The Rhino with Glue-On Shoes (28 page)

Moved by Denise's story, we invited Michaela back to the zoo to meet Amali in person. Normally full of energy, with bouncing blond curls and an insatiable curiosity, Michaela grew uncharacteristically shy and perhaps a little fearful as she gazed up at her four-legged inspiration. But fear soon turned to adoration when Amali bent her long neck over Michaela's head to reach for a piece of carrot in the keeper's hand. The little girl giggled at the giraffe's long scratchy tongue and her tendency to drool all over her visitors.

Denise had to visit five different orthopedic offices before she found one that carried John's purple butterfly print, but the effort was well worth it. When Michaela learned her next brace would look like Amali's, she actually became enthusiastic about her next fitting.

To our amazement, Amali's front legs straightened out over the next several months. The giraffe weaned herself off the bottle and then began to grow quickly. By the age of eleven months, she no longer needed the brace.

Then came a devastating shock: we arrived at work one late summer morning to find our young giraffe dead. She had fractured her neck against a barn wall and died instantly. We could only assume that her clumsy gait and bad hip had contributed to the accident. Something might have startled her and caused her to trip. We reminded ourselves that Amali faced an uncertain quality of life as an adult giraffe—that her hip and knee could have caused significant long-term problems. Even so, we were not prepared to say good-bye so suddenly, so unexpectedly.

The entire zoo community mourned the loss of our brave little giraffe. Each of us took solace in what we had learned from Amali. Her keepers had experienced first-hand the rewards of training and conditioning a young giraffe; their work had made a tremendous difference in our ability to care for Amali. I learned that if you are persistent enough, you can find the help you need, even in unlikely places: people will pitch in and help. And we all learned from Michaela. Her relationship with Amali showed us how much animals can help children adjust to difficult situations.

Our zoo's struggle to treat a young animal with a crippling condition had an impact far beyond its gates. Amali touched the entire community. We now have a formal relationship with a local children's orthopedic hospital, and the giraffe barn is always one of their favorite stops.

Even two years after Amali's death, Michaela remembers the sensation of Amali's sticky tongue on her fingers and how it felt to be the only child in her kindergarten class who had a giraffe for a friend. She will soon undergo a surgery to lengthen and straighten her arm. Though Denise knows the procedure won't be easy, she also knows her daughter will take it all in stride, including the months of physical therapy ahead. Now a spirited, confident six-year-old, Michaela recently announced that she might want to be a zoo veterinarian when she grows up.

Alfredito the Hippo

by Susan Mikota, DVM

M
ichael and I looked excitedly at each other as the flight attendant announced the final approach to San Salvador. I stared at the photograph of Alfredito clutched in my hand, focusing on the image of the broken tooth we had come to repair.

“Are you ready?” I asked Michael.

“Sure,” he said confidently.

I wished I didn't feel so nervous. It seemed like only yesterday that I had received a letter from my friend and colleague, Dr. Carlos Suazo, who had participated in our veterinary study program at the Audubon Zoo in New Orleans.

From the picture Dr. Suazo sent, it was clear Alfredito had broken his lower right tusk near the gum line, exposing the nerve and blood vessels at the center of the tooth. In other words, he had an open root canal. The open cavity had begun to fill with food material, and Dr. Suazo feared the tooth would become infected. Alfredito's behavior had changed. He seemed dull and quiet, both possible signs of pain.

I discussed the case with Michael McCullar, our zoo's dental technician. We decided that Alfredito needed a root canal procedure and began making plans. The project would present quite a challenge. Despite many calls to colleagues, I could not find anyone who had done a root canal on a hippo; they all agreed it would be a risky procedure. Michael would need to make special instruments. We knew we'd need to take a variety of equipment, including our dart gun. We also knew we might encounter tanks and even gunfire in the streets of San Salvador: in 1991, the country was in the midst of political turmoil. We agreed that while we couldn't do much to prepare for the unknown, we could do our best to plan everything else, right down to the last dental pick.

