Ulcers!!

[sjp1]

So really long story - but potted version!!

Got my new lad end of December. He couldn't be touched or groomed without being uncomfortable or biting. Could take ten minutes plus to get a bridle on, dipped his back having a saddle put on. Wouldn't pick any legs up - he had shoes on three feet which had been there a long time because farrier had walloped him and then he just booted out with back feet and moved around for front feet - this was for picking out. I had to have him sedated to have shoes removed - he fights sedation - hates injections, so this wasn't totally easy either - except that vet is very experienced equine vet and not afraid so sorted it and farrier was brilliant taking his life in his hands!! Actually horse had a lot of body pain - had osteo out loads and he is now fine for being groomed and touched. Sorted head shyness which had spilled into bridling issues with an american called Mike Hughes online - took some time, but well worth it! He has a saddle that fits. He now picks all his feet up fine, I have kept him barefoot because he has strong feet and the thought of sedating for every shoeing was a nightmare!! I can trim him myself, but have mostly left him to self trim.

He rushed around everywhere at a hundred miles an hour when he arrived and then in spite of a saddle that fits - the saddle he came with was ridiculously narrow - no wonder he dipped away from it - he started doing bunching up when girthed with a cat like back. He was OK ish, when walked around for a few minutes, but the saddling issue has not resolved. He subsequently got really slow hacking out and not happy going forward - which I put down to boredom because we were only doing short circuits because he was really unfit And then I got on him in the school and then he was back up and really tense. So different scenario - took feet out of stirrups (in case I had to do a hasty dismount) and did a lot of circles and poles and gradually his stress levels subsided.

But he isn't the type to be stressy and he is bright enough that it isn't remembered pain - every other pain scenario which has been taken away has gone immediately.

So I thought ulcers ......... spoke to my vet and said I wasn't keen on having him scoped because he isn't keen on vets (as vet can testify!), and he suggested no scoping but a trial of gastroguard - having seen my lad and his stressiness over vets etc., he agrees ulcers are a possible cause of this behaviour. So two weeks in on omeprazole he can now be rugged without doing this bunched up thing he does with saddling which he also did with rugs. In his old home when you put a rug on him he would almost wear the wall - osteo has sorted many pain issues so he doesn't shrink to the wall now, but we have never got over the bunching up over rugging until the gastroguard. I haven't actually saddled or girthed him in the last fortnight because a) it didn't seem right to ride him and b) I have had some sort of cold which has caused me to feel really sick and not want to do a lot so I completely empathise with him!

I have just bought some sulcrafate. He isn't insured so the omeprazole is going to cost me bundles anyway! Buying sulcrafate through the vets would be another sharp intake of breath!!

So which do you give first? Have been online a lot searching and the Abler people suggest sulcrafate first, and an hour after omeprazole but vet papers suggest the omeprazole first and sulcrafate an hour after!

Am going to saddle him tomorrow and see what difference there is ............ am hoping there is a big difference for him.

Ongoing - what ulcer supplements have you found work? Am so far thinking Equine Science or Ron Fields or Egusin SLH.

 

[dixie]

Blimey that’s a lot of issues - poor boy.
I have gone with Ron Fields and where the injections didn’t work with a bit of experimentation Ron Fields has. I have spoken to him though and he’s given great advice.
My horse had scoped clear but still extremely girthy but he’s 90% improved on Ron Fields.
Ive not tried the other products other than the vets and Immubiome which didn’t improve him at all.

 

[Bellaboo18]

Yes I'd feed the sulfracate first and then an hour after feed the omeprazole. Basically the important thing to do is feed the omeprazole on an empty stomach.
As far as ongoing supplements go, I really rate protexin acid ease, it reduces acid but also supports the hind gut.
Keep us updated

 

[fabbydo]

One of mine was on Succeed and it made a huge difference.
Lucky horse to have found someone who is listening to him. He's definitely trying to tell you something!

