Flatulent colic in horses

Flatulent colic is produced by overproduction of gas in the large intestine and caecum causes distension of stomach.

Symptoms
Distension of abdominal area
Difficulty breathing
Sweating
Pawing
Frequently looking at the flank
lying down
Rolling over
Causes
sudden change in diet
large quantities of green food
Indigestion
unclean water
improper feeding
irregular teeth

Treatment and Prevention
Consult the veterinarian immediately
Good management
Regular routine of feeding and exercise can able to prevent colic.
New feed should be introduced gradually
Plenty of clean water should be given
Regular deworming is necessary
Regular dental checkup is essential

GASTRIC ULCERS COMMON IN PERFORMANCE HORSES

Equine gastric ulcer syndrome is a common condition, both in performance horses, such as racehorses, and in foals.

More than 90 percent of performance horses have gastric ulcers, and between 25 and 50 percent of foals do.

“Ulcers are sores in the lining of the stomach,” explains Dr. Wilkins, who is boarded both in equine internal medicine and in equine emergency and critical care.

In horses, the top portion of the stomach is lined with flat non-glandular cells and the lower portion has glandular cells.

According to Dr. Wilkins, approximately 80 percent of equine gastric ulcers occur in the non-glandular upper portion, which is less resistant to injury from stomach acid. The glandular tissue is more resistant to damage because it secretes mucus.

“Ulcers in the upper portion of the stomach are caused by stomach acid, whereas glandular ulcers occur when the mucosal protection and blood flow are impaired, which may be related to the use of non-steroidal anti-inflammatory drugs,” says Dr. Wilkins.

There are multiple risk factors for equine gastric ulcer syndrome. During intensive exercise, such as training or racing, the body concentrates the flow of blood to the horse’s heart and muscles, and a reduced amount of blood flows to the gastric mucosa of the stomach, which can result in ulcers.

Intense exercise also increases the intra-abdominal pressure, causing compression of the stomach, which in turn may force acid that is normally in the lower portion of the stomach into the upper, non-glandular portion. Ulcers may arise, since the upper region has no mucosal secretions to protect it from acid.

Horses fed a diet high in carbohydrates are also at increased risk for ulcers.

“Excessive amounts of carbohydrates and sugars will ferment in the stomach,” says Dr. Wilkins. “The byproducts of this fermentation are thought to synergize with the stomach acid and may lead to non-glandular ulcers.”

Clinical signs of gastric ulcers in adult horses include poor appetite and body condition, attitude changes, mild to moderate colic, decrease in performance, and a dry, poor hair coat.

Horses kept on pasture are less likely to develop gastric ulcers.

Pamela Wilkins, DVM, PhD, DACVIM, DACVECC

In foals, clinical signs include poor appetite or intermittent nursing, colic, poor body condition, frequently lying on their back (indicates gastrointestinal pain and not necessarily an ulcer), grinding of teeth, excessive salivation, and diarrhea.

However, these signs are only suggestive of an ulcer. For a definitive diagnosis, a veterinarian must examine the horse via endoscopy, a nonsurgical procedure in which a light and camera attached to the end of a flexible tube are inserted down the throat and into the stomach. Images from inside the stomach are displayed on a monitor, enabling the veterinarian to determine definitively whether there are ulcers.

Equine gastric ulcer syndrome may be treated using management modifications or medical therapy or a combination of these approaches.

“Management modifications may include reducing the level of exercise, limiting periods of fasting, and changing the diet, such as by increasing the amount of roughage and reducing grain concentrate in the diet,” says Dr. Wilkins. “Horses kept on pasture are less likely to develop gastric ulcers.”

In horses as in people, stress can play a role in ulcer development. Dr. Wilkins recommends that owners limit stressful events for horses, such as trailering, overcrowding, and long-term confinement to a stall.

Medical treatment of gastric ulcers includes either antacid therapy (to neutralize the acid) or anti-secretory agents.

Anti-secretory medications and more specifically use what are called “proton pump inhibitors.” These medications work at the level of the parietal cell, where the acid is being produced, to inhibit acid formation.

“The most effective treatment of for equine gastric ulcers combines management and medical interventions,” advises Dr. Wilkins.

