Burnt at the Barn
Fearing the worst as they drove up the hill to the retreat, Parrish was already calling their veterinarian, Dr. Scot Lubbers. “I told him Toby was in a fire, and I don’t know his condition” she said. “He said, ‘I’ll stop what I’m doing and I’m on my way.'” He was about 45 minutes out.
As Parrish and her husband pulled up to the barn, a firefighting crew was in action. The barn was blazing in the summer evening. Joshua Tait, the camp’s executive director, was already on site. He and firefighters had opened the gate to the paddock and got Toby away from the flames.
But the damage had been done.
“The firefighters were giving Toby oxygen, like putting a human mask over his nose,” Parrish recalled. “His hair was blackened from melting, and he was standing there quietly, kind of comatose.”
Though not directly in the flames, the heat had severely burned Toby. “If he had been inside the barn, he wouldn’t have survived,” Parrish said.
As soon as Dr. Lubbers arrived, “He called OSU right away,” Parrish said. A 1984 graduate of the Oregon State University Carlson College of Veterinary Medicine, Lubbers spoke with the large animal emergency clinicians on call at the college’s teaching hospital to get advice on assessing and evaluating Toby’s condition and helping determine next steps.
“So, what are the lines in order to treat versus euthanize?” Parrish said.
As Lubbers spoke with the team at OSU, it became apparent that Toby’s condition looked about as hopeful as possible given the circumstances. They decided to do everything they could to try to save Toby’s life. First Toby needed fluid to help stabilize him before bringing him down to OSU’s Lois Bates Acheson Veterinary Teaching Hospital for emergency care.
“He’s a big boy, so getting the IV fluid [in that amount] was pretty tricky. We found some friends that drove around to all the local veterinary clinics and gathered burn cream and IV fluids and filled the back of their car with them. And we spent all night giving him fluids,” Parrish said. Toby was on a double drip with the IV fluid bags “hanging from a manure fork” stuck into the grass.
They finished giving him the fluids around 4 a.m., bundled Toby with “a burn blanket and then a regular blanket on top of it” and loaded him into a horse trailer, Parrish said. She and her husband Matt stopped briefly at their house for a quick nap before making the drive to OSU in Corvallis, Oregon. “We didn’t even change out of our smoke clothes,” Parrish said. “So we got there at about 8:30, or 9 o'clock in the morning.”
Dr. Kelsey Jurek, assistant professor of large animal emergency, and Dr. Bob McCarthy, large animal surgery resident, were working at the hospital over the weekend and received Toby’s case.
“Toby came in on emergency and overall was very quiet, very sedate, kind of dull. And Chrisy and Matt were like, ‘This really isn't like him. So, he's in a lot of pain’” McCarthy said. “That fit with the clinical picture we were seeing as well. He had a lot of swelling of his face, especially his muzzle and his lips were really droopy because they were just so swollen he couldn't really move them. And his physical exam wasn't horrible, but you could tell he was in some degree of pain.”
His burns were primarily on the left side of his body and deceptively almost appeared superficial at the time. “His face had gotten scarred. His eyelashes were gone, his whiskers were gone," McCarthy said. "And with those superficial burns, we were just really worried about them, overall. We know they'll get worse with thermal damage.”
Thankfully, Toby’s lungs appeared relatively undamaged from smoke inhalation, but in addition to the burns and general pain, McCarthy and Jurek were worried about Toby’s kidneys.
Blood work and the presence of pigment in Toby’s urine showed there was some degree of kidney injury. “We were worried about it because when he did urinate, it was discolored, it was really dark red tinged, and so anytime we have pigment in our urine, we get really concerned about that causing damage in our kidneys,” McCarthy said. To combat this buildup, they started giving Toby lots of IV fluids to cause him to urinate more and flush out the kidneys.
They also started treating the burns with a trick learned from human medicine. “The coolest thing I learned from the case was adding sucralfate to SSD cream,” McCarthy said. Silver sulfadiazine cream is commonly used to treat open wounds and stop bacterial growth. “Dr. Kate Schoenhals [rural veterinary practitioner at the college] stopped by in the middle of us working up Toby and passed on to Dr. Jurek that in human medicine it’s been noted that if you add sucralfate to burns it helps decrease the amount of protein loss.”
Protein is essential in building and repairing skin and other body tissue. In Toby’s case the increased liquid to flush his kidneys combined with his body’s natural use of protein in trying to heal his wounds could lead to a dramatic loss of protein that would then cause his body to “third-space fluid” or essentially swell everywhere, McCarthy said. In simplistic terms, this is because plasma protein in the blood vessels helps keep water in the circulatory system, and a loss of this protein allows the water to cross through the capillary walls at an unbalanced rate into the surrounding tissues, causing major swelling.
“We were worried about that, and we wanted to try and stop it as much as possible,” McCarthy said. “We would take the sucralfate tabs, add a little bit of water and make our own paste. And then we would mix it into our SSD cream and put that on top of his burns — kind of spackle it on. And it actually worked a lot better than I thought it would to help keep the protein at a level where he wasn't pushing fluid into varying spaces like in his limbs.”
Over the weekend, McCarthy, Jurek and the veterinary support team of technicians, assistants and veterinary students on their clinical rotations stabilized Toby and got his pain under control.
From there, Dr. Andee Frei, large animal medicine resident, took the lead on Toby’s primary care.