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Is Your Horse Stressed? Boehringer Ingelheim Has A Special Soundtrack For Them — No, Really

Boehringer Ingelheim is focused on helping keep horses safe and “sound” when it comes to stress with the release of a music track specially designed to help reduce stress in horses. Research shows stress can quickly turn into equine gastric ulcer syndrome (EGUS), with one study showing horses can develop stomach ulcers in as few as five days.

The musical arrangement features soothing music designed with the horse in mind. The track was created by Janet Marlow, sound behaviorist, composer, researcher and founder of Pet Acoustics Inc. Marlow focused on creating rhythms and melodies composed for the listening comfort of the horse, including specific pitch, tone and frequencies. Studies show that playing music can help balance equine behavior because it helps mask outside sounds and vibrations, as well as provide a positive and relaxing effect.

“When Boehringer Ingelheim expressed an interest in doing something to help manage stress in horses, I was extremely interested based on my research in this area,” said Janet Marlow, founder of Pet Acoustics. “It's all about composing music and modifying the decibel and frequency levels of each note for the comfortable hearing range of the animal. Using this process, we have tested music through clinical studies at veterinary hospitals, barns, etc. to see the music elicit a release of physical tensions and stress behaviors.”

To access it, veterinarians and horse owners can visit https://www.youtube.com/channel/UCoekmWDxfuaOGuL1ELoPIGQ/videos. Visitors will be able to play the music track and video, as well as gain access to additional resources on stress, EGUS, and ways to help prevent it.

This includes information on the use of Ulcergard^® (omeprazole), to help reduce the creation of acid in a horse's stomach during times of stress, helping to maintain optimal gastric health. For ulcer prevention, horses should be given ULCERGARD once daily during these stressful periods. ULCERGARD is the only prevention for equine gastric ulcers that is proven to be safe, effective and approved by the FDA.

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Ask Your Veterinarian Presented By Kentucky Performance Products: Identifying And Managing White Line Disease

Veterinarians at Rood and Riddle Equine Hospital answer your questions about sales and healthcare of Thoroughbred auction yearlings, weanlings, 2-year-olds and breeding stock.

Question: What is white line disease (WLD) and how can it be managed?

Dr. Raul Bras: Horses' hooves are subjected to a variety of influences that can impact soundness, including breed, limb conformation, and environment, which can change the shape of a foot. The function of the hoof can be affected by the environment, discipline, exercise, and farriery. The hoof has the ability to respond relative to its structural characteristics, its natural tolerance of the mechanical challenges, or by adaptation with changes in growth rate and shape. External alterations of the hoof capsule can be evident to the astute eye. However, many crucial changes go unnoticed until lameness or other problems are evident.

Many foot-related lameness involves hoof capsule distortions. Hoof capsule distortions occur when the tensile, compressive, or shearing forces on the hoof exceed the capacity of the hoof capsule components to withstand them. There are three basic situations in which the loading capacity of a structure can be exceeded: normal load on an abnormal structure, abnormal load on a normal structure, and abnormal load on an abnormal structure. The latter is a more reliable recipe for distortion and perhaps outright destruction of the compromised component.

WLD is a syndrome associated with structural defects of specific parts of the hoof and is characterized by progressive hoof wall separation that occurs within the non-pigmented Stratum Medium layer of the hoof wall. WLD describes a set of symptoms, rather than one specific cause of those symptoms.

The name of white line disease should not be confused with the anatomical white line that is visible around the edges of a horse's sole. Rather, it deals with the non-pigmented (or “white”) layer of the hoof wall. The hoof capsule's horn is made of three layers: the stratum externum is the stronger, denser layer of tubules that are pigmented in black feet. The stratum medium is nonpigmented. has a less dense configuration of horn tubules. stratum internum (inner layer) is the laminae and its blood supply that anchors the coffin bone to the wall.

WLD is often confused with laminitis, as the clinical and radiographic evidence are similar with a few key differences. In WLD, the separation seen in the foot will originate from the solar surface, whereas in laminitis, the separation starts in the dermal lamellae and continues distally. The air density line of WLD invades the white softer part of the wall via small breaks in the ground surface, and goes unnoticed for long period of time as the horse shows no evidence of discomfort until the capsular rotation reduces sole depth to a painful level. Capsule rotation occurs within the horn wall with WLD, and within the laminae with laminitis.

