“In conclusion, it looks like low-dose 24-hour furosemide with controlled water access shows great promise as a replacement treatment for our conventional four-hour pre-race treatment for EIPH in horses that are bleeding. It was less effective in horses that were not known bleeders.”
What are the specifications of controlled water access?
The article says “to maintenance levels”, so they get the amount they would normally drink if they had not been given the diuretic. You’d have to pull the article to see if that’s split out into multiple servings over the day, or they get given the day’s worth and when it’s gone it’s gone, or what.
On the flip side, an article today on PH showing studies on some therapeutic meds do more harm than good including Lasix, Omeprazole and Thyro-L.
Interesting read…
It read to me on first like all three together create a recipe for disaster. I haven’t read all the links in the article yet.
Please consider the source.
Casner cited many studies. Here’s a pull quote from one. “CONCLUSIONS:Current use of furosemide is associated with a 30% increased odds of hip fracture in older people in Taiwan.”
I perused most of the studies in that article. The more I read the more skeptical I became about their relevance to racehorses. (And of course there was no mention of the fact that people are dosed daily, while horses are given Lasix once a month, if that.)
I would agree that I was a bit skeptical as well on its relevance to horses vs humans.
In general, PR seems to release reasonable articles and thought this one was interesting while still being a bit unclear how relevant it is too racehorses.
Having said that, it would be IMO, interesting to study these meds and their relationship to racehorses 
(I’m fresh outta funding, sorry).
It is presented in the article as fact that most, if not all, racehorses are dosed regularly with gastroguard, Lasix, and thyrol-L.
"all owners are aware by our vet bills, many horses at the track receive a full or half dose of GastroGard on a daily basis as a “preventative” for stomach ulcers. "
“Thyro-L, which is the synthetic thyroid hormone Levothyroxine. Thyro-L has routinely been administered daily by many trainers in the feed of their horses.”
I disagree wholeheartedly. Maybe the horses Casners trains–or the trainers he used when he was affiliated with WinStar–medicated their horses that way. But in my experience, the majority of trainers do not.
I realize Casner is making these statements to drive home his points, but his delivery is heavily flawed. Citing studies that are only vaguely revelent to “prove” that these medications are causing fractures is just plain silly, IMO.
I’ve never owned a racing TB, however the TB’s I have owned never struck me as having any similarity to Taiwanese senior citizens at all.
I really can’t think of even one thing that they had in common. :winkgrin:
Drawing conclusions based on science is not the same as being scientifically correct. If any drug caused “weakened bones” a pattern would be revealed in necroscopy reports.
Yes, hip fractures in elderly people that are taking lasix can hardly be thought to have any relevance to lasix and racehorse fatalities. That was a real reach.
I think most educated people understand that separate scientific studies of the same medication, given to elderly humans and to racehorses, cannot be used to prove or disprove any correlation or causation of side effects between the species.
Why people try to compare such articles is beyond me, and I’m not even close to an expert in this field. Then again, I wasn’t born yesterday.
Far as I know, elderly humans have far more hip fractures then younger humans on Lasix or not. That’s a real reach as proof it causes fractures in extremely active young race horses.
Theres got to be better data then that out there to use as a comparison, like, same species, same age group and activity level…isn’t there?
There is - necroscopy reports. No horses have had compromised bone density, or “weaknesses” that indicate Lasix is doing any harm to the bones. If they can find microfractures, which they do, they can also determine the condition of the bone.
Do you know if, in the case of catastrophic breakdowns, the bone is examined for microfractures as part of a standard race horse necropsy?
Does any organization actually collect this information and attempt to analyze it across the different tracks and jurisdictions?
I don’t know what is standard wrt necroscopies, but a large percentage of injuries are to the front forelimbs, so it would make sense that they would take a very close look at the bones involved.
The EID analyzes the statistics.
I guess my thought process in pointing to this PR article wasn’t that the studies and results should apply to horses but more an interesting observation of a possible relationship between fairly common meds and possible results of their being used. And certainly, comparing hip fractures in older humans doesn’t directly have anything to do with extremity fractures in horses, but it seemed like this might be an interesting area to pursue… do these meds cause similar issues in horses? I would venture that hasn’t been studied and therefore possibly an interesting area in which to collect more data and analyze…
I personally don’t see how you could make any connection to a drug that is taken daily for years in humans and maybe once a month with horses even if everything else was the same.
When a horse breaks a leg, it’s pretty obvious. How would Lasix cause a leg to break without causing some sort of observable change to the bone? There is no central repository for most of this information, but if you Google a bit, vets have looked at a massive amount of information and the EID and have been able to identify correlations, if not cause/effect relationships. And bone density is NOT causing breakdowns.
This is like the 5th time I’ve posted this link. Bookmark it and then do more research online.
https://www.paulickreport.com/news/ray-s-paddock/santa-anita-breakdowns-your-questions-answered/
"Could we blame non-steroidal anti-inflammatories (NSAIDs) like phenylbutazone and flunixin? Do those turn bones to “Swiss cheese” by weakening them and preventing healing?
