Gastrogard aka Prilosec aka omeprazole

[hamsterpoop]

All the same drug. My recent purchase of gastrogard left my checking account empty. Has anyone given their horse the generic,over the counter, prilosec instead? Is that safe to do.? It's got to be cheaper.

[deltawave]

Millions of threads on this topic.

Party line from Merial: they have the ONLY "secret formula" of carriers that allows the active drug to survive long enough to actually get into the bloodstream and be effective.

Which begs the question--if the drug works so VERY well at reducing stomach acid, why does the drug need to survive the harsh, acidic environment of the stomach? :lol:

I think the reality lies somewhere south of "only the patented and approved and expensive formula actually works". Most published studies, however, were funded by Merial and done by vets on their payroll, so who knows?

[hamsterpoop]

Thank you . I may just bite the bullet and go for the gastrogard. Especially after what happened to those polo ponies in FLA.

[deltawave]

Misuse of drugs by a hack practitioner is not the same thing as using compounded drugs or generics. :)

The debate rages as to whether compounded omeprazole is as effective as the "brand name". Opinions and experience, even in this small slice of the horse world, are HUGELY variable. Until the studies are done, it's a big unknown. It's a matter of one's comfort level with compounded/generic drugs, some careful observation, and a willingness to accept that medicine isn't precise.

I for one would go with a well-done compounded omeprazole if I had a horse that needed the drug long-term. I'd be prepared to do a scope to assess effectiveness if there was any question--that's less expensive than a couple of months' worth of brand-name stuff! :eek: But that's me--others feel very strongly otherwise, which is cool. ;)

[Texarkana]

If you do the math, buying OTC Prilosec is a lot more expensive than brand name Gastrogard. Not to mention it probably won't work as effectively for the reasons Deltawave cited.

Omeprazole is expensive no matter which way you cut it, unfortunately.

[Simkie]

If you do the math, buying OTC Prilosec is a lot more expensive than brand name Gastrogard. Not to mention it probably won't work as effectively for the reasons Deltawave cited.

Omeprazole is expensive no matter which way you cut it, unfortunately.

Exactly. One tube of Gastrogard is 2.28 GRAMS of Omeprazole. That is a LOT of Omeprazole.

[eventinglvr]

My vet calls in a prescription of generic omeprazole for my horse to a place called Precision Pharmacy. It's an online pharmacy that ships directly to your barn. I give the same dosage for treatment and management that would be used in Gastrogard. It has saved me a bunch of money, and further scopings of my horse have shown that it is working.

The stuff is a powder and is very palatable, so I can just put it in his grain (saves me having to dose him everyday).

[Simkie]

My vet calls in a prescription of generic omeprazole for my horse to a place called Precision Pharmacy. It's an online pharmacy that ships directly to your barn. I give the same dosage for treatment and management that would be used in Gastrogard. It has saved me a bunch of money, and further scopings of my horse have shown that it is working.

The stuff is a powder and is very palatable, so I can just put it in his grain (saves me having to dose him everyday).

Want to buy the compounded omeprazole I purchased from the same place? Did less than nothing for my mare--in fact, I think it made her WORSE--and she refused to eat it in ANYTHING.

After my experiences with their product, I would not recommend it to anyone. Just goes to show that what works for one horse does not necessarily work for another.

[deltawave]

Generic omeprazole is dirt cheap if you buy it at a compounding pharmacy. Little piles of capsules from Wal-Mart? Not the way to go. :)

I find it strange that people are citing my posts as an explanation of why generic omeprazole won't work, when in fact I actually think it is likely to work just fine, provided you get the acid level knocked down in the first place, which can be done with some other product.

I just find it plain disingenuous for Merial to insist that only THEIR PRODUCT can survive the acidic stomach environment when their product is supposed to ELIMINATE or VASTLY REDUCE the acidic stomach environment. :rolleyes: Once you get the acid level down, the drug should pass through just fine--maybe we should just give ONE dose of gastrogard and then follow up with the generic. :) :) Will that study ever be done? Not bloody likely.

[Auventera Two]

Millions of threads on this topic.

Party line from Merial: they have the ONLY "secret formula" of carriers that allows the active drug to survive long enough to actually get into the bloodstream and be effective.

Which begs the question--if the drug works so VERY well at reducing stomach acid, why does the drug need to survive the harsh, acidic environment of the stomach? :lol:

I think the reality lies somewhere south of "only the patented and approved and expensive formula actually works". Most published studies, however, were funded by Merial and done by vets on their payroll, so who knows?

Ok listen up. I like you a lot. I generally love your posts. But you have GOT to get off this gastrogard lynch mob train. You keep throwing out false information on thread after thread after thread......

Here's the deal - there is not only "one secret formula." ALL OMEPRAZOLE TABLETS (HUMAN) ARE ENTERIC COATED TO GET THEM THROUGH THE STOMACH AND INTO THE SMALL INTESTINE. THIS IS WHY HUMAN OMEPRAZOLE TABLETS ALWAYS SPECIFIFY - DO NOT CRUSH OR CHEW - SWALLOW WHOLE.

OMEPRAZOLE REDUCES STOMACH ACID BY TELLING THE BRAIN TO SHUT DOWN PROTON PUMPS WHICH ARE RESPONSIBLE FOR ACID PRODUCTION. THE BRAIN DOES NOT RECEIVE THESE SIGNALS IF THE DRUG THAT TELLS THE BRAIN TO SHUT DOWN THE PUMPS IS DESTROYED BY THE STOMACH ACID. THE DRUG IS NOT ABSORBED THROUGH THE STOMACH WALL INTO THE BLOOD STREAM. IT HAS TO GET TO THE INTESTINES TO BE ABSORBED AND UTILIZED BY THE BODY.

This is why omeprazole used to be given IV. And some vets still do the IVs. You are incorrectly thinking that the omeprazole needs to be utilized by the stomach. No, it needs to be utilized by the brain. It's not an antacid. It is a proton pump inhibiter.

At this time, the ONLY company out there that is producing a paste with encapsulated omeprazole is Merial. It isn't that they're the only one with some secret formula. They own the patent. It has nothing to do with a magical secret formula. It is simple patent law.

The deal with the patented Merial paste is that the drug is encapsulated in teenie little capsules inside the paste. These capsules are enteric coated. The horse swallows the paste - swallows the enteric coated capsules with the omeprazole contained inside. These teenie enteric coated capsules pass through the stomach without harm where they are broken down and absorbed in the intestines, going into the blood stream and to the brain to tell it to shut down proton pumps.

Compounded drugs are NOT recommended by the AAEP because of loose regulations. Compounded and generic are not the same. If people want to use the cheaper compounded omeprazole, fine go ahead. I don't want to because of the loose regulatory compliance, and potential for great variability from pharmacy to pharmacy and batch to batch in terms of efficacy. And not to mention the fact that omeprazole is known to NOT SURVIVE THE STOMACH ACID ENVIRONMENT. Why do you think that ALL human omeprazole is enteric coated??????

http://www.glequinewellness.com/pdfs/drug_compounding_guidelines.pdf

You seem to have it in your head that Merial is fleecing the public into THINKING that only their omeprazole works. What they're doing is manufacturing a product according to patent law. They have developed a paste that enteric coats the drug to pass it through the stomach and into the intestines. Exactly the same as with human products. But how do you tell a horse "Ok, swallow these pills whole." You can't. So if you can give them a paste with the drug encapsulated in teenie little bubbles, they swallow them and the product is effective.

When the patent runs out, there will be other competitors and the price will fall sharply. We'll probably see omeprazole at $4.99 a tube ;). Same as happened with the paste dewormer situation. Remember when horses were nasogastric tube wormed with ivermectin? I'm not even that old and I remember those days.

[sublimequine]

A2; I'm just curious, when does Merial's patent run out, do you know?

[evans36]

My chiro/vet just put my horse on omeprazole Saturday past. It's a generic version made in St. Matthews, SC. It's a paste. She said that what she has been doing in folks that can't afford gastro/ulcerguard is to just dose the omeprazole at higher levels in order to get some of it through the system. She also said she's done the research and it's safe to do this. Plus she has used the system on several horses with "anecdotal" results - aka they didn't scope but the horses acted healed. It's $18/tube, and she gives the full tube daily for 1 week, then 1/2 tube daily for 2 weeks. Then 1/4 tube indefinitely for maintenance.

As far as if it "works" - I have seen monumental improvement in my guy in the last 3 days. (1) his eye just looks calmer; (2) he is usually a real jerk while I groom him, begging for carrots etc and kicking if he doesn't get them, also kicking even when he does if I'm working on his barrel, but now he is standing completely quietly, (3) I rode yesterday and he was round as a ball, and jumped larger than he has been and didn't once get sour or try to bolt back to the barn (which normally happened a couple times per ride); (4) this horse HATES to be wormed/medicated with paste - he's 17+hh and sticks his head up like a giraffe, all kinds of antics - and the second day I didn't even need a halter to give him this stuff in the pasture (it's not because it tastes so good either - I tried it!).

So... I'm sticking with it. The long and short to my mind is that it's not terribly expensive to try it, and there's no evidence that it will make your horse more sick (except maybe simkie's story...). If you want, PM me and I can give you more details on the mfg. Don't have the syringe with me @ work.

[Auventera Two]

http://www.fda.gov/cvm/FOI/141-123.pdf

April 4, 2015

Somebody was posting that it expires in 2012 but I haven't been able to find that information.

evans36 - what is the name of that paste and how do you buy it? I'm just curious because there was a paste I found online sometime back but the company was really shady. I never could get through on the phone or get a return phone call. Wondering if its the same place.

[katarine]

Evans, is it Pepto-Gard from Equi-fab?

http://www.equi-fab.com/gastro-intestinal.htm

[Auventera Two]

If that's the one she's talking about, Pepto-Gard is an antacid and not a proton pump inhibitor. Two completely different things. Antacids only work for 1-2 hours and then have to be re-administered. They're good for minor problems or just for buffering acid before a ride. They're not for healing ulcerations. Omeprazole shuts down acid pumps for 24 hours. Some people say that continual use of antacids makes the body go into overload and produce even more acid to try to raise the ph. I don't have any scientific facts on that though.

[meaty ogre]

All the same drug. My recent purchase of gastrogard left my checking account empty. Has anyone given their horse the generic,over the counter, prilosec instead? Is that safe to do.? It's got to be cheaper.

http://www.thehorse.com/ViewArticle.aspx?ID=3964
This is a comparison study of a compounded omeprazole suspension and Gastrogard. The coumpounded suspension was ineffective. From the article:
"UC Davis researchers found that the pH of the suspension was acidic (pH of 3.4), while the GastroGard was basic (pH of 8.4), so Snyder suggested that potentially the already acidic nature of the suspension had eaten away at the omeprazole in the suspension."

There was an additional similar study that I can't put my fingers on at the moment, but the same take-home message. The buffer is important, and other suppliers are likely to have figured this out (hence why some swear by compounded whereas others say it's a waste of $). If you do go with a compounded suspension, as the supplier what the pH of the suspension is or buy some litmus strips and test it yourself. Higher pH is likely to be more effective according to this study.

Are you treating a recurrance or looking for a preventative? If you're "financially challenged," "fiscally responsible" or just plain poor I'd recommend:
- fenugreek (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8D-45V717X-2&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=0468110928b31b21ea7810006ebe9705 - $2.75/lb at herbalcom.com)
- grape seed extract (http://pubs.acs.org/doi/abs/10.1021/jf9709156 - a bit more pricey at $9.95/lb at herbalcom.com)
- and/or alfalfa hay (http://www.thehorse.com/viewarticle.aspx?id=11596 - roughly $5 a bale round these parts) as potential alternatives.

[evans36]

I don't believe that is it, but I'll check at the barn when I go tonight. I am pretty sure it just says omeprazole and the dosage amount, which I am pretty sure is double the 2.something of the gastroguard. I'll post after I have a chance to check :)

[katarine]

A2 I can see that it's an antacid not omprazole, but when she mentioned the location in SC, I thought of Equi-Fab. We'll wait and see what it is, when she has a chance to check.

[rcloisonne]

http://www.thehorse.com/ViewArticle.aspx?ID=3964
This is a comparison study of a compounded omeprazole suspension and Gastrogard. The coumpounded suspension was ineffective. From the article:
"UC Davis researchers found that the pH of the suspension was acidic (pH of 3.4), while the GastroGard was basic (pH of 8.4), so Snyder suggested that potentially the already acidic nature of the suspension had eaten away at the omeprazole in the suspension."
But all of the UC Davis researchers are getting kickbacks from Merial don't cha know. It's a consipracy! ;)

[Addison]

RCLOISONNE....well-somebody has to be fundiing the research-it would actually be very interesting to know who funded the U.C. Davis study.

