The Rhino with Glue-On Shoes (23 page)

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Months later, once the genetic analysis was completed (these special tests require a lot of time), we learned that Baker D didn't belong to the group of dolphins near Monterey Bay. He belonged to another well-known group of animals, the group that lives near the Channel Islands. Baker D was never lost. He knew all along where he was and where he belonged.

V

C
ROSSOVER

Myriad anatomical and physiological differences exist among the animal groups, creating a special set of hurdles for the zoo vet. Even closely related species with the same condition may show different signs. The best medicine for a mammal may not work for a bird, reptile, amphibian, fish, or insect.

Fortunately, the basic principles of medicine do apply across species—human, domestic, and wild. Many vets who work with wild animals have also practiced on domestic animals at one time in their careers. Veterinary medicine for dogs, cats, horses, cows, and, to some extent, poultry is the basis of our formal education. From these species, we learn to extrapolate. Reptiles, for example, are evolutionarily closest to birds, so there is some crossover to chicken and turkey medicine. The more open-minded and flexible we are, the better we perform as zoo vets.

Kidney failure, for example, leads to a buildup of toxins in the blood that needs to be flushed out. The treatment is a combination of fluid therapy and modifications to the diet, plus antibiotics or other specific medicines, depending on the cause of the problem. In severe cases, dialysis can be used to keep the patient alive. When faced with a case of kidney failure, the zoo vet will typically review how this problem is diagnosed and treated in other, related species. The next step is to modify and fine-tune it to the animal's needs, with attention to the specifics of its species—physiology, anatomy, and disease susceptibility.

For example, an elephant with kidney failure becomes ill very rapidly. Such a patient requires vast quantities of fluids, over one hundred gallons a day, delivered intravenously and continuously if possible. How are these given? The ear veins work well if the elephant is trained to stand still for an intravenous catheter. Or the fluids can be given rectally with a garden hose, a technique also used for horses. Since acute bacterial infection is often the cause, strong antibiotics must be delivered quickly. Such a treatment plan requires a team of people and swift action.

By comparison, a desert iguana with kidney failure develops clinical signs much more gradually. It may show no signs of overt illness until just before death. Often its problem is not infection but rather a gradual buildup of precipitated protein by-products in the kidney. Because this species is evolved to conserve water, its cardiovascular system can handle only tiny amounts of intravenous fluids. An iguana in need of fluid therapy gets it just ounces at a time, once a day, under the skin. The subcutaneous delivery ensures slow, safe absorption.

Even related animals differ in their expression of the same disease. Most cats, domestic or exotic, develop kidney failure as they age. Some can live for years with this illness without showing signs, particularly the big cats from African and Asia. When a lion or tiger does become ill, it often responds well to a single treatment with fluids (under anesthesia, of course) and will feel better for months afterward. In contrast, cheetahs develop kidney failure at an earlier age and succumb to it more quickly, usually within a year.

In this final group of stories, zoo vets look to the experts in domestic animal and human medicine to diagnose and treat problems in various animals. Several seek help from talented medical professionals who willingly donate their expertise and time. The patients that benefit include a goldfish, a red kangaroo, a polar bear, a pair of weedy sea dragons, a giraffe calf, and a Nile hippo.

Lucy H. Spelman, DVM

Tulip

by Greg Lewbart, MS, VMD

T
he corners of the stiff cardboard box were mashed and crinkled like so many miniature accordion bellows. When the UPS man slid the container across the cluttered counter, you could hear water sloshing back and forth, and the box rocked gently as its small internal waves pushed to break free.

“Initial on the X,” the man said, handing me a clipboard. “Live fish, huh?”

“Well, I hope so,” I said, scribbling my initials somewhere close to one of the many X's littering the sheet of paper. I handed the clipboard back. Instead of turning to leave, the UPS man looked anxiously at the box and then at me.

“When you gonna open it?”

“Right away,” I said, surprised at his interest. “I'm going to open it right now.”

I reached into my lab coat pocket for a pair of suture-removal scissors. They come in handy for all sorts of things, in addition to removing stitches. Holding them open and using one sharp edge, I sliced the wide piece of transparent tape along one edge of the box. I flipped back the large brown tabs to reveal several sheets of classified ads from the August 1993
Des Moines Register.
At this point, the UPS man leaned over the box as if peering into a volcano. Tossing the newspaper aside, I snatched the double plastic bag from its cardboard hole. When I held the bag above my head so that the fluorescent ceiling light shone through it, we could both see an apple-sized orange-and-white blob swirling in the cool milky water. All that was left in the box was a perspiring, thawed ice pack.

“It's alive. Sure looks alive, anyway,” the UPS man remarked.

“Yes. Yes, it is,” I said with a smile. Then I addressed the fish, eye to unblinking eye. “Nice to meet you, Tulip.”

“Tulip? You mean this fish has a name? Like it's some kinda pet?”

