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Authors: DVM Lucy H. Spelman

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As expected, the whale lost weight at first, but she remained bright-eyed, energetic, and responsive to her human caretakers. She handled her new diet well, and her appetite was growing. After two months, the calf had surpassed her original weight. She was ready to meet the other whales.

Before Immi's death, Kayavak and her mother had lived together in a pool separate from the other belugas. They had access to each other only across netted gates. We wanted to minimize the chance of complications during birth and limit the risk of aggression toward the newborn. Mother belugas tend to be very protective of their babies. Additionally, female whales will sometimes try to steal another mother's calf. Now we followed a step-by-step plan to introduce Kayavak slowly to the adults, one at a time, over a period of months. Each time we opened the gate that connected her pool to the adult pool and began an introduction to a new whale, we felt considerable trepidation.

Immi had been the dominant animal in the pod before the birth of this calf. Whale social behavior depends largely on hierarchy; we wondered if Kayavak would benefit from her mother's prior status. Such social dynamics are complicated, however, and what we understood about the rankings of our beluga community was likely just the tip of the iceberg. With Immi gone, things could have shifted in ways that would be hard to predict.

Sure enough, despite the role her mother once played, Kayavak wasn't accorded any special status. On the contrary, she entered the pod at the bottom of the pecking order, and there were times when the older whales showed aggression toward her. But, ultimately, she held her own. Gradually she learned to navigate the society of her new pod and became a solid part of the community.

Even so, Kayavak maintained a bond with all of us. She would throw a glance toward her human companions now and then, as if to let us know she'd made it. We felt as though she were looking back at us with a wink and a nod. Our relationship with her continues to be a special one. Now a young adult, Kayavak is an integral part of the beluga group at the aquarium. A guest wouldn't be able to pick her out from among the other animals, but every member of the aquarium staff can identify her at a glance.

Kayavak's case, with its sad and startling beginning but successful resolution, made a lasting impression on me. Of all the lessons we learned that winter—about nutrition and infectious disease, behavior and environmental enrichment, tough decision making, and acceptance of risk—perhaps the most powerful were the ones we learned from Kayavak. She taught us about adaptability and survival. This endearing whale sought the care and companionship she needed to survive, and we happily provided it.

ABOUT THE AUTHOR

Jeff Boehm is a graduate of the University of California, San Diego, where he received his bachelor's degree, and the University of California, Davis, where he received his degree in veterinary medicine. He completed an internship in small animal medicine in Southern California and then worked as a veterinary clinician at the Los Angeles Zoo. Since 1992, Dr. Boehm has worked at the John G. Shedd Aquarium in Chicago, where he is currently the senior vice president for animal health and conservation science and the Louis Family Conservation chair. In this position, he oversees the aquarium's veterinary division, a variety of conservation science initiatives, and a Great Lakes conservation program. Dr. Boehm has a keen interest in aquatic conservation, specifically the role that zoos and aquariums play in fieldwork and research, and ultimately in public awareness.

II

T
ECHNOLOGY
H
ELPS

MRI scans produce excellent images in turtles, lasers limit blood loss during surgery in fish, ultrasound studies can detect heart disease in gorillas, orthopedic surgery works well in birds, and root canals are readily performed on lions, tigers, and bears. All of these animals are monitored during anesthesia with pulse oximetry, a measure of heart rate and blood oxygen saturation. With the help of medical technology, zoo vets arrive at diagnoses earlier, predict outcomes more accurately, and treat symptoms more successfully.

Given the range of species and potential problems in zoological medicine, there's sometimes a first-time technological solution. It might be the application of familiar technology to an unfamiliar species, or the replacement of a traditional medical tool with a newer one.

The process of applying such techniques in wild animals, however, is anything but routine. Even the simplest technique may require a degree of modification, depending on the species. In order to make such adjustments, we collaborate with experts in other medical fields, including domestic and large animal veterinarians, physicians, medical technicians, and veterinary and human dentists. Adding to the challenge, most of our patients must be restrained, anesthetized, or trained for months before they will tolerate even simple technology-based procedures. A sick octopus in need of a set of X-rays, for example, requires three sets of hands and a barrel of water, with a water-soluble anesthetic available as backup.

Radiography, the production of images using X-rays, is a good example of the application of medical technology in zoological medicine. In both humans and animals, bones and other cartilaginous structures appear white, internal organs appear various shades of gray, and air-filled structures appear black. X-ray images readily show the patient's skeleton, including its teeth, and the outline of major structures such as the heart, lungs, intestinal tract, liver, kidneys, and bladder.

