Competition Horse Medication Ethics

COMPETITION HORSE MEDICATION ETHICS

Gustafson S, DVM

Appreciation of the evolved nature and behavior of horses provides the foundation for the ethical veterinary care of equine athletes. The establishment of a veterinary patient client relationship (VCPR) is instrumental in providing ethical care for the competition horse. Ethical veterinary practice supports the horse’s long-term health and welfare interests while avoiding pharmaceutical intervention in the days and weeks before competition.

Horses evolved as social grazers of the plains, moving and grazing in a mutually connected and constantly communicative fashion on a near-constant basis. Contemproary equine health and prosperity remains dependent on providing an acceptable degree of this near-constant movement, foraging, and socialization. When horses are confined to fulfill convenience and performance interests, the horse’s natural preferences need be re-created to a suitable degree to avoid exceeding the adaptability of the horse. As the adaptability of the horse is exceeded, welfare is dimished and the need for medical intervention to remedy behavioral, health, and soundness deficiencies is intensified. Contemporary practices regularly exceed the competition horse’s adaptability, resulting in the need for extensive veterinary intervention to sustain health and remedy training and competition injuries.[1]

The more medical care and pharmaceutical intervention required to sustain any population of animals the lower the population’s welfare.[2] Ethical veterinary care supports the horse’s best welfare interests, as well as the safety of the horse’s riders and drivers. Medical intervention of the equine athlete should be avoided in the weeks, days, and hours before competition, as pre-competition medication is associated with increased catastrophic injury vulnerability as a result of the diminished welfare it perpetuates.[3] To properly support the health and welfare of equine athletes, the practitioner must be familiar with their patients both inherently and individually. Socialization, constant foraging, and abundant daily locomotion are the long-evolved requirements to promote and sustain optimal soundness, behavioural health, performance, and healing in competition horses. 

Healthy horses function and perform more consistently and predicatbly in an unmedicated state. Contemporary pre-competition medication practices remove the horse’s ability to protect their health and sustain soundness by masking pain and suppressing symptomology. Horses who require medication to alleviate medical conditions in order to compete are rendered vulnerable to injury and physical and behavioural dysfunction imperiling the safety of both horse and horseperson. Horses requiring medication to compete are not fit to compete safely. Horses and horsefolk are best served to compete free of short-term pre-competition pharmaceutical influence. Infirmities require appropriate medical care and rehabilition before competition is considered and resumed, rather than pre-competition medication to allay active medical problems. The equine practitioner should focus on post-performance evaluations and necessary therapies to sustain horse health on a enduring basis. An emphasis on fulfilling the medical, physical, and behavioural needs of the horse to prepare for the future competitions is the essence of ethical veterinary care of the competition horse. Pre-competition medication practices that replace or supplant appropriate health care are not in accord AVMA Principles of Veterinary Ethics.[4]

For human entertainment, convenience, and revenue, horses are bred, isolated, stabled, conditioned and medicated to perform competitively. Comtemporary pre-competition medication practices are often at the expense of the horse’s health, safety, and welfare. Many current medication practices violate the AVMA Principles of Veterinary Ethics, specifically the clause that states a veterinarian shall provide veterinary medical care under the terms of a veterinarian-client-patient relationship (VCPR).

The AVMA Principles of Veterinary Ethics state that it is unethical for veterinarians to medicate horses without a VCPR. Pre-competition pharmaceutical interventions to remedy insufficient attention and preparation for the horse’s long-evolved health requirements are seldom in the best interest of the horse. The medical and pharmaceutical practices which support equine competitive pursuits should be designed to enhance the health and soundness of the horse on a long term basis and should not be intended to enhance performance or permit training on infirm legs. 

Pre-competition pharmaceutical intervention has been demonstrated to have an overall negative affect on the health and welfare of competitive horse populations. Where horses are allowed to be permissevely medicated with and without a VCPR, injuries and catastrophic injuries are more prevalent, as are jockey injuries. Horses are best served to be properly prepared to compete in a natural non-medicated state. Pharmaceutical intervention of the equine athlete should be avoided during training and in the weeks before competition, as pharmaceutical intervention impairs the innate pain barrier while increasing musculoskeletal fragility. Intense and widespread pre-competition medication practices correlate with catstrophic injury vulnerability and diminished welfare.[5]

Equine athletic pursuits have historicaly been designed to measure the natural abililty of horses and the trainer’s ability to bring out the horses’ natural ability. Performance enhancing drugs devalue and debase competetive achievements. Equine competition was designed to measure the natural abilities of horses, with trainers and riders honing those natural abilitities. Hoseracing was never intended to measure medicated ability, thus maintaining genetic integrity of the breed.[6] Pharmaceutical scrims can impair horses for generations. To suppress a condition that is induced by low welfare is unacceptable. It is imperative in animal sensitive societies that the welfare and veterinary care of the horse take precedence over economic human interests. Horses are born to socialize, communicate, locomote, move about, graze and masticate on a near-constant basis. For behavioral and physical integrity, these preferences need to be re-created to an acceptable degree in the competition stable. The ethical practice of veterinary medicine includes providing clients with the guidance to provide appropriate husbandry, nutrition, conditioning, medical management, and behavioural fulfillment of their equine athletes. Medicating and suppressing injuries with the intent to continue training to later prevail in racing constitutes the unethical and illegal practice of veterinary medicine. Furosemide is a performance enhancing drug, masking agent, and metabolic alkalinizer, and as such is forbidden in racing jurisdictions worldwide, where racing is consequently safer for horses and jockeys.

Equine welfare is best supported when horses are properly prepared, physically and mentally sound, and fit to perform in an unmedicated state. Physically or behaviourally impaired horses who require medication to compete should not compete until they are able to compete without pre-competition pharmaceutical intervention. All sensation, behaviour, and proprioception should remain physiologically normal. Sensation and cognitive awareness should not be suppressed with pre-competiton medication. This inludes the use of sedatives, stimulants, and pain relievers of all sorts. Treatments should not interefere with functional physiology.

Sound horses properly prepared for competition have little need for pre-competition medication. Unsound or behaviorally dysfunctional horses should be medically and behaviorally rehabilitated in a fashion that restores soundness before training and competition are resumed. Medication is for infirm horses, and infirm horses should not compete. Horses who require medication to compete become increasingly unfit to compete safely. Rather than therapeutic intent, many pre-competition medication practices have become performance enhancing at the expense health and welfare of horse and rider. 

It has been demonstrated through time that horses and their riders are best served to compete medication free. As a result, anti-doping laws have been established by all agencies that regualte equine competition. Veterinarians are required by both ethics and law to follow these regulations. Horseracing statisitcs support that the less medication horses receive the more favorably and safely horses compete.[7]

The safety of the competition horse is dependent on unimpaired neurological functioning. Unimpaired sensation and cognitive ability are necessary for a horse to compete safely and fairly. Any medications or procedures which negate or diminish sensation and awareness in the horse impair the ability of the horse to compete safely.[8]

The safety, longevity, and durability of the equine patient should considered before short term pre-competition medical solutions are implemented. Familiarity of the patient includes familiarity with stabling, genetics, behavior, and husbandry of the patient. Many if not most medical conditions are a result of human mismanagement of equine stabling and conditioning. When the adaptability is exceeded, horses become unsound. Assessment of stabling conditions and athletic preparation practices are essential components of ethical equine care. Healing must be allowed to progress before competition and training are resumed. Client education is essential to create a husbandry situation conducive to equine healing. Restoration strategies that recreate the horse's social grazing and locomotion preferences facilitate and potentiate horse healing. Appropriate healing of many equine maladies is encouraged when the veterinarian provides appropriate medical care and carefully facilitates a scenario to provide the horse with appropriate physical rehabilitation and behavioural fulfillment. 

Despite domestication and selective breeding for docility and captivity, horse health remains dependent on locomotion. Locomotion is inherent to digestion, to respiration, to metabolism, to hoof health and function, to joint health, to bone health and durability, to resistance to limb failure, and to behavioral fulfillment. An interdependence exists between horse health and locomotion. Horses evolved to be near-constant walkers and grazers, depending on perpetual motion to sustain health of all systems. Horses did not evolve to be confined in stalls and stables, but to move on a continuous basis. Pulmonary health is dependent on abundant daily locomotion. Deprivation of adequate locomotion results pulmonary deterioration, resulting in an abnormal incidence of EIPH. By suppressing EIPH, Lasix perpetuates the substandard American training horsemanship that causes EIPH. 

When horses are deprived of adequate and abundant locomotion, they develop strategies and unwelcome behaviors to keep themselves and their jaws in motion, as is their essential nature. Horses deprived of friends, forage, and locomotion are at risk to develop stereotypies to provide themselves with the movement they need to survive. The more stereotypies present in a population of equine athletes, the lower their welfare.

No longer is intense medical intervention prior to competetion a viable, ethical, or legal approach. It has been demonstrated that the more intensely horses are medicated to compete, the lower their welfare. The more medications required to sustain any population of animals, the further the deviation from their physical and behavioural needs. Rather than pre-race treatments, the ethical approach includes  performance of exensive post-competition examinations to address any weaknesses or unsoundness as a result of the performance. 

