many species. . .
Clinicians at Penn Vet are often called on to treat animals outside the traditional purview of our hospitals' veterinary patients. Penn Vet staff have the skills to heal a wide variety of animals, not just those making up the bulk of our caseload, which consists of pets, horses and farm animals. Truly, our philosophy of "Many Species, One Medicine" can be seen in some more unusual cases, which we thought worthy of note in this section. These are the stories of staff members brought in to treat or consult on some very unusual clientele.
A Jaguar's Jagged Tooth: Teams from Penn Vet and the Philadelphia Zoo Come Together to Help Jutai
By Susan I. Finkelstein
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| A sedated Jutai undergoes a scan to assess the extent of the damage. |
Jutai, a four-and-a-half-year-old jaguar at the Philadelphia Zoo, visited the Dentistry and Oral Surgery team at the Matthew J. Ryan Veterinary Hospital on May 21 for treatment of a lower right canine tooth that had broken and subsequently cracked all the way through the root.
Dr. Alex Reiter, assistant professor of dentistry and oral surgery and chief of the Ryan Veterinary Hospital's Dentistry and Oral Surgery Service, led the group of doctors and nurses that removed the tooth and surrounding bone tissue from Jutai's sore mouth.
Involved in the process were the following people from both the zoo and Penn Vet: Dr. Keith Hinshaw, Dr. Carl Tinkelman and support staff from the Philadelphia Zoo; Dr. Paula Larenza, Chrissy DeMilner and many others from Ryan Anesthesia; Dr. Jennifer Reetz and Jayson Bennett from Ryan Radiology; Dr. Tara Trotman and Paula Olson (both on stand-by) from Ryan Endoscopy; and the Ryan Dentistry and Oral Surgery Service.
Surgeons begin the two-and-a-half-hour extraction process.
Jutai was wild born in the Central American country of Belize and found in a citrus orchard when he was about four months old. He was brought to the Belize Zoo in March 2004 and arrived at the Philadelphia Zoo on April 17, 2007. He is yellow with black rosettes.
Jaguar Facts
Type: mammal
Diet: carnivore; prey include fish, turtles or caimans from rivers
and larger animals such as deer, peccaries, capybaras & tapirs
Average lifespan in the wild: 12 to 15 years
Size: head and body, 5 to 6 ft.; tail, 27.5 to 36 in.
Weight: 100 to 250 lbs.
Protection status: endangered
Jaguars are the largest of South America's big cats. Unlike many other cats, jaguars do not avoid water; in fact, they are quite good swimmers. They sometimes climb trees to prepare an ambush, killing prey with one powerful bite.
A. J. the Aardvark Goes to the Dentist
By Susan I. Finkelstein
A. J., an 18-year-old aardvark from the Philadelphia Zoo, was brought to the Ryan Veterinary Hospital’s Dentistry and Oral Surgery Service to extract remnants of tooth roots on the right side of his jaw that had caused significant swelling, indicative of osteomyelitis (inflammation of the bone). Dr. Alex Reiter, assistant professor of dentistry and oral surgery, headed a team that included Dr. Stanley Blazejewski, resident in dentistry and oral surgery; Dr. Laurie Sorrell-Raschi, staff veterinarian in critical care and anesthesia; and Eileen Hendricks, CVT, staff anesthesia technician—along with Drs. Keith Hinshaw and Amy Hancock, from the zoo.
Inserting an intertracheal tube to anesthetize A. J. was difficult because of the length of an aardvark’s head and limited ability to open its mouth. Normally, anesthesia would be injected, but with A. J.'s oral procedure, blood could go into the throat, so the airways needed to be protected. The surgical team decided intubation was the best method of administering anesthesia.
