July 26th, 2011 by Greg Beroza

by Dr. Gregory Beroza & Paula Rodenas

Race Day Medication Summit at Belmont Park - Program Cover

A first ever international summit on race day medications, exercise-induced pulmonary hemorrhage also known as ‘bleeding’ (EIPH) and the racehorse was held June 13-14, 2011 at Belmont Park. It was hosted just days after the Belmont Stakes by the New York Racing Association (NYRA) and co-sponsored by the American Association of Equine Practitioners (AAEP), the National Thoroughbred Racing Association (NTRA) and the Racing Medication and Testing Consortium (RMTC). The goal was to be informative and exchange views on the management of EIPH that will hopefully help the United States in making appropriate future decisions about the controversial use of race day medications.

Dr. Robert Lewis - AAEP's Past President

Of all the available medications for EIPH or ‘bleeding’, the best results have been obtained from the medication Furosemide, also generically known as either Lasix or Salix. This diuretic was first used in the 1960s to control high blood pressure in humans, but it was later found to have a beneficial effect on heart-lung function. Despite years of resistance to incorporate its national use, in 1995 New York State became the last state to allow the use of Lasix in Thoroughbred racing. Prior to that era, a horse that might have won an out-of-town Grade 1 Stakes race such as the Kentucky Derby and/or the Preakness Stakes on Lasix would be forced to run in New York without it in the Belmont Stakes, giving that horse a perceived distinct disadvantage.

Alexander Waldrop- NTRA 69KB President & CEO

Critics of Lasix see it as a performance-enhancing substance and believe it can also mask the presence of other medications. Those who favor the use of Lasix believe it is humane and therapeutic and enables a horse to achieve its natural maximum potential by minimizing bleeding.

Robert D. Manfred, Jr.- Exec VP Major League Baseball

Performance-enhancing drugs have long been an issue in American sports. Robert D. Manfred, Jr., Executive Vice-President of major league baseball, started the summit by speaking of such drugs’ perceived impact on the integrity of the sport and noted that the best that can be done is to wage a strong battle against their use. He pointed out that performance-enhancing drugs are effective, and the subsequent pay-off is huge.

Dr. N.E.Robinson - Prof MSU College Vet Med & Eq Pulmonary Lab

Dr. N. E. Robinson, a well recognized veterinary authority on bleeding and a Professor at the Michigan State College of Veterinary Medicine and Director of their Equine Pulmonary Laboratory, explained the pathology of bleeding. As athletes, Thoroughbred racehorses, as well as other sport horses, are prone to injuries and other health-related problems. A large percentage of equine athletes have some presence of blood in their windpipes. This may increase with age, speed, distance, footing, cold weather and other factors. Blood is pushed through the lungs, particularly to the back of the lungs (the dorso-caudal area under the saddle), creating damaged areas formally referred to as ‘lesions’. The veins in those areas become thicker, capillaries rupture and bleed, and scarring occurs; sometimes permanently. Pulmonary arterial blood pressure increases with speed. During exercise, blood flow pumped from the right side of the horse’s heart may equal more than 75 gallons per minute. Eventually a narrowing of the blood vessels, or venoclusive remodeling, occurs. A horse that visibly bleeds from the nostrils after a race is called a “bleeder.” There are four grades of bleeders, Grades 1 and 2 being the mildest categories and Grades 3 and 4 deemed as substantial.

Race Day Medication Panel & Attendees

The summit’s panel discussants were comprised of prominent veterinarians, trainers and racing officials from many parts of the globe, including Hong Kong, England, Ireland, Australia, South Africa and France, and the attendees came from 13 countries. Many of the panelists critically considered Lasix as America’s best answer to EIPH. In fact, an Irish representative half-joked that Ireland’s solution to bleeders was ‘to retire them or send them to America’. Outside America, many other countries take a more conservative approach to dealing with EIPH; and many alternative medications and therapeutic approaches were discussed in detail, including medications such as Carbazochrome or “Kentucky red,” Premarin and others; a regimen of scoping and observation; lavage; improved diet and stable management; and giving the horse sufficient periods of non-competitive rest.

Bill Nader - Exec Director Hong Kong Jockey Club

Bill Nader, Executive Director of the Hong Kong Jockey Club and former Senior Vice-President of the New York Racing Association, encountered a whole new world when he moved to Hong Kong four years ago. No Lasix is allowed there in training or racing, and a horse that bleeds is given a mandatory three months off. If the bleeding returns a second or third time, the horse then faces compulsory retirement. Local racing fans are kept well informed with all such bleeding incidences being reported, and the racetrack has a hi-tech laboratory on its premises. Dr. Brian Stewart of Hong Kong said that a horse showing any amount of blood of pulmonary origin at the nostrils after exercise is considered an official bleeder. Post-race exams are mandatorily conducted on approximately 10% of runners at the request of the stewards, and any findings are reported. However, it is very difficult and controversial to compare the racing scene in Hong Kong to that of the United States, as Hong Kong is a small area, races are only held a few days a week, racing is controlled exclusively by the country, and horse racing is China’s only form of legalized gambling.

