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EIPH and Lasix

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  • #61
    Well, almost all TBs have Stockwell tail male these days, and his dam's dam was a roarer.

    Do we think that roaring is far more common now than it used to be?
    "I'm a lumberjack, and I'm okay."
    Thread killer Extraordinaire

    Comment


    • #62
      Originally posted by Pegasus5 View Post
      There are many studies that certainly disprove this study. You have to know the limitations of a study model, the sample population, all possible confounding factors etc to know whether or not a study actually proves or indicates anything. There are entire courses at the graduate level on study design, so do not be misled that just because something is promoted as proof, it is.
      Originally posted by Pegasus5 View Post
      Last, peer reviewed journals contain studies that are flawed and just plain wrong on a pretty regular basis. I have seen no proof of the calcium issue, and again, when properly administered dehydration can be prevented and dealt with.
      Originally posted by gumtree View Post
      As far EIPH and its inheritably the SF study only ‘suggests’ a link. ‘Suggests’ being the operative word. As it is in most horse “studies”. I don’t think it takes a PHD in genetics to make this statement.
      Oh dear. As someone with one of those graduate degrees in research study design, I just want in clear up a few things and perhaps raise the level of scientific literacy in this discussion.

      First, you don't have to control for every possible variable in order to have a good study that reaches valid conclusions. In fact, it's *impossible* to control for all variables. That said, a good study will control for known confounders (for example, a study of cancer would need to control for age, as age is related to cancer incidence) and perform statistical tests to look for unknown confounders. A large study also reduces the "noise" associated with uncontrolled variables; a power calculation can help the researchers determine whether the sample size is large enough to measure both the signal and the noise.

      It is very difficult to publish any epidemiological study without these limitations being addressed.

      A more useful critique of a study is to state specifically what limitations you perceive in the choice of study design or sample size; choice of variables or measurement; whether the statistical tests used were appropriate; whether the conclusions are reasonable based on the given results; or whether those findings are generalizable to other populations.

      While it's true that bad and flawed papers do get published, that is not as common as you might suspect. I spend my life trying to get good, solid, unique studies published. However, there are ways to judge the quality of peer-reviewed research. One measure is the type of journal publishing the work, and its impact factor, which gives some notion of the rigor and expertise of the reviewers. For example, one might consider evidence about a novel cancer treatment to be stronger if published in the New England Journal of Medicine versus The Bolivian Journal of Plant Based Drugs (I made that up, btw).

      Finally, do not be misled by research-specific terms like "suggests" (or hypothesis or theory, etc). The statistics used in research are designed to disprove a null hypothesis, that is, they tell us what the odds are that the results we're getting are just a fluke. Which means that our results "suggest" that the measured phenomenon is real. In the situation mentioned, without lab-based studies in cell or animal models (usually with the gene of interest "knocked out"), it is very difficult to "prove" genetic links.

      And, as will all research, reproducibility is important; this is difficult in equine/ veterinary research where funds are more limited than in lab or human-based studies. So we must work with the data we *do* have.

      Comment


      • #63
        Originally posted by omare View Post
        I do not understand how one is going to breed this "trait" out of the breed if 99 percent of horses bleed at some point and most horses that race are never used for breeding. Of course I wonder if horses running longer distance races tend to bleed less (less extreme exertion/sprinting?) ---remember the old days of the starter handicaps written really long for cheap horses?
        The vast majority bleed so little that it is of no consquence.
        co-author of
        Duel for the Crown: Affirmed, Alydar, and Racing's Greatest Rivalry
        www.duelforthecrown.com

        Comment


        • #64
          Originally posted by baxtersmom View Post
          Oh dear. As someone with one of those graduate degrees in research study design, I just want in clear up a few things and perhaps raise the level of scientific literacy in this discussion.
          I don't know about everyone else, but that paragraph was the only one in your post I fully comprehended. Good luck!
          Man plans. God laughs.