When you consider the fact that ulcers affect just about every aspect of a horse's demeanor, training and health, I would not try to save money on their treatment or prevention.

Just read the article which states that the lead investigator, Snyder DVM and "Merial" declined to name the pharmacy from which the compounded omeprazole was obtained. I guess that answers the question!

[deltawave]

it would actually be very interesting to know who funded the U.C. Davis study.That would be Merial.

A2, thanks, I'm actually very well aware of how proton pump inhibitors work. Been using them since they came out, when "Prilosec" was still called "Losec" and made good old Tagamet look like tap water. :) If Gastrogard is effective in raising stomach pH, and there is little doubt that it is, then subsequent doses should have an easier time getting past the acid barrier (presumably nonexistent or much weaker) so they can be absorbed intact downstream. Their patent is their patent, I have no problem with that, but it is a very real fact that a company that owns a patent on a VERY lucrative drug is not above doing whatever they can--including sponsoring "research" that makes generics or other alternatives look bad--to keep their cash cow solidly on the top of the heap. I suspect (but am not in any position to say I "know") that there are probably a whole lot of ways to get omeprazole safely past the gastric acid barrier. In the absence of realistic competition, and with a good patent, Merial owns the market right now. Which to me simply BEGS for not only more research, but a good, concerted effort to find ways to make this drug affordable and available. You could call it "compassionate use" although that's not exactly using the term correctly.

Compounding drugs an ideal solution? Hardly. But it's certainly not inconceivable to me that a good pharmacist can make a quality product that will do what it needs to do given the challenges posed by getting this drug into that species. Yes, there's potential for abuse but there are also some very gifted, ethical and clever pharmacists out there who still do compounding.

I don't begrudge Merial their billions. I simply don't believe that there is one and only one way to get the drug where it belongs. :)

[Foxtrot's]

Well, people, what would I know .... but I have a colt who started grinding his teeth when he was weaned. Vet (specialist) put him on three tubes of GG at 1/3 tube per day. Then he put him on the omeprozole 1/2 a tube per day, yet much, much cheaper. In two days he was grinding again. Three more tubes GG, seems fine, two days on omeprozole, grinding again. Now on my third batch of three tubes of GG and he's feeling good again.

Poor little guy - looks so thin, horrible coat, no spunk - hope we can get hm right soon.
I'm prepared to go GG until he's done. But if it was full tube dose every day, oh my....
Once he's better, the omeprozole will probably hold him as a preventative, I hope.

[evans36]

OK so I checked at the barn tonight. It's by Horse Necessities, Inc. in St. Matthews, SC. It is labelled omeprazole, 2g per 15 g and bismuth salicylate 5.5 g per 15 g. It's in a 30g dosing syringe of puce colored paste. Didn't know what bismuth salicylate was, so here goes: http://www.drugs.com/mmx/bismuth-subsalicylate.html

I'm assuming that's the buffering ingredient in this. The omeprazole is given at the same dose as gastroguard; I was incorrect before. I think when the vet was talking she was saying more than ulcerguard.

Hope that helps!

[deltawave]

It's Pepto-Bismol. :)

[evans36]

Yeah... got that off google :) New to all this, since I don't have gastric issues myself! But what I am figuring is that if there's a dosage of pepto, then the acid is buffered enough for the omeprazole to make it to the brain. Does anyone know what the buffer is in gastroguard? Is it a different chemical totally, or is the patent for the "encapsulation" technology (too lazy to do research if someone else knows...). It seems to be working on my guy anyhow, better than any of the other antacids we've tried, so I doubt it's just the pepto.

[deltawave]

Actually Pepto is a really lousy antacid (pH is 4.5) and is more useful for diarrhea and general "tummy upset". It is also used along with antibiotics to treat H. pylori infections in humans because it does seem to have a modest effect there. I'm not at all sure why this product would be selected to mix with anything as an "antacid" per se, because it kind of ISN'T an antacid. :confused:

Omeprazole doesn't need to get QUITE as far as the brain. :)

I think the buffer for GG is some sort of mix of a vegetable-type oil/emulsifier, but can't remember the rest of what's in it--it's out there somewhere on this BB.

[Auventera Two]

Well, people, what would I know .... but I have a colt who started grinding his teeth when he was weaned. Vet (specialist) put him on three tubes of GG at 1/3 tube per day. Then he put him on the omeprozole 1/2 a tube per day, yet much, much cheaper.

Gastrogard *IS* Omeprazole. ;)

delta - when you have a performance horse that falls apart at the seams due to gastric ulcers, you would GLADLY pay Merial their 29 dollars a tube to get the problem fixed. Hell of a lot cheaper than colic surgery, lost entry fees, and all the training and health issues that go along with ulcers. Not to mention paying for double and triple feed and forage rations to try to keep weight on.

When you watch your sweetheart horse turn into a fire breathing dragon ready to kill anybody who steps in her path, you'll be so glad to pay Merial that money, you won't even think twice about it.

Been there, done that. It aint fun.

People will dump a grand on some stupid show outfit or custom made blankets and bridles, but they kick and scream and cry and refuse to buy high quality, proven drugs to fix their horse's pain. Sorry but that's just unacceptable as far as I'm concerned.

I was told by a Merial rep that the omeprazole is enteric coated in tiny little capsules within the paste. The paste is just a carrier. It's not that the paste contains a buffer that buffers the acid. It is just like taking a Benadryl. You have one capsule with tiny beads contained inside. The beads break down in a time release formula over a 12-24 hour period. Gastrogard and Ulcergard work the same way.

If people would apply themself a little bit and actually talk to the company and find out how the drug works, you could avoid all this false information being tossed around on internet chat boards. But then that would avoid the drama and we CAN'T have that. :rolleyes:

[readytorodeo]

All the same drug. My recent purchase of gastrogard left my checking account empty. Has anyone given their horse the generic,over the counter, prilosec instead? Is that safe to do.? It's got to be cheaper.

I use a product called gastromin from Swedish Horse Power. I have had great results with it and it is cheaper than Gastroguard. I have customers at the track that say it works better for them than gastroguard. PM me if you want more info.

