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  Discussion on Ulcer treatment and management changes at a boarding stable where I have limited control?
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New Member:
arary

Posted on Monday, Feb 18, 2013 - 12:37 am:

On a hunch, I treated my mare with the full treatment dose of compounded Omeprazole for 30 days. Got the compounded product from my old vet (now out of state) who has had great results with it; he claims equal results to real Gastrguard. My mare is healthy but she is hard to keep weight on, resistant to training, and just generally grumpy. My current vet told me after 30 days treatment to just stop, but I weaned her off over a period of 10 more days. I noticed on the Omeprazole she was calmer, happier, and less grumpy, but as soon as I started weaning her off, she was even more grumpy than before!

I have an appointment to get her scoped on Tuesday, and insurance will pay for 30 days (maybe even 60 days if needed) of real Gastroguard. Unfortunately her management at the barn where I board is a nightmare for ulcers. She gets 3 lbs of Purina Strategy 2x daily, and 4 flakes of nice grass hay in the evening, plus all-day turnout. However, she's a pig and finishes her hay by 8pm, where she goes all night with nothing to eat, then gets that big grain meal in the am with no hay, then turned out all day on a winter pasture with nothing to eat. Between breakfast and dinner, she goes 8 hours with nothing to eat, and of course overnight.

She's still on the thin side, and I've been supplementing her with 1 cup flaxseed and 1.5 lbs of alfalfa pellets once daily. I do all I can to help: she is in very light, non-stressful work and I always put her in her stall and give her a flake of hay before I ride. But I can't get to the barn every day. I'm worried that without management changes, the ulcers will just come back after Gastroguard. Once the grass comes up this spring she should be OK, right? Maybe she just needs to stay on the treatment dose of Gastroguard until then? What else can I do? The barn will not put hay in the field, they will not bring her in to feed lunch. I can purchase some extra hay (looking for alfalfa now) and have them give her a flake in the morning and a couple extra flakes at night. Would more alfalfa pellets help?

I hate to move her to another barn. Most in my area are extremely expensive, and the barn owner really loves and cares about the horses. All the other horses seem OK so the owner thinks her management is just fine. I just bought this mare in the fall so she could have come with ulcers. The only other barns in the area I can afford that don't look scary only offer field board (my mare is a wimp and hates rain/cold/snow) or require you to take lessons with their hunter trainer (I ride dressage), or are way out of my price range (double what I'm paying now). One seems fine in all other ways (they always have hay in the fields) but the arena footing is terrible, so I'd be substituting lameness problems for ulcer problems. Do the management practices at this barn seem horrible, or can I make this work? Also, what do you think of the clinical research on SmartGut Ultra from Smartpak to prevent ulcer recurrence after Gastroguard treatment?
Member:
natalya

Posted on Monday, Feb 18, 2013 - 12:17 pm:

Hi Angela, I have a horse with ulcer 2nd grade, unfortunately we have to give her up to rescue to make a room for another horse, but we see her every week and she looks good. But about 3 or 4 years ago she was scoped for ulcer with positive result and went through a fool treatment with gastro guard, amazing result. For 28 days. then after treatment when we have to trailing her to the shows or she will go through some stress I have always kept couple of tubs of gastro guard and give her 1/4 of a tube before the event or a trip. She did well it’s never elapse since then. My horses eat 3 times a day too. No hay at night. They eat at 7,12 and 6. But I noticed a lot of horses in my experience do not tolerate Alfa- alfa hay very well. I have this mare that was rescue and she pooped a lot and it’s always runny. We put her on alfa-alfa cubes. All my horses were feed with it and grass hay. Then I noticed she is not holding weight very well, I add to her diet 2 lb of Purina senior. She was getting weight and holds it, but poop was still not firm. I treat her with gastro guard to no results. After we switched my horses to Bermuda alfa-alfa pellets everything went to normal I even lower her senior to a 1 lb a day. Weight still good and no ulcers!!! I think if you could avoid pure grain especially for breakfast and somehow convince barn manager to feed her for lunch, I think she would be ok with 3 times feeding.
New Member:
palolovr

Posted on Monday, Feb 18, 2013 - 5:24 pm:

Angela,
Ulcers are pretty common in horses, and lifestyle can attribute to ulcer formation. There are some great articles on "TheHorse.com" with many studies about ulcers. There was a very recent study reported at TheHorse.com where they took broodmares and open mares from a peaceful pasture that only received minimal human intervention and tubed them to check for ulcers. Surprisingly, several of those placid mares in a peaceful setting had ulcers. They also reported on a study that took TB yearlings that were negative for ulcers when scoped, and put them in stalls and fed them a small amount of hay ration with fasting and then re-scoped them at the end of the time period and most had ulcerative changes to their stomach linings. It was determined that since stomach acid is produced 24/7 even when there is no food to digest, the healthiest thing for a horse is to keep hay or grass in front of them and not let them go without eating. Cornell was stated to say that if you feed 1/4 cup of vegetable or corn oil top dressed on a horse's feed, it will help coat the stomach and help both prevent and heal ulcers. Also they said the chief ingredient in UlcerGard is lecithin, and lecithin can be found in soybeans. It was recommended that a soybean based feed should be fed to help protect against ulcers. Strategy is an inexpensive all purpose feed that is mostly grain, and grain should not be fed to horses with ulcers. Cornell says to remove all grain, add alfalfa hay for it's stomach buffering properties and to have hay or grass for a horse with ulcers to eat at all times, so the stomach lining stops being irritated by the acid in their stomachs.
I have barrel racing horses that are worked daily and hauled almost every weekend. We have had our share of ulcers in the past. I have used the compounded Omeprazole and it did help two horses about 4 years ago but the symptoms returned after we stopped the treatment. I then read Cornell's studies and started feeding a flake of alfalfa twice a day, removed all grain and started feeding Triple Crown's 30% Supplement which is a soybean based, vitamin, mineral and amino acids concentrated feed supplement that contains no grain, and is very low starch and sugar (one of the lowest NSC on the market)- an excellent product and one bag lasts one horse an entire 6 weeks. The Triple Crown 30% is concentrated calories and contains flaxseed and other ingredients that make it necessary to special order it for freshness if you live in a hot and humid climate like I do. I only feed one pound a day, split into two feedings. I provide free choice coastal bermuda hay fed in a slow grazer feeder which the horses have to pick out the hay through a small holed grate. This type of feeder slows their consumption, drastically reduces waste and keeps them busy eating all day and night without running out of hay. I put a whole bale in the feeder box and set the grate on top of the bale, and they nibble at the hay - much more like a grazing horse would do. One bale lasts three days and my horses look great. Dover saddlery also makes some really nice, thick, 1-1/4" hole diameter hay nets for $16.99 that are perfect for slowing hay consumption and allowing a horse to eat for extended periods. When I haul to barrel races and we are gone all day, I keep these Dover Saddlery hay nets in front of my horses and they nibble hay all day. I have tried the 2" hole hay nets that other horse supply places sell, and they let too much hay fall out, and my horses can eat a bag in 3 hours. I haven't found the 1-1/4" heavy duty hay nets anywhere other than Dover Saddlery, and I only have to refill the Dover nets ever 12 to 14 hours. My horses are worked hard and they are healthy and shiny and maintain their weight nicely on this feed regimen. We have had no repeat of ulcers since I changed to this feeding program. Good luck with your horse.
Moderator:
DrO

Posted on Monday, Feb 18, 2013 - 6:30 pm:

Hello Angela, how much do the flakes of hay weigh and what is in the Smart Gut Ultra?
DrO
Member:
arary

Posted on Monday, Feb 18, 2013 - 11:16 pm:

Hi Dr O,
I have not weighed the hay, but they are decent sized flakes of a timothy/orchard grass mix. Mostly grass but some timothy. Smart Gut Ultra is made by Smartpak. They claim clinical studies prove it helps prevent ulcer recurrence after Gastroguard treatment, but I'm always suspicious of studies conducted by the manufacturer. I was hoping you could tell me more about the scientific validity of that study.

From the company:
NEW! SmartGut Ultra is clinically proven to work. In a university-led research study, SmartGut Ultra helped maintain stomach health in horses under stress, as well as horses who had been treated for gastric lesions. This enhanced formula includes GastrAvert™, a proprietary blend of sea buckthorn, glutamine, aloe vera, pectin, and lecithin. Loved by riders and backed by research, SmartGut Ultra is the best choice for supporting horses under stress from training, competing, traveling and living in a stall, as well as those with a history of gastric problems. Patent pending.

I did purchase a nibble net thinking it would space out her hay consumption overnight, but then I got scared to try it. I worry about a horse getting tangled in a hay net overnight with nobody watching. Dunno if this is a reasonable fear. Plus I know it's better for horses to eat off the ground than up high.

Barn owner is NOT going to start feeding lunch as that would entail catching the horse in a huge field to feed her. Best I can do is modify what is fed at twice daily feedings. I work FT, so I can't go feed her lunch. I know Strategy is not the greatest, but other choice was sweet feed. Since she's already on 6 lbs/day of grain and flax seed and still thin, I don't think I can take her off grain. I could buy my own grain, and was thinking of switching to Pennfields Fibergized b/c it's low starch, high fiber and fat. I think I can buy some alfalfa hay so she gets more hay at feedings. What else can I do that's actually going to happen? I know free choice hay is best but that's not going to happen at this barn.
Member:
arary

Posted on Tuesday, Feb 19, 2013 - 6:05 pm:

Results are in:

The nonglandular region of her stomach had no ulceration however along the margo plicatus there was hyperkeratosis which can be a sign of healed ulceration. The glandular region of her stomach was also evaluated. Mild ulceration was noted at the pylorus. The pylorus had normal function and no abnormalities were noted in her proximal duodenum.

