It was standing-room only the other night at Equine ER's first bookstore reading at Joseph-Beth Booksellers in Lexington. Thanks to all of you who were able to make it and special thanks to Kimberly Brown and Chad Mendell of TheHorse.com (publisher/editor in chief and managing editor respectively) for hosting the Equine ER blog, which has permitted so many people to find out about the book. (And many thanks to the other Horse staffers involved.) We're working on some special features, including 10 Questions for Dr. Larry Bramlage, a follow-up to the Chelokee excerpt. Dr. Bramlage is his usually busy self (think moving target), so we don't have a date yet for that posting. Meanwhile, more excerpts coming, as well as more videos, so stay tuned. Below: Dr. Bramlage (left) in surgery. 

Equine ER author Leslie Guttman at Lexington, Ky.'s Joseph-Beth bookstore this Friday (8/28), 7 p.m.

On Monday in Part Five of this excerpt from the new book Equine ER, elite racehorse Chelokee, trained by Michael Matz (Barbaro’s trainer), recovered from surgery for a severely dislocated ankle and headed to his next phase of life: a stud career. But trouble surfaced for the colt four days before the open house for the public to view the new studs. In today's installment, what happened at the open house. 

In an adjacent barn, at tables covered with white tablecloths, people nibbled on cheese sandwiches and drank wine as they leafed through the glossy stallion catalog. A flat-screen TV flanked by evergreen trees replayed the different stallions’ races.

Back inside the larger barn, Chelokee was in his stall. He wasn’t being led out because of his foot. Nobody in the crowd asked why; spectators would just gather around his stall periodically, and a Vinery worker would open the door so they could get a look. When I was there, Chelokee came up to the entrance of his stall and gave everyone photo-ops and then circled around the space with no problems walking at all. He looked healthy, handsome, and energetic.

Chelokee at the stallion open house in January 2009.

“He’s got a pretty eye,” said one woman watching him, as her friend took pictures. After a while, the crowd left, and the stall door closed. But Chelokee was fired up; he began bucking around again. Then the colt kicked the stall with his back legs, on purpose. Maybe for the hell of it or to let someone know he wanted to get out in the paddock. The sound made me shudder, knowing the bill for his front leg had cost at least twice the down payment on my house. But Chelokee is a horse, not a person, who, after having a catastrophic injury one year earlier, would probably have still been cautious with how he threw his body around. Horses don’t look back. For Chelokee’s part, his health crisis was over. By the beginning of spring he had covered (bred) twenty mares, not as many as 2007 Breeder’s Cup Dirt Mile winner Corinthian across town (managed by the same partnership)  who had covered 100 mares and counting, but a good showing in a bad economy for a horse in his circumstances. Now Chelokee’s three-year clock had begun ticking.   

Chelokee is one of hundreds of horses that have been saved through Dr. Larry Bramlage’s invention of the fetlock arthrodesis. People often wanted to know from the vet, “Why do some horses recover from catastrophic injuries and others don’t?”

His reply when he was a guest on the Webcast “Talkin’ Horses” was: “There is no answer to this question. It is like asking why some car accident victims survive and some don't. It is the sum total of the various aspects of very complex injuries, the response of the horse, both in healing and in caring for themselves, and a certain degree of luck that determines the outcome.”

In other words, equine veterinarians can’t play God any more than human physicians can. Why one patient with the same injury heals over another is, like a horse’s mind, unfathomable.

Coming soon: Ten questions for Dr. Larry Bramlage

Readers have been weighing in with their feedback on Equine ER, the new book by Leslie Guttman published by Eclipse Press. Here's what reader Paul Groffie of Marlton, N.J., recently wrote us: "... I cannot thank you enough for taking a subject that you do not get to hear about that much and sharing it with your readers.  ... Barbaro opened up a new desire in me to learn a little more about what horses (& owners) go through and your book WAS AWESOME!" To order Equine ER, click here. Thank you for visiting this blog. 

