Problem Horse: Stomach Ulcers

                        

What are Stomach Ulcers?

Ulcers are a common medical condition in horses and foals. It is estimated that almost 50% of foals and 1/3 of adult horses confined in stalls may have mild ulcers. Up to 60% of show horses and 90% of racehorses may develop moderate to severe ulcers. Because they are so common, and can occur as a result of a number of factors, the condition is often called "equine gastric ulcer syndrome" (EGUS) or "equine gastric ulcer disease" (EGUD).

How the horse's stomach works

To understand why horses are prone to ulcers, it is helpful to know some horse anatomy. Holding only about 4 gallons, the horse's stomach is small compared to humans. It is divided into two distinct parts. The non-glandular portion (also called the esophageal region) is lined by tissue similar to the lining of the esophagus. The glandular portion is lined with glandular tissue, which produces hydrochloric acid and pepsin, an enzyme needed for the digestion of food. This part of the digestive system also produces substances to protect the stomach from the effects of the acid and enzymes. In humans, eating stimulates the production of hydrochloric acid. In the horse, however, hydrochloric acid is constantly being produced. So, if a horse does not eat, the acid accumulates in the stomach, and can start to irritate the stomach, especially the non-glandular portion.



Horses were a grazing animal that took in food 24 hours a day.  However, we as humans have taken horses off of the open ranges and locked them in stalls and small paddocks.  By doing this we have regulated their diets and altered natures way of smoothing the stomach.  Horses are typically fed twice a day and it is common for them to go without food for several hours at a time.  When the stomach is not taking in feed it has nothing to dilute the acid being produced.  This is what initially sets the horse up for gastric ulcers.

What causes gastric ulcers in horses?

There are multiple factors that can increase the risk of ulcers in horses, including:

Fasting (not eating) - Horses evolved to graze, eating many small meals frequently. This way, the stomach is rarely empty and the stomach acid has less of a damaging effect. If horses and foals do not eat frequently, the acid builds up and ulcers are more likely to develop.

Type of feed - The type and amount of roughage play a role in ulcer development. Roughage, because it requires more chewing, stimulates the production of more saliva. The swallowed saliva helps to neutralize stomach acid. There is an increase in acid production when concentrates are fed. The type of roughage is also important. Alfalfa is higher in calcium, and it is thought that this may help decrease the risk of ulcers.

Amount of exercise - As the amount of exercise increases, there is often a change in feeding (e.g., more times of fasting, less roughage), which increases the risk of ulcer development. In addition, exercise may increase the time it takes for the stomach to empty, so large amounts of acid can remain in an empty stomach for a prolonged period of time. Stress itself may decrease the amount of blood flow to the stomach, which makes the lining of the stomach more vulnerable to injury from stomach acid.

Medications - Chronic use of non-steroidal anti-inflammatory drugs (NSAIDS) such as phenylbutazone (Bute) and flunixin meglumine (Banamine® Paste) blocks the production of a particular chemical called PgE2. PgE2 decreases acid production, so when PgE2 levels are low, acid levels are high, contributing to the development of ulcers.

(http://www.drsfostersmith.com/pic/article.cfm)



What are some signs that my horse has ulcers?

• Poor appetite
• Weight loss and poor body condition
• Poor hair coat
• Mild colic
• Mental dullness or attitude changes
• Poor performance
• Lying down more than normal

Does your horse spook, bolt, rear, buck, or kick while riding?  Is your horse “girthy”?  Is your horse nervous or does it worry?  Do you ride a mare, stallion, or sensitive gelding?  Do you believe your horse is not happy? Does your horse always seem to be crooked to the right? Does it not want to pick up the right canter lead or do flying changes in that direction?  Does your horse have a hard time holding weight? Is it a picky eater? Does it have a dull coat? Has your horse just experienced a recent trauma in their life?  Have they been recently moved to a new barn, or their buddy has left? Has your horse's behavior gotten worse as your training proceeds where as it should be getting better? Does your horse colic or stress when the weather changes, either hot, cold, or both?

