Omeprazole

[stephanie teeter]

Here is the motion that was passed at midyear. The veterinary committee will be publishing an article in an Endurance News issue to further elaborate.

Proposed Motion   To update the appendices of Rule 13 with the following changes:

1)       Add to Appendix C: Allowed Substances – Omeprazole at the preventive dose only of 1.1 mg/kg – specifically Ulcerguard

2)       4 mg/kg doses of Omeprazole, including Gastroguard, would continue to be disallowed.

 

Background, analysis and benefit

 

The AERC Veterinary Committee does not support or encourage the competitive use of horses afflicted with clinically significant gastric ulceration.  Rather the.intent of this narrow use of omeprazole, at the FDA approved preventive dose, is aimed at improving ulcer prevention for those horses that are still in competition for 24 hours or longer. It is the opinion of the Veterinary Committee, and the bulk of the national and international equine veterinary community at large, that the sport horse is subjected to environmental conditions that promote GI ulceration.  While low dose omeprazole can be used up until 24 hours prior to the start of AERC competition, it is multiday horses, and 100 mile horses needing the full 24 hours of ride time, that are at increased risk for ulcer development under the current AERC drug policy.  These horses can not be administered omeprazole until after they have completed competition, including standing for BC.  This prevents these horses from receiving the beneficial effects of omeprazole for a full 24 -36 hours in the case of a 100 mile horse, or several days in the case of a multiday horse.  It is further the opinion of many ride veterinarians that some horses can and do suffer from clinically significant stomach ulceration  within 24-48 hours, particularly given the stresses of traveling to a ride, camping at a ride and then participating in the ride itself.  While the Veterinary Committee fully supports the AERC philosophy that horses should compete on their own natural abilities, the Veterinary Committee also feels a need to protect and promote the health and welfare of horses competing in the sport of endurance.  In this instance providing riders with an FDA approved tool to reduce ulcer development in their horses during stressful and strenuous competition is considered to be in our best interest as a national organization devoted to horse welfare.

[Ed & Wendy Hauser]

On 10/1/2014 4:47 PM, stephanie teeter wrote, quoting the AERC BOD minutes:

In this instance providing riders with an FDA approved tool to reduce ulcer development in their horses during stressful and strenuous competition is considered to be in our best interest as a national organization devoted to horse welfare.

Typical bureaucratic gobbley-gook.  Sounds to me the same as QH futurity vets saying that bute is OK cause it prevents further joint damage.

Call me old fashioned but drug free is drug free, allowing a "little drug" is at best being hypocritical, at worst it is the "camel's nose" entering the tent.  Perhaps horses who can not be managed for proper gastric health without the use of "even a little drug" need to find a different occupation.

Ed

Who at present giving his horse 2 more weeks off to allow complete recovery after a joint injection 2 weeks ago.

By the way I have consistently followed my own advice.  I have re-homed horses that were not suitable to continue in Distance riding using only their own natural abilities.

(I will now get down from my soap box.)

--
Ed & Wendy Hauser
5729 175th Ave.
Becker, MN 55308

Ed: (406) 381-5527
Wendy: (406) 544-2926

[Dawn Carrie]

Exactly, Ed.  If a horse can't compete on it's own abilities, it's either not suited for the sport, or is not being managed appropriately by the rider.  If a horse is eating adequately (ie, keeping food in the stomach to buffer stomach acid), then ulcers should be much less of an issue even on 100s or multidays.  I see this motion as a cave-in to those who have been whining that they need this drug in order to trailer their horses to rides.  Similarly, if a horse doesn't eat in the trailer, it's either not suited to the sport, or isn't being managed properly...work on teaching it to eat in the trailer.  We've had a horse or two that at first didn't eat well while trailering...but by working with them (offering super yummy foods - beet pulp/sweet feed mashes, etc.- that the horse just couldn't resist) in the trailer, we conditioned them to relax and eat in the trailer.  It was then a simple transition to munching on hay.

I'm disappointed in the BoD...again.

