Sunday, February 16, 2014

My favorite 2013 – International cooperation and surgeries for monkeys and others - Thanks to our advisors!

The amazing Dr. Brodeur surrounded by most the 2013 vet crew

Wow how time moves at lightning speed, relentless and with little down time to write! There are still so many more stories to tell and people to thank. Thinking about the best of 2013 I have to thank our Panel of Advisors and foremost our veterinarians! My gratitude is beyond words. I will try anyways.

I would like to start by thanking all for advising us frecuently via email. Your help is tremendously valuable. We could not do without. Our field is too broad. Then I would love to highlight and especially thank Drs. Gilbert Brodeur and Adolf Maas for advising AND for coming to visit to assist with needed surgeries in Belize which BWRC was not equipped for, nor was I experienced enough in them, nor could we find a veterinarian or even human Dr. in the country to do them. This applied in particular to the cases of the Howler Monkeys Livvy and Spartacus, as well as Vesper the dog and Diego the Margay.

Livvy the howler monkey had undergone her entire process of rehabilitation under the amazing care of Wildtracks directors Paul and Zoe Walker, without major complications. But then, only days before transferring into the pre-release enclosure, only weeks before release... her carer came to the enclosure to see her with one functionless arm in obvious pain.

It turned out Livvy had an extremely rare, and severe, dislocation of her ellbow, where basically any connecting tissue between the 3 bones, was destroyed. This injury was described in 11 cases in the literature, in humans. We studied a case of a professional gymnast, and compared. We were consoled to find that human Drs had taken the same approach that we had taken the first Sunday at BWRC. It had failed for them as it did for us. We were able to replace the ulna and humerus, but the radius kept slipping. The same happened to the human gymnast. But then 3 weeks in the human Drs. in the developed country made a special articulated external fixator, and the patient returned to professional gymnastics!

Unfortunately for us and Howler monkey Livvy in Belize that was not possible without help.
Thanks to networking, and particular thanks to my student Meghan we were put in contact with several surgeons including Dr. Gilbert Brodeur. Dozens of emails and hours of writing and reading later, networking and fundraising, thanks to Wildtracks and many others, Dr. Gilbert arrived in Belize. He came to spend 6 days with us and not only attempt an ingenious method at repairing Livvies fusing elbow and reconstructing her circular ligament, but also to help us repair Spartacus arm. For those who remember, Spartacus is the monkey in our logo. While all patients are special, this one is extra special to me. I credit him for pushing me "over the edge" to start a wildlife clinic myself. After treating him under my house I no longer wanted to continue working mobile and “in field” only, without a proper medical facility for wildlife. It was because of him, and a serious but lucky car accident, that I decided I finally had to be more vocal about my passion and mission, ask for help and grants, in order to leave something behind once I am gone. So I looked for grant support, saw “Inspiration in Action” contest and the story continues.

While I had been able to save Spartacus’ hand in my old tiny office, his wrist remained painful. He climbed well but when he jumped landing hard on his wrist, as monkeys tend to do, he would show obvious pain and guarding. So instead of going for release this summer he was held back for further assessment, now with proper facilities to x-ray him! The x-rays showed his radius and ulna had developed a fusion. This meant his arm could not rotate, nor could his arm and wrist continue to grow properly. Without surgical separation of the bones he would never be pain free nor would he be releasable. How lucky were we and Spartacus?! Dr. Gilbert was the perfect surgeon, teacher and friendly colleague that anyone could wish for and I can just not thank him, Megan or the Universe enough for the condensed teaching I and my assistants have received from him in those 6 days.

In addition to the successfully completed monkey surgeries Dr. Gilbert spontaneously took on a heart breaking case of a sweet domestic dog by name of Vesper with small fracture, yet a complete spinal dislocation, with remaining reflexes. A puzzling case! Dr. Gilbert spontaneously responded „you are so lucky to have so many interesting cases“.