“Of course,” I said to the startled deliveryman. I walked Tulip over to a running aquarium and floated her, bag and all, on the water's surface. This would help her acclimate to her new environment. Once she was safely afloat, I grabbed a blue plastic folder that had been lying next to the aquarium. “See. Here's her medical record.”

“What's she got? What's she here for?”

“Probably has cancer,” I said as I fiddled with the filter and checked the aquarium's water temperature. “Won't know for sure until we've run some tests.”

“Cancer? Come on, Doc. Fish get cancer?”

“Absolutely. And older goldfish are especially prone to skin and muscle tumors.” Then I pointed to what looked like a stem of cauliflower, dyed red, attached to the side of Tulip. “See this?”

By now the UPS man was standing with me, tank-side. “Yeah. That's cancer?”

“Well, like I said, we need to perform some diagnostic procedures. But it's most likely a tumor.”

“Will she be all right?” he asked, with a degree of compassion that surprised me.

“Hard to tell. She's five years old and has survived two months of treatment with shark cartilage extract. Not to mention nearly twenty-four hours bouncing a thousand miles across the country in your box. Fish are pretty tough, though,” I said. “We'll know a lot more tomorrow.”

“Would it be all right if I check back in some day when I'm delivering? To see how the fish is?”

“Sure,” I said. “She should be right here in this aquarium, unless she's in radiology or ultrasound having images made.” Smiling, I added, “We have open visiting hours for fish patients.”

Once Tulip was safely acclimated to her hospital tank, I picked up the phone to call Iowa. The woman who owned Tulip had tracked me down at North Carolina's veterinary school a few weeks ago, not an easy thing at the time. (This was before Google and the wide use of the Internet.) We'd talked several times about what to do next for this special fish, and I felt we'd made the right decision. Tulip seemed absolutely fine at the moment, despite her travels and her tumor. Dialing the number, I smiled at the thought of how her owner had found me.

A syndicated column called “News of the Weird” had run a short blurb about my work. Just above a paragraph headlined “Alien Abductees Form Support Group” was a short story about another fish, Zeus, I'd treated for a swim bladder disorder. The story, titled “Veterinarian Performs Surgery on Pet Fish,” must have struck the editors as weird, though I certainly wasn't the only one working on pet fish in 1993. It spawned several morning rock-station interviews—there's a media service that feeds “odd” story fare to the radio networks—and apparently Tulip's owner heard one.

As I'd expected, she was relieved that Tulip had survived her overnight shipping ordeal and was anxious for my opinion of her pet's prognosis.

“It sure looks like a tumor,” I said, trying to sound positive. “I'd like to take some radiographs and make sure it hasn't invaded the spine or any vital organs.”

“You mean X-rays?” Tulip's owner said.

“Yes, exactly. And we might want to do an ultrasound too.” I hesitated. “I would estimate that after these diagnostic tests, and a surgical biopsy of the tumor, your bill could run as high as four hundred dollars—”

“It doesn't matter what the cost is,” she said, cutting me off. “Please do anything possible for her. Spare no expense.”

“All right,” I said. Her reaction didn't surprise me. An owner who commits to veterinary care for a pet fish by sending it UPS to an expert several states away is prepared to make a significant financial investment. I outlined the plan for the next twenty-four hours and we said our good-byes.

I looked over at Tulip. She was breathing comfortably with regularly expanding O-shaped lips. Then she moved her shiny white-and-orange globoid body to the rear of the tank and squirted out several hundred tiny fish eggs, a ritual she would practice on a daily basis while she was in my care. All mature female fish produce eggs. Some, like Tulip, will lay them even without the presence of a male (fertilization is external).

Tulip was as beautiful as the flower she was named for. At least until an ugly tumor started growing on her side. She was a five-year-old oranda goldfish—
Carassius auratus
to ichthyologists. Her ancestors all lived in Asia somewhere, and she was probably at least a twentieth-generation American. Her life began as a fertilized egg with about 150,000 siblings at a fish farm. Within a few months, she was moved to a tiny corner pet store in Iowa. Young fish, or fry, go through a lot during their first few months of life. Imagine a blur of nets, plastic bags, cardboard boxes, and loud motorized vehicles.

Tulip probably lived in a tank at the Iowa store with other fancy goldfish, the kind with strange-looking telescope eyes or big yellow sacs on the sides of their faces. No doubt, the store provided these fish with the basic amenities: plastic plants, colorful gravel, and one of those scuba divers that bobs up and down every few minutes. That guy would annoy me if I were a fish. If goldfish had teeth, they might try to bite through his air hose. Their teeth are in their throats, however. That's how they grind up hard pellets.

Fish do really like the gravel, though. It's like candy to them. They suck up pieces of it, swirl it around in their mouths, and spit it out, swallowing the algae and bacterial slime that covers each little stone.

Tulip lived in the store for only about five weeks. Her owner spared no expense on a new aquarium, double the size of the group tank at the store. Gone were the plastic plants, diver, and dozens of other fish competing for food—and attention. Instead, Tulip swam among real plants. She had an automatic feeder that fed her the same time every day. Her weekly treats included a fresh pea or a freeze-dried worm.

