Third Class 4 Drug Complaint Issued Against Miller This Year

The Peter Miller trained Mr. Dougie Fresh (Ghostzapper) tested positive for phenylbutazone–a class 4, penalty category C drug–after the horse worked at the San Luis Rey Downs training center Sept. 19, according to a California Horse Racing Board (CHRB) complaint dated Sept. 26.

Miller, who did not request a split sample in this case, is scheduled to appear before the Santa Anita board of stewards at an unspecified date. This is Miller's third overage offense in 365 days.

On April 10, Miller was fined $500 after Hembree (Proud Citizen) tested positive for Isoflupredone, a 4C penalty regulated drug, after winning the seventh race at Santa Anita Park Jan. 1.

On Sept. 2, Miller was fined $1,500 and assessed one half point in accordance with the CHRB's multiple medication violations rule as a consequence of Mo Forza (Uncle Mo) testing positive for a phenylbutazone overage after working at San Luis Rey Downs June 19. Mo Forza most recently won the GII City of Hope Mile S. at Santa Anita Oct. 2.

Additionally, the Steve Knapp trained Socal Red (Lookin at Lucky) tested positive for methocarbamol, a 4C penalty regulated drug, after winning the 4th race at Del Mar Aug. 19, according to a CHRB complaint dated Sept. 29.

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Sore Back? Skip The Bute

Horse owners have been known to take medications prescribed to the animals in their care, despite the possible dangers. While some anti-inflammatories, antibiotics, and dewormers may be the same in both human and equine medicine, but their formulations can be vastly different; because of this, human ingestion of equine drugs isn't recommended.

An American woman experiencing severe back pain attempted to take some phenylbutazone (Bute) that had been prescribed for one of the horses in her care. She took three doses of the non-steroidal anti-inflammatory drug (NSAID), each suitable for a 400-pound horse, reports the journal Clinics and Practice.

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Three days later, the woman went to the hospital complaining of nausea, vomiting and weakness, which she said she had been experiencing for two weeks. She often had back pain that was controlled by use of over-the-counter naproxen, but reported that this episode was exceptionally painful, which is why she ingested the Bute.

She presented to the hospital with nearly low blood pressure, a high heart rate, and normal O2 levels, as well as dry mucous membranes. Blood work showed a low white blood count, low platelet levels, elevated liver enzymes, and acute kidney injury. Her urine blood screen showed use of amphetamines and marijuana.

Poison control and toxicology were engaged once it was discovered she had ingested the Bute, but no antidote was recommended. She was given an N-acetyl cysteine and sodium bicarbonate drip because of the suspected acute liver damage caused by the phenylbutazone.

After three days of in-hospital treatment, the woman was feeling better and checked herself out.

Though phenylbutazone was used in human medicine for the treatment of multiple forms of arthritis, it was removed from the human medicinal arsenal in 1970 because of an increased risk of agranulocytosis, a life-threatening blood disorder.

Read more at HorseTalk.

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Here’s What To Keep In Mind When Giving Your Horse Omeprazole For Gastric Ulcers

Thoroughbreds and gastric ulcers go together like a picnic and ants. Medications like omeprazole can effectively help treat or prevent gastric ulceration and has important welfare benefits, making these drugs extremely popular in the racing industry. However, the benefits of omeprazole may be overshadowed by some potential drawbacks that may dampen its use in some cases.

Between 80 and 100% of Thoroughbreds have ulcers in the squamous or upper region of the stomach (equine gastric squamous disease, EGSD). An additional 10-60% or more of Thoroughbreds also suffering from gastric ulcers in the glandular (lower) region of the stomach (equine gastric glandular disease, EGGD).

Ulcers, which are erosions of the lining of the stomach, cause discomfort to the horse. Signs of gastric ulceration manifests in various ways such as a dull hair coat, weight loss, bruxism (grinding teeth), and poor performance.

“Squamous ulcer disease results from management practices and isn't limited to just Thoroughbreds. Feeding any horse involved in high intensity or long duration of work high grain, high carbohydrate but low roughage diets will increase the risk of disease,” said Dr. Ben Sykes from the Equine Clinic, Massey University, New Zealand.

