Ugh what a weekend. I like my peace and quiet on a normal weekend. My staff tends to my care, and then it’s rest and relaxation for Teenie and I so we’re refreshed and ready to tackle our supervisory duties on Monday. This weekend was nothing like that, thanks to a colic that had my Docs and techs in here multiple times throughout the night. I hate these kinds of colics. They disrupt my carefully crafted schedule. However, my Docs hate them more, especially the kind we had this weekend. Let’s talk lipomas and older horses and why they send a wrecking ball through my sleep.

What is a lipoma?

Fat. Yep, good ol’ fat like I carry around on my belly. Lipomas are tumors made up of fat. Instead of forming a nice soft, cushy layer like my belly, these are firm balls of fat. They’re pretty common under the skin of dogs, and if you’ve got a dog, you may have felt one. They’re usually two to three inches in size, and readily move with the skin. They don’t hurt, and the skin over the top of them looks pretty normal. Sometimes on dogs (and humans, by the way) they form in areas like armpits that affect movement of a limb, or become very large, and cause issues because of their size. Overall though, these are pretty boring tumors. 

Horses don’t work that way. I mean, of course they don’t! They’re horses, so they have to do it better, and by better, I mean worse for their health. In horses, lipomas often form from the mesentery of the small intestine. What the what, Tony? you say. The small intestine hangs from a giant curtain suspended from the spinal column. It’s a thin, nearly see-through tissue that carries blood, lymph, and nerves to the intestine below.  Lining those vessels and nerves is fat. Most mammals use mesentery as a place to store fat. If that’s all that happened, this would be fine. However, over time, in horses, that fat turns into a ball, that ball pulls on it’s attachment turning it into a string, and soon you have something resembling a tetherball. Remember that super fun game from your childhood with the ball on a string attached to the top of a pole? Yep, it looks like that, only hanging off the mesentery. 

When fat goes wrong

So, we’ve got a fat ball hanging from a string sitting in the abdomen. Sounds fine. That fat ball isn’t doing anything bad…..yet. But, and it’s a really, really big but, one day the stars align, the horse moves everything just right and that string with a ball on the end goes flying around in just the right way to wrap up a piece of small intestine. When it does, the string tightens around the intestine and the mesentery. This causes blood flow to the area to stop, and keeps food from passing through the affected small intestine. It also puts pressure on those nerves, and as anyone who has whacked their funny bone knows, that hurts! These horses become very painful as the pressure increases on the nerves from backed up food, swelling, and dying small intestine. This is when you, the owner, get your first hint things are going wrong. You’ve got a painful, rolling, I daresay thrashing, horse.

Now what??

When my Docs arrive on the scene, they evaluate your horse for the telltale things that point to a lipoma: scrapes around the eyes and head, evidence of rolling, and a horse over 15 years of age. No one is quite sure why small intestinal colics cause the most scrapes on heads, but they sure do. Whenever my Docs see this, they start a full-on small intestine investigation. The rolling is because these guys are pretty darn painful, and the age is since it seems to take quite a few years for these dastardly fat balls to grow. 

The first thing my Docs are going to do is get a heart rate. This is a very important number. If it’s over 60, chances are very high the colic is going to need surgery to fix. Once heart rate is established, pain and sedative medications can be given (if these are given first, my Docs can’t get an accurate heart rate). Next, some blood will be drawn to run a quick test called lactate. This test is another indicator of how bad things are. If that number is over 3.0, that’s another point towards surgery. Next step is a palpation. They’ll glove up and head in for a feel of what’s going on. Distended small intestine will feel like a tube about 5-6” in diameter. 

The ultrasound comes out next. Ultrasounds allow them to look at what that distended small intestine looks like on cross-section. A few things they look for are thickened walls, and food settled on the bottom since that indicates things haven’t been moving for a while. If there’s extra fluid in the abdomen, they can see that, too. The body puts that excess fluid in the abdomen as a way to deal with the unhappy small intestine. If it’s there, my Docs can take a sample of it. They’ll look at what color that sample is first. It should be clear and yellow. If it’s red, there’s definitely very unhappy intestine in there. Next they’ll run a lactate test on the fluid. This is the same lactate they ran on the blood. Ideally they are close to the same number. If the belly fluid is greater than 1.5-2 times what the blood has, that’s yet another indication that surgery is needed. 

Can you fix it?

Yes, but. The only way to fix these guys is surgery. At surgery the string will be cut, and the lipoma taken out. Usually these guys have a few extra lipomas hanging around, and they’ll be taken out as well. The small intestine will get checked to see if it’s okay to leave in there, or if it will need to be removed too. Older horses can handle the surgery just fine. What gets tough is all the toxins involved if the small intestine is in rough shape. These toxins do a number on the body. They can cause laminitis, along with just plain feeling like crap. And that’s the tough part. Not only is this one of the more expensive colic surgeries, but the recovery can be rough. Which brings me back to my weekend. 

We had an old guy (31 years old!!!) in the clinic this weekend. Turns out he had a lipoma. I know his owner agonized over the right decision to make for his well being. In the end, surgery wasn’t the right answer for her and she let him go. I hate that this is always a tough decision for owners. Thinking about what you would do in the same scenario and having a plan makes it easier when one of my Docs has to ask the hard question of if surgery is an option. Sometimes the answer is no, and while that’s okay, it’s never easy.

As a cat, I’m not really wired for compassion, but even I can see that being a horse comes with a lot of challenges. Some of them we can impact with good diet and foot care, and some of them we just have to deal with when they happen, like lipomas and skimpy forelocks. But the good news is that you don’t have to go it alone. My docs are here for you, and that’s a pretty good team to have in your corner.

Until next week,

~Tony

 P.S. If you want to learn more about all the different things that make horses colic, I have a variety of blogs on the topic. If you’d rather listen to my docs explain it, they have a couple of podcasts that take a really deep dive into the horse gut. You can find them over on my Podcast Page.