I’ll Have Another . . . shock wave therapy treatment please

Written by JANE ALLIN

I’ll Have Another is first past the post winning the Kentucky Derby 2012. The horse was given shock wave therapy treatment just weeks before competing in the first jewel in the Triple Crown. Matthew Stockman / Getty Images.

News of this year’s Kentucky Derby winner, I’ll Have Another, undergoing extracorporeal (outside the body) shock wave therapy (ESWT) on his back shortly before the race drew some speculation as to the objective of this strategy.

Apparently there was nothing wrong with the horse, at least according to his owner, Paul Reddam, and trainer, Doug O’Neill.

Despite its name, ESWT is not electrical in nature but rather consists of high-intensity “positive pressure” acoustic waves that interact with the tissues of the body to stimulate healing (i.e. sound is a pressure wave). This non-invasive technology has been used for decades as a non-surgical method for treating renal stones (lithotripsy) wherein the pressure waves mechanically break up the stones and permit passage.

In Europe, ESWT has been used since the early 1990’s for the treatment of musculoskeletal disorders and is considered advantageous in treating such ailments as plantar fasciitis, epicondylitis, tendinitis and non-unions of bone.[1] Testing in animals began in the mid-1980’s and by the late 1990’s shock wave technology made its way from Europe to North America. Since this time the use of ESWT has gained increasing importance in the treatment of horses suffering from orthopedic disorders.

Although studies encouragingly show that this non-invasive modality is effective in accelerating tendon healing, diminishing symptoms of navicular disease and aiding in the treatment of osteoarthritis, the mechanism by which this occurs is not well understood.[2]

The general consensus is that orthopedic shockwaves microscopically stimulate interstitial and extracellular responses in the tissues and bone giving rise to regeneration.

Electrocorporeal shock wave therapy treatment being administered to a horse. Image from ESWT.net.

While original ESWT units were large, cumbersome and expensive, the current technology has introduced small, portable and affordable devices which are easily manipulated and transported from location to location. The therapy head of the handheld wand is flexible – somewhat similar to an ultrasound device – which can be focused on a specific anatomical site virtually anywhere along the horse’s body with effective treatment applied within minutes and while the horse is standing.

According to the literature there is an immediate short-lived (3-5 days) analgesic (pain numbing) effect together with decreased inflammation, new blood vessel formation in the soft tissues and osteogenesis (bone tissue formation).[3] While there are obvious positives of this therapy, the negative side of the analgesic effect must be considered and its implications with respect to racing.

In consequence of the analgesic effect, which has potential to mask the pain of orthopedic ailments, the use of ESWT must be categorized as a doping agent. It comes as no surprise then that racing jurisdictions in the US as well as the FEI (Fédération Equestre Internationale) have adopted explicit regulations that require a withdrawal period after treatment.

As with other racing regulations in the US the rules vary from state to state. At one extreme this therapy has been totally banned at race tracks and training facilities while others mandate a 14-day interlude prior to racing.[4]

Despite the fact that US racing commissions and the FDA have restricted the use of these devices to licensed veterinarians there has nonetheless been abuse reported.

“There have been reports of race horses being shocked prior to a race so that they would run better,” said Kinas. “Ironically, while this is an abuse and is not the purpose of ESWT, it offers further anecdotal evidence of shockwave therapy’s efficacy.”[5]

Although this may indeed demonstrate its efficacy, the sad reality is that it is yet again another conduit for cheating. Aside from the analgesic effect of ESWT, what is also disturbing from a racing integrity aspect is the fact that treatment leaves no visible signs of the procedure and without side effects — in other words, undetectable. This together with equipment size and portability is an accident waiting to happen, perhaps one that has already occurred.

Let’s return to Doug O’Neill, trainer of the Kentucky Derby winning horse, I’ll Have Another. O’Neill is being dragged through the mud in the media these days.

While the shockwave therapy administered to I’ll Have Another was above board and the horse spent the compulsory 10 days on the vet’s list as mandated by the California Horse Racing Board, O’Neill’s history of repeat violations begs for skepticism. Joe Drape and Walt Bogdanich’s recent New York Times article; “A Derby Win, but a Troubled Record for a Trainer” succinctly describes his dirty deeds.

“Over 14 years and in four different states, O’Neill received more than a dozen violations for giving his horses improper drugs. O’Neill’s horses also have had a tendency to break down. According to an analysis by The New York Times, the horses he trains break down or show signs of injury at more than twice the rate of the national average.”[6]

As much as O’Neill followed the rules this time, one has to wonder if there was a hidden agenda in administering the ESWT given that there was “nothing” wrong with the horse, other than some “tightness” in his back.

With O’Neill’s history of running horses at less than 100%, is it possible that I’ll Have Another was to some extent compromised from the grueling Santa Anita Derby after winning by a nose over heavily favored Creative Cause on April 7th?

Just asking.

In spite of the fact that ESWT is a legal therapeutic treatment there is lingering apprehension regarding any underlying issues that may have beleaguered I’ll Have Another that otherwise and precluded him from running in the Kentucky Derby. How could Reddam and O’Neill possibly relinquish that opportunity? It certainly would be a difficult decision to make.

Racehorse trainer and known “Milkshaker” Doug O’Neill who ranks highly on the doping charts is now using shock wave therapy on his horses. Its use is difficult to detect and numbs pain afterwards for a number of days. AP Image.

What’s more is that a minimum of 4 days’ rest is recommended after ESWT. Yet O’Neill continued to train and exercise I’ll Have Another in preparation for the Derby within the required 10-day interval following the horse’s ESWT treatment on April 20th.

I’ll Have Another completed a 6-furlong drill only 7 days later on April 27th and another on the track at Churchill Downs the morning of the 29th. Perhaps this is the norm but it certainly calls for contemplation.

