More than four years ago in response to the death of GI-placed Bobby Abu Dhabi (Macho Uno)–what was initially suspected a sudden cardiac-related event–the TDN took a lengthy dive into the issue.

In a nutshell, sudden cardiac deaths oftentimes leave no discernable physical sign for pathologists to piece together a clear diagnostic picture–no major lesions, faulty valves, ruptured arteries or damaged heart tissue for them to point to with authority and say this or that caused the heart to stop.

In a well-considered study published in 2011 looking at post-mortem findings from 268 Thoroughbred racehorses that suffered exercise-related sudden deaths, pathologists made a definite diagnosis in only 53% of cases, a presumptive diagnosis in 25% cases, while 22% of cases were left unexplained. In humans, coincidentally, about one-third of sudden deaths are presumed to be cardiovascular-related but don't actually have any concrete diagnosis.

Veterinary experts remain after all these years largely circumspect when pressed as to exactly what causes these events in racehorses, with fingers pointed towards electrical abnormalities like arrhythmias, genetic predispositions, drug use and faulty valves of the heart.

“We're asking better questions and we're asking more questions,” said Dionne Benson, chief veterinary officer for 1/ST Racing, when asked why progress has been slow in better understanding sudden death cases in racehorses. “But we've just started to ask those questions the last few years.”

Causes
Part of the reason is the infrequency with which these events occur. This paper pinned the number at roughly one sudden death per 10,000 individual starts.

Last Friday, the TDN asked the Horseracing Integrity and Safety Act (HISA)–mandated to record and report all equine fatalities at participating jurisdictions–how many sudden deaths have occurred since the law went into effect on July 1 last year. HISA did not provide an answer.

This study from last year found that sudden equine deaths were more likely during training than during racing, and horses with fewer lifetime starts were at higher risk.

“Exercise intensity appears not to be critically important in precipitating sudden cardiac death in horses,” the researchers summarized, before adding that typically, “sudden cardiac death occurred early in the careers of affected horses.”

A pivotal area of research surrounds so-called “electrical irregularities,” like arrhythmias (an irregular heartbeat), and heart murmurs (the presence of irregular heartbeat sounds).

Indeed, some 50% of racehorses experience cardiac arrhythmias when put under some kind of physical duress. That is one main reasons researchers out of the University of Minnesota are in the middle of a study of some 1,200 Thoroughbreds and Standardbreds with normal heart function at rest, but who develop arrhythmia during exercise.

“It's really hard to know for sure because when a horse dies, the electrical conductivity of the heart stops,” said Molly McCue, a professor and the associate dean for research at the University of Minnesota College of Veterinary Medicine, explaining why there still remains no concrete scientific proof that electrical irregularities cause sudden cardiac death, even though most experts agree that these issues are key to getting to the root of the problem.

In this regard, many veterinary experts bemoan the fact that in this scientific arena, horse racing is in some regards the medieval cousin of human athletics, which has already been closely monitoring and studying the heart's electrical capabilities for many decades, meaning so much of the dynamic possibility of a racehorse's heart remains shrouded in mystery.

Back in early 2015, in a study encompassing 30 racehorses in California, none of the horses suffered arrhythmias, but the authors noted a post-exercise increase in what is called valvular regurgitation, which is when heart valves don't close properly, allowing blood to flow backwards in the heart.

About 20% of healthy Thoroughbreds have some degree of valvular regurgitation when examined–but again, any clinical significance is currently unknown.

Despite the vast body of cardiac research in human athletes, the National Institutes of Health has its eye on the Grayson-Jockey Club funded arrhythmia study “as an interesting model for what happens in young human athletes,” McCue said, with the occurrence of sudden death in horses far higher than in humans.

“The frequency in horses, it's about 10 times more common than it is in people,” McCue said.

Another fast-evolving area of interest concerns genetics. Human science has found a genetic connection to a higher risk of heart disease. In racehorses, any potential genetic correlation with a higher likelihood of sudden death is still largely at lift-off.

McCue and her fellow researchers are taking DNA samples from the same 1200 horses in the arrhythmia study to see if any genetic pattern emerges. McCue calls these two studies “a two-pronged effort” to identify early horses at higher risk of experiencing sudden death.

“One is the genetics, figuring out who is high-risk and who we need to screen and look at really critically. And then two, developing tools that can identify the horses this is most likely to happen in,” said McCue.

“Our hope is that if we can develop computer models that can predict if a horse is more likely to experience severe arrhythmias today, we can then pull that horse from racing,” McCue added.

Some heart problems among horses that suffer sudden death are much easier to diagnose–but structural abnormalities are rare. A 2011 paper found that about 1% of horses who die suddenly suffer a ruptured aorta, which is the largest artery in the body.

Which brings the story around to the presumed connection between drugs and sudden cardiac death–the touchpaper of any high-profile sudden death in racing.

Drugs
“Here's the problem,” said Rick Arthur, former CHRB equine medical director. “People watch CSI and they see them taking a fingernail clipping and they can tell you what you had for lunch three days ago. Life doesn't work that way.”

In other words: Unlike an episode of CSI: NY, which typically wraps with a neat conviction, investigations into sudden racehorse death rarely conclude as tidily, even when a link emerges with a suspected substance.

Just take the case of a Standardbred that died suddenly at Cal Expo in early 2014. The horse, Arthur said, was subsequently found to have abnormally high levels of cobalt (a naturally occurring element) in its system.

The trainer faced no punitive actions because the death occurred before the CHRB passed rules instituting cobalt thresholds in test samples, said Arthur, who equivocated on whether the horse's death could have been definitively linked to an administration of cobalt.

