Following South America’s Lead On Lasix

[Wandering Eyes]

There are few topics in racing debated so intensely and passionately as that of raceday medication in the U.S., and in particular Lasix. Those who are for it stress that it is the only humane and effective treatment for horses who suffer from exercise-induced pulmonary hemorrhaging. Those against it believe that America must come into line with international standards and appease the expectations of a society where public perception is becoming rapidly more relevant.

What side one is on is no longer relevant; the Stronach Group–with its sweeping reforms with the abolition of raceday medication at its California tracks at the forefront-has ensured that change is afoot.

There are fears from some camps that the removal of Lasix from American horses would result in higher incidences of serious bleeding attacks, and thus depleted fields, plummeting handle and the demise of the sport. It is worth looking as a point of reference, however, at South America which, within the last six years, has phased out Lasix in black-type races-and in some cases even beyond–in its Part I countries.

And the general consensus? It’s been business as usual.

Beginning in 2013, South American countries with Part I racing were required to begin phasing out Lasix in black-type races; ie., those races with international implications. Those countries were Argentina (the continent’s largest producer of Thoroughbreds with a foal crop of around 7,000 annually), Chile, Peru and Uruguay. Raceday medication was already outlawed in Brazil in all black-type races and in horses younger than 3 1/2 years. The requirement was enforced by OSAF, an umbrella organization that represents South America on the world’s stage and that has governing organizations from each country as members. Each country handled the phase-out a bit differently; Argentina, for instance, began with Group 1s and Group 2s. By 2015 the ban was expanded to all black-type races. Finally, it was removed from all 2- and 3-year-old races. Raceday medication (Lasix and bute) remain allowed for 4-year-olds and older in non black-type races in Argentina.
John Fulton, an American-born horseman and former trainer who has conducted international business from his base in Argentina for 35 years, said that South America’s races medication-free races actually tend to draw larger fields than those where medication is still permitted.

“What I’ve seen down here is that the field sizes haven’t decreased. Here in Argentina, 2- and 3-year-olds can’t run on medication and in no black-type races can you run on medication, yet we have full fields.

“I owned a Scat Daddy horse [in Chile] with a group of friends that was a Grade I winner, but at age eight had lost a step or two,” Fulton continued. “We had to decide whether to go for a Grade I or a non-black type stake, where you could use medication. There were four horses entered in the non-black type race, but in the Grade I, where there was no medication allowed, there were 16 or 18 horses. So the decision was made to run him in the race where medication was allowed-he didn’t use any medication, we didn’t have any issue with it.
“People have learned to deal with it and they’ve accepted it. If you look at the stakes races they’re generally full fields. For the most part people have dealt with it and there’s almost no issue. To say that the U.S. is unique in the fact that they can’t run without medication, that’s something that’s hard to swallow for me.”

Trainers Taking It In Stride

San Isidro’s training center-located adjacent to the racecourse of the same name that is home to the G1 Carlos Pellegrini, South America’s most important race-is home to some 2,000 equines and is surely one of Argentina’s busiest training facilities. Champion trainer Enrique Martin Ferro holds court at San Isidro, as does his son Nicolas, an ambitious and worldly 32-year-old who counts among his patrons Haras Abolengo, one the country’s leading stud farms and the breeder of Candy Ride (Arg). Roberto ‘Coco’ Bullrich has recently been brought on as a trainer for Don Alberto, a dominant force across the continent with some 400 horses in training.

Nicolas Martin Ferro, perhaps with youth on his side, seems to have taken the medication phase-out in his stride. Asked what his feelings were six years ago when told the practice would stop, he shrugged his shoulders and said nonchalantly, “It was a little bit tough at first. As always we don’t like change, but I think we got used to it and I think it’s alright.

“I think we had to do it because otherwise we’d lose some faith [internationally]; I think the whole world is going that way. The Americans were the ones that stayed a bit out of it but all the other industries were going that way-no raceday medication.”

Martin Ferro said neither field sizes nor his stable numbers-which sit around 80–were affected by the ban, and that instances of horses being completely unable to race because of bleeding were “very rare-it wouldn’t happen once in a year.”