The size and density of the animal determines the type of cassette that holds the film and the power required to produce the image. Dental film, the kind we humans bite down on while sitting in a dentist's chair, works fine for whole-body images of tiny animals like hummingbirds, small fish, and frogs. We use standard-sized X-ray cassettes for small mammals like meerkats and monkeys, or for various body parts of larger animals—the thorax of a wolf, the abdomen of a tiger, the skull of a tapir, or the hoof of a zebra. Whether the exam is performed in a fully equipped veterinary hospital or in the field, the patient is almost always anesthetized or lightly restrained.

Interpreting the X-ray images poses another challenge. Experience and knowledge of comparative radiographic anatomy are crucial to accurate interpretation, and even then opinions may vary. The radiographic anatomy of a gorilla most resembles that of a human, but with quite a few differences, not the least of which is the size of the hands and skull relative to the body and the presence of air-filled sacs located beneath the neck and in each armpit. Birds have air sacs too, and some of their bones are full of air cavities. But there are many differences among these species as well. An X-ray of a parrot looks very different from that of a hawk.

With the arrival of digital photography and digital radiography, many zoo vets use e-mail to send radiographs to experts at other institutions for another opinion. As a whole, our profession has been quick to take advantage of the Internet. Not only do we use this tool for communication, it's often the first place we look for the latest medical technology.

Zoo vets show their low- and high-tech creativity in the next group of stories: horseshoes give a rhino relief, fiber-optic instruments help pandas, massive portable life-support systems transport whale sharks halfway around the world, orthopedic surgery helps a falcon, and frogs benefit from a new anesthetic method.

Lucy H. Spelman, DVM

The Rhino with Glue-On Shoes

by Lucy H. Spelman, DVM

T
here had to be a better way to deal with this rhino's feet. Blood dripped from Mohan's foot pads as veterinarians and technicians worked furiously to carve away diseased tissue. These were not small feet—each one measured about ten inches in diameter. A growing pile of soiled gauze and towels littered the floor. Next, bandages would go on. Then we'd roll the rhino over to work on the other side. The blood didn't worry us. Even if Mo lost a few pints during the trim, the 5,000-pound animal wouldn't know it.

In an odd sort of way, we were glad to see red. The blackened, unhealthy tissue wedged between his toes and into the cracks of his soles had outgrown its vascular supply. His back feet were the worst. We trimmed off the outside layers until we got down to healthy tissue, which bled profusely. I watched the foot-trimming team for a minute or so, long enough to gauge how much more anesthesia time they needed. Then I turned my attention back to the rhino. Though we'd done this procedure many times before, it still felt like a big deal to put him under anesthesia.

At thirty-two, Mo was one of the oldest greater one-horned rhinos in captivity and genetically valuable. When he arrived at the National Zoo, in Washington, DC, in 1998, three years before, everyone hoped that he and Mechi, our female, would breed. He had never bred, and we knew he had a history of foot problems. Unfortunately, the pattern continued. Though the two seemed compatible, Mechi showed more interest in Mo than he did in her and his feet continued to deteriorate.

Fortunately, Mo handled anesthesia well. He'd stand still for the darting and slump to the ground ten minutes later when the drug took effect. Sometimes he'd go down in the middle of the enclosure, which made it easy. Other times he'd jam his great nose in a corner. We'd reposition him using a few ropes and about a dozen people. I'd put a catheter in his ear, start him on an IV filled with muscle relaxant, and then put a rubber hose up one nostril to deliver oxygen. The minute we had our first set of vital signs, the rest of the team got to work and the trimming began.

Given his age and the ever-present risk of complications, I tended to keep Mo's anesthesia on the light side. At the slightest indication of a problem, I could quickly reverse him (wake him up). Since this strategy meant that a loud noise or bright light could cause him to stir, we covered his eyes with a cloth drape, packed his ears with gauze, and kept a syringe full of anesthetic at the ready.

I lifted the rhino's blindfold and peered into his big dark eyes. Even anesthetized animals have some sort of facial expression that offers a clue to their mental state. Mo stared past me, unblinking. His eyelids were stretched wide open, a side effect of the anesthetic, just as they should be at this stage in the procedure. I applied a bit more “eye goop,” a sterile ophthalmic ointment, to protect the surface of his corneas, and replaced the cover.

