In the Shadow of Horse

In the Shadow of Horse
In the Shadow of Horse

Monday, April 8, 2019

The Rise and Fall of Raceday Medications

The History of Permitted Medication in American Horseracing 

The Annals of Veterinary Medicine 

Sid Gustafson DVM

Phenylbutazone seemed a miracle drug when the stuff began coursing the bloodstreams of racehorses in the late 50s. By the time its use in horses became widespread during the ’60s, I had began collecting the urine that concentrated the ‘Bute’ metabolites, enabling its detection in racehorses. All drugs were forbidden in the game back then, and bute made the list of forbidden performance enhancing agents with the advent of its reliable detection in the urine.
Off with a cup on a stick to collect racehorse pee, I became aware of drugs and racehorses at a tender age. Trainers injecting drugs into their horse to win a horse race was a concept I found difficult to comprehend, a dent put in my faith in humanity towards animals, and at such a tender teen age. 
What a soothing anti-inflammatory effect bute brought to racehorses in those simpler days when its use first became widespread after being introduced in the '50s. Bute’s use alleviated certain lamenesses in dramatic fashion. “Really sweet stuff,” I remember Wright Haggerty’s Kentucky groom telling me on the Shelby, Montana, backside in the early 60s as he pestelled up tiny white 100-milligram pills he had received from my father, the attending and regulatory veterinarian (thus my job as urine catcher). 
After WWII and Korea, both veterans and veterinarians returned to the racetrack with a new appreciation of the influence of drugs on pain management and endurance. Of all domestic species, the racehorse is the most pharmaceutically malleable. Drugs can easily and readily, albeit perhaps not consistently or dependably, alter the outcome of a horse race. Drugs can ease certain pains to enhance performance, as well as stimulate, or more often, calm the racehorse to improve performance. Metabolism can be bolstered or impaired with a variety of hormones, electrolytes, vitamins, and nutrients injected before the race. 
Drug trouble began lurking for horses on the backside; narcotics, stimulants, calmers, blood builders, joint injections, hormones, almost any drug moved up a horse, or so it appeared to trainers so inclined to use drugs to win. I’ve watched and participated in the horseracing game since the 60s. Not everyone doped horses. Not everyone does, save the Lasix and bute permitted. Many folks ran clean as long as they could. When racing drugs became allowed, in no time every trainer jumped in the pre-race drug bandwagaon. These permitted drugs moved horses up. 
By the 80s, drug use became permissive, therapeutic the trainers' lobby said. As more drugs were allowed, horses durability began faltering considerably. Racehorses started breaking their legs more frequently, and it was not coincidental. Breakdowns were proportionate to pre-race drugs utilized. I was there, first as a urine collector, then as an attending veterinarian, and later as a regulatory veterinarian in New York in California. It was some experiment. Drugs weaken racehorses, each and every drug. The medicators began exceeded the adaptability of the horse. Drugs caused harm, especially over the long term.
I came to know the winners, the winning horses and trainers, and how they cared for their winners. Back in the day, I followed the winners to their barn to catch the sample. I could see what sort of husbandry produced winners. It was clear to me back then that horses run soundest and safest clean. That has proven true scientifically and statistically. The more drugs given a horse, the more likely that horse is to breakdown. The more drugs allowed in a racing jurisdiction, the more broken legs and shortened careers. 

The original medical plan, being that most racing jurisdictions back then prohibited the use of any and all drugs, was to utilize phenylbutazone for training. The Kentucky groom mixed the white powder into a mash, and fed his eager and waiting racehorse, who trained like Seabiscuit the next morning. “So drugs can really make a horse win?” I asked.
“Sure can , some horses, yes, drugs can make all the difference. But that’s not how the game was designed. Talent, natural and learned talent, riding and conditioning talent; that’s what gamblers are lookin’ for. They don’t want any horses getting’ the needle. No the needle never any good for horses or horseracing. No drugs, no needles, that’s the rule. We looking for natural talent, trained up talent, and riding talent. Heart, we lookin’ for horse with heart, with hoof and heart. Yes, we don’t want no drugs. Drugs break down a horse. Drugs may help for a race or two, but after that drugs weaken the horse, hollow out the bones and joints, soften the lungs. Drugs make horses bleed.” That was my education on drugs and racehorses, and right the groom was. Everything he told me back then has turned out correct. He even knew that Bold Ruler had the Lasix, given by the master of hop, Alex Harthill. Horseracing had become a drug game, and the vets became the croakers, pushing drugs like they were oats.
Bute cools hot joints and quiets inflamed tendons to desirable medical effect, allowing horses to return to training and racing sooner than otherwise, allowing them to maintain their conditioning. Tight, cool legs and hooves are necessary to continue conditioning the racehorse. If there is excess fluid in a joint, or swelling within a hoof, conditioning is generally counterproductive as further inflammation and damage follow exercise.
Bute was first used to facilitate continued training by quieting certain injuries or inflammations, and was especially effective when used conscientiously and conservatively. In a certain sense and in compassionate, knowing hands the drug provided humane relief to the rigors of racehorse life. The question quickly became: Could bute enhance performance? It was not a question for long. The answer was yes. Bute was and is the cleanest boost ever for a horse with mild inflammation in need of relief. The stuff could move a horse up, as they say, without a mental, or stimulant effect, but with an anti-inflammatory effect.
Two horses being equal, however, bute generally won’t make a horse with quieted inflammation run faster than a horse without joint, bone, or tendon inflammation. In a sense, bute restores normal overall biomechanical function. The nonsteroidal anti-inflammatory drug takes the heat out of mildly inflamed legs, feet, and joints, and this can be good in considerate hands.
Bute also became useful in the sense that it was diagnostic, or so the mind-set went at the time. If you administered bute and your horse went back to training and eating and being a sound horse after laming up a bit, then it was concluded that the condition was not significant enough to warrant rest, only to warrant bute. Bute, then, could be used to assess the severity of the lameness in racehorses. Some did not consider bute-responsive conditions serious, and this is one line of reasoning that eventually allowed the legalization of bute. There were medical arguments for its use in racing horses, medical arguments made by veterinarians and drug companies.
The conditions that bute administration does not resolve or effectively manage are considered problematic, and those conditions generally warrant rest, rather than more intensive treatment. Today, however, if bute does not manage the condition, more intense treatments are used, and more intense drugs are used.
Rest is the oldest and most effective treatment for lameness. In the history of horse doctoring, no treatment is more effective. The horse has a tremendous potential to heal musculoskeletal injuries if returned to natural pasture conditions, grazing the plains with herdmates. The problem is that it takes a full year of rest to cure many conditions racehorses develop, and at least months for others. No one has time to rest racehorses, to wait a year, and then take eight months to recondition the horse. With racehorses the clock is ticking, fast. If drugs can save time with racehorses, they are used for just that. And that is the case these days. The industry has transcended bute. The monthly veterinary bills at Saratoga and Santa Anita often exceed the monthly training bills. Ask any owner. Unwholesome and unfeasible.

