Lessons from Barbaro

Barbaro first captured America's imagination, then its heart. "People thought a superstar was on the horizon" after Barbaro's easy win in the Kentucky Derby, said Dean Richardson, DVM, Dipl. ACVS, the veterinary surgeon who headed the team that attempted to save Barbaro's life after a catastrophic injury in the Preakness Stakes.

The presentation, sponsored by Merial, was designed to walk the audience of several thousand equine practitioners through the ups and downs of medically attending a horse of this caliber with an injury one veterinarian had described to this editor as "a bag of ice" because of the multiple bone fragments involved.

Richardson began his talk by showing the video of that Preakness injury, which visibly affected Richardson. He said his unique presentation was designed "for veterinarians and adults" as he dealt in-depth with the injuries and techniques used to try to save Barbaro.

Richardson, known for his ability to handle complicated surgery cases and who became quite adept at fielding complicated press relations during Barbaro's stay at the University of Pennsylvania's New Bolton Center, had to contend with a sound system problem during about a quarter of his presentation. The fire alarm went off in a section of the hotel attached to the conference center, which turned on the house sound system speakers, which caused feedback squeals that were deafening. Richardson made it through that ordeal, and only paused when the feedback became unbearable.

The Story of Barbaro

He said the story of Barbaro became a phenomenon for several reasons, including trainer Michael Matz, the former Olympian who was a hero in his own right after saving three children during a plane crash. "He's a legitimately great human being," said Richardson.

"There's no such thing as a good horse without good owners, and you can't do better than the Jacksons." –Dr. Dean Richardson
"There's no such thing as a good horse without good owners," continued Richardson, "and you can't do better than the Jacksons. They are private people who had to become public."

At that juncture he showed a video of the Preakness, Richardson said, "It's really hard still for me to watch that tape." He accentuated the athleticism of Barbaro to keep galloping on three legs, and the skill of jockey Edgar Prado in pulling up Barbaro and keeping him from running off.

Richardson and moderator Eleanor Greene, DVM, Dipl. ACVIM, ACVP, head of the large animal hospital at the University of Florida vet school, both paid tribute to long lists of people who were involved in the Barbaro story. From those at the track who stabilized Barbaro, to those who drove him to New Bolton, to the nurses and technicians at the hospital who cared for the horse on a daily basis.

Richardson singled out Larry Bramlage, DVM, Dipl. ACVS, an orthopedic surgeon at Rood and Riddle Equine Hospital in Lexington, Ky., who was the AAEP On-Call veterinarian at the Preakness who spoke to media to try and explain what had happened to Barbaro.

The Surgery

Barbaro was transported and stabilized the night of the Preakness, and Richardson flew back from Florida where he had been performing surgery. He had seen the X rays taken at the racetrack prior to leaving Florida, "So I knew what I was dealing with," he said.

The extent and type of injuries "precluded certain options, such as external fixation," explained Richardson. "He was placed under general anesthesia in a s ling and the leg was unwrapped. There were no gross breaches in the skin, but there was serum coming through the skin."

He said there was no option but to do a fetlock arthrodesis (fusion). Richardson added that there was no history of lameness for Barbaro, and no evidence of pre-existing injuries evident at surgery. A question from the audience at the end of the presentation asked whether Barbaro breaking from the gate prior to the start of the race had any predisposing effect on Barbaro's injury. Richardson said, "I didn't address his early breaking form the gate because I don't think it was part of the injury. The horse was examined by a veterinarian when he broke out of the gate. It doesn't take much effort to break through a starting gate.

"My gut feeling is I don't think it was related, but we'll never know," he said.

Richardson walked his veterinary audience through the entire surgical procedure, showing images of the various stages of the operation with comments on the type of equipment, plates, screws, bone grafts, etc. that were used and why.

"Infection is the No. 1 concern with this type of surgery," said Richardson. In his "Lessons Learned" section at the end of the presentation, he said he wished there could have been better fixation of the pastern joint. "We got into trouble when the pastern joint didn't remain stable and we had to go back in and the horse developed an infection and foundered," reflected Richardson.

