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Palmer: ‘PET Scan Not Appropriate As Initial Screening Tool’

New York State Equine Medical Director Dr. Scott Palmer has described Positron Emission Tomography (PET) scan as a “fantastic diagnostic tool” and that “it can play a very important role” in helping to identify and pinpoint subtle musculoskeletal injuries in horses, but that the scan is not the best initial screening tool in singling out horses at risk for catastrophic injuries.

Palmer addressed the issue during an equine health and safety briefing held at Tuesday's meeting of the New York State Gaming Commission and also offered some preliminary findings on the 17 equine fatalities recorded during this summer's Saratoga meeting.

“Identification of horses at risk for catastrophic injury must begin with a screening protocol that can be scalable, practical, affordable, and can be used by every horse while training or racing without regard to any clinical indication of injury,” Palmer said in revised comments issued Wednesday. “Wearable biometric sensors are best suited to accomplish this first level of screening. These sensors detect subtle abnormalities in a horse's gait that are not detectable with the human eye. They serve as a 'check engine' light that alerts us to the possibility that there is something wrong with the horse and that the horse should be examined by a veterinarian.

“The veterinary examination is the second level of screening for an abnormality that might predispose a horse to injury. The goal is to reach a diagnosis of musculoskeletal abnormalities and typically will include use of diagnostic nerve blocks and digital radiography. If lameness is detected in a limb during this examination and digital radiographs are inconclusive, then advanced imaging such as PET can be employed as a final screening step in this process.

“In summary, PET can play a very important role in the diagnosis of subtle musculoskeletal injuries in horses, but it is not useful at the initial screening level,” he concluded.

Palmer added that biometric sensors placed in horses' saddlecloths that can help identify at-risk animals, are “not quite ready for 'prime time' use” at this time.

In referencing the 17 Saratoga fatalities–a number that is approximately 1% of the 2000 horses stabled at the track but three times higher than 2021 and 2022–Palmer noted that the incidents were clustered around Whitney and Travers weekends. He added that fetlock injuries, typically responsible for 48-50% of fatal musculoskeletal injuries in New York and California over the last decade, represented 92% of all the exercise-associated fatal musculoskeletal injuries at Saratoga, a “significant finding” in Palmer's estimation.

Twelve of the 13 exercise-associated injuries occurred either during the final furlongs of the race or during the gallop out, suggesting that fatigue was also a contributing factor.

Palmer explained that the unprecedented 11 inches of rain that fell during the meet–compared to nine inches in 2021 and 8 inches in 2022–had a material impact on the consistency of the racing surfaces. During the meet, there were 65 surface changes (16%) compared to just 17 (4%) in 2022. With those facts in mind, “increased moisture in the Saratoga main dirt track and spatial and temporal variation of the moisture content of the track during the meet were likely contributing factors to the increase in the number of racing fatalities.”

A comprehensive report of the investigation will be made available to the public as soon as the investigation is complete.

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HISA To Conduct ‘Emergency Veterinary Summit’ To Address CD Fatalities

With the number of equine fatalities during the current spring meeting at Churchill Downs now up to 12, officials at the Horseracing Integrity and Safety Authority (HISA) are convening an 'emergency veterinary summit' to be held Tuesday, May 30, in Kentucky.

“HISA's highest priority is the safety and well-being of the horses and riders competing under its jurisdiction,” a HISA statement released Monday begins. “We remain deeply concerned by the unusually high number of equine fatalities at Churchill Downs over the last several weeks. We continue to seek answers, and we are working diligently with Churchill Downs and the Kentucky Horse Racing Commission (KHRC) to mitigate any additional risk.”

The Tuesday meeting is expected to bring together the veterinary teams from Churchill Downs, the Kentucky Horse Racing Commission (KHRC) and HISA to 'thoroughly review all veterinary information available and conduct additional analysis in hopes of better understanding the events surrounding the recent fatalities.'

HISA is also enlisting the services of noted track superintendent Dennis Moore to provide 'a second and independent' review of the racing and training surfaces at Churchill Downs. The review is scheduled to begin Wednesday, May 31, and HISA CEO Lisa Lazarus and Racetrack Safety Director Ann McGovern will be on site to receive results and analysis and any suggested follow-ups needed.

