EIPH and Lasix

[rcloisonne]

Then how is it every other country racing TBs gets along fine without it? I’ve not seen this question answered satisfactorily on this board.

Funny how many of the top trainers in the US are supporting elimination of this drug starting in 2015. If there are any “credible” studies showing lasix is beneficial to racehorses I’d like to see them.

Have any of the proponents here ever wondered how much “track jewelry” and fractures can be directly attributed to calcium interference/depletion caused by the drug?

[Flash44]

Here is a summary of the actual article:

http://www.ncbi.nlm.nih.gov/pubmed/25055713

Still looking for the article itself, I read a detailed interview with the vet that did the study recently, but can’t find it at the moment. Of note - there does not seem to be much consistency within the positive population wrt the severity of the bleeding in an individual.

Also, if the horses that bleed run more races and over a longer period of time than those that do not bleed, how does that statistic support the allegation that it’s better for the health of the horse to get Lasix? The bleeders, without Lasix, are running more races and have longer careers than the non-bleeders. It’s rather confusing to me.

[Flash44]

Found it

http://www.thoroughbreddailynews.com/shared_content.cfm?id=602

[ellevt]

I’m involved in the data wrangling in this study. It has been accepted and published in the Equine Veterinary Journal. PM me if you would like a pdf of the original.

Dr. Preston is a PhD, not a vet, but she has been very involved on the track her entire life as a jockey and owner.

The results of this study indicate A) EIPH actually does not seem to have long term negative effects, as long as it does not progress to epistaxis (blood visible from the nostrils) B) It does not, in most cases, seem to be a progressive disease. I.e., horses that score a 3 will sometimes go back down to scoring 1s and 2s. Most horses that score 1s or 2s will never go any higher than that.

If you read the original, there is a citation (I think of a South African study) that indicates that horses on Lasix will often still bleed at the 1 - 2 level. That’s just one study but still interesting.

This was a longitudinal study made possible by the excellent data collection of the Hong Kong Jockey Club, so we’re not really aiming (or even able at this point) to answer the “why” so much.

Further publications (in progress) will look at actual race times and winnings of horses that are EIPH+ versus those that aren’t.

The big takeaway here- horse welfare is NOT compromised due to the lasix ban in Hong Kong.

[ellevt]

For those with institutional access- it can be found here: http://onlinelibrary.wiley.com/doi/10.1111/evj.12326/abstract

[SportArab]

I have yet to see documented proof that bleeding damages the lungs. Please do send citations so I can pull them up and read.

[SportArab]

And let me point out that elite human runners also bleed. I don’t see any of them taking diuretics.

[Flash44]

Thank you ellevt! The race times comparison will be interesting.

[halo]

You can not be serious.

http://www.thehorse.com/articles/12529/eiph-exercise-induced-pulmonary-hemorrhage

[SportArab]

Sorry. What I meant was research articles published in peer reviewed journals that I can pull up on PubMed. Reviews in popular lay mags don’t make the cut.

[ellevt]

[QUOTE=halo;7718148]
You can not be serious.

http://www.thehorse.com/articles/12529/eiph-exercise-induced-pulmonary-hemorrhage[/QUOTE]

I think, overall, this is a good overview. However, I HATE HATE HATE it when lay articles don’t actually provide links or specific information about the studies they cite. I would say at least 70% of the time, journalists will mis- or over- interpret data published in scientific studies.

" Because the low-grade lung inflammation associated with repeated bleeding episodes can worsen EIPH over time, it is very important to minimize further insults to the respiratory system. " (Emphasis mine) I do not know of any scientific study that suggests that EIPH is a progressive disease. Our results suggest the opposite is true.

Keep in mind that the Hong Kong study is HUGE- almost 1000 horses, over years, that are getting scoped multiple times. So it’s powerful in a way that a lot of previous studies have not been.

[ellevt]

[QUOTE=halo;7718148]
You can not be serious.

http://www.thehorse.com/articles/12529/eiph-exercise-induced-pulmonary-hemorrhage[/QUOTE]

I think, overall, this is a good overview. However, I HATE HATE HATE it when lay articles don’t actually provide links or specific information about the studies they cite. I would say at least 70% of the time, journalists will mis- or over- interpret data published in scientific studies.

" Because the low-grade lung inflammation associated with repeated bleeding episodes can worsen EIPH over time, it is very important to minimize further insults to the respiratory system. " (Emphasis mine) I do not know of any scientific study that suggests that EIPH is a progressive disease. Our results suggest the opposite is true.

Keep in mind that the Hong Kong study is HUGE- almost 1000 horses, over years, that are getting scoped multiple times. So it’s powerful in a way that a lot of previous studies have not been.

[Flash44]

[QUOTE=ellevt;7718697]
I think, overall, this is a good overview. However, I HATE HATE HATE it when lay articles don’t actually provide links or specific information about the studies they cite. I would say at least 70% of the time, journalists will mis- or over- interpret data published in scientific studies.

" Because the low-grade lung inflammation associated with repeated bleeding episodes can worsen EIPH over time, it is very important to minimize further insults to the respiratory system. " (Emphasis mine) I do not know of any scientific study that suggests that EIPH is a progressive disease. Our results suggest the opposite is true.

Keep in mind that the Hong Kong study is HUGE- almost 1000 horses, over years, that are getting scoped multiple times. So it’s powerful in a way that a lot of previous studies have not been.[/QUOTE]

Thank you again, ellevt. The sample size is very important in determining whether or not the results are accurately representing the population.