[crewgirl34]

I just wanted to jump in here and stick up for the researchers doing the work on these drugs using the company's money. I work in research, and have done similar studies. The companies do this because they need independent research to verify the findings. The public would be even more suspicious if the research came from the company itself. So the company hires independent researchers, but the researchers have to be paid, so the company has to pay. The researchers do what they do, and if the findings are great, the company is happy, if not, the product goes through more testing and development, or scratched entirely.

I work in cancer research, and we study drugs that the pharmaceutical companies think might be promising. I know we have worked with 5 drugs, and so far only 1 has made it past Phase 2 trials. The company pays us, because who else cares about a drug that may or may not work? As researchers, we report what we find. We would never skew results to make a company happy because 1) our reputation is on the line, if our results can't be verified and repeated, then all of our research is compromised and 2) the company wants independent results to make sure their people aren't skewing results 3) the company wants to make sure the product works before releasing it.

So yes, it does look suspicious that a company pays someone to research their product, but how else will it get done?

[evans36]

Gastrogard *IS* Omeprazole. ;)

delta - when you have a performance horse that falls apart at the seams due to gastric ulcers, you would GLADLY pay Merial their 29 dollars a tube to get the problem fixed. Hell of a lot cheaper than colic surgery, lost entry fees, and all the training and health issues that go along with ulcers. Not to mention paying for double and triple feed and forage rations to try to keep weight on.

When you watch your sweetheart horse turn into a fire breathing dragon ready to kill anybody who steps in her path, you'll be so glad to pay Merial that money, you won't even think twice about it.

Been there, done that. It aint fun.

People will dump a grand on some stupid show outfit or custom made blankets and bridles, but they kick and scream and cry and refuse to buy high quality, proven drugs to fix their horse's pain. Sorry but that's just unacceptable as far as I'm concerned.



OK, I usually don't take on folks who are all about doing the best thing for the horse, because that's the right thing. But honestly, you make it sound like everyone HAS the $$ required for a treatment with the best drugs. To be quite honest, I have what I consider to be a "performance horse" but at the same time, we don't lose money on entry fees, and I haven't spent money on colic vet bills. This is because (1) I don't have the cash to compete, and (2) my horse's ulcers aren't bad enough to cause him to colic.

I am a serious rider and a concerned horse owner. I love my horse. I want to do whatever is best for him and I certainly do not want him to be in pain. However, my resources are limited. Yes, there are people out there who drop money on the wrong things (show outfits) and refuse to drop it on the right things (horse care). But those people have the money to begin with. I don't. I'm dropping money on my horse's board, and have scraped together enough to start him on chiropractic treatments by waiting to start investing in my 401K until he is better. Honestly, I can't say that's a considerably wise sacrifice, but I'm making it because my horse needs it. He's at a safe facility with pasture buddies that he likes, but I can't ride all winter because I work a full-time job and my economy level, low-maintenance facility doesn't have arena lights. I've been using antacids on him to ease his pain until my tax return came in, when I can just afford to give this generic version to hope that it works. I have about $100K in student loans and I work for a non-profit. I CANNOT justify spending $1K+ on ulcer treatment for my horse when I owe that much money, I already spend about $400/month on him, and I myself need physical therapy that I'm not getting because I spend that money on my horse.

I understand that merial's drug is the only one that is *proven* to work. However, I also understand that small drug companies may not have the $$ or the time to conduct the testing needed to prove their drug in clinical trials, or to get the kind of FDA approval or even patent that Merial has. That doesn't mean the drug won't work, and at $18 per tube, it's much less of an investment in case it doesn't, especially when many of the ulcer diagnoses around are not firmly scientific coming from pictures of the stomach through a scope - they are just diagnosed from the outside symptoms.

I am not trying to jump on a soapbox (although I kindof did) or saying that there are not people out there who don't have their priorities in line, because there are. But I think that there are plenty of folks who, like me, are very interested in horse care and want the best for their animals, but cannot afford the most expensive alternative. My horse is basically a rescue. He lived a terrible, terrible life on the track, and now his life is better. Even if I can't afford ulcer drugs, he is much better off here than he was there, and he has a pretty great life. I'm doing everything I can do to make things better for him, and he's responding.

He is kindof a jerk so he's hard to sell - I considered doing that when my finances were worse and it was REALLY hard to keep him. But he has to go to an experienced horse person, and most experienced horse people in these financial times don't want a horse that might not really be capapble of serious work - and we didn't know if he would be until I started investing the $ in the chiro, injectible joint supp, etc. He would not have gone to a better home before, and now my finances are better so I don't need to sell him anymore. My goal as someone who loves him is to get him to the point where he would be saleable if anything ever happened to my job, so that this won't happen again. But, like everything else, it's a work in progress.

So, long story short, I think there's a lot of judging going on (not just you, but that I've seen all over the horse care forum specifically) of folks that are doing the best they can do for their horses with what they have. Sure, don't buy a horse unless you can care for it, but honestly we're lucky that there are people that will rescue a horse and then juggle their finances to take care of it - because there are always more that need rescuing, and not enough folks to take them on.

[Auventera Two]

Oh gosh evans, I'm sorry, that post was not directed at you! I was talking to deltawave. She has made it a personal goal to do everything she can to discredit merial and gastrogard. She tries to make them out to be some "shady" company that funded research underhandedly to tip the results in their favor. It just gets old. She doesn't have a horse with ulcers and she doesn't know what its like to do exactly what you're doing - research and think and research some more and try to figure out what is best for the horse.

I certainly understand the fundage problems. It was tough to dish out all that $$$ on gastrogard, but I did and I'm happy that I did. But for people that just simply can't do it, then you do whatever you can and nobody can fault you for that. And I sure don't!

My rant was aimed at those who just "don't like it" that gastrogard is expensive so they try to discredit the product and the company at every given turn. The fact is, the product is very expensive but it DOES work. If a person can spring for it, definitely do it. But if not, you do whatever you can do to still get good results. :)

[Addison]

CREWGIRL34 As a former research associate at Rockefeller University I know and appreciate the interdependent relationship between pharmaceutical companies and research institutions is unavoidable and not implicitly unethical. I agree that without these relationships many if not most advances in health care would not be possible.

