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  Discussion on Ulcers and post colic surgery
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Member:
Deggert

Posted on Tuesday, Sep 7, 2004 - 12:34 pm:

Hello all and Dr. O,
I will try to sum up this horse so I can get some ideas. Our 14 year old gelding , Arabian, never had a colic episode till last April 03. It was a hot day and the ranch tractor (arab killer tractor) must have been by his corral as when I came home he had run a path a foot deep on a 20 ft fenceline. He seemed fine that evening then when I did my late evening check he had left food and was down. Vet came that night etc etc by 9 the next morning he was headed for the surgery clinic about an hour and half away. His intestine was flipped 180 degrees. They did not find the softball sized rock till they were in him. They were just going to flip him back but thank goodness they checked the whole length of intestine. He had a tough recovery over the next few months, with banamine and all we concluded he had ulcers after surgery. I became very familiar with the symptoms, for him anyway. Initially we thought he was having surgical pain but somewhere in the banamine therapy we concluded ulcers. We did not return him to the hospital to scope as response to therapy was deemed a better way at that point. Fasting and trailer rides etc would do him in. He was on ranitidine for 3 months. He responded within 3-4 days of start of treatment. This was his symptoms: wants to eat but when he does within a few minutes he abrubtly goes and lays down, neck stretching and lip curling. Feeling poorly then leads to poor water consumption then impaction, which he did a couple times. When we did have to oil this horse for the impaction he hit the ground with pain. I spoke to the surgeons who said mineral oil is very irritating ( one reason it works) to the stomach lining. About Sept last year he was good to go, no more pain and started slow return to pleasure riding. July 04, a couple days after a trailer ride and hot probably stressful day, he was down, same symptoms. I got him through this one with low dose banamine for a couple days, and immediately started back on ranitidine. Has been on it now 8 weeks, it takes 3 times a day at 3000mg each for a good response. He does not have insurance so Gastrogard is out, and beside we are at the 9000 (yes dollars) mark on him for the year. By the way, he eats small meals 4 times a day, no grain, only Triple Crown LIte, Orchard and some alfalfa for ph. He is a shiny plump horse, not your poor doer. He is a stresser, but in hindsight I recall radical behavior and cinchiness as precursors to this last episode. We thought at first his time off had made him goofy but now we think it is stomach pain. I rode him lightly yesterday and he is 100% calmer now. I spoke to the vet about adhesions. He said at 16 months post surgery he should be out of the woods but also he would not expect a positive response to ulcer medication. This episode that started 8 weeks ago was tough to get under control. He had diarrhea and bloating. Both I have read can be symptoms of ulcers. I am trying to think of any more management changes but cannot. I can't turn him out, maybe down the road that will be available but not now. I thought of trying in conjunction with all else the Rapid Response as he is a high stress guy. I am trying to have plan for when I take him off ranitidine. Any thoughts on this would help, he is a great horse otherwise and I would like to have him live a healthy and ridable life. I have thought of an underlying other condition causing the ulcers, maybe he will need anti ulcer profilactically whenever he is in a stressful situation. Could the surgery have made him more prone to this? thanks ahead
Moderator:
DrO

Posted on Wednesday, Sep 8, 2004 - 7:12 am:

Debbie have you looked at the cost of the Gastro-Guard using the low dose protocol? One of the problems with ranitidine is that while it seems to help the discomfort of ulcers it does not do as good a job at getting the ulcers healed. See the article on gastric ulcers for details.
DrO
Member:
Fpony

Posted on Wednesday, Sep 8, 2004 - 7:47 am:

https://www.smartpakequine.com

Debbie,
If your vet will give you a prescription for Gasto-Guard you can get buy it by the tube at Smart Pak. I have a prescription for 7 tubes at a time and i give my Arab 500 lb dose as a preventative for a couple of days when something is stressful. We treated for a month last winter for an ulcer at doses. One tube is 1200lb dose so i get two and 1/2 days for $37. Still expensive but better than some of the prices i was quoted. My vet was going to get it for me at$39 a tube but I needed to buy a 28 tubes at once!

Good Luck! Kim
Member:
Deggert

Posted on Wednesday, Sep 8, 2004 - 12:40 pm:

Dr. O,
The cost is just very prohibitive here, when I bought a box (14 doses?) from my clinic it was 750 dollars discounted but this was on a horse with medical insurance and it was preventative for that horse because of his illness. I was wondering about the Prilosec otc as it is omeprazole, could this work if it was more economical? I have mentioned this at my clinic but haven't gotten a clear answer. I also haven't done the math as far as dosage and cost, do you think there can be a difference between Prilosec and Gastrogard when they are chemically the same? Do you think Merial is trying to keep this under wraps since they make a killing on gastrogard? I will check under ulcers to see if you give the low dose protocol. Since I have more time than money I was hoping that management and ranitidine will work eventually. My vets did say that 1 month on pasture turnout gave the same results as gastrogard but no such luck out here and the surgical facility said they have had good luck with ranitidine but only when treated 3 times a day at the 3000 mg per dose and duration can be much longer. I will probably continue for another month as I can treat for 3 dollars a day. I am tapped out of funds at this point.