HOWERVER, we discovered something else, a granuloma on her left arytenoid. The arytenoid was noted to abduct/adduct normally at rest. To further evaluate the granuloma an ultrasound of her laryngeal cartilages was performed. No abscessation was noted in the left arytenoid cartilage, however, it may be mildly thicker than the right. The CBC revealed a mild anemia with a HCT of 26.1%. The Chemistry revealed a mildly elevated Glucose of 175 (likely due to shipping stress), mildly low Ca of 10.2. The fibrinogen was normal at 100.

Barn owner was with me for the discussion on feeding. She is NOT willing to feed hay at breakfast. However, she will increase her evening hay from 4 flakes to 6 flakes. This is the only time during the day she gets hay. She still would get breakfast grain then turnout all day with nothing to eat. I had planned to switch grain to Pennfields Fibergized Ultra, however the vet noted an increased risk of choke on this feed. With her granuloma in her throat, is she at increased risk of choke? What other feed can I use that's high in calories but low in starch? Is she at more risk for choke? The vet said she'd never seen anything like this before, and I didn't really understand much about the granuloma. She recommended evaluation by an out-of-state respiratory surgeon and surgical removal, but she mentioned if I couldn't afford surgery trying antibiotics??? My horse has never had trouble breathing during exercise to my knowledge.

Do I have to treat this granuloma? Is the risk of surgery greater than the risk of leaving it? She's a lower level dressage horse, not a racehorse or endurance horse. I have about $3000 left before insurance maxes out, which I suspect does not even pay for a surgery. If she needs the surgery she will have it, but considering we'd never even know about the granuloma if we hadn't been looking for ulcers, is it something to panic over?
Member:
paul303

Posted on Wednesday, Feb 20, 2013 - 1:01 am:

Boy, Angela, I don't know about the granuloma. I DO own an ulcer prone mare that was seriously ill about 8 yrs. ago and spent a week hospitalized in North Jersey. When she came home, she did the 28 day cycle on Gastroguard, + an additional 14 days at half dose. We tried keeping hay in front of her 24/7, but we couldn't do that without doing the same for my other 2 horses. SHE didn't want to be locked in while the other two were out, and the other two didn't want HER eating while they were not. I had to keep hay in front of all 3, to keep the peace. Within a year, they all became horribly overweight. Their feed was cut to the level of 2 kitchen measuring cups of Safe Choice twice a day. They had 4 feedings of hay a day - which they wolfed down. We tried cutting back the hay, but the ulcers came back. A very expensive course of Gastroguard followed. Finally, about 4 years ago, a member on this site directed me to Nibble Nets. I've been using them ever since. They did solve the problem and I've had no trouble with them. Hay ceased to be their "end all, be all". They seemed to enjoy working the hay out of the nets, instead of becoming frustrated ( as I thought they would ). Eventually, they began to leave hay in the nets ( their stalls are open to their large communal turnout ), and come back to it later. There is no waste. My vet was so impressed with them that she recommended them to all her clients with problems. I was afraid that my horses would destroy them....so I ordered extras after a year...just to have them on hand. I've never had to open the new ones. They are extremely well made. I don't think you need to be afraid to use them.
Moderator:
DrO

Posted on Saturday, Feb 23, 2013 - 1:34 pm:

Hello Angela,
I certainly would not panic over this however we are not in a position to make any therapeutic decisions. You should follow the advice of the vet who saw the lesion. If the advice includes just watching it or try a course of antibiotic, I see nothing wrong with that since it is asymptomatic. The surgery may be possible with a laser which would be much less expensive.

Concerning the SmartGut our article on ulcers covers some of the ingredients and remember that dosage amounts may be important. I do not know of any good evidence that the other ingredients may or may not be of benefit.
DrO
Member:
arary

Posted on Saturday, Feb 23, 2013 - 10:46 pm:

My vet wasn't really sure what to do for the granuloma, but I just heard back from her yesterday. She's contacted a surgeon and sent him the pictures. She said the surgeon thinks they can just lop off the granuloma with the laser, which is great because my horse would just need standing sedation and the cost is under $1000. But there is a good chance that down the road she would need additional surgery because the cartilage itself appears abnormal, and that would be a major surgery.

I want to talk to the surgeon, but here's my concern:
If I opt for the more conservative approach and do the laser surgery, I'm sure when I renew my insurance they will exclude any further respiratory problems on the new policy. So when she eventually needs majorly expensive surgery years later, I'm not going to be able to afford it. Should I push for the more aggressive treatment now while insurance would cover it? I cannot tell you how relieved I am that I decided to get major medical and surgical coverage for my horse! This is a horse I purchased 6 months ago with a clean vetting.
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