Assisting Dr. Gilbert was an eye opening experience after which I said „I am now officially hooked on orthopedics“, (and purchased many of his tools for the best deal ever). I had seen spinal card for the first time. And believe me, I was plenty „freaked out“, when a dorsal processus broke off in the process of repair, and the spinal cord was therefore fully exposed. Dr. Gilbert did not even blink an eye, I swear! We cooled the cord with iced sterile water and proceeded. Vesper continues in care and is not walking well but can stand and take some steps and is in great spirits. His owners continue to provide the most loving care. Loving owners made many of our domestic cases this year very special.

Talk about condensed learning in a short period when Dr Adolf Maas came to visit only weeks later  to tend to Diego the margays’ chronic hip luxation with a femur head and neck ostectomy surgery, to give a second opinion on an amazons beak injury and to recheck on Izzie the spider monkey. Izzie was probably our most famous patient, rescued from pet trade on our BWRC inauguration day with multiple broken bones and gunshot wounds. Dr Adolf had come to repair her humerus fracture with a metal implant, a bit less then 12 months before. We had checked at 3 and 6 months post surgery but the question remained if her plate would have to be removed in another invasive surgery, or if it could remain in her for life, beyond release. 
Her recheck gave her the full green light, which meant she could be released eventually without another invasive surgery.  Aside the surgeries, Dr Adolf provided a wealth of knowledge and taught us about reptile hematology and countless other subjects with seemingly endless energy.

The older I get the more I know how much I DON’T know, and that is a lot... The most I have learned from cooperation with colleagues from all over the world. I feel like a broken record but can not help but say once more: THANK YOU dear Drs., friends and other supporters for helping critters and for helping us, to help critters.

Special thanks to Drs. Adolf Maas, Brodeur, Dorazio, Gupta, Huckabee, Kollias, Mc Ruer, Morales, Martinez, Phillips, and of course our professional interns Drs. Angela Gimmel and Jennifer Riley. Belize Wildlife & Referral Clinic and I could not have done it without your advice and help.

To recap the wild animals stories: at this point we have hopes that all 3 monkeys can be re-released back into the wild! Of course none of this would be possible without the amazing organization Wildtracks and the dedication of its directors Paul and Zoe Walker who are providing years of rehabilitation care for each individual monkey in their care. So I would like to end with a highlight on our amazing partners at Wildtracks who give imperiled wildlife in several species a chance at returning to their wild home.

Very special bonding moment between carer and head trauma patient.
We look forward to continue our cooperations and networking for international knowledge exchange to support wildlife conservation and sustainable development in 2014.

Wednesday, January 1, 2014

“My favorite 2013 experiences”: Lets get crocking for Hope with ACES, or my first flight to the rescue.

I know blog updates have not been forthcoming. I have been too incredibly busy, chronically, to the point of exhausted. But I shall try again, I promise. When I started to think about my favorite 2013 experiences I realized there are so many to still be mentioned, like the Tamandua with skull fracture cared for amazingly by Ella Baron, or the field visit for the Peregrine Fund, and the spay and neutre clinics, especially the one on Tobacco Caye, and not to forget the amazing people I have gotten to work with this year. Definitely there are too many stories for one blog. And there is too little time in my life to write. I and BWRC will attempt to produce a biannual Newsletter in 2014 to not forget the many amazing critter stories.
So to keep it short highlighting the best of 2013 and some of BWRC’s amazing partners one at a time here another crazy wild animal rescue assistance we were able to provide. It starts as usual...
Typical "chop wound" on this problematic croc

Just as I hoped for one of the first free days on a weekend in about 3 months, I received a Facebook message „We need your urgent help, to stitch a crocodile“. So from „finally weekend mode” to emergency mode. The severely injured croc had been rescued by Vince and Cherie Rose from ACES after complaints by concerned people on San Pedro. It was far from the clinic, and it was a 7-8 foot croc by name of “Hope”. A little too big to travel, so Cherie started looking for assistance to get the doc to the croc. Looking at a picture we determined that it was an older injury, the patient was in good body conditions and had eaten so she did not require surgery that Friday night, but Sunday would be fine and give us the time to prepare for this potentially complicated procedure. Ode to the miracles of networking: Within minutes the San Pedro Sun agreed to donate my flight to San Pedro. Shortly thereafter BWCN followed with a donation towards treatment costs.

Ensuing on Saturday were many hours of research on procedures, anesthesia and options available under our conditions. Cherie had suggested on the phone „you might just have to amputate“. Reptile anesthesia is not easy to begin with. And when it comes to a crocodilian this size and the need for forced ventilation under anesthesia – imagine yourself putting a tube in? We had a piece of PVC pipe for the emergency, but needless to say that this can be unnecessarily dangerous... we were once again working under complete field conditions, without much „amenities“. Not only did I need at least one medically trained assistant for this procedure, but also did BOTH of my veterinary assistants WANT be part of the action. I could not blame them and in an animal this size we could not have too many helping hands. Thanks to individuals, supporters and the Summerlee Foundation we were able join a fabulous medical team with Drs. Angela, Jen, myself, interns Helen and Lily and the ACES team with Directors Vince and Cherie Rose and Assistant Chris. Drs Jen and Angela took a boat and I took an early flight out of Belmopan. This was my first flight in Belize in 10 years! Something I had looked forward to yet then was surprised by the bumpiness of the ride. 3 stops later on short Island runways... I happily arrived on San Pedro with my 2 boxes and a backpack.

Most of the medical teams hands in the picture
Thanks to ACES fantastic capture and restraint we were able examine and treat this severe injury under local infiltration anesthesia. A bench as surgery table and the back of a golf cart as instrument and medication table, under a tree. Once she was restrained, “Hope” turned into a perfect patient. While the images of the injury had been suggestive of a very old, infected lesion, with likely loss of limb, in reality there was only a thin layer of necrotic tissue and below was healthy bleeding granulation tissue. The injury was typical of a cutting injury as sustained by machete or similar tools with a deep straight craniocaudal cut through the hindlimb at the mid femur level. The bone was also severed, and there was a lot of dirt inside the deep wound cutting through about 1/3 of the thickness. Fortunately the cut did not sever the close by femoral artery! “Hope” was not using the leg, but she was dragging it and comparing to the photo she had progressed in basically “self amputating” by slowly ripping the partially severed limb off! But overall we gathered hope to save the leg with treatment.

Wound nearly closed!
Thanks to our many helping hands we went to work and washed and flushed and debrided, and flushed and flushed some more. Then we reunited the severed tissues from the deepest layers to the surfaces with many sutures. We were surprised to see how the leg came back together and the protruding tissues were repositioned, and minus a drain opening, the wound could be fully closed. The bone underneath was still broken. Bone surgery was not possible under these conditions. Yet there was little muscle contraction and replacing the fracture was possible manually. We opted for external immobilization and with mostly duct tape (you better Belize it...) immobilized the leg to the tail.

Penguin duct tape cast to provide immobilisation
After being very concerned to begin with and worrying about loosing the patient, anesthesia complications, failed amputations or the likes... we were able to clean up, close and cast the injury within 2 h, and after 3 h 30 min on the Island, I hopped back onto the place to go back home to spend even a couple of daylight hours with my family home on a Sunday. That was awesome! And the return flight was just me, and the pilot of course, and we went straight home. Nice!

And, the best part of the story is the continuation in that Hope first of all ate well, then kept the leg and then started using it again! Check out the last picture after removal of cast! It's so exiting when something this challenging can end this well for the patient!

2 months later: Amazing recovery for Hope!

I would like to end with a thank you to our partners at ACES for their amazing work for crocodiles. This was definitely a highlight for 2013 for me, and I am very glad to have been able to help just a little bit. 
Holding hands with Hope

Thanks to the Team!