Vet's Corner

Regular medical updates on the work at the WRC

Loris stuck to trap for days

March 2006 A call was received from the Royal Project in Hua-hin about an injured slow Loris that had been brought in.  The loris had been stuck to a trap and was severely injured, it was in urgent need of treatment.  Her right forearm had been badly injured and with the bones and tissue of the wrist joint exposed and the hand non-functional.  We decided to amputate the lower injured half of the limb and treated the animal with subcutaneous fluids and antibiotics.  The wound is now healing well and the Loris doing fine but she will not be able to be released back to the wild in her injured state.  Hopefully she will be able to manage in one of our loris enclosures at some point in the future. Story with pictures

Jup Jang’s Sad Story

Unfortunately not all medical cases presenting to the wildlife rescue center have happy endings.  Jup Jang was brought into the veterinary clinic at the center in September having been found lying partly hidden from view on a street in Bangkok.  The people who found her thought her to be an injured dog initially until closer inspection revealed her to be a badly burnt and very weak gibbon.

Jup Jang had her injuries initially treated in Bangkok prior to being transferred to Petchaburi and the WFT Rescue Center.  On arrival, she appeared very quiet and was easily restrained for light sedation and closer examination.  She only required half the dose of sedative normally administered to a gibbon, given her weak and obtunded state.  Once sedated, Jup Jang was started on intravenous crystalloid fluids to assist her rehydration and administered antibiotics (Cephalexin and Gentamicin), multivitamins, a one off shot of low-dose steroids and an analgesic (Tramadol).  Her wounds were treated and dressed after assessing the damage further.  

Jup Jang’s injuries were quite extensive.  On initial presentation, they appeared serious but over two days of treatment, it was obvious that the extent of damage was greater than originally assumed.  Gibbons have black hands, their digits and palms being leathery which assists their day to day activity swinging in the tree tops.  Jup Jang had received extensive burn injuries to her hands, feet and rear end, and initially it was difficult to tell how extensive the burns were given the nature of the tissue on these areas of the body.  It was obvious however, that a greater section of her rear was blacker than normal and the skin of her distal limbs thickened and oedematous.  There were areas of burn eschar on her thighs and forearms and evidence of burn wounds around her face.

The people who found Jup Jang assumed she had been tortured or traumatized and left to die.  But the distribution of the burn wounds and the well demarcated edges of her wounds suggested injury by electrical burns.  It is possible that Jup Jang had escaped from a house or yard in Bangkok and attempted to cross electricity wires which pollute the skyline in Bangkok. 

Without advanced equipment such as blood pressure monitors, it was difficult to properly monitor the changes occurring in her body so that we could try to support every organ affected.  But it was almost certain that she was losing protein through her burn wounds and was in a hypercatabolic state, burning calories rapidly.  There was also the concern that if her blood pressure was poor, her kidney function may also be suffering.  

Jup Jang was able to be handfed and was maintained on intravenous fluids, analgesics and antibiotics for 48 hours with repeated dressing changes, assessment of wounds and slow debridement of tissue.  Blood was drawn for assessment and revealed low blood total protein and albumin levels – a result expected given the leakage of fluid that occurs from burn wounds; a lowered haematocrit, low platelet count, and mild elevation of kidney enzymes.

Blood and plasma transfusions are not available for gibbons.  Blood typing is probably unheard of for this species, hence, it was unlikely we would have been able to quickly support her in the face of progressive anaemia and hypoproteinaemia.  We also determined by the 3^rd day that her injuries were more extensive than initially hoped and further debridement showed the tissue beneath even apparently healthy looking skin, to be oedematous and lifeless.  Blood vessels in all distal limbs were thrombosed, the muscle of her lower limbs cooked meat and the fatty tissue firm, rubbery and oedematous.  Her right elbow was cooked to the bone and would need to be amputated.   

Our final assessment, unfortunately, was that for Jup Jang to live, she would require amputation of all limbs below the knee and elbow joints, while the right arm would need to be amputated above the elbow.  The decision to euthanatize Jup Jang was made, a difficult conclusion to arrive at, but definitely a humane one.  What kind of life would it be for a gibbon of her age to suddenly have to adapt to life without any arms or legs, no hands or feet to feed herself, and absolutely no hope of ever being able to behave as a gibbon should?  There was every chance that she could still die from complications associated with the burn injuries, and the blood tests suggested that DIC (disseminated intravascular coagulopathy) was a huge possibility within the next 24-48hrs.  Would it be fair to put her through surgery if she were to die from other complications post-operatively?  