“The cobalt was so high that it could have been associated with it,” Arthur said. “But again, that's when we were suspicious of cobalt–we might have over-interpreted it. But it certainly was very high.”

A recent limited study on six Standardbreds found a possible connection between cardiac arrhythmias (including atrial fibrillation) and levothyroxine–a thyroid supplement linked to the sudden deaths of seven Bob Baffert trained horses between 2011 and 2013.

A subsequent CHRB report noted that the horses had been administered thyroxine, and that use of thyroxine is “concerning in horses with suspected cardiac failure.” However, the report also noted that, because the drug had been administered to all horses in Baffert's care, the use of thyroxine “does not explain why all the fatalities occurred.”

Arthur co-authored a paper finding a “very strong” connection between anticoagulant rodenticide exposure and an increased risk of sudden death during exercise from unusual hemorrhaging. Strong suspicions surround the bronchodilator clenbuterol, which has been proven to increase heart muscle. Iodine–commonly found in seaweed-based supplements—has also been linked to arrhythmia.

“Certainly there are other things. Horses can build up levels of selenium [a naturally occurring mineral] which can cause sudden death,” Benson said. “You can also have things in the feed like monensin [a polyether antibiotic toxic to horses].”

In human sports the rise of erythropoietin [EPO]–a synthetic form of a natural metabolic product that thickens the blood–was linked to the deaths of multiple young professional cyclists and other athletes. Has illicit EPO use in horseracing ever been linked to any sudden equine deaths?

“No–at least not in California,” said Arthur, who said that EPO would have the same effect in horses' blood by thickening it though increased blood cell count, a process called polycythemia.

But a diagnostic complication in this issue, Arthur added, is how horses are “natural blood-dopers because of their huge spleens.”

Virus
 Springtime, of course, is equine virus hunting season. And viral infections are known to cause myocarditis, inflammation of the heart muscle.

“It's always a possibility,” said Francisco Uzal, coordinator of the California Animal Health and Food Safety Laboratory post-mortem program for the CHRB, when asked if a viral infection could explain the two recent Joseph-trained sudden deaths.

Uzal added, however, that while he has never seen during any sudden death necropsy instances of severe myocarditis–which would show up under the under the microscope as large lesions–“we've found in a number of sudden-death horses really, really mild and minor myocarditis.”

More tellingly, said Uzal, is how the same minor heart lesions appeared in horses that didn't suffer sudden death events. “You see it in normal horses, too. So, what does it mean? Probably nothing,” he said.

“This is so frustrating for us,” Uzal added. “We go home empty-handed most of the time.”

Which leads to the finer points of the actual necropsy process. Even if a substance suspected of increasing the likelihood of sudden equine death shows up at what are presumed elevated levels during the necropsy process, it doesn't necessarily indicate a smoking gun.

Take thyroxine, an endogenous substance, meaning it's produced naturally inside the body and therefore harder to evaluate than a medication with its own specific pharmacological signature.

“When you do a test, you compare what you find with the normal values in a normal animal in a living horse. There are no normal values for dead horses,” said Uzal, highlighting how difficult it is to determine baseline levels for endogenous substances like thyroxine.

“But having said that, we have compared the thyroxine found in postmortem blood in sudden death horses with the same in normal horses, and we found no difference,” he said.

Helpful to better understanding the underlying causes of sudden cardiac death in racehorses would be if all necropsies were made equal.

Uzal co-authored a 2017 paper highlighting how “autopsy technique” varies depending on personnel and “institutional preferences.”

As Uzal puts it, “pathology is a science as well as an art. You talk to 10 different pathologists, you hear 10 different stories. We have tried very hard to standardize, and we are still fighting for it.” In this regard, could federal intervention be on its way?

HISA's racetrack safety rules require all horses that die or are euthanized on licensed grounds at all participating jurisdictions undergo a necropsy. But the rules appear broad and fail to mandate more specific uniform rules on necropsy protocols.

HISA did not respond to a series of questions on the issue of necropsies. This includes whether every horse that has died during racing and training at jurisdictions under HISA's oversight have undergone necropsy examinations, and whether HISA has indeed instituted uniform protocols or guidelines for the actual necropsy process.

Future
In a bid to fill in some of the glaring blanks surrounding sudden death, UC Davis has begun storing necropsy samples taken from sudden death horses in a large freezer to be retrieved and re-tested in the advent of more sophisticated analytical technologies.

“The other thing we do from each horse, we have multiple different containers. So, the idea is we can provide it to different people,” said Uzal.

More contemporaneously, Uzal and his team are poised to begin studying the training records of horses that suffer sudden cardiac deaths for any possible explanatory patterns.

“We want to see if there's something in the training that could give us a clue of what's happening,” said Uzal. “We want to see if it's possible–and I don't know if that's the right expression–but see if it's possible that some horses are trained to the point of exhaustion.

“I don't know the answer–it's pure speculation,” Uzal added. “It could be nothing, or it could be something.”

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“It was horrific,” Butler said. “Can you imagine having bloody helicopters from the news stations flying over the track every time a horse was injured.”

Butler was relatively new to the job at the time, and a fresh perspective was helpful. While some were quick to tell him that the breakdowns were “part of the game,” he represented a management team that refused to accept what was happening and knew that Santa Anita may not survive unless they fixed the problem. So they went to work.

So when the field safely crossed the wire in the Dec. 31 Las Flores S., the last race of the year run on the main track, Butler could have been excused had he popped open a bottle of champagne. The year was over and not a single horse had suffered a fatal injury during a 2022 dirt race at Santa Anita.