Kim - thanks for the tip, that is a very reasonable price. But, I have a question in regard to prevention with gastrogard. To my knowledge it does not "kick in" for 3 days so giving it 2 to 3 days would seem contraindicated. Even when starting gastrogard on my other colt the vets had me give ranitidine for the first 3 days along with Gastrogard till it took effect. ranitidine is much more economical for prevention. Just a thought to consider, maybe Dr O can respond to this.
Thanks again, Debbie
Member:
Fpony

Posted on Wednesday, Sep 8, 2004 - 1:45 pm:

Hi Debbie,
There was an new study done at the university of Florida. I read about it in Equus mag April 2004 issue under Medical Front.

The study determined that Gastro guard usually rose the pH level within an hour of administration and stayed at an exceptable level for an average of 16 hours. Also, it stated that the horses in the study had suppression of stomach acidity between 4 and 8 hours after treatment.

It has been woorking for my guy. Of course i can only go on my own subjective data! First time intoducing trotting poles I thought he did wonderfully, but he started side biting by that night and the next day. The following week i gave him gastoguard (500 lb dose) before we tried some cavalettes (another stressor for him) No side biting---Was the side biting from acid pain? was the reason we had no sidebiting the next time because he was less fearfull or because he has a dose of gasto guard? I don't really know.
Member:
Swainl

Posted on Thursday, Nov 11, 2004 - 1:49 am:

Hi Debbie,
The best results I've had have been with soaking hay, feeding it in small amounts, and trying to feed requently throughout the day. I think this more closely mimics grazing---the water in the hay helps dilute the stomach acids similar to the moisture content of grass.
I've been struggling with ulcers for several years now. With my guy, it ended up being more of a management issue rather than a curative one. I did 3 separate courses of Omeprazole, 6 weeks at a time, and even after slowly weaning him off, I had ulcers recur every time.
Now, if I notice mine looking kind of 'punky'
I'll feed him neigh-lox or dose him with maalox 2 times daily for a few days. Although this doesn't heal them, it does seem to offer some pain relief.

When I go to shows, clinics, or any other stress inducing situations, he goes on ranitidine beginning before the stress starts until a couple of days after it's over.

Also, I try to give him a small alfalfa feeding before I work him to raise the pH levels.

Best of luck,

Laura

Member:
Deggert

Posted on Thursday, Nov 11, 2004 - 12:27 pm:

Hi Laura
You found my original post on this horse. He has been a learning experience (aren't they all) and I have had success so far with doing what you mention although I haven't soaked the hay. He eats 4-5 times a day and if I ride hime I do like you and give him a handfull of alfalfa. I spoke to one of our vets about him and he told me he has known horses that have to be on ranitidine the rest of their lives, but the good news is at least he responds to it, some horses only do well with gastrogard. He gets no grain (he is easy keeper. He has been on ranitidine since July. First 3 times a day for 3 months, to get it under control. Then he went to twice daily. The doctor had me go from 40 tabs twice day to 30 tabs twice. Now he has been on once a day at 30 for a couple weeks. so far so good. I have not trailered or been on hard rides. He is incredibly cinchy, more since surgery. I don't cinch tight and am trying fleece, although I have always used neoprene ( you can cinch looser with neoprene) Like you, when I have time and we return to more riding, I will profilactically treat with ranitidine. Right now, I am a bit afraid to take him off all together, as you know, when the ulcers come back you are at square one.
He is another one of my learning works in progress Thanks and good luck with yours too.
Debbie
Member:
Rgsaunde

Posted on Monday, Nov 22, 2004 - 8:17 pm:

Hi Debbie,

I have arabians and 1/2 arabians. My stallion now 15 had ulcers as a 3 year old. The first time he was given Zantac, after a short recovery we sent him back to the trainer. He got ulcers again, the second time he was one of the first to get the little purple pill, (at $2k per week) thank goodnes he was only on them for 2 weeks. He has go on to win national top tens and regional top fives. But he stays at home. I have found a company Cox Vet. Labs (www.coxvetlab.com). They have a product called Gastroade at $38.97 a gallion its a deal. I feed 1/4 cup twice a day to a foundered mare I have on bute. You may want to ask Dr.O about it. Good luck!!!!

