Ed Kane, PhD
AAEP guidelines offer clinical direction for veterinarians when treating these premier equine athletes.
Racehorses are bred, raised and trained to perform as athletes. As a result, their performance health needs are critically important to keeping them physically sound, happy and healthy. "The difference between the human athlete and the racehorse is that the person can say, 'Hey, today my knee is really bugging me,' but the horse can't," says Jeff Blea, DVM, president of the American Association of Equine Practitioners (AAEP). "So that's where the groom, the trainer and the veterinarian need to be able to pick up on those subtleties to help keep performance horses healthy and strong."
When caring for performance horses, their well-being should always be the No. 1 priority. In 2009, the AAEP released specific guidelines regarding healthcare for sport horses, including use of therapeutic medications, to ensure proper medical attention as well as the integrity of horse racing. (GETTY IMAGES/GINA GUARNIERI)
When maintaining and improving performance horse health, the horse's overall well-being must always come first, says Blea, a partner in VonBluecher, Blea, Hunkin Equine Medicine and Surgery in Sierra Madre, Calif. "Everyone who works on the backside of a racetrack has a lot of respect for these horses," he says. "The care they receive from the hot walker, the groom, the exercise rider, the blacksmith, the trainer and the veterinarian is first and foremost."
Whether it's proper nutrition, dental care, shoeing and foot care, or other aspects of veterinary care, everybody works toward optimizing horse health and performance.
"If a horse is healthy, it should perform well. If it's not healthy, it should not be performing," says Blea. "If necessary, therapeutic medications are used to treat ailments and injuries and to improve the horse's health and performance. Any prescribed and administered medication should be based on clinical signs or diagnostic tests and be part of a proper treatment plan."
There are currently 26 approved therapeutic medications with specific thresholds, as established by the Racing Commissioners International (RCI) (see "Suggested withdrawal times and threshold concentrations of therapeutic medications"). The RCI Controlled Therapeutic Medication Schedule lists these medications as well as corresponding detection levels at which a testing laboratory is required to report a positive test result. In 2009, the AAEP established a policy regarding therapeutic medications in racehorses. It states:
Suggested withdrawal times and threshold concentrations of therapeutic medications
"The AAEP policy on medication in pari-mutuel racing is driven by our mission to improve the health and welfare of the horse. The AAEP policy is aimed at providing the best health care possible for the racehorses competing while ensuring the integrity of the sport. The AAEP expects its members to abide by the rules of all jurisdictions where they practice. The AAEP condemns the administration of non-therapeutic or unprescribed medications to racehorses by anyone. The AAEP believes that all therapeutic medication should be administered to racehorses by or under the direction of a licensed veterinarian. Health care decisions on individual horses should involve the veterinarian, the trainer and owner with the best interests of the horse as the primary objective.
"In order to provide the best health care possible for the racehorse, veterinarians should utilize the most modern diagnostic and therapeutic modalities available in accordance with medication guidelines designed to ensure the integrity of the sport."
Here are the essential elements of the AAEP policy concerning veterinary care of racehorses:
> All racing jurisdictions should adopt the uniform medication guidelines set forth by the Racing Medication and Testing Consortium (RMTC; see rmtcnet.com). These guidelines and procedures strive to protect the integrity of racing as well as the health and well-being of the horse.
> Race day medication must be given in accordance with current RMTC guidelines.
> In the absence of a more effective treatment or preventive for exercise-induced pulmonary hemorrhage (EIPH), the AAEP supports the use of furosemide on race day to control EIPH. The AAEP advocates the research and development of new treatments to help prevent or control EIPH.
> The AAEP encourages proactive and constructive communication between regulatory bodies and practicing veterinarians and other industry stakeholders.
> The AAEP believes that all veterinarians should use judicious, prudent and ethical decisions in all treatments to ensure the health and welfare of the horse.
> The AAEP strongly endorses increased surveillance and enforcement of the above-mentioned regulations.
