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Gastric Ulcers |
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Gay3
Moderator Group Joined: 19 Feb 2007 Location: Miners Rest Status: Offline Points: 51993 |
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Posted: 07 Nov 2013 at 8:04am |
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As the subject came up recently over a medication given to a Melb. Cup runner on race morning, I thought this info might be handy for any punters interested in furthering their knowledge
Equine Gastric Ulcers: What Horse Professionals Should Know |
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Wisdom has been chasing me but I've always outrun it!
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Shammy Davis
Champion Joined: 14 Dec 2012 Status: Online Points: 8585 |
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Fiddlesticks
Champion Joined: 31 Dec 2012 Status: Offline Points: 49944 |
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So in nature horses are grazers, constantly eating and wandering around etc, hence why they are designed to secrete stomach acid, so taking this on board, if some pharmaceutical was developed that reduced stomach acid and was not harmful or performance enhancing, this might go some way to help reducing the problem across horses generally in work...?
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Panspermia.
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Gay3
Moderator Group Joined: 19 Feb 2007 Location: Miners Rest Status: Offline Points: 51993 |
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That's what omeprazole & ranitidine do basically but both have their limitations. The only thing that clears them completely is a course of the former combined with a fibre based diet & relaxed environment which is what the recipients of OTTBs do immediately the horse arrives
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Wisdom has been chasing me but I've always outrun it!
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Fiddlesticks
Champion Joined: 31 Dec 2012 Status: Offline Points: 49944 |
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I'm talking about a drug that inhibits the production of stomach acid, something that works similar to a Monoamine oxidase inhibitor.. |
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Panspermia.
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anabel
Champion Joined: 29 Mar 2012 Location: VIC Status: Offline Points: 1521 |
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Omeprazole is a proton pump inhibitor so that does prevent acid formation in the stomach. Not the same mechanism as the MAOs but it is very effective. Just extremely expensive to maintain for horses - hopefully there will be a generic alternative available soon.
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Shammy Davis
Champion Joined: 14 Dec 2012 Status: Online Points: 8585 |
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JMHO but gastric ulcers are the most significant problem facing the general health and well-being of the competitive horse during training through retirement.
In the USA, some racehorse trainers are giving omeprazole as a prophylactic measure, which I think is extremely sensibile.
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Gay3
Moderator Group Joined: 19 Feb 2007 Location: Miners Rest Status: Offline Points: 51993 |
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The trouble is, their digestive system has evolved to need acid.
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Wisdom has been chasing me but I've always outrun it!
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JoH
Champion Joined: 15 Oct 2009 Location: Whittlesea, Vic Status: Offline Points: 1781 |
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FWIW (ie it seems to work for me)
For horses that don't have half day (or more) access to green pick / ad lib hay I make sure they get a biscuit of hay at least 30 mins before ie. not at the same time as, their hard feed ration and if they are on an am / pm feed regime that they get one (hay) biscuit some time between those feeds. |
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suck it up ... Life isn't run at w.f.a. :)
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Gay3
Moderator Group Joined: 19 Feb 2007 Location: Miners Rest Status: Offline Points: 51993 |
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I think many do Jo, especially the non racing ppl & it does work well. Many in the industry also give ad lib hay which is certainly a big help but there'll always be the hypey ones best suited to a quiet, less stressful environment.
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Wisdom has been chasing me but I've always outrun it!
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Fiddlesticks
Champion Joined: 31 Dec 2012 Status: Offline Points: 49944 |
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I wonder if there is any data to support one way or the other if these ulcers are less prominent here or Overseas..( training methods ), my first boss I worked for ( Kiwi trainer ) was very big on hay after work, in fact we used to get this purple stuff that was almost wet, had a sweet smell, he told me the Queen used it for her horses, came in a white vacuum sealed bags...it was very sweet and fruity to smell... |
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Panspermia.
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Munga Rangi
Champion Joined: 18 Jul 2012 Location: Sydney Metro Status: Offline Points: 1954 |
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True guys, Just to add to the above, when my late father was training, we always grew our own greenfeed. We have never had a large property, but we are able to irrigate about an acre and this kept all the gallopers in various seasonal greenfeed all year round.The horses in work also went out into their 30mx 30m grassed yards every day after their exercise. The horses absolutely loved this, even the biggest 'picky' pain in the butt when first arrived, would eventually scoff every morsel. My father always said that the best recipe for success was to keep as close to nature as possible. Old fashioned I know, but when you have seen the once 'highest priced yearling in Australasia' - who suffered terribly with ulcers, weaving in his stable, with the door open, unsure of what to do...makes you realize that a lot of these problems are man made.
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Caveat emptor
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Fiddlesticks
Champion Joined: 31 Dec 2012 Status: Offline Points: 49944 |
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That's a very sad part of racing I feel...it's such an empty feeling to see unhappy animals being made to stand in tiny hot boxes day in and day out, then only come out to work hard for a short period of time before being boxed again...very unnatural... |
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Panspermia.
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JoH
Champion Joined: 15 Oct 2009 Location: Whittlesea, Vic Status: Offline Points: 1781 |
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I think many do Jo, especially the non racing ppl & it does work well. Many in the industry also give ad lib hay which is certainly a big help but there'll always be the hypey ones best suited to a quiet, less stressful environment.
Even in full work my endurance horses were trained out of the paddock so 24 hour pick was always available. I fully understand that this would not be available (or even suitable) for many/most TB's in work but one of the plusses with the (TB) trainer I'm happy to drive 2.5 hrs out of Melb to use is that the horses aren't stabled 24/7, that they are in day yards with a WI/WO plus they get a grass paddock turnout each day and don't live at the track - much as Munga described. Again, I'm aware city trainers would be hard pushed to do this but as most of my horses will be coming home once their racing days are done I do what I can to ensure they come home as physically (and mentally) sound as possible. |
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suck it up ... Life isn't run at w.f.a. :)
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Gay3
Moderator Group Joined: 19 Feb 2007 Location: Miners Rest Status: Offline Points: 51993 |
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Apparently in the old days, the Flemington trainers had daily deliveries of milk thistles from the multitude of market gardeners& imagine other city tracks did also.
Whilst I too feel sorry for the Aussie horses who only get out of their boxes for an hr max per day, at least they get to spell in paddocks. Imagine life for Hong Kong long termers who get the 'luxury' of a box to spell in |
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Mr Prospector
Champion Joined: 08 Dec 2008 Status: Offline Points: 2025 |
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I am using an Omeprazole based product when I feel its needed and never realised that it fully stopped the production of stomach acids . I will definitely have to have a close look at its used now .
Has anyone ever linked insisted worming problems with Ulcers ? Some of the wormers on the market do very little now and I've often wondered what long term issues would be caused by insisted worms . |
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JoH
Champion Joined: 15 Oct 2009 Location: Whittlesea, Vic Status: Offline Points: 1781 |
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Not sure if there is a connection between worming pastesand ulcers but moxidectin as active ingredient is the best (and IMO the only) way to get rid of encyctsed worms.
Suggested reading: Dr Anne Nyland's book on worms and worming for Horses and donkeys |
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suck it up ... Life isn't run at w.f.a. :)
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Shammy Davis
Champion Joined: 14 Dec 2012 Status: Online Points: 8585 |
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Gay3
Moderator Group Joined: 19 Feb 2007 Location: Miners Rest Status: Offline Points: 51993 |
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I'll 2nd that & it's only $5 as an ebook in many downloadable forms:
http://smashwords.com/books/view/114972 |
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Wisdom has been chasing me but I've always outrun it!
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Mr Prospector
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I was suggesting a high population of encysted worms due the lack of Moxidectin in some pastes may be a problem for horses . Our vet was expressing his concern over the lack of effectiveness of some pastes these days . |
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Gay3
Moderator Group Joined: 19 Feb 2007 Location: Miners Rest Status: Offline Points: 51993 |
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There are specifically only two wormers capable of clearing an encysted worm burden. Equest which is Moxidectin & Praziquantel combined. The other is Panacur or the generic Fenbendazole (1/2 the price).
