Worried - ulcers may have returned - suggestions please :(

[Muddywellies]

And perhaps how experienced the owner is.

Please don't insult mine or my vets intelligence. I have owned horses for over 3 decades and my vet is one of only a handful of Advanced Practitioners in Equine Internal Medicine.
I am merely passing on information and experience I have learnt with my own dealings with this frustrating condition. Advice can be taken or left, but my own knowledge does not need to be questioned - that isnt the issue here.

 

[Leo Walker]

Please don't insult mine or my vets intelligence. I have owned horses for over 3 decades and my vet is one of only a handful of Advanced Practitioners in Equine Internal Medicine.
I am merely passing on information and experience I have learnt with my own dealings with this frustrating condition. Advice can be taken or left, but my own knowledge does not need to be questioned - that isnt the issue here.

Honestly, if you missed the girth being the issue then I think it maybe is. No one is insulting you. We've all made mistakes. But to scope a horse, a fairly invasive procedure that isnt risk free and can trigger ulcers in its own right, when it wasnt necessary at all, and to then insist other people should be doing this, then that advice needs to be taken in light of this.

Everyone has to do what they are comfortable with. The OPs horse is a stressy mare at the best of times. Shes been very upset by the change in routine. It may well be that changing the routine back resolves the issues. If not then there is the option for further investigation and/or treatment. Omeprazole isnt the only treatment for ulcers, and the right supplement has helped lots of horses so again is something that can be looked at.

 

[BBP]

Out of interest, do you struggle to get them to eat the equishure BBP?

No never. And BBP is the fussiest eater (translated by my phone to fizziest water!) I have ever met. But it only takes 15g per feed to keep him comfy so not a huge amount. If he was on the 90g a day recommended for some then he may be less keen.

 

[DabDab]

No never. And BBP is the fussiest eater (translated by my phone to fizziest water!) I have ever met. But it only takes 15g per feed to keep him comfy so not a huge amount. If he was on the 90g a day recommended for some then he may be less keen.

Thank you! Thinking of trying little mare on it, because while she doesn't have any specific ulcery type symptoms, I do get a vibe that she has a slightly sensitive digestive system (if that doesn't sound too nutty and hippyish), but she is extremely particular about her feed so I'm always wary of spending any money on something that is most likely just to be chucked on the floor.

 

[Ellietotz]

Thank you everyone. So what was the conclusion here? Scope or just treat?

 

[Leo Walker]

Change the routine and then reassess

 

[flying_high]

Personally I’d consider rescoping. Process isn’t that bad and at under £300 it is cheaper than treating ulcers.

My horse had squamous and glandular ulcers in January. 12 weeks of treatment with 3 drugs and a tricky routine of drug administration. Then scoped clear.

Now same horse has performance and spine issues. My local Vet’s view was don’t scope and treat for ulcers for 4 weeks. As horse has ulcer history and current pain.

I decided to scope (as I had 3 days left on ulcer claim). And wanted to know if glandular (v hard to treat) were back. And scoped totally clear (aside from some old scarring where previous ulcers.)

Personally I’ve not found 3 sets of scoping too bad and prefer to know what I’m dealing with before the complex, arduous and v expensive treatments. I want the information to treat the right thing.

 

[Ellietotz]

Personally I’d consider rescoping. Process isn’t that bad and at under £300 it is cheaper than treating ulcers.

My horse had squamous and glandular ulcers in January. 12 weeks of treatment with 3 drugs and a tricky routine of drug administration. Then scoped clear.

Now same horse has performance and spine issues. My local Vet’s view was don’t scope and treat for ulcers for 4 weeks. As horse has ulcer history and current pain.

I decided to scope (as I had 3 days left on ulcer claim). And wanted to know if glandular (v hard to treat) were back. And scoped totally clear (aside from some old scarring where previous ulcers.)

Personally I’ve not found 3 sets of scoping too bad and prefer to know what I’m dealing with before the complex, arduous and v expensive treatments. I want the information to treat the right thing.

My insurance has unfortunately run out now for the ulcers. Scoping isn't the issue, I just can't weigh up if there is any point to tell me what I may already know. She was scoped a few times throughout the treatment process a year a go and it cleared up quickly. I know the signs are appearing again and I'm just thinking of the easiest/quickest options for her. I'm hoping that the change back to 24/7 turnout will help. I'm also considering getting a herbal supplement that consists of liquorice, slippery elm etc or something to help sooth but haven't decided yet.