(http://www.lunatunesfreestyles.com/horse_ulcers.htm)

If you are reading this and saying, "yeah that sounds like my horse" you probably have an ulcer issue.  Stomach ulcers are incredibly common and many horses have them.  Some are more affect by their ulcers than others.  However, I cannot say this enough when horses have issues there is a source.  Horses want to please us and when they are refusing there is normally a reason.  The reason does not always show itself quickly or easily but with persistence the problem can be solved.

If you have never dealt with ulcers and are unsure contact your veterinarian.  Your vet can determine if your horse is a candidate for ulcers according to the symptoms you are noticing.  If they feel your horse has ulcers they can confirm it by performing a gastric scope procedure.

I really love this excerpt from Cynthia Collins:

"Sometimes people think their horse is having training difficulties, when if fact, the horse is in pain.  I have found time and time again, if your horse cannot or will not do something that you think they should be able to do, PUT DOWN THE WHIP, GET OFF, AND START LOOKING FOR A PAIN ISSUE.  It may not be easy to find and you need a good vet to help, but I assure you, once you find it, the horse will work willingly.  It could be sore hocks, stifles, hooves, backs, ovulation in mares, TMJ, or stomach or hind gut ulcers.  There are very few horses that are bad tempered.  They usually want to please.  Most of the time, the horse is as frustrated as the rider."

What can I do to help my horse?

Step 1

Ulcer healing and prevention of getting new ones is all about controlling the production of stomach acid.  This is done through the use of a H2 blocker, they block the action of histamine. Histamine stimulates the production of stomach acid.

There are only a couple medication options.

• Ranitidine which is effective for 8 hours (give 3 times per day)

• Omeprazole which is effective for 24 hours(give once a day).

These medications are expensive however, they are completely worth the money!!  

My preference when buying medication is to use horseprerace.com  they offer the medications at a greatly reduced rate to ulcer guard.  Additionally, they offer free shipping on orders over $250. 

It is important to treat the ulcers for at least a 21 day period.  Once the ulcers have been treated then you will need to transition your horse to a maintenance product to prevent the ulcers from coming back.

There are many options for maintenance products some of them are:   Tums, Maalox, Mylanta, U-Gard, Gastro-Aid, or Neigh-Lox or there are many generic equivalents.



Stomach ulcer recurrence is not an if its when if left untreated.  Horses who are prone to ulcer's need to have their diet managed.  It is important to make sure these horses have access to hay 24 hours a day.  They also need to have low impact easy to digest foods.

Here is a grain free diet plan that is meant to help heal ulcers:

1/4 cup pumpkin seeds (heals everything including stomach)

1/4 cup dried cabbage (L-Glutamine heals the stomach),

1/4 cup Oat Flour/Fiber (heals hind gut; see below),

1  oz. Probiotics (aids digestion, I use Fast Track)

1/2 cup ground Flax seeds or 1 cup of Rice Bran

I mix them with:

1 cup soybean pellets (high protein, low sugar)

2  cup of Alfalfa/Bermuda hay pellets



Alfalfa is recommended for ulcers because it provides greater buffering capacity compared to grass forages for several reasons. First, alfalfa contains higher levels of protein and calcium, both of which buffer gastric acid. Also, alfalfa cell wall contains certain indigestible compounds such as lignin that gives it a greater buffering capacity than grasses.



The best results come from a combination of first treating the ulcers and then working to prevent them from reoccurring.  As with anything, you have to change something if you want to see results.  Doing the same thing and expecting change will not work.

I want to restate what I said at the beginning...

It is estimated that almost 50% of foals and 1/3 of adult horses confined in stalls may have mild ulcers. Up to 60% of show horses and 90% of racehorses may develop moderate to severe ulcers.

 At those numbers, the chances of your horse developing ulcer's is also very high.  I have seen huge changes in my horses after they are treated for ulcer's .  Better performance, attitude and improved feed utilization.

