April 29, 2012, 9:58 AM

New Model Needed for Race-Day Treatments

By SID GUSTAFSON

The white horse emerged late last year representing promise to restore a limping game; a new age of clean racing, race-day-medication-free racing; but the white horse hung coming down the lane. Too much Lasix, it seems; resulting in an inability to hold sway.

American trainers and their attending veterinarians remain unwilling to sacrifice their race-day needles just yet. They are reluctant to give up medicating racehorses before the runners head over to the paddock. Rather than educating trainers how to appropriately care for racehorse lungs and limbs as attending veterinarians should, the race-day vets continue to inject drugs, and more drugs. The more drugs attending veterinarians administer, the more they are paid. The only fees attending veterinarians generate are fees for administering medication. Attending veterinarians are paid in direct proportion to the drugs they administer.

One can easily see how that may sway their opinion regarding drugs, and their decisions to administer drugs to racehorses. There are no veterinary fees for consults or advice on the backside. Herein lies a significant part of the medication problem. Attending veterinarians have failed to learn how to charge for medical consults. To give the advice to let a horse run clean is to not be paid for anything, although it is often the best advice a veterinarian could give to a trainer regarding a champion runner. To be able to deliver sound horsemanship advice and be eligible to be willingly paid for his knowledge and professional acumen, an attending vet needs to appreciate the true nature of horses and learn how to manage bleeding and unsoundness in more appropriate, less pharmaceutical, fashions. When attending veterinarians come to understand as much about equine behavior and welfare as they know about manipulating horses with drugs, life will begin to improve for horses.

It is simply not good form to go after horses with needles and drugs before they race. It is not fair. It is not right. It is not medically or morally appropriate. It has been demonstrated to be a practice that is harmful to horses, a practice that when allowed is applied to virtually all horses rather than horses in need, regardless of their limb and lung health. To medicate nearly every horse who races in America with bute and Lasix is not the practice of veterinary medicine, but rather some sort of medication sham. Veterinarians should know better. As has long been suspected in ethical racing jurisdictions around the world, medicating racehorses on race day has proved to be an inappropriate and unethical practice, not to be allowed, much less tolerated. The regulators of racing in the 1960s had it right. No drugs allowed, no doping whatsoever permitted, regardless of the dope or the doper. The results of race-day medication will always be the same: rogue winners, rogue losers, more medical issues incited than resolved, more deterioration of the horses and the sport, shorter careers, more fragility, and more breakdowns. More public concern and scrutiny.

It has long been public knowledge that horse racing requires strident antidoping regulations and enforcement. It is becoming increasingly evident that the attending veterinarians are the people who require intense monitoring. Once entrusted with the health and welfare of racehorses afforded by their professional standing and education, they can no longer be counted upon to practice right by the horse. Racehorses and drugs have had a long, albeit dangerous, marriage, and the attending veterinarians have been the ministers of the nefarious relationship.

To relentlessly medicate racehorses, rather than to nurture and care for them properly in accord with their long-evolved nature, has resulted in tragedy reaching to the very top of the American horseracing game. The more medication horses are given, the less carefully their natural needs and tendencies are tended to, and the more fragile they become.

Rather than drugs, appropriate care and horsemanship are the keys to appropriately manage bleeding and unsoundness in horses. Racing was originally designed to be drug free, and that clean-running notion of ethical regulation holds to this day. It is generally accepted by most welfare-progressive societies around the world that trainers and their attending veterinarians cannot be relied upon to represent the health and welfare of their horses when money and fame are to be gained by pharmaceutical manipulation of their charges. Permissible race-day drug injections have deteriorated the game considerably.

All of this year’s Derby runners are scheduled to race on Lasix, and most all of them will also get injected with the adjunct bleeder medication which the Kentucky Horse Racing Commission allows to be injected into horses before the race, the drug known as Kentucky Red, or carbazochrome. Good stuff, that Kentucky Red. If one drug is good, two must be better, or so goes the veterinary reasoning and fee structure of attending veterinarians.

In addition to pushing drugs into the Derby runners’ veins shortly before they race, the veterinarians will also be very busy injecting the horses the day before they race. Never enough vetting has become the backside mantra. In addition to the race-day cocktail the Derby runners and all the other runners on the card will be receiving before they run, most of the runners will be medicated with phenylbutazone 24 hours before the Derby, along with various other additionally permitted nonsteroidal, anti-inflammatory drugs, as well as a surfeit of other permissible medications. Most Derby horses will have a cornucopia of drugs circulating through their systems by the time they reach the starting gate, enough drugs to float a battleship, as the saying goes, drugs that allow trainers to exceed the adaptability of their racehorses.

The reality, now demonstrated worldwide, is that horses and their riders are best served to race clean. The fewer drugs the better as far as the horses’ health and welfare are concerned. The public prefers an even field, and a fair horse race. Clean racing evens the field and protects horses, riders, and horseplayers. Clean racing selects for the best horse; the most durable, soundest, best developed, best bred, and fastest horse. Clean racing allows horses to persevere and prevail over a long career of running. Clean racing allows the best horses to prevail time and again, to win the Triple Crown.

Across the oceans, clean runners are currently competing more safely than the drug-addled American horses. Foreign runners break down less, and bleed little, if any, more than the heavily medicated American horses. Everywhere but in America, bleeding and soundness are managed with horsemanship and appropriate husbandry as bleeding and unsoundness should be managed. The correlation between race-day drug use and breakdowns has become painfully evident. The more drugs a jurisdiction permits to be administered to horses, the more breakdowns the horses racing in the jurisdiction experience. The time to ban race-day drugs is now. Horses cannot speak, file lawsuits, or tweet, therefore much of the medication abuse of racehorses in veterinary hands goes unnoticed as unreported, excepting, of course those abuses so prevalent and overwhelming that they require reporting by those news outlets genuinely concerned about the health and welfare of racehorses.

Next time, I’ll deliver another rousing sermon from my rabbit hole in the infield: how to race and win without Lasix, and to race and win again, and then win one more time. It is no coincidence that there has not been a Triple Crown winner since Lasix started sapping the vigor and durability out of champion runners in America. The times they are a changin’ for the better for horses, thanks to those who have the creative cause to step forth and take a stand for the health and welfare of Equus caballus.

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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.

Racehorse Advocacy, The End of Raceday Medications

Racehorse Advocacy

The End of Raceday Medications 

Sid Gustafson DVM

Equine veterinary behaviorist representing the health and welfare of horses

Thanks to a wide and diverse variety of racehorse advocacy efforts, a review of racehorse raceday medication practices by a variety of racing jurisdictions and organizations is making advancements to support the drug-free welfare and humane care of racehorses. Raceday medications are in the process of being rescinded, as are the indiscriminate and abusive use of drugs in racehorses in general. It has become clear to many that current racehorse medication practices in the United States and Canada exceed the adaptability of the racehorse, resulting in unnecessary breakdowns and injuries and death to both horses and jockeys. Rather than drugs, it is the humane care of racehorses that supports soundness of wind and limb.

A variety of groups have responded to the call by the HSVMA and HSUS to better care for racehorses. The Kentucky Horse Racing Commission invited the HSUS to testify at its raceday medication hearing, and I provided a version of the racehorse advocacy that follows. The Interstate Horse Racing Improvement Act is making its way through the United States Congress, and is supported by several congressional representatives. Make sure your representative supports this important Act. Governor Cuomo has called for an investigation of the New York Racing Association breakdowns. The New York Times is running a series of articles exposing the medication charade that has endangered horses and riders for decades in America. The Breeder’s Cup committee has banned raceday Lasix for two-year-olds racing in this year’s Breeder’ Cup.

Drug-free racing will improve stabling, conditioning, and husbandry practices for racehorses. Medication has long been a crutch that facilitates the improper care of stabled horses. Rather than alleviate medical conditions, recent data clearly demonstrates that racing medications allow people to exceed racehorse adaptability.  Drug use perpetuates fragility in racehorses.[1] Fragility is dangerous for both horses and riders. To appreciate the principles of equine behavior is to understand what is required to maintain pulmonary health in horses confined to stalls being conditioned to race, and it is not drugs. The solution to managing Exercise-Induced-Pulmonary-Hemorrhage and preventing breakdowns is appropriate breeding, development, horsemanship, training, and husbandry rather than drugs. The care that establishes and enhances pulmonary health and endurance in horses is the same care that enriches stabled horses’ lives. It is the same care that keeps racehorses’ musculoskeletal systems sound. It is humane care that keeps horses on their feet during races.

Horses with healthy lungs and sound limbs are content and fulfilled horses whose lives their caretakers adequately and extensively enrich. Lung health is supported by limb health. Appropriate husbandry and training maintains and establishes soundness of both wind and limb. Breathing and running are biologically intertwined on the track, a breath per stride. To stride correctly is to breathe correctly. To breathe correctly is to breathe soundly, and race sound. Limb soundness and pulmonary soundness are physiologically entwined.

Horses who are bred, socialized, and developed properly from birth, and who train while living enriched stable lives are seldom likely to experience performance-impairing EIPH while racing. They are more apt to stay sound of limb. Humane care of the horse prevents bleeding, my friends. Humane care of the horse prevents breakdowns. Pulmonary health is reflective of appropriate husbandry, breeding, training, nutrition, and the abundant provisions of forage, friends, and perhaps most importantly, locomotion. Bleeding in a race is reflective of inadequate care and preparation, of miscalculations and untoward medication practices. Drugs and raceday medications perpetuate substandard horsemanship, artificially suppressing the untoward result (bleeding and breakdowns) of inadequate preparation of the thoroughbred. Drugs are no longer the solution. Humane care of the horse based on evolved behavioral needs is the solution to safe horseracing.

The solution to manage bleeding and prevent breakdowns in racehorses is to breed, develop, teach, train, and care for horses in a horse-sensitive fashion. Horses evolved as social grazers of the plains, group survivalists moving and grazing together much of the time. Horses require near-constant forage, friends, and locomotion to maintain health of wind and limb, even if they are stabled. Racehorses are no exception. The last place a horse evolved to live is in a stall, alone, with a limited view and uncirculated air. Training and husbandry need to be a good deal for horses in order for horses to maintain healthy partnerships with people. Pulmonary health is reflective of overall health and soundness in horses. Pulmonary health is reflective of limb soundness.

In order to maintain pulmonary health, natural conditions need to be re-created in the stable. The solution to managing racehorse health is proper horsemanship and husbandry, which is sadly lacking at today’s racetracks. Horses prefer to graze together and move nearly constantly in natural settings, and to race without drugs, natural has to be re-created in the stable. The equine requirement for near-constant grazing and moving is essential for joint and bone health, hoof health, metabolic health, and pulmonary health. In order for lungs to stay healthy, horses need more movement than they are currently provided. Abundant on track and off-track locomotion is necessary to condition a horse’s lungs. Lungs deteriorate when movement is restricted by excessive confinement in a stall. Horses breath all day long, and trainers need to appreciate abundant movement is required through much of the day to maintain pulmonary strength and health.

To enhance pulmonary health is to enhance the horse’s entire life and outlook. Not only do properly stabled and trained horses’ lungs hold bleeding in abeyance, they hold sway and win. Pulmonary health and bleeding prevention are dependent on smooth running and biomechanically sound locomotion.

Horses evolved in the open spaces of the northern hemisphere and require the cleanest, purest air to thrive and develop healthy lungs and hearts. Stable air needs to be constantly refreshed to maintain pulmonary health. Ventilation is essential, and enclosed structures are often inadequate in providing healthy air horse require. Appropriate barn design and stabling practices maintain pulmonary health. Bedding is critical. Clean straw provides stall movement by simulating grazing. Horses stalled on straw are noted to move about with their heads down nibbling and exploring for hours, recreating nature to some degree, keeping their lungs healthy with movement, their respiratory tracts drained by all the head-down nibbling and grazing. This is not enough. For healthy lungs, horses need to get out of their stalls for hours each afternoon. Horses need near-constant movement to maintain optimum lung health. Long-standing horses’ lungs deteriorate quickly. Not only does near-constant movement maintain and enhance pulmonary health, abundant locomotion maintains metabolic health, joint and bone health, hoof health, and digestive health. To enhance support, and maintain lung and limb health without drugs is to enhance the overall health and soundness of the horse.

Sid Gustafson DVM

http://therail.blogs.nytimes.com/2011/10/28/goodbye-lasix-and-good-riddance/

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[1] http://www.nytimes.com/2012/03/25/us/death-and-disarray-at-americas-racetracks.html?pagewanted=all

Dr Gustafson is an equine veterinarian, veterinary behaviorist, and novelist. Applied veterinary behavior enhances optimum health, performance, soundness, contentment, and longevity in animal athletes. Natural approaches to development, training, nutrition, and conditioning sustain equine health and enhance performance. Behavioral and nutritional enrichment strategies enhance the lives of stabled horses. 

Drugs and Horseracing

June 4, 2008, 3:42 pm
Drugs and Racehorses
By SID GUSTAFSON
Phenylbutazone seemed a miracle drug when the stuff began entering the bloodstreams of racehorses in the 1960s. I was collecting the post-race urine that concentrated the metabolites of that drug during the ’60s, and as a teenager I became acutely aware of drugs and racehorses.
What a soothing anti-inflammatory effect bute brought to racehorses in those simpler days when its use first became widespread. The alleviation of certain lamenesses was dramatic. “Really sweet stuff,” I remember Wright Haggerty’s Kentucky groom telling me on the Shelby, Montana, backside in 1965 as he pestelled up tiny white 100-milligram dog pills he had received from my father, the attending and regulatory veterinarian (thus my job as urine catcher). The original medical plan, being that most racing jurisdictions back then prohibited the use of any and all drugs, was to use bute for training. The groom mixed the white powder into a mash, and fed his eager and waiting racehorse, who trained like Seabiscuit the next morning.
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 Belmont and Aqueduct often exceed the monthly training fee. Ask any owner.
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 it can be used beautifully. The most commonly injected joint is the fetlock, which is also the most commonly fractured joint. The reality is that most of fractured joints were cortisoned joints, although this information is inaccessible because of medical confidentiality. Bute is less intense, less potent, and a more conservative, safer remedy. 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.
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.
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 the next spring a 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.
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.
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 has to be reduced. Bute wasn’t enough. No drug is. Legal bute engendered a drug culture. 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 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.
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.