Surgery for Horses...

Under doctor's orders: Remarkable pictures from Britain's world-leading hospital for horses

Pictured for the first time, dedicated veterinary surgeons at Newmarket's equine clinic prepare to operate on a very special patient. Thanks to their skill, the lives of countless horses have been saved - and the oldest of sports is touched by a new humanity 

The £10 million Newmarket Equine Hospital is the largest and most sophisticated in Europe and a centre of excellence for orthopaedics

Her mouth lolls open as she is hoisted aloft, her hooves strapped together and clipped to a large steel hook. Weighing in at over half a ton, the magnificent but apparently lifeless Spanish mare dangles upside down and unconscious, from an overhead rail.

She is moved slowly, then lowered gently onto a green table, ready to be wheeled into a bare, sterile room. Her coat gleams in the harsh strip light. A team of highly trained equine surgeons, anaesthetists and nurses in surgical scrubs is waiting for her.

This ‘warmblood’ horse, bred for showjumping, has a large and potentially life-threatening tumour inside her mouth. Her owners are only interested in one place to treat her: they have driven her via France to Newmarket, to Europe’s most advanced hospital for horses.

Just 20 minutes earlier she was led, already mildly sedated, into a padded room to be put to sleep with potent doses of diazepam and ketamine. A nurse stroked and talked calmly to her as she drifted off. Her legs slowly began to fold beneath her, then staff moved in to steer her towards the rear wall so she could gently slide down and be rolled onto her side.

A Spanish show-jumping horse is lowered on to the operating table before mouth surgery. It was anaesthetised in an adjoining room before being winched into the air and transported via a ceiling track

Once the horse is safely delivered into the operating theatre, specialist surgeon Ian Wright jumps up on to the padded operating table. With the help of an anaesthetist, he heaves the horse’s head up to manoeuvre it into an accessible position. Once he has rearranged the horse, he begins to cut into the gum and part it, in order to remove the tumour from the lower jaw.

‘You have to be reasonably fit and strong, and aware of what the horse is capable of doing,’ he says.

‘I’ve been squashed many times. We’ve all been kicked, bitten, fallen on, stamped on and generally abused by our patients, so it’s probably not much different from the NHS.’

The medical set-up is indeed largely the same, except that here everything is oversized. The doors are bigger, the corridors are wider, and the operating theatre itself is larger than a double garage.

The plastic endotracheal tube the anaesthetist puts in the horse’s mouth to deliver gas is made by the same manufacturer as those for humans; it’s just that this one’s wider than the tubing coming out of a forecourt petrol pump. X-ray machines move around the horse on a huge gantry. Here, equine patients are not slid into a tunnel for an MRI scan – instead, the powerful magnet moves around them.

The Spanish horse is prepared for surgery (left) and a racing thoroughbred colt (right) has clingfilm wrapped around his lower limb to keep any dirt away from the surgery site, his stifle (knee)

The £10 million Newmarket Equine Hospital is the largest and most sophisticated in Europe and a centre of excellence for orthopaedics. It had 3,267 admissions last year from all over the Continent, and of the 834 surgeries, 344 were arthroscopies (keyhole surgery on joints), 88 fracture repairs, alongside 64 colics and 54 respiratory surgeries. The hospital will be the trauma centre for any horses injured at Greenwich during equestrian events at next year’s London Olympics.

The team at Newmarket consists of about 70, including five specialists (the equivalent of consultants), anaesthetists, nurses, as well as interns and students who come from abroad to train. Specialists are often called away – just this week Ian Wright has been to France and Ireland to operate. His past patients include winners of the Derby, the Yorkshire Oaks, Royal Ascot, the German Derby, as well as World Cup showjumping and Olympic Three-Day Eventing gold medallists.

But it’s not just for thoroughbreds, those aristocrats of the animal world. This is a referral hospital, so vets can send a horse of any size and shape here, be it an elite athlete or a treasured pet. By improving a horse’s quality of life they are helping to lengthen their lives.

All hands on after surgery as the Spanish horse is moved back in to recovery to wake up

‘They’re all athletes after all,’ says Wright, ‘even if, like a weekend jogger, they only go for a hack on Sunday morning.’

The Spanish horse (the hospital insists on patient confidentiality) had arrived at the hospital stables three days earlier. Clean, bright, airy and surprisingly smell-free blocks, they have high ceilings and ridge vents, with wood chippings on the floor.

Surgeon Ian Wright works on the patient in the operating theatre

Notice boards attached to each stable tell staff if the horse prefers dry or wet hay, and whether they like it to be served in a net or loose, on the floor or in a manger. The only sound, apart from the occasional conversational neigh, is of stable staff energetically sweeping and scrubbing with stiff brooms.

Security is tight. The 15-acre site is closed off behind security gates, with more gates inside the complex, which is covered by CCTV cameras. Five interns live on site, keeping watch over the horses 24 hours a day.

Horses come here from all over the world and just last month they operated on a thoroughbred stallion at stud estimated to be worth £50 million. Unsurprisingly, the owner sent along his own staff to stay nearby while the horse was undergoing treatment.