 

[Pearlsasinger]

I didn't go for a diagnosis and my mare's symptoms weren't anywhere near as severe as your horse's but she showed symptoms of ulcers and after I'd sorted her tack out so that she was happier to be tacked up, I saw someone on here recommending Aloe Vera juice to help with ulcer-type symptoms and got her some from Holland & Barrett. It worked very well and if I let it run out, her symptoms started up again - she got very grumpy.

 

[Muddywellies]

Firstly I would scope - you need a definite diagnosis before spending ££££££ on this.
On an empty stomach in the morning, sucralfate first. Then no food whatsoever, then half hour later, omeprazole. Then feed half hour after that. There are no supplements to treat ulcers - omeprazole is the only treatment. Do liaise with your vet about the ongoing management of ulcers as there are many lifestyle and management changes you’ll have to make. Stress is a huge contributing factor even if he doesn’t seem stressy so do take steps to reduce stress.
My mare was diagnosed 2 years ago now and we’ve spent thousands on her treatment (even after the insurance claim ran out) - it’s an expensive, time consuming and sometimes downright frustrating condition.

 

[Bellaboo18]

Firstly I would scope - you need a definite diagnosis before spending ££££££ on this.
On an empty stomach in the morning, sucralfate first. Then no food whatsoever, then half hour later, omeprazole. Then feed half hour after that. There are no supplements to treat ulcers - omeprazole is the only treatment. Do liaise with your vet about the ongoing management of ulcers as there are many lifestyle and management changes you’ll have to make. Stress is a huge contributing factor even if he doesn’t seem stressy so do take steps to reduce stress.
My mare was diagnosed 2 years ago now and we’ve spent thousands on her treatment (even after the insurance claim ran out) - it’s an expensive, time consuming and sometimes downright frustrating condition.

Agree with all of this apart from in your position I wouldn't scope either.

 

[BBP]

I fed omeprazole and sucralfate together in the same feed with no empty stomach (I don’t want an ulcer prone horse to go without food). It worked perfectly well, cleared up his ulcers nicely and my vets (leading equine hospital) told me to do it that way.

 

[sjp1]

Blimey that’s a lot of issues - poor boy.
I have gone with Ron Fields and where the injections didn’t work with a bit of experimentation Ron Fields has. I have spoken to him though and he’s given great advice.
My horse had scoped clear but still extremely girthy but he’s 90% improved on Ron Fields.
Ive not tried the other products other than the vets and Immubiome which didn’t improve him at all.

Thats really interesting - I saddled him for the first time today after 14 days on GG - the saddle going on is not the issue its the girth going on which is the bunching up issue and this is just as bad. He is better being rugged though - doesn't bunch up for that anymore. He also shot off when I got on him today, but soon calmed down. I have the next 14 days of eye wateringly expensive GG and some sulcrafate which I bought from someone who didn't need it. I am not going to any more GG after this next two weeks is up and I am leaning toward Ron Fields - thanks for heads up that the Biome didn't work - thats also really expensive!!

 

[sjp1]

I fed omeprazole and sucralfate together in the same feed with no empty stomach (I don’t want an ulcer prone horse to go without food). It worked perfectly well, cleared up his ulcers nicely and my vets (leading equine hospital) told me to do it that way.

Thats where it gets so confusing - they say that sucralfate stops the uptake of any other drug - was yours scoped?

 

[sjp1]

Agree with all of this apart from in your position I wouldn't scope either.

So thats what I did today - sucralfate first thing, then his feed with supplements, then gastroguard this afternoon and an hour after another dose of sulcrafate. Washed his legs after the gastro guard and started to do scissor destensitising for his feathers. He hates scissors anywhere near him, however, he needs to get over this like he got over his bridling issue and often is the only way forward I think. It didn't pull his hair and it doesn't hurt, but he clearly has had pain with his legs previously. I have got shot of all the scabby bits behind his knees now with Cetraban (no picking scabs off) and washed legs with a neutral shampoo - Camrosa. Fine about washing legs now, fine about cetraban, but scissors are clearly the devils work!! He is super sensitive!

