Forgotten Side of the Salix Debate: The Calcium Connection cont’d

I'll Have Another retired due to swollen left front tendon. (AP Photo/Matt Slocum)
The front legs of Kentucky Derby and Preakness winner I’ll Have Another, scratched the day before the Belmont Stakes due to a swollen left front tendon they said at the time. According to later reports, it turned out the horse had symptoms of chronic osteoarthritis that were hardly new or recent. I’ll Have Another was rushed off to stud weeks later. (AP Photo/Matt Slocum)


Drug Interactions Anyone?

This takes us to an even more insidious topic; the subject of drug interactions. As we are all aware there are always precautions associated with any medications, whether that be the so-called innocuous over-the-counter variety or more potent prescription medications. How two or more drugs interact, regardless of their harmlessness, can result in serious side-effects, sometimes life-threatening.

Besides Salix what else do horses have coursing through their veins during training or on race day that may put them at risk? Racehorses are routinely given an array of drugs known to interact unfavorably with furosemide which are more often than not concurrently circulating within the horse’s system.

The corticosteroids such as dexamethasone, prednisone or methyl prednisone are potent anti-inflammatories that are used to decrease inflammation, musculoskeletal pain, long-term joint degradation and opposite limb overload in horses with acute musculoskeletal inflammations. See

While it is acknowledged that corticosteroids pose a known risk of inducing laminitis in susceptible horses what is often overlooked is their effect on body water regulation and capacity to increase urine output (polyuria/polydipsia).

When used in combination with furosemide the corticosteroids further increase the risk of electrolyte imbalance and increased calcium losses yet are regularly used together in the horse. Moreover the combination of furosemide and prednisone is widely prescribed to reduce serum calcium levels along with the added danger of a reduction in potassium levels significant enough to require potassium supplementation. See .

Heavy sweating alone can induce serious dehydration, particularly in racehorses reaching speeds of up to 40 miles an hour with accompanying calcium and electrolyte losses. Obviously the combined use of Salix and corticosteroids significantly compounds these effects and can only be detrimental to the well-being of the horse.

Another drug administered, often on a “daily” basis, to many horses is clenbuterol, a powerful bronchodilator which works via relaxation of the muscles that line the airways to alleviate breathing problems in horses with inflammatory airway disease (IAD) and recurrent airway obstruction (RAO, more commonly known as heaves).

There has been much controversy over its use in terms of performance enhancement and despite the fact that most horses do not require it many trainers continue to use it for its muscle-building anabolic steroid effects.

Not only is it detrimental to the horse with continued use it also increases the risk of cardiac arrhythmias when used with potassium-depleting drugs such as loop diuretics – yup Salix – and corticosteroids; a triple drug interaction on the horse’s overtaxed system.

Moreover it also has vasodilator effects which can further compromise the horse particularly when given with Salix. Furosemide decreases the circulating blood volume which means that the kidneys (and most other organs) will have decreased blood flow to them. When a state of electrolyte balance is induced such as would be the case when Salix is administered, a drug with vasodilator properties such as clenbuterol should never be administered until that balance is allowed to return to equilibrium as it too will reduce blood flow to the kidney which may fail, possibly permanently.

Are these issues not serious enough to consider? Or does anyone care?

There are of course other drugs administered to horses on a regular basis that interact unfavorably with Salix many of which are related to potassium and magnesium loses (e.g. albuterol, ketoprofen, ephedrine) but the picture is pretty clear.

So much for the innocuous Salix theory.

But of course one cannot discuss drugs and the racehorse without mention of the ubiquitous phenylbutazone more commonly referred to as bute a non-steroidal anti-inflammatory drug (NSAID) used for pain relief. The Salix/bute combination is probably the most perplexing of all.

To begin with:

“A 2000 study by Ohio State University to determine the effects of bute on bone activity and bone formation in horses concluded “that the mineral apposition rate in cortical bone decreased and appeared to decrease the healing rate of cortical defects.”


So Salix leaches calcium from the bones and bute aids and abets the outcome. Great combination if you are Gumby’s sidekick Pokey, the talking red horse with rubber legs.

