If you go over any horse with a "fine-toothed comb" - deliberately searching for problems not readily visible - you'll always find something wrong

He's wrong, on a medical basis, to associate such insidious other problems as being causal of EIPH. There's zero scientific evidence - and that includes decades of veterinarians treating the problem - for his observations. There are standard "state of the art" medical protocols for diagnosing and treating EIPH, and there's zero scientific evidence that says to look for other systemic physiologic or medical problems as causal.

Above I listed some good articles on what research science and veterinary medicine consider causal to EIPH.

Ok so in effect the your trainer has shot down the breeding theory as to why we should ban lasix.

I dont disagree with him at all about triggers that may very well be underlying causes. Certainly stress can cause many issues and because they cant talk we often are clued in after the fact as well as viral or bacterial infections.
And once a horse bleeds once they are more prone to do it again. So with round about reasoning he is giving a solid reason why we should not ban lasix.

While your trainer may be a good horseman he obviously isnt skilled in statistical analysis because there is no sample size great enough of non-lasix horses to come up with an accurate assessment of sheet numbers for those types versus regular lasix horses. The sample pool would also be tainted as the vast majority of horses that run without lasix are 1st time starters and young horses, the vast majority of which are due to improve with time regardless of all other factors including lasix. And since you dont know the severity of a bleeding incident that would cause a horse to be placed on lasix couldnt the fact that the horse didnt bleed w/ medication allow the number to go back where it should be considering the bleeding may have artificially depressed the number?

Not to mention if everyone has equal access to the same medication and no advantage is being gained than why would lasix not be considered something that is leveling the playing field? And wouldnt the elimination of the medicine lead to replacement by various other remedies which will not only be unknown to the public and other participants and work with vastly different effectiveness causing more potential form changes?

We know that horses started at 2 and raced young have stronger bones, longer careers, and less likelihood of musculoskeletal injury over their lifetimes.

But PETA won't tell you that.

no, they use it because they can here. if everyone truly thought it was performance enhancing, than why do i see horses racing here without an 'L' next to their name???

The argument has gone away from the strongest argument in favor of using lasix, and why the veterinary world strongly supports it's continued use, and why it's used for training works in the countries that ban it on race day: it helps protect the race horse from lung damage. It is good for their health, with little downside.

Can we race without it? Sure. But horses won't be able to run as fast, as far, or as frequently. Not due to performance-enhancement, but due to increased level of side effects from chronic lung damage.

Before we used lasix, horsemen used to not allow horses to drink water for 1-2 days before racing, in order to dehydrate them. Far better one lasix injection is used to protect the lungs short-term during the work or race.

:$:
:tro:

No, not at all. In fact I think it's less likely, as they won't run as fast or hard, they'll produce a sub-maximal cardiopulmonary effort.

93% of race horses have evidence of red blood cells (bleeding into the airways) after maximal effort if you do broncho-aveolar lavage as a diagnostic method (squirt sterile water down there, suck it back out, and look at the cells under a microscope) This is where lasix is valuable to attenuate chronic, constant lung damage over a career.

Only less than half have visible bleeding in the airways via bronchoscope (merely looking down the airway) after a race.

And very few have such severe bleeding there is blood coming out their noses.

But believe me: if we stop using lasix, the first horse that pulls up a furlong from the wire, and is taken directly to the trainer in front of the grandstand snorting and losing copious amounts of blood out it's nose over the jockey, trainer, groom in front of the crowd - it won't be pretty what will happen in the press. But more importantly, that's not good for race horses. It's not good medicine. It's not good care. We want them to be elite athletes. Let's use current knowledge in veterinary medicine to help them achieve it. And that has nothing to do with "doping".

I don't know if every trainer thinks lasix is performance enhancing.

I personally think it is a big mistake to use lasix on a first-time starter. The reason is because there is a small percentage of horses that will actually run worse on lasix. I have no idea what that percentage is. It is probably somewhere between 1-5%. If possible, I would like to run a horse at least once or twice without lasix. That way you can at least see how they run without it as compared to how they run with it.

