Watching and Wondering
Well, Consolation and I did get to go for our ride Wednesday. Saddling up took extra time, as she clearly anticipated discomfort. (How was she supposed to know she had dexamethosone on board?) I lunged her briefly before getting on just to be sure I hadn’t missed anything, then led her out to the driveway and mounted up.
It took only a few steps to know she wasn’t 100%. She didn’t want to move off well, and her tail was too switchy for the bugless day. Then again, she wasn’t nearly as uncomfortable as she has been over the past few weeks. The obvious question: How much of this was actual discomfort — and how bad was that discomfort — and how much was the cleverness of a horse that is figuring out that fidgety behavior will earn her a day off?
Decision time. With horses, there can be a fine line between “I want you to be absolutely comfortable” and “Suck it up, Princess.” Endurance horses in particular need to be able to work through a bit of discomfort. If the first cloud of gnats or trickle of belly sweat sweat snaps their delicate psyches, you’re never going to get down the trail.
For the moment, I chose to proceed. Half a mile later, we were still going along reasonably well, and I asked for a trot. She moved out slowly. Hesitantly. I kept asking, and after a while she seemed to discover that her skin wasn’t going to bite her, after all. She did still lash her tail and snap her head around a couple times, but nothing like before. At the first intersection, we took a turn that often loops us back toward home. That sped her right up. Look, mom, I can trot! Wheeee!
Until the first turn away from home. Oooh, then her skin seemed much more troublesome. She switched her tail and flung her head around some more. Trot? Gosh, I dunno, mom… Uh-huh.
Again we pushed through, and again she recovered considerably as she became distracted by passing tractors and a herd of horses across the canal. Now, I don’t mean to say she wasn’t feeling anything at all — I do think she her skin was legitimately bothering her to some extent — but she was obviously able to get beyond the “I’m a fragile Christmas bauble, so please bubble-wrap me” stage. In fact, for the last several miles before our cool-down, she moved out quite normally, steadily and with enthusiasm. When we slowed to walk the last mile in, she remained normal.
Afterwards, she had just a hair of swelling on one side, well away from the saddle area. She was just about 24 hours out from her last dose of dex, though, so it’s unclear whether the ride or the timing was the issue.
So…maybe we’re making progress. Or maybe she’s just leaning on the dex crutch and will relapse as it tapers off. I’m worried about the latter because the affected areas were a bit warm last night — and yesterday was her first day off the dex. She’ll get a smaller dose today, tomorrow off, then still smaller doses ever other day twice after that.
Then what?
(Or Not) Consolation Skin Epic, Continued
Aaaaand, Sunday’s ride on Consolation…wasn’t.
The skin issue returned. Again. That makes twice I thought it was resolved, only to have it reappear within a day or two. Time to bring in reinforcements.
I’m pleased to announce that the vet’s visit confirmed I am neither crazy nor stupid. He’d never seen anything like Consolation’s skin problem, either. Its nature remains uncertain — not readily identifiable as bacterial, fungal, allergic, or anything else he recognized. We discussed a biopsy but his opinion was that the liklihood of learning anything useful was minimal.
Instead, he put her on anti-inflammatories to keep her comfortable while the skin takes time to heal itself. No topicals, just time, since it appears the problem is capable of resolving on its own. Hopefully, now that the inflammation is down and the mystery problem has moved away from the saddle area, I’ll be able to start riding very soon.
Hopefully.
The Skinny: Details of Consolation’s Mysteriously Itchy Skin Issue
I swear it’s a curse. Every spring, I seem to have some issue that prevents me from participating in the season’s first endurance rides. This year it was Consolation’s mystery itch — the undiagnosed skin condition on her back that made her utterly unable to tolerate being ridden.
Well. I’m pleased to report that we finally (after 6 weeks of trying) seem to have reached resolution. I’m going to post the details of her symptoms and attempted treatments here in the hope that someone else will find it useful one day. Why? Because in all my googling — and believe me, I did a LOT — I found not a single condition whose description matched Consolation’s presentation.
Week 1: Horse restless under saddle, beginning with tail switching and refusal to maintain trot, escalating to bucking and head-slinging regardless of gait. Behavior persisted when ridden or in tacked-up in hand. Horse was obviously extremely itchy under the entire saddle area from withers to loin. No other symptoms. Attempted another ride next day with similar results. Horse unable to settle into any gait. Sweat pattern was wet on off side and dry on near side, apparently from horse traveling very crooked due to discomfort.
Treatement Attempt: At this point, the bucking/head-slinging/inability to maintain gait (which was completely new behavior for this horse) seemed more likely to be a pain issue than a skin condition. The itchiness, while intense, was believed secondary. Horse was adjusted by equine chiropractor, who is also her vet. Suggestion made and followed to back up toes and lower heels to improve foot and shoulder comfort. Decision made to postpone further conditioning until new, custom saddle arrived.
Week 2: Horse resting, still itchy when rubbed by handler, but not in apparent discomfort in paddock. No excessive rolling or scratching at liberty. Shedding winter coat appeared somewhat thinner over affected area, but not so obviously that it caused further concern.
Treatment Attempt: None.
Week 3: New saddle arrived and appeared to be an excellent fit. However, attempts to test ride resulted in same behavior, but worse. Skin still itchy but not heated or inflamed. No sign of flaking, leisions, bumps, bites, swelling, or alopecia, though coat did still appear somewhat thinner in affected area. (I realized later that the coat was not actually thinner, but was raised so it only appeared thin.) Use of shedding blade revealed that skin was dirty and oily from winter. During one bath, small bumps, like mosquito bites, were barely detectable on withers. These disappeared quickly and did not return.
Treatment Attempt: Bathed 2x on different days with Selsun Blue medicated shampoo (active ingredient pyrithione zinc). Soaked affected area daily with 50:50 Listerine:water dilute. The original, amber-colored Listerine has long been used as a home remedy for sweet itch (reaction to mites) and various skin fungi. All brushes and tack disinfected with bleach dilute after each use.
Week 4: Horse still itchy with thin-appearing (raised) hair over affected saddle area of back. Still unable to tolerate tack. Scraping with shedding blade after application of Listerine sometimes removes gray/black specks that seem moist. Uncertain whether these were dirt, dandruff, or insect-related.
Treatment Attempt: Continued with Listerine application. Double-dosed with Ivermectin in case issue was caused by lice or mites, though this did not appear to be the case. Dusted 3x on different days with livestock flea dust, also as precaution to cover the bases.
Progress: Horse’s discomfort appeared reduced (was less itchy when rubbed by handler, and behavior improved significantly on a test ride). I realized later that this was because the skin condition had mostly resolved along the topline, but had “slid” down the horse’s sides in a characteristic drip pattern. Discomfort resumed within a day.
Week 5: Topline now returned to apparent normalcy, with itchiness gone and haircoat no longer raised. However, new affected patches appeared lower along the sides and loin, as though the condition had dripped down in the same pattern that water would cascade off the back. These patches showed raised hair and swelling. After a couple days, they felt hot to the touch. Horse again unable to tolerate tack. Even saddle blanket causes extreme “cringe” reaction, particularly when horse is in motion. The inflamed patches appear increasingly more tender and less itchy.
Here’s what the coat looked like at this point. Note gray areas that appear thin, but are actually raised.
Treatment Attempt: Applied Vetricyn to affected area but saw no change over 2 days of repeated use. Following phone call with vet, began 2x daily applications of over-the-counter athletes foot creams. These come with various active ingredients and cost about $4 per o.5-oz tube. Over the course of several days, applied creams with broad-spectrum antifungals clotrimazole and tolnaftate with no apparent results except increased inflammation in affected areas. Switched to a third broad-spectrum antifungal, miconazole (found in over-the-counter vaginal yeast infection medication), as a last-ditch attempt before scheduling vet visit. Cost is similar at about $12 for 1.5 oz. Also added daily baths with medicated shampoo (active ingredient salycylic acid) and full-strength iodine rinses over affected and surrounding areas.
Progress: After 2 days of bath/iodine/miconazole treatements, inflammation and tenderness appeared reduced in area, but not intensity. After 4 days, inflammation and tenderness are nearly eliminated in both area and intensity. Inflammation is always lowest in morning, following iodine soak. Continue with iodine soaks 2x daily but eliminate baths (worried about overdrying skin; also, weather too chilly) and miconazole. Improvement continues. Affected area possibly weeps a little (iodine on the coat interferes with judgement here) and shows some black flecks again, just as the topline did shortly before returning to normal.
