What's Next for Barbaro: External Fixation for Collapsing Right Hind

Left: Barbaro's right hind leg as it appeared on radiographs in November. This leg is now equipped with an external fixation device for support; pins were surgically implanted through the leg to attach to a brace.

A sobering statement from New Bolton Center this morning:

"On Saturday, January 27, Barbaro was taken back to surgery because we could not keep him comfortable on his right hind foot. That foot developed a deep subsolar abscess secondary to bruising when he went through a period of discomfort on the left hind foot. It is not laminitis but the undermining of the sole and part of the lateral heel region are potentially just as serious.

"We attempted to manage the right hind foot in a cast and then in a custom fabricated brace but it was impossible to have access to the foot for treatment as well as acceptable stability and comfort.

"We elected to place his right hind in an external skeletal fixation device in order to provide the foot a chance to heal. This means that two steel pins have been placed transversely through his right hind cannon bone. These pins are connected to external sidebars that in turn are connected to a lightweight alloy foot plate. This results in the horse eliminating all weight bearing from the foot; the horse's weight is borne through the pins across his cannon bone.

"There is significant risk in this approach but we believed it was our only option given the worsening of the right hind foot problem. The major risk of the external skeletal fixation device is that the bone bearing the weight can fracture. Unfortunately, we felt we needed to take this risk because this approach offered our only hope of keeping Barbaro acceptably comfortable.

"He had a perfect recovery from anesthesia and has been in and out of the sling since then. His left hind foot appears to be stable at this time. We remain concerned about both front feet. Remarkably, his attitude and appetite were excellent overnight.

"We will continue to treat Barbaro aggressively as long as he remains bright, alert and eating. This is another significant setback that exemplifies how complex his medical situation remains because both hind limbs have major problems."

External fixation for laminitis and other conditions is not an unproven technique for New Bolton. The hospital's Dr. David Nunamaker is probably the world's leading expert on this type of support. Photos of similar fixations from Hoofcare & Lameness files will be added to this story when I am back in the office.

From Gretchen Jackson, owner of Barbaro, on Saturday:

"He's got a lot of issues, and not any of them is bad enough to say goodbye. But put together it's not a good day for Barbaro," Mrs. Jackson told Mike Jensen of the Philadelphia Inquirer.

Scott Morrison DVM, consultant on Barbaro's foundered left hind foot, was at home in Kentucky yesterday.

Journalist Jensen recently won an Eclipse Award, racing's highest honor, for his reporting on Barbaro. He is basically embedded at New Bolton Center, somewhere near the reception desk.

Stride Characteristics vs. Conformation: The "Deep Impact" Impact

Interesting report today from the Japan Racing Association, as presented this week at the Asian Racing Conference in Dubai:

(As posted on http://www.thoroughbrednews.co.nz)

"The success of Deep Impact, an unremarkable-looking racehorse, is down to his incredible stride, extensive scientific data revealed.

"Dr Hiroko Aida, from the Japan Racing Association, displayed the running form of Deep Impact in the veterinary science workshop at the 31st Asian Racing Conference in Dubai.

"A host of measurements were taken from high-speed video data of the Kikuka Syo (Japanese St Leger) at a rate of 250 frames per second.

"Sophisticated analysis has revealed that the champion racehorse’s ratio of overlap time to stride duration was 8.5 per cent, compared to that of an average horse, which is 17.1 per cent.

"It was postulated that this characteristic, which is also common to the great American horse Secretariat, may be an essential feature of superior horses.

"Aida said that such video analysis could in the future identify the “next Deep Impact” before he hits the sale ring."

Editor's Note: Deep Impact was Japan's superhorse. He retired this fall with earnings of 1.5 billion yen (about $13 million US). When Deep Impact traveled to France this fall for his gallant third-place finish in L'arc de Triomphe, chartered jumbo jets full of his fans accompanied him. Deep Impact is one of many stakes-winning offspring of American champion Sunday Silence, who stood at stud in Japan before his death caused by laminitis.

Barbaro Update: Cast changes, heel abscess in right hind

From the University of Pennsylvania today:

“Barbaro was placed under anesthesia yesterday to have his left hind foot cast replaced,” said Dr. Dean W. Richardson, Chief of Surgery. “We also removed the cast on his right hind leg and replaced it with a custom-fabricated plastic and steel orthotic brace to give his foot additional support.” An abscess near the lateral heel of his right hind foot was drained, and the brace that was applied will allow more regular treatment of that foot.

“Barbaro had another smooth pool-recovery and has been comfortable with an excellent attitude and appetite since then,” said Dr. Richardson. “We will probably replace his left hind foot cast under anesthesia again at least two or three times at roughly two-week intervals if his comfort is maintained. We were very pleased with the progress of his left hind foot since the last cast was applied.”

In addition, new shoes were placed on both front feet for additional support.

Waltham and Royal Veterinary College Organize British Laminitis Conference in March

(edited from press release received 25 January)

The WALTHAM^® Equine Studies Group and the Royal Veterinary College have joined forces to host a laminitis conference at The Royal Veterinary College at North Mymms, Hertfordshire (England) on Saturday 24 March 2007. Targeted at vets, researchers and others interested in the condition, the conference includes recent research findings and advice with respect to laminitis.

