By: Dr. Sarah Reagan
Instructor & Advisory Board Member at The American Council of Animal Naturopathy
The debate about whether or not to allow a diuretic to be injected into horses on race day has been raging for several years. A 2009 article in New York Times referenced a study done in 2007 in South Africa on 167 race horses supposedly showing that Lasix reduced incidences of a condition in race horses referred to as Exercise Induced Pulmonary Hemorrhage (EIPH) – commonly called “bleeding” within the industry – and labeled an “occupational disease”.
That study was touted by some (obviously those trainers using the drug in horses) as the ‘end to the discussion’… no one needed to ever question the use of Lasix (trade name for furosemide) or its effectiveness; veterinarians were a little more cautious in their analysis of the study results but nevertheless continued prescribing or administering it.
It is interesting to note that the race performance results of the South African study were made public but the endoscopic results themselves were only made available to the owner & trainer. South Africa (as well as much of Europe) bans race day use of Lasix (an exception was made for this study); however the cost of using this drug in the US – where it is generally not banned on race day – is about $30 million! (1)
It is estimated that about 95% of all race horses in the US race on Lasix. (2)
Racing against horses in the US has been likened to racing against “septic tanks” by those from countries where race day use of drugs is banned. It appeared to me that this “positive” study seemed to be designed simply to justify the use of Lasix as it (horses running faster and winning more money) had already been “demonstrated in a study of over 22,000 Thoroughbred race horses”. (3)
The same author (Joe Drape, New York Times) that wrote the 2009 article recently came out with another article in the NYT the other day (Dec 16, 2013) – it caught my attention because of the issues I have just recently had with my mother being on Lasix (especially IV) and have been reading as much as I can find on it. In a study done on 55 two-year-olds in early November (2013), results showed that significant bleeding was much higher in the horses given Lasix than those not given the drug; furthermore five of those Lasix horses scored in the “high” range of the bleeding scale. The principal veterinarians in this recent study emphasized that the question was not whether Lasix was good or bad, but whether or not racing without it caused harm. (4) That statement, IMO, directly translates into…’if Lasix can’t be used, we will find or develop another drug to use’.
My elderly (currently 93) mother recently spent several days in the hospital during which time she was given IV Lasix at 40mg daily for several days. I started seeing what I highly suspected was an allergic reaction to it a couple days prior to her discharge, however was hoping it would not culminate in much (and the doctors did not seem in the least concerned) – but I was wrong; within a few days of coming home (and continuing the 40mg Lasix orally) she developed a major hive/itching reaction over much of her body, especially lymph node areas.
She has been conventionally diagnosed with transudative CHF (congestive heart failure) which is why the diuretic (Lasix) was given (I managed to stop the other multiple drugs). Without going into a lot of detail, for those of you who know me I do not typically resort to using conventional drugs of any type for myself or those under my care, prescription or OTC – drugs do not heal anything, they suppress the symptomology by various methods. My mother, however, reached a point of significant pulmonary effusion that I did not see any other way around both trying to get the fluid off and attempting to keep it from building back up; obviously the fluid itself was not the problem but a result of much deeper underlying issues.
Fluid can certainly be removed manually in a relatively safe, quick procedure * but one has to wait until the doctors are ready to do so. Thankfully a thoracentesis was finally done and which greatly relieved the fluid build-up (if that had been done immediately there would have been no need for any Lasix – 1400 mls was removed from the right pleural cavity).
As of this writing she is not accumulating fluid even having being taken off the Lasix shortly after coming home and is doing considerably better. She is on upper level doses of organic Dandelion extract as well as Juniper essential oil (in addition to quite a few heart specific supplements and other EO’s) and this protocol seems to be working quite well.
Because of the Lasix reaction I went on a research mission to try to understand the mechanism by which this occurred. During the months prior to her hospitalization I had been seeing definite lymphatic involvement, and I felt that played a significant role. It is curious that on lymphedema websites, diuretics are specifically contraindicated unless the patient has concurrent CHF; the general notion being that CHF is more fatal than lymphedema, even though the diuretic can exacerbate the lymphedema. I could not find any other references to the lymphatic system in researching this until just the other day. Apparently the lymphatic system is a very little understood process in the human body (which means it is also little understood in animals). But I think understanding this relationship holds the keys to understanding why drugs such as Lasix can have undesirable effects at best, and deadly at worst, on race horses. I finally came across on article in which this relationship is being looked at in human medicine…
Conventional diuretics seem rather benign – after all they are often simply called “water pills”. But this is very deceptive – in non-medical terms, a loop diuretic interrupts the natural process that typically occurs in the loop of Henle, causing the kidneys to excrete more water and sodium than would normally be, essentially creating a state of dehydration; this is the “standard” treatment protocol for most cases of CHF. The effect this has upon the lymphatic fluid is that water is not being reabsorbed as it normally would and thus leaves a very concentrated proteinaceous fluid. In race horses giving a diuretic has the desired effect of “lightening the load”, allowing the horse to race faster. Additionally, diuretics have the effect of masking the use of other performance enhancing drugs, allowing the horse to piss out the residuals prior to urine testing.
In my mother’s situation, I have no doubt that there has been damage done to the lymphatic system primarily from 50+ years of smoking which obviously is exacerbated by her age (she did not quit smoking until age 85). The comparison I want to make here is that – other than the smoking – she has led a fairly healthy life; in my lifetime (almost 60 years) I do not recall her taking anything more than the occasional aspirin, she didn’t even drink soft drinks, nor did she have any vaccinations since at childhood. Contrast this lifestyle to what a race horse is typically subjected to: yearly (or more) multi-way vaccinations, species inappropriate food and lifestyle, far more stress than any horse is biologically designed to handle (both physically and emotionally), and perhaps the kicker of all…every time this horse is made to race, he/she is given multiple “performance enhancing” drugs, not the least of which includes Lasix, whether on race day and/or in the days prior. Can anyone wonder if the lymphatic (i.e. immune) system of the race horse is compromised even at such a young age? The vaccinations alone would do that.
Based on my recent research this is my hypothesis on the action of Lasix:
The lymph fluid requires some kind of contractive action to enable it to move; this happens from muscular action as well as arterial action (and which is why massage can help move lymph fluid). This means if the heart is not working properly and thus not “pumping” blood through the arteries as it should, arterial contraction (which helps to move lymph fluid) is not occurring as it should and the lymphangions can become stagnated even causing the valves to fail leading to lymph backflow.
Exercise can certainly help move lymph fluid, but with respect to race horses especially, a major question I have is what happens to the lymphatic system during the extreme exercise to which they are subjected? Lymph fluid is caustic to begin with, that is its nature. If a loop diuretic is given, the lymph fluid is potentially made even more caustic due to it becoming more concentrated. Since the lymphatic system is not under pressure (i.e. requires “external” contractive actions to move the fluid), it makes sense that the lymphatic vessel walls are thinner than those of the vascular system.
What would happen if the forces acting against the lymphatic vessel walls become extreme enough as to cause them to leak and/or cause the valves to fail – especially if the lymphatic (i.e. immune) system has suffered “assault” on other fronts? It is my thought any leakage of this “caustic” fluid could damage arterial walls, in turn causing internal bleeding.
Regardless of whether this “hypothesis” is ever found to be true or not in all or part, I have no doubt the lymphatic system plays a major role in what happens in the breakdown of race horses on Lasix, other drugs, as well as multiple other species-inappropriate factors. There are known risks of diuretics used as a performance-enhancing drug in human athletes – even taken at medically recommended doses: (5)
•Drop in blood pressure
•Loss of coordination and balance
What we can wind up with is an ever-increasing “loop” of debased physiological processes…the Lasix affects the fluid which affects the lymphatic system which sooner or later affects the heart/vascular function which can exacerbate the lymphatic dysfunction…and so on into an ever increasing inflammatory situation until ultimate breakdown.
With regard to lymphatic involvement in human cardiology, a moment of “validation” came to me just recently when I found an article by a cardiologist (Dr. Philip D. Houck) at Texas A&M Medical College; it is a hypothesis published this past May (2013) questioning the involvement of the lymphatic system in cardiac “disease”. (6)
There is no reason to not apply this to all mammals including horses. In part he says: “All of the symptoms of heart failure, hence, compensatory mechanisms can be related to overwhelmed or dysfunctional lymphatic function. Lymphatics are responsible for tissue homeostasis controlling approximately 12 litres of fluid. These thin-walled valved pumping systems are also intimately involved in immunity, control of inflammation and lipid and nutritional transport. Repair of damaged tissues by cellular transport explain its many functions.
Therapies to remove salt and water excess have improved acute symptoms but have not lead [sic] to better outcomes. In fact, in some cases such therapies have contributed to worse outcome such as cardio-renal syndrome. The mainstay in the treatment of congestive heart failure has been diurectic [sic] therapy. However, the chronic use of furosemide has increased mortality in congestive heart failure [4,5].” [emphasis mine]
4. Ahmed A, Husain A, Love TE, Gambassi G, Dell’ Italia LJ, Francis GS. Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods. Eur Heart J 2006;27(12):1431-9.
5. Hasselblad V, Gattis Stough W, Shah MR, Lokhnygina Y, O’ Connor CM, Califf RM. Relation between dose of loop diuretics and outcomes in a heart failure population: results of the ESCAPE Trial. Eur J Heart Fail 2007 Oct;9(10):1064-9.
Thoroughbreds have a reputation of being spooky, anxious, nervous, and so on – is there really any wonder why? (Quarter horses are also commonly used in racing, especially in the western states in claims races; they have their own “emotional issues”.) Racehorses have become drug addicts – plain and simple. Look at the eyes in these photos – do you see a resemblance between the look in the eyes and the look in many domestic (especially race) horses’ eyes – that painful, empty, wanting look?
Through phenomenology we understand that genes are adaptable, meaning they will adapt to influences and stimuli, sometimes taking more than one generation. When the animal’s genes are exposed to these stimuli via nature, there is generally no problem effecting the adaptation. It is when we subject the organism to influences that are born not of nature but are synthetically derived in a laboratory (i.e. drugs, processed food, etc) that the genetic adaptations can begin to achieve abnormal physiological results. The central dogma of biology states that genes dictate the form, however we are beginning to see otherwise – “genetic potential” is a two-way street. (I wish to caution the reader here that I do not want to give the impression that I believe that all adaptation is “blind”, i.e. a result of conditioning. I am exploring much in this area both from a macrocosm as well as microcosm perspective, so stay tuned for more discussions on this immensely interesting subject – well, interesting to me anyway!)
On average 24 horses die per week at US race tracks. Many of them are the “lower end”, less expensive racers running in claims races; as a result, investigations into their deaths are very seldom done. (7) This is an industry that is mired in a drug culture. The subject of why race horses break down so much has been debated for years, and it always comes back to the drugs used. And not necessarily legal drugs…some trainers will experiment with anything that can give them a winning edge, not the least of which include chemicals that bulk up pigs and cattle before slaughter, cobra venom, Viagra, blood doping agents, stimulants and cancer drugs.
Unfortunately much of this doping occurs on-farm before the horses are shipped to the race track – where few states have the authority to legally test horses. (8) Even if all horses were tested, labs don’t even have the capability to detect the enormous amount of different drugs that have been tried and are used. And even legal therapeutic drugs (such as pain medications) are misused, being given in high enough doses to mask symptoms of physical injury; numerous horses have raced (and in many cases died) on high levels of pain meds – I would guestimate that almost every race horse does or at least has done so at some point.
Some veterinarians will speak of how difficult it is to ‘watch these animals being treated this way’ and yet continue to administer the drugs. There are no excuses – a vet that continues to cater to this kind of activity is every bit as much to blame as are the owners and trainers who allow and do this. There is no other word to describe what happens except “abuse”, plain and simple. It is when a well-known race horse suffers injury on national TV that the industry begins paying lip service to trying to stop the abuse. But the trainers and owners are very influential with regard to industry policy setting – well known trainers such as Bob Baffert and some of his wealthy owners threatened lawsuits and hinted at boycotting prestigious, money making races like the Breeders’ Cup, effectively squashing any changes in regulations regarding drugging of race horses. (9)
Can horses become addicted to drugs (legal and/or illegal) much as humans do? This is what one source says: (10)
For the fortunate racehorses who escape the slaughter pipeline, and accepted by an off the track Thoroughbred rehabilitation center, staff report that weening [sic] them off the medications routine to racing can take months. In cases where horses are also recuperating from sidelining injuries, it is difficult to watch them also struggle through the symptoms of withdrawal.
This begs the question – Why? The only answer is that it is because of human-centric wants … fame and fortune.
It is not about trying to find “safer” drugs to use. It is not that changes need to be made in the racing industry. It is simply that it needs to STOP – the entire racing industry.
There is nothing about being forced to run at this extreme that is good for any horse – even those horses such as Thoroughbreds that have been manipulated through breeding to run faster. The effects of the forced breeding are multi-fold, not the least of which these practices continue to perpetuate the theorized “need” for horse slaughter. Stop the industry breeding and you’ve stopped any perceived need for slaughter. See a previous post I did about nurse mares farms (warning – video is graphic).
Those who continue to support horse racing continue to support animal abuse – it cannot be put any other way. People like to anthropomorphize, saying that horses want to run races and enjoy winning. I have two words for that, the first begins with the letter “B” and the second begins with the letter “S”. Many people have a tendency to romanticize about race horses, especially top winners (those that don’t win become so much “trash”). There is a popular saying about race horses, something to the effect that…”so-and-so was a grand horse that would run his heart out”. A very good possibility that he did, literally. There is much more I could say about this subject, but now you have no more excuses to keep blinders on…
Resources (please note that links can change or be removed by the site owners at any time so they may become invalid)
* Note that no invasion into the body is without some risk. A thoracentesis is designated as a “test” although I had to sign surgical consent in my mother’s case (it is a test as the fluid is sent to lab for analysis). The procedure consists of localized anesthesia and a thin needle inserted between the ribs into the pleural cavity. Outside of a normal risk of bruising, pain, & bleeding at the needle insertion site (a risk with any needle insertion); the major risk is piercing the lung; normally this heals quickly on its own but if it does not and air gets trapped the lung may collapse (although an excessive amount of fluid pressing against the lung can cause it to collapse as well). X-rays are done before and after the procedure. In my mother’s situation, they seemed to be a bit concerned about pneumonia setting in since she had such an excessive amount of fluid. However, using appropriate essential oils (which I had with me in the hospital) can avert this quickly without side effects as well as negate the “need” for antibiotics.