But more bewildering is the fact that phenylbutazone and NSAIDs in general reduce the number of platelets in the blood and block aggregation such that clotting is limited and bleeding persists.

Ergo bleeding problems will intensify.


Medically speaking this is absurd. Give these horses phenylbutazone that promotes bleeding and then administer Salix in an attempt to mitigate its effects. Talk about medical malpractice. They call this “humane”? No, this is totally unacceptable and once more exemplifies the reckless abandon with which the North American horse racing industry prides itself on.

To even consider using these two drugs together in the performance horse is inexcusable. NSAIDs are well known to cause bleeding problems and bute, a particularly potent NSAID, is no longer used in humans for this very reason. Any physician in the real world would be under medical review by his/her licensing board for reckless known interactions like this in a patient under their care.

Finally, add to this the conspicuous difference between drug regulations here in North America and elsewhere.

“Withdrawal times for other medications commonly used within 48 hours of racing in the United States are considerably longer in Europe: anti-inflammatory drugs like flunixin or phenylbutazone are three weeks, and corticosteroids are not allowed less than 18 days before racing.”


Clearly there is something amiss that inherently puts the North American Thoroughbred at increased risk of breakdown and demise.

The Future: Armageddon?

Hock Injection. Image:
Hock Injection. Image:

There seems to be no stopping this drug frenzy here in North America. The unremitting defense of the use of Salix the celebrated “miracle” drug simply adds to the pathetic state of affairs. It seems clear enough to me that Salix is far from harmless, perhaps not an instantaneous death potion, but certainly unwarranted for the most part. Why are North American horses so prone to EIPH and higher breakdown rates? Given the drug culture that has morphed North American philosophy into something that extends beyond tolerable I suppose this merely is an effect of the cause.

Cause or effect? Terminology that many misinterpret and find confusing.

Medically speaking is the cause a fundamental issue with North American horses or is it because of the persistent use of medications that has weakened the breed? To those in the industry this query may seem foreign because this is the North American way that has persisted since the seventies.

Nevertheless it seems remarkably clear that the overabundant administration of these purported therapeutic drugs has reduced the North American Thoroughbred to a drug-dependent addict at the hands of the trainers with their obsession to win and succeed at the track. That said do not forget the overzealous veterinarians, many of whom seem oblivious to horse welfare, who have, with the aid of the breeding fanatics and their syndicated enterprise conglomerate, helped turn this once majestic sport into the profiteering industry it has become. This is the cause and sadly the effect is the deterioration of the Thoroughbred.

“In general, treatments designed to repair a horse’s injuries and to alleviate its suffering are now used to get the animal out onto the track to compete – to force the animal, like some punchdrunk fighter to make just one more round. Equine veterinary medicine has been misdirected from the art of healing to the craft of portfolio management, and the business of horse racing is in the process of killing its goose with the golden egg” ~ Dr. Gregory L. Ferraro


It is difficult to imagine that the rest of the world is uninformed. The world is replete with scientists and equally intelligent people outside of North America. This persistent North American stance on the use of Salix and other therapeutic medications is arrogance that continues to be challenged and has only shamed the integrity of its racing community from a global perspective.

Today, North American Thoroughbreds are considered drug-induced and genetically challenged.

“Racing is about natural selection. In the United States, there are stallions that shouldn’t be stallions, but you never know because the performance was achieved with medication. It is seriously affecting the breed.”~ Christiane “Criquette” Head, president of the European Trainers Association


The world of horse racing is not contingent on North America. In fact, North America is a smear on the face of horse racing; the horses who have grandly done their part in a time-valued and honorable way to bring emotion and life to this exhilarating display of shear fortitude have not disappointed. It is human intervention that has destroyed it all.

“Mankind” directs the fate of our animal companions and North America has failed the Thoroughbred. Egos and wealth are paramount and accountability seems non-existent and laced with disconcerting measures dedicated not to the welfare of the horse but rather to the people who exploit these innocent and noble creatures.

