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FDA Issues Warning About Several Gastric Ulcer Products

By Grant Miller, DVM, November 24, 2014


An equine ulcer. Looks painful, doesn't it?

As we've told you in our initial news story and Dr. Deb Eldredge's blog, the FDA has warned several companies with products they claim treat ulcers. The products are:

  • AbGard
  • Abler Omeprazole
  • Abprazole
  • Abprazole Plus
  • Gastro 37 OTC
  • Gastroade Xtra
  • GastroMax 3 (marketed by Horse Gold, Inc. and Horse PreRace)
  • Gastrotec (marketed by Horse Prerace and Tri-Star Equine Marketing, LLC)
  • Lomac Equine
  • Omaktive Oral Paste
  • Omeprazole Oral Paste
  • Omeprazole/Ranitidine Oral Paste
  • Omoguard Paste
  • UlcerCure OTC

 

So, why am I talking about this again? Because I believe equine health is at stake here and many horse owners do not fully understand the point of the warnings. 

 

First, as most of us know, the FDA is responsible for protecting the public health by assuring the safety, efficacy and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation. That's an important job.

 

In this particular incident, the FDA revealed that several of these products contained higher or lower levels of omeprazole than stated on their labels, ranging from as little as 36.3% to as much as 135% of the level claimed on the label.”  The statement goes on to say, “FDA has serious concerns about unapproved animal drugs. They may not be properly manufactured or labeled. Horse owners and caretakers are advised to avoid using unapproved animal drug products, including omeprazole products.”

 

We've heard grumblings from consumers believing the FDA just targeted those particular companies for hidden reasons and/or that Merial, the maker of the only FDA-approved equine gastric ulcer medications, was behind the warning. However, these beliefs are misguided.

 

The use of medications that are not FDA-approved is risky. Remember our articles about compounding pharmacies? We believe it's risky and not worth your time or money to use drugs from compounding pharmacies.  And, given that some of these products involved in the FDA warning are inconsistent with their dose strength, their use would subject your horse to a roller coaster of medication doses. Usually, horses given non-FDA approved medications wind up receiving subtherapeutic doses,  which not only equates to dollars being tossed into the manure pile, but also can confuse owners as to what is actually going on with their horse.  

 

Consider this: if your horse shows signs of gastric ulcers, you would expect that giving the horse an omeprazole anti-ulcer medication would cause a resolution of those signs.  But if you use a product that is not true to its label, you may end up mistakenly concluding that the cause of your horse’s problems are not gastric ulcers… when in fact they actually are.  This is probably the biggest factor weighing into why use of non-FDA approved products results in harm to horses. 

 

With the problem of equine ulcers becoming increasingly familiar to horse owners and veterinarians, the use of ulcer medication is likely to become more prevalent.  

 

There are two FDA approved anti-ulcer formulations on the market.  Both manufactured and marketed by Merial, Gastrogard and Ulcergard may be given at varying doses on a daily basis.  They both actually contain the exact same contents: each tube consists of 2.28 grams of omeprazole paste.  The difference is that Gastrogard has been approved by the FDA to be marketed as a prescription product to use for the treatment of diagnosed gastric ulcers.  Ulcergard, on the other hand, has been approved for marketing as an over-the-counter product for use in preventing gastric ulcers.  Other than their labels, there are no differences between the two products.  

 

But what makes these products so special?  What they have that the others lack boils down to a few critical elements:

 

1.   They are FDA approved.  This means that they have been rigorously tested for safety, efficacy and accuracy of label claims.  

 

2.  The chemical make-up of Gastrogard and Ulcergard renders them much more usable by the body.  Most folks assume that because gastric ulcers are occurring in the stomach, that the medications work once they are in the stomach.  This is inaccurate.  The medications must pass through the stomach and into the small intestine where they can then be absorbed into the bloodstream.  Once in the blood, they travel to the stomach from the other side of the wall and act to shut off the hydrogen proton pumps that create stomach acid.  The key to the product success relies partly on the omeprazole being able to pass through the stomach without being denatured by the acid.  To accomplish this, the drug manufacturer enterically coats the medication.  

 

Take home point: The copy-cat medications are not enterically coated in most cases, rendering them susceptible to digestion by stomach acid.  End result: your money being wasted and your horse not getting the treatment he needs.

