On June 9, 2007, Rags to Riches nosed out Preakness winner Curlin in a courageous duel down the stretch to become the first
filly in 102 years to win the Belmont Stakes, and only the third filly to do so in its 139-year history.
In top form: Jockey Garrett Gomez rides Rags to Riches to an easy victory in the 133rd Kentucky Oaks race at Churchill Downs
in May. The filly later won the Belmont Stakes, then underwent a high-tech full examination that included a bone scan before
being pronounced fit to run again.
Sired by Belmont Stakes winner A.P. Indy and half-sister to 2006 Belmont Stakes winner Jazil, Rags to Riches has five wins
in five starts in 2007 and earnings of $1,292,528.
But just six weeks after Belmont, Rags to Riches spiked a fever while stabled at Belmont Park on New York's Long Island and
was quickly declared out of the July 21 Coaching Club American Oaks race.
On Sunday morning, July 22, Rags to Riches was to breeze five furlongs but, after just one-sixteenth mile into the workout
under exercise rider Lauren Robson, she was pulled up abruptly. Though the 3-year-old filly reportedly showed no signs of
injury, Robson felt something was amiss and took the horse back to the barn.
Whether Rags to Riches stepped on something or just took a bad step is unknown.
Dr. Steve Allday, DVM, was called to give the horse a physical exam the next morning. While finding her generally sound and
in good condition, Allday believed it prudent to recommend she be taken to the University of Pennsylvania's New Bolton Center
for a complete physical, including a bone scan.
"She's here for elective nuclear scintigraphy, a bone scan," said Ben Martin, VMD, DACVS, associate professor of sports medicine
at New Bolton.
'Gamma camera' view: Bone scan picks up the radioactivity from the tracer substance and notes where the tracer is absorbed
(a "hot" spot) or not absorbed ("cold" spot) as darker and lighter images.
Nuclear scintigraphy is an effective methodology for horses where lameness is minimally detectable, cannot be localized or
remains uncertain after a common lameness exam and radiographs that determine bone damage, especially to limbs and pelvis.
A bone scan involves intravenous injection of a radioactive tracer substance, Technectium 99m, bound to a phosphate compound,
99mTc-MDP, "the bone-seeking agent," or tracer. The tracer travels first through the blood (phase 1 or vascular phase), which
may show impaired circulation in a limb; then to the soft tissues (phase 2), which may show an area of inflammation, possibly
a problem with the suspensories, a tendon; and finally to the bone, where a concentration of material indicates increased
bone metabolism/increased bone remodeling (i.e., possible fracture, stress fracture or infection).
The vascular phase is noted immediately post-injection, the soft-tissue phase within 30 minutes post-injection and the bone
phase within two to three hours. Areas that particularly absorb the material are known as "hot spots," as opposed to those
that do not, dubbed "cold spots."
The "gamma camera" takes bone images, picks up the radioactivity and notes these hot and cold areas as darker and lighter
aspects of the computer-generated images.
That completed, other modalities, including "blocking," radiographs, ultrasound and/or MRI, can be used to further diagnose
the potential injury site.