Equine ER author Leslie Guttman at Lexington, Ky.'s Joseph-Beth bookstore this Friday (8/28), 7 p.m.

On Thursday in Part Four of this excerpt from the new book Equine ER, elite racehorse Chelokee, trained by Michael Matz (Barbaro’s trainer), recovered from surgery for a severely dislocated ankle and headed to his next phase of life: a stud career. But in today's installment, trouble surfaces for Chelokee. (Background: Chelokee's surgery, known as a fetlock arthrodesis, was performed by Dr. Larry Bramlage, perhaps the most famous equine orthopedic surgeon in the world. The colt had broken down one day before the 2008 Derby at Churchill Downs and was rushed to Rood & Riddle Equine Hospital an hour away in Lexington.)

Every dream for a Derby winner begins in the breeding shed. Bramlage says a new stallion is similar to a new NFL running back. “They have three years to prove their worth,” he said, referring to how important it is for them to produce effective athletes at the track and that their three-year-old sons and daughters are the first and most important test. Despite some big names, stallions can come and go like reality show stars. The most heart-wrenching story I know about a failed stallion is that of Ferdinand. The gentle, chestnut 1986 Derby winner was unsuccessful as a stud in the United States and ended up in Japan in 1994 where, also a disappointment in the breeding shed after several years, he was sold to a slaughterhouse and most likely turned into pet food

Chelokee on a break outside of his stall as he mended at the hospital.

Chelokee came from solid sire Cherokee Run, whose sons include Zanjero, War Pass, and Chilukki, each with lifetime earnings of over $1 million. But he had never won a grade I race like the Breeder’s Cup, which is what top breeders want. He had to contend with the P.R. surrounding his injury. Plus, in 2009 when he went to stud, the economy was in trouble, and the horse industry reflected it, with most farms reducing their stud fees. The first week of January 2009, Vinery had its stallion open house. Thoroughbred mares start breeding every year mid-February, and the yearly open house is a parade of studs for horse people out matchmaking for their mares, and for the media and fans.

Chelokee had been doing well since he left Rood & Riddle at summer's end. But four days before the open house he started having problems traveling correctly on his right front foot, the same leg on which he’d had the arthrodesis. It turned out the horse had bruised the soft tissue of his right front heel.

Dr. Vern Dryden of Rood & Riddle’s podiatry department rushed over to see what could be done. Chelokee’s bruised heel was soaked in Epsom salts and wrapped in a bran mash poultice. Dryden shod him the next day with a specialized shoe. “The way he travels causes him to load that heel very hard,” Dryden told me. “He doesn’t have the flexibility because his fetlock is fused. ..." The horse was still adapting to his new anatomy. His size and the severity of his injury made it more difficult than it would be for most horses.

The day of the open house was cold with occasional puffs of snow, some liquid sun. At Vinery, the scene reminded me of the red carpet at a Hollywood movie premiere. Inside the farm’s huge white clapboard barn topped by spires, the horses were groomed and lustrous. Crowds of people stood at the entrance as a man in a green Vinery jacket called a stallion’s name … “RePENT!” and another green-jacketed handler escorted the stud up to the onlookers, stopping underneath the square of light filtering through the cupola above. Cameras flashed as the stud’s lines were appraised.

Thursday: Did Chelokee make an appearance at the open house?

Readers have been weighing in with their feedback on Equine ER, the new book by Leslie Guttman published by Eclipse Press. Here's what reader Paul Groffie of Marlton, N.J., recently wrote us: "... I cannot thank you enough for taking a subject that you do not get to hear about that much and sharing it with your readers.  ... Barbaro opened up a new desire in me to learn a little more about what horses (& owners) go through and your book WAS AWESOME!  It allowed me to somewhat understand what it takes to be involved in such a wonderful profession.  Large animal veterinarians are amazing, and after shedding so many tears over Barbaro your book allowed me to realize that so many other horses are helped every day, and they are just "regular" horses (if such a term should be used?) with great personalities and loving owners." Meanwhile, Susan Richards, author of the New York Times best-seller "Chosen by a Horse," says the book is “as thrilling and drama-filled as any of the popular hospital shows on television today.”   To order Equine ER, click here. Thank you for visiting this blog.  