Alternatives to precompetition medication with non steroidal anti-inflammatory medication and steroids include fulfillment of the horse’s long-evolved nature. Musculoskeletal soundness is attained by proper breeding, development, husbandry, and conditioning practices. Management of exercise induced pulmonary hemorrhage is achieved by specific lifetime daily development of the horse’s pulmonary and cardiac function. As well, unwelcome and unsafe competition behaviors are best managed by fulfillment of the horse’s inherent behavioral needs, which include abundant daily socialization, locomotion, and grazing.[9]

Recommended reading

Chyoke A, Olsen S & Grant S 2006 Horses and Humans, The Evolution of Human-Equine Relationships,  BAR International Series 1560, Archeopress, England, ISBN 1 84171 990 0

Magner D 2004 Magner’s Classic Encyclopedia of the Horse Edison, New Jersey: Castle Books

McGreevy P 2004 Equine Behavior: A Guide for Veterinarians and Equine Scientists Philadelphia: Elsevier Limited. ISBN 0 7020 2634 4

Waran N, McGreevy P & Casey RA 2002 Training Methods and Horse Welfare in Waran N, ed The Welfare of Horses, Dordrecht, The Netherlands: Kluwer Academic Publishers, p151-180

Paul McGreevy BVSc, PhD, MRCVS. Equine Behavior, 2004, A Guide for Veterinarians and Equine Scientists. Second Edition, Elsevier; 2012, Chapter 13 Equitation Science

Budiansky, S. (1997). The nature of horses: Exploring equine evolution, intelligence, and behavior. New York: The Free Press.

Hausberger M, Roche H, Henry S, and Visser E.K. “A review of the human-horse relationship” Appl Anim Behav Sci 109, 1-24. 2008

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[1] Zambruno, Teresita (2017) Epidemiological investigations of equine welfare at OSAF jurisdiction racecourses. Thesis

[2] Appleby M, Mench J, Olsson I, Hughes B (2011). Animal Welfare. CABI, Second edition; 2011.  

Fraser D (2008). Understanding Animal Welfare: The Science in its Cultural Context. Wiley-Blackwell; 2008.

[3] Slifer, Paige BMS 599 Dr. Alan Robertson 2017 A Review of Therapeutic Drugs Used for Doping of Race Horses: NSAIDs, Acepromazine, and Furosemide. Thesis

[4] The AVMA Principles of Veterinary Ethics, https://www.avma.org/About/Governance/Documents/2014S_Resolution8_Attch1.pdf

[5] Kentucky Horseracing Commission Raceday Medication Transcript, NOVEMBER 14, 2011 

 http://www.khrc.ky.gov/Documents/RaceDayMedicationTranscript.pdf

[6] Magner D 2004 Magner’s Classic Encyclopedia of the Horse Edison, New Jersey: Castle Books

[7] Kentucky Horseracing Commission Raceday Medication Transcript, NOVEMBER 14, 2011 

 http://www.khrc.ky.gov/Documents/RaceDayMedicationTranscript.pdf

[8] Furr M, Reed S editors (2007). Equine Neurology; Wiley-Blackwell

[9] Waran N, McGreevy P & Casey RA 2002 Training Methods and Horse Welfare in Waran N, ed The Welfare of Horses, Dordrecht, The Netherlands: Kluwer Academic Publishers, p151-180

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.

Conditioning and Winning, Lasix-free

Competition Horse Medication Ethics

Horses evolved as social grazers of the plains, group survivalists moving and grazing together most all of the time. During their 60-million-year evolution, horses came to require near-constant forage, friends and locomotion to maintain health and vigor of wind and limb.

http://therail.blogs.nytimes.com/2012/05/11/conditioning-and-winning-lasix-free/

Despite domestication and selective breeding, today’s racehorses are no exception. Although horses are extremely adaptable, the last place a horse evolved to live is in a stall, alone, with limited space to move and forage about with others. The solution to manage bleeding in racehorses is to breed, develop, teach, train and care for horses in a horse-sensitive fashion that provides abundant lifetime locomotion and socialization. Pulmonary health is reflective of overall health and soundness in horses.

In order to maintain pulmonary health, natural conditions need to be re-created in the stable. Horses prefer to graze together and move nearly constantly. Constant foraging, grazing, socializing and moving are essential for joint and bone health, hoof health, metabolic health and pulmonary health, and, of course, mental health. In order for lungs to stay healthy, horses need movement, more movement than American trainers currently provide the population of stabled. Horses communicate with movement and sustain physiologic and metabolic health via near-constant locomotion. Movement is what is most often missing in a racehorse’s stabled life.

Walking throughout the day enhances and maintains lung health. Stabled horses need hours of walking each day, more walking than most are currently afforded. Veterinarians who manage racehorse health need to ensure that their patients are provided with adequate daily locomotion. The movement of training and track conditioning are not adequate to condition healthy lungs throughout the rest of the day, as lung health requires 24/7 movement. For a horse, moving is breathing. Abundant on-track and off-track locomotion is necessary to condition a horse’s lungs and to provide the necessary resilience to withstand the rigors of racing.

Lungs deteriorate when movement is restricted. Horses breath all day long, and near-constant movement is required much of the day to assist their breathing to maintain pulmonary flexibility and vigor. Plentiful walking enhances breathing and lung health. Swimming and doing lunges are also appropriate lung-conditioning activities. Grazing while casually walking clears the airways. Hand grazing may be the best lung-healthy activity of all. Racetracks need to provide abundant hand-grazing opportunities for all of the stabled horses, and the green grass needs to be appropriate grazing grass. Kentucky limestone grass is always best, it seems.

Training over hills and dales, as well as walking up and down inclines helps develop and sustain pulmonary vigor. When horses are locked in a stall a large percentage of the time, their lungs deteriorate. Stabling that does not afford abundant movement and head-down grazing and foraging impairs lung health, making horses vulnerable to bleed when exerted in a race. The cause of exercise-induced pulmonary hemorrhage is insensitive and deficient stabling and husbandry practices and includes diagnostic failures to detect bleeding during training.

The care that establishes and enhances pulmonary health and endurance in horses is the same care that enriches stabled horses’ lives. Pulmonary care is providing the same near-constant movement that keeps racehorses’ musculoskeletal systems sound. It is the care that keeps horses on their feet during races. Horses must remain sound of limb to ensure lung soundness, and they must remain sound of lung to achieve and maintain limb soundness. Afternoon and evening hand walking and hand grazing are essential to develop and sustain lungs and limbs fit to race.

Horses with healthy lungs are content and fulfilled horses whose lives their caretakers adequately, if not extensively, enrich. Lung health is supported by limb health. 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.

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 E.I.P.H. while racing. They are more apt to stay sound. Humane care of the horse prevents bleeding. 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. Lasix perpetuates substandard horsemanship, artificially suppressing the untoward result (bleeding) of inadequate preparation of the thoroughbred.

Genetics play a role in pulmonary health and physical durability. Lasix perpetuates genetic weakness by allowing ailing horses to prevail and sow their seeds of pharmaceutical dependence. Running sore causes lungs to bleed. Lasix manages a wide variety of unsoundness, as do the cortisones and NSAIDs (bute and similar drugs). These anti-inflammatory drugs aggravate coagulation processes. Rather than drugs, pulmonary health is dependent on appropriate breeding and proper development for the vigor, durability and endurance thoroughbred racing demands. Drugs are not the solution. Competent horsemanship is the solution. Genetic dosage, behavioral and physical development, socialization, training, and locomotion husbandry are the keys to racehorse soundness, lung health, stamina, and durability. The causes of E.I.P.H. are no mystery to seasoned race folk. Horses prone to bleed are those horses that are mistakenly bred, inadequately developed and inappropriately stabled and trained.

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 inappropriate. Barn design needs to provide both clean air and abundant locomotion. Bedding is critical. Clean straw provides the most 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. Horses need near-constant head-down 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 lung health is to enhance the overall health and soundness of the racehorse. Racing appears much safer in Lasix-free jurisdictions, where the drug crutch is not allowed, because the drug crutch allows horses to be cared for in a substandard fashion. (A link to the transcript from the Kentucky Raceday Medication Committee hearing is here.) Drugs are not allowed to replace appropriate care and training in Asia and Europe, and raceday drugs should be barred in America as they are in the rest of the civilized world. The stabled racehorse has to be carefully and humanely cared for and nourished in a holistic fashion, both physically and behaviorally, to win and stay healthy to win again.

Sid Gustafson, D.V.M., is a novelist and equine veterinarian specializing in thoroughbred sports medicine and equine behavior. His talk at the upcoming AVMA annual veterinary convention in Boston is Competition Horse Medication Ethics.

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.

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.

http://therail.blogs.nytimes.com/2008/06/04/drugs-and-racehorses/?smid=pl-share

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. Training and husbandry from the horse's perspective result in content, cooperative horses. DrSid provides equine behavior 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/

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.