Any public relations expert knows that in many ways, everything rides on language choices.
That was one of the things that occurred to equine surgeon Dr. Larry Bramlage as he read through the safety regulations of the Horseracing Integrity and Safety Authority. Under Prohibited Practices, he noted item 2271(d), which lists “thermocautery included but no limited to pin firing and freeze firing, or application of any substance to cause vesiculation or blistering of the skin, or a counter-irritant effect.”
We've written before about the new restrictions on pin firing and freeze firing. See that article here.
But what interested Bramlage was the last part – the prohibition of substances to cause blistering or a counter-irritant effect. Bramlage is a member of the Authority's advisory council and believes that the primary goal of the language was to halt the use of severe materials that cause chemical burns on the skin. He agrees that those need to go, and that the damage to the horse is never an acceptable trade-off for an attempt to increase circulation.
But the fact that so many other substances are currently referred to by many horsemen with the catch-all phrase 'blisters' could be a problem.
“I think as the regulations mature, we should allow people to do things that improve the circulation as long as it doesn't significantly injure the skin,” he said. “That requires interpreting the wording so we understand what we're doing.”
There are “blisters” and then there are what many horsemen call “working blisters,” which Bramlage believes are poorly-named because they're not associated with blister-like bubbles of skin irritation – or any kind of surface damage. Working blisters usually reference liquids or gels that increase the circulation and create a warming sensation below the skin. In his days playing high school football back home in Kansas, Bramlage remembers his teammates applying a mixture containing the same compound of red iodide of mercury made for horses to their own legs for pulled hamstrings. The goal of these topicals is to increase the circulation to the area to aid in the healing but not to destroy the epithelial cells of the skin. When this happens, the horse loses those cells and get scarring of the skin to replace them. Mild or working blisters often “scuff” the skin (cause the shedding a thin layer of skin like a mild sunburn) but they should never destroy the epithelial cells of the skin itself. Horses' skin is actually more sensitive in this situation than people's skin.
Bramlage believes that perhaps the most useful application for a working blister is in managing osselets. Osselets (fetlock joint capsule thickening) have been described in horses for many decades and it wasn't until x-rays became reliable that veterinarians began to understand what they are. The term 'osselet' comes from the French for 'little bones' because veterinarians performing necropsies on draft horses with comparatively large ankles would find calcifications around those joints and believed that all enlarged ankles had similar features. Fortunately, we now recognize and manage “osselets” before these mineralizations occur.
In the racehorse, osselets will sometimes form in response to training stress on the fetlock joint capsules. Bramlage said mild cases will often resolve with time and rest, but a so-called working blister can help. Osselets restrict the movement of the fetlock because there's swelling of the joint capsule beneath the skin which reduces the pliability of the joint capsule, stiffening it and makes it less flexible. This becomes a self-replicating cycle – more stiffness creates more swelling, which creates more stiffness. Applying a warming liniment and allowing the horse to walk or jog will speed the reduction of the swelling, make the horse comfortable more quickly and speed the healing process. It is a management tool for the stress of training and uses the same concepts are used in human sports locker rooms all the time.
Then there's the question of sweats, which Bramlage also worries could unintentionally fall under the new regulation about counter-irritants. Sweats are applied under bandages to draw out swelling as the result of an infection or direct trauma, or to reduce fluid build-up in the legs during prolonged periods of stalling. They're not a solution for major injuries like bowed tendons and are most helpful in the early stages of edema. As with working blisters, horsemen have different product combinations they use, but most sweats contain one of the aromatic oils, like oil of wintergreen, and some kind of salt. The aromatic oil warms the leg, and the salt will draw moisture out of the subcutaneous tissue and reduce swelling. Because sweats rely on some degree of warming though, they could be considered counter-irritants.
Bramlage says that both working blisters and sweats have their place in the tack rooms of good horsemen so long as they're applied properly.
“These are all steps and I think we need a middle step,” he said. “We need a term like 'warming liniment' or some kind of term, not 'working blister' to define these treatments and save the term 'blister' for compounds that actually do damage to and cause scarring of the skin. Those are the compounds we want to outlaw.”
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