Commentary: St Nicholas Abbey's Brave Battle
St Nicholas Abbey
Photo: Anne M. Eberhardt/The Horse
Steve Haskin, senior correspondent for The Blood-Horse, gives a behind-the-scenes look at Irish Thoroughbred racing champion St Nicholas Abbey's battle to overcome a life-threatening fracture that was ultimately ended by a severe bout of colic.
Some stories are not destined to have happy endings. Although each chapter in St Nicholas Abbey’s remarkable fight for life seemed to end happily, pointing to the feel-good ending everyone had hoped for, it was not to be.
After surviving a catastrophic fracture, several complications from that fracture, a severe attack of colic, and appearing to be on the road to recovery from the dreaded laminitis, St Nicholas Abbey lost his battle for survival when he had to be euthanized Jan. 14 after suffering a second, more harsh bout with colic. Surgery revealed he had a severe twist that had robbed his large colon of blood for too long. Repair was not possible, and St Nicholas Abbey was euthanized on the operating table.
A little over two years ago at Churchill Downs trainer Aidan O’Brien’s face had lit up as he stood in front of a television monitor in the Churchill Downs winner’s circle, along with Coolmore partner Derrick Smith, and watched St Nicholas Abbey carry O’Brien’s oldest son, Joseph, to a stunning victory in the 2011 Breeders’ Cup Turf, making the 18-year-old the youngest jockey to win a Breeders’ Cup race.
Following a group hug, O’Brien, still beaming, went out to the track to greet his son, sitting triumphantly aboard St Nicholas Abbey. The youngster whom America had watched grow up through his yearly visits to the Breeders’ Cup had emerged as one of the brightest young stars in the sport.
St Nicholas Abbey naturally held a special place in Aidan O’Brien’s heart, which made the morning of July 23, 2013, all the more painful. The son of Montjeu was out on the Ballydoyle gallops in Ireland, training for the King George VI and Queen Elizabeth Stakes, when he fractured his right front pastern so badly his chances of survival seemed slim.
With the colt still on the gallops, his leg was promptly stabilized in a thick padded splint bandage, and he was rushed to nearby Fethard Equine Hospital, in County Tipperary, Ireland, founded by John Halley, MVB, for radiographs to determine the severity of the fracture and whether he could be saved. The radiographs revealed “multiple fractures of both the proximal and middle phalange of the right front limb, which involved both the fetlock and proximal interphalangeal (pastern) joints.”
St Nicholas Abbey’s only chance for survival was to reconstruct the bones with screws and bone plates.
The injury was a crushing blow to O’Brien, who had recently experienced the joy of seeing Joseph guide the 6-year-old St Nicholas Abbey to victory in the Investec Coronation Cup, becoming the first horse ever to win the prestigious Epsom event three times.
“It’s incredible, really, that he could survive that injury,” O’Brien said. “When it happened on the gallop, I thought it was over and that he’d have no chance of surviving. The minute it happened, he picked his leg up in the air like he knew. When the ambulance came down to get him and they put the ramp down, the most unbelievable thing happened. He skipped into the ambulance on three legs without being asked. He walked on there with his leg up in the air as if he had been on three legs his whole life. I had never seen anything like it before. You had to see it to believe it.”
Immediately after the horse arrived at the hospital, veterinarians Tom O’Brien, MVB, and Ger Kelly, MRCVS, contacted internationally noted orthopedic surgeon Dr. Dean Richardson, DVM, Dipl. ACVS, chief of large animal surgery at the University of Pennsylvania’s New Bolton Center in Pennsylvania. By the end of the day, Richardson was on a private jet to Shannon Airport in Ireland.
“I do this type of surgery and teach a lot of courses on fracture repair,” Richardson said. “There’s a very large group called the AO Foundation that does almost all the educational efforts on teaching techniques of fracture repair both in humans and animals. I teach a lot of their courses, and it just so happens I’ve taught Drs. O’Brien and Kelly, so those guys knew me. They’re both skilled certified surgeons in Europe and America. I had published papers and lectured widely on this type of fracture, and this was really bad.
“Drs. O’Brien and Kelly contacted me around 6 a.m. on a Tuesday and sent me the X-rays and asked me if I thought it was reasonable to try to repair this fracture,” Richardson said. “Once I found out the blood supply was still viable and it wasn’t a badly open and contaminated fracture, I told them I thought it was very reasonable to at least try to put it back together. Once that decision was made, Coolmore arranged to fly me over that same night. I had to take a lot of equipment over that I borrowed from my hospital, as well as from the company that makes the equipment. Coolmore got me a jet, and I flew to Shannon around midnight. They picked me up in a helicopter, and we went straight to the hospital and began the surgery.”