Equest is used 2 wks apart x 3 = 3 tubes Panacur is a 5 day course to be repeated..................I'd have to look it up. They are the only two despite claims from other companies & I doubt the relevance of worms to gastric ulcers but you never know |
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Wisdom has been chasing me but I've always outrun it!
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Fiddlesticks
Champion Joined: 31 Dec 2012 Status: Offline Points: 49944 |
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It is this that very reason..( and some others ) that I simply cannot continue to take an interest in their product. For quite sometime when they came on line here I would follow the HK & Singapore stuff, but as you say, the way horses have to lead their lives up there, well I just can't support that type of industry with my punting $. I really cannot see anything good coming out of the extended Chinese product that will soon be coming on line either.. |
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Panspermia.
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Mr Prospector
Champion Joined: 08 Dec 2008 Status: Offline Points: 2025 |
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I didn't want to hijack the thread but there is already some resistance reported to Moxidectin due to overmedication and shorter effectiveness to some strongyles I believe . |
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Gay3
Moderator Group Joined: 19 Feb 2007 Location: Miners Rest Status: Offline Points: 51993 |
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Moxi plus Prazi is the difference between all the other Moxis & there's reported resistance to everything available so we can only go with the best we've got & not worm indiscriminately e.g every 6wks for the sake of it, given 20% of the herd carry 80% of the parasites
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Wisdom has been chasing me but I've always outrun it!
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anabel
Champion Joined: 29 Mar 2012 Location: VIC Status: Offline Points: 1521 |
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I think Omeprazole blocks around 90% of acid production. I have a feeling it can also cause a rebound overproduction of acid once discontinued, although I can't remember where I read that so can't reference it. For this reason, I am nervous about using it long-term.
I am still experimenting with the best way to manage ulcers with our racehorses. At this stage they are receiving a treatment dose of Omeprazole followed by the maintenance dose, but will probably cease that and swap to supplements such as Gastrocoat & changed feeding practices once ulcers have healed. There seems to be no conclusive timeframe or recommended program for this though. |
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songline
Champion Joined: 08 Jan 2013 Status: Offline Points: 1587 |
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Best way to wean off omeprazole is to very gradually reduce the dose over a couple of months. Expect some discomfort for a couple of days after reducing the dose. Based on experience in people!
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anabel
Champion Joined: 29 Mar 2012 Location: VIC Status: Offline Points: 1521 |
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Thanks songline, glad to hear of your own experiences with it.
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Shammy Davis
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In human studies, flax seed oil (linseed) has proven to have a protective effect on the colon and reduce bile acids.
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Shammy Davis
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Gay3
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There’s no cure-all for equine gastric ulcer syndrome, but proper management and prevention methods can help your horse remain ulcer-free Janice L. HoLLand, PHd, PaS What could the following three situations all have in common? 1. You return home from a horse show after a disappointing weekend. Your elite performance horse, usual- ly high in the ribbons, did not place well. He occasionally looks at his sides and appears uncomfortable. 2. You have a young, excitable filly that was recently weaned. A normally robust and outgoing foal, she is now standing in her stall, uninterested in either interacting with humans or eating her grain. 3. Your mature gelding that lives on lush pasture recently went through a mild bout of laminitis. He’s always been a stoic fellow and rarely shows when he’s in pain. Now, his hair coat is dull, and he seems to be “depressed.” What might be surprising to some is that while these clinical signs could point to a number of problems, all three of these horses could be diagnosed with the same condition: equine gastric ulcer syndrome. history and signs Equine gastric ulcer syndrome includes not only ulcers found within the stomach (usually in the esophageal region, or upper portion), but also ulcers found at the duodenal part of the small intestine, which is the portion closest to the stom- ach. Ulcers occur when the pH of these gastrointestinal tract areas becomes too acidic, and cells of the lining are damaged. The primary acid of digestion in the stomach, hydrochloric acid, is produced and released continuously into the stomach of the horse. Horses produce almost 1.5 liters/hour of this acid because they have evolved as continuous eaters, or grazers. Ulcers can occur in horses of all disciplines and management situations,although horses in higher stress environments do appear to be more susceptible, according to veterinarians and researchers. A variety of studies have been conducted on gastric ulcer incidence in horses competing or training in different disciplines; some of these results are shown in the chart on the following page. A definitive diagnosis can only be made by a veterinarian who performs gastroscopy on the horse. This involves placing an endoscope (a tubular optical instrument) into the stomach of the sedated horse to view the stomach lining. However, there are some signs that a horse owner or farm manager can watch for that might be in- dicative of a horse experiencing ulceration. Some of these, on their own, might not indicate a problem, but owners should be concerned when they observe more than one at a time. Foals suffering from gastric ulcers, for instance, might show poor appetite (anorexia), bruxism (teeth grinding), exces- sive salivation, diarrhea, and lying on their back (to relieve some of the pain). Mature horses might show some of the same signs, such as anorexia, but they might also ex- hibit weight loss/poor body condition, a dull or rough hair coat, an attitude or behavior change (especially toward train- ing), poor performance, a tendency to lie down, and mild, chronic, or intermittent colic (Buchanan and Andrews, .NUTRITION Causative Factors There are a variety of factors that can predispose a horse to ulcers. Some can be managed, while others, such as genetic predisposition, are more difficult or impossible to control. The three most commonly mentioned causes of gastric ulcers are summarized below. The feeding regimen, including type of feed offered and how often, is one of the most common factors related to ulcer inci- dence (Reese and Andrews, 2009). Horses that are fed only a few meals a day, with grain or concentrate feeds that are high in soluble carbohydrates and comprise a large percentage of their diet, are most susceptible. Since the stomach empties fairly quickly after a meal, usually within 30-60 minutes, the cells lining the stomach can be exposed to the acids that are secreted for several hours before the next meal. So, horses that graze continuously or that are fed free choice hay tend to have a lower ulcer incidence. Feeding grains such as corn, barley, oats, and wheat products might also contribute to a higher ul- cer incidence, related to increased levels of a hormone called gastrin that stimulates stomach acid production. Training and exercise might also contribute to an increased incidence of gastric ulcers. Horses involved in strenuous exercise have a higher incidence of gastric lesions, as shown in the table below, and intense exercise might cause a serum gastrin increase similar to that observed in horses consuming high-grain diets. Decreased blood flow to the stomach during exercise, as well as increased abdominal pressure, might also be a cause (Orsini et al., 2009). Studies have shown that external pressure on the stomach during exercise forces the liquid contents of the lower portion of the stomach up- ward, exposing the sensitive mucosa of the gastric wall to the stomach acids and inducing ulcerous lesions. Another train- ing factor that might contribute to ulcers is increasing the physical demands on the horse too rapidly. This might lead to an increased physiologic stress level, which can in turn increase acid production, and decreased mucosal blood flow, which can delay gastric emptying. Stall confinement in performance horses could be a contributing factor as well, but ulcers might be more related to a horse’s feeding schedule than confinement alone. A study conducted in New Zealand (Bell et al., 2007) found that racehorses that spent part of the day on pasture hadthe same incidence of ulcers (89%) as stall- confined racehorses. Some medications are also recognized as causing ulceration. According to a 2009 study by Videla and Andrews, the most common medications implicated are non-steroidal anti-inflammatory drugs (NSAIDs), which can impair mu- cosal blood flow and compromise the mucus bicarbonate barrier of the stomach, a layer which generally protects the stom- ach lining from the acid. The most common NSAIDs used in horses are phenylbutazone (Bute) and flunixin meglumine (Bana- mine). The potential to cause ulceration is why these medications often are given for a few days and then discontinued. Treatment There are a variety of medications that can be given to treat ulcers. Some are available at the local feed store or in supply catalogs, while others are only available through a veterinarian. Histamine antagonists (H2 blockers), such as cimetidine and ranitidine, block hydrochloric acid secretion. Proton pump inhibitors (PPIs) such as omeprazole (Gas- trogard) also prevent hydrochloric acid secretion and are longer acting than the H2 blockers. Anthony Bliksl*ger, DVM, PhD, Dipl. ACVS, professor of equine surgery and gastroenterology in North Carolina State University’s Department of Clini- cal Sciences, recommends omeprazole as the best therapy for ulcers in horses. PPIs are very efficient at increasing the pH (decreasing the acid level) in the stomach but he says that it takes about three days for these to have the maximal effect of blocking the acid pump. Many veterinar- ians will recommend giving one of the H2 blockers concurrently with the PPI for the first few days because, although they do not decrease acid to the same extent, they will act more rapidly and can block secretion until the PPI takes full effect. Veterinarians sometimes recommend antacids, which contain magnesium hydroxide or aluminum hydroxide. According to a study by CK Clark et al., these treat- ments can cause rapid increase in pH and might eliminate some clinical signs quickly. However, most of these medications only provide relief for a few hours. Protectants such as sucralfate might be useful in combination with other therapies. These medications form a gel within the stomach that coats and binds to the surface of the ulcers and promotes healing. Bliksl*ger believes sucralfate can be a use- ful “third line” of treatment in combina- tion with PPIs and H2 blockers, depending on the severity of the ulcers. Foods that are high in amino acids L- glutamine and L-threonine, such as green cabbage, might also aid in gastric ulcer treatment and prevention, suggest someresearchers. These amino acids help repair and nourish the cells lining the stomach and intestines (Hagen et al., 2009). Changing the Diet Diet modification also is recommended for horses that are predisposed to gastric ulcers. Diets that are higher in forage content and lower in grain should promote the appropriate pH within the stomach and small intestine. In addition, having small amounts of feed present in the stomach for most hours of the day, mimicking the natural feeding tendencies of the horse, can help buffer the acid. According to Bliksl*ger, forage in the diet also essen- tially traps the acid in the lower portion of the stomach, thus protecting the upper regions that are more prone to ulceration. Horses that require more calories than can be provided by forage alone (e.g., competition horses) might need a diet with higher fat content. As well as decreasing the acidity in the stomach, some oils, such as oat oil and rice bran oil, contain polar lipids, which are watersoluble fats that help transport nutrients into the bloodstream and support a healthy gut lining (Frank et al., 2005). Due to its high calcium content, alfalfa might provide an effect similar to antacids (Lybbert et al., 2007).Prevention Ideally horses would be kept in a management situation where ulcers are not even a remote possibility, because ulcers are essentially a management disease. However, the reality is that even horses maintained under the most idyllic condi- tions can develop ulcers. For example, in a 2007 study (TheHorse.com/9950) researchers evaluated ulcer incidence in 62 Thoroughbred broodmares that were kept on pasture. More than 70% of the mares, both pregnant and open (not in foal), had ulcers, and no one factor was isolated as causing the problem. Some of the suggestions given to treat horses with ulcers can also be used to prevent ulcers from recurring, or even occur- ring in the first place. According to Bliksl*ger, the best thing a manager can do to prevent ulcers is to provide maximal pasture turnout and develop/offer a forage- based diet. He also recommends dividing the horse’s diet into multiple small meals throughout the day. For horses that must be confined to stalls for large portions of the day, Bliksl*ger advises using the newer hay nets available that have smaller holes. The horses cannot eat all the hay at one time and will essentially “graze” all day while trying to get the hay out ofthe nets. He also recommends decreas- ing the stress of training or competition (e.g., providing a horse with ample time to adapt to a new environment and sched- uling rest or downtime between periods of heavy training). If this is not possible, then your horse might require some of the medications mentioned in the treatment section. Take-home Message Some horses are more predisposed to getting gastric ulcers, due to manage- ment, performance, or temperament. Nonetheless, horses can be managed, even in less-than-ideal conditions, to lessen the incidence. With proper medical treatment and removal of predisposing factors, ul- cers can be healed, and horses can remain ulcer-free. However, ulcers will reoccur if diet, exercise, and management changes are not incorporated. As with all disorders, consult a veterinarian or equine nutrition- ist about syndromes that might be caused by diet or management. |
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