Gold-Medal Vet Care
- Nov 1, 2004
BY LEO JEFFCOTT, BVETMED, PHD, FRCVS, DVSC, MA, VETDR; JACK SNYDER, DVM, PHD, DIPL. ACVS; AND SHARON SPIER, DVM, PHD, DIPL. ACVIM, AS TOLD TO STEPHANIE STEPHENS
All eyes on the podium, and the Gold Medal goes to...the equine veterinary team of the XXVIII Olympiad. These veterinarians worked far beyond the competition dates in Athens of Aug. 13-29. And the presenters of this appreciative award were the competing horses in dressage, three-day eventing, and show jumping and their riders, coaches, and grooms.
While the horse-loving world watched high drama in the Olympic arenas, the Olympic Veterinary Clinic (OVC) personnel ensured that rules and regulations were followed precisely and that all horses received the highest level of care. Big jobs, but years of meticulous planning paid off when the pressure was on: Virtually nothing was left to chance and the veterinary team shone as brightly as a gold medal while working from their top-of-the-line headquarters.
Inside the Clinic
"From the veterinary point of view, we have never been provided with such good facilities to ensure the welfare of the horses at the world's premiere equestrian event," said a visibly pleased Professor Leo Jeffcott, BVetMed, PhD, FRCVS, DVSc, MA, VetDr, President of the Olympic Veterinary Commission--his second consecutive time in that role. "In our opinion, the horses wanted for nothing."
Jeffcott formerly was Dean of the Veterinary School at Cambridge University, United Kingdom, and as of October he is the newly appointed Dean of the Faculty of Veterinary Science at the University of Sydney (Australia). Athens was his fifth involvement with the Olympics. He also serves as Chairman of the Fédération Equestre Internationale (FEI) Veterinary Committee and is a member of the FEI Bureau--the latter is its main executive body. In that job he reports on all relevant medication, health, welfare, and inspection issues. Add to his list of titles Athens Veterinary Technical Delegate, which means he handled the all-inclusive planning for the event.
The United States won more equestrian medals than any other team with a total of five from six possible opportunities. Too busy to count medals while heading clinic operations and staff were Americans Jack R. Snyder, DVM, PhD, Dipl. ACVS, a professor in the Department of Surgical and Radiologic Sciences at the University of California, Davis, and his wife of 20 years, Sharon J. Spier, DVM, PhD, Dipl. ACVIM, an associate professor there. Both have worked every Olympics since Seoul in 1988--with the exception of Barcelona--as well as many of the Pan American and World Equestrian Games. They're considered veterans in this specialized discipline, and Snyder served as surgical team leader in Athens.
The Athens equine clinic is generally acknowledged to be the best in Greece, and during August it was home to that country's best equine veterinarians, reports Jeffcott: "That made it very difficult to provide any surgical cover to Greek racing and equestrian horses." Difficult, yes, but not impossible. Two non-Olympic Greek national horses were admitted into isolation there for surgery, which did not disrupt the overall mission of the facility.
The veterinary team at its peak consisted of about 60 professionals, including 16 senior students from the Veterinary School in Thessaloniki. So many practitioners on site ensured that safety was indeed first on cross-country day for eventing, which is considered the most potentially hazardous of all Olympic equestrian competitions. At other times, 20 veterinarians staffed the clinic and competition and training areas, including one veterinarian ready in the horse ambulance. An additional 35 veterinarians accompanied the 219 horses in a team or individual capacity.
In a veritable United Nations of Veterinary Medicine, Greek veterinarians played major roles alongside Jeffcott, Snyder, and Spier. Some of the attending practitioners from Greece were Alexander Mitsopoulos, BSc, DVM, MVM; Yannis Aleiferopoulos, DVM; Mazarakis Fotiadis, DVM; Nikos Diakakis, DVM, MVM, PhD; Petros Zafiris, DVM; Chrisula Koutsoukera-Liva, MD; Elias Nikolakopoulos, DVM, PhD, Dipl. ECAR, Fotini Emiri, DVM; and Pavlos Antoniou, DVM. "We are indebted to them for their remarkable professionalism and team cooperation," says Snyder. "When we had a problem or surgery with the horses, we worked as a team with them and they were right there helping. Also, when we needed to get supplies or surgery equipment, they worked all over Athens to get it."
