerLS]

I will talk to my vets and see if that’s a possibility! Certainly would like to take that step before possible exploratory surgery.
Im not sure if parasites are a possibility but they definitely would not be the original cause, which I’m sure was either ingesting dirt & sand in the hours after she was born or the stress of being in the vet hospital on antibiotics for the first week of her life (or a combination). Between her rehab facility which is run by a man with years of TB breeding experience and all her time at the vets she has followed all guidelines to a T.
Mare and filly have both been taken off grain starting today, mare will be put on the Seminole RB. I’m sure filly will sneak a bit of that, unfortunately Seminole was the only place open on Sunday and they were out of the milk-based pellet so I will have to see if I can find any somewhere else this week.

[JB]

It will be ok if the filly sneaks some of the Equalizer If the store will get their foal pellet in this week, it’s fine to wait until they do.

Has the filly been dewormed at all yet?

Another thought I don’t think I saw mentioned is BioSponge.

[EventerLS]

Filly got dewormed at 8 weeks, not sure if she’s had her 12 week dewormer yet but she’s just at 12 weeks now so shouldn’t affect much if she hasn’t had it quite yet.
I know she’s gotten BioSponge at the hospital when she had diarrhea the first time or 2 she was in, is that something that would help her long term? I’ve only really heard of it used temporarily for diarrhea.
Thank you so much for all your suggestions, JB, at the very least I’ve got some ideas to try rather than going stir crazy just sitting waiting for her to colic again!

[JB]

I have known some horses who were on BS relatively long term (like a few months) to finally help with issues. IIRC one was a young pony who developed right dorsal colitis, and would likely not have survived without it.

What did she have as a dewormer? The rotation should be something like this, to account for resistance issues:

• Double fenbendazole (Safeguard, Panacur) OR double pyrantel pamoate (Strongid) to ensure killing ascarids, which have a growing resistance to ivermectin
• then single ivermectin, to ensure killing strongyles which have really high resistance to the above.

Rotating each month will keep strongyles at bay for the 8 weeks the ivermectin is effective for, and the interim double X will help make sure ascarids are kept in check in case the ivermectin isn’t doing it.

The double pp has the added benefit of killing tapeworms, so is useful to do in the Fall for that particular rotation.

[DressageChic2]

good luck, i really hope you get her healed…its heartbreaking to see my guy decline despite all the meds he is in for a scope wed and i am praying to the horse gods that the steroids are working.

everything crossed for your little one

[EventerLS]

Hi guys-

Wanted to give a quick update. I chatted with my vet about the possibility of a bacterial component to the ulcers and she thought that that was a very unlikely scenario as she has been through a full course of minocycline since the original ulcers which should have taken care of any bacteria.
She was admitted to the hospital AGAIN Wednesday with colic symptoms. She was oiled at the farm prior to transportation and at the when she arrived at the hospital had already passed manure and oil but still refluxed when they tubed her which alleviated all her discomfort.
Based on all her ongoing issues we’ve decided the best course of action is to do elective exploratory surgery next week since they are guessing the colic is due to adhesions/scarring from her ulcers and former issues. Surgery always make me nervous but I am optimistic that I finally feel like we are being proactive and hopefully can find a fixable issue.
Could definitely use some jingles for a successful surgery and recovery

[JB]

Sometimes you need metronidazole to address any infection in the hind gut.