The Long Road

Richardson credited the water recovery raft system of waking horses up from anesthesia for helping keep Barbaro alive through his numerous surgeries and cast changes. He showed several videos of Barbaro being lifted in the sling while anesthetized and while awake and heading to his stall in ICU, which was about 100 yards away.

"He got used to it," said Richardson of the use of the pool, sling, and being moved via hoisting. But he did cite one "difficult" recovery that in hindsight, he said, was probably when the horse was developing laminitis.

"Things were working really well the first six weeks," said Richardson. "He was comfortable with bute. But I knew all the problems were not going to be addressed in the first two, six, or eight weeks. But I'm still human, and I got my hopes up."

When Barbaro's right hind pastern began to be unstable, he became sore. Richardson found on X ray that one of the screws was bent and coming out of the plate. That screw was replaced and more screws were added.

"If you put one moment that was the turning point of this case ... he ended up getting a local infection at the distal end of the plate" after that surgery, said Richardson.

Barbaro in the recovery pool raft

One rough recovery left the entire team sitting along the wall around the recovery pool exhausted while Barbaro stayed in the recovery raft with some hay in front of him.

That required going back into the pastern, removing the place, cleaning it up, putting two plates back in, and two cast changes. It was at this point he had a "rough recovery" from anesthesia, said Richardson. "That was one of the low points in this eight-plus month saga."

It took 16 hours to try and get him on his feet. "Every time we got him out he struggled," said Richardson. "It took three of four tries." One image Richardson showed was Barbaro in the recovery raft with some hay in front of him, and the team sitting along the wall around the pool visibly exhausted.

"I was sure we were in big trouble at that point," recalled Richardson. The pastern healed (fused), but that was about the time that Barbaro foundered badly in his left hind.

There was distal displacement of the coffin bone (it sank) within two days. "We had him on intense analgesia, including an epidural," noted Richardson. "He was remarkably comfortable."

A meeting was held in front of Barbaro's stall with Richardson, the Jacksons, and the Matzes s to discuss his future.

"I told them this was catastrophic and suggested it might be time to quit," said Richardson. "None of us could do it because all of us were in front of his stall and Barbaro looked like he had barely a care in the world. Barbaro had the final vote, and we pressed on."

At that point the foot was completely unstable since the hoof capsule had been removed. "There was nothing but a blood clot (under the hoof wall)," said Richardson. The only stable part of the foot was connected was the lateral quarter. "The medial side never recovered," said Richardson.

A hoof cast was applied, and "a dozen different appliances" were used. "He still had to bear weight on the right hind, and that resulted in some collapse," he noted.

For two weeks Barbaro was in and out of his sling. "He was a smart horse, and as long as you gave him plenty of attention, he was good in the sling," reported Richardson. Most of the cast and foot cast changes were done under general anesthesia.

Then Barbaro began having some healthy coronary tissue, and he improved to just wearing a bandage and cast. At that point Richardson could lead him out a few feet to a grassy patch outside the hospital for the horse to graze.

" Just having him munch grass made me happy." --Richardson
"Just having him munch grass made me happy," said Richardson. "He was walking on both hind limbs very well."

That progress continued through the fall of 2006, with the horse going out to hand graze every day. He was out of his for cast several months before things took a final downturn. His fracture healed, but the excess weight bearing resulted in less than perfect alignment of the right hind pastern. Barbaro was still not growing enough hoof.

"The real thing that led to his demise is when he developed a horrific sole abscess in his right hind," said Richardson. "Because his left hind foot was still not growing adequately and not comfortable for him, it was impossible to manage the abscess in the right hind foot." Then Barbaro foundered in his front feet, and, as Richardson termed it, "the story faded to black."

About the Author

Kimberly S. Brown

Kimberly S. Brown was the Publisher/Editor of The Horse: Your Guide To Equine Health Care from June 2008 to March 2010, and she served in various positions at Blood-Horse Publications since 1980.

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