The clinic setup included two surgical suites with four recovery stalls and six examination rooms, and it contained a computed radiography system with the ability to send images immediately to surgical theatres. One large and one portable high-resolution ultrasound unit were available for use in the clinic and stables. Other tools included a 2.5-meter endoscope, radial and focused shockwave systems, and a thermography camera. Surgical suites were expertly designed and the pharmacy well-stocked, according to the veterinarians.
The facility was built to handle the menial through the exceptional. As the first horses started to arrive on Aug. 8, temperatures reached 104ºF. Although the horses arrived in good condition, some required fluids--usually 15 to 25 liters--from the 9,000 liters on site.
The clinical pathology laboratory operated 24 hours a day, with more than 500 analyses to profile any possible abnormalities in the horses. Routine blood work (hematology and serum biochemical profiles) was often performed on the horses to catch any possible problem that was brewing. Bacteria cultures and serologic tests for infectious disease were also performed.
Jeffcott, Snyder, and Spier share with us just what it was like to oversee some of the most famous performance horses in the world. Note that the names of some horses are not revealed due to privacy concerns, while some incidents are part of the Olympic record.
We Take You There...
The equestrian venue was built on more than 4,900 acres at Markopoulo center for racing and other equestrian sports in 2003, so yes, it has life after the Olympics. However, no races were held in August or September.
Able to accommodate some 2,000 racehorses, the venue includes a huge racetrack and grandstands, ample parking for spectators, and the state-of-the art veterinary clinic adjacent to the stable compound. Other amenities are an elaborate equestrian park with a cross-country course, extensive training facilities, a separate stable compound, show jumping and dressage arenas, a large indoor arena, and an administration building.
"No expense was spared to provide comfort and safety for the 219 Olympic horses from 38 different nations," says Jeffcott. Of those horses, 205 actually competed in the three Olympic disciplines: 75 in eventing; 53 in dressage, and 77 in show jumping.
Stable compounds were designed and built to the highest standard, easily cleaned, with high ceilings, good airflow, large stalls approximately 13 feet square, wide aisles, insect protection, automatic watering, and ample electrical outlets. The layout featured 20 stalls per block; blocks were in groups of four with a central exercise area and longeing rings. Each block also had good space for tack and equipment, plus private rider lounges.
The equestrian compound--completely secure and stewarded--featured convenient horse wash facilities and three electronic scales. The compound contained a fully equipped farrier station and a large feed and bedding store organized by Kentucky Equine Research (led by Joe Pagan, MS, PhD), which served in the same position for Atlanta and Sydney.
This was a typical Grecian summer--hot and dry--so a 30-foot by 30-foot shade tent enhanced by banks of misting fans (like those used so successfully at Atlanta's 1996 Olympics) cooled the horses after training and competition. Weather was hot and dry with temperatures averaging 95º-100ºF many days, with a low relative humidity of 30-40%. A dedicated weather station positioned on the cross-country course provided the WBGT index, which is a system for combining shade, air temperature, radiation, humidity, and wind into a single value.
"It's the most accurate prediction of expected heat load experienced by the horses, and thankfully, excessive heat loads during competitions or training did not occur," said Jeffcott. Coincidentally, notes Jeffcott with a bit of irony in his voice, "Some of the hottest times were chosen for the Horse Inspections, probably to test the endurance of the Veterinary Commission to work under pressure!"
The International Olympic Committee's (IOC) tough anti-doping stand made major news prior to and during the competition and was focused on human athletes. But horses were not excluded from scrutiny, according to Snyder, who observes that keeping a horse "clean" applies to all levels of the Olympics.
Two official FEI Testing Vets--one from Switzerland and one from Greece--collected 40 equine blood and urine samples, stored them safely in an isolated area of the vet clinic compound, then sent them by courier to the central FEI laboratory in Paris for analysis. Results were then forwarded directly to the FEI headquarters in Lausanne, Switzerland.
Some medication is permitted during the Olympic competition, says Snyder, such as that for gastric ulcers, drugs to suppress estrus in mares, rehydration fluids, vitamins, and a few herbal/homeopathic remedies. No drugs on the Prohibited Substance List are permitted unless special circumstances exist. Eye drops, skin creams, and anti-spasmodic drugs for colic are in that category, but they must be approved by the Veterinary Commission and the President of the Ground Jury or the horse is ineligible for competition.
The samples include those randomly taken, a few spot tests requested by the Ground Jury, and mandatory samples from the medal winners.
The veterinary team lauds cross-country course designer Albino Garbari, Technical Delegate Mike Etherington-Smith, and their colleagues. All personnel were concerned about potential heat load during cross country and the new shortened CCI format (the steeplechase was excluded). "The course was beautifully designed at more than 1,800 feet with 34 obstacles and 45 jumping efforts in a time allowance of just under 10 minutes," notes Jeffcott for the record.
