A Solution to Horseracing's Medication Troubles

http://nyti.ms/1kGbh3Y

On-track pharmacies have the potential to restore racing integrity in America. 

The on-track pharmacy would be the only place drugs are allowed on the racetrack. The attending veterinarian examines a horse and prescribes a treatment. If medication is determined to be part of the therapy, the veterinarian submits the horse’s name, the diagnosis and requested medication to the racing regulatory body. The pharmacist and the regulatory veterinarian evaluate the request and dispense the medication. Everything is recorded; drug, dosage, frequency of administration, expiration date, lot number, brand name, etc.

Veterinarians would not be allowed to drive around the backside with truckloads of drugs, as this current practice has led to indiscriminate inappropriate treatments that have led to breakdowns and doping problems. On-track pharmacies would restore the medication protocols to be decided by veterinarians rather than trainers. 

Currently, trainers in large part decide what drugs their horses receive. With an on-track pharmacy policy in place, if a trainer thinks his or her horse needs a certain medication, a veterinarian would be required to assess the horse, arrive at a diagnosis, and then request the medication from the pharmacy, where further vetting would occur. 

Rather than being utilized as medication technicians, as attending veterinarians currently are, they would again become doctors practicing veterinary medicine. Instead of being paid for drugs they administer, horse doctors would again be compensated for their medical evaluation of the patient.

The pharmacy is the only place medication could be stored or dispensed on the racetrack, other than with the emergency trauma and colic responders. Pharmaceutical manipulation to enhance performance would be eliminated. No drugs would be allowed to come into the track through any other venue. Every horse would be medicated via this process, with the exception of emergency treatments. 

This is the model in Hong Kong, where the breakdown rate is one of the lowest in the world. This policy effectively prevents doping while providing horses with the necessary therapeutic medications to train and race. Every treatment is transparent. The bettors, trainers, owners, and all others are made aware of every treatment for every horse. The result is racing with increased integrity, increased safety, increased public support and increased handle.

The effectiveness of an on-track pharmacy on a wide-scale basis depends on the construct that all racehorses are stabled at the track, at least for a period of time before they run. Horses that are stabled off the track would be able to avoid the pharmacy protocol, unless some sort of stabling island surrounding the track could be established.

In Hong Kong, horses are required to be stabled at the track to race. Modifications to manage American racing could include that the pharmacy protocol, while best serving horses on a continuous basis, would be enforced after horses are entered into a race. This would also allow a gradual implementation of the on-track pharmacy. Protocols to include ship-ins could include prerace testing for horses stabled off track, but as we have seen, testing as a reliable method to manage doping has vast limitations.

Horsemen and veterinarians will oppose this, of course, as it is inconvenient, restrictive, and allows total transparency. On-track pharmacies have the potential, nonetheless, to manage doping and restrict the pharmaceutical manipulation of performance.

It is pharmaceutical manipulation that has caused much of the trouble the industry is having. Injuries to horses and jockeys are often because of doping and other improper medication practices, which also devalue horses, shortening their careers.

The sport was designed to test the natural ability of the horse, and the trainer’s ability to bring it out. Doping and pharmaceutical manipulation have become an integral part of horse racing in America. The breakdown rate in America is many times higher than in Hong Kong, and the ease of pharmaceutical manipulation is a primary reason.

Development of an on-track pharmacy policy is in the best interest of the racehorses, the riders, the players and the owners. It is this system that has the greatest potential to restore integrity to horse racing in America.

Sid Gustafson, D.V.M., is a novelist and equine veterinarian specializing in thoroughbred sports medicine and equine behavior. He currently practices regulatory veterinary medicine, representing the safety and welfare of thoroughbred racehorses. 

Link to the New York Times article by Dr. Gustafson outlining a potential solution to better manage racehorse doping in America to improve the health and safety of racehorses and riders.

Dr Gustafson is an equine veterinarian, veterinary behaviorist, and novelist. Dr Gustafson provides equine behavior and welfare consultations to help recreate the needs and preferences of horses in training and competition.

May 25, 2012, 10:09 PM

Alkalinization, Lasix and Milkshaking: A Veterinarian’s View

By SID GUSTAFSON

The Kentucky Horse Racing Commission’s hearing on race-day medication last November revealed that Lasix alkalinizes horses, elevating their racing TCO2 values.

The more Lasix, and the closer it is administered to the race, the more intense the alkalinization effect of Lasix, according to the science presented at the K.H.R.C. race-day medication hearing. Lasix alkalinizes horses, creating a competitive metabolic advantage similar to milkshaking, rendering the drug Lasix a clear and present doping agent. Human athletic regulators have deemed Lasix a doping agent, and horseracing regulators will eventually have to come to that appropriate conclusion. Lasix has significant potential to alter and enhance racehorse performance.

As well, in my experience as both an attending veterinarian and a regulatory veterinarian, the attending veterinarians administering Lasix are often requested (as long as they are in the stall with the horse before the race to give the Lasix) to administer intravenous sodium bicarbonate, calcium and wide variety of other substances, including adjunct bleeder medications and undetectable performance-enhancers to stimulate or calm horses while sustaining added endurance. By pharmaceutically altering and manipulating a variety of physiological and neurological parameters for competitive advantage, medicating veterinarians influence the outcome of horse races and racehorse performance. In addition, these race-day medicators put horses at increased risk to break down. The statistics presented at the hearing clearly show horses medicated on race day break down more often than clean racing runners. The connection is indisputable.

There are a wide variety of pharmaceutical and nutritional manipulations veterinarians and trainers apply to gain competitive advantages, especially when veterinarians are allowed to medicate horses on race day, and the day before. Intubation (passing a tube up the nose and down the esophagus to administer a gallon or so of a sodium bicarbonate, crystalline sugar, and whatever else doesn’t test but may help move a horse up) is one method to milkshake a horse. Intravenous, intramuscular, sublingual, and oral administration of drugs are other racing-vet approaches to alkalinize racehorses to buffer the metabolic acidosis they experience as they enter the anaerobic acidotic state in the later stages of the horse race.

The historical method to curb veterinary doping has always been to bar veterinarians with needles from being around horses on raceday. When I started collecting racehorse urine in the ’60s, veterinarians were not allowed to be around horses with their needles and drugs on raceday in America. Initially, racing regulators barred trainers from possessing drugs and needles. Next thing they knew, veterinarians were slinking around from stall to stall before the races injecting horses as if they were sick. When I practiced on standardbreds in New York in the late ’70s and early ’80s, racing veterinarians were not allowed to be on the grounds hours before the races at Batavia Downs and Buffalo Raceway.

Horses are notoriously vulnerable to pharmaceutical manipulation, and these days with all the permissive medication policies, trainers and their veterinarians remain notoriously tempted to pursue every pharmaceutical ploy they can devise to move a horse up. Alkalinization comes in a variety of bottles and can be achieved by utilizing a variety of methods. It is the nature of many trainers to take whatever pharmaceutical measures they feel they can get away with to get their horse across the finish line first.

To allow racing veterinarians in a stall with a horse before a race is to permit doping, as it has turned out in America. I have witnessed veterinary doping first hand from California to New York. The solution to prevent doping and render an even field is to keep medicating veterinarians away from horses in the days before they race, as is the policy in Europe and Asia, where racing is approximately four times safer than in America. There, veterinarians can attend horses, but they are forbidden to medicate them, as is the appropriate ethical standard. Horses are never denied appropriate veterinary care, but when horses do require medication, they are declared unfit to race, as should be the policy in America.

Certain bodywork, massages, and physical therapies are appropriate as the race approaches, but doping is not. Drugs and medications are to treat ailing and lame horses, and ailing or lame horses are not permitted to race in ethical racing jurisdictions. Horses deemed to require medication are horses unfit to race by current international ethical standards. The universal standard through horse racing time has been to bar administration of any and all medications before a horse competes. Racehorses and riders are best served to run with no drugs in their systems. The clean racing standard is the standard that has effectively and appropriately protected the health and welfare of horses through time.

There are a variety of conditioning, husbandry and nutritional strategies that can be used that do not include or involve drugs and medications to prepare horses to withstand the rigors of a race. Tapering down the digestive tract, appropriate nutritional supplementation, appropriate exercise routines, appropriate hydration and metabolic preparations, and an endless variety of other holistic and physiologic preparatory approaches are more wholesome medication-free approaches for horse, rider and horseplayer.

It should be noted here, as well, that California allows trainers to take horses on and off Lasix without public knowledge. The attending veterinarians are allowed to use the steroidal estrogen hormone Premarin instead of Lasix. The California attending veterinarians are at liberty to switch out established race-day Lasix administration for race-day Premarin without the public disclosure of the change. All the while the horse is listed on the program as a Lasix horse race after race, despite differing medication regimens from race to race. This can result in significant variations in the type and dosage of administered medications from race to race, with associated alterations in performance. A horse listed as a Lasix horse may legally receive Premarin instead of Lasix. Next race the horse may receive Lasix, or Lasix plus Premarin, or only Premarin. The betting public is not made aware of these medication switches. Potential performance variations because of medication changes are hidden from the public by the C.H.R.B. Their regulatory veterinarians are forbidden to disclose the information to anyone but the testing laboratory, so the lab knows why certain Lasix horses do not have Lasix in their urine. The race-to-race medication choices are orchestrated and controlled by the racing veterinarians administering the race-day medications.

The Breeders’ Cup is in California this fall. Oversight by the Breeders’ Cup or reconsideration of the medication rules is in order there to protect the health and welfare of those champion runners and to assure medication consistency from race to race and horse to horse. The betting public deserves to be accurately informed about which horses are receiving what drugs, and for which race, and what changes to the medication routine occur from race to race.

The journey to establish clean horse racing continues. Soon, the horses shall prevail as horses have prevailed through time. Trainers will soon be required to utilize horsemanship rather than drugs to chalk up a win.

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Sid Gustafson, D.V.M., is a novelist and equine veterinarian specializing in thoroughbred sports medicine and equine behavior. He currently practices regulatory veterinary medicine, representing the safety and welfare of thoroughbred racehorses.

http://therail.blogs.nytimes.com/2012/05/25/alkalinization-lasix-and-milkshaking-a-veterinarians-view/

