Health

EIPH: Stop the Bleeding

The anti-bleeding medication furosemide is used to treat bleeders in most racing jurisdictions in North America but what happens if the drug

Dave Landry photo

By: Jennifer Morrison | July 13, 2012

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you're listening to an article from canadian thoroughbred.com. eiph: stop the bleeding by: jennifer morrison. one of the toughest battles facing owners and trainers of today’s racehorse is exercise induced pulmonary hemorrhage (eiph), or bleeding internally from the capillaries in the lungs. more than 70% of racehorses are affected. the causes of eiph are many but what is known is that bleeding from the nostrils, called epistaxis, occurs because of hemorrhaging in the pulmonary vessels associated with strenuous exercise and increased blood pressure. probable contributing factors can include environment and pollutants and particles in the air, upper airway pathology, breeding and track cushion impact. advertisement scroll to continue with content the anti-bleeding medication salix (furosemide, also known by the brand name lasix) has been used to help curb bleeding since the 1960s and has been allowed for raceday use at most tracks in north america for more than two decades. clinical trials of lasix, which alleviates high blood pressure by increasing urine production, have proven that the drug eliminates or reduces eiph (most recently in 2009 on 167 horses in south africa, published in the journal of the american veterinary medical association). however, the movement by various industry groups to rid the sport of drugs and to take a stand on regulating or even banning lasix for raceday use has shaken up the sport. the association of racing commissioners international has approved model rules that would limit raceday furosemide administrations to regulatory vets. and the breeders’ cup has adopted a policy that will ban the use of the drug on raceday in its races restricted to two-year-olds at the event this november at santa anita. the american graded stakes committee has approved a rule allowing it to rescind the grade for any two-year-old stakes held this year in which horses are allowed to be administered raceday furosemide. the lasix debate has divided the racing industry and both sides argue strenuously over its use. if owners and trainers are indeed faced one day with no access to the drug on the day of a race there are some methods and products that can be considered to combatbleeding. proactive prevention. dr. daryl bonder of the toronto equine hospital and a veterinarian at woodbine racetrack, believes good old fashioned horsemanship and some common sense is the best way, other than the prophylactic administration of furosemide, to help horses that bleed. “it is about being a capable and aware trainer, groom or hotwalker,” said dr. bonder. “be aware of your horse and what environment he lives in. have you noticed any coughing from him? it could be an allergy or asthma and today, we have excellent, effective treatments for those afflictions. make sure you have a good vet who can perform good diagnostics on your horse such upper airway examinations. dr. bonder states that while the opinions as to the causes ofbleeding in a racehorse are as many as “blades of grass in a field”he firmly believes that environmental factors are one of the biggest dangers. “our horses live indoors out of necessity, they live in a 10 by 10 stall 23 hours of 24 hours per day and they can thrive in that environment,” said dr. bonder. “but don’t discount what effect dust, moulds and pollutants have on them in that environment. bedding in a horse’s stall is crucial to keeping irritants low. “your aim has to be for good, quality bedding, whether it be straw, shavings of peat moss,” said dr. bonder. “inspect your bedding for moulds, avoid the ones that seem to have a lot of dust particles.”. good quality hay is often underrated as a necessity for keeping bleeding at bay. “similar to bedding, you want the best quality hay that is not harbouring moulds or dust. soaking the hay in water before it is fed to your horse is probably a good idea to rid it of extra dust particles.”. some trainers, such as sovereign award winner reade baker, believe that not feeding his racehorses hay at the track is the best solution. “i think that not even feeding hay to my horses helps the ones who are bleeders,” said baker. “it just takes one possible cause (dust etc.) out of the equation.”. the barn has to be meticulously kept as clean and fresh as possible, especially given the abundance of products used for cleaning stalls. “if you walk into a closed in barn or shedrow and there exists a strong smell of ammonia, that’s obviously not going to be good for your horse to breathe in all the time,” said dr. bonder. “fresh air is important, barns that are closed up will not offer good air for horses – you see a ray of sunshine coming through the barn, look at it and you will see the particles in the air. besure to water the shedrow, keep the dust down.”. and being proactive in attempting to curb bleeding also means protecting your horse during exercise other than on raceday. “lasix is proven to help horses that bleed so use it during morning workouts,” said dr. bonder. “of course resting your horse, if he has had an incidence of bleeding, is crucial.”. au natural. while there may be no scientific studies that conclude that products or equipment can help control or eliminate bleeding, many horsemen use or have tried the abundance of non-medicinal products available. equiwinner© is a patented, non-invasive dermal patch that serves as a natural electrolyte balancing system. it claims to reset electrolyte balance and starts to work almost immediately and, combined with only walking exercise for a total of fifteen days completely restores all capillaries to prevent haemorrhaging. according to its website, a horses ‘lung tissue has scars caused by previous bleeding, and these scars will normally rupture, causing more bleeding, but the equiwinner procedure allows the scars to fully heal during the fifteen days. normal training can then be resumed with confidence. since electrolytes are involved in every physiological process in the horse’s body, restoring optimal electrolyte balance with equiwinner also improves overall performance.’. concentrated equine serum (ces), also called seramune, is a product used to treat failure of passive transfer in foals. some veterinarians are now using it to treat eiph, according to dr. howard erickson at kansas state university. dr. erickson,speaking to said ces, explained that it is product taken from draft horses that contains high levels of immunoglobins and other serum proteins. he said, based on results of a study he conducted at kansas state, that ces may have an immuno-modulatory effect and anti-inflammatory effects that are beneficial in the reduction small airway disease, which could be one of the causes of eiph. similar to ces are feeds that contain high concentrations of omego-3 fatty acids which can relax blood vessels and make it easier for red blood cells to travel through the capillaries. while the proper combination of omega 3’s and other feed that works most effectively is not yet known, omega 3’s already exist in many commercial horse feeds. these omega-3’s include eicosapentaenoic acird (epa) and docosahexaenoic (dha) which have also been studied at ksu and shows some reduction of eiph. there are a wide variety of herbal treatments that claim to treat eiph or respiratory diseases. research each product to see if clinical studies have been done on them such as that done for herbs for horses ( research done on its herbal composite and its effectiveness in alleviating the clinical signs of respiratory disease in horses with recurrent airway obstruction showed that horses tended toward a decreased respiratory rate while receiving the herbal composite as compared with a placebo. other treatments. ozone therapy (administered as ozone molecules that can be injected or administered as a gas) has been used on humans for over 150 years. in racehorses, some use ozone therapy gas, topically or injected) to treat various respiratory diseases that can lead to bleeding. hyperbaric oxygen therapy has also been used by horsepeople to treat bleeders. its process involves a large, walk-in chamber where a horse is subjected to gently pressurized oxygen for approximately one hour. the theory is that pressurized air can help open up constricted airways allowing horses to breathe easier. flair© nasal strips were a popular breathing assistant in recent years, similar to the nasal strips worn by humans. the idea of the strips is to pull each side of the nostrils away from the nasal passage to allow better breathing. studies done at the kansas state university (dr. erickson et. al.) were published in 1999 and showed data that ‘horses affected by eiph that wore a nasal strip had fewer blood cells in their airways after exercise when compared to the same horses not wearing the strip.”. &&>

One of the toughest battles facing owners and trainers of today’s racehorse is exercise induced pulmonary hemorrhage (EIPH), or bleeding internally from the capillaries in the lungs. More than 70% of racehorses are affected.

The causes of EIPH are many but what is known is that bleeding from the nostrils, called epistaxis, occurs because of hemorrhaging in the pulmonary vessels associated with strenuous exercise and increased blood pressure.

Probable contributing factors can include environment and pollutants and particles in the air, upper airway pathology, breeding and track cushion impact.

Scroll to continue with content

The anti-bleeding medication Salix (furosemide, also known by the brand name Lasix) has been used to help curb bleeding since the 1960s and has been allowed for raceday use at most tracks in North America for more than two decades.

Clinical trials of Lasix, which alleviates high blood pressure by increasing urine production, have proven that the drug eliminates or reduces EIPH (most recently in 2009 on 167 horses in South Africa, published in the Journal of the American Veterinary Medical Association).

However, the movement by various industry groups to rid the sport of drugs and to take a stand on regulating or even banning Lasix for raceday use has shaken up the sport.

The Association of Racing Commissioners International has approved model rules that would limit raceday furosemide administrations to regulatory vets. And the Breeders’ Cup has adopted a policy that will ban the use of the drug on raceday in its races restricted to two-year-olds at the event this November at Santa Anita.

The American Graded Stakes Committee has approved a rule allowing it to rescind the grade for any two-year-old stakes held this year in which horses are allowed to be administered raceday furosemide.

The Lasix debate has divided the racing industry and both sides argue strenuously over its use. If owners and trainers are indeed faced one day with no access to the drug on the day of a race there are some methods and products that can be considered to combatbleeding.

PROACTIVE PREVENTION

Dr. Daryl Bonder of the Toronto Equine Hospital and a veterinarian at Woodbine racetrack, believes good old fashioned horsemanship and some common sense is the best way, other than the prophylactic administration of furosemide, to help horses that bleed.

“It is about being a capable and aware trainer, groom or hotwalker,” said Dr. Bonder. “Be aware of your horse and what environment he lives in. Have you noticed any coughing from him? It could be an allergy or asthma and today, we have excellent, effective treatments for those afflictions.

Make sure you have a good vet who can perform good diagnostics on your horse such upper airway examinations.

Dr. Bonder states that while the opinions as to the causes ofbleeding in a racehorse are as many as “blades of grass in a field”he firmly believes that environmental factors are one of the biggest dangers.

“Our horses live indoors out of necessity, they live in a 10 by 10 stall 23 hours of 24 hours per day and they can thrive in that environment,” said Dr. Bonder. “But don’t discount what effect dust, moulds and pollutants have on them in that environment.

Bedding in a horse’s stall is crucial to keeping irritants low.

“Your aim has to be for good, quality bedding, whether it be straw, shavings of peat moss,” said Dr. Bonder. “Inspect your bedding for moulds, avoid the ones that seem to have a lot of dust particles.”

Good quality hay is often underrated as a necessity for keeping bleeding at bay. “Similar to bedding, you want the best quality hay that is not harbouring moulds or dust. Soaking the hay in water before it is fed to your horse is probably a good idea to rid it of extra dust particles.”

Some trainers, such as Sovereign award winner Reade Baker, believe that not feeding his racehorses hay at the track is the best solution.

“I think that not even feeding hay to my horses helps the ones who are bleeders,” said Baker. “It just takes one possible cause (dust etc.) out of the equation.”

The barn has to be meticulously kept as clean and fresh as possible, especially given the abundance of products used for cleaning stalls.

“If you walk into a closed in barn or shedrow and there exists a strong smell of ammonia, That’s obviously not going to be good for your horse to breathe in all the time,” said Dr. Bonder.

“Fresh air is important, barns that are closed up will not offer good air for horses – you see a ray of sunshine coming through the barn, look at it and you will see the particles in the air. Besure to water the shedrow, keep the dust down.”

And being proactive in attempting to curb bleeding also means protecting your horse during exercise other than on raceday. “Lasix is proven to help horses that bleed so use it during morning workouts,” said Dr. Bonder. “Of course resting your horse, if he has had an incidence of bleeding, is crucial.”

AU NATURAL

While there may be no scientific studies that conclude that products or equipment can help control or eliminate bleeding, many horsemen use or have tried the abundance of non-medicinal products available.

Equiwinner© is a patented, non-invasive dermal patch that serves as a natural electrolyte balancing system. It claims to reset electrolyte balance and starts to work almost immediately and, combined with only walking exercise for a total of fifteen days completely restores all capillaries to prevent haemorrhaging.

According to its website, www.signal-health.com, a horses ‘lung tissue has scars caused by previous bleeding, and these scars will normally rupture, causing more bleeding, but the Equiwinner procedure allows the scars to fully heal during the fifteen days. Normal training can then be resumed with confidence. Since electrolytes are involved in every physiological process in the horse’s body, restoring optimal electrolyte balance with Equiwinner also improves overall performance.’

Concentrated Equine Serum (CES), also called Seramune, is a product used to treat failure of passive Transfer in foals. Some veterinarians are now using it to treat EIPH, according to Dr. Howard Erickson at Kansas State University. Dr. Erickson,speaking to www.barrelhorsenews.com said CES, explained that it is product taken from draft horses that contains high levels of immunoglobins and other serum proteins.

He said, based on results of a study he conducted at Kansas State, that CES may have an immuno-modulatory effect and anti-inflammatory effects that are beneficial in the reduction small airway disease, which could be one of the causes of EIPH.

Similar to CES are feeds that contain high concentrations of Omego-3 fatty acids which can relax blood vessels and make it easier for red blood cells to travel through the capillaries. While the proper combination of Omega 3’s and other feed that works most effectively is not yet known, Omega 3’s already exist in many commercial horse feeds. These Omega-3’s include eicosapentaenoic acird (EPA) and docosahexaenoic (DHA) which have also been studied at KSU and shows some reduction of EIPH.

There are a wide variety of herbal treatments that claim to treat EIPH or respiratory diseases. Research each product to see if clinical studies have been done on them such as that done for herbs for Horses (www.herbs-for-horses.com). Research done on its herbal composite and its effectiveness in alleviating the clinical signs of respiratory disease in horses with Recurrent Airway Obstruction showed that horses tended toward a decreased respiratory rate while receiving the herbal composite as compared with a placebo.

OTHER TREATMENTS

Ozone therapy (administered as ozone molecules that can be injected or administered as a gas) has been used on humans for over 150 years. In racehorses, some use ozone therapy gas, topically or injected) to treat various respiratory diseases that can lead to bleeding.

Hyperbaric oxygen therapy has also been used by horsepeople to treat bleeders. Its process involves a large, walk-in chamber where a horse is subjected to gently pressurized oxygen for approximately one hour. The theory is that pressurized air can help open up constricted airways allowing horses to breathe easier.

Flair© nasal strips were a popular breathing assistant in recent years, similar to the nasal strips worn by humans. The idea of the strips is to pull each side of the nostrils away from the nasal passage to allow better breathing.

Studies done at the Kansas State University (Dr. Erickson et. al.) were published in 1999 and showed data that ‘horses affected by EIPH that wore a nasal strip had fewer blood cells in their airways after exercise when compared to the same horses not wearing the strip.”