Medications like phenylbutazone (commonly known as “bute”) or other non-steroidal anti-inflammatory drugs (NSAIDs) commonly used in horses may also contribute to the development or worsening of gastric ulcer disease although they are generally considered safe for short durations at label doses.

Given the importance of managing EGUS to optimize the health, welfare, and performance of Thoroughbreds, various medications have been developed. Sucralfate coats the ulcers to prevent further damage and allow healing, ranitidine and omeprazole decrease the acidity of the gastric juice, and misoprostol protects the lining of the glandular mucosa in the lower part of the stomach.

Manufacturers of most commercial preparations of omeprazole recommend treating ulcers with 4 mg/kg per day for four weeks. To prevent recurrence of gastric ulceration, horses can be treated longer term at a lower dose, usually 1 to 2 mg/kg per day.

Like any medication however, omeprazole doesn't always come up roses. In addition to the fact that long-term administration of any medication can be economically draining, omeprazole hasn't been tested for its long-term safety. Further, even its short-term use may not be as innocuous as one might think.

In a recent article in the journal, Equine Veterinary Education, Sykes shared four major concerns associated with omeprazole administration:

  1. Rebound gastric hyperacidity. After abruptly discontinuing omeprazole, the gastric contents may become more acidic than normal, which may explain the rapid recurrence of ulcers in some horses.
  2. Changes in fecal microbiome. The population of microorganisms in the equine hindgut that contribute to the overall health of the horse can be negatively affected by any medication. Omeprazole does not appear to alter the microbiome after 28 days of omeprazole administration, but the long-term effects have yet to be studied.
  3. Interaction with NSAIDs. Bute and other NSAIDs can contribute to the development of gastric ulcers, and many horses treated with these medications receive omeprazole.

    “A recent study showed, however, that while omeprazole helps prevent gastric ulcers potentially caused by NSAIDs, this drug combination appears to cause hind gut issues such as small colon impactions and diarrhea that can potentially be fatal, especially when high doses of phenylbutazone are used,” said Sykes. “Considering this, my current recommendation is to avoid the co-administration of NSAIDs and omeprazole, or at least to use the lowest effective dose possible for both drugs.  If concerns about the potential for NSAIDs such as bute to cause gastric ulcers persist in a particular patient, then sucralfate is a reasonable alternative to consider.”

  4. Increased fracture risk. Increased fracture risk is a significant concern with omeprazole administration in humans, both in geriatric and juvenile populations.

    “To date, no evidence exists that omeprazole has a similar effect in horses,” said Sykes. “Studies looking at the short-term effects of omeprazole on bone metabolism have found no effect of the drug. But there is data in horses that the proposed pathways that contribute to fracture risk in humans also occur with short-term omeprazole administration in the horse.”

    Long-term data are both lacking and much needed, considering the relevance of fracture risk in the racehorse industry.

In short, omeprazole is used widely both for short- and long-term use for EGUS in horses, has good reported efficacy, but may be associated with a number of important safety concerns.

“In other words, omeprazole has a high safety profile, but it does not mean omeprazole is universally safe,” Sykes said.

Ideally, veterinarians, trainers, and owners would seek to use the lowest possible dose of omeprazole that maximizes outcomes.

“Optimizing absorption will help us get more bang for our buck,” Syke said. “Giving omeprazole after fasting overnight will allow more of the drug to be absorbed compared to horses that had been fed. This means that we only need to administer about half the amount of the drug to achieve the same level of acid suppression if given when the horse has not fasted.”

As we know, though, one of the cornerstones of improving management of horses with EGUS is ensuring horses have continual access to hay. So, should we worry about withholding hay overnight? Sykes advised absolutely not.

“Horses naturally do not eat overnight even if they have ad libitum hay. Instead, they spend most of that time resting or sleeping,” he said.