Although I had been to Central America several times to teach in zoo veterinary workshops, this was the first time I'd be carrying darting equipment on such a trip. I wanted to make sure we followed every procedure properly so that things would proceed without a hitch. I consulted the El Salvador embassy to see if I would need any special permits for the dart gun. I asked the airline staff the same questions, explaining that at first glance the gun resembles an ordinary rifle. We would also be carrying potent narcotics to use for sedation. I found out we'd need special permits and packing to transport the carbon dioxide cartridges that are used to power the dart gun. We requested and received these permits, as well as a letter from the embassy approving a donation of medications.

Having never been to El Salvador, Michael and I were uncertain what supplies would be available. We decided to bring everything we needed: syringes, needles, fluids, IV sets, antibiotics, and, of course, emergency drugs . . . just in case. Our supplies filled two big trunks. Our dart gun was in its own special case.

___

As we retrieved our baggage at the San Salvador airport, I looked anxiously around for Dr. Suazo. He was nowhere to be seen. We stalled for as long as possible and then proceeded through customs. I had hoped Dr. Suazo would be there to escort us through the process so that he could explain the equipment we were bringing into the country. As I placed the dart gun case on the table, the customs inspector asked,
“¿Que es esto?”
(What is this?)

I froze for a second as my brain struggled to convert from English to Spanish.
“Es un rifle,”
I responded. His eyes got big as he opened the case and picked up the dart rifle.
“Este rifle es para animales,”
I said quickly.
“Para anesthesia.”
He glared at me as he turned the rifle over and then began to take it apart. I was getting more nervous. I glanced at Michael. He looked worried.
“Por favor, señor—este es importante—estés es para ayudar Alfredito, el hipo.”
(“Please, sir—this is important—it is to help Alfredito, the hippo.” )

The customs official stopped and looked up, smiling broadly.
“Ah, Alfredito—muy bueno—me gusto mucho—por favor pasar. ¡Buena suerte!”
(“Ah, Alfredito—very good—I like him very much—please go on. Good luck!”)

With great relief, we walked into the terminal. As we passed through the door, zoo officials, TV cameras, and a horde of children greeted us. Guillermo Saade, an eight-year-old boy, presented me with a dozen yellow roses from the children of San Salvador. Another child handed me a newspaper. On the front page was a story about the two Americans who were coming to save Alfredito. The story on the opposite side of the page was an article about the president of El Salvador. His name was also Alfredito. Speechless, I nodded my thanks. All I could think was “What if I lose this hippo?”

It was not an unreasonable fear. Hippos are notoriously difficult to anesthetize safely, even under ideal conditions. For one thing, it is important that a hippo land on its sternum when it falls from the effects of the drug. If it ends up on an incline with its head lower than the rest of its body, there is a possibility of excessive pressure on the diaphragm, which can result in suffocation. A hippo's large size makes it difficult—if not impossible—to reposition it under anesthesia. And hippos lack accessible veins, which can be a real problem in an emergency when IV drugs can be lifesaving.

As our driver navigated the streets of San Salvador, the reality of the situation hit me. Here we were, in a foreign country, full of political strife, getting ready to immobilize their only hippo, an animal that was obviously beloved by all. Though I tried not to notice, there were indeed huge green army-style tanks at almost every corner. We passed many damaged buildings riddled with bullet holes. We frequently heard gunfire. Our hosts were apparently used to this sound: they didn't jump as I did every time it occurred.

The next day I came to understand why Alfredito was such a star. Children and adults crowded around his exhibit to watch while his keeper placed whole heads of lettuce and cabbage in Alfredito's huge, open mouth. This species can be quite temperamental and dangerous. I'd never seen a keeper go into an exhibit with a hippo. But Alfredito and his keeper both seemed quite relaxed. So Michael and I went into the exhibit with them.

While the keeper scratched the hippo's chin, we were able to get a close look at the broken tooth. We stood right next to our patient and watched him eat a few more heads of cabbage. Although Alfredito was eager for the treats, it was clear he was in pain. The keeper was careful to place the offerings on the good side of his mouth. Watching them, I too became enraptured by Alfredito. He was adorable—and quite the showman. He seemed to enjoy the attention. It was clear why he had so many admirers. Now I was one of them, and tomorrow his life would be in my hands.

We met with Dr. Suazo and the zoo staff that afternoon to plan the procedure for the next morning. Alfredito would need to be fasted, a routine step for any large herbivore, as they sometimes regurgitate while under the effects of anesthesia. The sloped entrance to the pool was also particularly dangerous. If the hippo succumbed to the effects of the anesthetic while attempting to get back into his pool, he would go down with his head below the rest of his body. In such a position, the sheer weight of his abdominal organs pushing up against his diaphragm could cause his lungs to collapse. We would need to drain his pool and build a fence around it. We would also start early to avoid the hot sun, which could cause Alfredito to overheat. Dr. Suazo translated as we discussed the procedure and our requirements.

The procedure began at seven the next morning. I carefully loaded the narcotic anesthetic, known by its trade name M99, into the dart, then loaded the dart into the rifle. I walked slowly up to Alfredito and fired. The dart hit the back of his right thigh, but the needle bounced. It was impossible to know if he had received the full dose. Hippo skin is very thick and difficult to puncture. If the dart does not hit exactly perpendicular, it will do what this one did: bounce. We watched Alfredito, waiting to see signs of the anesthetic taking effect, but nothing seemed to be happening. Alfredito lumbered slowly around his exhibit and, after an hour, it was clear that although he was sedated, he wasn't ready to go to sleep.

I loaded another dart with great care. M99 is a very good drug but quite dangerous to handle: as little as one-tenth of a milliliter can be fatal to humans. I fired the dart, and this time it stuck. But Alfredito continued to amble around, and after twenty minutes, we decided the M99 had not injected. The needle I'd used had a large diameter opening, or bore. It must have been blocked by a small skin plug, just enough to prevent the drug from injecting. By this time, it was beginning to get hot; I instructed the zoo staff to prepare a tent to place over Alfredito to protect him from the hot sun. With the tent in place, the third time turned out to be the charm. Alfredito finally succumbed to the effects of my next dart.

Luckily, the hippo went down in a good position on his sternum and near the back of his exhibit, away from the gathering crowd. Michael jumped into action and began cleaning and preparing the tooth while I monitored Alfredito's respiration and heartbeat. About fifteen minutes into the procedure, the hippo's breathing began to slow. Then it abruptly stopped. I held my breath and for a brief second I felt my own heart stop.
Oh no,
I thought,
I cannot let this animal die.

With the narcotic reversal agent in hand—the only option I could think of at that point—I searched unsuccessfully for a vein. Almost simultaneously, Dr. Suazo handed me a syringe of doxapram, a respiratory stimulant, and said, “In his tongue.”
Good idea,
I thought. I quickly injected the doxapram and leapt over the sleeping Alfredito to search for a vein on the other side of his body. Luckily, I found one and was able to inject the reversal agent into Alfredito's vein while the adrenaline rushed through my own. The silence of the crowd of zoo staff and visitors hugging Alfredito's exhibit added to the tension. Suddenly a cheer arose: Alfredito had taken a long, deep breath.

While all of this was going on, Michael had continued to work on the tooth and miraculously had managed to finish the procedure before the full effects of the anesthesia were reversed. We gave Alfredito his antibiotic injection and then Guillermo, the child who'd handed me the flowers, was allowed a special close-up visit. With cameras flashing all around us, I assured him that his favorite animal was going to be all right.

But our worries were not over. Difficult anesthetic procedures can predispose to a serious condition called capture myopathy, a painful muscle problem that can be fatal. It is caused by the pressure on the downside muscles produced by the hippo's weight while it sleeps under anesthesia combined with changes in blood flow and blood pressure produced by the drug.

For the next twenty-four hours, we observed Alfredito for any adverse signs.

To our huge relief, everything seemed okay. The next day there was a picture of Michael and me on the front page of the newspaper, accompanied by a very long story of what had transpired. The reporter had written about Alfredito in detail, with dramatic descriptions of the action, so that the story read more like a novel than a news report. We were quite impressed.

When we returned to the zoo to check on our patient, the hippo seemed to be back to his old self. Children crowded around his exhibit, watching joyfully as Alfredito chomped down on whole heads of lettuce and cabbage—pain-free.

Three months later, we were invited back to the zoo to reexamine Alfredito. Our patient was doing fine, so they put us to work. Over the course of three days, we anesthetized and treated a grizzly bear, a lion, and four leopards. Michael performed seventeen root canals!