Management of EIPH from a veterinary perspective: Race Day Medication Summit

I really hadn’t planned on dragging this recap out for a week…but we’ve finally reached the last two presentations from last week’s Race Day Medication Summit. Following the trainers’ discussion of managing EPIH, the veterinarians took the stage.  Moderated by Dr. Scott Palmer, the panel included Dr. Scott Hay (U.S.); Dr. John McVeigh (SA, U.K., France); Dr. Foster Northrop (U.S.); Dr. Rob Pilsworth (via recorded comments); and Dr. Treve  Williams (AUS).

To reiterate: this isn’t a transcript. The full video for all sessions is supposed to be posted on the NTRA website at some point, and I’ll post here when that happens.

And best, probably, to read this one in little bites….it’s  long!

Northrop got the discussion going by referring to the “European” system for grading bleeders, saying that he didn’t “understand it,” and that bleeding on all levels affects horses. He implied that he didn’t agree about making such distinctions when it came to treating bleeding horses.

Williams acknowledged that the grading system has no medical standing, but maintained that it “holds well in terms of how we treat horses.” He also said that he treats horses with a bleeding level below a four or five.

McVeigh noted that in his experience, about 15-20% of bleeders get grade 2 rating, and that how many horses get scoped depends on the trainer, implying that it was an economic issue.

Northrop observed that horses that race every three weeks, that get Lasix every time they race, are “unthrifty” horses. “They go off their feed; they’re not happy horses,” he said.

Williams, talking about Lasix, said, “I can’t use it, but it’s the only drug with any value.” It’s “accepted,” he said, that hay needs to be washed and the stables cleaned to reduce the risk of bleeding.

“The long-term consequences of bleeding,” said Hay, “is more bleeding.”

McVeigh said that he considered grade two bleeding or up a “serious medical event.” “As soon as you have grade two bleeding or more,” he said, “you need to get the horse on prophylactic Lasix and stop racing.”

Williams said that he doesn’t treat grade four or five levels “because the horses get turned out because the bleeding is so severe.”

When asked by the moderator about the prevalence of Lasix in U.S. racing, Northrop said that he believed that treating 97% of horses here with the medication is justified. “Bleeding’s a terrible problem,” he declared, while saying that he wouldn’t use Lasix preventatively. “I’d tell a client not to use Lasix on a horse that hasn’t bled.”

Williams brought the conversation back to the suggestion that Lasix is performance enhancing.  “If you give Lasix to 97% of horses, and even if you presume that 50% of your horses bleed, the remaining 45% are being unnecessarily treated to prevent EIPH.  In my experience, trainers use it then as performance enhancing. That really worries me.”

Hay disagreed with Northrop. “I believe treating horses with Lasix in a preventative manner is a good thing. Our studies have shown that over the lifetime of a horse nearly 100% of them bleed. If you believe that EIPH is a cumulative event, I think that you can justify that treating them in a preventative fashion is warranted.” He suggested that that sort of care is parallel to taking an aspirin every day to prevent a heart attack.

McVeigh then cited a series of statistics correlating horses’ finishes in a race with their levels of bleeding, pointing out that horses that bleed less perform better.  “If you were training these horses,” he said, “you’d do it as well,” referring to using Lasix to prevent bleeding.

Williams disagreed. “I wouldn’t use it even if I could, because those people who use it at the bottom scale can yo-yo the drug.” At Betfair, he pointed out, “I can bet to lose,” and then suggested that taking horses on and off Lasix could be done to rig their finish in a race.

“When you introduce performance-enhancing drugs into a trainer’s arsenal,” he said, “you’re asking for trouble, particularly from the bettors’ point of view. And I remind everyone that we’re here because of betting.”

Williams also observed that if a Lasix ban is enacted in the United States, the cost of testing horses would be “astronomical.” “You have to understand,” he emphasized, “that to change what you’re doing at the moment is going to cost a great deal of money.”

McVeigh brought the discussion back to horse welfare, saying that he tries to stand in others’ shoes to try to understand their situation…in this case, he seemed to be referring to horseshoes.  “Horses that bleed look frightened.  Look at Lasix from a welfare point of view. It’s shown that it works and it’s shown that’s a good thing.  I’d give it from a welfare point of view, not just from a performance point of view.  But the long-term problem is in the breeding shed.”

