Lessons I’ve learned about hematomas in horses
Wikipedia definition of a HEMATOMA: “Hematomas exist as bruises (ecchymosis), but can also develop in organs.There are two kinds, an intermuscular and intramuscular hematoma. Some hematomas form into welt-like formations that are hard to the touch. Such a formation is a sac of blood that the body creates to keep internal bleeding to a minimum. In most cases the sac of blood eventually dissolves, however, in some cases they may continue to grow or show no change. If the sac of blood does not disappear, then it may need to be surgically removed.”
My story: Last fall, my yearling developed a low grade hematoma on his chest between his two front legs. It was about the size of my hand but very, very shallow. My vet advised that in time, it would likely reabsorb and not to worry too much.
Neither of us knew how or why he got it, our best guess was that he either fell in the field (he lives with a 25 + year old grandpa horse so it is not likely he got kicked), or he got it from constant pressure from a front hoof pushing into his chest when he laid down each night in his stall. He developed it soon after he was brought on inside board which supports theory 2.
After a few months it didn’t seem to be getting much better, some days it was slightly bigger, some days slightly smaller. It didn’t bother him and it never made him lame. The only reaction I got from him was the first day I noticed it, he seemed to be sensitive on his whole right side (support for the fall in the field theory).
In late January I came out on Saturday as is my custom, I usually work with him three days a week. I reached down between his front legs as I usually do to check out the status of his hematoma and OMG, the little baby hematoma was replaced by a grapefruit sized lump, hot and swollen.
I got on the phone immediately to my vet and she agreed to come out to ultra-sound and potentially drain it. I was a nervous nelly when the vet came out the next day. The hematoma was half the size of the night before which was a relief. My vet aspirated the hematoma to test for infection and ultimately decided to drain it as he had had it for so long without any real healing. She pulled out lots of blood clots and drained blood from an area of the lump that was still fluidic. She inserted a drain and gave me instructions for taking care of him post surgery (including twice/day care).
Within a day, my horse got a bit of a fever so my vet supplied me with anti-biotics and bute for pain/inflammation. Within 5 days the small fever was gone and the lump was looking better. At the time the vet thought exercise might help, so every night I went out and free lunged him. After a couple of weeks, the lump didn’t seem to be getting any smaller and after exercise it almost seemed worse. My vet instructed me to stop and felt that the nature of my yearlings hematoma (ie. integration with his muscle) might be such that exercising was having the opposite effect we wanted. As soon as I stopped the lump started to get smaller…whew.
I began to poultice the lump with epsom salts and warm water for 15 min and then run warm water over the lump after that for another 5 minutes. The incision sites have taken some time to heal so I’ve had to be very diligent to clean them and apply an anti-biotic/anti-microbe cream.
More recently, I started to massage his lump with some significant pressure as he no longer seemed tender. About a week ago to my surprise some yellow pus shot through one of the healed incision sites! Alarmed again, I called my vet. Her thoughts were that there must have been an isolated pocket that healed over at some point despite my constant attention. The pus wasn’t green or smelly so it was not likely a major concern. I kept cleaning it out daily, the pus only drained for two days and then it seemed to be gone. Within days of the pus being drained the lump began to drastically reduce in size progressively. I feel that within the next month it should be totally gone.
During this experience I’ve learned several things, both through real-life situations and through reading about hematomas. There isn’t a lot of concise information on line so I hope this helps anyone who runs into this problem.
1. low grade hematomas will go away if there is no re-injury or associated reason (such as an abscess or debris lodge in the area), if the hematoma gets worse or doesn’t go away after 3 months, you may want to have your vet lance and drain it – doing so introduces the risk of infection however
2. when the horse first gets the hematoma cold hosing or cold packs (no more than 15 minutes at a time) and bute help with the pain and inflammation
3. take your horses temperature on a regular basis as one means to monitor the effect the hematoma is having on his system
4. when the injury originally occurs check thoroughly to see if there is a puncture site, if there is there is a high chance infection could set in – call your vet and don’t be shy to start your horse on anti-biotics
5. if this experience has taught me anything it is the importance of getting regular tetanus shots
6. listen to your horse while providing treatment, if cold or hot compresses seem to be making it worse – they probably are, the same goes for exercise
7. in my situation, light exercise helped while the hematoma was fluidic, as soon as it hardened as they tend to do during healing, exercise made things worse
8. as long as it isn’t causing your horse discomfort massaging the hematoma is a good idea to help the healing process
9. hematoma treatment makes your horse an ace in the washrack!
10. DMSO is often used to reduce the size of hematomas, this is powerful stuff, if you use it make sure to only use a small drop on a test site first and do NOT apply it to wet skin – my gelding was way too sensitive for even the smallest amount of DMSO so I chose to poultice instead
11. hematomas can take over 3 months to totally heal