If gastroguard trial worked would insurance then still refuse to pay if no scope?

[seoirse]

My horse has suspected gastric ulcers. I really do not want to scope him, he's been through a tremendous amount of stress lately and I'm worried fasting him and travelling him and scoping him will be too much and give him colic again. The vet says petplan will not pay out if I don't scope him, though they are also willing to give me gastroguard for a week to carry out a trial to see if it does anything. Surely if he is vastly improved after a week of gastroguard then the insurance would have to pay? Especially if the vet agreed that it had worked and wanted to prescribe more?

My vet is going to ring petplan for me and try and get some clarity on this, but I was wondering if anyone else had experience of this?

Scoping really is a last resort at the moment as this horse gets so fretful if he is kept in without food so I'm really reluctant to fast him if I can avoid it as the colic risk is huge.

I'm currently treating him with egusin, which I only started him on yesterday, the vet seems to think it won't make any difference, so she wants to press ahead with scoping and GG, but I won't be going ahead with it til I have given the egusin a chance to work!

 

[wench]

You could try Tim Brazil... he does mobile scopings....

 

[Gingerwitch]

I would find the money to pay for the GG myself - you will know within 48 hours if its working or not - i know its expensive but then if you have to pay for box hire, starve the poor lad for 12 hours - risk the sedation etc - then sorry for me it is a no brainer.

I have had two horses treated with GG and neither were scoped - as agreed by my vets and the improvement is almost immedaite - it must be like having a soothing medicine - little lad took it quite happily and has never looked back

good luck

 

[cptrayes]

My understanding is that not all ulcers can be seen on a scope, those in the gut rather than the stomach. But that they are still cured by omeprazole. So why would the insurance company require a scoping? I'd ring Petplan YOURSELF, you have nothing to gain by having it done and your vet does. I can't see why Petplan would want to pay for a scoping as well if the trial shows that Gastrogard is working.

You can easily test this yourself, btw. Gastrogard is omeprazole. Omeprazole is now available over the counter in 10mg tablets for humans. Same drug entirely, just the generic version.

 

[seoirse]

Hiya, yeah I have spoken to him about it, he thinks it all points to EGUS as well, and he is actually going to be at our yard in Jan re-scoping another horse, so I could get him to do it. I'm really worried about the fasting though. My horse will colic if I don't feed him for that length of time.

 

[seoirse]

Thanks everyone - this is really helpful and exactly the reassurance I needed. I will ring petplan myself, as you point you, they will be paying for the scope, and they've already coughed up a fair bit on this already so would probably be happy to save on something. I don't understand why the vet is so insistent on the scope, but yes, I guess they will gain from it and my poor horse won't!

Thanks again. Really appreciate the advice.

 

[seoirse]

If you can buy omeprazole over the counter for humans and without a presecription for horses in the US why are we all being shafted here for the equine version?! I am sure this has been done to death on here but the more I read about all this the more baffled I am. Merial have everyone over a barrel don't they?

 

[lizness]

I think because gastroguard is so expensive! I have seen quite a few horses that have been thought to almost defiantly have ulcers who don't.
A horse I knew of has spent over £3000 just on gastroguard so in a way the insurance people have to protect themselves.
Also I suppise with scoping you can physically see if there has been an improvement, rather than being subjective.

After saying all this I fully understand and sympathise with your situation

 

[pedilia]

I have just fine through the whole GG and ulcers situation, unfortunately for my 2 year old it was one battle she couldn't win.

I do have some unopened syringes of GG though if you are interested in buying them.

 

[seoirse]

Thanks everyone. Really appreciate peoples thoughts on this.

Pedillia - I'll pm you. So sorry to hear about your horse.

 

[RachelFerd]

Personally I think it's lunacy to treat with gastrogard without scoping. More than possible to have a mobile scope done so you don't need to travel. I have been involved with starving horses in preparation for ops under general anaesthetic and they really do cope absolutely fine. It is the re-introduction of food afterwards that has to be done carefully.

Gastric ulcers are a very 'in' thing to diagnose right now, often with no proper evidence from scoping. It is absolutely no wonder that insurance companies are covering their backs so carefully on the issue.

 

[glenruby]

A tube of gastroguard contains 2.28gms of omeprazole so you you would needs tonnes if human omeprazole tabs at 10mg to treat a horse for 1 day.
Human omeprazole is available over the counter but that doesn't make it cheap to use.
Gastroguard in the states is most definitely a prescription drug.
Merial created a patent (at great cost no doubt) and for that reason have I believe 15 years before a competitor can bring out a rival version of the same. They must be over half way through this now. The price will become more competitive afterwards but I doubt it will be cheap!

 

[cptrayes]

Gastroguard in the states is most definitely a prescription drug.

But omeprazole, the same thing exactly, is not. It is freely available in many countries, from this site :

www.abler.com

Unfortunately it is illegal to import into this country, but I am aware that people do.

 

[cptrayes]

Personally I think it's lunacy to treat with gastrogard without scoping.

But there are ulcers further along the gut that do not show on a scoping. The drug is very safe and very low in side effects. In the US, for example, buying omeprazole from Abler is cheaper than scoping, so it's easier just to treat the horse than put it through the scoping and yourself through the trouble and expense.

