A recent initiative at The Stronach Group racetracks has been pushing the boundaries of that assumption – but not everyone is happy about it.

Taking the finances out of the equation

Two years ago, Stronach Group management was looking for whatever solutions it could find to the breakdown problem at Santa Anita. Facing what was an enormous public relations crisis, the company needed fewer dead horses. Its executives implemented a flurry of new protocols, including rolling back administration times for various therapeutic drugs, increasing veterinary oversight, and reducing whip use. Around that time, the company also began exploring the idea of funding surgeries on injured horses.

“As we looked around, we said, 'If we take the financial piece out of it, what decisions do people make?'” said Dr. Dionne Benson, chief veterinarian for 1/ST Racing, The Stronach Group's racing brand. “You look at a horse like ArchArchArch, who broke down in the Derby, got a fetlock arthrodesis and [became] a breeding stallion. Those are no-brainers for people because they want the residual value of the stallion. But often if you've got a gelding that's running for $5,000, there's an economic decision that's made. We wanted to allow people to make the decision for the horse while taking some of the economic burden away.”

Orthopedic surgery and subsequent care can cost thousands of dollars, and costs increase exponentially based on the complexity of the injury and the smoothness of recovery.  Benson and others worried that there were cases of owners or trainers looking at the prospect of operating on an injured horse as a money-loser, and choosing to euthanize – even in cases where the horse might have had a productive life in retirement. She also wondered how many horses were euthanized without significant diagnostics to even find out if they could be saved. Benson said she heard of one case – not at a Stronach track – where a horse was euthanized after pulling up lame with a sizable bump in the leg, which veterinarians assumed was a serious fracture. Only upon conducting a necropsy did they learn it was a hematoma.

Santa Anita is unique in that it has a fully equipped equine hospital on-site, so it's logistically easy to assess and operate on a horse with an orthopedic injury. Benson consulted the best orthopedic surgeons in the country, including Dr. Larry Bramlage at Rood and Riddle Equine Hospital in Kentucky and Dr. Ryan Carpenter, who operates at Santa Anita, looking for guidance on what makes for a good surgical candidate and what doesn't.

Then, the racetrack began funding veterinary care in cases where owners wouldn't or couldn't. In the past year and a half, Benson said The Stronach Group has paid for veterinary care on a variety of injuries, including some serious wounds, a bilateral condylar fracture, cannon bone fractures, and sesamoid fractures. The track was willing to pay for surgery even in cases where a referring veterinarian may have suggested euthanasia. So far, it has paid for surgery for 17 Santa Anita-based runners since the start of 2020, and 13 are alive and well – which Benson considers a solid success rate, assuming those horses may have otherwise been euthanized by their connections. From those 17, there were 11 fetlock arthrodesis surgeries, where a serious sesamoid fracture is repaired by fusing the bones in the ankle joint. Eight of those horses are still alive and doing well. For horses who would otherwise be dead, Benson said she's comfortable with those outcomes.

That early success rate prompted The Stronach Group to expand its surgical assistance program to its tracks in Maryland and Florida. In lieu of on-site surgery suites at the racetracks there, The Stronach Group has implemented partnerships with Rood and Riddle and the University of Pennsylvania to refer surgical candidates.

Currently, Benson said if a horse sustains an injury on track, the horse's treating veterinarian and trainer will typically put a splint on the injured limb, administer sedation and pain relief, and take the horse back to its stall for evaluation. Someone from The Stronach Group veterinary team will reach out and ask for diagnostic images on any horse who does not have a fracture coming through the skin and does not have injuries to more than one limb (with one exception in California). Horses with those injuries are not considered good surgical candidates. The track then offers to send those images to Drs. Carpenter, Bramlage, or Rood and Riddle surgeon Scott Hopper for a consult. If the surgeon tells the racetrack and connections they think the horse has better than a 50/50 chance at eventual pasture soundness with surgery and the horse's owner doesn't want to proceed, they are offered the opportunity to sign the horse over to The Stronach Group.

Dr. Ryan Carpenter

All of this takes time, but it's time Carpenter says he would normally give a horse anyway before deciding whether to proceed with surgery. Perhaps surprisingly, he says that the main indicator of whether a horse will do well with surgery isn't a matter of how gnarly their radiographs look – it's about the amount of swelling and blood supply they have to the area. Independent of this program, he often waits until the day after an injury before assessing a horse's fitness for surgery because that's when it'll be most clear how the blood supply responded to the injury.

Carpenter said he has learned from the past two years of the track-funded surgery in California that the responsiveness of on-track emergency personnel is key to a horse's chances. While a horse with a fracture wears a Kimzey splint in the trailer ride from the track to the barn, Carpenter prefers to remove it at the barn, take the necessary images, then wrap the leg and put the Kimzey back on as quickly as possible. That extra compression and support from the bandage can significantly reduce swelling, and even a few minutes' difference can have a massive impact on how the horse's blood supply reacts to the injury later.

While the program has been going full strength in California for a year and a half, it was implemented much more recently at Stronach Group facilities in Florida and Maryland. In Maryland, three horses have been sent to surgery at New Bolton Center by the track, and all three have lived. One was a spiraling medial condylar fracture on a hind limb that needed a plate. The referring veterinarian suggested euthanasia, but the surgeon said the horse had a 50 to 60 percent chance to return to racing. After seeing the surgeon's report, Benson said the horse's connections decided to proceed with the surgery themselves.

In Florida, Benson admits the results haven't been as strong; surgical success rate is at about 50 percent.

Not everyone is on board

The Paulick Report has interviewed a number of horsemen and veterinarians with direct and indirect knowledge of The Stronach Group's program to fund surgeries. All declined to speak on the record for fear of retribution from racetrack management, and most expressed serious concerns about the ethics of the program.

For horsemen who had not had a horse injured on track since the program came to their state, there seemed to be little concrete information provided by the racetrack about how it would work. Many had the impression the track was strong-arming trainers into signing over ownership of the injured horses (an allegation Benson denies), playing on their fears of losing stalls. They also had no access to information about the outcomes of injuries they'd witnessed and believed or assumed all or most horses trailered to nearby clinics for surgery had died.

People who had been involved with an on-track injury confirmed the track is not exerting pressure on connections to sign horses over, but did say they had serious concerns about whether the decision to send particular horses to surgery had been fair on the animal.

For horses that go through a complex surgery and long recovery from a procedure like a fetlock arthrodesis, many people questioned those horses' short- and long-term quality of life, along with the associated cost to care for them. Benson said that horses who had been saved by track-funded surgeries in California were placed via the California Retirement Management Account (CARMA) if they were only pasture sound. The track has committed to following those horses throughout their lives to ensure that, given the relatively limited vocational options for some, they didn't fall into a bad situation.

Carpenter said skepticism of the program in the case of serious injuries like sesamoid trauma likely comes from an outdated notion of what a surgical repair, like a fetlock arthrodesis, entails. Dr. Dean Richardson at New Bolton has perfected the procedure in recent years with new materials, cables and locking plates, and new approaches to the incision sites that make the surgery shorter, less complicated, and more likely to achieve a positive outcome than it did a decade ago.

“You have to acknowledge that just because we're done things a certain way for a long time, that doesn't mean that's the way we will continue to do them or should continue to do them,” said Carpenter. “An arthrodesis done today has a far better chance of survival than an arthrodesis done 10 years ago. but the perceptions of people today are often based on the perceptions of the past.”

This horse suffered serious wounds in a freak accident at Laurel when he reared and fell onto an iron fence. The Stronach Group funded his care, and he is ready to leave the hospital and begin rehabilitation.

He's also troubled by the number of people who seem intent on euthanasia in cases he thinks don't warrant it, including career-ending sesamoid fractures on horses without residual value in the breeding shed. While the critics of the program believe they are coming from a place of kindness, Carpenter believes he is, too.

“This is one where if it was American Pharoah, everyone would be cheering 'Give this horse a chance,' but when it's a $10,000 claimer, everyone's cheering 'Put it down,'” he said. “That, I don't understand. A horse is a horse. If it's good enough for American Pharoah and humane enough for American Pharoah, then it's good and humane enough for the $10,000 claimer that no one knows their name.”

But as the program expands to other states and continues over a period of years, a greater success rate will mean there will be more horses that need that kind of care and monitoring. Some have wondered whether it's fair to salvage a horse for pasture soundness, only to pass on the costs for the remainder of its 15 to 20 years of life to a non-profit or a well-meaning adopter. Private home placements for pasture ornaments are hard to come by, which is why there are so many retired horses in sanctuary facilities already.

The question asked independently by nearly everyone who expressed concerns to this publication was also – is The Stronach Group doing this out of the kindness of its corporate heart, or to reduce fatality numbers? Horses are considered racing or training fatalities for the purposes of the Equine Injury Database (EID) if they are euthanized due to injury within 72 hours of incurring the injury.

Benson said this isn't the motivation behind the program, and that horses vanned off and euthanized in the 72-hour window are reported by The Stronach Group to the EID as racing or training fatalities. In California, the horse racing board keeps its own records on racing and training fatalities and follows up with necropsies and post-mortem reports as part of state regulations. In Florida, on-track deaths are supposed to be reported to the Division of Pari-Mutuel Wagering, but it seems from public records as though those reports are made voluntarily by a trainer or treating veterinarian, not a state representative keeping independent track of deaths.

It's also true that the track's desire to give an injured horse a chance does, by default, create the opportunity to reduce fatality numbers – and those numbers are better in all three states since the surgical program and other reforms were implemented.

“We have reduced the number of racing related fatalities in Florida and they are consistent year over year in Maryland to date,” said Benson. “In training, we have reduced horse fatalities (on-track musculoskeletal and sudden deaths) by about half in both Maryland and Florida year over year. Additionally, while I cannot speak for Florida generally, we enter all fatalities and injuries to horses in the EID for our tracks and training facilities located there. Moreover, every horse that dies or is euthanized at Gulfstream Park or Palm Meadows is sent to necropsy at our expense. This has been the case for over a year.”

Benson and Carpenter agreed that those concerns voiced by horsemen in Florida and Maryland are nothing new – they heard them when they launched the program in California. Both now say that referring veterinarians and horsemen in California are on board with the program, largely because they've seen horses move on to second careers or achieve pasture soundness. They remain confident that eventually, their success at other facilities will convince the naysayers.

“I acknowledge the fact that what we're doing here in California is not going to be widely accepted in other states,” said Carpenter. “I think we're a little bit ahead of the curve and part of that is because of what we endured in 2019.

“What I saw very quickly in interacting with people who don't know anything about racing, is that every single fatality is significant. When you make the comment that 'This year we've only had 30 [fatalities]' — which from an industry standpoint is amazing — the people are still appalled because that's still a very, very big number.”

The post Stronach Group Funding Surgeries On Injured Horses, Amid Controversy appeared first on Horse Racing News | Paulick Report.

Source of original post

For racetrack practitioner and surgeon Dr. Ryan Carpenter though, the sea changes that started with mainstream media attention on Santa Anita haven't finished – and they probably won't anytime soon. Carpenter has been outspoken ever since about the ways he has seen the public focus improve racing for the better in California. At a recent virtual edition of the Tex Cauthen Seminar on racing safety, Carpenter continued to provide his thoughts on the interaction between the racing world and the world at large.

Carpenter was the first to admit he was skeptical of the initial changes the state and track ownership rolled out in response to the crisis —  chiefly, backing up therapeutic drug administrations – but after seeing them in action, he believes they are making a real difference. The new requirement to have horses examined after workouts and races has been key in letting veterinarians get a look at horses in vulnerable moments when they're most likely to show signs of a brewing discomfort due to bone remodeling.

But although trade media acknowledged when Santa Anita's spike not only passed, but fatality rates decreased significantly, Carpenter pointed out the mainstream media did not view it the same way. He highlighted a recent Los Angeles Times editorial that concluded: “If track owners and trainers want to keep racing horses, then they need to keep them from dying in the process.”

“The reality is that every horse that sustains a fatal injury in Southern California is going to make the news, in one form or another,” he said. “It's talked about commonly on news outlets like NPR and it's going to be in the LA Times or the national news.”

Carpenter presented the results of a study undertaken by the Thoroughbred Safety Coalition to better understand the impact of the Santa Anita breakdowns on public opinion. Survey takers were asked about what they thought the future of racing should be before and after they read about the Santa Anita fatalities. They were asked to choose whether they believed racing should continue, continue with reform, or be banned outright. As other surveys have shown, a small group of survey takers wanted racing banned – 16% of respondents before they'd read about Santa Anita and 19% after reading about it. The most interesting change for Carpenter was that 57% said prior to learning about Santa Anita that racing should continue on with reforms, but the number jumped to 66% after they read about the breakdowns.

Most people (82%) said the industry's biggest priority should be better protection of the safety and well-being of horses. Another 46% wanted to see increased transparency and accountability for rulebreakers.

The survey also asked people to indicate whether they had a favorable or an unfavorable opinion of various sports, including professional football, basketball, soccer, and racing. The Triple Crown was viewed favorably by 46% of respondents, unfavorably by 24%, and 30% had never heard of the series or didn't know enough to form an opinion. The American horse racing industry generally was 37% favorable, 35% unfavorable, 27% undecided – roughly equal to boxing and not too far off from the rankings for the greyhound racing industry. Professional football, by contrast, had left a favorable impression with 60% of followers and an unfavorable one with just 28%.

Carpenter thought the latter statistic was interesting, given the heat professional football took for its treatment of concussions a few years ago. It would seem it has rebounded some of its public trust in the intervening years thanks to reform and good marketing.

One of the most disturbing findings for Carpenter was a question asking people who they trusted to help enforce safety rules in racing. Large animal veterinarians like himself ranked highest, getting trust from 70% of the audience. Animal rights groups including the People for the Ethical Treatment of Animals (PETA) ranked second, with 49% of respondents saying they trusted the group to help enforce safety rules in racing.

“We can't let PETA – who doesn't want to reform the way we do things, they want to eliminate the way we do things – be the trusted voice for people to go to,” he said.

Carpenter cited a bill sponsored by a California assemblyman who took input from the industry and from PETA when drafting the legislation.

“Unfortunately, he followed some of PETA's recommendations. This bill was passed and is currently the law of the land in California. Some of the things we're doing differently is because PETA was able to speak on our behalf. In all honesty, we can't let this happen. We as veterinarians have to be the ones to speak on our behalf, and on the behalf of the horse.”

What about the familiar refrain from many hardboots that we simply have to tell the outside world what a good job racing does at protecting its equine athletes?

“People often say to me, 'You know Ryan, we just have to educate them about what we're doing. Once they understand what we're doing, they'll understand why we're doing it,'” he said. “I think it's important to acknowledge the fact that by and large, that train has left the station. While I don't think education is bad, if you look at this graph and you look at the stat analysis, people aren't asking us to teach them what we're doing. They're asking us to do it differently by putting the horse's safety first. I think you can do that when you cultivate a cultural change in your industry and in your backstretch.”

The post Carpenter: The Public Wants Change, Not Explanations, When It Comes To Racing Injuries appeared first on Horse Racing News | Paulick Report.

Source of original post

Carpenter, who is a racetrack practitioner and orthopedic surgeon in Southern California, has spoken before about the shift from skepticism of new medication and veterinary regulation by horsemen and private veterinarians to a comfortable acceptance.

“I think we all agree that from a racetrack perspective, safety begins and ends in the shedrow,” said Carpenter. “The cultural shift that we took here in Southern California was [to become] very risk averse. We can't afford to have fatalities. The media is very critical of us and every horse that is euthanized is a significant impact to our industry.”

Looking back, Carpenter said that one of the first important steps the state's racing industry took towards safety reform was its voided claim rule. The voided claim rule will void a claim if a horse comes out of a race with an injury or epistaxis.

“What that did was it took away this perception of passing off a problem to another trainer,” said Carpenter. “It made trainers take a little more responsibility for their horse at that time, and started the first step of this process of becoming more risk averse.”

Veterinarians from other equine sports echoed Carpenter's observations that participants and the public have demonstrated an increased interest in safety from them, too. The focus on steeplechase racing injuries can be a challenge for organizers, as many steeplechase meets are not parimutuel but are part of a charity fundraising effort. As such, the budget for certain types of improvements to fences and course is tighter than it might be at a conventional track.

“Nobody is feeling good about where we're at, but we know we're going in the right direction,” said Dr. R.R. Cowles, founder and past president of Blue Ridge Equine.

Cowles pointed out that American steeplechase racing began collecting injury data some 15 years ago and that national data shows that fatalities have decreased each year for the past decade, with the only exception being this year.

In eventing, Dr. Erin Contino, assistant professor of equine sports medicine and rehabilitation at Colorado State University, said that information gathering has been a critical first step. On a cross country course, some fences are not visible to anyone besides jump judges, who may have varying levels of experience or recall when it comes to documenting why a rider or horse fell. Now, at least at the international level, cross country runs are being videoed so that if an accident happens, the potential causes can be analyzed later. Data shows that corner jumps, downhill jumps, and water jumps are all associated with higher rates of accidents. That information is being provided to course designers, along with funding and encouragement to utilize frangible pin technology, which allows a fence to collapse if hit hard enough, in an effort to reduce rotational falls.

U.S. Equestrian Federation (USEF) medication restrictions have evolved significantly in recent years, according to Dr. Richard Mitchell, co-owner of Fairfield Equine Associates. He recalled a hunter years ago who was found to have three non-steroidal anti-inflammatories in its system — which were only discovered because the horse also tested positive for cocaine. That was a wake-up call, Mitchell said. Now, hunter/jumpers and equitation horses under USEF rules can no longer stack NSAIDs. There are also thresholds and withdrawal times just as there are at the racetrack.

“We've come a long way there with these horses,” said Mitchell of medication restrictions. “Granted they're not running at speed but yet we do have our jumpers that do have a speed element to their competition and accidents can occur. Ensuring these horses are fit to compete is really important.”

In the world of professional rodeo, Dr. Douglas Corey said changes have been slow.

“I think they've sometimes seemed very slow but I think they've come as a result of continually educating the membership,” said Corey. “I think communication is a very big part of it.”

Rodeos began requiring veterinarians on-site at competitions relatively recently, has allowed the beginnings of data gathering on accidents or injuries. Corey suggested that continuing education for participants, event organizers and fans of rodeo is the biggest hurdle for the sport to continue advancing. Many of the sport's participants come in with generational knowledge — but it's not always accurate.

“I think that's a challenge we've all had to overcome and I've really seen it in rodeo,” said Corey. “It's like my dad did it this way, my granddad did it this way, I'm going to do it this way. That's not always the best case. Changes had to happen.”

The post California Veterinarian: Looking Back, Voided Claim Rule Was First Step In Right Direction appeared first on Horse Racing News | Paulick Report.

Source of original post

In most cases, the prognosis for horses who suffer severe fetlock breakdowns is grim, but a procedure pioneered at the end of the 1970s called the fetlock arthrodesis suddenly provided a viable avenue to save some horses that would otherwise be euthanized.

Due to costs and limited range of activities for horses post-surgery, the fetlock arthrodesis–a procedure to stabilize the ankle, preventing joint movement by fusing it into a normal position for the leg–has been traditionally performed on horses with residual paddock value.

Perhaps the widest known fetlock arthrodesis recipient is Barbaro, the 2006 GI Kentucky Derby winner who suffered a complicated series of fractures to and around his right hind fetlock at the start of the 2006 GI Preakness S. In the end, Barbaro succumbed to these injuries, though only after an extended struggle.

But a program in California that has been underway for about a year has the aim of making the procedure a practical consideration for a wider net of injured horses.

“We have to recognize that there are times when we make decision based on finances,” said Ryan Carpenter, a SoCal-based veterinarian who performs the arthrodesis surgeries at Santa Anita. “So, we’re taking the approach that if you remove finances from the equation, what is the best course of action for this horse?”

As a rule of thumb, in the event an owner or trainer cannot afford the cost of surgery and convalescence–roughly $20,000 in total–expenses are shared between The Stronach Group (TSG), the Thoroughbred Owners of California (TOC) and the horse’s owner and/or trainer, said TSG Chief Veterinary Officer Dionne Benson. In some cases, TSG has picked up the entire tab, she said.

But the program–also employed at other TSG facilities in California, like Golden Gate Fields–has courted certain concerns. For one, the procedure is intricate and invasive, with the potential for a number of post-surgery complications. That horses who receive it are essentially paddock-bound raises long-term economic considerations.

Some have also suggested the program could be used to skew state fatality statistics, an assertion both Carpenter and Benson strongly deny.

“I would never do anything that I wouldn’t do on another horse,” said Carpenter, who added that the results of the program thus far are encouraging. Of the eight horses that Carpenter has performed fetlock arthrodesis surgery on over the past year, six have proven successful, he said.

“If American Pharoah needed the procedure, and we say it’s right and ethical and humane for American Pharoah to receive the procedure, then I think you have to say it’s right, ethical and humane for the $10,000 claimer to receive the procedure,” Carpenter added. “It’s either ethical or not, irrespective of value.”

What is Fetlock Arthrodesis?…

There are two primary candidates for fetlock arthrodesis, experts say: horses crippled with degenerative arthritis, and in racehorses, those that suffer a closed biaxial proximal sesamoid fracture (when both sesamoid bones break in the same leg).

The initial portion of the surgery concerns the removal of cartilage between the bones, to make the fusion as tight and stable as possible. “That’s the most important part of the procedure that’s often not done correctly,” warned Carpenter. “You need that bone-on-bone interface so that it can heal properly.”

A plate is placed across the front of the fetlock, which holds the whole joint in place. This plate is secured with screws that can be inserted into the fetlock, pastern, cannon bone and, when necessary, the sesamoids.

A “tension band,” which is essentially a wire that goes behind the fetlock joint, provides another layer of joint stabilization.

“When the sesamoid bones break, you have nothing that supports it back there, and the fetlock drops,” said Carpenter, of the need for this mechanism.

Not every horse that suffers a traumatic fetlock fracture is a candidate for the surgery. Compound fractures come with too great a threat of infection, for example.

Existing laminitis in the opposite limb is a serious problem, and “usually enough of a red flag that we would not proceed,” wrote Dean Richardson, chief of surgery at The University of Pennsylvania School of Veterinary Medicine’s New Bolton Center, in emailed answers to questions.

Most importantly, there needs to be a good flow of blood to the foot. “When a horse fractures its sesamoid bones and it drops its fetlock, they stretch the blood vessels,” said Carpenter, explaining the link between fetlock injuries and curtailed blood flow to the lower limb. “They don’t have a tremendous amount of collateral circulation when it comes to the foot, and that’s why tissue perfusion [the lack of adequate blood supply] is a big issue.”

Fetlock arthrodesis–pioneered by acclaimed veterinarian, Larry Bramlage–is long and complicated. In the course of perfecting the procedure, Carpenter reckons that he has shaved about an hour off the time he takes to complete the surgery, with it now taking him roughly two hours.

Because of the intensive nature of the procedure, coupled with the relative scarcity of viable equine candidates, there’s a limited number of surgeons across the country with the necessary skill sets to take the surgery on, experts say.

At the same time, “The procedure has evolved a lot from the way Bramlage first described it,” said Carpenter, pointing to the development over the years of locking compression plates, where the screws fix to the plate, making it a very “fixed, stable construct.”

And how successful is the fetlock arthrodesis surgery? In a 2008 article, Bramlage is quoted as saying that, “In the first group of horses we presented, the success rate of the primary treatment approached 70%.” For other kinds of injuries, such as degenerative arthritis, “It’s as high as 80%,” he added.

Likewise, Richardson said that success is inextricably linked to the severity of the original injury.

“Certain types of injuries such as complete disruption of the distal sesamoidean ligaments are much more difficult and the prognosis for success as defined above is probably only 50-60%, whereas fetlock arthrodesis in horses that need the joint fused for problems not related to being an active racehorse results in essentially a 100% success rate,” Richardson wrote.

Post-surgery, most horses are reasonably comfortable quickly after the fetlock is stabilized, say experts, though this is still the time when the risk of complication is high. “If you’re going to fail, you’re going to fail very quickly,” said Wayne McIlwraith, founder of the Orthopaedic Research Center at Colorado State University.

Laminitis and local infection are common medical hurdles to overcome in the short term–further down the road, experts warn of potential residual problems with the pastern region.

“The fetlock is meant to bend a lot for a reason,” said Carpenter. “Now that it can’t, you’re transitioning the stress to the other joints.”

For the first few months of convalescence, horses are restricted to box rest. After that, a process of light exercise can begin, leading eventually to a point where the horse can be turned loose in the paddock. This can take roughly six months, said Carpenter.

Though the overwhelming majority of horses will only ever be pasture or breeding-sound, Richardson said that a “small percentage” have been ridden at “low level work,” like trail riding. That these horses are essentially pasture-bound is not a reflection of pain in the fused joint, Richardson explained–rather, it’s due to the practicalities of a high-motion joint being fixed, immobile.

“Fusing it inexorably results in a marked asymmetry of gait that feels terrible when you sit on the horse,” Richardson wrote. “It is not painful to the horse but it looks bad and feels bad to the rider.”

Nevertheless, among some in the industry, the procedure carries a stigma. “When we started this, there were a lot of memories from these surgeries in the early days–how challenging they were, and how often they went poorly,” admitted Benson.

Several industry figures who spoke on the condition of anonymity also raised concerns about a lack–especially in the early days of the program–of clear guidance to determine which horses receive the surgery, and how the economics is structured.

According to Benson, TSG is in the process of developing standardized protocols to guide its California program. These primarily surround the funding mechanism, she said, but also include avenues to ensure others, like the attending veterinarian, weigh in on each case.

When asked if the CHRB, the state industry’s regulatory body, is overseeing the shape of these standards, equine medical director Rick Arthur said that, “I have certainly encouraged them to standardize protocols so all the horsemen understand what’s available, and what they’re being asked to do, and what they’re expected to do.”

The American Association of Equine Practitioners’ euthanasia guidelines outline five main points to assist veterinarian in making “humane decisions regarding euthanasia of horses.” These points are as follows:

A horse should not have to endure continuous or unmanageable pain from a condition that is chronic and incurable.

A horse should not have to endure a medical or surgical condition that has a hopeless chance of survival.

A horse should not have to remain alive if it has an unmanageable medical condition that renders it a hazard to itself or its handlers.

A horse should not have to receive continuous analgesic medication for the relief of pain for the rest of its life.

A horse should not have to endure a lifetime of continuous individual box stall confinement for prevention or relief of unmanageable pain or suffering.

The program, Benson said, has provided an opportunity to showcase the surgical advancements that have been made to the procedure over the years. “We’ve had far more successes, fortunately, than we’ve had issues,” she said, adding that ultimately, “Any decision that’s made on the medical side is made in the best interest of the horse.”

“Dr. Carpenter and the vets on our team are independent of the financial decision. They’re there to help make a medical decision for the horse,” added Benson. “And, if they say, ‘the horse has a reasonable chance of pasture soundness,’ then we turn it over to the people in the racing office to arrange the financial piece.”

Not Just Committed In The Short Term…

A not-inconsiderable sticking point to these surgeries is money. “I’ve long considered that if you’ve bred a horse and race it, or buy a horse and race it, you should be responsible for the welfare of that horse for the rest of its life” said McIlwraith. “Unfortunately, that’s an ideal that not everybody holds to.”

Which leads to the long-term economic considerations of caring for a pasture-sound horse. California’s aftercare program falls under the umbrella of the California Retirement Management Account (CARMA).

According to Madeline Auerbach, who founded the organization and remains on its board of directors, “CARMA’s position is that if this is veterinary driven, and the vets have determined that this is within their guidelines to operate on the horse, we support that and we support trying to provide services for the horse.”

Has the selection process for horses to receive the surgery thus far been vet driven? “It has been,” Auerbach replied. “It’s been vet driven in terms of: Is it worth trying or is it cruel and unusual punishment.”

Financially, CARMA is not “at this point struggling” to care for the horses, said Auerbach. But in the long-term, “We have to figure out a way that we get compensated for it,” she said, floating the idea of a fee or separate fund.

“We have not figured that out yet,” Auerbach said. “We’re still in the process of putting a dollar amount to it and trying to figure out trying to make sure that we do not deplete the funds. This year has been horrific, obviously, in terms of financial support, because we get most of our money from the purse account.”

(This recent TDN story breaks down the hit California purses have taken due to the COVID-driven betting shift towards ADW)

When asked if TSG will step in to provide additional funding in the event a horse who has undergone fetlock arthrodesis surgery finds itself in a financially precarious situation in the future, Benson replied: “If there comes a time when a horse in one of these situations, or a horse really in any risky situation, we want to help be part of the solution, not pass it down the road and assume it’s somebody else’s problem…We’re not just committed to the horses who race at our tracks for the short-term.”

Carpenter stressed the relatively small number of horses for which the surgery is applicable.

“If we have partnership from the industry to help decrease the financial burden to the owner, and we have well-respected lay-up facilities that are willing to take these horses on, maybe we find out that these horses can actually do more than we expected them to do, and we can place them at other places,” Carpenter said. “Then, this perceived burden may not be as big as it once was.”

The post Fetlock Arthrodesis Advances Provide Options appeared first on TDN | Thoroughbred Daily News | Horse Racing News, Results and Video | Thoroughbred Breeding and Auctions.

Source of original post

As with most injuries, the seriousness of a tendon problem depends largely on the severity and location.

“Tendon will generally swell before it tears,” said Dr. Ryan Carpenter, surgeon at Equine Medical Center in Cypress, Calif. “if you can catch a swollen tendon before it tears, then those horses do very well with time off. your typical juvenile tendonitis, you're going to give them 60 days off, let that tendon “set up” basically the inflammation will go down, and then those horses go on and have very long and successful careers with low rate of recurrence.

The problem comes when it tears.”

Carpenter also added that a tendon has to swell by about 20 percent before it could be perceptible to the naked eye. Fortunately, he said the attention paid to racehorses' legs means they're more likely than many other equine athletes to have a groom notice a change quickly.

It's also possible for tendon injuries to take several days after a race to become fully apparent. When Carpenter gets a call about a condylar fracture, it's usually because someone has noticed a horse looks uncomfortable after walking back to the barn and standing for a bath. Tendons don't tend to spark a lameness as quickly unless there's a major tear present. It's typical for ice boots or wraps to go on after cooling out, and if someone noticed a minor swelling with no lameness the next day, they may try icing it for a day to see if it was normal post-exercise edema before getting really concerned. Horses with tendon injuries may even jog sound initially. Generally, it's when a minor change seems to be stubbornly sticking around that Carpenter gets a call and comes out with his ultrasound machine to find the problem.

If a tear does occur, the location of the tear along the length of the tendon and within the tendon's width makes a difference in the level of severity, as does the size of the tear and whether or not there's fluid built up around the injury.

Tendons connect muscle to bone, while ligaments connect bone to bone. Both are made of stretchy fibers, and their stretchiness is especially important for front legs, which bear 60 percent of a horse's weight. During a gallop stride, a horse's front fetlocks flex and descend nearly to the ground, absorbing the shock of the footfall. That motion is possible because the tendons and ligaments have so much elasticity to them. That stretchiness also stores energy to propel the foot back up and the leg forward for the next stride. The suspensory ligament and the superficial digital flexor tendon are the most important to that process, which is why an injury to these structures is especially problematic.

When a significant tendon heals in a mature horse it must do so with scar tissue which is relatively inelastic because mature animals can no longer create tendon fibers. The scar tissue cells may adapt somewhat over time and become a little more stretchy, but they'll never be as good as the original tendon cells.

“You take what amounts to a rubber band and make part of it a piece of string that won't stretch,” explained Dr. Larry Bramlage, equine surgeon at Rood and Riddle Equine Hospital. “When you do that, the load stays the same, so the remaining tendon has to stretch even farther than it did before because it has to make up for the loss of elasticity in the segment that has the injury. So that means the probability of tearing the tendon again is very high, even higher than it was before it occurred the first time.

“All “bowed tendons” are not equal.”

In Bramlage's experience, tendon injuries in front legs are more difficult to rehabilitate than hind legs – particularly the superficial digital flexor, which he says is the worst soft tissue structure in the leg in which to have an injury. Tendons also don't do as well as suspensory ligament injuries in that they don't respond as well to treatment aimed at reducing the formation of scar tissue.

There are a few treatment options that may be used singularly or in combination, depending upon the injury. Stem cells or platelet-rich plasma may be injected at the injury site with the hope the cells can engineer a better healing process. Stem cells are immature cells which read the local environment and direct the repair. The goal is for them to order the formation of new, healthy tendon cells rather than scar tissue. Bramlage has found that this works better for ligament injuries than tendon injuries; the stem cells can make some improvement, but don't seem to consistently be as good at producing new, flexible tendon cells as they are at directing the formation of new ligament cells. The reason why still evades veterinarians.  Some people use platelet-rich plasma, but it tends to promote filling the defect with more scar tissue, something Bramlage likes to avoid.

Some veterinarians may also suggest an operation to cut the superior check ligament (referred to as a ligament desmotomy), which is part of the superficial digital flexor tendon unit. In other species, the superior check ligament is muscle, attaching to the radius and is called the radial head of the superficial digital flexor. But in the horse, all of the muscle in this portion of the superficial flexor has disappeared, replaced with inelastic ligamentous tissue. The superior check ligament is one of the evolutionary wonders that makes the mechanics of the fetlock possible and makes a horse function the way it does.  Mechanically, muscle tissue the size of the superficial digital flexor could never withstand the load of a 1,100-pound horse going 40 miles an hour on a lead limb.  “Pulled muscles” would be the rule. But the superior check ligament absorbs the load, protecting the muscle above it. This protection comes at a cost, however.

The presence of the superior check ligament creates a tendon of finite length, where the load progresses up the limb from the bone insertion of the tendon, up the back of the cannon bone via the tendon and then is transferred to the check ligament and into the radius in turn. This “unit” is what is able to withstand the stress generated by the size and speed of the horse. But the “unit” has a finite length and therefore a finite amount of elasticity within the tendon which makes the unit function. That elasticity is fine tuned to allow the fetlock to flex enough to absorb the weight bearing stress, but not stretch so much as to injure the fetlock joint during flexion. When the allowable stretch is exceeded and injury occurs.

Hind limbs have no comparable check ligament. Mechanically, they don't need one. That is why it is much easier to treat a hind limb tendon injury than a front limb.

One of the treatment options with a bowed tendon is to cut the check ligament after the bowed tendon occurs, adding some length to the check ligament, which lengthens the “tendon unit” trying to protect the tendon. The idea is that the approximately one centimeter of extra length provided to the wounded tendon will help prevent “over stretch” again.  It will also remove some tension from it during healing optimizing healing.

If fluid is present within the tendon at injury, it is best drained to prevent the pocket of fluid from turning to added scar tissue. This procedure is called “tendon splitting” although it doesn't actually involve cutting the tendon fibers. Rather, it refers to the surgeon cutting the thin protective layer of cells around the tendon to let the fluid out. That layer will heal itself.

Regardless of the treatment, the key component of recovery is patience.

“No matter what you do, nothing is going to take the place of time,” said Carpenter. “Time is what you need to get these things to heal. 'Time' on a decent sized lesion is going to be six, eight, months at minimum. That's the frustrating part from an owner's standpoint is you've got a horse that's injured and now he needs a year before he can run again. And when they do run again, a lot of these horses run a race or two and then they reinjure themselves and are back on the shelf again.”

Bramlage echoed those sentiments, referring to a published study finding that of 332 horses that had bowed tendons and underwent superior check ligament desmotomy, roughly two-thirds came back to the races, but only 48 percent made five starts or more. Of black type horses he looked at in unpublished data, only 20 percent ever ran in a black type race again, suggesting it can be very difficult for a horse to maintain class after a lay-off for a tendon injury. The average time from injury to first start was 10.5 months.  Veterinarians have since learned to shorten this some since the study, but the degree of injury plays a role.

Carpenter points out that rehabilitation time is the most expensive of all the potential treatments, and it's the one a horse must undergo. In Southern California, he estimates a horse who gets “the works” in terms of treatment may rack up $2,000 for stem cell therapy, another $3,000 for surgery, $10,000 to $15,000 at the farm for lay-up and another $10,000 for training to get back to the races. Those prices make it unlikely a cheap claimer will be brought back. For a top stakes horse, the question is more about opportunity cost than bills.

“I don't know anything about Honor A.P., but in general on a horse of his caliber you ask yourself, is it financially worth him to rehab for a full year to come back?” said Carpenter. “He'd have to run at Grade 1 level, because if he runs at the lower level you haven't accomplished much for him and his value. If we do that now, we've missed our breeding season that's coming, hoping he can do something great that will make him more valuable in the future. The chances of that happening are very low.”

That mostly leaves mid-level stakes geldings or hard-knocking mares available to try laying off and then coming back. It's hard for a horse to return to top form after a lot of time away – age factors into their ability to regain their previous athletic level, but it also may be an indication of how much the healed tendon struggles to keep up, allowing the same level of performance.

So, should those Grade 1 types enter the gene pool? Aren't they just passing along predispositions for the same injury to future generations?

In the case of tendon injuries, there's no evidence of that, according to Carpenter and Bramlage. Uneven or excessive loading of a tendon due to other soundness issues or unexpected abnormally high loads is most likely to contribute to a tendon injury, not genetics. However some conformational issues can make the horse more vulnerable (upright pasterns are one the upright angle comes from the fact the tendon is shorter in those horses).  That doesn't mean there is an actual defect of the tendon itself. Injury can also come as a result of uneven footing, especially if it's soft. Bramlage has found though that oftentimes, a bowed tendon occurs secondary to another problem. “Horses with chronic low-grade lamenesses will preferentially load the sound leg and it's normally the sound leg that gets the bowed tendon,” he said.

The good news for a retiring horse with a tendon injury is that they're usually sound for other purposes. Some more severe cases may be restricted in how much they can jump, but others are able to move on to new jobs with no restrictions if they don't head to the breeding shed.

The post Tendon Injuries: Why They’re So Difficult To Rehabilitate And Why So Many Racehorses Retire With Them appeared first on Horse Racing News | Paulick Report.

Source of original post

A group consisting of the Dolly Green Research Foundation and The Southern California Equine Foundation as well as several individuals, recently came together to purchase and install a Standing Equine MRI system, from Hallmarq Veterinary Imaging, at Santa Anita Park racetrack. The group is working closely with the Stronach Group, owners of Santa Anita, to introduce the technology to veterinarians and trainers.

“The Stronach Group is excited about the addition of a standing MRI to the existing diagnostic options for horses at Santa Anita Park,” said Dr. Dionne Benson, chief veterinary office for The Stronach Group. “Together with the standing PET (Positron Emission Tomography) system, which was installed at Santa Anita late last year, these new modalities greatly improve the ability to identify preexisting conditions, is an important step in ensuring horse safety and welfare.”

The groups began fundraising for the MRI last fall and were able to reach their target goals to allow purchase and recent installation.

“Hallmarq's Standing Equine MRI (sMRI) system brings the same diagnostic capability to equine clinical practice as the human sports medicine field” said Dr. Dan Brown, vice president and chief customer officer, at Hallmarq.  According to Brown, there have been close to 70 horses diagnosed using the Hallmarq MRI at Santa Anita.

Brown said that soft tissues are very hard to evaluate on radiographs and bone changes will show up on MRI weeks before they can be seen on x-ray, which can make a big difference for a horse trainer contemplating entering a horse in an upcoming race.

With the equine patient being at the forefront of every design decision, Hallmarq's unique sMRI capability avoids the risks associated with general anesthesia and allows equine veterinarians to offer clients the most advanced lameness diagnosis method on an outpatient basis.

“Traditional lameness diagnosis is often a cycle of trial and review that relies on a slow process of elimination,” said Brown, a former veterinarian with over 20 years' experience in the veterinary profession.

“The integration of Hallmarq's standing MRI to our diagnostic imaging center at Santa Anita has been seamless,” said Dr. Ryan Carpenter, one of the on-track veterinarians at Santa Anita. “Being able to identify bone pathology at the earliest stages allows us to intervene long before these abnormalities could be seen on radiographs. Knowing that we have this technology at our fingertips where horses can literally walk out of their stall, undergo sMRI and be back in a matter of a couple hours speaks to the commitment to greater safety for our athletes.”

Hallmarq has developed unique equine expertise over almost two decades by imaging more than 100,000 horses at 100 sites over six continents. With Q-Care, Hallmarq's world-class support system, customers have experienced uptime of greater than 99% and upgrades to their systems to ensure that practices enjoy a diagnostic rate in excess of 90%.

Other racetracks have used the system, including the world-famous Hong Kong Jockey Club.

“We installed the Hallmarq standing MRI in 2013 and since then have performed hundreds of examinations of the lower limbs primarily in Thoroughbred racehorses,” said Dr. Paul Robinson, Head of Veterinary Clinical Services at the Hong Kong Jockey Club. “We have found the information obtained to be invaluable in the identification of injuries that are not visible on conventional imaging modalities and it has helped us to manage a variety of conditions using an objective, targeted approach.  Of great interest in our population is the capability to perform multiple follow-up studies of the region of interest to monitor the healing process of subchondral bone lesions in the lower cannon bone of our thoroughbred population.”

Read more about standing MRI in this 2015 Paulick Report feature.

Standing Equine MRI Benefits:

• MRI can show problems that are not visible, or at an earlier stage than they would show up on any other imaging method.
• Standing MRI occurs under very light sedation, without anesthesia. This both eliminates risk of injury and makes it much easier for a client to say “yes” then conventional 'down' MRI.
• MRI involves no radiation unlike, CT, bone scanning or radiography.

The post New Standing MRI Has Already Helped Diagnose Nearly 70 Horses At Santa Anita appeared first on Horse Racing News | Paulick Report.

Source of original post