Sid Gustafson
Novelist and Veterinarian

Dr Gustafson is licensed to practice in New York, Washington, and Montana, and offers consultations throughout the United States and worldwide. He specializes in designing health plans and training facilities in accord with the horse's nature and preferences to facilitate peak mental and physical health and performance. He is licensed by the State of New York Racing and Wagering Board as a Thoroughbred Veterinarian to treat and manage racehorse health at Saratoga, Belmont, and Aqueduct.
Dr Gustafson focuses on the development of natural circumstances for confined performance horses--enrichment strategies that accommodate the horse's nature and inherent preferences result in enhanced, consistent, optimum performance. Natural approaches prevent the development of lamenesses, behavioral problems, and illness.
Additional services include non-surgical lameness resolution strategies, and enrichment strategies to soothe and heal horses exposed to excessive confinement, travel, and competition. swgustafson@yahoo.com

May 22, 2008, NEW YORK TIMES
A Veterinarian’s Take
By SID GUSTAFSON
Sid Gustafson is a novelist, social commentator, and former thoroughbred attending and examining veterinarian licensed in New York, Washington, and Montana, where he has had significant experience in the regulation of racehorses, especially as it pertains to soundness and breakdowns.

There are medical and cultural human-animal issues in the thoroughbred industry that warrant exploration and acknowledgment.

A prudent horseman could begin with the essential topic of stabling: how do we move forward to best recreate the natural preferences and tendencies of stabled racehorses? More intense issues such as racing age, medication, track surfaces, and breeding can be better addressed in subsequent articles after the nature of the horse and the implications of racetrack confinement are addressed.

The Fetlock Epidemic: When horses break their legs in races and have to be euthanized on the track, we have clearly exceeded the adaptability of the horse. Racetrack breakdowns are endemic, if not epidemic, in America, an undeniable veterinary reality of which I have first-hand experience. There are at least 60 identified factors which contribute to breakdowns, the leading one of which is a lack of prerace scrutiny by the trainer, his veterinarian, and the regulatory veterinarians. There are accidents, bumps, missteps, and bad luck, yes, but in my experience the vast majority of breakdowns are predictable, and most breakdowns are a result of running horses with fetlock lamenesses. Fetlocks are among the thoroughbred racehorse’s most vulnerable and complex joints. The fetlock gathers a vortex of anatomical structures that are intricately interdependent and essential. Inflammation, pain, or swelling in any one of the structures alters the essential biomechanical synchronicity for proper function and support of the critical joint.

As a professor equine studies, I attempt to teach my students appropriate moral reasoning regarding the well-being of the horse. Acquiring an academic and intuitive understanding of the horse’s nature enhances moral reasoning. Time spent with horses combined with intellectual academic pursuit helps us realize when equine welfare standards are exceeded by our competitive pursuits. This is not an easy task, as horses have been utilized intensely and harshly, assertively and aggressively through time, a cultural ideology that does not fade easily, although significant progress is taking place. In situations involving the welfare of animals progress is sometimes all we can ask.

Understanding horse behavior is necessary to refine our contemporary relationship with the horse. I attempt to engage my natural horsemanship students in analytical thinking regarding the management of confined horses in the context of the well-being of the horse, and in consideration of the intimately connected physical and mental needs of horses, especially the mental. Thoroughbreds are one of the most intensely stabled breeds. Mental and physical health become challenging to manage in confinement scenarios. After their yearling year, many thoroughbreds spend the rest of their performance life stalled, contrary to their nature. To restore confidence in thoroughbred racing, we could begin by trying to modify stabling practices to better accommodate horses’ nature, allowing the horses to develop stronger and more durable physiques in a natural fashion; to become more psychologically content and physically sound athletes, to become less dependent on drugs and surgeons. We need to place more focus on the horses’ racetrack environment and take steps to design appropriate stables and training facilities to accommodate the horses’ sociobehavioral, nutritional, and physiological requirements and preferences. To make horseracing a safer sport for horses and riders the industry could best be served by attempting to improve racetrack stabling practices, a topic on which most horsemen should find common ground in which to contribute appropriate practices and facility ideas to improve the horses’ racetrack life.

The contemporary racetrack-stabling scenario significantly displaces the horse from its natural preferences. Little semblance of a horse grazing the plains with its herdmates is apparent in a shedrow stall, where today’s racehorse spends over 90 percent of its time, depending on the trainer and his or her regimen of training and enrichment. Somehow, certain effective trainers recreate enough natural preferences for racing success despite this restrictive stabling. Their horses train sound and win races and return sound and uninjured in the best circumstances. These trainers create success for their horses; make it easy for the horses to succeed by fulfilling their inherent needs. Other trainers fail to adequately fulfill their horses’ needs. Adaptation is exceeded. Their horses become injured, sometimes because of inappropriate conditioning, and subsequently become prone to break down, as certain conditions really never return to normal function. An injury in one location, or two or three as can be the case, significantly disrupts the synchronous movement of the horse, stressing multiple joints and legs, an interdependence demonstrated so unfortunately by Eight Belles, fracturing not one, but two fetlocks.

How do we strengthen legs? Improved husbandry and stabling practices can offer remedy when the horses’ adaptability is exceeded. How can we better recreate the natural needs and conditions of stabled racehorses? All horsemen have ideas about recreating natural circumstances to fulfill natural tendencies of horses, like friendship and play, sleep and grazing and walking together. If we design the stable and manage horses in a more horse sensitive manner, horses have the potential to race stronger and safer. Many trainers adequately fulfill these needs in horses. Certain individual horses require more fulfillment than others, they are less adaptable to stabled life, require more patience and understanding to facilitate gate relaxation and acceptance.

What improvements in stabling facilities and exercise paddocks can be implemented to improve the horses’ mental health and physical endurance? Let’s ask the horsemen. Let’s ask those who study horses. Let’s attend The Horse display at the Museum of Natural History. Let us look to many venues to understand the horse. Can natural approaches improve the durability and safety of thoroughbreds? Can we create stabling conditions that promote the need for less medication while creating increased physiologic durability and mental health? Yes. Educational, informative articles make a difference for racehorses, literarily, medically, and journalistically.


The slippery slope of racehorse medication
Sid Gustafson DVM

Phenylbutazone seemed a miracle drug when the stuff began entering the bloodstreams of racehorses in the sixties. I was collecting the post-race urine that concentrated the metabolites of that drug during those 60s, and as a teenager I became acutely aware of drugs and racehorses.
What a soothing anti-inflammatory effect bute brought to racehorses in those simpler days when its use first became widespread. The alleviation of certain lamenesses was dramatic. “Really sweet stuff,” I remember Wright Haggerty’s Kentucky groom telling me on the Shelby, Montana backside in the mid sixties as he crushed up tiny white 100mg dog pills he had received from my father, the attending and regulatory veterinarian (thus my job as urine catcher). The original medical plan, being that most racing jurisdictions back then prohibited the use of any and all drugs, was to use bute for training. The groom mixed the white powder into a mash, and fed his eager and waiting racehorse, Walking Box, who trained like Seabiscuit the next morning.
Bute cools hot joints and quiets inflamed tendons to desirable medical effect, allowing horses to return to training and racing sooner than otherwise, allowing them to maintain their conditioning. Tight, cool legs and hooves are necessary to continue conditioning the racehorse. If there is excess fluid in a joint, or swelling within a hoof, conditioning is generally counterproductive as further inflammation and damage follow exercise.
Bute was first used to facilitate continued training by quieting certain injuries or inflammations, and was especially effective when used conscientiously and conservatively. In a certain sense and in compassionate, knowing hands the drug provided humane relief to the rigors of racehorse life. The question quickly became could bute enhance performance? It was not a question for long. The answer was yes. Bute was and is the cleanest boost ever for a horse with mild inflammation in need of relief. The stuff could move a horse up, as they say, without a mental, or stimulant effect, but with an anti-inflammatory effect.
Two horses being equal, however, bute generally won’t make a horse with quieted inflammation run faster than a horse without joint, bone, or tendon inflammation in the first place. In a sense, bute restores normal overall biomechanical function. The non-steroidal anti-inflammatory drug takes the heat out of mildly inflamed legs, feet, and joints, and this can be good in considerate hands.
Bute also became useful in the sense that it was diagnostic, or so the mindset went at the time. If you administered bute and your horse went back to training and eating and being a sound horse after laming up a bit, then it was concluded that the condition was not significant enough to warrant rest, only to warrant bute. Bute, then, could be used to assess the severity of the lameness in racehorses. Some did not consider bute-responsive conditions serious, and this is one line of reasoning that eventually allowed the legalization of bute. There were medical arguments for its use in racing horses, medical arguments made by veterinarians and drug companies.
The conditions that bute administration does not resolve or manage effectively are considered problematic, and those conditions generally warrant rest, rather than more intensive treatment. Today, however, if bute does not manage the condition, more intense treatments are utilized, and more intense drugs are used.
Rest is the oldest and most effective treatment for lameness. In the history of horsedoctoring, no treatment is more effective. The horse has a tremendous potential to heal musculo-skeletal injuries if returned to natural pasture conditions, grazing the plains with herdmates. The problem is that it takes a full year of rest for many conditions racehorses develop, and at least months for others. No one has time to rest racehorses, to wait a year, and then take eight months to recondition the horse. With racehorses the clock is ticking, fast. If drugs can save time with racehorses, they are used for just that. And that is the case these days. The industry has transcended bute. The monthly veterinary bills at Belmont and Aqueduct often exceed the monthly training fee. Ask any owner.
If conditions are diagnosed accurately and thoroughly, and drugs are dosed properly and administered in timely manner, doctors can reduce problematic inflammation in a given leg or joint, which in turn protects the rest of the horse by minimizing the risk of extra-strain on other joints and limbs to compensate for the painful-injured joint. However carefully dosed and administered, however, this brand of racehorse sports medicine puts more pressure on the weakened, and now treated joint, and herein lies the danger. In addition to systemic medication given intravenously to treat joint inflammation, cortisone is injected directly into joints and tendon sheaths to get a significant anti-inflammatory effect. Cortisone is in a different class of drugs called steroids, which can be used more specifically than bute to reduce the inflammation in a specific joint.
When there is swelling in a joint or tendon sheath, excess synovial fluid is secreted, distending the joint structures, and in some cases, deforming them, making for irregular movement. The reason for excess fluid in a joint is most often damage to the sensitive joint structures; damage to the synovial membranes, articular cartilages, ligaments, tendons, and underlying bone, any or all of the above. Damaged joints are weakened joints. They are inflamed joints, and in racehorses, many become cortisone-injected joints: weakened joints that are quieted down with cortisone. Why? Horse joints need to flow smoothly. Imagine an abraded joint surface, or a tendon that loses its lubrication as is passes over a running, moving joint, the resultant pain, swelling, inflammation, increased friction, and impaired function. If there is rough movement in one joint, the roughness is relayed throughout the horse’s musculo-skeletal system, increasing the burden on the other legs and joints.
