Thursday, January 29, 2015

The Barbaro Effect: How One Horse Changed the Face of Laminitis Awareness--and Google Search Statistics--Forever

A racehorse named Barbaro won the Kentucky Derby in 2006. He fractured his right hind leg in the Preakness, two weeks later, and suffered from laminitis during his complex recovery from surgery to repair the limb that summer. The world watched him struggle to recover. Eight months after his injury, he was euthanized. Laminitis was given as the reason for ending his life. The world--not just the horse world--was stunned that his life couldn't be saved. What was this disease, they wanted to know? Barbaro showed them what it was, in the most tragic possible way. His name became synonymous with laminitis awareness and research. And Google has proof of that.

Barbaro died on January 29, 2007. Where were you, eight years ago today? More importantly, where was your awareness and knowledge of the disease of laminitis? And where are you--and your laminitis awareness and knowledge--now?

The "Barbaro Factor" of laminitis in international news media and Google Search: The spike at (G) was the announcement in the summer of 2006 (July 13, to be exact) that Barbaro officially had laminitis in his left hind foot. (F) marked the laminitis improvement announcement. (E) Barbaro's foot cast was removed to evaluate his laminitis in November 2006. (D) Laminitis setback in January 2007.  (C) is media coverage of the laminitis-related death of racehorse Kip deVille. (B) is Pleasant Tap's euthanasia for laminitis. (A) is the laminitis death of Intense Holiday last year. Notice that Google is forecasting a few more laminitis "bumps" in media coverage for 2015, based on past statistics.

Laminitis, as I see it, began its modern era in the early 1980s. Something changed then, the first of several things that would bring laminitis ever closer to all our horses.

Before that, laminitis was a dreaded word that was spoken in a whisper. It was something most people had never seen. I know I hadn't, except maybe in fat ponies who seemed to get lame every spring, or long-coated old horses and ponies who hobbled around some back field somewhere, or into and out of an auction. I saw it, but I didn't know what it was. And I didn't give it a second thought. Few people did.

The horses affected by laminitis were invisible, and so was their disease, unless a horse got into the grain room, suffered an adverse reaction to a medication, or possibly "overloaded" the good limb after an orthopedic injury.

The few high-profile cases were out of sight, in university hospitals and big vet clinics, or under the care of fly-in laminitis super-heroes like Dr. Ric Redden or the late Burney Chapman.

Then two things happened in veterinary medicine. The first was that colic surgery--and surgery in general--became more common and more available to pleasure horses (if their owners could afford it), so post-surgical ("complication") laminitis became a much more common problem to fear and dread. "Complication" is an understatement. Is there anything more complicated than laminitis in a horse already struggling to recover from major abdominal surgery?

The second thing: Veterinarians and farriers across the USA started to roll up their sleeves and take these cases on, armed with advice from Redden, Chapman and others given generously at meetings like the Bluegrass Laminitis Symposium. Insurance companies went to bat to save horses. Vets and farriers had a reason to work together. They had to. To make matters worse, a mysterious new disease appeared in the east, Potomac Horse Fever, that often caused severe and sudden laminitis.

We wouldn't be able to see what was going on until much later. Then the great racehorse Secretariat died with laminitis as a cause on October 4, 1989; if he couldn't be saved, what hope was there?

Two years later, Standardbred Horse of the Year Nihilator would spend nine months at the University of Pennsylvania's New Bolton Center undergoing laminitis treatment. In spite of marked improvement and a return to breeding, laminitis returned. He was euthanized November 7, 1991.

What else might cause laminitis? We didn't know. As early as 1999, Philip Johnson's research identified obesity-related laminitis as having an endocrine factor; he called it "peripheral Cushing's syndrome" or "pre-Cushings". In 2001, California farrier and nurse Matt and Susan Fredericks, bravely reported their theory at the Bluegrass Laminitis Symposium for a possible hyperinsulinemia syndrome unique to horses that suggested you could connect the dots between insulin levels and hoof tissue breakdown.

How interested were people in Barbaro's battle with laminitis? Compare stats from Google Search and Google News for Barbaro vs the equine influenza crisis that shut down the horse industry, breeding, and racing on Australia's east coast in 2007. That crisis directly effected horseowners and horses, yet the activity was a fraction of Barbaro's.

Secretariat and Nihilator put laminitis in the headlines, even if no one outside the horsecare world really knew what it was. It took the lives of champions, that was all the public needed to know.

But the ubiquitous "pasture" or "grass" laminitis was becoming so common that almost everyone had some experience with it. It could have easily been called "backyard" laminitis. Whether it was the low-grade chronic laminitis of the easy keepers or the sadly debilitating Cushing's disease in older horses, laminitis seemed to be in all our barns, sometimes without even our knowledge.

Laminitis is a seasonal disease. Information queries should peak in the spring and taper off after that, right? Wrong. Google records quite consistent search queries for laminitis information throughout the year, with a peak from March to May, indicating that horse owners are seeking ways to prevent the disease as the grass turns green. Yet there is only a small drop off to other months. October also shows significant inquiries.

Today, supplements, designer trims, grazing muzzles, vibrating platforms, hoof boots, slow feeders and hay soaking promise salvation. American horse owners have learned about laminitis the hard way: not by reading about it, but by living with it in our barns.

Some of us learned the very hardest way of all, by losing our horses. We lost them because we let them go, because we wanted to spare them the pain, because we were frustrated that there was nothing anyone who flew in from any far corner of the planet could do. And they told us so.

Interest and frequency of publication on the subject of laminitis is almost three times higher in Great Britain than in the United States, and almost two times higher in Australia than here, yet the "spiking" news moments occurred in the US, related to celebrity racehorses. (Hoofcare Data via Google Trends research)

And then came the summer of 2006 and Barbaro.

He didn't have "pasture" laminitis, or Equine Metabolic Syndrome as we now call it, or PPID. He had little to nothing in common with the thousands of horses in the United States whose owners fight laminitis for them. But 2006 was also a turning point when management strategies were taking over laminitis on the local level. Prevention ideas, led by the quiet direct-to-owners web advice of Dr. Eleanor Kellon through her articles in the Horse Journal and her Equine Cushing/Insulin Resistance web group, empowered owners to see what choices in nutrition meant to the big picture, and that unraveling the exact cause of a horse's laminitis was a complex task that might never be complete.

People ask me why, then, an elite Thoroughbred like Barbaro resonated with so many yeoman horseowners and I always say, "Because so many of us had been there, or were there, at that time, with our horses. And the rest of us fear that we'll be there one day."

"There" is that point at the end of the long, painful road where laminitis still leads far too many of our horses.

To the general public, laminitis translated simply as  "painful". They understood the analogy of a horse standing on a ripped fingernail and knew the horse was suffering, and in a very public way. That was all that was needed for an outpouring of support. Everyone roots for the underdog. A beautiful colt like Barbaro would be the one to beat the odds. And he almost did.

A 7 ft by 72 ft get-well card for Barbaro from fans at the Belmont Stakes in 2006 (Naoki Nakashima photo)

After his tragic but humane death, Barbaro became the poster boy for laminitis research, and for laminitis itself. Public awareness soared. Research coffers swelled. Articles about laminitis were everywhere. Notice the spike on the Google Trends chart for 2006-2007: that's the Barbaro Factor.

The "Big L" cases of septic and support limb laminitis are still out there in the vet clinics and university hospitals, but the common laminitis, laminitis with a small "l", was--and is--everywhere. The problem is that, when not properly diagnosed and treated, small "l" laminitis keeps recurring until it's not just an annoying seasonal lameness problem, but the horse's entire health and quality of life are endangered. Small "l" laminitis just can't be ignored.

And yet it is, day after day. Horse owners simply are not getting the message. Laminitis is something horrible that your horse wakes up with one day, they think. Like Barbaro. Their horses are just a little ouch-y some days, just a little hesitant to turn. The hoof walls are just a little ridged. The white line is just a little stretched. He's just a little bit overweight. His neck is just a little cresty.

They remember Barbaro: the drama, the tragedy, the big announcements.

Their horse is fine! He's not hanging from a sling or hooked up to IV pain medication servers. He's still kicking his stall for breakfast in the morning, still pushing the others away from the hay in the paddock.

But he's not ok.

Maybe it will be next week, next month, next spring or next fall, or the year after that, when people finally pay attention. When the vet who has been advising feeding less and exercising more after seeing this horse for shots twice a year finally stops what he or she is doing and says directly to the owner, "Well, he's been showing all the signs for years. I've been telling you he needs to lose weight. It's too late now."

And the owner will inevitably say, "Why didn't anyone tell me?"

They did. We did. Will it take another spike in the Google stats, and another, and another for the information to finally reach the people who need to hear it? Does laminitis need to be in the headlines every day?

Let's look forward to the day when the Google Trends data analysis for laminitis is a flat line. "No data to report, sorry." Let's make a last big spike of our own and get the word out: Prevention is more successful than treatment. Prevention is possible, in many cases. These are the warning signs. These are the tests your horse needs. This is when the tests should be done. These are the risk factors. These are things you can do.

The Barbaro Effect is incomplete, as long as the surge in common chronic cases goes on, and as long as these horses are not receiving sufficient treatment for their disease because the owners still are not educated about the causes and signs of laminitis.

Look at the chart again. You can see that Google is predicting a few bumps, or laminitis-related events, to make news in 2015. Let's make that story the end of it. Let's get laminitis over with, while we still remember who Barbaro and Secretariat and Nihilator and all those other great known and unknown horses lost to laminitis were. Eight years of knowing about Barbaro's losing battle with the disease is enough. End it now.

Thank you for reading and sharing this article.

Thank you also for continuing to support laminitis research. The Animal Health Foundation is an organization dedicated solely to funding laminitis research; 100 percent of public donations go directly to research. 

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