Wednesday, September 18, 2013

...And the Hopefully Not As Ugly As I Expected

OK, so I've convinced myself that my horse has an ulcer(s).  I've called the vet to set up an appointment for bloodwork and whatever other testing seems appropriate.  In the meantime, I need to do something to keep myself from spiraling into deep thought and overanalyzing every single horse care decision I've ever made in my life.

I happened across a website by a lady named Dr. Renee Tucker.  She has published a book called "Where Does My Horse Hurt?" and she has an Ulcer Report available on her website that purports to offer solutions for horses with ulcers:  http://wheredoesmyhorsehurt.com/horses-with-ulcers.html.  I have to admit that: 1) I am a sucker for internet books and 2) I have never purchased an internet book that I thought was worth the paper that it would have been printed on if it had ever been published.  On the other hand, at least this lady had a published book with some positive reviews on Amazon.  And after reading about the usual treatment for ulcers, I had concerns.

I should preface my concerns by disclosing that I have had almost no positive experiences with human doctors, canine vets, or horse vets.  I think there are very good medical people out there, but I haven't run across any except for my chiropractor, who is the only doctor (human or otherwise) who has ever helped me or any of my pets.  I could write whole new blogs about my medical experiences, including the GP who spent more time trying to tell me what cosmetic surgery I needed instead of addressing my chronic migraines, the assorted vets who misdiagnosed my horse who actually had a textbook case of navicular syndrome, the assorted vets who after 3 plus years have been unable to cure my dog's chronic vaginal infection despite countless tests, antibiotics, Chinese herbal remedies, and even porn-star surgery, the gynecologist who happily dispensed assorted drugs to me over many years without telling me about any of the possible side effects and without trying to find out why I had recurring infections that never fully cleared up, and last but not least, the team of incompetent midwives, misogynist obstetricians and perinatologists, and emergency room doctors who nearly killed me and my baby (this last one is so common, many books have been written on it, and most women would be better off giving birth in any other developed nation besides the U.S. because our maternity care system is so bad).

I realize that not everyone has had those experiences and there are many people who trust their doctors.  Just know that I am not one of them.  I assume that anything a doctor or vet tells me is a lie or just ignorance unless I can determine otherwise.  So, my understanding is that GastroGard is the treatment of choice for ulcers.  My research indicates that the drug essentially works by stopping acid production in the stomach.  The lack of acid then allows the ulcers to heal.  That makes sense to me.  But, horses need the acid in their stomachs to digest food.  So, no acid = no digestion = no nutrients.  What I can't find is anything that really addresses what I see as not an inconsequential result.  What are the effects on the horse of basically shutting down digestion?  Oh, and how about the $45/day cost of the drug that is recommended for at least 28 days?  Not to mention that every time I hear about a horse with ulcers, it seems that the horse is on either GastroGard or its "preventative" equivalent forever.

Please understand that if I thought my horse was in serious pain, I would give him whatever painkiller he needed until I could address the cause of the pain.  And I get that ulcers can be quite painful.  But, as it turns out, my horse was not as bad off as I originally thought.

Back to the Ulcer Report I mentioned above.  Unlike the other internet books I've purchased, this one seemed to have a better level of info.  Not all of it was backed up by the kind of sources I like (I hate the "take my word for it, I've been doing this a long time" argument, although anecdotal evidence does often have merit), but a lot of things the author said made sense.  In particular, she said horses that have ulcers should not get grain or beet pulp.  The reference to beet pulp is what got me.  I've been giving my horse 1 cup of oats, 1 cup of Cool-Stance (essentially ground coconut meal), and 1 cup of beet pulp am and pm.  As I mentioned in my last post, he had completely stopped eating that whole mixture, along with the chopped alfalfa hay he was getting (which is normally like candy).  So, the first thing I did was cut the oats and beet pulp out of the feed.  I also took out the salt and trace mineral supplement, just in case, leaving just the coconut meal.  Instantly, my horse started eating again.  The other change I made was to have the barn wet the feed just before feeding instead of soaking it for several hours, just in case there was a palatability issue.  I've heard a couple of people say that their horses won't eat beet pulp that's been soaking.  And at the old barn, Nimo's food was soaked for just a short time before feeding.  I wanted to cover all the bases.

However, once Nimo started eating his feed again, he almost instantly seemed to get more comfortable at the new barn, and eat more hay and grass.  It was literally like turning a switch.  Just over a week after making the change, he has gained most of the weight back that he lost and is completely happy and calm in his stall, when before he was a basketcase.  I know many of you will be tempted to think that what happened is coincidental and that Nimo really just finally got comfortable in the new barn.  I would agree that is a possibility except for the fact that Nimo had already gone through a significant weight loss at his old barn and was already demonstrating a lack of willingness to eat grass in his field and during and after rides.  Whatever was going on started well before his move.