          Comment


          • #65
            Originally posted by SportArab View Post
            I'm not a vet, so I can't tell you what their thinking is. But I can say as someone who covers human health, that antibiotics are VASTLY over prescribed even in people. Much worse when it comes to animals.
            I'll make it real simple for you--blood outside of the circulatory system is an irritant. A horse has natural processes to remove blood from its lungs, but if something happens where it can't or is slow to process out, then the body fights it just like a foreign substance.

            For someone advocating such a radical and inhumane position, your lack of even the most basic knowledge of equine care is appalling.

            Comment


            • #66
              Originally posted by SportArab View Post
              The vast majority bleed so little that it is of no consquence.
              So...

              Those of us who don't want our horses bleeding in their lungs are the cruel ones???

              But the crowd (made up mostly of people not even actually in the sport) that would rather let 'em bleed are the "good guys". Sorry, but I don't make light of my horses being in discomfort, unlike the above quoted post.


              The "logic" here is scary. So far we have heard:

              • A medication that has been around for a few decades has already entirely changed an breed hundreds of years old.

              • We should do something simply because everyone else is doing it, regardless of the vast differences in geography, climate, and the differences in the races written and ran.

              • Disregarding advances in medicine and reverting back to the rudimentary practices of the early 1900's will be better for horses.

              • Taking away a medication that was created because the condition existed in the first place, will make the condition go away.

              Right.......


              I feel badly for the horses in the "care" of some posters here.

              "Pat the horse; kick yourself" - Carl Hester

              Comment


              • #67
                I can assure you, that everyone involved in this study are extremely concerned with horse welfare and safety.

                I own 2 OTTBs, one of whom ran on Lasix and still bleeds from time to time. Dr. Preston is a former jockey, racehorse owner, and avid polo player. Dr. Riggs is "in the trenches" at Hong Kong working with racehorses every day. Dr. Troedsson is a world famous equine researcher and one of the kindest and most intelligent people I have had the pleasure to have known.

                What we all want is the best for our horses- and the best way to get there is with evidenced based medicine.

                It is, frankly, insulting to suggest that we don't care about horses or their health.

                The efficacy of Lasix at preventing bleeds is far from settled. In any case, it's probably not very effective at abating low-level bleeds (<3). Furthermore, low-level bleeds do not seem to have any negative or long-term effect on horse health or performance. Lasix does seem to help prevent incidents like epistaxis, which are quite rare to begin with (4% of total bleeders in this study). Deaths or long-term health issues resulting from epistaxis are even more rare.

                We don't know what causes EIPH to begin with, and we have even less idea of how Lasix is supposed to work. It wasn't invented to treat EIPH- it's a diuretic often used in human medicine.

                I find it very alarming that such a huge percentage of horses in the US are running on a drug with an unknown mechanism of action, with some worrying side effects, to "treat" a problem that is already exceedingly rare. I say "treat" in quotations because incidents of Epistaxis are so rare that it's hard to make a statistically significant conclusion from the available data.

                I don't mean in any way to minimize or make light of the trauma of losing a horse in this way- I know it is devastating. But without well designed, controlled, scientific studies, we can't tell the best way to prevent these things from happening.

                Comment

                • Original Poster

                  #68
                  Originally posted by baxtersmom View Post
                  Oh dear. As someone with one of those graduate degrees in research study design, I just want in clear up a few things and perhaps raise the level of scientific literacy in this discussion.

                  First, you don't have to control for every possible variable in order to have a good study that reaches valid conclusions. In fact, it's *impossible* to control for all variables. That said, a good study will control for known confounders (for example, a study of cancer would need to control for age, as age is related to cancer incidence) and perform statistical tests to look for unknown confounders. A large study also reduces the "noise" associated with uncontrolled variables; a power calculation can help the researchers determine whether the sample size is large enough to measure both the signal and the noise.

                  It is very difficult to publish any epidemiological study without these limitations being addressed.

                  A more useful critique of a study is to state specifically what limitations you perceive in the choice of study design or sample size; choice of variables or measurement; whether the statistical tests used were appropriate; whether the conclusions are reasonable based on the given results; or whether those findings are generalizable to other populations.