One of my trainers (a different trainer than the one I was on the phone with) had a horse that had run 3 times without lasix. He had run great every time. He had two wins and then ran 2nd in a stakes race. He then decided to put the horse on lasix for his next race. He figured that lasix helps most horses and it would probably help this horse (even though the horse had never bled). The horse ended up running poorly in his first race with lasix. The trainer never even thought of the possibility that lasix might have been the cause of the dull effort. He was dumbfounded as to why the horse ran so bad. The horse had been training great. He ran him again with lasix and he ran bad again. They went over the horse with a fine-tooth comb and couldn't find anything wrong with him. He came out of the race great and he was training great.

At this point, the trainer started thinking about the possibility that the lasix was the cause of the two bad races. The horse had run great three times in a row without lasix. Then the horse ran poorly two races in a row with lasix. The trainer couldn't come up with any explanation for the horse's two bad races. So he thought there was a small possibility that this horse was one of the few that runs worse with lasix. He took the horse off lasix for his next race and the horse won (it was a stakes race) by 8 lengths.

This is not something that is common. As I said, I don't think anyone knows what percentage of horses that run worse with lasix. It could be as low as 1%. But this trainer is lucky that he ran that horse without lasix those first few races. Otherwise he would have never known that the horse was much better without lasix. That horse ended up being a multiple graded stakes winner. I'll bet you that horse would have never won a stakes race on lasix. That is why I think it is a good idea to run a horse a couple of times without it.

Every vet and trainer I know say exactly the opposite. They will all tell you that if a horse who doesn't normally bleed, all of a sudden bleeds (a decent amount like a 3), there is almost certainly something going on. As Chuck said, it could be an infection. It could be an injury that has yet to be diagnosed. It could be a lot of things. It would be a huge mistake to just assume that the horse bled for no reason and that a bigger dose of lasix is the answer.

Rupert, to your trainers impressions, there has been contrary scientific measurements regarding lasix. Studies that show horses on lasix don't do as well (dehydration, electrolyte changes). Then one study in the 1990's, looking at actual race horse races run, that showed horses on lasix did better (ran slightly longer, faster) What couldn't be eliminated in the second study was maidens simply learning their job and improving their 2-3-4 starts (as they also were then put on the vet's list for lasix due to evidence of bleeding).

I consider lasix a performance-enabler. Not a performance-enhancer. It helps prevent lung damage. It enables a horse to do the best they can with what they have. Let's use modern sports medicine to help horses, not hurt them. It has nothing to do with doping.

With all the problems horse racing has, that the poobahs of racing are even addressing lasix like this is beyond my comprehension.

Whoa - that's not how it's looked at ;)

What I am saying is that no, "other things" are not considered causal for Exercise Induced Pulmonary Hemorrhage.

There can be bleeding in the lungs due to other things that are NOT EIPH. Not all bleeding is EIPH. But 93% of race horses have evidence of microscopic bleeding due to EIPH in their lungs after races.

Including some lung infections (which can be secondary to chronic subtle bleeding in origin, as blood is the perfect bacterial growth medium)

there's more to it than just saying ' a first time starter'. they've been in training, maybe there's already been a bleeding episode? or maybe they just don't want to have to have a problem ever show up? if you can prevent bleeding and lung issues before they become an issue, why wouldn't you?
lasix has become the popular target for some reason, and really isn't the issue where drugs are concerned. the issues are with cheaters, some who are caught countless times, suspended countless times, and are still training. that's the issue, not a legal drug that has legitimate reasons for being used. it is absolutely a red herring in the whole discussion of what needs to be done to fix racing. cheating trainers and the owners who hire them are the issue. rather than all this bs posturing over lasix, where are the hearings and rules for many-times over cheaters? where are the moves for expanded testing, more security?

