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This page directs you to a variety of non-infectious disease conditions in elephants: -bone fractures -botulism -colic -dental problems -dermatology -esophagus obstruction/impaction -esophagus spasm -hiccup -intoxication -lameness/orthopedic problems -mesenteric hernia -ophthalmology -perineal hernia -reproduction problems -tetanus -umbilical hernia Non-infectious diseases Bone fractures 'Hiccup' Botulism Clostridiosis Colic (abdominal pain) Dentistry Intestinal impaction Intoxication Lameness/orthopedic problems Mesenteric hernia Dermatology Edema Esophagus obstruction Esophagus spasm Ophthalmology Perineal hernia Reproduction problems Tetanus Umbilical hernia Clostridiosis I need your input to write these chapters: Bloat Constipation Neonatal problems Urinary/kidney problems Clostridiosis Tetanus Enterotoxemia Clostridioides difficile Malignant edema Black leg Clostridium novyi Botulism

This case report describes the treatment of temporal gland impaction in an Asian elephant by regular flushing the gland. Diluted povidone-iodine and a product called Skinsept Mucosa (containing clorhexidine and hydrogen peroxide) were used as antiseptic fluids. -Temporal gland -Asian elephant -Treatment -Flushing Continue To dermatology Case report Temporal gland impaction History Species: Asian elephant Accommodation: Zoo Age, gender: adult, female Following a musth period the right temporal gland of an adult Asian bull started to swell within a short period. An impaction of the gland duct was suspected. The elephant was well trained and could be examined and treated without sedation. The manipulations were painful, but well tolerated by the animal. The animal was rubbing the area and continuously tried to sip out the content from the region and he frequently threw sand on it. Rostrally from the gland a fistula was formed spontaneously, discharging pus and necrotic tissue. Treatment After the tension subsided and the contents was released, the animal allowed flushing the region, which was done at least twice daily and was continued for several weeks, when the frequency was reduced to once daily. Diluted povidone-iodine and a product called Skinsept Mucosa (containing clorhexidine and hydrogen peroxide) were used as antiseptic fluids. The fluid was administered through a very long catheter to reach the deep part of the gland and flushing was powerful. This produced a lot of necrotic tissue which sometimes blocked the possibility of discharge. For 2 weeks, intramammary infusion injectors (Ubrolexin with cephalosporin) were used to inject an antibiotic inside the fistle. Treatment results After 2 months the size of the temporal gland was back to normal and the fistle had closed completely. To page top

The "Infectious diseases"pages directs you to diseases caused by viruses, bacteria, protozoa and parasites. Infectious diseases Virus infections Rabies Foot and Mouth disease Encephalomyocarditis EEHV Pox virus Bacterial infections Tuberculosis Anthrax Salmonellosis Leptospirosis Pasteurellosis Parasite infections Ectoparasites Stomach bots Nematodes Cestodes Trematodes Blood parasites Cutaneous filariasis Zoonotic diseases To page top

Monitoring fecal quality in elephants includes regular control on parasites, consistency and fiber length. Fecal quality reflexes molar condition, food passage speed and presence of parasites. Intestinal infections can cause abnormal feces. Increased fibre length can indicate poor mastigation due to abnormal molar wear. Fecal quality control Compiled by Christian & Linda Schiffmann The physiology of defecation in elephants Elephants are megaherbivores with a mean retention time of about 24 hours (Rees 1982; Hackenberger 1987). Elephants do defecate on average around 12-16 times per 24 hours with a mean amount of five fecal boluses per defecation (Coe 1972; Ratnasooriya et al. 1994). Being hind gut fermenters, the plant fibers of their diet are shed in the feces exactly the size as they have been swallowed after being chewed. Therefore, fecal particle size is correlated to chewing efficiency in elephants. With respect to this physiology, fecal quality offers a valuable opportunity to assess an elephant’s digestive health. Accordingly, regular fecal check is strongly recommended as an integral part of continuous health monitoring in elephants under human care. Aspects to be assessed through regular fecal checks We recommend checking the following criteria for elephant feces in the indicated intervals: fecal consistency, structure and bolus size – on a daily basis fecal particle size – monthly coproscopy in order to detect intestinal parasites – 1-4 times a year (depending on regional parasite prevalence and housing conditions). In addition, fecal samples can be used to determine glucocorticoid metabolites and reproductive hormones, if this information is relevant for management decisions or scientific research. Fecal consistency, structure and bolus size Although fecal consistency and structure may slightly vary depending on diet composition, it usually allows the building of well-shaped and evenly sized boluses (Fig. 1a). Ideally, the boluses are compact and can be taken from the ground without breaking into pieces. They have a brown color which can tend towards slight green or yellow depending on the roughage fed. Gastrointestinal disorders as well as short-term stress may lead to reduced fecal consistency resulting in varying degrees of diarrhea (Fig. 1b-e). Not well-masticated food stuff (e.g. seeds, fruits) can be observed in the fecal boluses (Fig. 1f), as well as foreign materials which have been swallowed intentionally or unintentionally. These indicators provide information on which material the elephant has access to and on his (potentially abnormal) feeding behavior. Fecal bolus size varies with age and therefore size of an elephant (Coe 1972; Morrison et al. 2005; Leopardi et al. 2013). Elephants with improper chewing efficiency (e.g. due to molar issues), may show heavily enlarged fecal boluses as a consequence of poorly masticated roughage (Fig. 2). Such mega boluses may cause abdominal pain or even lead to constipation. In addition to the bolus size, also the total amount of feces during a 24h cycle should be checked. Showing an increased or decreased amount of feces may hint to digestive disorders or inappropriate feed intake in an elephant. Even the distribution of fecal boluses in the habitat of an elephant may tell you a story. As an example, geriatric individuals suffering from severe degenerative joint disease may not interrupt their lying rest to defecate, which can be recognized by the pattern of their defecations (Fig. 3). Taking this together, macroscopic fecal check as a daily routine can provide experts in charge with a multitude of valuable information on elephants’ (digestive) health status. Figure 1. Fecal consistency in elephants may vary from well-shaped firm boluses in a healthy situation (a) to different degrees of diarrhea with reduced fecal consistency (b-e). Unchewed parts such as corn may offer additional information on an elephant’s food intake