Sunday, May 10, 2015

Case Notes: Inside Bal a Bali’s Laminitis Recovery

An earlier report on the successful return to racing for Brazilian champion colt Bal a Bali regretted the lack of details about the horse’s fight against laminitis and what types of therapy had been utilized to aid his recovery after he arrived in the United States in July 2014.

Thanks to an interview today with Rood and Riddle Equine Hospital’s Vernon Dryden, DVM, some of the details of Bal a Bali’s nine-month ordeal can now be shared. Dr. Dryden acknowledges the willingness of the colt’s owners, Sienna Farm and Foxhill Farm, to share information that might benefit another horse suffering from a similar problem.

Every case of laminitis is different and many factors come into play in determining the horse’s chances for survival, if not recovery and return to athletic performance. In Bal a Bali’s case, the cause of his initial illness is not known, so the story is still quite incomplete.

Vernon Dryden, DVM of Rood and
Riddle Equine Hospital
A horse’s treatment plan also needs to be designed with realistic factors in mind: will the horse need to return to racing or showing? does it have breeding potential? is age, previous injury or medical history a factor? does the owner or caregiver have facility or financial limitations that limit the types of therapy that can be given? is it possible to monitor the horse in a clinic setting? will primary and consulting professionals be able to visit the horse often to monitor progress and adjust treatments? Even with a carefully designed plan, laminitis can have everyone involved thinking on his or her feet throughout the experience. And things rarely go as planned, even when they seem to be going well.

Arrival and quarantine

Bal a Bali shipped from Brazil to Florida in late July 2014. After arrival, he was quickly identified as a horse in need of medical care. He was transferred to Palm Beach Equine Clinic in Wellington and the care of Weston Davis, DVM, DACVS.

As stated in the previous article, Palm Beach Equine accommodated the colt by setting aside a barn as a quarantine unit to meet his import requirements.

Meg Miller-Turpin, DVM, DACVIM consulted on the internal medicine care of the horse and Vernon
Dryden, DVM, CJF of Rood and Riddle Equine Hospital in Lexington, Kentucky was contacted for his expertise with treating laminitis cases and podiatry management.

Intensive therapy

A cold-water spa from The Sanctuary, a horse rehabilitation center in Ocala, Florida was trucked to Wellington. In spite of the mid-summer Florida heat, the horse was able to stand in the spa’s ice-cold water about eight hours each day for several days. Prolonged cryotherapy, or intense cold application, has been shown to decrease the severity of damage caused by laminitis.

Dryden said that he was very concerned by how ill the horse was. He immediately began the first of four monthly stem-cell treatments in the horse’s front feet, which were in Soft Ride boots. He reported that radiographs showed rotation of the coffin bones and that the horse was beginning to sink soon after he took on the case. 

Additionally, sterile maggots were used in the horse’s right front foot to prevent osteomyelitis following the debridement of a deep subsolar seroma.

“If the colt had not responded to the treatment, I would have (recommended to either) cut the (deep
digital flexor) tendons or put him down,” Dryden recalled, emphasizing the severity of the horse’s
condition over the summer months. He did not put the horse in foot casts, but instead designed custom supportive Sigafoos glue-on shoes for the horse when the feet were able to be shod.

Bal a Bali remained at Palm Beach Equine Clinic for about three months. He continued to improve and was considered healthy enough by October to be transferred to Siena Farm in Kentucky. At Siena Farm, the colt stood on a vibration platform each day and in another cold water spa. Before long, he could be turned out, and plans were made to start him back in training. 

Dr. Nathan Slovis of Hagyard Equine Medical Institute became involved the horse’s medical care during this transition period.

Back on track

Winstar Farm in Kentucky has a training track, which Bal a Bali used as his first step back to racing. Dryden removed the Sigafoos support shoes, and replaced them with plastic glue-on EasyCare shoes, noting that occasionally the colt had some soreness. Eventually, as training continued, the feet were re-shod with glue-on Burns Polyflex shoes, and it was in those that he shipped to California in January.

Dryden made three trips to California between the end of January and early May to check on the colt and shoe the front feet with Polyflex front shoes while he was in training. On Saturday, he raced in the Polyflex shoes.

And he won.

Post script

Readers of The Hoof Blog will see many therapies listed in this article that are often short-listed or long-listed for laminitis therapy. Bal a Bali checked off almost all the boxes.

Dryden gave credit to the horse’s owners for the free rein given to him in treating the horse. “I can’t thank Anthony Manganaro of Siena Farm and Rick Porter of Foxhill Farm enough,” he said. “They gave this horse every chance. Having owners like that is amazing. There was no holding back: whatever the horse needed, it got.”

Hopefully this case also illustrates that it was not just “what” the horse needed, but “who” and “when”. The right people at the right time in the progress of laminitis might be even more important than the right machine or the right shoe or the most advanced treatment protocol.

The ultimate weapon against laminitis will always be the human brain; Bal a Bali had a lot of help in that department, as well as all the latest tools.

by Fran Jurga

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