If conditions are diagnosed accurately and thoroughly, and drugs are dosed properly and administered in a timely manner, doctors can reduce problematic inflammation in a given leg or joint, which in turn protects the rest of the horse by minimizing the risk of extra strain on other joints and limbs to compensate for the painful injured joint. However carefully dosed and administered, however, this brand of racehorse sports medicine puts more pressure on the weakened, and now treated joint, and herein lies the danger. In addition to systemic medication given intravenously to treat joint inflammation, cortisone is injected directly into joints and tendon sheaths to get a significant anti-inflammatory effect. Cortisone is in a different class of drugs called steroids, which can be used more specifically than bute to reduce the inflammation in a specific joint.
When there is swelling in a joint or tendon sheath, excess synovial fluid is secreted, distending the joint structures, and in some cases, deforming them, making for irregular movement. The reason for excess fluid in a joint is most often damage to the sensitive joint structures; damage to the synovial membranes, articular cartilages, ligaments, tendons, and underlying bone, any or all of the above. Damaged joints are weakened joints. They are inflamed joints, and in racehorses, many become cortisone-injected joints: weakened joints that are quieted down with cortisone. Why? Horse joints need to flow smoothly. Imagine an abraded joint surface, or a tendon that loses its lubrication as is passes over a running, moving joint, the resultant pain, swelling, inflammation, increased friction, and impaired function. If there is rough movement in one joint, the roughness is relayed throughout the horse’s musculoskeletal system, increasing the burden on the other legs and joints.
Intra-articular injection of a joint with cortisone is a potent treatment. In certain veterinarians hands cortisone can be injected efficaciously. The most commonly injected joint is the fetlock, and not coincidentally, the most commonly fractured joint. The reality is that most fractured joints are cortisoned joints, although this information is inaccessible because of medical confidentiality. Bute is less intense, less potent, and a more conservative, saferremedy. The original idea was that legalized bute would replace joint injections, or that was part of the intent. That has not been the case.
Phenylbutazone, or bute, abbreviated from the early popular brand Butazolodin, is a nonsteroidal anti-inflammatory drug very similar to aspirin. Those who understand the pharmaceutical principles of aspirin understand phenylbutazone. Bute reduces inflammation, and subsequent to that, pain. That is the sequence, anti-inflammatory first, with subsequent pain relief. As a result of reduced inflammation, there is restoration of function accompanying relief of the joint pain. Platelets are coated by bute, and coagulation is impaired, potentiating EIPH.
Bute is an anti-coagulant. If you consider aspirin a painkiller, then I suppose you can consider bute one, as well. Bute lasts longer, a day or two, while aspirin is more quickly metabolized in the horse, a matter of hours. The sustained anti-inflammatory effect of bute is especially therapeutic to horses. Prolonged anti-inflammatory relief allows the interdependent musculoskeletal system of the horse to redistribute weight appropriately. Lameness anywhere imbalances the horse. In a sense, bute can improve the balance by providing anti-inflammatory relief of the inflamed parts, but the trainer tendency is to abuse this effect, and train a lame horse under the influence of bute, and then race the horse under the influence of bute, banamine, and Lasix, as is permitted. Dreadful results. Breakdowns.

Initially, drugs for racehorses being illegal, bute was used to facilitate training and not so much enhance racing. That came next. The medication got to working pretty darn good, and in time trainers began administering bute to their horses closer and closer to racing, and soon the testing folk started picking it up. Matt Lytle was one trainer who taught me about bute, the smile it put on his face until Croff Lake, one of his horses, suffered a bad test after winning the Oilfield Handicap in Shelby, Montana, one of those years in the mid-’60s. Lost his purse and sort of soiled his reputation all because of a shade of bute in the urine.
Later, I heard him defend the drug, and his use of it: he gave it for the horses well-being, he claimed, and knowing Matt and his connection to his horses, I did not doubt his intent and compassion. Pain relief is compassionate, especially the sort of racehorse pain relief bute provided. The problem today is that a good thing, bute, or medication in general, has been taken too far. In the passion of competition and in a world of big money, horses have become victims of a misguided pharmaceutical culture.
My dad, having dispensed the bute, sampled Matt’s horse after it won the Oilfield Handicap. I was the one who caught Croff Lake’s urine, which tested positive. Then in 1968, Dancers Image, the winning horse tested positive in the Kentucky Derby. Rather than further restrict drug use to remedy the situation, the industry legalized drugs. From that time, horse racing shifted from a covert medication culture to an overt medication culture, which has been recently brought to its knees. Bute prolongs coagulation time, and makes horses more vulnerable to bleeding. Certain cortisones also delay and alter normal coagulation. As the use of drugs to keep horses training and racing intensified, so did the incidence of bleeding, or Exercised Induced Pulmonary Hemorrhage, EIPH. The more commonly bute and other steroidal and non-steroidal drugs were used, the more racehorses bled. With the medication ideology in full swing, the next drug allowed became Lasix, given hours before the race to stop all the bleeding all the other drugs incited. Lasix became the seat of drug abuse, facilitated the overuse and abuse of more and more drugs. 
After hundreds of other doping incidents, there came a general consensus that if so many felt the need to use bute, maybe it should be O.K. to run on. After all, it was only a type of aspirin. And perhaps its legalization would eliminate the need for other more abrasive medications, such as opiates and amphetamines, and local anesthetics. Some even thought it would reduce the urge to administer intra-articular injections of cortisone. Not the case. The bute allowed horses to run that ought not run, and more and more horses began to bleed, the bute and other drugs altering coagulation while hematinics and other blood boosting drugs and hormones elevated red blood counts, further aggravating bleeding.
By the time I graduated from vet school and began practicing at Playfair Racecourse in the late ’70s, I could legally treat racehorses with nearly everything except stimulants, opiates or depressants. That left a lot of anti-inflammatory drugs, antihistamines, hormones, steroids and bleeding medications to administer to running racehorses, not to mention a multitude of vitamins, amino acids and minerals thought to help a horse endure the rigors of confinement training and racing.
Now virtually all racehorses run on bute and Lasix, and now with too many fractured fetlocks the medication ideology has to be curtailed. Bute wasn’t enough. No drug is. Legal bute engendered a drug culture. Lasix facilitated the doping by suppressing bleeding. The ideology that more conservative use of potent medications would follow legalization of bute did not prove up. More intense drugs and medical treatments followed, rather than less. The pharmaceutical adaptability of the racehorse has been exceeded. Horse racing has to wean itself from its addiction to drugs that no longer help, but instead weaken horses. Racing jurisdictions are in the process of rolling back drug use. The trend should continue as a part of the remedy to reduce breakdowns. Foreign horse racing jurisdictions run without raceday medication, and their safety records are better than the United States’. Horses running clean are less likely to break down than those running on medication.
All the efforts by all the organizations involved with racing to curb medication abuse will never be enough until Lasix and other raceday drugs allowed to be injected into the racehorse hours before racing are banned. It is poor form to inject horses with drugs shortly before they race. Where the practice is allowed, horses breakdown more often, as much as four times more often. Where raceday medication is banned, horses are better cared for and racing is safer for both jockeys and horses. 
Drugs have long been a problem with horseracing. Gambling has encouraged the use of illicit means to cash a bet. One of the most available means to help ensure a horse would win was to dope the horse with a performance enhancing drug. Horses have long been hopped, blocked, doped, and shocked in an effort to command a winning performance at tall odds, and often these means have worked. As America and the world are well aware, performance enhancing drugs have been utilized to nefarious effect in a variety of sports. Horseracing, cycling, and baseball have proven that drugs can and do enhance performance, giving unfair advantage to those who medicate illicitly. The benefits are often immediate.