WLD has an air density lesion that extends from the ground surface and can have irregular borders, often with considerable debris filling the defect. Laminitis has capsule rotation that occurs within the laminae, and the gas line does not extend to the ground surface even when the coffin bone has penetrated the sole. Only after weeks to months from onset does the defect communicate with the ground surface.

The venogram can provide key information to veterinarians and farriers when diagnosing either laminitis or WLD, as it allows them to see areas that are deprived of blood flow.

WLD and laminitis can occur simultaneously when either is very chronic in nature.

The syndrome was first described by Drs. Ric Redden and Al Gabel in the 1970s after they observed that this defect involved the non-pigmented part of the horn. Biomechanical tests have shown that the non-pigmented portion of the stratum medium is the least rigid area of the hoof wall and has the highest water content, which could play a role in the expression of white line disease.

Redden observed that when WLD happens in one foot only, it tends to be in the hoof with a steeper profile or a club foot shape. Additionally, other researchers found a connection between the symptoms of WLD and a fungal infection called onychomycosis. Since then, we have learned the fungus is probably common in equine hooves but isn't present in all cases of WLD. Additional research has searched for an association between symptoms and different types of bacteria, the theory being the symptoms may be a sign of a bacteria that destroys hoof horn. Of course, like fungi, bacteria are also very common in a horse's environment and the bacteria that have been studied seem to be present in some cases of WLD, but not all of them. It seems more likely that bacteria are secondary opportunists which add more damage to a weakened hoof wall but aren't the main cause of damage

As with many other types of foot-related lameness, prevention is much more effective than treatment. Prevention begins with careful observation. It is important that detrimental changes in the foot be recognized early and dealt with appropriately while there is still a chance to preserve the integrity of the foot. Failure to understand the normal structure and function of the equine foot and to manage the foot and the horse accordingly can have deleterious effects.

Treatment for WLD varies from sheer mechanics to wall removal and debridement of the affected areas. Mechanical benefits that can produce medical benefits appear to be a major key to therapeutic and pathological shoeing. A well-made strategic plan based on the basic mechanical requirements of the foot can greatly improve the outcome and success of many podiatry cases. Understanding the basics principles of podiatry allows the veterinarian and farrier to aid in the prevention of foot related lameness, maintain a sounder horse, and implement therapeutic shoeing when necessary.

Dr. Raul Bras is a certified journeyman farrier and veterinarian in the podiatry department at Rood and Riddle Equine Hospital. A member of the International Equine Veterinarian Hall of Fame, Bras graduated from Ross University and completed the farrier program at Cornell University. He is a partner at Rood and Riddle.

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Fact Check: The Pharmacology Of Betamethasone In Horses

It's clear that the battle over the outcome of the 2021 Kentucky Derby is likely to wage on for years to come. The Kentucky Horse Racing Commission (KHRC) has yet to make a ruling, but preliminary and split sample tests on winner Medina Spirit both came back positive for betamethasone in violation of Kentucky rules. Attorneys for Medina Spirit trainer Bob Baffert and owner Zedan Stables have been vocal about their feelings that the finding in the horse shouldn't matter for a variety of reasons — they say the administration of the drug to the horse came from a topical and not an injectable, they claim that post-race drug testing is designed to find therapeutic drugs at an unreasonably small concentrations, and they claim that the concentration found in Medina Spirit had no appreciable impact on the outcome of the race.

Further, Baffert attorney Craig Robertson said in a CNN interview June 3, a small amount of betamethasone detected in blood couldn't even be having an appreciable impact on the horse's body.

“Just because that's the rule doesn't mean that it's a proper rule,” Robertson said to anchors John Berman and Brianna Keilar on New Day. “And the reason why it's not a proper rule is that at that level, there would be zero pharmacology in a horse – zero – and it would have had no effect on this race. And one thing that you haven't heard, and you will not ever hear, is an equine pharmacologist to come out and say that 21 picograms, 25 picograms would have any pharmacology in a horse. They're not going to say that, because they can't say that.”

But the research – what little peer-reviewed research exists on betamethasone in horses — doesn't support that.

It's difficult to know what concentration of a drug in a horse does or doesn't influence a race; that's a separate question altogether, but there have been two peer-reviewed studies published in recent years which suggest that even small amounts of betamethasone in the blood may indeed reflect some effect on a horse's body.

A study published in the Journal of Veterinary Pharmacology and Therapeutics in 2015 sought to learn more about the pharmacology of intra-articular betamethasone injections in horses. Researchers administered two intra-articular betamethasone to eight 4-year-old Thoroughbreds and exercised them, then took blood and urine samples to check on levels of betamethasone and hydrocortisone for six weeks.