Sykes therefore proposed the following tips for using omeprazole as safely and effectively as possible based on the currently available information on this drug:

  • Fast horses overnight. Take away the horse's feed by 10 p.m.
  • Administer omeprazole first thing in the morning before feeding and exercise. Peak absorption of omeprazole from the gastrointestinal tract into the circulation occurs around 60 minutes so the horse should remain unfed for 30 to 60 minutes after administration
  • Start treating horses with only 2 mg/kg omeprazole per day. Only increase the dose to 4 mg/kg if needed (based on a lack of clinical response or gastroscopy—direct visualization of the stomach wall using a scope by a veterinarian)
  • Administer other medications for gastric ulcers separate from omeprazole.

“Sucralfate, ranitidine, and misoprostol should not be administered at the same time as omeprazole. These medications will interfere in the action of omeprazole and the pH of the stomach contents will not increase as expected,” Sykes explained.

Instead, these other medications can be administered at the time of feeding, 30 to 60 minutes after omeprazole administration, or in the afternoon (omeprazole is given once a day in the morning).

“Exercising after omeprazole administration and feeding, even if just a small meal, will also increase the effectiveness of omeprazole because most of the damage to the squamous mucosa in the upper region of the stomach occurs during exercise,” Sykes said.

Overall, Sykes suggested that owners should not necessarily be deterred from using omeprazole, but should certainly cognizant of these safety issues.

“Omeprazole, like any prescription medication, should be used in a safe and responsible manner,” he said. “Implementing the recommended management changes alongside administration will help achieve either comparable or even more complete treatment responses and better outcomes with lower omeprazole doses. This not only has financial benefits but is also expected to further improve the drug's safety profile by using the minimally effective dose.”

Dr. Stacey Oke is a seasoned freelance writer, veterinarian, and life-long horse lover. When not researching ways for horses to live longer, healthier lives as athletes and human companions, she practices small animal medicine in New York. A busy mom of three, Stacey also finds time for running, hiking, tap dancing, and dog agility training. 

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Pain Management Strategies for Laminitic Horses: Different Solutions For Different Causes 

Very few equine conditions can be as debilitating as laminitis, which can be triggered by a variety of events or occur on its own. Laminitis occurs when the laminae, a set of finger-like structures which support the coffin bone and hold it in place in the hoof capsule, become inflamed. This inflammation is incredibly painful and can be catastrophic for the horse's athletic career.  

Many horses that develop laminitis are not euthanized because of the changes to the laminae, but because of the uncontrollable pain the condition brings on. A virtual session of the 2020 American Association of Equine Practitioners annual convention summarized the current research on the best way to manage pain in different types of laminitis cases.

The pain a laminitic horse feels is multidimensional. It can be brought on by pressure within the hoof capsule, inflammation of the laminae, tearing of soft tissues, a reduction of blood supply to the hoof, contact between the coffin bone and the sole of the hoof, and neuropathic pain.  

Dr. Katherine Ellis of Gail Holmes Equine Orthopaedic Research Center at Colorado State University, explained several different strategies for different causes of laminitis. Phenylbutazone (bute) is commonly given to treat laminitis, but that other drugs, including as flunixin, ketoprofen or firocoxib, may be better at controlling laminitic pain.

Ellis stressed that if an NSAID doesn't seem to be providing pain relief to a laminitic horse, another should be considered. A horse that has developed laminitis from overindulging in grain would benefit from having his hooves submerged ice water. This will be helpful for controlling pain and limiting injury. Ideally, the hooves would be submerged constantly for 48 to 72 hours, though this is a labor-intense endeavor. 

Metabolic issues like equine metabolic syndrome (EMS) and Cushing's disease can put a horse at risk for chronic laminitis. Gabapentin has been shown to be an effective pain medication for horses with chronic laminitis, but higher doses of pain medications may be necessary to provide relief. 

Ellis noted that acupuncture and use of a TENS unit may offer some additional pain relief. Chiropractic work and massage may offer respite from body pain brought on by the laminitic stance.

A horse that has an injury to a leg may develop supporting limb laminitis. Ellis suggests using morphine and butorphanol blocks and fentanyl patches to help control pain in these cases. A tramadol and ketamine infusion can also be used. Ellis notes that biologics like stem cells and platelet-rich plasma can be used for the anti-inflammatory properties. 

Read more at EquiManagement

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