Signs of a Problem...

In early October Kelly spotted some small blotches of blood on the floor under Joe’s favorite sleeping area, which was of great concern to us all, for obvious reasons. Joe’s not used to being touched, but we’re training him to open his mouth and show us body parts, which is a slow process, requiring a lot of love, trust and patience on all sides. Kelly was able to look at Joe’s mouth, nose and ears with a flashlight and we couldn’t tell what the source of the blood was, so we monitored him closely and advised our vet team.  Joe was eating and acting normally and showed no signs of distress.  Indeed, if anything, everyone agreed Joe was acting happier than any of us had ever known him to be, rumbling and purring more often and enjoying his food and time in the habitat during our lovely summer and fall weather.

 After a week of finding dried up blood spots most mornings, but never fresh signs or smears of blood anywhere else in the cage during the day, we suspected possible nose bleeds, or gum disease, etc, but we needed to rule out more serious symptoms possibly relating to Joe’s IMHA (immune mediated hemolytic anemia) disease – or worse. Immobilizations on gorillas are extremely tricky and potentially fatal.  I’ve known too many gorillas – even young and apparently healthy ones – who did not come out of the anesthesia and died, so no one does immobilizations on a whim or without sound medical reasons. Needless to say, we were all confident in our amazing medical team, but also had a healthy respect and fear for what we were about to embark upon.

The First Immobilization

On Friday October 29th, we assembled a team of doctors and specialists to have a quick look at Joe, once immobilized. We decided we’d do this quickly, only keeping Joe “under” (ie: anesthetized/immobilized) about half an hour, while we drew blood for testing and did a quick assessment of his eyes, ears, nose and mouth. Our vet, Dr. Francis Cipullo (right with Dr. Rita McManamon-left and Dr. Lynn Lewis-center), was thorough and in charge, giving each person present specific duties to perform to make the procedure professional and quick.  Fortunately, all blood work and tests came back great, so this was a huge relief.

Three people from the Birmingham Zoo, who “own” Joe (and thus make all final decisions regarding his care, although they trust GH and know Joe couldn’t be loved or cared for more), came to observe, what was our first immobilization at Gorilla Haven.  We put them to work, clipping Joe’s nails, which had grown long and which are so thick and hard, it took garden clipping sheers and a dremmel sanding machine to file them down!  So while the doctors were looking at Joe’s head, the Birmingham ladies were clipping his finger and toenails, as the other vet techs were drawing blood and monitoring his vital signs.

Each villa is designed for medical procedures to be able to be done in them, with the floors/surfaces easily sanitized, and room to maneuver. We have a fully set up hospital at GH as well, but decided for this procedure, we could do what we needed to do in the villa, thus lessening the amount of time Joe had to be immobilized.  Our consulting vet, Dr. Rita McManamon (5th from left in right photo), helped Francis and his team, which included Dr. Sam Rivera (2nd from left in right photo), a vet who did an endoscopic exam of Joe’s mouth, nose and throat to rule out problems there, as well as Dr. Stuart Loos (4th from left in right photo), a human dentist, who quickly identified the problem:  an abscessed canine tooth.  Since gorilla teeth, especially their canines, or “eye” teeth, are so long, when Joe would open his mouth for Kelly, we would only see part of the tooth, which looked fine.  But once we were able to lift away the lips and expose the upper gums, it was clear the tooth and Joe’s gums and other teeth, were in serious trouble, including an infection, which – if left untreated – could have been fatal. Steuart was assigned the task of taking detailed photographs and video of the operation while Jane observed from above (photos right).

Joe’s had more immobilizations than many captive gorillas, due to his health problems in the past. Usually, the drug “Telazol” is used to anesthetize gorillas, and the recovery afterwards isn’t too slow or hard on the animal.  However, Joe has had serious problems with this drug, and has to use “Ketamine” which requires a larger dose, and thus more darts to be shot into Joe to get him ‘down.’  Ketamine also is harder to recover from, taking a longer time and so we wanted to limit its use to the minimum safe and effective dose, for obvious reasons.

After giving Joe a dose of Midazolam, a valium-like relaxer, Pete prepared the dart gun (photo above left) and took on the unhappy task of darting Joe, who was in his smaller squeeze cage, a little dopey, but still aware of what was happening.  Only Pete, Kelly and Doctors Rita and Francis were in the villa while Joe was darted, to keep him as calm as possible, since our full medical team included 15 people!  The rest of us waited at the vet hospital or Gatehouse nearby, until we were radio’d that Joe was ‘down.’

