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  Discussion on Ulcerated lip and chronic oral ulcers
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Member:
drtrish

Posted on Sunday, Mar 22, 2009 - 5:19 pm:

Hi, I have yet another problem with my "problem child". I posted a thread a few months back under neurological disorders. No one could figure out if he had EPM, cervical stenosis, or exactly what was causing his pain and weakness. Last thing we did was a PSSM test because he had a lot of the symptoms, it came back negative, but I kept him on the diet because it was helping. Two months later, he is still better (about 50%), so I'm going to keep him on the diet and see what happens.

Today I decided to ride him. He is a 4 y/o QH gelding. I have not ridden him since November. He threw a fit when I tried to put the bit in his mouth. I figured he was just being fresh so I kept at him and he just wouldn't accept it. I finally looked at his mouth and saw 2 junks of lip missing, or ulcers, on his upper lip. One is where the lips fit together and is visible on the outside, and the other is just inside the lip. I went ahead and got the bit in since I had his mouth open - I only did so to make sure he didn't think he could get away with not taking the bit in the future. Once the bit was in he kept opening his mouth and showed obvious pain. After 2 minutes I went ahead and took the bridle off, put some salve on the sores and put him back in his stall.

In retrospect, he has always had a history of oral ulcers. Last time his teeth were floated was last Sept, and the vet mentioned he had some bad ulcers then. A few months later, I took him to Purdue for a neuro eval and during the routine exam they noted several oral ulcers still, but told me not to worry about it. After the Purdue visit, they had me treat him with Marquis for EPM and half way through the 30 day coarse he became very difficult about taking the medicine. I figured he was just getting fed up with daily tubing. Now I am beginning to wonder if the medicine didn't worsen the ulcers. Still to this day he doesn't even like to be wormed.

What would cause these chronic lip and oral ulcers? Could the Marquis have made it worse? What is the best treatment for these sores? I tried to upload pictures, but it said the files were too big. Any advice would be greatly appreciated.
Moderator:
DrO

Posted on Sunday, Mar 22, 2009 - 7:55 pm:

Trisha, I would like to see those images let me direct you to directions on getting the image size and file size manageable, check out \i Help & Information on Using This Site » Uploading Images and Files Into a Posting}.
DrO
Member:
sdms

Posted on Sunday, Mar 22, 2009 - 9:46 pm:

Hi Trisha. If, after reading the uploading instructions, you still can't get the pictures to upload feel free to e-mail them to me and I'll post them for you. My e-mail address is in my profile.

~Sara
Member:
drtrish

Posted on Monday, Mar 23, 2009 - 12:52 pm:

Dr. O,
Sara is going to post the photos for me. They are not of the best quality, but all I have for now. The first picture is of the ulcer on the outside of his lip, and in the second picture the inside ulcer is just below my thumb. It is not red, and the edges are firm. The other ulcer is located under my index finger, and it is red and wet. Since he seems to have so many problems (neuro and muscular) could the ulcers be a result of a larger, systemic problem? He used to eat his manure, did so from last September to just a few weeks ago. Again I had vets tell me not to worry about it because it was behavioral. I decided to give him probiotics and he stopped eating his manure 3 weeks after I started him on Probios. Could the manure eating have caused the ulcers? I've also noticed he occasionally does weird things with his mouth, like putting his head down and open and twist his jaws around like he's chewing on something in the back of his mouth.

Any information you could give me would be greatly appreciated.
Member:
sdms

Posted on Monday, Mar 23, 2009 - 12:56 pm:

Here you go, Trisha!



Member:
dres

Posted on Monday, Mar 23, 2009 - 2:03 pm:

Could these be summer sores?
What is your worming program.. ?

On the first day God created horses, on the second day he painted them with spots..
Member:
drtrish

Posted on Monday, Mar 23, 2009 - 6:33 pm:

Sorry to sound ignorant but I don't know what summer sores are. Worming method is every 2 months; rotational pastes.
Member:
dres

Posted on Monday, Mar 23, 2009 - 7:13 pm:

https://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/71801.htm

Summer sores are caused by worm larvae.. a common area for the sores to be seen is around the mouth..
My mare had them one time..I had never heard of them either..

On the first day God created horses, on the second day he painted them with spots..
Moderator:
DrO

Posted on Tuesday, Mar 24, 2009 - 8:49 am:

Hello SaraM,
The first image appears to be a wound, including a little tag of ripped off skin which you would not see with a ulcer (unless it was traumatized). The bottom photo does not have enough focus to tell much.

For more on summer sores and other very similar diseases and the way to tell them apart see Diseases of Horses » Skin Diseases, Wounds, and Swellings » Bumps / Nodules / Warts / Tumors » Overview of Bumps, Nodules, Warts & Tumors.
DrO
Member:
drtrish

Posted on Tuesday, Mar 24, 2009 - 10:48 am:

Thanks Dr. O. I know the pictures aren't the greatest. Actually there isn't any ripped tag of skin on the ulcer in the first picture. Since he has a history of chronic oral ulcers could it be a result of another illness? Even after his teeth were floated last he still had problems with ulcers. What could be other causes for oral ulcers? Immunosuppression? Lack of a vitamin or mineral? He hasn't been ridden all winter so he wouldn't have any bridle trauma. Thanks!
Moderator:
DrO

Posted on Tuesday, Mar 24, 2009 - 9:20 pm:

Trisha, is that not a piece of loose skin at 3 o'clock on the first image?

Let's straighten one thing out first: this is not an oral ulcer which would be a ulcer of the mouth's mucosa. These are skin ulcers that are around the mouth. The first thing I think of when I see the above image is a traumatic wound. So our first step to a diagnosis is a accurate description of the lesion which will require examination and possibly culture and biopsy. Has anyone specifically given you a diagnosis on this?
DrO
Member:
drtrish

Posted on Tuesday, Mar 24, 2009 - 10:30 pm:

No, that isn't a piece of loose skin, it's a reflection of light off the moist skin.