on the previous day (f). Picture a: Photo Courtesy of Martin Kristen. Pictures c,d and e Photo Courtesy Patrycja Kasprzak. Figure 2. Mega boluses of different sizes (cell phone for size comparison) and in relation to regularly formed fecal boluses (upper right). Note the large plant fibers contained in the mega boluses (left). Photo Courtesy of Martin Kristen. Figure 3. Defecation pattern of an elephant suffering from severe degenerative joint disease and therefore avoiding to interrupt its lying rest for defecation. Healthy elephants do get up from recumbency in order to defecate. Fecal particle size Chewing efficacy has been shown to vary during an elephant's lifetime, presumably due to continuous changes in the molar grinding surface caused by the physiological process of molar progression (Schiffmann et al. 2019). Fecal particle size as an indicator for chewing efficacy can be used to monitor these physiological changes over time and to detect pathological alterations (Fig. 4). A simple sieving method allows the determination of fecal particles by focusing on the largest fibers. This method is practical in the field and has been shown to correlate well with a sophisticated approach in the lab (Schiffmann et al. 2023). A concise description of the procedure is given in Figure 5. It is recommended to document the detected size of the ten largest fibers photographically (Fig. 6). This enables the monitoring of fiber length of an individual elephant over time. Of course, this information should be completed with parallel monitoring of the molar status, which can also be documented photographically (Fig. 7). Figure 4. Obvious difference in fecal particle size between two female Asian elephants on the same diet, but with varying chewing efficacy. While one female with a healthy molar status was able to chew roughage as needed (a), the other female suffered from molar issues and struggled to chew properly (b). Figure 5. Guidance for a simple sieving protocol to determine fecal particle size in elephants. Figure 6. The size of the ten largest fibers can easily be documented photographically. Figure 7. Ideally, molar status in the upper and lower jaw should be monitored and documented on a regular basis. We recommend a frequency of three months for photographic documentation. Coproscopy for the detection of intestinal parasites Basically, African as well as Asian elephants are susceptible for clinical gastrointestinal parasite infestation. Most relevant gastrointestinal parasites for elephants do belong to the trematoda, cestoda, nematoda and protozoa (Vimalraj and Jayathangaraj 2013; Abeysekara et al. 2018; Chel et al. 2020). Severe parasite loads are reported in free-ranging as well as captive elephants in the range countries with the potential for fatal outcomes (Kinsella et al. 2004; Obanda et al. 2011; Nishanth et al. 2012; Hing et al. 2013; Vimalraj and Jayathangaraj 2013; Lynsdale et al. 2017; Abeysekara et al. 2018; Kingori et al. 2020). They seem less relevant in modern zoos. Prevalence of gastrointestinal parasites seems significantly higher in free-ranging elephants compared to elephants living in human care (Abeysekara et al. 2018; Abhijith et al. 2018). The composition of parasites seems to shift from helminth-dominated in free-ranging elephants to mostly protozoa in captive elephants, presumably due to regular anthelminthic treatment in human care (Abeysekara et al. 2018). Based on these reports, the recommended monitoring interval heavily depends on the geographic region and the housing conditions in particular regarding feed hygiene (Fig. 8). In Western zoos annual to biannual coproscopy seems a reasonable protocol, if appropriate hygienic conditions are ensured. Figure 8. Providing roughage in top-feeders (e.g. hay nets) can significantly reduce contamination of food items and ensure hygienic conditions. Especially for Asian elephants, these feeders should not be too high (like on this photo) as this may place too much strain on the flexibility of the spine, which could result in damage to the spinal joints. In order to cover the intestinal parasite species relevant for elephants, the fecal sample should be examined both by sedimentation as well as flotation. Table 1 gives an overview on which detection method is appropriate for which parasite species. Various treatment options are available (Fowler and Mikota 2006). If anthelmintic treatments are administered a subsequent coproscopy should be conducted to confirm the effectiveness of the treatment (Lynsdale et al. 2015). Table 1. Appropriate detection methods for the parasite classes most relevant in elephants Summary Regular fecal checks provide a non-invasive, simple and cheap opportunity to monitor an elephant’s molar and digestive health. Fecal consistency, structure and fiber length provide valuable information and should be checked on a regular basis. In combination with parasitology in the lab on an interval appropriate for the parasite prevalence in the region, these fecal checks present an important part of health monitoring in elephants under human care. References Abeysekara N, Rajapakse RPVJ, Rajakaruna RS (2018) Comparative cross-sectional survey on gastrointestinal parasites of captive, semi-captive, and wild elephants of Sri Lanka. Journal of Threatened Taxa, 10, 11583-11594. http://threatenedtaxa.org/index.php/JoTT/article/view/3406 Abeysinghe KS, Perera ANF, Fernando P (2012) Developing a practical and reliable protocol to assess nematode infections in Asian elephants. Gajah, 37, 22-26. Abhijith TV, Ashokkumar M, Dencin RT, George C (2018) Gastrointestinal parasites of Asian elephants (Elephas maximus L. 1798) in south Wayanad forest division, Kerala, India. Journal of Parasitic Diseases, 42, 382-390. https://link.springer.com/article/10.1007/s12639-018-1012-0 Baines L, Morgan ER, Ofthile M, Evans K (2015) Occurrence and seasonality of internal parasite infection in elephants, Loxodonta africana, in the Okavango Delta, Botswana. International Journal for Parasitology: Parasites and Wildlife, 4, 43-48. Chel HM, Iwaki T, Hmoon MM, Thaw YN, Soe NC, Win SY, Bawm S, Htun LL, Win MM, Oo ZM, Masum MA, Ichii O, Nakao R, Nonaka N, Katakura K (2020) Morphological and molecular identification of cyathostomine gastrointestinal nematodes of Murshida and Quilonia species from Asian elephants in Myanmar. International Journal for Parasitology: Parasites and Wildlife, 11, 294-301. Coe M (1972) Defaecation by African elephants (Loxodonta africana africana (Blumenbach)). East African Wildlife Journal, 10, 165-174. Fowler ME, Mikota SK (2006) Biology, Medicine, and Surgery of Elephants. Iowa, USA, Blackwell Publishing. Hackenberger MK (1987). Diet digestibilities and ingesta transit times of captive Asian (Elephas maximus) and African elephants (Loxodonta africana). Guelph, University of Guelph. MSC Thesis. Hing S, Othman N, Nathan SKSS, Fox M, Fisher M, Goossens B (2013) First parasitological survey of endangered Bornean elephants Elephas maximus borneensis. Endangered Species Research, 21, 223-230. http://www.int-res.com/abstracts/esr/v21/n3/p223-230/ Kingori E, Obanda V, Chiyo