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View Full Version : 50-70% race horses with IAD?



3Spots
Oct. 2, 2009, 12:36 AM
My 3 yo was just diagnosed with IAD (inflammatory airway disease), and now must be removed from dust, have hay watered, and use steroids or nebulizers if we get another flare-up.

Hard for me to believe this came on so suddenly and with such exercise intolerance, and it was something I never heard of. But, if 50-70% of racehorses have it, someone must have a way of managing it successfuly.

Care to share?

Flypony
Oct. 2, 2009, 01:37 AM
Train on Clenbuterol, start with a low dosage and work up , it is a 72 hr withdrawl.

3Spots
Oct. 2, 2009, 08:07 AM
Thanks, Flypony! I should clarify that I am just a pleasure-rider.

We tried Ventipulim with him (low dose) but didn't see any results. I think it was 2x10cc, and maybe we have to go higher.

Do they ever outgrow it?

jan

DickHertz
Oct. 2, 2009, 09:27 AM
10 cc's twice a day is a very extreme dose..are you sure you are wording that correctly? Try 5cc's 2x per day for 2 weeks.

If you only gave 10cc's twice that's not going to help because it's a maintenance medication given in a series. Works best to give a 7 days series before race and 5 days after the race.

Meredith Clark
Oct. 2, 2009, 11:07 AM
I had a Filly (off the track but she was supposed to be an eventing prospect) that developed a breathing problem almost over night. It became obvious that her racing trainer had been giving her something to mask it and I took her to many vets to have her scoped but she had so much inflammation to the point where neither flaps could move.

While we were still in the diagnoses stage she was given high amounts of MSM and bute to help the inflammation (which helped a lot) and one vet gave her steroids which didn't seem to do anything.

Unfortunatly her condition became worse and worse and I had to put her down, the Vets all agreed she could not be managed and I risked having her suffocate herself if she overexerted.

MintHillFarm
Oct. 2, 2009, 11:59 AM
Two out of the dozen or so OTTBs that I have had eventually had IAD, progressing to COPD. One was put down at age 13, he did not do well. When I had him put down, my vet after the necropsy, said he was only getting about as much air as breathing through a straw. I had him on all the best meds available in the late 80's and early 90's and spent time at New Bolton, but he only got worse...The other I have still. He is 15 and managing fine. Interestingly physically they are very similar though that has no real meaning in this disease...both chestnut, 3 or 4 white socks and over 17hh.

I brought Fred, the one I have now, to Cornell and he had a vocalcordectomy which gives him 30% more air. He was diagonsed first as a roarer at age 12. When they scoped him at Cornell, they added on the beginnings of COPD diagnosis. They did not recommend he have a tie back surgery to correct the roaring because of the COPD so the last resort was the other. He is doing well and I am pleased with his condition and he is very comfortable....

Las Olas
Oct. 2, 2009, 12:01 PM
No, 50-70% of racehorses do not have IAD. The numbers are closer to 5-10%. And, although there are some horses that need the clenbuterol for breathing, the primary reason racehorses are given Ventipulmin/Clenbuterol is for fat/muscle conversion.

As Dick said, 10ccs BID just doesn't sound right. Very high. If the Clenbuterol doesn't work, you may want to ask your vet about Prednisolone, possibly even Tri-hist, depending on the nature of the problem.

3Spots
Oct. 2, 2009, 12:46 PM
Dick & Las Olas,

Technically it was 7-10mls twice a day. I substitued "cc" for "ml" assuming they were interchangeable. Vet told me it was a low dose for a 1200# horse. I trust this vet as usually being conservative with medication, so I am surprised to hear this might be a high dose. We had him on it for five days with no anxiety or tachycardia effects.

Exercised him 45m after a dose on fifth day and he was coughing hard five steps into the trot. I understood that if it worked, it would be effective somewhat immediately. He is not on it now, but I will reconfirm with vet.

This horse was fine on Sunday, had a cough on Wed and was exercise intolerant on Thursday. Does IAD happen that quickly?