Although this was a rare type of injury, Richardson was still optimistic it could be repaired. Richardson said the long pastern bone is located below the fetlock, then the short pastern, and then the coffin bone. St Nicholas Abbey had shattered the long and the short pastern, which is something you don’t see very often.
“It’s actually quite a rare fracture in my experience,” Richardson said. “The bone was shattered into so many pieces that, as soon as you made the skin incision, they were essentially falling out of the leg. You can’t put that back together, so you have to fill the voids with bone grafts. Because he had two bones that were shattered, we knew we had to fuse those two bones to each other. We used two bone plates and 20 screws and a large temporary transfixation pin above the fetlock to further protect the site. It’s important to see the pre-op X-rays, so people will know I just didn’t go crazy with a hardware store. The one good thing was that his skin wasn’t broken, which is a big deal. And he did not lose the blood supply to his pastern and foot.”
The actual surgery took three hours, which Richardson said is very long surgery time.
“The surgery technically went very well,” he said. “It was a very good team, and having two extremely skilled surgeons scrubbed in with me was great. After the surgery you still have to get the horse up, and bad things can happen with a horse waking up from anesthesia. I was very happy when he got up and bore acceptable and comfortable weight on the limb. I got some sleep, checked the horse the next morning with Drs. Kelly and O’Brien, and then flew home.”
But St Nicholas Abbey’s problems were far from over. Three days following the surgery, July 26, the horse had a major setback, coming down with a colic attack around midnight that was caused by an impacted cecum, which was brought on by the stress on the body resulting from the fracture and surgery. All that contributed to the cecal malfunction. He was forced to undergo emergency surgery, and his condition following the surgery was listed as guarded.
“Having to go through surgery and wake up on his leg again was kind of scary, but it worked out for him,” Richardson said. “I kept in touch with Drs. O’Brien and Kelly. I went back to see him once because my wife and I were already scheduled to go to the Dublin Horse Show at the end of July.
“In a lot of ways, he was a really good patient. He’s a kind and quiet horse and he’s more the athletic type, not a great big brute of a horse. It seemed to be going well, but the boys in Ireland had many sleepless nights.”
On July 27, Nathan Slovis, DVM, Dipl. ACVIM, CHT, director of the McGee Medical Center at Hagyard Equine Medical Institute in Lexington, Ky., arrived to oversee the horse’s recovery and treatments.
“I got called in immediately after he had the colic surgery,” Slovis said. “They noticed he had an impaction of the cecum. The cecum is the equivalent of a human appendix, but unlike humans, horses graze all the time, and they need an appendix to help their digestion and process their food properly. We see those quite often in Kentucky, which is the reason they called me in. These can be very painful for the horse and are difficult to treat because they can re-impact and perforate the cecum. They were concerned because if that were to become re-impacted they would have to go in for surgery again and that was not an option. It would have put the horse so far behind.
“I went there to consult on the case in regard to what medication we could do to help kick-start the motility in the cecum. There are some medications you can give four times a day to help prevent the cecum from getting impacted again. I devised a feeding program for him and also how to utilize his medication properly, and also to create a caloric intake to help maintain his weight and help supply much-needed calories. What ends up happening when the cecum becomes impacted is you have to withdraw that animal from food. He cannot eat for a week or so.”
That was particularly rough on St Nicholas Abbey, who never left an oat in his feed tub. Instead, he was provided with nutrition intravenously.
Slovis also was consulted on which pain medications to use. Because Butazolidin and Banamine can irritate the bowels, they had to use fentanyl patches, a derivative of morphine, to help relieve the pain.
“Morphine can slow down the motility of the bowels and we didn’t want that, but he needed pain medications, so we had to figure out how often to use the Bute (phenylbutazone) and Banamine (flunixin meglumine) and when to put the fentanyl on,” Slovis said. “A lot of medical knowledge had to go into that, and we all worked as a team.”
Slovis remained in Ireland for 48 hours and then returned three weeks later to reassess the situation and see how the horse was progressing. He estimates the cost of St Nicholas Abbey’s postoperative care and medication to be close to $100,000.
“We’re really lucky the way the horse responded to our therapy,” Slovis said. “He was remarkable. He has such a high tolerance of pain, which really helped him. Coolmore had somebody in front of his stall 24/7, and that gave him company and kept him relaxed. And they groomed him all the time. He liked the attention and he didn’t sulk, which was so important.”
By July 30 St Nicholas Abbey was eating small amounts of freshly cut grass.
Richardson said, although the surgery was a success, the horse would not be out of the woods until he was running in a field and breeding mares.
“Problems in the other foot, mainly laminitis, can occur at any time, even when things go perfectly,” he said. “But it’s been about 14 weeks now, so we’re pretty far removed from the surgery.”
On Aug. 9 St Nicholas Abbey had his fiberglass cast replaced, and O’Brien and Kelly were happy with the wound and alignments of the joints, which they said were as good as could be expected.
A month after the surgery he was continuing to make progress, and the veterinary interns who stayed with him 24/7 described him as the “best he’s ever been.” His radiographs looked good, his temperature remained normal, and his white blood cell count was good. He was eating well and beginning to put on weight.
On Aug. 28, however, the horse appeared uncomfortable, and radiographs showed the steel weight-bearing pin in his cannon bone had broken. The procedure to remove it was completed with no problems, and the horse was soon bearing weight on the fractured leg.
By Sept. 4 he was walking as well as could be expected with a cast and continued to show gradual improvement. He would lie down in his stall several times a night to rest, and his appetite began picking up. His temperature and blood work both had stabilized.
On Sept. 30 St Nicholas Abbey was fitted with a lighter, less restrictive cast and was more mobile, putting weight on his leg with restored confidence. Then came what everyone had feared. Although it was termed a “mild case of laminitis,” serious doubts surfaced about whether this story would have a happy ending. The fact he had come this far was a miracle in itself.
“It’s amazing what Dr. Richardson was able to do, putting that many screws in the area and none of them touched,” O’Brien said. “When you consider how bad the fracture was and the trauma the horse went through afterward with the colic surgery, I have to admit I never thought this could happen.
“As it stood since mid-December, we were very pleased with how St Nick was doing orthopedically,” he continued. “His fracture had fully healed and his pastern fused. Although he had developed arthritis in his right fetlock, we felt this was something we could deal with in due course and were planning this with Dr. Richardson.
“Regarding his laminitic left front foot, we were also happy with his progress. There was some growth of new sole and new horn at the coronary band. Dr. Scott Morrison (DVM) had been to see him again last week and was pleased with the progress of the left front foot. The plan was to leave him in a foot cast for a few more months while managing his right front fetlock and pastern.
“In the past few weeks the horse had been as bright as ever,” O’Brien said. “Overall he was very comfortable when walked and when standing in the stall. He had never walked as well since late July as he did on Monday and Tuesday morning of this week.”
But the good news was short-lived, as colic put an end to a six-month ordeal that tested the latest advances in veterinary medicine and the fortitude and dedication of those closest to St Nicholas Abbey.”
He explained, “He began to show signs of mild discomfort and colic, which was unusual for him. He was only mildly colicky for very short periods. However, as these were not going away completely and recurring, and as this was so atypical for him the decision was made to go back to surgery to investigate the cause of colic. This was not a decision taken lightly, considering the risks of another surgery and general anesthesia and what was at stake.”
Other horses O’Brien has seen with such a violent case of colic exhibited extreme pain and surgery was able to be performed immediately. But not with St Nicholas Abbey.
“Unfortunately St Nicholas Abbey was just mildly uncomfortable and in effect his ability to tolerate a lot of pain masked the seriousness and life-threatening nature of his colic,” O’Brien said. “His toughness allowed him to survive for as long as he did, but ultimately it was his undoing. Any other horse would have shown signs of extreme discomfort and the need for surgery would have been immediately obvious. He didn’t.”
St Nicholas Abbey will be remembered always by everyone at Ballydoyle who witnessed his will to live.
“He was a horse I’ll never forget,” Joseph O’Brien said. “He gave us at Ballydoyle some great days and over a mile and a half, on good ground he would have given any horse in the world a run for their money. His win in Dubai last year was possibly his best performance, and he was probably better than ever last year. But from my point of view winning on him at the Breeders’ Cup was very special. It was my first big win on the world stage and my first big win outside Ireland.
“What happened to him was very sad. Everyone would have liked to see him stand at stud.”
Aidan O’Brien added, “We were all really upset to hear that St Nicholas Abbey had to be put down after suffering another bout of colic. He was a firm favorite here in Ballydoyle with all the lads that worked with him every day during his racing career, as he was such a gentleman to do anything with. We would like to express our thanks to all the vets and staff in the Fethard Equine Hospital and in Coolmore that worked so hard to try and save him.”
(Originally published on BloodHorse.com. Feel free to share your own thoughts and opinions at the bottom of the column on BloodHorse.com.)
About the Author
Steve Haskin is Senior Contributor to The Blood-Horse magazine, sister publication to The Horse.
POLL: Rehabbing the Injured Horse