This page directs you to the following case reports about botulism, Dieffenbachia and paraquat intoxication in elephants. To non-infectious diseases Intoxication Botulism Dieffenbachia intoxication Paraquat intoxication Kodo millet intoxication Reference values toxicology

Bone fractures are not uncommon in elephants. Radiography is needed for a proper diagnosis. A case of mandibular fracture is described in this chapter. To non-infectious diseases Bone fractures Mandibular fracture Mandibular fracture Mandibular fracture Mandibular fracture Mandibular fracture Mandibular fracture Bone fractures Mandibular fracture

This incomplete case report describes an intoxication of 7 Asian elephants with paraquat, resulting in ulcerations of oral mucosa, tongue, skin of the trunk foot and cuticles. Kodo millet poisoning in elephants is also described on this page. To intoxication Diagnostic notes The diagnose of paraquat intoxication was based on the information provided by the care taker and the symptomes as described above. Background information Paraquat intoxication in humans ( CDC | Facts about Paraquat ): Paraquat is a toxic chemical that is widely used as an herbicide (plant killer), primarily for weed and grass control. Paraquat causes direct damage when it comes into contact with the lining of the mouth, stomach, or intestines. After paraquat enters the body, it is distributed to all areas of the body. Paraquat causes toxic chemical reactions to occur throughout many parts of the body, primarily the lungs, liver, and kidneys. Cells in the lung selectively accumulate paraquat likely by active transport. Immediately after ingestion: pain and swelling of the mouth and throat. Severe gastrointestinal symptoms, followed by dehydration, low blodd pressure. Ingestion of small amounts may result in: Heart failure Kidney failure Liver failure Lung scarring Medical managment of paraquat ingestion in humans: Medical management of paraquat ingestion - PubMed (nih.gov) To page top Case report Paraquat intoxication Date: 2020/2021 Location: Thailand History A ... years old female Asian elephant that was kept as ....................(tourist camp, working camp, zoo, rehab camp. etc...) was exposed to the toxic chemical Paraquat in her mouth, trunk, and ankle area. The animal developed the following symptoms: u lcerations of oral mucosa, tongue, skin of the trunk foot and cuticles, hyperemia................... Appetite: (food, water intake) General symptoms: Behaviour: Treatment When the animal was brought to the Veterinary clinic, the following treatment was initiated: Turmeric .................. .................... Treatment results When were the forst improvements recovered Application of turmeric powder on the skin lesions The photos on the left show the lesions after 1 month treatment; the photos on the right were taken 10 days later. Foraging elephants poisoned by paraquat PUBLISHED : 5 MAR 2021 AT 16:01 CHIANG MAI: Seven elephants suffered serious burns to their mouths and tongues from eating grass contaminated with the herbicide paraquat at a border village in Omkoi district. Five of them were reported to be in critical condition. The paraquat poisoning occured at Khorphator village late on Thursday night. The domesticated elephants had been set free to forage for food, and ate the grass at nearby farms which had been sprayed with the banned chemical. Veterinarians and rescue workers were rushed to help after the elephants' distress was reported to Chiang Mai University’s Centre for Elephant and Wildlife Research and to the Kusol Songkhor rescue foundation. It took several hours for the team to reach the remote village, which is near the border. The vets examined the animals and diagnosed paraquat poisoning. The chemical had caused severe burning around their mouths and to the animals' tongues. They cleaned the injuries and gave the elephants anti-inflammatories. Five of them were diagnosed in critical condition. They were being trucked to the Elephant Hospital in Lampang for further treatment, the Thai Elephant Alliance announced on its Facebook page. The Centre for Elephant and Wildlife Research said the first three had already arrived at the hospital. The others were expected to arrive on Friday evening. The use of paraquat is illegal in Thailand. The NHSC issued a resolution banning the use of paraquat and chlorpyrifos in agriculture, effective from June 1 last year. Farmers' groups have lobbied strongly against the ban , arguing they have no alternative chemicals for insect and weed control. Many continue to use them. Three of the seven poisoned elephants arrive at the Elephant Hospital in Lampang for urgent treatment, after paraquat contaminated grass at a border village in Omkoi district, Chiang Mai. (Photo: Phanumet Tanraksa). The image on the right shows the severe lesions on the tongue of one of the affected elephants. Close-up image of the severe lesions on the tongue of one of the affected elephants. To page top Kodo millet intoxication (Cyclopiazonic acid ) Kodo millett (Vargu) Paspalum scrobiculatum has been reported to be responsible for the deaths of free-ranging elephants in India. The crop is grown in India, Pakistan, the Philippines, Indonesia, Vietnam, Thailand, and West Africa. Under certain circumstances, seeds may become infected with a fungus Claviceps paspali that produces a very stable mycotoxin (Cyclopiazonic Acid Toxicity) similar in action to ergot. Toxicity studies have shown degeneration, necrosis, and liver dysfunction, lesions of the myocardium, by affecting calcium signalling in the heart, leading to cardiomyocyte damage and impaired heart function as some of the symptoms. Symptomes Usually the elephants are found dead or moribund. Diagnosis The food source which contains sclerotia of the fungus needs to be found to get to a probability diagnosis. The presence of mycotoxins can be confirmed in the lab. In one outbreak of a Kodo millet intoxication in 13 elephants, Cyclopiazonic acid was detected in all samples of lever, kidney, spleen, heart, lung, stomach, and intestinal contents with concentration above 100ppb (parts per billion) in 10 dead elephants suspected of kodo-millet intoxication Treatment/Prevention If the intake of toxic food has taken place only a few hours before the animal was found, gastric lavage should be considered. Large borehole tubes should be used and a suction pump with sufficient capacity to wash the toxic products out of the stomach. In the mean time, the elephant should be protected from self-inflicted injuries if the animal is recumbent. Food and fresh water should be supplied if the animal is still capable of taking food and drinking. References Vet Med Small Anim Clin 72(4):633–637. 