 

[Fransurrey]

Thank you! Thinking of trying little mare on it, because while she doesn't have any specific ulcery type symptoms, I do get a vibe that she has a slightly sensitive digestive system (if that doesn't sound too nutty and hippyish), but she is extremely particular about her feed so I'm always wary of spending any money on something that is most likely just to be chucked on the floor.

My mare wouldn't touch it. She ended up with a stupidly big feed for an Exmoor and she still wouldn't eat it at recommended dose - not even near! I used it up feeding at half dose which perhaps not surprisingly, was ineffective. She's now managed on anti-histamines as her ulceration seems to be allergy related.

 

[DabDab]

My mare wouldn't touch it. She ended up with a stupidly big feed for an Exmoor and she still wouldn't eat it at recommended dose - not even near! I used it up feeding at half dose which perhaps not surprisingly, was ineffective. She's now managed on anti-histamines as her ulceration seems to be allergy related.

Oh that's interesting. Presumably you just started the anti histamines for the allergies and then the ulcers sorted themselves?

 

[Fruitcake]

Scoping is the only way to diagnose. Yes they go a little hungry, and yes, there's a chance it may aggravate existing ulcers, but there's no other way. My horse was showing signs that her ulcers had returned so we re-scoped, and on that occasion she was totally clear of ulcers ! (One of only two times she scoped clear). Turned out she was uncomfortable in her new all singing all dancing anatomical girth. Why would anyone throw supplements and medication at a horse on the off chance that it may have a condition. Sorry but after spending thousands on my horses ulcers, I would always get a firm diagnosis and deal accordingly. It's vital to work closely with a specialist vet and not self diagnose.

It’s actually common practice to carry out an ‘Omeprazole trial’ as a method of (re)diagnosis, certainly in cases where a horse has a history of ulcers. In my view, this is common sense. Why would anyone put a horse through the process of starving (and yes, going all night without food is starving for a natural grazer; my horse was very stressed and clearly in pain after being starved before each scope) and sedating when it wasn’t totally necessary? Indeed, with humans, this is the standard method to diagnose ulcers: I’ve had Omeprazole on two separate occasions without ever being scoped! Is it really any different to doing a bute trial before nerve blocking and scanning / x-raying for lameness?

I can’t help thinking that, with the modern wide-spread practice of insurance, there does tend to be a lot of costly investigation recommended by some vets. I’m not saying this is always unnecessary: I’ve had a number of investigations done on our horses, but when the insurance runs out, it does make you think about the best use of funds. The fact that investigations in humans are, in many cases, less involved seems to support this view.

 

[flying_high]

It’s actually common practice to carry out an ‘Omeprazole trial’ as a method of (re)diagnosis, certainly in cases where a horse has a history of ulcers. In my view, this is common sense. Why would anyone put a horse through the process of starving (and yes, going all night without food is starving for a natural grazer; my horse was very stressed and clearly in pain after being starved before each scope) and sedating when it wasn’t totally necessary? Indeed, with humans, this is the standard method to diagnose ulcers: I’ve had Omeprazole on two separate occasions without ever being scoped! Is it really any different to doing a bute trial before nerve blocking and scanning / x-raying for lameness?

I can’t help thinking that, with the modern wide-spread practice of insurance, there does tend to be a lot of costly investigation recommended by some vets. I’m not saying this is always unnecessary: I’ve had a number of investigations done on our horses, but when the insurance runs out, it does make you think about the best use of funds. The fact that investigations in humans are, in many cases, less involved seems to support this view.

My horse had glandular and squamous ulcers when scoped. The treatment of glandular is much harder and longer. If we hadnt scoped we wouldn’t have known this.

Also the treatment of ulcers is complex, and does involve restriction of food at certain times to give and allow drugs to work.



I don’t think should always scope, but I do think the information from scoping is invaluable. And I am no longer insured, and the cost of scoping is very low approx £300 compared to the cost of treating glandular and squamous ulcers which even keeping as low as possible is into the thousands.



In terms of humans, the stomach function and acid production is not comparable to horses, and ulcer treatments are not a good comparison. Humans only produce stomach acid when food present. Horses produce it continually whether food is present or not. Though lower amounts at night.



