Veterinary/Nutrition Roundtable Discussion...determination Post-surgical wound care Anemic animal diet Animal protein requirements Abnormal menses/menopause Thyroid problems Firm stools

Veterinary/Nutrition

Roundtable Discussion Nancy Lung, VMD; SSP Veterinary Advisor

Deb Schmidt, PhD; SSP Nutrition Advisor

Joe Smith, DVM; SSP Veterinary Advisor

Low starch biscuits

Current pain relief

strategies

Quality of life

determination

Post-surgical wound care

Anemic animal diet

Animal protein

requirements

Abnormal

menses/menopause

Thyroid problems

Firm stools

Biscuit choices

Dividing diet in the day

Vitamin regimens

Activity range targets

Physical development

milestones

Fiber in the diet

Constipation

Deworming strategies

Social issues

Dry skin

Inappropriate lactation

Inappropriate copulation

Heart/renal diet

General Respiratory

General Cardiac

Chronic Diarrhea

General Reproductive

Low starch biscuits

“We have had great success with our

orangutans losing weight with Mazuri low starch

biscuits. Is anyone else using this? We also had

to modify our other starchy items in their diet.”

Nutrition – Low starch biscuits

oAnyone using low starch biscuits? oSaint Louis – in rotation, exclusively for a diabetic

animal we had

oDr. Valdes – DAK

oDrs. Dennis & Less – Cleveland Metroparks Zoo

orangutan & chimpanzee serum

o insulin

o cholesterol

o glucose

o triglycerides

Nutrition – Low starch biscuits

Browse Low

Biscuit Starch

Protein 18% 20 %

Fat 5.2% 6.2%

ND Fiber 26% 34 %

Starch 19% 5%

Energy 3.185 kcal/g 3.2 kcal/g

Reminder; better to NOT cook items for

animals routinely

Current pain relief strategies

“Current pain-relief strategies for arthritis,

cancer, etc. How to determine if your animal is

in pain. How far to go with treatment of pain.”

Signs of pain

Could be NONE!

Decrease in appetite

Decrease in activity

Changes in behavior

Holding/pointing to painful area

Sensitive to touch

Lameness/decrease use of limb

Radiographic changes?

If it would cause pain in a person, assume it also causes pain in primates

Analgesia/pain management

Opioids (sensitive!)

Steroids (side effects)

Non-steroidal anti-inflammatories (NSAIDS)

Tramadol

Gabapentin/pregabalin (neuropathic pain)

Nutraceuticals (for OA)

Physical therapy/exercise

Environmental modifications

Acupuncture

Laser therapy

How far to go?

Differing philosophies

Is the treatment/management working?

What is the animal’s quality of life?

Are there other reasonable treatment options?

Do the good days outnumber the bad?

Does the animal do the things it used to enjoy doing?

No single answer

Quality of life determination

“Quality of life determination; when to euthanize and

how to decide.”

Post-surgical wound care

“Post-surgical wound care”

Anemic animal diet

“Diet for anemic animal”

Nutrition – Anemic Animal

oWhat recommendations are for an anemic animal?

oIs animal consuming primate biscuits?

oAre there any medical problems causing anemia?

oWith veterinary approval, supplement with iron tablets

or multi vit/min tablet.

Nutrition – Geriatric Diets

oChanges associated with geriatric diets? oFemales – stop Fe supplementation when they stop menstruating

oSofter foods - severe dental issues

oMonitor weights

o Excessive fat stores?

o Muscle wasting due to inactivity

oOther medical issues easily complicate the issue

Animal protein requirements

“Do Orangutans require animal protein as part of a

daily, balanced captive diet. If not, what ways other

than formulated biscuits, can we increase their protein

intake.”