29. Morris, R.C. 1935. Death of 14 elephants (Elephas maximus Linn.) by food poisoning. J Bombay Nat Hist Soc 37:722–723. Wikipedia: https://en.wikipedia.org/wiki/Cyclopiazonic_acid Fowler M.E. 2006. In: Biology, Medicine, and Surgery of Elephants. Ed. Fowler & Mikota, Toxicology Chapter 33, 422-423 Newspaper articles: The Nation Herold : Bandhavgarh elephant deaths: Suspected poisoning from kodo millet, samples sent to UP for probe. The Indian Express : How consumption of kodo millet led to the death of 10 elephants in MP . The Wire : Toxins in Kodo Millet Crop Caused 10 Elephant Deaths in Madhya Pradesh: Toxicology Report. To page top Kodo millet intoxication

Esophageal spasms are rarely seen in elephants. This case reports describes this condition in an Asian elephant. Water regurgitation indicated the blockage of water, while the animal was unable to swallow any food. A home-made endoscope greatly facilitated the visualization of the esophagus and stomach wall. A standing sedation using detomidine and butorphanol was used during the treatment procedure. No mouth gag was needed to open the mouth. Continue To non-infectious diseases Case report Esophagus spasm Place: Selwo Zoo, Spain Date: 2019 Data provided by: Cecilia Sierra Arqueros, DVM History Species: Asian elephant Accommodation: Zoo Age, gender: 54 years, female For several years this female Asian elephant had episodes of rhythmic contractions in the ventral area of the neck at the entrence to the thorax (video 1). These contractions were only observed during in the cold seasons of the year. At the age of 54 years, she suddenly became unable to swallow her food and water (video 2). Video 1. Rhythmic contractions in the ventral neck area of an Asian elephant Day 1: The elephant tried to drink water. After 10-20 seconds the water came out her mouth again (regurgitation). The regurgitated water was clear and had no abnormal smell (no stomach smell). Appetite: in the morning she ate horse pellets and some roughage, but then she refused bread and apple slices (her favorites!). She tried to eat fresh gras, but after chewing on it, it came out; no smell of stomach contents. Refused to eat anymore. Regular defecation, though the fecal balls became smaller during the following day. The digestion of the fibers had not changed. Water regurgitation Day 2: No change. Oral inspection: 2 small (5 mm Ø) ulcerations on the tongue base, that were not there the day before. The animal did not cooperate as good as she did on the first day. A standing sedation was performed using detomidine and butorphanol. A 2.4 m plastic tube and flexible endoscope could be advanced into the esophagus, reaching the stomach. No mouth opener or gag was used. Gastric fluids were seen, but no obstruction in the esophagus was encountered. Video 2. Regurgitation of water. Endoscope Plastic tube with endoscope advanced into the esophagus. Treatment Rectal fluids Antibiotic + flunixin meglumine + Vit E/selenium Day 3: Standing sedation using detomidine and butorphanol. Treatment: antibiotics, dexamethasone, vitamin B complex, 240 L rectal fluids Day 4: In the morning, the elphant was able to drink water. Nevertheless another standing sedation was performed using detomidine and butorphanol. 3.5 meter tube inserted in esophangus with mini-camera. Antibiotic + dexametasone +vit- sel + complex B + Buscopan Thirty minutes after finishing the procedure, the elephant started to drink and she ate a melon. From that moment on her appetite came back and she did not regurgitate anymore. Differential diagnosis: Esophagus spasm Esophagus constriction: unlikely because this would have been confirmed by endoscopic examination. Botulism . Botulism had occured in the same environment 200 kilometers from this place, resulting in paralysis of the entire body and the death of the 4 affected elephants. Comments: Esophagus spasms in elephants have not been described before. There is only anecdotal evidence of this phenomenon in horses (van der Kolk, pers. comm. 2021). Hypocalcemia is high on the list of the differential diagnoses. Hypocalcemia has also been associated with " hiccups " in Asian elephants, occuring in the cold seasons. The total calcium concentration in this elephant was 2.7 - 2.9 mmol/l while the hematocrite was 48-50% (average normal value 35%), which is an indication that the elephant was dehydrated. The actual total serum calcium concentration in non-dehydrated condition was probably lower: 35/50 x 2.7 = 1.89 mmol/l. Conclusion: Hypocalcemia may have played a major role in this case of esophagus spasm. To page top

Broncho-alveolar lavage (BAL) describes: gastroscopy, bronchoscopy, esophagus, trachea, mouth-opener, mouth gag. Approach is done either via the trunk or via the via, always under standing sedation. The purpose of a BAL is to collect samples for culture/PCR (tuberculosis) or histology. To physical examination Sample collection Trunk wash Broncho-alveolar lavage Trunk wash procedure Trunk wash procedure Compiled by Willem Schaftenaar Background The trunk wash procedure was developed as a method for diagnosing tuberculosis or the detection of Elephant Endotheliotropic Herpes Virus. This procedure is an active manipulation at the elephant trunk, which can be performed in free and protected contact systems in non-immobilized elephants after they are conditioned for this procedure. The principle is that a sterile 0,9% saline solution (approx. 