At the first Veterinary Examination, horses all looked fit and well, and they had acclimatized quickly to their surroundings at the equestrian venue, he says. The Wexford Lady, ridden by Sarah Cutteridge of Great Britain, had injured herself in training and had to be substituted with a reserve, Mary King and King Solomon. For the first inspection, only two horses were held, and after examination in the Holding Box, both were accepted to compete.
For the first time, both tracks for inspection were composed of exactly the same surface of tarmac (asphalt) with a light dusting of sand. The horses performed well on this surface.
At the second Horse Inspection, four of the 70 horses presented were examined in the hold, but all were subsequently accepted--a tribute to the overall fitness of the horses. After cross-country day, only two were not presented at the inspection because of lameness incurred the previous day. Withdrawn were Britain's William Fox-Pitt on Tamarillo and Australia's Olivia Bunn on Top of the Line.
Very high-quality dressage left four teams nipping at each other's heels--Germany scored 114.40; France scored 113.40; Great Britain scored 113.20; and the United States scored 128.40.
On cross-country day, the temperature only reached about 77ºF with the relative humidity about 45% and the WBGT index between 24 and 27, which is quite low. The completion rate was greater than 90%, with only three horses failing to finish and two more withdrawing before the jumping.
Only 10 horse and rider falls were recorded from 75 horses competing, and only one at the 26th fence turned out to be serious. "The horse Over and Over from Belgium, ridden by Joris Van Springel, unfortunately sustained a major fracture (of the femur)," reports Snyder. "Despite valiant efforts to repair this at the clinic, the animal had to be humanely destroyed.
"The only other orthopedic problem was a stifle injury, albeit much less serious than the first one, and this horse completed the cross-country and was still apparently sound," he adds.
The horses finished the cross-country in good shape when being presented to the Second Veterinary Examination in the D-Box. Since horses started at three-minute intervals, several horses were present in the box at any one time. In spite of this, the organized system of "recovering" the horses went smoothly as follows:
- Brief clinical examination (including TPR--temperature, pulse, respiration) on entering the box. Rectal temperatures were taken with 10-second digital thermometers;
- Aggressive cooling with plenty of water and ice while holding horses in one of two shade tents with misting fans;
- Vet checks were repeated every 10 minutes and horses were not permitted to return to the stable until a member of the Veterinary Commission was satisfied they had cooled sufficiently to walk the 20 minutes back to the stables.
The mean rectal temperature on entry to the box was 106ºF and due to the cooling process was progressively reduced over the next 30 minutes. Horses were hot on entering the box, but not excessively. After only 10 minutes, the mean rectal temperature had decreased significantly, and by 20 minutes it was down to nearly normal. Pulse and respiration also decreased progressively over the half-hour monitoring period. After 30 minutes, horses looked good clinically with normal mucous membrane color and capillary refill time, and they were acceptable to return to the stables. After cross-country, 51 horses received from 10 to 30 liters of rehydration fluids by intravenous infusion to replace what was lost while sweating on course.
The night before show jumping, one horse developed progressive signs of colic and was managed by Snyder and associates with IV fluids and spasmolytics. The horse was well enough to compete the following day.
Eventing ended with major controversy due to German rider Bettina Hoy's having gone through the show jumping start timers twice. Original placings rearranged, the French captured gold, the British got silver, and the United States got bronze; Leslie Law of Great Britain took individual gold.
Germany, Spain, and the United States won team dressage medals in that order. Gold individual went to Anky Van Grunsven of the Netherlands. Fifty-three horses initially were presented for inspection, with four sent to the Holding Box for examination. Of these, three were accepted and only one horse was considered unfit to compete: Heros, ridden by Greek Alaia Demiropoulou.
"The dressage horses were comparatively free of serious issues," Spier says. "One horse developed a recurrent urticarial (allergic) skin reaction that responded to antihistamine treatment, while another formed a nasty laceration in the mouth that unfortunately required withdrawal from the competition."
Three horses experienced colic in Athens, with the most severe occurring following completion of dressage. The horse was diagnosed with a colon displacement and although surgical intervention was considered, the horse responded to aggressive medical treatment and made a full recovery.
In show jumping, 76 horses were inspected and four sent to the Holding Box. One horse was not accepted initially, but passed upon re-inspection.