 

Make life easy on yourself and your horse!  Use FDA-approved medications and work with your veterinarian to determine an appropriate dose.  Beware of compounded drugs!

 

 

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Tips to Make Your Horse Drink

By Grant Miller, DVM, November 16, 2014


Automatic waterers can fill slowly or completely freeze in cold weather, thus restricting available water.

This week’s front of bitter cold arctic air sweeping the middle and eastern United States is making many pull the horse blankets out of storage and finally accept that winter is here.  With the change of season comes the resurgence of winter problems.  Pesky ailments like rain rot and thrush are among them, but they pale in comparison to the big guys - like colic- an issue that commonly occurs when temperatures abruptly plummet.  Why? 

Because horses have trouble drinking cold water and often “give up” a few sips in. Consequently, they can gradually become dehydrated to the point where their digesta impacts in the tortuous curvatures of the intestine or colon. Healthy drinking can head colic, as well as several other problems off at the pass.  Thinkstock
Credit: Thinkstock
Winter snow's pretty, but it's not without critical horsekeeping challenges.


Here are some tips to increase your horse’s water intake this winter:

1.   Check water to make sure pipes aren’t frozen/ ice sheet hasn’t formed.

This tip goes without saying- but it is so easy to forget to check your horse’s water source daily (especially when the roaring fire and cup of apple cider await you back in the house!).  Horses can only last for a matter of hours without water before they begin to be dehydrated.  To avoid the vet’s colic tube, check those water sources! Make sure that they have adequate and accessible water, and also routinely test that they are filling in a timely manner if they are automatic. See Solar Tanks.

2.   Heat water with an electric bucket warmer.

There are all sorts of bucket heaters available on the market ranging from handheld submersible warmers to buckets with permanent heating coils built in. In the case of the handhelds, most people just submerse them in the water bucket while they are cleaning the stall each day.  The water doesn’t necessarily get warm, but it is heated enough to bring the temperature into a more tolerable range to encourage drinking. 

The advantage of a hand held warmer is that it works relatively quickly (a 20 gallon bucket can be heated up by 10 degrees in about 15 minutes). The disadvantage is that they are labor intensive. 

Buckets with permanent heaters are great because you just have to plug them in.  But therein lies a weakness since the cord must be kept out of reach of the horse. Additionally, the heating implements are not known for their longevity and so these types of buckets may only last a season or two.

3.   Feed a warm bran mash a couple of times per week.

The high fiber content of bran along with the warm water used to make it into a mash can provide a bit more water content in the diet.  The average bran mash combines between 5 and 8 cups of bran with enough water to make it stick together in clumps when handled.  Be careful about feeding bran too often- it can lead to a calcium/ phosphorous imbalance which could result in serious problems! Truth be told, most horse owners use bran mashes as a vehicle to deliver salt into the horse’s system, but we will get to that in a moment. 

4.   Make sure your horse is current on dental care.

If a horse unevenly wears his teeth, excessive pressure on some of the teeth can result in gingival (gum) recession and subsequent root sensitivity.  We all know what ice cold water feels like when it touches the nerves in our teeth.  Horses feel no different.  They will be deterred from drinking frigid water if they have dental issues.  Because routine dental care enables us to balance the occlusal surfaces in the horse’s mouth, gingival recession is minimized, thus reducing tooth root nerve sensitivity.

5.  Feed salt.

What is the best way to make a horse drink?  Make him thirsty! What is a cheap and easy way to induce thirst? Feed salt! A couple of tablespoons of salt or electrolytes can go a long way when you “lead a horse to water.” Remember- the goal is to make him drink. Be careful though- from time to time horse owners will decide to put electrolytes in the horse’s water. But that is not what electrolytes were designed for - and drinking salt water is not going to result in a favorable outcome! Just feed some salt or electrolytes every day, and it will help with water intake. See Supplementing Salt.

With these tips in practice, you will keep your horse happier at the water trough.  Happy horses make for happy owners so enjoy the fire and the cider, and rest assured that your horse is getting enough to drink.
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Not Enough Vets in Your Area?

