As Baltimore prepares to host the 132nd Preakness Stakes this month, memories of last year's blighted race—and its roller coaster of emotions—linger. There was the hopeful anticipation of a nation excited by the possibility of a second win (and maybe a Triple Crown) for the favorite, a stunningly fast horse named Barbaro.
That anticipation quickly turned to horror; millions saw the nauseating image of his leg flailing freely with a shattered bone only seconds after leaving the gate. Then came heartbreak, as he was taken away in an ambulance for what many assumed was certain death at the hands of veterinarians.
But Barbaro didn't die that day—he fought to heal his leg, and battled against infections and maladies for nearly a year. To the surprise of many, the horse's trials captured the attention and sympathies of people across America. Barbaro carried on a long battle that finally ended in January 2007, when his owners chose to euthanize the animal after a hard-fought struggle for recovery that he just couldn't win.
While this year's race may be haunted by memories of Barbaro's ill-fated run, his fight to survive brought the little-known world of equine medicine to the forefront of people's consciousness. The public learned about the advances made in treating horses' injuries and ailments—and found out just how far veterinarians and scientists have to go.
The first lesson came quickly, when most people who thought Barbaro would be destroyed because of his injury were surprised to learn he had a real chance to live.
One person who would play a crucial role in Barbaro's recovery was Dr. Corinne Sweeney, executive hospital director at Kennett Square, Pennsylvania's New Bolton Center.
She was watching the Preakness last year when Barbaro's accident took place. "When it occurred, almost anyone who worked here [at New Bolton] knew it was likely he would come here," she recalls. "Not because he was a celebrity patient, but because he had a severe injury."
Located just an hour and a half north of Baltimore, in rural Kennett Square, the New Bolton Center is home to the George D. Widener Hospital for Large Animals, part of the University of Pennsylvania School of Veterinary Medicine. The school sits on 700 acres of farmland and sees 6,000 patients a year—and an additional 19,000 are seen through the center's field service. Although the center treats everything from sheep and alpacas to pigs, 80 percent of the patients are horses.
In the event that a catastrophic injury does take place, Maryland is a well-located place for it to happen. There are many effective equine facilities in the state, and cutting edge hospitals in Virginia and Pennsylvania. The population density of horse-lovers (many with financial resources) means that hospitals in this area receive an educated clientele that is willing to try new treatments and push the envelope of equine medicine—and a place like New Bolton is where these innovations are born.
"In the mid-Atlantic, they are the premier equine hospital," says Bill Reightler, horse owner and thoroughbred blood stock agent based in Whitehall, Maryland. He's used New Bolton for young horses with orthopedic issues, thoroughbreds with racing injuries (none as severe as Barbaro's), and for diagnostics. "You get into certain situations when you need to get to a hospital quickly, especially with horses with breakdown injuries, and New Bolton is the best resource."
It's important to know that major breakdown injuries like the one Barbaro suffered are not common. Says Tim Keefe, who has been training horses for the racetrack in Laurel since 1994: "The biggest mistake people can make is to think [Barbaro's accident] happens all the time. It doesn't. It was just an unfortunate thing that happened when the world happened to be watching."
When Barbaro broke down, many racing enthusiasts drew a parallel to another grand horse, Ruffian. In 1975, the undefeated filly broke her leg in a match race at Belmont Park with Foolish Pleasure, that year's Kentucky Derby winner. Like Barbaro, Ruffian's will to race made it difficult to "pull her up" (when the jockey makes the horse stop quickly), and like Barbaro, heroic efforts were made to save her life. Unfortunately, she was euthanized that day, after surgery proved ineffective.
Dr. Larry Bramlage, an equine orthopedic surgeon in Lexington, Kentucky, was at the Preakness last year as the American Association of Equine Practitioners (AAEP) "on call" representative—and it was his job to field questions from the media in the event of a veterinary-medicine-related crisis.
"Going back about 30 years ago," he recalls, "there was Ruffian, and she had an injury that was almost as severe as Barbaro's, but not quite. We had no good surgical procedure to do anything with Ruffian's injury. Since that time, Ruffian's injury has become fairly routine to treat."
New Bolton's Sweeney says that most of her patients are routine, everyday horses, not superstar thoroughbreds. So when Barbaro arrived in this quiet rolling landscape with a media maelstrom in tow, it was like an injured Brad Pitt being admitted to St. Joseph Medical Center in Towson.
Like human doctors, veterinarians observe privacy policies; it was the decision of Barbaro's owners, Roy and Gretchen Jackson, that the media be kept abreast of the horse's condition. According to Sweeney, this is the greatest good that could ever come out of such a tragedy.
"Allowing the world to know more about veterinary medicine will bring attention to the support of research in equine diseases," she says. "It also had a huge affect on people. [Barbaro has] inspired people, he's encouraged people. People see inspiration in Barbaro for many reasons." She leafs through a file of letters from well wishers, only a fraction of the thousands of letters the Center received.
"The general public latched on to him in a way that seldom occurs," says Bramlage, "especially with a horse with an injury. It's the kind of charismatic attachment that Secretariat still holds for people in Kentucky, who still want to visit Secretariat's grave when they visit Lexington. He connected with people who weren't even racing fans."
