December 6, 2009

The shock waves from the FEI's implementation of the progressive medications list has encircled the globe and sharply divided the equine community. I am very concerned by the rhetoric being used to justify the change. I signed the petition at www.no-fei.com, and stand squarely with the BEVA, many of the FEI's own present and past veterinarians, their Honorary Scientific Advisor, all national organizations opposing this change and concerned individuals everywhere.

To suggest that nonsteroidal anti-inflammatory drugs (NSAIDs) are not performance enhancing but rather “restorative”, implying they are actually beneficial to the horse, is patently ridiculous and flies in the face of current scientific knowledge. These drugs do not “treat” musculoskeletal issues. They mask the animal's natural, protective pain response by interfering with inflammatory pathways (the cyclooxygenase enzyme systems) while the cause of that pain remains.

Short term use of NSAIDs for the humane relief of pain in injured animals is reasonable, but no horse genuinely in need of NSAIDs should be competing. Compelling evidence has accumulated in the human literature that this class of drugs used chronically interferes with the normal metabolism and healing process in bone, joint cartilage and tendon insertion sites onto bone. In fact, human orthopedic surgeons caution their patients to avoid NSAIDs for at least a week before and several weeks after surgical procedures. A review article on the impact of NSAIDs on the musculoskeletal system in humans which appeared in the September 2008 issue of Drugs Today concluded:

“It is clear, however, that cyclooxygenase activity is involved in the healing of many skeletal tissues, either directly or indirectly through modulation of the inflammatory response. Consequently, pharmacological manipulation of cyclooxygenase using NSAIDs or celecoxib can profoundly affect skeletal health.”

Preliminary studies, published in the American Journal of Veterinary Research in May of 2000 and December of 2001, confirm similar effects in equine tissue. In the study by Dr. Rhode et al, Ohio State, phenylbutazone at 4.4 mg/kg every 12 hours (a common therapeutic dose), significantly reduced mineralization and delayed healing at bone biopsy sites compared to untreated horses. Dr. Beluche et al, also at Ohio State, used the same dosage to assess the effects of phenylbutazone on cartilage and concluded:

“Oral administration of phenylbutazone for 14 days significantly decreased proteoglycan synthesis in articular culture explants from healthy horses to a degree similar to that induced by in vitro exposure to IL-1beta [an inflammatory cyotkine in arthritis - EK]. Phenylbutazone should be used judiciously in athletic horses with osteoarthritis, because chronic administration may suppress proteoglycan synthesis and potentiate cartilage damage.”

The BEVA has expressed concern that the change could lead to an increase in catastrophic injuries, a concern that is supported by a June 2009 study in the Journal of Veterinary Pharmacology and Therapeutics which found higher levels of phenylbutazone and flunixine in catastrophic breakdowns in racehorses, as well as injuries in general. Pain means injury. Is it not simply common sense that masking pain so that a horse can perform with weakened tissue is asking for trouble?

This is to say nothing of the legendary potential for this class of drugs, in particular phenylbutazone, to cause oral ulceration, gastric ulceration, renal damage and right dorsal colitis.

It is being claimed that there is no concern over NSAID use in human athletes. In truth, several recent articles have expressed concern over the level of NSAID use by human athletes with respect to decreased blood clotting, drug side effects, negative effects on the ability of muscle to respond normally to exercise, electrolyte abnormalities and the potential for worsening injury, for example:

http://sportsmedicine.about.com/od/medicationanddrugs/a/NSAID_endurance.htm 

We are told that the permitted dosage of 1 gram of phenylbutazone no closer than 12 hours before competition is too low to have a significant effect on lameness and would be administered in a supervised setting. There are several problems with that statement.

A study in the December 1994 issue of the Journal of Veterinary Pharmacology and Therapeutics found that 2 mg/kg of phenylbutazone, 1 gram for a 500 kg horse, the same “low” dose being proposed by the FEI, provided as much pain relief as higher doses in an experimental model of severe arthritis. Higher doses only provided a longer duration of pain relief.

It's true that a 1 gram dose of phenylbutazone 12 hours out from competition would not be providing significant pain relief at that 12 hour mark. However, the proposed allowable plasma level of 8 µg/mL is well within the known therapeutic blood level and is more consistent with the level that would be found between 6 to 7 hours after administration, not 12. This leaves the door wide open for abuse by anyone inclined to give the horse more drug on their own, a practice called “topping off”. In his letter to the FEI protesting the rule change, Leo B. Jeffcott, former Chair of the FEI Veterinary Committee, refers to past problems with topping off. Does anyone seriously believe that won't happen again?

Advocates of the change also refer to violations that occurred under the zero tolerance policy, alluding to those being unjust or the test too sensitive, and applauding the new rules for that reason. However, the level detectable under zero tolerance depends on the sensitivity of the assay being used. These drugs lose their analgesic effects long before the nanogram levels detected by ultrasensitive ELISA tests. Using chromatography techniques, a typical limit of detection for a 3 gram dose of phenylbutazone correlates with the drug having been administered 30 hours prior to testing, or 39 hours for its metabolite, oxyphenylbutazone when testing blood samples. The limit of detection for this high dose when testing urine is 48  hours for the drug itself and 120 hours for its metabolite. Lower doses would be undetectable much sooner. Is it really all that unreasonable to ask that a horse not be given NSAIDs for 3 to 5 days prior to a competition?

I am also concerned that the rule change will lead to greater use of NSAIDs in general, both between and at competitions. Trainers and riders will feel that those who are using them are at an advantage and will feel compelled to give their horse an equivalent edge.