                  While it's true that bad and flawed papers do get published, that is not as common as you might suspect. I spend my life trying to get good, solid, unique studies published. However, there are ways to judge the quality of peer-reviewed research. One measure is the type of journal publishing the work, and its impact factor, which gives some notion of the rigor and expertise of the reviewers. For example, one might consider evidence about a novel cancer treatment to be stronger if published in the New England Journal of Medicine versus The Bolivian Journal of Plant Based Drugs (I made that up, btw).

                  Finally, do not be misled by research-specific terms like "suggests" (or hypothesis or theory, etc). The statistics used in research are designed to disprove a null hypothesis, that is, they tell us what the odds are that the results we're getting are just a fluke. Which means that our results "suggest" that the measured phenomenon is real. In the situation mentioned, without lab-based studies in cell or animal models (usually with the gene of interest "knocked out"), it is very difficult to "prove" genetic links.

                  And, as will all research, reproducibility is important; this is difficult in equine/ veterinary research where funds are more limited than in lab or human-based studies. So we must work with the data we *do* have.
                  Thank you for taking the time to contribute to the discussion in a very detailed educational way.

                  Though I don’t have any formal degrees of note I am a person by natural that enjoys being as well educated on any topic/subject that I am going to offer up an opinion and or discuss. Before the internet lots of reference books. I take very little for granted and if someone is going to make a statement of fact that I don’t necessarily agree with they better be able to back it up. I rarely make statements of fact when it comes to “all things horse”. My comments all almost always stated as my opinion and experience. I am also one of the rare on this forum who gives a complete “bio” link on my profile page along with all of my contact information. So anyone that takes strong exception to my comments, can email, call, write, stalk or come up my driveway and punch me.

                  I have been around and worked with and have made my living in the horse business. Thoroughbreds only and mainly on the racing side of them. My clients expect and pay me to be well versed in all aspects, be it care and feeding, breeding, management and as a consultant and agent. I go to great lengths and devote a lot of time to keeping up on all aspects of the sport, industry and business. I have read countless studies over the years. I took the time to educate myself on what constitutes a “sound” well executed horse study so as to extrapolate what I feel is worthy taking note of and or repeating to others.

                  Given the fact there is no “New England Journal of Medicine” that I am aware of makes for a lot of studies being published in the “The Bolivian Journal”. (a great term and will give you credit every time I use it). But I do not dismiss any by and large just because they are either sell published or in The Bolivian Journal. Nor because it because it goes against what I intuitively believe.

                  Comparing human studies and what they “suggest” to horse studies is a bit like comparing apples and oranges IMO. Exactly for the reasons you gave;

                  “And, as will all research, reproducibility is important; this is difficult in equine/ veterinary research where funds are more limited than in lab or human-based studies. So we must work with the data we *do* have”.

                  Not only is the funding limited the shear logistics would be very difficult and expensive to gather sufficient number of horses and maintaining a pretty exacting “control groups”
                  Each having a different set of “parameters” IMO.

                  So, IMO when the word “suggested” is used in a horse study it does not carry with it anywhere near the strength as it does when used in a human study published in the New England Journal of Medicine.

                  The internet is a wonderful educational portal. But just like the proverbial “Grape Vine” a lot of things go from “suggested” to fact. Which was my point.
                  The “Lasix debate” has been a very HOT and polarizing issue in the racing world for over 6 years now. There are far better forums then here with well educated people on both sides of the issue to be found. I posted the link because IMO and many others with far better “credentials” then I feel the study was well executed and has merit. Maybe not the best some may say but probably the best to date. Regardless of what side the reader is on.

                  I also posted it because when ever the term “bleeder and or EPIH” comes up I read things being stated as fact when they are not. Or at least not as facts that everyone agrees one.
                  IMO the definition of a “fact” is something that can not be disputed.