Pat Harris PhD MRCVS, head of the WALTHAM^® Equine Studies Group will chair the conference; she said: "This conference should bring you up to date with the current thinking on the pathophysiology of laminitis and how to manage affected animals. In addition, we will provide exciting new insights into ways that may help us to predict which animals are more likely to suffer from this debilitating condition, as well as management strategies that may reduce the risk of an episode occurring."

The program covers key aspects of laminitis, its possible causes and management regimens. Dr Annette Longland BSc, PhD will discuss "Starch, sugar, and fructans: what are they and how important are they?". Jonathan Elliott MRCVS (Professor of Veterinary Clinical Pharmacology) will look at new insights into the cause. Ray Geor PhD, DACVIM will examine the role of obesity and insulin resistance. Pat Harris will cover the nutritional counter-measures to laminitis. Celia Marr PhD, MRCVS will examine the medical management of the acutely laminitic Horse. Simon Curtis FWCF HonAssocRCVS will explain the role of the farrier in the management of laminitis. Nicola Menzies-Gow MRCVS (Lecturer in Equine Medicine) will provide insights based on various laminitis field studies. Jonathan Elliott will present a paper by Simon Bailey MRCVS (Lecturer in Veterinary Pharmacology) examining how an increased risk of suffering from this condition may be predicted now and in the future.

To register for the conference please telephone Kerry Knight on (011+ from the USA) +44 (0) 1908 576258. The fee is £30 (approximately $60US), which includes lunch and a full copy of the proceedings.

EDITOR'S NOTE: The Royal Veterinary College (RVC) is the UK's first and largest veterinary school and a constituent College of the University of London. Equine laminitis has been a focus for researchers at the College for the past 15 years. The research team involved includes pharmacologists, endothelial cell biologists, bacteriologists, endocrinologists and epidemiologists. The group has made significant steps towards understanding the link between events in the gastrointestinal tract and failure of the dermal-epidermal bonds within the hoof laminae. Recent work has turned to understanding the factors making some horses and ponies particularly susceptible to bouts of laminitis.

Eclipse Awards: The Hoofcare & Lameness Connection

At last night's Eclipse Awards for "horse of the year" honors, the racing world waved good-bye to the stars of 2006. It was a great year for racing, although most of the nominated horses are injured or retired; one is even dead (Pine Island, who broke down in the Breeders Cup).

Barbaro, nominated for top three-year-old honors, was no doubt watching the ceremony from a tv in his stall at New Bolton Center's ICU. He didn't win. He lost to Bernardini, the horse who kept on running and won the 2006 Preakness while Barbaro broke down near the start. Bernardini is already in Kentucky, with mares lined up for the breeding season that is starting now.

At evening's end, Barbaro again ran second to Invasor as horse of the year. Invasor's story was one of the quirkiest of the year. He arrived from Uruguay as a surprise to his trainer, having been purchased on a whim by Hoofcare & Lameness subscriber Hassan bin Ali, who was in Uruguay buying endurance horses for Dubai's royal family.

Hassan's next stop from Uruguay was the Hoofcare & Lameness office, where he grilled me, as usual, about new horseshoes and technologies that might be of use to his training program. But he also showed me videos (on his cell phone, of course) of the horses in Uruguay, and "this super racehorse".

The next time I saw Hassan bin Ali was when he joined Invasor in the winner's circle at the Whitney Stakes in Saratoga. Invasor just kept on running, all year, and won the Breeders Cup Classic, defeating even Bernardini. And the best news is that Invasor will keep on running in 2007.

Back home in Uruguay, I'm sure the crowd went wild. Congratulations!

Barbaro Update: Surgeon Honored by Media

New Bolton Center's Dr. Dean Richardson was in the spotlight at last night's Eclipse Awards. Earlier in the day, Richardson was honored by the Turf Publicists of America with the group's Big Sport of Turfdom Award. The award is given to key non-media figures in racing who cooperate with or provide expert information to the press.

Today's Daily Racing Form has a nice article about the award and Richardson; here are a few salient quotes about Barbaro's current status.

"He has steadily improved," said Richardson. "He's eating great. He hasn't been in a sling in over a week. The fact that he bounced back, and quickly, is very encouraging. It's still disappointing that he had a setback, but these types of things are not unexpected."

"We've been able to decrease his pain medication," Richardson said. "He's not sedated. It's to address his hind foot."

"But this was a significant setback, so I don't think he'll leave for at least a month, and it could easily be longer," Richardson said.

"He's a smart, enduring, tough kind of horse," Richardson said. "I think this shows that a lot of horses can behave like this if given the opportunity. Most horses who make it this long go home. I'm hoping he's one of those.

"It's awkward getting an award like this because we're not done. We haven't finished the job. Trying to reconcile that, I hope the award is for the effort that has been made, and for the ongoing effort. I hope something good comes out of this. I'm just a small part of this. Barbaro is the biggest part."

Richardson said that if and when Barbaro is relocated to Kentucky, his care would be handed off, most likely, to Dr. Scott Morrison of Rood and Riddle Equine Clinic.