Northrop disagreed with the performance-enhancing suggestions. He had, he said, had a racetrack practice for 22 years and treated thousands of horses at all levels. “I’ve never had a trainer say, ‘I want to enhance this horse’s performance; I want to give him Lasix.’  I think it’s a misnomer to call it a performance-enhancing drug.” He also said that the level of supervision of the use of Lasix here already guards against the possibility of betting shenanigans.

Williams stood his ground.  “I remain against introducing anything that you could maybe yo-yo. With our form of betting, it would absolutely be dynamite.” (“Dynamite” in the sense of being explosive/incendiary, not in the Jimmy Walker “Dyn-o-mite!” sense.)

Palmer asked whether any of the panelists had seen any significant complications from using Lasix. Northrop said that he “rarely” sees any, though he cautioned that with “non-sweaters,” he had to be careful to give as little Lasix as possible.  He also noted that sometimes horses get a little “flutter” (presumably from the heart?), and that in using Lasix, it was important not to change a horse’s electrolyte balance.

Williams noted the very humid Sydney days and said he was very conscious of post-race recovery.  “I feel very definitely that if we added this to the arsenal, we’d be in trouble.”

Hay said that a lot of Lasix is used in hot and humid south Florida and that everyone is worried about dehydration. He noted that horses seem to recover pretty quickly, even those who get Lasix every week. He, too, said that he saw a little of the “flutter.” “I’m not sure it’s caused by Lasix, but Lasix can complicate it. We need to watch those horses and how we hydrate them.” Other than that, he said, he sees very few complications in most horses.

McVeigh referred to a South African study in which 100 or 200 ml, and sometimes 500 ml, of Lasix was administered, and in which trainers reported “good recovery rates.” Because of the heat and humidity, he said, they will actively try to rehydrate horses quickly.

Regarding treatment after a race, Northrop said that the majority of his clients want intravenous therapy after a race, and sometimes after a workout.  He’ll generally give three liters of fluid after a race and one after a work, though he admitted that he thinks that three liters is the minimum necessary for rehydration. “If a horse is truly dehydrated, which you rarely see after a shot of Lasix or after a race, you need 10 liters before you make a dent.”

Williams didn’t answer the question about post-race treatment, saying instead, “If you take issue with calling Lasix performance-enhancing but admit to using it because those who do have an advantage, that to me is very much the same thing.”

Hay indicated that post-exercise hydration is “pretty much a client option.  “We go any direction we can. Some people want IV therapy, sometimes a liter, sometimes five; some get electrolyte replacement. From a scientific point of view, one liter doesn’t make a difference, but I’ve got guys that pretty regularly request that and the horses seem to recover pretty well.”

Palmer asked Williams and McVeigh what recommendation regarding race day medication they’d make if one of their clients were going to ship to the United States.

McVeigh said that that’s a common question, particularly with the Breeders’ Cup. “We’ll try the horse with Lasix first to make sure that there’s no abnormal reaction. If it worked the last time, do it again.  The result was obvious. A couple of my trainers are brave enough not to, and they are brave. “

Williams said that you have to do what everyone else is doing, “or you’re behind the eight ball.”

Northrop and Hay were asked how they’d change their treatment plans for EIPH if Lasix were no longer available.

Hay said that in a conversation with an Australian trainer, he was told that they draw hay and water night before and have no problem.  That was, Hay said, that trainer’s answer to the bleeding problem. “We’ll have to look harder at inflammatory airway disease and make sure that we take care of all the underlying issues,” he said.

He pointed out that Lasix has simplified a lot of these treatments and feared that there would be more nutritional supplements and homeopathic treatments in the absence of Lasix. “We’ve got a cultural issue here that says that we need to treat bleeders to reduce bleeders. We’ll scramble to look for something to try to get us there.” He emphasized his fear that more unproven remedies will be tried.

Northrop went a step further.  “If there is truly no treatment on race day, individual state racing commissions and tracks will have to seriously look at security and make sure that everyone’s on same playing field. Otherwise, we’re worse off than we are now.”

“As a track vet,” Northrop said, “I see a potential ethical dilemma that could emerge if security’s not in place. I think it’s going to create a nightmare for trainers and vets, a lot of pressure to do things we’re not supposed to do. I’m not talking about harming the horse; I’m talking about innocuous treatments that probably don’t change anything.”

He foresaw the same sort of pressure evident when New York didn’t permit Lasix. “It was called the ‘New York bleeder treatment,’” he said without being more specific. “I’d hate to see us go back up that way again.”

He exhorted tracks and racing commissions to “please provide security” if the rules change.

Deliberately using the pronoun “we,” Williams added, “We’re going to have to accept one set of rules someday.  At the Asian Racing Conference, not one of those nations is going to move. So it’s either we’re going to have to move [“we” being the United States] or we’re going to have troubles on our own.

“One of the great problems we have is perception.  We’ve got to try and get rid of the perception the rest of the world has.”

Hay concurred with the concerns about security.  “We’re not going to be in a stall on race day, but we can’t say that for everybody. I know how much pressure there is to win, how much pressure for horses to run as well as they can. Unfortunately, we’re not all on same page with the best way to treat a horse, so certainly a lot of people that will want to do more, want to feel like they’re doing the best thing for their horse.

“It would be a tough competitive environment on race day if there’s not enough security around to enforce the rules. It will cost a lot of money and not all jurisdictions are willing to pay that.”

Referring to the increasing incidence of bleeding in South Africa, McVeigh pointed to the studies from Hinchcliff and Stewart that demonstrated the efficacy of Lasix. “I’m already a fan of it,” he said.

Palmer asked about the stress on lower level horses: would the absence of therapeutic medication have a greater effect on them?

Northrop said yes. “Overnight horses are under a lot more stress. They’re cheaper and get cheaper treatment.  We’re still talking about horrible environments.  Comparing Europe to the U.S. is apples and oranges. We’re not in yards. A place like Fair Hill is a rarity.

“Most of our stables are old and dusty, in terrible parts of cities, and we’re asking horses to be professional athletes.  The environment exacerbates problems the horses already have.  Taking Lasix away will be devastating to cheaper horses. Better horses will be better taken care of.”

Williams said that he asked trainers what they thought should be done about Lasix. “In every case,” he said, “they said, ‘For God’s sake, don’t change it. We think we’re breeding it out.’”

Northrop maintained that eliminating Lasix will not be cheaper for owners. Williams said it would be; McVeigh “suspected no.”

McVeigh cited a 1986-2002 study of bleeding at South African tracks. The study included 63,000 horses and looked at genetic and environmental factors.  According to the study, McVeigh said, “The inheritability of bleeding from stallions is a .4,” which is, according to him, “extremely high.”

The study showed, McVeigh said, that two sires, both champions, produced the greatest number of bleeders.  While McVeigh said that the study named the sires, he did not.

“According to the South African stud book,” he said, “we’re importing or producing sons of American stock, and bleeding is on the increase.”

5 thoughts on “Management of EIPH from a veterinary perspective: Race Day Medication Summit

  1. The term EIPH is a joke. How about there’s a 120 lb. jockey on my back, beating the shit out of me, wearing blinkers, cannot see for the dirt flying back in my face, and having been administered a diuretic, I’m thirsty as hell, and expected to outrun my pedigree. Human induced is more suitable.

  2. And once again, at least according to the South African sutdy, it comes back to breeding……

    Thanks again for the summary.

  3. So what do you make, Linda, of the fact that it was champions that bred those bleeders? I don’t know enough about pedigree or breeding – in SA or elsewhere! – to draw any conclusions.

    Alex, I’m not sure why you’re continuing to read about this…you’ve taken issue with much that was presented, by trainers or vets or scientists. I don’t get the sense that you’re interested, really, in what they had to say?

  4. I’m not a pedigree expert either, but it concerns me. Especially champion stallions that may have bred hundreds, if not thousands, of potential bleeder foals. Are breeders in the US weakening the American thoroughbred through overbreeding, mishandled breeding, etc? It sure seems that way.

  5. Linda,

    Yes, would be my take on the “Lasix” crisis. Gone are the days when trainers would — could — shelve a colt or filly for necessary R & R. Time and Mother Nature proved very effective healers for a laundry list of ailments many years ago. Wish it were still so.

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