In addition to the letters that poured into New Bolton, there were also donations to the Barbaro Fund (established by the Jacksons to support equine medical research), to the tune of over $1 million. According to Sweeney, they are spending the money as soon as they get it to further the care of horses.
When the world turned its eyes on Barbaro and the New Bolton Center, what they saw was one of the most advanced veterinary medical centers in the country—and one designed to handle 1,200-pound patients that can be temperamental and harm themselves if aggravated.
New Bolton employs approximately 400 people, including board certified specialists in everything from critical care to cardiology.
Currently, the center has the capacity to conduct corneal transplants and treat glaucoma and cataracts. In its treadmill facility, cardiologists can diagnose heart arrhythmias, congestive heart failure, and upper respiratory problems. There is a neo-natal unit for monitoring high-risk pregnancies and nursing premature foals. Four hospital ward barns provide areas for rehabilitation or, in the case of infectious disease, isolation.
The orthopedic surgery suite is a sterile environment complete with padded prep rooms and recovery stalls, an operating room with a hydraulic hospital bed, and a pool recovery room, one of the few of its kind in the U.S. Horses are sedated in the padded prep stalls, where they are attached to a hoist fastened to a remote control monorail system on the ceiling. The monorail "flies" the horses from prep to the operating room and on to either the pool or directly to an ICU recovery area. Like human medicine, equine medicine has evolved as technology and research have improved.
Although colic (an ailment of the gastrointestinal tract) is still the largest killer of horses, musculoskeletal issues ("lameness") are the most common form of injury. These include tendon injuries and fractures in the joints called "chip fractures" that are compression injuries.
"The veterinarians, as well the horse owners and trainers, have become much more aware of the possible conditions that cause lameness," says Dr. Nat White, director of the Marion DuPont Scott Equine Medical Center in Leesburg, Virginia (a campus of the Virginia-Maryland Regional College of Veterinary Medicine). "I think there's been an overall [increase in] awareness—one, that these things can happen and that we need to be looking for them, and two, veterinary medicine has stepped up to be able to do more than ever before to treat these things successfully and have the horse return to racing or some other pursuit."
The short version is that injured horses, which decades ago would have been euthanized before they ever left the track, can now go on to race again or to start new careers as show horses, hunters, studs/broodmares, or pleasure horses.
The adaptation of human medical technology to equine medicine has provided many advances in the treatment of musculoskeletal injury. Technology such as ultrasound, CT scanning, and on-site digital X-rays allow trainers and veterinarians to identify problems, often before they have a chance to get out of control.
The bone plates and screws used to heal fractures (Barbaro had one plate and 23 screws inserted into his broken leg) were unheard of many years ago; today, they are extremely durable and commonplace. Pain management, which keeps a horse comfortable through recovery, has advanced, as have the delivery options for antibiotics. Arthroscopic surgery has revolutionized the treatment of joint problems.
Efforts are going into understanding laminitis, a common condition in horses and ponies that causes pain in the hoof (and can cause the condition known as "foundering"). Barbaro developed laminitis in several legs over the course of his recovery attempt, and it was ultimately a major factor in the decision to euthanize the horse.
While some look at horseracing—where a more than half-ton animal is racing at more than 30 miles an hour around a track—as an obvious recipe for disaster, veterinarians remind skeptics that horses are designed to race. They have big bones built for the activity, and hearts and lungs that give them a great physical capacity to run. And there's an inherent inclination in horses to race—just watch horses as they play, run, and chase one another in fields or in the wild.
"They are built to be athletes," says Sweeney. "When you are an elite athlete, along with that comes the potential for injury."
Many people are looking to artificial track surfaces as one way to reduce the chance of injury (Pimlico's dirt track is not believed to have had a role in Barbaro's injury, and there are no plans to install artificial tracks at either Laurel or Pimlico).
Artificial surfaces (such as PolyTrack) are made of a synthetic material that is not unlike the surfaces enjoyed by football players and track stars. These surfaces provide consistency regardless of weather or the number of races run over the material—and maintaining the consistency of a racing surface has been found to reduce the potential for injury in horses. Tracks around the U.S., including Keeneland in Kentucky, Arlington in Chicago, and DelMar in California, have switched to these new materials for their races.
"Artificial surfaces are the newest hope for the prevention of injury, and I think they have serious potential," says Bramlage. "I think they will reduce injuries, but they won't eliminate them."
Like human medicine, research is the key to the future. "As a profession, the way we can help the most is through research," says White, "and that requires funding.
"We literally need to look at how these injuries occur and look at risk factors," White continues. "Just like you and I may have risk factors for heart disease, horses have risk factor for some of these injuries—everything from horseshoes to training to track surfaces."
That is because, with all athletes, even prevention and padding cannot take the risk out of competition.
"These horses have a personality, and they really want to compete," says White, who owns a racehorse. "I wouldn't want him to be hurt, but I would want him to do what he wants to do and what he was meant to do—which is race other horses."
