See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/327931131 Cooling interventions for thoroughbred racehorses: an overview of physical heat transfer mechanisms & practical considerations Racing NSW Barkers Lodge Road Picton NSW 2571 Conference Paper · September 2018 CITATIONS 0 READS 100 2 authors, including: Some of the authors of this publication are also working on these related projects: Exertional Heat Illness in the thoroughbred racehorse View project Margaret Brownlow Racing New South Wales 30 PUBLICATIONS 274 CITATIONS SEE PROFILE All content following this page was uploaded by Margaret Brownlow on 28 September 2018. The user has requested enhancement of the downloaded file.
Transcript
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/327931131
Cooling interventions for thoroughbred racehorses: an overview of physical
heat transfer mechanisms & practical considerations Racing NSW Barkers
Lodge Road Picton NSW 2571
Conference Paper · September 2018
CITATIONS
0READS
100
2 authors, including:
Some of the authors of this publication are also working on these related projects:
Exertional Heat Illness in the thoroughbred racehorse View project
Margaret Brownlow
Racing New South Wales
30 PUBLICATIONS 274 CITATIONS
SEE PROFILE
All content following this page was uploaded by Margaret Brownlow on 28 September 2018.
The user has requested enhancement of the downloaded file.
Exertional Heat Illness in Thoroughbred Racehorses: Observations and Treatment in the Field C&T No. 5377, Issue 274, March 2014.
The Management of 'Hot' Thoroughbred Racehorses After Strenuous Exercise in Hot & Humid Conditions Perspective No. 126, Issue 283, June 2017.
All previously published articles are available to Members in the CVeLibrary: cve.edu.au/cvelibrary
Read Meg's previous articles in the ebook:
Strenuous exercise increases metabolic heat production
When thoroughbred racehorses perform strenuous exercise at maximum intensity the metabolic heat produced from muscular contraction can elevate core body temperature. This can usually be tolerated but when adverse climatic conditions restrict cooling, especially the evaporation of sweat, core body temperature may rise to levels which can compromise the health of the animal. The clinical manifestations of exertional heat illness in racehorses are related to the effect of heat on the central nervous system and depend on the degree and duration of the hyperthermia. Clinical signs may present initially as a relatively benign set of symptoms such as head nodding, irritability and kicking out but if left untreated can quickly escalate to more severe symptoms such as ataxia, altered mentation, bizarre behaviour and collapse.1,2
Heat illness is not uncommon in human athletes and there is considerable evidence-based literature concerning cooling techniques.3,4,5,6,7,8,9,10 It is well documented that the key to maximizing recovery from exertional hyperthermia in humans is to rapidly lower the
core body temperature, and best evidence supports the use of ice-cold water immersion.3,5,7 While it is obvious that immersion is not practical for a 500kg thoroughbred racehorse, the same basic physiological principle can still be applied by exposing as much as possible of the horse's body surface area to the coldest water available.
Physics of cooling – convective and evaporative heat transfer mechanisms
The physics of cooling in horses and humans is similar, both relying mainly on evaporative sweating for cooling and are related to temperature and vapour pressure differences. Convective cooling depends on temperature gradients or differences between skin and air, or skin and water. Heat will flow from an area of high temperature to one of low temperature, and the temperature difference between the two will determine the rate of flow. During racing, heat is stored in the body and it is during the recovery phase that it must be dissipated. Heat from the core reaches the skin surface partly by conduction through the tissues and partly by convection via the blood. If the ambient air is cool heat transfer from skin to air will be quite rapid and efficient; if the air is warm the process will be slower and if the air is hotter than the skin surface (>38°C), heat may actually be gained by the body from the environment. Evaporation is a two-step process involving the phase transition of sweat on the skin surface from liquid to vapour followed by the diffusion of vapour into the surrounding air which cools the body. Evaporative cooling is then similarly driven by the vapour pressure gradient between the skin surface and the ambient air. Cooling is usually a combination of both processes but air flow over the body is essential for maximising evaporative cooling and wind velocity will have a profound effect on both processes.