[deltawave]

I have lots of personal goals, A2, and I assure you that NONE of them have diddly squat to do with Merial. :) Like most other people here, I do have opinions and am not averse to sharing them. And like most people with opinions, I'm fairly nonplussed when other people react to them so violently. :confused: I've posted on this topic--what--maybe 5 times? This makes me a fanatic? OK, so be it. :)

If I had a horse with ulcers, I would probably cough up for the GG. That's why I have insurance. And a job. :) But my opinions on pharmaceutical shenanigans are really not even closely tied to what Merial does--it goes much deeper and farther than that, it pervades everything I do, all day long. I don't think drug companies are evil, but the are "for profit" and just because they have a lovely glossy website and some data doesn't mean their product is the be-all and end-all. :) It pays to be aware of reasonable alternatives to expensive products, and "expensive" does not necessarily mean "superior"--it usually just means "we got there first, we have iron clad patents, and we are not above scaring the bejeebers out of anyone who thinks about trying something else". Which is NOT to say I'm in favor of trying all the other stuff out there--papayas and what not. Those don't have any proof at ALL. But if omeprazole is what you need, then omeprazole ought to be what you're able to get, without paying a fortune.

You should hear me go on about Plavix and Lipitor. :lol: Do I love them, and use them every single day? Yup. But that doesn't give them a "pass" on the ridiculous prices. Not black and white--I appreciate the R&D, etc. But it makes me nuts that these patents are flogged for all they're worth just to keep the prices up. Just wait--I guarantee that when GG goes off patent there will miraculously be a new and "better" drug or formulation that is studied, published, and marketed within months of that day. Guarantee it. It is how the game is played. No point in bringing it out NOW, is there? :no:

[Auventera Two]

Well, that's the way the world works. Everybody's out to turn a dime, and they're within their legal right to do so. No, I don't love paying 29 dollars a tube for UG. But I trust the research, and more importantly, I trust the positive effect the horse tells me it has.

When you buy that $89 dressage show pad, do you REALLY think it's worth $89? It probably cost the manufacturer 12 bucks to make it. But the manufacturer has to make a profit, and the retailer has to make a profit. I am a dealer for a particular horse product and it floors me what the markup is.

Everything is that way, tack, drugs, feed, etc.

[deltawave]

Did you know that the backbone of GG's research was done on 100 horses? I'm not bashing the fact that they did it--in fact, I praise anyone who takes the trouble to high heaven--but it really is not very simple to parse what makes sense and what doesn't when you consider how complex this sort of thing really is. Their research also indicated that something like 90% of the horses in their study re-developed ulcers when the drug was stopped. Scary! But to me it suggests either a very strange group of study subjects OR more holes in our knowledge of horse ulcers than it does anything else. :sigh:

I usually spend $15 on saddle pads, or ask for them for Christmas! :lol:

[evans36]

I am sorry about that rant. It's just that there are so many horse people out there who have expendable cash to do those sorts of things (not just on COTH, although I think I'm more frustrated since I've been here, just because the volume of horse people I've spoken with has increased dramatically since I joined). There just seems to be an attitude out there that folks should just pony up for these expensive things, without realizing that there are plenty of folks that just can. not. afford. it. It's frustrating to be told that you are less of a caring horse person because your personal circumstances are financially limiting.

As far as the drug companies... I am sure merial's product works on gastric ulcers. I am also sure it's the only one proven to work. However, that doesn't mean that other products WON'T work - like I said before, Merial is the one with the money to run the tests and to get the approval. Just because the tests haven't been run doesn't mean something won't work. Merial isn't wrong for advertising the truth. We just aren't usually smart enough to know that companies advertise the truth but not always the entire truth.

And I don't think we can fault them for wanting to turn a dime - someone has to fund the research and development. If the company isn't making money off the drug, it can't afford to pay the independent researchers to do the studies to prove efficacy or study side effects or any number of other things. When (I say when because I agree that this will happen) another drug that is "better" than gastroguard comes out just after Merial's patent expires, that doesn't mean that gastrogard will be any less effective. It will just be the "next big thing" for consumers to consume, and those of us that need ulcers cured in our horses will just buy the cheap gastroguard and feel slightly browbeaten that we can't afford the next big thing.

[flshgordon]

when you have a performance horse that falls apart at the seams due to gastric ulcers, you would GLADLY pay Merial their 29 dollars a tube to get the problem fixed. Hell of a lot cheaper than colic surgery, lost entry fees, and all the training and health issues that go along with ulcers. Not to mention paying for double and triple feed and forage rations to try to keep weight on.

When you watch your sweetheart horse turn into a fire breathing dragon ready to kill anybody who steps in her path, you'll be so glad to pay Merial that money, you won't even think twice about it.


I would love to know what "money grows on trees here" planet you live on...seriously. My performance horse has battled ulcers for several years and not for lack of giving her full courses of GG or ulcergard 3-4x per year...yes that comes to $3-4000 per year on GG. I do not GLADLY send Merial one penny. In fact every time I have to send them money (bags of it), I honestly want to blow up their factory. I am not grateful at all because $1000 a pop sure is a hell of a lot more than our entry fees for a show. They have a patent on the product....I get that, but they don't have to be so freakin greedy. If they would bring the price down, people who really NEED the drug could afford to use it and I for one might use it even more often on a maintenance basis if it were affordable. There are many, MANY horse owners who look for alternatives (that usually end up not working) because they just simply cannot afford the treatment and that in itself is a travesty that I feel Merial is personally responsible for. With the overwhelming statistics citing the number of horses that suffer from ulcers, think of the market share they have alienated with their pricing.

So good for you....you apparently don't think twice about a company gouging everyone because you are so glad to pay them that money. I personally don't have the luxury of that and have to save up every dime to be able to afford that treatment for my horse.

[Auventera Two]

What about a bottle of dormosedan that is $90? Or Surpass, or Equioxx, or Marquis, or Pergolide, or any of the other drugs you can think of? Drugs are expensive, and that's just the way it is. Wormers used to be just as expensive as Gastrogard. The price will come down after the patent runs out, but there's not a lot you can do until then.

Well, I pay for the drug because it's a whole lot better than not having it. Beyond that, I don't know what to tell you????

Yes, I do look for alternatives. Alfalfa hay, antacids, and supplements shown to improve the digestive tract. But beyond that, the horse had severe ulcers and it severely affected her performance, and her health. Until the patent runs out, I'll just keep paying it because there's not a whole lot of other choice right now that I find acceptable.

I did ask the vet about rantidine and cimedidine and they told me to not even waste my money. Never works. I asked about papya, aloe, fenugrek, etc. but everybody has different ideas on what works and what does not, and how much to give. I am going to try giving fenugreek. If I can use less omeprazole, yay for me. But the horse is only 6 and I can't ruin her life ditzing around with crap that doesn't work.

People drop 100 bucks per chiropractic visit, 250 bucks every 6 weeks for therapeutic shoeing. I don't need anything like that, so I spend the money where the horse needs it. My horse is barefoot, I am a trimmer so I do feet myself. Besides needing pergolide and omeprazole, I don't have any other real horse expenses. I don't board either so my costs are about 1/10th what some of you pay. So yeah, I guess I'm really glad that the product is available and that it works so darned well.

[BeastieSlave]

A2, I've been following this thread because I have a horse that I have shelled out my hard earned cash to buy GastroGard for. It works, and until something else is proven to work, I'll keep shelling out for it. I think there are a lot of us on this thread who are glad that GastroGard is available and consider ourselves lucky to be able to buy it for our beasties. That doesn't mean we have to be happy with how much it costs.

That also does not mean that I don't agree with what deltwave is saying - and I don't think she has a personal grudge against Merial. I think she's just bringing up some points that seem quite valid to me. Maybe I missed it, but I don't think she's said anything inflamatory about Merial other than they have funded the studies and that seems to be self-serving. It's starting to sound to me like you are having a problem with deltawave though...

Also, I don't think that searching for a more cost-effective way to give omeprazole to horses means you are a bad owner or are somehow trying to cheat Merial. There usually is more than one way to skin a cat (or deliver a drug).

[Lori B]

A2, you do know that DW is a doctor, right? I mean, seriously. She might have just a teeny tiny bit more a) scientific education than you, and b) experience with the scientific and business practices of big pharmaceutical companies. Just the tiniest bit. And what she says, about the possibility that the folks who make GastroGuard may be working as hard to protect their patent as they do to make a good drug is quite believable, to me. So please settle down, wouldja?

[evans36]

Just to play devil's advocate here... I know that the new statistics are that 93% of performance horses have ulcers. Buuuuut - isn't it Merial that commissioned that study? Ulcers range anywhere from irritation in the stomach lining to holes that go through the lining. I'm not disputing the number of horses with ulcers, but I think there's probably a disconnect between the statement "93% of performance horses have ulcers" and "gastroguard is the only thing that CURES ulcers rather than just treating the symptoms." Gastroguard is probably the only thing that will work on a horse whose ulcers are really advanced. But I highly doubt that it's the ONLY thing that will work on the milder cases.

From the knowledge I have, doesn't omeprazole only impact acid production so that the body can heal the ulcers? I don't think the omeprazole heals the ulcers itself. So theoretically, anything that buffers the acid level in the stomach - as long as it's given at intervals to keep the levels consistently high enough - should work just as well as omeprazole.

[jn4jenny]

So what would it take for those of you who are "thankful for GastroGard" to try something that's *not* scientifically proven? One anecdotal story of success? Two? Three? Ten? Fifty?

I'm not against GastroGard myself, but my jaw just DROPS when I see these stories of spending multiple thousands of dollars on a drug once only to find oneself administering the drug again months or years later. Obviously Merial has no incentive to help horse owners address the underlying causes of ulcers--they make more money putting a band aid over the ulcers with GastroGard, helping people "cure them" over and over again without taking away whatever is causing them in the first place. And obviously the answer is not as simple as "just reduce the horse's stress level", because we see folks here on COTH who've done all they can to give the horse an anti-ulcer lifestyle (24/7 turnout, alfalfa cubes, no work, etc.) and they STILL see ulcer symptoms.

A2, you have a PM from me. I'm sure that based on this post, you can figure out which PM I'm referring to.

[Auventera Two]

Well here is where I'm coming from, I have ulcers myself and I've been using Nexium, Protonix, and Prilosec for years. I am going to go on the antibiotics because I've not been successful in clearning them up long-term. I have been in the ER with pain so severe I thought it was a heart attack. I have coughed up blood before. Ok, I know that ulcers are nothing to screw around with. I know how painful they are. When the horse was diagnosed, I felt so terrible I cried all the way home from the clinic. Unless you've had an ulcer you can't imagine the pain and gastrointestinal upset that comes with it. Antacids do almost nothing for me. I can take a double or triple dose of Maloxx and sometimes it makes it worse. Sometimes it helps for 30 minutes or 1 hour, and then its back again. It seems like the more antacids you take, the worse it gets. But the proton pump inhibitors give you REAL relief that lasts for weeks or even months.

I remember my grandmother giving me tums and papya pills at bedtime because my belly hurt so bad I could not sleep. My weekly grocery shopping list used to include antacids. I ate tums like they were candy to try to stop the acid reflux and stomach pain. I've tried gaviscon and simethicone. I've been diagnosed with IBS and gallbladder stones. It all just flat sucks. When you hurt like that, you just want relief.

Someone on this board mentioned to me that she thinks the body ramps up acid production and pumps out more and more to counteract the alkalinity in the stomach from the antacids. I believe it! When you use a proton pump inhibitor, THAT CAN'T HAPPEN because the pumps are physically inoperable.

For that reason alone, I never wanted to mess around with anectdotal evidence or just antacids. I wanted something with science to back it up because I know first hand the severe pain that comes with ulcers.

I did get your PM and thank you for that. I'll consider what you had to say :)

[deltawave]

It's also not at all uncommon for people to have ulcers and have NO SYMPTOMS at all. The treatment is the same. It's very, very difficult to detach ourselves, especially when it comes to our helpless loved ones (kids, horses) and I certainly applaud ANYONE who is pro-science and wants proof. But it is just really, really difficult to see the forest for the trees sometimes. Bodies are ridiculously complicated and no two behave the same.

For example: (sorry to pick on you, A2) :)
Someone on this board mentioned to me that she thinks the body ramps up acid production and pumps out more and more to counteract the alkalinity in the stomach from the antacids. I believe it!

You believe it because it makes sense? Or because you've seen the data that proves this hypothesis? There is not really any good evidence that this theory holds water, but it sure DOES sound reasonable. Some stuff out there that's suggestive, and other stuff which indicates it's not an issue, but that is a long way from a conclusion. Attractive and obvious as it may sound, it is NOT KNOWN.

http://www.springerlink.com/content/p684458058030v2l/
http://www.springerlink.com/content/p86746k1m901w361/
(small studies, nothing really super-compelling, the topic needs more study in general)

It's SOOO easy to want to believe what we read, and what we hear, and that what we're doing is the "right" thing. It's so easy to use our own personal experience and weight it even more heavily than a mountain of evidence. I have to fight this all the time, it's really difficult. :sigh:

[Lauren12]

My vet calls in a prescription of generic omeprazole for my horse to a place called Precision Pharmacy. It's an online pharmacy that ships directly to your barn. I give the same dosage for treatment and management that would be used in Gastrogard. It has saved me a bunch of money, and further scopings of my horse have shown that it is working.

The stuff is a powder and is very palatable, so I can just put it in his grain (saves me having to dose him everyday).

I also used compounded generic omeprazole from Precision. I get it for $125 for a 90 day supply. My horse used to be on 3000 mg of Ranitidine daily, and I had to give it mushed up in a syringe because she wouldn't eat the crushed pills. Horse eats omeprazole powder in grain and licks the bucket clean.

It has made a HUGE HUGE HUGE difference - horse is VERY picky eater (probably because of ulcers in the first place), and on the omeprazole power she eats everything in one sitting. She has also nearly completely stopped weaving in her stall - something she has a lot in the four years I have had her. She also doesn't grind her teeth very often anymore while under saddle.

My vet gives the compounded powder to her horses also. I'm not sure she has noticed as much as a difference with hers as I have with mine, but she recommends it to all of her ulcer-prone patients.

[suzyq]

Here's what I'm doing. I did 1/2 dose of Ulcerguard for about 2 weeks. I believe the study showed 89% results with a full dose and 80% results with a half dose. So I went with the half dose. Then, I started two things: ranitidine 2X per day and smartdigest ultra. So far, this is working for me. I don't know how long I'll stay on the ranitidine, but I'll probably keep the smartdigest ultra.

My horse wasn't scoped, but his attitude is 100% different now. In particular, less grumpy, less spooky, loves to be brushed now, finishes his food better, less watery manure.

[Foxtrot's]

To answer A2 - Gastroguard is Omperezole. We know the active ingredient is, but the carrier is different. I was just saying how the one product does not work the same as the other product. I didn't just make it up.

[BeastieSlave]

So what would it take for those of you who are "thankful for GastroGard" to try something that's *not* scientifically proven? One anecdotal story of success? Two? Three? Ten? Fifty?


I'll take a stab at answering this one.... I'd be willing to try something that hasn't been scientifically proven when:
A) Our beastie's ulcers are fairly well under control (I can pretty well gauge by his symptoms)
B) The source of 'new stuff' is someone (preferably several someones) that I trust and respect with anecdotal stories of success in situations similar to mine
C) The 'new stuff' is something that is generally considered safe - possibly for other uses - in equines.

[Foxtrot's]

I think I am paying a lot for my GG - C$55.00/tube; Omeprazole/Sucralfate C$10.00 - however, like a lamb to slaughter I've got to pay it.

This thread reminds me of John Le Carre's book "The Constant Gardner" where the big pharmaceutical companies test their medications on the poor and helpless in Africa and make millions. (a book of fiction, he says).

[sisu27]

Ok, help me out here...are Gastrogard and Ulcergard the same? Both have 2.28 g of Omeprazole per tube don't they?? Or is the GG a lower dosage and thus no need for rx but you would have to dose UG at a higher rate for equal results (false economy type thing)??? Both produced by Merial??

Foxtrot...have you tried ordering online from the US??? Wouldn't that be cheaper? I am thinking about ordering some UG from discountpetdrugs.com and it is only $29.99/tube.

[Auventera Two]

Yes, both IDENTICAL. The only difference is how they are LABELED. One is labeled - Give your horse 1 full tube per day. The other is labeled - Give your horse 1/4 tube per day for prevention. Same drug, same mg/kg per tube, same price. One you need a script for, one you do not.

Imagine it this way - Ibuprofen. You can buy a bottle at Walmart and the directions say to take 1 or 2 tablets every so many hours. OR you can go to your doctor and get a script for the exact same drug but you take it at a higher dosage per day to treat an active inflammation or pain problem.

If you want to use Gastrogard at 1/4 tube per day, then you have to measure the tube and mark it into 1/4 tube marks. Or you can buy Ulcergard, which is already marked in 1/4 tube marks. Or if you buy Ulcergard but your horse needs a full tube per day, you just ignore the little marks and give a full tube per day.

[deltawave]

Yes, that's a perfect analogy--it's like the 800mg Motrin pills you get by prescription vs. the 200mg OTC Ibuprofen pills you can buy at the store. Same drug, different size.

[sisu27]

Ahh, I see. Thanks you two.

The prescription and non-prescription part confused me...I didn't know that by altering a recommended dosage you could change that designation. Interesting and dumb....even I understand that if I want 800mg of Motrin I need to take 200mg(4)!!

Also...anyone know of a cheaper source or is $29.99 about the best I can do???

Thank you!!

[jn4jenny]

Also...anyone know of a cheaper source or is $29.99 about the best I can do???


Coupon codes, my friend, coupon codes. Try checking retailmenot.com for coupon codes at Discountpetdrugs.com and Entirelypets.com. IME, EntirelyPets is usually the winner and you can get down to about $28.40 per tube.

[Simkie]

Also...anyone know of a cheaper source or is $29.99 about the best I can do???

Thank you!!

That's about as good as it gets.

[sisu27]

Coupon codes, my friend, coupon codes. Try checking retailmenot.com for coupon codes at Discountpetdrugs.com and Entirelypets.com. IME, EntirelyPets is usually the winner and you can get down to about $28.40 per tube.


Thanks but that sounds like a lot of work for $1.60/tube....I drink more than that!! discountpetdrugs here I come!

Thanks again all.

[kiwifruit]

I just finished up a 30 day treatment of GG on my horse and saw a pretty good difference in his attitude and weight. I called my vet and he recommended a generic paste that runs about 12.00 a tube. I'm not sure what it is called but when it comes, I'll be sure to post the name and the ingrediants. He claims that it has the same amount of Omeprazole in GG but I'll wait to see what it is exactly.

[Simkie]

I just finished up a 30 day treatment of GG on my horse and saw a pretty good difference in his attitude and weight. I called my vet and he recommended a generic paste that runs about 12.00 a tube. I'm not sure what it is called but when it comes, I'll be sure to post the name and the ingrediants. He claims that it has the same amount of Omeprazole in GG but I'll wait to see what it is exactly.