PI, Soriguer RC, Morrondo P, Angelone S (2020) Patterns of helminth infection in Kenyan elephant populations. Parasites & Vectors, 13, 145. Kinsella JM, Deem SL, Blake S, Freeman A (2004) Endoparasites of African Forest Elephants (Loxodonta africana cyclotis) from the Republic of Congo and Central African Republic. Comparative Parasitology, 71, 104-110. Leopardi S, Keratimanochaya T, Solmi F, Roberts J (2013). Estimation of a linear model capable to predict age of Asian elephants (Elephas maximus indicus) using dung bolus circumference. Proceedings of the International Conference on Diseases of Zoo and Wild Animals, Vienna, Austria. Lynsdale CL, Franco dos Santos DJ, Hayward AD, Mar KU, Htut W, Aung HH, Soe AT, Lummaa V (2015) A standardised faecal collection protocol for intestinal helminth egg counts in Asian elephants, Elephas maximus. International Journal for Parasitology: Parasites and Wildlife, 4, 307-315. http://www.sciencedirect.com/science/article/pii/S2213224415300031 Lynsdale CL, Mumby HS, Hayward AD, Mar KU, Lummaa V (2017) Parasite-associated mortality in a long-lived mammal: Variation with host age, sex, and reproduction. Ecology and Evolution, 7, 10904-10915. Morrison TA, Chiyo PI, Moss CJ, Alberts SC (2005) Measures of dung bolus size for known-age African elephants (Loxodonta africana): implications for age estimation. Journal of Zoology, 266, 89-94. Nishanth B, Srinivasan SR, Jayathangaraj MG, Sridhar R (2012) Incidence of endoparasitism in free-ranging elephants of Tamil Nadu State. Tamilnadu Journal of Veterinary & Animal Sciences, 8, 171-173. Obanda V, Iwaki T, Mutinda NM, Gakuya F (2011) Gastrointestinal parasites and associated pathological lesions in starving free-ranging African elephants. South African Journal of Wildlife Research, 41, 167-172. Punya MS, Shyma VH, Reshnu VC, Vijayakumar K, Vinodkumar K, Ambily R, Zachariah A (2021) Gastrointestinal parasites of captive Asian elephants in Kerala. Journal of Veterinary and Animal Sciences, 52, 312-315. Ratnasooriya WD, Molligoda PS, Molligoda WHM, Fernando SBU, Premakumara GAS (1994) Absence of synchronization either in defaecation or urination of the Sri Lankan elephant (Elephas maximus maximus) in captivity. Ceylon Journal of Science, 23, 47-51. Rees PA (1982) Gross assimilation efficiency and food passage time in the African elephant. African Journal of Ecology, 20, 193-198. Schiffmann C, Hatt JM, Hoby S, Codron D, Clauss M (2019) Elephant body mass cyclicity suggests effect of molar progression on chewing efficiency. Mammalian Biology, 96, 81-86. Schiffmann C, Schiffmann L, Bonillo J, Blukeviciute I, Gozalbes Aparicio E, Paniagua J, Ribera G, Ruiz M, Torro M, Clauss M (2023) A simple approach to monitor faecal particle size in the Asian elephant - A proof of concept study. Gajah, 56, 30-35. Thewarage LD, Dissanayake DSB, Perera US, Bandara AT, Perera BVP, Wickramasinghe S, Rajapakse RPVJ (2020) Morphology and molecular characterization of Parabronema smithii (Cobbold, 1882) (Nematoda: Habronematidae) from wild Asian elephant (Elephas maximus maximus) of Sri Lanka. Acta Parasitologica, 65, 504-517. Vanitha V, Thiyagesan K, Baskaran N (2011) Prevalence of intestinal parasites among captive Asian Elephants Elephas maximus: effect of season, host demography, and management systems in Tamil Nadu, India. Journal of Threatened Taxa, 3, 1527-1534. http://threatenedtaxa.org/ZooPrintJournal/2011/February/vanitha.htm Vimalraj PG, Jayathangaraj MG (2013) Endoparasitic infections in free-ranging Asiatic elephants of Mudumalai and Anamalai Wildlife Sanctuary. Journal of Parasitic Diseases, 39, 474-476. To page top

This paragraph describes aspects related to lameness in elephants. Lameness is a visible disruption of the normal locomotion. Diagnostic procedures and treatment options are discribed. Orthopedic shoes can help correcting abnormal posture. Muscle-related diseases can result in abnormal locomotion. This chapter also describes bone fractures, metabolic bone disease and botulism. Sometime injuries due to snares and mines can only be treated by partial leg amputation and the use of a prosthesis. Back to index orthopedic problems Lameness This paragraph describes the aspects related to lameness in elephants. Lameness is a visible disruption of the normal locomotion. Observation of the gait and resting behavior are important. It is therefore advised to make videos from the different locomotion tests that will be performed during the clinical examination. Replaying such a video in slow motion can facilitate making the proper diagnose and also makes it possible to share data with colleagues if additional consultation is useful. Smartphones are very useful for this purpose. African elephant showing signs of lameness. Lameness: Diagnostic procedures Although lameness is considered the most important clinical sign of musculoskeletal disorders in other species, elephants have been shown to rarely express distinct lameness patterns. This might even be the case in severe lesions. Nevertheless, elephants do express specific alterations in their posture indicative of musculoskeletal disorders. These alterations are visually perceptible for the experienced observer (Schiffmann 2021). To diagnose lameness it is important to know the normal locomation of an elephant. This is described in detail in the corresponding chapter. Any abnormal form of locomotion should be regarded is lameness. Usually l ameness is a signal from the elephant that it is suffering of pain. However, abnormal anatomic abberations can also lead to lameness, which not always necessarily leads to pain responses (e.g. slight difference in leg length). If the elephant lifts it head during walking, special attention needs to be paid to the front legs, as this head movement may be usied as an extra manner to bring a painful leg forward. To find out the reason why an elephant displays abnormal locomotion, the clinician needs to follow the following diagnostic steps: Observe the locomotion while the elephant is walking straight from left to right and from right to left, towards the observer and away from the observer, in a left circle and in a right circle. A numerical rating scoring system as described by Turner e.a. (2023) can be a useful tool to evaluate the lameness. A 4-point scale with the following numerical values for each leg was used in this study: 0=clinically sound, 1=stiffness, 2=abnormal tracking, and 4=reluctance to bear weight. The maximum total score per leg is 7 (28 for all 4 legs). Observe the elephant's posture when it is in rest. For more background information about abnormal posture click here . General clinical examination . Check the pads and nails of all feet for cracks, tears, swelling and pain reaction on deep palpation. Try to evaluate the joints by palpation (temperature, swelling pain reaction during deep palpation) and bending/stretching on command. Thermography. Radiography. Click here to read about radiography of the elephant's foot. Depending on the power of the X-ray equipment, joints higher up in the leg can be visualized. Digital equipment greatly improves the image quality. Full blood tests: hematology and chemistry. Walking the elephant from left to right and vice versa will make clear if the elephant is making long steps: the hind foot needs to step into the footprint of the front foot on the same side. It also allows to observe the joints: all joints of each leg should be bent and stretched during every step the animal makes. The rhythm of the steps should be regular. If the elephant feels pain in its right front leg, it will not support on that leg as long as will support on its healthy left front leg. What the observer will see, is that the elephant "falls" on its healthy leg. Usually this is a sign of "weight-bearing lameness" . This form of lameness is usually associated with sole lesions (foreign body, abscess), fracture and the acute phase of osteoarthritis. The second form of lameness is "movement-restricted lameness" , which is seen as stiffness in one or more joints and shortening of the steps made by the affected leg (and mostly in the other legs too). This type of lameness is seen in joint and muscle problems. Most lameness cases, however, are a combination of both forms. The gallery below shows several examples of lameness in Asian and African elephants. Asian elephant displaying several forms of lameness, filmed at normal speed and in slow motion. The animal can bend the joints of the left front leg and puts a lot of its body weight on that leg. At the same time, it lifts both left legs almost simultaneously ("pacing") in contrast to its left legs. The right carpal joint is completely stiff and to bring the right front leg forward, the animal has to bring it in abduction. The right hind leg is lifted abnormally when making a step forward with this leg. Nevertheless, this leg is placed in the footprint og the right front leg (normal), while the left hind legs makes too short steps. The lameness in this elephant was most likely due to multiple degenerative osteoarthritis. 35-yrs-old Asian zoo elephant with signs of severe lameness. All steps of the hind legs land in or even anterior to the footprint of the corresponding front leg. The joints of all but the right hind leg are bending and stretching normally. The knee joint of that leg is stiff. The time during which the right hind leg is on the ground is significantly shorter than that of the other 3 legs. In order to bring the right hind leg forward, the elephant needs to abduct it, lift it by lifting the right part of the pelvis at the same time. No other details about this elephant are known. This elephant may have had a fracture of the right humerus or the pelvis. 28-yrs-old Asian zoo elephant with signs of severe lameness in its right front leg. All steps are shortened. When this condition did not improve after prolonged treatment with several pain killers (NSAIDs and opiates) the elephant was humanely euthanized. At necropsy multiple joints showed severe degenerative osteoarthritis as well as an old, partly healed fracture of the right ulna. 45 yrs-old African zoo elephant with a stiff, left front leg. This leg is brought forward by swaying it in abduction. All steps are shortened and the head is sometimes slightly lifted when the left front leg is swayed forward. NSAIDs were provided but not really with the desired effect. As this condition persisted for a prolonged period, chronic degenerated osteoarthritis is the most likely cause of this lameness. Asian zoo elephant with a stiff, slightly swollen right front leg. This leg is brought forward by swaying it somewhat in abduction. All steps are shortened. According to the zoo staff, this condition disappeared after a period of conservative treatment (reduction of movement periods). The cause of such a temporary lameness could be muscle trauma (e.g. by a blow from a herd mate) or early degenerative osteoarthritis. Asian elephant with very stiff, legs, especially the right front leg (movement-restricted lameness). After bringing this leg forward, the animal "falls" on this leg, which means that supporting on the left front leg is painful, despite the apparently better movement of the joints of that leg (weight-bearing lameness). The distal joints of both hind legs are also limited in their movements, reflecting in shorter footsteps. African elephant displaying joint instability in the carpal joints of both front legs. When the feet are placed on the ground, the distal parts of the legs show a valgus position. Radiographs taken from the same African elephant demonstrated periostal reaction 10-12 cm above the carpal joint, an osteophyte (spur, right red arrow) in the radiocarpal joint (osteoarthritis). The image to the right represents the carpal joint of a healthy African elephant. The first thermography image shows a hot area at the level of the knee joint (upper arrow), suggestive for the presence of an inflammatory proces in that area. The lower arrow indicates another large hot spot. This Asian elephant was used for carrying tourists for many years in Nepal and was chained when she was not at work. The second thermography image shows a high temperature in the area of the right elbow in an Asian elephant with a swollen right front leg, also suggestive for a n inflammation of the joint (I mages: courtesy of Susan Mikota). Degenerative osteoarthritis/ Degenerative Joint Disease (DJD) Degenerative osteoarthritis or degenerative joint disease (DJD) is quite common in elephants of advanced age. Factors that contribute to DJD are : Local infection (e.g. from nail abscess) Poor quality bedding substrate, no comfortable resting possibilities (sand heap) Generalized infection: Mycoplasma have long been mentioned as cause of DJD because it involves multiple joints, often has a shifting lameness (Clark, 1980). Rheumatoid arthritis has also been mentioned without any scientific evidence. However, lack of evidence does not necessarily exclude this form of joint disease. In humans aggravation of rheumatoid symptoms is often correlated to humidity and low temperature. As some keepers have seen a correlation between these environmental factors and pain signals of the elephant, both environmental conditions can better be avoided for elephants kept in captivity. DJD is a chronic arthritis, characterized by loss of healthy carti lage, abnormal synovia, and irregular outline of the joint bones. Cartilage acts as a soft buffer between the bones bordering a joint. When that protective layer becomes thin or has gone, the surface of the bones are exposed to each other, which is the major cause of the pain that is experienced in DJD. In the early phase, the area around the affected joint may be warm. In chronic cases (the majority that is seen by clinicians), the temperature is often normal or even lower than the surrounding area. Synovia is a yellow, viscous, thread-pulling liquid, produced by the joint cartilage (see photo below). It makes it possible for the joints to articulate smoothly. If the cartilage becomes diseased, it will form abnormal synovia with a much lower viscosity (see video below; BBC). The diagnosis of DJD is based on: Symptoms as described above. Some of the following symptoms will be present: lameness during