- See more at:http://vetmed.illinois.edu/pet_column/equine_ulcers/#sthash.sJMHG2hA.dpuf

PREVENTION OF COLIC

Steps to reduce the risk of colic

1. Always have fresh, clean water available

Horses without water for as little as 1-2 hours, were at increased risk of colic in one study. The risk was especially high for horses over 6 years of age. Additionally, horses have been shown to prefer to drink out of buckets compared to automatic waterers, likely due to the ability to ingest large quantities quickly. In the winter, it is important to ensure automatic waterers and other water sources have free flowing water. In colder weather, horses drink more water if it is warmed. Twice daily addition of hot water to buckets works as well as continuous warm water. When traveling on longer trips, stop to let horses drink and/or have a veterinarian pretreat them with mineral oil before starting.

2. Allow pasture turnout

Horses that have access to pastures have been shown to have a lower colic risk than those without pasture access. Feeding from round bales increased the risk of colic in one study. This increased risk may have been related to decrease in quality in the round bales due to exposure and storage (stored outside), types of hay baled, and/or uncontrolled ingestion of certain types of hay.

3. Avoid feeding on the ground in sandy areas.

Horses may ingest enough sand to irritate their intestines. Feed in tubs or hay racks. Place rubber mats or catch pans underneath racks to enable horses to get the scraps without getting sand.

4. Feed grain and pelleted feeds only as needed.

Colic risk increased 70% for each pound increase in whole grain or corn fed in some studies. Horses eating pelleted feeds and sweet feeds are also at increased risk for colic compared to horses on a 100% hay diet.

5. Watch horses carefully for colic following changes in exercise, stabling, or diet.

Colic risk increases during the two weeks that follow changes. Farms that make more than four changes in feed in one year have three times the incidence of colic than farms with less than four feed changes. Even changing the batch of hay can increase the risk of colic. Make only gradual changes in diet, housing, and exercise whenever possible. To make changes in feed, mix ¼ new with ¾ old for about seven days, then increase the percent of new feed gradually.

6. Horse's teeth should be floated every six months.

This ensures good ability to properly and thoroughly chew hay and other feed stuffs.

7. Control parasites.

Horses on a daily wormer or horses regularly dewormed are less likely to colic.

8. Closely monitor your horse and care for it as much as possible yourself.

Owners who take great interest in their horse's care on a day-to-day basis have fewer incidences of colic. Early signs of impaction colic include dry fecal balls or fecal balls that are smaller than usual. Some horses with impactions, may go slightly off feed (particularly off grain) or change drinking habits during the early stages of colic. Subtle signs will be picked up more quickly if you are familiar with what is normal for your horse.

9. Watch broodmares and horses who have colicked previously.

Watch broodmares closely in the two months following foaling. Monitor any horses that have been ill or have colicked before as all are at an increased risk of colic, and early treatment is essential. Treatment with phenylbutazone (bute) can also make horses prone to types of colic and can hide early signs of colic. Discuss the appropriate levels of bute with your veterinarian and avoid using large amounts or prolonged treatment whenever possible.

Above all, be a proactive owner. If your horse is being placed at unnecessary risk for colic, try to adjust the situation. If your horse does colic, appropriate and timely care makes a great deal of difference in the outcome.

Reviewers: Brenda Postels and Betsy Gilkerson Wieland, and Krishona Martinson, PhD, University of Minnesota Extension; Abby Duncanson, Indigo Acres; Harlan Anderson, DVM; and Missie Schwartz, MN Horse Council and Tucker Road Stables.

ENTEROLITHS

Enteroliths are concretions composed of magnesium ammonium phosphate salts that forms slowly around a nidus such as a small metallic object or stone.

Enteroliths are single or multiple and usually do not cause any clinical signs unless they become lodged in the transverse or small colon.

It is commonly seen in middle aged horses,with Arabians, Morgans , Saddlebreeds and Miniature horses.

A large percentage of affected horses are on an Alfalfa diet with a high magnesium and protein content

That foreign object can be as insignificant as a sliver of wood or a piece of binder twine that didn’t get sorted out from the hay.

In the rare instance that the body fails to expel the indigestible particle, it tries to protect the gut instead, by encasing the object in layers of mineral deposits

Small ones are generally passed in the manure (eventually), but larger ones can be responsible for mysterious, recurrent colic and need to be removed surgically before they cause a fatal intestinal rupture.