There is NO generic. Gastrogard and Ulcergard are still on patent.

What you're probably getting is compounded omeprazole (probably plus something else...as I understand patent law, it is illegal to compound omeprazole paste), which has been talked about several times on this board. The general consensus is that it *may* work for *some* horses.

[Auventera Two]

Yeah there's been a couple posts on this board about somebody giving their horse a "generic omeprazole paste" but until the patent runs out, that is ilegal. So whatever paste you're giving can't be just plain omeprazole. Somebody else posted something that was mixed with a bunch of stuff like aloe vera and fungreek or something, I can't remember.

[jn4jenny]

Thanks but that sounds like a lot of work for $1.60/tube....I drink more than that!! discountpetdrugs here I come!

Thanks again all.

Go find your purse and rip up two $1 bills for us and report back about how it felt. That's approximately what you're doing by saying "I'm too lazy to spend 3 minutes looking up coupon codes." Unbelievable.

Across a full course of 28 tubes, saving $1.60 per tube would save you $44.80. But I suppose you'd rather rip up two $20's and a $5.

[sisu27]

Go find your purse and rip up two $1 bills for us and report back about how it felt. That's approximately what you're doing by saying "I'm too lazy to spend 3 minutes looking up coupon codes." Unbelievable.

Across a full course of 28 tubes, saving $1.60 per tube would save you $44.80. But I suppose you'd rather rip up two $20's and a $5.

Yikes...relax. I didn't ask you to do as I do. So I skip Starbucks for a few days...whatever. Are you one of those people that will drive around for days to find the gas that is .03 cheaper too??? That is fine if you do but some of us feel that life is too short. Actually...that is the equivalent of one case of 24 (thats a 2-4 US peeps) Millstreet Brewery Organic Ale that I won't be buying to put it in Canadian terms....I'll live!!

[Auventera Two]

I don't stress out over a few bucks here or there either. Life is too short. Convenience and time are worth a tremendous amount too.

[jn4jenny]

Yikes...relax. I didn't ask you to do as I do. So I skip Starbucks for a few days...whatever. Are you one of those people that will drive around for days to find the gas that is .03 cheaper too??? That is fine if you do but some of us feel that life is too short. Actually...that is the equivalent of one case of 24 (thats a 2-4 US peeps) Millstreet Brewery Organic Ale that I won't be buying to put it in Canadian terms....I'll live!!

Sorry if you took it the wrong way, but you're the one who asked if you could do better than $29.99. I told you how you could do better with about 3 minutes of additional effort, and you say that "life is too short". We're talking about MINUTES of effort, not HOURS. It probably took you about as long as to write your reply back to me as it would have to look up the coupon code. And if you can find a way to save $1.60 in 3 minutes, that's like paying yourself $32 per hour.

I don't believe in wasting time, but I do believe in finding efficient ways to save money that don't require me to sacrifice my lifestyle. I am HAPPY to invest 10 seconds to press F10 to open my Apple Widget Menu and have the Gas Saver widget show me where the cheaper gas is. If it happens to be on my regular commuting route, then yes, I'll go to that particular gas station and save the 3 cents. Why drive around for it when you can get the info that easily?

If you feel that 3 minutes of invested time is "inconvenient", that's your choice. But you asked for a cheaper way to get the drug, I gave you one, and my genuine opinion is that anyone who can't spare 3 minutes to save $1.60 is throwing good money after bad. You've got your opinion and I've got mine. I'm sure that someone who reads this thread will need 28 tubes and will be GRATEFUL to be saving $40+.

[foxhavenfarm]

Ok, so I stumbled on this thread while doing some research. We have a one month old filly that was a twin and has had ulcers since about one week of age. The vet recommended omeprazole and suggested that we just buy the over the counter human kind and make a suspension to give to her orally. I have been giving this to her daily for three weeks and have seen no improvement and now I guess I have figured out why-because of the capsules that protect the omeprazole from the stomach acid. So now, I am going to try her on ranatidine for a week and see if there is any improvement.

Deltawave, I'll direct this question to you: Is it safe to give omeprazole and ranatidine at the same time? We are obviously going to have to get some Gastrogard since the human stuff is not surviving her stomach acid, but I would really like to find a way to relieve her discomfort as soon as possible-not to mention I am VERY afraid of perforation and we simply can't afford surgery for her.

[deltawave]

Ranitidine and omeprazole work on two different parts of the stomach-acid-pumping system; I don't think it's a problem to use both, but [insert disclaimer] I'm not a vet, nor a pediatrician. :) How were the newborn's ulcers diagnosed? Maybe you're treating something that isn't even there?

Human omeprazole is also enteric coated to get past the stomach, but of course horses make acid 24/7 (unlike humans) so it's conceivable that human prilosec might not make it through. It should be OK to open the capsule--it's the little pellets inside that are designed to survive the stomach. It's even available in a powder. . . there's nothing special about the capsule itself.

I've often wondered if just 1-2 days of the GastroGard wouldn't knock down acid production enough to allow the regular "non secret formula" stuff to get where it needs to go--by rights it SHOULD, if the GG is as good as it's cracked up to be. :) Remember this is ONLY OPINION on my part, but I do think a lot of the "patented formula" stuff is hot air and the drug ought to be making it where it needs to be without all that much help. :)

It's also a fact that in the days before omeprazole ranitidine was considered very good stuff--I'd not shy away from trying it.

[foxhavenfarm]

Ranitidine and omeprazole work on two different parts of the stomach-acid-pumping system; I don't think it's a problem to use both, but [insert disclaimer] I'm not a vet, nor a pediatrician. :) How were the newborn's ulcers diagnosed? Maybe you're treating something that isn't even there?

Thanks for the info...we are going to get some Gastrogard to try. I found generic Cimetidine at Family Dollar for $2 a box for 30 200mg tablets so I thought we'd try it.

It is definitely ulcers. She has constant teeth grinding and drooling which is producing foam, and when it's really bad she is refluxing out her nose. (It helps that my mom is a retired veterinarian, but these meds were not widely used on horses when she was in practice)

Fortunately, she has not inhaled any of the reflux into her lungs as of yet. (touching wood!) She has not had a fever either, but she is not growing like she should be and still looks like a newborn. We just have to keep fighting it.