“That's one of those things you hope for but it seems almost impossible,” said Dr. Dionne Benson, the chief veterinary officer for the Stronach Group. “I could not be more thrilled with the work done by everyone involved. And that is what has made all the difference.”

There was also plenty of good news last year at Del Mar. Not a single fatality occurred in a race during either of the 2022 Del Mar meets. There were two fatalities during fall racing, both were non-musculoskeletal and were classified as sudden death.  In 2019, the track experienced two deaths during races.

“Since we implemented a series of reforms four years ago, including enhanced training protocols and increased veterinary and track surface monitoring, Del Mar has been one of the safest tracks in the country for horse and rider,” said Del Mar President and COO Josh Rubinstein. “It is great to see similar progress throughout the state, though we know safety and welfare are ongoing and we need to stay vigilant.”

At Santa Anita, the numbers in 2019 were ugly. During the meet that began on Dec. 26, 2018 and ran through June 23, 2019, 30 horses died. And that was with Santa Anita shutting down for three weeks to try to get the problem under control. The media was relentless and every breakdown became a major story. Animal rights groups like PETA were putting immense pressure on Santa Anita and some were calling for racing to be shut down in the state.

“At the time it was a very angry place and everybody was pointing fingers at everyone else,” Butler said. “A lot of it was completely unnecessary. Nobody wants to see animals get injured. Its not good for anyone's business.  But 2019 gave us the ability to look at things differently because things had really gotten bad. Everybody understood that something had to change. Something had to give.  Horsemen, owners, trainers, everyone, understood that business as unusual will not fly anymore. The emphasis on safety had to be the core of the sport because without it the sport could be in jeopardy.”

The question became, what can be done? There will probably always be fatalities in racing, but can steps be taken to reduce the numbers significantly to the point where Santa Anita is no longer the most dangerous track in the country but one of the safest?

“Everything we do must have an emphasis on safety,” Butler said. “That's bandied around a lot and everybody likes to talk about safety and how they want the races to be safe. We had an opportunity in 2019, albeit after an awful situation, to really reset the clock and look at every aspect of how we operate at Santa Anita.”

So what they did was look at virtually every aspect of the sport and try to figure out how they could make things safer. While many factors were in play, the one that seems to have produced the most results was management's decree that horses had to constantly be under the microscope and constantly subjected to veterinary exams. In 2022, 5381 veterinary exams were conducted on 4,673 unique horses.

“If I could pick one thing that had made a difference is the vet-trainer inspection prior to a workout or a race,” said trainer Eoin Harty, the president of California Thoroughbred Trainers. “You're forced to stand there and watch your horse jog up and down the road with your vet. If there is any doubt whatsoever your vet isn't going to sign off on it because it's going to be on his head if something happens. They have to sign a book that says the horse is good and that information is turned into the racing office. All the checks and balances have to be in place.”

Benson said that trainers have learned not to attempt to race or work horses if they are having any problems that could lead to an injury.

“It's been an effort by the veterinarians that we have who work for Santa Anita as well as the private veterinarians,” Benson said. “We look very critically at horses to make sure they are ready to race. And the trainers are doing an excellent job of horsemanship and making good decisions for their horses.”

Harty said that while trainers don't like all aspects of the extra scrutiny they have come to understand that it is necessary.

“Initially, there was some push back,” he said. “But trainers in California realized at the time that we were in a dire situation and unless everybody got on board and started pulling with the same oar potentially we were going to be out of business. There is always resentment when there is a change like that but in general horsemen have come to embrace this. People can adapt very quickly when they have to.”

Management has also been extra cautious when it comes to the racing surface and hired Dennis Moore to be the track superintendent. Concerned that when there is too much moisture in the track problems could arise, Santa Anita will cancel when the weather gets to be a problem. That was the case over the last few days when racing was cancelled on both Saturday and Monday due to heavy rains in the area.

Butler said another factor has been a crackdown on the use of medications used to block or numb pain.

“We're making sure any horse out there isn't on any pain blocking medications,” he said. “With any athlete, if you have anything wrong, medications that block the pain is where larger problems can start.”

The numbers weren't perfect at Santa Anita in 2022. When turf racing, training on the main track, training on the training track and sudden deaths are included, there were 12 deaths at the track in 2022. While that's 12 too many, it represents a major decline from recent years. During the fiscal year that ran from July 1, 2018 to June 30, 2019, there were 49 total deaths at Santa Anita.

Maybe there will come a time when 12 deaths seems like a lot, and the Santa Anita team has vowed to keep working to reduce the number to as a close to zero as a racetrack can come. In the meantime and after the situation had hit a rock-bottom level, it's not lost on anyone at Santa Anita how much better things have gotten.

“What happened in 2019 is that it opened up our eyes as to how we must make this sport safer,” Butler said. “Because if we didn't the sport was going to be in jeopardy and be in jeopardy quickly. Luckily for us, Belinda Stronach is not the sort of person to shy away from a battle. We engaged in what we thought was the only way to try to fix things and the numbers we see now speak for themselves. By fixing things the way we did I think we potentially saved the sport in California.”

The post With No Main Track Racing Fatalities in ’22, Santa Anita Continues to Make Strides on Safety appeared first on TDN | Thoroughbred Daily News | Horse Racing News, Results and Video | Thoroughbred Breeding and Auctions.

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   The latest edition presents a trio of successful veterinarians–The Stronach Group's Chief Veterinary Officer Dr. Dionne Benson, equine surgeon Dr. Patty Hogan (Hogan Equine Clinic in Cream Ridge, NJ) and longtime racetrack practitioner Dr. Bill Hawk, who counts Hall of Famer Steve Asmussen among his vast clientele.

