Barbaro Loses Battle With Laminitis

By Joanie McKenna
Animal Health Foundation

As Barbaro romped across the finish line of the Kentucky Derby on May 6, 2006, it looked like nothing could stop the undefeated 3-year-old bay colt. 
 
Eight months later, his owners and veterinarian announced to the world through tears that they felt they had no choice but to put him down. 
 
The laminitis in his left hind foot had worsened, causing complications to his right hind foot; and a severe case of laminitis had developed in both front legs. 
 
"That left him with not a good leg to stand on," Dr. Dean Richardson told a packed room of reporters gathered Monday, Jan. 29, 2007, at New Bolton Center in Kennett Square, Pa. 
 
Barbaro was euthanized that morning after a weekend of setbacks. 
 
Richardson and owners Roy and Gretchen Jackson described how the disease had affected Barbaro's personality by Sunday. The champion's eyes no longer glistened, showing sadness and distress. The usually laid-back horse couldn't get comfortable and had a bad night Sunday night. 
 

Photos by Sabine Louise Pierce / University of Pennsylvania

Barbaro is lifted out of a special recovery pool May 21 at the New Bolton Center following 5 hours of surgery to repair a shattered right hind leg.

"You could see he was upset," Richardson said. "That was the difference. It was more than we wanted to put him through." 
 
It was a heart-breaking ending to Barbaro's very public struggle to survive..    Emotionally, Richardson said he had hoped the horse would make it. Intellectually, he said he knew what he was up against.
Through it all, Barbaro endured nearly two dozen surgeries and other procedures. Weeks of positive reports had turned into months. 
 
But, his medical outlook changed quickly in January, and, in the end, laminitis claimed another victim, showing no mercy to the global superstar. 
 
The beloved thoroughbred's legacy to the veterinary world may be in putting a celebrity face on a disease that was virtually unknown to the general public. He also raised the education level of those in the horse world.   Richardson acknowledged that he learned a lot through the process and believes he would have better results if he went through the same ordeal with another horse. 
 
"I honestly believe I would have a better chance to save his life, because I would probably not make the same mistakes," Richardson said. "I'm sure I made mistakes. Everybody makes mistakes, or knows of things you could have done better." 
 
As late as December 2006, Barbaro looked like he was on the mend. With his right hind nearly healed and his laminitis seemingly in check, he was enjoying his daily walks outside, and there was talk of moving him home. But Richardson cautioned once again that the left hind foot was a "formidable long-term challenge." 
 
On Jan. 10, Richardson had to remove more damaged tissue from Barbaro's left hind hoof, and the colt was placed back in a protective sling. 
 
On Jan. 13, another section of his left rear hoof was removed. 
 
Forced to continue bearing more weight on his healing right hind leg, Barbaro developed first a heel bruise, then a deep subsolar abscess, in his right hind foot within two weeks. 
 
His veterinary team attempted to manage the foot in a cast and then in a custom fabricated brace, but it didn't allow access to the foot, nor did it offer acceptable stability and comfort. Surgeons next tried putting his right hind in an external skeletal fixation device, placing two steel pins transversely through his right hind cannon bone. These pins were connected to external sidebars attached to a lightweight alloy foot plate, eliminating all weight bearing from the foot; the horse's weight was carried through the pins across his cannon bone. 
 
The procedure carried risks, including the possibility that the once fractured cannon bone couldn't hold up to the stress. The team also expressed concern about laminitis developing in the front feet, which were being overloaded more than ever as the back feet worsened. 
 
It was that development of laminitis in the front feet that was the breaking point, Richardson said. 

 Barbaro's medical journey
 
Barbaro's seemingly golden life suffered its initial heart-breaking setback May 20, 2006, at the start of the Preakness. The son of Dynaformer, trained by Michael Matz, was expected not only to have an easy win at Pimlico but to be the first Triple Crown winner since 1978. 
 
Coming out the gate, the colt shattered three bones in his right hind leg. Surgery the next day at New Bolton Center reconstructed the broken bones with pins and plates. 
 
But no matter how well the right leg healed, the bigger concern was the possibility that laminitis would develop on the left side. Other equine superstars, including the Triple Crown winner Affirmed, had lost their life due to laminitis developing in a good foot after surgery on the opposite foot forced the good one to bear more weight during the healing process.  Richardson used many preventive measures in the weeks that followed surgery. 
 
On May 27, Richardson put Barbaro's left hind foot in a special three-part shoe that was designed to:  

* Support the sole;

* Minimize weakening and infection of the sole with a material inserted inside;

* And build up the length of the left hind to compensate for the cast being on the right hind. 

Other measures included taking a venogram, or injecting a contrast agent into the left hind foot and taking x-rays to show where the blood flowed; the venogram indicated everything was fine, Richardson said. 
For six weeks, all reports were upbeat. Then, the first week of July, complications set in the right hind leg, and surgery was performed several times to replace screws and plates and try to get rid of a newly developed infection. 

Dr. Dean Richardson leads Barbaro in the hospital July 14, a day after Richardson describes the severity of the laminitis that has developed in the left hind foot.

On July 13, the focus shifted back to the left hind leg, as Richardson set up a news conference to explain that "the most feared complication from the outset" had happened: During the previous week, Barbaro had developed a severe bout of laminitis in the left foot. Richardson said, "The horse had no real problems with the left hind leg until he started to have some problems in terms of comfort in his right hind at about seven weeks." 
When asked how severe the case was, Richardson said, "It is as bad as it gets." 
 
Richardson admitted there always would be second guessing on how the horse was monitored, but added that, "as far as the catastrophic type of laminitis that developed, it was very rapid." 
 
In response to a reporter's question of what caused the laminitis, Richardson said: "It's a problem in horses due to excessive weight bearing and inflammation." 
 
He added: "If I knew the answer of how to prevent this, I guarantee I would be giving this press conference from my mansion somewhere. It’s a devastating problem in horses that nobody has a solution to." 

Richardson performed a hoof wall resection on the left foot, removing all the hoof wall that had lost its connection to the coffin bone, or about 80 percent, in order to make room for a new hoof wall to grow again. 
To minimize Barbaro's pain in having to bear weight on a foot without a hoof wall, Barbaro was put in a foot cast with foam padding and antiseptic dressings. He also was trained to stand in a sling so he could take the weight off his feet for several hours a day, a procedure the horse apparently was enjoying. In the days that followed, he was said to be using the sling similar to a Jolly Jumper, bouncing off the ground. 

Barbaro's medical reports that followed were upbeat. Richardson said repeatedly that Barbaro had good vital signs, a good attitude, a great appetite, was taking small walks around his stall and had found comfort in his sling. 
But when asked what the horse's chances were, the answer always was the same: Not good. 

On Jan. 29, as word spread of Barbaro's death, fans deluged New Bolton Center with cards, flowers and gifts. Thousands of e-mails poured into the hospital's web site. 

At his press conference, Richardson, chief of surgery at New Bolton, was asked if he felt any gratification from his epic attempt to save America's No. 1 patient. Richardson answered with a quick, seemingly frustrated "no," then amended his answer to say he was grateful that, for the vast majority of Barbaro's time as a patient, he was a happy horse.