460
EQUINE VETERINARY EDUCATION
Equine vet. Educ. (2018) 30 (9) 460-463 doi: 10.1111/eve.12692
Case Report
Acupuncture and traditional Chinese veterinary medicine for treatment of a mare with rectal paralysis
M. M. Sleeper†*, K. Fishman‡, R. J. MacKay‡, M. Brown‡, A. G. Bauck‡ and H. Xie‡ †College of Veterinary Medicine, University of Pennsylvania, Philadelphia; and ‡College of Veterinary Medicine, University of Florida, Gainesville, USA.
*Corresponding author email:
margaretmsleeper@ufl.edu Dr Sleeper’s present address: College of Veterinary Medicine, University of Florida, Gainesville, Florida 32610, USA.
Keywords: horse; acupuncture; rectal paralysis; traditional Chinese veterinary medicine; herbal; tail block
Summary An 8-year-old Appaloosa mare with rectal paralysis due to a cosmetic ethanol ‘tail block’ was treated with traditional Chinese veterinary medicine treatments including acupuncture and herbal medicine. Her rectal and tail tone gradually improved after the treatment. At 4 months after initial presentation, the mare was able to produce faecal piles on a regular basis, and manual evacuations were no longer needed. Significant improvement was within 30 days of beginning treatment. At 8 months, the owner indicated that the mare had normal defaecation, was able to swish the tail from side to side and lift the tail to urinate, and had no evidence of straining to defaecate or colic.
Case history and clinical findings
An 8-year-old Appaloosa mare was given a cosmetic ‘tail block’, which involved injection of ethanol into the dorsal muscles at the base of the tail. The next day the mare was unable to defaecate due to rectal paralysis and was also noted to dribble urine without posturing to urinate. The referring veterinarian managed these clinical signs for 2 days by administration of mineral oil and magnesium sulfate via nasogastric intubation and manual removal of manure from the rectum. A rectal tear was detected 2 days later and she was referred to the Large Animal Hospital at the University of Florida College of Veterinary Medicine for definitive treatment. At presentation, the mare was bright, alert and normothermic. Heart rate was normal (42 beats/min) and respiratory rate was normal (12 breaths/min). A full neurological examination was performed and there was no tail, anal or rectal tone up to 30 cm orad from the anal sphincter. Although there was evidence of a moderate sensory response at the perineal body and vulva, there was
no skin sensation at the level of the anus. The rectum was filled with impacted faecal material, which was evacuated manually. A 3 cm grade 1 rectal tear, located in the dorsal rectal wall, 25 cm cranial to the anus, was palpated and visualised via speculum and endoscopic examination. Only minimal blood was collected on the sleeve following rectal examination.
Treatment
Flunixin meglumine (250 mg i.v. twice daily) therapy was initiated and her feed was switched to a complete, extruded product (Purina Equine Senior pellets1; initially 5.7 kg per day,
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calculated to be 75% of her daily requirement, and then increased to 7.5 kg over a 5-day period) supplemented with corn and mineral oils (0.24 L of each) three times daily. Sixty- two grams of table salt (NaCl) were added to the feed daily. She was also hand grazed three times daily. Every other day, 3.8 L of mineral oil and 248 g of magnesium sulfate (Epsom salts) with 6 L of water were administered via nasogastric tube to help soften faeces. Because of the lack of potential therapies, a protocol of traditional Chinese veterinary medicine (TCVM) was initiated, which included acupuncture (AP) and herbal therapy. With evaluation of the AP points prior to beginning therapy, she was noted to be sensitive at: BL-27, BL-54, BL-18 (right), CV-4, CV-6 and generally in the sacral region. The initial acupuncture therapy included: Dry needle: Bai-hui and GB-21. Electro-AP (EAP; 20 Hz, 30 min):GV-14-GV-5,GV-4 + Wei-jian,
Bai-hui +GV-1, Qi-hai-shu (R) + BL-23 (R), Qi-hai-shu (L) + BL-23 (L), Ba-jiao 1 (L) to Ba-jiao 4 (R) and Ba-jiao 1 (L) to Ba-jiao 4(R). Aqua-AC (the mare’s own blood from jugular vein): GV14
(10 mL), BL20 (5 mL), BL 25 (5 mL) and Ba-jiao (10 mL). The same acupuncture procedure as on Day 1 (Fig 1)
was repeated on the following day. The third day after admission she was treated with electrostimulation using transcutaneous electrical nerve stimulation (TENS) because she was becoming increasingly recalcitrant to needle insertion. The following protocol was used:
Day 3: TENS- sacral region (Ba-jiao; 2 Hz for 20 min); Shen- shu-Shen-shu, Bai-hui-GV2, BL-18(L)-BL-20(L), BL-18(R)-BL-20 (R) (4 Hz for 20 min) Day 4: TENS- sacral region (Ba-jiao; 2 Hz for 20 min); Shen- shu-Shen-shu, Bai-hui-GV2, BL-18 (L)-BL-20(L), BL-18(R)-BL-20 (R) (4 Hz for 20 min). Day 5: TENS- sacral region (Ba-jiao; 4 Hz 20 min); Shen-shu- Shen-shu, Bai-hui-GV-2, BL-18 (L)-BL-20 (L), BL-19(R)-BL-20(R) (4 Hz to 6 Hz for 30 min). Day 6: TENS - sacral region (Ba-jiao; 4 Hz for 20 min); Shen- shu-Shen-shu, Bai-hui –GV-2, BL-18 (L)-BL-20 (L), BL-19(R)-BL- 20(R) Lu-gu-Lu-gu (4–6 Hz for 30 min). Defaecated during treatment.
After the first 3 days of therapy, mild-moderate anal tone
was noted and the mare began to posture normally to urinate. However, the rectum remained atonic and manual
removal of faeces was necessary three times daily. Over the first week of hospitalisation, it was noted on rectal examination that both anal tone and rectal tone were
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