Over the course of the last decade, racing has faced significant growing pains, transitioning from the norms of yesterday into the necessities of today. And veterinary medicine is no different, having seen its equine professionals put under increasing scrutiny and pressure. Also, long work hours and weekends and keeping pace with the enormous volume of work among a dwindling community of peers are just a few of the factors making it increasingly harder to entice graduating vets and to keep existing ones in the equine branch.

“It's an incredible career but it does have some real highs but some real lows,” admitted Dr. Hogan.

One of the highs in the industry, according to Dr. Hawk, is a communal approach among vets, including both track practitioners and regulatory veterinarians, who help propel the industry in the right direction.

“This is where practicing and regulatory veterinarians in my view work very well together,” he said. “Every time that I had an incidence where I thought there was not proper care being delivered or stalls bedded properly or certainly an injury not properly taken care of, I spoke to our regulatory veterinarians anywhere I've ever been and I always found that was attended to almost immediately.”

While equine health and safety is generally among the key talking points in the industry, the health–both physical and psychological–of the equine veterinary community is one that is often overlooked. However, the emotional investment by the equine vet underscores the unwavering commitment to made to the animal and their clients.

“I'm like a high-end auto repair shop for sports cars, but these sports cars are animals that have personalities and they react to you,” said Dr. Hogan. “When I have a particularly hard case, and I lose that case, it's very tough. I still think of horses that I had to euthanize 20 years ago. They are all individuals. That's the hard part for me. They're real-life animals and you get to know them.. So it's still very personal for me because I have very individual relationships with these horses.”

And like other professions in racing, veterinarians have come under fire of late for the behavior and actions of a few bad apples, however, the vast majority of vets remain staunchly motivated to do right, and passionately work to help protect the animals they oversee on a day-to-day basis.

“I get really offended when somebody mistreats one of these horses,” admitted Dr. Hawk. “Let's be honest, this is an entertainment industry and they are giving there all for our entertainment..and we're not doing our part if someone does not take care of that animal and then we don't say anything about it. It's just wrong on every level.”

Despite all the hard work and oftentimes thankless press, the men and women that are charged with caring for the sport's equine athletes are often driven by the most basic of forces–the sheer love of the horse and the commitment to its health and welfare.

“I can't look at the day-to-day, because I'm going to have really bad days and, hopefully, a lot of really great days,” Dr. Benson added. “I look at where we're headed. Are we improving the industry? Are we making things better? Are we seeing fatalities drop? Are we seeing horses racing healthy longer. If I feel like we're still moving, that's what keeps me going personally is that I feel like there are still things we can do to help.”

To watch the 'Let's Talk' podcast, click here and to listen to the audio only version, click here.

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The Equine MediRecord platform that will be used for the 2022 Pegasus World Cup allows for the full veterinary history of the horse to be collected digitally and recorded securely. Use of this innovative platform will be mandatory and will provide all entrants, trainers and veterinarians with a user-friendly system to comply with the strict medication protocols for this year's event. Integrity of the veterinary information will be ensured using the unique algorithms found in the Equine MediRecord technology. Once the records are entered into the system they cannot be altered. Results are submitted digitally to designated regulators and officials ensuring the highest level of integrity and transparency of veterinary records.

“The digitization of veterinary records for the Pegasus World Cup is an example of how 1/ST is innovating and using technology to improve our sport,” said Dr. Dionne Benson, Chief Veterinary Officer, 1/ST RACING. “The partnership with Equine MediRecord and the collection of this data is a tool that we can use to protect the safety and wellbeing of horses. 1/ST is committed to integrity and accountability, and this is another measure available to us to enforce those standards.”

“Equine MediRecord's platform has seen extensive international traction in the three-years since we have launched and we are thrilled to be partnering with 1/ST for the Pegasus World Cup,” said Pierce Dargan, Chief Executive Officer, Equine MediRecord. “We are excited about our partnership with 1/ST and doing all we can to help ensure that best horse welfare and transparency protocols are followed in equine sport”

The Irish company whose technology is fast becoming the global standard for equine sport organizers has already amassed an impressive list of clients and users including the Thoroughbred Owners of California, Irish Veterinary and Welfare Commission, Kentucky Thoroughbred Association, the Arabian Racing Organisation, Breeders' Cup World Championships and the Saudi Cup.

The post Pegasus World Cup Partners With Equine MediRecord To Digitize Veterinary Records Ahead Of Race appeared first on Horse Racing News | Paulick Report.

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The Equine MediRecord platform that will be used allows for the full veterinary history of the horse to be collected digitally and recorded securely. Use of this platform will be mandatory and will provide all entrants, trainers and veterinarians with a user-friendly system to comply with the strict medication protocols for this year's event. Once the records are entered into the system they cannot be altered. Results are submitted digitally to designated regulators and officials ensuring the highest level of integrity and transparency of veterinary records.

“The digitization of veterinary records for the Pegasus World Cup is an example of how 1/ST is innovating and using technology to improve our sport,” said Dr. Dionne Benson, Chief Veterinary Officer, 1/ST RACING. “The partnership with Equine MediRecord and the collection of this data is a tool that we can use to protect the safety and well-being of horses.”

The Irish company whose technology is fast becoming the global standard for equine sport organizers has already amassed an impressive list of clients and users including the Thoroughbred Owners of California, Irish Veterinary and Welfare Commission, Kentucky Thoroughbred Association, the Arabian Racing Organisation, Breeders' Cup World Championships and the Saudi Cup.