This morning, on Day 7 of iodine rinse treatement, no heat, swelling, itching, or other discomfort can be detected. Will continue treatment just in case and try saddling up tomorrow.
Lessons learned:
- I think the Listerine worked as well as the iodine.
- 2x daily treatment seems to have been important.
- Both iodine and Listerine took at least a week to resolve the issue.
- I should have treated a broader area to start with, in order to prevent spreading beyond the presently affected area.
- Mystery skin issues are really frustrating.
Dear Consolation: Next time you decide to cultivate a fungus, please select morels or truffles or something else worth selling to local chefs. Thank you.
UPDATE: It transpires that the skin issue was not resolved, after all. Details here.
Consolation is Better!
She’s not 100%, mind you, but she is much improved.
As a test this evening, I saddled her and lunged her for 20 minutes (in 80-degree heat, to get her sweaty since that seems to make the itch worse), then took her out for a few miles’ hack. She switched her tail a bit, and her trot was less than steady, but she didn’t feel the need for head-slinging and bucking every few strides.
Her back was still itchy, but nothing like it has been. If (and it’s definitely still a big IF), this progress continues, we might be able to go to Tough Sucker II next weekend, after all. Fingers crossed.
In other news, Acey and I had a nice ride in the hills today. We took it fairly slowly and soaked up a couple hours’ worth of sunshine over our 11 miles.
(Whoa, that photo looks terrible on my screen. I hope it looks better on yours!)
Scratch That
Well, I thought I had Consolation’s itching issue under control. She certainly seemed normal when brushed and worked from the ground. She still has no hives or bumps or scabs or leisons, just relatively thin hair over the affected area (not bald spots, but shorter and rougher haircoat).
And yet, yesterday’s ride revealed that she is clearly still very itchy — driven to distraction, in fact. She seems to want to move out, but can’t bear to trot more than a few strides without slinging her head around as if to whack a horsefly, or nearly bucking. She moves along with her back hunched up in discomfort It gets worse as the ride progresses (and the area gets warmer under her tack?), but the skin does not appear to change. The behavior continues whether I’m mounted or not.
Over the past month, I’ve tried anti-fungal shampoos, Listerine soaks, and livestock dust. I’ve double-dosed with Ivermectin and removed the only new item in her diet (Strategy). I’ve washed and triple-rinsed her tack and brushes. She already gets flax as part of her Show N Go supplement. She lives in the open air, has access to shelter, and is in a largely dry and sunny climate. Her skin doesn’t seem dry. I considered the season (estrous issues?) but she is obviously itchy, not just ouchy or grouchy.
I’ve scoured the internet for ideas and come up empty. Nothing seems to match her symptoms. I’m at the point of calling her vet again to see if he thinks a fungal culture or somesuch might be in order. On the one hand, I hate to fork over a few hundred bucks for a farm visit and lab tests, but on the other hand, I hate watching more time and endurance rides go by without being able to participate!
In the meantime, I am trying to let gratitude outweigh frustration. At least I have another horse to ride, and more beyond that to train, while we get this resolved.
But still, please please please, can’t we find a solution quickly?
Equine Back Data Collection Series
Saddle fitting has to be one of the most frustrating issues for any thoughtful equestrian. From endurance riders whose horses must carry them thousands of miles in a year, to dressage riders whose mounts must be comfortable enough to round over their backs, to casual riders who simply care about the comfort and behavior of their horses, we all face the same questions:
How, and how much, is a horse’s back likely to change over time? Do different body types change in different ways? Could we learn to predict changes within types? How much do bodyweight and level of fitness change a horse’s back over the course of a competative season? Over years? When is it safe to have a saddle fitted, or even custom-built, for an individual horse?
Right now, the answer is often: Nobody knows. Nobody has collected the data in a consistant format and documented their findings over time.
Jackie Fenaroli, owner of Stonewall Saddles, and I have decided to change that. Starting right here, at In the Night Farm, we’re going to collect data. We’ll use the card-fitting system I’ve introduced here before, and we’ll follow most of my Barbs as they grow, age, and compete. I’ll collect data monthly and create a chart to document our findings, and I’ll post periodic updates here at The Barb Wire.
NORTHWESTERNERS: If you attend the same rides I do and would like to volunteer your horse in exchange for his or her measurements, let me know. We’ll put your horse on a scaled-down version of the data collection program, measuring just a couple times annually, ideally at the beginning and end of the season. Measuring only takes about 15 minutes.
CALIFORNIANS: Stonewall Saddles will be at the Horse Expo in Pomona this weekend (Feb 2-4). They’ll be offering an Engineered Saddle Fit presentation each day, and will be giving away free Boomerangle kits to anyone who fills out a quick survey regarding saddle features for trail riders. I have one of these kits and it’s really handy for making quick assessments of whether a particular saddle is likely to fit a given horse.
100%
I rode Consolation on the flats Wednesday. There’s an unbroken stretch of irrigation canal that winds between cow-dotted BLM land and vast wheatfields, where the footing is good and there’s no traffic or downgrades or fences to distract us from pure, exhilirating effort. It was Consolation’s first test on familiar terrain since I returned her to work after her spring weirdness.
I’ve suspected for a couple weeks now that she is back to normal, but it was hard to evaluate given that we’ve been riding in such different environs. To be positive, we needed to ride in one of our old haunts. Conditioning-wise, we also needed the kind of long, brisk trot that we can’t always do out in the hills. Wednesday was the day.
I was a little nervous. What if she wasn’t better? What if the balky, jumpy, witchy mare from our last ride along the canal resurfaced? What if I was wrong, and we wouldn’t be ready for Cheap Thrills after all?
I needn’t have worried. Wednesday’s ride was the flight of spring all over again, complete with ducks, but without the muddy hide or rain. We blasted through 12 miles at 10 mph, and at the end Consolation was still full of air and offering speed. It was just the ride we needed.
So, what was her problem? It’s hard to be sure, because I was too interested in finding a solution to waste time being methodical and scientific. I tweaked several factors at once, at least some of which must have been the right ones. My best guesses:
- She was footsore. Most of a month off, with careful barefoot trimming and vigilance against thrush in the wet weather, followed by rides on trails instead of gravel, could have addressed this. Her hooves have certainly done some remodeling of late.
- She was marish and/or magnesium deficient. The more I think about it, the more I believe this was an issue. It helps explain why Consolation exhibited some similar behaviors last spring. After a month of magnesium supplementation, she is no longer cold-backed or girthy, and her attitude has improved dramatically. I also tried a sample of Mare Magic that I had sitting around, and she seemed to benefit. I’m now awaiting a shipment of bulk raspberry leaves from HerbalCom. (At $20 for a year’s supply, how can I go wrong?)
- She was bored. Consolation isn’t a huge fan of trailer rides, but she’s learning to relax, and she surely does seem more intersted in workouts when we use them to explore new trails.
Now, if only I can remember all this and apply it next spring, perhaps we’ll be all set.
Footsore?
The search continues…
I spoke with Consolation’s vet yesterday, initially to ask whether he thought we might learn anything useful from a blood panel. I described her symptoms, and we ended up focusing more on a different theory from my list: Pain. Specifically, hoof pain.
He remembered that, at about this time last year (when she had similar symptoms), Consolation seemed footsore when trotted out at a ride. I’ve been more careful this year, booting her for nearly every ride, but of course that isn’t foolproof. (For starters, sole bruising is only one kind of hoof pain.) Sore feet would certainly be consistent with Consolation’s tendency to stock up lately, as well as her slowness, balkiness, stiff back, and general lack of enthusiasm. Also, she’s been a little clumsy lately, tripping more than usual — a symptom I failed to mention before but another potential indicator of hoof pain.
Of course, hoof pain isn’t the only possible explanation. It seems to me that back pain could be responsible for all of the above symptoms, as well. Furthermore, let’s not forget to think in cycles and systems: Consolation could be dealing with multiple issues, each of which exacerbates the others.
I think I’ll take my vet’s advice, though, and have him take a look at Consolation’s feet. I love working with someone who knows endurance and knows my horse!
On another front, the magnesium supplement arrived yesterday. I hear it’s not uncommon to get results in a week or so. We’ll see.
