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  Discussion on Gastric ulcer treatment question
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New Member:
anniel

Posted on Monday, Jul 27, 2009 - 7:18 pm:

Hello, This is my first time posting and I have a question about using ranitidine and omeparazole together.
My mare, Penny has had loose, pudding stools to diarrhea off and on for the two years that I have owned her. Have done blood work which my vet said did not tell much. To look at Pen would not indicate that anything was out of sorts with her. But I am concerned to do more than light trail riding. Last year we did quite a few long rides as this issue had not been as bad.
Last week when she had diarrhea I started her on ranitidine 16, 150mg pills ground up in apple sauce, 3 x day eight hours apart. Penny is 13.3 hands, taping at 765 to 800 lbs. One week later and her stools are formed pudding. I know with the length of time this has been going on I should be more patient. The other day I sat in on a webinar on ulcers and treatment in horses and it was mentioned that ranitidine and omeparazole could be used together, but I have not found any information regarding their combined use. Anyone have any experience with using these drugs together?
Also I have a high quality digestive enzyme, microbial culture supplement and want to know if this would be safe to use with a horse that is suspected of having ulcers?
Sorry this is so long.
Thanks,
Annie
Member:
scooter

Posted on Monday, Jul 27, 2009 - 11:04 pm:

Hi Annie, Welcome to HA. DrO can ans. your question about the medications.

I have to ask as I was reading your post I wondered what made you think she has ulcers?

Can you tell us what her diet, worming, turnout, sand? ect consists of it may help form an opinion.
Moderator:
DrO

Posted on Tuesday, Jul 28, 2009 - 7:36 am:

Welcome Annie,
Hmmm, I do not know of any work that has looked at the safety of using these products together and question the necessity of such use. Note that these two products work differently. While ranitadine is a antihistamine that works on H2 receptors, omeprazole is a direct ion pump inhibitor. I would not expect any unusual toxic effects when put together but do wonder if over alkalization of the stomach is possible. Remember that the stomach is acid for a very good reason, to help digest food.

Omeprazole is very effective at correcting overly low stomach ph and management is the most important component to preventing further ulceration. If you had a headache would you take both acetaminophen and ibuprofen?

I agree with DianE the question seems to be why suspect ulcers? And why do you think your horses loose stools are an indication for limited riding. This is just the way some horses are. For more on this see, Diseases of Horses » Colic, Diarrhea, GI Tract » Diarrhea in Horses » Diarrhea an Overview.
DrO
Member:
mrose

Posted on Tuesday, Jul 28, 2009 - 10:15 am:

For what it's worth, and I realize horses and humans are different, but doctors frequently put patients (human) on both of these drugs at the same time. Sometimes saying one before a meal (the ranitadine) and the the other (omeprazole) after a meal.
New Member:
anniel

Posted on Tuesday, Jul 28, 2009 - 10:24 am:

Hello DrO and DianE,

Penny is an arab/qu cross, 11 years old. I was conditioning her for endurance, but have those plans on hold at this time for unrelated reasons.

Pen is on 24/7 turnout with my other horse, on not too lush a pasture, has hay 24/7, orchard grass/timothy/some red clover, very small amount of soaked beat pulp once a day for her selenium supplement. We live on clay here in PA and the run-in stalls are concrete covered with very good matting. Has water from muni tap, no well, spring or pond water access. She is on a regular worm schedule, plus herbal wormer between.

A friend of mine purchased Penny when she was four and had her for several months before selling her to a friend of hers. She went through two additional owners before I purchased her almost three years ago. Pen is very sensitive and though she was not abused, she came to me clearly stressed. It has taken her all of two years to really settle in and trust me, but is doing very well now.
My friend said her stools were normal for the time she had her.
I’ve had blood work, selenium/vita E and urine tests on Pen. She does tend to have strong heat cycles through the winter and spring – stallion type behavior, lots of winking and squirting, tail flagging.
With her being so sensitive, having loose stools and in the absence of other ideas of what might be going on with her I decided to try the ranitidine. I wanted to see if it would make any difference at all before shelling out the big bucks.
My plans are to do 50 mile rides with a goal of trying a 100 with Pen. With riding these distances I need to try to resolve the loose stool issue.

