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Giving Omeprazole To Horses Getting Phenylbutazone


Eleanor Kellon, VMD
 

It sounds like a good idea to use Gastrogard to protect the stomach when on bute - but it might not be. A recent study found the combination reduced squamous ulcerations in horses getting bute but had no effect on worsening/creation of ulcers in the glandular portion of the stomach. They also found that 50% of the horses getting the combination had clinical signs of colic or diarrhea, two of them severe and fatal, compared to 16.6% with mild signs in the phenylbutazone only group. All horses were healthy before the trial and were scoped before, during and after the 14 day trial period.Blood total protein also dropped more in the bute + omeprazole group than bute alone.

https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.13323
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Elaine Winter
 

where do they get these poor horses that they experiment on?

Elaine Winter, MSW, LCSW



On Thursday, February 25, 2021, 07:15:59 AM MST, Eleanor Kellon, VMD <drkellon@...> wrote:


It sounds like a good idea to use Gastrogard to protect the stomach when on bute - but it might not be. A recent study found the combination reduced squamous ulcerations in horses getting bute but had no effect on worsening/creation of ulcers in the glandular portion of the stomach. They also found that 50% of the horses getting the combination had clinical signs of colic or diarrhea, two of them severe and fatal, compared to 16.6% with mild signs in the phenylbutazone only group. All horses were healthy before the trial and were scoped before, during and after the 14 day trial period.Blood total protein also dropped more in the bute + omeprazole group than bute alone.

https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.13323
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

Hi Elaine,
I note that you’ve been a member for awhile but somehow not been sent our ECIR group welcome which is sent to new members upon their first post.  My job today is to send that to you as well as try to answer your questions.  I went through the article Dr. Kellon posted and could not find more specifics about the horses except for their breeds.  The owner consent form was marked as not applicable.  Under the Ethical Animal Research statement was the following: This research has been approved by Louisiana State University Institutional Animal Care and Use Committee (IACUC #19‐004).  Perhaps they would know more specifically.

And now for the ECIR group welcome letter!  I don’t know if you have an IR/PPID horse you are caring for but if you’ve come to learn, you’ve come to the right place and this should help out.

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck. 

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating". 

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine. If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 



--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Maxine McArthur
 

Dr Kellon, would there possibly be a similar caution when using flunixin? Indy had omeprazole while on the flunixin for her uveitis flare. 
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Nancy C
 

On Thu, Feb 25, 2021 at 11:58 AM, Elaine Winter wrote:
where do they get these poor horses that they experiment on?
You can find the answer under materials and methods in the study link provided.
 
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room


celestinefarm
 

Elaine, under the Materials and Methods is the following:

Horses from the Louisiana State University teaching herd were used.


Many research universities maintain a herd of horses for research purposes. The horses are sometimes donated, sometimes they are purchased with the knowledge they are to be in the facilities research studies. There are strict protocols regarding how research is to be conducted on living animals, and universities will have a committee in the veterinary school that approves how research will be conducted and will monitor it. In this particular study, the horses were examined daily and scoped and were removed from the study as soon as adverse events began in the treatment group. It's unfortunate that a couple of the horses developed colic severe enough to be euthanized , but the gift in that is the knowledge we have now in understanding the potential for severe reactions and consequences that can occur from simultaneously using omeprazole and bute.  


--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Eleanor Kellon, VMD
 

  Maxine,

There certainly could be, but can't draw direct comparisons.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Glenda Hewalo
 

Good Information to Know, thanks

G


On Thu, Feb 25, 2021 at 8:15 AM Eleanor Kellon, VMD <drkellon@...> wrote:
It sounds like a good idea to use Gastrogard to protect the stomach when on bute - but it might not be. A recent study found the combination reduced squamous ulcerations in horses getting bute but had no effect on worsening/creation of ulcers in the glandular portion of the stomach. They also found that 50% of the horses getting the combination had clinical signs of colic or diarrhea, two of them severe and fatal, compared to 16.6% with mild signs in the phenylbutazone only group. All horses were healthy before the trial and were scoped before, during and after the 14 day trial period.Blood total protein also dropped more in the bute + omeprazole group than bute alone.

https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.13323
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


--
Glenda H Saskatchewan April 2020


 

Glenda, there’s an ECIR welcome waiting for you here.  Thanks for posting.

--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


LJ Friedman
 

Not to hijack this message but thinking if we’re learning about omeprazole this post says it’s best to give it on the fasted horse.
--


Sherry Morse
 

I was happy to see that study come out because finding WHEN to dose is almost impossible (and I'd like to think I'm pretty good at ferreting stuff out using Google).  For my own sanity I dosed on an reasonably empty stomach prior to grooming/riding as I figured that would give a good hour or more for it to start working before any food would be ingested.



Sara Gooch
 

Thank you Dr. Kellon,

This is pertinent and timely for me.  On my veterinarian’s recommendation, I have recently been treating a horse with intermittent ,mild colic with Banamine and Gastrogard.  She has been treated in the past with omeprazole for ulcers, but never scoped.  (When our winter weather permits mountain traveling to an equine hospital where she can be scoped, I plan on getting her scoped.)  Do you think Banamine would have the same effect as Bute when used with Gastrogard?  If so, that could help explain her intermittent ulcer symptoms.

Thanks for  your thoughts,

 

Sara Gooch, NE California

ECIR, 2011

 

Sent from Mail for Windows 10

 

From: Eleanor Kellon, VMD
Sent: Thursday, February 25, 2021 1:22 PM
To: main@ECIR.groups.io
Subject: [Special] [ECIR] Giving Omeprazole To Horses Getting Phenylbutazone

 

It sounds like a good idea to use Gastrogard to protect the stomach when on bute - but it might not be. A recent study found the combination reduced squamous ulcerations in horses getting bute but had no effect on worsening/creation of ulcers in the glandular portion of the stomach. They also found that 50% of the horses getting the combination had clinical signs of colic or diarrhea, two of them severe and fatal, compared to 16.6% with mild signs in the phenylbutazone only group. All horses were healthy before the trial and were scoped before, during and after the 14 day trial period.Blood total protein also dropped more in the bute + omeprazole group than bute alone.

https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.13323
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

 


Eleanor Kellon, VMD
 

Sara,

I can't say for sure but it's in the same drug class.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sara Gooch
 

 

Thanks Dr. Kellon,

That research is enough to  make me suspicious of using omeprazole with Banamine.  I’m eager to get my mare scoped to find out if it is still ulcers causing her intermittent mild colic.  She initially responded well to a 28-day treatment with omeprazole.

 

Sara Gooch,  NE California, 2011

 

Sent from Mail for Windows 10

 

 


 

Sara, my horse, Logo, had mild colics for awhile before he was tested for PPID.  My vet had me give him a small amount of cimetidine when he looked uncomfortable to see what his response was.  Within a short time, maybe 30-40 min, he would be back to his usual self.  I don’t recall the cimetidine dose but I can imagine you could do the same with GastroGard.  He invariably did this when I was away.  The first time he evidenced this discomfort, I had a vet out who felt it was an impaction and suggested I keep him away from hay and hand walk him where he could grab some grass.  He had no interest in grass at all and would drag me to the stacked hay.  At 17.2h, he generally won.  Looking back, I realized the issue was most likely the same.  I can’t say he had ulcers without scoping, and knowing how uncomfortable he was without hay in his stomach, I really did not want to do that but it might be an alternate means of checking.  I did not have insurance but gather you generally need to scope to get insurance to pay for the omeprazole.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo