Jumbo, the doctor will see you now

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Like a lot of 3-year-olds, Sundzu was an active guy who liked to play rough. One day last autumn at his home in Tucson, he was mixing it up with his older brother when got an owie.

If you're an elephant living at the Reid Park Zoo and you crack your tusk, be glad not only that your dentists are associated with San Diego Zoo Global, but are as familiar with the power tool aisle at the DIY center as they are with the oral surgery suite.

Dr. Jim Oosterhuis and Dr. Dave Fagan had treated Sundzu before. Oosterhuis is principal veterinarian at the San Diego Zoo/Safari Park, sister institutions to Zoo Global, and Fagan is executive director of the Colyer Institute, a San Diego nonprofit dedicated to the study of oral disease and nutrition in exotic animals. In spring 2013, they had repaired the fractured tip of Sundzu's left tusk by performing a routine root canal, if any such procedure on a pachyderm can possibly be described as "routine." But the new injury was different. The right tusk was infected, and it had to be removed.

Fagan got his D.D.S. decades ago at University of the Pacific in San Francisco before veterinary schools had developed the protocol for animals to open wide. He began his career practicing dentistry on humans, but he prefers animals, and as a regular consultant for the Zoo/Park, practically invented the field of exotic animal dentistry.

The currency of inventors, of course, is imagination, and Fagan is rich with resources. Said Dr. Don Janssen, corporate director of animal health for San Diego Zoo Global, "He's a very inquisitive, creative person." Standing outside a surgical suite at the Safari Park's veterinary medical center where a Thompson's gazelle was undergoing a bladder procedure, Fagan described the tusk extraction. He was as juiced as a kid who took apart mom's microwave. And put it back together.
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Later related in detail by Oosterhuis, the operation, which also included San Diego vet Dr. Allison Woody, employed a variety of tools to remove the 28-inch tusk, half of which was impacted in the socket. An elephant, even a youngster, is too large to undergo surgery in a proper suite, so the tusk miners worked in the zoo's elephant barn, on their hands and knees.

Because the tusk was broken off at the gum line, the vets had nothing to grab onto for yanking it out. So, using a periotome, a stainless steel cudgel driven by a compressed-air hammer that Oosterjuis referred to as "Home Depot dental equipment," they severed the periodontal ligaments holding the tusk in the socket.

Then they grabbed the edge of the tusk with a vice grip pliers (see: Home Depot), and began pulling on the tusk. They attached an electrical cable puller, like what you'd find at an electrical supply store to pull wires through conduit, to the vice grip handle, and hooked a slide hammer, which auto mechanics use to pull bearings out of a motor or wheel, to the puller thingy and wrested the tusk out of the socket.

Once it was exposed a few inches, they used a chain wrench, a tool commonly used by plumbers or, as Oosterhuis suggested, "to rip the bumper off your truck," to twist the tusk as the slide hammer pulled it all the way out.

It was a two-hour procedure that left a happy, healed -- if mono-tusked -- patient ready for another round with his 'bro, and the casual listener wondering if Fagan's business card reads: "Animal dentistry and general contracting."

The team was pleased with the outcome, but they weren't expecting the procedure to take so long. "When we did the walrus in Germany two years ago," Oosterhuis recalled, "each tusk was out in 20 minutes."

How do you say "Home Depot" in German?

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A Thompson's gazelle undergoes a surgical procedure at the San Diego Safari Park veterinary medical center.

The Zoo/Park sends experts all over the world, if necessary, to tend to animal needs, but its veterinary staff is blessed with a wow-inducing hospital right in its back yard. Built 13 years ago, the Paul Harter Veterinary Medical Center is an exotic animal doctor's sweet dream. After eight years of touring hospitals nationwide, staffers devised a state-of-the art, LEEDS-certified facility that can handle pretty much any challenge a distressed animal throws its way.

It's a modular design born of input from not only administrators and veterinarians, but keepers, technicians and any animal lover with a good idea. The walls and equipment are mobile to accommodate a range of patients, from ailing pelicans to newly arrived gorillas under quarantine. The medical center must be able to move, anesthetize and treat animals of all sizes, and return them to their habitats with minimal effect.

After an animal has undergone a procedure, it's moved to a recovery bay with padded walls and a spongy floor to reduce stress. The IV apparatus is external, contained within a box on the door's exterior so that fluids can be changed or refilled without disturbing the patient.

Staffers can monitor their charges from the administration area via web cams. Such hidden assessment promotes better diagnosis and treatment because animals mask illness or weakness to appear more resilient to predators. But clinicians need to see the real story to help them recover, and thrive.

The Zoo/Park has a total animal population of about 6,300; 30-some animals are in residence at the medical center at any one time, some of them outsiders.

This is a hospital, but it's also a primary-care facility. "Zoological vets are the ultimate generalists," Janssen said. In the space of a day they might be suturing the pelican's pouch that was torn by a sharp fish bone, monitoring the internal parasites of okapis and shopping for slide hammers at AutoZone. The goal is to do whatever is necessary and safe in order to reintroduce an animal to its customary lifestyle in its natural habitat.

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A pelican recovers under web cam watch from an operation to repair its torn pouch.

When it comes to intervention, sometimes less is more. All ruminants, for example, are subject to parasites, which can't be eradicated on the savanna, only managed. So the clinicians at the medical center don't use drugs to rid the park's hoofed animals of intestinal freeloaders, they manage them naturally by adding copper, tannin and fungi to their feed. The treatment serves the dual purposes of nutritional supplementation and cultivating a digestive tract environment that retards, if not eliminates, the growth of parasites.

Because exotic animal medicine is a relatively new field -- when Janssen graduated as a D.V.M. in 1978 from UC Davis, there was no curriculum for such studies -- practitioners here are constantly figuring out how to figure out what's wrong, and how to treat it. For example, a naked mole rat (native to East Africa and more closely related to a porcupine than a mole or a rat) requires less and different anesthesia from that required by an Andean bear, so Janssen's team must determine the best drug cocktail for each animal undergoing surgery.

When you're devising medical protocols for exotic animals, it helps to be teammates with some of the best wildlife researchers in the world. Although their work is global, the Zoo/Park is renowned for saving native species, such as the California condor and the desert tortoise. Did you know that the newest threat to this endangered reptile is bladder stones? Tortoises have huge bladders, and with the increasingly dry conditions in California, they consume less water, which creates more stones.

For the Pacific pocket mouse, native mostly to Riverside County and threatened by habitat loss, researchers are cultivating an "assurance" colony at the Park in the hope of boosting their numbers and reintroducing them to the wild. Such a project found success recently for some mountain yellow-legged frogs, which were released into the high-altitude, cold-water streams from whence their forebears came. And the extremely endangered San Clemente Island Shrike is lucky that scientists from San Diego Zoo Global, in conjunction with the U.S. Navy, have spent 20 years creating and managing a self-sustaining population back on their island.

Janssen's a vet, but he's also a custodian of habitat. "We see ourselves as a conservation organization," he said.

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Lion cubs Dixie (far) and Ken get lunch from their keepers at the Animal Care Center.

At the Zoo/Park, caregiving isn't limited to the medical center. On the day we visited last month, the Animal Care Center was home to a pair of 6-week-old lion cubs whose mother had rejected them shortly after birth. The lion keepers aren't certain why, so we'd suggest she has a vision problem -- no babies this cute could ever be rejected by any sentient being.

The Animal Care Center, explained lead keeper Eileen Neff, tends only to young animals requiring special care, and only long enough to enable them to return to the herd or habitat once they're weaned.

Staffers try to remain as aloof as possible from the creatures in order to minimize human residue that could impair their ability to thrive in their habitat. The South African sable, giant eland and Thompson's gazelles in residence during our visit were sequestered as much as possible from their keepers. But some animals need to be hand-reared, like the lions.

It's natural to have mixed feelings about any animal kept in captivity, any animal deprived of the freedom to which all living creatures should be entitled. But the Zoo/Park respects the captives, some of whose species won't survive without human intervention, and whose caretakers seek only to promote a healthy planet.

Photos: Top, Drs. Jim Oosterhuis, left, and Dave Fagan perform a tusk procedure on an elephant; Ken Bohn, San Diego Zoo Global. Other photos, Ellen Alperstein.

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