Clinical signs

• Decreased faecal passage,colic and weight loss.
• If enteroliths is in colonic mucosa, the obstruction is complete and gas and ingesta accumulates leads to severe acute abdominal pain.
• Tachycardia
• Abdominal distension
• Nasogastric reflux

Diagnosis

Diagnosing enteroliths is usually done by a combination of radiographs and surgical exploration

Preventions

• Eliminate, as much as possible, the chance that your horse will ingest a foreign object by removing binder twine from hay and checking his surroundings and paddocks for debris and garbage.
• Feeding on the ground should be avoided.
• Feed grass hay. Most horses that develop enteroliths have a diet of at least 50% alfalfa hay, which has much higher levels of calcium, magnesium, and protein than grass hay.
• Reduce the amount of wheat bran in your horse’s diet. Bran provides high levels of phosphorus, which could contribute to enterolith formation.
• Provide free-choice hay or increase the number of feedings each horse gets per day. This will help keep the digestive system occupied because when the gut isn’t actively moving feed material along its length, it could be providing a favorable environment for enteroliths to incubate and grow.
• Provide daily exercise and avoid prolonged stall confinement. Inactivity also contributes to reduced intestinal movement of feed.

References


The Equine Manual by Andrew J.Higgins and Jack R.Snyder
thehorse.com

CHOKE IN HORSES

Choke is a condition in horses in which the oesophagus is blocked, usually by food material. Although the horse is still able to breathe, it is unable to swallow, and may become severely dehydrated.

SIGNS OF CHOKE

• Difficulty swallowing (horse may try to swallow without success)
• Disinterest in food
• Coughing
• Extending the neck and head, usually in a downward direction
• Discharge from the nostrils. usually green in color, although it may also be yellow or clear, often looks like vomit
• Increased salivation saliva drooling from the mouth
• Heart rate may increase slightly, due to the distress of the animal
• Occasionally, a lump on the side of the neck is visible or can be palpated where the esophagus is blocked. This is normally most obvious on the left.

DIAGNOSIS

If a horse is suspected of choke, a veterinarian will often pass a stomach tube down the animal's esophagus to determine if there is a blockage. Failure to access the stomach with the tube indicates a complete obstruction; difficulty passing the tube may represent a stenosis, or narrowing; or a partial obstruction.

TREATMENTS

The only treatment needed is sedation to relax the horse and the esophagus, allowing the obstruction to pass on its own.

The next step is gentle pressure with a nasogastric tube and some type of lavage (washing).

The tube is passed to the level of the obstruction, then warm water is gently pumped into the esophagus to help push the obstruction along.

This must be done gently and carefully to prevent rupture of the esophagus.

The horse is usually sedated so that the head is hanging low, helping the extra water flow out of the nose.

Indigestible objects should be removed via an esophagotomy (an incision into the esophagus).

Following the clearance of an esophageal obstruction, it is a good idea to view the esophageal lining with an endoscope.

This helps determine if there has been any damage, This will help determine how quickly the horse can resume eating food.

If the esophagus has been damaged by the obstruction-- usually seen as erosion or ulceration of the esophageal mucosa--then feed might be withheld or gruel (thin, watery nourishment) can be fed.

Often the horse will be restricted to eating gruel until the esophagus is healed. Sometimes, intravenous fluids and nourishment are required during the time the horse cannot eat or drink.

ABOUT THE AUTHOR

Michael Ball, DVM

Michael A. Ball, DVM, completed an internship in medicine and surgery and an internship in anesthesia at the University of Georgia in 1994, a residency in internal medicine, and graduate work in pharmacology at Cornell University in 1997, and was on staff at Cornell before starting Early Winter Equine Medicine & Surgery located in Ithaca, N.Y. He is also an FEI veterinarian and works internationally with the United States Equestrian Team.

STOMACH ULCERS

A common case of heartburn can bring intense discomfort, even pain, to a person. Imagine your horse trying to perform with a stomach ulcer. Did you know that the clinical signs of ulcers in horses are subtle and nonspecific and might be reflected in a slight attitude change, a decrease in performance, or a reluctance to train?

Gastric ulcers are common in horses. Their prevalence has been estimated to be from 50% to 90%, depending on populations surveyed and type of athletic activity horses are engaged in.

Gastric ulcers can affect any horse at any age. Foals are particularly susceptible because they secrete gastric acid as early as 2 days of age and the acidity of the gastric fluid is high. Foals that have infrequent or interrupted feeding, or are recumbent for long periods have been found to have lower gastric fluid pH (aqueous solutions with a pH less than 7 are acidic), suggesting that milk has a protective effect against ulcers and that recumbency increases exposure of the stomach to acid.

