Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Revolutionizing Racehorse Care with Stride Analysis
Unlock the future of horse racing safety with our distinguished guests, Drs. Denise McSweeney and Warwick Bayly, as they unpack the cutting-edge world of equine technology. Remember the tragic events at Santa Anita racetrack in 2019? Discover how they acted as a catalyst for the innovative StrideSafe technology, a tool born from StrideMaster in Australia, now essential for assessing stride characteristics in thoroughbreds. Our conversation takes you behind the scenes at renowned tracks such as Washington State University, Saratoga, and Belmont, where this technology is transforming efforts to prevent catastrophic injuries.
Imagine a world where artificial intelligence can foresee equine injuries before they happen. This episode promises insights into the StrideSafe technology's partnership with AI, offering groundbreaking potential to preemptively identify high-risk horses. Join us as we delve into a comprehensive study involving 28,000 horse starts and the fascinating role of PET scans in correlating injury severity. With backing from computer scientists and electrical engineers, the potential to distinguish between different types of injuries through stride analysis is closer than ever.
Beyond the tech, it’s about the welfare of our equine athletes. Learn how accelerometers and PET scans are becoming invaluable allies for veterinarians and trainers in their quest to improve horse welfare. Denise and Warwick share their vision of collaboration among industry professionals as a cornerstone for change, emphasizing the shared responsibility for the well-being of these majestic creatures. Their recent article published in JAVMA is a testament to their commitment, and we encourage our listeners to explore this vital contribution to equine health research. Don't miss the chance to be part of this enlightening journey that promises to change the future of horse racing.
Open access JAVMA article: https://doi.org/10.2460/javma.24.02.0114
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You're listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode, we chat about using accelerometers to identify a high risk of catastrophic musculoskeletal injury in three racing thoroughbreds, with our guests Denise McSweeney and Warwick Bailey.
Lisa Fortier:Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have Denise and Warwick joining us to talk about the hottest topic in racehorses, including sport horses as well, that is, wearables. Denise and Warwick, thank you so much for taking the time to be here with us today and share your knowledge on this subject.
Denise McSweeney :Thanks so much for having me.
Warwick Bayly:Thank you, Sarah.
Sarah Wright:All right, let's trot on over. So, like Lisa said, this is a super hot topic. I know I saw it even in a few e-letters that I'm subscribed to. That just got picked up from it being published, so we're really excited to chat with you both about this today. So your JAVMA article discusses using accelerometers to identify a high risk of catastrophic musculoskeletal injury in three racing thoroughbreds. Please share with our listeners the background on this article.
Warwick Bayly:I'll start with that and then Denise can sort of she'll carry on from the background because she was the boots on the ground. Just coincidentally. So, we use technology that is associated with a company called StrideSafe USA, the chief executive officer of whom is Dr. David Lambert. David and I have known each other for many years and in late 2018, just coincidentally we were at a meeting in Australia where we came across an Australian product called StrideMaster, which had been developed by David Hawke, who's married to an equine practitioner. Coincidentally, we got to talking with David Hawke regarding how his StrideMaster was being applied and had been used in the state of Tasmania for a little over nine years to really sort of give GPS-related information during a race and after a race. But it also incorporated some accelerometry and we saw some potential, you know, for maybe using that with respect to gait assessment. Dr Lambert, back in the about 10, 15 years before then, had investigated the use of a variety of ways of assessing stride characteristics in thoroughbreds using accelerometers, but at the time, initially they were on the legs and then they were under the girth. Shortly after we'd been at that meeting, which was in November 2018, then, as everybody is aware if you're involved in horse racing at all that there was a spate of catastrophic breakdowns in Santa Anita racetrack in early 2019. And that really brought the racing industry into the limelight for unwanted and tragic reasons, and David already been thinking about how to use the stride master technology in a way that could relate to stride characteristics, that Santa Anita event was sort of, if you like, the impetus to really develop this.