"We tell our young veterinarians, 'Everything you do, you have to be able to justify,'" Blea says. "If you hold to that code of practice, you will be able to show the owner, the trainer, the press or the public that everything you do to a racehorse medically will put the horse first." And that particularly includes administration of medications.
The use of furosemide has divided the industry worldwide. "Whether it's performance-enhancing or not, I don't know, but it is performance-optimizing," suggests Blea. "Furosemide is good for the racehorse, but it's not good for racing. As a veterinarian, my concern is what's good for the racehorse. The AAEP has taken the position, with which I agree, that furosemide is scientifically proven to be efficacious in treating disease in the horse—to reduce or prevent EIPH while racing. It is a necessary, therapeutic medication." (see "Furosemide facts and fiction" in the March 2013 issue of dvm360)
Other therapeutic medications are properly administered to racehorses (that is, given within AAEP and RMTC guidelines) for ailments, strains or joint inflammation similar to the way therapeutic drugs are given to human athletes. Both racehorses and human athletes require medical intervention at some point in their training regimen because of either minor or major injuries.
"For the racehorse with athletic issues, some will require rest and others will require medical intervention," Blea says. "Before administration of any treatment or medication, veterinarians need to make a diagnosis and treatment plan. All therapeutic treatments should be prescribed based on a medical diagnosis after a thorough examination to properly evaluate the condition, to properly treat the condition and, more important, to subsequently evaluate the response to treatment. That's critical."
The AAEP also released its Clinical Guidelines for Veterinarians Practicing in a Pari-Mutuel Environment in 2010 (see dvm360.com/AAEPguidelines). The document discusses various aspects of racetrack practice that "put the health and safety of racing horses first."
GETTY IMAGES/ANT MCLEAN
Some of the issues addressed include:
> No medication, with the exception of furosemide, should be given to a horse on race day.
> Any medication given prior to race day should be in accordance with RMTC guidelines.
> A 10-day withdrawal period is necessary after shockwave treatment.
> Hyperbaric oxygen therapy should not be performed after the entry date.
> Caution should be used in the selection, timing and frequency of intra-articular corticosteroids in high-motion joints.
> Intra-articular use of local anesthetics is indicated for diagnostic procedures only.
> Under no circumstances should local anesthetics, anti-nociceptive agents or neurotoxic agents be used intra-articularly or periarticularly prior to competition.
> Under no circumstances should perineural treatments be used to desensitize a portion of the body prior to competition.
> Integrative therapies should be based on valid medical diagnoses.
> All procedures performed should be documented in a medical record.
> Practitioners should not reuse needles, syringes or any equipment that might be contaminated with blood or other body fluids.
> All communication with owners and trainers should be transparent.
> Practice vehicles should only contain medications that are legal for use under FDA guidelines, with appropriate compliance to labeling, refrigeration instructions and expiration dates.
> The veterinarian should limit the use of compounded drugs to unique needs in specific patients and for those uses in which a physiological response can be monitored or those for which no other method or route of delivery is practical.
"These AAEP policies and guidelines are out there, but nobody—especially those within the public and press—talks about them," says Blea. "I'm hoping people will read this and get this information out."
When horses are training well and feeling good, you know it, Blea says. "Their coats look good, they're eating well, there is a presence about them when they're right," he continues.
"It's our job to solve problems using open communication, clinical signs and sound diagnostic or treatment plans to improve their performance health and prevent injury."
Ed Kane, PhD, is a researcher and consultant in animal nutrition. He is an author and editor on nutrition, physiology and veterinary medicine with a background in horses, pets and livestock.
1. Putting the horse first: Veterinary recommendations for the safety and welfare of the thoroughbred racehorse (white paper). Am Assoc Equine Pract, 2009. Available at: http://www.aaep.org/custdocs/RacingIndustryWhitePaperFinal.pdf.
2. Clinical guidelines for veterinarians practicing in a pari-mutuel environment. Am Assoc Equine Pract, 2010. Available at: http://www.aaep.org/custdocs/AAEPClinicalGuidelinesPariMutuelEnvironment.pdf.