In fact, Martin Ferro said he “doesn’t like” Lasix and in the old days would not administer it simply as a rule.

“I don’t think it’s an advantage,” he said. “If I had a horse that didn’t bleed, I wouldn’t use it. I don’t like it. I wouldn’t give Lasix just in case.”

Bullrich–who is also a veterinarian–said that while he agrees now with keeping the black-type races free of raceday medication, he would like to see it permitted in all lower-level races. He said those horses have a much larger market share in South America than they do in Europe, and helping those horses and owners win races, and thus encouraging them to reinvest, would be to the benefit of the industry. As it stands now in Argentina, horses of non-stakes class cannot use Lasix until they turn four.

“The big mistake is to compare our racing to European racing,” he explained. “You talk about the genetic selection of French horses and British horses, and it’s very different from here. It’s a very select group in Europe with only strong mares and stallions. Here it’s very different. There is a very big group of owners and trainers who operate because they just want to win a little race worth maybe $2,000. I feel very strongly that you should help those people because they work for us to maintain that sector of the industry.”

Alternative Measures

As all three trainers concurred, no Lasix doesn’t mean no bleeding-it just means coming up with alternative methods of managing it, and they said injecting dextrose (a simple sugar) into the bloodstream is a widely used practice in Argentina. Horses will be given a serum that is 50% glucose and causes their blood sugar levels to spike, which causes the horse to urinate and shed water weight.

Dr. Jim Prendergast, a racetrack veterinarian in New York and Florida for more than 40 years, said dextrose was used in the U.S. in the pre-Lasix days, but that it “doesn’t work very well.”

“It’s 50% glucose and it acts like a mild diuretic,” he said. “They don’t want anybody treating the horses the day of the race, and dextrose is a short-term thing, so it wouldn’t be applicable as far as helping to keep a horse from bleeding. Dextrose is a step back in time.”
Dr. Pamela Wilkins of the University of Illinois’s College of Veterinary Medicine, however, said dextrose can actually be more harmful than Lasix.

“I’m sure it’s effective, but it’s worse for them than Lasix is,” she said. “Fifty-percent dextrose is hyperosmolar, so it pulls water from the cells into the bloodstream, and then the dextrose is filtered by the kidney and pulls water with it. However, 50% dextrose is very irritating to the blood vessels and it will throw their insulin and glucagon regulation way off. It’s worse for them than Lasix; it damages their blood vessels. I think using 50% dextrose is going to be more harmful than using Lasix ever was.

“It’s a repetitive stress injury,” Wilkins added of bleeding. “All horses at maximal exertion, no matter how fit or unfit they, are likely to bleed, whether it’s a little bleed or a big bleed, it’s going to happen. I think one option to try is low-dose Lasix. You don’t need to use 10ccs–once those receptors are loaded, they’re loaded. Tons of things have been tried in basic science studies and clinical studies, and the only thing that works is Lasix.”

Dr. Rob Holland is a Kentucky-based veterinarian specializing in respiratory and infectious disease. Holland stressed the fact that an onset of EIPH is multi-factoral, and thus the ways to help minimize it are the same.

“It can be a puzzle, just like lameness,” he said. “You have to figure them out. And when you do figure it out and get it right, it’s fun to watch a horse when they can breathe really well. And you don’t need a lot of drugs to do that; it’s about cleaning up their environment and stuff.”
Holland suggested that pre-existing conditions like dynamic throat issues, a cold or pneumonia, or even body soreness that causes the horse to lock up could contribute to instances of EIPH. He said that good biosecurity measures like reducing exposure to dust and proximity to muck pits in troubled horses can help, and he advocates for productive discussion surrounding the heated topic of Lasix.

“I know many owners, vets and breeders who want to talk about whether Lasix is needed or not needed, and I think getting everybody in a room would probably be helpful,” he said. “I think that good, clean dialogue and maybe bringing people from Argentina would be good for the industry. Right now, there are people that are pro-Lasix or not pro-Lasix. I’m more pro-therapeutic in trying to figure out why they’re doing it, and then putting medications and other things together that will help them, like wetting their hay, or nebulizing with saline to keep their airways clean. I’d like to have some Argentinean vets come up and talk to us about it.