He was on SMZ for two weeks with no change, ventapulim for one week with no change, spiked a fever on 4th day post-SMZ, started on IV gentamicin and was on his 4th day of gentamicin when I dropped him off at Alamo Pintado. Within two days his exercise intolerance and cough cleared without any further treatment. The vets felt that supported an IAD diagnosis because it was a change of environment. They did not think that it was a bacterial infection because blood and serum chemistry results were all normal. (although I'd expect them to be if he was on antibiotics????)

BAL results were all normal except MAST cells coming in at 3.5% against a norm of <2%. That appears to be the main reason for the IAD diagnosis.

I was given prednisilone. 200mg daily, then 100mg daily, then 100mg every other day for the next three weeks. AND, an oral antibiotic (erthyomicin) for one more week. I am hesitant to start the prednisolone since he seems to be improving. I've moved him to a different barn that isn't as dusty while I figure out my next steps.

FWIW, whenever I do an internet search, I keep coming up with the 50-70% IAD number. 5% would sound more reasonable because I don't know a soul who has an OTTB who has it...

Thanks for your guys perspective. I'm not sure if this diagnosis means I'll never be able to ride him, or whether this is an isolated flare up and he will simply be susceptible to airborne allergens.

Laurierace
Oct. 2, 2009, 01:09 PM
CC's and ml's are interchangeable and it is a very high dose. Many horses would break out in a sweat and get a very rapid heart rate from that dose.

3Spots
Oct. 2, 2009, 01:30 PM
Hi Laurierace,

Wow, I am going to drive to the barn at lunch and look at the syringe. I was not the one administering it, but thought I clearly understood the dosage, and I did ask if he exhibited any anxiety upon receiving it.

I hate not being the one to do this myself and really KNOW what is happening.

jan

Barbara L.
Oct. 2, 2009, 01:45 PM
I'd think the % would be a lot lower, too. The reason I say this, is that you'd think due to the number of injured/noncompetitive horses we have taken into the program here at Pha, that we'd see a HIGHER % because none of our horses are competitive any longer. I have had maybe 10-12 horses with any breathing problems (which we fully investigate) and have not had any that were diagnosed with IAD, although 3 had tie back surgery, or had throat surgery that did not work.
Even if those horses could be diagnosed with IAD, the percentage of 3-5 (or including ALL breathing problem horses at 10-12 tops) out of 260 horses total would be at highest 6%.

I'm just saying--we get the horses that are DONE, basically, and our percentages are not close to high, and they all are checked out at the track--have not been away on a farm or turnout yet.

Not sure if this means anything, but thought I'd throw it in. I like keeping really good records of every kind of injuries/trainer/season to see if there are any patterns...

Laurierace
Oct. 2, 2009, 02:13 PM
Percentages don't matter when its your horse you are talking about but for comparison I have been training for 18 years and never had a single horse with that diagnosis.

Blinkers On
Oct. 2, 2009, 02:14 PM
10 cc x2/day is an extreme dose rarely used IME. IF a horse is used to a high dose and it is begun low to high, you won't get the shaking and sweating, 5cc is about as high as I want to go, have had to do the 10 on a couple of occasions, but..... lower is better. There is some tolerance to clen, so it does become a progressively higher dose needed type of thing.

3Spots
Oct. 2, 2009, 02:24 PM
I still haven't made it to the barn to look, but this is an oral dose of Ventapulim, consistency of cough syrup, not an IV dose. Maybe that makes a difference?

You guys are great. I appreciate the perspective on the frequency of occurence as well. I can't imagine it is that high without it being a crises in the racing and OTTB industry.

Blinkers On
Oct. 2, 2009, 02:48 PM
I would venture to say the oral syrop that is clear in color is what we all use

Las Olas
Oct. 2, 2009, 03:20 PM
I still haven't made it to the barn to look, but this is an oral dose of Ventapulim, consistency of cough syrup, not an IV dose. Maybe that makes a difference?