A post-mortem examination was performed, and although her abdominal organs all appeared healthy, her lungs showed convincing evidence of electrical burn injuries.  Where her lungs were situated in contact with the ribcage, there were black lines neatly crossing the lung tissue, appearing almost as though grilled on a barbeque.  Within the lung tissue were many small black filled alveolar spaces, possibly smoke inhalation, but the distribution appeared too random to have been soot.

Jup Jang had a horrible end to her life, unfortunately, most likely a life in captivity since her childhood.  For it to end in such a manner is solid reminder that such animals do not belong in suburbs or cities, and should be left in the wild where nature can take its course as it has done for thousands of years.

Stinky’s ongoing problems

October 2005 Around the beginning of September, Stinky, our juvenile Stump-Tailed Macaque fell sick and had an unusual course of illness.  For two weeks, he had recurrent fevers which initially were put down to zoonotic viral transmission from humans.  This was thought to be likely since he is one the most approachable primates at the center for visitors, given that he was raised at the center from a few months of age.  There was no external evidence of disease, trauma, or any problem that may cause such high fevers, sometimes reaching up to 40.8-40.9 degrees Celsius.  His fevers would often respond to antibiotics after a few days, but once a 5-7 day course stopped, the fevers would return, and then disappear when antibiotics were restarted.  This response suggested that the problem was more likely bacterial, but a source of infection still could not be found. 

Two weeks into his illness, Stinky started hopping on three legs and appeared quite lame on his left hind-leg.  The leg was not particularly tender to handle or manipulate, and he did not appear to be in significant discomfort.  The joints were not swollen or painful, so a joint infection was probably unlikely, but not impossible.  We thought that maybe he had fallen in his cage since he does prefer to climb up to the ceiling and hang upside down…  And strangely, the lameness disappeared after a couple of days. 

By the end of the week though, changes were becoming more obvious with the lameness returning and the proximal tibia starting to show tenderness, slight redness and very mild swelling.  Over the next few days, the swelling and pain increased and Stinky was taken for a radiograph.  The radiograph suggested osteomyelitis with radiolucency of the proximal tibia and inflammatory flare toward the distal tibia.  We couldn’t rule out the possibility of a greenstick fracture but this was not evident. 

At this point, Stinky was started on a 2 week course of enrofloxacin and amoxyclav and a robert-jones bandage placed on his leg.  The following three days saw an increase in the size of the soft tissue swelling, with eventual rupture of an abscess forming over the affected section of bone.  The bone too was thickened but once the abscess burst, Stinky’s limb was suddenly much more comfortable to touch and for him, to walk on.  The antibiotics were continued, the leg redressed daily with gentle wound care, and a short time later his problems appeared to be resolving.

But as chance would have it, this well loved and, unfortunately, over affectionate young primate became unwell again on the day he was due to go back into his enclosure with six other stump-tailed macaques.  The problem this time was projectile vomiting, seemingly starting out of the blue.  Within three hours, he had vomited at least six times, mostly just bringing up bile, indicating a potentially severe problem.  He still appeared reasonably bright and had normal faeces, but had some abdominal tenderness that prevented me from palpating his abdomen well.  Medication was attempted but immediately brought back up (Belcid – antacid) despite intramuscular injections of metoclopramide and cimetidine.  The problem seemed to involve gas but since we were not certain, we took Stinky for a second radiograph. 

This radiograph was difficult to read, but indicated a moderate gastric distension (gas in the stomach) with some small pockets of gas through the upper small intestine.  The rest of the details were a little vague and unclear, but there was no firm evidence of a foreign body or other serious problems.  I suspect that Stinky may have had a problem with gas formation associated with overgrowth of abnormal bacteria in his stomach, due to the prolonged courses of antibiotics. 

Treatment was given with further injectable metoclopramide, oral sucralfate and belcid.  Stinky was kept off food that night and the next morning, with free access to water only.  He had one more vomit in the evening but no further since then, and he spent his night wide awake screaming for food!  The following morning we started him on small volumes of Yakult/Betagen (acidophilus concentrates) which he devoured anxiously and fortunately did not vomit back up.  During the morning, the yakult volume was increased until midday at which point we decided to start him on bland food.  He kept this down and has been thriving ever since.   

