Tuesday, December 17, 2013

Equine Ulcers - The Diagnosis

Is there a horse blog that exists without writing about health-related issues, especially equine ulcers? I know a lot of people say that this is just the next new fad, like everyone thinking that gluten is the devil, but I am a firm believer that people are now more knowledgeable about this aliment, as well as more willing to endure the expense of treating it when they are looking at a companion animal, or a high dollar show horse who might become literally worthless with a bad case of ulcers.



Lifestyle
Abbey has been in regular training 3-5 days a week for the past year, with me riding her an additional 2, 3, or 4 days a week, so sometimes she gets used twice a day. It's a rigorous schedule, but one that she did well with for at least 6-7 months. The trainer and I noticed a shift in her attitude in late summer. Less willing, more frustrated with us asking her to round and carry herself on her back end. Her right hind is the most difficult to get her to reach up and under, so loping to the left feels less fluid and flowing (ulcers apparently cause more discomfort in the upper right hind area sometimes, so that makes sense).

Possible Ulcer Factors
Other than the amount of riding time, there are other possible contributing factors. Here is a list that I have complied that I think have added to the ulcer issues for Abbey:
1. My barn is limited to dry, sandy lots that are not overly large in size. There is no natural forage.
2. In the summer, they are fed grain in the AM on an empty stomach, then turned out into the dry lot with a few flakes of hay each.
3. The Trainer rides during the day, and may at times be on a more empty stomach, especially in the summer when they are only fed some flakes of hay rather than on a round bale.
4. They come in at night, and sometimes have hay already down, other times, get grain first, then hay (grain on an empty stomach can be tough on the stomach, and if undigested, can pass into the hindgut and create ulcerations there as it ferments).
5. I got into the habit of riding her after her PM grain and little to no hay consumption because I didn't want to be at the barn until 9 or 10 each night riding, especially when the feeding is late for some reason. Riding on an empty stomach can cause the acid to splash up an irritate the unprotected part of the stomach.
6. We went to a show in July (although I think this was taken in stride really well, as she settled in fine, and was fine for the next month or so after we came home). Stress can bring on ulcers in as little as a few hours.
7. She had a new volitile pasture-mate for a week in August that really set her on edge and high alert - this was when the most marked changes began to occur. She had a stressed out week, and just never really recovered from it to my observation.
8. She caught a cold in September, which turned into a sinus infection with a fever, and was on bute and antibiotics. Bute can cause ulceration, and antibiotics aren't good for natural flora in the gut.
9. We started working on going over poles for trail, as well as introduced a correction bit (since removed and gone back to the kimberwicke or tom thumb). Stress here from learning something new, being required to round up in the correction bit, and more actual movement of stomach acids from the activity over the poles, especially at a lope.
10. Hoary alyssum exposure and reaction in late November. The first round bales of hay dropped this winter had a large amount of this toxic weed in them, and many of the horses displayed classic symptoms of  edema (swelling) of the lower limbs, usually rear but some of them in both front and rear, fever, intestinal discomfort. More Bute was given for a day or two to reduce the fever and inflammation. MSU has good information on plants toxic to equines in Michigan. http://msuextension.org/publications/AgandNaturalResources/EB0194.pdf
http://www.ans.msu.edu/uploads/files/ToxicHayPasture.pdf

Pre-Veterinarian Diagnosis/Process of Elimination
I have done extensive googleing of this subject, so the statements above are a collection of thoughts taken from people who know way more than me about this.

My trainer wanted to rule out a few things before getting the vet involved:
1. Heat cycle - with it being winter in Michigan, she should not be in heat and any cyclical symptoms should have subsided for the season.
2. Joint pain or lameness that is not being openly displayed when in training. She never feels off, just resistant and hollow. To test for joint versus muscle/soft tissue pain, Abbey was dosed with Bute for 3 days while in regular work. There was not a marked improvement, so the issue was likely not related to soft tissue. This left joint or bone issues or ulcers as the next likely candidates.

Veterinarian Diagnosis Part 1 - Lameness Exam
The Vet came out yesterday, December 16th. He did a full lameness exam, which involved him observing her at the walk, trot, and canter on a lunge line, trotting off from the side and from behind, and flexing one rear leg, watching her trot off, then the opposite foreleg, trot off, other rear, trot, final fore, trot off. He also watched tight circles that required her to cross over in front and behind. He scored her movement on each of these tests (this is way out of my realm of understanding, and I think you have to be around horses for years to see what trained eyes see here).

He also used an accelerometer with a tracker placed on her poll, her sacrum (highest point on her butt) and one on her front right pastern. The accelerometer confirmed his observations of her in the visual evaluation, that she is having some drag on one side on take-off, and harder impact on the other side on landing. He said she was also a little crooked in her hips and we could adjust that chiropracticly.

He measured her hoof angles and exclaimed that he was amazed that the angles were almost identical - we have a wonderful farrier.

The outcome of the lameness exam was that she had a very small amount of imbalance in her stride, but overall she looked good and sound. There was a little sensitivity in the right hock, but nothing that would cause the changes in personality that we have noticed. He thought that if we could clear up the source of irritation (likely ulcers) that the mild imbalance would resolve itself over time.

He did say that we should keep an eye on the right hock and it will likely need maintenance down the road at some point spring, or later on in her career).

Veterinarian Diagnosis Part 2 - Trigger Points
The Vet then checked her trigger points from head to toe, literally. He noted that she had pain in her TMJ area (from clenching her jaw from discomfort). Her poll was non-reactive. Her neck had some stiffness, and two-thirds of the way down her back on her barrel was moderately reactive with her moving away from the pressure on that point. She was also reactive on her gluteus medius, gluteus superficialis and her biceps femoris (all haunch muscles that have been working to compensate and protect her from the irritation in her gut). The ulcer point on her belly was moderately reactive too, not to where she wanted to kick, but she was angry and moved away.

Without performing a scope, which only looks at the stomach, the Vet felt that she has a moderate case of ulcers. He is not certain if they are fore or hindgut, but we will treat for the foregut, and if we still have issues then we will follow up with treatment for the hind. I think she has both (from reading that the hindgut causes problems with the right hind end).

He also checked her ovary points, and didn't get a reaction there, so that is a good sign as some mares develop cysts that are very painful and require surgery.

Treatment Part 1 - Holistic Health
The Vet adjusted her in the neck and through her spine, as well as in her SI joint near her hips and pelvis. She enjoyed the treatment, with licking and chewing and seemed to be more comfortable.

We followed the adjustment with some acupuncture of the TMJ point, as well as the other reactive areas on her barrel, and in her rump/SI/hip region. Three locations got an injection of B-12 as well to stimulate healing in those areas. He also pricked a point on the rear pasterns just above the coronet band that is where the median for the stomach runs. She didn't enjoy the acupuncture as much as the chiropractic, but she tolerated it well.

He and the Vet Tech also showed me some TMJ massage/stretches we can do to help relax that area and relieve some of her tension. (Probably to help relieve some of the owner tension as well, since it always feels good to be doing something!) She gets two days off to let the chiro and acupuncture settle, and then she can get back to training.

Treatment Part 2 - Drug Therapy
We will be treating Abbey for 30 days with omeprazole in granular form. Because she is not exhibiting severe symptoms like colic, we will use something other than the ungodly expensive UlcerGard and GastroGard. He provided me with 90 packets of Abprazole. http://www.abler.com/gastric-ulcer-treatments/abprazole. She will get 3 packets in the AM for 30 days. If she doesn't want to eat the granules, then we will mix them with applesauce and administer in a syringe like a paste wormer.

Treatment Part 3 - Dietary Changes
She also needs to have access to hay 24 hours a day to give her stomach acids something to eat besides her stomach. I just ordered a NibbleNet from Deb over the phone. http://www.thinaircanvas.com/nibblenet/nibblenetframe.htm She was very helpful and friendly, and helped me pick out what she thought would be the best option for our needs. I went with the DoubleNibble 12" which holds 20-25 lbs of hay and has one side with 1.5" openings and the other side with 1.25" openings. I am going to start her on the 1.5" side, feeding one flake on the ground and then pulling some of the hay through the holes to encourage her to eat from the net. After she gets used to the 1.5" openings, I will flip the bag over and feed through the smaller holes.


Follow-Up and the Future
We will reevaluate her in 30 days with the Vet, as well as keep tabs on her in training to see if we notice improvement in her comfort and ability to move forward and be round.

If there is still reaction at the ulcer points, and sour attitude, then we will be more aggressive with the treatment and will go to GastroGard/UlcerGard and look at getting her off of her grain and going to a beet pulp mixture that my Vet mentioned. I hope we don't need to go that far, but it's nice to know that he has a plan if we need to do it.

My trainer said that when they go off the round bales in the spring/summer, she may not be able to have a lot of turnout if she needs to always have hay, as she can't afford to give three horses unlimited access to hay (she has two pasture mates) all year round. I'm not crazy about this idea, as I would prefer for her to be out at least 6-8 hours, but I will cross that bridge when I come to it. For now, she is on a round bale, and hopefully that will help with the ulcers healing. If we can get them healed and make sure she has the slow feeder for her hay at night then hopefully we can get her back on track to keep enjoying her training and ready to show this next season.

A Year in Retrospect
It is hard, when I look back at the year, so see the injuries and set backs in health that are related to keeping a horse confined to a stall and with limited space in turnout, as well as the demands placed on them for training and showing. It's hard because I am imposing these unnatural things on an animal that is not really given a choice.

Like a medical person, our job as horse owners is to first, do no harm. That is not always possible, as they are animals prone to injury and illness in these human-made settings. We can learn as much as possible, and do our best to optimize the living conditions for their mental and physical health. So, until I win the lottery and can buy a ranch out west with unlimited access to pastures and varied terrain, I am going to make my beloved barn home the best home it can be for Abbey. Some people might choose to move to a barn with more access to pasture, or choose not to train as hard, or show, but for me in my life, I know I am in the right place on the right path with the people who can support me in my pursuits as a horsewoman and equestrian. I love my trainer, and I love my fellow boarders. These relationships are part of the whole experience, and having come from a very negative barn just over a year ago to where I am now - there is no amount of pasture that can make up for the mental health and safety I feel and I know Abbey feels now.

So, I am coming into this Christmas season with gratitude for the amazing amount I have learned from my beautiful Abbey, and for her huge heart that keeps giving and trying, and for her trust in me as her owner that I will be her voice and her advocate when I know in my gut something is just a little off. I am grateful for the friendships that I am making with fellow horse people at my barn, and for their kind words of advice and support when times get tough. I am grateful for my husband giving me his guarded support for the most expensive hobby known to man, and for a job that pays me well enough to indulge in this passion of mine.

I am saying a prayer as I type this that you and your loved ones are happy and healthy, and if you are seeking a diagnosis for an ailment that you find your answers are are able to heal with love and time. Thanks for reading, this was a long one!





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