In adult horses, gastric ulcers occur more frequently in horses that perform athletic activities, with the highest frequency found in Thoroughbred racehorses (80-90%), followed by endurance horses (70%), and show horses (60%). Researchers have found that exercise increases gastric acid production and decreases blood flow to the gastrointestinal (GI) tract.

In addition, when horses exercise, the acidic fluid in the stomach splashes and exposes the upper, more vulnerable portion of the stomach (squamous mucosa) to an acidic pH.

Why are gastric ulcers so common in horses? First, the stomach of the horse is smaller compared with the stomach of other species. Because of this, horses cannot handle large amounts of food; rather, they are built to graze and eat frequent, small portions of feed for extended periods of time.

In a natural grazing situation, the horse requires a steady flow of acid for digestion, so a horse's stomach produces acid 24 hours a day, 7 days a week--up to 9 gallons of acidic fluid per day, even when not eating. In a natural, high-roughage diet, the acid is buffered by both feed and saliva.

Second, understanding the horse's anatomy, it is possible to see how ulcers could be considered a "manmade" disease. When horses are fed two times per day, the stomach is subjected to a prolonged period without feed to neutralize the acid. Furthermore, high-grain diets produce volatile fatty acids that can also contribute to the development of ulcers.

Other risk factors for developing gastric ulcers include physical and environmental stress such as transport stress and stall confinement (intermittent feeding and lack of exposure to other horses). Recent studies have demonstrated that a few hours of transport can induce gastric ulceration in horses that had none prior to departure, as determined by gastroscopy.

Finally, chronic administration of some non-steroidal anti-inflammatory drugs (NSAIDs)--such as phenylbutazone, flunixin meglumine or ketoprofen--can decrease the production of the stomach's protective mucus layer, making it more susceptible to ulcers.

Anatomy of the Horse Stomach

The horse's stomach is divided into two distinct regions: the squamous region at the top (considered a continuation of the esophagus lining) and the glandular mucosa at the bottom (similar to the human stomach). The bottom part is glandular and secretes gastric acid. However, this region also produces mucus and bicarbonate, which protect the mucosa from acid exposure. So even though this region is also exposed to acid for several hours a day, it is not a common place for ulcer formation. When ulcers do form in this region of the stomach, they are usually secondary to chronic NSAID administration.

The top portion of the stomach is designed for mixing of the contents of the stomach and does not have as much protection from the acid. This is the most common place to find gastric ulcers. The lining of this section of the stomach is very thin and does not have many mechanisms for acid protection. Because the horse's stomach produces gastric acid at all times, even when not eating, the squamous mucosa is exposed to acid several hours a day, which can easily erode the lining of this region.

Clinical Signs

The majority of horses with gastric ulcers do not show outward clinical signs. They have more subtle signs, such as:

• Poor appetite;
• Dullness;
• Attitude changes;
• Decreased performance;
• Reluctance to train;
• Poor body condition;
• Poor hair coat;
• Weight loss;
• Excessive time spent lying down;
• Low-grade colic; and
• Loose feces.

More serious cases will show abdominal pain (colic) and/or grinding of the teeth. Some horses are found on their backs, commonly seen in foals, since this position seems to provide some relief from severe gastric ulceration. Others will walk away from food for a period of time as if they experience discomfort when the food first hits the stomach.

Clinical signs of ulcers in foals include intermittent colic (after suckling or eating), frequently lying down, intermittent nursing (interrupted nursing due to discomfort), diarrhea, poor appetite, grinding of teeth, and excess salivation. When a foal exhibits clinical signs, the ulcers are likely to be severe and should be diagnosed and treated immediately.

Note that horses that look completely healthy can also have gastric ulcers. Approximately half of the horses presented for colic at UC Davis have gastric ulcers and often it is hard to know whether the colic is the result of the ulcers or the other way around.

Diagnosing Ulcers

The only way to definitively diagnose ulcers is through gastric endoscopy, or gastroscopy, which involves placing an endoscope into the stomach and looking at its surface. This procedure is easy to perform, is minimally invasive, and allows us to evaluate the esophagus, squamous and glandular regions of the stomach, and proximal segment of the small intestine in horses. (See a video of gastroscopy from UC Davis here.)

Since feed material can prevent a complete evaluation of the stomach, horses are fasted for a minimum of 12 hours and water is withheld for four hours before examination.