After Korea and WWII, veterans returned to the racetracks, and many had come to know the opiates, morphine and company, as well as the local anesthetics, and stimulants, as well as the sleepers. The world of medicine was becoming a pharmaceutical world, and racehorses became the pincushions. As a child having been by and large raised by horses in a Native American environment, I had trouble getting my head around the concept of giving a horse a drug to win a race. The Indians had long held contests of horse speed and agility, and it was as natural as an event as I had ever witnessed. 
When I was eleven years old, my father came to be in charge of ensuring horseracing was clean in Montana. It was said drugs had drifted in, and cer I was there in the 60s collecting the urine to test for drugs. The rule back in the day was no drugs allowed; none after the horse passed the entry box, and certainly none on raceday. To make racing safe and fair, drugs were simply banned altogether. The horse was designed to run naturally. The winner was to be the healthiest, happiest, fittest, and fastest horse. Horses that needed drugs or treatment were considered unfit to race, having to wait until the day they were healthy and recovered, returned to form, as it is said. 
Horses are especially vulnerable to pharmaceutical manipulation, both to enhance and impair performance. Racing, and most all other athletic endeavors, were designed to find the best developed and most naturally conditioned athlete. Form faltered with injuries and miscalculations, and drugs came to be used to restore form in an athletic sense. Medical therapy drifted to medical doping. Drugs have long been known to restore and enhance athletic ability, and for that reason, any and all drugs have long been banned from a variety of athletic competitions, horseracing in the 60s being one of those sports. 
When I first hired on to collect urine, I was shocked such a measure had to be instituted to ensure fair play. “Some people just refuse to follow the rules,” Matt Lytle told me. “They’ll do anything to win a race and cash a gamble.” And it was true. He could point out the violators as they walked through the backside to the betting windows. Coming into the game young, and made aware of such doping shenanigans, along with my father being a veterinarian, both attending and regulatory, I came to develop a keen eye not only for gimpers, but a keen eye for dopers. As it often turned out, those who had the stable of gimpers were those who had the illicit pharmacies pharmacy in their tack rooms. I soon came to see drugs and lameness went hand in hand. As well, it became clear to become a trainer of horses, one often became a juggler of potions. There seemed to be some great mystical power in jugging a horse (giving a medication intravenously in the jugular vein) and winning a race. The practice became the talk of the backside. Through the years as a urine catcher, attending racetrack veterinarian, and finally a regulatory veterinarian, and came to appreciate the affect of drugs on racehorses, and in the end, no drug ever helped a horse for long. It became clear one could restore form by suppressing unsoundness, and beyond that, one could medicate a horse with a variety of performance enhancing drugs to win a race. As modern medicine inundated horseracing, so did scientific regulation. Before one could accuse a trainer of doping a horse, one had to prove the doping with science. Although it was obvious to most on the backside who was doping, it had to be proven. Veterinarians came to be the ones who stayed ahead of the regulations and kept the trainers supplied with the latest drugs that the laboratories could not test for. New drugs came out weekly, and horsedoctors became the foremost authorities on the illicit medication of racehorses. Through the decades I became witness to a long progression of untoward drugs and procedures to restore soundness and enhance performance. 
As medication and doping practices intensified, racehorses began to bleed. Drugs facilitated training shortcuts and replaced proper conditioning. Healthy lungs require clean air and abundant daily locomotion. Bleeding became limiting for improperly trained and often overmedicated racehorses. This was followed by additional pre-race medication strategies to stop the bleeding, Lasix being a most effective cover for the aggressive medication practices and substandard husbandry that potentiates EIPH. 
EIPH is caused by inadequate conditioning, husbandry and race condition preparation. Intense pre-race medication practices increase the incidence of EIPH by thinning the blood and enhancing performance. Bute and many others alter coagulation processes and capillary integrity. EPO, blood-building, and the current trendy blood-doping practices overburden the circulatory system potentiating EIPH. 
As American trainers began relying on drugs to sustain and enhance performance, the care of the racehorse began to deteriorate in corresponding fashion. The more drugs utilized, the less care horses received. Drugs replaced proper care. Lasix perpetuated substandard horsemanship. Pre-race drugging engenders disrespect for horse and rider, endangering both, a most insidious aspect of horseracing that continues to this day, and must be stopped to save our sport.

Dr Gustafson graduated from Washington State University as a Doctor of Veterinary Medicine in 1979. He is a practicing veterinarian, animal welfare journalist, equine behavior educator, and novelist. The application of behavioral science to the husbandry of horses enhances optimal health, performance, soundness, contentment, and longevity. Behavioral, social, locomotory, and nutritional strategies enhance the prosperity, vigor, and health of stabled horses. Sid offers veterinary care, training, husbandry, and conditioning from the horse's perspective to achieve willing and winning equine partnerships with humans.

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