It's not that Dawson is indecisive, it's more a matter of him reacting to what is a constantly changing situation.

“A few weeks before the sale we had made plans to ship him to Gulfstream Park to Bill Mott to prepare for racing,” Dawson said. “We decided to have him examined one more time at Rood and Riddle and have an ultrasound to play it safe. The previous ultrasound had been really good so we were confident. This ultrasound showed he had regressed in his healing of the suspensory ligament. We had almost replaced all the scar tissue and it seemed to be repaired. We canceled transportation the next morning to Florida.”

So they entered him in the Keeneland November Horses of Racing Age sale as a stallion prospect. But Dawson was able to read the room. With Rich Strike coming off dismal performances in the GI Clark S. and in the GII Alysheba, his value as a sire prospect had never been lower.

“Throughout the process and up until a couple days before the sale, the gut feeling I had so far as Rich Strike becoming a stallion at this point in his career was that I was not going to get what I was hoping for,” Dawson said.

So it was on to Plan C., try to get him back to the races after all.

Under the advice of Dr. Larry Bramlage, Rich Strike has been, since exiting the sale, undergoing stem cell treatments aimed at healing the problems he's been having all along with the suspensory ligaments in his two front legs.

“After the sale I was thinking 'what am I going to do now?'” Dawson said. “I started checking options. I started further researching other options. We visited with Dr. Bramlage at Rood and Riddle and we talked about stem cell treatment. We were so close to getting him back before. If stem cells could bring anything to the party it could really make a difference. He's not terribly injured. He just has this on-going nagging-type issue and so we thought if we could get him healed he could race again and do so at a high level and win. That would make his stallion value a lot better. It's not a matter of dollars to me. I just want to get him into a situation where he has access to really good mares and therefore get him to a level playing field to produce great offspring. If you're covering mediocre or less-than-mediocre mares your stallion career is going to be pretty short.”

So the hope is that they can get Rich Strike over his problems and then turn him over to one of the best in the business in Bill Mott.

Rich Strike | Coady

“Bill Mott believes that if we can get him back to 100%, he can return to a similar level as his Derby race, his Travers, the Lukas Classic, races where he did really well,” Dawson said. “Bill doesn't think there's anything that can prevent him from doing that and I tend to agree.

“With the stem cell treatments, I talked to one trainer and owner and they'll tell you they had little or no success with stem cell treatments. Then others tell you they had a lot of success. If I can't get him healed and back to a point where he can withstand training and racing and being safe doing so then I will retire him. As long as I feel like we're improving his health, taking our time and giving him every opportunity to heal I'm all in favor for it. We have no time clock.”

Rich Strike remains at Margaux Farm, where all he is doing is walking and is not yet back under tack. Dawson is aiming for him to join Mott in April and begin serious training. Of course, that plan could go up in smoke if the vets don't like what they see from future ultrasounds. Dawson understands this plan is no sure thing, but believes it's the best possible route to take.

“All this means is that we're going to have a year off and haven't gotten beaten up,” the owner said. “In his age group, every time I look I see that someone else has been retired. The older class just gets smaller and smaller. My hope is that when he turns five, he'll be back in great condition and he'll be in great position. He can be older, bigger and better. I feel like if we get him back well and he could win a race or two will that will not only further his resume as a race horse, but it's also going to increase his value as a stallion. The risk is worth taking.”

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While discussing his thoughts on the rollout of the Horseracing Integrity and Safety Act's (HISA) drug control program, Ferraro shared his fears that the new federal rules on joint injections were weaker than had previously existed in California.

“It's a step backwards,” Ferraro said. And this regulatory reshuffle, he added, could lead to an increase in California of irreparable musculoskeletal injuries, especially of the fetlock joint.

“California is the point of the spear in terms of dealing with the public and the liability of horse racing,” said Ferraro, advocating for federal adoption of California's joint injection regulations. “I think they should use us as a sort of leader in animal welfare and jockey welfare.”

Ferraro's comments re-ignited a debate that has been simmering away in some fashion or other for decades. Just take the New York Task Force report into the rash of fatalities that bedeviled Aqueduct during the winter of 2011-2012.

“The Task Force believes that the use of systemic or intra-articular corticosteroids may have impaired veterinarians and trainers in accurately assessing horses' soundness leading up to a race,” the report found.

“The Task Force also believes that the use of these medications too close to the race may have limited the ability of the NYRA veterinarians to identify the presence of pre-existing conditions disposed to progressing to catastrophic injury.”

The New York Task Force's findings frame a key bone of contention among trainers, veterinarians and regulators: What is a smart regulatory timeframe for limiting joint injections before workouts and race days?

HISA's joint injection rules bar joint injections within 14 days prior to post-time, and within seven days of an official workout.

In California prior to HISA, the intra-articular corticosteroid fetlock injection rule mandated a 30-day stand down period prior to racing, and all corticosteroid joint injections had a 10-day stand down before workouts.

After those rules were adopted, the number of irreparable fetlock injuries in California had fallen off precipitously. Experts point to this as a prime example of the long-term systemic effects from corticosteroid usage.

Even so, there remains some skepticism within the industry that California had indeed got it right.

Mark Casse | Sarah Andrew

“Thirty days is ridiculous,” said trainer Mark Casse, who argues that such a rule is difficult to police. “What happens is, when you make rules that you cannot really enforce, it only makes the bad guys better because they don't care.”

