Exercise induced pulmonary hemorrhage (EIPH) in the horse is a common problem especially in the Thoroughbred racing industry and the Quarter Horse competing in barrel racing. The precise cause of the bleeding in the lungs is uncertain but only theorized currently. Despite the heavy usage of medications including Lasix or other diuretics, the problem of EIPH persists and usually becomes worse with time, impairing performance in the horse. Despite similarities, EIPH in the Thoroughbred can be different than that in the Quarter Horse, requiring different approaches.
When it come to alternative medicine, not every approach is correct for every horse. Two horses can be presented with a similar clinical problem, but the underlying cause creating that problem may be different. Thus, it is important to thoroughly review their situation and the patient. In doing this, the outcomes are generally more successful, even in the case of EIPH in the horse as we will demonstrate in this article.
EIPH in the Thoroughbred Race Horse and Herbal Management
A 3-year-old Thoroughbred gelding was presented for evaluation of persistent EIPH which had been occurring since being started in training. Initially, the gelding was being controlled on 3 cc’s of Lasix pre-race, but this amount has been increased steadily to 5 cc’s and then currently at 8 cc’s. Even at this high dose, there were incidents where the horse bled through the medication, indicating a lack of proper control. In addition, his race times were steadily falling as the condition was impacting his overall performance and stamina.
On physical examination, the gelding was alert and responsive with a body condition score of 4-5/9. He was somewhat anxious and difficult to handle at times. His physical exam was considered normal and a quick upper respiratory endoscopic exam under sedation did not reveal any abnormalities.
The trainer was feeding him 2-2.5% of BW per day in alfalfa and 8-10 pounds of a fortified race blend grain, sometimes twice daily. He was on omeprazole daily for stomach ulcers, a joint supplement, and a trace vitamin-mineral blend.
It was also noted that this gelding had been having foot soreness off and on for some time. Despite farrier attempts with different shoes, he still seemed to be tender at times. The veterinarian had been prescribing phenylbutazone for daily use as needed to control soreness.
The recommended therapy regimen was as follows:
- Elimination of all grains
- Increased turnout in run-in paddock or otherwise to allow for non-stall time.
- Removal of trace vitamin-mineral supplement
- Cur-OST EQ Plus twice daily at label doses for 14 days, then once daily.
- Cur-OST EQ Stomach twice daily initially for 14 days, then once daily.
- Cur-OST EQ Adapt & Calm once daily in the evening, to be withdrawn 48 hours prior to race day due to being a ‘prohibited substance’ in some venues.
- Omeprazole was to be continued for the first week and then halved in dose the following with goal of removal.
- Lasix medication could be utilized at current dose at next race, but ideally, the medication should be reduced in dosage over time going to minimum effective dose.
Outcome was incredible per the owner after 4 weeks. The horse seemed to be more quiet and content and easily managed. Performance and stamina were up in training sessions and in the last race, he did not bleed through the Lasix diuretic. In addition, the foot soreness which had been present was now markedly improved and the phenylbutazone was used sparingly. The biggest hurdle for the owner was removal of the grain, substituting in an alfalfa pellet instead. It is generally believed that grain is needed to enhance energy and stamina, but this is not always the case.
In this particular case, generally what is seen from an alternative medicine point of view is overall reduced body moisture and an increased amount of internal heat. The high grain load stimulates internal heat and dryness, then when coupled with increased stress due to training and stall confinement, the problem worsens. The blood circulation requires fluid and moisture, as does the stomach and other areas of the body. If these areas become dry, problems will develop. EIPH in this case is a release of excess heat in the blood circulation, being manifested as ruptured capillary vessels deep within the lungs. If one resolves the problems, being a deficit of moisture and excess of heat, more times than not, the EIPH or bleeding problem becomes more controllable. The reason that many continue to require higher doses of diuretics and bleed through is simple. The diuretics are moisture depleting, thus creating more of the same and worsening the problem. Correct the underlying problem and the need for diuretics can become minimal.
The only question in some horses is damage done to the lung tissue and blood vessels. If damage is present due to long-term bleeding issues and poor management, then the condition can be harder to manage. In those cases, I will add herbs that benefit the circulation directly, such as Arjuna or Hawthorne or Amalaki which can help with circulatory repair and are generally cooling to the body.