To minimize stress, we sedate the horse slightly with a short-acting tranquilizer. We then insert the endoscope through the nostril and down the esophagus into the stomach. The light and camera on the end of the endoscope allow the veterinarian to observe the stomach lining. The procedure is very safe, and a complete evaluation takes from 10 to 20 minutes.

Some practitioners will treat a horse for gastric ulcers and look for a change in clinical behavior. This can be helpful but does not answer the question of when to discontinue treatment. Horses that improve with treatment should be scoped prior to discontinuing therapy.

Prevention and Treatment

As always, prevention is preferable to treatment. We have described some common risk factors that can contribute to the formation of gastric ulcers in horses. The following management techniques may assist in preventing ulcers:

• Feed horses frequently or on a free-choice basis (pasture). This helps to buffer the acid in the stomach and stimulate saliva production, nature's best antacid.
• Reduce the amount of grain and concentrates and/or add alfalfa hay to the diet. Discuss any feed changes with your veterinarian so that medical conditions can be considered.
• Avoid or decrease the use of anti-inflammatory drugs. If anti-inflammatory drugs must be given, consider newer ones such as firocoxib, if appropriate.
• Limit stressful situations such as intense training and frequent transporting.
• If horses must be stalled, allow them to see and socialize with other horses as well as have access to forage.

A common question asked by horse owners is, "If the prevalence of gastric ulcers is so high, do I need to treat my horse for the rest of its life?" Considering that treatment is expensive and that acid in the stomach is there for a reason, we do not recommend that horses be treated continuously.

Antacids are commonly used in humans to buffer or neutralize gastric acid and protect the mucosa. However, in horses, the dose of antacids required to buffer the pH is high and would need to be used several times a day to be effective. If antacids are used for treating gastric ulcers in horses, they should be used in combination with agents that decrease acid production.

Acid pump inhibitors such as omeprazole and pantoprasole stop gastric acid secretion completely.

Other effective types of drugs for the treatment of ulcers are the histamine type 2 (H-2) receptor blockers such as cimetidine, ranitidine, and famotidine, which partially block acid production.

H-2 receptor blockers work in a similar way to antihistamines used for allergies, except that antihistamines act on type 1 histamine receptors, while the acid blockers act on type 2 histamine receptors. H-2 receptor blockers are less expensive than acid pump inhibitors, but they need to be administered three times a day and only partially block acid production.

Currently, there is only one treatment--omeprazole--approved by the U.S. Food and Drug Administration (FDA) for gastric ulcers in horses. In 2000, the Fédération Equestre Internationale allowed the use of the gastric ulcer medications omeprazole and ranitidine during competition.

Omeprazole is available as a paste formulation and it has been very effective in preventing and treating gastric ulceration in all types of horses. Although the commercial paste is expensive, it is very effective and requires administration once a day. Due to the cost of this product, some compounding pharmacies prepare and sell paste or liquid omeprazole at cheaper prices. However, several studies have shown that the amount of active omeprazole in those products is lower than the label. In addition, the ability of those products to inhibit gastric acid production and their ability to resolve gastric ulcers has been variable.

Horse owners should be wary of claims for products that are not controlled or regulated by the FDA (compounded products) or evaluated in scientific studies. While those products might be less expensive, they could cost you more in the long run.

We recommend treating (1) horses with severe gastric ulceration, (2) horses with clinical signs of gastric ulceration, and (3) horses that are under stressful conditions and at risk of gastric ulceration. Under these circumstances, treatment with a product that is labeled specifically to prevent and/or treat gastric ulcers and approved by the FDA should be used. Treatment should be given for a full month, followed by a recheck endoscopy to confirm complete healing.

A preventative dose of omeprazole is commercially available for use around transport or stressful events. Horses with a history of gastric ulceration may benefit from proactive treatment to decrease the chances of ulcer recurrence. At this dosage, the omeprazole is less costly and could serve as a good investment in your horse's well being.

by Jorge Nieto, DVM, PhD, Dipl. ACVS--Reprinted from The Horse Report with permission from the Center for Equine Health, School of Veterinary Medicine, University of California, Davis (UC Davis).

EQUINE COLIC

Colic is a general term given for any abdominal pain. There are many types and causes of colic, as well as predisposing factors.
Digestive colic, the true form of colic, can be caused by feeding and management practices. The intestine may become blocked and twisted, or gas may develop. A horse’s digestive system is highly sensitive; therefore, colic is a major cause of death in horses.


