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FDA Warnings On Ulcer Drugs

By Deb M. Eldredge, DVM, November 14, 2014


UlcerGard is available without a prescription. GastrGard requires a prescription. Both are FDA-approved for the treatment of ulcers.

 

As of today, November 12, 2014, the U.S. Food and Drug Administration (FDA) has sent out letters of warning to a number of companies about unapproved drugs that contain omeprazole and are being marketed for horses. Omeprazole is most commonly used in the treatment of and prevention of gastric ulcers in horses. 

These particular versions of the drug have not gone through safety and efficacy testing that the FDA requires. In addition, the FDA’s own testing showed that some versions did not contain the stated amount of omeprazole. Some were under (as little as 36% of the drug present) and some were over (up to 135 % of the drug found). 

The only FDA-approved versions of omeprazole for horses at this time are GastroGard and UlcerGard, both manufactured by Merial.

Products covered in the warning letter include: AbGard, Abler Omeprazole, Abprazole, Abprazole Plus, Gastro 37 OTC, Gastroade Xtra, GastroMax 3, Gastroted, Lomac Equine, Omaktive Oral Paste, Omeprazole Ranitidine Paste, Omoguard Paste, UlcerCure OTC and Omeprazole Oral Paste. We think these products should be voluntarily removed from the market. If we were consumers who purchased these medications, we would consult with the retailer where they were purchased about possible refunds. 

As always, any complaints about animal medications can be made to the FDA by contacting a consumer complaint coordinator or filing a report using the Veterinary Adverse Drug Reaction form.  You do not have to be a veterinarian to do so. 

We all like to complain quite loudly about the FDA – wishing they would approve drugs we want for our horses faster, wishing they would lighten up on requirements for drug approvals, etc. This case demonstrates why our system of drug approval with the FDA works. 

Yes, all the products tested contained a drug that is approved for ulcers – one that we know helps horses with gastric ulcers or a tendency to develop ulcers in certain situations. BUT, the FDA states these companies did not go through the required procedures to market the products as drugs, and the actual amount of medication found in some of these products did not match the label. 

If your horse has liver disease, giving what amounts to an overdose of omeprazole could cause some problems. If your horse is taking omeprazole to help counter side effects of NSAIDs (nonsteroidal anti-inflammatory drugs) and he is not actually getting the full amount prescribed, you could, again, have problems as the lower amount may not be effective. 

The FDA looks at a variety of areas before doing a recall. There may be adulteration problems – something in the medication that does not belong there. This could be a chemical contaminant or a biological one. The formulation may not be correct (and that would include not having the specified amount of medication present in the product). 

Depending on the exact situation, I wouldn't be surprised if an official recall is sent out. However, the most serious recalls are for products that have the potential to cause serious health problems or even death. Less serious are for products that have a low likelihood of causing a health problem or are only going to cause temporary/reversible problems. Least serious are products that aren’t going to cause any adverse health problems but don’t work or are misleading. 

So while we do grump about the FDA at times, we should also thank them for keeping our horses (and our food supply and our own medications) safe.

 

 

 

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Bots Anyone?

By Deb M. Eldredge, DVM, October 24, 2014

Thinkstock
Credit: Thinkstock
Normally at this time of year I would be doing the final “bot check” of my horses’ legs. I would be prepared to use my bot knife or sand paper to scrape them off or I might wipe the legs with warm water to force the eggs to open prematurely and die. This year – basically no bots!

 

I will assume it was our weather. It was a fairly cool summer here in upstate New York with many days in the low 70s and nights in the 50s. My favorite kind of summer though I know many lamented the scarcity of warmer days.

 

Back to bots. While in vet school, it was actually debated as to whether bots really caused horses any problems. Yes, post mortems with a stomach full of bots looked impressive but did they actually drain nutrients and cause horses discomfort? I know – that seems a bit amazing to us now!

 

Bots are actually flies (Gasterophilus species) that resemble bees a bit but they don’t sting or really “buzz.” Depending on the exact species, they will lay their eggs on the horse’s legs, mane, nose or jaw area. Nasal bot flies are especially irritating to a horse when the eggs are deposited. On a bad year, a horse with dark colored legs will have obvious solid patches of light yellow eggs.

 

Most eggs hatch with warmth and moisture – such as your horse nosing or rubbing the area or you using a warm, wet rag to wipe the area. The larvae then enter your horse’s mouth and hang out in those tissues for a couple of weeks. While in the mouth, some horses will develop reactive sores. The larvae are then swallowed or migrate to the stomach.