About Those Steroids and Big Brown

June 10, 2008, 8:02 am
About Those Steroids and Big Brown
By SID GUSTAFSON
Lack of steroids did not appear to be the reason Big Brown tanked the Belmont. I went over the reasons I thought were significant in my last article. Big Brown is a stallion. Horses are seasonal breeders. Anabolic steroids are naturally occurring. As days lengthen the endogenous anabolic steroids, those produced internally by intact male horses, are increasingly secreted into their bloodstream.
The days have lengthened considerably since April. Whatever Winstrol was excreted or metabolized by Big Brown before the Belmont Stakes had by and large been replaced by race time with his increased secretion of seasonal anabolic steroids. By this time of year most stallions have established higher levels of androgenic steroids in their bloodstreams by secreting their own endogenous hormones in response to the lengthening days.
Although steroids can improve performance in horses, steroid administration in itself does not assure enhanced performance. Generally speaking, horses are adequately big, strong, and fast enough. Steroid administration is not always a beneficial thing, especially over the long run. There are adverse reactions and side effects aplenty. When the dosage is excessive, or sometimes even with small dosages, difficult behavioral issues often arise. The biggest problem is that horses become hard to manage and handle. They act rank. With horses control is essential to safety and performance. It seemed Big Brown was plenty frisky as he broke out of the gate for the Belmont. Behaviorally and physically, there appeared to be little appearance of a lack of steroids in the big horse’s system.
Since steroids can indeed at times improve performance for some horses, they should be banned. There is little doubt that life will be healthier and safer for racehorses when steroid use is restricted. Artificially enhanced performance means that some medicated horses will exert themselves more than they might without steroids, putting added stress on their legs and muscles, leading to more injuries than would be the case without the added juice. Additionally, there are significant deleterious side effects due to the injudicious use of anabolic steroids: subsequent sterility, cancer, heart disease, unhandleabilty, psychological confusion, and other troubles.
Are there justified medical uses for anabolic steroids in racehorses? Yes, but justified medical use does not include enhancement of performance beyond what would normally be a horse’s inherent ability. What then are anabolic steroids used to appropriately treat? Anabolic steroids are given to help horses recover from certain medical conditions involving weight loss, reduced appetite, and loss of muscle mass. There are also valid medical uses for anabolic steroids to help horses recover more quickly and heal stronger after undergoing arduous surgical procedures, prolonged stress, and racing and training injuries. Anabolic (building up the protein) steroids induce metabolic protein retention, resulting in the incorporation of additional protein into the muscular and other structural tissues, bulking up the horses and athletes on the stuff.
Any other uses? Well, yes. Horses that are given significant amounts of catabolic steroids may need anabolic steroids to allay the protein loss the catabolic steroids induce. Catabolic steroids or cortisone (those steroids that break down protein and cause it to be excreted) are often administered to race horses to reduce joint, bone, tendon, ligament, and muscle inflammation, as well as to treat a plethora of other medical, immune, and metabolic conditions (pulmonary disease, hypoglycemia, tying-up, allergies, and many other medical issues).
Joints are injected with cortisone, and cortisone is also given systemically (intravenously, intramuscularly) to be absorbed into the bloodstream. Anabolic steroids compensate for the deleterious side effects of cortisone injections. If the use of catabolic steroids is limited, this will eliminate the medical indication to use anabolic steroids to compensate. If the industry is going to move forward in the best interests of race horses, they should significantly limit the use of cortisone as well. This will level out the drug-playing field, and bring our medical racehorse morals up to the standard of the rest of the civilized world.
Are there other examples of where one drug needs another follow-up drug to compensate for the side effects of the original drug? Yes. Phenylbutazone (bute), in addition to its vaunted non-steroidal, anti-inflammatory effect, thins the blood, increases the clotting time, and can increase the potential for bleeding into the lungs during racing (exercise-induced pulmonary hemorrhage, EIPH). If we ban the bute, the horses hopefully won’t bleed as much, and we can then reduce the need for Lasix.
Without bute and other NSAIDs in the horse’s system, the racehorse will be less likely to bleed. Both anabolic and catabolic steroids cause fluid retention, which also increases the possibilities to bleed with the increased blood volume. Lasix, a diuretic and lung-blood-pressure reducer, is used to eliminate this excess fluid.
The horse racing industry could begin to restrict the original allowed drugs bute and cortisone, thus reducing the need for Lasix, anabolic steroids, antibiotics (steroids impair immunity) and other drugs which tend to be needed to mitigate the side effects of the original drugs.
The preference of many is that race horses should run clean. Drug-free racing is safer. It favors sound horses. Fewer drugs, then, allow horses to race sounder and longer, and drug-free racing might protect the horseplayers a bit. If horses are treated with the drugs veterinarians determine they need to be treated with, then the patients should not be allowed to race until the resultant therapeutic drug levels have subsided to insignificant levels.
Will this no-drug policy then push trainers to use drugs that cannot be detected? Yes again, but then attempts to gain advantage with drugs have always been problematic in horseracing. Legalizing the use of bute and Lasix drugs did not curtail this activity, it simply enhanced it. Allowable drugs “clouded” the tests, hiding other drugs. Lasix diluted illicit drugs in the urine, making them harder to detect.
The 35-year-old raceday-drug horseracing experiment has failed, or is failing. Too many fractures. Too many wrecks. Too many injured jocks. Too many down, dead horses. It is time to start running American racehorses clean like horsemen do in the rest of the world. The cleaner, the better. Racing jurisdictions gave veterinarians and trainers the go-ahead to use drugs liberally in the 70s. And, as is apt to happen with drugs, some individuals abused the dosages and administration of those drugs. They topped allowable drugs off with more drugs, and in doing so did their horses and patients and the thoroughbred industry a significant disfavor.
The ethical rule of equine veterinary medicine is this: First, do no harm. When drugs are implicated with harm, then it is time to re-evaluate their use. The argument that legal drugs somehow help horse racing is getting weaker and weaker. Legal drugs engender the use of more drugs. Some drugs may have their place in racing horses, but we need more evidence to overcome the contradictory evidence that drug use is diminishing the public’s confidence in horseracing.
We’ll never forget those images of Eight Belles trying to rise on two broken legs. None of those who witnessed that misfortune will, not even Big Brown. But that image will fade and be less-likely to be repeated if we all get together to make racing a more reasonable sport for the horses’ sake, for everyone’s sake. It is a good feeling to win a horse race with a thoroughbred, but the ultimate good feeling in horseracing comes when a horse runs clean, wins, and returns to the barn fit and sound. Let’s get that feeling going, now.
Sid Gustafson is a novelist, social commentator, and former thoroughbred attending and examining veterinarian licensed in New York, Washington, and Montana, where he has had significant experience in the regulation of racehorses, especially as it pertains to soundness and breakdowns.

Belmont Stakes, 2008

June 8, 2008, 5:10 pm
Horse Racing Prevails
By SID GUSTAFSON
Big Brown burst from the gate fresh and fast. He immediately veered out, causing some concern that he was getting off the left front hoof (or was he just shying a bit from the starter in light of his freshness?). Despite his best efforts, Kent couldn’t contain his horse’s energy and settle him in. Checking can take the timing, balance, and rhythm out of a horse, disordering their physiology, expending their energy.
The heat, Brown’s rankness, the rough-going in tight company early, the necessity of having to rein heavily, the lost conditioning due to the quarter crack, the quarter crack itself, three races in five weeks, one mile and a half in the heat; all adequate reasons for the altered performance from the veterinary view. No surprises in the realm of equine medicine, at least.
The day was very hot; Brown was washing and foaming between the thighs. All the trouble the horse had to contend with early in the race expended needed energy not later available at the top of the homestretch. Down the backstretch Brown’s head was bobbing significantly more than the other racing horses, suggesting the onset of exhaustion.
Medically, the media and veterinary consensus thus far is that Big Brown is fine. Kent Desormeaux’s decision to pull the horse was commendable in light of the knowledge that a medical problem existed in his foot. No one wanted to risk the horse injury, especially his rider. The pressure was on to bring the horse home sound, and Kent did that. Big Brown expressed his displeasure at being held back, fighting with Kent, unfamiliar with having a herd of horses leave ahead of him, wanting to go on as Kent was bringing him to a stop in front of the grandstand. It appears our fallen hero was more likely exhausted than injured, for which we are all grateful.
Big Brown had a bad day, but things have could have turned out worse, as we all know. Horses humble men on a regular basis. Here is to the smooth and steady Da’ Tara, the sweet-riding Alan Garcia, and a superb conditioning job by Nick Zito.
The beauty of horse racing is overcoming great odds to win, rising out of the dust to prevail in the big race. The Da’ Tara team did just that, especially impressive in Saturday’s hot weather.
Sid Gustafson is a novelist, social commentator, and former thoroughbred attending and examining veterinarian licensed in New York, Washington, and Montana, where he has had significant experience in the regulation of racehorses, especially as it pertains to soundness and breakdowns.