Checking for an ear twitch, I tickled the hairs in his upside ear. No reaction. Good. A chunk of brown wax stuck to my gloved finger. I fiddled with the hose delivering oxygen. No snort or change in breathing. Our monitors showed a steady heart rate and good blood oxygen saturation. I slipped my hands into his mouth to check his jaw tone; the muscles resisted. He'd definitely need a supplement of anesthetic before the team rolled him onto his other side. Otherwise, he might be able to kick out, or even try to get up. I also got a whiff of bad breath. Maybe we could float (file) his teeth if we had time.

“How's it going, Paul?” I asked. A large animal veterinarian, Dr. Paul Anikis had long since become a vital member of our zoo's consulting team. He'd driven ninety miles into the city from the Virginia countryside early this morning. It was now just past seven-thirty
AM
.

“These feet are a mess, Lucy, they really are. We're gonna try perfusing him today, the way we do in horses. The back feet, anyway. I don't think oral antibiotics will even touch this stuff.” Paul shook his head. “It seems like these toe pads are the problem. They've got to be really sore. If we can get a cephalosporin IV in there, it'll reduce all that swelling. We're mixing some up now.”

When Mo's feet needed trimming, the rhino's entire demeanor changed. Normally, he never missed a chance for a food treat or a belly scratch. Erin, one of his keepers, had trained him to stand next to the bars of his indoor enclosure, close enough that she could reach in and work on his feet. While the other keepers distracted him with bits of sweet potato, Erin could give him a mini-pedicure.

But she could only trim bits of the overgrown tissue. Rhinos have three hooved toes on each foot. The skin between Mo's toes and the soles of his feet grew abnormally. At a certain point, this tissue fissured and cracked, allowing dirt and bacteria in and causing infection. Then it swelled. Mo couldn't stand without pinching this infected skin. It hurt. Because the problem affected all four feet, we didn't always see lameness, but his overall behavior changed. He avoided standing for long periods of time. Instead of enjoying his shower for an hour, for example, he would lie down in the middle of his enclosure. His eyelids and ears drooped. He would rarely come over to the bars. At that point, we'd schedule him for a complete trim under anesthesia.

I knelt back down next to the rhino's huge head, and watched again as Paul worked on the feet. He used a rope to fashion a tourniquet just below the rhino's tarsal-metatarsal (ankle) joint. Using a short piece of tubing with a needle on the end, a butterfly catheter, he quickly found a vein and injected the medicine. It would flood the tissue of the foot and stay there until he removed the rope. He followed that with some lidocaine, a local anesthetic, to ensure that Mo wouldn't feel anything.

For the bandage, Paul started with a combination of cotton and gauze wrap, covered by stretchy material called Vetwrap. We'd been through a fair amount of trial and error with this last step. Our first set of bandages stayed on for only a few hours. Mo got his feet wet and kicked them off. We wanted the bandages to last a day or two, long enough to keep his feet clean immediately after the trim. The answer? Duct tape, of course: the wide gray sticky tape used to patch holes in just about anything. The brand in our kit that day had a clever brand name, Duck Tape, with a picture of a yellow duck standing in a puddle of water.

The team waited for me to give the rhino a bit more anesthetic and then pushed him up onto his sternum and over onto the other side, folding his legs under his body. Mo's heavy head rested in my lap during the shift, temporarily pinning me to the floor. Adjusting the blindfold, I checked his eyes again: no change. The extra dose had worked perfectly. I couldn't resist giving his neck a light pat. His rough skin felt like concrete with a little flex, reminding me of Rudyard Kipling's description: bumpy plates of armor.

Thirty minutes later, just as Paul finished bandaging the second rear foot, the rhino blinked and opened his eyelids extremely wide. The initial narcotic anesthetic had begun to wear off at just the right time. Minutes later, with most of the staff and equipment cleared away, I gave Mo a drug that would reverse the remaining effects of the anesthetic, took a last set of vital signs, and removed his catheter. Erin stayed with me at his head. Her shoes spattered with blood, she looked tired, having spent most of the time bent over, helping to hold Mo's feet.

“He'll feel so much better in a few days,” I said quietly as we waited for the effects of the reversal drug to kick in.

“I know,”Erin responded.“I just wish we didn't have to put him through this much, at his age.”

As the anesthetic reversal took effect, the rhino took a huge breath and lifted his nose. We pulled out the ear gauze, removed the blindfold, and backed out of the stall. Mo heaved himself to his feet, wobbling. Watery blood dripped from his elbows. He took a few steps, shaking his bandaged feet. The duct tape held. Once again, he'd sailed through the anesthesia. When I stopped by to check him two hours later, he appeared remarkably normal.