Introduction: Equine Exertional Rhabdomyolysis Series
Friday evening. Mid-June. Consolation has enjoyed a two-week holiday following her 60-mile, top-ten finish at Owyhee Fandango. I’m excited to get back to riding. But, I’ve had a long day at work. I decide to loosen her up with a few minutes of liberty work in the round corral, then saddle up the following morning.
We start at the walk. Mosey along, do a few circles. Her behavior is typical. No cause for concern. I move her up to a slow trot, to continue warming up. A few rounds of the corral go by.
Wait a minute. Is she off? I squint at her hindquarters, her back, her head. Listen to her hoofbeats. Isn’t she a touch short-strided behind? If so, it’s subtle.
I ask for a faster trot, the better to judge possible lameness. She responds, but sluggishly. It’s hard to tell whether this is her signature energy-conserving attitude, or something more. At least, it’s hard to tell for another thirty seconds.
Then it becomes obvious. Something is very wrong.
Consolation’s spine hunches with discomfort. Her head rises, ears cocked back, alarmed. She tucks her tail between bunched hindquarters. And refuses to move.
Now I know what I’m dealing with. I’ve never seen it before, except from a distance when another horse is being treated at a vet check, but I’ve read enough to be sure.
Myositis. Exertional Rhabdomyolysis. Whatever you want to call it, Consolation is tying up.
Like many conscientious horse owners, I knew the basics of ER, including the fact that it remains a rather mysterious and poorly understood syndrome. All the same, as Consolation recovered, first at the veterinary hospital and then during a month’s layoff, I set about investigating what had happened, and why.
Over the next couple weeks, I’ll provide a series of posts detailing the questions I asked and the answers I complied from various resources both online and in print. Here are the questions we’ll explore:
- What is ER and how does it affect a horse’s body in the short and long term?
- What factors appear to predispose a horse to ER?
- How should a horse owner identify and respond to an episode of ER?
- How is ER diagnosed and treated by a veterinarian?
- How should a horse owner return a horse to work after an episode of ER, and what precautions can be taken to prevent initial or recurrent episodes?
Please remember that I’m neither vet nor expert. I’m just a bookish nerd who loves my horse and doesn’t want to sit out any more race seasons. Feel free to comment throughout the series with your own experiences or additional resources. I look forward to your insight. After all, ER is not uncommon in equine athletes. It pays to be informed.
Update & Answers
I received no call from the hospital last night, which means Aaruba is still holding steady or improving. I think it’s likely he’ll get a bit of Senior mash today. I’ll spend some time with him, take him for a couple walks, try to keep his mind quiet. Now that he’s feeling better, he could become a littler harder to manage, mentally, because of his dislike of confinement.
Some of you have wondered about how this misadventure will affect Aaruba’s stomach, considering his history of gastric ulcers. As part of the diagnostics for this colic, we scoped him and found no ulcers, which is good in and of itself. However, it means that the symptoms we’d been attributing to ulcers in the past couple months were caused by something else — something unknown and possibly more sinister. Anyway, to avoid recurrence of the ulcers, we’re had Aaruba on a maintenance dose of omeprazole (GastroGard) so he won’t have an overabundance of acid in his empty stomach.
Also, several people have asked me for an explanation of refluxing. I’m no vet, but here’s my layman’s explanation:
A horse’s small intestines secrete fluids to aid in the extraction of nutrients from feed. Normally, these fluids continue into the large intestines, where they are reabsorbed into the horse’s body. However, if a portion of the horse’s gut is obstructed and the fluids are unable to pass through, they back up into the stomach. A horse’s stomach has about a 4-gallon capacity, and a sphincter where it joins the esophagus prevents vomiting. In a horse with an obstructed gut, therefore, fluids with nowhere to go build pressure in the stomach and can cause it to rupture, which is fatal.
To relieve this pressure in a case like Aaruba’s (small intestine impaction, in which fluids excreted by the small intestine refluxed into his stomach), vets pass a tube down the esophagus to siphon off the excess fluid, relieving pressure and resultant discomfort. The process must be repeated every few hours if the horse continues to reflux, in order to protect the stomach until the obstruction can be eliminated. Diagnostically, of course, refluxing is an indicator that the gut is indeed obstructed; that’s why it was concerning that Aaruba refluxed a little yesterday afternoon, though he had not done so several hours before.
Okay, I’m off to try to eat some breakfast and visit Aaruba. Many, many thanks for all your comments and emails and blog posts of support as we continue through this ordeal. They mean more than I can say.
Bad News
FRIDAY MORNING UPDATE: No call from the vet last night, which is good news. They’d have let me know if Aaruba had turned for the worse. That’s all I know at the moment…thanks so much for all your messages of hope and support. Keep jingling!
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Aaruba is in the hospital. We checked him in at 11:00 last night with mild, persistent colic symptoms that reminded me too much of his near-fatal impaction in October 2007. Everything is the same this time, only we caught it sooner, and he’s not improving at the same rate as before.
He appears to have a small intestine impaction, which my vet tells me is unusual in our area. Even more unusual is the fact that his heart rate is normal (32 bpm) and his pain is mild. He’s passed some manure, but he also refluxed 4 gallons a couple hours ago. Surgery is not an option due to poor prognosis for success, given his history. Everything points to some kind of flaw in his intestine, an adhesion or similar, that has persisted for years now and causes occasional, serious problems. Even if he makes it through this time, the underlying issue will remain.
All we can do is keep him on IV fluids and try a drug to enhance intestinal motility. Typically, the drug is contraindicated in cases where an impaction already exists, and you probably wouldn’t want it in a horse that might go to surgery, but we’re running out of options. I’ll be honest with you: this looks very bad.
As they say on the Chronicle of the Horse forums, start jingling.
Q & A: Aloe and MSM for EGUS
Thanks for all your enthusiasm over Aaruba’s improved health! You all asked enough good questions about Saturday’s post about Aloe and MSM for equine gastric ulcers that I decided to answer them here:
For what does MSM stand?
MSM is the abbreviated name for Methylsulfonylmethane, a naturally derived sulphur product with anti-inflammatory properties. The bitter, white substance is frequently used to treat joint problems in equines, as well as other animals and humans. Some believe it may also enhance the curative benefit of aloe or other substances by increasing absorption through enhanced circulation. While a vast array of curative benefits are attributed to MSM (everything from arthritis to ulcers appears on the many lists available online), all are related in some way to inflammation or circulation.
From where did I order my pure aloe gel?
Imedmart.com sells Lily of the Desert aloe products for $15.42 per gallon, which will last two weeks if fed at a rate of 1 cup daily. They offer $5.95 flat-rate shipping.
From where did I order my human-grade MSM?
Kala Health sells MSM in 1-pound, 10-pound, or larger bulk quantities. A 10-pound bucket sells for $139.00, and shipping is free in North America. They offer MSM in powder or course flakes, with or without 0.1% silicon dioxide to prevent clumping. I selected the non-clumping powder, which dissolves quite easily. The flavor is mildly bitter, but I find that 1/2 tsp dissolved in a 1/4 cup of cranberry juice (for my own consumption) is almost undetectable. Aaruba doesn’t object to 1 Tbs mixed into a pound of soaked beet pulp.
How did Aaruba get ulcers to begin with?
Causes of equine gastric ulcer syndrome are myriad. We can’t be sure, but my vet believes it is likely Aaruba’s ulcers were secondary to a serious impaction colic that kept him off feed and highly stressed for several days in October 2007. The problem went undetected until it was exacerbated by the increased stress of endurance conditioning and competition in summer 2008.
Got more questions? Bring ‘em on — I’ll do my best!
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Related Posts
Introduction: Equine Gastric Ulcer Series
Strategies for Prevention of Equine Gastric Ulcer Syndrome
Pharmaceutical and Alternative Treatment Options for EGUS
Equine Ulcer Supplement Options
EGUS, Endurance, and the AERC
A Fair Question: Equine Athletes, Equine Ulcers
Bringing it Home: EGUS Prevention at In the Night Farm
Sheer Brilliance: Aloe and MSM as Alternative Therapy for EGUS
The Good Bad News: Gastric Ulcers in Equines
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Sheer Brilliance: Aloe and MSM as Alternative Therapy for Equine Gastric Ulcer Syndrome
“He just keeps getting better and better,” I told Travis when he met me on the driveway. “I can’t remember the last time Aaruba had so much energy!”
(Actually, I can. It was this ride. But that was different — a special kind of ride that comes unplanned and unbidden, like dreaming of a long-lost love.)