walking, abnormal position in resting position, swollen joint. Locomotion test: see diagnostic procedures above. Palpation: warm joint, painful joint on deep palpation) Thermography: if the affected joint is warm, it will show in the thermographic image as a hot spot. Radiography: DJD can only be visualized in the smaller joint (digits, carpus, tarsus). More proximal joints are hard or impossible to visualize by X-ray. Affected joints can show a smaller joint space, irregular outlines of the bones (exostosis), osteolysis, dislocation or bone fusion (ankylosis). When an infection of the joint is suspected, aspiration biopsy from the affected joint should be considered for culture and antibiogram and evaluation of the synovia. However, one should be well aware of the risk to introduce an infection. Radiograph and post-mortem photo of the hind foot bones taken from a 21 yrs-old Asian elephant with DJD involving multiple joints. Exostosis and reduced joint space can be seen on the radiograph. At necropsy the ankylosis of the digits and tarsal bones explain why the elephant was unable to bend the joints of his feet. Positive reinforcement training made it possible to provide physiotherapy to an African elephant. Courtesy San Diego Zoo African elephant resting its head on a tree. https://geogypsytraveler.com/wp-content/uploads/2014/01/09-028-Elephant-rest-against-a-tree-Kruger-NP-SA-gfb-knp-fff44-1024x678.jpg TREATMENT OF DEGENERATIVE JOINT DISEASE Acute phase: Rest Head rest* Proper substrate (dry sand) Sand pile for sleeping at night Pain management Corticosteroids: maybe in acute phase? [Dexamethasone (1mg/5 kg BW); Prednisolone (1mg/3 kg BW)] Chronic phase: Head rest* and sand piles Physiotherapy: opportunities for walking exercises, unlimited free access to hydrotherapy (swimming pool) Pain management Weight reduction (if applicable) Correction of abnormal pressure on foot pads Monitor the condition of the lameness on a daily mobility score chart. Pain management: NSAID’s in acute phase (for 5 days as a start) and whenever needed in chronic cases: Firocoxib 0.1 mg/kg BW PO/day (tablet or paste) Meloxicam (0.03 mg/kg BW PO/day) Flunixin (1,1 mg kg BW, PO/IM/IV, BID) Ibuprofen (6 mg/kg BW PO, BID) Phenylbutazone (4,4-8,8 mg kg BW PO/day) Opiates: tramadol (0.5mg/kg PO BID) – combined with NSAID Some of the anecdotally reported treatments for DJD are: Physiotherapy: 2x30 minutes/day walking in figure 8 rounds, walking over small steps. Hydrotherapy Laser Glucosamine/chondroitin Gabapentine (anti-epileptic drug, 1.5mg/kg BID) Acupuncture Stem cells The provision of sand piles is essential for the prevention and treatment of joint problems Correction of unequal leg length: One report describes the use of a rubber sole to correct the abnormal positioning of the right front leg of an Asian elephant, caused by unequal leg length. A thick multiple-layer rubber sole was glued underneath the pad of the animal (figure below A and B) (Johnson 2018). A liquid urethane glue (also used in horses) kept the pads in place for 4 weeks. The elephant was provided with bilateral wedge pads to offload pressure from the fourth nails (C). A rubber sole can probably also be used to protect a very thin sole with a compression sore. Rubber sole Elephant glue-on shoe construction and materials. A. Paper pattern pieces for a whole foot shoe (left), and a partial wedge (right). B. A view of the side of the wedge showing the multiple layers of rubber soling material sandwiched together. C. Shoe bottom with checkerboard tread. D. Top of a used shoe. E. Another view of the shoe showing the medial height. F. Elephant wearing the oblong wedge pad on the bottom of the right foot. Elephant posture standing, before and after shoes. A. Elephant leaning on the left front foot because of asymmetry in leg length before shoes were applied. B. Elephant wearing shoes and standing square. C. Close-up of partial wedge pad on right foot (arrowheads) and elevated shoe on left foot. * Especially in case of joint disease in the fore legs, reducing the weight on these legs is a great relieve to the elephant, as the fore legas and the head form 60% of the total body weight of the elephant. A head rest is just an elevated bar, where the animal can put its head on. Any surface that is strong enough to hold the weight of the head adjusted to the right hight may relieve the pain caused by degenerative joint disease. Muscle-related problems Wound, abscess Lameness may be seen when muscles are involved in (local) infection or traumatic injury. A local infection can be caused by any perforation of the skin by and injection, arrow, gun shot, etc. This may result in abscess formation. When the elephant ahs to sleep on a concrete floor, it may develop a compression sore, that can affect the underlying muscles. Treatment of this kind of lesions includes: Creation of draining Removal of the foreign body Daily flushing of the wound with saline and mile disinfectant (e.g. diluted Betadine or chlorhexidine). In severe cases a systemic antibiotic might be indicated (after culture and sensitivity test) Black leg (Clostridium chauvoei or C. septicum This bacterial infection is described on the web page: Clostridiosis. Click here for further reading. Capture myopathy Cap t ure myopathy or exertional stress is a condition is characterized by severe lameness of all 4 legs. It is caused by a complex alteration of metabolic processes usually associated with capture, transport, restraint or work overload (timber industry). The acid-base and electrolyte balances are disturbed, which results in an acute lameness. It becomes fatal when the heart muscle is affected. The urine turns dark brown due to the presence of myoglobine that is the result of muscle necrosis (see photo). In some less severe cases and when the animal is treated adequately the muscle damage can be limited and the animal may survive. Treatment of capture myopathy: Absolute rest Deep sand layer on floor NSAID’s Easy-chewable forage, chopped Darkened environment Long-acting tranquilization Tendon laxity Tendon laxity (or flexural deformity) refers to a disorder that causes weak flexor tendons. It is not uncommon in newborn horse foals, especially premature ones. This condition usually fixes itself with controlled exercise. The orphan African elephant on this photo seems to suffer a similar condition. The outcome of treatment exercises remained unknown, as the elephant died of non-related problems. Tendon contracture (arthrogryposis) An assumed arthrogryposis was found in a stillborn calf that was delivered by fetotomy after a retention period of 13 months. Both carpal joints were firmly fixated in bent position. Stretching of the joint was only possible after cutting the flexor tendons (as done in the left front leg of the calf on the photo). Click here for the case report. Neurology-related lameness Tetanus Elephants are susceptible to Clostridium tetani. Similar to exertional myopathy, the affected elephant will have stiff legs. External stimuli will result in excitation and aggravation of the muscle contractures. For further reading click here . Botulism Botulism