Chimpanzee Sanctuary Northwest

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surgery

Jamie’s Morning in the Clinic

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Last fall, Jamie underwent an exam to follow up on concerns about her reduced activity levels and her growing belly. Both are more common with age, but we thought an exam was warranted to rule out other causes. And indeed, ultrasound examination did reveal a possible cause: the presence of uterine fibroids, which have the potential to cause significant pain and discomfort. After much research and consultation, Dr. Erin decided to take a twofold approach to managing Jamie’s condition: First, Jamie would receive a subcutaneous hormonal implant that would help shrink the fibroids. And second, those fibroids that could be removed would be extracted using a procedure (and specialized piece of equipment) known as MyoSure.

After receiving an anesthetic injection, Jamie is wheeled to the clinic.

Kate Uselman, CRNA, places an endotracheal tube while 4th-year vet student, Larrea Cottingham, observes—Dr. Erin is always happy to help train vet students who are interested in careers in sanctuary medicine! Dr. Dan prepares Jamie for gas anesthesia.

Dr. Chavez performs the MyoSure procedure while Huong Johnson assists with ultrasonography.

The MyoSure procedure utilizes a hysteroscope and a special cutting and extracting wand to visualize and remove the fibroids. The team watches the procedure on the monitor.

Jamie receives the hormonal implant. With chimps, implants are often placed between the shoulder blades so that they don’t try to remove them.

CSNW Vet Assistant, Krissy, monitors Jamie’s vitals as she recovers back in Front Room 1. We loosely ties scarves to the chimps’ wrists and ankles so that they can’t try to climb or walk away before they are coordinated enough to avoid injury. The scarves also help us safely manipulate their body positioning to maintain an open airway. Providing veterinary care to potentially dangerous animals requires creativity!

We’re so grateful to Dr. Dan Low, Kate Uselman, Dr. Chavez, Huong Johnston, Ashley Mellotte, and Larrea Cottingham for volunteering their time and services to help Jamie (and Dan and Kate for also braving a monster snow storm on the pass!). Thanks, as well, to the folks at Hologic for supplying some of the MyoSure equipment. And thanks—as always!—to our own Dr. Erin for all her research, networking, recruiting, and leadership.

Jamie’s care team (Ashley not pictured) poses for a photo while monitoring Jamie’s recovery.

Jamie takes advantage of a Squishmallow-filled nest while recovering—her scarves still tied to her wrists and ankles.

With those pesky scarves untied, it’s time for a drink.

Dr. Erin serves Jamie some baked sweet potato for dinner.

As long as that snow doesn’t hit us down here in the foothills, I’m sure Jamie will be back on her patrols tomorrow—and hopefully, feeling a whole lot better.

 

 

 

 

Late Winter on the Hill and A Day in the Clinic

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The weather has been beautiful lately and the chimps have been taking full advantage of this false spring before the inevitable second winter strikes back. Enjoy a few scenes from The Bray and Young’s Hill from the past couple of days.

I also want to share with you that yesterday, Honey B took what we hope will be her last trip to the clinic for a while. Here’s more on that from Dr. Erin:

Yesterday, Honey B had her 3rd clinic trip to manage a bite wound on her left hand. She’s had 2 regional limb perfusions to concentrate antibiotics, including deep flushing of the infected wound. Despite twice daily laser treatments, x-rays, and antibiotics, the swelling and drainage have persisted. A team of medical professionals, including Dr. Jeffrey Friedrich, a board certified hand surgeon, and surgery residents Dr. Thais Calderon and Dr. Emma Dwyer, performed a deeper exploratory surgery, which, unfortunately, resulted in the amputation of the affected finger to prevent arthritis and chronic pain. As sad as we are that we couldn’t defeat the bone infection in Honey B’s finger, we are looking forward to her being more comfortable and regaining better use of her hand. We’re grateful for the expertise of Dan Low MD (chimp anesthesiologist extraordinaire) who introduced us to Dr. Friedrich, CRNA Kate Uselman (anesthesia), Dr. Rachelle Chavez, DC, OB/GYN, and sonographer Huong Johnston who performed ultrasound and a complete pelvic exam. Honey B recovered well and was awake and hungry by dinnertime. Even though she was ready to join a brief fray yesterday afternoon, she will need to be isolated for a few days to monitor her healing. A huge thank you goes out to the entire medical team for their care and expertise!