 

[glenruby]

Incorrect - the dose rate for a horse is 4mg/kg.
As for the "in the US" argument - we are not, therefore it is irrelevant. Many carcinogenic and other potentially dangerous drugs are legal in the States - it does not mean they are safe for any Tom Dick or Harry to get their hands on. The US is particularly lax on drugs laws compared to Europe/australia

 

[cptrayes]

Many carcinogenic and other potentially dangerous drugs are legal in the States - it does not mean they are safe for any Tom Dick or Harry to get their hands on. The US is particularly lax on drugs laws compared to Europe/australia

Omeprazole has been released in this country as an any Tom Dick or Harry medicine for humans and it has been used for years in horses with exactly the same benefits and low side effects.

Please let's not pretend that this ban on using anything but Gastrogard in horses is anything but a device to give a flipping enormous markup to Meriel for another couple of years .

 

[glenruby]

POM restrictions are put in place for good reason. The patent however is another story.

 

[Goldenstar]

Glenruby I have bought gastroguard over the counter in tack shops in the US they have it on open display.

 

[glenruby]

Golden star - the merial usa website states must be prescribed by a veterinarian. I have worked in the USA and been incolved in client gastroscoping workshops with Merial there and can assure you it is FDA restricted and the equivalent of POM- V.

 

[Goldenstar]

Never the less I bought over the counter it was displayed openly I just picked up the tubes and handed over the cash.

 

[glenruby]

That doesn't mean it's legal or right or widely available by that means but regardless of all that, it is not possible in the uk so not relevant.

 

[Goldenstar]

I worry a bit about the long term use of gastroguard I asked my vet this and did not get a satisfactory answer and then we got side tracked .
Surely the horses stomach is very acid for a reason so what potential issues are there of long term use of these drugs .
but for sure its much too expensive most veterinary drugs are my brother a doctor asked me how much I was paying for some dog pills turned out they where same as a given to humans I can remember exactly but I was being charged an obscene amount for pills that cost buttons for humans .

 

[glenruby]

Ah but Goldenstar, procedures carried out in veterinary are a minute fraction of the cost they are in humans. The major downside to the NHS is that people do not value the medical care they receive. In many other countries you pay to even see a GP. In Irelabd the average is £40-£50! That would make you think twice about going! The cost of being involved in say an RTA and breaking a leg can cost over 1000 euro!
Also small animal veterinary is far far more expensive than the equine equivalent. Referral fees for small animal can be very high indeed but equine rarely reach 5k.

 

[seoirse]

But there are ulcers further along the gut that do not show on a scoping. The drug is very safe and very low in side effects. In the US, for example, buying omeprazole from Abler is cheaper than scoping, so it's easier just to treat the horse than put it through the scoping and yourself through the trouble and expense.

Agree re above, there is no way of seeing if there are ulcers further along, though I was led to believe omeprazole doesn't treat hind gut ulcers? My vet doesn't seem to know either way and isn't being vastly helpful so I'm struggling really to get the information I need to make informed decisions!

Thread has been helpful though as lots of good points raised. Thanks everyone.

 

[cptrayes]

Agree re above, there is no way of seeing if there are ulcers further along, though I was led to believe omeprazole doesn't treat hind gut ulcers?

D

I have seen other posters on HHO refer to omperazole being used for hing gut ulcer treatment. I guess it doesn't mean that it necessarily works!

 

[seoirse]

I have seen other posters on HHO refer to omperazole being used for hing gut ulcer treatment. I guess it doesn't mean that it necessarily works!

Hmmm, yes, its confusing me a bit. My vet seems to be unwilling to treat anything she can't see, and since it's impossible to see hind gut ulcers how am I supposed to get them diagnosed? Even if we scope and nothing shows in the stomach, he is still showing all the signs of ulcers in there somewhere so what do we do then? It's all doing my head in a bit!

 

[Ruth_Cymru]

I have been in exactly the same situation as you this past month. My horse started dropping weight and showing colicy signs while eating his bucket feeds, which ranged from stopping eating and looking uncomfortable, to kicking out with a hind leg while eating, and wanting to go down and roll imediately after eating. I didn't have my horse scoped as I didn't want to add the stress of travelling- he's had a few trips to the vets recently, and I didn't want to stress him out any more. I also discussed with my vet what other possible causes there could be for his behaviour, she said in his case with the signs he was showing that there was nothing other than ulcers.

I decided to start the gastroguard the day the vet came, and deal with the prospect of the insurance not paying if it came to it. My horse has not shown any of the symptoms he presented from the first dose of GG that I gave him. He has completed the months full dose and is now on a quarter dose, and touch wood, he's doing fine.

Happily, I got confirmation through a few weeks ago that my insurance would be paying for his treatment. I would have had him scoped had they requested it, but with the symptoms he was showing and, in my opinion because my vet is soley an equine vet this was sufficient for the insurers.

 

[WebLeC]

We have never had any problems with insurance companies paying for gastroguard without scoping if used reasonably as a valid diagnostic test - which response to medication is in a case like this.
Horses cope with travel, scoping, box rest etc far more than people give them credit for - most of the time the problem is with the owner - not the animal!
Scoping will confirm the diagnosis, give you a baseline to see how bad things are and how long treatment should last, and may give clues about other treatments that may be required. Vets dont just do it for the fun of it - it is a tricky examination to do correctly and the equipment costs a small fortune and is easily broken.

 

[GreedyGuts]

Agree with the above; a Gastroguard trial is a reasonble approach if your vet agrees that the symptoms are consistent with EGUS. I have had owners successfully claim for this. However, gastroscoping is a good diagnostic test, which should give a fairly definitive answer.

Ulcers of the colon will not respond to Gastroguard, only those of the stomach and first part of the small intestine, so anything that can be treated with omeprazole should be visible on gastroscopy.