is a paralytic disease caused by the toxines of Clostridium botulinum . In elephants it was first reported in 1962 in a German zoo (Elze, 1962). The diagnosis was based on the successful treatment of the paralytic lameness by the timely administration of botulism antitoxines. In another outbreak 5 out of a group of 6 Asian elephant bulls died of botulism in the course of a few days. It started with a general weakness that became progressively worse. Shivering and mild salivation preceded the inability to stand and properly use of the trunk. For further reading click here . Metabolic bone disease Nutrition-related lameness Metabolic bone disease Metabolic bone disease (rickets, secondary nutritional hyperparathyroidism) has been reported in very young hand-raised elephant calves. It is a caused by an absolute deficiency of nutritional calcium (and vitamin D?), and a imbalance or lack of other minerals (e.g. phosphorus, magnesium) and proteins. There is no evidence about the potential involvement of vitamin D3 deficiency. Elephants up to the age of 9 months are susceptible to this condition, basically during the period that they should be on a 100% maternal milk diet. During lactation the fat concentration in the mother milk increases together with the calcium level ( Abbondanza, 2013) . This means that the calcium concentration in milk replacers must be increased as the calf grows older. Asian elephant calf with a distinct swelling in the left elbow region. Note the abnormal posture of the left front leg (Courtesy: Susan Mikota). Radiograph showing pathological fractures consistent with secondary hyperparathyroidism (Courtesy: Charles Reid in: Fowler en Mikota, 2006). As demonstrated by the CT-scans on these photos, the demineralisation of the growing bones will lead to pathological fractures: one fracture in the distal humerus and one fracture in the distal radius. (Photos of the CT-scans were kindly provided by the Leibniz Institute for Zoo- and Wildlife Research). Treatment and prevention of metabolic bone disease is based on maintaining the right diet (fat, proteins, Ca, P, Mg, vitamin D) and monitoring the blood total and ionized calcium levels, as well as phosphorus and magnesium. It is also recommended to make X-rays of the long bones of the growing calf on regular intervals (2-3 months) to check the bone quality and shape. Sufficient exercise of the hand-raised calf is very important for the development of a strong skeleton. Bone fractures Bone fractures Despite the solid consistency of elephant bones, fractures are not uncommon. Fractures always result in weight-bearing lameness as is clearly demonstrated on the video of the young Asian elephant bull with a fracture of the radius and ulna (Courtesy Dak Lak Elephant Conservation Center). The animal was hit by an adult female. As the distal part of the elephant's foot is missing, it was not possible to apply a splint. Possibly the shortage of the affected leg worked to his advantage, as he was able to walk on 3 legs until the fracture ends had healed. Radiographs taken from the same young Asian elephant. Note the spiral shape and dislocation of the fracture ends of the radius and ulna. The bones healed completely within a 3 months period. Several types of casts and bandages have been tried in elephants that had a fractured leg. Some of them are displayed below. An adult Asian elephant presented at the Lampang Elephant Conservation Center-Thailand with a fracture and dislocation of the left fibula (see radiographs). A cast was made locally, which remained in place for the next 5 months. During this period the elephant stayed with the owner and the cast was changed 3 times. Photos courtesy: Taweepoke Angkawanish This adult Asian elephant was also presented at the Lampang Elephant Conservation Center-Thailand. A fracture of the tibia was suspected and a splint was made just to assist the elephant by reducing full the weight on its affected leg. Photo courtesy: Taweepoke Angkawanish At Pinnawala Elephant Orphanage (Sri Lanka) a radius and ulna fracture in a 2-yrs-old Asian elephant was treated by the application of a Robert Jones bandage and a fiberglass cast (Karunarathne, 2017). The bandage and cast were renewed twice. Several sedations were required to put the cast in place. Two weeks after the 3rd cast was fixed, the calf succeeded in removing it, but at that time it was able to put weight on the affected leg with a mild limp. To reduce the pressure on fractured bone ends, it may be helpful to provide a sling in which the elephant can be supported while standing. This is only an option if the elephant is accepting such a device, which needs to be located in a trusted environment outside the reach of other, non-friendly elephants. Some improvisation skill to make such a construction will by useful. It can also be used in elephants that have a joint dislocation or other conditions in which weight reduction on one leg is required. Photo courtesy: Susan Mikota Hydrotherapy Many attempts to treat major bone fractures in elephants have failed, largely due to the animals’ immense body weight. To date, no scientific reports have documented the use of hydrotherapy in such cases. However, at the 19th International Elephant Conservation and Research Symposium of the International Elephant Foundation (Chiang Mai, 2023), Dr. K.K. Sarma, Head of the Department of Surgery and Radiology at the College of Veterinary Science in Guwahati, India, presented several cases of leg fractures in semi-wild and free-ranging Asian elephants. Remarkably, these elephants appeared to choose hydrotherapy on their own, spending extended periods—sometimes several weeks—in water bodies such as lakes or large pools. They would typically emerge only once a day to forage. No splints or orthopedic devices were applied, yet the healing outcomes were striking. Joint dislocation Traumatic joint dislocations have been reported anecdotically. A 3-yrs-old orphan Asian elephant was found in a range country after a bushfire. It was noticed that its right front leg seemed longer than the left one. It was brought up in a zoo in Asia and moved to Europe to become integrated in the EAZA breeding program. Is he grow older, the asymmetry of his front legs worsened and he developed a significant weight bearing and movement-restriction lameness. During locomotion he swayed his right front leg forward. The bull was mildly sedated and examined in a restraint chute. Ultrasonographic examination revealed excessive fluid in the right elbow joint. Radiography failed due to the large size of the animal. To check the stiffness of the left elbow joint, a long rope was tied to the left carpus while in left lateral recumbency. Three individuals tried to stretch that leg; during this attempt, a clear crack was heard while the joint stretched only a few degrees. It was concluded that the joint was severely damaged and partial ankylosis had taken place. The elephant was humanely euthanized. At necropsy a ruptured joint capsule and ruptured ligaments of the right elbow were found. The cartilage showed multiple defects, exposing the underlying bone. Another