Another key point in this whole debate? Not all joint injections are made equal.

In the decade since the New York report was issued, veterinary experts describe a shift away from corticosteroids towards hyaluronic acid joint injections, and biologic therapies like IRAP and platelet-rich plasma (PRP) injections.

They don't mask injuries the way corticosteroids can and are better at promoting joint health and healing in a way more advantageous to the horse in the long term, say proponents of these therapies.

Nevertheless, these same proponents voice frustration that the rules governing joint injections often treat corticosteroids and biologic therapies as equals.

“A lot of these injections are actually helpful, especially when you're doing PRP or you're putting [hyaluronic] acid in there,” said Casse, about biologic therapies. “I can tell you for a filly like Tepin, we would put acid in her ankles. We probably did it 20 times and she ran for years.”

Corticosteroids

Internationally renowned orthopedic surgeon Larry Bramlage is among those experts who believe HISA has got its rules surrounding corticosteroid joint injections about right.

“I think it is a good approach to being able to treat the joint that has been properly examined,” said Bramlage, who explained that corticosteroid joint injections should never be part of a “routine training program,” no matter the stand down time. “You want plenty of time to reassess the condition of the joint without the corticosteroid masking anything.”

Part of Bramlage's reasoning is how the marketplace for corticosteroids has evolved from high-dose, long-lasting versions like Methylprednisolone acetate–also called Depo-Medrol–to lower-dose, shorter acting corticosteroids like Betamethasone and Vetalog.

What kind of difference are we talking about? “We tend to think in terms of volume injected into a joint,” said Bramlage. Depo-Medrol can come in doses as strong as 40 milligrams per milliliter (mg/ml). Betamethasone, on the other hand, typically comes at a strength of 6 mg/ml.

“The original one–and as it turns out the most harmful one–was Depo-Medrol. When I was a student, we would put as much as two cc's [cubic centimeters] of Depo-Medrol when we were treating a joint,” explained Bramlage.

“But it's very long acting,” he added. “Its crystals are absorbed very slowly, so it can be found up to three months in the joint after you put it in. And that is a big disadvantage.”

Dr. Larry Bramlage | Horsephotos

Bramlage believes that the new wave of corticosteroids continues to play a role in managing the sorts of routine aches and pains that accompany high stress training programs.

“If you let inflammation go unchecked within a joint, it can eat up the articular cartilage. So just leaving a joint seriously inflamed without treating it with anything is also not the best route once you know there is no structural damage,” he said.

And the use of a low-dose, short acting corticosteroid like Betamethasone within a week of a timed workout, Bramlage said, is “a medically sound” approach if the joint has been properly assessed beforehand.

If the corticosteroid is eliminated from the horse's system enough to be undetectable in a test, he added, and the horse is still exhibiting signs of lameness, then there is a strong possibility the lameness is tied to some deeper-seated structural problem. A burgeoning stress fracture, for example, or abnormal bone remodeling. “That is the rationale for the stand down time,” he said.

The modern short-acting corticosteroids “reduce the inflammation and then get out of the way so you can read the joint again,” explained Bramlage. “And if there is a physical injury, a structural problem of some kind, it'll show up again.”

Other veterinary experts in the field have a slightly different take.

Though a corticosteroid won't necessarily show up through testing after seven days, it can still impart a systemic effect on the horse through effects like decreased inflammation in the joint and reduced lameness, said veterinarian Wayne McIlwraith, a distinguished professor at Colorado State University and like Bramlage, internationally renowned in the field.

As an example, McIlwraith cited a study he was involved in from 1997 where researchers studied the effects from triamcinolone acetonide joint injections–drugs which come under the trade names Vetalog or Kenalog. The horses were suffering osteoarthritis in the knee and were injected at 14 days and 28 days after the study start.

“We showed that lameness was significantly reduced at day 70–42 days after the second injection,” said McIlwraith. He described these effects as reduced inflammation in the joint fluid and in the joint lining membrane, as well as beneficial effects on the articular cartilage.

These effects were seen “whether we injected the osteoarthritis joint or we injected the opposite normal joint,” McIlwraith said. “In other words, a systemic effect that was very long lasting.”

McIlwraith and his fellow researchers used the same study design on Depo-Medrol–then considered the most potent corticosteroid available. They found “significant deleterious effects” to the joint cartilage in both the osteoarthritic joint and the opposite “good” joint, he said.

“The bottom line is that all the tissues of the musculoskeletal system are being exposed to the multiple complex effects of corticosteroids,” he said.

The fetlock has long been the Thoroughbred racehorse's Achilles heel. As an example, fetlock failures constituted in California nearly 60% of all musculoskeletal injuries that proved fatal during the 2018-2019 fiscal year, according to CHRB data.

The CHRB instituted its 30-day standdown regulations for corticosteroid fetlock injections on Oct. 19, 2021.

In the 20 months preceding that date, there were 83 catastrophic fetlock failures statewide, according to CHRB data. In the 19 months after that date, there were 24 catastrophic fetlock failures statewide.

Dr. Wayne McIlwraith | Colorado State University

Zeroing in specifically on Los Alamitos, the number of catastrophic fetlock failures dropped from 21 to just three during those two same periods of time bookending the rule change.