Dr. Jennifer Durenberger, the director of equine safety and welfare, is also being dispatched to provide additional veterinary expertise and observation to ensure optimal veterinary oversight of the horses.

Following a special Memorial Day program Monday, racing is set to resume at Churchill Thursday, June 1, with a first post of 5 p.m. ET.

Following the 11th and 12th equine fatalities last Friday and Saturday, respectively, officials at Churchill Downs issued a statement of their own, pledging their commitment to pursue answers and solutions to the problem.

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Letter to the Editor: Doug Daniels, DVM, National HBPA President

After reading both the Bennet and Parkin article published in the Journal of the American Veterinary Medical Association entitled “Fifteen risk factors associated with sudden death in Thoroughbred racehorses in North America (2009-2021)” followed by the TDN analysis of that article, I have become increasingly aggravated over the last three weeks from the implied message portrayed by each.

The dramatic click-bait headline “Horses on Lasix at Increased Risk of Sudden Death” is unwarranted by the facts. When compared to the end of the article, one becomes more frustrated with the headline since the statement “further work is required to determine which, if any, clinical signs are potential indicators and, indeed, whether such a rare outcome could be reliably predicted” provides more realistic information than the sensationalistic title.

The authors of the JAVMA paper claim no conflict of interest, but it is funded by the Grayson Jockey Club Foundation, and “help in interpreting the Equine Injury Database” was provided by two long time employees of The Jockey Club. The Jockey Club has a long history of both funding Lasix research and also pressuring the recipients of this funding to interpret findings in a manner consistent with their long-held goal of the elimination of race-day administration of Lasix in American racing.

My first concern: “Sudden death” as defined in this paper deviates from accepted definitions. Exercise associated sudden death (EASD) is typically defined as acute death in an apparently healthy animal within one hour of exercise. Bennet and Parkin define sudden death as any horse that perished from non-musculoskeletal causes within 72 hours of racing, using five “codes” unique to the Jockey Club's Equine Injury Database (EID). Left undefined are the facts behind how a horse becomes classified into one of these categories.

Even the authors of the paper agree that “it would be reasonable to assume that several of the listed codes would not be accurate.” By the authors' own admission, using the EID with undefined codes that may have very different meanings in different jurisdictions result in conclusions that are not accurate.

More importantly, only 5.6% of the horses in this study started without Lasix. No effort is made on the part of the authors to determine what, if any, other factors are associated with not using Lasix. For example, they have determined that older horses are at higher risk of EASD, and this age group also consists of almost all horses who race on Lasix. The younger age group is the only age group where any number of horses can be found that race without Lasix.

The bigger question–completely ignored by the authors and their study funded by The Jockey Club–is why do horses in North America suffer EASD at a substantially lower rate than their counterparts in other parts of the world? In this paper, EASD (with all the caveats previously mentioned about its definition) occurs at a rate of 0.13/1,000 starts, which is close to 10% of the total deaths of racehorses. In Australia, this rate is more like 25% of the total, with a whopping 37% of these EASD a result of Exercise Induced Pulmonary Hemorrhage (EIPH). In a similar study in the United Kingdom, published by the same researchers in 2011, the rate of EASD was 0.3/1,000 starts.

Bennet and Parkin–of all people, being well familiar with the principles of epidemiology–should know full well that correlation does not equal causation. Yet, they offer in the conclusions of their paper that, “The association between furosemide and sudden death prompts further study to understand which biological processes could contribute to this result.”

What we do know however, is the presentation of information can greatly impact the public's reaction, as we have seen in these recent headlines. As presented in the TDN article and others on this topic, the odds ratio was presented as furosemide increases the risk of sudden death in horses by 62%. Yet as noted by James C Meyer DVM MSc in his recent paper, if stated as an increase in the absolute risk, it would be 0.005%. That figure as you can see does not have the sensationalized purposeful negative effect as saying 62%.

I implore the readers of this letter along with the authors of the JAVMA article to consider that the biological process is simply the passage of time. The most obvious association between Lasix and EASD is that the majority of horses not racing on Lasix during the time of their study were 2-year-olds.