Bob
Moderator:
DrO

Posted on Tuesday, Nov 23, 2004 - 8:50 am:

Hello Bob,
Though I have not done the math the percentage of active ingredients is much lower than over the counter human products and it appears more expensive (Compare if you mixed pepto and a antacid, through in a little aloe and kaopectate and voila!). On top of this these ingredients have no proof of efficacy in the treatment and prevention of gastric ulcers in horses. Some have shown to not be effective.
DrO
Member:
Deggert

Posted on Tuesday, Nov 23, 2004 - 11:59 am:

Hi Bob,
My gelding is doing well ( knock on wood) and I continue the ranitidine once daily. What purple pill did you give him? Or did you mean Gastrogard? - I had asked in an earlier post if Prilosec OTC could be crushed up for horses at a lesser expense than buying Gastrogard. Anyway, I appreciate your thoughts on the Gastroade, I did take a look but I can give ranitidine once a day cheaper than I give Gastroade. I agree with Dr. O that the ingredients can be put together at home but if it worked for you I am all for that. I would be concerned about Aluminum on a daily basis. I did find a source of Gastrogard at $30 tube, but the zantac works for him and it runs 5.99 for 240 75mg tabs at Costco.(at the current maintenance dose it lasts me a week) I have spoken to alot of people that say many post surgery horses continue to be a little "different". My gelding Zak has always been a hot horse but a good one,
thanks again for your thoughts
Debbie
Member:
Rgsaunde

Posted on Sunday, Nov 28, 2004 - 4:19 pm:

The purple pill I referred to was Nexium. It's been a while but I think I gave him 20 pills twice a day. It was perscribed by the University of Tenessee.
Bob
Member:
Deggert

Posted on Tuesday, Feb 8, 2005 - 4:01 pm:

Hello all
update on Zak. After 3 months off zantac we have had a colic incident. In hindsight I saw the signs of discomfort, not loping, very cinchy, tail swishing and spooky. I put him on a joint supplement about 2 weeks ago that has a "calming formula". HMMMMM Valerian, chamomile and ginger. Although they claim to be stomach calmers I wonder if it irritated him. Well, no more of that stuff.
He is back on zantac and has had an easy recovery as opposed to the July 04 setback. I think we caught it very early on.
Dr O. I read up on Buscopan as my vet had me try it on him. Zak initially had 5 cc bananmine Saturday AM, although he was still comfortable late Saturday night I gave him 6cc buscopan to ensure (hopefully) that he would remain comfortable through the night. When he has these incidents he get varying degrees of gas, bloating and diarrhea. He never impacted prior to the diarrhea and had many normal BM's in the paddock.
The morning after the buscopan he looked fine although slightly sedate. All systems looked normal. I did some research on the buscopan and it has an anticholinergic in it. After more research the active ingredient does have a sedation effect as it is also sold as a motion sickness drug. I have also seen reference to it reducing stomach acid. This is so interesting, and have you heard of any of this before? What are others experience with Buscopan?
thanks ahead for responding, Debbie
Moderator:
DrO

Posted on Wednesday, Feb 9, 2005 - 8:29 am:

I have not read that it will reduce stomach acidity in horses but we have a lot of information on this medication at Equine Medications and Nutriceuticals » Miscellaneous Drugs » Buscospan for Colic.
DrO
Member:
Deggert

Posted on Wednesday, Feb 9, 2005 - 1:15 pm:

Thanks Dr O
I looked in the wrong place, it was not listed under alphbetical drugs. I noticed that back in Oct 04 you did not use it in your practice, I was wondering if you have tried it yet? Any comment on the sedation effect, it was a different type of quiet than just pain relief. I wonder since he was having some increase in manure and the consistency was getting softer, if this drug worked to slow the gut in a good way. Also, if it gives relief in some instances is it easier on the stomach unlike NSAIDS for these ulcer horses that get into a colic situation?

so many questions

Thanks, Debbie
Moderator:
DrO

Posted on Thursday, Feb 10, 2005 - 7:41 am:

No I haven't Debbied but your case would the sort of thing I would be looking for. Sedation is not listed as one of the side effects and I wonder if the horse was still a bit uncomfortable. Perhaps some of our European members could comment on the sedation as this product has been available for years there.
DrO
Member:
Deggert

Posted on Thursday, Feb 10, 2005 - 1:17 pm:

Thanks Dr O
If any of the members have experience with Buscopan it would be great. Dr O did you have any
opinion on the part about buscopan being easier on the stomach as opposed to banamine? Is it correct that it is not an nsaid?
Debbie
Moderator:
DrO

Posted on Friday, Feb 11, 2005 - 8:30 am:

It is not a NSAID and I cannot find any information to suggest it has an adverse effect on the stomach.
DrO
Member:
Chohler

Posted on Friday, Feb 11, 2005 - 3:15 pm:

my vet has used banamine, rompin?, and buscopan on my horses we had quite a bit of sand colic/ and gas colic last year. I don't know much about it or any real reasoning, but the horses that we used buscopan on I only had to deal with for a day and the other horses averaged 2 days. It seemed to work on the pain better and last longer than banamine.
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