Sunday, August 14, 2011

British Racehorse's Story Touches a Nerve: Illicit Neurectomy Revealed After Breakdown and Euthanasia

Nerves in the distal limb of the horse, shown in yellow in this image, are very specialized. It is possible to selectively de-sensitize only the heel area of the foot, a common location of foot pain, with a neurectomy, a relatively simple surgical procedure that is commonly used for many racehorses in the United States but banned in Great Britain on welfare grounds. Image from The Glass Horse: Elements of the Distal Limb.
Political scandals often draw a line in the sand for the accused. It comes down to: “What did they know and when did they know it?”

Sometimes, lame racehorses can make the same question a valid one. And the wrong answer can cost a trainer his career.

That’s what happened in England this week, when a trainer received a four-year ban, ostensibly for the off-season use of steroids. But what really earned him the ire of the public and the racing world was the post-mortem discovery that a horse in his stable had run eight races after having a chronic foot lameness caused by an ulcerated corn resolved by surgically severing the nerves to the back part of his foot.

The British racehorse suffered from a lameness problem stemming from an infected corn, which is a form of heel bruise in an area of the horse's foot known as the "seat of corn". Corns are common in so-called "thin-soled" horses. (Photo © 2011 Hoofcare Publishing, from the Wildenstein Photo Library.)

How did anyone come to know the horse had been secretly nerved? During the horse's eighth race since surgery, the horse ruptured the superficial flexor tendon in the same leg as the injured foot. The trainer ordered the horse to be euthanized on the track. A subsequent necropsy looked closely at the injured limb; the pathologists reported their finding, that the horse had been nerved in that foot, in violation of British racing rules.

The very same surgical procedure would have been legal in many racing jurisdictions in the United States.

It's not all bad news for lame horses in jump racing. Here's a horse who's been on the Hoof Blog before. This is Knowhere, one of the original poster colts for stem cell implantation in tendons. He suffered a serious tendon bow in 2005 but has managed to stay in training and racing since his return. He lost his rider somewhere at Cheltenham this year.

The procedure is known as a “low” palmar digital neurectomy (PDN). This minor surgery has traditionally been performed on many horses that have so-called incurable navicular disease. It is sometimes performed repeatedly in the same horse, since the nerves regenerate. And it is sometimes even performed on multiple limbs of the same horse.

The problem in America? Buyer beware: it is difficult to ascertain if a horse has been “nerved” or not. Nerved horses (sometimes called de-nerved horses) are suspected by some of being unsafe mounts.

The problem in Britain? No one knew the horse had been nerved until it broke down on the track and necropsy examination revealed the surgery.

Debates go on and on in the United States about both the safety of nerved horses and the ethics of performing the procedure. If you believe that it is best to relieve a horse’s chronic pain, neurectomy certainly achieves that goal.

The nerves of a horse’s distal limb are very specialized, and it is possible to selectively desensitize the palmar or plantar region of the front or hind foot. This is where heel pain and “navicular” type pain are centered. One snip and the horse’s pain is gone.

So is its ability to know if it stepped on a nail or not. The British and some US states—such as California and Arizona—think a horse shouldn’t race if it can’t feel its foot. In the show horse world, nerving is still a common and economical solution to the problem of a lame horse that has not responded to therapeutic shoeing. FEI rules prohibit a nerved horse from competing. But how would anyone know?

Nerving salvages the careers of laid-up show, performance and rodeo horses. Horses that I see nerved are usually older horses with chronic conditions and the owner understands that it is a salvage procedure to keep the horse comfortable. They ride with care It makes a less painful retirement for many geriatric horses with chronic foot pain.

But I don't live in the real world. In some cases, horses return to the show ring. In some states, neurectomy keeps a horse racing and earning money.

Jump racing horses are among the fittest equine athletes of the horse world. This is Neptune Collonges, one of the top horses in Great Britain. He's expected to race again this year, at age 11. (Charles Roffey photo)

And that was all British trainer Howard Johnson wanted: a horse that kept racing, so its owners would be happy.

On page 32 of the rules of British racing it says simply: "Neurectomy operation: horse may not start 152(iv)".

Compare this with most US states that require a nerved horse's surgery to be recorded on a list (Massachusetts), or added to his official registration records, as is the case with harness racing horses in the state of Kentucky.

In Britain, there is no list and apparently no official recording of the surgery. It's a Catch-22: the procedure makes it illegal for a horse to race so the horse would be removed from racing. But then again, there's no record so if the horse changed many trainers are savvy enough to really tell if a horse has sensation in his heel bulbs or not? How many actually feel their horses' feet?

The effects of a neurectomy gradually wear off but the timeframe varies from horse to horse. Some horses might benefit from the surgery, such as the case of the British horse, who suffered from an infected corn and went on to race successfully in the tough sport of National Hunt racing.

But the flip side is also true: an infection could go deeper into the foot and cause more damage...but the horse might gallop on until the infection spreads to an area served by other nerves or until a structural rupture or fracture occurs.

Neurectomy surgery is performed at the site of the nerve branch that the surgeon wishes to sever. (Modesto Bee photo of surgery at Pioneer Equine Hospital as published previously on The Hoof Blog.)

Johnson's hearing before the British Horseracing Authority conflicted with the testimony of his veterinarian. It was vague whether the vet knew that the trainer planned to race the horse again; the vet testified that he hadn't ever heard of a neurectomy being done on a racehorse before.

When interviewed, Johnson gave the following explanation when questioned as to what was his understanding of the denerving operation: “…Well, when you de-nerve something like say in the foot he said the horse would become sound, and I just wanted the horse to run.…you have to try every corner to get a horse to win a race.”

The Panel received expert evidence from (veterinary surgeon) David Ellis from the Newmarket Equine Hospital. He explained that a neurectomy removes sensation from the painful area, masking the signs of pain but not curing any pathology which gives rise to the pain.

Following a palmar neurectomy, such as undergone by the horse in question, Mr Ellis explained that the gelding was at risk that an injury, such as a fracture of the heel or navicular region or a penetration or infection, would go undetected.

As to the welfare aspects of equine care, Mr Ellis noted that it cannot be in the best interests of a racehorse’s welfare that in order for it to be sound enough to be trained and raced it has to have an operation to permanently desensitize the area which is giving rise to pain and lameness. The Panel accepted this evidence.

Racehorses of all types are under scrutiny for how their welfare is being protected. What seems like an act in the best interest of the horse is sometimes disputable.

Hoofcare and Lameness originally learned of the judgment against Howard Johnson when word came from the British charity World Horse Welfare that it welcomed the British Horseracing Authority’s decision to impose a four-year ban from training on Johnson, who subsequently announced his retirement. The charity’s Chief Executive Roly Owers said: “We welcome the BHA’s verdict and sentence of Howard Johnson which is proportionate to the seriousness of his crime.

“When we use horses in sport, that places a significant burden of responsibility on our shoulders for their welfare, and Howard Johnson simply did not live up to that responsibility. He showed a callous disregard for the well-being of the horse when he made the decision – not once but eight times – to run Striking Article without any feeling in one of his forefeet.

"This was a reprehensible act that clearly crossed the line between the acceptable and unacceptable use of horses in sport.

“We are also dismayed that a trainer of Johnson’s experience and stature is pleading ignorance of the rules. Ignorance is no excuse for not knowing the rules but more importantly it’s no excuse for cruelty. Looked at it another way, we just need to apply a little simple common sense: how could anyone think it was acceptable to race a horse that was in so much pain it needed a neurectomy in the first place?

“This case should send out a clear message to everyone involved in racing that the welfare of the horse has to come first, not the need to win at any cost.”

There are plenty of ways for a jump racing horse to go lame. (Pablo Camera image)

Remember the old saying, "Beauty is in the eye of the beholder"? We're learning that equine welfare is in the mind of the owner (or trainer). What seems like the kind thing to do in one country is seen as the antithesis in another.

The moral of this story: Remember what you say and when you say it. And to whom. Most of all: know the rules...and follow them. Work to change them if you don't think they're in the best interest of the horse.

Maybe that's what Howard Johnson will do in his retirement.


Hoof Blog: Neurectomy Ethics Rear Up Again in California (October 2007): What happens when you buy a horse in a state where nerving does not have to be disclosed but you intend to run it in a different state...where nerved horses are prohibited from racing? That's what happened in California a few years ago. The following year, running nerved horses was banned in California.

Hoof Blog: Watch a horse undergo a neurectomy procedure at California's Pioneer Equine Hospital in a special video.

Hoof Blog: Cobra Venom Raises Its Numbing Head at Racetracks (Cobra venom use has been described as creating a "chemical neurectomy" when injected into a horse's foot)

Watch a detailed procedural video of a neurectomy at Cornell University College of Veterinary Medicine

Thanks to Charles Roffey for the photo of Neptune Collonges, to Pablo Camera for the action photos and to Carine06 for the photo of Knowhere.

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