July 15, 2006

 

 Barbaro's care illustrates veterinary profession's capabilities - July 15, 2006

 

Colt's recovery from injury stirs positive media attention

posted July 1, 2006 

Just two weeks after clinching the Kentucky Derby, Barbaro suffered a broken hind limb shortly after the start of the Preakness Stakes, May 20. Though the injury was career-ending, the 3-year-old colt's positive strides toward recovery—and the willingness of the involved veterinary team to share details of the horse's care—have made it possible to showcase the capabilities of veterinarians to a concerned public.

Top radio and TV programs and print media from around the country have interviewed veterinarians at the University of Pennsylvania School of Veterinary Medicine's New Bolton Center, where Barbaro was transferred soon after the accident in Baltimore.

At the center of many interviews was Dr. Dean W. Richardson, chief of surgery at the center's George D. Widener Hospital for Large Animals. Dr. Richardson repaired Barbaro's fractured limb during a six-hour surgery, May 21.

"The sort of minor inconveniences of getting interviewed all the time and so forth is really out weighed by the good press that the profession is getting," Dr. Richardson said. "I don't think that the veterinary profession can get out there enough, particularly the equine side of things."

"Sometimes people think veterinarians are just sort of doing whatever is easy and convenient, and I don't think that that's the case," he continued. "I think that there are lots of people that work hard to do what's best for the animal."

Dr. Larry Bramlage fielded media questions almost immediately following Barbaro's injury. He was the spokesperson for the American Association of Equine Practitioners' On Call Program, which provides accurate veterinary information to the broadcast and print media during live network races.

"More than anything else, it shines a light on our capabilities as a profession," Dr. Bramlage said about the positive media attention that followed Barbaro's surgery.

"The general public tends to view medical progress as giant leaps, such as the discovery of penicillin. In fact, medical progress is a progressive accumulation of knowledge over time," he continued. "Prominent events such as this focus the attention on how far we have come."  

Broken and shattered

Barbaro reportedly injured himself 50 to 75 yards after leaving the starting gate. The horse suffered a lateral condylar fracture of the cannon bone, which alone probably might have been career-ending, Dr. Richardson said.
 

"He also shattered his long pastern bone. That was in 20-plus pieces. Then on top of that, he also broke one of his proximal sesamoid bones," he continued. "The most important ligament he tore was the intersesamoidean ligament." The horse's fetlock was also partially dislocated.

"The degree of bone injury was dramatic," said Dr. Bernd Driessen, chief of the Large Animal Anesthesia Service at New Bolton Center, who with another colleague, a resident, and an anesthesia nurse managed Barbaro's anesthesia during the lengthy surgical procedure. "I definitely have never seen such a severe multiple-bones-affecting fracture."

"The fact that this horse fractured the leg so early in the race made the case more difficult, as Dr. Bramlage had pointed out early on, insofar as Barbaro was still very energy-loaded," Dr. Driessen said. He said injuries to horses are more likely to occur toward the end of a race, and for that reason the horses are oftentimes more exhausted. On the other hand, he said, one advantage of the horse injuring itself earlier in the race is that dehydration was less of a concern.

Dr. Driessen said Barbaro was unusually calm immediately following the injury. "Normally, horses get very excited if they suffer those types of injuries. As soon as the jockey jumped off, the horse was pretty easily controllable, from what I could see on the (TV) images."

Dr. Driessen observed Barbaro the morning of the surgery and was pleased to see that the horse was much calmer than he had anticipated. "He was even capable to lie down for short periods without significant problems and then to stand up by himself," he said.

During the surgery, 27 screws and one locking metal compression plate were placed in Barbaro's limb, and a cast was set.

Once the surgery was completed, Barbaro was moved into an equine recovery pool at New Bolton Center. The pool is used primarily for horses undergoing major orthopedic or trauma surgery. It allows a disoriented animal to awaken suspended in a specially engineered harness which together with the horse, is lowered into a large raft modified with four long rubber sleeves to accommodate the limbs of the horse. The pool raft recovery system allows the animal to move its limbs forward or flail in the warm water until fully conscious, reducing the risk of reinjuring the newly repaired limb. Once awake, the horse is hoisted from the raft and moved to a recovery stall.

Dr. Driessen said the pool proved invaluable for the immediate postanesthetic management of Barbaro.

Although Barbaro received epidurals for analgesia for a period after the surgery, the horse's pain management regimen as of June 2 was 1g of phenylbutazone in the morning and 1g at night, Dr. Richardson said.  

Potential complications 

While Barbaro continued to do well in the initial postoperative period, a long road to recovery lies ahead.

Dr. Richardson said laminitis in the opposite hind limb will be a concern for months to come. He said, "It's not rare to have a horse with this type of injury that actually founders on their good foot six to eight weeks after or more."

Though the skin was not broken in the initial injury, infection remained a concern. "I would say the chances of a catastrophic infection at this point are diminishing because of the fact that we've got a horse that has had a normal body temperature for basically the whole time he's been here. His blood work has been consistently good. He's showing no lameness," Dr. Richardson said. "But that doesn't rule out the possibility that we could get some infection that could slow up fracture healing and end up being a major complication."

Dr. Richardson also noted that the internal fixation could fail. "The horse just walking and eventually fatiguing the metal to the point where some portion of it breaks—that's always a possibility when you're talking about internal fixation techniques, particularly if they're in an extremely unstable situation, like we have in Barbaro."

Cast changes will also be a challenge. Dr. Richardson said Barbaro will be in a cast for at least eight to 10 weeks. During the cast changes, the surgeon plans to take radiographs to assess the progression of fracture healing.

Given Barbaro's calm temperament and cooperative nature, Dr. Driessen said, he anticipates that the cast can be changed when the horse is suspended in an Anderson sling and merely under heavy sedation.

"Should this not be possible, Barbaro could also be anesthetized in this sling and then gradually woken up from this short-term anesthetic in the sling till he regains sufficient muscle strength and coordination capacity that he can be walked back to his stall," he said.

With numerous obstacles to overcome in the next few months, Barbaro seems to be up to the challenge.

"He's a very well-behaved horse and does pretty much anything you want him to do, which for a 3-year-old colt is a pretty good trait, because they don't always behave that well," said Dr. Liberty Getman, a second-year surgery resident who takes care of the horse on a daily basis.

"He's a pretty smart horse; he takes care of himself very well," added Dr. Steven T. Zedler, a first-year surgical resident assigned to Barbaro's care. "All in all, he's been an excellent patient. I think that that's definitely in his advantage insofar as his recovery is concerned."

Cost figures in  

Dr. Driessen feels the positive coverage in the media of Barbaro's case could push veterinary orthopedic surgery a "big step forward." The field has benefited from technical advancements, he said, but many horse owners don't pursue orthopedic repair procedures of this type because of the cost.

"It means that for a long period of time, you are not sure that the animal will survive ... and yet you have to invest an enormous amount of money," he said.

Dr. Richardson estimated the medical treatments for Barbaro would cost tens of thousands of dollars. "I think it's very important for the public to recognize that in fact, the surgery that was done on (Barbaro) is really ridiculously inexpensive compared with what would be charged for the same effort, same materials, same everything, in treating a human with a similar fracture."

Aside from the dollars and cents, Dr. Richardson believes repairing Barbaro's limb was just part of his job as a veterinarian. "There are many things that can be done for horses, and lots of veterinarians and owners who will do whatever it takes, within reason, to save animals and give them a good quality of life."

For updates on Barbaro's condition, visit the University of
Pennsylvania veterinary school's Web site at www.vet.upenn.edu.