As a veterinarian and advocate for the horse, I cannot support the progressive drug list and strongly agree with those who feel it is a step backwards both in terms of equine welfare and the clean sport effort.

Eleanor M. Kellon, VMD

Equine Nutritional Solutions

Denver, Pennsylvania

USA

www.drkellon.com

Dr. Eleanor Kellon, VMD Biography

Eleanor Kellon, VMD of Equine Nutritional Solutions, Ephrata, Pennsylvania, is one of a handful of experts in the field of applications of nutraceuticals for horses. She is an authority in the field of equine nutrition as well as conditions affecting performance horses. As co-owner and moderator of the Yahoo Equine Cushings and Insulin Resistance list, a group that has over 8000 members, Dr. Kellon is a most valuable resource. Background: An Honors Graduate of the University of Pennsylvania, Dr. Kellon completed her internship and residency in Large Animal Medicine and Surgery at the renowned University of Pennsylvania New Bolton Center. She is a member of the Veterinary Advisory Board for Smart Pak Equine. As Veterinary Editor for Horse Journal and John Lyons Perfect Horse, many of her clinical trials have been published. Lay Publications: Dr. Kellon routinely writes four to six articles a month. A prolific writer, her articles have appeared in magazines such as The Chronicle of The Horse, Hoofbeats, Practical Horseman, Equus, Horse Journal, and John Lyons Perfect Horse.  She has written over 1500 magazine articles, most concerning nutrition. Professional Publications: Dr. Kellon has also contributed to professional publications and professional meetings. Her topics frequently include muscle disorders, thyroid disorders, and nutrition. Her most recent have been: Contributing author on laminitis and dietary therapy of insulin resistance in Equine Podiatry, WB Saunders Co, 2006. Use of the Herb Gynostemma Pentaphyllum and the Blue-Green Algae Spirulina Plentensis in the Horse. Third European Equine Nutrition and Health Congress, Gent, Belgium, March 2006. Iron Status in Hyperinsulinemic/Insulin Resistant Horses. Third European Equine Nutrition and Health Congress, Gent, Belgium, March 2006. Treatment of Equine Metabolic Syndrome, Compendium of Continuing Education for the Practicing Veterinarian, Vol 26(2) February 2004. Books: As a best-selling author, her books are compelling, easy to read and informative. They include: The Older Horse, Breakthrough Publications Keeping the Older Horse Young, Breakthrough Publications Raising and Feeding the Perfect Horse, Belvoir Publications Guide to First Aid for Horses, Breakthrough Publications Equine Supplements and Nutraceuticals, Breakthrough Pubilcations Equine Drugs and Vaccines, Breakthrough Publications Horse Owners Veterinary Advisor and Record Book, Breakthrough Publications Horse Journal Guide to Equine Supplements and Nutraceuticals, Globe-Pequot Press Field Trials: Best known for her field trials, Dr. Kellon continues to break new ground with her findings. A few are summarized below.    In  2000, Dr. Kellon published, in Horse Journal, the results of the first field trial on Chastetree Berry (Vitex Agnus Castus) for horses with Cushings syndrome. For more information, visit: http://www.equiworld.com/uk/horsecare/veterinary/cushingssyndrome/ In 2000, Horse Journal published Dr. Kellon’s field trial on the use of magnesium supplementation in horses with cresty necks and laminitis. In June 2000, Dr. Kellon published, in Horse Journal, the first warning against feeding organophosphates to horses. Ultimately, this created awareness amongst horse owners andbrought about some changes in common feeding practices. In March 2006, Dr. Kellon was a guest speaker at the European Equine Health and Nutrition Congress in Belgium. Her presentations included "The use of Jiaogulan and Spirulina in Horses" and "Iron Status of Hyperinsulinemic/Insulin Resistant Horses". For more information on Jiaogulan for laminitic horses, visit: http://www.naturalhorsetrim.com/Jiaogulan.htm In Aug. 2006, Horse Journal published Dr. Kellon's article on DSLD's Devastation, which included the results of a field trial treatment plan to help alleviate the pain and symptoms of this disease. In Dec. 2007, Horse Journal published an article on the use of Acetyl-L-Carnitine in horses with chronic laminitis. This was another ground-breaking field trial on the use of supplements for a chronic condition. Equine Advocate: Veterinary editor and contributing author of Horse Journal, the only completely subscriber supported horse magazine that accepts no advertising. Being free of industry ties, Horse Journal publishes objective and unbiased product reviews and field trials on supplements, feeds and all things of interest to horse owners, from hoof picks to trailers. Pergolide: In March 2007 the FDA removed pergolide from the market, a drug that has been very  successful in the management of Equine Cushing's disease. Dr. Kellon spearheaded a nationwide effort to urge companies who market and distribute Pergolide to keep this drug available for veterinary use.  She was relentless in her communications with the FDA until they announced on May 11 that they would allow bulk pergolide to be used in compounding pergolide for use in horses. Feed Recall: Recently, Dr. Kellon has been involved in informing readership of the feed recall in the eastern United States. Always an advocate for the horses, she has kept the public up-to-date on the developments in this very serious health risk. Professional Experience: Dr. Kellon currently works as a writer, teacher and internal medicine/nutrition consultant. Prior to this, Dr. Kellon has over 10 years experience in private practice, including management of a breeding farm and rehabilitation facilities. She also has extensive experience with performance horses, including eventing, fox hunting, racing, and showing. Dr. Kellon lives on a farm in Pennsylvania where she and her husband raise, train and race Standardbreds.