Intra-articular injection of a joint with cortisone is a potent treatment. In certain veterinarians hands it can be used beautifully. The most commonly injected joint is the fetlock, which is also the most commonly fractured joint. The reality is that most of fractured joints were cortisoned joints, although this information is inaccessible because of medical confidentiality. Bute is less intense, less potent, and a more conservative, safer remedy. The original idea was that legalized bute would replace joint injections, or that was part of the intent. That has not been the case.
Phenylbutazone, or bute, abbreviated from the early popular brand Butazolodin, is a non-steroidal anti-inflammatory drug very similar to aspirin. Those who understand the pharmaceutical principles of aspirin understand phenylbutazone. Bute reduces inflammation, and subsequent to that, pain. That is the sequence, anti-inflammatory first, with subsequent pain relief. As a result of reduced inflammation, there is restoration of function accompanying relief of the joint pain.
If you consider aspirin a painkiller, then I suppose you can consider bute one, as well. Bute lasts longer, a day or two, while aspirin is more quickly metabolized in the horse, a matter of hours. The sustained anti-inflammatory effect of bute is especially therapeutic to horses. Prolonged anti-inflammatory relief allows the interdependent musculoskeletal system of the horse to redistribute weight appropriately. Lameness anywhere imbalances the horse. In a sense, bute can improve the balance by providing anti-inflammatory relief of the inflamed parts.
Initially, drugs for racehorses being illegal, bute was used to facilitate training and not so much enhance racing. That came next. The medication got to working pretty darn good, and in time trainers began administered bute to their horses closer and closer to racing, and soon the testing folk started picking it up. Matt Lytle was one trainer who taught me about bute, the smile it put on his training face until Croff Lake, or one of his horses, suffered a bad test after winning the Oilfield Handicap in Shelby Montana one of those years in the middle 60s. Lost his purse and sort of soiled his reputation all because of a shade of bute in the urine.
Later, I heard him defend the drug, and his use of it: he gave it for the horses well-being, he claimed, and knowing Matt, the Blackfoot Indian he was, and his connection to his horses, I did not doubt his intent and compassion. Pain relief is compassionate, especially the sort of racehorse pain relief bute provided. The problem today is that a good thing, bute, or medication in general, has been taken too far. In the passion of competition and in a world of big money, horses have become victims of a misguided pharmaceutical culture.
My dad, having dispensed the bute, sampled Matt’s horse after it won the Oilfield Handicap, or one of those Marias Fair races. I was the one who caught the urine. Then the next spring a winning horse tested positive in the Kentucky Derby, Dancer’s Image, 1968, I believe, a trace of phenylbutazone. Quite controversial. Rather than further restrict drug use to remedy the situation in response to positive tests, the industry legalized drugs, state by state. Montana and New York held out the longest. From that time horseracing shifted from a covert medication culture, to an overt medication culture, which has been recently brought to its knees.
After Dancer’s Image and hundreds of other similar “doping” incidents, there came a general consensus that if so many felt the need to use bute, maybe it should be okay to run with the drug in their system. After all, it was only a type of aspirin. And perhaps its legalization would eliminate the need for other more abrasive medications, such as opiates and amphetamines, and local anesthetics. Some even thought it would reduce the urge to administer intra-articular injections of cortisone. Not the case. By the time I graduated from vetschool and began practicing at Playfair Racecourse in the late 70s, I could legally treat racehorses with nearly everything except stimulants, opiates, or depressants. That left a lot of anti-inflammatory drugs, antihistamines, hormones, steroids, and bleeding medications to administer to running racehorses, not to mention a multitude of vitamins, amino acids, and minerals thought to help a horse endure the rigors of confinement training and racing.
Now virtually all racehorses run on bute and Lasix, and now with too many fractured fetlocks the medication has to be reduced. Bute wasn’t enough. No drug is. Legal bute engendered a drug culture. The ideology that more conservative use of potent medications would follow legalization of bute did not prove up. More intense drugs and medical treatments followed, rather than less. The pharmaceutical adaptability of the racehorse has been exceeded. Horseracing has to wean itself from its addiction on drugs that no longer help, but weaken horses. Racing jurisdictions are in the process of rolling back drug use. The trend should continue as a part of the remedy to reduce breakdowns. Foreign horseracing jurisdictions run without medication, and their safety records are better than America’s. Horses running clean are less likely to break down than those running on medication.