And a huge thank you to Dr. Erin, too!

One team performs the ultrasound while another begins a regional limb perfusion:

The anesthesia team monitors Honey B’s vitals:

The surgical team at work, while CSNW Vet Assistant, Krissy, and visiting veterinary student extern, Eden, observe and help coordinate:

Honey B in recovery:

And Honey B the next day, ready to explore and rejoin her friends (but not until the doc gives the OK):

Honey B Update and a February Day on the Bray Video

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Watch the video above to see Cy’s group enjoy another mild February day—a welcome change from January’s relentless cold and snow. Just don’t tell Gordo that I shared that clip of him.

And a quick update on Honey B:

As you may know, Honey B sustained a laceration to her lower right eyelid a couple of weeks ago and Dr. Erin leapt into action to perform an emergency repair that same day. After monitoring the healing process, Dr. Erin thought that it would be in Honey B’s long term best interest to have a surgeon perform a revision to the eyelid to ensure that both the lid and tear duct would continue to function correctly. As she always does, Dr. Erin assembled a great team to not only perform the surgery but also to conduct as much diagnostic evaluation and preventative treatment as possible while Honey B was under anesthesia to reduce the need for further procedures down the road.

We were grateful to have Leah Bezzo, CRNA return to the sanctuary to perform anesthesia along with her colleague Christine Zielke, CRNA. Tyler Sugerman, DVM, another veteran CSNW volunteer, performed an abdominal ultrasound using our new machine. On the other side of the table, Jerry Woodfield, DVM DACVIM (Cardiology), performed an echocardiogram. And after the initial tests were conducted, Karen Brantman-Crosetto, DVM DACVO performed the surgery.

Here’s the good news: Honey B is overall quite healthy and Dr. Brantman-Crosetto did a wonderful job on the eyelid. Honey B will, unfortunately, need some additional time apart from her group while the revision heals but we are optimistic that she’ll be back with her friends soon. And in the meantime she will sit with her chimp friends at the window, spend tons of quality time with her human ones, and receive extra enrichment from Chad, Ellen, and the rest of the team.

As she often does, Dr. Erin served as both orchestra conductor and player, sneaking in joint and dental exams, x-rays, and other tests as her assembled team proceeded through their evaluations. Did you know that the CSNW caregivers also take turns serving as Procedure Manager? This role, filled on this occasion by Kelsi, ensures that the medical team follows a schedule developed in advance by Dr. Erin, keeps notes and records throughout the procedure, makes sure each task is completed, and finds that thing that no one else in the clinic can seem to find when they need it.

Many thanks again to this incredible group of volunteer medical professionals! And keep your fingers crossed that Honey B leaves Dr. Brantman-Crosetto’s beautiful handiwork alone.

Jamie’s surgery

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Yesterday, Jamie underwent surgery to repair an anal fistula. As I write this, she is bright, alert, and recovering well.

This is a problem we’ve been aware of and have been treating for some time. If you’re not familiar with fistulas, they are small tunnels that connect an infected gland within the anus to an opening on the skin outside the anus. They can be painful and may result in recurring infections and chronic discharge from the opening.

When Jamie’s fistula first appeared, Dr. Erin consulted with other veterinarians and several colorectal surgeons on a course of action. While we were prepared to perform the surgery at that time, and even got as far as purchasing plane tickets for a surgeon from Missouri that had worked on a chimpanzee before, in the end the consensus was that if Jamie was cooperative we could manage her symptoms without surgery. Most humans with the means to do so would probably choose fistula repair, but chimpanzees are somewhat different in that they don’t experience any stigma from fistula symptoms. If we could keep the infection at bay and provide pain relief, we could avoid the trauma of surgery and recovery as well as any potential complications. Jamie was incredibly cooperative – she would allow us (usually Diana, who was her positive reinforcement trainer) to irrigate the tracts with antiseptic solution using a plastic-tipped syringe.

While this had the desired effect at first, over time the infections became more frequent. After additional consultation with colleagues who were planning a similar surgery at an Australian zoo, Dr. Erin decided that it would be in Jamie’s best interest to have her fistulas repaired. Dr. Petty, a colorectal surgeon from Kittitas Valley Hospital in Ellensburg, volunteered to perform the procedure.

