Thanks to the Jockey Club's recent push to publicize pre-race vet records of top-level runners, a sizable volume of handwritten forms have appeared online, ostensibly providing the transparency many in the industry have pined for. The contents of the records themselves, however, seem to have gone largely unnoticed. Even once the records are available, fans aren't given context and are left to wonder why a racehorse needs a dose of vitamin B complex or polysulfated glycosaminoglycan.
Dr. Jeff Berk of Equine Medical Associates in Lexington, Ky., sat down with the Paulick Report to help explain the purpose and use of several of the most common medications in the records, as well as their effect on performance.
According to the published records of this year's Belmont Stakes field, each horse received either bute or banamine at some point during the five days prior to the race. Some had specific diagnoses written next to their treatments (California Chrome received a dose of bute on June 5 for back pain, for example), while many just read “inflammation.”
Bute and banamine (technically known as phenylbutazone and flunixin meglumine, respectively) are both non-steroidal anti-inflammatory drugs (NSAIDs). They and other NSAIDs operate not on the pain receptors in the brain but in the musculoskeletal tissue, where they control inflammation. With the reduction in inflammation comes pain relief. They are also thought to avoid damage that may be caused to tissue by excessive inflammation, which is another reason they may be given before a big performance.
Berk believes that the medication issue with regards to NSAIDs is two-part: to an extent, trainers may be running their horses on small doses of bute or banamine before races or after breezes because they know their competitors are doing it and don't want to be left behind. They also may be addressing common, minor inflammation that could be part of normal athletics at a high level.
“It's a legitimate thing to say that these are professional athletes, they do this for a living, they live with (as we all do) a certain amount of inflammation, and if we can minimize that inflammation and the soreness that goes along with it, that that's a good thing for the horse,” said Berk. “There are reasons why you would use bute for a specific diagnosis, but I think most of the time these horses are not going to have a real diagnosis, it's more that they're performing athletes and they have a certain amount of inflammation in their bodies in various places.”
Experts say the problem comes in when NSAIDs are given frequently and indiscriminately. At the Welfare and Safety Summit in early July, Kentucky Horse Racing Commission equine medical director Dr. Mary Scollay expressed concern about horsemen giving the drugs after every big effort without taking the chance to see how they recovered from the exercise.
“It can fool the trainer into thinking the horse is better than it actually is,” she said. “One of the reasons you train a horse at high speed is not only to get him fit but to also to assess his response to the exercise. If you put a medication on board that's going to blunt an inflammatory response, does that horse cool out well because he's fine or because he's been given an assist?”
Four of this year's Belmont runners, (Ride On Curlin, General a Rod, Commissioner, and Matterhorn) received Adequan, Legend, or both in the five days leading up to their start in the 1 ½-mile classic.
Both medications are designed to promote joint health by helping to replace the slippery fluid that lubricates the joint (hyaluronic acid) and by promoting healthy cartilage development.
Legend is hyaluronate sodium, which mimics the hyaluronic acid naturally present in the joint. The substance helps to relubricate the joint and discourages inflammatory mediators in the ankles and knees. Although it may be given into the joint, it is frequently given as an intravenous injection. Adequan is polysulfated glycosaminoglycan, which may be given either in the muscle or in the joint. Polysulfated glycosaminoglycan is similar to the glycosaminoglycans naturally present in the joint's cartilage matrix—adding in the synthetic version helps reduce the loss of healthy cartilage due to trauma and can also help boost hyaluronic acid.
Neither drug should be confused with the corticosteroids that are often injected into joints, and can cause with negative side effects if given too frequently. Both Adequan and Legend can be used either as preventative measures to combat arthritic changes, or as treatment for stress damage to joints that has already occurred. Again, the idea should be to use the medications together with diligent monitoring of the horse's joints after arriving at a diagnosis.
“Medication discussions should go hand-in-hand with management discussions,” said Berk, who believes that repeated administration of joint health products as a response to clinical signs (like joint filing or heat) without radiographs and/or a change in management is ill-advised.
Neither medication itself has demonstrated detrimental side effects, even with repeated use; using the medications instead of investigating repeated symptoms can have negative consequences.
It's relatively common to see an electrolyte and/or vitamin complex provided to horses, especially as they approach race day. Electrolytes have the same purpose in horses as they do in human athletes—to guard against the loss of minerals through sweat.
The horse's body takes up vitamins and minerals to fulfill its needs, and the rest is left unabsorbed, exiting the body in the urine. There's no proof that supplementing a horse before a race gives him any advantage, but Berk said if it's unnecessary, the vitamin and minerals aren't going to hurt the animal in the doses given. Instead, trainers provide the substances just in case they help.
“They are overwhelmingly more likely to get what they need from a high-quality hay and grain than anything you can stick in intravenously,” said Berk.
Wicked Strong, General a Rod, and Samraat received either electrolytes or vitamin
injections in the days leading up to the Belmont. The teams around horses receiving electrolytes or vitamins seemed to have different ideas about what worked best —Samraat received vitamins B1, B12, and B complex the morning of the Belmont, and B1 and C the day before, while Wicked Strong and General a Rod seemed to have gotten a mix of unspecified vitamins. Elsewhere on the Belmont undercard, Antipathy and Rookie Sensation got boosts of calcium in addition to B1. Some horses got one brand name of electrolytes, while others got a different brand.
Ultimately, the medication issue is in the eye of the beholder. Berk echoed the viewpoint often expressed by experts at the recent Grayson-Jockey Club Welfare and Safety Summit: the medication issue isn't black and white.
Berk traces the overuse of medication to the 1970s and 1980s, when medications became cheaper and more available—that's when the veterinarian/client relationship changed on the track. In many situations, the trainer directs the veterinarian's actions, throwing the practitioner into a difficult situation. If they aren't willing to perform a given legal treatment, they know a colleague will be along to do it instead. In other jurisdictions, like Japan, officials direct the diagnosis of an ailment, supervise the work, and dispense the needed medication, eliminating that dynamic.
“Just like everything else in life that's worth talking about, complicated issues can't be encapsulated into one catch phrase like 'no medication,'” Berk said. “The judicious, transparent use of therapeutic medication has a necessary place in the care and welfare of horses.”
Instead, a proactive plan of physical exams and diagnostics followed by treatment and management changes results in the best environment for the horse. Berk said the idea should always be to diagnose the source of soreness or joint stress and address the cause, rather than patching over the symptoms and pushing forward. A well-balanced approach can also mean acknowledging that an athlete might have occasional sore muscles, and that it's fair to treat that soreness, as long as his discomfort isn't a sign of a serious underlying problem.
Berk points out that the publication of vet records steps into some sticky legal ground: in many states, an animal's veterinary file legally belongs to its owner, not to its physician or its trainer, meaning that a trainer or vet might be pressured to disclose records as part of transparency campaigns but not legally allowed to comply.
“If it can be done legally I think it's interesting because it does shed light on the excesses of therapeutic medication,” he said. “It's hard for anybody to look at the records of horses who are running in a big race and to fully understand why many of them need so much medication. It does call into question whether it's appropriate or not. And I think that's good.”
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