They found that the administration of betamethasone coincided with a reduced production by the horses' bodies of hydrocortisone. Hydrocortisone is naturally produced by the horse's body and acts similarly to its fellow corticosteroid betamethasone. There are synthetic versions of hydrocortisone out there in therapeutic medications, too.

It's thought that circulating levels of a closely-related, administered drug are read by the horse's brain similarly to the endogenously-produced substance, and the brain will halt production of its own corticosteroid until the synthetic corticosteroid wanes. The study found that the suppression of hydrocortisone was present for 96 to 120 hours after the administration of betamethasone.

The study found the last detectable level of betamethasone in plasma at an average of 64 hours post-injection and 69 hours in urine, although those measurements were using .05 nanograms per milliliter (or 50 picograms per mL) of plasma and .25 nanograms per milliliter (or 250 picograms per mL) of urine as their limit of detection – much larger concentrations than what was detected in the Medina Spirit case.

More interestingly though, in 2017 the journal Drug Testing and Analysis published a study which examined the concentrations of betamethasone in blood, urine, and joint fluid in Thoroughbreds. That study found that when betamethasone was injected in a horse's joint, concentrations of the drug in fell below detectable levels much sooner in plasma (96 hours) and urine (seven days) than it did in joint fluid. It took between 14 and 21 days for the drug to disappear from joint fluid in the joint that received the treatment.

“One of the basic tenants of pharmacokinetic/pharmacodynamic analysis is that blood levels reflect drug concentrations at the site of pharmacologic effect, thereby allowing the extent and duration of effect to be estimated based on blood concentrations,” wrote the study authors, led by Dr. Heather Kynch. “However, this does not appear to be the case for intra-articular corticosteroids.”

The study's findings were not wholly surprising, given that corticosteroids generally are known to be a little fickle in their withdrawal times. One previous study found triamcinolone in joint fluid for 35 days after a joint injection, and another found methylprednisolone 77 days after a single intra-articular dose.

Knych's study also noted that the diffusion of drugs from joints may vary from one joint to another.

“Although more comprehensive pharmacodynamic studies are necessary, these findings suggest that the anti-inflammatory effects may continue even though drug is no longer detected in blood,” wrote the Knych team. “A major concern with this finding is that horses may be able to return to racing before they are completely healed following an injury. Even though blood concentrations would be below the recommended threshold, allowing the horse to race, therapeutic drug concentrations in the joint may mask the clinical signs of an injury that is not completely healed. This could ultimately increase the risk of additional damage to the joint.”

At the time Knych and her team performed that study, the Racing Medication and Testing Consortium (RMTC) recommended a seven-day withdrawal of corticosteroids to clear a regulatory threshold of 10 picograms per mL. In the intervening years, jurisdictions like California and Kentucky backed up their corticosteroid administration timeframes to coincide with additional layers of pre-race veterinary checks performed to improve safety after the Santa Anita fatalities. In Kentucky, any level of corticosteroids like betamethasone in a post-race sample is a violation, based on the belief that the drug now can't be found farther out than 14 days post-administration.

Perhaps incredibly, those two studies seem to be the bulk of the peer-reviewed, published research that has been done on the behavior of betamethasone in a horse's body. It's not uncommon for research into equine medications to be limited, even for commonly-used therapeutic drugs like betamethasone.

Baffert's view on the Medina Spirit case would likely dismiss both studies as irrelevant. He asserts he gave the drug via a topical cream to treat a skin condition, not a joint injection, as was done in both studies. Further testing of the blood and urine from Medina Spirit will seek to clarify whether the betamethasone found in the horse came from an injection or an ointment, and it seems that will be an ongoing point of debate for his legal team. But with the limited peer-reviewed research available, the suggestion that the drug doesn't have any pharmacological effect at low levels of detection in blood is going to be an uphill battle.

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What Will That Extra Urine Testing In The Medina Spirit Case Actually Tell Us?

Attorneys for Medina Spirit's connections spilled a lot of ink last week to ensure their clients will have the opportunity to run extra tests on a split sample of the horse's urine. They hope to demonstrate that the betamethasone detected in two rounds of testing after the Kentucky Derby was the result of a topical ointment applied for a skin rash, not an injected treatment to relieve pain or inflammation. The eventual goal, according to a civil suit filed in Franklin Circuit Court over that extra testing, will be to argue that a topical application of betamethasone isn't prohibited by Kentucky regulations and that repercussions for trainer Bob Baffert and owner Zedan Racing should therefore be mitigated. A judge ruled on June 11 that the extra testing will go on, and it only remains for the Kentucky Horse Racing Commission and the horse's connections to agree on how much urine will be tested.

The second objective, the question of whether administration route matters, will come down to a long (and probably dry) legal argument. The first objective, the proof of where the betamethasone came from, hangs on that extra testing, which means this is a good time to ask – can extra urine testing actually prove the origin of the betamethasone in question?

Maybe, says equine drug testing expert Dr. Rick Sams. But maybe not.

There are two ways that drug testing could try to establish whether the betamethasone came from an ointment or an injectable: by looking for the other ingredients in Otomax, the topical cream Baffert eventually said was used to treat a rash on Medina Spirit's hindquarters, or by identifying the exact chemical makeup of the betamethasone in the sample.

Besides betamethasone, Otomax also contains gentamicin, an antibiotic, and clotrimazole, an anti-fungal. Post-race samples aren't tested for most antibiotics or antifungals because those drugs are not acting directly on the body of the horse — they're designed to combat bacteria or fungi. As such, most of them aren't regulated in racehorses the same way an anti-inflammatory is, so it's not surprising that these ingredients weren't reported on the initial post-race test or in the split sample.

(Procaine penicillin is the common exception to this, since procaine is a numbing agent also used in other ways, outside the combination with penicillin. Penicillin is known to cause some discomfort in horses when injected, so it's often formulated with procaine to make repeated administrations more tolerable.)

Sams worries however that it's unlikely either of those drugs would have made it into the horse's urine in a sufficient amount to be testable, because they were given as topicals. They were present in a topical application with the directive to work on a surface- level skin rash, so their purpose was to work on bacteria or fungi on the skin's surface. He suspects they weren't designed to be readily absorbed through the skin and into the bloodstream, since most of their work was to take place on the outside of the horse.

“I think the likelihood of gentamicin ever getting absorbed in sufficient quantities to show up in the urine is essentially zero,” he said.

In the case of clotrimazole, it's present in very low levels in Otomax, making it even less likely it would be absorbed.

“There are no studies I can find that demonstrate any appreciable absorption of clotrimazole after topical administration,” Sams said.

It's also not immediately clear how many accredited racing labs would be able to test for either substance, because it's not part of the usual battery of post-race tests. A civil court hearing June 11 revealed that New York's Equine Drug Testing Program housed at Morrisville State College will conduct the extra testing.

The other thing Zedan and Baffert hope the extra testing will reveal is the chemical makeup of the betamethasone detected in post-race sampling. Otomax contains betamethasone valerate, which is chemically different from betamethasone acetate and betamethasone sodium phosphate – the two versions of betamethasone used in injectable products. The words acetate, sodium phosphate, and valerate all refer to esters, which are chemical compounds derived from acids that are attached to a molecule of betamethasone.

“If one was to look for the valerate ester and find it, that would demonstrate that something other than the injectable preparation was administered to the horse,” said Sams. “But I think the chance of finding the valerate ester of betamethasone is zero, because the valerate ester has very low water solubility, and substances have to have water solubility to get excreted into the urine so I don't think it ever gets into the urine as valerate.”

It's possible that the legal team will ask the lab to look for betamethasone acetate and betamethasone sodium phosphate instead, with the idea that if they aren't found, that would demonstrate the horse wasn't given injectable betamethasone. Sams said the betamethasone acetate is, similarly to betamethasone valerate, not all that water soluble and therefore he wouldn't expect to find it in urine, even if it had been administered to the horse. The sodium phosphate ester however, is very water soluble and that may be excreted into the urine readily. Sams has done previous research on a chemically similar ester and found it was pretty easy to detect.

Racing labs aren't typically asked to determine which form of a drug like betamethasone is in a sample and Sams said he is not aware of any racing lab ever previously attempting to make this distinction.

So how helpful could this additional testing be? Its usefulness to Bob Baffert and Zedan Racing may be more about what it doesn't show than what it does. If the testing confirms betamethasone but can't determine which form is present, or finds no evidence of either injectable version, the attorneys may point out that there is no evidence to refute Baffert's version of events.

Of course, Sams and many others have stated that they don't believe Kentucky's rules differentiate between routes of administration for regulated substances like betamethasone. Whatever Baffert and Zedan hope to learn from the extra testing they've fought for, they will no doubt look to challenge that belief in court proceedings that may stretch on for months or years to come.

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