Barbaro's injury highlighted problems, medical advances

Barbaro's death illustrated both the great advances and the continuing mysteries that surround the treatment of horrific thoroughbred injuries.

"I think the veterinary profession, from owners, to trainers, to doctors, should be proud of the way that horse was treated," said Gregory L. Ferraro, director of the Center for Equine Health at the University of California, Davis. "The day of the injury, there wasn't a vet out there who thought he had much more than a nil chance of surviving. The fact that they came very close to saving him is an example for other vets to follow. I can't think of a case where more was done to save an individual horse."

University of Pennsylvania surgeon Dean Richardson was able to piece together Barbaro's right hind leg a day after he pulled up during the Preakness Stakes at Pimlico in May. But veterinarians and trainers worried about complications - laminitis in the left hind hoof, an abscess in the right hind hoof and laminitis in both front feet - that ultimately made it necessary to euthanize the Kentucky Derby winner yesterday. They knew the horse would have trouble maintaining even weight distribution and that the imbalance would expose his healthy legs to laminitis and abscesses. As predictable as those problems are, veterinarians can't do much to prevent them.

"They're designed for speed, not necessarily to be ill and recover well," said Kimberly May, a veterinary surgeon and spokeswoman for the American Veterinary Medical Association.

Laminitis, a painful inflammation that causes separation of the hoof, has long affected racing horses. References to it can be found in books on lameness from the 1800s, May said. Barbaro's laminitis developed from uneven weight distribution, but other horses might contract the disease from infections, exposure to chemicals or an unbalanced diet.

The disease's pathology is uncertain and that is part of the reason it is so difficult to prevent or manage. Veterinarians said they hope Barbaro's case will draw attention to laminitis and inspire greater funding for research.

"Even though the result was not positive in this case, I think it will have a lasting effect on the treatment of racehorses and on veterinary medicine in general," May said.

A 'near miss'
Veterinarians said that in addition to the extensive measures devoted to saving Barbaro over eight months, his doctors and owners should be credited for giving up when the horse's suffering eclipsed his chances to get better.

Rick Arthur, a racetrack veterinarian at California's busy Santa Anita course, compared Barbaro to early human recipients of heart transplants, who often survived only a few days but heralded the coming of remarkable advances.

"We're at a stage in the profession where saving a horse with an injury as bad as Barbaro's is possible," Arthur said. "Despite the outcome, this was a very, very near miss, and that's amazing."

But the case illustrated the difficulty of working with 1,200-pound animals that support themselves on spindly legs and can't remain off their feet for long periods.

"It will always be a serious complication to what we do, because basically, the horse has to be standing within an hour of surgery and has to bear that weight relatively evenly," Arthur said. "That's what mother nature has given us. If you or I had the same break, we'd be resting in bed for weeks."

Arthur said it's too early to know what breakthroughs might spring from the case. But he said veterinarians worldwide will analyze the pain management and weight distribution techniques applied to Barbaro's recovery.

The same physical equation that makes recovery difficult - such powerful bodies supported by such delicate legs - makes injuries inevitable as well.

"There's a certain implied risk and we hope each time we do it that we don't get hurt," said Mike Trombetta, a Maryland trainer whose Sweetnorthernsaint opposed Barbaro in the Preakness. "With this horse, he had a misstep and a terrible injury and it didn't work out. The same thing goes with any professional athlete. ... You can see a football player run down the field and without anyone around him, get a hamstring injury or something else happen to him that turns out to be career-ending."

That comparison is one animal rights activists may never accept.

"They're just pawns and treated as such and while Barbaro was going through his treatment, many horses were dying on tracks around the country and no one cared about them," said Jackie Vergerio, a spokeswoman of People for the Ethical Treatment of Animals.

Better treatment
Veterinarians cited several technological leaps that helped Barbaro survive as long as he did: stronger plates and pins held the horse's shattered leg together; improved anesthesia allowed for gentler transitions into and out of surgery.

"The fact that they were safely able to get him down, work on him and get him back up so many times is a great tribute," May said.

She pointed to the 1975 case when an undefeated filly, Ruffian, suffered a leg injury at New York's Belmont Park and was euthanized shortly after. Veterinarians repaired Ruffian's leg but couldn't keep the horse from re-injuring it while coming out of surgery. Barbaro's greater success showed how much smoother the process has become, May said.

She and others were amazed at Richardson's ability to reconstruct a leg broken in three places.

"Repairing that leg was almost in violation of the laws of orthopedics," she said.

Jockey Jerry Bailey noted that Barbaro was a remarkable patient as well.

"What's amazing is how good of a patient he had to be, keeping proper balance of weight, being in the sling, and allowing himself to receive the help," he said.

Veterinarians said they felt no misgivings about the length of time and intensity of efforts to save Barbaro.

May said the equation is relatively simple with major leg injuries. "If the owners are willing to spend the money, and the blood supply to the limb is there, than you can go ahead and try it," she said.

But many can't afford to go as far as Barbaro's owners.

"It's thousands of dollars just to walk in the [veterinarian's] door," said Stephen Fulton, a farrier and owner of Full Moon Farms in Finksburg. "You start thinking that's a year's tuition for your kid."

Barbaro was a rare case. "He was an incredibly valuable horse and they are very wealthy people," Fulton said. "[Veterinarians] have made major advances, but they [horses] are still very fragile and they don't recover well."

The trickiest part comes when setbacks arise and the veterinarian has to weigh a horse's suffering against his prospects for survival. Arthur said he visited with Richardson in California last week and found him well aware that Barbaro's health was worsening.

"There was no doubt that the welfare of the horse was his primary concern," he said.

Veterinarians said Richardson did an ideal job of balancing his search for medical solutions with concern for Barbaro's suffering.

"This case demonstrates what we all use as a guideline, which is that we make heroic efforts to save the animal, but when the suffering outweighs the possibility for survival, euthanasia becomes almost a gift to the animal," Ferraro said.

He said experienced veterinarians develop a sense for when their patients have had enough.

"They just sort of give you a look that says, 'I can't take this anymore,'" he said.