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Water compared to air as a medium for heat exchange
Compared to air, water has specific physical characteristics which enhance convective heat transfer. The thermal conductivity of water is approximately 24 times that of air, which means that heat will transfer from skin to water more readily than from skin to air, and given that a horse can have the majority of its surface area covered by water translates to a convective heat transfer potential far superior to that provided by air alone. Water also is able to penetrate the very-fine thoroughbred hair coat and contacts the skin surface directly, allowing heat to easily transfer to the water which is then removed by the addition of further water or by scraping. The continual re-application of water should be considered as equivalent to scraping because it disperses the potentially insulating boundary layer of 'still' heated water immediately adjacent to the skin. If horses are struggling to cool it is recommended that scraping be abandoned in favour of continuous reapplication of cold water. Once the horse has cooled satisfactorily and the application of cold water has been suspended perhaps temporarily, scraping the skin surface to remove excess skin surface water can then be performed.
Critical concepts in cooling techniques for exercise-induced hyperthermia
1. The critical thermal maximum dictates outcome – this is not the absolute temperature elevation but the duration of that elevation. Minimising time between recognition of early clinical signs and initiation of treatment is an absolute priority.
2. Cooling modality dictates cooling rate which dictates outcome.
3. The manipulation of the skin surface temperature by the use of ice/cold water makes heat transfer to the surface more efficient and reduces thermal strain.
4. Physiological response to cooling – aids all parts of the recovery process.
4. Skin temperature on hot days before racing 34°C and after racing might be 40°C.
5. Passive cooling – is the combination of convective, radiant and evaporative cooling afforded by the given environmental conditions. Warm humid weather conditions (>30°C, >65% RH) are not ideal for passive cooling. Cool environments (< 24°C, <35%RH) will favour passive cooling mechanisms.
6. Active cooling assists convective and evaporative heat transfer mechanisms by hosing and/or fanning or misting.
7. Active targeted cooling is the application of ice-cold water over most of the horse's body surface area, with a stream of water being used to target the major superficial blood vessels which act as major conduits for heat transfer.
Critical thermal maximum
The main predictor of outcome in cases of heat illness is the duration and degree of the hyperthermia. There is overwhelming evidence across all species that the period of time the core temperature remains above a specific limit, referred to as the critical thermal maximum for cell damage, actually dictates the severity of the outcome.3,5,6,7 Casa and colleagues6 have argued for lowering the core body temperature
Figure 1. Assessment of skin temperature by an experienced worker is a simple and effective technique to monitor clinical progress and needs to be taught across all levels of the industry.
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in humans to less than 40°C (target of 38.5°C) within 30 minutes from first presentation, which they have described as 'the golden half-hour' as being absolutely critical for a successful outcome.5,7 Whilst official race-day veterinarians do not monitor rectal temperatures for safety reasons, experience with skin temperature assessment shows it could be a useful alternative. Research11 has shown that there is a strong positive correlation between levels of heat storage and skin temperature and infrared thermometers can be easily used for initial assessment of 'hot' horses and periodic monitoring of the cooling process. Clinical improvement parallels drops in skin temperature. Alternatively, feeling the temperature of the skin with the back of the hand for an experienced worker is a simple and effective way to monitor progress.
heat illness but colder water, greater air velocity and larger quantities of water all improved the cooling rate – suggesting that successful outcomes are heavily dependent on technique.8,9,10 Other modalities have given mixed results, such as ice-packs over arteries (0.028°C);12 fanning alone (0.02°C);13 dousing with water while fanning (0.035°C);12 placing patients under helicopter downdraft while spraying (0.102°C),14,15 and although there has been much interest in cooling blankets these are considered to be in the unacceptable cooling rate range (<0.078°C).16,17
Marlin and colleagues18,19 doused horses in 6°C water intermittently after exercise in hot and humid conditions and documented a cooling rate of 12°C per hour (0.2°C per minute), compared to passive rates of cooling while walking with fans of 2.4°C per hour12 (0.04°C per minute and passive walking without fans of 1.5°C per hour13 (0.025°C per minute). The Marlin study18,19 has shown that use of cold water and a technique which can deliver a cooling rate of 0.2°C can result in rapid reductions in stored heat after exercise which was found to be superior to passive cooling by either standing or simply walking.