I'm aware the pictures are not of oral ulcers; the title of my thread is lip and oral ulcers. I mention the chronic oral ulcers because I thought they might be related to his lip ulcers. I could not get a picture of the oral ulcers because I couldn't keep is mouth open long enough. No, no one has ever mentioned doing a biopsy or further evaluation. Both my vet and Purdue University said "Don't worry about it". Well, now the problem is getting worse and I DO worry about it!
Moderator:
DrO

Posted on Wednesday, Mar 25, 2009 - 8:37 am:

Trisha oral ulcers are a common finding in horses. At least small yet numerous ulcers are. I often see them in routine yearly exams. Irritant they chewed(?), mild viral infection(?), we just don't know but 95% of the time they are subclinical and self limiting. Was this what they were seeing? Or did they see large nasty deep ulcers? It is hard to believe that they would just shrug there shoulders at such a finding.

Then we have your images of lip lesions that look traumatic. I don't know what or if there is a relation between it all there are not any conditions that jump out at me that would cause both while having an otherwise normal physical exam. Do you have thorns, foxtail awns, or particularly severe bot infestations? None of these fit both conditions well but could cause one or the other lesion.

If you really feel these are a chronic problem that is adversely effecting this horses health it is time to get that exam and consider the other diagnostic techniques reviewed above.
DrO
Member:
paul303

Posted on Wednesday, Mar 25, 2009 - 11:09 pm:

Trisha: You should probably carefully go through your hay. Look for foxtail or any sharp spikey seeds that can be fairly common in hay. I know we've discussed this in the past, and they DO cause ulcerative lesions that are sometimes very severe. They may not be in every bale, due to the fact that every section of a hayfield may not be contaminated by these weeds.
Member:
drtrish

Posted on Thursday, Mar 26, 2009 - 7:42 am:

I think you're on to something, Lee! I took a look at my gelding's companion last night and she has them too!! Exact same ulcers on the lips - looks like someone carved out chunks of flesh. I couldn't get her mouth open to look inside, but when I was trying I noticed a HORRIBLE stench coming out of her mouth - like a dead rotting animal. So it has to be something in the hay. Neither one crib, chew or have any bad habits. Both get completely different grains and supplements. The only thing they have in common is the hay and mineral block. I tried doing an internet search for weed and grass identification, and am not having a whole lot of luck. Last year I had the county extension officer out to identify some plants and trees and at first he called what I thought was timothy grass foxtail. I said, "Are you sure? This is what we bale for hay." He said after another look he didn't think it was foxtail afterall, but never confirmed it was timothy grass. If I can get the picture to upload I will post what I think is timothy grass and maybe someone can identify it for sure.
Moderator:
DrO

Posted on Thursday, Mar 26, 2009 - 9:00 am:

I have a problem with the foxtail awn theory with respect to the lip lesions shown above. I have seen many horrible cases where the gums are just torn up with ulcers some an inch across but I have never seen a single ulcer on the outside of the lips.

That said perhaps there are two different problems. Bad odor coming from the mouth is consistent with foxtail induced oral ulcers. We have an image of a foxtail at Diseases of Horses » Colic, Diarrhea, GI Tract » Mouth, Esophagus, and Liver » Disorders of the Mouth and Teeth and how to go about diagnosing foxtail ulcers by appearance.
DrO
Member:
vickiann

Posted on Thursday, Mar 26, 2009 - 9:08 am:

One of mine has gotten sores on the lips after eating pig weed, and gingivitis on the gums due to golden coydalis weed.
New Member:
jjrichar

Posted on Thursday, Mar 26, 2009 - 11:03 am:

WOW how awful! Before I would spend a lot of time researching plants etc. on the internet, I would try removing the things they eat in common from their diet ASAP and see if the ulcers improve. Although identifying the plant may be helpful later on, in all my years of horses, sometimes the easiest thing is to just backtrack and remove things one by one until you find the cause. I wouldn't make a bunch of sudden changes to diet right away, as that could induce colic, etc. but a change from one type of grass hay to another shouldn't cause problems.

Hay is obviously an easy fix, by finding another source for your hay. I would try and find a hay that is mostly coastal or at least a mild orchard grass that is free of weeds, etc.

Now removing what they eat in the pasture could be more difficult. I would first start by observing their favorite spot in the pasture and see what it is they are eating. Anything that could prickle or cut your hand could do the same to a horse's mouth.

If you have a smaller area fenced where you can place a round roll bale of hay (not baled nearby or from your own field) and keep them off the pasture for a time, that would be most helpful. If that is not possible, just placing a round roll in their normal pasture may help too, as they may be more inclined to graze on that than the stuff that is ripping them up.

I would think you should see an improvement fairly quickly and know if that is the cause. I would also talk to my vet and see if either of the horses need to be on antibiotics too. The stench could be the result of a pretty bad infection.

Bottom line, whatever is causing it needs to be addressed ASAP. If the stuff they are eating is messing up their mouths... just think what it is doing to their insides. I wouldn't be surprised if they have gastric ulcers too. SHAME ON PURDUE for brushing this off. I am not sure what all of the problems are that you have had w your horse, but I know that ulcers, etc. can cause a lot of problems that may quite possibly look like something else.

So sorry you are having to go thru this... Good luck to you!
Moderator:
DrO

Posted on Friday, Mar 27, 2009 - 9:40 am:

Jennifer is right, you don't go to the internet to try and discover possible causes here you go to your pasture, barn, and feed. Try then to identify what you find there.
DrO
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