• Welcome to the Chronicle Forums.
    Please complete your profile. The forums and the rest of www.chronofhorse.com has single sign-in, so your log in information for one will automatically work for the other. Disclaimer: The opinions expressed here are the views of the individual and do not necessarily reflect the views and opinions of The Chronicle of the Horse.

Announcement

Collapse

Forum rules and no-advertising policy

As a participant on this forum, it is your responsibility to know and follow our rules. Please read this message in its entirety.

Board Rules

1. You’re responsible for what you say.
As outlined in Section 230 of the Communications Decency Act, The Chronicle of the Horse and its affiliates, as well Jelsoft Enterprises Ltd., the developers of vBulletin, are not legally responsible for statements made in the forums.

This is a public forum viewed by a wide spectrum of people, so please be mindful of what you say and who might be reading it—details of personal disputes are likely better handled privately. While posters are legally responsible for their statements, the moderators may in their discretion remove or edit posts that violate these rules. Users have the ability to modify or delete their own messages after posting, but administrators generally will not delete posts, threads or accounts upon request.

Outright inflammatory, vulgar, harassing, malicious or otherwise inappropriate statements and criminal charges unsubstantiated by a reputable news source or legal documentation will not be tolerated and will be dealt with at the discretion of the moderators.

2. Conversations in horse-related forums should be horse-related.
The forums are a wonderful source of information and support for members of the horse community. While it’s understandably tempting to share information or search for input on other topics upon which members might have a similar level of knowledge, members must maintain the focus on horses.

3. Keep conversations productive, on topic and civil.
Discussion and disagreement are inevitable and encouraged; personal insults, diatribes and sniping comments are unproductive and unacceptable. Whether a subject is light-hearted or serious, keep posts focused on the current topic and of general interest to other participants of that thread. Utilize the private message feature or personal email where appropriate to address side topics or personal issues not related to the topic at large.

4. No advertising in the discussion forums.
Posts in the discussion forums directly or indirectly advertising horses, jobs, items or services for sale or wanted will be removed at the discretion of the moderators. Use of the private messaging feature or email addresses obtained through users’ profiles for unsolicited advertising is not permitted.

Company representatives may participate in discussions and answer questions about their products or services, or suggest their products on recent threads if they fulfill the criteria of a query. False "testimonials" provided by company affiliates posing as general consumers are not appropriate, and self-promotion of sales, ad campaigns, etc. through the discussion forums is not allowed.

Paid advertising is available on our classifieds site and through the purchase of banner ads. The tightly monitored Giveaways forum permits free listings of genuinely free horses and items available or wanted (on a limited basis). Items offered for trade are not allowed.

Advertising Policy Specifics
When in doubt of whether something you want to post constitutes advertising, please contact a moderator privately in advance for further clarification. Refer to the following points for general guidelines:

Horses – Only general discussion about the buying, leasing, selling and pricing of horses is permitted. If the post contains, or links to, the type of specific information typically found in a sales or wanted ad, and it’s related to a horse for sale, regardless of who’s selling it, it doesn’t belong in the discussion forums.

Stallions – Board members may ask for suggestions on breeding stallion recommendations. Stallion owners may reply to such queries by suggesting their own stallions, only if their horse fits the specific criteria of the original poster. Excessive promotion of a stallion by its owner or related parties is not permitted and will be addressed at the discretion of the moderators.

Services – Members may use the forums to ask for general recommendations of trainers, barns, shippers, farriers, etc., and other members may answer those requests by suggesting themselves or their company, if their services fulfill the specific criteria of the original post. Members may not solicit other members for business if it is not in response to a direct, genuine query.

Products – While members may ask for general opinions and suggestions on equipment, trailers, trucks, etc., they may not list the specific attributes for which they are in the market, as such posts serve as wanted ads.

Event Announcements – Members may post one notification of an upcoming event that may be of interest to fellow members, if the original poster does not benefit financially from the event. Such threads may not be “bumped” excessively. Premium members may post their own notices in the Event Announcements forum.

Charities/Rescues – Announcements for charitable or fundraising events can only be made for 501(c)(3) tax-exempt organizations. Special exceptions may be made, at the moderators’ discretion and direction, for board-related events or fundraising activities in extraordinary circumstances.