Finding the Problem

We quickly found the abscessed tooth, which was loose, indicating it had broken off in the root somewhere. We thought perhaps we might be able to break the tooth off and remove it, so we topped off Joe with more ketamine, but when he reacted slightly (his heart rate went up on the monitors), we knew he wasn’t under enough to withstand the pain, so we stopped the procedure and decided to finish up for that day, and return, better prepared the next time.  We had a de-briefing and discussed what things went well, what things we’d do differently next time (not much, since it went so well) and prepared for the next procedure. Photo right shows the team waiting in the service corridor for Joe to wake up.

Coming out of anesthesia

It was my first experience watching a gorilla come out of anesthesia like Ketamine, and it was so painful to watch, as my poor Joe was crawling around the well-bedded cage on his tummy, trying to stand, but falling and stumbling like a drunken fool.  Photo left shows Dr. Rita McManoman (left) and Dr. Francis Cipullo watching Joe as he starts to come out of anesthesia. That evening, Pete tried to give him some juice, but each time Pete held the bottle up, Joe flinched, like perhaps he thought Pete was going to dart him again.  Pete felt awful and I wasn’t feeling much better.  Thankfully, the next day, Joe was snapping his fingers and clapping his hands, asking for his breakfast and readily accepting juice and treats from Pete, so all had been forgiven.

The Second Immobilization

The next procedure was scheduled for Saturday November 13th and once again, we decided to do it in Silverback Villa, since it worked so well the last time and it was easier on Joe.  This time, however, instead of working on Joe from the floor, we improvised an “operating table” which consisted of a heavy-duty piece of marine plywood on top of bales of hay, which we’d later use to bed down the recovery area. This worked so well, we may just make it routine, instead of getting a fancier portable table for use in the villas.

We brought up the surgical lights from our operating theater along with a gas anesthesiology machine and a pulse oximeter (photo left) which allowed us to constantly monitor Joe's condition while he was under the isofluorane (or 'gas.').

We had another group of amazing people gathered to help us and once again Dr. Francis was a great team leader and organizer so everything went smoothly and competently.  Dentist Dr. Stuart Loos was back again, joining Dr. Francis and Dr. Rita, but the primary responsibility for the dental surgery lay in the hands of Dr. Laura Braswell (photo left), a renowned human dentist and specialist in periodontal diseases, who’s worked with Dr. Rita on several gorillas at Zoo Atlanta and Yerkes. Dr. Loos brought Dr. Nelson Woo and a surgical assistant and Dr. Francis had several vet techs and volunteers helping him, including a senior high school student from nearby Gilmer County High School (photo right) , which must have been a great experience for her!

We knew the tooth had to come out and Dr. Laura went straight to work, after quickly reviewing all Joe’s teeth and assessing the severe gum disease he was suffering from.  The huge canine came out relatively quickly, but as suspected, the tooth had broken off inside the long root canal, and getting the smaller piece from the root took a while longer. This time, we knew Joe would be out longer and we needed him to be ‘under’ deeper, so we used a gas anesthesiology machine that provided a mixture of oxygen and a small amount of isofluorane gas to keep him anesthetized after Pete darted him with ketamine. Then Dr. Laura was able to inject pain killers straight into Joe’s gums (photo right), so afterwards he wouldn’t be in a lot of pain, especially if he refused to take pain medicine from us (like he refused to do!) after the procedure was over.

Once the tooth was out (photo left shows the tooth, circled, that was removed), Dr. Laura was relieved to see the infection had not spread to the nearby sinus cavity, which would have meant complications and more trouble for Joe, so we all heaved a sigh of relief as Dr. Laura went about stitching up the huge gaping hole where Joe’s big tooth once was. Dr. Nelson and Dr. Stuart helped her clean the rest of his teeth, which were in pretty bad shape, due to genetics, not diet, according to Dr. Laura and research done by her and Dr. Rita on other gorillas.  Apparently Zoo Atlanta’s Willie B. and his family have a very similar genetic trait towards the same kind of gum disease and tooth decay, so while it’s over my head, apparently papers are being written about this phenomenon, which might help other zoo gorillas in the future.

Since this procedure included surgery, we worried about the loss of blood (which was amazingly little, much to my surprise), and had Joe monitored constantly, as well as having IV fluids to help keep him hydrated, since the first time he refused to drink anything afterwards. The tooth that was pulled clearly shows the break (photo left). We have IV stands, but had decided not to use them, to keep the floor area clear around Joe, so instead one of the vet techs held the IV bag, until we improvised a clip to hold it over the brachiating bars.  We used less ketamine this time and Joe’s recovery was easier and faster, which was a relief for me, as well as everyone else, I'm sure.

