We met Connie, a 45-year-old female Asian elephant from Reid Park Zoo, in February 2012 when she arrived at the San Diego Zoo destined for integration into our middle-aged and geriatric elephant herd. We received her medical records six months prior to her transfer and, in discussion with Reid Park Zoo veterinarians, began preparations for her ongoing health care at the Zoo’s Elephant Odyssey (EO). Monitoring her urine on a regular basis was on our agenda as we noted several bouts of urinary tract infections (UTI) over the past few years, a condition not uncommon in middle-aged to geriatric females, animal or human.
Connie seemed to adjust well to her keepers and life at our Elephant Care Center during her quarantine. She learned the touch and smell of the veterinary team. She gently put her trunk up to the mesh at breath level, curious to know who was visiting. Excited to build a good relationship with her, I’d place a few food pellets or produce in her trunk and meet her eyes, hoping she would know that all the things I would do or ask her to do were an effort to keep her healthy in her golden years. As time passed, and with the heightened observation period of quarantine, keepers did notice some of the same things as her Reid Park Zoo keepers that signaled concern for recurrent UTI: urine dribbling and discharge along with changes in attitude and food and water intake. I requested a sample of urine. How to get that, you might wonder? The keepers have a collection cup resting inside a loop of zip-tie on a telescoping pool-cleaning pole that they sneak under the elephant for a mid-stream catch. The samples supported evidence of infection from either the urinary or reproductive system. We treated with broad-spectrum antibiotics, and Connie seemed to feel much better over the next 10 days.
As other blogs mentioned, Connie and Shaba moved on to the next stage of EO life: meeting new elephants and exploring new places. Our veterinary minds did not move on quite as quickly; we want to know why medical events occur and place great emphasis on preventing problems. We began discussion for additional procedures and diagnostics to evaluate Connie and initiated regular urine monitoring.
Unfortunately, just two months later, Connie had a marked decrease in appetite and output. Whenever Connie chose not to eat medicine cleverly disguised in all sorts of food items and then chose not to eat or drink much of anything, we moved quickly to investigate.
Our special-needs facility (SNF) was designed to ease diagnostic evaluation and intensive care for our middle-aged to geriatric elephants. How? What is so special there? The elephant restraint device (ERD) has big, wide straps that we can wrap from the axillary (armpits) and inguinal (groin) regions up to steel beams on a hydraulic system that will support the weight of a leaning, weak, or sedated elephant. In addition, the ERD articulates to allow a mesh wall with windows and doors to come close to different parts of the body, giving RVTs (veterinary technicians, aka nurses) and veterinarians a chance to safely examine and access body parts, collect blood samples, place intravenous catheters, administer medications, and provide overall intensive care for a sick elephant.
Test results returned, and we were quite disappointed to learn that Connie was severely leukopenic [leuko=white blood cells; penic=decreased], suggesting that the immune system was fighting disease somewhere in the body. We instituted several antibiotics and transformed the SNF into an ICU unit and initiated more intensive treatment for Connie. After intramuscular injections of medications did not ‘fix’ her abnormal blood results or her overall attitude and appetite, we chose to sedate Connie for placement of IV catheters (back of the ear and inside of the back leg), administration of fluids (120L = 30 gallons for a 3,000 kg patient), and administration of medications both intravenously and into the colon (absorption occurs here as well). Connie was not keeping herself hydrated with her water intake (or electrolytes or nectar or other undercover tactics) nor was she taking in enough food for long-term sustenance, not to mention her lack of interest in taking any foods ‘doctored’ sneakily with medications.
We invited a reproductive and overall elephant specialist to join us in evaluation of her bladder, kidneys, and uterus to uncover any cause for the previously seen thick urinary discharge and/or the work of the immune system to combat her disease process. Unfortunately, we identified another serious problem atop the other ones—a lot of fluid floating in her abdomen. Fluid like this can cause problems with breathing and a full feeling in the belly and can come from some challenging diseases (heart or liver disease, cancer, vasculitis, ulcers), no matter what age or creature. None of the possible explanations suggested a good prognosis for Connie’s health. This examination did not reveal the root cause of her illness, but it confirmed that without intensively supporting her system, she would not survive.
Since her arrival in San Diego, veterinarians, technicians, keepers, and managers have worked extensively with Connie to manage her health concerns. We saw improvements, but this time the response was not the same. Over the last couple of weeks, her condition continued to deteriorate and severely affect her quality of life. She was drinking about 1.5 gallons of water when she needs 75 gallons daily to live. Connie’s immune and organ systems simply were not keeping up with her disease. This morning, we made the heartbreaking decision to euthanize her when it became apparent that Connie would be unable to sustain herself. We know many of you will share in our loss as we say goodbye to Connie and hope that you know she will be greatly missed.
Tracy L. Clippinger is a senior veterinarian at the San Diego Zoo.