And in yet another turn of events leading up to the Preakness, I’ll Have Another isn’t housed in the stakes barn at Pimlico which is reserved for the Derby winner. Instead O’Neill chose a nearby barn.

“O’Neill elected to pass up the stakes barn and not have I’ll Have Another in the traditional Derby winner’s stall. Instead, he is one barn away where the horses competing in the undercard stakes will be stabled.

“They told me there’s always a big hoopla at the stakes barn, and I like having my own serene spot and a nice quiet environment,” O’Neill said.”[7]

Maybe, but yet again it raises suspicion.

But there’s more.

News has it that O’Neill plans to saddle I’ll Have Another in the indoor paddock at Pimlico Race Course rather than out in the open when the colt goes for the middle jewel of the Triple Crown May 19.[8]

How many more distractions will we be subject to before the colt finally races? Are these simply actions intended to detract from O’Neill’s reputation in an attempt to canonize the whole ritual, particularly if I’ll Have Another wins the Preakness, goes on to take the Belmont, completing the elusive Triple Crown? It’s like building a strategy otherwise different from the past in the pretense that there was something unparalleled or astounding about it.

These antics fall prey to even more suspicion. And why shouldn’t they?

Although not the worst offender, in 2010 O’Neill ranked 7th on the list for multiple drug violations according to records compiled from the Association of Racing Commissioners International.[9] Furthermore, O’Neill continues to deny any wrong-doing yet the frequency with which his horses break down is more than twice the rate of the national average.

In an irony of sorts O’Neill is currently contesting the allegations of “milkshaking” a horse called Argenta at Del Mar in 2010 which could see him suspended for up to 180 days. This coming from Doug “The Milkshaker” O’Neill — how amusing. According to the Blood-Horse magazine, not just once, but four times now O’Neill has been accused of “milkshaking” horses.[10] And how many more have gone undetected one can only guess.

But O’Neill is not the only culprit. It was simply an inopportune time to win the Derby, if one can say there is such a thing, given the current state of Thoroughbred racing and the ugly reality of race-day and other medications that are regularly administered to these chemical horses.

The greater majority of the top trainers in the industry are equally culpable. Had Bob Baffert’s horse Bodemeister or Mike Maker’s Hansen won the Derby would it be any different? Both of these trainers have a higher frequency of drug violations than O’Neill.[11]

If Thoroughbred racehorse trainer and “drug lord” Rick Dutrow wins the Preakness and spoils I’ll Have Another’s run at the Triple Crown, the media will have a field day. Image by H. Darr Beiser / USA Today.

What’s even more exasperating is that one of the “drug lords” of racing, Richard Dutrow is hoping to run Zetterholm in Preakness.[12] If on a long shot this horse wins, the press will have a field day.

“For years, Dutrow trained horses at tracks across the country despite amassing dozens of drug violations. Last October, New York authorities, citing 70 violations in 15 states, revoked Dutrow’s license, barring him from state racetracks for 10 years. But Dutrow appealed the ruling and continues to race horses effectively enough to be the nation’s 11th-ranked trainer with more than $2.2 million in earnings for 2012.”[13]

The sport of horse racing itself is becoming increasingly irrelevant in North America.

As long as governing bodies permit reckless behavior and impose minimal fines and penalties, the cheaters will cheat. When others witness the cheaters getting away with these infractions there will be more who cheat. After all it is a competition. And as much as competition can breed success, the power of the dark side can wreak havoc where some will go to any length to win. Sadly in horse racing this seems a given.

It is conspicuously incomprehensible why those in the North American racing circuit continue to uphold the need for race-day drugs. Race-day drugs represent the persona of North American racing: deception, death and dirty laundry.

That said, while this may be bad timing for those trainers who operate on the shady fringe — which by the way seems to be the norm rather than the exception — it is nonetheless a very auspicious time for these stories to grace the headlines.

Currently there is federal legislation pending before Congress banning the use of all race-day medications. Additionally a number of industry organizations have come forward with proposals for new medication regulations and integrity measures to enhance the safety of both the horse and jockey alike.

Salix. Photo: Anne M Eberhardt

The Jockey Club and the Thoroughbred Owners and Breeders Association (TOBA) have also launched an advocacy website — www.cleanhorseracing.org — with its focus issue the hotly debated usage of race-day medications, in particular Salix / Lasix.

As Vivian Grant Farrell of the Int’l Fund for Horses points out:

“Perhaps this new advocacy site aimed at ridding horse racing of race-day medications such as Lasix means to demonstrate that the industry is seriously determined to begin cleaning house. Whatever the motivation, it is good for the horses and racing, and a welcome start by us.”[14]

In any case, I digress.

Getting back to Extracorporeal Shock Wave Therapy, there appears to be significant benefit,with few drawbacks in this promising technology[15, pdf]:

• Proven success for the treatment of bone and soft tissue even for animals with unfavorable prognosis
• Treatment without severe strain for the horses
• Relatively painless (i.e. similar to hitting the funny-bone)
• Outpatient treatment
• Can be performed with the horse standing
• No surgery required
• Accuracy in locating where the pain originates
• Rapid healing relative to how chronic the problem is
• Treats the cause, not just the symptom
• Best of all – NO DRUGS

However, as with anything good in horse racing, the omnipresent dark side looms.

With impending reform in North America, and potentially drug-free race days, where will these “cheaters” turn in their lust to win? And more importantly how far will they go? We have already witnessed the shamelessness. Why should anything change? It will be a long hard road to change and there will be those who conspire to create progressively more illusory ways to cheat.

Shock wave therapy seems like the perfect answer to this drug-ridden sport.

Or perhaps the perfect crime? Undetectable.

© Int’l Fund for Horses