Before I realized that such a simple change would have such a dramatic effect, I had the vet out for a CBC plus another blood test for liver/kidney, etc. function, a fecal text, and a Lyme Disease test (vet recommendation, not my idea, and I may regret having it done...).  I forewent the scope that would send a camera down his digestive tract because it involved more money and even if no ulcers were found, I'd still get the whole, "Well, the scope can't see everything.  There could still be a hindgut ulcer that we can't get to."  I hate tests that aren't definitive.  Anyway, the test results came back with a normal CBC, except a red blood cell count slightly low (as in 6.5 when a low of 7 is normal).  That would make sense if there was an ulcer.  The GGTP (or GGT) was slightly elevated (as in 36 when the lab listed 35 as the upper normal), indicating a potential issue with the liver.  Based on my research, I think this reading would also support an ulcer because there can be some stress on the liver.  The fecal came back very low, which is typical for Nimo.  And the Lyme Disease test came back as equivocal.  Grrr...

I hate the Lyme Disease test.  My husband once had it done for our dog.  No reason, just because the vet wanted to charge us an extra fee, I guess.  I always had refused it, but my husband trusts the medical profession.  Anyway, the test came back positive for the dog.  And that meant:  she has Lyme Disease, or she doesn't have Lyme Disease but was exposed at some point, or she might be getting Lyme Disease at some point in the future.  I specifically addressed this concern with the vet.  She assured me that the test for horses is much better than the test that had been done for my dog.  She said it would come back with values that would clearly allow a determination of whether the horse actually had the disease. Right...Now, because of that "equivocal" result, I have to pay to get the horse retested in a couple of weeks.  I'm wondering if I have "sucker" stamped on my forehead.

I'll also need to have the liver test redone to see if the value is increasing, which could indicate a serious issue with Nimo's liver.  I am guessing that because he already looks like a different horse, there is probably no issue, but I'll get it done, just in case.

I also want to mention that the vet agreed that my diagnosis of ulcers was likely and promptly tried to prescribe GastroGard without even asking what my budget was or talking about any risks.  Luckily, I knew that there was another, much cheaper, although probably not as effective drug, called Ranitidine.  I asked about it, and the vet said it did work for many horses.  At $35 for a bottle of about 8 days worth of pills, I thought it made economic sense to at least try it.  If it didn't work, I wasted $35.  But if it did, I would save $1260.  However, again, there was no discussion of potential side effects or risks.  I think drugs are like magic (only those who watch Once Upon a Time will get this one).  They have a price, whether it is a side effect, adverse reaction, or just covering up the symptom so you don't look for the real problem.

I have taken both over-the-counter and prescribed drugs.  I have given them to my dogs and my horses.  And pretty much every time, one of the three things above happened.  Sometimes, especially if there is a lot of pain, there isn't much choice.  But, the problem is that relieving the pain doesn't solve the problem.  My concern is that I'll never figure out if Nimo really has an ulcer or something else if I use any ulcer medication.  And I'll never fix it.  And he will have chronic pain the rest of his life.

The other concern I had, which I also mentioned to the vet, was that I felt uncomfortable about giving the drug to Nimo before the bloodwork came back.  What if we were wrong about the ulcer and he actually had liver disease?  Giving him a drug would just be another toxin for his stressed liver to handle.  The results would only take 2 days to get back and given that he didn't seem to be in a lot of pain, waiting 2 more days seemed to make sense.  The vet said there was no need to wait, which I think is irresponsible, especially given the result of his GGTP.

If you've managed to stick with me this long, you can see where this is going.  I'm not giving my horse the ulcer medication as long as he looks like he is in good shape.  I will keep it on hand, so that if his health changes and we have reason to suspect that he is in real pain because of an ulcer, I can give it to him without delay.  I will also have the bloodwork redone in 2-3 weeks to check the RBC and GGTP to rule out other issues.

But, what about Nimo's weight loss, his poor appetite, his difficulty settling in at a new place?  Surely just changing his feed couldn't be the solution to what seemed like such a serious problem?  I don't really know the answer to that.  I do know that I am going to look into some digestive support supplements and be even more diligent about monitoring Nimo's appetite.  I've always made sure he gets at least a little hay before I ride, a snack during long rides, and food when he gets done.  But, I'm starting to bring a variety of foods now, so that I can make sure he gets something in his stomach, even if he's not crazy about eating.  I've never seen him turn down an apple or a carrot.  And apparently he loves bananas too.  I don't want to feed too much sugar, but I want to make sure he's got something to eat.  And, I'm going to look into some natural remedies that may help with stress.  He doesn't seem stressed in the trailer or on our rides, but I want to make doubly sure that I'm doing everything I can to help him.  I also believe that life at the new barn will be more stable for Nimo and that stability will help with any potential stress caused by deviations from routines.  And I have every reason to expect that he will always have hay or grass available to eat, so there shouldn't be any long periods with stomach acid being produced and no food to digest.

And for those of you who might question natural remedies, let me say that I have found some that do seem to work.  Of course, there are the many others that haven't worked for me, but none of them have caused my horse harm.  My favorite is the homeopathic remedy, arnica montana.  It got me completely off painkillers in less than 24 hours after my c-section and it helped my injured foot heal in a week when I had the exact same injury in my other foot at a different time that took 8 months to fully heal.  I'll keep you posted about what works and doesn't work for Nimo.

4 comments:

  1. You watch OUAT! Win! (I cannot wait for season 3 to start...)

    I have to say, while I've been fortunate to not have *bad* experiences with the medical field, I wholeheartedly agree with what you say about doing a careful weighing and assessing of risks in any kind of treatments or tests.

    The vets I use now are, I would use the term, "Forward thinking" in that they are very cutting edge and are always researching whatever the latest and greatest the medical field puts out. But that also means they are very fast to push a variety of tests and treatments for any possible problem, or "overly preventative measures" for something that might or might not be a problem. Unfortunately, my wallet doesn't feel like being their guinea pig.

    My favorite vet was the one my current vets bought their practice from, and he was Old School in the best possible meaning. He was bottom-line practical. His treatment for ulcers? Turn the horse out on grass pasture with no work and no grain or concentrate feeds for 10 days to 2 weeks. 95% of the time, that cleared it up. That's the kind of practicality I miss.

    In terms of trail snacks, I've had good luck with making ground flax cookies -- horses seem to love them and it's just one more thing to add to the variety buffet. :)

    And I second the use of arnica! I'm amazed how fast it has cleared up various scrapes, dents, and bruises the horse life manages to inflict.

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    1. Ashley, your Old School vet sounds like my kind of guy:) I definitely considered stopping our rides for awhile, and if Nimo hadn't bounced back so quickly, I probably would have. And, it's still on the table for the future if it seems like other management changes aren't helping. I don't feel like the kind of riding we're doing is the kind that would typically lead to ulcers because we're honestly still just doing mostly walking, with some trotting, but there's always the possibility that it is causing stress or physiological changes that I don't see.

      And thanks for the tip about ground flax cookies. I'm not sure I would want to eat them, but they sound like they are right up my horse's alley:)

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  2. I agree with you on the giving ulcer medications like GastroGard forever and ever. Nevermind the expense: it has to affect digestion and the functionality of the horse's stomach when used long-term. Like many equine nutritional details, it seems no one has done a study on that yet.

    It is wonderful that Nimo is back to his usual self. When caught early, often all it takes to help heal ulcers is a couple of management changes.

    Bananas are great for a horse's stomach. Alfalfa is an amazing thing, too! The calcium in alfalfa helps buffer stomach acid, and is a big thing among endurance riders. For Nimo's pre-workout snack, you can also try a handful of alfalfa hay or chopped alfalfa forage. For snacks on the trail, a baggie of alfalfa pellets might work, too. My mare developed ulcers while on stall rest (she was already on free choice hay and a handful of low starch grain; she just hated being locked up), and her daily alfalfa forage snack + alfalfa pellets as treats seemed to do wonders for her. Just another tool for your toolbox. :)

    Check out Karen Chaton's "Prevention and Recommendation" here: (you may have seen this already, but in case you haven't she brings up many of the same points you write about regarding ulcer treatment. :) )
    http://www.aerc.org/ENNov05Ed.asp

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    1. Saiph, I've also heard that alfalfa can help with ulcers. In fact, I think I even read about a study done with racehorses where they fed the horses some alfalfa before a workout and there seemed to be reduced incidents of ulcers (I think I read it in The Horse). I've always given Nimo chopped alfalfa, but it was actually one thing that he stopped eating. He's back to eating it again, but I've reduced the amount for awhile, just in case there was something that was causing digestive upset.

      I'm definitely keeping it on the table for rides, though. I know there is a lot of controversy about whether horses should be fed alfalfa at all, but I feel like the prevalence of feeding orchard grass hay (it has an inverted calcium-to-phosphorus ratio) in my area means that I need to feed something to help balance the calcium/phosphorus in my horse's diet.

      And thanks for the great resource on ulcers by Karen. I love her blog, but hadn't seen this article. I kind of wish I would have seen it sooner - I would have felt more comfortable with my thought process! It's always nice to hear what experienced endurance riders have to say about horse health, and there are some suggestions in that article that I think I'm going to try with Nimo.

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