Thanks for any help!
Annie
Member:
scooter

Posted on Tuesday, Jul 28, 2009 - 9:34 pm:

Annie when my horses had diarrhea for no obvious reason my vet said to try metamucil or something along those lines. I bought a big carton of the genaric brand and gave it to them. It worked. If one starts getting loose stools I put them on it for a week. It usually clears them up in a few days. I can't remember the dosage, but give the amount for a 1000# human.
Mine are not on sand either...just clay soils.

I don't know what Dr.O thinks of this therapy.
Moderator:
DrO

Posted on Tuesday, Jul 28, 2009 - 9:47 pm:

That is interesting to note Sarah. One important difference in human and equine physiology that might be of importance here is that horses continually secrete a fairly constant amount of acid while humans secrete acid episodically and predominantly at meal time. That is not to say someone in the future might not find the combination more effective in horses but at this time I would not consider the use of the two together unless I had some very firm evidence that the omeprazole was not doing the job. I have always been able to successfully treat equine ulcers with good feeding practices and environmental management.

I think for Annie the real question should be whether she has any clinical signs referable to gastric ulceration at all. If she does I think she ought to switch to omeprazole rather than use the two together.
DrO
Member:
mrose

Posted on Tuesday, Jul 28, 2009 - 11:15 pm:

I would just add that if diarrhea is the main symptom, I'd look again at her feed. I notice that she is getting hay which contains clover. I don't know how consistant your hay is, but with our grass/alfalfa mix some bales have more alfalfa than other bales. If it is the same with the clover in your hay, and if she is getting very much at all, you might want to try hay that is only grass. I had one mare that could not eat much alfalfa; if she did, she got diarrhea. Since both clover and alfalfa are legumes, I'd wonder about the clover.
New Member:
anniel

Posted on Wednesday, Jul 29, 2009 - 9:47 am:

I agree with you Sara about considering the clover in her diet. There is very little in the bales, but could be enough to be giving her trouble. I have limited this hay in her diet, but will try just the grass hay.
I have had her on the ranitidine for a week now with no real change or improvement in her stools, should I continue to give it more time or take her off? If taking her off, do I need to wean her off or can I just stop dosing?
In administering the med I ground the pills up and syringed with apple sauce. By grinding up the pills did that compromise their effectiveness? Is Ranitidine as delicate as omeparazoie?
DianE mentioned about using a fiber product like Metamucil, how did you feed this, by syringe?

Annie
Member:
mrose

Posted on Wednesday, Jul 29, 2009 - 10:50 am:

I might be wrong, and if I am I'm sure someone will correct me, but feeding Metamucil is just like feed wheat bran and wheat bran is a lot less expensive. You could try adding a half cup to her diet/day. However, I'd only try one thing at a time so you will know what helped unless she is in "dire straights" and you want to "hit her" with everything you can. I would think after a week on ranitidine you would see an improvement, but don't know for sure. There are so many causes for diarrhea I think it's hard to figure out. Is she getting any probiotics? Platinum Performance makes a good one, as do several other mfgs.. If she's not getting any, it might be worth a try also. If she will eat yogurt it's been known to help foals, but the probiotics I think would be cheaper and unless she likes yogur, easier to get down.
New Member:
anniel

Posted on Wednesday, Jul 29, 2009 - 2:01 pm:

Again Sara, I agree with you about making too many changes at once so I'm trying to be conservative in implementing any. For the time being I will keep Pen on the ranitidine and have just begun feeding her Absorb-All which has microbials in it. Will see how things go this coming week.
I appreciate the tip to save money, but the problem I have with using wheat bran is it's cal/phos ratio imbalance. Unless it would be a short term use I would need to supplement calcium. What is Metamucil made of? Now if I'm missing something pleeeease let me know as I am on a learning curve with this whole issue;o)

Thanks!!!
Member:
mrose

Posted on Wednesday, Jul 29, 2009 - 2:29 pm:

I believe rice bran has a lot of phosphorus, I don't know if wheat bran is the same. Maybe someone else (Dr.O ) knows or you can do some research and find out. I've always fed a wheat bran mush one night a week in the winter, something I was taught to do many, (too many!) years ago and still do.

Metamucil is psyllium. It is usually given to act as a laxative, so it seems to me it would have the opposite effect from what you want. What is Bio-sponge made from? Need to look it up; it is used for diarrhea in foals.
Member:
scooter

Posted on Wednesday, Jul 29, 2009 - 3:39 pm:

I always thought that of metamucil, but I believe it can act as a laxative OR adding bulk to the stool. It is fiber for the most part. The generic brand I give my horses isn't all that expensive..I get the Walmart brand.
Of course this is humans, but does explain what it does.
https://www.irritable-bowel-synDrOme.ws/metamucil.htm

Excerpt...
What symptoms can it treat?

Although Metamucil may be marketed as a laxative it can actually be useful for both diarrhea and constipation sufferers. For diarrhea sufferers the extra fiber make the stool firmer and more solid. For constipation sufferers, the extra bulk can make waste food softer and easier to pass
Member:
scooter

Posted on Wednesday, Jul 29, 2009 - 3:44 pm:

Annie I forgot I just added it to their feed( I have the unflavored kind) but have heard horses like the orangd flavored...they ate it well, I do water down their feed a bit too tho. You could probably add it to her beet pulp.
Moderator:
DrO

Posted on Wednesday, Jul 29, 2009 - 6:37 pm:

Hello All,
I too tend to look at fibrous feed as a regulator rather than specifically a laxative or diarrhea medicine. It has two opposing effects in the horse with respect to fecal water content. Fiber tends to hold onto water, keeping extra water in the gut. But fiber also slows gut emptying giving more time to reabsorb water. Some have found adding certain types of fibrous feeds to the diet helpful and we list these in Diseases of Horses » Colic, Diarrhea, GI Tract » Diarrhea in Horses » Diarrhea an Overview.

Concerning bran, it should be noted that the amount of fiber in bran is quite a bit lower than some of the other foodstuffs discussed. In the article on bran we discuss its effect on fecal water content and how to balance the mineral profile, see Horse Care » Equine Nutrition, Horse Feeds, Feeding » Bran: Wheat and Rice.
DrO
Member:
vickiann

Posted on Wednesday, Jul 29, 2009 - 8:47 pm:

Diane and Dr. O are right on.

Psyllium is more of a digestive aid, whatever the problem.

My personal belief is that bran does not nearly rise to providing the level of the benefits that psyllium does.

My horses are much better off since I DrOpped my once weekly bran mashes, many, many years ago.

That's not to say that many reputable horse barns don't still practice this ingrained system.

I just never found it particularly helpful, and in fact found it to be quite the contrary.

As a digestive aid in sandy conditions, I have found that the psyllium has been helpful.

With my older boy who had chronic diarrhea for years, the psyllium absorbed a lot of the extra water out of his gut and lessened the problem, though it was never a true solution.

As with any solution that treats symptoms rather than the root problem, it helped, and over a short term, a lot.

Whatever fixed him there were three factors that were unique: 1) a different feed (in his case, Triple Crown LITE) that suited his system that had a built-in probiotic (and the probiotic was probably not the main solution as I had used many over the years with limited success).
2) An effective worming program that administered a large enough dose as outlined by Dr. O and that incorporated wormers (Quest) that would get to the encysted strongyles. 3) Great foot balance that took away the constant pain and intermittant lameness of the horse; which when fixed, resulted in all around improved health -- physically and mentally, plus a normal, comfortable "way of going."
New Member:
anniel

Posted on Wednesday, Jul 29, 2009 - 10:45 pm:

Thank You all for your input, and DrO, I will dive into your suggested reading.
Ideally I would go forward with a battery of tests to identify the root cause of Penny's issue, but alas I, like many people at this time, am running on a very tight budget. For you all to care enough to enter into this discussion has been of great comfort to me. I hope I have not dominated your attention too much.
Most grateful, Annie
Member:
vickiann

Posted on Thursday, Jul 30, 2009 - 8:54 am:

Annie,

Believe me, I know how tiring it is to deal with this problem and I have spent much time over a period of years cleaning off my boy's behind and legs plus trying every possible remedy.

While in my Buddy's case, the condition did not seem to cause him true ill health, it was very bothersome and worrisome.

I hope that your course of trial and error will yield answers in a shorter term than mine did.

I do think that parasite load or excess sand in the gut can be major factors.