Today’s was just a standard conditioning ride of 21 miles along the agricultural roads that spin their web around In the Night Farm. Impending rain sapped color from the landscape and hemmed the horizons with clouds. Yes, the weather was dull…but Aaruba was not. He was the horse I remember from the pre-ulcer days, my Arabian dragon set loose to conquer the world. Like the dream-walking lover, I’d all but forgotten him.
In the last post of my Equine Gastric Ulcer Series, I mentioned that I was planning to try an alternative ulcer therapy should Aaruba’s minor ulcer symptoms persist despite 60 days’ treatment with GastroGard and a rigorous preventative program. Though much improved, Aaruba’s minor “colic” symptoms did continue to manifest themselves periodically throughout November and December. He occasionally displayed reluctance to canter and a tendency to spook unnecessarily. Most subtle and frustrating of all was his continued lack of the perfect brilliance I used to know.
And so, exactly three weeks ago, I decided to give my alternative EGUS therapy a whirl. I’ve been mixing 1 tablespoon of pure, human-grade MSM and 1/2 cup of high-quality aloe vera gel into Aaruba’s beet pulp twice daily. That’s it.
Within three days, every ulcer symptom disappeared, and I haven’t seen them since. No more mild colics that resolve with a dose of equine antacid. No more pinned ears and bucks. No dosing with antacids every hour during workouts. No spooking, unless you count the playful variety that’s good for a mile of full-on, 18-mph trot. And with every ride, another notch up in energy and enthusiasm. Aaruba blasted through today’s ride so “fit to continue” that I think we could have finished a slow 50 despite the toll winter has taken on our conditioning schedule.
A few details:
1) Yes, the human-grade MSM is important. As Carla of Focus Equine explained to me, animal-grade products vary by huge percentages from their labels; human-grade products must actually contain the ingredients they claim. Human-grade MSM is considerably more expensive than the products marketed for equines, but take the time to shop around. I found it for $14.00/pound in a 10-pound bucket.
2) I also ordered gallon-sized jugs of high-quality, pure aloe gel. You can’t get this stuff at Walmart, but at $15 per gallon, the price isn’t ridiculous. At the rate I’m currently feeding it, the aloe & MSM treatment adds up to a whopping $2.00 per day. (Compare that to $28.00 for a full tube of GastroGard, or $7.00 per day for the preventative dose.)
3) No, of course this isn’t scientific. Although Aaruba was scoped in August and diagnosed with gastric ulcers, he has undergone a variety of treatments since, and I haven’t had him re-scoped to prove that his more recent “ulcery” behavior was, in fact, caused by ulcers.
4) Furthermore, I haven’t taken Aaruba off the aloe and MSM regimen yet, so it remains to be seen whether its apparent effect is an actual cure (!) or merely a remarkably soothing paring of feed additives. We’ll know soon enough: MSM is an AERC banned substance, so when competition season rolls around, the aloe is on its own.
5) Finally, my thanks to Brad with Performance Animal Nutrition for putting me onto the aloe and MSM idea to begin with.
6) Welcome back, Hot Stuff. Now, settle down, will ya? 
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Related Posts
Introduction: Equine Gastric Ulcer Series
Strategies for Prevention of Equine Gastric Ulcer Syndrome
Pharmaceutical and Alternative Treatment Options for Equine Gastric Ulcer Syndrome
Equine Ulcer Supplement Options
EGUS, Endurance, and the AERC
A Fair Question: Equine Athletes, Equine Ulcers
Bringing it Home: EGUS Prevention at In the Night Farm
Q & A: Aloe and MSM as Alternative Therapy for EGUS
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Bringing it Home: Equine Gastric Ulcer Management at In the Night Farm
I started this series on Equine Gastric Ulcer Syndrome in an effort to help my ulcer-prone endurance horse.
Diagnosed over the summer with multiple, bleeding ulcers (probably the result of an impaction colic that kept him off feed for several days last fall, combined with his highly emotional nature), Aaruba has benefited from two, 30-day courses of GastroGard and the attentions of a team of excellent vets who are very experienced not only with regard to internal medicine, but in the sport of endurance as well.
Four months after diagnosis, Aaruba’s condition is dramatically improved. He has put on weight and cleans up an astonishing quantity of feed. He has plenty of energy, a healthy coat, and a gleam in his eye. His bare feet are healthier than ever, his post-workout recoveries excellent, and our endurance goals for 2009 look achievable indeed.
All the same, I’m not about to let down my guard. Gastric ulcers have no respect for the thousands of dollars horse owners pour into Merial’s pockets. GastroGard may allow ulcers to heal, but it doesn’t prevent them from recurring…unless you can continue to administer a small, daily, $8.00 dose. Considering that the effect of long-term omeprazole use is unknown, and that omeprazole is listed by the AERC as a banned substance, endless GastroGard treatment isn’t a practical option in Aaruba’s case, price tag notwithstanding.
I’ve explored my options and settled upon the following routines for preventing EGUS here at In the Night Farm:
- I keep feed in front of the horses as much as possible. Constant access to feed appears to be the single, most important factor for prevention of EGUS.
- All horses receive some alfalfa in their diet, as it is believed that alfalfa’s calcium content has a buffering effect on gastric acid.
- Horses are never worked on an empty stomach. If the horse I plan to ride hasn’t finished a meal recently, I offer half a flake of alfalfa to munch while grooming and tacking up. There was a time when I would never have considered doing this, fearing it would encourage poor manners. However, there is an undeniable advantage to making endurance prospects comfortable with eating during saddling — and expectation of imminent snacks makes the horses even happier about being caught than they were before.
Having proved himself prone to EGUS, Aaruba enjoys some additional, preventative measures:
- He has grass hay in front of him 100% of the time, except during workouts that total approximately 5-6 hours per week.
- He receives daily probiotics to promote general intestinal health. Right now, I’m using GUT, which is sold as an ulcer preventative containing probiotics. When the GUT runs out, however, I’ll be switching to Fastrack because it contains a broader spectrum of pre- and probiotics.
- About 40 minutes before tacking up for a workout, I give Aaruba a large flake of alfalfa. 10 minutes before tacking up, he receives a pound of beet pulp (soaked) mixed with an ounce of U-Guard, a powdered antacid product. This ensures that his stomach is full and buffered when we begin work.
- Every hour during workouts, I dismount to administer a 1-ounce dose of Pro CMC, a liquid antacid, to keep Aaruba’s stomach buffered.
- During long rides, we pause halfway for five or ten minutes of grazing, as a full stomach is less likely to be damaged by sloshing acid.
- To deal with the high-strung mentality that contributes to Aaruba’s tendency to develop ulcers, I also have him on a maintenance dose of a product called Focus Equine. Neither drug nor herb, this powder is a vitamin/mineral blend that simply quiets Aaruba’s emotions without tranquilizing or dulling him. I know, I know. It sounds like snake oil…but it works, and the company is fantastic to work with. Talking to the owner is like calling an old horsey friend. I haven’t encountered such personal service in years. (By the way, if you check it out and decide to try Focus Equine, be sure to say I sent you. After buying all that GastroGard, I could really use the referral discount!)
So, is my ulcer prevention routine working?
Mostly. Though Aaruba’s appetite and energy level have returned to normal, he does sometimes show reluctance to canter and a tendency to shy at objects that normally wouldn’t faze him — both possible ulcer symptoms on which I’m keeping a careful eye.
I have a stock of high-quality aloe and human-grade MSM on hand, too, should I determine Aaruba needs some extra support to fend of ulcer recurrance. Yes, it’s an alternative therapy…but if 60 days of GastroGard didn’t fully resolve the ulcers, I’m ready to try something else.
I also have my eye on Stomach Soother, a papaya puree reputed to have great benefit in relieving EGUS symptoms. Because traditional antacids usually contain AERC banned substances and have some undesirable side effects when used long-term, I will try replacing Aaruba’s U-Guard and Pro CMC with Stomach Soother in the near future.
EGUS prevention is a long-term chore requiring careful observation, ongoing research, and experimentation to determine what works for each, individual horse. I’m certainly not done tweaking my routines — but my hopes are high that when the 2009 endurance season rolls around, Aaruba’s stomach will be ready for it.
