Thursday, May 3, 2012

One Horse, One Week of Injections

This brief article and illustration, titled "One Horse, One Week of Injections" was in the New York Times recently.  The original article and the illustration may be found by clicking here.  I have attempted to copy/paste below:

One Horse, One Week of Injections

Coronado Heights, a 4-year-old thoroughbred who received a diagnosis of early degenerative joint disease, broke down and was euthanized on the track at Aqueduct on Feb. 25. Below, an illustration of the drugs and dosages given to Coronado Heights the week before he broke down. Related stories »

Phenylbutazone

(painkiller)
Bute is an anti- inflammatory used to control pain. It is injected intravenously and can contribute to gastric ulcers.

Estrone

(hemorrage prevention)
A longtime racetrack remedy; an estrogen-based hormone used to prevent pulmonary hemorrhaging while running.

Flunixin

(painkiller)
A very potent anti-inflammatory that acts quicker than phenylbutazone.

Hyaluronic acid

(loosens joints)
A synthetic joint fluid that replaces degraded joint fluid. It improves a horse’s range of motion and reduces swelling.

Lasix

(prevents bleeding)
A diuretic given four hours before races; flushes the system of water and reduces blood pressure to prevent pulmonary hemorrhaging.

Adequan

(promotes healthy cartilage)
A synthetic replacement for cartilage to combat the wear and tear of running.

Xylazine, Detomidine

(sedative)
A sedative injected in a horse’s neck to calm it before injecting the stifle joints in the hind legs.

Vitamin B1

(calms horse)
Commonly administered four or six hours before a race to calm a horse.

Methylprednisolone

(anti-inflammatory)
A powerful cortisone usually shot in the joints to battle arthritis and degenerative joint disease.

Calcuim

(calms horse)
Another intravenous injection usually administered to keep a horse calm and composed.

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I guess in a completely selfish way I should be happy to see this.  After all with that type of management program we should not be hurting for future retirees.  Like most of you (I hope) my actual reaction was 'holy crap, poor horse, no wonder he broke down and was euthanized."  

Some of the injections themselves I don't have any issue with. I do not fall into the camp that joint injections are evil, and a lot of people who take this stance do not seem to fully understand what the injections do and how they actually work.  That being said joint injections need to be used appropriately.  It amazes me how many people have a horse that is stiff behind and just have the hocks injected before actually doing an x-ray.  No way is anyone sticking a needle in my horse's joint without an xray first.  I also think if the same area is needing to be injected 3 to 4 times per year then all involved need to take a step back and reevaluate the horse's entire program and make some significant changes.  According to the illustration above this horse had his stifle injected a few days before racing.  I would never inject a horse's joints a few days before he raced.  If you look at the boxes under the pictures there are 7 of them with the last one being race day, and the lighter shade box indicates the day that particular injection was given.  

As I review the above I think the only injection I don't have a problem with when I look at the whole picture is the adequan injection.  Given separately over the course of time many of these injections are valid.  Give some bute after a particularly hard workout?  I have no problem with that.  But this horse was being propped up on pain meds before race day. The joint injection would involve the sedative, the hyaluronic acid and also an anti-inflammatory.  I'm assuming the xylazene was the sedative and the methylprednisolone the anti-inflammatory for the joint injections. Used judiciously I have no problem with joint injections. A few days before a race does not fall into the category of judicious use in my opinion.

The one thing that threw me was the Hyaluronic acid being given 5 days before race day and then again two days before race day. My best guess is that the first injection was the stifle joint injection and then maybe the horse had a Legend injection two days before race day on top of his joint injection.  This might be the one other injection this horse had the week before his race that would not bother me.  If I am going to go away to say two horse shows back to back where my horse would be working hard and stuck in a temporary stall at a show for two weeks I would consider giving a Legend shot before we loaded up on the trailer and left.  

According to this the estrone was given to prevent pulmonary hemorrhaging.  In the sport horse world it is often used to help stifles so I am wondering if that was the actual use for it or if maybe at the track estrone serves two purposes?  

As far as the Lasix for racing I am not a fan.  However you can find people to rabidly argue for and against the use of Lasix for racing.  Some states have banned it, others have not.

Flunixin is more commonly known as banamine, and this horse was doubled up on bute (phenylbutazone above) and banamine the day before the race.  In my little world you don't double stack NSAIDs unless you are in a truly exceptional medical situation with the horse, the potential repercussions are too high, especially doing this repeatedly.

As for the B-1 and the Calcium I know they are used in the sport horse world to attain a calming effect and it states above this was the same aim for poor Coronado Heights.  I consider the Calcium downright dangerous, right along with the current trend of giving IV Magnesium to the show hunters.

In total this horse had 17 injections in the week before the race where he broke down and was euthanized.  SEVENTEEN.  He was four years old.  Out of those 17 injections the only ones I could be comfortable with in the week leading up to a race or a show would be the adequan injection and the second HA injection if it was legend.  

It is easy to pick on the sport of racing but it is amazing to me how the sport horse world is gravitating more and more towards this type of management.  And I mean all sport horses from western pleasure to reining to dressage to jumpers. Multiple joints injected multiple times per year.  Everyone trying to find the calming injection that won't test.  Routinely buting horses to keep them in work.  The trainers continually fighting to have the medications rules made more lax.

I first saw this article a few days ago and have been thinking about it ever since.  Did the same vet sell and/or give all these medications to this horse or did the trainer have to use multiple vets so one would not be aware of that the other one had done?  What do the jockeys think about riding a horse propped up by 17 injections in one week?  Do the owners know, care or even understand any of this?  Clearly the trainer knew what was going on and had no issues with it which is unfathomable to me. 