If you have a first-time starter that has already bled during training, that is a different story. You asked, "If you can prevent bleeding and lung issues before they become an issue, why wouldn't you?" I answered that in my last post. The reason I wouldn't want to use lasix for the first couple of races (assuming the horse has never bled in a workout), is because I would want to see how the horse runs without it. As I said, there is the rare horse that runs far worse with lasix. How would I know if my horse is one of those rare horses if I never ran him without lasix?

I wasn't talking about microscopic bleeding. It may very well be true that 93% of racehorses have evidence of microscopic bleeding. Microscopic bleeding is not a big deal. We don't need lasix for microscopic bleeding. Microscopic bleeding isn't going to affect a horse's performance in the least bit. Could it turn into a problem eventually? Yes, of course it conceivably could turn into a problem if it gets worse. But there is also a good chance that the microscopic bleeding won't get any worse and it will never turn into a real problem and it will never affect the horse's performance.

I know you will probably argue that we should use lasix prophylactically to make sure that the microscopic bleeding doesn't get worse. That is a fair argument. Some people will agree with that argument and others won't.

Whoa, wrong, no, yes, it does. Microscopic bleeding is indeed the big deal. It causes small airway and alveoli scarring, impedes their breathing, sets them up for lung infections, pneumonia, fear of running. This is precisely why we use lasix in most horses! Not just to keep from looking at massive, uncontrolled bleeding which is only visible in the larger airways.

There are about 18 branching divisions looking down into the lungs, and the bronchoscope only goes down a few. If there is so much bleeding down in the lungs that it's bubbling up to be visible, that's not good!

Yes, it's true the horses are not approved for lasix use on the track until they have a visible episode of bleeding (bleeding so significant it's literally coming up out of their lungs into their bronchi), but we know that 93% have bleeding that isn't severe enough to see grossly on a scope. Yes, we want to protect their lungs, too! If your distal airways at the tiny microscopic aveolar sacs are filled with blood cells, you can't get oxygen exchange and you start to suffocate. A horse can and will pull up with this, and the horse can get scoped, and you might not see bleeding grossly in the larger airways. But if you do bronchoalveolar lavage (not done stallside at the track commonly to diagnose EIPH) yes, you find the cause.

This is why the AVMA and AAEP support lasix use in race horses.

Remember that 30 years ago, we didn't even have common stallside bronchoscopy right after races to diagnose bleeding. We only diagnosed it if blood came out the nostrils. Now, we know better, as more horses that don't bleed visibly out their nostrils still have blood in the larger airways. And we know that horses that still don't have blood in the larger airways still show evidence of EIPH by blood down in the smaller airways and alveoli (air sacs that exchange oxygen with the tiny blood capillaries). 93% of them do.

The end point is: we use lasix in the United States and South America, and it's a good thing for race horse lungs. We could eliminate our lasix use on race day, but it would still be used in the morning to prevent injury to horse lungs when they work at speed (just like other countries do now). Why? Because it protects horse lungs. Even if a race isn't on the line.

thing is, if you wish not to run them on it, you have that choice. however, i don't think it's something that should be banned. i don't buy that it's a performance enhancer or a mask. if it was a masking agent, there sure are a lot of horses that stil pop in post-race testing...and if it is an enhancer, i'd think every horse would use it. that they aren't all on it belies that argument, doesn't it?

Do all professional athletes juice?

If not, how come? Roids definitely enhance performance.

This is true now, but it hasn't always been the case. There were plenty of numbers to go around back in the 80s and 90s. Of course back then, horses actually bled in a race before getting lasix, so they usually ran poorly, but they improved a lot given first lasix.

However, I've seen the "Champions" book advertised here. Check out the performance of some really good horses and the Beyers they earn before and after lasix. Many of these did not come after poor races. There is an obvious improvement time and time again of at least a few lengths.

In the last 5 years or so, 1st timers with Lasix return 77 cents on the dollar. Those without return 47. The sample size is huge. Euro shippers with Lasix return 66 cents on the dollar, those without 38 cents. Obviously the sample size isn't as large, but it includes over 8000/2000 in those categories.

