07/12/2006 11:00PM

Stopping treatment a complicated choice

Sabina Louise Pierce / Univ. of Pennsylvania
Dr. Dean Richardson said Barbaro's comfort level and long-term outlook are foremost.

LEXINGTON, Ky. - Thursday's news that Barbaro's prognosis had darkened because of acute laminitis in his left hind leg does not mean, his surgeon said, that the colt's destruction is imminent.

But complications like laminitis often mark a crossroads as owners and veterinarians try to determine which course - euthanasia or continued treatment - is in an animal's best interest. That decision, horsemen say, often is complex. It involves objective criteria like the statistical chances of success. But it also involves subjective interpretation of a horse's physical and mental willingness to endure treatment. And that information can change on an hourly basis.

"The reality is that we are doing the best we can to make the appropriate judgments," Barbaro's surgeon Dr. Dean Richardson said Thursday. "And that's really - it is subjective. But there's a lot of people involved in making this decision. And literally every single person involved in making this decision cares only for the well-being of this horse."

In deciding to treat Barbaro's laminitis, owners Roy and Gretchen Jackson are taking into account the colt's current comfort level and his long-term prognosis, Richardson said.

"We discussed at length the fact that his prognosis for both life and long-term comfort has been significantly diminished by this particular complication," said Richardson, who called Barbaro's prognosis "poor."

But, Richardson added, "The reality is that when you come in and see this horse every day, he nickers to you. He is still eating well. He has excellent GI [gastro-intestinal] function. He is capable of walking around the stall. He is maintaining his weight well. His heart rate is low and his temperature's back to normal."

Such seemingly tiny signs are important guideposts in determining whether treatment should continue, horsemen say.

"I think you always have to weigh whether the treatment is going anywhere, and obviously you don't want the animal to suffer," said Stuart Janney III. Janney's family campaigned the champion Ruffian, who suffered a catastrophic breakdown in 1975 during a match race with Foolish Pleasure at Belmont Park. The Janneys agreed to surgery, a new and unusual option at the time, but the effort failed and Ruffian was humanely destroyed on July 7, 1975.

"We felt we had to do it," Janney said of the surgery. "But it had to be with the understanding not to put an animal through senseless suffering for a result that wasn't going to be positive."

"It's a gray area," said Gus Koch, manager of Claiborne Farm in Paris, Ky. Claiborne stood 1973 Triple Crown winner Secretariat, who died in 1989 after battling laminitis for several weeks. "In Secretariat's case, we went into it with the attitude that we are not going to let this horse suffer needlessly. He started to recover, and we thought he was improving, and then he regressed. It's a painful condition, and when he regressed, that's when the decision was made to euthanize him. He was in pain. The main decision was that the horse was suffering and it looked hopeless."

Veterinarians could tell objectively that Secretariat's condition was worsening, Koch said, because they could measure the rotation of the coffin bone, the main bone inside the horse's foot, which rotates down and eventually through the sole of the hoof in severe cases of laminitis. But it wasn't just the X-rays that indicated Secretariat was in trouble; it was his general demeanor, including a decreased appetite, weight loss, and general discomfort.

"He had pain, and he showed it like any horse," Koch recalled. "He was sore, and it was hard to keep condition on him."

Barbaro has what Richardson called "intensive pain management," including epidurals, to keep him comfortable. So far, he hasn't shown any of the disheartening signs the Claiborne staff saw in Secretariat. But if he does, the gray area will become a bright line.

"If we can't keep him comfortable, we will not continue," Richardson said.