Warwick Bayly:We have a racetrack at the College of Veterinary Medicine at Washington State University I think we're still the only veterinary college that has a racetrack and so in early 2020, we did some initial work with David Lambert and StriveSafe to work out the best place to put these sensors, which had been developed subsequent to the conversation with Stridemaster, and we did that on our track, and it became apparent that the location behind the saddle, which is where Stridemaster was putting their sensors, was, fortuitously, I'll say, a great place to really get a sense of the stride characteristics of a galloping horse. From there, Stride Safe did some preliminary work at the racetrack in Emerald Downs at their meeting late in 2020. And then from there, in 2021, they were picked up by the New York Racing Association and, with the assistance of Dr. Scott palmer and um, were used in over 6, 000 or over 6, 600 starts in races, mainly at Saratoga and some at Belmont. That sort of gave us the initial database from which the data used in this paper sort of emerged.
Warwick Bayly:After that I wrote a proposal to the Equine Tribe Research Council, which is an arm of the Kentucky Racing Commission, requesting support to investigate more about these the application of StrideSafe in racing horses because the real crux of the matter that we realized is that horses that break down catastrophically have been cleared to race because they do not appear to be unsound, they appear to be fine to go, but yet these injuries happen.
Warwick Bayly:And so it was apparent that, despite all the pre-race interventions, these horses were racing and horses were suffering injuries, many of them fatal. We developed StrideSafe and we'd come up with this risk, if you like, risk factor index, which we can talk about or which is described in the paper. But the real gist of it was, even when they were high-risk cases, not every one of them would suffer an injury, and we'll come back to that because that's one of the hardest things for people to grasp. So the grant was about how do we identify the horses in the highest risk categories that are the most likely ones to suffer an injury? Because, as I say, they don't all it's a risk and it's not 100% guaranteed, so you've still got to sort them out, and that led to Denise going to Churchill Downs and investigating some of the cases and she can talk about it for now.
Denise McSweeney :Yeah, so I got involved with this study last spring, which led to me spending the spring meet at Churchill Downs. So, what I was doing whilst I was there was, you know, basically speaking and meeting with a lot of the trainers and sometimes their veterinarians, going through the data that we collected on their horses and discussing you know how we were interpreting it and what we believe that it meant. And part of this was trying to engage with the trainers, you know, make them aware that this was a screening tool and that really we were here to help them and try to get some feedback on some of these cases, because you know a lot of, you know a lot of what we need to know is when a horse does have a high risk category run, so if it runs and comes back with a high risk warning, you know what are they finding on these horses. So, that was my main prerogative while I was there. I was also, you know, working a little bit with some of the breezing horses, getting sensors on them and seeing if we could look at the data compared to the racing data. But really it was talking to these trainers and, you know, getting their feedback, which really meant a lot to us and you know, and how we were actually reviewing their data and looking at the stride data and seeing what their feedback was, um.
Denise McSweeney :So, typically what would happen is, you know, I would take a look at the days, uh, the day's results, um, I'd actually watch back a lot of the races for those high risk races, so horses that had come back with a category four or five, I'd actually watch their race, um and see how, see how they performed, see if something perhaps happened during the race. That was very obvious, um, and then call the trainer and discuss, you know, our findings, introduce them to the concept of the accelerometers and basically chat with them and see, hey, did the horse come out of the race okay? um, you know, how are they doing now? and some of that feedback was really interesting and, you know, really helped us kind of see what was going on with some of these animals. We also had funding, um, thanks to this generous grant from the, from the Kentucky Equine Drug and Research Council, to pay for some pet scans, so actually just advanced imaging in general, whether it was a pet scan or nuclear scintigraphy, um. So thankfully, Churchill Downs has a lovely brand new standing PET scan unit right there at their own medical center.
Denise McSweeney :So, some of these horses that you went ahead then following having a high risk category and had standing PET scan imaging performed there, which was very interesting for us to, you know, really see what was going on with these horses and see if there were underlying conditions that could have been correlated with the high risk category which they were getting. And you know we had some very positive findings from that. So, it was quite a rewarding experience to be there and to be able to follow up on these cases.
Sarah Wright:Well, that's fascinating. What important work, and thank you so much for sharing it with us at JAVMA.