By Grant Miller, DVM, November 10, 2014

Thinkstock Photo
Credit: Thinkstock Photo
Finding a veterinarian in some rural areas can be difficult, but Congress has a plan - one that needs some tweaking.
Last year, we posted an article that generated a lot of chatter among our loyal HJ readers - it discussed the debate over the supply of veterinarians in the United States. To summarize the article, some people contend that there is or will be a shortage of veterinarians while others think that there are/will be too many vets due to several foreign schools now being “viewed” by accreditation powers as U.S. equivalent institutions.  This has caused concern. A key point overlooked by many, however, is this: While the overall number of veterinarians in the United States is excessive, the distribution of those veterinarians is imbalanced. And that imbalance causes service shortages in many parts of the country.

 The American Veterinary Medical Association (AVMA) conducted an extensive study last year to look into the supply and demand issue in greater detail.  The study, called the AVMA Workforce Report, concluded:

 “We estimated that the supply for veterinarians (90,200) in the U.S. in 2012 exceeded demand for veterinarians (78,950) by approximately 11,250 (or excess capacity of 12.5%) at the current levels of prices for services. Between 2012 and 2025, under a baseline scenario we projected that both supply and demand would grow by about 11% (reaching demand of 88,100 and supply of 100,400 by 2025).”

 In other words, we have too many veterinarians. 

However, horse owners in several parts of the country report that veterinarians are scarce in their area.  

How do we solve this problem?  

Congress has attempted to fix the problem by dangling a carrot in front of qualifying veterinarians (thanks to heavy lobbying efforts by the AVMA).  About six years ago, the United States Department of Food and Agriculture (USDA) was given the authority to administer the Veterinary Medicine Loan Repayment Program (VMLRP), which would  pay up to $25,000 per year towards qualified educational loans of eligible veterinarians who agree to serve in underserved areas, with payments up to three years. 

That sounds good, but there are two problems:

 1.The overall amount of funding Congress provides for the program is only enough to enroll a handful of veterinarians each year, if at all and,

2.  Every veterinarian who enrolls for the program is taxed at a 39% rate for the money awarded to them. 

Double take!  The government takes 39 cents out of every dollar that it gives to veterinarians who enroll in the program!  Do you think this is ridiculous?  Ludicrous? Sensible? Logical?

 The AVMA is leaning toward ridiculous. They have introduced new legislation that will remove the 39% tax liability for veterinarians participating in the VMLRP.  The new legislation is called the Veterinary Medicine Loan Repayment Program Enhancement Act of 2013 (S.553 / H.R. 1125).  You can find more information here.  Now is a crucial time for the bill since it is moving its way through Congressional committee review. 

If you feel that you need more veterinarians in your area, and you think that it is just flat-out wrong for the government to take back 39% of money that it is supposed to be giving out on behalf of tax payers to ensure that our animals get access to the veterinary skill they need, then make your voice heard by sending a message to your Congressmen, women, and representatives.

Time is of the essence here.

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Bipartite Navicular Bones

By Grant Miller, DVM, November 03, 2014


A bipartitie navicular bone with the fibrous junction between the two ossification centers indicated by a red arrow.
Every once in a while a veterinarian will come across a peculiar navicular bone abnormality when radiographing a horse’s foot. Most of the time this occurs because the horse has presented for front limb lameness. But sometimes, the horse isn’t lame at all - the problem is coincidently identified when radiographs are being taken for a prepurchase exam. The condition is called bipartite navicular bone(s.) 

 

When forming in utero, all bones begin as cartilaginous structures. Special stem cells in the bone begin to collect minerals and ossify the bones. In the vast majority of bones, the ossification process begins in one location and emanates outward until the complete bone is formed.  But in the case of bipartite navicular bones, there are two centers of ossification that form the bone. Unfortunately, the result is essentially two bones where there is only supposed to be one. Bipartite navicular bone is a congenital problem - meaning that it occurs when the fetus is developing in utero and the foal is born with it. 

 

Although congenital suggests that the problem is genetic in origin (faulty DNA from the parents), this is not necessarily the case. Congenital issues can arise from environmental factors in the uterus such as toxins, hormonal influences, biochemical mediators, and others at critical times during development or throughout development.  In the case of bipartites, the veterinary community just doesn’t yet know what causes them. There is no breed or sex predilection that has been noted - they just seem to happen randomly. Fortunately, they don’t occur very often.