Nutrition – Protein

oDo orangutans require animal protein as

part of a daily, balanced captive diet?

oAmino acid profiles – plant vs animal

oAll have same AAs

oDifferent proportions of AAs

oPlants limited in lysine, methionine,

threonine, & tryptophan

oDifferent rate of absorption

oDifferent rate of use

Abnormal menses/menopause

“We have an older female orangutan who has

gradually been getting heavier and longer menses. We

were wondering if anyone knows if this might be normal,

possibly menopausal? We are just wondering if we

should be concerned or if anyone has experienced this

with their older female primates?”

Menopause

Post-reproductive, infertile

Humans: 12 consecutive months of acyclicity

Not a light-switch—slow and gradual

Prolonged menses

Irregular intervals

Extra or skipped cycles

Irregular bleeding patterns

Not well documented in orangutans

What are you all seeing?

Maybe not menopause?

Reproductive Tract Diseases # of Institutions % of Institutions

Dysmenorrhea 5 11.1% Endometriosis 4 8.9%

Uterine Leiomyoma 3 6.7% Infertility 2 4.4%

Menopause 2 4.4% Vaginitis 2 4.4% Endometritis 2 4.4%

Mammary Neoplasia 1 2.2% Ovarian Cyst 1 2.2%

Uterine Cyst 1 2.2% Uterine Neoplasia 1 2.2%

Benign Prostatic Hypertrophy 0 0.0% Cervical Neoplasia 0 0.0% Mastitis 0 0.0%

Ovarian Neoplasia 0 0.0% Prostatic Neoplasia 0 0.0%

Prostatitis 0 0.0% Testicular Infection 0 0.0% Testicular Neoplasia 0 0.0%

Other Reproductive Diseases 4 8.9%

Diagnostics to rule out problems

Monitor cycling

Hemastix in urine

Fecal hormones

Thorough exam

Vaginal exam

Rectal exam

Abdominal palpation

Imaging of repro tract

Ultrasound

CT

Contrast radiographs

Serum hormones (validation issues)

Endoscopy

Thyroid problems

“I have a question regarding zoos who treat orangutans

for thyroid issues. How often do their meds get

changed? Are there thyroid values they go by for

altering medications? Will thyroid conditions prevent

females from becoming pregnant? Will taking thyroxine

have any effect on carrying a pregnancy to full term?”

Thyroid testing

Validation issues with great apes

Difficulty in interpreting results

Better to evaluate clinical signs

Current research—updates?

Clinical signs

Hypothyroidism

Rough, dry skin

Pallor

Coarse hair

Hoarse voice

Slow thought/action

Fatigue

Weight gain

Cold intolerance

Hair loss

Bradycardia

Muscle cramps

Constipation

Amenorrhea

Hyperthyroidism

Nervousness

Goiter

Palpitations

Poor concentration

Fatigue

Weight loss

Heat intolerance

Bloating

Tachycardia

Muscle cramps

Changing meds

As needed

May need multiple alterations over time

Base on clinical signs

Effects on reproduction

Hypothyroidism is associated with infertility in females

Levothyroxine considered safe during pregnancy and

lactation

Drugs may be required to control disease well enough to

allow pregnancy

Firm stools

“We have several orangutans with extra firm stool. We

have tried a number of remedies for this with varied

success. My question is, what do they consider to be a

stool condition that needs to be treated and what has

worked well with orangutans to soften hard stool? In

other words, how do you know if the stool condition you

see is normal for that individual or if it needs treatment?”

Orangutan Stool Assessment FORT WORTH ZOO

Nutritional Services Department in Cooperation with the World of Primates Exhibit

SCORE 1: Very loose, runny, liquid, no form

SCORE 4: Well formed feces, drier, but not hard

SCORE 2: Mix of formed and unformed, loose, some runny liquid

SCORE 5: Formed feces, but very hard

SCORE 3: Formed feces, but very soft

Score 6: Separated hard feces, hard to pass

June Stool Chart S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Chantek 2 2 2 2 3 1 1 1 1 1 1 1 1 2 2 1 1 2 1 1 1 1 1 1 2 1 2 1 1 1