I personally don't care about banning Lasix. There are WAY bigger issues. But, anyone racing without it is racing at a disadvantage.

Are you suggesting that furosemide stops microscopic bleeding?

Yes. Research shows a decrease in red blood cells and hemosiderophages via transtracheal washes post lasix vs. without lasix.

Diagnosing EIPH gives vastly different incident percentages depending upon the method: visual assessment by laypeople vs visual assessment by vet vs. bronchoscopy vs. transtracheal wash (TTW) or bronchoalveolar levage (BAL).

The gold standard is something we don't do on the track, BAL or TTW.

We do use bronchoscopy, but it misses evidence of lower airway bleeding, only detecting visible blood that has been moved up into the upper airways.

Is decreasing the severity of bleeding the same as stopping bleeding?

Not necessarily - sometimes lasix makes it less, sometimes it makes it stop completely, sometimes it doesn't do anything. Overall yes, lasix vastly reduces the incidence of detection of bleeding due to EIPH in horses, including stopping it in some horses.

Here's a cross section of lung (viewing it from the horses left side, the front of the horse is on the left) showing where bleeding occurs, the top (dorsal) back (caudal) part of the lung. We only detect blood when it comes out of the lungs up into the trachea. The trachea isn't shown here, it would be to the left of the lungs:





Here's a horse bleeding so bad blood is bubbling out of the lungs, up the trachea, and out the nose. Only 1 out of 20 will bleed so badly this is seen:



Here's a horse with a little blood in the trachea via bronchoscopy:

So the majority of horses treated with lasix do not bleed?

I dont think that 1st timers or euro imports are of particularly valid use. The fact that a first timer is on lasix or isnt on could be conceived as trainer intent and as such muddies the water there. And plenty of euros that bleed are sent here specifically to get lasix which would also signal intent. The problem in analyzing the numbers is it isnt clear what horses improve because they are being helped by eliminating or reducing bleeding and what horses are running better simply because they are on it. I have had plenty of horses not improve much if at all on lasix. When I worked for Jerkens he was one of the last guys who ran a lot of horses w/o lasix and we had quite a few not improve much at all when the owners insisted we put them on it.

And being that not using lasix is voluntary no one has to be at a disadvantage unless they choose to be.

don't know, ask them.
what's that got to do with lasix? and of course other legal substances are regulated for race days, that do affect performance. so, the fact that lasix is not regulated, or having a parts per millions rule for race days tells me it's not considered by racing groups as performance-enhancing.

Of course it is their choice, I never said differently. I disagree about a sample including 100,000 horse not being relevant. That is a HUGE discrepancy in ROI among the maidens. I study this stuff all the time and you won't find one factor with that kind of difference very often.

I have no doubt Lasix enhances performance. Just because everyone uses it now making it difficult to test doesn't erase a few decades of evidence.

Has anyone addressed this question other than with an "I don't care about the rest of the world" response? Someone said horses only average 3 or 4 starts a year in Ireland and France. What about Australia and Hong Kong? Are horses in those areas making fewer starts per year than here?

To read this thread, one would think we are currently in a Golden Age of horseracing, and that to go back to the pre-1995 situation in New York is absolutely unthinkable. Were New York horses making fewer starts per year before 1995 than now?

Rupert's point, I think, is that "the sky is falling, the end is near" may be an over-reaction in the face of the experience of the rest of the world. That seems like a reasonable point to me, especially considering our own long experience pre-Lasix.

--Dunbar

Banning lasix probably isn't going to do any good for the horse player.

It's also extremely unpopular with a strong majority of trainers and vets...who are both far more powerful groups in the industry than betting customers.

A lasix ban is basically a bid for more worthless PR from industry do-gooders. It would make the New York Times feel like it did some good.

It's unfortunate that it's an issue at all right now.

Meanwhile, poker is still on TV ... and everytime I go to the track I see the poker tables, slot machines, craps tables, blackjack tables, and Roulette tables all kicking the sh!t out of the horse racing simulcast section.

At-least horse racing is still holding its own with Pai-Gow when both are being offered in the same place...as the Asian population in Erie isn't so large.

However, I have no doubt Pai-Gow is handling far more than 30-track full card simulcasting here...and that's not because the local horse bettors are going the Internet and rebate shop route. It should be a wildly superior game to all -- and it's laughably uncompetitive when people have the option.

Being totally honest..as much as I love Horseracing, if I had access to REAL craps dice, I'd be there every second that I could! It is just so much fun and fast action.

Great thread with some interesting viewpoints.
I have seen several horses die after crossing the finish line from a heart attack. Why would this happen to a perfectly healthy young animal? I'm not an equine expert, but if lasix is a diuretic that stops bleeding doesn't that mean it's a blood "thickener"? and if the blood is thicker, wouldn't that make it harder for the heart to pump it through the system causing more heart attacks? Something unnatural about a animal losing so much fluid from the body; there has to be some drawbacks.

What the international aspect of the argument boils down to in general is: year-round racing (NA) vs. seasonal racing (elsewhere).

Do racehorses, as athletes, need a signficant period of rest from competition annually?

A lot of comparisons are made between racehorses and human athletes to make points about medication. But what human athletes are asked to train and compete indefinitely during the length of their careers?

Which of these schedules would tend to favor the health of the horse?

Year-round racing is necessary for a lot of people in the industry to stay in business. Furthermore, it does not appear to be economically viable to voluntarily give horses time off. This was one of the arguments used to oppose the ban on anabolic steroids. If horses couldn't be helped artificially to recover from their races, how could they continue to race year-round? A similar argument was used by Dale Romans recently about lasix. The wealthy owners can afford to give horses time off after a significant bleeding episode, the average horseman cannot.

This issue will underly every future medication debate beyond the lasix one. Therapeutic medications are used in racing to promote the well-being of the racehorse, but are they also being relied upon to avoid the cost of resting the horse? If so, will be banning medications make it impossible to race horses in the current year-round fashion?

And that's the problem, right there. It isn't how the public perceives the use of drugs; it's that now that there is plenty of competition for gambling dollars, the average American prefers to spend his or her gambling dollars elsewhere.

Not only that, it will make it tougher.

If you are talking about horses with established form being enhanced it would be a much clearer picture. How exactly can you show an enhanced performance with horses who have no baseline performance? Comparing those with and without simply on the basis of one factor and drawing an absolute conclusion? Who is good with first time starters that starts them without lasix nowdays? Anybody? You may be correct in your assessment but the data used is not really pertinent except in a roundabout fashion.

I have no doubt that horses treated aggressively with gastrogard for stomach ulcers perform far greater than those who arent treated but because those horses are not designated no one talks about that. Using the logic that some do, Gastrogard would be considered a performance enhancer as well.

If you cant see that racing in different jurisdictions in this country let alone other countries is different than you just arent trying very hard.

At the medication summit at Belmont last Summer we were given materials that showed US horses were making more starts per year than England, Ireland and France. I dont think any other countries were included. Of course when asked the foreign participants said that because their racing schedules and systems were different than ours hence the fewer starts. Naturally they unwittingly made the point that so many of us have been making, that racing is different in different places and as such simply comparing them is a bit of an apples and oranges argument.

There was a reason that lasix was legalized, it isnt just some nationwide plot by vets and trainers. To act like we can simply ignore the issue and turnback the clock is myopic. Perhaps we can revive Oscar and have him perform some of his pre-1995 magic?

Exactly, seems logical to me that horses have bled during a race would "move up" when they aren't bleeding. Is their performance enhanced or are you eliminating a barrier that was not allowing him to perform? Semantics.

Going after Lasix is like deciding to trim a dog's nails when he is covered with fleas.