Dr. Larry Bramlage: There’s no data to support that. NSAIDs have been looked at in relation to bone physiology many, many times, both in horses and laboratory animals and sort of indirectly in people. The impetus for looking at that was wondering if you should have people who have fractures on any sort of nonsteroidal to make them more comfortable – the common one in people being ibuprofen. There’s never been anything showing nonsteroidals impact healing at all, with one exception. There was one paper which showed a change, but it wasn’t the quality of the bone healing itself, just the calendar. Bone healing is a process of step after step after step. This affected two of the steps, but not the long-term efficacy of the healing. Sometimes that study gets quoted as NSAIDs affecting bone healing but that’s not really true. There’s lots of work that shows NSAIDs don’t have any significant effect on bone physiology.
What about Lasix? Doesn’t that weaken the bone?
Dr. Larry Bramlage: There is a study by Kentucky Equine Research which shows Lasix does affect the total calcium outflow in the urine, but that is happening while the Lasix is effective. I think they looked at a 24-hour loss, but most of the change was in a few hours. That’s a transient effect, and most horses waste calcium anyway. In other words, they’re intaking way more calcium than they actually need. Horsemen can easily determine if this is the case by looking at their horses’ urine. If it’s cloudy, that’s due to excess calcium. If it’s perfectly clear, you might want to look at your horse’s calcium balance, but most horses’ urine is cloudy.
The effect of Lasix, that all started with a corollary paper in Scandinavia that showed elderly people who were on Lasix would have calcium deficiencies and increased fractures. The study initially blamed Lasix for the problem. When it was repeated, it turned out those people were on Lasix because they had cardiac disease and they were getting Lasix continuously. When they unraveled the whole scenario, they learned the fracture incidence was mostly fractures of the wrist due to falls. Those people were on medication for heart disease, and when you’re on that you have lower blood pressure. When you stand up real quickly and your blood pressure is too low, you get postural hypotension, and you have an instant where you’re a little vertigo and in a second it passes away. What was really happening was people were falling more and that was the reason for the increased fractures. When the study was repeated, that association between Lasix and fractures was disproved.
The practicality of the fact is horses are not on Lasix multiple times a day like people are when they have cardiac disease. In the overall scheme of calcium metabolism, it has very little effect. We tend to overfeed calcium to horses anyway."
Thank you for repeating that.
It’s worth reading every time these same questions get asked.
The president of the North American Association of Racetrack Veterinarians replies to Bill Casner’s article. He says in part:
Because Bill Casner has a deserved reputation as a fine owner and breeder of racehorses, I read with interest his article “Studies Show Some Therapeutic Medications Do More Harm Than Good,” appearing in the October 8, 2019, issue of the Paulick Report. I also did so because a significant part of my 30-year professional career as a racing equine veterinarian, president of the North American Association of Racetrack Veterinarians, and former member of the AAEP’s Racing Committee has revolved around the appropriate use of therapeutic medications in racehorses. Further, I am a co-author of the groundbreaking AAEP White Papers regarding medication use in the racehorse and the treatment of racehorses in a pari-mutuel environment.
Therefore, I was surprised to see Bill Casner assert that the therapeutic use of Lasix (furosemide) significantly increased bone fracture rates in racehorses and caused fatal racing breakdowns. (I’ll save my disagreement with his indictment of omeprazole and thyroxine for another time.)
Casner’s cited support for the spurious conclusion that Lasix contributes to breakdown injuries of horses was a series of 12 human studies involving the use of loop diuretics (Lasix) by elderly men, post-menopausal women, children with heart defects, and others with underlying health and balance problems.
Human studies of that sort cannot be applied to condemn Lasix use in horse racing for at least two reasons. The human patients all had substantial chronic issues that compromised their health. And the human subjects generally were on long term daily doses of Lasix. Horses, on the other hand, receive Lasix on race day with the average horse racing six times a year, according to the Jockey Club Fact Book. Even quadrupling administration to account for Lasix use in training makes it highly unlikely that such low dosage can have any significant effect on bone structure.
But that aside, all the veterinary science that I know of demonstrates Lasix use does not compromise a horse’s musculoskeletal system. For example, a study involving 5,000 racehorse necropsies at the University of California at Davis found no evidence of bone weakness (osteoporosis) even though an estimated 90% of the horses raced on Lasix.
The entire article can be read here: https://www.paulickreport.com/news/r…eletal-system/
The author of the article LaurieB linked above has been my vet for close to 20 years. He is brilliant and extremely good at what he does. I believe whatever he tells me except for the one time he suggested pin firing.
By submitting your email, you agree to our Terms of Service and Privacy Policy. You may also receive promotional emails from The Chronicle of the Horse. You can opt out at any time.
For Customers
Company
Terms of Use