Dr. Larry Bramlage- AAEP On Call & Dr. Steven Reed- Rood & Riddle Equine Speaker

In Ireland, Lasix is regarded as a therapeutic substance only and cannot be used on race day. Denis Egan, Chief Executive of the Irish Turf Club, attributed EIPH to several possible causes: genetics, stress, environment, poor stable management, allergies, frequent shipping and overwork. Irish bettors are also well informed and can obtain information on their web sites, and generally they won’t bet on a horse known to bleed.

Dr. Anthony Stirk of the British Jockey Club said that as there is no official definition of EIPH in the British rule book, medication may be given during training and is not checked, but the horse must be drug-free on race day. He noted a significant improvement in horses that are turned out in a field as opposed to those kept in a more contained conventional stabling environment.

Trainers-Christophe Clemente, John Size, Graham Motion & Richard Mandella

Hall of Fame trainer Richard Mandella from California believes that EIPH is the result of stress, not necessarily from racing, but even from the pressure of just going to the gate. The trainer of recent Kentucky Derby winner Animal Kingdom, H. Graham Motion, said of the use of Lasix in two-year-olds, “Prevention is better than the cure.” Motion, who trains in several different countries, stated that Lasix is controllable. Interestingly, several of the foreign trainers said they would use Lasix if they could. Veterinarians were mostly concerned about greater long-term complications such as inflamed airways and pleuropneumonia due to bleeding. There is also an economic consideration, as Europeans and Asians are reluctant to buy or breed to American Thoroughbreds that race on Lasix. “My worry for American racing is that you are becoming isolated,” said Dr. Stirk. “We want to see more (drug free) international racing.”

Attendees-Jockey Guild Director Terry Meyocks & Jockey John Velazquez

In England and Ireland, horses are stabled away from the racetrack and able to enjoy long, easy gallops in the countryside. By contrast however, the American racehorse spends most of its time isolated to a stall and is exercised only during its daily gallop on the track, which creates an unnatural environment. This contributes to many of its problems, and efforts to overcome these by use of bleeder medication, steroids and other substances have resulted in negative publicity for the sport. Legislators are now calling for serious federal regulation of performance-enhancing drugs and medication.

Although no formal recommendations were announced at the summit, many issues were discussed, such as options for the administration of Lasix, barn security, more stringent medication abuse penalties, education and research. The RMTC (Racing Medication and Testing Consortium), which consists of 25 racing industry stakeholders and organizations representing Thoroughbred, Standardbred, American Quarter Horse and Arabian racing, is currently holding its own separate sub-committee meetings. According to Chris Scherf of the RMTC, these sub-committees will report to the governing board Aug. 4-5. If their recommendations are adopted, they will be sent to the racing commission and, hopefully, implemented as quickly as practically possible.

Dr. Pam Corey-ASPCA Veterinary Director-Attendee

With present hopes of a much needed renewed financial racing vigor due to the current addition of increasing gaming dollars, there is also a significant threat of preserving racing’s integrity by more stringent monitoring of its medication protocols and testing. It appears that future regulatory developments will determine the allowance or exclusion of Lasix in Thoroughbred racing in America, and the rules will be enforced on a national basis rather than managed state by state. Presently racehorses in New York may be given 100-250 mg. of Lasix by a NYRA veterinarian four hours prior to a race. Under national regulatory pressure, New York State exhausted its jurisdictional last standing non-medication position in 1995. It is amazing that now, some 16 years later, a return to non-medication standards are even being considered.
For an even playing field, Lasix must either be permitted and controlled uniformly in all states and potentially all countries or be completely banned, with stiff penalties for noncompliance. Several European trainers agreed that they would not like to race their non-medicated horses against a field of American horses on Lasix, because they believe it gives those medicated horses an edge. There appears to be a dichotomous political standoff between American breeders and trainers who feel that Lasix is necessary and European purists who don’t want to compete against their American counterparts. The long-term effect of Lasix use in the future equine breeding stock has also been questioned, again on a partisan basis.

Thoroughbred Times Senior Staff Writer-Frank Angst

One suggestion offered by a seminar attendee was to first eliminate the use of Lasix in all American Graded Stakes races, which are the races most often entered by European race horses. The Graded Stakes winners are also the most probable horses to go to the breeding shed and most heavily contribute to the future genetic pool of race horses. Americans appear more prone to first consider eliminating Lasix use in the lower tiered claiming races of less talented race horses.
It was pointed out at the summit that if Lasix is eliminated in American racing, additional security issues will become problematic, training methods will change, and – worst case scenario – something else, including more exotic medications, will come along! Ultimately, the welfare of the horse should be the primary concern.

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