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Q&A: Modern Medicine for Barbaro

Julie Rovner is an NPR health policy correspondent and a longtime horse owner. She visited the University of Pennsylvania's New Bolton Center on Tuesday to see how large-animal veterinary care has advanced to even attempt to save a horse with an injury as severe as the one Kentucky Derby champion Barbaro suffered in the Preakness. She describes Barbaro's care and the outlook for his recovery.

Q: What was the extent of Barbaro's injury?

About 50 yards into the start of the Preakness, Barbaro took a bad step and fractured three separate bones in his right hind leg -- the cannon bone, the long pastern, and the sesamoid. He also dislocated the fetlock joint, which is equivalent to a person's ankle.

Q: Why was he taken to the New Bolton Center?

The center is, in fact, the closest major equine hospital to Pimlico racetrack in Baltimore, where the injury occurred. But Barbaro's owners, Roy and Gretchen Jackson, also have a long association with the facility. Both are University of Pennsylvania graduates; their farm is about 10 miles from New Bolton; Gretchen Jackson serves on the veterinary school's board of overseers, and New Bolton's equine sports medicine clinic is named for Roy Jackson's mother and stepfather.

Q: What was done for Barbaro there?

On Sunday, Barbaro underwent about four hours of surgery in an attempt to stabilize the extensive fractures. New Bolton Chief of Surgery Dean Richardson inserted a locking compression plate and about 27 titanium screws (Richardson told reporters Tuesday that he had misspoken Sunday when he said he used 23 screws).

After the surgery, the still-unconscious Barbaro was then placed in a sling suspended from a monorail on the ceiling and moved to a "wake-up pool" next door. There he was lowered into a black rubber raft with individual full-length "pockets" for each leg, which was, in turn, lowered into the pool. The pool allowed him to thrash as he awoke from anesthesia without re-injuring the surgically repaired leg or injuring another part of his body.

Once awakened and calmed, Barbaro was moved in the sling to a padded recovery stall and then to a more permanent stall in the adjacent intensive care unit, where he is likely to remain for some months.

Q: How much does this sort of surgery cost?

Vets have been coy on that subject, but surgeon Dean Richardson did concede that the care will cost "in the tens of thousands of dollars," which does not necessarily include all the long-term nursing and rehabilitation costs, assuming Barbaro survives.

Q: Given the cost, how often is this type of surgery performed?

Richardson said such complicated surgery, while not routine, is not reserved exclusively for high-value horses such as Barbaro. "We did a somewhat similar procedure, actually, just a couple weeks ago on a gelding," a neutered male horse, he said. "They're not being saved just for monetary purposes. People love their animals."

Q: What kind of advances in veterinary medicine make it possible to do this kind of surgery now that made it impossible in the past?

As with human medicine, veterinarians now have available new types of screws and implants that can hold together badly shattered bones with fewer complications -- the compression plate now in Barbaro's leg was originally developed for people. Veterinary hospitals also have better and faster laboratory testing and imaging techniques, and better overall care. New Bolton's intensive care unit is staffed around the clock by vets and medical technicians specially certified in critical care, Veterinary School Dean Joan Hendricks said.

Q: Why are the vets still so guarded about Barbaro's prognosis?

Horses are prey animals that basically need to move around in order to survive, and Barbaro is currently confined to a stall where he is likely to have to stay for weeks, if not months. Beyond the always-present possibility of infection in a wound so large, the biggest concern is laminitis, a painful and sometimes fatal condition that can develop when a horse stands unevenly because it is favoring one leg. In an attempt to prevent laminitis, Barbaro's good hind leg has been fitted with a specially padded, glue-on shoe, to allow him to stand evenly with the bad leg, which has a cast on it.

Another major concern is colic, also a potentially fatal condition that develops when the horse's intestinal system slows or becomes blocked. The need for the horse to keep weight on its feet and the potential for colic is a major reason a horse with a broken leg can't simply be suspended from a sling while the injury heals, says vet school dean Hendricks.

"You can't take the weight off their feet and you also can't put the sling around their abdomen because their intestines are as delicate as their toes.

Veterinarians are also worried that a horse as young and fit as Barbaro may simply become unable to tolerate such a lengthy confinement. Hendricks says "keeping, in this case. a very smart... juvenile critter whose life is racing, and now he's in a small stall" is not easy. Although Hendricks is quick to add that so far, things are going well. "He's being entertained, I have to say, he likes what's going on around him. He watches and he's eager to see people, which is really great."

Q: If Barbaro survives but his leg is not strong enough to allow him to breed naturally, can he breed by artificial insemination?

No. While artificial insemination is common in the world of sport horses, the Jockey Club, which regulates racing thoroughbreds, requires that all breeding be done "naturally." That means Barbaro's leg must heal well enough for him to be able to mount a mare, or he will not be able to sire horses eligible to race.

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