BOSTON — Hoppy, a young red panda, was the first patient of the day, carried — and anesthetized — into the exam room so he could get a physical.
Then Mildred, a 24-year-old barnacle goose, wobbled painfully across the floor as veterinarians analyzed her gait. They couldn’t see any improvement 10 days after an earlier exam. Replacement of the degenerating joints isn’t an option for a goose. Maybe acupuncture could help?
Next up was Sofina, an 8-year-old diabetic lemur that had done well on insulin shots for six years, but displayed troubling new symptoms. She kept her right hand clenched, though she could use it when necessary — reminiscent of a human diabetes patient coping with neuropathy.
This was a typical morning for three veterinarians at the Franklin Park Zoo. But it was a fairly unusual one for the Harvard Medical School student alongside them.
Although medical students usually stick to the human species, Harvard med students have been signing up for rotations at the zoo during their final months of training. The clinical elective, offered for the last three years, is also intended to reinforce the idea that animals and people share the same environment.
Outbreaks of infectious diseases like Ebola and Lyme disease are stark reminders of how vulnerable people are to a dysfunctional ecosystem, said Dr. Eric Baitchman, vice president of animal health and conservation at Zoo New England, which operates the Franklin Park Zoo in central Boston, and the smaller Stone Zoo in nearby Stoneham, Mass.
“Most medical students don’t get that side of the picture,” Dr. Baitchman said, noting that it is often human logging, bushmeat consumption and other man-made habitat changes that trigger such crises. “Human activities can have direct influences on our own health,” he said.
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Dr. Sharon Deem, director of the Institute for Conservation Medicine at the St Louis Zoo, said zoos and medical specialists have worked together for decades, but there have only been modest collaborations between zoos and medical schools.
What Harvard Medical School and Zoo New England are doing is more formal and longstanding than any other program she’s aware of. “Eric and his team are at the forefront of what is hopefully going to be a common thing, but it’s not right now,” she said, speaking of Dr. Baitchman. “I feel like the wick is lit now and it’s got enough momentum that it will light the candle at the end.”
People also have a profound need for animals and nature, Dr. Deem said, citing things like therapy dogs and the restorative power of a walk in the woods. “These have positive physical and psychological impacts that we shouldn’t overlook,” she said.
Several students who completed the rotation said they were surprised by how much they learned during a month at the zoo. One tested a gorilla for heart disease, another treated a bat who had broken a wing in a fight, and another spent part of his first day struggling to keep an African tortoise from ambling out of an X-ray machine while he tried to check it for bladder stones.
“Seeing him being shy helped me come out of my shell,” said Dr. Gilad Evrony, the first Harvard medical student to do a rotation. Dr. Evrony, now a pediatrics resident at Mt. Sinai Hospital in New York, wrote about his zoo experience in 2016 in the Journal of the American Medical Association.
“I would never have predicted that I would spend my final month of medical school performing fetal ultrasounds on a pregnant gorilla, phlebotomizing a 500-pound tapir with hemochromatosis, caring for a meerkat in heart failure, and investigating medical mysteries across the animal kingdom,” he wrote in the article.
He also observed: “For nearly every disease I saw at the zoo, the simple question of why certain species, human or nonhuman, are susceptible to it, while others are not, raised immediate possibilities for research. Nearly every day at the zoo, the veterinarians and I would make fascinating, unexpected connections between human and veterinary medicine.”
In an interview, he said the stint at the zoo inspired new respect for the complexity of veterinary medicine. “I really had to overcome some bias that I think pervades much of medicine, that human physiology and disease is unique and that veterinary medicine does not have much to teach us,” Dr. Evrony said.
He and other students in the elective said they were repeatedly struck by how much they learned from treating species other than their own.
Dr. Travis Zack, now a resident in internal medicine at the University of California, San Francisco, said he gained new insights into a rare form of human chronic lymphocytic leukemia by treating the zoo’s 13-year-old black swan, Merlot, for the same disease. The swan appeared to be responding well to a human leukemia drug.
“We think of these as human diseases, but they’re really diseases that occur across the animal kingdom,” said Dr. Zack, who also has a doctorate in biophysics, and works at the Broad Institute, a genetics research institute affiliated with Harvard and MIT.
Of course, Drs. Zack, Evrony and their peers are not the first to realize that there’s a lot to learn from the animal kingdom. The vaccine for smallpox, for instance, was developed after Edward Jenner at the turn of the 19th century recognized that milkmaids were protected against smallpox because they’d already been infected with a related disease from cows.
Flies, worms, fish and mice have long been research laboratory staples. But many of those animals don’t naturally develop the same diseases as humans, so the ailments have to be created through genetic manipulation or other means, some of which raise ethical concerns.
Dr. Elisa Walsh, another student who did the rotation, said she was impressed by the range of evolutionary changes among animal life, solving problems in different ways. “It’s just incredible how much diversity there is,” she said.
She collaborated on a project with a nearby hospital that is using ultrasounds to test gorillas for heart disease — aimed at learning more about the disease in humans and other great apes.
She also learned about tricky diagnoses, and how to to improvise, she said. Among other animals, Dr. Walsh treated an aging Macaw named Henry that suddenly couldn’t fly. Rolling him into an MRI machine to figure out what was wrong was an “interesting experience,” she said. After diagnosing him with a small stroke, she and the veterinarians devised a physical therapy regimen to help him recover his ability to fly. “Thankfully it had a good ending,” she said.
One morning at the Franklin Park Zoo, Wataru Ebina had a few ideas for tests that might help identify what was going on with Sofina the lemur. The veterinarians suspected that the animal’s newfound resistance to insulin might have been caused by Cushing’s disease, an endocrine problem triggered by too much of the stress hormone cortisol.
But testing cortisol levels requires several exams over time, which is tricky for an animal that won’t pee in a cup or stay still for a blood draw. Medical tests cause animals tremendous anxiety, which drives up their cortisol levels. And taking them out of their social environment for repeated testing can upset the social dynamics and hierarchy of all five of the lemurs that share a habitat.
Dr. Ebina, who also has a doctorate in stem cell biology, offered several suggestions, based on what he knew from human treatments, but allowed that none was a great option for a lemur.
In the end, Dr. Megan Watson, an associate veteran, decided they would get a urine sample first, by strategically placing a plastic sheet under her. Then Sofina was briefly anesthetized to get a blood sample. The results didn’t suggest Cushing’s disease, so the vets have tried another form of insulin that seems to be helping.
Hoppy, the male red panda who is now 3 years old, taught Dr. Ebina different lessons. The student helped the vets carry the sedated animal in a dog crate. Inside the zoo’s hospital, they slid Hoppy carefully out onto the metal exam table. A veterinary technician slipped a mask over its face, and positioned the tongue out of the way.
Dr. Ebina gingerly inserted a tube down Hoppy’s throat, intubating him to make sure he could breathe.
“How much to push the tube in is very different” than in human patients, Dr. Ebina said.
As a technician took Hoppy’s temperature, the medical team checked his eyes: his pupils were constricted but looked healthy; his ears, no problems; his abdomen: “No obvious masses. Not distended.” They moved each of his limp limbs to ensure he had a full range of motion, and squeezed his furry paws to poke out and inspect each extended claw.
“It’s all the same anatomy,” Dr. Ebina said, a few minutes later with the exam successfully completed, and Hoppy’s X-rays displayed on a nearby computer. “Seeing an animal that looks completely different but is actually similar reinforces the anatomical concepts that we learn, which is very helpful for my education going forward.”
Later, driving the red panda back to his exhibit space at the front of the zoo, Dr. Alex Becket, an associate veterinarian, reported that Hoppy seemed to be recovering well from the anesthesia. He hadn’t vomited, appeared aware of his surroundings, and had begun grooming himself to get back to normal. Although the elective program is supposed to teach species interdependence, Hoppy hadn’t quite gotten the message. “He’s trying to get the stink of human off of him,” Dr. Becket said.
Source : Nytimes
