EQUINE VETERINARY EDUCATION / AE / SEPTEMBER 2018


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once daily from Day 11 to Day 17. Subjectively, the rectal tear became less and less prominent and the presence of blood on sleeve was infrequently noted after rectal evacuations were decreased to once daily. On Day 11 the mare defaecated several faecal balls unassisted and postured to urinate. Flunixin meglumine administration was also reduced to 250 mg once daily. On Day 12, she produced several small manure piles in addition to individual faecal balls and moderately strong perianal, anal, and distal rectal tone was noted during rectal examination. Reduced rectal tone persisted cranially. It was judged that she was passing approximately 25% of her faecal volume without assistance. On Day 14, EAP was performed at the following pairs of


Fig 1: The mare receiving electroacupuncture treatment.


gradually improving. On the seventh day after starting AP therapy, moxibustion (MOXA) therapy was added to her protocol and on the eighth day the herbal Bu Zhong Yi Qi2 was added (started at 20 g the first day and then increased to 70 g twice daily). AP continued as described below:


Day 7: MOXA for 20 mins at GV-5/6/7 and CV-2/3/4/5 in the morning; 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 Hz to 6 Hz for 30 min) in the afternoon Day 8: MOXA for 20 min at GV-5/6/7 and CV-2/3/4/5 and dry needles at Shen-shu, Lu-gu, BL-54 bilaterally, Bai-hui in the morning TENS: sacral region (Ba-jiao; 2 Hz to 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 Hz for 30 min) in the afternoon Day 9: MOXA for 20 min at GV-5/6/7 and CV-2/3/4/5 in the morning TENS: sacral region (Ba-jiao) (4 Hz for 20 min); Shen-shu- Shen-shu, Bai-hui -GV2, BL18 (L)-BL20(L), BL19(R)-BL20(R) Lu-gu-Lu-gu (4 Hz for 30 min) in the afternoon Day 10: MOXA for 20 min at GV-5/6/7 and CV-2/3/4/5 in the morning TENS: afternoon procedure the same as for Day 9 Day 11: MOXA for 20 min at GV-5/6/7 and CV-2/3/4/5 in the morning TENS: afternoon procedure the same as for Day 9 Day 12: MOXA for 20 min at GV-5/6/7 and CV-2/3/4/5 and TENS: Sacral region (Ba-jiao) (5 Hz for 20 min) this morning. TENS: afternoon procedure the same as for Day 9 Day 13: TENS: sacral region (Ba-jiao) Shen-shu-Shen-shu, Bai- hui-GV2, BL18 (L)-BL20(L), BL19(R)-BL20(R) Lu-gu-Lu-gu (5 Hz for 20 min)


As consistency of faeces continued to be soft and overall


volume was decreased, the frequency of rectal evacuations decreased to twice daily from Day 4 to Day 10 and then


points (20 Hz for 25 min followed by 80–120 Hz for 20 min) after sedation using intravenous injection of 15 mg of acepromazine: GV-14 + GV-5, Bai-hui+GV-1, Ba-jiao 1 left to Ba-jiao 4 right, Ba-jiao 1 right to Ba-jiao 4 left, Left BL-21 + right BL-25 and ST-37 to ST-39, bilaterally. Additionally, herbal therapy was changed to 70 g Double P II (modified Da Huo Luo Dan)2. On Days 16 and 17, the points were changed so that the following treatment was administered (EAP with 20 Hz for 25 min followed by 80–120 Hz for 20 min): GV-14 + GV-5, Bai-hui+GV-1, Bai-hui+GV-6, GV-1 + Wei-jian and Shen- shu + BL-21 and BL-20, bilaterally. On Day 17, the mare produced 10 small faecal piles and on Day 18, there was noted improvement in rectal tone, and during manual evacuation, a peristaltic wave was felt. From Day 18 to Day 30, the mare was evacuated every 36 h and mineral oil and Epsom salts with water were administered via nasogastric tube every 72 h. She was continued on the diet previously described. On Day 23 and 24, the AP points were changed so that the following treatment was administered (EAP with 20 Hz for 25 min followed by 80–120 Hz for 20 min): Bai- hui+GV-14; BL23 + GV-6; GV-1 + Wei-jian; Shen-shu+ BL-23; Ba-jiao + Shen-jiao. On Day 26, an increase in anal tone was noted, however


there was still no tail movement. On Day 30, the herbal supplementation was changed from Double P II to Ju Pi San2. Ju Pi San (30 g) was given orally. Additionally, on Day 30 and 31, EAP was performed at the following pairs of points (20 Hz for 25 min followed by 80–120 Hz for 20 min): Bai-hui+GV-14, BL23 + GV-6, GV-1 + Wei-jian, Shen-shu + BL-23 and Ba-jiao + Shen-jiao. By Day 31, overall rectal tone had improved by


approximately 50% since presentation and anal sphincter tone was normal. Minimal tail tone was present, but the mare was able to make small movements of her tail on occasion. Small piles of faeces were produced several times throughout the day. Feedings and herbal supplementation remained the same until discharge at Day 42. At the time of discharge, she was producing multiple


small faecal piles daily and rectal evacuations were performed once every 72 h. Moderate rectal tone and peristaltic waves were present during rectal palpation. Anal tone was strong and the mare was able to move her tail from side to side. During evacuations, no blood had been evident on rectal sleeves and the rectal tear appeared to be healed. Recommended home care included twice weekly manual evacuation by the primary veterinarian, with the suggestion to decrease the frequency of these visits dependent on anal tone and manure production. The owners were asked to monitor the mare daily for sudden drop in manure


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