Types of colic:
spasmodic, impaction, incarceration, displacement, and excessive fermentation.
Spasmodic colic is the mildest and most common. It is associated with over-excitement or sudden feed changes. It generally responds well to modest medical treatment.
Impaction colic is caused by normal ingesta or foreign material blocking the intestine. It may be caused by increased coarseness of forage, decreased intestinal fluid, or interference with normal intestinal movement. If the blockage prevents passage of gas as well as ingesta, surgical intervention may be necessary
In incarceration colic, a loop of the intestine may become trapped within a normal or abnormal structure in the abdominal cavity. A common example is a strangulating hernia. This situation may require surgery if the blood supply is cut off. In displacement colic, a portion of the intestine becomes twisted or caught in an abnormal position.
The displacement may or may not be strangulating, but surgery usually is required to save the horse’s life.
Excessive fermentation occurs when the stomach’s contents ferment more rapidly than they can be eliminated. This usually is caused by eating too much grain. Surgery rarely helps, and medical treatment is difficult. This situation also can cause rapid chemical changes in the blood that lead to abnormal blood flow to the hooves. This usually cripples the horse

Causes
Improper food, water, and management practices are big factors in colic.
• Irregular feeding times
• Lack of water
• Giving excess water to hot horses or horses deprived of water
• Excess grain
• Moldy feed
• Improperly chewed food due to bolting or poor teeth
• Overeating grain when hungry from being off feed
• A diet of extremely coarse roughage or very fine roughage such as coastal Bermuda hay • Consuming foreign objects
• Fecaliths or enteroliths (large accumulations formed in the intestine around foreign material)
• Feeding on the ground where sand can be ingested
• Feeding excessive salt to saltdeprived horses when water is not readily available (rare)
• Parasites

Symptoms
In colic, the horse exhibits early signs including:
• Playing in water with its mouth
• Curling the upper lip
• Refusing to eat
• Biting its flanks
• Looking at its abdomen
• An expression of anxiety on its face Moderate signs include:
• Kicking at its belly, rolling, pawing, getting up and down frequently and overall restlessness
• Assuming a saw horse posture (legs stretched out as if to urinate)
• Increased pulse rate
• Normal or raised temperature
• Sweating
• Abdominal distention
• Depression
• Lack of defecation
• Small volumes of firm, mucuscovered feces
• Anorexia


Treatment
• Do not allow the horse to drink or eat.
• Prevent injury. Walk the horse if it is trying to roll.
• If the horse is quiet, leave it alone and observe.
• Do not give pain medication prior to the veterinarian’s analysis. Medical treatment could include the following procedures:
• Nasogastric tube to relieve gas
• Sedation to allow examination
• Analgesic for pain
• Intravenous fluid to correct electrolyte and acid-base imbalances
• Water lavage (enema) at the site of an impaction
• If mild—fecal-softening agents such as psyllium hydrophilic mucilloid (Metamucil TM) (1–2 cups for 30 days), mineral oil, or warm-water enemas with lubricants
• 10–12 liters of warm water via a nasogastric tube every 2 hours


Reference
https://catalog.extension.oregonstate.edu/sites/catalog.extension.oregonstate.edu/files/project/pdf/ec1474.pdf

DEWORMING SCHEDULE FOR HORSES

When To Dose	Product (Chemical Name)
January 1:	Broad Spectrum de-wormer such as fenbendazole (Panacur, Safe-Guard); oxibendazole (Anthelcide EQ)
March 1:	Ivermectin 1.87% (Equell, Equimectrin, Eqvalen, Ivercare, Zimectrin), for general de-worming.
April 15:	Moxidectin plus praziquantel (Quest Plus or Combo Care), to treat encysted strongyles and tapeworms.
June 15:	Either double dose pyrantel pamoate (Strongid, Strongyle Care) OR single dose praziquantel combination product with either ivermectin or moxidectin (Equimax, ComboCare, Quest Plus, Zimectrin Gold), to treat tapeworms.
August 15:	Ivermectin 1.87% (Equell, Equimectrin, Eqvalen, Ivercare, Zimectrin) for bots; first dose.
October 15:	Ivermectin 1.87% (Equell, Equimectrin, Eqvalen, Ivercare, Zimectrin) for bots; second dose.
November 25:	Broad Spectrum de-wormer such as fenbendazole (Panacur, Safe-Guard); oxibendazole (Anthelcide EQ)