California's tightened joint injection rules have been just one part of a suite of stricter drug and equine welfare and safety rules instituted in the state over the past few years.

But for the likes of McIlwraith and Ferraro, the remarkable drop in irreparable fetlock injuries is due largely to one thing–the stricter corticosteroid joint injection regulations.

“I think we can relate this knowledge to our data in Southern California showing that injection not being allowed for 30 days in the fetlock has reduced the incidence of catastrophic injury,” said McIlwraith.

Indeed now, Ferraro advocates for the total elimination of corticosteroid use in all joints in racing and training.

“I would argue, look at our results. We didn't really have a breakdown problem with fetlock joints [in California],” said Ferraro. “In other words, if you're going the corticosteroid route, then that horse ought to be given significant time off, which means sending him to the farm.

“You can't legislate good judgment,” he added. “Corticosteroids in the hands of a wise, experienced equine veterinarian, you could probably do fine with it. But we put in this legislation because we know good judgment is not something that's always [wielded on the] backside.”

Which leads to alternative therapies to corticosteroids.

Biologic Therapies

“What you're trying to do is either slow something down or speed up something, and the goal is to slow the bad stuff down and speed up the good stuff,” said Bramlage, of the role of veterinary intervention with biologics. “[They] don't work by stopping things. They try to augment healing, not only block the mediators of inflammation.”

In explanation, Bramlage pointed to how the joint protects itself from harm and degeneration by naturally producing hyaluronic acid in the joint fluid, along with a class of molecularly heavy proteins called proteoglycan in the cartilage.

White Abarrio | Coady Photography

But corticosteroids hinder the body from producing both hyaluronic acid and proteoglycans. As such, hyaluronic acid is frequently used in combination with corticosteroid joint injections.

“You're essentially artificially adding hyaluronic acid because the corticosteroids are going to slow or stop the manufacturer of hyaluronic acid in the joint when you put them in,” Bramlage said.

When it comes to the use and efficacy of biologic treatments on racehorses, there seems to be a broad and largely favorable consensus among veterinary experts.

“You get your results from them because they stimulate healing within the joint. They calm the membrane down, and they help the cartilage surfaces. In other words, you could say they're a form of nutrient for cartilage, whereas steroids are a toxin to cartilage,” said Ferraro.

Should biologic therapies and corticosteroids joint injections be treated the same by regulators?

“No,” said McIlwraith. He explained that through research and through widespread clinical use, these therapies have been shown to have “uniquely beneficial” and other specific effects, but “no significant” negative effects.

“They are less potent immediately compared to corticosteroids which means that they are not going to be useful if used in an 'inject and race or work soon after' manner, which has been a philosophy of use by some,” said McIlwraith.

But under HISA's current rules, all joint injections are indeed treated the same. This means that biologic treatments like IRAP and PRP injections require the same 14 and seven-day standdowns for races and workouts respectively as corticosteroids.

HIWU has suspended 40 horses from racing for 30 days due to joint injections within seven days of a timed workout. Equibase only publicly maintains 60-days' worth of workout data. With what information is still available through Equibase, at least one horse on the list was injected one day before a workout. But HIWU does not publicly detail what kinds of joint injections were administered to these horses–corticosteroids or biologic treatments.

Efforts are underway to potentially modify HISA's joint injection rules.

A red-lined version of HISA's ADMC program recently shared with the TDN prohibits horses administered a fetlock joint injection from racing for 30 days, and from working for 14 days. For all joints other than the fetlock, the current restrictions–14 days from racing, seven days from working–remain in place.

According to this red-lined version, the rules still don't differentiate between corticosteroids and biologic therapies.

CHRB equine medical director Jeff Blea sits on HISA's anti-doping and medication control (ADMC) committee.

Though Blea was speaking on behalf of HISA, he said his personal opinion was that the federal ADMC program should be altered to mirror California's rules, which allow biologic therapies to be used unrestricted on any joint before a workout.

“We should want to be promoting biologic therapies because I think it's beneficial not only in the short term but the long term,” he said.

At the same time, not all veterinary practitioners agree with all aspects of the CHRB's rules on joint injections. If a horse is injected three times into the same joint within 60 days in California, the horse is automatically placed on the vet's list for 30 days.

This rule went into effect in the state on July 1 this year. And it has curbed Southern California veterinarian Ryan Carpenter's use of biologics, as it fails to distinguish between those sorts of injections and corticosteroids.

Dr. Jeff Bleu | AAEP

“It essentially has eliminated our use of IRAP, which is designed to be done once a week for a loading dose and then monthly after that,” said Carpenter.

“The unfortunate thing is that rule has actually incentivized people to not use biologics and put them back towards corticosteroids,” said Carpenter. “My corticosteroid use has increased since that rule has come in effect and would have loved to have stayed on the biologic route because I think it's better overall.”

When asked about this criticism, CHRB executive director Scott Chaney argued that the 60-day period was specifically chosen to still permit the use of biologic therapies while curbing excessive injections into the same joint.

“Even if it's not degrading the joint, clearly it's not working if you're having to mess with a specific intra-articular space over and over again within a short timeframe,” Chaney said.

More broadly, Chaney's thoughts about corticosteroid use in racing align with Ferraro's.

“Corticosteroids are unnecessary in horseracing,” he said, calling this issue a “litmus test” for HISA. “Our horsemen in California have been there and done it. We're four years into this,” he said.