According to her owner, Tulip had looked the picture of health until six months before, when the lump appeared on her side. It grew quickly, although if you looked at the fish from the healthy side, she appeared normal. From this description, I couldn't recommend the best course of treatment, so her owner agreed to send her all the way to North Carolina for a thorough exam.

Radiology was a breeze for Tulip and the hospital staff. She was the star patient of the day. No barking. No scratching. And no shedding! She lay on the plastic-covered X-ray plate like a big slimy dinner roll. Her breathing became more rapid out of water, but she didn't struggle at all. Once the technician had pushed the button to make the exposure, I was there to scoop her up and plop her back into her transport tank.

We took two views, one from the side and another from the top. The radiologist on duty marveled at their clarity and beauty. Fish radiographs always look beautiful to me. The delicate bones form a lacelike pattern. Aquatic animals have less bone density than a terrestrial animal of the same size. Tulip's two little otoliths (ear stones), used for balance in the water column, looked like small pearls in her head. Her pharyngeal teeth (the ones in the back of her throat) created rows of tiny white triangles.

Overall, Tulip's skeleton looked good, as did her egg-distended belly. And then there was the tumor. It had not spread into her spine or kidneys—very good news. This would also make surgery easier. Next stop, the operating room.

We anesthetized Tulip by placing her in a water bath containing a special fish anesthetic called MS-222. After about three minutes, she was asleep. The trick with this anesthesia is to keep the fish's gills submerged, adjusting the concentration of chemical in the water so the fish stays asleep. It sounds easy, but fish eyes are always wide open (no eyelids). You get used to it—your patient staring at you.

For Tulip's surgery, I was the anesthetist and my colleague, Dr. Craig Harms, performed the surgery. Craig is a reserved, humble, and extremely competent veterinarian with a soft, deep voice. Like a fuel-efficient automobile, he produces a lot from every word and action. He quietly accepted the challenge.

Our plan was to “debulk,” or remove, as much of the tumor as we could. Craig used a technique called electrocautery, using a forcepslike device that cuts and controls bleeding at the same time. He quickly removed the tumor with very little bleeding. The entire procedure took less than fifteen minutes. To wake Tulip up, we flushed her gills with fresh water. In minutes, she was back in her tank, leaving us little egg presents.

We sent the tumor to the pathology laboratory and waited about forty-eight hours for the diagnosis. The results were grim: undifferentiated sarcoma. The fish had a malignancy that probably had not spread but was nonetheless an aggressive tumor. Even worse, we hadn't gotten it all. Repeating the surgery would do little at this stage. I informed Tulip's owner of the findings, and she agreed with me that our best recourse was to keep the fish in the hospital and consult with the university oncologist. If the UPS man wanted to stop by to see Tulip, he'd have plenty of time. (He never did. Maybe he didn't want to know the outcome.)

That's when Dr. David Ruslander entered the story. Dave is one of the most compassionate veterinarians I know. He's also one of the most opinionated. But the patient always came first. The arguments could wait for the bar or coffeehouse. Dave was thrilled to be involved with Tulip's case, and after carefully reviewing her medical record, radiographs, and biopsy report, he had a one-word suggestion: chemotherapy.

“I'm thinking cisplatin,” Dave said with authority. “It's the best one for these nasty sarcomas. And I couldn't use radiation without frying the whole fish.”

“But have you tried cisplatin on a fish?” I asked, virtually sure the answer was no. I also knew that this was a pretty heavy-duty drug with the potential for significant side effects in mammals.

“Nope,” he said quickly. “And I don't imagine anyone else has, either. But if you don't go with the chemo, that thing's going to grow back. You don't have clean margins. And to get 'em you'd have to cut deep into the musculature.”

“Yeah, I know,” I said in a somber tone. “Well, I've got to talk with Tulip's owner. See what she says.”

“No problem,” he said, smiling. “We've got some time. But I wouldn't wait more than a couple of weeks.”

Tulip stayed in the clinic aquarium for the next several weeks. She seemed fine, but close inspection of the surgery site revealed a small blip of tissue that was surely a new tumor. I showed this to Dave and he said simply, “It's cisplatin or more surgery. Or both.”

“Both?”

“Well, with this aggressive a tumor, the chemo might not be enough,” Dave said.

Unfortunately, Dave's prediction was accurate. Tulip was tranquilized for an injection of the cisplatin. We used an anesthetic just to take the edge off, which she tolerated well. But the tumor continued to grow during the next several weeks. Craig performed a second, more aggressive surgery, which cut into the underlying muscle. Tulip tolerated the second surgery well, which was followed a week later by a second and final round of injectable chemotherapy. But still the tumor persisted.

“I think my baby's had enough, don't you?” Tulip's mom said to me through hundreds of miles of phone line. “I mean, will more surgery or chemo stop this thing?”