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Discussion Starter · #1 ·
I thought this should be a separate thread since my other thread, Weird symptoms... what should I tell the vet?, has gone in a lot of different directions. I need to figure out how to get all these ulcer meds into Rusty and my vet's office is closed until Monday. I just got the meds yesterday afternoon (they had to be shipped to me by the vet who is 2 hours away from where I live), and by the time I got home, had no way to reach the vet. I don't want to call his emergency #, obviously, as this is costing me a small fortune already.

He needs to take:
a dose of omeprazole once a day
two doses of sucralfate per day (20 BIG pills)

All three of those doses are supposed to be on an empty stomach and the sucralfate needs to be given an hour after the omeprazole. Not sure if I should withhold food after dosing too?? Anyone??? Obviously, it's far from ideal because it means withholding food in a horse with ulcers! Not to mention shooting a bunch of meds into his mouth with a syringe which he hates, and which is a big battle every time... won't that cause stress too?

My feeding schedule is as follows. I've added in the medication where I thought I could fit it in:

8 am - hay
10 am - beet pulp + hay cubes
11 am - SUCRALFATE?
1 pm - hay
4 pm - hay
7 pm - beet pulp + hay cubes
8 pm - OMEPRAZOLE?
9 pm - SUCRALFATE?
9:30 pm - hay in haynets for the night

That's 9 trips to the barn, 3 of which involve giving meds to horses who are very unhappy that I am not giving them hay (not going to give Harley hay if Rusty can't have any). What would you do? Would it be ok to give the meds and still let him eat a big of hay before and after? Like if it's in a 1" hole haynet?

Vet wants me to do this for 14 days and see if there is improvement before deciding on the rest. How do people do this?
 

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With respect to the liquid medication, could you try putting it in water with a little sweetener like apple juice added and then seeing if he will just drink it? I know my Teddy would refuse it because he can taste medicine in anything, but might it be worth a try? To avoid the stress of syringes?
 

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Discussion Starter · #3 ·
With respect to the liquid medication, could you try putting it in water with a little sweetener like apple juice added and then seeing if he will just drink it? I know my Teddy would refuse it because he can taste medicine in anything, but might it be worth a try? To avoid the stress of syringes?
It's not liquid, the sucralfate is in the form of large tablets, and I have to give 20 at a time. So here's what I did for the 20 giant pills I'm supposed to syringe in his mouth twice a day: I'm supposed to dissolve them in water anyway, so I added a bit of water, a tiny splash of molasses (like 1/8 tsp), about 1/2 tsp ground flax, and a dash of cinnamon. Mixed well to get a thick paste. It's still pretty light in colour, so really not a lot of molasses added. Offered it to him and he ate it right up. No idea if this is ok, but I figure the syringes usually have flavouring. He's not a fan of applesauce and the apples can be acidic so I don't think I can use that. Any other ideas? I will check with vet on Monday, but this might save my sanity and Rusty's if I can do it this way. It still means a bunch of trips to the barn, and letting him go hungry between feedings though...

The omeprazole is already in a syringe, and has to be given on an empty stomach as well so I'm just going to keep syringing it in his mouth once a day. It means haltering him (he now runs from me when I have the halter in my hands) and forcing it, but he is tolerating this. It seems to have some apple/banana flavouring (not that I tasted it, but that's what it smells like). He would definitely taste it if I tried to put it in his water. My horses are very fussy about their water. If it's not fresh, I have to dump it out and put fresh water in their buckets.
 

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You can absolutely give the sucralfate that way.

I bet your vet can help with that intensive schedule. What you have above would be undoable for me.
 

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Your schedule looks fine don't see why it wouldn't work.

I Know from dealing with ulcer issues with ice both gastric and hindgut. Took longer then 14 days of treatment. Had to do 3 months of daily dosing with sucralfate an ulcer guard. 14 days made not much difference. His appetite wasn't good ,eat a few bites of feed and leave over half uneaten. Picked at grass hay with not much interest. Only thing he'd eat decently was alfalfa hay 3rd cutting.

Ice liked the sucralfate so could syringe it in no halter,same for ulcer guard. Didn't at first but after a week or so he decided it tasted good. He's not normally good about being syringed.
 

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Discussion Starter · #7 ·
You can absolutely give the sucralfate that way.

I bet your vet can help with that intensive schedule. What you have above would be undoable for me.
Thanks, and the problem is that I can't talk to my vet until Monday. Trying to figure out how to do this in the meantime.
 

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Discussion Starter · #8 ·
Your schedule looks fine don't see why it wouldn't work.

I Know from dealing with ulcer issues with ice both gastric and hindgut. Took longer then 14 days of treatment. Had to do 3 months of daily dosing with sucralfate an ulcer guard. 14 days made not much difference. His appetite wasn't good ,eat a few bites of feed and leave over half uneaten. Picked at grass hay with not much interest. Only thing he'd eat decently was alfalfa hay 3rd cutting.

Ice liked the sucralfate so could syringe it in no halter,same for ulcer guard. Didn't at first but after a week or so he decided it tasted good. He's not normally good about being syringed.
Ideally, I'd reduce the number of trips to the barn. 9 is a lot, even for me. If I could give the sucralfate, and do chores for 10-15 minutes, then give hay, it would make my routine more doable. But if I have to wait an hour to feed hay after the sucralfate, it means a lot of back and forth to the barn.

Rusty fights against the syringe every time. It doesn't matter if the stuff tastes good, he objects to me putting a syringe in his mouth. I can do it if I have to... but hoping I can mix the sucralfate into a paste instead. Will run it by the vet on Monday, but if that can work, it also makes the whole thing more bearable. Otherwise, I have to chase him down to halter him, fight to give him the meds which he tries to spit out, and do that 3 times a day, each time being harder than the last because he knows what's coming when he sees the halter.
 

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The only reason to give the carafate "alone" is because of the binding with other medications. It doesn't matter if you give it with food. It coats the stomach, so they say give it on an "empty" stomach because that means the coating effect will be more pronounced. For horses, I'd let them eat right after. The omeprazole in my opinion is the most important, because it reduces the acid that is perpetuating the ulcers. Coating is fine, but with humans we consider the carafate more of a secondary/adjunct treatment while the omeprazole is more of a first line drug. Just to be safe, I might give the omeprazole just before the 7 pm beet pulp feeding so there is plenty of time for it to absorb before the carafate.
 

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I don't think your schedule allows for an empty stomach before dosing. I've never had a horse with ulcers but I take omeprazole for acid reflux. I have to take it in the morning before I eat anything and then wait 30 minutes. If I forget I pay for it by it not working that day. Did your instructions say which med he should be dosed with first? What I would do given that task would be:

8:00 a.m. omeprazole
8:30 a.m. feed and a flake of hay. You can always burn up those 30 minutes getting hay nets stuffed, feed ready, barn chores etc... Would keep you from running back and forth.

1:00 meds and then another flake of hay. I don't know how sucralfate works so don't know if or how long you need to wait between dosing and feeding.

7:00 meds and then feed and hay for the night.
 

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If he likes molasses, would he just lick it up out of the feeder? I don't have to use a syringe when I mix meds with molasses and give as a treat.
 

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When I did gastroguard, I never worried about having an empty stomach. Vets didnt stress it either. Still worked fine. My guy was on a roundbale at the time.

Not sure if it would work for this, but I give pills in granola bars. The fig newton type bars with a soft exterior and jam inside. Shove the pill into the jam and he gobbles it up.
 

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Discussion Starter · #13 ·
If he likes molasses, would he just lick it up out of the feeder? I don't have to use a syringe when I mix meds with molasses and give as a treat.
Yes, that's why I am making a paste with the pills and just adding molasses and putting in his feed pan. He eats it right up.
 

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Discussion Starter · #14 ·
When I did gastroguard, I never worried about having an empty stomach. Vets didnt stress it either. Still worked fine. My guy was on a roundbale at the time.

Not sure if it would work for this, but I give pills in granola bars. The fig newton type bars with a soft exterior and jam inside. Shove the pill into the jam and he gobbles it up.
It's 20 large tablets though, lol. I like your idea, but that's a LOT of pills.
 

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It's 20 large tablets though, lol. I like your idea, but that's a LOT of pills.
When I had to give Pony pills like that, I ground them up. I have one of those old fashioned mortar and pestles and used it. But if he's doing fine with the paste you made, I'd just go with that. Why change it if it works?
 
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Discussion Starter · #16 · (Edited)
Ok, so after @JCnGrace commented about having an empty stomach, I did some further reading, and I decided to give the omeprazole first thing in the morning. Some vets even recommend not giving any food the night before so they go at least 8 hours without anything to eat (this is long, but worth watching if you're new to ulcers: https://youtu.be/SXyIdvh0bWI). I'm not willing to do that. This is hard, because I have to go to the barn and not feed. To minimize disruption to their eating schedule, I decided to go earlier so they still get their first meal at 8, as per usual. But I still have a question: does the sucralfate HAVE to be fed an hour after omeprazole, or can it just be fed anytime during the day, but not within an hour after giving omeprazole? Right now my schedule would look like this:

7 am - omeprazole
8 am - sucralfate, then hay
10 am beet pulp + hay cubes
1 pm - hay
4 pm - hay
7 pm beet pulp and hay cubes
9:30 pm - sucralfate, hay
 

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I don't think the hour is a hard and fast rule. I had to give meds to our mare (20 tabs twice per day) and I would make a paste out of them in warm water and then I mixed with her soaked beet pulp. She ate it with hesitation at first but hunger got the best of her. I did have to keep her and the other horses separate to ensure she ate all of the food. I had to do this for 5 weeks. This was not for ulcers but for a terrible case of cellulitis we ran into in October
 

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Discussion Starter · #19 ·
Kept meaning to update after talking to my vet Monday morning, but I got distracted by my cute new pony. In case anyone is reading this, he says no to feeding immediately after sucralfate.

He says that a) Rusty should get the omeprazole on an empty stomach (as empty as possible is what he said). This is a problem because it's -20C here lately, so depriving him of hay overnight could lead to other problems as he will not be able to keep himself warm. Also, I would have to separate him from Harley which would cause even more stress. b) I need to give the omeprazole on an empty stomach, wait an hour, then give the sucralfate, wait an hour, then feed. And c) I need to wait an hour to feed after the other dose of sucralfate as well. The only good thing that came out of the conversation is that the paste I'm making with the sucralfate is fine. Sucralfate needs to be given 12 hours apart (or as close to that as possible).

So I've tried different schedules and they just don't work. This is a PITA, Rusty hates me now, and I don't think all the changes in his schedule are good for him either but those are the vet's instructions. This is what I'm trying now:

7:30 am - hay
9 am - beet pulp & hay cubes
10 am - sucralfate
12 - hay
3 - hay
6 - beet pulp and hay cubes (Rusty only gets about a cup of this)
7 - omeprazole
8 - sucralfate
9 - hay in haynets for the night

That's still 9 trips to the barn which is madness. I can't quite get the sucralfate 12 hours apart, but hoping 10 hours is close enough. I work from home, but I do have to work!
 

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It's good you're able to do that kind of schedule. I can see how you'd want to, since the ulcers have come back. Still, most people can't do anything remotely like that so we just feed a dose of omeprazole once a day, the horse is still eating the whole time, and the ulcers go away. I've never even given sucralfate for ulcers and treated horses a few times now. My personal opinion is that the first treatment was too short, and in the second one the sucralfate negated the omeprazole. Anyway, you're bound to be successful with this treatment! But you shouldn't feel bad if you have to make it more doable.
 
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