My experience of scoping wasn’t too bad at all. My horse didn’t have food overnight, whilst all was quiet and was scoped first thing in the morning. It would have been beyond impossible if he’d had others fed in front of him, or turned out in front of him, or day time starvation.



There is evidence (see the podcast / articles from Ulcer Specialist vet Richard Hepburn) that horses produce far less stomach acid at night, than day, and that being without food at night is much lower risk than day.

 

[Ellietotz]

It’s actually common practice to carry out an ‘Omeprazole trial’ as a method of (re)diagnosis, certainly in cases where a horse has a history of ulcers. In my view, this is common sense. Why would anyone put a horse through the process of starving (and yes, going all night without food is starving for a natural grazer; my horse was very stressed and clearly in pain after being starved before each scope) and sedating when it wasn’t totally necessary? Indeed, with humans, this is the standard method to diagnose ulcers: I’ve had Omeprazole on two separate occasions without ever being scoped! Is it really any different to doing a bute trial before nerve blocking and scanning / x-raying for lameness?

I can’t help thinking that, with the modern wide-spread practice of insurance, there does tend to be a lot of costly investigation recommended by some vets. I’m not saying this is always unnecessary: I’ve had a number of investigations done on our horses, but when the insurance runs out, it does make you think about the best use of funds. The fact that investigations in humans are, in many cases, less involved seems to support this view.

Very good point.

It's £250 for my vet to scope or £180 for 1 month full omeprazole treatment and then weaning off again. This is omeprazole purchased online and a lot of people in the same boat purchase from the same place. I just don't know whether to do both if scoped and found with ulcers or just go straight for treatment. She's been back on 24/7 turnout since last weekend though not enough time to tell really if it has helped or not.

 

[Pearlsasinger]

I can’t help thinking that, with the modern wide-spread practice of insurance, there does tend to be a lot of costly investigation recommended by some vets. I’m not saying this is always unnecessary: I’ve had a number of investigations done on our horses, but when the insurance runs out, it does make you think about the best use of funds. The fact that investigations in humans are, in many cases, less involved seems to support this view.

I agree and would be very suspicious that the Advanced Practitioner in Equine Intestinal Medicine had forgotten about the basics and ' do no harm', which I am pretty sure is the same for vets as it is for doctors. It sounds as if this one can't see the wood for the trees. imho

 

[HBB]

You have mention ordering Sucralfate, as she has had gastric ulcers in the past I would also consider using Omeprazole at the same time to reduce the production of stomach acid.

I would also keep her on the Gut Balancer for just now to help support her hindgut and I would also consider taking her off the sea salt and using a "protected" Safe Salt as salt can sometimes cause gut irritation.

If it was me in your situation, I'd just go ahead and treat.

I've also had great results with Agrobs AlpenGrün Mash Gut Restorer.

There are 2 fantastic Horse Ulcers groups on FB that are definitely worth joining for further advice and support.

 

[Fruitcake]

My horse had glandular and squamous ulcers when scoped. The treatment of glandular is much harder and longer. If we hadnt scoped we wouldn’t have known this.

Also the treatment of ulcers is complex, and does involve restriction of food at certain times to give and allow drugs to work.



I don’t think should always scope, but I do think the information from scoping is invaluable. And I am no longer insured, and the cost of scoping is very low approx £300 compared to the cost of treating glandular and squamous ulcers which even keeping as low as possible is into the thousands.



In terms of humans, the stomach function and acid production is not comparable to horses, and ulcer treatments are not a good comparison. Humans only produce stomach acid when food present. Horses produce it continually whether food is present or not. Though lower amounts at night.



My experience of scoping wasn’t too bad at all. My horse didn’t have food overnight, whilst all was quiet and was scoped first thing in the morning. It would have been beyond impossible if he’d had others fed in front of him, or turned out in front of him, or day time starvation.



There is evidence (see the podcast / articles from Ulcer Specialist vet Richard Hepburn) that horses produce far less stomach acid at night, than day, and that being without food at night is much lower risk than day.

My reference to human diagnosis was in terms of the often reduced amount of investigative work that the NHS tend to carry out in comparison to vets. (This could indicate a better understanding of cost-effectiveness when it’s not the client’s money).

I am very aware of the differences between equine and and human acid production and stomach function (and various treatment options), having experienced issues from both my own and horse’s perspective.

I know ulcers can be tricky and vary in type and location. An Omeprazole trial, however, can be a good starting point, particularly if there is previous scoping information and there appears to be a relapse.