Would you be comfortable with any of these injections being given to your horse in the days before an event, show or race?   

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Cinnamon, MyLight and Silky


Leo and Chance

Lucky, O'Reilly and Snappy


Noble, Lightening and Fabrizzio


Tiny and Johnny


Lily (and Maisie in the background)


Cuffie


Sam doing his post meal licking routine; he licks the air for about 10 minutes after a meal or treat like he is saying "that was SO GOOD!"


Faune, Winston and Lotus


New face around the farm:  Titan


Titan having a fun run through the field with Romeo, Silver and Lotus


10 comments:

Bif said...

Like you, I am OK with the Adequan and possible Legend. I would be OK with one or two shots of bute if the horse had a gas colic 6 or so days out, with a pinpointed cause that has been eradicated.

If your horse needs joints injected, they shouldn't be that close to hard work/ serious competition IMO.

I don't know where I stand on Lasix, but it is legal to race on and many horses race successfully on it for a long time without any apparent consequences. Others, of course, have issues, or bleed through it, and really shouldn't be racing.

The only other thing I am sort of OK with is the B1, although I think it should be feed-through rather than injected.

I had a horse who developed arthritis early (quite noticeable changes as a late 5 year old, due mostly to EPM. He was started as a 4 year old). He got his hocks injected and did great, and was also kept on a supportive joint supplement. I knew he would not last forever with those joints, but he needed them injected about once a year if working, longer if not, and was comfortable and did not need bute, etc.

It's a fine line between maintaining an athlete that *may* have a longer, more comfortable life if you didn't use them. But, they can also hurt themselves in the field or colic and twist/rupture. You want to be fair to the horse but also enjoy your use of him. When there is money tied up in it, the horse probably always loses.

CG said...

That makes me sick. My heart was just pounding reading your post, and I have a racing background.

I'm sorry, I think that the trainer belongs in jail- and the vet too if it was all one vets "work". Disgusting.

Kate said...

That was a particularly disturbing case. Not all injections are bad if done for specific reasons to treat a specific condition, as you point out. But injections should never, ever be used to make a horse able to race, or go in the show ring/pen, if the horse wasn't sound enough or healthy enough to do so without the injections. But this sort of thing is a problem in many horse disciplines, where horses are just sports equipment to be used up and thrown away. If multiple joint injections are needed to keep a horse in work, the horse is in the wrong sort of work and may need to be retired or at least stepped down in workload - that's my objection to many joint injections, where they're used to treat a symptom and mask the real problem. And don't get me started on breeding without regard to conformation or soundness . . .

I no longer watch racing, although I used to love it - too many breakdowns even at the highest levels of the sport.

Landers said...

Beautiful pictures - and yes, what a shocking amount of medications. 0_0

Jeni said...

JMHO - if a horse needs all that to race\compete\perform his\her job.. he\she shouldn't be racing\competing\working.

I'm ok with the Adequan and maybe legend. Ok with hock injections but only after x-rays. But to keep comfortable on an ongoing basis. Not to prop up for race\show
job.

Touchy subject - glad you wrote about it.

Anonymous said...

Adequan and Legend if neccessary, bute and banamine ditto but the amounts suggest it wasn't for a one time thing. A number of those drugs also cause bone demineralization as a side effect. Added on top of a routine that involves 23 hours a day in a stall, too little exercise, large amounts of grain (high phos=less calcium available for bone strength) in the ration, and often long-toe/low-heel shoeing, and it's a wonder more breakdowns don't occur. And I'm not even anti-racing, just against some of the "traditional" methods that are detrimental.

FD said...

B1, yes, although if the horse needs a soother that badly I'd be worried about competing it. Legend, yes although I'd be concerned about the necessity in a four year old.
Bute... well maybe a single dose no less than seven days out, say if the horse had a fall or got cast. Ditto for the banamine although I'm less comfortable with that. I'm not happy with a horse being worked on both, still less at those dosages, still less competing.
For older horses I'd be ok with a very low level dose of bute the morning of a day of hard work - say an old hunter getting a half dose to ease his joints. Not banamine and not for competitive purposes though.
Adequan and joint injections in a competitive 4 yr old? No way.
The rest in a pre race week? Also no way.

All of those drugs have a place and a use, but I remain firmly of the opinion that they should be therapeutic, not to mask problems for competition, except possibly for older horses in the case of joint injections.

RuckusButt said...

Wow, I'm honestly shocked (naive, I know). Having the images and timing of doses like that really gives it a physical reality, if that makes any sense. I don't know much at all about injections of most types (haven't had much cause to learn about most just yet) but it doesn't take an expert to think that program is awful.

My friend just got back from the winter of working with a dressage rider in Florida and she was telling me that it's the norm to inject pretty much any issue that comes up, on a regular basis. It's definitely not just racing.

When Willy's stifles were locking, the vet was preparing to do an internal blister. It's not a joint injection in the usual sense, but rather creates a bubble of fluid that last a few days to keep the ligament in the path it's supposed to be in. I asked a million questions before I felt even remotely comfortable with proceeding. I'm sure some people would disagree on the procedure, but my perspective was that risk was slim to none and it could really help him.

All that to say, I agree medication had it's place - I take anti-inflamatories to clear inflammation out of a bad ankle so that I have healthier muscle recovery. I do the same for my dog on occasion. I don't do it so that either of us can run a marathon/sprint the next day (but maybe run 5k a couple times a week).

Vivian, Apollo's Mom said...

I am aghast! I knew these things were common in racing but not to this extent! A four year old!!?? No wonder the poor thing broke down- he shouldn't have been racing in the first place. But where large amounts of money are involved...

An American in Tokyo said...

Would LOVE to see a video of Sam licking the air!! *hint, hint* =)