The first sign that I notice with my horses is normally attitude.  I spend a lot of time in the barn and around my horses, I pay attention to the little things.  Changes in their attitude tend to catch my attention quickly.  When a horse runs up to you in the pasture everyday to go for a ride and then slowly over time you are chasing them... You may need to ask yourself why your horse no longer wants to be caught.  There is most likely a reason that they quit wanting to be ridden often times it is some kind of pain.  Another sign I notice is how they eat.  Horses who show aggression towards their feeder or are reluctant to eat also get my attention.  The key to identifying ulcers is noticing the small changes.

               

What is a broke horse?

The definition of a broke horse varies greatly depending on who you are talking to.



Definition: Broke means a horse is trained. Broke to saddle or harness indicates what the horse has been trained for. Dumb broke may mean the training has just started. Well broke may mean the horse is well trained. Un-broke means the horse has not been trained to carry a rider or pull a vehicle.

These definitions leave lots of room for interpretation.  What I consider broke varies greatly from what someone else calls broke.  A lot of what goes into a horse being considered broke by different people is what they want to do with the horse.  People who are planning to only trail ride a horse will most likely not care about leads, collection and headset.  However, when you are working to train a performance horse all of those things have to happen first.



I am of the belief that all horses should saddle and ride quietly inside and outside of the arena.  I do not care what discipline they are being trained for you should be able to take them on trail rides and they should be able to remain quiet.

I have been around entirely too many horses that were sold as "broke" and they were terrified of trails and only knew how to do one thing.  Horses that only know how to run barrels are likely to get burnt out and start having problems performing.



There are many things that a horse needs to know how to do before you start running barrels on them.  Collection is a major one, horses need to carry themselves properly and stay in the proper frame through transitions and lead changes.

What is Collection?



In the top drawing the horses head is elevated and the horses back is dropped.  Try rolling your head back, what happens?  Your back instantly curls away.  This is what happens when a horse carries their head high.  Try the opposite put you chin to your chest your back now arches out.  We want our horses to move with a low headset and an elevated back.  Why?  When a horse is round in their back they have their hind quarters under them and engaged.



Horse's need to drive with their hind quarter's and not drag themselves along with their front ends.  In order to achieve collection, we have to get the horse to relax and drop their heads.  It requires the horse to be well broke and comfortable with their rider.

                          

Transitions



Notice how in the above animation the horses head is in the same place.  This is called the horses frame, they need to look the same no matter what speed they are going.  Horses have to be able to stay balanced as they transitions through their gates.  If they do not maintain a consistent frame they are likely to stumble and to fail to drive from their hind ends.

Additionally, horses need to maintain this balance through lead changes.  Young horses must be able to perform flying lead changes.  Flying lead changes are required in barrel racing.  The best way to work on these is by doing figure eights.  Vary the size of the circles to change the amount of time that the horse has to prepare for the transition.


Starting a young horse takes a lot of time and skill.  There is nothing that can replace the value of a solid foundation.  Horses who are started slow and correct will have longer and more successful careers than those who were rushed into the ring.  The amount of time that is spent on the ground teaching manners and in the saddle before the horse sees barrels is what truly makes a horse broke.

Problem Horse: Dentistry

                   

Could my Horse have a Tooth Issue?

Do they exhibit any of these symptoms?

• Weight loss.
• Bolts his food or eats it unusually slow.
• Dribbles his feed or drops feed half-chewed from his mouth.
• Drools or salivates excessively.
• Chooses to eat hay before grain.
• Tilts or shakes his head while chewing his feed.
• Tongue, lips or gums develop sores.
• Manure contains un-digested grain kernels or pieces of hay.
• Resistant to drink cold water.
• Bad odor from his mouth or nostrils.
• Pulls his head to one side or rears while riding.
• Carries his tongue abnormally.
• Shakes head

If you are seeing these symptoms, you need to find a dentist.

                 

What causes dental issues?