If timing is indeed everything, one horse has the Olympic veterinary team to thank for being able to compete and win a medal. The horse developed progressive signs of colic the day of the inspection, and it was finally diagnosed with a colon displacement.
The veterinary team rectified the problem by manipulating the colon back into a normal position, recalls Snyder. "The horse responded immediately with a great relief: You could actually see it in the horse's eyes. Once corrected, the horse basically went back to normal and passed inspection." Exemplifying that "the show must go on," the jumper breezed into the arena to compete.
Humane training methods are paramount at notable equine competitions, and with the eyes of the equestrian world trained on Athens, even what might be considered a minor injury received intense scrutiny.
For example, one horse was presented with a nasty wound from an old spur injury. On leaving the arena, the horse was inspected and a 2.0 cm cut in the skin with minor bleeding was found. A report was made to the Ground Jury and an enquiry held, resulting in wound treatment and use of a girth with a specially designed leather protection piece over the horse's flank.
A heart-stopping silver medal contention under lights between the United States and Sweden included three clear rounds each before the Swedes realized the impossibility of making up nearly eight seconds by their final rider. America's Peter Wylde, Beezie Patten, McClain Ward, and Chris Kappler were Team USA's silver group.
The second inspection ended with all horses accepted. Additionally, random boot/bandage checks made by the Veterinary Commission after the Individual First Qualifier, the Team Jumping Final, and the Individual Jumping Final found no indications of hypersensitization or other abuse, according to Jeffcott.
During jumping competition, three horses incurred tendon injuries: Dileme de Cephe, the mount for France's Bruno Broucqsault, the reigning 2004 World Cup champion, bowed a tendon while landing after a jump. Argentina's Who Knows Lilly, ridden by Federico Sztyrle, also incurred a tendon injury. Royal Kaliber, Chris Kappler's horse, left the arena injured as well.
With 29 horses in contention, the gold medal went to Ireland's Cian O'Connor on Waterford Crystal. "I'll drink plenty of Guinness when I go home!" said the winning rider. The silver medal jump-off between Brazil's Rodrigo Pessoa on Baloubet du Rouet and the United States' Chris Kappler on Royal Kaliber was one for the records, and sent the clinic into high gear once again.
"Pessoa set a scorching pace," recalls Spier. "Then Royal Kaliber was flying round and going clear, but at the large oxer, Fence 15, he seemed to put a foot wrong and landed badly, then took another step awkwardly and pulled up lame on the left forelimb. The horse was immediately splinted and taken to the Olympic Veterinary Clinic for radiographic and ultrasound evaluation. It was not difficult to diagnose an acute strain of the superficial digital flexor tendon, and the horse was treated accordingly. By the next morning, he was bright, alert, and pretty comfortable. Arrangements were being made to delay his departure for three to four days to ensure a safe journey home."
"It was something at oxer Fence 15, before the double verticals in the jump-off," bronze medalist Kappler said, as reported by United States Equestrian Federation's (USEF) Brian Sosby. "He just seemed to land and take a funny step...I knew right away I had to pull up." With eight faults, Kappler retired in the jump-off. Silver medalist Pessoa commented, "I would say the ground is not perfect."
An FEI committee has begun a thorough investigation into the footing, as many present reflect that it was most unusual to cart three horses off the field in an ambulance. One veterinarian remarked that he and others hoped to learn as much as possible to prevent similar future occurrences.
On-field controversy aside, everyone involved in the equestrian events admits that veterinary medicine ran smoothly and consistently. After all, no other sport required doctors to treat animals as well as human participants, and under Jeffcott's, Snyder's, and Spier's direction, this most critical component of the competition operated nearly flawlessly from start to exciting finish.
"For me, it went exceptionally well," said U.S. Team Veterinarian Tim Ober, DVM. "It's very comforting to have someone with Jack's experience at one of these clinics. His presence, and that of his staff, provided a great deal of support to all of us."
And they're leaving a legacy: "The good news for the horses of Athens is now they have a top surgical clinic staffed with trained Greek veterinarians to provide care and greatly improve the survival of horses, both previously very difficult to manage," reports Jeffcott. He, along with Snyder and Spier, aren't resting on their laurels, but are already considering ways in which they can make the 2008 Olympics in Beijing even better.
About the Author
Stephanie Stephens is a USEF Media Award winner and American Horse Publications award winner whose work appears in major consumer magazines worldwide. She lives in Southern Calif., but she splits her time between New Zealand and the United States.
POLL: University Equine Hospitals