As part of its ongoing owner education effort, the Thoroughbred Owners and Breeders Association (TOBA) recently held a virtual panel with three of racing's top equine veterinarians.
Dr. Larry Bramlage, renowned equine surgeon at Rood and Riddle Equine Hospital, gave a presentation on conformation and how it relates to racing soundness. Dr. Steve Reed, internal medicine and neurological specialist at Rood and Riddle, gave owners an overview of Wobblers Syndrome and of equine herpesvirus, and Dr. Lisa Fortier, professor of surgery at Cornell's College of Veterinary Medicine, presented information on alternatives to intra-articular corticosteroid use on the track.
Here are a few takeaways from the presentation. You can watch the full version of the seminar below.
–Each panelist was asked what the noteworthy medical advance they had witnessed in their career. Both Fortier and Reed nodded to the advanced imaging technology that has become more accessible and widely-applicable, for diagnosing limb lameness but also for neurological issues. Perhaps surprisingly for an equine surgeon, Bramlage said deworming medications were the greatest advance he'd seen.
“In my career, I think the most significant development was the anti-parasitic drugs that eliminated strongylus vulgaris,” he said. “That used to be the disease that killed most horses. It was a parasite that migrated inside the blood vessels as a larva and it caused the thromboembolic colics. When I started practicing, an “old horse” was in their early twenties. Now, it's nothing for a horse to go into their thirties. That is pretty much all the result of better wormers.”
–Although her presentation was focused on alternatives to joint injections, Fortier made clear that her presentation was not anti-corticosteroids. On the plus side, she acknowledged the drugs tend to be potent, easily available, and fairly cheap, but pointed out their strengths can be drawbacks, too.
“Will humans and dogs and horses do things they shouldn't do when they have steroids because you've killed the pain? Yes,” she said. “Am I saying that leads to breakdown injury? No, but in humans you could do this too – they could overtrain because you've taken away the vast majority of their pain.”
Corticosteroids can also be associated with what in other species is called 'steroid euphoria' – a desired effect when it's used in an ailing, older dog or cat. The sudden rush of positive feelings will sometimes get the patient back to some level of activity and appetite for a brief period. In horses, Fortier said she sees some degree of uptick in training for horses receiving the treatment, but that effect fades over time.
–There is some degree of risk involved with any kind of injection, especially one that's going into a joint. That risk is small, usually small enough that a veterinarian can conclude the potential benefit to the horse is greater than the limited chance for drawbacks. Fortier did note, however, she has ceased using Depo Medrol in most cases because she has found it to be associated with more significant infections in the rare case a joint injection does lead to an infection.
–Fortier touted the potential benefit of regenerative therapies, such as platelet-rich plasma (PRP), which is an umbrella term for several different types of products made from a horse's own cells. The most basic form involves taking blood from the patient, spinning it, and reinjecting the plasma portion of the spun sample into the area of injury.
The World Anti-Doping Association (WADA) looked at the use of orthobiologics, which includes PRP and stem cell treatment, and determined PRP use is not considered doping, although the administration of certain growth factors that may be contained in blood is. If the anti-doping rules for horse racing are based upon the rules in place for human athletes (as has been implied, with the new Horseracing Integrity and Safety Authority on the horizon), Fortier said that would seem this could be a type of therapy veterinarians could use to help an injured horse recover without the fear of a positive drug test down the road.
–Most people believe regenerative therapies are significantly more expensive than corticosteroids, but Fortier said that isn't necessarily the case. She also cautioned that PRP is not a miracle cure.
“It's an option to use instead of steroids, not when steroids fail,” she said.
If a horse's joint has had too much chronic damage and is no longer responsive to corticosteroids, it probably won't respond to regenerative therapies either. Fortier said she prefers to do one injection of PRP and if she doesn't see the response she expected, she does not repeat the same treatment, because it could be a sign that the therapy has been placed in the wrong area of the body, or that there's another, underlying injury somewhere.
–Reed provided a brief overview of equine herpesvirus (EHV) for owners who may have read headlines during outbreaks, but may not be familiar with the virus. He says it's estimated 80 percent of horses are latently infected with the virus, meaning they carry the virus around but aren't actively showing symptoms of infection and aren't transmitting it to others. This means it's unlikely we will eradicate EHV, but should instead aim to better respond to outbreaks.
–It's not always easy to recognize a fever from EHV because it can be biphasic, meaning there is one bout of fever and then an apparent recovery before another spike in temperature. As we know, some horses experience respiratory symptoms with EHV infection, and in some cases, a patient may also develop neurologic symptoms that signal severe infection. Those neurologic symptoms are the result of damage to the nervous system which mimics the lesions caused by a stroke.
–Vaccination isn't really effective at preventing EHV at this point, and Reed said he's not aware of anything immediately on the horizon that will work better. He did point out, however, that the Grayson-Jockey Club Research Foundation has put out a call for development of an RNA vaccine, which could prove successful where other types of vaccines have not.
–In his presentation on conformation, Bramlage said there are essentially two types of conformational flaws in horses: those that he believes result in unsoundness, and those that just make the horse an inefficient mover, which is also not desirable.
Most horses aren't perfectly-conformed, he said, “but most horses that are successful have reasonable conformation.”
–When examining yearlings at a sale, observers should anticipate changes that can occur to limb angles as the horse grows. Bramlage said a yearling being slightly knock-kneed and toed out isn't much of an issue, because as the horse finishes growth and development, the chest will become wider and the elbows will get pushed out in relation to the shoulders, realigning the joints below.
“If he looks perfectly straight as a yearling, he's going to toe in as an adult racehorse,” said Bramlage.
–Most of the time, conformation issues at birth self-resolve, because growth plates are designed to help rebalance themselves automatically. There are two circumstances in which Bramlage is interested in performing corrective surgery to address conformation: if there's not enough time for the self-correction to happen before the growth plate in the impacted joint closes, or if the horse has inherited a conformation that won't be suited to maintaining soundness during racing.
“Horses highly inherit toed-in and offset knee conformation, so if the mare is producing that in the foal, we have to negate it somehow,” he said. “The reason we manipulate conformation is to make a sounder horse.”
–When asked by an audience member about the potential benefits about training a horse in both directions, Bramlage was hesitant to suggest that this could reduce orthopedic injuries.
There are some issues, including stress fractures in the knee, that we see more frequently in left legs than right legs, according to Bramlage, and that could be due to the fact American racing is conducted on counterclockwise ovals. It's also true that those same stress injuries are seen less in Europe, where horses may train in both directions or in straight lines, but those types of stress fractures tend to come from dirt racing, which doesn't take place much in Europe.
Bramlage said it wouldn't likely hurt to train horses in both directions, but it's not going to benefit the skeleton, which develops in response to the type of exercise a horse does routinely.
“In practicality, the horse is adapting to what you're giving them,” he said. “So for the most part, you want him adapted to racing counterclockwise. I think that the idea of going both directions is more related to the way you train the heart and lungs, which is rarely the limiting system in the horse. The skeletal system is almost always the limiting system.
“As far as splitting the training equally [between two directions], no. They need to train in the direction they're going to run.”
The post Corticosteroids, Galloping Both Ways, And The Importance Of Good Conformation: Vet Panel Provides New Insights For Owners appeared first on Horse Racing News | Paulick Report.