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Some readers have since wondered whether any of the samples taken as part of the procedure may be preserved for future testing. According to a statement from the CHRB made to the Paulick Report Dec. 8, that is part of standard protocols for all equine necropsies in the state.

“The CHRB has a post-race retention policy for official post-race samples,” said CHRB spokesman Mike Marten. “Under Rule 1859, samples are frozen and retained for possible retrospective analysis. The samples from Medina Spirit have been retained.

“Additionally, regarding separate necropsy samples, fresh/frozen tissues are usually kept for three months, Formalin fixed tissues for five years, and paraffin blocks and slides forever.”

The final report on the horse's death will be made public.

Medina Spirit had just completed a five-furlong workout Monday morning when rider Juan Ochoa felt a change in the Bob Baffert trainee just past the wire and began pulling the horse up. Blea said the colt, owned by Zedan Stables, had already fallen and died when attending veterinarians got to him. Ochoa was uninjured.

Roughly 15 percent of on-track deaths in California are these so-called “sudden deaths” which are not connected to an musculoskeletal injury or illness and happen with no outward signs of anything amiss. Experts suspect many of them are attributable to cardiac problems, but the exact cause can be elusive. Necropsies in these cases can sometimes identify a physical abnormality in a horse's heart, but sometimes the veterinary pathologist is unable to find anything unusual.

Read more about what the goals of a necropsy program in this 2017 Paulick Report feature.

It remains unclear whether The Stronach Group will conduct an independent investigation apart from the CHRB's fact-finding surrounding the horse's death.

“We are awaiting the results of the CHRB investigation and we will wait until the conclusion of that process,” said Dr. Dionne Benson, chief veterinary officer for 1/ST Racing. “We are, however, providing any and all information we have to the CHRB.”

The post CHRB: Medina Spirit Samples Will Be Preserved After Necropsy, Per Standard Procedure appeared first on Horse Racing News | Paulick Report.

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The Zoom webinar meeting will be held on Tuesday, Sept. 28 at Noon eastern.

Participants include MRC Executive Director Mike Hopkins; MRC member Dr. Thomas Bowman, who chairs the commission's Equine Safety, Health and Welfare Advisory Committee; Dr. Dionne Benson, Chief Veterinary Officer for 1/ST RACING (The Stronach Group); Dr. Mary Scollay, Executive Director of the Racing Medication and Testing Consortium and Alan Foreman, Maryland Thoroughbred Horsemen's Association general counsel and Chief Executive Officer of the THA.

The MRC, upon the recommendation of the advisory committee chaired by Bowman, approved a motion to modify a regulation on the five corticosteroids to eliminate testing threshold levels and employ limit of detection—the lowest level at which a laboratory can, with confidence, detect a substance in a sample.

The change will be filed with emergency status and there will be a public comment period. It is anticipated the updated regulation will be implemented Nov. 1, Hopkins said.

The five corticosteroids are dexamethasone, prednisolone, betamethasone, isoflupredone and triamcinolone. The current 14-day stand-down period for intra-articular injections will remain in place under 2019 model rules approved by the Association of Racing Commissioners International and RMTC.

The advisory committee discussed the proposal at a Sept. 8 meeting as a result of several dexamethasone positives and reports the corticosteroid was being regularly administered by some veterinarians at 48 hours before a race at a lower dose rather than the RMTC-recommended 72-hour withdrawal time at the regular dose.

The webinar is open to all Maryland horsemen and practicing veterinarians. Advance registration is required to join by clicking here.

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Dr. Dionne Benson, chief veterinary officer for The Stronach Group and former executive director of the Racing Medication and Testing Consortium, presented a continuing education seminar for trainers in July to help them distinguish the different categories a drug may fall into and to determine if the product they're looking at is illegal.

When dealing with prescription (sometimes called “legend”) drugs, the first approved version of a new drug is called a pioneer drug. This is a substance that has been legally recognized by the Food and Drug Administration as a new animal drug and has been subjected to considerable testing to demonstrate its safety and efficacy, as well as the purity of its manufacturing process and the stability or shelf life of the drug. They also must show that the manufacturing process is consistent, and the concentration and purity of the drug doesn't change from batch to batch. Pioneer drugs also must show considerable research to validate their suggested doses and uses, and must meet rigorous requirements regarding their package labeling and advertising to be sure consumers are being presented with accurate and complete information.

The FDA approval process for new drugs is long, arduous, and expensive, so to give drug makers an incentive to go through it, they are permitted temporary patents on new substances. This means that for a limited number of years, the company that went through the approval process will be the only one that can legally produce the drug, allowing them to better recoup some of their expenditures in the approval process.

A generic medication is subject to all the same requirements regarding safety and efficacy, and may only be legally produced when the patent on the pioneer version of the drug has expired.

Both types of medications are also subject to adverse event reporting, so there is a public record of any negative side effects or bad reactions to a given drug or batch of drugs and those events can be investigated.

Compounded drugs aren't subject to any of that federal oversight.

Compounding may only be legally done in certain narrow parameters. A compounding pharmacy may only make a drug in response to a prescription a veterinarian has written to treat a specific condition in a specific animal, and it should only take place when there is no legend drug (either a pioneer or a generic) available to serve the patient's needs. Compounders can legally add flavoring to drugs to make them easier to administer, or take a drug traditionally offered in one form like a paste and make it into another, like a powder. In some limited circumstances, a compounder may legally mix two medications to reduce the amount of needle sticks a horse has to endure. In none of those situations should a compounder have large amounts of pre-formulated compounds sitting on the shelf awaiting an order – that, in the eyes of the FDA, is manufacturing. If an FDA-approved drug is no longer being manufactured or is on back order though, a compounder may make small batches of it but should not be in the business of mass manufacture.