We know there is a mountain of evidence demonstrating that Lasix mitigates EIPH. When combined with further evidence that EIPH remains the most common cause of EASD in other countries, it is beyond irresponsible to use this Jockey Club-funded study as the basis for any policy intended to safeguard the health and welfare of our racehorses.

Dr. Doug Daniels is president of the National HBPA and an equine practitioner who owns Virginia Equine. He owns and breeds Thoroughbred racehorses.

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Study: Horses On Lasix At Increased Risk of ‘Sudden Death’

A new study published this week in the Journal of the American Veterinary Medical Association and funded by the Grayson Jockey Club Foundation, has found that horses racing on Lasix were 62% more likely to die within three days of racing than were horses running without the diuretic.

Fatalities due to catastrophic musculoskeletal injury were not included in the study.

The use of Lasix was one of 15 risk factors identified in the report.

The study, relying on information from the Equine Injury Database, examined starts made by 284,387 Thoroughbreds at 144 racetracks in the U.S. and Canada from 2009 to 2021. A total of 4,198,073 starts were included in the study, which was conducted by Dr. Euan Bennet and Dr. Tim Parkin. The number of starts equals 92.2% of all races in North America run during the period of the study.

Among the starters, there were 536 instances where a horse died within the three-day window after racing, a rate of 0.13 per 1,000 starts.

Horses falling into the “sudden death” category had to have died within three days of racing and have had one or more of five fatal injury descriptions: (1) sudden death (recorded as “SUD” in the EID); (2) pulmonary hemorrhage; (3) exercise-induced pulmonary hemorrhage (EIPH); (4) postexertional distress/heatstroke (PED); and (5) cardiac arrhythmia.

The study included 233,276 starts made by horses without Lasix. Eighteen or 0.08 per 1,000 starters died within three days. There were 3,964,797 starters who ran with Lasix and the result was 518 sudden deaths or 0.13 per 1000 starters. Ninety-four percent of all horses in the study raced with Lasix.

“…it could be hypothesized that furosemide administration in horses may increase the risk of sudden death through fatal arrhythmogenesis,” the study reads. “However, as the exact cause of sudden death (cardiac vs non-cardiac) was not determined for the horses of this study, we can only speculate at possible mechanisms. Further investigation is required to understand which, if any, pathophysiologic mechanisms could underlie the association between furosemide use and sudden death, as this finding raises further concerns about the ethics of race-day administration.”

The researchers also concluded: “…identifying any potential causal link between furosemide administration and sudden death should be a priority.”

The study looked at 49 risk factors and concluded that 15 of those factors could have led to a horse dying following a race. The list includes:

(*) Horses racing in the winter were at a 28% reduced risk of dying when compared to horses racing in the summer;

(*) There were fewer fatalities in longer races. In races contested at a mile or longer horses were 32% less likely to die than horses competing in races at six furlongs or shorter;

(*) Older horses were more likely to die than younger ones. Horses five or over were 44% more likely to die than horses who were three or younger;

(*) Horses that had been racing frequently were less likely to die than horses who had their races spaced out. For each additional race start made in the previous 0 to 30 days, individual horses were at reduced risk of sudden death. Horses that had made two or more race starts in the period 90 to 180 days before the current race were at 19% decreased risk of fatality compared to horses that had made 0 or 1 start in the same time period;

(*) Horses racing for the first time in a claiming race were at an increased risk. They were at 38% increased odds of sudden death compared to horses that were not making their debut in the claiming ranks;

(*) Horses that had previously been on a vet list, were 31% more likely to die compared to horses than had never been on a vet list;

(*) Horses whose last starts were made on a synthetic track were at 33% reduced odds of sudden death compared to starts made on dirt tracks;

The researchers hoped their information could lead to fewer sudden deaths.

The study reads: “Further work is required to determine which, if any, clinical signs are potential indicators and, indeed, whether such a rare outcome could be reliably predicted. The thoughtful application of big data predictive modeling would be helpful here; routine biometric monitoring of racehorses throughout their training and racing careers could provide valuable insights into horses' physical well-being.”

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