There’s so much confusion about exercise-induced pulmonary hemorrhage (EIPH) in articles, blogs, and SM today that I want to clarify some issues as they have appeared in recent posts in this space. For one, whenever possible I’ve defined a “bleeder” as a horse exhibiting epistaxis (bleeding through nostrils) when referring to studies quoted here from Hong Kong, Australia, and South Africa, because that is how they are defined in these regions as opposed to here in the US where a horse does not need to visibly bleed from the nostrils to be classified as a bleeder.
That said, EIPH from endoscopic examinations is graded in these countries (and in recent scientific papers quoted here) on a scale from “Grade 0” to “Grade 4” with epistaxis effectively being a de facto “Grade 5.” Therefore, in this country a “bleeder” is defined as any horse between “Grade 0”—no bleeding evident—to “Grade 4”; a horse anywhere is obviously a bleeder if it exhibits epistaxis. Preakness winner Summer Squall was a notable example of such a horse here.
Now, some have questioned whether use of Lasix (furosemide)—legal in the US but not elsewhere— is effective at treating EIPH, as some posts here have suggested based on expert opinions. That is, obviously, the debate raging everywhere today, most recently with the Kentucky Horse Racing Commission. The Jockey Club has taken the position that it isn’t, and supporters of advocates of the anti-Lasix debate include high-profile journalists as Joe Drape of the New York Times.
But even Joe has covered some studies that seem to indicate that Lasix is effective at treating EIPH. In a June 2009 Times piece titled “Lasix Reduces Bleeding in Horses’ Lungs, Study Says,” Joe wrote, “The debate about whether thoroughbreds should be treated with a diuretic on the day of a race became thornier Monday when researchers released a study showing that furosemide, known as Lasix, significantly reduces bleeding in horses’ lungs.” Click here to read the entire article.
Speaking of Joe, I quoted one of his tweets in a post below (click here to read the post) that said this:
“Not complex: In Hong Kong, over past 5 years, only 8 deaths among 45,000, 1 per 5,692 starters vs. 2.14 per 1,000 here. Why? No drugs..”
Joe’s a fine reporter and a good guy as far as I can tell—I appreciated his email to me after the death of my son last year—but his tweet above is erroneous and misleading. I mentioned this in the comments to the post and will say it again here so that those figures aren’t quoted as fact by others, but they are only specific to “sudden death,” as opposed to catastrophic breakdowns from musculoskeletal causes. These deaths were highlighted by the Hong Kong Jockey Club as being caused from EIPH (2), heart failure (5), and abdominal hemorrhage (1). The actual catastrophic deaths in HK are at 0.7 per 1000 starts—a figure much lower than the 1.5 per 1000 usually associated with US racing but far higher than the figure he quoted as such.
The debates about EIPH and Lasix are important to the future of racing in this country, and it’s vital that only legitimate figures, statistics, and arguments are put forward by both sides, don’t you think?