 

The bipartite development can occur on one, two, three or all of the navicular bones in the horse’s body. Unfortunately, most horses with bipartite navicular bones will have significant ongoing lameness. Remember - the navicular bone sits the heel region of all four feet inside the hoof capsule. Therefore, we tend to see the “classic” navicular-type symptoms: chronic heel pain in which the horse stumbles, bobs its head, lands “toe-first” and takes small steps.

 

Management strategy for bipartite navicular bones involves radiography to determine the extent of the issue (sometimes there can even be three centers of ossification in the bone!), protective shoeing, and use of medical therapy to help with caudal heel pain.  In general, veterinarians are still using antinflammatories such as bute or Previcox to manage navicular problems, +/- intermittent use of isoxuprine to help with blood flow in the foot.  Because both Tildren and OsPhos are labeled for navicular bone disease, they may also be helpful in improving the health of the bone and keeping the horse serviceably sound.  Remember - both Tildren and OsPhos are bisphosphonates which increase calcium retention in the cortex of the bone.

 

Sadly, most horses with this condition progress in severity and become too lame to ride, despite therapies.  Not exactly a motivating post to start the week, but there is so little information available about bipartite navicular bones, it seemed useful to share with HJ readers.

 

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Equine Allergy Testing

By Grant Miller, DVM, October 27, 2014



Hives can be so severe that the horse rubs itself raw trying to get relief from the itch.

 

For those owners whose horses are plagued with allergies, few long-term options exist to effectively manage the problem. 

 

About 90% of the time, allergies manifest themselves in horses as hives.  When they flare up, the vet will often prescribe antihistamines and/or corticosteroids to combat them.  Sometimes antihistamines work to reduce the severity of the hives, yet many times cannot resolve them completely.  Corticosteroids, on the other hand, work exquisitely to make hives disappear within hours.  Cold-water therapy or ice packs can also be helpful in slowing down an allergic reaction.  The bottom line: All of these therapies really only work well for the short term. 

 

Long-term corticosteroid therapy, while possible, can be dangerous.  We know that corticosteroids can induce many metabolic changes in the horse that can result in some serious problems.  Laminitis, gastric and colonic ulcers, as well as immune suppression are on the list.  With that said, corticosteroids can be a God-send in relieving an itchy horse of his allergies.  But, are there any safer options?

 

The answer is YES.  Veterinarians have the ability to perform Serum IgE testing and hyposensitization that can provide long-term relief from allergies.  IgE is an immunoglobulin found only in mammals that plays a pivotal role in hypersensitivity (allergic) reactions. Horses plagued with hives often have elevated IgE levels to dozens of allergens prevalent in the environment.  Because of so many triggers, the horse’s immune system remains hyperactive on an ongoing basis.

 

Labs such as Spectrum Labs offer comprehensive test kits that test for common regional allergens. Testing is simple - It just involves drawing 1 blood tube sample and shipping it at room temperature to the testing facility. The Spot Platinum equine assay represents the most comprehensive allergy testing available, with a total of 86 of the most common allergens in the region that the sample is shipped from, including grasses, trees, weeds and shrubs, common barn allergens, grain mixes, foods (such as alfalfa, barley, corn, linseed, milo, oats, etc.), molds and biting insects common to horses.  Also, if you suspect that a specific trigger is causing the allergies, you may request that a test be run for it. 

 

Once testing is complete, the lab will send a report that details the allergy profile for your horse.  It will assist you in eliminating or minimizing allergens in your horse’s environment.  But what if that isn’t enough?  It just so happens that you can use your horse’s own serum to formulate a hyposensitization treatment regimen. It is actually quite simple - the lab will titrate low doses of all of the allergens that your horse is sensitive to (up to 21 standard, with additional allergens costing extra) into an injectable solution. Shots are administered over a 9-month period and administered in increasing doses as well as gradual increases in concentration. This method serves to gradually habituate the horse’s system to the presence of the allergens, thus creating a tolerance for them.  The initial 9-month period of hyposensitization is followed by monthly maintenance shots.

 

While this process does not work quickly, it may prove to be a viable option for horses and owners who are plagued with allergies year after year.  It is surprising cost effective and has either cured or reduced allergic reactions significantly in the vast majority of horses that receive it.  With adherence to the treatment schedule, one can expect an excellent chance of elimination of or reduced dependence on steroid drugs. Improvement in most cases is seen after 3-5 months of treatment, at which stage shots are given monthly.

 

To access more information about SPOT serum IgE testing, click here.

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