Jamie willingly accepts injections – everything from vaccines to anesthetics – so she was ready to go even before we were yesterday morning. She was wheeled into the clinic and masked prior to intubation.

The rest of the team prepared to give Jamie a complete exam while Dr. Petty performed the procedure.

Dr. Petty was pleased to find that most of the tracts were near the surface, which would mean a quicker surgery and faster healing. Fistulotomies, wherein the tracts are opened surgically to heal from the inside out, are often simple enough to be outpatient procedures for humans, but chimps don’t always follow the same level of post-operative care so we will be paying extra close attention to how she heals.

Sofia and Dr. Erin performed a head-to-toe exam while Anthony oversaw the procedure checklist and took photos and video.

Jamie was given an abdominal ultrasound using our Butterfly ultrasound machine. Though the chimps’ usual cardiologist couldn’t make it, she was also given an echocardiogram thanks to a donation of time and equipment from some very generous zoo colleagues.

After getting x-rays and other routine diagnostics, Jamie was wheeled back to the recovery room.

There she would be under close supervision until she was stable and alert.

Everything that we’ve learned from Jamie’s exam so far shows that she’s in good health and we’re hoping that she will not need to spend much time in isolation. For now, we’re trying to keep her enriched with peanut butter magazines and her favorite movies.

Her friends also visit and groom with her at the caging.

Jamie is not one to enjoy sitting around for long, so let’s all wish her a speedy recovery so she can get back to managing her group soon. Many thanks to Dr. Petty and the many other doctors and zoo and sanctuary professionals who helped plan for and carry out this procedure, which we hope will keep Jamie healthy and comfortable.

A Trip to the Clinic for Negra

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The group of seven got into a fight yesterday and poor Negra sustained a significant laceration on her back side that required stitches. The staff got her isolated and Dr. Erin began mobilizing for the procedure. We are grateful to have been joined by Jim Repsher, PA-C, from Kittitas Valley Hospital who, with his background in surgery and emergency medicine, was able to tend to her wound while Dr. Erin, Sofia, and other staff gave Negra a full workup.

Negra handled the procedure well and got an ultrasound of her heart, x-rays, blood work, and a dental exam while receiving her stitches.

Diana ensured that Negra’s IV remained in place while Negra was repositioned for various diagnostics.

Sofia examined Negra’s teeth and gums.

Identification tattoos on each of Negra’s thighs serve as a stark reminder of her decades spent in various laboratories.

Negra’s caregivers often have to hold her arms to ensure that the various cuffs and catheters stay in place. These moments bring us some comfort, even if Negra is unaware of our presence.

Getting sutures to remain in place, especially in fragile tissue, can be a challenge with chimpanzees, who are prone to pick at them and pull them out. For this reason, we often employ distraction techniques so that they will direct their attention elsewhere while they recover. In some cases, we place shallow “distraction sutures” in areas away from the injury. Here, Sofia paints Negra’s fingernails so that she will have something else to pick at while she recovers. It’s a tip we learned from colleagues at another sanctuary and it certainly can’t hurt to try.

Before long Negra was back in the recovery room in a pile of blankets and stuffed animals, with her team of caregivers monitoring her closely.

By morning she was alert and ready for some juice.

She made a nest next to the caging and gave kisses through the mesh before eventually falling back to sleep.

That is, until Annie started spitting water on her to get her attention and make sure she was OK! Once Negra sat up, Annie was satisfied and let Negra go back to bed.

We’re pretty confident that Negra will have an uneventful recovery – after all, she lives her whole life on restricted activity! But she will remain isolated, with her caregivers watching over her and her chimp family next door, until Dr. Erin is confident in her healing.

The life of a chimp vet is never dull. For the last month, the staff have been taking turns doing overnight duty, sleeping on a cot in the chimp house foyer to monitor the newly integrated group of nine and respond in the event of a serious conflict. Friday night was Dr. Erin’s night, and I’m sure she was looking forward to a day of rest following her shift. The chimps had other plans, though. As always, we are grateful to have Dr. Erin caring for these sixteen chimps and four cattle and we hope she can get some rest today.

