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After participating in Barney's ulcer study only to find out that my
virtually asymptomatic horse (since being treated the horse is a little
easier to catch in the pasture and seems to like Apple Snacks better and
she seems a little friendlier, but she was pretty friendly before the
treatment) had ulcers, I had to decide on a treatment for something that
I had no clinical signs for.

The only way to make sure that any treatment worked would be to do a
follow up endoscope to see if the ulcers were healed....or to use a drug
that I KNOW was going to work because (after having investigated things
for a client's horse that had much worse ulcers) I was told by most of
them, "Gastrogard is such a good drug for treating ulcers we don't even
bother to do follow up scopes."  Although we did with that horse because
she was NOT asymptomatic before the treatment...and the symptoms did not
go away after giving the Gastrogard so we did do a follow up scope and
found that, yep, the Gastrogard did heal the ulcers and we needed to
find some other explanation for why the horse was still colicky.

Also, during this process with that mare, I was told by these same vets,
including an internationally recognized colic specialist that at their
hospital, they treat ulcers with cimetidine instead of Gastrogard
because of the expense.  However, it is necessary to administer
cimetidine three times a day, pretty religiously at eight hour intervals
for it to be effective (and this is something that THEY have discovered
by doing follow ups with endoscopes).

In a hospital clinic setting, administering medication once a day or
three times a day, when horses are being monitored and treated by
experienced veterinarians and clinical staff 24-hours a day makes little
difference.

For me, administering any medication three times a day at regular
intervals was a total non-starter.  I'd have spent more in gas money and
opportunity cost of time spent on the freeway as I might have saved on
the expense in medication, and there wasn't anybody who I could reliably
expect to do it for me.  If I administered it less often than that,
maybe it would work, maybe it wouldn't (remember, my horse was
asymptomatic) and I would have had to do a scope to follow up to see if
it did (as much if not more money than the expense of Gastrogard, and
certainly more aggravation).

I discussed with Barney the option of treating with a generic omeprazole
(the only one of the nine in the clinical study that demonstrated the
ability to lower the acidity in the stomach); however, it had two draw
backs...the first was that it is significantly less stable than
Gastrogard (probably needs to be refrigerated and doesn't have a long
shelf life), and (because of this) he didn't have it with him), but
additionally, though this clinical study showed that it lowered stomach
acidity almost as well as Gastrogard, it still didn't have the well
known history among vets in the community at large to work so well that
there was no reason to do a follow up scope...so, being the doubter that
I am, I probably would have wanted to do a follow up scope anyway.

Besides, he didn't have it with him, so I would have had to wait a week
to start the treatment, and the next endurance ride I wanted to go to
was only a month away....so, if I did the Gastrogard I could start that
day and not have to interrupt the treatment to attend the ride if I
wanted to (which I ended up not doing because I had to work to earn the
money to pay for the Gastrogard :)).

Given all this information, I decided to pony up an extra $250 (the
difference in the cost for the Gastrogard v. the generic omeprazole) for
the convenience of having an easy to administer paste (that seems to
taste good enough that horses don't object in the slightest to its
administration) that I can keep at the barn in my tack shed and not have
to wonder, "Did it really work?"

If I had my horse in my back yard, and somebody trusworthy (and a good
enough friend r relation that I could impose on them in this huge way)
was there all the time to administer cimetidine at eight hour intervals
(which _I_ wouldn't be even if my horses DID live in my back yard), then
I would have treated the ulcer with cimetidine...but I don't, so I
didn't.

What I also learned from my experience with both these horses (mine who
was totally asymptomatic that I took to the study just because I wanted
to make the contribution to the study, not because I thought she might
have ulcers, and my client's who had chronic colicky symptoms, weight
loss, in appetance before, during and after the administration of the
drug, which made me wonder whether some of the symptoms might be a side
effect of the drug), was the symptoms are not a very good indicator of
whether or not a horse has ulcers.

So, my recommendation is, don't treat a horse for ulcers unless you have
done a scope to be sure that they are present, and if you do find
them...treat them with a protocol that is clinically proven to work
(there are several available), or, if you are going to use some other
treatment that "might" work, because some people have noticed the
abatement of symptoms when they have used them...then do a follow up
scope to see if they actually did cure the ulcers and didn't just "calm"
the symptoms.

_I_ intend to do a follow up scope on my horse in about a year.  Not to
check whether the Gastrogard healed her ulcer (I am confident enough it
the drug to think that it did, and besides, she seems to like Apple
Snacks better :)), but to find out whether the ulcers have returned from
a year of living and going to endurance rides.

I don't know what caused the ulcer, she is out to pasture on 100 acres
grazing on (predominantly) oat grass 24 hours a day and is such an easy
keeper that she gets fat on a handful of dirt.  I am hoping that it was
the stress and disruption of spending a month on the road at the 2001
XP, and since I don't plan on doing that again, I am hoping they won't
return.  But I will check in a year to see if they do.

The other horse, BTW, had to be put down because the colicky symptoms
(despite the fact that multiple follow up scopes including on the day
she died showed that she had no ulcers after the Gastrogard cleared them
up) became so bad that heavy pain medication and sedatives didn't
alleviate them, and the owner elected not to do surgery...which didn't
really matter because an autopsy showed that they would have stopped the
surgery even if she had elected to do it because her entire gi tract
would have needed to be removed because of excessive thickening and
necrosis of the intestinal walls.

Had an intestinal biopsy been done before she got in so much pain (and
had gotten so thin) when she was "a bit colicky and was having
difficulty holding weight" (i.e. showing classic ulcer symptoms) they
MIGHT have been able to find some drug treatment (it depends on what the
biopsy showed) that would have reversed the deterioration of her
intestines.

If Barney comes to your neighborhood willing to do an endoscope on your
horse for $50. Do it (whether you think your horse might have ulcers or
not).  Not only because it increases the validity of his study to scope
all horses, not just the ones whose owners think they might have ulcers,
but because it is a very cheap way to get information that can be gotten
in no other way.  And trust me, it is the only reliable way to determine
if you need to treat your horse for ulcers.

kat
Orange County, Calif.

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