Dawn Carrie

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[Carolyn beckstrom]

I disagree.  I think with all the recent studies showing that most working horses have some degree of stomach ulcers, that the rule is changing because of new knowledge and a chance to take better care of our horses.  It is not allowing horses that are being be treated for ulcers to enter a ride, simply helping prevent them in a situation that is likely to cause them - stress, trailering, intermittent eating, stomach acids sloshing for hours at a time while being ridden at a pace over a walk, dosing with electrolytes, etc.  it allows 1/4 dose, a preventative dose, not a treatment dose.  my horse does not display any sign of ulcers, but I will help insure she doesn't develop them by giving her a preventative dose prior to a ride next year.  

The argument that if it can't compete on it's own abilities, that it isn't suited for the sport seems like saying some horses complete 100's without electrolyte supplementation, so if your's needs electrolytes to perform at it's best, he isn't suited for the sport or should only do LD's. Or since some horses complete barefoot and if yours can't, he isn't suited for the sport or you should manage it by only going to rides with soft terrain.

Plus, it's not easy, at least for me, to re-home a horse, and many of us can only have one horse, so anything I can to do ensure her health, soundless and happiness, I will do.  I'm not saying we should force a horse that obviously is not able/doesn't want to do endurance  make it by masking problems with drugs and injections etc, but something simple like 1/4 dose of omeprazole is like making sure your tack fits properly so they are as comfortable as possible for what we are asking of them.

Carolyn

---

Date: Thu, 2 Oct 2014 07:42:12 -0500
Subject: Re: [RC] Omeprazole
From: rdca...@gmail.com
To: ride...@endurance.net

[Ed & Wendy Hauser]

On 10/2/2014 9:08 AM, Carolyn beckstrom wrote:

seems like saying some horses complete 100's without electrolyte supplementation, s

Since electrolytes are absolutely required for all animals and are normally found in feed and salt licks by all horses including free living unowned horses, this is not a valid comparison to a drug not found in nature and manufactured by man for the purpose of treating disease.

"...Plus, it's not easy, at least for me, to re-home a horse,..."  

It is not easy for anybody to re-home a horse.  By the way I deliberately used the word "re-home" not sell to indicate that I willingly took a financial hit to make sure that the horses in question would continue to have a quality life, just not in Distance riding.

Ed

[Carolyn beckstrom]

I understand what you are saying.  it is a drug and it also may open the door for other drugs to be more easily allowed.  I guess my argument is that it's not at a dose to treat a disease or mask an unsoundness, but just to help the horse not develop a problem doing something we ask that is not "natural" either.  

I guess you could compare it to hoof protection, which is not found in nature either, but we use it to prevent excessive wear and discomfort when we ride longer and faster than they would on their own.

and I meant no offense about the "re-homing",  it just seems that is always an argument when this topic comes up and it's not an easy solution for anyone, I know.  BUT, in this case, it's not about a horse with a problem needing to have a new career, it's about helping prevent a problem.  maybe like giving prophylactic joint injections and supplement to help insure a long career....

---

Date: Thu, 2 Oct 2014 09:31:32 -0500
From: ra...@sisuwest.us
To: ride...@endurance.net
Subject: Re: [RC] Omeprazole

[Ed & Wendy Hauser]

On 10/2/2014 9:44 AM, Carolyn beckstrom wrote:

hoof protection, which is not found in nature either,

Hoof protection does not change the metabolism of the horse.  To my mind that makes it much different than an ingested substance that radically changes the metabolism.  It also has been used by equestrians for thousands of years, and thus has stood the test of time.  It never has been prohibited in any fashion by the AERC.

By the way I do not propose any test relating to the "naturalness" of an ingested substance.  Many drugs are found in plants and thus are "natural".  Note that I used terms to indicate that electrolytes, from whatever source, were "absolutely required" for life.  I stand by that assertion.

[Bruce Weary]

I have come full circle on the Omeprazole issue, and used to feel very strongly the same as Ed does, and in fact would give the same emphatic argument against its use in endurance horses. I now am in strong support of the allowance to use it in preventive dose measures. Here's why: First, we aren't really a totally drug free sport, and that is largely because technology has gotten so refined that molecules of things like bute can be detected for weeks or months after dosing, though they are well below a therapeutic level, so it has become an issue of degree.  Secondly, the horse, as a prey animal tends to have a strong startle reflex when he is exposed to sudden, unknown or scary stimuli or other stressors. We have all seen our horse's heart rate accelerate when the horse sees something on the horizon that he doesn't recognize, or go tearing around the corral when something startles him. The quickness of a horse's shy exemplifies how fast he becomes alert and ready to flee-it can be instantaneous. This reflex is short-acting and started by the nervous system, but sustained by longer acting factors of the sympathetic nervous system, namely the hormone adrenaline. Guess what else tends to elevate as a result of this increase in sympathetic activity? Gastric acid. Possibly frequently or ongoingly  in the horse at a competitive event due to his sometimes skittish nature as a prey animal. Add all the stressors of travel, exposure to new people, places and things, and you have increased chances of GI distress through expression of the sympathetic nervous system. This is deeply ingrained, and I have heard it said in the case of many Arabians, we are riding the descendants of the horses that were quick enough not to have been eaten by predators. :) I have begun to use the preventive dose in our horses, and the change has been remarkable. They nearly empty their hay bags in the trailer now,urinate MUCH more (not sure why) and eat and drink better on the trail. And we never really felt we had problems in these areas until we saw these changes. Now a fuller gut, better hydration and free urination likely make for a horse that will be more able to handle endurance riding with less likelihood of colic and other metabolic distress. At least theoretically, and I think that can be supported.

   Having said that, what about the slippery slope of increased drug use, and our claim to be drug free? I think we should change our motto from "drug free" to "We don't allow doping/performance enhancing or pain masking meds." We already allow Regumate, Pergolide (for Cushing's) and injectable/oral joint nutraceuticals. Since we can't be expected to overcome, on a broad scale, every horse's natural fight/flight/startle/prey animal instincts, I think the use of a preventive, not therapeutic, dose of omeprazole is warranted in performance horses. We may see fewer colics and metabolic distress at our rides as usage becomes more prevalent.    Bruce Weary

--

[Chrystal Woodhouse]

Bruce, you raked me over the coals years ago when I started a conversation about omeprazole ( it was at least 7 years ago) - if I ever meet you in person I demand  satisfaction.....a duel to the death; or a beer......, you can choose... ;-)  I was told by pretty much everyone on RC that I was a terrible person, was doing an awful disservice to my horse, if I was worried about ulcers I needed to get rid of her as she was obviously unsuited for this sport  and by continuing on with her I was the Worse...Person..Ever...... that mare went on to complete 100's with me, including the OD- she has just over 2000 miles in long distance riding and is happily  " retired" at 19 doing 25 miles rides with a 10 yr old....

I am super interested in the changes you saw in your horses Bruce using small doses .. funny 7 years ago you were super anti ompeprazole and I was super for it.... I have not come full circle to totally changing my mind but have a lot more appreciation for why there was/is so much hesitancy and am in hindsight glad it takes forever for the vet committee to allow anything new. :-)

Chrystal

[Ed & Wendy Hauser]

On 10/2/2014 11:39 AM, Bruce Weary wrote:

. Possibly frequently or ongoingly  in the horse at a competitive event due to his sometimes skittish nature as a prey animal. Add all the stressors of travel, exposure to new people, places and things,

By this reasoning, we should allow the use of tranquilizers or "calming agents" to suppress the excitability of horses who are uncontrollable at the start of a ride.

"..."We don't allow doping/performance enhancing or pain masking meds." We already allow Regumate, Pergolide (for Cushing's) and injectable/oral joint nutraceuticals..."

I think you are saying that the camel's nose and much of his head is already in the tent so why not allow a little bit more.  This simply illustrates the danger of compromising principles one little step at a time.

I was and remain opposed to all the above listed drugs.

