The author, who has attended Rolex Kentucky seven times as a private, treating veterinarian and an official FEI veterinarian, explains some of the work that goes on behind the scenes to ensure the horses are in top form.

As we approach the fourth week of April, the most exciting week in the sport of three-day eventing in this country, the last-minute preparations start, and the excitement begins to build. However, for the very select and elite barns around the world that have horses traveling to compete at the Rolex Kentucky CCI****, the fastidious preparations began months, even years, ago.

Certainly during the final month the preparations and the corresponding stress level intensifies for all involved parties—riders, owners, grooms, far-riers, veterinarians, physiotherapists, etc. It takes an experienced team of professionals and an exceptional program to get a sound, competitive, fit and peaked horse ready to compete for the title at the Rolex Kentucky Three-Day Event. The invested man-hours that go into the months of preparation are staggering, but when it all comes together for a successful outcome on Sunday afternoon, it’s a truly wonderful accomplishment for all involved.

From a veterinary perspective, the four-star equine athlete is one of the most exceptional and yet challeng-
ing horses to manage. The horse potentially has one or two weeks a year where he has to be in peak physical form, in soundness and in fitness. After months of preparation, if the horse gets a close nail or a strained muscle in April, there’s not the Rolex of next week, or next month—there’s only one chance each year.

Before The Event
The veterinary preparation for Rolex starts the week after the last three-day event the year prior. Most of these horses will get complete work-ups the week following their last three-day, which may involve baseline tendon ultrasounds, lameness examinations, rechecks on any respiratory or cardiovascular issues, even nuclear scintigraphic examinations (bone scans) in some cases.

It’s important to critically assess how the horse has come through the preceding season and deal with any persistent or unresolved soundness issues. Additionally, mild injuries can be treated or addressed during the upcoming vacation time rather than allowing a mild injury to turn into something more persistent next season. Many of these horses will get four to six weeks off and several months of easy conditioning before they start building up again. This is the perfect time to treat and diagnose things that would otherwise haunt the horse during another upcoming season.

The information gained from this post-season workup—examining the horse after one of the most physically and mentally taxing weeks of the year—is invaluable in preparing for the next season and assessing if that particular program is working for that horse.

Because it takes years to make a four-star horse, all of the horses have miles of wear and tear and athletic stress on their bodies and joints. They all take some sort of proactive veterinary management plan to keep
them competitive, uninjured, and at the top of their games. We love to see these horses be healthy and competitive at the uppermost level of the sport well into their teenage years. With many new sports medicine modalities, it’s not unusual to see some of these horses have their biggest successes late in their careers.

For many of the Rolex-bound horses the spring season really starts in January with the annual trek south. To keep the same critical team working together, it’s not just the horse, rider, and groom who make the journey south to Aiken, S.C., Ocala, Fla., Southern Pines, N.C., or Wellington, Fla.—it’s also the veterinarian, the farrier, the massage therapist and anyone else involved in the horse’s welfare. The continuity and consistent monitoring of the horse is imperative to being able to keep a minor issue in January or February from turning into a major season ender.

I have the opportunity to be south with many of these horses from January 1 until the caravans head to Lexington for Rolex week. Many are trotted up and checked weekly, some after each horse trial run, but all are monitored carefully by all involved parties. A sore inside heel one week, mild increased heat in a front fetlock the next week, gastric ulcers, a sore back, or a minor cough are all things that can easily be addressed if dealt with quickly before the horse starts to compensate and change his performance to deal with the discomfort or physical issues.

As a veterinarian I rely on these weekly checkups as well as continual feedback from the rider, grooms and farriers to constantly assess how the horse is doing. The frequent checkups will often include trotting and walking on a straight line and longe line, sometimes evaluation under tack or watching the horse work, hoof tester examination, flexions, palpations (back, tendons, ligaments, joints) and sometimes acupuncture. If there’s a problem detected then additional diagnostics and treatment will be performed as needed.

There’s definitely value in continuity and constant assessment. Some of these horses I’ve examined or evaluated so routinely over the past five years (or most of their competitive careers) that I expect a sore right front inside heel or a sore left gluteal muscle post gallop or run, but increased fill or effusion in the left stifle might be a new finding that needs to be addressed.

Most of these horses are galloping twice a week and jumping one or two times a week so there are plenty of opportunities for new problems to arise. Additionally, these weekly checkups often include consultation with the farrier team to decide when shoeing changes are necessary depending on footing or schedules.

Making A Plan
At the beginning of the season I get a general outline and competition schedule from the Rolex-bound rider. We will sit down and discuss the tentative plan and identify peak competitions, potential FEI competitions, and ideal times for routine veterinary maintenance.

With CCIs like Rolex and CICs such as Red Hills (Fla.), Galway Downs (Calif.) and The Fork (N.C.), the horses are competing under FEI rules several times during the season. The drug and medication rules are very different for horse trials run under U.S. Equestrian Federation regulations versus CIC/CCI competitions run under Fédération Equestre Internationale rules.

For example, medications such as isoxsuprine, methocarbamol and phenylbutazone are permitted medications for horse trials but are prohibited even in trace amounts at FEI competitions.

Additionally, the medications used in routine joint injections, such as corticosteroids, must be modified depending on withdrawal times and the timing of the next FEI competition. This situation is again much different from a horse trial run under USEF regulations where the treating veterinarian can fill out a medication form to document therapy such as a joint injection to allow the horse to compete.

It’s absolutely critical for all involved parties to be aware of drug and medication rules and with-drawal times when dealing with these Rolex-bound horses. It’s also critical that these horses not be given anything orally, topically, or injectable until the substance has been thoroughly investigated.