The horse is a grazing animal by nature, and his teeth are designed to select and chew grasses—often coarser stuff than that found in lush pastures. The process of mastication (grinding) wears away the tooth enamel, and as a result, the horse evolved with self-replenishing dental work. Domestication disrupted Nature's balance, and most modern horses consume a diet that consists of large amounts of concentrates (grain) and hay, with limited opportunities to graze. Chewing hay and grain is less natural for the horse than chewing grass. It limits the movement of the lower jaw, and the process of chewing grain also requires a more up-and-down jaw action than that of chewing forage. A common result is the development of sharp enamel edges, most often along the inside edges of the lower teeth and along the outside edges of the upper teeth.

                          

Why Worry About Teeth?

Okay, so your horse's teeth weren't designed to chew hay and grain. He's not likely to be mountain lion bait these days, and he doesn't need a dazzling smile to win ribbons. So why worry about dental care?

Because if you don't, you might find yourself with one or more health or performance problems on your hands. On the health side, Emerson and Auman say they've seen cases of malnutrition, weight loss, chronic colic, cheek and tongue ulceration, glossitis (an inflamed, swollen tongue), periodontal disease, choke, and even an inability to eat—all resulting from insufficient dental care. On the performance side, dental discomfort can manifest itself as head-tossing, head-shyness, resistance to being bridled, evasion of rein contact, lugging on one or both reins, overflexing (going "behind the bit"), a head-up/hollow-backed way of going, and even rearing or going over backward in extreme cases. Not surprisingly, tooth and mouth pain also can cause irritable behavior.

                         

Auman emphasizes that the symptoms of other physical problems and diseases can look much like those of dental difficulties. However, given the numbers of horses he sees with poorly maintained teeth (he estimates that 80-90% of the horses on which he conducts prepurchase exams are in need of dental care), he's quick to suspect dental discomfort as a possible cause of suspicious behavior or physical symptoms. As he points out, "It's pretty easy to tell whether a problem is indeed related to the teeth, particularly in the case of a performance or behavioral problem—when the teeth are fixed, the problem goes away."

Eating difficulties also are telltale signs of teeth or mouth problems—spilling grain while chewing, dunking hay or feed in the water bucket, holding the head to one side while eating, bolting grain, or dropping partially chewed balls of food. Excess salivation, foul breath, and facial swelling can also indicate discomfort or infection.

From the Author:

Dentistry is an important part of my care routine with my horses.  Good dental care is essential for optimal feed utilization and performance.  I have seen drastic changes in both my horses condition and behavior following dental work.  Feeding horses is expensive, but feeding horses with bad teeth is a complete wasted effort.  Dental work is definitely one of my number 1 checkpoints with problem horses.

                          

Special Addition: Colic

Due to some recent problems a friend of mine has had, I thought that it would be a good idea to give some general information about colic.  I am going to cover what colic is, why it happens and what to do when it happens.  Additionally, I am going to go over some best practices for preventing colic and colic reoccurrence.





What is it

The word “colic” simply refers to abdominal pain. It covers a multitude of abdominal and intestinal problems, ranging from simple excess gas in the intestines to severe torsion or twisting of the intestines. It can also include stomach ulcers, uterine pain in pregnant or post-foaling mares and pain associated with disease in organs of the abdomen.

It is critical for horse owners to recognize the early signs of colic, because the sooner the horse is seen and treated, the greater his chances of recovery. All colic's begin with mild pain and subtle symptoms. If the horse is lucky, it will be a mild colic and resolve on its own or with moderate treatment from a veterinarian.

However, the first clinical signs might be an early stage of a life-threatening colic that will eventually require extensive treatment or surgery. Unfortunately, no one can tell at the beginning.



What does it look like?

Signs of colic include:

• Pawing
• Rolling
• Bloating
• Sweating
• Distress
• Uneasiness
• Loss of interest in food and water
• Peculiar postures (sitting, stretching)
• Absence of gut sounds

Why does it happen?