Racehorses get hurt alot. The vast majority of these injuries are minor and are easily treated. When people talk about banning medications and they talk about giving horses rest as opposed to "drugs" I wonder what world they live in. I would love for someone to give me the parameters of a medication ban. So no meds from what point? 3 days? 5 days? A week? A month? Are we going to going to modernize and standardize our system of testing so that those who follow the rules arent unjustly persecuted because the current system is frighteningly vague.

Most people don't know that we have no steadfast rules concerning withdrawl times in most jurisdictions. The Pletcher incident in the BC a few years ago where he and the vet asked the state vet if they would be ok giving a medication 18 days before the race and were told they would be and yet the horse still got a positive test should be a great indicator of where we stand. The RMTC has made some progress in this area but is still a longway from being complete. People also don't realize that a positive test does not necessarily mean that the drug in question had any effect on the performance of the horse but rather is just the detection of a drug above a certain number which often arbitrarily assigned.

So I want to know what am I supposed to do when a horse has an issue? If a horse acts colicky should I not give her medication and just hope that it is a little gas because if I give her banamine she wont be able to run the following week? If Bodemeister grabs a quarter working a week before the Derby should Baffert not treat him or go to the local church and pour some holy water on it? Or just scratch and turn him out? Because the evil Bute and Banamine would be among the meds called for in these situations.

Is it that black-and-white with even minor injuries where the use of medication totally replaces any form of rest? Shouldn't the two be used in conjunction?

Anyways, the type of "rest" I was talking about was an "off season" of sorts. While horse racing can certainly be successful as a year-round venture, can it do so using the same group of horses the entire time? Can any individual racehorse stay in full race training and competition continuously? Is it feasible to stratify the horse population so that one group of horses (eg low-level claimers, stakes horses) get "down time" while another is actively running?

Why do racehorses get hurt alot? A huge factor is the number of miles they accumulate in a finite period of time.

On the other hand, how many "therapeutic" positives are the result of indiscriminate "pre-racing"? Take the Tom Amoss case from this year. Five positives for the same medication in the span of a few weeks. Or Kiarin McLaughlin at a fall Keeneland meet a couple of years ago with multiple positives for an inhalant. Superficially, does this look like bad luck or mismanagement? Should the public reasonably be expected to accept that a significant number of horses in the same barn need to be on the same medication (never mind still be entered to race)?

Isn't more likely that trainers in these instances are being too aggressive with their "pre-race" regimens? In the event of a positive and subsequent punishment, are the regulators really unjustly persecuting the offendors? Who is making the sport (and medications) look bad in these instances?

If the plan is to adopt a zero-tolerance policy, then racing probably can't operate. Not sure if that's what's being called for. If threshold levels of therapeutic medications are still utilized, then the scenarios you suggest should be comfortably handled with the horse's health put foremost.

The majority have their previously documented level of bleeding markedly decreased or gone, as evidenced by bronchoscopy clinically and BAL/TTW in research. Lasix does not work in all horses, some are unaffected.

The origins and causes of EIPH are thought to be multifactorial. In the 1990's I worked on the research that first measured actual cardiopulmonary intravascular pressures in horses while galloping at racing speed both on and off lasix. Lasix decreases the exercise-induced increase in cardiac and pulmonary pressures. High blood pressure rupturing fragile capillaries in the lung has always been one suspected cause of EIPH.

Chronic airway inflammation predisposing to capillary failure is another. I'd love to study the lungs of horses that live year-round at Churchill Downs, bordered by highways and under airport plane exhaust.

Another is the physical pounding, and physics: the sheer forces created within the lung tissue as a horse gallops a long time over firm ground carrying weight.

Another is the huge variance in intrapulmonary airway pressures, upper vs lower, during massive air intake of exercise - why the Flair nasal strips which hold the upper airway open decrease EIPH as much as lasix in some horses.

That's a very good analogy, actually.

I cannot consider lasix a performance enhancer any more than preventative inhaler asthma meds are for a running athlete who happens to have asthma. Lasix enables a horse to run to their peak, by helping prevent the development of a medical condition that will inhibit running ability by suffocating the horse in it's own blood to a lesser or greater degree.