“Compounded medications are legal under some circumstances,” said Benson. “Your vets use them every day and in the large majority of those cases they're using them appropriately.”

Benson has seen a number of examples of illegal compounds floating around the track however – sometimes sold online and sometimes peddled by sales reps.

One of the biggest areas of confusion seems to be what constitutes a generic drug. Compounded omeprazole products are a favorite of compounding pharmacies to produce in bulk, in part because horsemen are always looking for cheaper alternatives to the pioneer drug. But Benson said the patent on Gastrogard and Ulcergard, the pioneer form of the drug, hasn't run out yet, so all those “knock off” versions which people may think of as “generics” are actually illegal.

Compounders are also fond of getting around this restriction by combining omeprazole with another ulcer drug like ranitidine, with the result often being priced more cheaply than pioneer omeprazole.

“The funny thing about that one is if you're combining omeprazole and ranitidine you're actually deactivating one of them,” said Benson.

Omeprazole works by reducing acid secretion, while ranitidine works by neutralizing acid. You don't need both, and they tend to be used in different types of ulcer cases.

Of course, Benson said, it's true that the FDA isn't likely to show up at your barn and ask to examine your prescription bottles (although, the federal case demonstrates they will take an interest in racing now and then). So why should horsemen worry about the technicalities of drug production?

Benson said that the illegal compounds she has seen often come along with safety concerns. Compounders mass producing a legend drug and selling it as a “generic” version aren't having their products tested like approved generic drug manufacturers, and testing by the RMTC suggests the amount of active ingredient in these illegal substances can be wildly mismatched to what's on the label. Benson recalled one bottle of clenbuterol that had ten times the labeled concentration of the drug, which was “getting into toxic ranges.” Another test of a triamcinolone bottle found it contained just .01 percent of its labeled concentration.

Another trouble with unauthorized mass manufacturers of prescription drugs is that there's no assurance of consistency from batch to batch of the medication, so just because a horseman has given a drug from a pharmacy once with no issue doesn't mean the next batch will be the same.

Many of these illegal substances can also be missing key safety information on their packaging. Benson cited Gastrotec, an omeprazole/misoprostol product which she said is still in circulation, despite FDA warnings about it.

“What's terrifying about this medication is the misoprostol,” she said, pointing out that drug is half of the abortion cocktail used in humans. “In veterinary school, you can't touch this stuff without gloves. All the women on the backside, they're given this to give to the horse, and what's the first thing we do? We put the tube in our mouth to pull off the cap and give it to the horse.”

There was no warning about these human health risks on the boxes or tubes of Gastrotec, Benson said.

Benson said she believes trainers have a responsibility to educate themselves about what is and isn't permissible in the drug-making world. Just acquiring a product from a sales representative or a veterinarian isn't a guarantee it is legal.

“Oftentimes we assume whatever the doctor or veterinarian says is right,” she said. “We don't want to make them mad; we just go along with it. But realistically it's your license on the line. Very rarely does a vet get called into a hearing or have to call an owner when a horse dies.”

The post Here’s The Difference Between Pioneer, Generic, And Compounded Medications For Horses – And Why It Matters appeared first on Horse Racing News | Paulick Report.

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The presentation will feature Dr. Dionne Benson, Chief Veterinary Officer at The Stronach Group Racing and Gaming. Compounded substances are an area of concern for trainers interested in ensuring horse health and avoiding potential regulatory issues. While the use of compounded substances has a place in proper horse care, often they are overused, which increases the risk to horses and trainers alike. This CE will teach trainers the differences between compounded, generic and label medications. Additionally, the potential risks of using compounded medication will be covered.

You must register in advance to participate in this seminar.

To register, go to: https://us02web.zoom.us/webinar/register/WN_Km1xGy9rR6Ktx4BdUVUjdA

After registering, you will receive a confirmation email containing information about joining the seminar.

Following the presentation, there will be an opportunity to ask questions.

Dr. Dionne Benson, Chief Veterinary Officer at The Stronach Group Racing and Gaming, served as the Executive Director and Chief Operating Officer for the Racing Medication and Testing Consortium (RMTC) in Lexington, KY, from 2012-2019. She earned her Doctorate in Veterinary Medicine from the College of Veterinary Medicine at the University of Minnesota, and received her Juris Doctor (JD) from the William Mitchell College of Law. She practiced law as a commercial litigator for a number of years prior to enrolling in vet school, and was a Law School faculty member while attending veterinary school.

Horsemen U Website Offers 11 CE Courses Online

If you do not yet have a HorsemenU account, we invite you to go to the website, www.HorsemenU.com, to register. Trainers and assistant trainers can take the required hours of CE and store their Certificates all in one place, in the event they need documentation of compliance with Continuing Education regulations. Click here for answers to Frequently Asked Questions about HorsemenU.

There are currently 11 approved Continuing Education Courses available for trainers and assistant trainers on the Horsemen U website. The topics include:

• Basic Pharmacology for Racehorse Trainers
• Diagnostic Imaging of the Racehorse Fetlock
• Equine Drug Testing, with Dr. Scott Stanley
• The Equine Fetlock with Dr. Susan Stover
• Equine Welfare, Horseracing, and the Social License to Operate
• Equine Injury Database: 2019 Statistics and Data
• Lessons from the California Postmortem Program
• MRIs, with Dr. John Peloso
• PET Scans, with Dr. Mathieu Spriet
• Racetrack Safety, with Dr. Mick Peterson
• Racing Medication and Testing Consortium

Click here for more details of the CE Courses offered by Horsemen U.