If you’d like to contribute towards the veterinary care of Negra and her friends, we have had (thanks to the folks who purchased these so quickly!) a dental scaler and a polisher on our Amazon wish list that would be a huge help the next time one of the chimps finds themselves in the clinic.

Midnight bagels

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Whenever a chimp is in the clinic for a procedure, I can’t wait for it to be over so we can put them back into the recovery room.

Drs. Zamzow and Khachatryan perform surgery on Burrito

But as soon as we get them in the recovery room, I almost wish they were back in the clinic.

Diana repositions Burrito, still under anesthesia, for x-rays in the recovery enclosure

That’s because in the clinic, we have tons of information about their vitals and far more control over the administration of analgesics, antibiotics, and other drugs that are essential for well-being and even survival. Once they’re in recovery, we have to hope for a cooperative patient. And chimpanzees are not known to be very cooperative under even the best of circumstances…

If a chimpanzee has a major surgery or shows difficulty recovering from anesthesia, we will stay with them overnight – sometimes for nights on end. We’ll monitor their respiration, give medications, and in some cases just nudge them to get up in order to promote circulation and deeper breathing. Our recent sleepovers with Burrito were actually pretty quiet, though the other chimps occasionally had something to say about the cornucopia of food available only to Burrito.

During critical recovery periods, caregivers sleep just outside the recovery enclosure to provide 24-hour care.

Some of the behaviors we work on in positive reinforcement training come in handy in times like these. While a no-contact thermometer isn’t very scary to begin with, it helps that Burrito is used to holding his temple to the caging while we get a reading.

A no-contact thermometer is an effective way to record trends in body temperature
In addition to charts for medications and procedures, caregivers maintain a log of vital signs such as temperature and respiratory rate

Administering meds is the most difficult part by far. Anesthesia and medications can make a chimpanzee lose his appetite – even a professional eater like Burrito. And some medications taste and smell disgusting. So whenever a chimp is on medication after a procedure, you will find the counters filled with all sorts of goodies – pudding, applesauce, juice, yogurt, soda, smoothie, bread, bagels, baked goods, jam, honey, syrup, dried fruit…anything that will mask the pill or liquid. And in many cases it only works once, so next time it’s back to the drawing board. But they have to take their meds, so there’s no giving up.

Burrito enjoys a midnight snack (spiked with pain relievers).

We’re so grateful that Burrito’s world-famous appetite is beginning to return and his suspicion of being surreptitiously medicated is starting to wane. In the not-too-distant future, he will be back to his old routine. And while I’m sure he’ll be thrilled to go back, I know he’ll miss those midnight bagels…

Jody on the mend

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Jody is recovering right now on a big, comfortable pile of blankets after undergoing a procedure to repair an injury to her eye.

Yesterday, during lunch, the chimps got into a fight. There’s nothing unusual about that, as you probably know by now. And it’s not unusual for a chimp to get bitten or scratched during these kinds of fights either but they don’t often require much in the way of treatment. However, during this fight Jody’s eyelid became partially detached and a quick surgical repair was required.

The staff and Dr. Zamzow quickly isolated Jody in Front Room 1, our medical treatment enclosure, and prepared Jody for anesthetization. When Jody was safely under, Dr. Zamzow reattached the eyelid with a few subcuticular sutures and we did a quick health exam before letting Jody recover.

Jody getting prepped in the enclosure for an IV catheter after receiving the anesthetic:

Whenever we do these procedures, we get the other chimps out into the Greenhouse and Young’s Hill to allow the patient some peace and quiet inside during induction and recovery. By evening, Jody was starting to come around while the other chimps were eager to check in on their friend.

Jody recovering after the procedure:

Missy, Jamie, Burrito, and Foxie checking on Jody through the windows to the playroom:

When Dr. Zamzow finished suturing, Jody’s eye looked so good that I had to try to remember which eye had been injured! But the challenge in treating chimps is getting them to ignore their wounds and leave sutures in place. For the next couple of days, Jody will remain separate from the other chimps, though she can have contact with them through the caging. Foxie and Annie in particular have expressed concern for Jody and check in on her regularly.

We’ll be keeping a close watch on Jody’s eye as it heals and hoping that no follow up procedures are necessary. For now, she’s happy being catered to and seems to be really enjoying some quiet time on one of the largest nests she’s ever built.

The Princess and the Pea: