Polo Players Edition

NOV 2018

Polo Players' Edition is the official publication of the U.S. Polo Association. Dedicated to the sport of polo, it features player profiles, game strategy, horse care, playing tips, polo club news and tournament results.

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POLO P L A Y E R S E D I T I O N 39 they also enter the ulcer bed and inhibit the bad bacteria and facilitate healing. "It's not as effective as antibiotics, but more effective than no treatment," he explains. Ulcer medication "Not all formulations of omeprazole are equally effective," says Dr. Carol Clark, Peterson and Smith Equine Hospital, Ocala, Florida. "Compounded omeprazole (though cheaper) is generally not as effective as GastroGard. The buffering mechanism is a proprietary technique that is not easy to accomplish. The company that created GastroGard worked hard to make sure it happens, and this is what makes the drug more active and effective. At best, you get only 25 percent efficacy from compounded or generic forms. If you are using the whole tube you get some benefit for prevention because it only takes a quarter dose for prevention. If you are trying to treat ulcers, however, generic products won't work very well," she says. "The other important thing about using omeprazole is timing, especially when giving the low dose for prevention. That quarter dose will not suppress acid very long, but it does work long enough to assist in prevention. Thus we want to time it so it's given on an empty stomach, so it's on board and active before the horse starts exercise. During exercise the stomach is compressed by the abdominal contents. The stomach juices are pushed upward and come in contact with the upper non-glandular part of the stomach that doesn't have acid protection. If the stomach contents are acidic, this is more harmful, so we want to give the GastroGard or UlcerGard two to four hours before a training workout. You pay a lot of money for the product, and properly-timed use can greatly enhance the benefit from it," says Clark. Ulcers in young horses Clark says young foals are much less at risk for ulcers, especially the classical gastroduodenal ulcer disease, than older foals. "But if they have a painful condition early in life that requires pain relief via non-steroidal drugs (such as for an infected joint), those are the foals I would consider putting on ulcer prevention medication. And if foals get sick any time between 2 weeks and a year of age, ulcer prophylaxis is important. A sick foal—whatever it is sick with—could benefit from ulcer prevention," says Clark. "That's when we see gastroduodenal ulcer disease in foals, and it's different than the older-horse ulcers. Often in young foals it is glandular rather than the non-glandular ulcers we see in adult horses. In foals it may involve the stomach but also in many cases includes the first part of the small intestine, the duodenum. This can result in strictures and be very serious. Often they get a chronic form of ulcers with delayed gastric emptying, esophageal reflux, and sometimes secondary liver dysfunction. Foals with ulcers can also suddenly rupture and nobody even knew they were sick," she says. "The biggest difference between young foals less than 6 months of age and the older horse—or even the young adult horse—is that young adult horses don't generally get the glandular disease. Then as we look at yearlings and at 2-year-olds going into training, these youngsters are much more at risk for non-glandular disease," says Clark. "However, many of these youngsters are also being treated with NSAIDs for various reasons. This puts them at risk for glandular disease, not only in the stomach, but also in the hindgut. Many youngsters, especially those being prepped for sales, get too many NSAIDs and possibly even steroids. Colonic ulcers are harder to actually see (than gastric ulcers), but what we do see is low protein levels. Due to the ulcerative colitis, often in the right dorsal colon, these horses are low on protein. It may not be enough to need plasma, but it's an indication that the horse is not handling the NSAIDs," she says. This can vary a lot with the individual horse. "Some horses can be given NSAIDs long-term and not show any drop in protein, while others are very sensitive to these drugs—and the hindgut is just as sensitive as the stomach. Sometimes those horses have intermittent diarrhea—which is rarely a symptom of gastric ulcer disease. It can be a symptom of hindgut ulcer disease, however. It is not a symptom of gastric ulcers in adult horses but can be a symptom of gastric ulcer disease in a young foal. Anything that causes abnormalities in the small intestine can cause intermittent diarrhea in the foal." Young horses getting ready for sales or being pushed in training should probably be maintained on some sort of ulcer prevention. There are other things that can reduce the risk for ulcers, such as limiting NSAID use. "It's also wise to limit the times a horse has no feed in front of him. Horses need something in their stomach. If they do have to go without feed, limit those times to less than four- hour periods," says Clark. Young horses transitioning from the farm to a training facility face many changes—in environment, diet, etc.—and have more stresses, including transport. Owners and trainers need to be proactive in making this transition as easy as possible and not just rely on preventative medications like omeprazole. "We can do a lot more ulcer prevention in sales prep youngsters and horses in training than we can do for very young foals. If a sick foal is over 2 weeks of age, you probably should have it on ulcer prevention, but beyond that there is not a lot we can really do. If they are sick, we can try to keep them from getting ulcers during that time. We can't do much in the way of diet manipulations. Until they are weaned, they are on a milk diet, which is great, but once they go into the real world and start learning their job, their normal management is changed a lot. That's when ulcers tend to happen in young adults, and it is our goal to try to improve that situation."

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