Bramlage, McIlwraith on Santa Anita: A Combination of Factors to Blame

A collection of factors ranging from racing surface to perception of soundness could have contributed to the 30 horse fatalities at California’s Santa Anita Park, say two world-renowned racehorse health experts.

But, they suggest, there are ways the industry can combat such issues—from canceling racing when conditions dictate to more frequent and detailed lameness examinations.

In June 2019 the Colorado State University (CSU) Translational Medicine Institute posted a video featuring a discussion between Larry Bramlage, DVM, MS, Dipl. ACVS, an equine orthopedic surgeon and shareholder at Rood & Riddle Equine Hospital in Lexington, Kentucky, and C. Wayne McIlwraith, BVSc, PhD, DSc, FRCVS, Dipl. ACVS, an equine orthopedic surgeon and a University Distinguished Professor and Barbara Cox Anthony University Chair in Orthopaedics at CSU—on its YouTube channel. The two talked about the Santa Anita catastrophic injuries and other industry controversies such as race-day medications and uniform drug rules.

‘A Combination of Factors’

Thirty horses have died or been euthanized due to injuries sustained during racing or training at Santa Anita since just before the new year. Theories and debate about what caused the cluster of catastrophic injuries swirled among horsemen, industry stakeholders, and even the general public. So, what’s the most likely explanation?

“It was a combination of factors,” McIlwraith said, potentially including:

  • Racetrack surface;
  • Weather conditions—specifically excessive rain;
  • “Notices sent to horsemen at last year’s Autumn Meet and at the start of the Winter Meet, telling them that stall allocation would be related to a number of horses entered in races which could obviously push trainers to enter horses, perhaps before they were ready,” McIlwraith said; and
  • “Soundness of the horses or difficulty in diagnosing some horses having pre-existing problems.” he said.

Statistically speaking, Bramlage pointed out, the overall Thoroughbred catastrophic injury rate gradually declined during the past several years.

“Now, nothing lasts forever, and you’re always going to have variations—increases at some times and decreases at some times,” he said. “There was (an increase) this year at Santa Anita. Six years ago, it was at Aqueduct (Racetrack, near New York City). … Certainly, weather and racetrack surface played a role in both those incidences—the winter weather in New York and that rainy (winter) in California.”

But, he added, it’s important to remember that injuries are a part of all high-level athletic competition, regardless of which species is participating.

For example, “one of the things that has the most effect on a football team having a good season is how many of the 22 starters that play the first game are still playing the last game,” Bramlage said, noting that some years teams have virtually no injuries, which almost always amounts to a good season. But if they sustain higher-than-normal levels of injury, the opposite happens.

“I think that’s what we see in racehorses,” he said, regarding the increased injury rate.

The Jockey Club Equine Injury Database reported that, in 2018, the catastrophic injury rate was 1.68 per 1,000 starts for all surfaces; it was 1.86 per 1,000 starts for dirt tracks alone.

That rate is fairly low, Bramlage said, “but at Santa Anita, you’ve got 3,000 horses training.”

A large horse population coupled with even one of the factors McIlwraith described could lead to an increased injury rate, he said.

“That’s not an excuse for it being okay,” Bramlage added. “But we have to look at it. It actually may show us some things we need to know.”

Weather and Racetrack Surface Consistency

Bramlage and McIlwraith agree that weather likely played a role in the recent cluster of injuries.

“Inconsistency is the thing that bothers the horse the most (and) the weather tends to change the consistency of the racetrack,” Bramlage said.

He explained that a horse working or racing is accustomed to one kind of surface. When they hit another kind—or one of a different consistency—the limb biomechanics and loading change, as well.

McIlwraith said the high volume of rain Southern California experienced left the dirt track wet, which, in turn, led to the track superintendent and crew sealing it. When a track is sealed—a process used only on dirt tracks—the maintenance crew compacts the surface to allow water to run off it.

“Sealed racetracks increase injuries, and I don’t think anyone questions that,” he said. “The dilemma, of course, is when do you decide to close that track? In hindsight, I think there are certainly days that instead of sealing the track, they should have closed the track.”

It’s next to impossible to have a good racetrack when the ground is excessively wet, he said.

More Thorough Exams, More Diagnostics, More Often

While new approaches can’t change the past, they could help reduce the number of catastrophic injuries racehorses suffer. Bramlage and McIlwraith believe more thorough lameness exams across the board could help in that regard.