‘Operating on him didn’t make me nervous,’ insists the dedicated but jovial Wright, a partner in the Newmarket practice.

‘It makes no difference – the procedures are the same. But usually the owners are only too keen to make you aware of the value of the horse. The patients may not talk, but you certainly need a bedside manner with the owners.’

The charges are the same irrespective of the value of the horse. The Spanish horse is not insured, so the clinical evaluation, X-rays, anaesthesia, surgery, drugs and dressing, and ten days in the hospital will cost about £3,000 plus VAT. Arthroscopy on the stifle (the equivalent of our knee) for the Irish grey gelding (pictured on the following pages) to remove torn cartilage cost between £2,000-£3,000.

Ian Wright removes a tumour from the jaw of the Spanish showjumper

‘Many privately owned horses have insurance but not all,’ says Wright.

‘Elite athletes, and particularly the racing thoroughbreds, are not insured for veterinary fees. It’s just not offered. It’s a little like footballers or other elite athletes. The higher the athletic demands, the more likely they are to become injured, so insuring against the increased risk is hard, and the costs are met by the owners.’

There are 84 stables; at most times about 60 are in use, and room is left for emergencies. Owners can choose between outside stables and the more sociable indoor option.

Surgical equipment for arthroscopy, non-invasive joint surgery

‘Some owners prefer outside because they don’t like their horses to associate with other horses, although of course it does make sense if it has a big race coming to avoid any chance of picking up a cold.’

There are also four isolation stables in case of infection. As well as paddocks and a menage area, used to assess any lameness of horses (basically whether or not they have a limp), the hospital also offers X-ray, ultrasound, and MRI scans, as well as laser surgery. It has a six-box intensive care unit.

This is currently home to a mare who had a Caesarian and her foal, born with deformed knees (both are making a rapid recovery), as well as a delicate-looking Arab yearling who had spooked and crashed through a metal gate and is left feeling sorry for herself in a full-limb cast.

‘In the past we wouldn’t have carried out a lot of these surgeries,’ says Wright, who graduated from Trinity College, Cambridge, in 1979.

‘Morbidity, ie the side-effects of surgery, would have outweighed the potential benefits, meaning fewer would have gone on to have useful lives so they may have been put down.

‘There have been massive improvements in anaesthetics and surgery. The rise of minimally invasive arthroscopic techniques has run parallel to that in man over the past 20 years, while fracture repair has been helped by improved stainless-steel implants big and strong enough to withstand the forces, along with a greater understanding of bio-mechanics. We have prolonged useful lives and therefore lives themselves.

Ian Wright helps lift the Spanish mare's head into the correct position for surgery

‘Now, mercifully, there are relatively few horses that need to be destroyed as an emergency on a racecourse. Often, of course, it’s a matter of economics; that’s the harsh reality.

'With fractures of upper limbs, above the hock or knee, the horse would probably still not survive to have any reasonable quality of life. With many fractures below there, horses can be saved but the owner might still consider it not economic to do so if a horse can no longer race, in which case it might be humanely put down.’

An anaesthetist and a nurse look into the padded recovery box to check up on a horse

If things do go wrong at a racecourse, wherever it is, the horses are all sent to the pathology department at Liverpool University, which collates information on all racecourse deaths. This is why the horses that died recently in a freak electrocution in Newbury were driven all that way for a post-mortem.

Despite improvements, there are still those who call racing cruel – Animal Aid protested about horse deaths at the Cheltenham Festival and also want the Grand National banned. Does Wright sympathise?

The Irish grey lies in the heated, dimly lit recovery box, his eyes covered to reduce distress

‘I understand their position, but racehorses are competing at the limits of athletic endeavour. The only difference between them and professional athletes and footballers is that they have the choice – these animals don’t.

'However, without sport they have no life anyway – they are not bred to simply stand in a field and eat grass. They owe their lives to it. For me, the philosophical argument of Animal Aid and others fails on that basis. I do, however, think it’s beholden on all of us involved in horse sports to ensure that animals compete in as safe an environment as possible.’

After their operations, the horses are returned to the padded box to wake up. They are given a mild tranquiliser as they enter, and for the 20 or so minutes it takes to recover heaters are put on, the lights are dimmed and the horse’s eyes are gently covered.

‘Generally they stay very calm, and even after arthroscopy on a leg joint they are back on their feet very quickly. They’re somewhat tougher than us.’

The Irish grey, anaesthetised, is prepared for theatre

All three horses pictured here have recovered well. The tumour on the Spanish mare was found to be benign, so the horse returned home a lot more comfortable than she was. Lives have been improved – and potentially lengthened.

‘I’m a great admirer of horses as athletes,’ says Wright, ‘and I do follow with particular interest any I have operated on. I don’t bet at all though. Anyway, I’m too busy watching how they move. I’m the same with films. Even if John Wayne is about to be shot, I’ll spot an interesting lameness in a horse in the background.’

He surrounds himself in his office with pictures of winning horses.

‘Nearly all of these horses won the event for which they are best known after I operated,’ he laughs. ‘Which is just as well, otherwise I’d have starved and this place would have been repossessed.’

A horse having a lameness evaluation