Barbaro's steady doc - A Wonderful Article About Dr.Dean Richardson

Surgeon relentless through stress, critics, rehab.


By DICK JERARDI
jerardd@phillynews.com
GEORGE WIDMAN/Associated Press

Dr. Dean Richardson, on Barbaro: 'I can look myself in the mirror easily and say I haven't put this horse through pain.'


WHEN YOU have been doing something for nearly 30 years, you know what can go right and what can go wrong. Still, as June blended into July, Dr. Dean Richardson began to believe that his case of a lifetime was going to end with the outcome that everybody wanted. Kentucky Derby winner Barbaro's fractured right hind leg was healing. Just about every sign was positive.

Perhaps all those people who are so attached to animals and really became attached to this animal, who had sent all those flowers and all those posters to the New Bolton Center in Kennett Square, were going to able to see Barbaro walk out of the hospital.

Then, with no warning, everything changed. Even now, weeks after that first week in July, Richardson - the chief of surgery at New Bolton and the doctor who performed the May 21 surgery on Barbaro the day after the colt shattered that right hind leg in the Preakness, a man who has seen just about everything there is to see in his business - finds those days hard to relive.

Seated at one of the desks in the auditorium where he first explained Barbaro's injuries and then made the grim prognosis in mid-July, he went back to the weekend of July 8-9, describing all that went down before then and all that has transpired since.

Late that Sunday afternoon (July 9), Richardson attended a party honoring Gov. Rendell at Mark Reid's Walnut Green Farm, a farm a few miles from New Bolton. He had just finished approximately 20 hours of surgery on Barbaro. He knew the issues had gone from serious to life-threatening. Outwardly, he was calm and relaxed. That belied how he felt.

"I was in tears by the end of that day, at home," said Richardson, whose eyes were getting moist during the telling. "I almost get emotional just thinking about how upset I was about that day, because I thought we were going to lose him.

"Then, I was exhausted, physically and mentally. I don't even like to think about that day.

"Getting him up was so stressful. Getting him up out of the pool and not having him stand and then fight us.

"It's one thing for everybody else who was there, because there were tons of other people involved in this. They were all stressed. But I'm sure that on that one day, as stressed as everybody else was, that's the one day I would say I'm sure I was more stressed than anybody else, because I knew that every decision that was made basically was mine - good decisions, bad decisions were my responsibility.

"That was an awful day. That's when he was foundering. At that point, I knew we were in trouble. You second-guess every single thing you did from the day after the Preakness."

It would be several days later when Richardson would tell the world that Barbaro had foundered, contracted the often-deadly hoof disease, laminitis, in his left hind foot. It was then that he would call the colt's long-term prognosis "poor."

"We had an awful lot of things going on, including very, very extensive discussions with Gretchen and Roy [Jackson, Barbaro's owners] and Michael [Matz, his trainer] about whether or not that was the time to call it quits. I think everybody's happy that we didn't call it quits. The horse really has not suffered since that time. Minor discomfort at worst. The horse has had a lot of good quality time since then, and I can look myself in the mirror easily and say I haven't put this horse through pain.

"I can't say that that's true for every single horse I've worked on. I know that I've had horses where I deeply regret that I kept them going longer than I should have kept them going. I make mistakes. Everybody makes mistakes. Sometimes, you think you're going to pull them out of the fire and sometimes that doesn't work out."

When you decide in college that you want your life's work to be with horses, as Richardson did at Dartmouth, you get attached to the animals. You really have no choice. And when you lose a patient, you don't forget.

"It's pretty devastating and it's not just me," Richardson said. "It's all my colleagues, my residents, my interns, the nursing staff, everybody that gets involved in these horses, people really should understand that we get pretty tied up with these animals and I don't mean like in a kind of schoolgirlish, 'Oh, isn't he a cute pony?' type thing. You know, that's your job, and you take it seriously. And the whole reason you became a vet is because you wanted to help animals."


 


Richardson has been a surgeon at New Bolton for 27 years. He went to Dartmouth wanting to be an actor, but when the would-be drama major took a class in horseback riding, he was hooked almost immediately, reading "100 books about the theory of riding."

Riding morphed into an all-encompassing infatuation with everything to do with horses.

"I just got very serious about it very quickly," Richardson said. "Finally, it dawned on me that I was a crappy actor. I was in a bunch of stuff and I just learned after watching people that were better.

"The whole time, I was taking some science courses because, for me, science was relatively easy. I finally decided to become a vet."

After spending a year working for a vet in North Carolina, he went to Ohio State Vet School. To this day, Richardson has never regretted his choice of profession.

"A lot of veterinarians have [had second thoughts], because the fact is, the more specialized, particularly when you do very, very sophisticated types of surgery and you recognize what you are getting paid, a pittance compared to what a human surgeon would get for a similar surgery, some people let that worry them," Richardson said. "The fact is, I love my job. I've always loved my job."

It was that mind-set that would not let Richardson give up on Barbaro, even when it seemed a reasonable alternative.

"It was always an issue of everyone agreeing that we would go on, because we thought we could manage his pain [with medication]," Richardson said. "That was the determining factor. You could walk up to his stall and look at him in the eye and he looked back at you. He'd eat carrots out of your hand. He wasn't lying on his side and groaning.

"I know what painful horses are like. I've seen a lot of them. He wasn't a horse that was in distress. It wasn't hard for me to want to go on. What was hard for me to acknowledge, the reality was that the long term was going to be very, very long term. That was what we discussed. The Jacksons grasped that. We all basically bought into this notion that we're just going to go and go until he tells he doesn't want to go on."

A perfect, if graphic description, of laminitis by Dr. Austin M. Moore, in Bloodhorse magazine, explains just what Richardson and his team were dealing with.

"Imagine that your shoe was actually part of your foot and inside the shoe are the bones in your foot," Moore wrote. "Now imagine a disease that causes your foot [the bone] to break loose from your shoe; while you walk and stand your foot pushes through the sole of your shoe. Eventually the shoe wears away and you start walking on the bones in your foot. This is the reality of laminitis in horses."

Richardson was convinced he could get Barbaro through the pain with all the medication. And he was right.

"I think we made the right decision on that," Richardson said. "There's hardly anybody out there that knows anything about horses that probably would have disagreed with that.

"Now, having said that, did I get crazy letters in the mail telling me I was inhumane, I should have put the horse down? Yeah, I got those. Did I get the phone calls telling me I was an awful person for spending money on a horse when there are starving people in Philadelphia? The answer is yeah, I got those.

"Cursing me out for wasting my time and rich people's money on dumb farm animals. All those kind of hate mail and voice mail. I got all that, but that's no big deal."

There is a whole segment of society that never understood the outpouring for Barbaro anyway. The reality is that thousands of people are more attached to their animals than they are to fellow human beings. Thousands more just love animals because they do.

"There's a whole group of people who understand that, and there's some people who just don't get it," Richardson said. "Some people think just because someone really is wrapped up in an animal that they therefore don't like people, and I don't think that's the case, either."

Saying that, he pointed around the room at all the posters hanging from the walls.

"You look at all the people that signed all these [posters]," he said. "I am sure that not every one of these is a misanthrope. I'm pretty sure just because you like animals doesn't make you misanthropic. I think that's kind of an important point. I like people. I just happen to like horses."


 


Richardson has always done his work in relative anonymity. Not this time.

"I've had a few name horses, but nothing like this," Richardson said. "To my knowledge, nobody's done anything with quite this much press.

"What you're dealing with here is just modern media, too. The media now is so efficient at getting a story out. He did it in a Triple Crown race. If he'd been a horse that had run 10th in the Derby, it was hardly a story, even if the same surgery had been done. The deal was that he came out of the Derby looking to the world like he was a super horse."

Richardson has handled the media equally as well as he has handled the horse. Very few people can do it and explain it so others can understand. He is one of those people.

He knew millions waited on the surgery that day.

"It is very easy to block that out," Richardson said. "It makes absolutely no difference if it's a 10-cent pony or [a multimillion-dollar horse like Barbaro]... It limits your options. It wasn't like I would have to stop in the middle and wonder if the Jacksons will pay if I use a second plate. That's the only thing where the value of the horse comes into play is how much money you can actually spend.

"Which is very different for us vs. a human orthopedic surgeon. If a human orthopedic surgeon gets into the middle of a surgery to fix your femur, he or she is not going to stop in the middle and go, 'Well, I can't spend more than a certain amount of money to fix it and I've run out of money,' whereas we have to do that. That does happen to us.

"In this case, the money is not an issue just because the Jacksons would have paid whatever it took because they loved this horse. And they do love this horse. Money is just not an issue. That is one of the reasons I have steadfastly refused to discuss money. People keep wanting to ask how much does this cost. What difference does it make how much it costs?

"People, their imagination runs wild and that's fine. As soon as I were to say, 'Oh, it's costing X-number of dollars' then all of a sudden, that ends up the story. That's not the story. The story is the horse is being cared for the best that we can.

"People ask me, 'Well, how come you haven't checked his semen to see if he's fertile?' It makes no difference. If he were a gelding, they'd be saving him for what he did for them."


 


For 6 weeks, the story was that Barbaro was making steady progress. Then, the story changed dramatically.

"Before he got into that trouble in early July, I was really starting to get optimistic at about that point," Richardson said. "He had no signs of infection, but then he started to break the pastern fusion down a little bit. We went backin, replaced a couple of screws, ended up with an infection...

"The point is that he started to have some problems much later than I thought [likely], but that's the nature of it. It's an unusual situation. And then he foundered so badly. If he hadn't foundered, the right hind was definitely under control. The right hind was markedly stressed more by the foundering in the left hind, which made my life harder and his life harder."

When problems start to manifest themselves in horses, they tend to multiply quickly.

"That's true in human medicine as well, but not to the extent that it is in horses," Richardson said. "Horses tend to snowball very fast."

That's what happened with Barbaro.

"He definitely had some pus in his left hind foot," Richardson said. "The biggest problem was the acute problem in his right hind. He got super stressed by the whole situation. It was just a perfect storm of problems right in that one spot. I think that led to his acute laminitis."

These days, Barbaro continues to have a cast on his right hind, which has healed wonderfully. His left hind is bandaged. The bandage is changed daily.

Without the laminitis, "he'd have been out of the cast [on his fractured leg] already," Richardson said. "By now, he'd been in a splinted bandage."

The right hind is still an issue, but not a major issue.

"There's details about where it stands right now that aren't perfect," Richardson said. "We've had some collapse... He's got a slight curvature of his leg, which is going to be something we are going to have to worry about down the road, the way he loads his leg. That's not my worry right now. My biggest worry is his left hind foot."

And only time will tell about that, much more time. Months, for sure.

"He's just got to stay walking," Richardson said. "If he stands and walks comfortably... As long as he does that, we can manage him a long time while the foot comes down. His foot is growing, but it is a long process."

It is sort of the equine equivalent of a torn-off toenail.

"Only it's bigger, takes longer," Richardson said. "It's more important to the exact structure of it. You'll see people who have crushed fingers that their nails come back deformed. That's no big deal. It doesn't impair their function.

"If his foot doesn't come back and have a reasonable structure, it's not going to work. So we need him to get the foot to a reasonable structure and it is not an easy thing to do. Part of it's going to be the way he heals and some of it's going to probably be just dumb luck and another will be attention to detail."

Much could still go wrong.

"He could get colic, pneumonia, get infections in his foot," Richardson said. "He could founder in any of his other three feet. There's all kinds of things that could happen, and he could have a setback in his left hind foot. He could lose ground."

Even if Barbaro gets over the laminitis, there simply are no guarantees.

"Things break in horses' legs," Richardson said. "It's conceivable he could rebreak anything that we have in there. A bone is a bone is a bone. They can break it.

"Eventually, his leg is just going to get stronger. If everything goes well, bone is the most miraculous substance in your body in terms of its ability to reconstitute itself. Everything else in your body heals in the sense of scar tissue. Bone gets as good as it ever was and better. It's the only structure in your body like that.

"There's nothing else in your body like that. Your brain sure as hell isn't. People challenge their liver, but it's not like that."

Since the colt got through the immediate days after the laminitis when Richardson had to cut off much of the hoof wall on his left hind, Barbaro has been as comfortable as possible. He had a significant weight loss after all the trauma, but is slowly getting that back. The colt grazes outside daily. Still, his future remains uncertain.

"I have to correct people when they say, 'Congratulations,' " Richardson said. "Throw me a party when the horse leaves the hospital. I honestly don't think anything's been accomplished until the horse leaves. I really don't. I know people don't believe that, but that is the truth. I don't think we've actually accomplished until the horse actually makes it. We certainly haven't accomplished our goal."

Now, Richardson, the Jacksons, Matz and everybody else can only wait.

"If I could have some miraculous way of speeding the process up... if I could have this horse out of the hospital, believe me, there'd be nobody happier," Richardson said.

"It's not because I don't like the horse, because I'm actually very, very fond of him, but admit it, it's intensely stressful, because you just worry about him all the time."

Richardson has had 27 years' worth of patients. He treats them all the same, but...

"Yeah, it is different," Richardson said. "It's become different. I've had lots of other horses that I've cried my eyes out over, been devastated when I lost them. I can reel you off dozens of them by name going back 27 years, but this is different.

"Part of it's how much I have invested, but that's not just it. It's also the weight of the wider world wanting this horse to survive. Certainly, if good wishes could heal the horse, this horse would be running in a field right now."

Doctor: Few surprises during Barbaro's surgery

(c) 2006 Phildelphia Daily News and wire service sources.