traumatic joint dislocation was reported from Myanmar (Ann-Kathrin Oerke, 2022). An adult bull got its left hind leg stuck between the fork formed by two trees when it fell down. The capsule and ligaments of the tibio-tarsal joint ruptured and the distal part of the tibia perforated the skin. Treatment was no option and the animal died under miserable circumstances. Severe traumatic leg injuries Too many elephants have suffered traumatic leg injuries due to mine explosions, snares and other forms of poaching. In recent years partial leg amputation has been practiced with some success in Asian range countries. In most cases a prosthesis is needed to enable the elephant to walk. Missing all toes of front leg A 3-4 yrs-old wild Asian elephant bull was found with an old injury on its left front leg. All toes were missing and there was a deep wound on the palmar side of the remnants of that foot. A circular scar was visible about 15 cm from the "pad"; 4 small fistulas were located in the line of this scar, each of them oozing thick purulent exudate. Most of the time (70-90% the animal displayed stereotypical behavior: touching the remnant of its left foot and beating it with its trunk. The animal was brought to a rescue place at the Dak Lak Elephant Conservation Center in Vietnam. During the following months he became accustomed to the presence of humans by positive reinforcement training. The wounds were taking care of by daily flushing with saline and antiseptic (povidone-iodine solution) solutions. Arrangements could be made to make X-rays of the affected leg, which revealed the piece metal wire. During a surgery under general anesthesia (ketamine and xylazine by IM-injection and oxygen supplementation in the trunk), a 20 cm of wire was removed. The incision was made perpendicular on the wire until the scalpel touched the wire. By slightly enlarging the wound the wire was easily removed. The wound was left open and flushed daily during the following weeks (saline and antiseptic solutions). The incision wound healed restless. Three of the 4 initial fistulas closed in the following year. However, one fistula located at the medio-palmar side of the circular scar remained oozing. Seven months after the removal of the wire, there was an opportunity again to inspect the wounds and radiographs were made again. Based on these images osteolysis of one of the carpal bone was suspected. A second surgery was done and pieces of smelling necro-purulent bone material were removed by cutting the affected carpal bone using a bone chisel and bone scraper. A large tunnel between the incision wound and the original wound was created in order to allow easy draining of necro-purulent exudate during the daily flushings. The surgical wound and fistula healed completely. To date (2025) the original wound is still being managed by weekly cutting away excessive horn and daily flushing. The animal can walk reasonably well. The episodes of displaying stereotypic behavior have significantly reduced in frequency and intensity. Several examples of a prosthesis can be found on the internet. Most of the victims lost part of the leg by the explosion of a land mine they stepped on. Chhouk, an Asian elephant in Laos has been living for several years with a prosthetic device (See also : Wildlife Alliance ) Prevention orthopedic problems Prevention of orthopedic problems Management-related factors play a major role in the development of foot problems. Two studies (one performed in European zoos and one in Nort-American zoos) found the following factors influencing one or more orthopedic issues (Wendler 2019; Miller 2016): Enclosure size: the larger the enclosure, the less problems occurred. Bedding: soft bedding reduced the number of orthopedic problems. Floor: a dry floor promotes foot health Time spend outdoor: the longer an elephant spends time in its outdoor enclosure, the better it is for its locomotion apparatus Exercise: adequate exercise by many social interactions reduces orthopedic issues Provide a headrest (see under 'treatment') Nutrition: more brows results in less foot problems. Benz (2005) could not find a correlation between the supplementation of the diet with biotin (vitamin B8) and foot health. Body condition: no negative correlation was found between overweight and orthopedic problems. Elephants that are kept in range countries are facing different management-related issues. Walking large distances on hot tar roads may result in damage to the pad. Elephants working in the logging industry may be more affected by muscle or joint injuries. As many elephants are not trained for foot care, easy-to-treat nail or pad lesions may lead to complications like foot abscesses or osteolysis of the distal phalanges. However, no data are available about the incidence of foot problems in range countries. A separate chapter about regular foot care in elephants kept in zoos can be found here . Stereotypical behaviors like "weaving (or swaying)" may result in excessive pressure on the lateral nails resulting in cracks. This stresses the importance of providing a divers social setting for elephants to live in, mimicking their natural social environment. Training of elephants to allow proper foot care is important to address early problems of foot lesions. Mahouts should have the minimum knowledge and skills to perform proper foot care. In order to monitor the effect of pedicure, it is important to describe the status of the feet. By clicking on the icon displayed below, you will find a document that can be used for this purpose (from EAZA Best Practice Guidelines for Elephants, 2020): Click here to download the foot examination form for Asian elephants Click here to download the foot examination form for African elephants No studies about the prevention of degenerative joint disease have been publish ed. As the cause of this problem in elephants is not known, it is hard take appropriate measures to prevent them. Without hard evidence some more anecdotal statements may still be useful: Provide sand piles for sleeping during the night Stimulate locomotion (free ranging elephants walk many miles per day!) Provide sufficient soft bedding. Further reading: see reference list. References Abbondanza, F.N., Power, M.L., Dickson, M.A., Brown,B. and Oftedal O.T. 2013. Variation in the Composition of Milk of Asian Elephants (Elephas maximus) Throughout Lactation. Zoo Biology 32(3):291-8. Benz, A. 2005. The elephant’s hoof: Macroscopic and microscopic morphology of defined locations under consideration of pathological changes. Master's thesis, Veterinary Faculty of the University Zürich, Switzerland. Clark H. W., Laughlin D. C., Bailey J. S. and Brown T. McP. 1980. Mycoplasma Species and Arthritis in Captive Elephants. Journal of Zoo Animal Medicine, Vol. 11, No. 1 pp. 3-15. Csuti B, Sargent E.L., Bechert U.S. (Editors) 2005. Book: The Elephant's Foot: Prevention and Care of Foot Conditions in Captive Asian and African Elephants 1st Edition. EAZA Best Practice Guidelines for Elephants. 2020. Click here for full text. Elze K. 1962. Über eine unter dem klinischen Bild van Botulismus verlaufene Erkrankung beim Elefanten. Nord.Vet.