Ramses 4 4 4 3 4 4 4 4 4 4 4 4 4 3 3 4 4 4 4 4 4 3 3 3 4 4 4 4 4 4

Nick 2 2 2 1 1 1 2 2 2 2 3 3 3 3 3 2 2 2 1 2 1 2 2 2 2 2 2 2 2 2

Mekong 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

PT 3 3 3 ns ns 3 3 ns 3 3 ns ns ns 4 3 3 3 4 4 4 4 ns 4 5 4 ns 4 4 3 NS

1 - Very Loose Liquid Spatter * Stool was seen but could not determine from which animal

2 - Mixture of Formed and Unformed

3 - Formed but Very Soft

4 - Well Formed Drier but not Hard

Daily tracking of stool quality

“Chantek” “PT”

Biscuit choices

“When choosing biscuits, which criteria are most

important? What are the benefits of low starch? How

much fiber is a good amount? Do you worry about

factors like gluten? Are there any other

qualities/nutrients of high priority? Is there such a thing

as "too much" variety if your orangutans will consume

five different types?”

Nutrition – Biscuits

oWhich criteria are most important?

oHow much fiber is a good amount?

o Any other high priority nutrients?

Nutrition – Biscuits

Marion

Leafeater

Mazuri

Low

Starch

Mazuri

Browse

Biscuit

ZuPreem

Primate

Diet Dry

Protein % 23 21 18 21

Fat % 6.5 5 3 6

Neutral Detergent

Fiber %

21 33 26 2

Ca % 1 1 1.3 0.6

P % 0.7 0.7 0.7 0.4

Vit D3 IU/kg 3500 4270 3325 2076

Sugar % 14 5 13 ?

Starch % 12 7 19 ?

Nutrition – Biscuits

oDo you worry about gluten?

oAllergic response

o Is there a thing as “too much” variety if your

orangutans will consume five different types of

biscuits?

Dividing diet in the day

“When determining how to feed out diets, should you

consider spacing carbs vs sugars at certain times of the

day or is it sufficient to simply divide the diet in half for

morning/evening or throughout the day?”

Nutrition – Feeding

oWhen feeding diets, should you consider

spacing carbs vs sugars at certain time of the

day?

oOr is it sufficient to simply divide the diet in half

or feed throughout the day?

oMultiple feedings are always beneficial

oMay need to target feed high calorie items

and scatter feed low calorie items

Vitamin regimens

“Discuss the pros and cons of vitamin regimens for

growing youngsters, adults, pregnant/nursing moms.”

Nutrition – Supplements

oDiscuss the pros and cons of vitamin regimens

for growing youngsters, adults,

pregnant/lactating moms.

oGreatest benefit to poor eaters

o Supplement with multi vitamin/mineral unless

you know specifically what is lacking

Activity range targets

“Is there a target range of activity for adults as they age

to help combat the health issues associated with a more

sedentary lifestyle?”

Physical development milestones

“Human babies have three - six month check ups to

assess growth and development. Are we, as the SSP,

gathering data to have physical developmental

milestones (not Carol's behavioral ones) as a reference

base? What would you most need from trainers to help

establish these?”

Fiber in the diet

“What percentage of the orangutan diet is fiber? Do

you routinely use some kind of fiber supplement like

FiberCon, Miralax, etc.”

Nutrition – Fiber

oWhat percentage of the orangutan diet is fiber?

o Knott (1999)

o 20-60% NDF, most above 50% NDF

o biscuits average 25-33% NDF

o produce NDF o fruit: raspberries 25%

o greens: alfalfa sprouts 28%

o vegetables: whole ear of corn 44%

Nutrition – Fiber

o Do you routinely use some kind of fiber supplement

like FiberCon, Miralax, etc.?

oLaxatives

oFiber

o Soluble fiber – psyllium (Metamucil), pectin, guar gum

o Insoluble fiber – neutral detergent fiber

oCrude Fiber - used in human diet analyses

Constipation

“Do your orangutans have problems with constipation?”

Chronic Constipation

• ???????