The post Thoroughbred Horsemen’s Association To Host Compounded Medications Webinar Monday appeared first on Horse Racing News | Paulick Report.

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A recent initiative at The Stronach Group racetracks has been pushing the boundaries of that assumption – but not everyone is happy about it.

Taking the finances out of the equation

Two years ago, Stronach Group management was looking for whatever solutions it could find to the breakdown problem at Santa Anita. Facing what was an enormous public relations crisis, the company needed fewer dead horses. Its executives implemented a flurry of new protocols, including rolling back administration times for various therapeutic drugs, increasing veterinary oversight, and reducing whip use. Around that time, the company also began exploring the idea of funding surgeries on injured horses.

“As we looked around, we said, 'If we take the financial piece out of it, what decisions do people make?'” said Dr. Dionne Benson, chief veterinarian for 1/ST Racing, The Stronach Group's racing brand. “You look at a horse like ArchArchArch, who broke down in the Derby, got a fetlock arthrodesis and [became] a breeding stallion. Those are no-brainers for people because they want the residual value of the stallion. But often if you've got a gelding that's running for $5,000, there's an economic decision that's made. We wanted to allow people to make the decision for the horse while taking some of the economic burden away.”

Orthopedic surgery and subsequent care can cost thousands of dollars, and costs increase exponentially based on the complexity of the injury and the smoothness of recovery.  Benson and others worried that there were cases of owners or trainers looking at the prospect of operating on an injured horse as a money-loser, and choosing to euthanize – even in cases where the horse might have had a productive life in retirement. She also wondered how many horses were euthanized without significant diagnostics to even find out if they could be saved. Benson said she heard of one case – not at a Stronach track – where a horse was euthanized after pulling up lame with a sizable bump in the leg, which veterinarians assumed was a serious fracture. Only upon conducting a necropsy did they learn it was a hematoma.

Santa Anita is unique in that it has a fully equipped equine hospital on-site, so it's logistically easy to assess and operate on a horse with an orthopedic injury. Benson consulted the best orthopedic surgeons in the country, including Dr. Larry Bramlage at Rood and Riddle Equine Hospital in Kentucky and Dr. Ryan Carpenter, who operates at Santa Anita, looking for guidance on what makes for a good surgical candidate and what doesn't.

Then, the racetrack began funding veterinary care in cases where owners wouldn't or couldn't. In the past year and a half, Benson said The Stronach Group has paid for veterinary care on a variety of injuries, including some serious wounds, a bilateral condylar fracture, cannon bone fractures, and sesamoid fractures. The track was willing to pay for surgery even in cases where a referring veterinarian may have suggested euthanasia. So far, it has paid for surgery for 17 Santa Anita-based runners since the start of 2020, and 13 are alive and well – which Benson considers a solid success rate, assuming those horses may have otherwise been euthanized by their connections. From those 17, there were 11 fetlock arthrodesis surgeries, where a serious sesamoid fracture is repaired by fusing the bones in the ankle joint. Eight of those horses are still alive and doing well. For horses who would otherwise be dead, Benson said she's comfortable with those outcomes.

That early success rate prompted The Stronach Group to expand its surgical assistance program to its tracks in Maryland and Florida. In lieu of on-site surgery suites at the racetracks there, The Stronach Group has implemented partnerships with Rood and Riddle and the University of Pennsylvania to refer surgical candidates.

Currently, Benson said if a horse sustains an injury on track, the horse's treating veterinarian and trainer will typically put a splint on the injured limb, administer sedation and pain relief, and take the horse back to its stall for evaluation. Someone from The Stronach Group veterinary team will reach out and ask for diagnostic images on any horse who does not have a fracture coming through the skin and does not have injuries to more than one limb (with one exception in California). Horses with those injuries are not considered good surgical candidates. The track then offers to send those images to Drs. Carpenter, Bramlage, or Rood and Riddle surgeon Scott Hopper for a consult. If the surgeon tells the racetrack and connections they think the horse has better than a 50/50 chance at eventual pasture soundness with surgery and the horse's owner doesn't want to proceed, they are offered the opportunity to sign the horse over to The Stronach Group.

Dr. Ryan Carpenter

All of this takes time, but it's time Carpenter says he would normally give a horse anyway before deciding whether to proceed with surgery. Perhaps surprisingly, he says that the main indicator of whether a horse will do well with surgery isn't a matter of how gnarly their radiographs look – it's about the amount of swelling and blood supply they have to the area. Independent of this program, he often waits until the day after an injury before assessing a horse's fitness for surgery because that's when it'll be most clear how the blood supply responded to the injury.

Carpenter said he has learned from the past two years of the track-funded surgery in California that the responsiveness of on-track emergency personnel is key to a horse's chances. While a horse with a fracture wears a Kimzey splint in the trailer ride from the track to the barn, Carpenter prefers to remove it at the barn, take the necessary images, then wrap the leg and put the Kimzey back on as quickly as possible. That extra compression and support from the bandage can significantly reduce swelling, and even a few minutes' difference can have a massive impact on how the horse's blood supply reacts to the injury later.

While the program has been going full strength in California for a year and a half, it was implemented much more recently at Stronach Group facilities in Florida and Maryland. In Maryland, three horses have been sent to surgery at New Bolton Center by the track, and all three have lived. One was a spiraling medial condylar fracture on a hind limb that needed a plate. The referring veterinarian suggested euthanasia, but the surgeon said the horse had a 50 to 60 percent chance to return to racing. After seeing the surgeon's report, Benson said the horse's connections decided to proceed with the surgery themselves.