• High grain based diets/Low forage diets
• Moldy/Tainted feed
• Abrupt change in feed
• Parasite infestation
• Lack of water consumption leading to impaction colics
• Sand ingestion
• Long term use of NSAIDS
• Stress
• Dental problems
• Cribbing

Impaction: a blockage formed by something the horse has ingested


NSAID: non-steroidal anti-inflammatory drug


Parasites, such as strongyles can be a common cause of colic. It is important
to practice a deworming routine to prevent parasites in equines.



Antibiotics may lead to colic because they alter the microbial population in the gut, which in turn affects starch digestion. Dental problems may cause colic if the horse is unable to chew its food sufficiently. Older horses fed coarse hay are at greater risk of impaction colic.  Horses who crib are sucking in air the excess air in the intestines can cause them to twist.




 What can be done?

To give the proper treatment for colic, it is important to determine the cause, so that it can be corrected. The severity of the signs of colic is not necessarily indicative of the severity of the colic, and sometimes it is difficult to determine the exact cause and therefore the correct treatment. For these reasons make sure to have a veterinarian evaluate your horse as soon as possible. Many cases of colic can be treated successfully with medication, while others involving severe impactions or twists may require immediate surgery.

While you are waiting for your veterinarian, you should:

• Observe your horse and monitor vital signs as well as passing of any feces. Remove access to feed. If there is a blockage, any feed intake will only intensify the problem.
• Let the horse rest as much as possible. It is not necessary to walk the horse unless the horse is rolling and endangering himself or people.
• Do not administer any medication without the direction of the attending veterinarian. Pain medication may mask the colic symptoms and complicate diagnosis and treatment. In addition, banamine if administered in the muscle can cause a clostridial abscess that can be fatal. Banamine should always be administered intravenously or orally.
• Upon arrival, the veterinarian will listen for gut sounds, monitor vital signs, pass a nasogastric tube and perform a rectal exam. Most colic cases can be treated on the farm with medication and the use of a nasogastric (stomach) tube to alleviate gas and administer medications. However, if the veterinarian suspects a displacement or an impaction that can't be successfully treated on site, they will refer you to an equine surgical hospital.

What can I do to keep it from happening?

Once you figure out the cause and have treated the colic, some of the preventative measures are self-explanatory. For example, if an abrupt change in diet caused a problem, make sure to make dietary changes gradually in the future. Some other preventative measures include:

• Feed your horse on a regular schedule even on the weekends.
• Do not make sudden changes to the horse's diet.
• A clean fresh water supply should always be available.
• Horses need to drink 5-10 gallons daily
• Water is key to keeping your horse healthy
• Water is the most essential nutrient 
• Water needs to be made available 24hrs a day
• Keep feed boxes and hay racks as well as the feedstuffs clean and free of mold and dust.
• Check teeth frequently for dental problems that may cause chewing issues.
• Provide adequate exercise.
• Feed the appropriate amount of forage (at least 50% of the total diet).
• Like water forage is essential to keeping the guts working right
• Keep feed off the ground to avoid sand ingestion.
• Practice an effective parasite control program that fits your farms needs.
• If you notice your horse is not drinking enough add electrolytes to their diet.
• Electrolytes encourage fluid consumption and keep horses better hydrated
• Winter is one of the most common times for dehydration due to the cold temperatures.
• Additionally, adding salt can help improve fluid consumption.

I good strategy to prevent colic is to provide horses with 24hr access to hay and water.  When their guts stay full, it is hard for them to become twisted and its keeps everything moving at a consistent pace.



Colic is a scary and life threatening situation, as horse owners the best policy we can have is to focus on prevention.  Treatment is expensive and not always successful.  Once a horse has coliced their chances of colicing again go up.  However, those chances are largely controlled by the animals management.  If the horse coliced and nothing was done to prevent it from happening again it most likely will happen again.  Colic happens for a reason, thus to prevent it from happening in the future you must determined why it happened in the first place.

As always I hope this post is helpful and educational!