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Related Posts
Introduction: Equine Gastric Ulcer Series
Strategies for Prevention of Equine Gastric Ulcer Syndrome
Pharmaceutical and Alternative Treatment Options for EGUS
Equine Ulcer Supplement Options
EGUS, Endurance, and the AERC
A Fair Question: Equine Athletes, Equine Ulcers
Sheer Brilliance: Aloe and MSM as Alternative Therapy for EGUS
Q & A: Aloe and MSM as Alternative Therapy for EGUS
The Good Bad News: Gastric Ulcers in Equines
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A Fair Question: Equine Athletes, Equine Ulcers
In response to yesterday’s post regarding EGUS, Endurance, and the AERC, Lori at The Skoog Farm Journal courageously posted the following:
I’m sure that this comment won’t be very popular, but if people know that there is a good chance of horses suffering from this gastric problem, why are these animals pushed to that extent? They are living things, not machines. What is wrong with moderation? I have watched many people in the Dressage World push their horses until they break down…and dump them. All for the glory of the person at the expense of the animal. Why do we do this?
In other words, is it morally acceptable to engage our equine partners in rigorous athletic competition, such as endurance riding, knowing full well that doing so adds a risk factor for EGUS?
It’s a fair question, one I’ve considered at length throughout my research on Equine Gastric Ulcer Syndrome (EGUS). I believe it’s worthy of further discussion.
Note that Lori includes sports other than endurance in her question. She is right to do so; in fact, 60% – 90% of performance horse across all disciplines appear to be affected by gastric ulcers. Endurance seems to fall on the lower end of this range; all the same, 67% represents a lot of horses.
The question grows more complex when we consider that not only performance horses are affected. In fact, nearly all domestic horses are at risk, and as little as an hour’s training per day can result in ulcer formation. Furthermore, a great many ulcer cases are asymptomatic, apparently causing no distress to the horse.
Moderation is, as Lori suggests, an option…but it still won’t solve the problem. Simply stalling a horse, or failing to keep hay in front of him, or administering frequent doses of bute to relieve pain from other medical problems, can result in EGUS (and a host of other ailments). Equines ranging from old schoolies to greenies just starting under saddle are at risk.
To eliminate EGUS, we would have us give up horsekeeping altogether. However, turning our horses loose in the Nevada desert to be rounded up by the BLM and sent to slaughter seems an imperfect solution. (Ahem. Shall we avoid a slaughter debate, please? If you want to discuss that issue, make tracks to the nearest online horse forum and knock yourself out.)
So, should we compete in equine sports? Should only those individuals who can provide 20 acres of quality pasture per horse be allowed to keep them…and ride them only lightly, if at all? Is there an acceptable middle ground? Where do you draw the line, and why?
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Related Posts
Strategies for Prevention of Equine Gastric Ulcer Syndrome
Pharmaceutical and Alternative Treatment Options for Equine Gastric Ulcer Syndrome
Equine Ulcer Supplement Options
EGUS, Endurance, and the AERC
Bringing it Home: EGUS Prevention at In the Night Farm
The Good Bad News: Gastric Ulcers in Equines
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EGUS, Endurance, and the AERC
Intense physical conditioning. Consumption of feed concentrates. Long trailer rides. Frequent change of venue and companions. Is it any wonder that equine endurance athletes are prone to the development of Equine Gastric Ulcer Syndrome?
Obviously, the stress of travel and competition can scarcely be avoided in the life of an endurance horse. Furthermore, although exercise is known to promote beneficial intestinal motility, prolonged exercise — particularly at a canter and/or on an empty stomach — can result in ulceration due to splashing of gastric acid onto the non-glandular portion of the stomach. Prolonged exercise also draws blood circulation away from the stomach and stimulates acid production, further increasing risk of ulcer formation, and the electrolytes many endurance riders administer to ward off metabolic problems may exacerbate existing ulcers [Holbrook, et al, 2005].
It is possible that many of the mild colics experienced in association with endurance racing are actually caused by gastric ulcer pain, not impactions or gas. Fortunately, no major blood loss seems to occur as a result of EGUS in endurance horses, and I found no evidence that gastric ulcers may perforate the wall of the stomach or otherwise result in equine fatality.
Little research exists on EGUS in endurance horses because race day isn’t conducive to endoscopy, which requires 12-18 hours of fasting followed by sedation. However, a 2003 Pride Project research study of 140 endurance horses indicated that 51.09% of the participating horses had gastric ulcers. A study by J.E. Neito, published in 2004, found that 67% of the endurance horses tested suffered from EGUS. Both studies concluded that endurance horses tend to have milder cases of EGUS than are commonly suffered by Thoroughbred racehorses. Neither study indicates a percentage of afflicted horses that is dramatically out of line with the 60% incidence of EGUS in performance horses across the spectrum of disciplines.
Though a substantial percentage of equine endurance athletes suffer from EGUS, omeprazole — the drug most recommended and proven to cure and prevent gastric ulcers — is banned by the AERC. Considering that omeprazole is not considered to be performance enhancing, and that the AERC actively promotes the welfare of horses participating in the sport of endurance, omeprazole’s presence on the prohibited substances list may seem incongruous.
In 2005, the AERC issued a letter expressing its reasons for prohibiting the use of omeprazole during endurance competition. The letter is included in its entirely in the minutes from the June 27, 2005 meeting of the AERC’s Board of Directors. An excerpt is quoted below:
After much discussion of the benefits and drawbacks of such a modification, the veterinary committee has come to the decision not to recommend a modification of the current drug rules to allow the use of omeprazole while competing.
This decision is based on several factors:
1) Allowing the use of a testable drug during competition is a far deviation from AERC’s long-standing policy of absolutely opposing the presence of drugs during endurance ride competition.
2) The reasoning for allowing omeprazole during competition could, and we anticipate will, be used for other existing drugs such as anti-inflammatory agents. For example, flunixin (Banamine) certainly has beneficial, protective effects in the horse and is not considered performance enhancing in the normal horse.
3) The affects of long-term use of omeprazole are not known and the veterinary committee will not recommend nor endorse off label (very long term) use of the drug.
4) Horses symptomatic for gastric ulcers should not be competing.
An article by Marcia Smith, DVM, published in the October 2008 issue of Endurance News, the AERC’s monthly publication, included a recommendation that horses be given maintenance doses of GastroGard (omeprazole) for four days preceding a competition. The last dose must be administered at least 24 hours prior to the start of the competition to comply with recommended withdrawal times in Appendix E of the AERC’s drug rule.
According to its manufacturer, Merial, GastroGard’s beta blocking effect lasts only 24 hours. Because an endurance competition officially begins upon pre-ride vetting, which usually takes place the evening before the ride itself, it seems unlikely that Smith’s recommendation would benefit an endurance horse during a race, though of course there is value in lowering stomach acidity during travel to the ride venue.
AERC publications recommend that horses with gastric ulcers (at least, those that are symptomatic) be voluntarily suspended from competition. Preventative measures such as frequent feeding of roughage and application of antacids during stressful circumstances are encouraged, though the ingredients in some antacid products marketed for use in horses are also on the AERC’s prohibited substances list. Sucralfate is specifically listed as a permitted substance in Appendix C of the AERC’s drug rule, and may be beneficial in easing the discomfort of an endurance horse suspected of having gastric ulcers.
It seems that, if we wish to participate in endurance riding (or almost any equine sport), our horses are more likely than not to suffer some degree of gastric ulceration. We must, therefore, either choose not to participate — perhaps even to avoid domestic horse keeping altogether! — or else commit to doing our best to prevent the onset of EGUS, cure it when possible, and manage symptoms as necessary to keep our equine partners comfortable and content.
The final post of this series will cover the specifics of how I have chosen to deal with the subject of EGUS right here at In the Night Farm.
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Related Posts
Introduction: Equine Gastric Ulcer Series
Strategies for Prevention of Equine Gastric Ulcer Syndrome
Pharmaceutical and Alternative Treatment Options for EGUS
Equine Ulcer Supplement Options
A Fair Question: Equine Athletes, Equine Ulcers
Bringing it Home: EGUS Prevention at In the Night Farm
Sheer Brilliance: Aloe and MSM as Alternative Therapy for EGUS
Q & A: Aloe and MSM as Alternative Therapy for EGUS
The Good Bad News: Gastric Ulcers in Equines
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Equine Ulcer Supplement Options
Next time you’re in the mood for a challenge, try selecting an ulcer supplement for your horse. Scores of products litter the marketplace, many boasting glowing testimonials and some backed by a bit of research. Anecdotal evidence suggests that what works for one horse may not work for another. Therefore, if you seek to control ulcer symptoms in your horse or prevent the development of EGUS, you may be doomed to a long treasure hunt. This post will provide a map to help you get the lay of the land.