 “He’s got a little pastern sag,” Bramlage said finally, meaning the pastern joint was bending backward slightly, caused by both the original ligamentous injury and the fact that the pastern was now being asked to do some of the job of the fetlock. Then the veterinarian kept looking at the films.

Finally, Bramlage said, “So far, so good.” Dr. Megan Romano, an intern, put a final set of X-rays on the screen, and he said, “That’s great.” The implants were “solid” and the bone fusing. The healing was on track. The supporting limb showed no signs of problems. Everyone around Bramlage exhaled. With the cast now off, the test in the coming weeks would be how the pastern joint took the added weight load, and how the (natural) ligaments and tendons moved and adjusted to life without a movable fetlock joint.

Chelokee (here with tech Dana Kielar) became a favorite patient of hospital staff.

Throughout the summer Chelokee held court in Barn 2, continuing to charm the staff. The colt was a ham. When journalists came to see him, he posed for photographers, making sure they got his best side. Unlike some other horses, he loved his baths. He didn’t squirm or try and get away. As the stream from the hose hit him, he became motionless, reveling in the feel of the water against his coat.

In late summer, as his exercise load was being increased to thirty-minute walks twice a day, the colt started to get sore on his left front leg. He was stretching his pastern joint in the injured right front, which put more weight on the opposing limb. It was worrisome. Laminitis could develop. In discussing the fetlock arthrodesis once, Miller, Bramlage’s tech, said: “It can make you feel like you’ve done the best thing in the entire world, or it will break your heart.”

To deal with Chelokee’s sore limb, Bramlage changed his medication and altered his exercise. Eventually, the colt came around. By the end of August he was ready to go to Vinery, a stud farm in Lexington, for further recuperation and, fingers crossed, a stud career.

The day Chelokee left for Vinery, he got a bath. After that, he was groomed and fussed over by the techs and barn crew. When the trailer came to pick him up, he walked steadily toward it. Right before he stepped up, he stopped, looked around a moment (for the cameras?) and boarded. A prince was healthy again.

Bramlage would continue to visit Chelokee on the farm, monitoring his progress. The colt and other Bluegrass Thoroughbreds were, as someone put it to me at a party, the only patients left in the state who still got house calls by their doctor. 

Monday: Did life at Vinery go smoothly for Chelokee?

In her advance praise for Equine ER  by Leslie Guttman, Susan Richards, author of the New York Times best-seller "Chosen by a Horse," says the book is “as thrilling and drama-filled as any of the popular hospital shows on television today.”  Sales of the book, published by Eclipse Press, have been brisk. In Lexington, Kentucky, Eclipse's home base, reports are that at the biggest independent bookstore in the city, copies are cantering off the shelves. A national online retailer nearly ran out of books twice. We recently found out that the company Intervet/Schering-Plough Animal Health will be purchasing 500 copies for veterinary students who will be coming from across North America to the Opportunities in Equine Practice conference (OEPS) held each year in Lexington in early September. To order Equine ER, click here. Thank you for visiting this blog.  

On Thursday in Part Two of this excerpt from the new book Equine ER, elite racehorse Chelokee, trained by Michael Matz (Barbaro’s trainer), was operated on by Dr. Larry Bramlage, perhaps the most famous orthopedic surgeon in the world. The colt had broken down one day before the 2008 Derby at Churchill Downs and was rushed to Rood & Riddle Equine Hospital an hour away in Lexington. Today, Chelokee's final cast comes off.

Dr. Larry Bramlage gives Chelokee a peppermint.

A second career as a stud looked like a good possibility for Chelokee in the weeks after his operation with his recovery going relatively smoothly. He also seemed to be enjoying himself as the most popular horse at the hospital. He was good-looking and knew it, smart, proud, and a little goofy. A four-year-old horse is at the end of the puppyhood stage of equine maturity, and Chelokee loved playing with the red and green balls someone had put inside his stall and pulling on people’s clothes. Sometimes, the way women around Rood & Riddle talked about Chelokee reminded me of the way girls discuss boys in high school.