“There’s a lot of variation between barns, trainers, and vets as to how detailed an examination is regularly done on horses,” McIlwraith said. “(We need) a uniform diagnostic level where these horses get thoroughly examined regularly. I’m not talking about going into a bone scan or that kind of thing—just jogging up for the vet.”

And, he added, this shouldn’t just be for horses on the vet’s list, meaning a regulatory veterinarian has observed that the horse is lame at any point. “It needs to be a regular event,” he said.

Bramlage concurred but noted that imaging should be a part of the process, as well.

“There’s this perception sometimes that we don’t have diagnostic equipment that can identify the kind of injury that predisposes a horse to a fatality,” he said. “More times than not, it’s not that we can’t identify it, it’s that we’re not looking. We have to continually move toward … when a horse is showing something’s bothering him, you need to get to the bottom of it.”

For those horses on the vet’s list, Bramlage recommended a protocol to help protect them.

“The Equine Injury Database shows that a horse that goes on the vet’s list … three times, they’re almost certainly going to have a fatal injury,” he said. “That is because they’re not being diagnosed.

“A lot of those horses get time (to rest), they get palliative medication, they might get physical therapy, they get sound, they have to work then before they race, but when they go back into high-speed activity they get lame again,” he continued. “That gets them on the list the second time and they still may not get a veterinary examination.

“I think if we could make one change, we should require a horse that goes on the vet’s list to have a veterinary examination or they’re out for 90 days, because we can’t tolerate this increased risk that we’re not eliminating where we could.”

Uniform Medication Rules and Race-Day Medications

Catastrophic injuries aren’t the only controversy in racing.  One of the most enduring debates has been about medications and uniform rules regarding them for all racing jurisdictions. Bramlage and McIlwraith agree that uniform rules are needed moving forward. However, over the past 30 years industry stakeholders haven’t been able to agree on them.

Bramlage said this is due, in part, to each racing jurisdiction seeking to tailor policies to their own needs. “I think that if we’re going to have a uniform medication policy, everyone’s not going to get what they want,” he said. “But I think we need to get to a place where everyone has something they can live with.”

McIlwraith concurred. “It can’t happen with individual needs and preferences,” he said. “We need a national authority. Some major (racing industry) segments have resisted that. But that’s what we need.”

The pair also touched on whether race-day use of furosemide (marketed as Salix but commonly referred to as Lasix) should stay or go. Marketed to lessen the effects of exercise-induced pulmonary hemorrhage (EIPH, or “bleeding”), Lasix is the only drug permitted to be administered on race day in North America, and most other racing jurisdictions worldwide prohibit race-day Lasix administration.

“The question of eliminating race-day Lasix, there’s some there’s some laudable reasons to do so because we’re out of step with the rest of the world. However, there is no scientific evidence for Lasix promoting musculoskeletal injury,” McIlwraith said.

Bramlage added, “No one really argues with the fact that Lasix is effective at reducing bleeding.  … So, we need to find a way to get around this situation, and it takes the wisdom of Solomon trying to find that.”

If the North American racing industry as a whole were to ban race-day furosemide, McIlwraith said, “it’ll be forgotten in six months,” meaning it would just become part of the fabric of racing.

“There’s still be a winner in every race,” Bramlage added. “I think it’s a question of how you want to attack the underlying problem: the fact that horses in high-level athletic activity are vulnerable to pulmonary hemorrhage, and whether that’s acceptable or not … or whether we’re able to tolerate that occasional occurrence or the underlying occurrence that affects performance.

“We’re all on the same playing field now because almost every horse gets Lasix,” he continued. “So if every horse didn’t get Lasix you would lose some horses (from the sport, unable to race without it), there’s no doubt about it, but it’s going to be much fewer than I think most people perceive.”

McIlwraith agreed: “There’s enough experience internationally in every other country where Lasix is not allowed that we know the decrease will be relatively small.”

Still, Bramlage said, “the performance of a lot of horses is going to be affected.”

The pair also discussed biologic therapies (specifically IRAP, or interleukin-1 receptor antagonist protein) in racehorses, medication rules for differing racing breeds, and the 2019 Kentucky Derby winner disqualification ruling. Watch the full 51-minute video at youtu.be/DRqL-DjjTng.