What made us (and Joe, fortunately) gasp!

Everyone had finished their tasks and we were all clearing out of the cage as Dr. Rita (Photo left) was explaining to Pete how tricky removing the trach-tube with the gas anesthesia can be on gorillas.  We had just disconnected the monitors, as the cage was bedded down with a lot of hay, so if Joe stumbled, he wouldn’t hurt himself, etc.  Joe was on his side as the tube came out and Dr. Rita explained how the head had to be at the proper angle, or else the thick skin of a gorillas neck could fold over and collapse the wind pipe, causing a gorilla to stop breathing … and die.  Pete told me later, “Not one second after Rita told me this, I watched Joe take a deep breath, then stop … no more breaths!” 

Then, instantly realizing what was happening, Dr. Rita stuck her hand down Joe’s mouth/throat and pulled out his tongue, causing him to gasp and sputter … and breathe! – thereby saving his life!  Some might argue it’s foolish to stick one’s hand down a waking gorilla’s mouth, but Dr. Rita has done these kinds of heroics before.  She went into the cage at Zoo Atlanta to give CPR to Caesar, a silverback who died suddenly, but who they weren’t 100% sure he was gone when she entered his cage to pound on his chest and hope to revive him, never showing any concern for the possible consequences if he actually responded. You have to love and admire someone who puts an animal's welfare ahead of her own and just goes on auto-pilot to help a dying or distressed animal, so we’re genuinely thrilled and honored to have Dr. Rita on our team!

Finally ... Recovery

While Joe’s recovery wasn’t nearly as heart-wrenching to watch that day, he was a bit more grumpy and very suspicious of both Pete and Kelly for about 2 weeks afterwards, refusing his medicines and old standby favorite treats, fearing they’ll be laced with the vile tasting antibiotic “flagyl” (metronidazole) that he had to take to ward off infections.  I went to the grocery store and spent over $100 on puddings, sodas, hummus, fruits, applesauces, coffee, juices, etc, trying to find things we could disguise the flavor in, and we finally ended up getting a $300+ bottle of specially prepared flagyl, which doesn’t have such a hideous taste to it. 

Kelly was cracking me up, since she taste-tests all Joe’s food, including the medicated ones. She radio’d me asking if I had some mouth wash and sounded a bit panicked. I said I had some and she rushed down to the cabin, explaining how she’d been trying all the combinations of flagyl she’d been trying to get Joe to take, and how she felt like vomiting and couldn’t get rid of the disgusting taste in her mouth, making her especially sensitive to Joe’s plight.  Finally, Kelly and Pete got Joe to take all his medications, including ibuprofen for pain, and even the Designer Flagyl, although not without trials and tribulations.

I went to see Joe about a week ago, with some treat tubes including green beans and cornflakes.  I’ve never been one of Joe’s favorite people, but he knows I bring him good treats, so when I offered him the tube, he came to take them from me, but lunged at the mesh, trying to scare me (I didn’t flinch, expecting him to be grumpy).  When I offered him the second treat tube, he took it in his mouth and bit down hard, like he wished it were my fingers, perhaps, but then settled down to munch on the green beans. 

When I mentioned I had some more green beans, Kelly said it was ok to give them to Joe, who hadn’t had them for a while, since our greengrocer’s supply had been expensive or not up to our standards.  Joe saw me coming in with more green beans and the grumpiness was gone suddenly, as he patiently extended his big hand into the food basket and gobbled down the green beans like a starving gorilla, instead of the well fed boy he really is.  What a character!  A new edict has since been passed down by me, that if/when green beans aren’t available by the normal avenues, I am to be alerted, so I can drive the 120 miles to the nearest good grocery store and get Joe a supply.  Nothing is too good for my Joe – nothing!  Indeed, when Randy S. our new maintenance guy, asked for my permission to come in to introduce his young son and wife to Joe, I said “yes” on the condition he bring Joe green beans!  Joe loved the green beans and the visit, as he’s getting back to his old self, thankfully, enjoying more visits from friends and family coming over the holidays.

We have a lot to be thankful for this year, as always, and we are especially grateful to our amazing team of professionals and volunteers!
And a very special thanks to all who participated in the successful immobilizations: