December 2008 Newsletter
Equine Gastric Ulcer Syndrome
Equine gastric ulcer syndrome (EGUS) is a broad term used to describe a wide array of clinical symptoms, including erosions and ulcers in the bottom of the esophagus, the stomach and the first part of the small intestine (duodenum).
Ulcers are a common medical condition in horses and foals. Gastric ulceration affects a large number of horses and foals: the overall prevalence ranges from 25% to 50% in foals up to 2-months old and 80% to 90% for race horses in training. One study, based on endoscopic evidence, found that >50% of apparently normal horses had gastric lesions. (Murray MJ – Equine Vet J 1989; 21(suppl 7):68-72)
Anatomy
The equine stomach holds only about 3-4 gallons. The horse’s stomach is small in relation to its size. The stomach is divided into two distinct parts. The non-glandular (upper) portion is lined by tissue similar to the lining of the esophagus. The glandular (lower) portion is lined with glandular tissue, which produces hydrochloric acid and pepsin, along with mucous and other protective factors. Hydrochloric acid and pepsin are enzymes needed for the digestion of the food, but can also contribute to the formation of ulcers. There is normally a balancing act between the acids/enzymes vs the mucous and other protective agents. There is a stepped edge called the margo plicatus that divides the nonglandular and glandular regions of the stomach. Most equine gastric ulcers occur in the non-glandular portion of the stomach, right along this division.
Factors that can increase the risk of ulcers in horses
- Fasting or intermittent feeding - Hydrochloric acid is produced constantly in the horse, so if the horse does not eat, the acid accumulates in the stomach, and can irritate the non-glandular portion of the stomach. Remember, horses were evolved to eat many small meals frequently (grazing), which will keep the stomach full and decrease the damaging effects of the stomach acids.
- Exercise – the pressure in the abdomen increases during exercise which forces the acidic contents up into the upper portion of the stomach. “Stress” itself may decrease the blood flow to the stomach, which makes the lining of the stomach more vulnerable to injury from stomach acid.
- Dietary factors - High grain diets cause more acidity than low grain diets. Alfalfa is higher in calcium and is thought to decrease the acidity, thus may decrease the risk of ulcers.
- Transport stress and Stall confinement – both of these have been implicated as a risk factor for EGUS
- Nonsteroidal Antiinflammatory Drugs (NSAID) – Long term use of Bute or Banamine have been shown to induce gastric ulcers. NSAIDs inhibit the production of prostaglandin. This inhibition of prostaglandin results in decreased mucosal blood flow, decreases mucus production and increases hydrochloric acid.
Clinical Symptoms
Foals - poor appetite, diarrhea, colic, teeth grinding, excessive salivation and lying on the back. Many foals probably never exhibit clinical signs, and some do not exhibit clinical signs until ulceration is severe or fatal perforation has occurred.
Adults - Mild colic, poor performance, poor hair coat, weight loss and body condition, poor appetite, mental dullness or attitude changes, lying down more than normal.
Diagnosis of Gastric Ulcers
Although one may suspect a diagnosis of EGUS based on clinical signs and response to treatment, the only current method of confirmation is via gastroendoscopy, which we can perform easily in the standing horse or foal with mild sedation. We have a 3 meter scope at Colorado Equine Clinic that allows us to access all portions of the stomach and pylorus.
Treatment
Several types of agents are available to treat gastric ulcers in horses. These include antacids, H2-receptor antagonists, sucralfate, prostaglandin analogues and omeprozole. These treatments act by differing mechanisms and agents. Antacids, including nutraceuticals, have not yet been determined to be effective in the treatment of gastric ulcers. With the exception of omeprazole, the above drugs require very frequent dosing and are often cost-prohibitive. The only agent that is FDA-approved and proven to heal stomach ulcers in horses is omeprazole (GastroGard). Omeprazole acts to completely suppress acid secretion. One tube of GastroGard given once per day for 28 days effectively heals or reduces the severity of equine stomach ulcers. In addition to medications, changes in management are almost always necessary.
a) Limit periods of fasting by providing regular small meals
b) Feed alfalfa hay or a mix of grass and alfalfa hay to act as a stomach buffer
c) Decrease or avoid grain/concentrates
d) Decrease stress in a horse’s life
e) Give probiotics to aid in digestion
Awareness is the key to prevention. The more you know about gastric ulcers, the better you will be able to manage your horses to avoid it.
If you have any questions, please call Colorado Equine Clinic at 303-791-4747.
Happy Trails
Dr. Lana Groom
The Nerve Center of the Horse – the Foot
Why is the foot the nerve center? When life progressed form single cell to multicell, the first system to develop was the nervous system. The need of an organism to feel and respond is basic and primary in the development of organisms for survival. Horses, as three toed and single toed animals, developed in the Western part of the United States. This environment is dry, hard, and sparsely vegetated. To obtain sufficient food, horses spent most of the day walking. They spend most of their time standing so to be ready to run if danger approaches.
Thus the foot is one of the most used part of the horse’s body. The foot has more nerves than any other part of the body. In contrast, the human has more nerves in the brain than in any other part of the body. In accordance with need, the human, a prey animal needs to think to prey on others, the horse, an animal which is preyed upon, needs to spend most of the time standing or moving so to escape, thus has more nerves in the feet. Propriocepor nerves supply the innate sense of knowing where the foot/limb is and are located at the back of the foot at the base of the frog. The majority of nerves which feel pain are located in the same location and also in the laminae and heel and toe pillars.
The health of the foot has a huge influence on the survival of the horse in the wild, and in the domestic environment for the general health of the entire musculo/skeletal system and happiness of the horse. Because the foot is such an important part of horse health, H magazine will bring to you each month a section on information of the foot.
Kid's Corner
He trots across the field towards me.... All around him his mane flows, only when he reaches me does he yield. In his eyes there lies a warm glow, I
walk him to his stall as I tell him everything about my troubles and my happiness, my rises and my falls
When I talk he is the only one who
is listening, The reds and browns in his main flows beautiful and
bright As I put him in his stall, the stars in his eyes, brighter than
the
night I look at him and know all is alright and I have it all
I am Nine year Bailey Christiansen with blond hair and freckles across my nose. My long legs are perfect for my favorite thing “horseback riding”. Like most girls my age, I love horses more than anything in the world. I read books about horses, draw pictures of horses, collect toy horses, and even pretend to be a horse sometimes. I dreamt of one day having a horse of her very own. And that day did come.
To tell you about my love of horses and how hard you have to work to keep them happy and healthy is a joy for me. My horse Dart is one of a kind, and has something special in his eyes. He is very gentle and loving where ever I am around. Our true love is barrel racing and it is a lot of work but it brings us joy. I am a member of the mile high barrel racing and love to spend all my free time riding and training Dart to run the barrels. You have to know that when you own you own horse, you can't just leave your horse alone; it takes lots of hard work and love to keep them happy. Feeding everyday morning and night and clean up after him. Getting them check ups and to make sure they are healthy. But at the end of the day I am very thankful for my horse and the love I have for him.
We started out slow when I first got him at age 6, taking lessons to teach both of us how to work together and ride, But we where a match. Every once in a while he we be a little bad, but time and work make it all better. They are a lot of things to learn about horses and a lot of years to learn them. So if you are thinking about getting a horse make sure you know what you are in for and are ready for hard work. But they give back as much love as you give them.
Bailey Christiansen Age 9
Blanket or No Blanket?
Whether you plan to blanket your horse this winter or not, there are some important facts that you should take into consideration. In general, it is best if you do not blanket your horse, but there are a few acceptations.
According to Horse.com, horses acclimatize to colder temperatures between 10 to 21 days. A horse’s natural winter coat is the best blanket! Their winter coat is composed of short finer hairs that act as an insulator and long hairs that protect the horse’s fluffy insulator (short hairs) and skin from moisture, such as rain. Horses have a summer coat and a winter coat which begins to change just after the summer and winter solstice. Yes, this means that your horse’s winter coat actually begins growing in late August. It is not the coldest temperatures that trigger the coat’s growth; it is actually the decreasing daylight.
Along with a warm coat to keep the horse comfortable, horses have other behaviors to stay warm. If the temperature drops suddenly, horses will use their shelters more; they will huddle together in groups, and will turn their hindquarters into the harsh winds. A study out of Canada shows that horses can tolerate temperatures as low as 5° F, before there is any decrease in actual body temperature.
Guidelines for Blanketing: When your horse may require it.
If you will trailer you horse this winter, be sure to dress him/her appropriately. Even though it may be frigid outside, it doesn’t mean your horse is shivering inside your trailer. Be sure to keep your trailer well ventilated, and don’t over blanket your horse. This will give him the most enjoyable ride. An over-blanketed horse in a poor ventilated trailer will overheat, causing him to sweat.
To help your horse stay comfortable this winter, there are things you should consider, even if you do decide to blanket. Be sure your horse has adequate shelter and extra food. Shelter can reduce heat loss by 20% by protecting your horse from wind and rain. Your horse has the best built in temperature control! In extreme weather conditions, shelter is better protection than a blanket. Have a warm and safe winter!
A Magical Connection with Horses
It’s a magical bond: the one between horses and humans. A quiet ride before sunset, watching the birth of a foal in the middle of the night, soft horse lips affectionately nuzzling your shoulder, are just a few examples of the ordinary everyday magic that horses provide.
Horses have been used by man for thousands of years in work, war, and recreation, but today a new relationship is emerging. It is one that touches people deeply – on the level of the soul. It demonstrates the amazing bond that can exist between two very different creatures. It gives hope that if such a bond can exist between beings with such diverse natures, then perhaps man can recognize that we are all connected.
This new relationship is one where horses participate in therapeutic riding programs, aid speech therapists, assist with counseling, corporate training, and sex offender rehabilitation. This column will explore these different avenues of horses helping humans and the special connections they form along the way. It will also provide heartwarming stories about horses and the people they love.
The first story I will tell you is about my purebred Arabian mare, Mattame and how she spoke to me. I know it sounds crazy, but I’m not talking about Dr. Doolittle here. It’s not like we had a long drawn out conversation where her lips moved and sound came out of her mouth. It was nothing like that.
She had recently arrived in Colorado pregnant, with a four-month-old filly by her side that was now weaned. I wanted to get to know her better so I decided to spend some time with her in her pen. It was a quiet summer day, the sun hot overhead in a brilliant blue sky. As I carried a bucket of grooming tools and carrots through the gate, Mattame gazed at me with a deep and quiet wisdom. I began to curry her and she stood very still, eyes closing contentedly. It was so peaceful.
I was thinking strongly about her foal and wondering if it was going to be a colt or filly. Suddenly the thought was in my mind: colt. I stopped brushing her, startled. It was not a voice speaking words in my mind, simply the clarity and sure knowledge that it was a colt. I stepped back and looked at her and she gazed back at me. Nothing supernatural was happening. But for that brief moment we had a special connection. I hugged her and she nuzzled my back. In my mind I asked her: Did you really tell me that, Mattie Lou? There was no answer. I was very excited and wondered if she would tell me when the foal would be born. Silence. Maybe she didn’t know that. Then I wondered about my other mare, Princess, since she was also pregnant. No answer there either. But then I was not able to quiet my mind. Finally I managed to still my thoughts and slow my breathing. I started brushing her and asked again about Princess. And this time the answer came: Filly.
Wow, this was so amazing! At first I was afraid to tell anybody. It was too weird! But then I told my good friend Beth and she wasn’t surprised at all. “Horses are so intuitive,” she told me. And she was right. And Mattame was right. She had a colt and Princess had a filly.
The following year I asked her again about her and the other two pregnant mares. And she gave me the correct answer: one colt and two fillies. This was the only situation where I received such a clear message in my mind from a horse. But as I write this I realize that since then I have not spent the same kind of quiet time with Mattame (or any of my other horses) that I did then. We allow ourselves to be distracted by so many unnecessary things in life that we don’t see the miracles that are occurring all around us every day.
I’d love to hear stories from all of you about your special experiences with horses. And we’ll find that magical connection together.
December Case of the Month: NSAID Toxicity
Welcome to H Magazine’s “Case of the Month”! Each month, we will be presenting a case that will provide an interesting and educational topic. These cases are carefully selected from experiences we have seen/treated at Colorado Equine Clinic or researched from professional journals. This month’s “Case” will briefly cover the topic of NSAID toxicity; what is it and why does this happen?
CASE: A seven year-old intact male miniature horse was brought to the hospital for signs of colic, not wanting to eat, rolling in his stall, and passing an infrequent amount of soft manure. Important history includes a one-week old kick to the right forelimb that was being treated with Phenylbutazone, current on vaccinations and deworming, no changes in diet, and all other horses were acting normal.
On examination, the mini was depressed with an elevated heart and respiratory rate; purple, ulcerated mucous membranes with a prolonged capillary refill time; and moderate abdominal pain and distention. A small amount of stomach fluid refluxed when a nasogastric tube was passed into the stomach. A complete blood cell count revealed a chronic inflammatory condition and a chemistry panel indicated decreased blood flow to the kidneys. An abdominal ultrasound, radiographs, and abdominocentesis (abdominal tap) were performed. A small amount of abnormal fluid was present in the abdominal cavity and there was a prolonged clotting time at the site of abdominocentesis. Based on clinical signs and history, the mini was diagnosed with NSAID toxicity. Treatment consisted of IV fluids, antibiotics, plasma administration, ulcer medication, and pain management. However, the mini’s condition continued to deteriorate and the owner elected euthanasia due to uncontrollable pain. A post-mortem examination revealed extensive ulceration of the oral cavity, esophagus, stomach, and portions of the intestinal tract, especially the right dorsal colon. There were also damaging lesions in the liver and kidneys.
DISCUSSION:
- What are NSAID’s?
NSAID is the acronym for nonsteroidal anti-inflammatory drug. NSAID’s belong to a class of drugs that inhibit cyclooxygenase, an enzyme, which then allow for control of pain, inflammation, and fever. At low doses, NSAID’s also counteract the effects of bacterial toxins. - How do NSAID’s work?
There are two types of cyclooxygenase, COX-1 (helpful) and COX-2 (sometimes harmful). COX-1 is responsible for helping to maintain balance of mucosal integrity and blood circulation, while COX-2 is involved in producing certain cell lines, especially prostaglandins, in an injured area and inducing the cascade of “inflammation”. Prostaglandins are why an injured area on your horse feels warm and painful, as well as sometimes swollen and reddened. However, prostaglandins are also why the horse’s kidney is well-perfused with blood and the lining of the stomach remains healthy and intact despite constant acid production. By inhibiting the action of cyclooxygenase, NSAID’s prevent the production of prostaglandins, thereby controlling inflammation, as well as compromising gastrointestinal mucosa and blood perfusion to the kidney. Different forms of NSAID’s include aspirin, phenylbutazone (Bute), flunixin meglumine (Banamine), carprofen, ketoprofen, etc. The majority of NSAID’s on the market are non-selective for COX-1 or COX-2; however, there are a few products which are only selective for COX-2, namely firocoxib or Equioxx. - How do NSAID’s cause toxicity?
NSAID toxicity is usually dose-dependent, meaning that there is exposure to a high dose for a prolonged period of time. NSAID toxicity results in ulceration of the gastrointestinal tract, especially the right dorsal colon, decreased clot formation, and damage to the kidneys due to decreased blood flow. While controlling inflammation, a large, prolonged dose of NSAID also inhibits COX-1, thereby preventing the production of the protective prostaglandins necessary for maintenance of gastrointestinal mucosal integrity and perfusion to the kidneys. When the gastrointestinal mucosa is compromised, erosion and ulceration occurs, which may also lead to perforation of the ulcer and bacteria entering the bloodstream causing a dangerous condition known as endotoxemia.
Signs of NSAID toxicity are usually due to the gastrointestinal ulceration and include decreased appetite, depressed attitude, colic behavior, diarrhea, weight loss, blood in the stool, cyanosis (purple color) of the mucous membranes, and ulcerations noted in the oral cavity. With excessively high doses these signs may be appear between the second to fourth day of NSAID administration. Ponies and foals seem to be at a greater risk for developing NSAID toxicity. NSAID toxicity is not a frequent occurrence and typically arises from administering high, prolonged doses of NSAID.
Phenylbutazone appears to be implicated most commonly in toxicity cases; however, flunixin meglumine has caused some toxicity as well. Phenylbutazone is a more common cause of toxicity due to its irreversible enzyme binding, and therefore, long half-life in the circulation. Research also indicates that phenylbutazone causes direct damage to the cells comprising the lining of blood vessels, resulting in decreased blood flow and necrosis of the gastrointestinal mucosa.