Convective cooling
Although there have been few actual studies in thoroughbred racehorses relating to cooling rates, the abundant information in the human literature and the studies from other equestrian activities18,19,20,21 can be extrapolated to the racetrack. An ice-slurry mix, so that the water is cold, is considered to be the gold standard for achieving rapid cooling. Racing NSW has developed a spray unit based on a 180-litre plastic water container with a pump capable of providing 18 litres per minute, feeding into a large diameter hose. The unit is powered by a 17.5 volt battery, enabling continuous use for
43
39
37
Time (min)
Critical level
0 20 40 60 80 100
41
Closed-circled line
Open-circled line
Figure 2. The concept of the critical thermal maximum.
The vertical axis shows the temperature in degrees centigrade and the horizontal axis elapsed time up to 100 minutes. The dotted line represents the critical thermal maximum, defined as the temperature above which cell damage may occur (close to 41°C). The aim of cooling is to decrease the core temperature below that level in the shortest possible time. The open-circled line and the attendant arrow at 43°C represents an early intervention within 10 minutes of clinical signs appearing. Note that the early intervention reduces temperature below the critical thermal maximum at approximately 30 minutes post intervention. Comparatively, a late intervention (closed circles) allows body temperature to remain above the critical thermal maximum for an extended period. In this case cell damage is probably substantial and recovery may be compromised. (From Armstrong4)
Cooling modality dictates cooling rates in °C per minute
For humans, evidence-based data shows that ice-cold water immersion (pure conductive cooling) achieves the fastest cooling rates (range 0.15 to 0.24°C per minute6) and has the best outcomes.10,11 Combinations of aggressive convective/evaporative cooling where the patient is continually doused with cold water while fanning produced acceptable results of 0.15°C per minute. The latter technique has been used with some success in the Israeli military on recruits suffering from
Figure 3. The cooling unit contains water and ice. Note the length of hose and trolley design so that the unit is mobile and can be taken anywhere in the horse stall area.
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approximately 5 to 6 hours. This unit has been provided to every metropolitan, provincial and most country racetracks in NSW. The author believes these units have been a 'game-changer' in the prevention of heat stress. The spray unit enables active targeted cooling. There is fair efficiency with the longevity of the ice although an insulating blanket to cover the container on very hot days could further prolong ice life. Operating the unit involves minimal effort by staff on very hot days, even if there are numerous horses requiring active cooling. In the author's experience, effective cooling can be carried out with substantial improvements in clinical status in 10 to 15 minutes, which is within the required time frame for the critical thermal maximum as discussed.
'Chiller bins' are large receptacles where an ice/water slurry mix is provided and the contents can be 'bucketed' over horses when required. This technique requires someone to fill then lift the bucket over the horse and pour. Horses that are irritable and agitated with early signs of heat stress often jump forward as the bucket is emptied, presenting a risk to handlers. This technique wastes ice because the majority ends up on the ground, and the contact time for convective cooling on the skin surface is minimal. Bucketing is a very inefficient process and can be exhausting for staff if the weather is very hot.
Key concept
fans can be ineffective and possibly harmful if used on extremely hot days when the ambient temperature exceeds skin-surface temperature16,17 because fanning hot air (forced convection) onto the body may actually promote heat gain.
Physiological responses to cooling
The implementation of aggressive cooling after strenuous exercise has been shown in humans to effect faster reduction in heart rates, core body temperature, skin temperature and muscle temperature17 and as a result, the cardiovascular (thermal) strain during recovery is lessened. In addition, the rapid decrease in skin temperature causes a degree of peripheral vasoconstriction which augments circulating blood volume, actually increasing cardiac output. This improves the ability of an athlete to remove waste products such as lactate and may actually enhance recovery from strenuous exercise. Similarly, cooling will lower muscle temperature, decreasing muscle metabolism and muscle energy demand. Extrapolating from this it has been argued that cooling may decrease muscle stress directly after exercise, resulting in lower muscle soreness. Research in horses has also shown beneficial results.18,19,20,21 with overall reductions in skin, rectal and pulmonary arterial temperatures and improved heat transfer from muscles without any apparent deleterious effects and was well tolerated by most animals.
