Carlson College of Veterinary Medicine

Headstrong Toby

Toby’s a 22-year-old Belgian draft cross weighing in at more than 1,600 pounds. 

At Royal Ridges, he’s their “beloved vaulting horse,” according to program materials, and is used both in their recreational vaulting program as well as their competitive Royal Vaulters team that Parrish leads. Parrish’s kids compete on the team. 

Though he has a steady disposition for vaulting, he’s also very competitive and takes no guff from anybody – especially his fellow horses. “He’s hardheaded and stubborn, but he’s also very playful, Parrish said. “He’s a lot of horse.” 

Because of this, Toby was kept in a paddock near the hay barn at night, rather than out to pasture with the retreat’s other 40 horses. 

Hence the panic in Parrish voice when she yelled, “Toby!” 

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.” 

At OSU

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. 

A Long Haul for a Big Horse

Toby was facing a daunting journey. “At that point he had pretty severe burns to about 80% of his face and probably 70% of his total body surface area had some kind of thermal damage, whether that was a raw and weeping wound at the time, or this looks singed, this is going to slough later. And his lower limbs were affected as well, such that we were really concerned about his coronary bands really on all feet,” Frei said. “His eyelashes were singed into curls, and most of his face was very raw. He had corneal ulcerations. Overall, he was at risk for high pain as well.” 

Of particular danger was the potential for Toby to develop laminitis. Horses’ hooves are quite complex with connective tissues called laminae connecting the surface of the coffin bone and the inside of the hoof wall. From an anatomical perspective in comparison to humans, horses essentially walk on their fingertips (front feet) and toe tips (back feet) and the coffin bone is the equivalent to the middle finger or middle toe. The laminae can become inflamed or damaged, which is called laminitis. 

“Laminitis is one of the most common and commonly devastating diseases in horses because their entire body weight is suspended within their hoof capsules. The bone has to eventually connect to the hoof capsule, and it does that by soft tissue. And it's a very delicate, basically a high-tech biological Velcro that responds rapidly to any kind of insult or inflammation, and is suspending their entire body weight,” Frei said. “Laminitis is excruciatingly painful if it develops. It’s like smashing your finger with a hammer and then trying to walk on your fingertips, so it can pose a lot of welfare issues. The laminae is a soft tissue. It's highly vascular, and once it becomes inflamed, it loosens that grip and it loses its suspension ability, and you can't ever get it back to its original integrity.”

Laminitis can be deadly, with extreme cases causing horses to completely walk through or out of their hooves. Even lesser cases can be so painful that horses need to be euthanized.  

“We were very concerned about that with Toby because the tissues around his feet, around the coronary band, and therefore very close to the blood supply to the lamina, had been injured by the fire,” Frei said “He was also systemically very inflamed overall from all those burns and high levels of inflammation send alarm bells to the laminae and can injure them.”

The challenge was to help preserve the laminae to hold “up his body weight as a large draft horse,” Frei said. 

Toby’s long-term care became “very complex and it took on several stages,” according to Frei. There was systemic support to control his pain and keep him hydrated and fed. There was wound treatment to care for his burns and keep them from getting infected. And there was ongoing treatment to help prevent laminitis which included “boots on his feet to give extra cushion and support his hooves,” Frei said. 

It was a round-the-clock effort that “in a nutshell, included everyone in the entire hospital.” Frei said. 

“We had our emergency team who started him off with inventive therapies. 

“He had a dental done by Dr. Kate Schoenhals because his mouth had swelled so much that any of the abnormalities in his teeth really started damaging the inside of his mouth. The dental made him a lot more comfortable and able to start eating sooner.

“There were technicians around the clock who were not only administering his treatments, but monitoring him closely, and his treatments were long and complex.

“Then there were the students like Katrina Coalwell and Katie Juarez who were on the case for the majority of it. There were so many medications to prepare, and the students also did a really great job of noting minute differences in his physical exams. 

“Then on the medicine team I was with him for all but his intake and the last one or two days. But we had I think every clinician participating at some point.

“There was the diagnostic imaging department. Toby got frequent radiographs for his feet.

“The surgical team gave really helpful input on bandaging techniques and wound dressings.

“Our pharmacy department, Dr. Brian Bowers was looking up papers saying, ‘I just heard about this new treatment, is that something that might work for him?' Everyone was really invested in Toby.” 

All told, Toby was in the hospital from July 8-26. Each phase of his care resulted in new teaching and learning opportunities. 

“His case had so many facets that I truly got exposure to most of the categories of large animal internal medicine in one patient, including wound care, ophthalmology and laminitis management. With all his various treatments, I gained numerous technical skills ranging from the basics of how to administer large quantities of tablets orally to more advanced tasks like giving pain medications via an epidural catheter,” said Coalwell, a fourth-year veterinary student who was on her large animal medicine rotation during Toby’s time in the hospital. “His case was so impactful that I will truly remember it for the rest of my career.”

As discharge from the hospital neared, Toby left with one final parting gift from OSU. At home his wounds would require ongoing care, and raw local honey is an ideal wound care agent, but it’s also very expensive, particularly in the quantities needed for a big horse like Toby. 

The hospital reached out to OSU’s Honey Bee Lab in the College of Agricultural Sciences. “They were super generous and provided us with a huge amount of honey,” Frei said. 

Finally, after weeks of care, Toby was cleared to go home. “It truly took a village of a care team to get him out the door. So many people throughout the hospital were rooting for him to go home. His discharge was such a wonderful culmination of all the hard work so many people had put in,” Coalwell said. “Words cannot express how amazing it felt to see him walk out of the hospital after all that we had invested into his recovery.”