100 ml) is injected in each nostril of the trunk. The trunk has to be lifted actively by the elephant or passively by the keeper so that the solution is running up to the base of the trunk. The mixture of the solution and trunk mucus is collected in sterile plastic bags by active blowing of the elephant through its trunk (training required). The staff should protect themselves against spilling trunk content into their face. A full trunk wash procedure requires 3 different trunk washes performed within a period of 7 days. Each sample must be sealed and stored at 4°C. Depending on the quality of the samples, the diagnostic lab can decide to pool the samples for culture/PCR. Samples must be shipped to the TB-diagnostic lab immediately after the 3-rd sample has been taken. The maximum storage period at 4°C is 7 days. NB: follow the EU guideline for shipment of potentially hazardous biomaterials. For the (q)PCR detection of EEHV, the sample can be shipped directly or kept frozen at -20°C until shipment. Trunk wash in a non-contact situation requires a full anesthesia of the elephant and a portable fluid pump and sucking system, which allows the operation under sterile condition. The external pump and sucking system will be connected to a sterile PVC tube (1 cm diameter, with distance markers) with a length of approx. 2 meter. The amount of sterile solution and the collection bag are like described before. In non-contact situations, a bronchoalveolar lavage (BAL) under standing sedation is the preferred procedure. Training for a trunkwash procedure Broncho-alveolar lavage (BAL) and Gastroscopy Broncho-alveolar lavage Compiled by Willem Schaftenaar Procedure A bronchoalveolar lavage (BAL) may be indicated when a sample from the deeper regions of the lungs is required, such as for the diagnosis of tuberculosis (TB). Gastroscopy is a procedure that allows direct visualization of the esophagus and stomach. It enables the collection of biopsy specimens and stomach contents, and it can also be used to perform a lavage for TB diagnosis. Fluids obtained through BAL are additionally used for the isolation of mononuclear cells and for cytological evaluation (Engel, 2005). The procedure has been performed in free-ranging savanna African elephants under general anesthesia (Engel, 2005). The protocol described here outlines a workflow for the successful isolation and characterization of alveolar cells, predominantly alveolar macrophages, from BAL fluid. Differential cell counts and cellular characterization were carried out. This technique for isolating alveolar mononuclear cells provides a foundation for further investigation into the functions of respiratory immune cells. Under more controlled conditions, the procedure can also be performed under standing sedation . There are 2 ways to approach the alveoli: 1. Trunk approach An endoscope measuring 10–12 m in length is advanced through the trunk ( Hermes et al, 2017 ). The main advantage of this method is that the operator can remain outside the enclosure. However, the procedure requires an extra-long endoscope, which is not readily available. To facilitate passage of the endoscope alongside the cartilage plate in the trunk, bilateral block anesthesia of the nerve rami at the base of the trunk has been recommended (Hildebrandt et al.). Nonetheless, D. Schmidt has reported performing a similar procedure without block anesthesia (pers. comm., 2019). Once advanced, the endoscope allows visualization of the inner walls of the trachea and bronchi for bronchoalveolar lavage; biopsy samples can also be collected if required. In addition, the endoscope can be directed into the esophagus to perform gastroscopy or gastric lavage. 2. Oral Approach In this method, a 5 m long endoscope is introduced through the mouth. The primary disadvantage is that the operator must remain inside the elephant enclosure. A specialized mouth opener for elephants is required to provide access to the oral cavity. The endoscope may be guided manually into the trachea or introduced through a rigid plastic tube, which can be advanced relatively easily into either the trachea or the esophagus. Once within the trachea, the bronchial branches can be examined. Abnormalities may be assessed, and biopsy samples collected. Bronchoalveolar lavage samples are obtained by instilling 50–60 ml of 0.09% sterile saline into a bronchus, followed by aspiration of the fluid. For TB diagnosis, this procedure is repeated three times in each lung. Collection of stomach fluid and broncho-alveolar lavage in an adult African elephant by Dr. Imke Lueders ( https://www.geolifes.com/en/services/index.html) References: Engel S.C., Kerr T.J., van der Spuy G.D., Jooste T., Buss P.E., Johns J.L., Miller M.A., Kleynhans L.2025. Optimisation of bronchoalveolar lavage fluid preparation for mononuclear cell isolation and cytologic evaluation in free-ranging African elephants (Loxodonta africana ). Veterinary Immunology and Immunopathology, Volume 286 , August 2025, 110974. https://doi.org/10.1016/j.vetimm.2025.110974 Hermes R et al. 2018. Bronchoalveolar lavage for diagnosis of tuberculosis infection in elephants. Epidemiology and Infection https://doi.org/10.1017/S0950268818000122 To page top

We developed this website with the input of Elephant Veterinarians worldwide. -Willem Schaftenaar, DVM -Susan Mikota, DVM -Elephant Medicine This website is the joined effort of numerous veterinarians, who work with elephants world-wide. The name(s) of the vet(s) who contributed to a particular topic is mentioned in the left upper corner of each topic page. Some authors may wish to remain anonymous. In that case, the name has not be filled in. Some cases have been published online as open source manuscript and are incorporated in this website via an internet-link. You are encouraged to critically read the information and the clinical cases described on this website and send us your comments! Please submit your clinical cases, no matter whether they have a happy or a sad ending. By sharing our experience we can all learn from each other. Willem Schaftenaar, DVM Website moderator Worked for 30 years at Rotterdam Zoo as clinical veterinarian. Veterinary advisor to the EAZA elephant TAG Associate researcher Elephant Care International. Susan Mikota,DVM Co-founder and Director of Veterinary Programs & Research for Elephant Care International Contributions have been made both anonymously as by name. All the names are known to the moderator. Named contributors are (in alphabetic order) : Dalen Agnew DVM, PhD, DACVP, Department Chair and Associate Professor Pathobiology and Diagnostic Investigation at Michigan State University (USA) Marcus Clauss , University of Zürich (Switzerland) Thittaya Janyamethakul (Tip), DVM., MS, Patara Elephant Farm, Chiang Mai (Thailand) Christine Kaandorp , head veterinarian Rotterdam Zoo (The Netherlands) Arne Lawrenz DVM, director of Wuppertal Zoo (Germany) Susan Mikota DVM, Co-founder and Director of Veterinary Programs & Research for Elephant Care International (USA) Fieke Molenaar DVM, senior veterinary officer Zoological Society of London Zoo (UK) Joost Philippa DVM, zoo veterinarian at Rhenen Zoo (The Netherlands) Tina Risch DVM, Thüringer Zoopark Erfurt, Am Zoopark 1 D-99087 Erfurt (Germany) Ann-Kathrin Oerke , PhD, researcher at Göttingen Primate Center (Germany) and Research advisor to the EAZA elephant TAG Vijitha Perera DVM, Senior veterinarian Elephant Transit Home, Sri Lanka Van Thin Pham DVM, head veterinarian at Dak Lak Elephant Conservation Center (Vietnam) Christian Schiffmann DVM, veterinarian (Germany), research advisor to the EAZA elephant TAG Linda Schiffmann , zoo keeper, TBZ - Tierbegegnungszentrum, Hochrhein (Germany). Linda van Sonsbeek, DVM, head veterinarian Rotterdam Zoo (The Netherlands) Taweepoke Angkawanish PhD,DVM, Lampang Elephant Conservation Center (Thailand) Francis Vercammen DVM, zoo veterinarian at Antwerp and Planckendael zoo (Belgium) Jürg Völlm DVM, Basel Zoo (Switzerland, † 2021) Christian Wenker DVM, Basel Zoo (Switzerland) Kasper Willebrands, elephant headkeeper Rotterdam Zoo (The Netherlands) Malin Wiklund , area manager Colosseum and Savanna/Desert Kolmarden zoo (Sweden) About Us

Dirt, foreign bodies, a short tusk remnant after a tusk fracture and parasites (Cobboldia sp) can cause a purulent sulcus infection in elephants. To parasitology To dentistry case report Tusk sulcus infection Place: Dak Lak elephant Conservation Center Vietnam Date: 2017 Data provided by: Van Thinh Pham, DVM History Purulent discharge from the dental sulcus in an adult Asian elephant bull since a few days. The area around the sulcus was itching, demonstrated by the bull by frequent rubbing the tusk base against trees. Diagnosis Frequent blowing sand in the sulcus area may also be the cause of this problem. in this case, no sand or dirt was present in the sulcus. An infection with larvae of the stomach bot ( Cobboldia sp. ) was suspected. Treatment The dental sulcus area was cleaned with cotton wool and flushed with Betadine and the bull was treated with ivermectin SQ, 0,2 mg/kg BW Treatment results The sulcus lesion healed completely within 7 days. Cobboldia (stomach bot) larvae To page top

Abdominal surgery for male castration, laparoscopic ligation of the ovarian pedicles, umbilical hernia and abdominal surgery to treat repeated colics are described here. To procedures Surgery Surgery in elephants usually follows the rules that are applicable to surgery in horses. Standing sedation with or without local anesthesia is required for minor procedures, while general anesthesia (in lateral or dorsal recumbancy) is required for large procedures (such as abdominal surgery) and if standing sedation poses a risk for the surgeons. See for anesthetic procedures the anesthesia page . Abdominal surgery in elephants Access to the elephant's abdomen is restricted to a relatively small area between the last ribs on the cranio-dorsal side, the hind leg on the caudal side fusing together in the ventral midline. Indications for abdominal surgery described in the literature are limited: cesarean sections have all resulted in the death of the dam. However, a dorso-lateral approach has been used for castration of male African and Asian elephants (Fowler 1973, Byron 1985, Fourner 1994). Fourteen male African elephants (12–35 years old) were anesthetized with etorphine and supported in a sling in a modified standing position, and positive pressure ventilated with oxygen (Rubio-Martinez 2014). Anesthesia was maintained with IV etorphine. Vasectomy was performed under field conditions by bilateral, open‐approach, flank laparoscopy with the abdomen insufflated with filtered ambient air. A 4‐cm segment of each ductus deferens was excised. Behavior and incision healing were recorded for 8 months postoperatively. Successful bilateral vasectomy (surgical time, 57–125 minutes) was confirmed by histologic examination of excised tissue. Recovery was uneventful without signs of abnormal behavior. Large intestine lacerations (3 elephants; 1 full and 2 partial thickness) were sutured extracorporeally. One elephant that was found dead at 6 weeks, had no prior abnormal signs. Skin incisions healed without complication. Laparoscopic ligation of the ovarian pedicles has been performed in free ranging African elephants (Stetter 2004). A specially designed 90 cm long operating laparoscope was used to reach for the ovaries. An umbilical hernia was diagnosed in a 2-wk-old Asian elephant (Elephas maximus) by physical and ultrasonographic examinations (Abou-Madi 2004). Umbilical herniorrhaphy was elected because the defect was large (approximately 7 cm long and 10 cm deep) and could potentially lead to incarceration of an intestinal loop. General anesthesia was induced with a combination of ketamine, xylazine, and diazepam and maintained with isoflurane in oxygen. The hernial sac was explored and contained fibrous tissue, fat, and an intestinal loop but no adhesions. The hernial sac was resected and the body wall closed using the technique of simple apposition. Following a superficial wound infection, the surgical site healed with no further complications. There is one anecdotal report on successfull abdominal surgery in a 14-month-old African elephant suffering of repeated colics ( click here for the case report). References Abou-Madi, N., Kollias G.V., Hackett R.P., Ducharme N.G., Gleed R.D., and Moakler J.P. 2004. Umbilical herniorrhaphy in a juvenile Asian elephant (Elephas maximus ). J. Zoo & Wildl. Med35(2): 221–225, 2004. Byron H.T., Olsen J., Schmidt M., Copeland J.F. and Byron L. 1987. Abdominal surgery in three adult male Asian elephants. J. Am. Vet. Ass. 187, 11. Foerner J.J., Houck R.I., Copeland J.F., Schmidt M.J., Byron H.T. and Olsen J.H. 1994.Surgical castration of the elephant (Elephas maximus and Loxodonta africana ). J. Zoo & Wildl. Med. 25 (3), pp 355-359. (Click here for summary) Fowler M .E., Hart R. 1973. Castration of an Asian elephant, using etorphine anesthesia. J. Am. Vet Ass 163, 6. Rubio- Martinez L.M. Hendrickson D.A., Stetter M., Zuba J.R. and Marais H.J. 2014. Laparoscopic Vasectomy in African Elephants (Loxodonta africana ). Veterinary Surgery 43 (2014) 507–514. Stetter M.D. 2004. Laparoscopic surgery in elephants. Int. Elephants Res. Symp. Fort worth, Texas. December 2-5, 2004 Non-abdominal surgery in elephants Surgical procedures not associated with open access to the abdomen are more common. Despite the enormous healing capacity of the elephant skin, wound healing often takes place per secundam, because it is hard to protect the sutured wound against negative mechanical and biological influences. However, even large wounds (like in vaginal vestibulotomy ) will heal completely per secundam, leaving at most a 2 mm fistula ( click here for wound healing in vaginal vestibulotomy). Trunk injuries are hard to repair because of the extreme mobility of this organ. Many attempts to suture large perfortaing trunk wounds have have failed or at best resulted in partial adhesion of the sutured sites. Repair of a perineal hernia has been described ( click here to read this case report).

This page describes the normal birth process in elephants, including progesterone and ultrasound monitoring, preparation, list of requirements for veterinary assistance, transrectal massage to induce the Ferguson reflex and post-partem care. To reproduction Normal birth process This chapter is based on the EAZA Guidelines for the reproduction-related management of female elephants . Taken care at the birth process means that the pregnancy has been confirmed. More detailed information is provided in the chapter: pregnancy confirmation. After a pregnancy period of 87- 95 weeks (610- 670 days, 20-22 months), parturition is sometimes announced by subtile changes in the behaviour of the elephant. Twentyfour hours observation including the use of a (time-lapse) video recorder starting in week 85 may add to information about relevant events prior to parturition: night pacing, kneeling down, climbing, short periods of separation from the group, beating the vulva with the tail, frequent production of small-sized feces and small quantities of urine, loss of mucous plug, playing with mucous plug, rupture of the allantois sac, labour waves. Preceding any recommendation in this chapter, the following remarks need to be made: It is a myth to think that a multiparous elephant does not need to be monitored and assisted during parturition according to this protocol. Too many calves have been born dead or very weak because of the fact that parturition had started unnoticed and stopped unnoticed. In our view, this protocol should be followed in ALL cases of elephant parturition as much as the elephant management allows. It is a also myth that oxytocin is a harmless drug to be used in elephant parturitions. In at least 3 cases the administration of oxytocin has been associated with the occurrence of an uterus rupture because of insufficient cervix dilatation. It should never be used without ultrasonographic examination of the cervix uteri. The visible presence of the allantois sac as a subcutaneous bulging mass under the tail is not a guarantee for a sufficiently dilated cervix. Many elephants, including very experienced multiparous elephants may just stop the parturition process, often unnoticed. Hypocalcemia is one of the main causes for this phenomenon to happen.This will compromise the health of the calf. Don’t relay only on what you see from the outside! For a proper judgment about the presence of labor activities or the progress of parturition, your professional judgment should be based on the results of progesterone tests and ultrasonographic examinations. If you do not believe in the above mentioned statements, you may find yourself confronted with a dead elephant calf or a dead elephant mother or both. So, discuss this item with your staff and make your decision before you start breeding your elephants. If the management of elephants in your zoo does not allow blood sampling or ultrasonographic examinations, you must be aware of the risks associated with a silently interrupted birth process, no matter the reproductive experience of the animal involved. Safety for the personnel should never be challenged by unacceptable risks. Predicting the time of parturition, measures and observations: Daily blood sampling from week 89: every other a day progesterone assay, until week 91 (637 days). From week 91 (637 days): daily assays and as soon as progesterone starts to decrease: sample twice daily. Daily monitoring of progesterone is only possible if you have a nearby facility that runs these assays on a daily basis. Find out from your nearby hospital in the early stage of pregnancy! Many veterinary labs do not have tests that are sensitive for levels of progesterone (P4) in elephants 1-3 days prior to delivery. Also check the availability during the weekend. NOTE: a decrease of progesterone to baseline level is not always occurring. A 23-yrs-old Asian elephant at the Rotterdam zoo (with a baseline progesterone level < 0.6 nmol/l) delivered a healthy calf while her progesterone remained above 0.65 nmol/l. Progesterone plasma concentration during pregnancy. After a gradual decrease in the last months of gestation, progesterone drops to baseline level a few days before parturition. Note that the absolute height of the progesterone concentration depends on the assay used! Different assays measure different metabolites = different levels! Signs of an approaching parturition may include: ·Loss of mucous plug (not seen in many facilities) ·Pre-and post-parturition ventral edema may be noticed. ·Group members may react differently (vocalizations, restlessness) ·In most cases (75%) rupture of allantois sac and loss of allantois fluid (looks like urine) is seen within 2 hours prior to birth. ·The size of fecal balls may get smaller towards the end of pregnancy. ·Frequency of urination may increase around parturition, resulting in more “watery” consistency of the urine, resembling more like allantois fluid . ·Development of mammary gland and production of milk shortly before birth is often seen, however this may also occur in a much earlier stage of pregnancy . Milk accumulation can be visualized using transcutaneous ultrasonography several hours prior to parturition. ·Softening of the pelvic ligaments (due to estrogen surge) may result in slightly abnormal locomotion of the hind legs. Parturition/Preparations for calving: ·Training and/or desensitizing of the pregnant elephant for veterinary intervention, like blood sampling, injections, IV-infusions, milking and rectal manipulations ·If possible, store some colostrum (freezer) or store plasma obtained from the dam in weeks prior to parturition. ·Have artificial milk available (Salvana GmbH, Germany; hand raising has been done at Emmen Zoo and Berlin Zoo) ·Check restraint chains and fixation points for the legs and one extra fixation point between the hind legs for pulling devices. Soft ropes for pulling the calf away if needed should be available. The use of a calf harness has been described. ·Check the stable and place bars where a calf could possibly escape. Block all possible escaping routes for the calf (not for staff!!). ·Take out all obstacles. ·Be prepared for closing the elephant house for the public (sign post, etc.) ·Make sure there is a good stock of commercial cat litter or saw dust to be used on a concrete floor as soon as the calf is born. This will absorb much of the allantois fluids and prevent the animals from slipping on the wet floor. ·2 or 3 pairs of keeper-gloves (soccer) to get a better grip on the wet, slippery calf when needed ·Plastic hose pipe (with pump, if necessary) for rectal cleaning with lukewarm water ·3 birth-chains with proper handles (2 for the legs, 1 for trunk or tail); find a way to avoid back sliding when manual extraction (vaginal vestibulotomy) is required. ·Drugs to be kept in store: ·Ca-borogluconate for I.V. infusion ·Estradiol gel (EstroGel® 0.06%) ·Oxytocin ·Lidocain ·Xylazine, detomidine or medetomidine ·Butorphanol ·Azaperone ·Atipamezole ·Doxapram ·Oxygen ·(Betadine®-)iodine solution for navel disinfection (umbilical infection is a major cause of perinatal complications) ·Lubricant (many liters). J-lube®, a concentrated lubrication powder, has proven to be very useful. The normal calving process should take place within 2 hours after rupture of membranes (release of fetal fluids). If the plasma progesterone level decreases to below base line concentration, this is a signal that calving should take place within 48 hours. Prolonged intervals have been reported (as long as 14 days) still resulting in the birth of a living calf, but it is very likely that this is due to a disturbance of the normal birth process that should be corrected before the health of the calf is jeopardized. There is one report of a parturition taking place without a complete drop to base line level. The calving process is a natural process. Elephants should give birth in their own social environment, excluding any external disturbing factors (e.g. noisy building in the neighborhood, visits of unknown individuals, etc.). With a well trained animal, blood sampling and ultrasonographic examinations can be done while the animal is temporarily separated from the group. Immediately afterwards, the animal should return to its group. All efforts should be made to make sure that the calf is born in the group while the mother is NOT chained! This will stimulate the acceptance of the calf by the mother and group members and is an investment for future breeding successes for the entire elephant group. To determine the right moment when calving starts, 2 parameters are essential: - The progesterone blood level - The relaxation of the cervix, monitored by ultrasonographic examination. Progesterone: the sensitivity of the equipment and the time needed to run the assay are the bottleneck for using the progesterone concentration as a reliable tool. Today many human hospitals use advanced equipment with a very low detection level that can provide results in less than 2 hours. Make sure that you have made arrangements with a lab long before you expect the parturition. Ultrasonography: to use this technique as a reliable tool, it is indispensable for the veterinarian to gain experience long before the elephant birth is expected. This will enable the veterinarian to distinguish a normal cervix from the relaxed cervix (figure 4a + b) from the normal cervix. Preferably a 3.5 MHz probe should be used transrectally. Longitudinal, transrectal ultrasonographic image of the vagina and the closed cervix of a pregnant e lephant. The same image as with the vagina and cervix indicated with white lines. Transversal, transrectal ultrasonographic vagina and cervix of a pregnant elephant. Allantois sac with cloudy fetal fluid in the (partly) dilated cervix of an Asian elephant 12 hours prior to delivery (transverse section, white arrows: allantois sac, open arrow: pelvic bone) The same image with the vagina and the closed cervix indicated by white lines. Note the folds in the cervix uteri. Allantois sac with cloudy fetal fluid in the (partly) dilated cervix of an Asian elephant 12 hours prior to delivery (longitudinal section, white arrows: allantois sac, open arrow: pelvic bone) During the last 2 weeks of gestation, the mucous that is present in the vagina during gestation will be discharged gradually. This is a clear indication for a pending parturition. Recognizable onset of parturition occurs normally within 24-48 hours after progesterone has dropped to below base-line level. In these guidelines the absence of visible signs of parturition in the same time frame is considered an abnormal condition; this status requires veterinary intervention. At this point 2 situations may occur: the parturition process has started but has been interrupted without or with spontaneous rupturing of the allantois sac. Interpretation of findings and action to be taken 1. No rupture of allantois sac noticed If the calf is not born by natural way 24 hours after blood progesterone has dropped to baseline level, rectal palpation and ultrasonographic examination of the cervix is highly recommended. This will demonstrate the rate of relaxation of the cervix, the presence of the allantois sac or parts of the fetus in the cervix or vagina and should be repeated at least every 8 hours. A blood sample should be taken to measure the calcium level. If below 2.5 Mmol/l, calcium should be administered as an IV-infusion (NB: when given in an ear vein, it should be given strictly IV in order to avoid damage to the vein) or orally (suggestion: calcium syrup concentrate for human use, enveloped in the carton core of toilet paper, covered and sealed with fresh tamarind paste has worked well; most elephants will eat it, including the carton material). The effect of the calcium administration should be confirmed by rectal palpation (increase of contractibility of the uterus) and determination of the blood calcium level. Store an EDTA and heparine sample for herpes virus diagnostic purpose (both cells and plasma in freezer after separation). Transrectal ultrasonographic examination at 48 hours: A. No relaxation of the cervix at 48 hours: search for calf movements and nail position of the fetus (palpation and ultrasound) and blood flow in fetal vessels (ultrasound). Transcutaneous ultrasonographic examination (both flanks have a small ”window” where visualization of fetal movements may be seen) may help to determine the status of the fetus. Apply estrogens rectally. Good results have been obtained by the rectal and transdermal (perineum) application of an estradiol containing estrogen gel (Estrogel 0,06%, total dose 700-800 mg estradiol). The effect on the cervix dilatation should be monitored closely by transrectal ultrasonography! At this time, at least 1 hour after the local application of estradiol, rectal massage should be applied to test and stimulate the contractibility of the uterus. Technique: remove feces from rectum, flush out the rectum, use abundant lubrification, keep both gloved hands (NB: the rectal mucosa is vulnerable due to estrogens) with the fists joined in a firm grip and press with the wrists or the dorsal sides of the hands against the pelvic ring to stimulate the pelvic receptors until strong labor waves appear or at least 10 minutes. When labor waves occur, continue this massage for 3 hours (if needed change operator). Check regularly by means of ultrasound the condition of the cervix. If there is still no cervix relaxation, continue monitoring the viability of the calf. If no fetal parts can be detected, consider the presence of pseudopregnancy (ovarian tumor, dysfunction of the pituitary gland, etc.). The application of estradiol gel (total dose: 400-500 mg 17-β-estradiol) as described above may be repeated 3-4 hours after the first treatment if the cervix dilatation is still incomplete. B. Partial or complete relaxation of the cervix at 48 hours or later as a result of the situation described under 1A: Apply rectal massage to test contractibility of the uterus. If limited or no reaction, the administration of oxytocin is contra-indicated. In this case, the administration of calcium is recommended (even when blood calcium level is within normal ranges). After 2 hours the use of estradiol as described under 1.A is recommended. Only if uterus contraction can be provoked by the rectal massage, the use of oxytocin may be considered using the following dosage: 25-50 IU oxytocin s.c. or i.m. (if needed use a blow dart). Oxytocin should be used with care, as it may dramatically exhaust the contractibility of the uterus muscles as well as the general condition of the female. There might also be the risk of reduced blood circulation in the umbilical chord, due to the spasms in the myometrium. Prostaglandine E (dinoproston) has been used on a few occasions for cervix dilatation (after the administration of estradiol) and to stimulate uterus contractions. As there is still limited knowledge of its efficacy after transrectal administration and the risk of stormy uterus contractions, it should only be used when any obstructions or abnormalities of the calf can be ruled out. Depending on the progress obtained, rectal massage and the administration of oxytocin are the 2 major treatments to follow from this point. In between these treatment events, the animal should be exercised to relieve the pain and stimulate position changes of the calf and preferably it should be kept in the group. Only when the animal cannot be separated whenever required, the cow should be kept separated from the group, but with as much physical contact as possible. Oxytocin should be given in intervals of at least 2 hours for a maximum of 12-24 hours under the guidance of ultrasound to evaluate tAhe progress. Continue this approach of treatment until parts of the calf have entered the pelvic cavity. If the efforts remain unrewarded and no access to fetal parts is possible, not much can be done. Continue monitoring the viability of the calf. If the calf has died, while the membranes are still intact, the risk of intoxication is limited, but immunosuppresion could be a complication for the cow. To date, no proper data are available. The dosage of oxytocin may only be increased to 100 I.U. after parts of the calf have entered the pelvic area and progress is clearly observed. At this time, a bulge containing parts of the body under the tail of the dam should be visible. Progress of parturition must be monitored strictly at this stage. If this increased dose of oxytocin does not result in parturition a vaginal vestibulotomy should be performed soon to get better access to the calf. See next chapter. Expulsion of the calf should follow soon after the bulge appears under the tail of the dam. The allantois sac usually ruptures during the (induced) passage through the pelvic canal. One complication described at this stage, is reduced passage space as a result of edema in the urogenital canal resulting in a “catching effect” of the head and/or shoulder of the calf inside the soft part of the distal (vertical part) genital tract. Suffocation of the calf is a realistic complication. This condition has been observed several times in primiparous elephants of more advanced age. Elephants in this category should be prepared by the local application of J-Lube in the distal part of the vaginal vestibulum and massage of oestrogel/creme in the skin between anus and vulva. If this condition occurs, quick intervention is required by applying firm manual pressure from the outside on the calf in the sliding direction of the calf. Be aware of the risk of kicking by the mother. 2. Ruptured allantois sac A significant event in the parturition process is the rupturing of the allantois sac, which – when intact - acts as a hydraulic dilatator for the cervix, a natural lubrication for the dam and a pressure protection for the calf. NB: The amniotic sac that covers the body directly, usually remains intact during the expulsion of the calf and ruptures during the final passage through the birth canal and is actively removed by the dam. NB: a chained dam, may not be in the position to remove these membranes, possibly resulting in suffocation of the calf. Differentiation between urine and fetal fluids is extremely difficult; smell, creatinin test strips and possibly protein concentration could be helpful. If no progress in parturition is observed, major complications should be considered, like a dead calf, malposition of the calf (which is often dead), oversized calf, malformation and twin pregnancy. Because of the urgency of this situation, the calf should be born within 2 hours after rupture of the allantois sac and loss of allantois fluid. If not so, veterinary intervention has to take place. Two situations may occur: No fetal parts positioned in the pelvic area: treatment should aim on the urgent relaxation of the cervix. Calcium status should be determined and treated accordingly (see above). The further approach is according to 1A, however the situation is more critical for both the dam and the calf. Fetal parts have entered the pelvic area: Calcium status should be determined and treated accordingly (see above). Ultrasound is essential to determine which fetal parts have entered the birth canal, determine the position of the calf (visualization of the nails, posterior or anterior position, number of nails, trunk) and viability. Malposition (e.g. only one leg in birth canal, no head while in anterior position) is an indication for vaginal vestibulotomy or fetotomy. If no abnormalities are found during ultrasound, 50-100 I.U. of oxytocin should be given i.v. or i.m. and rectal massage should be practiced. Birth should be completed within 1 hour. Other drugs used Uterine laxants have been used in elephants on rare occasions. There are some anecdotal reports about the use of denaverinehydrochloride (Sensiblex®, Veyx) at a dose of 0,04 – 0,05 mg/kg BW (i.m.). Isoxsuprinelactate (Duphaspasmin. Fort Dodge Animal Health, 6290AA Vaals, The Netherlands) was used in a fetotomy case at 0,15 mg/kg BM (i.m.). Carbetocine (Depotocin®, Veyx), a long acting oxytocine has been used in 3 occasions dosage (0,09 µg/kg BW) i.m. Presentation of the calf A study in 46 elephants demonstrated that the overall ratio between anterior and posterior presentation was 12:34. In dystochia cases the situation was quite different: 6:3. In normal birth procedures the ratio was 6: 29. Anterior presentation has a higher risk of dystochia than posterior presentation of the calf. (Ilic D. et al. 2021. The incidence of anterior and posterior presentation at birth in Asian (Elephas maximus ) and African elephants (Loxodonta africana ): A Review Study. Indian Journal of Animal Research.DOI: 10.18805/IJAR.B-1319) It has been observed that the calf may rotate during the final phase of the expulsion, similar to what happens in horses and cattle (see video). This may be important in case of a dystocia, if the calf has remained in complete 'horizontal position' and a vaginal vestibulotomy is indicated. Note that the calf has rotated during the final phase of the expulsion. Transrectal massage: Transrectal massage is a very effective method to stimulate uterine contractions if the uterus is prepared for it . Certain conditions (especially hypocalcemia) may impair the contractions. This should be solved first. Stimulation of the pelvic wall by rectal massage is known as the Ferguson reflex . Transrectal massage of the pelvic wall is best performed by firmly pressing the closed fost against the roof and sides of the pelvic cavity and on the dorsal side of the vagina making the movements as shown in this video. Post-partum care Disinfection of the navel with Betadine® iodine is strongly recommended (if the mother allows its application). The afterbirth usually comes off within 12 hours. There are a few reports on retained (parts of) placenta for several weeks, without major complications for the dam. Hygienic measures should be applied to reduce the infectious burden for the calf. Be aware of the fact that a second calf can still be present in the dam. There are reports that second calves were born between several hours up to 3 months (the prevalence of twins in elephants is 1:3000). The calf should drink (colostrum) as soon as possible, at least within 24 hours. If not, or when the calf makes a weak impression, the banked serum (or freshly taken serum) should be given to it orally. Try to find out the reason why the calf is not drinking successfully: e.g. too small, weak, painful mammary glands, malbehaviour of the dam. If for any reason the mother is rejecting the calf, lactating herd member can take care of the calf. There is evidence that the mother takes over from this surrogate mother during the first 72 hours. If no lactating elephant is present in the herd, training for bottle feeding should start after 12 hours and continued for 72 hours. If the mother still rejects her calf, the best option for the calf is to move it to another herd with a lactating elephant. If introduction to this herd fails too, bottle feeding is the last option. To date very few bottle-raised elephants have reached the age of puberty. To page top

Intramuscular, subcutaneous, intravenous and epidural injection techniques are described in this chapter. To procedures Injection techniques Hand injections Intramuscular injection: Subcutaneous injection: Intravenous injection: Epidural injection: An epidural injection in elephants is recommended when a vaginal vestibulotomy is performed in order to reduce tail movements of the elephant and provide additional analgesia in the perineal region. Procedure: Restrain the elephant as appropriate in a chute and sedated if necessary. Disinfect the injection site. Move the tail up and down to determine the position of the most mobile intercoccygeal space. Inject local anaesthetic (2% Lidocaine) into the skin over the injection site. Palpate the intercoccygeal space wearing a sterile glove and insert the needle (14 gauge, 3 inch) at approximately a 60 - 70 degree angle cranially. The epidural space is about 6.5 cm below the skin surface. Inject Lidocaine : 30 ml was sufficient to produce tail relaxation in a 3,000 kg elephant, and the elephant remained standing. Remote injections Make your own blow dart Blow dart injection: Jam-stick injection: Dart gun injection: To page top

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