In Florida, Benson admits the results haven't been as strong; surgical success rate is at about 50 percent.

Not everyone is on board

The Paulick Report has interviewed a number of horsemen and veterinarians with direct and indirect knowledge of The Stronach Group's program to fund surgeries. All declined to speak on the record for fear of retribution from racetrack management, and most expressed serious concerns about the ethics of the program.

For horsemen who had not had a horse injured on track since the program came to their state, there seemed to be little concrete information provided by the racetrack about how it would work. Many had the impression the track was strong-arming trainers into signing over ownership of the injured horses (an allegation Benson denies), playing on their fears of losing stalls. They also had no access to information about the outcomes of injuries they'd witnessed and believed or assumed all or most horses trailered to nearby clinics for surgery had died.

People who had been involved with an on-track injury confirmed the track is not exerting pressure on connections to sign horses over, but did say they had serious concerns about whether the decision to send particular horses to surgery had been fair on the animal.

For horses that go through a complex surgery and long recovery from a procedure like a fetlock arthrodesis, many people questioned those horses' short- and long-term quality of life, along with the associated cost to care for them. Benson said that horses who had been saved by track-funded surgeries in California were placed via the California Retirement Management Account (CARMA) if they were only pasture sound. The track has committed to following those horses throughout their lives to ensure that, given the relatively limited vocational options for some, they didn't fall into a bad situation.

Carpenter said skepticism of the program in the case of serious injuries like sesamoid trauma likely comes from an outdated notion of what a surgical repair, like a fetlock arthrodesis, entails. Dr. Dean Richardson at New Bolton has perfected the procedure in recent years with new materials, cables and locking plates, and new approaches to the incision sites that make the surgery shorter, less complicated, and more likely to achieve a positive outcome than it did a decade ago.

“You have to acknowledge that just because we're done things a certain way for a long time, that doesn't mean that's the way we will continue to do them or should continue to do them,” said Carpenter. “An arthrodesis done today has a far better chance of survival than an arthrodesis done 10 years ago. but the perceptions of people today are often based on the perceptions of the past.”

This horse suffered serious wounds in a freak accident at Laurel when he reared and fell onto an iron fence. The Stronach Group funded his care, and he is ready to leave the hospital and begin rehabilitation.

He's also troubled by the number of people who seem intent on euthanasia in cases he thinks don't warrant it, including career-ending sesamoid fractures on horses without residual value in the breeding shed. While the critics of the program believe they are coming from a place of kindness, Carpenter believes he is, too.

“This is one where if it was American Pharoah, everyone would be cheering 'Give this horse a chance,' but when it's a $10,000 claimer, everyone's cheering 'Put it down,'” he said. “That, I don't understand. A horse is a horse. If it's good enough for American Pharoah and humane enough for American Pharoah, then it's good and humane enough for the $10,000 claimer that no one knows their name.”

But as the program expands to other states and continues over a period of years, a greater success rate will mean there will be more horses that need that kind of care and monitoring. Some have wondered whether it's fair to salvage a horse for pasture soundness, only to pass on the costs for the remainder of its 15 to 20 years of life to a non-profit or a well-meaning adopter. Private home placements for pasture ornaments are hard to come by, which is why there are so many retired horses in sanctuary facilities already.

The question asked independently by nearly everyone who expressed concerns to this publication was also – is The Stronach Group doing this out of the kindness of its corporate heart, or to reduce fatality numbers? Horses are considered racing or training fatalities for the purposes of the Equine Injury Database (EID) if they are euthanized due to injury within 72 hours of incurring the injury.

Benson said this isn't the motivation behind the program, and that horses vanned off and euthanized in the 72-hour window are reported by The Stronach Group to the EID as racing or training fatalities. In California, the horse racing board keeps its own records on racing and training fatalities and follows up with necropsies and post-mortem reports as part of state regulations. In Florida, on-track deaths are supposed to be reported to the Division of Pari-Mutuel Wagering, but it seems from public records as though those reports are made voluntarily by a trainer or treating veterinarian, not a state representative keeping independent track of deaths.

It's also true that the track's desire to give an injured horse a chance does, by default, create the opportunity to reduce fatality numbers – and those numbers are better in all three states since the surgical program and other reforms were implemented.

“We have reduced the number of racing related fatalities in Florida and they are consistent year over year in Maryland to date,” said Benson. “In training, we have reduced horse fatalities (on-track musculoskeletal and sudden deaths) by about half in both Maryland and Florida year over year. Additionally, while I cannot speak for Florida generally, we enter all fatalities and injuries to horses in the EID for our tracks and training facilities located there. Moreover, every horse that dies or is euthanized at Gulfstream Park or Palm Meadows is sent to necropsy at our expense. This has been the case for over a year.”

Benson and Carpenter agreed that those concerns voiced by horsemen in Florida and Maryland are nothing new – they heard them when they launched the program in California. Both now say that referring veterinarians and horsemen in California are on board with the program, largely because they've seen horses move on to second careers or achieve pasture soundness. They remain confident that eventually, their success at other facilities will convince the naysayers.

“I acknowledge the fact that what we're doing here in California is not going to be widely accepted in other states,” said Carpenter. “I think we're a little bit ahead of the curve and part of that is because of what we endured in 2019.

“What I saw very quickly in interacting with people who don't know anything about racing, is that every single fatality is significant. When you make the comment that 'This year we've only had 30 [fatalities]' — which from an industry standpoint is amazing — the people are still appalled because that's still a very, very big number.”

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