Warwick Bayly:Another important part of this is that some fantastic work that's been done, principally at the University of California in Davis and I know Dr. Fortier is well aware of it is that in the necropsy programs that look at the horses that do break down, despite the fact that they appear to be fine, over 90% of them have pre-existing lesions, and so part of why we thought let's get PET scans on them was this awareness that they may well have lesions that are, we'll say, percolating and developing but haven't led to overt lameness at the walk and the trot.
Warwick Bayly:And so, the real gist of that and that came back to can we look at these horses and try to sort out the ones that appear to be high risk, the ones where we can see lesions, and then do something about them? And that really is what being a clinical or a practicing veterinarian is about. So, I have to keep emphasizing StrideS afe, and these wearable sensors are not diagnostic tools. They screen horses and they can help veterinarians work out which ones are you going to pay most attention to or which ones appear to be most at risk, because, at the end of the day, every horse that gets in a race there's some risk, just like every time you get in a car there's some risk, but there's more risk if your car doesn't have any brakes.
Lisa Fortier:You guys have both really nicely highlighted why this is needed in the industry and what some of the really important findings led you to this manuscript. But every time we write something or do a study, things surprise us. So when you wrote this, what things were the most surprising findings?
Warwick Bayly:Honestly, I don't think anything surprised us per se with regard to oh, didn't expect that, because this was more sort of proof of the pudding, so to speak, and we wrote it fundamentally because we thought the technology is so new and there's no other publications sort of about it, and we thought it was critical to start communicating to the practitioner what might be possible and how to apply this technology in a clinical sense. What did start to emerge if you want surprising, but we were hoping for it is that and, Dr. Fortier, you certainly understand you've dealt with a lot of practitioners, and you are a clinician.
Warwick Bayly:So sometimes, when you're confronted with a horse and somebody says well, this horse has got a risk of this, where do we start? As you looked at more and more of the stride-safe files, some patterns started to emerge that could potentially help the practitioner by saying this horse we think is at high risk. Now you might want to start looking at this particular quadrant, because if you can narrow down, let's start here. Rather than well, you've got four legs and they're lower legs and they're upper legs, and then you've got a back and all sorts of things. Again, just the ability to provide some insight or suggestion. That was very helpful, and I certainly didn't know how quickly that might occur. We were hoping that it would eventually, but it proved to be useful and, as in the cases which were described.
Sarah Wright:Yeah, it's super cool.
Sarah Wright:I'm learning so much through this episode, so this is really really important information. So what are the next steps for research in this topic?
Denise McSweeney :Yeah. So, what I'm working on at the moment is looking at a larger caseload. So, the study group that we had for this particular paper was about 1,500 starts. So, our current paper that we're working on we're looking at 28,000 starts. So, we want to see how these numbers correlate and reflect when you look at a bigger population. So, that is our main thing that we're heading for right now.
Denise McSweeney :We're also looking to get funding and try to get some research going on, looking at a large number of PET scans.
Denise McSweeney :So, can we take, you know, 25, 50 category one horses so low risk horses and then the same number of the high risk horses, and can we perform PET scans on their distal limbs and see, does the severity of the pathology identified on the PET scan correlate with the increase in what we would consider risk factor?
Denise McSweeney :You know, if we can see a real correlation between those two things, I think it's going to be extremely helpful going forward in deciding what to do with these horses. I think those are kind of our biggest things that we're looking at. And then, as was mentioned a moment ago, when we look at the stride patterns of these horses and, using AI and machine learning, what we hope and what we believe we're already developing and working on is, you know, actually can we see the horses that are at higher risk of having, you know, a sesamoid injury versus a condylar fracture? And we believe that we're getting there. However, of course, the numbers that we're working with are quite low. We have data on about 100 catastrophic injuries right now, but it does seem that there is a difference, at least that AI can pick up on and look at the difference between those sesamoid fractures, or suspensory breakdowns, versus a condylar. So that is something that we'll be looking at in the future.
Lisa Fortier:And you stole my thunder, Denise. My next question was going to be what's the role of AI? I mean, you mentioned you're starting to study with 28,000 starts and how many data points per start, and this isn't the only wearable on the market, so it's fascinating and again, we really appreciate you sharing this super early clinical information with us at JAVMA and our listeners.