• Inadequate dietary fiber

• Inadequate hydration

• Long retention time in the colon

• Treat any identified cause

• “Tweak” the protocol to the individual and follow daily fecal scoring

• Mineral oil

• Pumpkin

• Prunes

• Miralax

• Other laxatives

• Combinations of the above

• May be needed for life

Possible causes Possible therapies

(Diagrams from Wrong, Edmonds and Chadwick, 1981)

Managing Chronic GI Disease

Chronic Cases % of reporting institutions

Yes 42.2%

No 40%

No answer 18.8%

Symptoms/Diagnoses % of reporting institutions

Acute diarrhea 57.8%

Chronic Constipation 35.6%

Chronic diarrhea 28.9%

Chronic regurgitation 17.8%

Other GI – (FB, hemorrhoids, etc.) 6.7%

Appendicitis 4.4%

Abdominal abscess 2.2%

Constipation and Diarrhea

These conditions are multifactorial and

challenging to tease out and manage.

Orangutan Stool Assessment FORT WORTH ZOO

Nutritional Services Department in Cooperation with the World of Primates Exhibit

SCORE 1: Very loose, runny, liquid, no form

SCORE 4: Well formed feces, drier, but not hard

SCORE 2: Mix of formed and unformed, loose, some runny liquid

SCORE 5: Formed feces, but very hard

SCORE 3: Formed feces, but very soft

Score 6: Separated hard feces, hard to pass

June Stool Chart S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Chantek 2 2 2 2 3 1 1 1 1 1 1 1 1 2 2 1 1 2 1 1 1 1 1 1 2 1 2 1 1 1

Ramses 4 4 4 3 4 4 4 4 4 4 4 4 4 3 3 4 4 4 4 4 4 3 3 3 4 4 4 4 4 4

Nick 2 2 2 1 1 1 2 2 2 2 3 3 3 3 3 2 2 2 1 2 1 2 2 2 2 2 2 2 2 2

Mekong 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

PT 3 3 3 ns ns 3 3 ns 3 3 ns ns ns 4 3 3 3 4 4 4 4 ns 4 5 4 ns 4 4 3 NS

1 - Very Loose Liquid Spatter * Stool was seen but could not determine from which animal

2 - Mixture of Formed and Unformed

3 - Formed but Very Soft

4 - Well Formed Drier but not Hard

Daily tracking of stool quality

“Chantek” “PT”

Deworming strategies

“What are the current tests/drugs used for deworming?

Any prophylactic dosage or only treatment as needed?

What parasites are being found? How frequently do you

examine samples?”

How often are routine fecal exams conducted?

Fecal Frequency # of Institutions % of Institutions

Annual 7 15.56%

2x/year 27 60.00%

3x/year 2 4.44%

4x/year 6 13.33%

Opportunistically 2 4.44%

Did not answer 1 2.22%

Which of the following methods are used?

Methods Used # of Institutions % of Institutions

Direct 41 91.11% Flotation 36 80.00%

Centrifugation 17 37.78%

Sedimentation 4 8.89%

Special Stains 6 13.33%

Other 3 6.67%

Special Stains: Iodine (4), Acid Fast (2), Diff Kwik (2), Gram’s (1),

Trichrome (1)

Other tests: Baermann’s (1)

Which of the following parasites have been identified in the past 10 years?

Which parasites do you believe contribute to clinical disease in your

orangutans?

Parasite Identified % Identified Clinical % Clinical % Clinical of

Identified

Balantidium coli 32 71.11% 14 31.11% 43.75% Strongyloides sp. 12 26.67% 4 8.89% 33.33% Entamoeba coli 10 22.22% 3 6.67% 30.00% Giardia sp. 7 15.56% 4 8.89% 57.14% Coccidia 4 8.89% 0 0.00% 0.00% Oxyurids 2 4.44% 0 0.00% 0.00% Cryptosporidium sp. 0 0.00% 0 0.00% 0.00% Other 21 46.67% 5 11.11% 23.81%

Other Parasites: Trichomonas 7 (1); Flagellates 3 (0); Amoeba 1 (0);

Baylisascaris 1 (1); Blastocystis 1 (0); Capillaria 1 (0); E. hartmanii 1 (0); Strongyle 1

(0); Trichuris 1 (1)

Do you perform routine parasite prophylaxis in your orangutan

collection?

Answer # Institutions % of Institutions

Yes 14 31.11%

No 29 64.44%

Did not answer 2 4.44%

Prophylactic Treatments:

Albendazole annually: 1

Albendazole q3wks: 1

Fenbendazole q3mo: 1

Ivermectin during exams: 1

Ivermectin q1mo: 6

Ivermectin

quarterly/metronidazole q6mo:

1

Ivermectin/Strongid/Fenbendaz

ole rotated monthly: 1

Pyrantel q2mo: 1

Pyrantel q3mo: 1

Social issues

“Social issues between female Orangutans - aging,

maturity, breeding related?”

Dry skin

“How humidity and/or temperature affects skin and hair

- dry skin and hair loss remedies. We have one of our

three Orangutans that have seasonal dry skin problems.

She is on fish oil capsules, but we didn't see a great help

in the Winter.”

Inappropriate lactation

“Lactation in animals that are not pregnant and have

never been pregnant or ever had a baby”

Normal lactation

Two phases

Lactogenesis

Controlled by prolactin, growth hormone, and

glucocorticoids

Synthesis of milk fat, protein, etc in mammary tissues

Milk ejection

Controlled by oxytocin from pituitary

Mechanical stimulation of nipple evokes oxytocin release

Ejection stimulates prolactin release which triggers additional

milk synthesis

What can go wrong?

Galactorrhea

Excessive or inappropriate production of milk

Prolactin

Pituitary adenomas—very common in people

Physical stimulation

May trigger oxytocin/prolactin cycle

May cause discharge that is not milk

Hypothyroidism

Side effects of drugs

H2 blockers (cimetidine)

Antidepressants (MAOI, SSRI)

Antihypertensives

Contraceptives

Herbs (anise)

Inappropriate copulation

“Our male really enjoys the company of our young

female (16years), but he does not breed her often,

maybe two or three times a year. They often engage in

presexual behavior, and we often will find what appears

to be dried semen on the floor. We would like ideas on

increasing copulation.”

Heart/renal diet

“With the rising concerns of renal and age related heart

issues, is there any plan to come up with a diet that

caters to address these issues? It would be nice to have

lists of foods to avoid and foods to help with these issues

that are quite prevalent. I know that kidney problems

are related to high potassium levels and we have cut

out certain food items to hopefully help slow down renal

problems. I’m also curious if the panel could touch on

geriatric diet changes that should occur.”

General Respiratory

Condition Score

Respiratory Infections 83

Heart Disease 41

Obesity 41

GI Conditions 11

Repro disease/complications 7

Renal Disease 5

Trauma 5

Dental Disease 4

Husbandry 3

Osteoarthritis 2

Anesthesia 2

Diabetes 2

Neoplasia 2

Allergies 1

Geriatric Disease 1

Strongyloides 1

COD >15yr

Heart Disease 28.9%

Respiratory Infections

15.7%

Renal Disease 14.5%

GI Conditions 6%

Repro Disease 4.8%

Neoplasia 4.8%

Anesthesia 3.6% (obesity)

2012 Health Survey

Clinician’s Opinion 2008 Mortality Survey

COD <15yr

Strongyloides #1

Respiratory Infections

#2

GI Conditions #3

Condition % institutions *

Respiratory Infections >50

Repro Disease/complications >50

Obesity 47

Chronic GI Conditions 42

Strongyloides 27

Osteoarthritis 27

Renal Disease 17

Heart Disease 16

Maternal Neglect 13

Diabetes 2

2012 Health Survey

*have diagnosed and/or managed in the

past 10 years

Respiratory Disease

• #1 Cause of Death in Orangutans 9-40yrs

• 38% North American institutions managing chronic respiratory disease

• 20.4% of all captive orangs in the European Union have had chronic URTD or air sacculitis – (2009 EU Orang health survey)

Respiratory Disease Respiratory

Disease

%

Institutions

Air sac infection 42

Sinusitis 31

Pneumonia 31

Bronchiectasis /

Chronic bronchitis

24

Allergies 16

COPD 9

Other

2

Seasonal colds 2

Anatomy

• Main anatomic differences across ape species occur in the upper respiratory tract

• Orangutan Sinuses – Large maxillary sinuses

– Lack frontal sinuses and ethmoid air cells

• Extensive laryngeal air sacs

• Identical lower respiratory anatomy identical to humans and gorillas

Sinusitis—Pay attention to it!

• Physical Traits – fluid accumulation

– mucosal membrane thickening or atrophy

– airway obstruction

– sclerosis of adjacent bone

• Chronic sinusitis is undiagnosed in many cases

• *Likely precursor to development of air sacculitis and pneumonia*

• CT necessary for determination of extent of sinusitis

Normal Mild Moderate/Severe

Air sacculitis • Most commonly reported

respiratory disease

• Large volumes of purulent fluid

• Secondary aspiration pneumonia

• Don’t let the big bag of pus cloud your judgement

• Paired laryngeal ostia--just below the

vocal cords

• Variable shape

• Passes under pectoral muscles and clavicles

• Increases in size and complexity as animal matures

• Very extensive in adult male

• Function unknown

Laryngeal Air Sac

Anatomy

Adult female

Air Sacculitis

• Pus varies from liquid to “peanut butter”

• Mixed bacterial infection,

mainly enteric Gram negative, kitchen sink stuff

• Fibrous bands in chronically

infected air sacs may form compartments, complicating the drainage process

Peanut butter looks

“normal” on CT

Not so normal on CT

Air Sacculitis Management • Persistent / recurrent infections common. Don’t expect a cure. • It’s important to manage it to reduce the morbidity

from secondary pneumonia and bacteremia. • Most cases require drainage. Antibiotics alone

cannot penetrate. • Closed drainage and lavage • Marsupialization • Closure of laryngeal ostia • Complete or partial air sac resection

Marsupialization

Ostia closure

Throat sac

resection Surgical drainage through operant

conditioning

Lower Respiratory Tract Pneumonia: The under-appreciated culprit

• Pneumonia: 31% • Bronchiectasis: 24% (why?) • Undiagnosed: Many more

Lower Respiratory Tract

• The similarities to cystic fibrosis are striking

– Genetic/ultrastructural explanation?

– The high incidence of bronchiectasis

• Medical management of chronic respiratory patients is similar to cystic fibrosis management – Control the bacterial load, improve mucous clearance,

maintain pulmonary function

Invest in Operant Conditioning

• Nebulization

• Intramuscular injection

• Throat sac manipulation, ultrasound, treatment

• Postural drainage

• Blood collection

• Thoracic radiography

General Cardiac

Condition Score

Respiratory Infections 83

Heart Disease 41

Obesity 41

GI Conditions 11

Repro disease/complications 7

Renal Disease 5

Trauma 5

Dental Disease 4

Husbandry 3

Osteoarthritis 2

Anesthesia 2

Diabetes 2

Neoplasia 2

Allergies 1

Geriatric Disease 1

Strongyloides 1

COD >15yr

Heart Disease 28.9%

Respiratory Infections

15.7%

Renal Disease 14.5%

GI Conditions 6%

Repro Disease 4.8%

Neoplasia 4.8%

Anesthesia 3.6% (obesity)

2012 Health Survey

Clinician’s Opinion 2008 Mortality Survey

COD <15yr

Strongyloides #1

Respiratory Infections

#2

GI Conditions #3

Condition % institutions *

Respiratory Infections >50

Repro Disease/complications >50

Obesity 47

Chronic GI Conditions 42

Strongyloides 27

Osteoarthritis 27

Renal Disease 17

Heart Disease 16

Maternal Neglect 13

Diabetes 2

2012 Health Survey

*have diagnosed and/or managed in the

past 10 years

Orangutan Cardiac Disease

• Orangutan cardiac knowledge lags behind that for chimps and gorillas

• In the literature: – 1991: sudden death

– 1995: successful treatment

– 1999: Coxsackie myocarditis

– 2009: pericardial effusion / heart failure

Acknowledgement for this section: Dr. Lauren Howard, Dr. Rita McManamon, Dr. Linda Lowenstine

• 20% of adult deaths due to heart disease

– Additional 12% contributory

• Myocardial fibrosis predominant

• One recent aortic dissection

• Infective myocarditis in literature

• More aortic atherosclerosis seen in orangutans compared to other apes

What we know so far…

UCD VMTH Linda J. Lowenstine

The main lesion in all the apes

in zoos is myocardial fibrosis

And arteriosclerosis

Atherosclerosis: orangutans in aorta and

internal iliac arteries, rarely in coronary

arteries

Linda J. Lowenstine

Linda J. Lowenstine

What are we doing?

• 68% of institutions are performing heart ultrasounds on routine exams

Great Ape Heart Project

• More orangutan studies needed!!!

Chronic Diarrhea

Chronic Diarrhea

• chronic stress

• Parasitism

• Dysbiosis

• Inflammatory bowel disease

• Food allergy/celiac

• Chronic enteritis

• Treat any identified cause

• Gluten-free diet

• Stress management trials

• Pharmaceuticals (budesonide,

metronidazol, immodium, etc)

• Pro-biotics

• Voodoo (forever flagyl)

Possible causes Potentially useful therapies

Chronic Diarrhea

• Easy to ignore

• Can persists for decades

• Can lead to life-threatening protein loss and electyrolyte imbalance.

• Monitor your animal regularly (training for blood collection)

General Reproductive

Orangutan Reproductive Health

• This is a very broad category! – Fertility

– Contraception

– Perinatal care

– Pediatrics (handrearing, surrogacy, vaccines)

– Reproductive pathology

Acknowledgements for this section: Dr. AJ Marlar, Dr. Linda Lowenstine

Normal Captive Parameters • Age of puberty : Female 7-12 Y Male 7-14

– Menarche: approx 7 Y

– Menstrual cycle length 23-33 days (6 animals, 35 cycles)

– Estrogen peak: approx mid-way through cycle

– Pregnancy: 227-275 D, Avg 245 D

– Labial Swelling- usually starts 2-4 weeks into pregnancy

Pregnancy Related Disease 2012 Health Survey

Condition # institut % institut

Maternal Neglect

6 13.3

Dystocia 6 13.3

Other 4 8.9

Birth Defects

3 6.7

ParturitionMortality

2 4.4

Premature 2 4.4

Stillbirth

2 4.4

Condition #institut % institut

Abortion 1 2.2

Placentitis 1 2.2

Placenta abrupta

0 0

Placenta previa 0 0

Pregnancy toxemia

0 0

Pregnancy Diabetes

0 0

Reproductive Tract Diseases 2012 Health Survey

Condition #institut %institut

Dysmenorrhea 5 11.1

Endometriosis 4 8.9

Uterine leiomyoma 3 6.7

Infertility 2 4.4

Menopause 2 4.4

Other 4 8.9

Vaginitis 2 4.4

Endometritis 2 4.4

Mammary neoplasia

1 (MALE) 2.2

Ovarian Cyst 1 2.2

Condition #institut

%institut

Uterine cyst 1 2.2

Uterine neoplasia 1 2.2

Prostatic hyperplasia 0 0

Cervical neoplasia 0 0

Mastitis 0 0

Ovarian neoplasia 0 0

Prostatic neoplasia 0 0

Prostatitis 0 0

Testicular Infection 0 0

Testicular neoplasia 0 0

Perinatal

Causes of

Death

Fetus – Day 1

• Placentitis; placental infarction • Umbilical strangulation • Congenital malformation • Maternal pre-eclampsia