NSAID’s can be a safe and very effective drug for controlling pain and inflammation. Carefully follow your veterinarian’s guidelines for administering NSAID’s. If your horse displays any abnormal signs, discontinue NSAID use and contact your veterinarian as soon as possible.
Seeking to Understand the Mind of the Horse
Horses have been a part of human life for millions of years. Drawings of them are often found on rock walls in ancient culture. They have provided transportation, work load, food, and companionship. Yet, they are the animal most able to flee (except the deer), and humans, are the most opposite of animals in behaviour, we are naturally aggressive. Therefore, horses are often trained with force and coercion. But as the human race is experiencing more sophisticated methods of behaviour, a newer method to train horses, Natural Horsemanship, has developed. This method still trains horses for dressage, jumping, working, cutting, but the methods used are by understanding the horse’s mind, wisely working with his mind, to produce the results we need. We can develop leadership with our horses, something they need from us, not with force generated from our natural aggression, but with their language, a language of movement, body language, desensitization. This is often a difficult change from our human instincts yet a change which improves our lives as humans. The following quote is from Robert M. Miller, DVM,
“I can personally attest to how much horses can improve one’s basic qualities. I am an impatient person. Horses taught me patience. I don’t think I’ve ever been unkind, but having been a normal young male, horses sometimes provoked me to aggressiveness. They taught me, sometimes painfully, to be kinder and more tolerant. I have a farily volatile personality being quick to laugh, to cry and to anger. Horses taught me to contain my emotions. They taught me the futility of losing my temper. They increased my awareness, my perceptivity and my compassion. Above all, they taught me that far more can be accomplished with persuasion than with coercion.”
The best way to train the horse is with love and leadership. Science has helped uncovered the horse’s mind. Future articles will elucidate that mind and how we can work better with our horse companions.
Parents Looking For a Horse For a Child Make a List and Check it Twice
Buying a horse is a complicated business at the best of times. When you are looking at buying one for a child it becomes a lot harder. It can be an unpredictable business over how the horse and child react to one another, it is imperative that you make the right choice.
You must establish that the child is committed to having a horse before you start to make enquiries about buying one. After all, what child hasn’t asked for a horse at some point in their lives? You must ensure your child is fully committed to having a horse and all that it entails and is not going to get bored with it after a few weeks. The best way to establish this is to get lessons for them for about 6-12 month and see if they enjoy it. If they do, then get them to look after the horse they are borrowing and see if they can cope with it. All of the cleaning, brushing, mucking out stall and vet visits. Also make sure they feed both in the morning and night. Once that cold wind and snow hits they have to remember that there horse still needs them.
What Age of Horse?
It may seem like a lovely idea to buy a young horse for a child. They can grow up together and mature together. But in truth it is a very bad idea. First and foremost, it is not safe. Young horses are apt to startle easily or misbehave. They are not usually a good match for young and inexperienced riders who do not know how to handle any horse, least of all one which has hardly ever been ridden. The best type to try is an older, more mature horse. This type of horse knows how to handle itself and it will have seen the world the horse will know more than its young rider. The child will be much safer on an older horse and, what’s more, the horse will help to instill them with confidence and help them to become a better rider. An older horse will also forgive a child their mistakes whereas a younger horse will not know how to cope with them, souring the relationship.
Disposition of Horses
The ideal horse for a child will be of a safe and gentle disposition. You will need a horse who does not exhibit any bad behavior or habits, as a child will not be able to break him of these. Not only can this, but a horse which has bad habits or makes mistakes actually be made worse by a child. The perfect horse for a child will be placid, so that a child’s mistakes can be forgotten and no grudge will be held as it may be with a stronger willed horse.
There are many things to consider when buying a horse for a child. It is best not to take the child along the first time you view a prospective purchase as you do not want them to fall in love with them on sight. If the horse turns out to be unsuitable you may have a battle on your hands if they have already made them their own in their mind’s eye. But before you part with any money, do make sure the child and horse have met and are happy with each other, and you will hopefully have the beginning of a beautiful friendship.
As always ask question, check with an equine Vet and you should always budget for the new cost of owning a horse. It can be costly. But the experience of a child owning a horse can be wonderful and enjoyable for all around.
Mireille Harr
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