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production, signs of colic or straining to defaecate. Suggested feeding included pelleted feed and grazing throughout the day, with hay introduced slowly over 3 weeks. At 4 months, the owner noted that the mare was
producing faecal piles on a regular basis. The owner described a return to normal defaecation without need for manual evacuations. There had been no reports of straining to defaecate or colic. Tail movement was reported to be 85% normal, with the mare able to move the tail from side to side and lift the tail to urinate suggesting improved caudal nerve function to the sacrocaudalis dorsalis and ventralis muscles. She returned to training and competed successfully at her previous level. The owner was contacted 8 months after discharge and reported that the mare’s defaecation and tail tone was essentially normal.
Discussion
Tail blocking with ethanol results in partial paralysis of the tail. It is a procedure used in some performance horses to prevent them from moving or wringing the tail during competition, which is generally considered a vice and may result in point reduction. It is usually achieved by injecting ethanol into the tail close to major nerves (Tozzini 2003). The American Veterinary Medical Association (AVMA) endorses the American Association of Equine Practitioners (AAEP) position statement on “Tail Alteration in Horses” which states: “The AAEP condemns the alteration of the tail of the horse for cosmetic or competitive purposes. This includes, but is not limited to, docking, nicking (i.e. cutting) and blocking. When performed for cosmetic purposes these procedures do not contribute to the health of the horse and are primarily used for gain in the show ring.. .” (AVMA Welfare Statement). The most common result of this technique is an inability to
lift the tail to its normal height. However, post-mortem examinations on horses that have been injected with ethanol consistently show areas of fibrosis in the muscle (Cobb 2004). In some individuals, the tail will be offset to the side or crooked (Cobb 2004). Return to function is unpredictable and may take a long time (Cobb 2004). In a case series describing complications associated with alcohol tail blocks in three horses, all three horses were subjected to euthanasia because of significant neurological deficits, including rectal paralysis in two of the cases (Stewart et al. 1990). The adverse result of rectal paralysis appears to be rare, but is potentially a very serious outcome. In one of the cases described by Stewart et al. (1990), clinical signs had not improved over 9 months following the injection. The pudendal and caudal rectal nerves arise from the
ventral branches of the third and fourth sacral nerves. These nerves innervate the urinary bladder, urethral sphincter, the terminal rectum, the internal and external anal sphincters, and the skin of the anus (Stewart et al. 1990). In some individuals, the alcohol injection may diffuse cranially in the epidural fat to affect nerves supplying motor innervation to the bladder and rectum and sensory innervation to the skin surrounding the tail and anus (Stewart et al. 1990). Recent studies suggest that acupuncture can repair
nerve damage (Li et al. 2015; Liu et al. 2015). In these studies, using rat models, evidence of nerve repair was present after 7–10 days of therapy. In the case presented here, acupuncture treatments may have enhanced nerve repair to
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eventually allow the mare to defaecate normally. Acupuncture points were chosen for calming effect (Bai-hui and GB-21), local stimulation of rectal and bladder function (BL-27, BL-28, Ba-jiao, Lu-gu, BL-54, CV-4, CV-6, GV-1 and to stimulate the central nervous system (BL-18, 19, 20, 23, 25, GV- 5, GV-4, GV-2, GV-3, GV-14, Qi-hai-shu). Acupuncture is often defined as applied stimulation at
discrete and specific points in the body in order to cause a therapeutic effect. These discrete and specific locations on the body are called acupuncture points or acupoints. There are various stimulation methods or acupuncture techniques. In the perspective of TCVM, a classical acupuncture technique is dry needling or conventional needling. In modern times, constant manual stimulation of the needles has been replaced by low current electrical stimulation (called EAP). EAP is more commonly used for pain management and nerve damage. EAP stimulation is strong and some horses will not accept it. In this scenario, for safety reasons, TENS can be applied at the acupoints for stimulation instead of EAP. TENS is a milder stimulation and may be tolerated more readily by some horses. Another treatment modality in TCVM is herbal medicine.
Three herbal recipes were used orally in the case presented here. Bu Zhong Yi Qi is often used for faecal incontinence in veterinary cases (Song et al. 2010). Double P II (modified Da Huo Lou Wan) is used for the central nerve disorders including spinal cord injury (Luo et al. 2010; Zheng 2001). Ju Pi San is used to treat colic or gastrointestinal disturbances in horses (Ferguson 2010). Herbal formulae are usually palatable and can be top
dressed on the patient’s feed, particularly when the dose is small (e.g. 15 g). However, because this case did not readily eat the herbal formulae (perhaps in part because the dose was 30 g), each dose was mixed with water and administered using a dose syringe. Tail blocking procedures are generally cosmetic,
unnecessary and, in fact, condemned by the AAEP and AVMA. It is imperative that owners are aware of the risks and potential complications that may result from this procedure. There is little information regarding successful treatment of this condition in the literature and what is available indicates that the prognosis is generally poor to grave. In the case presented here, the use of TCVM appears to have resulted in the reversal of rectal paralysis. Because we report on a single case, it is impossible to know how the mare would have fared without TCVM modalities, which is a significant limitation of this report. However, we believe it is important to consider TCVM therapeutic options, particularly for those cases for which western veterinary medicine therapies are limited.
Authors’ declaration of interests No conflicts of interest have been declared.
Ethical animal research Client consent was given to attempt this treatment.
Authorship
M. Sleeper and K. Fishman contributed to study execution and preparation of the manuscript. R. MacKay and M. Brown
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