 

The next seven or so months see the bots attaching to the stomach or small intestine where they drain nutrients. They can cause blockages if they are numerous enough and in the “right” locations. Ulcers, anemia and colic have all been blamed on heavy bot infestations.

Eventually the larvae pass out in the manure where they sit, then pupate and turn into flies. The flies themselves do not bite but they can irritate horses simply by buzzing around them.

 

Until safe versions of ivermectin came along for horse deworming, there were separate dewormers just for bots. Most of these were organophosphates. They had to be used carefully and with consideration of any other chemical or medications given to your horse around the same time. Currently, most people simply rely on ivermectin preparations. Even with very few bot eggs noted, you may choose to deworm for them with your usual fall deworming. Simply use an ivermectin product in late fall to catch them in the stomach. Be sure to use a product labeled as effective against both second and third stage larvae, which will be present in the stomach.

 

It is important to realize that bot infestations won’t show up on a fecal examination like strongyles do. So your veterinarian will be relying on your observations of finding eggs on your horse. You need to carefully check your horse through late summer and into early fall.

 

Bot eggs are easy to spot on Crispy, our red dun Quarter Horse, or Spice, the donkey’s legs. Not so easy to find on Cinnamon the roan colored Appaloosa or Frodo the pinto Mini horse. Check manes and hairs around the nose and under the jaw as well as legs. Keep an eye out for any of the bot flies themselves.

 

I did see some bot flies around so I suspect our equines have at least a few of the larvae in their stomachs. So, yes, I will deworm with bot control in mind as well as the other internal parasites.  

 

 

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Horses in Fiction

By Deb M. Eldredge, DVM, September 17, 2014

ritamaebrown

I am admitting to a slight addiction here. I LOVE mysteries and thrillers. No, I am not really a blood thirsty person but I can read a somewhat gory murder mystery without turning a hair. And yes, I sleep with the lights out but I always have a Belgian Tervuren near me so I feel safe even if no other humans are home.  No book related nightmares here!

I read mysteries of all types, not just horse themed but I do especially enjoy the horse themed ones with a caveat. If you are going to include horses, particularly as a major part of the book, you should know about horses. If you center the book on a specific horse sport, you need to know that sport. You don’t have to be a Grand Prix level rider to have dressage in your mystery, but you need to at least be an educated spectator.

I always flip to the back inside cover to look for an author biography or search it out at the end of the book. I want some sort of horse connection if the book includes equines. I don’t care if the author has simply owned backyard horses for 30 years. At least that person knows which end of a manure fork to put where! I do realize that people can do research and figure out the equine world but I think that the book misses out on something if the author does not have personal experience. Maybe it is simply the “little” things.

The mysteries by Rita Mae Brown (and her cat, Mrs Murphy) always delighted me. I love Corgis as well as horses so I enjoy the dogs in the stories as well as the horses. Rita Mae is a well-established foxhunter and her earlier mysteries often touched on the fox-hunting world. They have moved away from the horse world quite so much but her “equine moments” always ring true.

I have recently read some books that cover equine mysteries with driving events involved, three day eventing and equine photographers. All of these books gave realistic pictures of the sports and events. The authors’ love and knowledge of horses was evident in the written word. These are the books I enjoy and pass on to my “horsey” friends.

Then, of course, we have the nonfiction equine books. I loved the biography of Snowman. He was an equine hero of my youth and his whole life story is basically an equine fairy tale come true. I am about to start on a biography of Native Dancer. I hope it will give some of the “essence “ of this horse as well as his career data. His son Northern Dancer was my first “equine pinup” on my bedroom wall!

We all have our favorite kids’ equine books. I believe I own everything written by Marguerite Henry. The whole Black Stallion series was also read and reread. Black Beauty is a standard for every horse crazy kid. Smokey was another big favorite. Oh, and Colonel Podhajsky and the Lippizaners! I would love to hear about your favorites, too!

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Human and Veterinary Surgeons Partner up at Cornell for Stifle (Knee) Innovations

By Deb M. Eldredge, DVM, August 27, 2014

horse_knee

Could joint repair techniques be used in both humans and horses?

First off – true confessions. I am a Cornellian through and through and I bleed red and white. That out of the way, I am proud to tell you about a partnership that may help many horses with stifle injuries in the future – and incidentally a few humans with knee problems too! 

Recently a team at Cornell worked on five horses to repair meniscal cartilage injuries. The team used a veterinary surgeon (Dr. Lisa Fortier), a human surgeon (Russ Warren, a specialist employed by the Giants football team) and a biomechanical engineer from the Hospital for Special Surgery, an affiliate of the Weill Cornell Medical College in New York City (Suzanne Maher). There were plenty of support staff as well but these three were the main force behind this research. 

Maher developed a biocompatible scaffold to insert into the damaged joint. This provides support for the injured joint to help with repairs and hopefully to offset the development of arthritis. Cartilage is notoriously short on vasculature, which makes it so difficult to repair. Any help that can be given to the joint is a plus. 

A second procedure will make its debut in a couple of weeks with sheep going under the knife. The sheep will benefit from a custom designed meniscal transplant. A professor of dental medicine at Columbia University (Jeremy Mao) has come up with a biodegradable transplant that is also infused with growth hormone. The goal is to provide a template for regeneration of the meniscal cartilage. 

Both surgeries benefit from MRI evaluations of the joints involved, leading to custom designed and produced 3-D printed replacement pieces. Obviously there will need to be some more surgeries done before the technique will cross over to humans but in the meantime, a number of animal patients will benefit. It is also refreshing to see veterinarians and physicians working together on challenges that face both human and animal patients. Bringing in biomechanical engineers and dentists simply rounds out a team of talented, far thinking researchers. 

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A Physical Exam Can Help Your Horse

By Deb M. Eldredge, DVM, August 25, 2014

equine_wellness

Your veterinarian may see changes you might miss.

When horse owners think about veterinary care, they tend to quickly list the quantifiable, easy to check off basic health items:

  • Coggins -  Required annually in some states, biannually in others, for horses that leave their own property.

  • Rabies vaccine - Required by most states and often required by events you might want to enter. Currently, this is an annual vaccine.

  • TEWF (Tetanus, Eastern and Western Encephalitis and Influenza) vaccine -Recommended for all horses as an annual vaccine. (Other vaccines are as needed or recommended for your horse's lifestyle and area where you live.)

  • Deworming - Ideally based on fecal counts with drugs that target the parasites to which your horse might be exposed.

  • Shoeing And Trimming - How extensive and, to some degree, how often can vary with each horse and how your horse is worked.

  • Good Nutrition - Ideally a combo of forage (especially pasture) and grains, plus any needed supplements. don't forget fresh water!

These items are all important, and in some cases essential, for your horse's health. But there's one more item that should be on your yearly list for required health care: An annual physical exam.


During a physical exam, your veterinarian will look your horse over carefully from the tip of his nose to his tail and everything in between. If nothing else, it's another set of eyes and hands thoroughly evaluating your horse. Changes that you might miss, as they have occurred gradually over time, may be quickly picked up by your vet.


Looking at your horse's eyes, your veterinarian may pick up early signs of conjunctivitis or age changes, including cataracts.

The nose will be checked for any unusual discharges or flaring indicating some labored breathing. The increased flare could be quite subtle but is often the first sign of a respiratory problem brewing.

His teeth and mouth will be checked for any changes or problems there.

Your horse's pulse will be checked. His heart and lungs will be carefully listened to, all in an attempt to catch problems sooner rather than later. it's easier and less expensive to treat problems early on. Plus, they tend to have a better prognosis long term. Your veterinarian will listen to your horse's gut sounds and check his manure. His temperature will be taken, while the vet is there, too.

The quality of your horse's hair coat as well as the condition of his skin will be checked. Any unusual lumps or bumps will be thoroughly examined. His overall condition and weight will be discussed, including suggestions for any changes in diet.

Then, as is so important with horses, your horse's soundness will be evaluated. Your veterinarian may notice a slight change in gait or a subtle loss of muscle in one leg. Those are gradual changes that you might miss since you see your horse every day.

If your horse is older, has lost weight or is in poor condition, your veterinarian may suggest some blood work to rule out certain problems. A fecal egg count of the manure might be recommended if you haven't done one recently.

If your horse is young, healthy and basically in his prime you may feel the annual veterinary physical is something you can skip, especially if funds are tight.

Realistically, it's important to have at least an occasional exam done when your horse is healthy. That exam will provide a data base of "normal values" for your horse. If you can afford it, doing a set of blood work when your horse is young and healthy is also a good idea. If he does get sick, you have a record of his normal levels and can see what has changed and just how much it changes.


When money is an issue, talk to your veterinarian honestly. You may be able to get a discount if you schedule an exam during a slow time for his/her practice. Many equine practices slow down in the winter (with the exception of some breeding operations). Scheduling a couple of exams, especially if you have a barn so your horse and the veterinarian are out of drafts and the extremes of winter weather, could be a win/win situation for you and your veterinarian.
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