“I think everyone goes into their corners. The veterinarians, we want to make sure therapeutic medications can be used to help the horse, but at the same time if owners and the betting public have issues, we need to talk about that. We need to be realists and sit down and discuss if there are other ways we can handle it, whether it’s nebulizing, trying to reduce inflammation, or cleaning up the environment where the horses are and trying to reduce the allergen load.

“I think the step going from 10 to 5ccs [of Lasix permitted at Santa Anita] is a good one,” Holland added. “I think we need a lot more data, but I can tell you there are many jurisdictions in the world that don’t run on Lasix. Their training is different; they run them for a mile kind of coasting and the last quarter mile they’re really running hard. That seems to work.”

Dr. Steve Jackson, an equine nutrition consultant based in Kentucky and with clients all over the world, said he had never heard of dextrose. He said research has been done on vitamins and supplements that could help reduce EIPH by strengthening capillary walls, but that he doesn’t think there is going to be a ‘magic’ product from a nutritional standpoint.

“There’s been a lot of work done on Vitamin K that probably isn’t very fruitful,” Jackson said. “There’s been a lot of work done on Vitamin E because it’s a biological antioxidant. My concept of the thing is that if you have a ration balanced correctly with adequate amounts of Vitamin K and Vitamin E, additional is probably not going to help.

“There’s some interest now in Omega-3 Fatty Acids, particularly the ones that are derived from deep water fish, DHA and EPA that are long chain Omega-3 Fatty Acids. There are a couple studies from Kansas State where they thought they saw a decrease in EIPH with DHA and EPA and even from flax oil, linseed oil, which is a fairly high vegetable source in Omega-3 Fatty Acids. Nitrous oxide they looked at, and it was actually detrimental; it caused an increase in EIPH. I really don’t know that anybody has found anything, from a nutritional standpoint, that actually significantly reduces bleeding.”

Jackson described Lasix as “a big crutch for trainers.” With that crutch being removed, he said, trainers are likely to be more conscious of how and when they feed their horses, and what is in their environment.

“I don’t think anybody would suggest that a horse that is inclined to bleed isn’t helped by Lasix,” Jackson said. “The problem is, people aren’t going to allow it anymore. I don’t think in this day and time, the public is going to stand for the thought of us giving drugs to a horse to run. Lasix is the baby that’s going to get thrown out with the bath water, and people need to accept it, because it’s going to happen. Look at greyhound racing. Who would have thought in Florida there were enough [animal rights activists] to get greyhound racing banned?

“We’re probably going to go back to where people had a strategy for reducing gut fill and body weight prior to the race, and that’s going to involve half feeds in the morning, removal of water, and less hay because that’s going to stimulate thirst. I used to run 10ks. I was never as good an athlete as I thought I was, but I know I didn’t try to go eat three waffles with maple syrup before I went out and ran a 10k. I think we’re going to rely more on gut management, nutrition management pre-race, time of feeding pre-race, because the crutch is going to be taken away.”

Jackson said that in Japan–where he does work for Koji Maeda, the breeder of Lani (Tapit), among others–maintaining a well-ventilated environment is paramount.

“It’s cold there in the winter time, but they never close the doors,” he said. “It’s about fresh air, ventilation and reducing inflammation. And maybe that’s why they don’t typically have as many bleeders. It’s interesting, in our shedrow society here, some of the stalls are poorly ventilated. How do you keep them dust-free? Japan has fewer lung problems, less pneumonia, less inflammatory airway disease, and the environment there is harsh in the winter. In the summertime they have fans and run misters to reduce dust. The approach there is to reduce particulate matter that may cause inflammation of the airways. When you don’t have the crutch, when you don’t have Lasix, then you find different modalities that give you some relief.”

Fulton: America Must Assimilate

In nearly 50 years in the Thoroughbred business–early on as an assistant to Horatio Luro, the trainer of Northern Dancer, and more recently as an agent based in Argentina with an international reach–John Fulton has seen plenty. He said he is adamant that his home country needs to come into line with international standards, and also, considering what was done in his adoptive country, that it is very possible.

“Raceday medication should be eliminated, in my mind,” Fulton said. “I think it would be better for the horses and it’d make better horsemen out of us and honestly create a better ambiance for the fans and bettors.