[SportArab]

[QUOTE=ellevt;7718697]
I think, overall, this is a good overview. However, I HATE HATE HATE it when lay articles don’t actually provide links or specific information about the studies they cite. I would say at least 70% of the time, journalists will mis- or over- interpret data published in scientific studies.

" Because the low-grade lung inflammation associated with repeated bleeding episodes can worsen EIPH over time, it is very important to minimize further insults to the respiratory system. " (Emphasis mine) I do not know of any scientific study that suggests that EIPH is a progressive disease. Our results suggest the opposite is true.

Keep in mind that the Hong Kong study is HUGE- almost 1000 horses, over years, that are getting scoped multiple times. So it’s powerful in a way that a lot of previous studies have not been.[/QUOTE]

In my non-horsie life I am a journalist who covers health - mostly in humans. But around the time of the Belmont when California Chrome’s nasal strip was in dispute, I wrote a story (for NBC News) about nasal strips and bleeding. I interviewed several experts and was told there is NO evidence that preventing bleeding has any health benefits to the horse.

[SportArab]

And by the way, while we’re talking about the cited article, did you happen to notice this:

“The real solution to this dilemma is to come up with a treatment that effectively lessens the severity of bleeding without altering performance. A newer approach is the use of the Flair equine nasal strip (see “Opening the Airways” in the August 2001 issue of The Horse, article #938). This simple device is designed to support the nasal passages and optimize air flow. Much of the resistance to air flow occurs as air travels through the horse’s nasal passages. This resistance probably contributes to the overall stress on the blood-gas barrier during strenuous exercise. Therefore, lowering the resistance to airflow could help reduce bleeding.”

Every expert I spoke with, including Dr. Larry Bramlage, said that there is no evidence that nasal strips have any effect.

[SportArab]

[QUOTE=ellevt;7716794]
For those with institutional access- it can be found here: http://onlinelibrary.wiley.com/doi/10.1111/evj.12326/abstract[/QUOTE]

Interesting article. Thanks for the cite.

[On_the_Farm]

[QUOTE=SportArab;7718390]
Sorry. What I meant was research articles published in peer reviewed journals that I can pull up on PubMed. Reviews in popular lay mags don’t make the cut.[/QUOTE]

Does this meet your criteria
http://m.vet.sagepub.com/content/45/3/316.short.

My own views on lasix have evolved over time. Was on the fence until I had to deal with a multiple stakes winner who had a deep and undetected bleed. The resulting lung infection almost took his life and when he did recover and return to the races after several months , it was no longer as a stakes horse. I’m all for doing our best to prevent EIPH and if that means lasix, then so be it. I wonder how McPeek’s recent first timer that bled without lasix would have faired with the medication. Unfortunately we’ll never know.

[ellevt]

[QUOTE=On the Farm;7719306]
Does this meet your criteria
http://m.vet.sagepub.com/content/45/3/316.short.

My own views on lasix have evolved over time. Was on the fence until I had to deal with a multiple stakes winner who had a deep and undetected bleed. The resulting lung infection almost took his life and when he did recover and return to the races after several months , it was no longer as a stakes horse. I’m all for doing our best to prevent EIPH and if that means lasix, then so be it. I wonder how McPeek’s recent first timer that bled without lasix would have faired with the medication. Unfortunately we’ll never know.[/QUOTE]

Interesting, although I am troubled they didn’t include control samples. Surely there are enough euthanized racehorses in the world, they could have found one that wasn’t a bleeder. Unfortunately I know next to nothing about pathology, so I can’t say whether these types of lesions are worrisome or not.

[ellevt]

[QUOTE=SportArab;7718870]

Every expert I spoke with, including Dr. Larry Bramlage, said that there is no evidence that nasal strips have any effect.[/QUOTE]

My own [admittedly brief] GoogleScholar search led me to more or less the same conclusion. I think there was one study that suggested the nasal strips increased max O2 but the sample size was small

[Pegasus5]

[QUOTE=rcloisonne;7716697]
Then how is it every other country racing TBs gets along fine without it? I’ve not seen this question answered satisfactorily on this board.

Funny how many of the top trainers in the US are supporting elimination of this drug starting in 2015. If there are any “credible” studies showing lasix is beneficial to racehorses I’d like to see them.

Have any of the proponents here ever wondered how much “track jewelry” and fractures can be directly attributed to calcium interference/depletion caused by the drug?[/QUOTE]

Where have you come up with this information? Trainers in Europe train on Lasix regularly, they just aren’t allowed to use it on actual race day. Also, many European trainers that ship horses to the US to run, do use Lasix on race day because it is allowed.

None of the big trainers that signed the recent proposal in support of banning Lasix on race day are Lasix- free. They all use it. If you read their interviews on why the signed it, they said that it was to help public perception and make racing “look” better…not the proper way to handle PR IMO. To say the big trainers don’t use it is completely false.

Last, peer reviewed journals contain studies that are flawed and just plain wrong on a pretty regular basis. I have seen no proof of the calcium issue, and again, when properly administered dehydration can be prevented and dealt with. I’m also appalled that people are actually saying that bleeding into the lungs really isn’t an issue! When capillaries burst and blood (a fluid) pours into the lungs it is drowning! That’s how horses die in severe cases of EIPH. That’s my 2 cents.