Equine Veterinarians Likely to Learn From Barbaro

by Richard Daub

2006 Kentucky Derby winner Barbaro will be remembered by most for his triumph and tragedy after fracturing his right hind leg in three places at the Preakness Stakes two weeks after his win at Churchill Downs. He will also be remembered for his courageous eight month recovery attempt that came to an end in late January. 
      His true legacy, however, may be what has been learned from the efforts of veterinarians at the University of Pennsylvania School of Veterinary Medicine's New Bolton Center, where the champion spent the last eight months of his life. 
      "If you pull out equine orthopedic textbooks, most of them would tell you that that fracture would not have been able to be repaired at all," Dr Kimberly May told Animal Pharm. Dr May is the medical/science writer for the American Veterinary Medical Association and a practicing equine veterinarian and surgeon. 
      Similar assessments of the injury did not discourage Barbaro's owners Roy and Gretchen Jackson, nor Dr Dean Richardson, chief of surgery at the New Bolton Center, from doing everything they could to save him. 
      "Barbaro presented us with a case that was about as difficult as such an operation could be," Dr Richardson said on May 22nd, 2006, following surgery to repair the fracture. The procedure involved the insertion of a 'locking compression plate', which had until then only been used in humans to hold long pieces of broken bone together. 
      To avoid triggering a 'flight response' when Barbaro woke up from anesthesia, which is when a horse starts thrashing when awakening in an unfamiliar environment, Dr Richardson's team used a pool-recovery system developed by Dr Jacques Jenny, whom some consider 'the father of large-animal orthopedic surgery'. 
      The New Bolton Center states that their pool-recovery system "allows the disoriented animal to waken suspended in a specially engineered harness and rubber raft, allowing him to gallop or flail in the warm water until fully conscious, significantly reducing the risk of re-injuring the damaged limb. Once awake, the horse is hoisted from the raft and moved to the recovery stall where he can stand at once". 
      Barbaro's recovery went surprisingly well until a couple of months following the injury, when he developed "an acute, rather severe bout of laminitis in his left hind find," as described by Dr Richardson on July 13th, 2006. 
      "What caused the horse's demise was the complications of the injury, and that's always been a big problem when you deal with horses," Dr May said. "You treat one thing, and something else might occur that you either expected and couldn't prevent, or that you didn't expect." 
      Despite being diagnosed with laminitis, Barbaro remained strong enough to continue rehabilitation. In the meantime, Dr Richardson treated each new complication as it arose, going well beyond the range that veterinarians normally traverse in such cases. 
      "Very few horses have been through as many anesthesias and recoveries as [Barbaro] has in that period of time," Dr May said. "Every time you anesthetize and recover a horse, there are risks involved. Every time they laid that horse down, they learned more about the anesthesia and the recovery system for him. 
      "There are a lot of horses that survive laminitis. It really depends on the severity and how they respond to treatment—if they respond to treatment. He started with laminitis in the left hind, then started to develop laminitis in the front legs as well." 
      Most experts were surprised that Barbaro hung on as long as he did, but in the end he developed what Dr Richardson described as a "deep subsolar abscess secondary to bruising when he went through a period of discomfort on the left hind foot". Dr Richardson's team made a risky, last-ditch effort by inserting two steel pins into his right hind cannon bone that were connected to external sidebars and a foot plate, a device designed to take all weight off the foot, but the pain became unbearable and the owners finally made the decision to euthanize him. §

Written for Animal Pharm, February 2007