                  IMO to use the term “suggest” that EPIH is hereditary, so as to “take it to the bank” would take a far more detailed research then has been done to date. First it would take identifying some specific families. And then following all siblings out of specific mares from last cover to the starting gate. In numbers that meet the criteria you laid out. A pretty daunting task. And considering the majority of horses are bred, raised, trained in a multitude of different ways and environments would make it that much harder.

                  Eliminating “fixed” unwanted traits like, offset knees, back at the knee, ect is fairly straight forward. Because Thoroughbreds are easily the most studied and have extremely detailed statistics to work from. More then any other breed. But as a breeder it can be an expensive lesson. The results from our mating choice when using some “unknown” crosses we may or may not end up with the above. But we know how to be pretty confident in our choices 2 years down the road.

                  Figuring out if we are breeding “bleeders” based on what we know about families in this day and age would take YEARS. And given the fact that it takes almost 5 years from last cover to the starting gate means that until we have found out the a particular family produces horse that are “bleeders” a definition that is still under debate the will be 4 more foals on the ground.

                  Again, I don’t feel a well educated and experience breeder needs a degree in genetics to “suggest” that there maybe a collation. But it is not something to take to the bank. But there is no research to date that anyone can take to the bank on this subject.

                  If anyone has any reference links to the contrary please pass them on. I don’t like to comment out of turn. I am not set in my ways and or thoughts on these things. As a breeder of Thoroughbreds mistakes are very expensive. It is much cheaper to stand corrected.

                  Comment


                  • #69
                    Originally posted by vineyridge View Post
                    There was a South African study a few years ago that linked EIPH to genetics. It doesn't seem to have made much impact on America.
                    Does anyone have the reference for this?

                    There is a recent paper (June 2014) that examined the heritability of epistaxis in Australian thoroughbreds: http://www.ncbi.nlm.nih.gov/pubmed/25011713

                    The abstract notes fairly high levels of heritability (.27 and .50, depending on the unit measured, either lifetime or per race).

                    This means that a large proportion of the variation in which horses were bleeders was explained by genetic factors (note that a study like this does not identify which genes are at work). Likewise, they also found a lot of significant environmental factors. I don't have access to the full article here at home to look at it in more detail.

                    Comment


                    • #70
                      Originally posted by gumtree View Post
                      T
                      So, IMO when the word “suggested” is used in a horse study it does not carry with it anywhere near the strength as it does when used in a human study published in the New England Journal of Medicine.

                      IMO to use the term “suggest” that EPIH is hereditary, so as to “take it to the bank” would take a far more detailed research then has been done to date. First it would take identifying some specific families. And then following all siblings out of specific mares from last cover to the starting gate. In numbers that meet the criteria you laid out. A pretty daunting task. And considering the majority of horses are bred, raised, trained in a multitude of different ways and environments would make it that much harder.
                      I think I understand better how you're using the word "suggested" here: that a single study is evidence but not proof. That is basically the way researchers think.

                      That said, the reference I just posted strongly suggests that genetics do play a large role in the likelihood a horse will have EIPH. Although this kind of study doesn't do anything to say which genes (or even how many) are at work.

                      Notably, risk of EIPH could be a combination of many different genes. Some of those genes might even be related to desirable traits in a racehorse (say, a deep heart girth and increased lung capacity, perhaps), that you may not want or be able to breed away from.

                      It's also not comparable to an inherited disease like HYPP, which is a single-gene disorder.

                      Comment


                      • #71
                        I have worked in European yards. I still spend part of my year in European yards every year. I am not saying that Europeans use it as frequently as people in the US do, but many people here have the impression that is not used over there hardly ever...not true. Interesting that you mention they use Lasix with their best or "elite" horses.

                        Originally posted by Drvmb1ggl3 View Post
                        No they don't. Go talk to anyone that has spent time in a racing yard. The number of horses in Europe that would train on Lasix is quite small, and they would invariably be elite horses. You guys need to stop repeating this untruth.


                        Or course they do, because it's a performance enhancer. Why would you cede that advantage to all your competitors?

                        Comment


                        • #72
                          Originally posted by Angelico View Post
                          So...

                          Those of us who don't want our horses bleeding in their lungs are the cruel ones???

                          But the crowd (made up mostly of people not even actually in the sport) that would rather let 'em bleed are the "good guys". Sorry, but I don't make light of my horses being in discomfort, unlike the above quoted post.


                          The "logic" here is scary. So far we have heard:

                          • A medication that has been around for a few decades has already entirely changed an breed hundreds of years old.

                          • We should do something simply because everyone else is doing it, regardless of the vast differences in geography, climate, and the differences in the races written and ran.

                          • Disregarding advances in medicine and reverting back to the rudimentary practices of the early 1900's will be better for horses.

                          • Taking away a medication that was created because the condition existed in the first place, will make the condition go away.

                          Right.......


                          I feel badly for the horses in the "care" of some posters here.
                          I see, anyone who disagrees with your stance on lasix, a drug whose side effects in horses we know little about, is cruel and mean to horses. Give me a break.

                          Your reaction is the same knee jerk reaction I've seen bouncing around racing circles for quite some time.

                          I happen to think that asking a horse to exert itself after it's body has been drained of fluids (which means there will be less ability to sweat) is potentially dangerous.

                          As for horses that are heavy bleeders - perhaps what they really need is a new career. But that, of course, means that owners might take a hit on the value of the horse.
                          co-author of
                          Duel for the Crown: Affirmed, Alydar, and Racing's Greatest Rivalry
                          www.duelforthecrown.com

                          Comment


                          • #73
                            Originally posted by gumtree View Post
                            Thank you for taking the time to contribute to the discussion in a very detailed educational way.

                            Though I don’t have any formal degrees of note I am a person by natural that enjoys being as well educated on any topic/subject that I am going to offer up an opinion and or discuss. Before the internet lots of reference books. I take very little for granted and if someone is going to make a statement of fact that I don’t necessarily agree with they better be able to back it up. I rarely make statements of fact when it comes to “all things horse”. My comments all almost always stated as my opinion and experience. I am also one of the rare on this forum who gives a complete “bio” link on my profile page along with all of my contact information. So anyone that takes strong exception to my comments, can email, call, write, stalk or come up my driveway and punch me.

                            I have been around and worked with and have made my living in the horse business. Thoroughbreds only and mainly on the racing side of them. My clients expect and pay me to be well versed in all aspects, be it care and feeding, breeding, management and as a consultant and agent. I go to great lengths and devote a lot of time to keeping up on all aspects of the sport, industry and business. I have read countless studies over the years. I took the time to educate myself on what constitutes a “sound” well executed horse study so as to extrapolate what I feel is worthy taking note of and or repeating to others.

                            Given the fact there is no “New England Journal of Medicine” that I am aware of makes for a lot of studies being published in the “The Bolivian Journal”. (a great term and will give you credit every time I use it). But I do not dismiss any by and large just because they are either sell published or in The Bolivian Journal. Nor because it because it goes against what I intuitively believe.

                            Comparing human studies and what they “suggest” to horse studies is a bit like comparing apples and oranges IMO. Exactly for the reasons you gave;

                            “And, as will all research, reproducibility is important; this is difficult in equine/ veterinary research where funds are more limited than in lab or human-based studies. So we must work with the data we *do* have”.

                            Not only is the funding limited the shear logistics would be very difficult and expensive to gather sufficient number of horses and maintaining a pretty exacting “control groups”
                            Each having a different set of “parameters” IMO.

                            So, IMO when the word “suggested” is used in a horse study it does not carry with it anywhere near the strength as it does when used in a human study published in the New England Journal of Medicine.

                            The internet is a wonderful educational portal. But just like the proverbial “Grape Vine” a lot of things go from “suggested” to fact. Which was my point.
                            The “Lasix debate” has been a very HOT and polarizing issue in the racing world for over 6 years now. There are far better forums then here with well educated people on both sides of the issue to be found. I posted the link because IMO and many others with far better “credentials” then I feel the study was well executed and has merit. Maybe not the best some may say but probably the best to date. Regardless of what side the reader is on.

                            I also posted it because when ever the term “bleeder and or EPIH” comes up I read things being stated as fact when they are not. Or at least not as facts that everyone agrees one.
                            IMO the definition of a “fact” is something that can not be disputed.

                            IMO to use the term “suggest” that EPIH is hereditary, so as to “take it to the bank” would take a far more detailed research then has been done to date. First it would take identifying some specific families. And then following all siblings out of specific mares from last cover to the starting gate. In numbers that meet the criteria you laid out. A pretty daunting task. And considering the majority of horses are bred, raised, trained in a multitude of different ways and environments would make it that much harder.

                            Eliminating “fixed” unwanted traits like, offset knees, back at the knee, ect is fairly straight forward. Because Thoroughbreds are easily the most studied and have extremely detailed statistics to work from. More then any other breed. But as a breeder it can be an expensive lesson. The results from our mating choice when using some “unknown” crosses we may or may not end up with the above. But we know how to be pretty confident in our choices 2 years down the road.

                            Figuring out if we are breeding “bleeders” based on what we know about families in this day and age would take YEARS. And given the fact that it takes almost 5 years from last cover to the starting gate means that until we have found out the a particular family produces horse that are “bleeders” a definition that is still under debate the will be 4 more foals on the ground.

                            Again, I don’t feel a well educated and experience breeder needs a degree in genetics to “suggest” that there maybe a collation. But it is not something to take to the bank. But there is no research to date that anyone can take to the bank on this subject.

                            If anyone has any reference links to the contrary please pass them on. I don’t like to comment out of turn. I am not set in my ways and or thoughts on these things. As a breeder of Thoroughbreds mistakes are very expensive. It is much cheaper to stand corrected.
                            Most studies in human beings do not appear in a journal held in as high a regard as the NEJM. Any study that is epidemiological can only "suggest."
                            co-author of
                            Duel for the Crown: Affirmed, Alydar, and Racing's Greatest Rivalry
                            www.duelforthecrown.com

                            Comment


                            • #74
                              I never can choose a side in this debate.

                              Inherently, I strongly feel we over use/abuse lasix in this country.

                              But on the flip side, if I were running without lasix and my horse bled, or even worse, had an epistaxis episode, I would feel like I was doing the horse a disservice. No matter what the data says, I think all of us can agree we'd feel guilty if we allowed a condition to progress that could have been (legally) prevented.

                              The problem is that lasix truly is a performance enhancer. The argument that the horses run and recover better while on it, therefore it must be "good" for the horse it is not a valid conclusion in my mind-- of course they are going to run and recover better on it. That's what performance enhancers do. Acepromazine is another vasodilator effective for prevention of bleeding, yet amazingly that one has never caught on for race day use. (Although I imagine that has more to do with the risk involved!!!)

                              From a medical standpoint, frequent lasix use is extremely taxing on the animal. The fact that we (the racing community) take that somewhat for granted is scary. Folks argue that lasix is needed the most for the claimers running hard and paying their way-- which is completely true, but that also means they're receiving lasix the most frequently...

                              Bottom line, it would be nice if we had a better alternative...
                              Don't fall for a girl who fell for a horse just to be number two in her world... ~EFO

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                              • #75
                                I have not read the entire thread but It appears to me that if Lasix strips you of K+ that is a big problem with the Na/K+ pump in your skeletal muscles and cardiac muscle.
                                Who is monitoring that? It is about the side effects too not just that should the horse really run? Other countries do without just fine and our horses typically do not do well without. (as far as racing overseas) A few have but not most.
                                If it causes the horse to lose water weight that is performance enhancing on race day. They handicap the rider with the saddle not the overall weight of the horse. If you lost 10 pounds you would run faster too...
                                I will go back to lurk mode now..
                                Mai Tai aka Tyler RIP March 1994-December 2011
                                Grief is the price we pay for love- Gretchen Jackson
                                "And here she comes. Is it a bird? Is it a plane? No, it's ZENYATTA!"

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