 

[sjp1]

I didn't go for a diagnosis and my mare's symptoms weren't anywhere near as severe as your horse's but she showed symptoms of ulcers and after I'd sorted her tack out so that she was happier to be tacked up, I saw someone on here recommending Aloe Vera juice to help with ulcer-type symptoms and got her some from Holland & Barrett. It worked very well and if I let it run out, her symptoms started up again - she got very grumpy.

Thats really interesting, and I am happy to try anything - another thing on our bucket list

 

[sjp1]

One of mine was on Succeed and it made a huge difference.
Lucky horse to have found someone who is listening to him. He's definitely trying to tell you something!

He has an awful lot to say now someone is listening!! But he does soon stop saying when you get it which makes me think I haven't got it yet. But as fellow livery mentioned today, with head shyness issues I worked on them constantly for a fortnight and more and thats all I did. With feet I just kept insisting once his shoes were off that he had to pick every foot up every day - front feet were easier than backs because you can't be kicked! But now all feet are fine - because we do it every day. I think there is potentially a hind gut issue which we are trying to fix and I think I am going to saddle and girth him every day whether we ride or we don't and see if that helps. Today I tried to cut some of his huge feathers off. They were sharp scissors, it doesn't hurt and it doesn't pull but somewhere along the line someone has hurt him and he is protective. But as we had to wait an hour between Gastroguard and Sulcrafate, we had to do something, and so decided this was something to do. Meltdown a lot less than previously, but still not happy, but he will get there I am sure. Shall look into Succeed

 

[sjp1]

Yes I'd feed the sulfracate first and then an hour after feed the omeprazole. Basically the important thing to do is feed the omeprazole on an empty stomach.
As far as ongoing supplements go, I really rate protexin acid ease, it reduces acid but also supports the hind gut.
Keep us updated

Great - thats what I have done - but fed the omeprazole later in the afternoon because he is fed up of eating hay by then and today did washing of legs etc, and an hour later fed the additional sulcrafate dose. Very time intensive, but determined to get it right for him!

 

[Muddywellies]

Great - thats what I have done - but fed the omeprazole later in the afternoon because he is fed up of eating hay by then and today did washing of legs etc, and an hour later fed the additional sulcrafate dose. Very time intensive, but determined to get it right for him!

The omeprazole needs to be administered first thing in the morning - not sure of the science behind it (vet did explain but it was a while ago) but I’m sure it is something to do with enzymes in the stomach in the morning making the medication far more effective.
So, before feeding in the morning , sucralfate, wait half an hour, omeprazole, wait half an hour, feed. In the evening feed sucralfate half hour before feed.
However, rather than take advice from an online forum on such a tricky medical condition you really need to work closely with your vet. Mine explained pretty much everything over a 12 month treatment period, advised me on feed, management etc etc. My vet is a gastrointestinal specialist and totally held my hand throughout.

 

[ycbm]

There are no supplements to treat ulcers - omeprazole is the only treatment. .

Omeprazole is not the only treatment. Ranitidine also works, and in some cases works where omeprazole fails. It's also reputed to deal better with hind but ulcers.

Vets can prescribe ranitidine, but unlike omeprazole it is also available legally without prescription in bulk from online suppliers.

Personally I wouldn't starve and scope a horse except as a last resort. I would test with ranitidine and see if it has any effect. In my experience, it usually shows results within 48 hours, then you know you need a full course of treatment and can choose which. Ranitidine needs to be given at least twice a day, recommended four times. and the dose rate is high. Legal omeprazole is very expensive, but once a day, or even less for injection.

.

 

[BBP]

Thats where it gets so confusing - they say that sucralfate stops the uptake of any other drug - was yours scoped?

I’ve read lots of studies, some say sucralfate before omeprazole, some say the other way around. This is the way my dumb science brain works it out...Sucralfate acts locally, it reacts with hydrochloric acid in the stomach to create a sticky substrate that binds to the exudate found at ulcers sites, creating a protective layer over the active layer. Omeprazole has an enteric coating to assist it surviving transit through the stomach so that much of the active ingredient makes it to the intestines for absorption. Full absorption takes 6-8 hours (apparently). Ive seen figures that state a 16% reduction in omeprazole absorption of taken with sucralfate. What difference does 30mins make? Any residue of one drug will still be present at the point of feeding the other surely given the speed of gastric emptying. And to feed either drug on an ‘empty’ stomach the horse will have had to have gone without food for many hours, which is obviously contraindicated for horses.