 As far as distinguishing between a difficultly detectable tiny residues, that are many orders of magnitude smaller than a therapeutic dose and drugging a horse, I hold that the difference is clear.  Those who can't do this, are not being completely honest with themselves or are not aware of the nature of our world.  For example, Hg (Mercury) and As (Arsenic) are deadly poisons.  Even discounting recent human activities, they always have been and will continue to be found in our food and water at detectable levels given 21st century analytic chemistry.

[Terre O’Brennan]

Respectfully, Bruce, I disagree...altho I do appreciate your well-reasoned response.

The article in EN a month or so ago regarding this pretty much focused on multi-day rides; I believe '100s' have been tacked on as a selling point.  More research has been done on one-day 100 mile rides than any other aspect of endurance; this issue hasn't previously come to the fore.

Multi-days (especially 255 miles in 5 days) are an 'extreme' version of endurance, just as are 100s.  Up until now, they've been touted as being 'safer' for the horses due to generally slower speeds.  Now an issue specific to multidays has arisen...and we are looking to drastically alter our rules to accommodate.  This is no different than if somebody said "really fast FEI 100s cause stress to the horses, so they should be allowed drugs to compensate".

In other words, a risk has been identified to a small population of horses practicing an extreme version of the sport, and we are looking at a rule change that will affect all endurance horses, in all types of competition, to mitigate it.  Multiday rides are more 'culturally acceptable' to us than other extremes of this sport but the philosophy remains the same.  In my opinion.

terre

[Bruce Weary]

My Dear Chrystal--

  You have my utmost and sincere apologies if you ever felt disrespected by any of my prior orations on this, or any other subject. As to the options you offer to resolve the past contention, : " I demand  satisfaction.....a duel to the death; or a beer......, you can choose... ;-)"  How about a compromise:

  "death by beer." ?  It would take years, and could actually be fun. :)  Seriously, I found it an interesting experience to do a 180 degree turn in my perspective on this issue, and I'm sure it will be hotly debated for some time to come, and rightly so.

  So, can we still be friends?     Bruce

[Truman Prevatt]

I have come full circle a couple of times on the use of Omeprazole or more correctly as the new rule states allowing a residual level in the blood but not allowing to the point of where it was unitized for the purpose for "doping" for a competitive advantage. This is consistent with our current drug rule - we are not drug free in the absolute sense. We do allow the replenishment of electrolytes through forced administration by syringe. We do allow the use of compounds such as Adaquan. There are some other, like those to control the cycle of mares. It gets down to risk and benefit. If in fact our sport is causing our horses harm and it is identified - which might be the case for multiday rides - then if we are concerned about the welfare of the horse we should either eliminate the event or we should allow precautions to mitigate the risk to the horses.

However, the concerns with the long term use of Omeprazole are not mitigated because we change the rules. There are open question as to the impact of long term use concerning the calcium levels in humans at least in several categories of humans (decreased bone density). The open question is "does it impact and if so how does it impact horses?" Just because there is a rule change regarding the use or Omeprazole does not mean that using it even in preventative levels is the best long term strategy for a given horse. The horse owner will have to make that decision. There is a vast difference to use preventative levels of Omperazole while trailering a long distance to a ride and using it continually. There is a vast difference to using preventative levels of Omperzole during a hard 5 day ride and using it continually. The former in both cases would not present the horse to a long term risk. The latter - while it hasn't been scientifically established it will present a long term risk for the horse - there is sufficient evidence that the potential is there and caution should be used.

The unfortunate thing is it is difficult to write a rule that will forbid long term continual use that could result in a long term risk to a horse but on the other hand will allow the mitigation of the risk horses faced in our sport for specific events based on blood levels of the drug at isolated blood test. That is why I think in general we should tread very carefully and very slowly in loosening any use of drugs.

On Oct 2, 2014, at 12:39 PM, Bruce Weary <weary...@gmail.com> wrote:

> I have come full circle on the Omeprazole issue, and used to feel very strongly the same as Ed does, and in fact would give the same emphatic argument against its use in endurance horses. I now am in strong support of the allowance to use it in preventive dose measures. Here's why: First, we aren't really a totally drug free sport, and that is largely because technology has gotten so refined that molecules of things like bute can be detected for weeks or months after dosing, though they are well below a therapeutic level, so it has become an issue of degree. Secondly, the horse, as a prey animal tends to have a strong startle reflex when he is exposed to sudden, unknown or scary stimuli or other stressors. We have all seen our horse's heart rate accelerate when the horse sees something on the horizon that he doesn't recognize, or go tearing around the corral when something startles him. The quickness of a horse's shy exemplifies how fast he becomes alert and ready to flee-it can be instantaneous. This reflex is short-acting and started by the nervous system, but sustained by longer acting factors of the sympathetic nervous system, namely the hormone adrenaline. Guess what else tends to elevate as a result of this increase in sympathetic activity? Gastric acid. Possibly frequently or ongoingly in the horse at a competitive event due to his sometimes skittish nature as a prey animal. Add all the stressors of travel, exposure to new people, places and things, and you have increased chances of GI distress through expression of the sympathetic nervous system. This is deeply ingrained, and I have heard it said in the case of many Arabians, we are riding the descendants of the horses that were quick enough not to have been eaten by predators. :) I have begun to use the preventive dose in our horses, and the change has been remarkable. They nearly empty their hay bags in the trailer now,urinate MUCH more (not sure why) and eat and drink better on the trail. And we never really felt we had problems in these areas until we saw these changes. Now a fuller gut, better hydration and free urination likely make for a horse that will be more able to handle endurance riding with less likelihood of colic and other metabolic distress. At least theoretically, and I think that can be supported.
> Having said that, what about the slippery slope of increased drug use, and our claim to be drug free? I think we should change our motto from "drug free" to "We don't allow doping/performance enhancing or pain masking meds." We already allow Regumate, Pergolide (for Cushing's) and injectable/oral joint nutraceuticals. Since we can't be expected to overcome, on a broad scale, every horse's natural fight/flight/startle/prey animal instincts, I think the use of a preventive, not therapeutic, dose of omeprazole is warranted in performance horses. We may see fewer colics and metabolic distress at our rides as usage becomes more prevalent. Bruce Weary
>
>

--
"It is hard to fight an enemy who has outpost in your head." - Sally Kempton

[Mary K]

I'm all over the place on this one. Omeprazole saved our pony, then hurt him! The problem with allowing a small dose seems to me exactly what happened in your case Bruce Weary--now people think it's ok to use omeprazole indiscriminately "just in case", even in horses that are asymptomatic.

Please please please ask our vets to issue lots of warnings against using this drug just for the heck of it. The quarter dose is a good idea, but even that amount is causing radical change in a horse's stomach--good if needed, quite bad if not.

Our pony had terrible ulcers and omeprazole saved him. But, ultimately he couldn't survive being on a light dose of the stuff all the time. He started getting impaction colics that, if one reads the fine print, aren't surprising even if not super common. The wonderful result of the initial treatment and our having to stop though, is that he is healthier and happier now than he ever has been. We were forced to discover an effective protocol by having to forego the omeprazole (which was no longer keeping ulcers at bay either, proven by endoscope).

Where did we land? No more omeprazole, no more beet pulp mashes, a reduction to almost no concentrates whatsoever--including at rides. Instead, as Mary Nunn suggested, he gets "Hay and Water, just Hay and Water!" He gets no electrolytes but salt. (We did 6 months of Smartgut and Equisure as well, then cut that to half which probably does nothing but I'm too scared to remove--and unlike omeprazole, its only bad outcome is expensive pee and poo.) Result: 100% recovery. Last year I thought he was done. This year--he drinks and eats in the trailer like a nut, he drinks the second we get to a ride, he drinks on the trail. He just finished one LD and two 50's at Owyhee and looked ready for another the next morning. He has expanded his girth by 4 holes! Pony Boy is back on the trail!!!

The point of my story is that omeprazole is a really great breakthrough, but it is not always a panacea for lifetime gut trouble. I'm glad they ok'd a maintenance dose and dearly hope people use it on their horses judiciously and for the short term.....