“But it seems like horsemen around the rest of the country need a 'come to Jesus' moment because they're still clinging to the belief that they need corticosteroids to work a horse or run a horse. That's absurd. Any horseman or veterinarian who tells you that, they do not know what they're talking about.”

`I Would Put This Stuff In The Water'

It turns out the evolution in the use of joint injections in human athletes—and aging athletes in particular—appears remarkably similar to that of the racing world.

Andrew Pearle is the Chief of Sports Medicine at the Hospital for Special Surgery, the country's top orthopedic hospital. He is also a team physician for the New York Mets.

Pearle's area of expertise? The human knee.

“When I'm giving a steroid injection, I typically give 80 milligrams of Kenalog. It's a really good injection, particularly if there's fluid on the knee. It's certainly highly effective. In fact, there was a Nobel Prize given for the development of cortisone,” he said.

But there's a caveat.

“It's got these downstream negative effects with repeated use, and many of us don't like to give more than two shots over a lifetime in a joint,” Pearle said.

Instead, said Pearle, human medicine had moved towards alternative joint therapies like gel shots, PRP and hyaluronic acid.

“I tell patients if I could put this stuff in the water and feed it to everybody,” he said, “I would.”

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Finley, who has been a member of The Jockey Club since 2019, at the helm of West Point campaigned either solely or in partnership Horse of the Year Flightline (Tapit), GI Kentucky Derby winner Always Dreaming (Bodemeister), and a number of other Grade I winners. Finley also serves as chairman of the New York Race Track Chaplaincy, the board of directors for the Thoroughbred Charities of America and New York Thoroughbred Horsemen's Association, and the board of trustees for the Thoroughbred Owners and Breeders Association.

The other members of the Jockey Club Board of Stewards are Barbara Banke, Dr. Larry Bramlage, Louis A. Cella, William S. Farish Jr., Stuart S. Janney III (chair), William M. Lear Jr., and R. Alex Rankin.

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Created in 2017, the award will be presented at a dinner hosted by the chairman of The Jockey Club, Stuart S. Janney III, in Saratoga Springs, New York, the week of the Round Table Conference on Matters Pertaining to Racing, which is scheduled for Thursday, Aug. 3.

“This is especially meaningful for me based on who it is named after,” Dr. Bramlage said. “The Phipps family has played a big role in my career by giving me some credibility early on when I was still 'wet behind the ears.' I will look forward to this event and will always cherish the honor.”

To make a donation to Grayson in honor of Dr. Bramlage, please click here.

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“Racehorses are so good because they produce their skeleton based upon what they do,” Bramlage begins. “They're not born with it. Their skeleton is the minimum weight that they can produce and still carry them around the racetrack. So they have a big engine, but their undercarriage is no heavier than it needs to be. And that's why they're fast.”

That's true, in some evolutionary measure, of all horses–and other animals, too, people included.

“The skeleton is different than hearts and lungs and muscles,” Bramlage explains. “Those train to a volume of work that you're doing. Skeleton trains to the level of work that you do.”

He recalls a series of experiments conducted on turkeys some years ago, where one wing was restricted and the fowls learned to flap the other to get food. The idea was to establish how many cycles of this activity were required to stimulate bone.

“Well, it's interesting,” Bramlage says. “Because when you reach 36 cycles in a day, that's the maximum the bone will respond to. You can go to 2,000 and it won't get any stronger than in those 36. And that's what makes a trainer's job tough. Because they have to push the horses hard enough, that they get strong enough to carry themselves around the racetrack. But if you do too much, then those extra cycles begin to be destructive.”

Those 36 cycles, for our purposes, apparently equate to about a furlong. Which, Bramlage explains, means that your fastest eighth will be the level for which your horse produces bone. Obviously that doesn't happen overnight, albeit bone is far more dynamic than most laymen assume.

“But the stimulus is there that it'll try to reach that next level before the exercise does,” Bramlage explains. “And then you repeat that over and over, and eventually the skeleton gets appropriate enough that you don't acquire any damage during those 36 cycles. So while there's some always ongoing wear-and-tear, the most important part of making a racehorse is usually up to four or five races. Once they get there, their skeleton is virtually made.”

The living nature of bone, however, does mean that the “made” skeleton can regress once taken out of training. But Bramlage is keen to address a misapprehension, which took root maybe a decade ago, that persistently galloping a young horse creates the foundation for a strong skeleton.

“Galloping a horse a lot helps the heart and lungs–but once you go past those 36 cycles in a day, the rest of them are just wear-and-tear,” he explains. “A lot of horses were actually harmed by excess galloping.”

Previously there had also been the attempt to extrapolate the principles of interval training, in human athletes. “I knew a couple of people who, as runners themselves, were going to interval train and beat everybody,” he recalls. “And they ended up with 4-year-old maidens with splints on their hind legs. Because the skeleton just can't take that that many fast intervals. In people, the limiting system is the heart and lungs, not the skeleton. Horses have such great heart and lungs that, unless they're bleeders, they virtually never limit. The horse's heart and lungs can respond to anything you throw at them. But the skeleton has to do it in little stair steps. And that's how, in young horses especially, the heart and lungs often get ahead of the skeleton.”

Though the tibia also registers trouble here–it absorbs a lot of force, in locking the reciprocal motion of stifle and hock–the most familiar symptom is shin trouble.