FEI medication rules allow only limited medications such as gastric ulcer medications, anti-infectious substances and Regumate for mares. This reflects the international attitude of most medication rules, which differ widely from the liberal medication policy of our national rules. This policy adopted by the FEI attempts to ensure a “level playing field” for all competitors.

At The Competition
When everything goes according to plan… well, I guess that never happens. But, when the bumps in the road aren’t season ending and the team comes together to produce an equine athlete that’s sound, fit, and ready to compete at the top level of the sport during that week in April at the Rolex Kentucky Three-Day Event, it’s an accomplishment in and of itself. It’s also an exciting trip to Lexington filled with anticipation.

Most of the North American-based horses arrive in Lexington on Sunday night or Monday to allow for minimization of transport stress and acclimatization. The horses will go through a thorough arrival or in-barn examination with one of the official or treating veterinarians, which includes examination of passport, auscultation of the heart and lungs, and palpation of legs, joints and body.

This examination is done to get a baseline at the start of the competition and to make sure all of these horses are fit to compete. Most of the horses will also be assessed for hydration status post transport. The horses have access to a scale in the stable area so the riders and grooms can continue to weigh the horses and monitor hydration status during the week.

The veterinary team, composed of official FEI veterinarians and treating veterinarians, put the horses’ health and well being as top priority. There are veterinarians on call 24 hours a day for any concern a rider
might have about their horse during this big week.

The “stabling compound” or competition officially goes under FEI rules one hour prior to the first horse inspection on Wednesday afternoon. With the permission of the FEI veterinary delegate, horses can still receive rehydration fluids and antibiotics, but all other injections and medications are strictly prohibited. There’s a provision for emergency medication with approval from the ground jury only in isolated and special circumstances such as a colic or a laceration.

The goal of the first horse inspections or “trot-up” is to make sure the horse is sound and fit to start the competition. After the first horse inspection the horses can be managed with tools such as acupuncture (dry needles only, no aquapuncture), massage and other physiotherapy modalities (such as laser and ice). Additionally, many of these horses are on daily preventative gastric ulcer therapy (omeprazole or Gastrogard) due to competition stress. This medication is also permitted under FEI rules.

The next obvious veterinary commitment is dealing with the challenges of Saturday—the cross-country day. Any number of challenges and situations can arise on Saturday, on course and post cross-country. Fortunately, there’s a remarkable and extensive team of veterinarians who assemble every Rolex Saturday, including treating veterinarians in the barn, on-course veterinarians, a staffed horse ambulance and official FEI veterinarians to help deal with any situation that might arise.

Again, the horse’s welfare is paramount, and plans are made to deal with any kind of emerging situation. Typical scenarios that may arise are a horse with exertional rhabdo-myolysis (a tie up), lacerations and puncture wounds, cardiac arrhythmias such as atrial fibrillation and different causes of lameness.

The hope is certainly that everything comes together for each horse and rider for that perfectly orchestrated 10 minutes out on the cross-country course. But even the most perfect of rounds over the challenging four-star cross-country course is a physical task that only a top equine athlete can endure.

After being checked over carefully by the veterinary staff, cooled down appropriately, and released from the end of the cross-country, the horses are returned to the stables for many hours of recovery and careful monitoring.

The next several hours might include a routine of rehydration fluids, if needed, depending on the weather conditions and hydration status of the horse, icing of the limbs, massage, acupuncture, hand walking and grazing.

All of these steps are important in aiding in the recovery process to assure that the horses can perform in yet another athletic challenge with the show jumping on Sunday.

There’s full access to any additional veterinary care needed, such as wound care, ultrasound, radiographs and shoeing changes. Additional and supportive care is also given to the horses that failed to successfully negotiate the course due to any number of reasons. The select group of horse/ rider combinations that have gotten to Rolex and successfully negotiated cross-country then start to prepare for the final horse inspection and show jumping.

After the crowds have left the cross-country course there’s still a flurry of activity back in the barns making sure the horses are recovering as well as possible and that there will be no surprises before the horse inspection on Sunday morning.

The horses will usually be assessed by a veterinarian several more times before the barns close at 11 p.m. A sore or bruised heel might be treated with ice and a heartbar shoe, a puncture wound might be cleaned and flushed and treated with antibiotics, a sore stifle rub might be iced and lasered. All of these therapy modalities are permitted under FEI rules.

The horses are then put to bed until the flurry of activity again resumes between 5 a.m. and 6 a.m. to prepare these horses for the final horse inspection.

By the time the horses have passed the final horse inspection and riders begin to walk their show jumping course, the veterinarians have finally finished the bulk of their work—until it’s time for the post-event inspection and work begins toward the next major three-day.

Veterinary Advances For The Older Sport Horse
Thanks to improving techniques, continued research, and recent veterinary advances, many of our upper-level three-day event horses appear to be competing well into their mid- to late teenage years. As we become better at diagnosing and treating some of these issues we can keep these horses more comfortable and competing successfully for longer.

Diagnostic technology like nuclear scintigraphy, digital radiology, improved ultrasound techniques and MRI lead to more specific diagnosis and therefore more effective and targeted therapy.

Therapies such as high energy focused shockwave therapy, IRAP (interleukin receptor antagonist protein), ultrasound-guided cervical facet (neck joint) and sacroiliac injections, and radiographic-guided navicular bursal injections make some of these horses able to attain their athletic potential and stay sounder longer.

In addition, many of these horses are on oral (glucosamine, hyaluronic acid) and injectable (weekly Adequan and Legend) joint supplements and have periodic intra-articular therapy (joint injections with hyaluronic acid and corticosteroids, intra-articular Adequan, or IRAP.) The goal is not to just make the horse sound enough to get through the competition, but sound and happy enough to get through the entire season to condition, train, improve and peak for that week in April.

Christiana Ober DVM