Today, 12^th of October, we feel fairly confident that he is out of the woods and decided it was time to go back with his old group.  He was a little nervous at first but within minutes, he was chasing the other youngster, Fook, and returned to the old bully that we know and love…

Luna’s scare

June 2005 ‘Luna’, our female Dusky Langur, was moved from her temporary enclosure in late May to a new environmentally enriching enclosure of 10x10m & 12m high set around a primary forest fruit tree.  Her new companions were two female pigtailed macaques and two male gibbons, all of whom, fortunately, seemed to get along.  Several days after moving in, Luna was found on the ground of her enclosure in a state of stupor and shock.  She was severely neurologically depressed when handled, occasionally trying to resist my hold but not progressing beyond a limp flailing of her legs and arms.  She appeared to stare off into space unable to focus on her surroundings.   

Once arriving at the clinic, she was quickly examined and the situation assessed.  Luna’s cranial abdomen was bloated and tympanic, her mucous membranes pale, heart rate rapid and pulses thready.  Her body temperature was slightly below normal and her anal tone flaccid.  Time was of the essence for a number of reasons – firstly, Langurs are renowned for doing poorly and dying quickly in captivity, but mainly, that wild animals are generally masters of disguise, only showing symptoms of illness when the end is near.  It was critical for us to treat aggressively and urgently in this situation.  Intravenous fluids were commenced at once, running as rapidly as gravity would allow and slowly her heart rate and pulse pressure improved with a slight return of color to her gums.  Her demeanor became less distressed though she was still poorly responsive. 

Luna after the operation

Our options were to take her on a one hour drive to the local veterinary clinic at Petchaburi for a radiograph, after which Luna may have required surgery, or straight to surgery to assess the most likely problem, an intestinal/gastric bloat potentially with a torsion of the bowel.  We feared she would not make the one hour drive, so despite her unstable condition, the decision to take her to surgery was made.  Under a light intravenous anesthesia, an exploratory laparotomy was performed revealing significant gas accumulation in her intestinal tract and a lot of food still in her stomach.  No torsion or other gross pathology was found fortunately, but an intestinal ileus and inflammation was most likely, causing severe pain due to gas distension, sudden fluid loss into the intestinal tract and hence, a progression to the shock state in which she was found.  Gas was gently aspirated from the larger dilated loops of bowel and her abdomen lavaged with warm saline before closing the abdomen.   

With intensive nursing over the next few hours, Luna recovered from her ordeal and proved a stronger creature than any of us expected.  She remained on intravenous fluids for 3 days with a gradual return of appetite and a regular flow of foul smelling diarrhea.  Once the diarrhea settled and she was off the fluid therapy, she was returned to her enclosure though a couple of days later appeared to be slowly getting worse.  Her body temperature had risen and after examining closely, she vomited.  Fearing that she may aspirate, and concerned that her abdomen was still moderately distended, Luna was transported to Petchaburi and a radiograph taken, which showed no significant intestinal gas but confirming an accumulation of fluid in her abdomen.  Aspiration revealed the fluid to be a modified transudate (slightly bloody but non-infected fluid) which cleared over a few days after an injection of antiinflammatories.  We continued her on antibiotics, antiemetics and gave her another twenty four hours on IV fluids. 

Luna recovering in the clinic

The cause of Luna’s sudden decline was not immediately obvious but we considered a couple of possibilities:

1) She had recently been introduced to an enclosure where she had ad lib access to leaves (and probably ate to excess!), and,

2)  She also had more access to fruits than before, including jack fruit, papaya and other foods that may not agree with a leaf-eater’s intestinal tract.

In this environment, it is difficult to ensure they are eating a well balanced diet, despite daily leaf supplementation.  Luna definitely has a sweet tooth, heading straight for fruits such as melon, guava and pineapple when these are fed to the other primates in her enclosure, though we have eliminated some items we suspect may have contributed to her illness. 

I am thrilled to say that Luna came through in the end with flying colours and today, almost two months later, her appetite is as good as new and she is beating off the gibbons who try to steal her leaves!

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