A. J. and members of the surgical team
Since the mouth did not open much, surgery had to be done from the outside in—incising the cheek, cutting through skin and muscle until the oral mucosa on the inside of the mouth was reached. Dr. Reiter was concerned about causing further infection, so no high-speed tools could be used. Also, A. J. was the first aardvark treated by Dr. Reiter and his team, so they decided to use a gentle approach when it came to the blood vessels and arteries. “It was a long process,” remembered Dr. Reiter, “but after many minutes, we were able to locate all three teeth and roots and extract them.”
“I think what I liked most about this experience was the bond created between Penn and the Philadelphia Zoo,” Dr. Reiter said. “It is very helpful for both parties: for their residents to see how we work, and vice versa. It’s important that we create a relationship so they can come back and provide us with other opportunities to do surgeries on their animals.”
Aardvark Facts
Name: “aardvark” is Afrikaans for “earth pig”
Size: 24 inches at the shoulder
Weight: 88 to 143 pounds
Lifespan: 23 years in captivity
Habitat: dry savanna to rain forest; sub-Saharan Africa
Diet: omnivorous, but especially likes termites
Gestation: 7 months (give birth to one offspring at a time)
Predators: humans, lions, hyenas, leopards, pythons
The “Dawn” of a New Dinosaur Species
By Alan Atchison
In 2002, a brand new species of horned dinosaur was discovered in China. The new species, named Auroraceratops rugosus, was found with its skull and lower jaw almost completely intact. The animal distinguishes itself from other horned dinosaurs due primarily to the breadth of its nasal passages, the roughness of its lower jaw and the rigidness of its upper teeth. In 2004 the remains were examined and studied by Dr. Peter Dodson, professor of anatomy, who has worked with students and research teams all over the world in excavating and researching dinosaur fossils. In his studies, Dr. Dodson teamed up with Dr. You Hailu, a 2002 graduate of the Department of Earth and Environmental Science at the University of Pennsylvania. Dr. Dodson, who has a secondary appointment from the Department of Earth and Environmental Science, collaborated with Dr. Hailu and others to write the first publication on the new species of dinosaur.
Dr. Dodson with leg bone of
Auroraceratops.Currently, the remains of Auroraceratops are in Beijing, where they are being studied in further detail. Dr. Dodson believes the find is especially significant because it “shows greater diversity among horned dinosaurs throughout the world.” While scientists had previously believed that large-horned dinosaurs existed only in North America , new finds from China reveal a direct genetic link between the two groups. The find is particularly endearing to Dr. Dodson, who named the new species after his wife, Dawn, since “aurora” is Latin for “dawn.”
Auroraceratops rugosus
Snow White and the Seven Stones:
Philadelphia Zoo Snow Leopard Receives Laparotomy
By Alan Atchison
Since its opening in 1874, the Philadelphia Zoo has been one of the biggest attractions in the city of Philadelphia. From time to time, some of its most popular stars fall ill, and outside assistance is needed to help return them to top form. The School of Veterinary Medicine has proudly been able to fill that role over the years; the most recent instance involved an aging snow leopard suffering from bladder stones.
Zoo staff began noticing that Du, a 15-year-old female snow leopard, had blood in her urine. The diagnosis confirmed the presence of cystic calculi, which often results from metabolic defects or as a byproduct of various infections. Zoo veterinarian Dr. Keith Hinshaw then contacted Dr. David Holt, associate professor of surgery and clinical studies at the School, and the two set a surgery date to remove Du’s bladder stones. For Dr. Holt, the opportunity to work alongside veterinarians at the Philadelphia Zoo was not a new one, as he and Dr. Hinshaw have worked together in treating several Zoo animals in the past.
The procedure was performed on January 11 at the Philadelphia Zoo, primarily by surgery resident Dr. William Culp, with Dr. Holt’s assistance. The team of doctors from the School also included anesthesia personnel Drs. Ben Brainard, V’00, Lisa Bubb and Margaret Wypart. Doctors determined that Du would require a caudal ventral midline laparotomy and cystotomy to cure her condition. “We made an incision into her abdomen and then another incision into her bladder,” said Dr. Holt. “We then removed the stones and also some sand from the bladder, made sure the urethra was clear by flushing it out and finally closed the incision.”