Convective Cooling uses water as the medium. The colder the water the better the cooling rate and the technique enabling the greatest surface area coverage of the animal will also provide the best cooling rates.
Convective/Evaporative Cooling uses water plus fanning BUT the colder the water, the stronger the velocity of the air currents, and the larger the quantities of water, the better the cooling rate; so the efficiency of this method is extremely technique-dependent.
Fanning and misting devices work by convective
cooling and deliver fan-propelled fine water mist over the body. Studies in humans have shown that although misting does seem to provide some advantage over passive cooling in hot environments, there is little impact on core body temperature15 and it can be counterproductive in humid environments, where although there may be an improvement in convective heat loss the increase in humidity level (approx. 20%) will actually inhibit evaporative heat loss.15,16,17 Finally,
Figure 4. A good example of convective/evaporative cooling technique provided by the Hong Kong Jockey Club installation. Here the shade cloth protects horses from the effects of radiant heat while horses are hosed with cool water and walked under the strategically placed misting fans.
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Overcooling and Rebound Hyperthermia
Overcooling can occur but does not appear to cause significant problems and from a clinical standpoint the dangers of hyperthermia far outweigh those associated with overcooling hyperthermic individuals. In humans, adverse effects have included alterations to cardiovascular function, leading to reductions in cardiac output.12 Careful observation of individual response and attention to skin temperature by touch or thermometer should minimize the possibility of overcooling. Rebound hyperthermia is a phenomenon frequently seen: a horse that has presented initially 'very hot' and been cooled has heated up again 20 minutes later. This is due to the very high heat load stored during strenuous exercise and a reminder that we are not cooling the core directly. This horse will require continual monitoring for some time after the initial cooling process.
Practical Points:
1. Walking horses for a period of time to cool them before hosing in hot and humid conditions can be deleterious to the health of the animal and is not recommended. Compared with water, air is a poor thermal conductor and will not transfer heat as efficiently as water; however, if no active cooling is available the use of fans capable of generating air velocities greater than 2.5 m/sec can speed up heat transfer by improving the convective/evaporative gradient close to the skin surface.
2. Based on the human literature and the studies in horses, active targeted cooling with cold water is the recommended method of cooling. Cooling the skin will effectively reduce the thermal strain associated with strenuous exercise in the heat. All strappers need to be educated in assessing and monitoring skin temperature by touch and be familiarised with the active targeted cooling technique.
3. Early recognition of the signs of heat illness is most important because it is the duration of temperature elevation rather than the absolute temperature reached that dictates outcome. Many cases of heat illness are missed and mis-diagnosis is common. Early signs may include irritability, head-nodding, increasing levels of agitation and kicking out. The latter can be confused to be fly worry or an episode of colic.
4. The cooling modality will dictate outcome. Cold water is best in terms of the cooling rate it provides. Covering as much of the surface area of the individual animal as possible with cold water will also achieve the best cooling rates. Continue cooling until
the skin surface has lost its heat, as evidenced by touch or infrared thermometer. Using warm water on hot days from racetrack hosing bays is not advisable.
5. Horses should be cooled so that the surface blood vessels are still visible but have not disappeared completely. The skin after cooling should be warm not cold to the touch. Walk the horse at this stage. Horses who have been very hot post-race and have been cooled may experience a 'rebound hyperthermia' and must be continually monitored.
Acknowledgements
To all those who have worked tirelessly to cool horses on hot days and especially the Heat Study team who rally to the cause without hesitation - to you all - I am extremely grateful. These are Sue McMaster, Pat Cozzi, Carol Griffiths, Melissa Kay and Kylie Smallwood. Many thanks also to the Chief Veterinarian of Racing NSW Craig Suann for his patience and tolerance.
References
1. Brownlow MA (2014). Exertional Heat Illness in Thoroughbred Racehorses: Observation and treatment in the field. CVE Control and Therapy Series, Issue 274:13-25.
2. Brownlow MA, Dart AJ & Jeffcott LB (2016). Exertional heat illness: a review of the syndrome affecting racing Thoroughbreds in hot and humid climates. Aust Vet Journal, 94: 240-247.
3. Casa DJ, McDermott BP, Lee EC, Yeagin SW, Armstrong LE & Maresh CM (2007). Cold water immersion: The Gold Standard for Exertional Heatstroke Treatment, Exercise and Sports Sciences Reviews, 35:3: 141-149.
4. Armstrong LE, Casa DJ, Millard-Stafford D, Mran D, Pyne SW & Roberts WO (2007). American College Sports Medicine: position stand exertional heat illnesses during training and competition. Medical Science Sports Exercise, 39(3): 556-572.
5. Gagnon D, Lemire BB, Casa DJ & Kenny GP (2010). Cold-water immersion and the treatment of hyperthermia: using 38.6°C as a safe rectal temperature cooling limit. Journal of Athletic Training, 45(5): 439-444.
6. Casa DJ, Armstrong LE, Kenny GP, O'Conner FG & Huggins RA (2012). Exertional Heat stroke: new concepts regarding cause and care. Current Sports Medicine Reports, 11(3): 115 - 123.
7. Casa DJ, McDermott BP, Lee EC, Yeagin SW, Armstrong LE & Marsh CM (2007). Cold water immersion; the gold standard for exertional heat illness. Exercise and Sport Sciences Review, 35: 141-149.
8. Proulx CI, Ducharme MB & Kenny GP (2002). Effect of water temperature on cooling efficiency during hyperthermia in humans. Journal Applied Physiology, 94: 1317-1323.
9. Gaudio FG & Grissom CK (2016). Cooling methods in heat stroke. The Journal of Emergency Medicine, 50 (4): 607-616.
10. McDermott BP, Casa DJ, Ganio MS et al., (2009). Acute whole body cooling for exercise-induced hyperthermia. A systematic review. Journal Athletic Training, 44, 84-93.
11. Saunders AG, Dugas JP, Tucker R, Lambert MI & Noakes TD (2005). The effects of different air velocities on heat storage and body temperature on humans cycling in a hot, humid environment. Acta Physiol Scand, 183: 241-255.
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12. Binkley HM, Beckett J, Casa DJ, Kleiner DM & Plummer PE (2002). National Athletic Trainers' position statement: exertional heat illnesses. Journal Athletic Training, 37(3): 329-343.
13. McDonald A, Goode RC, Livingstone SD & Duffin J (1984). Body cooling in human males by cold-water immersion after vigorous exercise. Undersea Biomedical Research, 11: 81-90.
14. Barwood MJ, Davey S, House JR & Tipton MJ (2009). Post-exercise cooling techniques in hot , humid conditions. European Journal of Applied Physiology, 107: 385- 390.
15. McEntire SJ, Suyama J & Hosteler D (2013). Mitigation and prevention of exertional heat stress in firefighters: A Review of Cooling Strategies for Structural Firefighting and Responders. Prehospital Emergency Care, 17(2): 241-260.
16. Selkirk GA, McLellan TM & Wong S (2004). Active versus passive cooling during work in warm environments while wearing firefighting protective clothing. Journal Occupational Environmental Hygeine, 1: 521 -531.
17. Bongers C, Hopman M & Eijsvogels T (2017). Cooling interventions for athletes. Temperature, 4(1): 60-78.
18. Marlin DJ, Scott CM, Roberts CA, Casas I, Holah G & Schroter RC (1998). Post exercise changes in compartmental body temperature accompanying intermittent cold water cooling in the hyperthermic horse. Equine Veterinary Journal, 30 (1): 28-34.
19. Marlin DJ, Scott CM, Schroter RC, Mills PC, Harris RC, Harris PA et al., (1996). Physiological responses in non-heat acclimated hprses performing exercise in cool hot dry and hot humid conditions. Equine Veterinary Journal, Suppl. 22, 70-84.
20. Williamson L, White S, Maykuth P, Andrews F, Sommerdahl C & Green E (1995). Comparison between two post exercise cooling methods. Equine Veterinary Journal Suppl. 18 (Equine Exercise Physiology 4), 337-340.
21. Kohn CW, Hinchcliff KW & McKeever KH (1999). Evaluation of washing with cold water to facilitate heat dissipation in horses exercised in hot, humid conditions. American Journal Veterinary Research, 60(3): 299 - 305.
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Internal Medicine: A Problem Solving Approach
Tutors: Susan Bennett and Jill Maddison
Rose Anderson, ACT King Tsun Max Chan, Hong Kong Joyce Chan, Hong Kong Syn Yii Choo, Malaysia Julia Dowsett, QLD Catherine Fitzgerald, QLD Nigel Gifford, WA Yu Ming Goh, SA Rebecca Goode, VIC Robert Gordon, New Zealand Jennifer Gordon, NSW Tuovi Joona, QLD Sara Kahler, QLD Tanja Kahrs, Singapore Rachel King, QLD Girisha Lakhiani, Singapore Yan-Yi Lee, Singapore
Kathy Lee, VIC Anna Linehan, VIC Erin Macdonald, WA Leonardo Moriconi, Spain Alice Mutton, VIC Sarah Patterson, WA Kelly Payten, NSW Thana Pengkasame, Thailand Simona Peyrer, NT Melissa Rogers, VIC Katherine Ross, QLD Aileen Russell, New Zealand Shalini Sinnan, NSW Pritsana Sirisakorn, Thailand Jeffrey So, NSW Roshani Suriyaaratchi, VIC Geetha Swaminathan, VIC Leah Withers, VIC Kerry Wong, Hong Kong Eugenie Wu, Hong Kong
Internal Medicine: Keys To Understandiing
Tutors: Jen Brown, Darren Merrett and Boyd Jones
Melanie Asquith, Hong Kong Reeva Been, VIC Penny Cumines, QLD Ruth Devlin, QLD Eimear Geary, QLD Neil Harding, VIC Kate Harmon, TAS Steven Holloway, VIC Arunrat Kornkaew, Thailand Peter Lee, NSW Wanlin Lin, WA Jayne Milward, QLD Gareth Moss, NSW Ruweka Pethiyagoda, VIC Kayleigh Ross, NSW Stefan Saverimuttu, NSW Lauren Walker, NSW Rachel White, WA Donald Wiggins, United Kingdom Simon Willis, VIC Wai Fong Yim, Hong Kong
Ophthalmology
Tutor: Robin Stanley
Sheng Yu Sheena Cheng, Hong Kong Yuen Ting Dorothy Cheong, Hong Kong Lena Ferguson, QLD Mark Matthews, VIC Stephen kimani Mwaura, Kenya Burin Nimsuphan, Thailand
Nuanwan Rujirekasuwan, Thailand Alisa SuzukiMetzelaar, Hong Kong Allison Tso, QLD Kathryn Ward, VIC
Surgery
Tutors: Chris Tan, Guy Yates, Wing Tip Wong and Mark Newman
Samantha Adamson, VIC Ali Ashrafi, ACT Wan Sze Cheung, Hong Kong Andrew Collins, VIC Paula de Klerk, VIC Ronny Rachel Eidels Shimonny, NSW Mark Gillyon, New Zealand Caroline Gout, QLD William Hawker, NSW Seung Kang, VIC David Kim, VIC Jo Ann Lam, Malaysia En Lim, VIC Cindy Lo, VIC Ealasaid Manson, VIC Francisca Martinez Alderson, Spain John McKenna, TAS Jacelyn Neo, ACT Mark Newman, WA Danae Noitakis, VIC Megan ORourke, VIC Kate Phillips, VIC Ben Porter, VIC Peta Rak, NSW Matthew Ray, VIC Catherine Rowley-Neale, QLD Michelle Smith, WA Shyue Wei Tan, Hong Kong Sarah Thompson, WA Andres Townsend, QLD Natasha Usherwood, VIC Lai Wun Lillian Wong, Hong Kong Nick Yeow, QLD
Congratulations to the Distance Education class of 2017
Distance Education is demanding and requires dedication and commitment, especially when juggling study commitments with work and family.
Congratulations to you all for successfully completely a vigorous but rewarding year of continuing professional development.