Also, some horses have touchy systems (that may sometimes have been damaged by past events?) where any little change such as eating some different woody weeds in a pasture, or any physical or emotional stress will seem to further trigger or contribute to the problem.
Member:
anniel

Posted on Saturday, Aug 1, 2009 - 10:35 am:

Hello All, I have an update on Penny. Now I'm not sure if I should have started a new discussion based on new information, but am quite tecky challenged and could not find where to start a new discussion. Sorry...
but I ran a fresh stool sample of Penny's to my small animal vet a couple of miles from me, my horse vet is almost two hours away, and just got the results. Penny had a large population of smalll strongyles in her stool sample. Well this could certainly explain the loose stools she has been having. I thought I was following a sound worming schedule, but had been discouraged in running fecals. After reading DrO's articles I am revamping my program. I would like to post my question in a new discussion on dealing with worming her if I can figure out how to start it, but to conclude, I think Penny's loose stool problem can be resolved with dealing with these nasty critters. But boy do I know more about uclers than when I first joined the list.
Annie
Moderator:
DrO

Posted on Sunday, Aug 2, 2009 - 9:14 am:

Hello Annie,
There is a start new conversation button at the bottom of every article page, under the list of already existing discussions. From the location of a already existing discussion it is always back one page in the navigational tree reachable from the navigation bar at the top of this page.

However I think you should continue all the discussions about your horses diarrhea in this conversation until the problem is resolved. If you have questions about specific dewormers or techniques certainly read the appropriate article and post in that topic. This makes it easier for others to follow.

Once resolved we will move this discussion to the more appropriate Overview of Diarrhea topic.
DrO
Member:
anniel

Posted on Sunday, Aug 2, 2009 - 11:39 am:

Thank You DrO! Sorry, I have a rather steep learning curve when it comes to the computer.

I had the results of Pen's fecal faxed to my horse vet and will talk with them on Monday. Until then I am trying to get my mind around how to resolve both treatment and maintance.
Well, back to reading as I need to make notes. It's all running together in my mind from reading last night.
Annie
Member:
sodmonst

Posted on Sunday, Aug 2, 2009 - 2:42 pm:

After struggling to administer horsie kaopectate on the advice of the large animal vet with no improvement, I asked my cat's vet if he had any ideas. He suggested feeding Metamucil, it worked great.

The fiber in psyllium makes a smooth and slippery bulk that I believe is more soothing and effective. Bran did not help, and I do not use it any more. My horse got diarrhea every time it rained, so it was a different issue, same symptom. Anyway, it worked great.
Member:
dres

Posted on Sunday, Aug 2, 2009 - 4:39 pm:

Susie, how much Metamucil did you give , how often and where did you buy it.. ??

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

Posted on Monday, Aug 3, 2009 - 7:30 am:

DrO, with a large worm load do I still give the full dose of Quest?
The way I'm understanding this process is after confirming with fecal test, treat and do another fecal at about 40 days and retreat if test is positive? Test again in about 40 days and treat if positive? Continue until...?
I will be doing a fecal on my other horse to see if she will need to be treated.
I have changed my approach to worming with what I've been learning and am wondering if Penny will always be extra susceptible to worms?
Thanks, Annie
Moderator:
DrO

Posted on Tuesday, Aug 4, 2009 - 7:36 am:

Annie if a horse is in good health and has been dewormed regularly, though apparently not optimally, I would consider a full dose of moxidectin but you should discuss this with your veterinarian. Be careful if your horse weighs close to 1000 lbs as a single tube of Quest will not be adequate and therefore it costs considerably more than some other products that give enough moxidection for a full 1250 or even one with 1450 lbs. For that reason I prefer some of the other moxidectin products currently available.

How often you should retest depends on many factors but should at least be no more often than the prepatency period of the particular dewormer. This is discussed in the Deworming Overview article and the prepatency times in the individual articles on each dewormer. I think I would put off planning a program until I saw what the second horse's parasite load is. My plan would be completely different if both horses are a strong positive vs one negative and one positive. This latter finding will be your first indicator of a parasite permissive horse. If it is, no need to worry, just manage the horse a bit closer will work fine.

Also keep in mind that pasture and feed management issues are at least as important for controlling parasites as dewormers. Usually when I find large burdens of parasites in horses that are regularly dewormed I find a management issue. We discuss these too in the article on Deworming Overview.
DrO
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