For me, I don’t have two hours in the morning to feed my horse, and I refuse to leave him without food at a time when all the others are being fed. I’d only heard these rules on here, not from my vet, so I fed it all together. Horse was scoped prior to treatment and again 3 months later. He had low grade ulcers in the glandular/pyloric region on the first scope that clearly caused him a lot of pain as he was very anxious and reluctant to trot or canter. 3 months after starting treatment the ulcers had cleared. So all I know is it worked for mine. If the ulcers are more severe or squamous then perhaps my way wouldn’t have worked. Hopefully your vet can explain it all fully.

 

[fabbydo]

If he seems over sensitive to his feathers being trimmed, it would definitely be worth looking for evidence of mites and damage to his skin. It can be very painful for them.

 

[sjp1]

Thank you all!! fabbydo - he did have a load of scabby lesions behind his knees when I got him. I was not at all allowed to even touch his legs when I first had him as previous owner had used pig oil and sulphur and I suspect it nipped him as sulphur isn't always kind. I have used cetraban lotion and we are pretty much clear now of all scabs so I am allowed to touch all over his legs now and wash them and groom them - with a lot of desensitising. However, clearly he has been forced to accept scissors somewhere along the line and he is the same with scissors anywhere - mane etc. It doesn't hurt and it doesn't pull but he is convinced it does so we are just doing a lot of touching and some scissor work where we can. He is a sensitive soul! BBP - I have started doing sucralfate now first thing, poo pick and then do his feed with supplements about an hour after, and then mid afternoon do the omoprazole and then an hour and a half later do the second sulcrafate and do a bit of stuff with him and then turn out. He has hay in his stable - they are all out during the night and in during the day - am also not going to leave him with out any feed but he doesn't seem to eat that much hay during the day as he is full up of grass during the night.

Am hoping it is either stomach or hindgut ulcers - I can't say the omeprazole has sorted it at all with girthing problems - it has helped with rugging issues and he is fine with saddle being put on his back but as soon as the girth goes on he bunches up in quite a reactive way. But we are only into week three of Omeprazole. We are only day two into sulcrafate. I have started today putting saddle on morning and evening today without riding. He was better this evening girthing up. Less explosive. If we can't sort this either by ulcer treatment or hindgut ulcer treatment or the way we have sorted everything else with him which is continually doing things he thinks are going to hurt ( he was super headshy when I got him and was rearing in the stable when I tried to bridle him - actually he was just headshy and doing a lot of desensitising headwise has sorted the bridling issue - then I am looking at either kissing spine xrays or even intercostal neuralgia. Am so hoping its neither of the latter - but just an issue where he thinks its going to hurt much like touching his legs was - it had hurt and until I touched his legs enough he thought it would hurt but he is starting to realise it doesn't hurt touching his legs and I will continue with the scissors which also don't hurt - he just thinks it will hurt and thats fair enough. I haven't ridden him much because I have been afraid it will hurt him one way or another with all his reactions, so think along with the ulcer treatment continuing the saddlling process twice daily might eliminate it for him. He is a thuggish looking horse but is hyper sensitive and I don't blame him - he has had a lot of body pain according to my chiro and as the layers unpeel so more stuff comes to the surface. All a bit of a nightmare for us at the moment, but there is no way I will make him do anything he is uncomfortable with - although a lot of liveries think I should just make him get on with it - that won't be happening!! He came to me because no-one else wanted him and he is a diamond to ride once you get over the back up issue of getting on and saddling - something is off and I do my best to sort it for him. I am not happy about riding him when he is so pent up about being saddled - it just isn't fair - so I guess we will just carry on trying to find the answer!

 

[fabbydo]

Hope it all goes well for you both.