The procedure, which took about an hour, proved successful – at least so far. Dr. Holt claims that the true verdict won’t be revealed until the culture of the stones can be studied. At that time, doctors will have a more accurate reading on whether Du’s bladder stones are a serious threat to return.
In the meantime, Du recovered as well as can be expected following surgery. She was kept indoors for two weeks to keep from aggravating her surgical wounds, as leopards have a tendency to climb and jump in open spaces. Du was placed on post-operative antibiotics as a precaution for any potential urinary tract infections.
Snow leopards, an endangered species in the wild, are fairly rare, though not uncommon to the Philadelphia Zoo. Besides the obvious outward appearance, the biggest difference between snow leopards and the standard yellow leopards, according to Dr. Hinshaw, is in climate preferences. Snow leopards in the wild originate from some of the highest points in the Himalayans, where temperatures are freezing. By contrast, most other leopards are tropical.
Currently, Du is back at the outdoor exhibit at the Zoo. And since January is a month filled with freezing temperatures, the open air probably suits her just fine.
Snow Leopard Facts
The snow leopard, known and prized for its beautiful, thick fur, has a white, yellowish or soft gray coat with ringed spots of black on brown. The markings help camouflage it from prey. With their thick coats, heavy fur-lined tails and paws covered with fur, snow leopards are perfectly adapted to the cold and dry habitats in which they live.
Height: about 2 feet (shoulder height)
Length: 6–7.5 feet (includes 40-inch tail length)
Weight: 77–121 pounds; females about 30% smaller than males
Lifespan: Their reclusive nature makes it hard to determine snow leopard lifespan in the wild. They have, however, been known to live for as long as 21 years in captivity
Diet: Staples are wild sheep and goats; also known to eat smaller animals like rodents, hares and game birds
Gestation period: 3–3-½ months
Litter size: 2–3 cubs
Threats: Snow leopards are illegally hunted for the fur trade. Snow leopard bones and body parts are also used for traditional Asian medicine. There is also increased conflict with humans when snow leopards attack livestock during times when their natural prey is scarce.
Legal status/protection: endangered
Source: Defenders of Wildlife
Thor the Camel Battles Bone Disease
By Alan Atchison
Thor, a nine-month-old Bactrian camel, was brought to New Bolton Center in early December 2005 because of severe lameness in his left hind leg, a problem that reportedly had been ongoing for about three weeks. He had also been suffering from a decreased appetite and weight loss. Physical examination confirmed that Thor was rather depressed and thin, as well as severely lame. Radiographs of Thor’s left hind limb showed a mottled appearance of the medullary cavities of both the tibia and the metatarsus. The severe lameness and radiographic changes in the bones indicated that Thor may have been suffering from panosteitis, a clinical syndrome found in young, large, fast-growing dogs. But the attending veterinarians, Drs. Jen Smith and David Levine, could find no previous record of the disease in species other than dogs.
Over the next week, Thor was treated symptomatically. Diagnostic tests included a small biopsy from the affected metatarsus, and through the aid of supportive care and analgesics, his appetite soon improved. However, Thor’s kidney function had deteriorated from the use of non-steroidal anti-inflammatory drug Banamine, which had been given as an analgesic. This renal complication required treatment with intravenous fluids and the use of Banamine was immediately discontinued. The serum creatinine concentration—a test for kidney function—was carefully monitored, while other non-steroidal drugs to be used as potential analgesics also had to be avoided to prevent further damage to Thor’s kidneys.
During the time Thor was in the clinic, his lameness improved as did his kidney function, and his owners decided to take him home. He was discharged with instructions that he be confined to his stall for rest, monitored and given an attempted increase in his food intake. The biopsy of the bone did not yield a definitive diagnosis and panosteitis was still the primary suspicion at that time.