Ulcer supplements tend to fall into three categories: antacids, digestive aids, and natural alternatives. Supplements are available in a variety of forms. Pastes and liquids may be administered even to a horse that is off feed, while powers, pellets, and granules are easily mixed with mashes or concentrates.
Antacids
Antacids reduce the pain that occurs when stomach acid irritates nerves in the stomach lining by “buffering,” or raising the pH of the stomach environment to reduce its acidity. Most antacids employ calcium carbonate, magnesium hydroxide, or aluminum hydroxide as their active ingredients.
Although antacids do effectively reduce stomach acidity, their effect appears to be very short term (an hour or less) unless the dosage is higher than 240 milliliters, or approximately 8 ounces. The standard, recommended dose of equine antacids is 1-2 ounces.
Antacids are most effective when administered frequently (at least 4 times daily) and immediately preceding exercise. Their true benefit may be in relieving ulcer pain long enough to allow a horse to eat in comfort. The natural reduction in stomach acidity as a result of forage consumption then promotes additional eating, beginning an upward spiral.
Unfortunately, long term antacid use is not without risk. Many antacid supplements include magnesium, which retards calcium absorption. Because calcium deficiency can cause bone and muscle weakness and even aberrations in heart rhythm, this possibility bears particular consideration for equine athletes. Additionally, antacids may reduce the effectiveness of other oral medications by interfering with absorption; they may also affect normal urinary excretion of certain drugs.
Below are notes on several of the most common equine antacids:
U-Guard – Available in powder or pellet form. Mixed anecdotal reviews on effectiveness and palatability. Approximate cost: $15/month for powder or $30/month for pellets.
NeighLox – Available in pellet form. Mixed anecdotal reviews on effectiveness and palatability. Approximate cost: $95/month.
Pro CMC – Available in liquid form. Limited but positive anecdotal reviews on effectiveness when administered by oral syringe before exercise. Approximate cost: $30/month.
Digestive Aids
“Digestive aids” is a catch-all term for products reputed to improve general intestinal health. Some of these products claim to reduce ulcer symptoms or prevent ulcers; others are not labeled as ulcer supplements but boast anecdotal support for their positive impact on EGUS.
Probiotics – Probiotics are live microbes that exist naturally in the digestive tract. As beneficial bacteria, they are thought to promote health by suppressing the growth of unfriendly bacteria, improving the immune function, and enhancing the protective barrier of the digestive tract. Daily stressors, particularly in an emotional or hardworking horse, can upset the natural, bacterial balance of the gut. Probiotic supplementation attempts to stabilize friendly microbe populations through frequent ingestion of live or freeze-dried organisms. Clinical proof of the effectiveness of probiotic supplementation in soothing equine gastric ulcers is limited, though anecdotal evidence abounds.
L-Glutamine – L-Glutamine is an amino acid, one of the building blocks from which proteins are constructed, and among its primary functions is the nourishment of cells in the protective lining of the digestive tract. Although L-Glutamine is generally considered non-essential, that is, a normal body produces it in sufficient quantity, evidence suggests that an equine under stress (including travel, illness, athletic conditioning, disrupted social environment, etc.) may require dietary supplementation.
Digestive Conditioners – A variety of products market themselves as digestive conditioners. Most of these products combine fiber, probiotics, and amino acids in an effort to improve overall digestive health, including, in some cases, the easing or prevention of EGUS. Other ingredients may include polar lipids (fats that protect intestinal lining), threonine (an essential amino acid necessary for the production of protective mucus), and various immune system stimulants.
Below are notes on two of the most common equine digestive aids:
G.U.T –Ulcer supplement containing L-Glutamine, probiotics, and more. Available in powder and paste form. Mostly positive anecdotal reviews on effectiveness and palatability. Approximate cost: $20/month.
Succeed – Digestive conditioner containing L-Glutamine, probiotics, soluble fiber, and more. Advertised as all natural. Available in granular and paste form. Mostly positive anecdotal reviews on effectiveness; mixed anecdotal reviews on palatability. Approximate cost: $100/month.
Natural Alternatives
Gastric ulcers are nothing new, and many natural substances have been used for centuries to soothe and protect ulcerated stomach lining. Research on the effectiveness of these substances is limited, just as with antacids and digestive conditioners, but a great many individuals swear by them.
Below are notes on some of the most common natural ulcer supplements:
Seabuckthorn berries – Reportedly provides benefits including improved mental focus, enhanced digestive health, and bolstered immune system. The equine product Seabuck Complete is available in liquid form. Approximate cost: $80/month.
Papaya juice – Reportedly increases production of protective mucous in the gut, resulting in improved appetite and reduction of ulcer pain, diarrhea, and cribbing behavior. The equine product Stomach Soother is available in liquid form. Approximate cost $50/month.
Slippery elm bark, aloe, MSM, okra, and chamomile, previously discussed in this post, may also be used as natural ulcer supplements.
The Conclusion
There is no simple answer to the question of which ulcer supplement will work for any given horse. Research on the subject is limited and inconclusive, and results are so highly individualized that your only recourse is likely to be trial and error. I recommend testing one supplement at a time and taking careful notes on your horse’s attitude, appetite, and behavior as you determine the most appropriate regime for his well-being.
As you make your selections, bear in mind that some ulcer supplements contain substances banned by various sanctioning bodies, including the American Endurance Ride Conference (click here to view the AERC’s prohibited substances list). The next post in this series will further explore the AREC’s position on EGUS in endurance horses.
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Related Posts
Strategies for Prevention of Equine Gastric Ulcer Syndrome
Pharmaceutical and Alternative Treatment Options for EGUS
EGUS, Endurance, and the AERC
A Fair Question: Equine Athletes, Equine Ulcers
Bringing it Home: EGUS Prevention at In the Night Farm
Sheer Brilliance: Aloe and MSM as Alternative Therapy for EGUS
Q & A: Aloe and MSM as Alternative Therapy for EGUS
The Good Bad News: Gastric Ulcers in Equines ______________________________________________
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Pharmaceutical and Alternative Treatment Options for Equine Gastric Ulcer Syndrome
What treatments can effectively cure equine gastric ulcers? For too many horse owners, that is the $64,000 question — almost literally, it seems! To make matters worse, attempts to answer the question are often rife with controversy. Below is an introduction to the most common pharmaceutical treatments, as well as some natural alternatives.
Omeprazole
Omeprazole is a proton pump inhibitor that halts the production of stomach acid, allowing ulcerated tissue to heal. Omeprazole’s key weakness is its susceptibility to rapid destruction by gastric acid. This means that omeprazole will be most effective if administered in conjunction with ingredients that protect the drug long enough to permit its absorption into the bloodstream. Omeprazole is available in a variety of forms:
GastroGard and UlcerGard — These Marial products are formulated specifically to ensure the desirable absorption of omeprazole by the equine body . The prescription version, GastroGard, boasts a body of research proving effectiveness in curing equine gastric ulcers. Non-prescription UlcerGard is labeled as a preventative and is therefore subject to less rigorous research and inspection than its Rx twin, but it appears the contents of the tubes are indeed identical; only the recommended dosages differ. Unfortunately, at $30 or more per dose, a month or more of treatment is beyond the reach of many a horse owner’s pocketbook.
Prilosec — This human form of omeprazole does not contain the necessary protective carrier and is, therefore, ill-suited to use in equines. However, anecdotal evidence suggests some horses have enjoyed at least some benefit from the administration of Prilosec.
Compounded omeprazole — Compounded medications consist of a mixture of ingredients, presumably combined with a particular effect in mind. Compounded omeprazole, therefore, includes some omeprazole in combination with other ingredients. The actual quantity of omeprazole in such compounds varies widely – some say omeprazole may comprise anywhere from 20% to 90% of the compound – and this variation would seem to account for the diversity of results achieved through its use. Though available for about one tenth the price of GastroGard, compounded omeprazole may not permit bioavailability of the critical drug, and it may not be shelf stable.
The results of a University of California, Davis, study indicate that GastroGard is more effective than compounded omeprazole for curing equine gastric ulcers and preventing their recurrence. Some have questioned the validity of this research, saying it is limited, flawed, and influenced by Merial as a funding source.
Long-term, low-dosage use of GastroGard/UlcerGard is frequently recommended for prevention of EGUS recurrence in ulcer prone horses. Aside from the financial burden of such a regimen ($7-$10 USD per day), however, it bears remembering that horses produce gastric acid for a reason. Stomach acid aids in the breakdown of dietary protein and destroys potentially harmful bacteria. Protracted suppression of stomach acid, therefore, may result in inefficient use of dietary protein and/or predispose the horse to stomach tract infections. In humans, long term acid suppression leads to poor absorption of Vitamin B12; this may or may not be a factor in equines.
Sucralfate
Administered orally in the form of pills dissolved in water to form a paste, sucralfate adheres to existing gastric ulcers, reducing pain and continued deterioration. However, it has no proven curative effect, and because it adheres only to ulcerated tissue, it will not serve as a preventative for horses that do not already have ulcers.
Ranatidine
Ranitidine is a histamine receptor antagonist that suppresses acid secretion but does not block acid production. It is somewhat effective for curing equine ulcers and is considerably cheaper than GastroGard, but must be administered every 8 hours and is only effective if training is suspended for the duration of treatment. For these reasons, ranitidine is typically rejected as impractical.
A 2005 study at Murdoch University in Australia indicates that ranitidine is less effective than omeprazole at curing EGUS.
Alternative Treatments
The internet is rife with anecdotes touting the effectiveness of various alternative cures for equine gastric ulcers. Unfortunately, research to support such claims is sadly lacking. Below are links to a few options, some of which are presented in an alarmingly pseudoscientific manner, but all of which have their own contingent of proponents:
Okra Pepsin E3
Chamomile tea and slippery elm bark powder
Aloe , sometimes in combination with MSM or slippery elm bark
Certainly chamomile, aloe, and slippery elm all have ancient reputations as soothing substances. Both slippery elm bark and okra form a mucilaginous gel reputed to calm and protect the stomach lining. Chamomile has long been used as an anti-inflammatory antibacterial agent, thanks to the natural chemical chamazulene; it also contains A-bisobal, which is believed to hasten the repair of damaged tissues. Methylsulfonylmethane (MSM), a naturally derived sulpher product with anti-inflammatory properties, is frequently used to treat joint problems in equines; some believe it may also enhance the curative benefit of aloe or other substances by increasing absorption through enhanced circulation.
All these alternatives appear to be low risk, and anedcotal evidence suggests that they may have at least some efficacy in horses with EGUS. For details, consult your local witch doctor.
The Conclusion?
Draw your own. When Aaruba was diagnosed with ulcers, I followed my vet’s recommendation to administer a full course of GastroGard. Its positive effect was obvious after only five days, but when the 30-day treatment ended, the ulcers recurred almost immediately. Others report more complete success with GastroGard, and still others say compounded omeprazole or alternative treatments benefited their horses. The choice is up to you, your vet, and your bank account.
Regardless of how you treat them, chance are you’ll need to take steps to prevent recurrence of EGUS. The next post in this series will compare a variety of supplements billed as ulcer preventatives.
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Related Posts
Introduction: Equine Gastric Ulcer Series
Strategies for Prevention of Equine Gastric Ulcer Syndrome
Equine Ulcer Supplement Options
EGUS, Endurance, and the AERC
A Fair Question: Equine Athletes, Equine Ulcers
Bringing it Home: EGUS Prevention at In the Night Farm
Sheer Brilliance: Aloe and MSM as Alternative Therapy for EGUS
Q & A: Aloe and MSM as Alternative Therapy for EGUS
The Good Bad News: Gastric Ulcers in Equines
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Strategies for Prevention of Equine Gastric Ulcer Syndrome
“Expensive horse,” said my vet, passing a rueful gaze over Aaruba as he drowsed in the stocks, still half-tranquilized after his annual dental float. It wasn’t routine work like this that made him expensive, though. It was his gastric ulcers.
Aaruba’s Equine Gastric Ulcer Syndrome (EGUS) has cost me over $2,000 over the past two months. Endoscopy, GastroGard, sucralfate, extra feed, more GastroGard, Doxycycline, ulcer supplements… Expensive horse, indeed.
Sadly, Aaruba’s condition is not unusual. Evidence abounds that at least 60% of performance horses across the spectrum of breeds and disciplines suffer from some degree of gastric ulceration. Many cases are asymptomatic, others manifest themselves in subtle shifts in performance or behavior, and some go so far as to cause anorexia and recurrent, mild colic.
Trust me, you don’t want to go through ulcer treatments for your horse if you can avoid it. If you’ve already been through treatment, you most certainly don’t want to do it over. So, what strategies can you apply to prevent equine gastric ulcer formation or recurrence?
Free feed hay: An empty stomach is an acidic stomach, and an acidic stomach is prone to ulceration. Horses on pasture or allowed unlimited access to grass hay are at lower risk.
Limit or eliminate grain in the diet: Grain promotes the production of the hormone gastrin, which in turn stimulates increased production of stomach acid. Research indicates that the bacterial fermentation of concentrated carbohydrates releases volatile fatty acids that contribute to rapid ulcer formation. Additionally, horses produce less saliva when eating grain when eating hay; this is significant because saliva works to neutralize stomach acid. Some experts recommend that, if you must feed grain, quantities be limited to one pound per feeding; ideally, the calories your horse currently receives from grain should be replaced with fats such as corn oil.
Similarly, don’t make a practice of feeding soaked hay: A horse consuming soaked hay doesn’t need to produce as much acid-buffering saliva as a horse consuming dry hay, and therefore has a more acidic gastric environment.
Include alfalfa in the diet: Alfalfa’s calcium content acts as a buffering agent in the stomach. Unfortunately, excess calcium is also associated with synchronous diaphragmatic flutter, or “thumps,” during protracted exercise. Furthermore, alfalfa has a high protein content (up to 20% or more), and excess protein is known to increase risk of metabolic problems such as azoturia, or “tying-up syndrome.” For these reasons, endurance riders must balance the risks and benefits of feeding alfalfa, taking steps to balance the diet appropriately. In most cases, two or three pounds of alfalfa hay daily is acceptable.
Avoid exercising a horse on an empty stomach: The upper, non-glandular portion of a horse’s stomach does not produce acid and is not meant to contain acid; it lacks the protective coating that is present in the lower, glandular portion of the stomach. Experiments using an endoscope demonstrate that exercise on an empty stomach allows acid from the glandular portion of the stomach to splash the non-glandular portion, contributing to ulceration. The presence of food in the stomach creates a floating mat or paste that reduces splashing and resultant irritation.
Avoid long-term or frequent NSAID use, if possible: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone (bute) and flunixin meglumine (banamine) block production of the prostaglandin PgE2, resulting in decreased blood circulation to the stomach and increased gastric acid production. Interestingly, ulcers caused by NSAID use tend to appear in the lower, glandular portion of the stomach rather than in the upper, non-glandular portion where ulcers related to athletic effort generally develop.
Consider preventatives: When your horse faces a stressful situation, such as trailering or competition, you may wish to administer preventatives such as UlcerGard (omeprezole) or an antacid. When selecting a preventative, be mindful of drug policies; some sanctioning bodies prohibit the use of common ulcer preventatives.
Reduce stress: EGUS appears to be largely a man-made condition. A horse on the range, left to its own devices regarding shelter, feeding habits, and exercise, is highly unlikely to develop ulcers. Unfortunately, such a life is impractical for the vast majority of domestic horses. It is our responsibility as horse owners, however, to mimic as closely as possible the lives our horses are designed to lead. Minimize stalling, maximize turnout, allow constant access to hay or pasture, respect your horse’s innate need for equine companionship. Know your horse as an individual, and go out of your way to make his life easier. His stomach will thank you.
Despite our best efforts, some horses will still suffer from gastric ulceration. The next post in this series will examine treatment options for curing existing ulcers in adult horses.
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Related Posts
Introduction: Equine Gastric Ulcer Series
Pharmaceutical and Alternative Treatment Options for Equine Gastric Ulcer Syndrome
Equine Ulcer Supplement Options
EGUS, Endurance, and the AERC
A Fair Question: Equine Athletes, Equine Ulcers
Bringing it Home: EGUS Prevention at In the Night Farm
Sheer Brilliance: Aloe and MSM as Alternative Therapy for EGUS
Q & A: Aloe and MSM as Alternative Therapy for EGUS
The Good Bad News: Gastric Ulcers in Equines
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Introduction: Equine Gastric Ulcer Series
If I had my way, I would not be writing this post. If I had my way, Aaruba’s gastric ulcers would have resolved with treatment and never recurred. If I had my way, I would not care about ulcer treatments, preventatives, or alternatives.
