X-rays more than black and white issue

Sheamus Mills raised his frustration with how issues such as bone chips are categorised in a recent social media post, after receiving a report on a weanling x-ray that a hind fetlock chip had been characterised as 'medium risk'.

What irks Mills most about instances like this is not that the chip is discovered, but that a recommendation of surgery is made based on the saleability of the horse itself, not because of any potential issues with soundness.

"A far as I can tell, these are clinical explanations of the x-ray findings of a horse. They determine whether or not there is a chip or a lesion, or OCD, or any other abnormality or issues," Mills told TDN AusNZ.

"That then gets parcelled up into a category of being labelled, low, medium or high risk. That to me is where the problem lies.

"I have had so many horses over the years, where they might categorise a client's horse as medium risk for a hind fetlock chip, and I have never seen a horse's career end due to a hind fetlock issue of that nature.

"The biggest problem I have with them, is when you get advice from vets that if you are keeping the horse to race, don't worry about it, but if you are going to sell the horse, it's best we clean it up."

For Mills, that means a horse may undergo surgery for what amounts to cosmetic issues which may impact their marketability at the sales, rather than their ability to realise and sustain their potential on the racetrack.

"It’s either performance-affecting or it's not. I'm not suggesting that there aren't issues with the x-rays results that shouldn't be noted and I am certainly not suggesting that x-rays should be done away with," Mills said.

"The frustration I have is where these categorisations are made on a cosmetic basis. The report I spoke about on Twitter said specifically that the horse would need surgery if it was to go through the sale.

"The message there, is not that 'for this horse to become an athlete, we need to take a chip out', the comment was specifically, 'if we are going to take it to the sales'. That's not right."

The frustrating aspect for Mills is that in an era where equine welfare is increasingly in focus, he believes there are more and more young horses undergoing operations for reasons which don’t necessarily improve their soundness.

"Every time you put a horse under, you are taking a risk. This should not be underestimated. It goes under the knife to make a couple of humans happy, with no suggestion that it is going to give it every chance to be a nice, sound racehorse."

Evidence-based medicine crucial for vets

Dr Bridget Bester is an experienced equine vet based at Hunter Equine Centre at Scone. She works extensively assessing x-rays of horses for agents and vendors and said science must sit at the heart of any assessment.

"Evidence-based medicine is so important, because if you go on your own experience, it is not really good enough to be honest," she said.

Dr Bester estimates around 15 per cent of thoroughbreds she sees would fit into the category of having medium or high-risk x-rays, but also said it was important to note that not all issues are equal when it came to assessing horses.

"The studies tell us that things like sesamoids are higher risk and so we have to be fairly strict on sesamoids," she said.

Crucial too, according to Dr Bester, is the relationship between the vet and the client, be they a buyer, seller or agent.

"It does depend on the financial situation of the person involved, their stake and their opinion. Different people have different risk profiles dependant on their circumstances. It is a case of letting people know that there is a risk there as opposed to saying, you can't buy that horse. They do rely on our opinion, because they don’t know what the science is behind it," she said.

She said this was a key reason why there is not a consistent approach across different vets when it comes to things such as x-rays.

Black and white replaced by beige

Segenhoe Stud General Manager, Peter O'Brien, has long been outspoken about how the proliferation and interpretation of x-rays has impacted the ability of commercial breeders to sell what he would assess as perfectly sound horses. He says ambiguity and uncertainty kills you as a seller in the marketplace.

"I think the John O'Shea court case made everybody wary about litigation. That has driven an approach from vets, in particular, where everything has now got very beige rather than black and white. If you are at a horse sale and if you have an ambiguity of opinions, it affects your price," he said.

"What frustrates me is that x-rays have been around for about 20 years and there is a lot of knowledge that has been gleaned as to what x-ray issues are and how they impact on the racetrack as far as affecting performance.

"Most of these issues have no bearing on the racecourse. For us, we have Winter Bride and Pretty In Pink and the only reasons we have them is because they were high risk x-rays. You would hope after 20 years that maybe the veterinary profession would have the balls required to make some more black and white opinions."

Like Mills, O'Brien is concerned that possible opinions of the marketplace, rather than proper rigorous scientific evidence, is leading to an increasing amount of horses undergoing surgery.

"The only winners out of these x-rays are vets. They clip the ticket with the x-ray and then recommend surgeries. It has been a bonanza for the veterinary profession, but it has been a disaster for commercial breeders, because it can take 90 per cent off the value of a horse," he said.

O'Brien utilises the services of Dr Angus Atkins at Segenhoe, someone who he says has the experience and understanding of racehorses to properly assess x-rays and determine the right path to take in their development.

He said a broader industry approach utilising experienced vets like Dr Atkins as well as the clout of Thoroughbred Breeders' Australia and the Australian Veterinary Association to develop specific guidelines is what is needed.

"Race vets, who are on a racetrack seven-days a week, dealing with issues that directly affect a racehorse, they have a much clearer idea of what is concerning and people like that need to be at the vanguard," he said.

Taking out the medium

Mills' solution, and he admits it is one which may require a degree of greater thought, is to abolish the medium risk status, and just establish if a horse is high risk or low risk from an x-ray.

"Medium is a complete waste of time. The approach to the report should be totally focussed around making the horse more sound, or to give it a greater chance of being sound," he said.

"What we should be doing, if we are truly considering the horse's welfare, is that every comment on that form should be about making the horse more sound and making it a better athlete, not about increasing the horse's sale price," he said.

Dr Bester said the more detailed categorisation of x-rays is an important tool for vets in dealing with their clients, and the solution to issues such as the one outlined above lay in the trust and communication with the client.

"It's very hard to say 'low risk' if there is anything there. We always ensure our reports have the detail to split them into categories. We might use phrases like 'low with time' or 'low with care'," she said.

"Sesamoids, you might say low medium, because with sesamoids, statistics say you can not leave them as low. But we might think in six months, it might be back to low."

She said the pressure is there when you are making decisions on someone else's potentially significant investment to ensure you give them the best information possible and it's a complex issue for everybody.

"There's a lot of conflicting issues and things to consider, let alone the complexity of the science itself," she said.