The racing industry here in North America is a web of deceit, insulated from the rest of the world and lacking focus on the very athlete that sustains it — no lifeblood, no nurture, no compassion, no accountability, where one answers to the lure of money, greed and ego without heed to the welfare of the horse.

Everything has been passed over in favor of the bottom line; that being return on investment at all and any cost. The horses have nothing to do with it – they are simply a means to an end.

Crash and burn — totally broken.

There are no words for the sadness of it all.


© Int’l Fund for Horses

Read Part 1 >>

Forgotten Side of the Salix Debate: The Calcium Connection


Salix. Photo: Anne M Eberhardt
A bright, shiny bottle of Salix, a drug given to virtually every horse who starts a race in N. America. Photo: Anne M Eberhardt

It seems a day does not go by without some reference to drugs and breakdowns in the world of horse racing here in North America. While it is unambiguous that a drug culture permeates America’s racetracks where horses are over-medicated with the misaligned intent of keeping them on the track without heed to their welfare, the Salix debate stands alone in its incoherency and lack of reliance on the science behind its use.

Without a doubt the arguments for and against its use focus wholly on the incidence of EIPH (Exercise-Induced Pulmonary Hemorrhage), whether it is ethically and humanely correct to administer it and of course the tipping point – its demonstrated performance-enhancing effects alongside the fact that North America is the only racing jurisdiction in the world that sanctions its use. Indeed this has stirred frenetic sensationalism on both sides of the debate and despite a number of scholarly articles and other research projects on the subject no consensus has been reached; at least not in North America.

However there is a glaring deficiency in these well-intentioned undertakings in that there seems no concern or interest in investigating the effects of Salix beyond the EIPH and performance-enhancing perspectives. Salix is a powerful drug with numerous serious side-effects and harmful drug interactions, many of which are also administered to racehorses, yet the pro-Salix crowd tends to downplay the significance of these effects and oversimplifies the science of its mechanism and interactions within the body.

A survey of the average of the number of starts by North American horses reveals a systematic downward trend since the introduction of Salix to the sport in the mid to late sixties and early seventies where the sustaining incentive was not the health of the horse but rather the performance advantage it conferred. Note the precipitous drop starting in 1965 at or around the time of its induction.

Figure 1. Average Starts per Runner Since 1950

Avg Starts Per Runner Since 1965 Chart by Jane Allin

Coincidence? I think not.

As time has unfolded the conjecture as to its advantage has carefully, and at the same time recklessly, been manipulated and massaged to conform to horse welfare when in fact the underlying ideology is presumably related to providing a competitive advantage; simply put, compulsive and unwarranted cheating.

Repeatedly we hear the same droning mantra from the salix camp asserting that salix is innocuous and has no significant side effects that would put the horse in harm’s way. Add to that the constant reminder that there will be an exponential increase of deaths on the track if salix is withheld.

“Thomas Tobin, D.V.M. and Ph.D. in pharmacology, said racing could see the number of EIPH-related sudden deaths on the track skyrocket if race-day Salix is banned in the U.S.”

Tobin goes on to say:

“We respectfully submit that it is unethical and improper to withhold medication that protects the lives of horses and riders,” Tobin said. “Salix has no significant adverse effects.”



Surely then it must be divine intervention to explain why other Salix-free racehorses around the world are spared this ill-fated end. Did God leave out the North American horses? I hardly think so.

Well, I beg to differ on both counts.

Besides, science tells us otherwise.

Salix or furosemide is a loop diuretic, the most common and most powerful class of diuretics available. Loop diuretics act rapidly upon the kidneys by blocking the normal electrolyte re-absorption mechanisms causing large volumes of urine to be excreted along with a host of electrolytes such as sodium, potassium, chloride, calcium and magnesium. Add this to the fact that horse sweat is hypertonic meaning that it contains more mineral salts or electrolytes than water, unlike humans who lose more water than salts (isotonic – same concentration of electrolytes as the blood). The use of Salix exacerbates the already-depleted stores of calcium and other salts lost through sweating that occurs during training or on race day and taxes the horse even further.

Despite the fact there are myriad side effects of excessive electrolyte loss the primary focus here will be the potentially deleterious effects of chronic furosemide administration on calcium loss and the skeletal soundness of the physically immature racehorse.

Compromising bone development certainly can only lead to ruin in the young racehorse whose skeletal system dynamically changes over time with the conversion process to maturity taking a minimum of 5 ½ years depending on the size and sex of the horse. See

Until then bone is in a continuous state of turnover and remodeling. Also take into consideration that many racehorses begin their careers as early as 18 months of age when they are extremely vulnerable to injury as a result of bone mineralization lagging behind growth in height and weight.

Just how does the depletion of calcium on an on-going basis affect and disrupt the remodeling and bone development in the horse?

Ninety-nine percent of the calcium in the body, horses and humans alike, is found in the bones and teeth. Calcium (and phosphorous) plays a vital role in maintaining strong and healthy bones, as well as cartilage and joints, helping to maximize performance while minimizing the risk of injury or breakdown. Calcium is incorporated into bone in the form of calcium phosphate as a highly structured crystal called hydroxapatite which is instrumental to the development of bone hardness and rigidity. Moreover horses are naturally prone to suffer from a lack of calcium and phosphorous more than other minerals which can lead to adverse effects on bone formation and development.

Bone is comprised of about 35% calcium which not only performs a structural role in skeletal robustness but also serves countless other functions related to cardiac function, muscle contraction, blood coagulation, cell membrane function and enzyme regulations necessary for biological reactions. See Blood-calcium content is tightly controlled within a narrow range due to the dependencies on physiological function inherent to homeostasis and control.

Figure 2. Calcium Regulation. Jane Allin.

As a result of this tightly controlled mechanism, blood calcium levels alone do not provide a good assessment of just how much calcium is actually stored in bone – the process is complex and continuously maintains a fixed level in the blood via the mechanisms of release from the bone stores, uptake from the blood to the bone and excretion in the urine. Accordingly even if the blood level is in the normal range this is not an indication of bone integrity.

Bone is a major bioavailable storage reservoir for calcium. When furosemide is administered the large loss of calcium flushed out in the urine signals a feedback mechanism such that within 15 minutes calcium is being released from the bone reserves to return blood calcium levels to an acceptable level. See

Furosemide is regularly used in humans to reduce high calcium blood levels which are inherently dangerous to the kidneys. Moreover it is well known that the chronic use of loop diuretics, such as furosemide, in humans is associated with increased fracture risk, decreased calcium bone reserves, thinning bones and osteoporosis. This is no different in the horse – the same mechanisms are involved. Horses here in North America are routinely worked on Salix as a preventative measure against EIPH, not just on race day. How can anyone say that this is not chronic in nature?

Many will use the argument that calcium levels in the blood and bone can be restored by overfeeding with calcium supplements. Despite the fact that without doubt a calcium-rich diet is beneficial to the developing horse, this is not the case.

“Because of tight regulation in the blood, absorption of dietary calcium will vary in order to maintain normal calcium homeostasis. Therefore, free-choice or overfeeding calcium does not ‘increase’ stored levels of this mineral. Excess calcium will be eliminated from the body through urinary and fecal losses.”


This demonstrates how the mechanism for calcium balance in the bloodstream supersedes the requirements for optimum bone formation. Since these horses are constantly subjected to significant migration of calcium from the bone to the bloodstream to maintain equilibrium as a result of the amount flushed out in the urine, the potential for calcium deficiency over the long term is undeniably of concern. If such a scenario arises one can only expect that this constant state of flux would lead to decreased bone strength and inadequate bone mineralization especially given the need for adequate calcium in the still-developing bones of the two and three year old horse, or any horse for that matter.

It is simply ludicrous to assume that the chronic use of Salix has no effect on soundness and neglecting to consider this is shamelessly irresponsible.

Moreover, a study conducted by Kentucky Equine Research (KER) confirms the profound and long-lasting effect of Salix administration on electrolyte balance in horses. Urinary and fecal calcium, phosphorous, magnesium, sodium, potassium, chloride and sulfur levels were measured 72 hours before and 24, 48 and 72 hours after the administration of a single dose of 0.5 mg of furosemide per kilogram of bodyweight. See

Of particular note was the observation that urinary levels of calcium, potassium, chloride and sulfur levels remained elevated for a full 72 hours post-treatment. That’s three days where the bone stores are being called upon to restore blood-calcium levels. What’s more, calcium, potassium and chloride balances were negative at 72 hours despite the fact the horses had been given adequate dietary mineral levels. See

Clearly there is good reason for further investigation. No drug is without side effects, including furosemide, regardless of what the pro-salix crowd will have you believe. And, as with all medications, it is necessary to determine whether the side effects outweigh the benefits or vice versa. Unfortunately in the case of salix and the racehorse it seems there is little interest in performing a risk/benefit analysis of its implications on the skeletal foundation of the young racehorse. The impression is that it’s never about the welfare of the horse, only the deep pockets of those who exploit them.

Consider the analogy “out of sight, out of mind”.

No one can “see” calcium-depleted bones nor do horses typically display any severe clinical signs of increased fluid losses apart from excessive sweating and dehydration after a race. Besides it is normal procedure to treat them after the race with “post-race jugs” to replenish electrolytes which rehydrate them and quickly restores them to their pre-race condition. The KER study clearly points out that what you see is not always indicative of what is happening with the systemic processes within the horse particularly in the case of calcium homeostasis and its relationship to the operative mechanism of bone mineralization.

The question then that begs asking is whether these horses are given adequate time between these incessant Salix injections to allow recovery from this constant leaching of calcium from the bone stores?

Given the dynamic nature of bone formation and remodeling, particularly in the immature horse, it seems this cyclic and significant disruption in calcium reservoirs in the bone can only spell disaster for the North American Thoroughbred. As it stands the most vulnerable part of the breed is their structural skeletal system in consequence of inbreeding for speed rather than stamina and endurance. One need not look further than the difference in breakdowns between Salix-infused North American horses and those around the world who train and race without it. Comparing apples to apples (i.e. turf to turf) a quote from an article posted on the ThoroEdge Equine Performance blog entitled: “Foes of Lasix are Cruel to Horses? Ridiculous Nonsense” says it all.

“At last look, 2 of the top 6 horses in the world according to Timeform are Australian sprinters Black Caviar and Hay List. No American turf sprinters make the top 20. I’ve heard the subjective arguments that our turf courses are firmer than others and that is partially to blame for our sky high breakdown rate – but how can that be if our race times are slower? On turf US horses are allowed to use a potent diuretic 4 hours prior to post – and breakdown 3X more often while running slower finishing times, far from an ideal combination. I, for one, don’t require a Jockey Club sponsored study to confirm this fact.”


Reflect also on the pitiful situation with the Kentucky Derby hopefuls and contenders over the last few years. Many don’t make it through the Derby trail, others may race in the Triple Crown series but are injured shortly after and retired to stud or worse yet forgotten about and end up in places no wants to think about. Just look at this year’s Breeder’s Cup Classic –- the North American race that often decides the “Horse of the Year” — and count the number of 3YO’s who raced in it. Only three, and only one of whom ran in one of the Triple Crown races placing 12th in the Kentucky Derby.
Where were all the rest of the great hopefuls? Either in the shed or broken down I suspect.

These horses are only three years old and already washed up. Furthermore it is mind-boggling why anyone would breed such fragile, chemically-saturated horses and expect their offspring to be sound. The widespread and permissive use of these so-called “therapeutic” drugs is literally running the North American Thoroughbred into the ground before our very eyes. How can the breed’s integrity be preserved if this insanity continues?

Barbaro's shattered  leg before and after surgery. Images: University of Pennsylvania/New Bolton Center.
X-rays show Barbaro’s shattered leg before and after surgery.

Indeed, the science speaks for itself yet the misanthropes insist that administering Salix and other potent medications is the “humane” thing to do. These drugs are simply band-aids that cover up the sorry state of racehorse welfare here in North America. Pump these innocent creatures full of Salix to keep them on the track irrespective of the negative consequences of compromised skeletal structures all at the expense of the horse.

Well at least we can be thankful that there won’t be rivers of blood gushing down the backside. The sensationalism is simply too much to tolerate anymore.

© Int’l Fund for Horses


Drugging racehorses: Economics collide with Veterinarians’ Oath

Clenbuterol. Photo: Benjamin Norman / New York Times.
A bottle of the drug Clenbuterol, also know by the brand name Ventipulmin. (click to enlarge)

Cross-posted from the New York Times

Racing Economics Collide With Veterinarians’ Oath
Horse-racing veterinarians are both doctor and drugstore; the more drugs they prescribe, the more money they make.


(Sept. 21, 2012) — Only after Bourbon Bandit broke a leg racing last November did his owner, Susan Kayne, learn the full extent of prescription drugs that veterinarians had given him at Belmont Park on Long Island.

Until then, Ms. Kayne had believed that Bourbon Bandit was “sound and healthy,” because that is what her trainer told her, she said. But new veterinary bills arrived, showing that the horse had been treated regularly with clenbuterol, a widely abused medication for breathing problems that can build muscle by mimicking anabolic steroids.

“If a horse is sound, why does it need all these drugs?” she asked. “I never gave consent.”

Gene and Eileen Hartis said they, too, were shocked by their bill, from a California veterinarian, showing that in just over three months in 2010, their graded stakes winner, Princess Haya, had been given drugs for pain, soreness and swelling 34 times, as well as seven doses of clenbuterol.

“It’s so contrary to our philosophy that we explained in length to our vet and trainer,” Mr. Hartis said.

More than anyone in the sport, racetrack veterinarians are supposed to put the horse first, having taken an oath to protect “animal health and welfare.”

Yet in the shed rows of America’s racetracks and at private training centers, racehorse veterinarians often live by a different code — unique in the veterinary community — one that emphasizes drugs to keep horses racing and winning rather than treating soreness or injury through rest or other less aggressive means, according to dozens of interviews and a review of medical and regulatory records. Continue reading >>

The more drugs veterinarians prescribe and use on racehorses, the more cash they pocket and the more pharmaceutical companies pocket as well. The banning of even select racehorse drugs will cost the drug industry millions of dollars, possibly up to a billion. — Ed.


Blood Money: Salix and Beyond – Part 1, the Blood; Tuesday’s Horse; by Jane Allin; Sept. 7, 2012

Blood Money: Salix and Beyond – Part 2, the Money; Tuesday’s Horse; by Jane Allin; Sept. 9, 2012

The Chemical Horse; Int’l Fund for Horses; by Jane Allin; April 2011

Dullahan may be racing I’ll Have Another for HOY award

Dullahan exercises and keep fit in between races.
Dullahan exercises and keeps fit in between races. One of the few “top” remaining three year old Thoroughbreds still in training this year, the amazing feat of staying on his feet, racing and winning has the colt earmarked as possible 2012 Horse of the Year. Horse racing, American style. Matthew Stockman – Getty Images

I really like Dullahan, and am so happy for his recent victory and third Grade I win this season. The colt now has automatic entry into the Breeders’ Cup Classic.

I can’t remember where (probably on Twitter) but someone said that this puts Dullahan in a position to challenge Kentucky Derby (where Dullahan finished 3rd) and Preakness winner I’ll Have Another for Horse of the Year. It seems it is never too late to start that hoo-ha, even though the pickings are very slim this year, mostly because all the top stars are out of the picture or retired with injuries.

Still, there seems to be considerable excitement in the Dale Romans’ camp. Jenny Rees who writes about horse racing for the Louisville Courier-Journal has a headline that reads “Dale Romans racking up Elipse Award resume“.

That’s pretty awesome. What a feat it is for Romans to have one of the few (top) 3-year old Thoroughbred racehorses left standing, and training — never mind racing, winning and beating older horses while he is at it.

Dullahan must be a medical marvel. And let us not forget, a darn talented racehorse too.