I’ve been in practice for over 13 years now and really thought that if I hadn’t seen it all yet, I’d probably seen most things, at least once! However I was quite unprepared for what I found when I was called one morning to attend a horse with an itchy tail. On the way there, as I normally do, I ran through a list in my head of differential diagnoses and whether I had the necessary kit in the car to cope with it. Sweet Itch? A bit early in the year, but midges definitely about so a possibility. Supplies of Switch and Benzyl Benzoate on board. Pinworm? A definite contender. Sellotape (for taking samples for microscope analysis) and wormers in the boot. Lice? Dectomax injection – tick.
What I found when I got there was a long way from any of the above. The reason that Smokey was itching his tail was no clearer but he’d made himself sore, secondary infection had set in unoticed under several layers of winter rugs, and the heat and moisture had made a perfect breeding ground for bacteria. The smell was horrendous. Not a good call to go to right before lunch!
Smokey was amazingly good about having his tail gently cleaned with hibiscrub and warm water. Unfortunately most of his tail hair from the injury down came off, along with the festering top layers of skin. What hair he had left came out over the course of the next couple of bandage changes so he’s going to look a little odd for most of this year until it grows back. As always with these things once it was cleaned up there was a much larger area affected than had initially appeared, including a very deep horizontal wound on the underside near the top of the dock. I revised my prognosis accordingly from ‘average’ to ‘poor’. The good news was that the bottom of his dock felt warm and appeared to have sensation so I was cautiously hopeful that it wouln’t either fall off or need to be amputated.
I chose to use manuka honey dressings (Manuka AD, Kruuse) to control the infection and support healing. These dressings come ready-impregnanted with top-grade medical manuka honey and are easy (and not sticky!) to apply. The dressing was covered with a layer of soffban, knitfirm and vetrap taking care to bandage it firmly enough to stay in place, but not so firmly as to reduce the blood supply which it was vital to maintain for healing purposes. Smokey’s tetanus status was checked and he was given painkillers and five days of antibiotics. I warned the owner that the next few days would be critical if we were to save his tail. There was also the chance of ascending infection from the deep wound leading to either bacterial infection of the spinal cord or septicaemia, both of which would be life-threatening.
I returned every three days for a fortnight to re-clean and re-dress Smokey’s tail and we were amazed by how quickly the would had changed from a horrible festering exudative mess to showing signs of healing, epithelialisation and fresh granulation tissue. I had to debride (surgically remove) a few islands of necrotic tissue that were preventing healing but the horizontal wound filled in within a week or so and the rest looker cleaner and healthier every time I was there. Smokey, through all this, continued to be an angel and never even required sedation at any stage in the proceedings. He mostly munched on a haynet and let us get on with it! For the next fortnight I let the owner clean and dress the tail and when I returned, a month from the original injury, I really was amazed. The whole tail was covered with a fresh layer of skin cells, the worst area had decreased in size and was looking red and healthy and the horizontal wound had disappeared altogether. Other than the first five days Smokey had received no other treatment than the honey dressings.
It will probably be another month before his tail heals completely, and another 6-8 months before he has a reasonable growth of hair, but already there is evidence of some very fine hair regrowth which is making his owner very happy indeed.
I will follow this report up shortly with one about the the development and use of manuka honey in veterinary medicine. For now I’d like to thank Smokey’s owners (Smokey is an alias!) who were happy for me to take pictures and write up this case.