Occasional posts regarding horses available for adoption through IRS-registered horse rescue or placement programs are permitted in the appropriate forums, but these threads may be limited at the discretion of the moderators. Individuals may not advertise or make announcements for horses in need of rescue, placement or adoption unless the horse is available through a recognized rescue or placement agency or government-run entity or the thread fits the criteria for and is located in the Giveaways forum.

5. Do not post copyrighted photographs unless you have purchased that photo and have permission to do so.

6. Respect other members.
As members are often passionate about their beliefs and intentions can easily be misinterpreted in this type of environment, try to explore or resolve the inevitable disagreements that arise in the course of threads calmly and rationally.

If you see a post that you feel violates the rules of the board, please click the “alert” button (exclamation point inside of a triangle) in the bottom left corner of the post, which will alert ONLY the moderators to the post in question. They will then take whatever action, or no action, as deemed appropriate for the situation at their discretion. Do not air grievances regarding other posters or the moderators in the discussion forums.

Please be advised that adding another user to your “Ignore” list via your User Control Panel can be a useful tactic, which blocks posts and private messages by members whose commentary you’d rather avoid reading.

7. We have the right to reproduce statements made in the forums.
The Chronicle of the Horse may copy, quote, link to or otherwise reproduce posts, or portions of posts, in print or online for advertising or editorial purposes, if attributed to their original authors, and by posting in this forum, you hereby grant to The Chronicle of the Horse a perpetual, non-exclusive license under copyright and other rights, to do so.

8. We reserve the right to enforce and amend the rules.
The moderators may delete, edit, move or close any post or thread at any time, or refrain from doing any of the foregoing, in their discretion, and may suspend or revoke a user’s membership privileges at any time to maintain adherence to the rules and the general spirit of the forum. These rules may be amended at any time to address the current needs of the board.

Please see our full Terms of Service and Privacy Policy for more information.

Thanks for being a part of the COTH forums!

(Revised 1/26/16)
See more
See less

So my friend the gastroenterologist and I got to talking about horses . . .

Collapse
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • So my friend the gastroenterologist and I got to talking about horses . . .

    . . . after he got done yelling at me about giving aspirin to everyone. (cardiologists and GI docs don't often see eye to eye on the wonders of aspirin therapy)

    Anyhow, I asked him about a few things I've been meaning to try and figure out with all the horse ulcer topics, specifically:

    Is omeprazole really so incredibly fragile that it must be given in the Secret Expensive Formula?

    Is there a "rebound effect" from using PPIs or antacids?

    His answer to the first question was that yes omeprazole is vulnerable in acid but why not do what a lot of the later PPI formulations do, and give the omeprazole along with a sodium bicarbonate buffer? That raises the pH in the stomach for 20-30 minutes, which is about as much time as it takes for oral omeprazole to be absorbed and start doing its thing. Apparently the newest reincarnation of omeprazole (Zegerid) is just that: a combination of omeprazole and good old baking soda.

    The answer to the second question is yes--SUSTAINED use of PPIs can cause a rebound of acid production when the drugs are stopped, but regular antacids do not do this.

    The conversation then turned elsewhere, I won't bore you.
    Click here before you buy.

  • #2
    Delta, sigh...
    I am so not at your level of intellect. Could you please rephrase to a layman who is interested because she's concerned her older mare may be developing ulcers?
    Thank so much.

    Comment


    • #3
      I would ask you to start with spelling out PPI's.
      save lives...spay/neuter/geld

      Comment


      • #4
        Acid production in the equine stomach is a fairly constant process. Not sure how you could have a rebound effect in that case.
        "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

        ...just settin' on the Group W bench.

        Comment


        • #5
          Originally posted by fivehorses View Post
          I would ask you to start with spelling out PPI's.

          not delta, but PPI=proton pump inhibitors
          That's the class of drug (mechanism of action) of omeprazole.
          "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

          ...just settin' on the Group W bench.

          Comment


          • #6
            So why not combine PPIs plus other H2 and H1 blockers? (i.e. other acid reducers)

            Combine ranitidine/famotidine/cimetidine + omeprazole...treat ulcers for 2-4 weeks at 20mg/kg (or is it 40mg/kg?) 2x/day, then wean off WHILE keeping on the non-PPI acid reducers?

            Comment

            • Original Poster

              #7
              Dang, where'd my reply go? Is Merial stalking the BB?

              I guess I figured that even in a model where there is normally full-time acid production, turning it OFF (with a PPI) for a period of time could still potentially give you rebound hypersecretion of acid when you remove the drug, no? Not just full-time acid, but MORE full-time acid?

              My guess is that there are probably MANY different ways to get ulcer meds where they need to go safely and effectively without paying thirty bucks a day or whatever it is. That kind of price is just obscene, and I'll freely admit that I have an axe to grind with pharmaceutical price gouging. It gives me an agenda, no question.

              I wish to God some independent group would do a nice study on buffering cheap old twenty-year-old omeprazole with good old baking soda so horses can be treated more readily without bleeding their owners dry.
              Click here before you buy.

              Comment


              • #8
                Originally posted by deltawave View Post
                Dang, where'd my reply go? Is Merial stalking the BB?

                I guess I figured that even in a model where there is normally full-time acid production, turning it OFF (with a PPI) for a period of time could still potentially give you rebound hypersecretion of acid when you remove the drug, no? Not just full-time acid, but MORE full-time acid?
                I'm no gastroenterologist, but I have taken omeprazole on several occasions. My docs totally blew me off when I said I the acid was much, much, much worse after I stopped the drug. It was unbearable! I'm very leery about taking it again.
                "Rock n' roll's not through, yeah, I'm sewing wings on this thing." --Destroyer
                http://dressagescriblog.wordpress.com/

                Comment


                • #9
                  Originally posted by deltawave View Post
                  . . . after he got done yelling at me about giving aspirin to everyone. (cardiologists and GI docs don't often see eye to eye on the wonders of aspirin therapy)

                  Anyhow, I asked him about a few things I've been meaning to try and figure out with all the horse ulcer topics, specifically:

                  Is omeprazole really so incredibly fragile that it must be given in the Secret Expensive Formula?

                  Is there a "rebound effect" from using PPIs or antacids?

                  His answer to the first question was that yes omeprazole is vulnerable in acid but why not do what a lot of the later PPI formulations do, and give the omeprazole along with a sodium bicarbonate buffer? That raises the pH in the stomach for 20-30 minutes, which is about as much time as it takes for oral omeprazole to be absorbed and start doing its thing. Apparently the newest reincarnation of omeprazole (Zegerid) is just that: a combination of omeprazole and good old baking soda.

                  The answer to the second question is yes--SUSTAINED use of PPIs can cause a rebound of acid production when the drugs are stopped, but regular antacids do not do this.

                  The conversation then turned elsewhere, I won't bore you.
                  Thanks for this info! I was particularly interested in the part about antacids not having a rebound effect.
                  Last edited by Riley0522; Jan. 22, 2011, 09:00 PM.

                  Comment


                  • #10
                    If one tapered off the PPI, rahter than just stopping it, boom, I wonder if the rebound effect would be as profound?

                    Riley, I believe the point was that "antacids" DO NOT have a rebound effect.

                    Comment

                    • Original Poster

                      #11
                      Riley, not to quibble re: rebound effect, but it is NOT ANTACIDS that can produce it, but PPIs. Antacids = TUMS, Rolaids, that sort of thing. A bit of trivia, maybe, but IMO important to distinguish to prevent confusion.
                      Click here before you buy.

                      Comment

                      • Original Poster

                        #12
                        atr, jinx!

                        I don't know about the tapering. Physiologically it makes sense. Dang, I should have asked him that one. We're both on call so maybe I'll see him tomorrow.
                        Click here before you buy.

                        Comment


                        • #13
                          Deltawave-I fully agree with you regarding the pricing of Gastroguard. Even if it were $500/month (which would still give the company a healthy profit, I'm sure), it's a lot better than what it costs now to do a month of therapy! I wonder how many people either skip doing the scoping or don't complete the full recommended course of therapy due to the exhorbitant costs?

                          I'm also wondering how much we can extrapolate humans vs. horses as far as ulcers/acid production, etc. Although we both possess simple stomachs, there are some major differences between human and equine gastrointestinal tracts.

                          Humans are omnivores, able to eat fewer and larger meals. IIRC, our acid production is in response to meals, not continually secreted as in the equine. H. pylori has been implicated in human ulcers, but not equine (there was just a blurb on this on thehorse.com). Are ulcers in humans less prevalent in people who eat smaller meals that are high in fiber(analogous to horses with hay in front of them 24/7)?

                          Could there be equine versions of acid hypersecretion diseases? I know that even broodmares have been shown in studies to have ulcers-and they are living the recommended lifestyle for reducing ulcers. But then I think being pregnant 11 months of the year and rebred with foals at their sides probably brings it's own kind of stress.

                          I don't know the answers to these questions. These are just some random ponderings.
                          http://thepitchforkchronicles.com

                          Comment


                          • #14
                            I know what you guys were saying, antacids do not have a rebound effect. I worded it that I was interested in the topic of antacids having a rebound since I've been hearing it come up more often. I am glad to hear that they DON'T .

                            I fixed my first post!

                            Comment


                            • #15
                              My dad is also a gastroenterologist and I've asked him a lot of the same questions. He thought nexium would work well for horses- it is esomeprazole instead of omeprazole, but basically the same thing. It's formulated so that the capsule can be taken apart and the power can be put in feeding tubes and such so stomach acid won't destroy it.

                              Of course, I haven't talked to any vets about it, and I doubt it is any more cost effective than gastrogard.

                              Comment

                              • Original Poster

                                #16
                                It's ALWAYS good to be wary about comparing species, but as far as I'm aware the gastric mucosa is pretty close to the same, the methods of acid production similar (although the timing is very different) and the effects of PPIs nearly identical between species. And even with H. pylori, acid suppression is an important part of treatment.

                                Sooner or later Gastrogard will go generic, and the price will drop like a rock. And as I've said before, you can put MONEY (no pun intended) on there being a "new and improved" (and patented, of course) product coming out at almost exactly the same time.

                                In the meantime, if I had ulcers to treat in a horse I'd personally be inclined to go with a compounding pharmacy with an excellent reputation and give the omeprazole with a big slug of baking soda.
                                Click here before you buy.

                                Comment


                                • #17
                                  Delta, thanks for this info! I'm a lowly second year student right now, but I was surprised to read your post. We had a guest lecturer last year, a physiologist from another university, that gave our GI lectures and he told us pretty much the exact opposite- you get rebound with antacids and NOT with PPIs (you had me interested enough to go back and double check my lecture notes- that's definitely what he said ). I emailed him about it and will be interested to hear what he says. In the meantime keep us posted if you find out more about tapering, I'd be interested to hear if that's been done with any success.
                                  Balanced Care Equine

                                  Comment

                                  • Original Poster

                                    #18
                                    What this guy said was that antacids have such a brief effect (20-30 minutes) that there isn't much time for the change in pH to register in any feedback loops. Whereas long-term acid suppression causes gastrin levels to go up and up. I'd have to look it up myself to check my own thinking--you are MUCH closer in time to learning this stuff than I am!

                                    Here's a little blurb:
                                    http://www.medscape.com/viewarticle/705224

                                    Not sure if it is a predictable thing or an occasional thing, though.
                                    Click here before you buy.

                                    Comment


                                    • #19
                                      Deltawave, I suppose maybe you could give your Tums treats, then mix your omeprazole pills in with the grain a little while later. OTOH, since it's 2.28 grams omeprazole per tube, how much money do you save by giving 100 pills of 20 mg each day? I haven't checked the prices.

                                      ETA: omeprazole is unstable in aqueous solution; also, by definition a reputable compounding pharmacy does not break the law, and AMDUCA is pretty clear on this. You would have to make the argument along the lines of "my horse won't take oral meds and I'm going to be tubing this in to him" to have a legitimate excuse for compounded liquid omeprazole. I'd go with the Tums and pills.
                                      The plural of anecdote is not data.
                                      Eventing Yahoo In Training

                                      Comment

                                      • Original Poster

                                        #20
                                        I honestly have not done the math. I'm not sure buying all those itty bitty "human sized" pills is the way to go at all, although they're available everywhere. As I said, I'd probably find a good compounding pharmacy and have them mix it up. Or ask my F-I-L, who is a pharmacist. But yes, something along the lines of giving the antacid first, then the PPI soon after, give the antacid a chance to raise the pH and then dose the good stuff.

                                        I also wonder at the seeming dichotomy of the manufacturers insisting that their drug does a fantastic job of reducing acid production over a 24-hour period, followed by their insisting that the drug MUST be given in their Secret Formula because otherwise ALL THAT STOMACH ACID will chew it right up. Hmmmm, if the super drug is suppressing all that acid so well, why wouldn't doses #2 through infinity pass right on through that supposedly acid-free environment. Huh? Huh?
                                        Click here before you buy.

                                        Comment

                                        Working...
                                        X