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I'm stressing out

5K views 20 replies 10 participants last post by  EGUSVet 
#1 ·
I need some perspective.



Horse is a cripple, jacked stifles, hocks, ect. Had everything injected last August. Needs them done again.

I always float his teeth yearly, but because of the massive vet bill from dealing with his lameness last year, I put off his float. Still needs to be done and I'm also noticing some bridle issues that could be teeth.

He has ulcers from his Previcox(has been off it since late Dec). Been treating those with esomeprazole since January. Tried to wean him off it once and as soon as I lowered the dose he started colicking again. Put him back on full dose for another month, start another taper. This time he lasted until the second lowering of the dose before he colicked.

As far as colicks go, they are pretty minor. As far as I can tell, they pretty much only happen when he gets his extra hard feed(beep pulp + low nsc pellets). He'll start eating, then stop, be really still like he's holding his breath. Sometimes he'll paw a few times or shake his head. Then in a few minutes it passes and he wants to eat again. There have been a few times I've noticed him do this under saddle too. Usually after a trot. Tho, I'm not riding him currently because his hocks are making his back sore. He's already on hay 24/7. He's otherwise in good weight, good coat, not girthy or abnormally sensitive, solid poops, nothing else that makes him look like an ulcery horse.

I'm having the barn staff continue the taper. He only has 5 days left and I don't know if I'll be able to get enough esomeprazole for another round of treatment without risking him having to come off it suddenly. I called a few pharmacies today, either they don't have any and had their shipments delayed all week, or they only stock like two at a time. Even before the whole pandemic mess, it was hard to find a large enough quantity of boxes. Often out of stock. Ordering online will take way too long to get here.

I'd like to get him scoped since he isn't responding as desired after 3 months. Contacted my vet, scoping is preferably done at the clinic. If they had to do it during a farm call they can't take any images to document and it sounds like it's overall more difficult to perform. I don't own a trailer. I'd need to hire someone to haul the 1h to the clinic. There is someone at the barn who hauls, but understandably they don't want to be making any unnecessary trips if they don't have to.

I asked for a quote. ~$450 for the scope. The ulcerguard afterwards for 28 days is $975! Then another $400 for the dental float to be done at the same time. $100+ for hauling. $35 for a stall as he needs to be fasted. $2000+ by the end of it. No joint injections for a while(but of course, the pain from his joints can be a contributor to the ulcers...).

I literally just finished paying off the vet bill from his injections last year and it wasn't as large.

So I forgo the expensive meds and make a trip to every pharmacy in the city and stockpile esomeprazole(~$70 for a month)? And hope I don't catch covid in the process? I still feel like it's irresponsible not to scope him at this stage. Then that goes back to farm call vs clinic. I'd much prefer the farm call option, but if they can't diagnose him reliably from it, what's the point? With the Gastroguard, apparently the company will pay for the second month if there are still ulcers after a 28 day treatment. Idk, maybe that would be most effective, taking a gamble that his ulcers are bad enough that it would take longer than a month to heal...

I also have no idea if we might end up in a lock down or something in a few weeks, so if I put this off, he might not be able to get anything done for a while and then he's off any meds. So far there isn't any talk of lockdowns, at least. My job is safe(100% remote), I got a raise last month, and we have quarterly bonuses coming next week. No extra financial stress at least, just normal levels.

Gahhh
:dance-smiley05:
 
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#2 ·
First, give Thanks you still have your job:). Many horse owners are at risk of not being able to pay board because they have lost their job.

Second, if you haven’t already wiped the shelves clean of esomeprazole, don’t do it. If you have a credit card buy this stuff and see if it helps.


Egusin

Your horse may very well be dealing with hind gut ulcers. No type of omeprazole will help the hind gut. This Egusin addresses both front and hind gut issues and is all natural:)

It’s not cheap but it helps more than anything else I’ve tried on my IR/Cushings/founder damaged hooves horse with the re-fractured sacrum.

I fed Joker the 2-phase program the beginning of last November and he is just now starting to act like he might need it again.

Both horses are due for spring de-worming, so I will put them both on the Egusin to help ease that discomfort.

3. Unless your horse has points on its teeth, dismiss the floating. He shouldn’t be ridden at all with his current stifle & jock issues. Teeth don’t re-grow themselves so having them perfect to avoid bit discomfort isn’t an issue right now.

4. You can always get him off the hard feed and start adding a condensed it/min supplement to his beet pulp. Try and buy something that is in meal or powdered form:)

5. Are you POSITIVE the people who feed him are giving him what they are supposed to and. It taking short cuts so they can hurry up and get the chores done?

That would be a big worry, especially if you’re at a big barn.

6. I don’t know what your BO’s barn policies are but, for now, I would make whatever horses are there a “closed herd” and not even let anyone in or out for shows or big organized trail ride; trail riding would be fine if done locally and only with horses at the barn. That way even annual vaccinations could be delayed, as your horse may not receive those too well right now.

7. You are better off than many:). TV news casters are starting to devote time to handling the possibility of increased domestic violence due to families being shut in small living environments.

Things could be much worse:)
 
#4 ·
6. I don’t know what your BO’s barn policies are but, for now, I would make whatever horses are there a “closed herd” and not even let anyone in or out for shows or big organized trail ride; trail riding would be fine if done locally and only with horses at the barn. That way even annual vaccinations could be delayed, as your horse may not receive those too well right now.
I would completely disagree with that. Vaccines aren't just for contagious diseases, but also things that bite and can be transmitted through animals. I would never, EVER skip vaccinations, worming, or farrier.
Everything else can be talked about as a one on one basis for each horse.
You can lose a horse real quick to WEE or EEE or Rabies...

So from this I'm getting your horse is lame in multiple places and has ulcers that are super bad.
How old is this horse?
Is it worth it to pour all of this money into him right now, when there's no competitions or really anything happening for the foreseeable future? As well as... is it fair to him to keep pushing him to work if he's this unsound and hurting?

I'd sit down with your vet and really look hard at the nutrition your horse is getting from everything he's eating, as well as his turnout situation, living situation, and overall stress and workload.

A lot of vets are now looking at studies of omeprezol and how it really doesn't do much for horses. The reason gastrogaud works is because it has a coating over the medicine that allows it to be protected from the acid in the stomach so it gets all the way to the hind gut.
Honestly why scope him if the answer to the question is going to be try gastrogaurd? Why not just try that first and save the other $1000 for a possible emergency?

Coming from the show world, I love gastrogaurd and we give it quite often when traveling and competing. It really does help.

All of this said though.... it sounds to me that this horse is trying quite hard to retire himself... It's always a sucky decision to make, but they tell us when they're done, and all of this sounds a lot like 'hey mom, at the very least could I have a break?'
 
#3 ·
Are you doing anything else for his gut health/ulcers? Because omeprazole only helps stomach ulcers(not hind gut ulcers at all) by stopping stomach acid production. This does indeed help, if the horse is on little & often, low carb meals(horses cannot digest high NSC food in the stomach without the enzymes), by giving a reprieve to the damaged tissue. But it does not actively aid healing. So if ulcers are significant, they tend to need more help than just preventing further exacerbation from the acid.

Aloe, liquorice, and other 'herbs' can help, as can supps such as Kelato Gastro Aid, altho if ulcers are serious, they may need to be given in combo with omeprazole or such. Insufficient Mg in the diet(which can be due to too high Ca) is linked with stomach ulcers, BUT more Mg in the diet can also exacerbate ulcers, so I'd be inclined to use Mg Chlor applied to the skin, while ulcers are severe.
 
#7 ·
What are you wanting to achieve by scoping and putting the horse on gastrogaurd? Right now I'm not understanding how your horse is 'colicing' and then fine a few moments later? That seems more like he's just a little sore instead of a colic.
Colic = medical emergency which doesn't seem to be happening here. Or he's getting sore from chewing if his teeth are as bad as they normally get.

Have you tried to just let him be? Will this really improve his quality of life greatly or make you feel as if you're doing something?
For a pasture sound horse, I wouldn't scope it and put $2000 into it unless it was worth a lot or was very close and special to me. I understand wanting to do all you can to help, but is he really suffering to the point of spending a lot on treatment?

Also, here are some good reads on why gastrogaurd works so well and why feeding normal OTC or compounded omeprazole never works in horses.
Gastrogard vs. Generic Omeprazole: Not Worth the Risk - Equine Veterinary Associates
https://www.ncbi.nlm.nih.gov/pubmed/14649361
Omeprazole Alone Doesn?t Heal Ulcers | Equine Chronicle
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895457/

The basic premise is that the general compound on it's own needs a vehicle to get past the acidic stomach to be absorbed in the hind gut to work through the bloodstream. Remember that this isn't just a coating that you put on like a bandaid to the ulcer, it heals it from the inside out as well as calming the stomach.
 
#11 ·
What are you wanting to achieve by scoping and putting the horse on gastrogaurd? Right now I'm not understanding how your horse is 'colicing' and then fine a few moments later? That seems more like he's just a little sore instead of a colic.
Colic = medical emergency which doesn't seem to be happening here. Or he's getting sore from chewing if his teeth are as bad as they normally get.
Colicing doesn't have to be a medical emergency. It's simply abdominal pain. I don't believe it's pain from his teeth causing the episodes seeing as it correlates pretty closely to when he's on a full dose of esomerazole vs reduces or none. Before starting meds he was having these episodes sporadically, once every few weeks with increasing frequency. Within a couple days of starting meds he stopped and didn't have another until we lowered the dose, then went away again when put back to the full dose.
Have you tried to just let him be? Will this really improve his quality of life greatly or make you feel as if you're doing something?
For a pasture sound horse, I wouldn't scope it and put $2000 into it unless it was worth a lot or was very close and special to me. I understand wanting to do all you can to help, but is he really suffering to the point of spending a lot on treatment?
Valid point. He's content and not suffering. At the same time, I know how stoic he is. Before all this, he was always such a picky eater and I had written that off as who he is. But once starting the ulcer meds, his appetite is better than I've ever seen. So part of the fear of just leaving him as-is, is he was evidently uncomfortable even before he started colicing.

Also, here are some good reads on why gastrogaurd works so well and why feeding normal OTC or compounded omeprazole never works in horses.
Gastrogard vs. Generic Omeprazole: Not Worth the Risk - Equine Veterinary Associates
https://www.ncbi.nlm.nih.gov/pubmed/14649361
Omeprazole Alone Doesn?t Heal Ulcers | Equine Chronicle
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895457/

The basic premise is that the general compound on it's own needs a vehicle to get past the acidic stomach to be absorbed in the hind gut to work through the bloodstream. Remember that this isn't just a coating that you put on like a bandaid to the ulcer, it heals it from the inside out as well as calming the stomach.
I'll read those tonight when I get a chance.



Let's address the lockdown issue first. Veterinary care and animal/livestock transport is considered essential, so if you have to haul for a scope, haul for the scope. You won't be prohited from that.

Purina Outlast is good stuff. I used it before they added it to their feeds, bought it by the bag and added it myself. I had a foal who was having some health issues and on antibiotics/steroids for an extended period of time and not able to eat hay that hadn't been soaked, or cubes and was feeling pretty stressed. He came through it all without any ill effects. But it won't HEAL the ulcers (if that's what he has) but it will help to protect his gut while you treat him.

Maybe see if you have a compounding pharmacy that you can order from? I have one here in OK that I ordered a liquid omeprazole/ranitidine compound from for another horse who did have ulcers and it worked like a miracle. You can order the powder from NexGen (you need an RX from your Dr. for it) and mix it up yourself. Here's a link: https://nexgenvetrx.com/omeprazole-1-gm-scoop-ranitidine-200-mg-scoop/. I don't know the price.

If you're going to haul him for a scope, then I would have his teeth done at the same time, no point in 2 hauls or sedating twice if you don't need to. I would postpone any vaccines until he's feeling better.

I don't like that he's eating and "colicking" and a few minutes later feels better and eats some more and colicks and so on. I had a mare who seemed to have little colics and she'd park out, bite her sides, and then get better and go on about her business. I had her checked several times. No ulcers, no real reasons that we could see for colic. One day she colicked, went down and I took in to be examined again and determined she had twisted her gut (torsion colic). They suspected that with her history that perhaps she had some lipomas or something that was blocking the passage of feed periodically. We ended up having to put her down.

And that brings me to the cold hard questions about the money. He's 10 and you describe him as a "trainwreck". That means you don't really expect him to get better. If that's the case, would you (and he) be better off considering euthanasia for him and later on when money isn't such a concern, getting another horse?

At this point, I would not buy anymore esomeprazole (throw $70 down the trash chute 10X and you've just about paid for the more expensive drugs and diagnostics) because it's not doing what you need it to do. It's making him more comfortable, sort of, it's not healing the ulcers, if that's even his problem. I'd also have the vet do a fecal occult blood test which is a LOT cheaper than anything else, and will test for blood in his stool. If it's there, you pretty well know he's got hind gut ulcers and can treat that and see if it helps. That could be your least expensive way to go right now, and might solve your problems. At least the gut ones.
Right, the Outlast is for support, not treatment. Could be that+medication. There are compounding pharmacies around, though I've never had anything to do with one before. My vet mentioned a compounded omeprazole as an option, with the disclaimer that not all will respond to it. Waiting to hear back with more information.

It a possibility that there's something more sinister than ulcers at play. Ulcers made sense given that it happened after he had been on Previcox for several months and my vet agreed, plus it went away with the medication. Don't look for Zebras, right?

It's usually only once that he will colic, if he gets to finish the rest there's no recurrences and he'll have full appetite. Usually I will remove his grain, though.

I know he's not going to live into his 20's, but I don't feel there's any reason to consider euthanasia at this point. Keep in mind, while I say he's a trainwreck, there's a lot of people(not beginners either) who will watch him and say he moves great and looks good. He's not dragging himself around on 3 legs or anything. He gets around fine and still plays with his pasture mates (as much as I tell him not to), is in good weight and his attitude is positive. His joints are not going to recover, though it's my hope that I can keep enough muscle on him to help support his stifles. I watch him closely to see if he ever has trouble getting up or any changes in his attitude. So far so good. When he gets to that point, I'm not going to string him along for my own sake.

He had a FOB test done last summer and it was double negative. I've since heard opinions from other vets that they aren't very reliable.

Could he be allergic/sensitive to an ingredient in his feed? What about trying alfalfa pellets as a carrier for his vitamin/ mineral and see if that makes a difference?
Suppose crazier things have happened, though he's been getting the same pellets for a couple years now and he's been eating beet pulp for 5+ years.

I don't believe that decisions on looking after an animal's health should be at all dependant on whether you can *use* him 'in the foreseeable future's or otherwise.

I also didn't see where Apuetsot said anything about riding or working the horse while he was lame. I def don't think you should be, if you are doing so OP??
I'm not 'working' him. He hasn't been ridden in a month or two and at most he ever had was 15min walk and straight line trots. If he said he was done, we'd stop. Currently we long line once or twice a week, again mostly at the walk with some trot depending how he's feeling that day. All stuff that was approved by the multiple vets that saw him for his lameness. He essentially has bad arthritis, so there's no risk in the realm of reinjuring or making something worse. With his injections being past due, we're taking it especially easy. Most days he just rolls in the arena.




Right now, I'm flopping between going all in, or letting him come off the meds and seeing how he does, and just have the vet out for a float (but then if he doesn't do well??). I'm out tonight, so guess that'll give me more information. Expecting an email back from my vet at some point.
 
#14 ·
I'm not sure I would scope- just treat and see if he improves. My vet and I had a discussion about my very sick cat. We could have done a couple thousand dollars worth of diagnostics and known for certain what is wrong, or we could treat, if he improves we know we are treating him correctly. If he gets worse, then you probably have something more severe, like cancer. And it may not be ethical to do advanced diagnostics on an already sick cat- exploratory surgery was one option that I declined.

I would get his teeth done, treat for ulcers and see how he does. If he starts going downhill, that is not your fault. You are already making a considerable effort to get him healthy.

I would strongly consider feeding only alfalfa hay and alfalfa pellets with a ration balancer. No grain. Alfalfa is excellent for ulcer horses when combined with ulcer medication.
 
#15 ·
Think I've settled on a decision. Have the vet out to the barn to do a dental float(that was never a point of contention), forgo the scope, and treat. I think the extra stress of fasting and hauling will be too much. Still thinking on full gastroguard vs gg + compounded. From what I read, the compounded can be unreliable because of the pH of the carrier. It's not that compounded doesn't work, it's all in how it's made, but then it's not like I can tell the pharmacist how to make it, lol.



Friday when I was out, had another colic episode. Sunday he did not. Interesting thing on that was Friday I allowed him to roll in the arena first, Sunday he didn't roll. Wish I had made better notes on what we did before all his other episodes. It would make sense if the ulcers were in the upper portion of the stomach that they would be increasingly irritated after exercise or rolling where the stomach acid would have splashed up.






4horses;1970850775 I would strongly consider feeding only alfalfa hay and alfalfa pellets with a ration balancer. No grain. Alfalfa is excellent for ulcer horses when combined with ulcer medication.[/QUOTE said:
He lives out in a herd with round bales so it's not realistic that he gets alfalfa hay. The other horses in his herd certainly don't need it. I've tried to give him alf pellets before and he won't touch them. He does like alf cubes, though. I'm due for a run to the feed store.
 
#16 ·
I'm glad you decided to do what you are, it's probably how I would treat this horse currently.
I would say just do full GG, no compound. There's too many variables in there for it to be worth anything, honestly.

As for feed, I think just being out, with friends, and free choice forage is the absolute best thing you can do for a horse with ulcers.
 
#18 ·
Hey - hope you don't mind me joining in the conversation. This may sound overly simplistic - but is he stalled much? How much time is he allowed to graze? Is his stomach ever empty? I'm just wondering if you might be able to find him a place where he can be on pasture 24/7 with free access to a run-in shelter, where he would constantly have a small amount of grass in his stomach and get all of his nutrition from grass and hay if things might balance out on their own.

I know a lot of people stall their horses at night and turn them out during the day (or vice versa) and I've heard those horses get ulcers more often, and have more problems with soreness, than horses who are on pasture.
 
#19 ·
Started the GG today. If he finished this round and is still reactive in the end, then I'll take him in for a scope. If it is still an ulcer, the drug company will pay for a second course of treatment even without a initial scope. Just needs the second. If it's not an ulcer, then he would need to be scoped anyway.



Hey - hope you don't mind me joining in the conversation. This may sound overly simplistic - but is he stalled much? How much time is he allowed to graze? Is his stomach ever empty? I'm just wondering if you might be able to find him a place where he can be on pasture 24/7 with free access to a run-in shelter, where he would constantly have a small amount of grass in his stomach and get all of his nutrition from grass and hay if things might balance out on their own.

I know a lot of people stall their horses at night and turn them out during the day (or vice versa) and I've heard those horses get ulcers more often, and have more problems with soreness, than horses who are on pasture.

He's outside full time, no stalling. Has food in front of him all the time. Still winter, so roundbales currently, but come June he's usually on pasture.
 
#21 ·
I'd like to bring some prospective here from reading this thread. As a disclaimer, it has been at least 10 years since I worked in the states, so I might be a bit out of touch with regards brand names, and i might forget to convert kg to pounds sometimes. But these would be my suggestions based on the limited history given by OP.

1. Remove all hard feeds - your horse is not in work, does not need this.

2. Obviously, increase the roughage. A high quality Alfalfa type hay has a lot of digestible energy in it. To feed a horse in maintenance levels, you would need about 40 calories per kg bodyweight (so that would be 40 calories per 2.2 pounds in weight)

2 pounds of good quality alfalfa hay gives about 1,912 calories

If you can get hold of sugar beet pulp, you can soak that. It is great for horses that have gastric ulcers. It contains pectins which is also good for gastric ulcers.

Have a chat with your veterinarian about the option of getting omeprazole and sucralfate. This combination works better than omeprazole by itself. I seem to recall that Ulcergard was not a prescription medicine, so look into that as well.

I would highlight the fact to your veterinarian, that due to welfare issues and the current situation we are facing with COVID-19, would it be ok for your veterinarian to prescribe a course of omeprazole and sucralfate without a scope, and see how that progresses while you are trying not to travel with this pandemic.

I am a bit worried about the fact that your horse seems to be having mild colic and then seems fine after and continues to eat.

It sounds more like a type of spasmodic colic, or even the beginnings of intussusception, but I would be hesitant in going so far as trying to diagnose without examining your horse. Therefore I would recommend removing all hard feed.
 
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