Warwick Bayly:Yeah, I think that, as Denise said and Denise knows it better than me but I think, for instance, there might be 45 condylar fractures, or are they 45 sesamo? So AI, it's like anything. AI is only as good as the information you put in. But we have some excellent. Well, StrideSafe has some excellent what I call computer scientists, slash electrical engineers, who understand a lot about signal processing and artificial intelligence, and so I think that there's great hope that, as there are more and more real cases and AI can look at them, it looks like they're starting to detect certain characteristics within the StrideSafe signal that may be indicative of a condylar fracture, as Denise said, some sesamoid type lesions, who knows what else suspensory problems. It's just going to be a matter of continuing to grow.
Warwick Bayly:The database was clearly. There's a great advantage the more information the practitioner can be given with regard to you know, knowing where to start looking or really to hone in on, the better off the horse is going to be. It's for the benefit of the horse's welfare. It's all about preventing fatalities and if you ask me why I'm involved in it and how we got involved, way back in 2019, Dr. Lambert and I both basically said we have to do this because it's the right thing to do. You know we care deeply about the industry and the horses, and this is absolutely the right thing to do, because nobody likes seeing something die in front of them.
Lisa Fortier:Sure, and I like what you said about preventing injury. This isn't just about oh, don't let that horse race again. Eventually, this data will come out to say this is the best way to train a horse, and maybe this is the biology. It's not just about training. There's obviously individual biology, but that will all come out, probably in our lifetime because of wearables.
Warwick Bayly:Right.
Warwick Bayly:The closing point in the paper and the and what people may not fully pick up on is that in the case of the three cases because of the pet scan, which confirmed that there was a problem, the horses were all given a rest and then have come back, or two of the three, at the time of riding and come back, were back in work and or racing and the risk factor had dropped from what it was to down to a much more sort of, I think one was a category two and the other was a category one. So, whereas we can't say if they'd kept racing that something terrible would have happened, but we can say that their risk was greatly diminished by giving them some time off. We had Pet scan imaging that there was a developing problem, and the Pet scans in the paper, I think because they're in color, everybody can see that. So hopefully it's reassuring. One of the most important things was I think some trainers became convinced that huh, this might help me, because it's hard when there's pressure to keep horses racing from owners and racing secretaries and you tell them there's something going on, but the horse looks great. The vet said it's good to go racing and I think that over time.
Warwick Bayly:One of the things that I would hope happens and comes sort of related to research developments, is we gradually change our way of thinking about soundness, if you like, because a horse walking and trotting, normally that's not a guarantee that it's not feeling something when it's galloping. A gallop is a totally different kettle of fish. You know 140 strides a minute and the ground, the feet hitting the ground individually with a little bit of overlap. 140 strides means that the feet are hitting 560 times in that minute. You cannot see something. You can't see it, but these sensors can detect it and we have to get our heads around it. I liken it again, showing my age too. When I was just starting out and ultrasound was just becoming a possibility, it was mainly in universities. People were dabbling with it. There was skepticism. How is this going to help me? 40 odd years later? You can't live without it. The students in third year students will walk around with the machines like it's commonplace.
Lisa Fortier:Right off their IPhones.
Warwick Bayly:Yeah, I'd like to think that in years to come we can educate veterinarians as to how to read these and interpret these files so they become sort of ubiquitous, they're widely used, and that they become a really, really useful benefit the horse and of assistance to the veterinarians, especially as we get as the database grows.
Sarah Wright:Wow, it's absolutely fascinating. So now we're going to move into the section that's really important for our listeners. So, Denise, what is one piece of information the veterinarian should know about using accelerometers to identify a high risk of catastrophic musculoskeletal injury in racing thoroughbreds?
Denise McSweeney :Yeah, I think the biggest point here that we're trying to drive home is this is not a diagnostic test. It is a screening tool. It indicates a level of risk, but from that point you know, it is up to the vet and the trainer to fully investigate the horse. It's not here to replace good horsemanship or a good clinical exam. So really it's not replacing anything, it's adding to it, it's narrowing down that stable of horses. You know you have 100 horses inside that barn that you need to look at every morning. Well, here's you know, here's four or five that we say these ones are the ones that you really need to pay very close attention to. So it's there as an aid. It's not replacing.
Sarah Wright:Thank you, very well said.
Sarah Wright:So on the other side of the relationship, what one thing clients, so owners, trainers, racing stewards should consider around using accelerometers to identify a high risk of catastrophic musculoskeletal injury in racing thoroughbreds
Denise McSweeney :I think it's along the same lines as what we would say to the veterinarians, and I think that is, um, you know, quite really has to do with how the industry is put together, right, I mean, our trainers and our trainers are really in place for our owners, that our owners need to trust their trainers and their veterinarians and also the veterinarian, the veterinarians at the track. I think that if somebody is saying, hey, I've got a concern with this horse and this is backing it up, we have a concern with this horse, I think it really is something that people need to take into mind and take a step back, and this is really maybe an area that you can just hit the pause button for just a minute. Uh, you know, make sure that you're everybody, everybody's comfortable to move forward, um, you know, and make a decision from there.
Denise McSweeney :We're all on the same team, right?
Denise McSweeney :We're all on the same team, for the welfare of the horse, the jockey and the industry.
Warwick Bayly:I'll just add something to that. I see great potential for a partnership, if you like, certainly between the use of these sensors and the companies that are producing them and the racetrack management, in that I think there's opportunity and it's already emerging to learn a lot more about the impact of racing surfaces, be they turf, grass, synthetic. The impact of a lot of moisture you can work out. You look at these signals you can work out pretty much exactly where on the track the horse was, because it's not like every stride is off. Some, you know, sometimes in the turn, a different lead. That's when the signs become apparent or it's starting to get tired.
Warwick Bayly:But also there may be some parts of the track that, because they're unduly wet or soft, or who knows that, the management through good communication and that's, you know, people have got to want to open their ears and listen and think, be prepared to accept. Oh, we don't know everything. We can learn something here, because that's at the end of the day, like Lisa said, we're trying to look after the horses and the people who work with the horses in the industry. So there's So, ability to help the veterinarians and the trainers focus on potential sites, but there's also a huge potential in learning about racetracks, the impact of surfaces and getting them better if there's a problem, ergo making it safer for the horses.
Lisa Fortier:Yeah, very good. Well, we look forward to, Denise, to reading your results in JAVMA on the 28,000 horses you're looking at.
Denise McSweeney :Thank you, me too.
Warwick Bayly:Well, you can count on it.
Lisa Fortier:Thank you as we wind down. Thank you again. I learned so much. These accelerometers, wearables, whatever technology you want to call them, is fascinating, and we'd just like to ask a small personal question before we end. And, Warwick, I would like to know from you when you put together a puzzle, do you start with the exterior border pieces, or do you do the interior by color or shape? What's your strategy?
Warwick Bayly:That's like planning a research project L isa, you've got to have the framework, so I definitely get the outsides, which is why I tend to only do rectangular puzzles.
Warwick Bayly:None of these funnys.
Lisa Fortier:Amen, amen, 3d and circular puzzles no thanks.
Warwick Bayly:Right.
Lisa Fortier:Uh Denise uh for you? We would like to know what is your favorite animal fact?
Denise McSweeney :okay, um, my favorite animal fact.
Denise McSweeney :So, I think that delayed implantation in bears and polar bears is just seriously cool. That the, the, you know the, the blastocyst just hangs out inside in their uterus until like late fall. Um, an oral only implant, if you know they've got enough calories on board, enough fat on board, otherwise it won't. I just think delayed implantation in bears I'm like that sounds like a really handy thing for anybody in life. What a crazy trick of nature.
Warwick Bayly:I didn't know that.
Sarah Wright:Yeah, Thank you. That's why it's a fun question. We get to learn something. Well, thank you both so much. We really appreciate you being here sharing your time with us, and again for submitting your manuscript to JAVMA.
Warwick Bayly:Thank you for having us.
Denise McSweeney :Yeah, thank you for having us and giving us a platform to talk about this. I think it's really important and we're really excited to be able to work on it and share it with everybody.
Sarah Wright:I couldn't agree more. And to our listeners you can read Warwick and Denise's article in JAVMA. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
