As I wrote in my first post about this Monday summit, I came to it with little prior knowledge about the use of Lasix or about bleeding in horses. Given the length, detail, and number of the presentations, it would be impossible to capture everything that was said; I’m trying to distill what I found most useful as I formulate my own opinions about the use of furosemide on race days.  So on we go to the international perspectives on the regulation of race day medications and management of EIPH.

Dr. Brian Stewart is the head of veterinary regulation and the international liaison at the Hong Kong Jockey Club, and he spoke at length about the how the HKJC deals with the problem of EIPH.  His presentation is available here.

According to Stewart, horses that are believed to have underperformed are given a vet exam after the race; one element of that exam is scoping the horse to see if he bled, looking particularly at the quantity of blood in the horse’s trachea; a horse is considered to have bled if a blood level consistent with the HKJC’s grade of 3 or 4 is  found in the horse’s upper respiratory fact.

If any quantity of blood of pulmonary origin is visible at the nostrils after exercise, the horse is designated an “official bleeder.”  According to Stewart, such incidents occur about 42 times a season, or 4.6 times per 1000 runners.

At the first instance of official bleeding, the horse is given a compulsory three-month ban from racing. At the second instance, the horse is given a regulatory assessment, the outcome of which can be either a three-month ban or compulsory retirement. At the third incident, the horse is made to retire. Compulsory retirements average about 13 horses per year, or .09% of the total racing population.

Stewart cited statistics that indicated that 57% of official bleeders return to racing after the first incident, and that 40% of those horses bleed again within 12 months.

The incidence of grade 3 or 4 amounts of blood in the trachea is about 6.4/1000, or about 57 horses a season. 26% of these horses went on to become official bleeders within 12 months.

Stewart observed that the compulsory downtime as a result of bleeding did not affect field size, and he acknowledged that “the primary cost” of the compulsory downtime is to owners.

Stewart explained that the HKJC will not permit race day Lasix for a variety of reasons:

• The belief that it interferes with analysis for prohibited substances.
• The perceptions of attempting “to pharmacologically adapt the horse to the demands of the industry instead of adapting the demands of the industry to the limitations of flesh and blood.”
• Race day Lasix could be seen as a crutch or substitute for skillful training, vet input, and horsemanship.
• The desire to achieve international harmonization of medical policies.
• Concerns about dehydration and electrolyte imbalance in sub-tropical conditions.
• Concerns about the impact of race day Lasix on the consistency of racing performances.
• The principle that a race should be a test of the best athlete at that particular point in time
• The concern about the degradation of the Thoroughbred (??).  [Question marks Stewarts’]

Stewart was the only member of this panel that gave a full presentation; the other participants (Denis Egan of the Irish Turf Club; Dr. Ted Hill, former chief vet for NYRA and now a NYRA steward; Bill Nader of the HKJC; and Dr. Anthony Stirk, senior veterinary advisor to the British Horseracing Authority) responded to questions from moderator Dr. Rick Arthur of the California Horse Racing Board and the audience.

Stirk, in discussing the U.K.’s approach to bleeding, said that the U.K. doesn’t regulate bleeding and that there is no official definition.  “Bleeding” is commonly used when blood is detected during a scope or in the nostrils. He said that there was a low incidence of bleeding from the nose (epistaxis) and that Lasix was used in some “yards” (training facilities). He also confirmed what Egan had said earlier, which is that environment plays a big role in bleeding and that horses improve when they can train out in a field, in all types of weather.

In response to a question from Arthur, Hill said that while pre-Lasix New York did not see a lot of bleeders (New York was the last state to permit Lasix, in 1995), Lasix has “clearly decreased” the number of horses that bleed on the track. Egan said that the results of the South African study that showed that furosemide (Lasix) had a positive effect on bleeding did nothing to change the Irish stance against race day medication.  Stewart agreed, noting all the “downsides” to the use of the drug.

Egan also said that if a good horse in Ireland bleeds, its owner would try to sell it to an American owner.

Hill addressed the recent change in the way Lasix is administered at NYRA tracks. Prior to this year, Lasix was administered by private vets; this year, NYRA vets visit the horses that are due to get the medication on race day and administer it themselves. Hill noted that from the Saratoga meet of 2010 to the end of the year, there were 18 scratches for Lasix administration errors.  So far in 2011,  there have been none.  Said Hill, “The old system meant that a private practitioner could be in a stall up to four hours before a race,” suggesting that those private practitioners could also be administering other drugs.

Both the U.K. and Ireland permit the use of Lasix during training, a concern about which was raised for the gambler: if horses can train on the medication but not race on it, it’s hard for gamblers and handicappers to make sense of a horse’s form. There was also some skepticism about the practices of the U.K and Ireland, given the privacy of the yards and training areas. How, it was asked, can gamblers and the public be sure that race day medication isn’t being given?

Stewart at one point took issue with a statement from earlier in the day that indicated that continued bleeding had a deleterious effect on horse’s health. If, he was later asked, bleeding has a limited effect on a horse’s health, why is a three-month ban imposed, particularly when a dose of furosemide would be so much less costly?  He responded, “We think it’s best managed by time off,” adding that it would be “incorrect” to say that the HKJC doesn’t consider bleeding a welfare issue. He also said, “We don’t think that traces of blood in the trachea a couple of hours after a race are a problem.”  He acknowledged that there is “much gnashing of teeth” when a high-profile horse bleeds and is made to retire.  “It’s a hardship on the owner,” he said, “but we still think that horse is better out of the racing system.”

Next up, we hear from U.S. and international trainers about how they manage EIPH.