Ventipulmin syrup is the only form of Clenbuterol available for horses in the US. It is illegal to compound it, although I've seen (and been offered) compounded versions (which are most likely albuterol and worthless).

As BlinkersOn stated, sounds like you have the same stuff the rest of us use, it comes in a blue and white box.

Also, I'm not clear on the treatment timeline of your horse. Was he given all of these different meds at the same time, or did you try one when another wasn't working? Why was he on SMZ's if the bloodwork was normal, or was the bloodwork taken after the SMZ's & Gentocin, not before? Is he still on an antibiotic?

3Spots
Oct. 2, 2009, 03:52 PM
I won't get to barn til this evening to check it out, but it sounds like we have the same stuff.

Timeline:

He developed a wet cough/exercise intolerance within three days, called vet, she took tracheal wash and put him on SMZs until we got cytology. His blood work was normal, no temp, appetite fine, bright and eager, just coughing up phlegm.

SMZs didn't appear to work after 10 days, so it was assumed IAD problem and not pneumonia. SMZs stopped and Ventapulim started. No results on Ventapulim. Fever spiked on 4th day without SMZ. Decided SMZs must have been keeping an infection subclinical and it could be pneumonia after all. Cytology had suggested gentamicin, so we switched to that and stopped ventapulim.

Still had a cough after four days of gentamicin so we opted for hospital to do BAL and lung xray. While at hospital, still on gentamicin, his cough and exercise intolerance cleared in two days. We did the BAL, xrays, CBC and blood chemistry panel. Xray showed some mild infiltrates, BAL showed high MAST cell, everything else normal.

Diagnosis is IAD, and I was sent home with instructions to remove dust, put him on one week of oral antibiotics and concurrently on tapering dose of prednisilone. They thought he did experience a low level pneumonia, but that IAD was the main probem due to high MAST cell reading. I now understand that the antibiotics are not for residual pneumonia, but are prophylatic with the prednisilone since it lowers the immune response.

Everything I have read about IAD says it comes on slowly. This didn't. He had been at that barn for 18 months, exposed to the hay, dust, etc. The only thing new is that he was backed for the first time in June and was beginning very easy ridden work, maybe 20 min 3x a week. So his workload increased slightly from ground school and roundpen and turnout, but definitely not vigorous.

I might just be an owner in denial, but it seems strange to me.

My plan is to hold off on giving the prednisilone until he's had a couple days at the new (less dusty) barn -- I want to see if the new barn causes him to react with a cough. I'm afraid if I start the pred, I might be masking a reaction and in three weeks I'll be doing this again.

Blinkers On
Oct. 2, 2009, 09:33 PM
Sorry, I only very quickly scanned your response.. busy day.. again sorry.. did anyone bother to scope? Cause you might consider it. Is there still mucus?and a cough? At rest or only when exercised? What color is the goo coming out of him? Are his nostrils hugely crusted with thick yellow snot or is it runny and clear with whitish snot? Is it still a wet cough? Have any of the antibiotics been used to fulfillment of scrip?

3Spots
Oct. 3, 2009, 09:44 AM
Hi Blinkers..

Right now he seems to be fine. No cough, no snotty nose, no temp, on third antibiotic for another week. They don't want me to "test" him for exercise intolerance for two weeks.

If he didn't have the higher MAST cell count, I'd say he had pneumonia, not IAD.

I'll make it to his old barn today to check out the ventipulim dosing -- that one really has me wondering, lol!

