A week after our strenuous efforts to create Amali’s leg mold, John came back to the zoo to show us the result. I still had not quite gotten the kink out of my neck or the sawdust out of my boots when I was once again escorting John and his assistant to the giraffe barn. From the wariness with which the keepers and supervisors watched us enter, I guessed I was not the only one still suffering from the effects of our last wrestling match with Amali.
John put his bag down and fished around inside it, pulling out Amali’s first brace with a flourish. Made of shiny white plastic with animal cartoons stenciled on it in bright primary colors, the brace looked more suited to a child’s bedroom than to our musty giraffe barn. It was split along the sides into two long halves, and was to be held in place by four bright white Velcro straps. On the inside, the brace was padded with a soft white foam to prevent rubbing, and it still smelled vaguely of glue.
From the grins on the faces in the giraffe barn, the brace was clearly a hit among the staff. But what would Amali think? Would we have to wrestle her to put it on? She was standing nonchalantly by herself in a sunny section of the giraffe yard. When she saw us coming, she started drooling, anticipating the bottle that was sure to come (and would provide a necessary distraction). While she sucked on the bottle, John and I gently placed the brace around her front leg and fastened the straps. It fit perfectly, extending from just below her elbow to just above her ankle. When Amali finished her bottle, she nosed my blond ponytail as I bent over her to help John with the fitting. Soon I felt warm giraffe saliva sliding down my neck. Amali had developed a taste for certain fruity shampoos, and often sucked on my hair as eagerly as she did her bottle.
Holding our breaths, we stepped back to watch her in her new brace. She took a tentative step forward, bore full weight on the leg, and started to walk carefully around the yard. Clearly her little giraffe brain knew there was something different about her leg. Soon she decided this new thing attached to her wasn’t such a big deal. After all, it was a nice, sunny day—and hey, aren’t those yams you’re holding?
Reaching up to hand Amali a thin slice of yam, I silently congratulated my patient—the first giraffe in Texas to have her own custom-made leg brace. Then I thanked John, who had generously donated his time, that of his assistants, and all of the materials for the brace. Grateful handshakes and the occasional soggy giraffe kiss were all he required for services rendered.
Thanks to the design of the brace and Amali’s enthusiasm for her bottles, we never had to restrain her in order to put the brace on or take it off. With the leg straight and protected from further damage, the next step was exercise and rehabilitation, a challenge taken up by Dr. Mark Haugland, a local equine surgeon. He had years of experience treating horses with leg problems very similar to Amali’s. I knew the basic principles of managing limb issues in hoofed animals (“If it’s straight, make it bend; if it’s bent, make it straight”), but the nuances of treating an angular versus a flexural deformity were beyond me.
Dr. Mark had an affable bedside manner and was remarkably enthusiastic about examining a patient we couldn’t restrain and that he might not even be able to touch. Over several visits to the giraffe barn, he helped us define Amali’s multiple orthopedic problems and focus on improving the health of her front legs and her right knee. On his recommendation, we slowly increased the length of time Amali was in the brace until she was wearing it twenty hours a day and could lie down and sleep comfortably in it. He also recommended daily physical therapy for all of her limbs, which the keepers performed religiously and without complaint.
Before long, the shiny plastic exterior of the brace was scuffed and scratched, the white Velcro straps had darkened to an earthy brown, and the pristine padding on the inside had begun smelling like a sweaty giraffe leg. John Fain and his assistants made four more braces for Amali as she grew taller and taller.
Amali’s physical therapy sessions and colorful leg brace attracted the attention of our zoo visitors. We’d anticipated their questions (“What happened? Is it broken? Does it hurt?”) and posted signs around her exhibit explaining why the baby giraffe was wearing a brace. The response was overwhelming. Visitors not only expressed empathy and support for our efforts, they also shared accounts of people in their own lives who needed special braces or had lost a limb. Some told their stories directly to zoo staff; others called or sent e-mail.
One story about a little girl named Michaela touched us all. Her mother, Denise, wrote to us asking for a photograph of Amali in her brace. Michaela had suffered a hand injury when she was a premature infant. Despite multiple surgeries, she’d worn a brace on her wrist ever since. Now a willful four-year-old, Michaela had begun resisting wearing her brace, particularly at preschool and in front of her peers.
During a recent visit to the zoo, mother and daughter had turned a corner and found Amali standing nearby. The giraffe was contentedly wearing her newest brace, this one covered with purple butterflies (John felt she’d outgrown the brightly colored baby animals). Michaela had found a friend—and a role model. We happily sent Denise the photo, and learned that Michaela had carried it to school and shared it with her friends; more than that, she’d resumed wearing her own brace without complaint or argument. Denise described her daughter’s transformation as immediate—and remarkable, as if a lightbulb had suddenly been turned on.
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 firsthand 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, i
ncluding 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.
ABOUT THE AUTHOR
Lauren L. Howard grew up in Maryland with a houseful of pet rodents. She became interested in zoo medicine during high school, thanks to her father, a biomedical engineer, and his acquaintance with veterinarians at the National Zoo in Washington, DC. She received her veterinary degree from the Virginia–Maryland Regional College of Veterinary Medicine in southwestern Virginia and then spent a year as small animal medicine and surgery intern at the Oradell Animal Hospital in New Jersey. She completed a residency in zoo medicine in a joint program between the University of California, Davis, and the Zoological Society of San Diego. While in San Diego, Dr. Howard participated in the California condor reintroduction project in Baja California, Mexico. A staff veterinarian at the Houston Zoo since 2005, she lives south of Houston with her husband, Doug, a small animal veterinarian, and their two dogs, three cats, and J.C., their pet lizard—a bearded dragon.
Alfredito the Hippo
by Susan Mikota, DVM
MICHAEL 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.
Dear Dr. Mikota,
We have a serious problem on our hands. Our hippopotamus, a sixteen-year-old three-thousand pound male (fondly known to the public as “Don Hipo” or “Alfredito”), shows an eight-inch-deep vertical cavity in his large right incisor. We are at a loss to know how to sedate the animal or to perform the necessary procedure. Can you help?
Dr. Carlos Suazo, National Zoo, El Salvador
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.
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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 mo
rning. 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.
The Hippo with Toothache Page 24