Friday, 1 May 2015
Equine Ulcers: A Suitable Case for Treatment? Part 2: Treatment and Implications
In the first part of the blog on 15th April we looked at the causes and diagnosis of ulcers. Fortunately they are easy to treat, although having said that there is some controversy over what to do next.
What is the treatment regime?
Omeprazole (trade name Gastrogard – although since that came off patent there are now other, cheaper drugs with the same active compound) is a highly effective inhibitor of acid secretion in the stomach of the racehorse. It is administered orally from a sachet or syringe. Some of it is destroyed in the stomach, but an amount is absorbed, circulates in the blood stream and acts back on the stomach. As a result it can be readily detected in a blood sample, which as discussed below can lead to disqualification. Godolphin’s Doonside Cup winner, Sky Hunter, was disqualified last season after testing positive for this drug. Normally a one-month course of treatment is recommended with the horse coming off it at least five days before racing. Ulceration can start again within that short period of time, so many vets recommend that the horse remains on a low dosage between races.
Can ulcers be avoided?
In theory yes, but in practice only with some difficulty, particularly in larger training yards. It needs amendments to stable management policy, particularly around feeding and turn-out. Ideally the horse should have access to feed on a continuous basis, and there are some innovations emerging now, particularly in Germany, whereby the horse can eat every hour, day and night, through special feeders. Increasing turn-out in paddocks or pens allows the horse to graze, and is now recommended for horses that are susceptible to ulcers. More controversially, some vets recommend a small amount of feed early in the morning prior to exercise.
But in larger yards it is unlikely that horses will be able to have that level of individual attention and ulcers are likely to form regardless of some stable management changes.
Should all racehorses be treated with Omeprazole, and will this affect race planning?
On balance I think I have been converted to that approach, and we may make that an OfO policy next season. One of our vets believes that rather than training horses, identifying ulcers and then treating them, a parallel programme of training and veterinary treatment should be adopted. So taking the example of Shantou Magic, who won his first race back after ulcer treatment, we may aim him at a race such as the Hennessy in the autumn. Six weeks prior to the race he would begin a course of treatment, stopping it in time to ensure that no traces remain in the bloodstream. After the race he would then go back on a lower dosage before his next outing. We might give him a mid-season break to relax and de-stress, then follow the same regime again, aiming at a spring target. This potentially means dividing the season up into three parts: racing and treatment in the first and third part, but a holiday in the middle. If this policy were adopted widely, it would have implications for frequency of NH races mid-season, because there will be no plans for horses to race at that time. Indeed this is starting to happen with some of the bigger yards dramatically reducing the number of runners in January and February. Of course, a trainer could be counter-cyclical to that approach and concentrate on those months.
It obviously also has cost implications for owners. Scoping and treating ulcers usually costs between £600 and £900, so if a dual treatment regime were adopted by OfO and our trainers it will put approximately £200 extra on the bill for each of our six owners. In the greater scheme of things that is not a lot of money.
Finally, is the treatment performance-enhancing, and what is the BHA policy?
This is very controversial. At the moment the BHA has a zero tolerance on the presence of Omeprazole in the blood of a horse on race day. Therefore a withdrawal period of at least three days is required, and most vets would extend that to five. At the moment it is on the list of prohibited substances and many in the sport, not least the National Trainers’ Federation, believe that because ulcers are an occupational hazard of training then the drugs to treat them should not be prohibited. A similar example would be the use of wormers, which are allowed. Ulcer treatment enables the horse to race to his potential, but doesn’t directly improve performance.
In a number of other countries the welfare argument has convinced the authorities to allow the drugs to be used. In Australia, medication can take place up to one day prior to racing; in Hong Kong, two days prior, and the Fédération Equestre Internationale allows treatment up to the day of treatment.
So there appears to be a strong case for relaxation of the zero tolerance policy in the UK.
Hope you found these two blogs on ulcers of interest. We’d be delighted to hear views and experiences, particularly relating to changes in stable management. If there are other veterinary subjects you would like covered in the blog, please let us know.