Several weeks later, over the holiday break, Thor was readmitted to New Bolton Center by Drs. Janet Johnston and Andrew van Eps. However, this time due to very severe non–weight bearing lameness in his right hind limb. He also exhibited a very poor appetite, decreased water consumption and signs of depression. He was placed on intravenous fluids and closely monitored. Radiographs obtained of the newly affected leg showed changes similar to those previously found in the left hind limb, with the tibia especially affected. Panosteitis was again considered the most likely diagnosis. At that time, Thor was under the care of Drs. Jill Beech and Valerie Brown in Medicine, and Drs. Smith and Dean Richardson were his surgeons. Thor’s owners had asked whether his signs could be due to metabolic bone disease, but neither the radiographs nor results of subsequent endocrine testing supported this diagnosis.
Pain management was a major goal in Thor’s treatment, as his pain was extreme and thought to be a major reason for his depression and lack of appetite. Non-steroidal anti-inflammatory medications, commonly used in dogs with panosteitis, had to be avoided due to Thor’s sensitivity to the drugs and his renal compromise. As an alternative, Dr. Kim Olson placed an epidural catheter that allowed regular injections of morphine and bupivicaine with the hope of alleviating the pain in Thor’s hind leg. Unfortunately, these medications appeared to do little to improve Thor’s comfort, despite the fact that this technique has been used successfully in other animals, including horses, to manage severe hind limb pain. Thor’s veterinarians believed that another bone biopsy was necessary, both to aid diagnosis and potentially to decrease pain, as dogs with panosteitis have typically displayed a decrease in pain following bone biopsies. Drs. Smith and Richardson performed a trephine biopsy of Thor’s right tibia, obtaining a larger piece of bone than that obtained during the first biopsy. It was thought that the larger piece of bone would better represent the actual bone pathology, and its removal also could potentially decrease intermedullary pressure within the diseased bone.
The day after the biopsy, Thor was still experiencing a great deal of pain. Fentanyl patches were placed over the skin on the inside of his thigh, with the expectation of absorption into the blood stream, and resulting in blood concentrations of the analgesic drug. Within a few days Thor was able to support himself on his right hind limb and over the next several days his comfort, appetite and mood progressively improved. His nursing care and attempts to present a wide variety of tempting foods continued all throughout the time that he was hospitalized. With the return of his appetite, Thor appeared to enjoy hand-fed fresh grass, carrots and oats, and lavished in all the attention he received. He was soon able to walk outside fairly comfortably. During the time of his second hospitalization, Thor was treated with intravenous fluids because his kidney function was still abnormal and because he was not drinking sufficiently. As his recovery progressed, his fluids were slowly discontinued. His kidney function improved and he started to drink and eat. The results of his second bone biopsy revealed a compatibility with panosteitis.
By mid-January, Thor seemed to be recovering extremely well. His appetite had returned and was able to walk comfortably on all four legs. He was discharged from New Bolton Center with instructions to monitor his clinical signs, weight gain and creatinine level. He also was to have future radiographs to ascertain the status of his bones.
Thor has continued to do well at home and is eating and gaining weight. His creatinine returned to normal and has remained normal on several subsequent measurements. The progress in Thor’s health has also provided a boost in his popularity, resulting in has two popular 24-hour webcams. As his food intake has increased and his walking has become more confident, Thor’s success story in overcoming panosteitis appears to be the first of its kind in camels.
Bactrian Camel Facts
Type: mammal
Diet: herbivore
Average lifespan in wild: up to 50 years
Size: over 7 ft. tall at the hump
Weight: 1,800 lbs.
Gestation period: 12 to 14 months
Protection status: Endangered
Branching Out into Primate Territory: Penn Veterinarians Help
with Hysterectomy for Philadelphia Zoo Gorilla
By Alan Atchison
The relationship between Penn Veterinary Medicine and the Philadelphia Zoo has been a long-standing one, centered around the common thread of helping each other help animals in need. One recent case involved a zoo primate named Demba, a 34-year-old Western Lowland gorilla in need of a hysterectomy.