“He’s a jock (said admiringly). But it seems like all he cares about is himself.”

“He’s just so handsome.”

“He’s like a little boy. He’ll mess around with you, pretend he’s going to try and be bad, but he doesn’t have a mean bone in his body.”

After the colt had his first cast change two weeks after the operation, his coronary band, the circle of vascular tissue whose critical job it is to nurture and grow the hoof wall, was healthy, undamaged by the period of lost blood supply. His entire foot looked good, his incisions healed. No soft areas were evident that might have indicated infection. The horse had lost skin on the back of his ankle due to the vascular damage, but nothing serious or deep into the tissue, and healthy tissue was underneath the areas that had sloughed off. Bramlage’s plan was to leave the cast off for a couple of days and let the tendons move and stretch. Doing so would make the colt’s transition to bearing weight easier. The next cast would leave his toe open, allowing for a little bit of motion in the tendon as he stepped, creating another transitional stage. The radiographs of the injured fetlock showed no problems. Just as important, the X-rays of the supporting limbs also showed laminitis had not begun.

About one month after the operation, it was time for that open-toe cast to now come off, “the last critical transition,” according to Bramlage. From here on out, the colt would wear only a bandage for support. It was an early June day, steaming hot. When I got to the hospital, Chelokee was already in a radiology room. His dark mane was parted down the middle, his gaze confident. He was the equine version of homecoming king.

Bramlage was in his trademark Smurf-blue scrubs. The small cast saw he held in his hands had a blade on the end that looked like a pizza cutter. He turned it on and began to roll it back and forth over the purple cast on the horse’s right front leg. Dust flaked off into a little purple pile. Chelokee, the sedation having now taken effect, hung his head.

Sheri Miller, one of Bramlage’s techs, held two sets of cast spreaders in her hand, one small, one large; they looked a little like pliers. She handed the small set to Bramlage first, and he pried the cast open. Chelokee’s lips quivered, his eyes were downcast. Another tech gently held his ears.

“Pick him up,” Bramlage said to Miller, and she lifted his right front hoof. “The big one now,” he said, and Miller handed him the large set of cast spreaders. Then to Chelokee, “We’ll get this off you in a minute.”

Bramlage pried the cast completely off. A funky smell filled the room, gym-locker-like. Bits of moist hay were stuck to his hoof. A translucent protective patch designed to keep the cast from rubbing the skin was stuck to the leg. It was red from the scarlet oil, an anti-bacterial ointment applied to the wound to help speed the healing. Bramlage peeled the patch back to show the damp, sticky skin.

“As soon as we get some X-rays, let’s sweat him,” Bramlage said, referring to a process done to take down the swelling in the soft tissue. An ointment is applied to the fetlock and then it is wrapped in plastic with another bandage on top of that.

After the X-rays were taken, Bramlage put them on the light stand. I gathered with the techs and several interns around him. He looked at them without saying anything for what seemed like forever. The doctor’s face was unreadable. Sweat rolled down his left temple.

Thursday: What Chelokee’s X-rays showed.

In her advance praise for Equine ER  by Leslie Guttman, Susan Richards, author of the New York Times best-seller "Chosen by a Horse," says the book is “as thrilling and drama-filled as any of the popular hospital shows on television today.”  Sales of the book, published by Eclipse Press, have been brisk. In Lexington, Kentucky, Eclipse's home base, reports are that at the biggest independent bookstore in the city, copies are cantering off the shelves. A national online retailer nearly ran out of books twice. We recently found out that the company Intervet/Schering-Plough Animal Health will be purchasing 500 copies for veterinary students who will be coming from across North America to the Opportunities in Equine Practice conference (OEPS) held each year in Lexington in early September. To order Equine ER, click here. Thank you for visiting this blog.