Posted on 01/28/2007 3:00:36 PM PST by HairOfTheDog
By RICHARD ROSENBLATT, AP Racing Writer 40 minutes ago
Kentucky Derby winner Barbaro suffered another significant setback over the weekend, and his fight for survival may have reached a critical point. After Barbaro developed a deep abscess in his right hind foot, surgery was performed Saturday to insert two steel pins in a bone, one that was shattered but now healthy, to eliminate all weight bearing on the ailing foot.
The procedure is a risky one, because it transfers more weight to the leg. If the bone were to break again, chief surgeon Dr. Dean Richardson said: "I think we'll quit.
"When things start to go bad, it's like a house of cards," he said Sunday in a telephone interview with The Associated Press. "If one thing fails, that puts more stress on another part. And if that fails, then you're stuck with managing two problems. That's why these are difficult cases."
The right rear leg was on the mend until recently. It's the one Barbaro shattered at the start of the Preakness Stakes eight months ago, and the three broken bones had completely healed.
Now this. The surgery, in which a cast was removed and replaced by an external brace known as a skeletal fixation device, addresses one problem but could create others.
Barbaro likely will have to bear more weight on his front feet because of his two ailing back legs, making him more susceptible to laminitis, a painful and often fatal disease caused by uneven weight distribution. Laminitis already struck Barbaro's left rear foot in July, and 80 percent of the hoof was removed.
"It's something that we are watching closely, and that could also be a thing that could lead to us quitting," Richardson said.
The colt was doing well Sunday, according to Richardson, and "we will continue to treat Barbaro aggressively as long as he remains bright, alert and eating," he said in an update sent out by the University of Pennsylvania's New Bolton Center in Kennett Square, Pa.
Based on Richardson's advice, owners Roy and Gretchen Jackson have been making the decisions concerning Barbaro. Their major concern from the start has been to keep Barbaro comfortable.
"No one is interested in putting the horse through any type of misery," Richardson said. "We're going to treat him the best way we can as long as he stays comfortable. And we're going to stick with that no matter if his chances are 1 percent or 90 percent.
"If he gets to the point where we just don't think it's reasonable to go on, we will not go on."
Gretchen Jackson spent time with Barbaro on Sunday, and said her colt is "still bright-eyed and still eating.
"It's not over 'til it's over," she said. "I'd say he's comfortable and being treated very well. As long as he's comfortable ... Dean knows our feelings. We trust him."
After months of upbeat progress reports, Barbaro has endured several setbacks the past three weeks.
On Jan. 9, Barbaro had a cast placed on his left rear leg to help realign a bone. The next day, Richardson removed damaged tissue from the colt's left rear hoof, and Barbaro was placed in a sling to help him keep weight off his feet.
On Jan. 13, another section of his left rear hoof was removed, and a cast was placed back on his right hind leg for additional support. He was gradually improving, but last Thursday, Barbaro's left rear cast was replaced and a custom-made plastic and steel brace was applied to his right hind leg. The leg also was fitted with a special orthotic brace for more support.
In the latest setback, the right hind leg is again at risk.
The pins in the right rear leg are connected to an external brace, which is connected to a lightweight alloy foot plate. This results "in the horse eliminating all weight bearing from the foot," Richardson said Sunday in a statement. "The horse's weight is borne through the pins across his cannon bone."
Allowing the pins to bear weight carries "significant risk."
"We believed it was our only option given the worsening of the right hind foot problem," Richardson said in a statement. "Unfortunately, we felt we needed to take this risk because this approach offered our only hope of keeping Barbaro acceptably comfortable."
He explained Barbaro had been uncomfortable on his right hind foot because of an abscess that developed when the horse had 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," Richardson said.
Sunday, Richardson sounded as serious as he did on May 21, the day after the Preakness, when he delivered the news that Barbaro's chance of survival was a "coin toss."
"I'm upset, worried, not sleeping well," he said. "A lot of people are very, very committed and spent a huge amount of emotional sources on this horse. So it's very upsetting when things go badly."
I didn't realize that they couldn't just use a needle or something. You know I said all along I wanted some little Barbaro or Barbarette quarterhorses, if nothing else.
I had a hunch something was wrong this morning when I was tending the candles in the FR Prayer Room candle room and had trouble lighting some - the server was overwhelmed and kept timing out.
Sure enough, 12,000+ candles were being lit for Barbaro in another room. He usually averages about 1000 daily. I didn't want to look, but I *knew.*
Actually, the owners would have gotten insurance money if they had put him down at the track. But they love the horse so they're trying to save him. And it's not for stud purposes as his hind leg will never be able to bear his weight for that.
Actually Hair, they do make a hand-held artificial v. The stallion doesn't have to mount anything to use it. It does take a well-trained stallion and expert handler though. I know of a number of warmblood breeders who use it.
But again as has been pointed out many times, the Jockey Club does not allow AI and will pull the papers on anyone who gets caught doing it. It has happened and the perpetrators were punished by having not only the stallion's papers pulled, but also the papers of ALL of his get foaled after the AI was done.
Maybe, maybe not. I'm not a fan of AI. I think the possibility of fraud is too high. One vial of goo looks an awful lot like any other vial of goo.
There's nothing but emotion to suggest he would have been a valuable producer, there's a lot of good stallions out there... At least their will be as long as AI and stored semen is not allowed. If a big supply of Secretariat had been stored, who'd ever choose anything else? Natural breeding does ensure a more diverse gene pool, and no one stallion can dominate the gene pool. Those are valuable reasons to leave it the way it is, though many breeds have given that up for sake of the economy of it.
Ah - thanks for the correction on the gadgetry... even if it was allowed, as a young 'virgin' stallion, I don't know if they could get him to use such a thing or not :~)
"Unfortunately, we felt we needed to take this risk because this approach offered our only hope of keeping Barbaro acceptably comfortable."
Dear, dear Barbaro remains in God's hands. Prayers for him and for all of the people around him.
The bad thing about this hoof stuff is that Bobby is so valiant, he will never complain, never give up - he won't really know, other than being uncomfortable, how his life is threatened.
He won't stop eating, he won't just lie down and give up. That's what has been so wonderful and magnificent about him - but may be his undoing, too.
I don't want this horse to suffer nor dogs or cats or any animal. But the world would be a better place if people had the same concern for their fellow man as is demonstrated towards this unfortunate horse.
I know your comment on 'do no harm' has been responded to by others, but I felt it was my duty as a veterinarian to also post a reply.
To quote the oath I myself swore to (from American Veterinary Medical Association website (www.avma.org)):
'Veterinarian's Oath
(Adopted by the House of Delegates, July 1969, amended by the Executive Board, November 1999)
Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.
I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics.
I accept as a lifelong obligation the continual improvement of my professional knowledge and competence.'
In this case 'relief of animal suffering' is the section in question. 'Do no harm' is certainly a basic tenet of medicine but is not formally part of the oath. As Barbaro is, so far, not showing us signs that his discomfort is beyond medical control, then 'do no harm' actually precludes his euthanasia. After all, death itself is rather harmful. I hope this helps.
Also, as the oaths of the medical profession is a common source of confusion, here is an excerpt from the American Medical Association's position on the Hippocratic Oath (www.ama-assn.org):
'Q: What obligations does a physician have under the Hippocratic Oath?
The AMA does not have formal policy related to the Oath. Some of the tenets of the Oath represent long-standing ethical traditions that the AMA supports, while others are somewhat outdated. A May 2000 article from AMNews discusses the modern meaning of the Hippocratic Oath.
The AMA used to reprint a translation of the Oath in our Code of Medical Ethics. We still have information on the history and relation of the Oath to the AMA Code of Medical Ethics included in the preface to the Code.
Physicians may take other oaths when they begin or when they graduate from medical school. In addition, they may pledge to uphold professional standards and codes of ethics when they become members of professional associations, such as the AMA or their specialty or state medical society. For instance, every physician who is a member of the AMA must uphold the AMA’s Principles of Medical Ethics.
Because most oaths and codes are administered by voluntary associations and not by regulatory agencies (such as the state agencies that issue licenses to practice medicine), the most serious disciplinary action these voluntary associations typically can take is to expel the member physician from the association.
However, regulatory agencies that oversee physicians take allegations of unethical or unprofessional conduct very seriously, and such actions may warrant more serious disciplinary action against a physician’s license to practice. For further information on how to contact these agencies, please see the information above on how to file a complaint.'
Doc, because you're a vet, I know you see these things differently than us non-vets. I totally admire the efforts of everyone close to Barbaro to try to save him. I also know the vets at that equine hospital may have learned a great deal from his case, and that the effort to try to save him has been worth it on several levels.
However, as just an ordinary person who loves animals, what I see is a young, vital colt who has been cooped up at a veterinary hospital since last June. True, he's had his good days when he could be walked outside for short periods to graze. But he's living an exceptionally confined life for a horse. He's undergone multiple surgeries, foundered in his unbroken hind leg, and now has more difficulties with the leg that was broken.
The question has to be asked by someone: What about that colt's quality of life? Even if they are somehow able to get all four legs under him, and as sound as possible, what kind of life is that colt going to have long term?
I don't doubt the sincerity of everyone involved with that horse. I don't doubt that those closest to him love Barbaro. I also know my opinion and feelings don't mean squat. But still, I have to wonder if letting him go would be the greatest act of love at this point. I wouldn't feel this way if I thought the colt had a genuinely reasonable chance at a decent quality of life if they ever get him sound enough to leave the hospital.
So much has been learned from his treatment. You saw what he posted. They aren't going to let him suffer.
"...keeping Barbaro acceptably comfortable."
I have no problem with any of the information you offered and thank you for taking the time to share it with us.
From the outset, Dr. Richardson has stressed that both he and Barbaro's owners will ONLY proceed with Barbaro's treatment if they are able to keep the horse comfortable. Or, "acceptably comfortable," as he stated in his latest release.
I don't understand the confusion over Dr. Richardson's words. They seem very clear to me.
Why is a ceiling mounted sling not an option for this horse, to absorb some of his weight?
Preserving Barbaro's quality of life is certainly of paramount importance. However, a deeper question to be considered is this: does a temporary period of discomfort, or even suffering, outweigh the possibility of a happy life in the future? It's a very hard question and always a terribly difficult decision. Personally, I am an optimist. I couldn't survive in my profession otherwise. Also, I have personally seen cases turn around, where I honestly thought there was no hope. There was one case in particular while I was in vet school involving a Bassett Hound with intervertebral disc disease. This dog was completely paralyzed, underwent several invasive surgeries, suffered through over a year of hospitalization and rehabilitation, and there were days where, even with heavy medication, it was impossibly to completely control the pain. However, the owner knew her dog and could tell that he just wasn't giving up yet. He still had the will and desire to live and because of that owner's knowledge of, and faith in, her dog, he is now a happy, bouncing Bassett again. To see him now, you would never guess that he had been injured in the slightest. That being said, there are many other dogs who would never have been able to take what that dog went through. It's incredibly difficult to be privy to any being's suffering, animal or human. But as long as Barbaro continues to *want* to live, I'd say we owe it to him to try.
Actually, they have been using a padded sling quite often with him. He can't stay in it all the time, since there are health problems associated with that as well starting with muscle atrophy and pressure sores. There's been quite a bit of research and innovation in that department over the last few years, but no perfect solutions yet, unfortunately.
Dang. That poor baby. I hope he can pull through all of this. Thanks for the info.
Barbaro's candles at the prayer candle website are up to 16,000 now, from 66 countries. And that's just *one* little prayer place. He is *much loved*!
Thank you for your thoughtful reply. As you say, it's a tough balancing act, but I sure don't begrudge the people around him for taking all the measures they are to try to save him. I'm glad it's not my decision to make, because I struggle with envisoning how this horse could possibly have any genuine quality of life under the circumstances.
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