“The trainers will learn to adjust,” he added. “Almost all the trainers training today have had the use of raceday medication. I’m old enough where I can remember where we didn’t have it, and of course down here [in South America] we’ve seen it for a good number of years where in the big races there is no medication allowed, and even to the point where they send the tests to France and Australia and other parts of the world, just to make sure the horses are running clean.”

Fulton said he thinks the American style of training could make horses more prone to bleeding. Whereas Americans tend to have easier routine training and harder works, European and South American horses generally do the opposite: a bit more in their day-to-day training but less intense works.

“I don’t profess to have been a great trainer and I’m not a vet, but in 49 years in this I’m an observer, and these are things that I’ve seen that I think can affect it,” he said. “The horses in South America and Europe tend to run a bit lighter; they’re fit to the ultimate, where I think we see horses in the States that are carrying more weight than what we would see in other parts of the world where there is no medication used, and I think that can be a contributing factor. We do a lot of good, strong, open gallops in South America, whereas the American horses tend to do less during the week and faster works. The horses that do a stronger gallop and slower works tend to be more relaxed. They learn to get into a comfortable pace and they’re not as high strung when they go to the races.

“You can make adjustments in training, and in the States there are a lot of really good horsemen. They’ll learn to deal with it.”

Fulton also pointed out that U.S.-breds race with a high level of success in all parts of the world with no raceday medication.

“American horses go from sales in the U.S. to Europe and they race fine,” he said. “It’s not that we’ve created a breed in 30 years that’s fragile-I don’t believe that, I believe it has more to do with training and feeding and eliminating bad bleeders from the gene pool.

“Luro, when I was with him, when we had a horse that had a tendency to bleed we tried changing the feed, and one of the things we did was change the bulk food, alfalfa and that stuff, to beet pulp. We fed a lot of that in place of hay and it decreased their tendency to bleed. If we couldn’t control it then they were turned out, and if they came back and still had problems then more than likely they weren’t going to enter the gene pool. I do believe it is inherited to some degree.”

American-bred and raced stallions have historically done well in South America-with Scat Daddy and Roman Ruler just two examples-and while interest in American sires is still strong, European stallions are showing up with greater frequency in Argentina. The reason for that, Fulton said, is a desire to reintroduce stamina and durability to the breed. And a lack of raceday medication is a significant factor in the Europeans’ favour.

“I think we got to the point where we realized we were losing a lot of our strengths down here, which is durability and stamina, by bringing in a lot of pure speed horses,” he said. “People wanted to bring more stamina back into the gene pool and to do that you lean more to Europe. And the fact they run clean is a factor beyond a doubt. It’s just one more ingredient that goes into the decision-making on who you’re going to bring in.

“Sheikh Mohammed has asked me to buy mares for him down here because we have a reputation for soundness and durability, and I’ve had other owners do the same. The Japanese have been hugely successful buying mares here and producing top horses, and it’s because of this reputation for soundness, durability and stamina. So we’re in a situation where we have to swing a bit back towards that, and when you do that you go to Europe.”

But the U.S. has much more at stake than losing favour with shuttle stallions.

“The other side of the situation that’s even more grave is that we could have racing shut down,” Fulton said. “People don’t believe that, they don’t want to believe it, but it can happen.

“The industry is a crossroads now where we have a chance to say ‘look, do this or we’re gone.’ I was talking to a friend the other day and he said, ‘this is going to give us more opportunity to sell horses into the U.S. because our good horses run clean, so we can sell our horses to California trainers.’ I said, ‘that is if there are races in California.’ It could end up that way and people don’t want to admit that, but I can see from a distance that it could be snubbed out. That’s a real threat. We need to take some action, make some changes and take charge of this situation that [before raceday medication] we always dealt with fine.

“What happened in California, I don’t blame it on Lasix or probably any other type of medication,” Fulton continued. “I think part of it was coincidence and part of it was the rain and the track change and maybe there were some holes in the track, that kind of stuff. I don’t think medication is likely the cause of the breakdowns, but right now is the point where we need to make a dramatic change or we’re going to go downhill fast.”

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