His surgeon discusses the trials and challenges of caring for the high-profile Kentucky Derby winner

by Dean W. Richardson, D.V.M.

As the year draws to a close, the crush of media and public attention since mid-May on the University of Pennsylvania's New Bolton Center's most famous resident patient, Kentucky Derby Presented by Yum! Brands (G1) winner Barbaro, has resulted in 2006 being an exciting, if busy, time for everyone connected with the horse.

While things now have settled down and are back to normal here at the New Bolton Center, I remain cautious about Barbaro. I am always careful to remind anyone who inquires about Barbaro's long-term prognosis that while I remain encouraged and optimistic, I do not consider the horse to be out of the woods, by any means. He is still in the process of trying to regrow his left hind hoof after a very severe case of laminitis that necessitated removal of nearly all his hoof wall. There is still a long way to go.

Having Barbaro here has been, for the most part, exciting for everyone involved. I think everyone likes to know that their work is recognized, and if someone here goes to the grocery store wearing a New Bolton Center shirt, they invariably will be asked about Barbaro. That has been kind of fun, plus the overwhelmingly generous support from the public at large has been enormously gratifying. The positive response has been truly remarkable, and it does not affect just me, but everybody here: the staff, the students, everybody.

I think it was obvious, even before he broke down, that Barbaro has genuine charisma; he is a big, beautiful colt with real presence. He is also a horse who just seems to do things right. When you talk to trainer Michael Matz about the horse or with people who have worked with the horse, one part of the conversation is remarkably consistent: What an intelligent, untroubled kind of a horse he is. He is a horse who goes about his business in a very professional way, not in a dull way. He basically just seems to do things right, and that is a pretty attractive feature in a horse. You do not have to fight to get him to do the right thing.

I graduated from veterinary school (Ohio State University) in 1979 and began working at New Bolton on July 1, 1979. I have been here ever since I graduated. Some of the other horses I have worked on whom the racing crowd might recognize include the retired racemare and dual Grade-1 winner Shine Again for the late Mrs. Allaire duPont, who was a good friend and client; Kicken Kris, who won the 2004 Arlington Million Stakes (G1) for one of the great ladies of the Turf, Betty Moran of Brushwood Stable; and the multiple Eclipse Award-winning steeplechaser McDynamo, who won his fourth consecutive Breeders' Cup Grand National Hurdle Stakes this year. Like Barbaro, he is a son of Dynaformer.

As a surgeon, it is true that you try to learn from every case, and that has been no different with Barbaro. I have been asked if, due to the complexity of his surgery (a metal plate and 27 screws were implanted in his right rear leg that sustained three separate fractures; he also suffered a dislocated fetlock in the Preakness Stakes [G1]), Barbaro's procedure will represent a new paradigm in equine surgery.

High-profile patient

In all honesty, and at the risk of seeming egotistical or arrogant, I do not think so. The reason is because the surgery I performed on May 21 was not remarkably different from other surgeries that I and others do on a regular basis. It's just that Barbaro has been higher profile, more in the press. There are other surgeons who do similar work, so, at best, it would be disingenuous of me to claim that I performed some sort of miraculous surgery.

I am not denying the complexity of the case, because Barbaro's situation was very difficult. I have never tried to save a horse that had his severity of laminitis at the same time that we were managing such a difficult orthopedic challenge.

In my experience, the unique feature to Barbaro's case is that we have managed to at least get this far despite two simultaneous problems. Each of them alone often has been cause for euthanasia. I think it is a fair statement to say that our management challenges concerning Barbaro's care and treatment have been more difficult than the specific intraoperative surgical challenges.

Another aspect of Barbaro's case that has been different is that there have been literally no bounds as to what we could try to keep him comfortable as we attempted to save his life. Owners Roy and Gretchen Jackson always have been willing to do whatever it would take, as long as the horse stayed comfortable. I hope the public at large has come to realize that there are horse owners out there like the Jacksons who are truly interested in doing the right thing for their horses.

A third important component of Barbaro's care has been the meticulous feeding program we have had him on from the outset. One of the most important considerations in a horse convalescing from a major injury is to get enough nutrition into him. Many hospitalized horses do not eat enough, and those that have suffered severe weight loss are not willing to eat as well as they need to eat.

So we have been meticulous in trying to make sure that he eats a very high-calorie, high-protein diet with appropriate supplements. We have paid close attention to that because, as any racehorse trainer will tell you, there is little chance to make a really good athlete out of a horse that does not eat well.

That is one of the things that has been a big plus with Barbaro; he continues to eat very well for a horse who has been confined to a stall for as long as he has. Eventually, a lot of horses just lose their enthusiasm for eating. Perhaps one big reason Barbaro has thrived is that Mrs. Jackson visits him twice every day and brings Barbaro fresh-cut grass right off their farm.

I am often asked if Barbaro is more intelligent, or has special qualities, compared with other horses. We veterinarians talk about this issue a lot, and the quick and glib answer is to say, "Yes." But you also just wonder whether sometimes you get really attached to some horses and start to anthropomorphize--ascribe human emotions--a little bit.

The reality is that if you have a horse with a very complicated problem that is difficult to manage, you get much more attached to him compared to a horse where you can fix the problem and send him back out the door. There is no doubt that horses with complicated problems, like Barbaro, are the ones you get to know the best.

Personal attachment

The personal attachment to these patients is very real for our staff, especially our nursing staff and house officers, residents, and interns. They invest a lot of energy and emotion, so it is not surprising that Christmas cards coming from the nursing staff usually are posed with one of these "chronics." (Unfortunately, I have to admit that most of these "chronics" tend to be my cases, which is not a good indication that I can fix them up and get them home quickly!)

From a teaching perspective, Barbaro has not been a particularly good case in some ways. I say that because our aim is to teach students the important things--the basics. The complexity of his case makes it less than ideal in that regard. At the same time, I think what we have tried to do is the same thing that we do with our students all the time--attempt to teach them a high level of professionalism and dedication.

Right now, Barbaro is undergoing some degree of physical therapy, but we are very limited as to what we can do. If he did not have the problem with his left hind foot, he would certainly be getting more aggressive rehabilitation right now. We would be aiming toward getting him strong enough to cover mares this coming year if he did not have the problem with his left hind foot. It is very difficult to predict how long (or even if) he will grow an acceptable quality hoof. At this point, we are happy that he can exercise enough to stay healthy and happy.

Unless it is raining, Barbaro goes outside every day, usually for 40 to 60 minutes. He is always kept on a lead shank, and only a very few people are allowed to graze him. He is a very well-behaved colt, but we still recognize that he is not ready to be allowed to get too frisky.

One of the nicest aspects of this whole episode is that the Jacksons have been steadfast throughout in terms of clearly wanting to do what is best for the horse. I have to admit, the one thing that has been the most irritating to me is hearing people claim that it is all about money. I do not know how many times I have attempted to clarify that such an explanation is complete nonsense.

The Jacksons are not trying to save Barbaro for that reason; they are doing what they think is the right thing for the horse. They never have questioned how much everything costs, never tried to take the easy way out, or even suggest it. On top of that, they are genuinely nice, humble people who are fortunate enough to own a couple of great racehorses right now.

There is no doubt that the grimmest time during this whole story to date was when the laminitis set in; it was just crushing. Even now, it is difficult to occasionally think about it. I am not one to live in the past, but it is hard not to imagine that if it had not happened, Barbaro would be in Kentucky right now. At the time it happened, Barbaro foundered so badly and so quickly that I did not have much hope that we were going to be able to keep him going. I was absolutely devastated.

When the four of us--the Jacksons, trainer Michael Matz, and me--were discussing the gravity of the situation, there were no dry eyes. But the nice thing is that there was one other individual there taking part in the decision who didn't have tears in his eyes. That was Barbaro! Because he was just standing there--looking like a great horse--telling us that he wanted to go on.

That is why we went on then and why we continue to go on now.

Dean W. Richardson, D.V.M., is the Charles W. Raker professor of surgery at the  University of Pennsylvania's George D. Widener Hospital for Large Animals at New Bolton Center in Kennett Square. He recently was named the recipient of the Turf Publicists of America's Big Sport of Turfdom Award. He and New Bolton received the National Turf Writers Association's Joe Palmer Award last month.