jan

tbracer65
Oct. 3, 2009, 02:01 PM
Did they ultrasound the lung for fluid (I know you said the x-ray'd).... I had a filly about 10 yrs. ago that came up from Texas & would get the snots here & there. When she went into heavier work the mucous would come & go. Vets here just kept changing the antibiotics with her (which of course she would build resistance to) & we never really knew the problem. Took her to the clinic (finally ... as after every different antibiotic the vets gave mucous would go away for a few weeks) & here she DID have pneumonia. She had a partially collapsed left lung & was put on Doxy for a long time (I THINK it was like 60-90 days). Never had a problem after that although that one part of the lung was still going to remain "damaged." She even continued onto a decent race career. Vets at the clinic explained that she came up from Texas WITH the pneumonia (had the snots unloading off the van but NO other symptoms) -- something about how the damage was they could tell the timeline??. She was thin upon arrival, but definitely not weak or sick otherwise besides the cold (which vets had diagnosed). It took months for her to be "correctly" diagnosed. At the time no vets at the track had ultrasound machines (just x-ray). We even cultured the mucous, flushed the gutteral pouches, etc... vets here tried everything, but still missed it because she didn't have the regular 'sick signs' of pneumonia... & the bad thing was I had a filly that was pretty much immune to all the antibiotics available.....

....also wanted to add that this filly the vets even had me order an expensive allergy test to test EVERYTHING as that's all they could figure out was her problem. I give them credit for trying what they could, but still highly upset on the final diagnosis as it cost me a TON of money (thousands) when my bill at the clinic was only $650 for the ultrasound & meds & a CURE.

...I've had horses previous that did catch pneumonia & they were the typical 'sickly sluggish'...VERY sick. This filly was in training & training VERY well --besides the mucous. She also was on clen twice a day, but only 4cc's twice/day. Agree with everyone else that 20/day is way too much.

Agree with Laurie too...been training for many years & around tons of horses & haven't even seen 1 with this diagnosis.

Las Olas
Oct. 3, 2009, 06:38 PM
tbracer65 reminded me of a filly I had at Keeneland a few years ago. Had the snots and coughing, tried every antibiotic, bloodwork WNL, BAL, trach washes, etc, etc. Had Dr. Woodie (breathing specialist) from R&R come look at her several times. He thought maybe an allergy, so we treated for that and swapped out all of the variables (straw to shavings, changed feed types, etc). Still couldn't figure out what it was. So, sent her to R&R for a treadmill scope (twice). Still think it's an allergy, coughing w/snots, bloodwork is now a little low WBCs, no hives or anything. Turns out it ended up being the SweetPDZ powder. Over $5,000 in vet bills and 2-3 months training lost to figure that one out, and it ended up being something simple and obvious.

LAZ
Oct. 3, 2009, 11:43 PM
A friend of mine is earning her PhD (she's already a board certified horse surgeon) doing a study right now on racing Tb's and IAD--she's starting with yearlings and will follow them through training and racing. It's too early in the study to have much information, but if anyone is interested I can direct you to her research.

3Spots
Oct. 4, 2009, 08:21 AM
Hi guys!

tbracer, yes, he was evaluated with an ultrasound and the result was "comet trails left ventral" My vet said horses with pneumonia typically have more. The xrays also pointed to some "pneumonia," but they really though IAD was the culprit.

Laz, I would be interested in her research.

Ventipulim: the dosage WAS 2x5cc a day, and the assumption was that the effects should be immediate, not require a build-up over time. nada, had no effect after four days.

At the hospital, 2 hours away, he cough cleared up spontaneously within two days; also leading them to believe it was the air. They did not wet his hay and he was kept in a sandy pen. (I, of course, thought the improvement could also be due to the effect of the more aggressive antibiotic!)

I brought him home and did not wet his hay either, wanting to see if his recovery would stick. Now two days later, his cough is returning. Arrgh. It is either the air or the hay. Equine hospitals always have great hay, so I will pursue that next.

I will take him off of hay today and hopefully find the bagged (kaching!) substitute so I don't have to trust the barn to soak his food. I will also begin the prednisilone. My human doctor friends suggest I need to get the inflammation down, and figure out how to improve the condition later.


thanks for the feedback on the hard to diagnose filly w pneumonia, and the sweet pdz story. gives me some hope that there might be a crazy answer to this that is not IAD. Because it just floors me that it could come on this fast!

Anyone hear of using DMG or spirulina for this? I have added MSM (6g) and Ester-C. And has anyone ever heard of them "growing out of it," like human kids do?

Once again, your input has been very helpful in giving me a perspective.

jan