“You go too fast, the wear-and-tear begins to exceed the response and you get bucked shins,” Bramlage continues. “Shins have to triple in size. The front cortex of a cannon bone in a 'made' racehorse is three times thicker than in the yearling that started training.”

So how does this translate, ideally, into building up a young horse towards a race? Bramlage suggests a pretty familiar scenario: one or two furlongs at a rather higher level than the rest of the exercise, in effect showing the skeleton where it's going to be asked to go in three days' time. The real skill, in training, is monitoring attitude.

“People ask, what makes a good trainer?” he says. “For me, it's an easy question. It's being able to understand when the horse is happy and when he's not. When horses are adapting well, they're happy to train. When a horse starts not wanting to go to the track in the morning, not wanting to load in the gate, those are the kind of things you need to look out for. It's a real art for trainers to understand when to push a horse and when to back off.”

Obviously you would hope that trial and error, over the generations, should have brought horsemen's intuitions pretty close to where they might land through learned science.

“If you go back to when Aiken, South Carolina, was the winter training center–because that's how far the railroad went south–they would have the Aiken trials and those 2-year-olds, early on, would be breezing an eighth,” Bramlage says. “Those short breezes were actually very useful to the horses. Especially when you're making the horse, it's a matter of trying to train heart and lungs–because you have to do that–without overtraining the skeleton.”

When a horse is past that stage, but has to be laid off training, the skeleton will not lose much strength through the first month but the situation will change pretty rapidly after two months. And a more significant spell, say four months, notoriously invites humeral or tibial stress fractures in a small number of horses: again, because heart and lungs train back so much faster than the skeleton.

Needless to say, by the time a horse is sent into the clinic, they have typically signaled a loss of form.

“If a horse has swelling in a knee or ankle, those guys at the racetrack pick it up,” Bramlage says. “These horses [sent into the clinic] don't have any obvious pain, heat or swelling, but their form has gone down. And a lot of times they have either bilateral lameness–two fronts or two hinds, sometimes all four–or they're just early wear-and-tear injuries. I think most of the really successful trainers today understand better than they did 10 years ago that the horse is subject to that wear-and-tear; and that whenever a horse is not giving you what it can, then you need to start looking.”

Parallel advances have been made in imaging technology. It is barely 30 years since radiographs were still processed on celluloid. Digital radiographs have themselves improved dramatically, and now scanning in three dimensions via CAT and MRI and ultimately PET is available.

“Nuclear imaging was a huge tool because those scans allowed us to look for stress fractures that didn't have any outward clinical signs,” Bramlage says. “But whenever regulators think in terms of needing a PET scan to monitor horses at the racetrack, that's not really true. You need to look at them and identify the horse that needs to be looked at, not scan them all. Most of those can be unraveled using all the tools we currently have. It's just a matter of knowing when you need to look. And so more than we need more equipment, we just need to look more often.”

The role of regulatory veterinarian is a contentious and evolving one. The process is being aided, however, by a growing injury database to succeed anecdotal assumption. Already Bramlage can see where this might take the profession.

“It may not hit during my lifetime, but I think the next really exciting revolution, which is going to totally change our care of racehorses, is digital timing,” he says. “It just makes sense that it will eventually move away from clockers and all be done passively, automatically, by the equipment. Well, when you have that data, it's not a real hard step to write an algorithm that identifies [problems that may be brewing].

“You could look at a horse's exercise fingerprint because stride length and stride cycle is pretty stable for individual horses. When the length begins to shorten, he's protecting something. And so each horse will have his own digital fingerprint, and this will be automatically recorded every time a horse works, every time they race. And all of a sudden you can say, 'This horse is getting into trouble.'”

Some early research has detected patterns that might anticipate injury as many as three races ahead. Bramlage can see a future where every horse will transmit data to central monitoring for red flags. For now, until the necessary technology is available, it falls to people like Bramlage to determine the level of risk that warrants its prohibitive cost.

“But I think that in the next generation beyond me, that will become automated,” he predicts. “And that will revolutionize the prevention of injuries. It'll be the best thing that ever happened.”

And that's one of the things that maintains such youthful enthusiasm in a septuagenarian who has already witnessed such transformation in the tools of his trade: the curve is only going to steepen.

Aside from digital radiography, the biggest leaps forward have been internal screws and plates; plus arthroscopy and its adaptation from diagnosis to treatment. For internal fixation, the initial debt was apparently to a Swiss cost-benefit analysis of chronic disagreement between tibias and ski-boots. Of arthroscopy, meanwhile, Bramlage muses: “Surgery never used to happen until there wasn't anything else you could do. Then with the arthroscope it became easier, quicker, better. And so now that is the first line of defense. The horse gets a chip fracture, they take it out right away. The joint doesn't degenerate, they go back to normal.”

Horsemen nowadays have gained faith that condylar fractures can be routinely secured. One of Bramlage's most celebrated patients, Personal Ensign, went a long way to changing perceptions. Nowadays you'll find many a Breeders' Cup winner with a screw lurking somewhere in its skeleton. It's a very different world from when Bramlage started out, and yet he feels we have barely started.

“Yeah, we were dipping X-rays in chemical solutions when I was a student,” he reflects. “But the young veterinarians right now will probably see the same explosion. Probably in the biologic areas: the understanding of cell biology, and cell communication, is doing the same ramp up. The ability to treat is going to be much more pointed and effective than now.”