From past experience, we knew the rhino's feet would improve after the trim. We also knew we hadn't solved anything. The infection would return within several months. In fact, Mo had been suffering from this problem for much of his life. It started long before he came to Washington, DC, while he lived at a zoo in Florida. Maybe the antibiotic perfusion would knock down the bacteria and keep them away for a bit longer this time. Like Erin, I wondered how many more times we could anesthetize him safely.

Some months later, at a veterinary conference, I attended a presentation about foot problems in rhinos, expecting to hear the familiar advice: trim and trim again; try antibiotic footbaths. Instead, the speaker, Dr. Mark Atkinson, focused on what he had learned about greater one-horned rhinos in the wild. Throughout India, Nepal, Bhutan, and Thailand, this species—also known as the Indian rhino—lives in swampy grasslands and mud wallows.

Mark recommended that zoos dramatically change the way they housed these rhinos. A pool isn't enough, he said; give these animals the swamps and mud their feet need. Take the pressure off their soles by getting them off gravel and cement floors. He also pointed out that many zoo rhinos were overweight, compounding the problem. Why weren't zoos providing the proper conditions? It was partly due to lack of understanding of what this species needs to be healthy, partly the cost of adding wallows, and partly the weather.

For nine months of the year in Washington, Mo had access to his outdoor pool and the mud around it. And he spent most of his time there. During winter, however, he lived mostly inside, protected from the cold. Mo's feet worsened within weeks of the start of wintertime housing routines.

While he spoke, Mark flashed images of normal feet from wild rhinos in Nepal alongside images of abnormal ones living in captivity. Rhinos have three toes and a main foot pad. They naturally bear most of their weight on their toenails, each analogous to a horse's hoof with a hard outer wall that extends well below a concave sole. Healthy wild rhinos are “toe walkers.” Since they naturally walk on soft ground, their toenails show very little wear. Captive rhinos have short nails with flat soles that fall even with the main foot pad; they are “pad walkers.”

Suddenly, Mo's real problem became crystal clear: his toenails were completely worn down from a lifetime on hard ground, exposing his soles—and then his main foot pad—to excess weight. Swampy ground might have prevented this problem, and it certainly had to be part of the long-term solution, but for now this rhino's feet were caught in a painful vicious cycle. Every time we cut the overgrown sole tissue back, it barely came even with his nails. He walked mostly on his sore soles.

I arranged for Paul to stop by to see Mo so I could show him some of the photos. He reacted to Mark's findings with a new idea.

“Okay, so let's put shoes on him,” he said.

“Shoes?” I was surprised. “Paul, you're crazy. How do we do that?”

“We'll just glue 'em on. No problem. I've been putting these aluminum shoes on the US Equestrian Team dressage horses because they're light, and you don't have to put nails through their feet to keep them on. We use epoxy and a fiberglass patch. You know, the way you fix broken turtle shells. If we can just get him up off his soles and give his nails some relief, they might have a chance to grow out more normally.”

“But won't we have to go back and take the shoes off at some point?” I asked, worried about the number of times we'd have to put the rhino (and ourselves) through anesthesia. The more I thought about an aluminum shoe glued onto the bottom of a rhino foot, the crazier it sounded. I imagined two scenarios: the rhino would wake up from anesthesia, tap around inside his enclosure, and throw off the shoes. Or the glue would hold them in place forever.

“Nah, he'll wear 'em off eventually. Most people probably won't even notice he has them on.” Paul thought for a moment. “Send me measurements of his back feet—the really bad ones—and some tracings of his footprints, if the keepers can get them. I'll make a prefab set of shoes so the whole thing goes quickly. I think we should do this sooner rather than later, before his feet get really bad again.”

We were all excited when the time came to give Mo his new shoes. Once again, there was extensive secondary infection in his rear feet, though the front feet were not so bad. After the trimming and antibiotic perfusion, Paul pulled the shoes out of his bag. I'd visualized thick pads of some sort. Instead, they looked a lot like standard horseshoes, without the holes, and shaped a bit differently. Of course, the other difference was that Mo would wear three shoes on each back foot, one for each of his three toes.

Paul started prepping the shoes for the epoxy. He checked each one for size and shape. The shoe for the middle toes was a larger C shape than those for the smaller inner and outer toes. Since rhino toes spread out when the animal stands, the three shoes would support a fair amount of Mo's weight; his main foot pad would support the rest. The combined surface of the shoes would function as surrogate toenails.

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