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| Demba being prepped for surgery. |
Demba was brought to the Philadelphia Zoo five years ago in hopes of starting a new line of gorillas. As she failed to conceive over time, however, zoo doctors became increasingly concerned. Upon further examination, Philadelphia Zoo veterinarian Dr. Keith Hinshaw discovered a benign tumor in Demba's uterus. Clearly, any mating hopes now were out of the question, and the priority shifted solely to saving Demba's life. To remove the tumor, Hinshaw requested the services of Dr. Sean Harbison, a human surgeon at Temple University Hospital, and Dr. David Holt, section chief of surgery and associate professor of surgery at Penn Vet.
"Keith contacted me and said they had a gorilla with an abdominal mass and asked if I would be prepared to come out," said Dr. Holt, whose expertise mainly involves dogs and cats. For both Drs. Holt and Harbison, gorilla surgery was breaking new territory, as Dr. Harbison only performs surgery on humans. Holt believed such a move by Dr. Hinshaw was wise. "We thought that bringing in a human surgeon was important because the gorilla's anatomy is obviously going to be much more like a human than it is like a dog or cat."
Due to the doctors' schedules, Dr. Holt didn't get a chance to visit Demba prior to the surgery to learn more about her condition. He described his role during the surgery as that of an assistant, deferring most of the credit to others. Dr. Steve Mehler, a soft-tissue surgeon at the School, also assisted in the gorilla's hysterectomy. The School was also represented by an anesthesia team consisting of Dr. Lin Klein of New Bolton Center, as well as residents Drs. Patrick Burns, Tamas Ambrisko and Ben Brainard, V'00. The four took care of most of the preparatory work before the actual surgery took place.
"The anesthesia team had the gorilla anesthetized when Steve and I arrived," Dr. Holt said. "One of the staff from the zoo prepped her. We did our regular scrub and organized the instruments. Once they were prepped, we draped and did the surgery."
The beginning of the surgery proved to be the most difficult part for the surgeons, as gorilla skin generally is much tougher than that of humans, dogs or cats—with a few exceptions. "Cats, if not neutered, can have very tough skin," said Dr. Holt. "But the gorilla skin was tougher than most of the dog and cat skin that we deal with. We had to push a bit harder with the scalpel blade to get through the skin. But once we were through, it was pretty much like a regular exploratory abdominal procedure, similar to one we would perform for a dog or cat."
One potential hazard was the threat of Demba losing too much blood during the procedure, though the surgical team took all the necessary precautions to keep such a situation from occurring. "We didn't have a blood loss problem because we took our time and made sure we dealt with all the vessels, some of which were quite large," he said.
The surgeons successfully removed Demba's uterine tumor in just over an hour. Dr. Holt credited much of the success to Dr. Harbison, and described him as the unofficial leader of the team. "He was really great. He let us do quite a lot of the surgery and he just chipped in where he thought he needed to chip in. He was a really nice bloke to work with, he and his resident."
In addition, Dr. Holt praised the staff of the Philadelphia Zoo and welcomed the chance to treat other species of animals there in the future. "They have a really good professional team," said Dr. Holt. "The whole setup was very well run and it's something I think we should stay involved with."
Demba is expected to live a normal life now, despite the fact that she will never become pregnant. "The procedure itself went really well. I was very happy to have had the experience," said Dr. Holt. "Demba did well and hopefully will be able to stay in the primate center for several years to come."
Western Lowland Gorilla Facts
Lowland gorillas are endangered, but they remain far more common than their relatives, the mountain gorillas. Western lowland gorillas live in the smallest family groups of all gorillas, with an average of four to eight members in each. They live in heavy rainforests, and it is difficult for scientists to accurately estimate how many survive in Cameroon, Central African Republic, Congo, Equatorial Guinea, Gabon, Angola and the Democratic Republic of Congo.
Type: mammal
Diet: omnivore
Average lifespan in wild: 35 years
Size: standing height 4 to 6 ft.
Weight: 150 to 400 lbs.