EIPH in the Barrel Racing Quarter Horse
The Quarter Horse is an entirely different beast than the Thoroughbred. Despite having similar clinical problems, the underlying cause is much different and requires a distinct approach. Let’s take a look at a case.
A 12 year-old Quarter Horse gelding presented for evaluation of ongoing EIPH problems despite Lasix usage. The horse was being used for weekend barrel racing and was requiring diuretics to control post-race bleeding. Unlike the Thoroughbred, this quarter horse generally did fine on a mid-range dose of 5 cc and didn’t require any increases. The owner was more concerned with overall loss of stamina associated with the medication at times and was seeking options.
Currently, the gelding was being offered about 8 hours of turnout per day on a dry lot due to concerns over metabolic issues that were raised in the past. His body weight tended to be on the heavier side of things, which impacted performance, so the owner kept him on a sparse lot most of the time. He was being offered a Fescue hay at 1.5% bodyweight per day along with grain and a ration balancer. There were no other supplements being given and he received his Lasix a few hours before the race, being administered by the owner most of the time.
Outside of weight issues in the past, the only other notable problems were an intermittent productive cough associated with exercise and foot soreness at times.
On examination, the gelding was alert and responsive. He was determined to be overweight, being just below 16 hh and taping in at 1200 lbs. He was not overly anxious but more quiet and subdued for most of the exam, readily willing to yield any body part for evaluation. His heart and lungs ausculted normal but with a rebreathing bag, there was a slight rattle noted higher in the lung fields on both sides. His oral examination was normal. Digestive sounds were somewhat sluggish. Feces were brown and somewhat moist, but had a distinct odor of sweetness. He was sedated for an upper airway endoscopic exam which was unremarkable.
The Quarter Horse has a different body type and general constitution than the Thoroughbred. Instead of being lean and mean, the QH is often heavier set and quieter. In the world of Ayurvedic medicine, we would equate the QH to a tendency to be more kapha or accumulate weight easily. This body type is also more prone to digestive sluggishness which can result in ama or toxin accumulation in the body, which can be seen as fat stores, discharges, and mucous or phlegm. Given this situation, this breed is more prone to metabolic concerns as well and insulin dysfunction.
The recommendations were as follows for this QH:
- Allow for increased paddock time and socialization with other herd mates in a larger paddock to encourage movement and exercise.
- Elimination of all grains, substitute with alfalfa pellets at 1 pound per feeding
- Elimination of the ration balancer
- Recommended the Cur-OST EQ Total Support twice daily at label doses for 14 days, then down to once daily at label doses.
- Continue lasix at current dose with goal of reducing it down and possibly eliminating.
The outcome in this horse was very good. The owner noted a return of stamina and performance within two weeks. Foot soreness and the cough were dramatically reduced by four weeks into the regimen. The owner continued the lasix at the next race at normal doses (5 cc), but was able to reduce to 2.0 cc by the next race the following week with no bleeding issues. Despite likely being able to come off of the medication, the owner had fallen into a habitual routine and felt that a lower dose was optimal.
In the QH, the main problem is dampness or toxin accumulation within the body, which is tightly connected with digestive health and metabolism. Being a heavier breed, they are prone to weight gain easily, which can disturb the digestive microbiome and result in inflammatory problems. In many, this results in dampness or toxin accumulation, similar to a wet sponge on certain levels. This dampness can then slow energy production and travel through the body, slowing stamina and performance. If it blocks energy flow enough, then internal heat can develop and create problems, such as EIPH. However, the underlying cause is not the same as in the Thoroughbred.
Our goal in the Quarter Horse is to improve digestion and eliminate dampness, while managing inflammation. The EQ Total Support allows us to do this on a very basic level, which is often very effective in many cases. In others, sometimes we need to add further digestive support to eliminate the dampness and get that energy moving.
In the case of the Quarter Horse, the diuretic is actually beneficial because it helps to remove dampness or excess fluid in the body. This is the opposite effect as seen in the Thoroughbred. If we took the same approach in the Quarter Horse as used in the Thoroughbred, more than likely we would create more dampness and more problems. The same goes for the Thoroughbred. If we used the same approach as that in the Quarter Horse, likely we would dry out the TB more and create more problems.
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Author: Tom Schell, D.V.M, CVCH, CHN