By the end of the day following our 55-mile ride at Owyhee Canyonlands in September, two weeks after Aaruba finished his month-long course of GastroGard, I knew the ulcers were back. Aaruba’s poor appetite and uncomfortable aspect led to a call to the vet, which led to another $500 GastroGard purchase and $100 in Doxycycline, in case the recurrence was due to an infected ulcer.
The antibiotic treatment went out the window after four doses. Poor Aaruba despised the stuff and lost every bit of appetite the GastroGard had so recently restored. So, I had to hope the GastroGard alone would do the trick…but what if it didn’t?
Time to do some homework.
Over the next couple weeks, I’ll provide a series of posts detailing the questions I asked and the answers I compiled from various resources both online and in print. My research focused particularly on gastric ulcers in endurance horses, which face some special concerns. Here are the questions I’ll address:
- What strategies can prevent equine gastric ulcer formation or recurrence?
- What medications and alternatives are available to combat equine gastric ulcers, and are there any problems associated with their long term use?
- How effective are ulcer preventative supplements, and are there any problems associated with their long term use?
- How do the costs and benefits of various supplements compare?
- What does the American Endurance Ride Conference say about ulcers and ulcer treatments in endurance horses?
- And finally, how will I apply this information for the benefit of my own herd?
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Pharmaceutical and Alternative Treatment Options for Equine Gastric Ulcer Syndrome
Equine Ulcer Supplement Options
EGUS, Endurance, and the AERC
A Fair Question: Equine Athletes, Equine Ulcers
Bringing it Home: EGUS Prevention at In the Night Farm
How to Condition a Horse for Endurance: A Collection of Resources
I promised in this post to provide a list of my favorite resources regarding equine endurance condition- ing. Below are links to some of the articles I returned to time and again while creating a conditioning program for Aaruba’s first year in the sport. (For those who’d like to see the day-by-day details of my horses’ endurance conditioning logs, check out the sidebar of The Barb Wire blog.)
In the meantime, feel free to comment with your favorite resources for equine endurance conditioning programs. I’m always looking for more to update this list over time; I’m particularly interested in articles about conditioning up from LD and endurance, maintaining fitness in the off season, avoiding overtraining while building fitness during a busy ride season, and other topics less commonly addressed in resources designed for individuals just getting into the sport.
Rider Resource: Endurance Conversions Chart
Rider Resource: Endurance Conditioning Log
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The Good Bad News: Gastric Ulcers in Equines
“We have our answer,” Aaruba’s vet announced when I answered the phone. “He has ulcers.”
I sighed in relief. “Good!”
Ummm…Why am I so pleased that my beloved horse has lesions in the lining of his stomach?
Well, the bad news is good news because it answers a lot of questions: Why has Aaruba suffered recurrent, mild colics? Why do I have such difficulty keeping weight on him, though he has access to hay 24/7? Why is he brilliant some days and lethargic others? Why does he sometimes fail to clean up his feed? Now we know.
It’s also good news because ulcers are curable. Not cheap, but curable. This is a huge relief, as another possibility suggested was that of permanent parasite damage left over from Aaruba’s youth.
You can’t live among performance horses for long and not encounter one with gastric ulcers. Many sources claim that about 60% of equine athletes suffer from ulcers. The percentage of affected horses tends to rise with increased training and competition; at an estimated 90%, racehorses top the list for ulcer risk.
In equines, gastric ulcers are caused by excessive acidity in the stomach. A horse’s stomach produces about 1.5 litres of acidic fluid per hour. Ideally, this acid is neutralized by the alkalinity of a horse’s saliva. However, saliva is only produced when the horse eats.
Do you see where this is going? Horses that don’t have constant access to forage are unable to follow their natural eating pattern of consuming small amounts of food at frequent intervals. Long periods without forage result in inadequate saliva production, which results in highly acidic gastric PH levels, which can result in gastric ulcers.
So, will offering your horse free-choice hay or pasture eliminate the possibility of ulcers? Unfortunately, no — just ask Aaruba, who enjoys a free-choice, 60/40 grass/alfalfa mix. While constant or frequent access to forage dramatically decreases ulcer risk, other factors are also at play:
1) Stress. Whether the result of buddy-sourness, competition, travel, training, or other causes, stress increases gastric ulcer risk in horses, just as it does in humans. Some horses (Aaruba among them) are more prone to stress than others. Performance horses will, obviously, face stressors as an unavoidable part of their jobs.
2) Exercise. Research demonstrates that increased exercise equals increased ulcer risk in equines. The reason for this are unclear, though some suggest it is a combination of elevated stress levels and extended periods with limited feed intake.
3) Feed concentrates. Grains and other concentrated feeds stimulate increased stomach acid production. Obviously, this problem is exacerbated if the horse cannot follow his grain consumption with plenty of forage.
As you can see, the lives of many equine athletes are perfect recipes for the development of gastric ulcers. The problem is often overlooked, however, because the symptoms can be quite subtle. Here’s what to look for:
1) Acute or recurrent colic symptoms, often mild and responsive to Banamine. This was a major tip-off in Aaruba’s case.
2) Weight loss or persistent poor condition. This was Aaruba’s other significant symptom — despite access to abundant feed, he struggled to attain the fat layer appropriate for an endurance athlete. Some horses also show decreased hair coat quality.
3) Decreased appetite or a tendency to walk away from a half-finished meal.
4) Compromised performance. In hindsight, I believe many of Aaruba’s less energetic workouts could be attributed to his ulcers.
5) Reduced manure output or, less commonly, diarrhea.
6) Attitude and behavior changes such as increased nervousness, irritability, or biting/mouthiness.
If these symptoms sound familiar, what should you do? Aaruba’s vet offered two courses of action — either have the horse scoped to determine conclusively whether ulcers are present, or simply medicate the horse and rely on the cessation of symptoms to give us an answer.
Easy choice, right? Not really. Scoping costs around $250 or $300, but the drug of choice, GastroGard, runs at least $28 per tube (I’ve heard of prices up to $75 per tube!) — and the dosage for most horses is one full tube per day for 30 days. That’s a lot to pay for medication you aren’t sure your horse needs. It’s true that horses may show signs of improvement after just a few days on GastroGard, but this is inconclusive as ulcer symptoms often come and go even in the absence of medication.
GastroGard can be purchased online for lower prices than you’re likely to find at your local vet, but it does require a prescription. Non-prescription UlcerGard is the same drug (Omeprazole) labeled as a preventative medication rather than a cure. At first glance, UlcerGard appears less expensive than GastroGard; however, this is because the recommended dosage (for prevention) is 1/4 the dosage required to actually resolve existing ulcers. Using enough UlcerGard to cure ulcers costs about the same as using GastroGard, so I’m sticking with my vet’s recommendation to order the name brand.
What about recurrence? Gastric ulcers can certainly recur after treatment, but preventative measures can be taken to keep an ulcer-prone horse like Aaruba healthy even during the stress of continued athletic endeavors. In addition to employing our usual management strategies to keep him as calm as possible, we’ll keep Aaruba on preventative medication and remove all grain from his diet, replacing it with Purina Equine Senior.
Keep an eye on your horses, friends, and don’t be afraid to delve into possible causes of that niggling concern. You might just get some good bad news of your own.
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Related Posts
Introduction: Equine Gastric Ulcer Series
Strategies for Prevention of Equine Gastric Ulcer Syndrome
Pharmaceutical and Alternative Treatment Options for Equine Gastric Ulcer Syndrome
Equine Ulcer Supplement Options
EGUS, Endurance, and the AERC
A Fair Question: Equine Athletes, Equine Ulcers
Bringing it Home: EGUS Prevention at In the Night Farm
Sheer Brilliance: Aloe and MSM as Alternative Therapy for EGUS
Q & A: Aloe and MSM as Alternative Therapy for EGUS
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The photo accompanying this post is by equine sculptor Lynn Fraley. Be sure to take A Virtual Visit to Laf’n Bear Studio!
Tamara Baysinger