Bramlage is acutely aware of our industry's exposure to an ever more urban society that professes ever fiercer vigilance on behalf of animals with which it typically has little interaction, certainly compared with generations past. In that respect, veterinary regulation manifestly has a front-line role. He's excited, then, that a digital fingerprint might give mute animals a new way of telling doctor what's wrong.

Even with the advent of such tools, however, Bramlage believes that the essential mystique of the Thoroughbred will endure. We might be able to explain how everything fits together, and learn how to put things back together, but the key to performance will remain elusive.

“And actually I hope we never do get to that point where we understand everything about a horse,” he admits. “Because I think that's what's intriguing to people. You can improve your odds by improving your breeding. You can keep the horse healthy, you can have a trainer that's capable to that level. You can do all those things, but you still can't just go buy a Derby winner.

“Every horse is a product of a dip out of the gene pool. It's not a one-to-one combination of the mare and the stallion. There are all sorts of units. Like you've got four genes that cause eye color in people. There are all those different combinations of things. So to combine whatever comes out of that gene pool with the mental capacity, to train hard enough and compete hard enough, you never know which horse is going to have it.”

He chuckles, and asks whether you ever heard of a racing mule named Black Ruby?

“Well, she was on the California fair circuit for about 10 years and there was only one other mule could occasionally beat her,” he explains. “But they cloned her several times, and none of them could beat me. They had the exact same genetic makeup, but none of them would run like that. So that elusive factor, I think, is what keeps people intrigued. And I hope we never identify that.”

Even his exceptionally intimate professional relationship with horses, ranging from Personal Ensign to claimers at Ellis Park, has only marginally clarified the enigma.

“I don't know that there's any one thing,” he says with a shrug. “Good horses are always physically attractive, well balanced. They're almost always smart, they're very intelligent, very adaptable.”

Does that make better horses better patients, too?

“Absolutely,” he replies. “But racehorses are the best patients anyway, in my opinion. The worst patient is the 4H horse that's never felt anything but a rub rag, because when they have to deal with pain, you never know how they're going to handle it. But racehorses are just like people who train hard: you're stiff and sore next day and then it goes away and you feel better than you did before you started. They have better survival instinct.”

And while recruitment to equine practice is becoming harder, given the reduced social exposure nowadays between young people and horses, Bramlage guarantees endless fascination to the next generation. The measure of your work, he says, is so much more gratifying than in small animal practice.

“I think equine practitioners tend to practice a lot longer because there's another level of assessment,” he says. “Your horses have to go back and run. They have to win barrel races. They have to win ribbons, if they're a backyard horse they have to trail-ride. There's a couple of books I read, discussing why do armies fight? It's mostly not for abstract ideals. They fight for the people next to them, the people they trained with, the things they know and the fear of failure. And I think this level of assessment, with the possibility that you'll fail, but the rewards when you succeed, it's higher in horses.”

And there are literally hundreds of horsemen in the Bluegrass who will be relieved to hear him say that. “I could easily be retired,” he says. “At some point, physically it's not going to be possible to continue. But I think that's why people stick around. I mean, when the success barometer is the dog being able to get up on the sofa? That's not quite as intriguing!”

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“This was the tenth edition of the Welfare and Safety of the Racehorse Summit,” said Grayson-Jockey Club Research Foundation's President Jamie Haydon following the event. “It's really astounding to think that we couldn't measure how many horses had died on the racetrack when we started this, and now not only are we presenting risk factors nationally, but we heard veterinarians also giving local risk factors. Since the first summit until now, the safety and welfare of our human and equine athletes is the guiding principal and stays the guiding principle. To see over a 30% decrease in fatality rate tells me that we've come together and we've done a lot of work.”

The full video of the Welfare and Safety of the Racehorse Summit will be available to watch on the Grayson-Jockey Club Research Foundation's website on Thursday, June 23.

Equine Injury Database Update, 2-Year-Old Fatality Spike in 2020

Dr. Tim Parkin, the Head of Bristol Veterinary School and a member of the Equine Injury Database Scientific Advisory Committee, provided the most recent findings from the Equine Injury Database.

Parkin reported that since the database was launched over a decade ago, annual fatality figures on all racing surfaces have reduced by 30.5% from a high of 2.1 per thousand starts in 2009 to less than 1.5 in 2021. In addition, fatality risk has reduced by 35.6% since 2009 for dirt racing specifically.

Parkin also presented findings on data collected in 2020, when there was a 43% increase in fatal injuries in 2-year-old compared to 2019. With the increase in fatalities, there was a decrease in the overall number of workouts by 2-year-olds due to the impacts of COVID and an altered racing schedule.

“It is interesting to see that while we saw a similar, less pronounced training disruption in older-aged horses, we didn't see an impact on their risk of fatal injuries,” Parkin noted.

Along with the conjecture that the disruption in training may help explain the increase in fatal injuries, Parkin said they found that later in the year as racing resumed to a more normal schedule, 2-year-olds workouts suddenly increased–presumably in an attempt to compensate for a lack of training earlier in the year. He noted that this could have been another contributing factor leading toward the spike in fatalities.

Parkin also discussed recent findings on sudden deaths in racehorses. Since 2009, the database has recorded a 30.6% drop in the risk of musculoskeletal fatal injury, but only an 18% drop in risk of sudden death in the same period.

“A decrease in breakdowns suggests that risk factors have been identified and people are starting to develop interventions for musculoskeletal injuries, but those same risk factors haven't had the same impact on sudden death,” he explained.

While the percentage of overall fatalities due to sudden death was between 5 and 6% in 2009, in several recent years, sudden death has accounted for over 10% of overall fatalities.

“Probably the reason why people are talking more about sudden death, apart from potential high-profile cases, is that because of the reduction in the overall contribution of musculoskeletal injuries to the total number of fatal injuries, the proportion of horses that are dying due to sudden death is rising,” Parkin said.

One potential risk factor for sudden death, according to Parkin, could be the use of Lasix. Their data has shown that use of race-day Lasix increases the risk of fatality by 62%, with a 0.08% incident of sudden death per thousand starts with horses raced without Lasix and a 0.13% incident per thousand starts with horses treated with Lasix.

“The reason why this has not been identified before is purely due to statistical power,” he said. “When you have more than 95% of starts being made on Lasix, it is very difficult to identify a difference between those racing on Lasix and the very few that are not. We now have a sufficient number of years of data related to sudden deaths in the database to enable us to draw these conclusions.”

Dr. Bramlage Examines Advantage of 2-Year-Old Racing

Internationally-recognized equine surgeon Dr. Larry Bramlage of Rood and Riddle Equine Hospital spoke on recent findings relating to the racing and training 2-year-olds. Bramlage is a strong advocate of training horses as juveniles.

“2-year-olds are right at the end of their growth period,” Bramlage explained. “During their growth period, their skeleton is replete with the blood supply and cell population to build bone. It doesn't make any sense to let that totally atrophy until this horse is a 4-year-old, because then you have to build it all back. You want to pick up that support system and convert it from growth to adaptation to training.”

Bramlage evaluated findings examining the most effective methods for building up bone in racehorses. He said that one important aspect of equine physiology is that while bone trains to the level of work, the cardiovascular system trains to the amount of work. He used the example of interval training. While the high-intensity exercise benefits humans, whose limiting factor is the cardiovascular system, he said the same form of training is not as effective for horses.

“Horses can't take that amount of training,” he said. “Their heart and lungs are so good that they just pass the skeleton. The limiting system is always the skeleton in the horse. The best training episode will have a furlong in it that's a little faster than the other furlongs. That shows the horse where they're going to go next week when they breeze.”

Bramlage connected this idea to what may have caused the increased 2-year-olds fatality rate in 2020. During the first half of the year, with few race dates on the horizon, most trainers were only galloping their 2-year-olds. Bramlage said that once racing started up again, trainers may have squeezed breezes together in a tighter time period with a higher intensity.

“What that does is we've now wound up the engine at a much higher level than we've wound up the undercarriage,” he said. “Since the heart, muscle and lungs train to the amount of training, not to the level, if you're just galloping at the same speed, the bone is not making much adaptation. When you ask it to adapt in a short period of time, you compound the problem of the faster breezing schedule with the fact that the heart, lungs and muscle are more mature than the skeleton is. The horses could go faster, but the skeleton wasn't as prepared.”

Regulatory Veterinarians' Perspectives and Looking Toward Racing's Future

In a session focused on equine safety and welfare from a California perspective, Dr. Dionne Benson, the Chief Veterinary Officer of 1/ST Racing, and Equine Medical Center surgeon Dr. Ryan Carpenter discussed the many changes California racing has made since the publicized series of breakdowns at Santa Anita in the spring of 2019.

Medication reform, private veterinary exams, additional race day monitoring and risk assessments prior to races and works were among the major implementation that Benson said has bettered their program and improved the safety and welfare of their horses. Since September of 2019 at Santa Anita, 7,400 unique horses have been examined and over 21,000 pre-work exams have been conducted.

“We just finished a six-month meet at Santa Anita and had three fatalities in racing,” Benson said. “I think it's working. It's certainly a team effort. It's not just the veterinarians. It's the trainers, the owners and the private veterinarians. The one thing that impresses me the most is that we really have changed to a culture of safety out there. Very few people will take that one last shot and enter that horse to get one last race whereas at other tracks, we tend to see that more aggressive attitude. I think there is a conscious effort to put the horse first there.”

Later in the day, a regulatory veterinarian panel was moderated by Dr. Mary Scollay-Ward, the Executive Director and COO of the Racing Medication and Testing Consortium. Participants included Prairie Meadows' Dr. Jaclyn Bradley, Churchill Downs Equine Medical Director Dr. Will Farmer, and the Minnesota Racing Commission's Chief Commission Veterinarian Dr. Lynn Hovda.

Scollay asked the three veterinarians a series of prompts centered around how their jobs have evolved since they first started out in the industry.

“One of the unique aspects of my role is that I deal with multiple racing jurisdictions,” Farmer said when asked of the most challenging aspect of his position. “For me to really be in the weeds in each of those jurisdictions, that's why I see the usefulness of HISA to be able to bring some of that together. I have four racing jurisdictions and every one of them is different. As regulatory veterinarians, our biggest challenge is communication.”

Later in the day, KEEP Foundation's Equine Education Coordinator and Amplify Horse Racing President Annise Montplaisir, who served as MC for the summit, moderated a panel on the importance of welfare and safety to youth entering the Thoroughbred industry. Participants discussed why the younger generation places a greater emphasis safety and welfare and shared their thoughts on practical tactics individuals in the industry can use to promote racing to young people.

Also during the summit, a panel was held on the latest updates with equine wearable technology. TDN's Dan Ross recaps the segment here. Other topics throughout the day included jockey wellbeing and fitness, positron emission tomography, an update on racing surfaces testing, and Keeneland and The Thoroughbred Training Center's use of InCompass Solutions.

Biographies of participants, agendas and additional material from the summit can be found here.

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Rood & Riddle Equine Hospital is pleased to announce the installation of an equine positron emission tomography (PET) scanner at the Lexington, Kentucky, hospital. This modality is used for diagnostic imaging in select lameness cases and can be used in standing, sedated horses. It does not require general anesthesia. The scans result in quantitative, three-dimensional, cross-sectional images that can help accurately pinpoint the location and severity of a problem. Any area on the limb from the foot to the carpus (knee) and tarsus (hock) can be imaged. Two different types of scans can be performed. One looks at areas of increased bone metabolism and is useful to identify sub-chondral bone disease, signs of impending fracture, suspensory ligament attachment disorders, and osteoarthritis. The other looks at the overall tissue metabolism and is useful in cases of soft tissue injury or laminitis. Rood & Riddle is the fourth location for this standing PET scanner for horses globally and is the site of the first installation at a private practice.

“We are excited to introduce this new technology for our patients,” said Dr. Katherine Garrett, Rood & Riddle's director of Imaging. “PET scans will increase our ability to detect bony injury in horses, which will hopefully lead to improved outcomes.”

Orthopedic surgeon Dr. Larry Bramlage added, “We started with radiographs alone, and they depended on celluloid and silver ions for an image. Then, digital radiographs moved us forward in the quality of what we could see. Nuclear scintigraphy was the next step because we could image physiology, not just anatomy. Then, the three-dimensional imaging with computed tomography (CAT) scans and magnetic resonance imaging (MRI) further expanded our capabilities. We have now moved forward to another level with PET scanning, which combines the physiology of nuclear medicine and the three-dimensional capabilities of CAT and MRI into a three-dimensional image of bone physiology. It can also look at the three-dimensional activity of some soft tissues. PET adds significantly to our imaging and understanding of the true status of the equine athlete.”

In 2015, Grayson-Jockey Club Research Foundation funded the first-ever research project that performed PET scans on equine athletes and followed that up with additional research funding in 2019. Now, this new cutting-edge research will assist vets coast to coast in identifying lameness problems that are hard to locate.

“Grayson has been a longtime supporter of research on the efficacy of PET scans in diagnosing injuries in horses, and we are pleased to see a PET scanner installed at one of the premier equine hospitals in the world,” said Jamie Haydon, president of Grayson. “We are proud to have contributed to the development of a technology that will help countless horses at Rood & Riddle for years to come.”

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“We weren't completely happy the way he came out of it. So we decided to send him up to Kentucky to Rood & Riddle, where Dr. (Larry) Bramlage did the surgery and is overseeing his comeback,” Stidham told bloodhorse.com. “Nothing serious, but enough to where we are in a holding pattern, where we had to slow down again and give him a little more time before he resumes his training.”

Mystic Guide has not raced since finishing second in the G2 Suburban Stakes on July 3, 2021, after which he underwent surgery to remove a knee chip. He managed to record a pair of workouts at the Fair Grounds in December, but now the horse's future is uncertain after the latest setback, which does not involve the knee on which surgery was performed. Mystic Guide will be in Kentucky with Godolphin trainer Johnny Burke for at least the next three weeks.

The lightly-raced Godolphin homebred has a record of four wins from nine starts, with earnings of $7,593,200.

DRF's Marcus Hersh first reported the news.

Read more at bloodhorse.com.

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A winner on debut at Saratoga, Jack Christopher returned to capture the G1 Champagne at Belmont Park before shipping West, where he would likely have been the favorite in the World Championships race. Instead, the colt was scratched and Dr. Larry Bramlage wound up surgically inserting a screw to repair a stress fracture in his left shin.

Brown is not optimistic about having Jack Christopher ready for the Run for the Roses.

“He's going to be up against it, that's for sure,” Brown told the TDN. “I don't want to rule anything out until I put my hands on him, but he's certainly behind. To get him to go a mile-and-a-quarter I'm going to need to have something under his belt. We'll see where he takes us and if he doesn't make [the Derby] we have several other races we'd love to target with him.”

Read more at the Thoroughbred Daily News.

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According to the Daily Racing Form, the 3-year-old son of Maclean's Music has undergone surgery with Dr. Larry Bramlage of Rood and Riddle Equine Hospital, and is expected to return to the races in 2022.

This year, Jackie's Warrior has won the G2 Pat Day Mile, G2 Amsterdam, G1 H. Allen Jerkens, and the G2 Gallant Bob.

“He's an unbelievable, tremendous horse,” trainer Steve Asmussen told DRF. “I thought that the Allen Jerkens against Life Is Good was as good as horse racing gets. Unbelievably fortunate to be involved with him and very anxious to race him next year – because they don't get any better.”

Read more at the Daily Racing Form.

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