-Med. 14 (1) 259-271. Fowler M.E. and Mikota S.K. 2006. Biology, Medicine, and Surgery of Elephants. 271-290. Hess A. 2022. Lesions found in the post-mortem reports of the Asian (Elephas maximus) and African (Loxodonta africana) elephants of the European Association of Zoos and Aquaria Master's thesis, Department of Exotic Animal and Wildlife Medicine University of Veterinary Medicine Budapest, Hungary. Johnson G., Smith J., Peddie J., Peddie L., DeMarco J., Wiedner E. 2018. Use of glue-on shoes to improve conformational abnormalities in two Asian elephants (Elephas maximus ). J. Zoo&Wildl Med. 49(1): 183–188, 2018. Karunarathne H.P.R.N.S., Bandara M.R.B.N., AbeysingheA.M.N.D.B., Liyanage E.M.E., Rajapaksha R.C., Kodikara D.S. and Dangolla A.. 2017. Fixation of a Radius and Ulna Fracture in an Asian Elephant Calf by Using Fibreglass Casts. Gajah 47 (2017) 40-41. Kottwitz J, Bechert U, Cruz-Espindola C, Christensen J.M., and Boothe D. 2024. Single-dose, multiple-dose, and therapeutic drug monitoring pharmacokinetics of firoxicab in Asian elephants (Elephas maximus ). Journal of Zoo and Wildlife Medicine 55(1): 73–85, 2024. Miller M.A., Hogan J.N., Meehan C.L. 2016. Housing and Demographic Risk Factors Impacting Foot and Musculoskeletal Health in African Elephants [Loxodonta africana] and Asian Elephants [Elephas maximus] in North American Zoos. PLoS ONE 11(7): e0155223. doi:10.1371/journal.pone.0155223. Schiffmann C. 2021. Posture Abnormalities as Indicators of Musculoskeletal Disorders in 12 Zoo Elephants – a Visual Guide. Gajah 53 (2021) 20-29. Turner A., Masters N., Pfau T., Hutchinson J.R., and Weller R. 2023. Development and evaluation of a standardized system for the assessment of locomotor health in elephants under human care. J. Zoo&Wildl Med. 54(3): 529-537. Wendler, P., Ertl, N.,Flügger, M., Sós, E., Schiffmann, C., Clauss, M., and Hatt,J-M. 2019. Foot health of Asiane elephants (Elephas maximus ) in European zoos. Journal of Zoo and Wildlife Medicine 50(3): 513–527, 2019. To page top

Serum chemistry data in elephants can provide valuable information about organ function (liver, kidney, muscles, intestines, pancreas) and disease conditions (inflammation, infection), hormone levels and toxins. Proteins, AST, ALT, GGT, creatinine, bilirubin, CK, LDH, Ca, P, glucose, Na, Cl, K are part of the comprehensive chemistry panel. To lab diagnosis Blood chemistry Reference values blood Serum/plasma chemistry Refractometry Serum/plasma Chemistry Serum quality Ser um quality Serum chemistry data may help determining the function of certain organ systems. The reliability of the results largely depend on the quality of the sample. Before running any biochemistry tests, the blood should be well clotted, preferably without hemolysis (shown as red colorat ion of the serum). Chemistry data are usually obtained from serum. Some tests can also be run usi ng plasma. Before using plasma, this option should be checked with the test instructions. Test tubes to be used: red-topped serum-tubes with or without a clotting activator. The color of the serum should be light yellow. The figure below shows different serum characteristic: Hemolysis: Red to brown color due to hemolysis (destruction of erythrocytes). This can have a pathological origin or can result from poor sampling/handling; the red-brown color can also be caused by myoglobin after massive muscle damage (rhabdomyolysis) Milky white color due to presence of fat particles in the serum (physiologic shortly after eating or pathological condition) Yellow color due to the presence of bilirubin (liver damage ->icterus). Blueish-red color due to methemoglobin (low venous oxygen saturation). Lipemia Lipemia, which can be a natural occurrence if the elephant has just eaten, can alter several test results. Calcium, phosphorus, total bilirubin or hemoglobin may be falsely elevated. When using a refractometer to measure the total protein remember that the serum must be clear. If not the value may be falsely elevated. Albumin, sodium and potassium may be falsely lower. Lipemia also enhances hemolysis which in turn can affect lab results. But there is a solution: If you refrigerate your sample the lipemic portion will separate and you can use the clear aliquot below the lipid layer. Normal and lipemic elephant serum Reference values Normal serum chemistry values are determined by species, age, gender and reproductive status of the elephant. It is important to have an understanding of the limitations of laboratory values. The term “reference value” is now considered a more appropriate term than “normal value.” Ideally reference values should be established from studies using a minimum of 30 healthy animals and stated selection criteria. Few elephant studies have been conducted to meet this standard. One report describes chemistry results for different genders of Asian elephants used for logging in Myanmar (Santo, 2020). Moreover, many reference ranges are laboratory specific. So it is best to use one laboratory that can help to develop reference ranges for your elephants. Another important point is that a test result that falls outside of the reference is not necessarily clinically significant. Lab values are information that must be used with all the other information that you have when you are faced with a sick elephant. Establishing a baseline during health and performing sequential tests during illness will give the most reliable information. You also want to use a lab that has good quality controls. If you change labs it is advisable to get new healthy baselines. V ery odd results should always be double checked at the same lab. To page top One study in 10 healthy Asian elephants showed that most Asian elephant hematology and biochemistry parameters are highly individual, requiring individual normal values for accurate interpretation (Perrin, 2020). Test result units Another complicating factor when looking at serum chemistry values is that there is a lack of uniformity regarding units and this can be confusing. Most U.S labs use conventional units whereas in Europe they use SI units. There are conversion factors to go from one system to the other but the conversion factor is test specific – so each test has a different conversion factor. You can find SI conversion calculators online, i.g. ht tps://www.amamanualofstyle.com/page/si-conversion-calculator. Liver The liver plays an important role in the following processes: Protein synthesis and degradation (albumin, clotting factors) Carbohydrate and lipid metabolism Breakdown of hemoglobin Storage (fat soluble vitamins) Detoxification Liver enzymes: Aspartate aminotransferase (AST; SGOT) Alkaline phosphatase (ALP) γ-glutamyl transferase (GGT) Bilirubin Bile acids (?) BSP excretion (bromsulphthalein) AST (SGOT) Aspartate aminotransferase, previously known as serum glutamic oxaloacetic transaminase (SGOT) occurs in all cells. Highest levels are in the liver, cardiac muscle, and skeletal muscle. If AST is elevated then you should also look at the creatine kinase (CK) value. If the CK is normal then AST is likely of liver origin. If the CK is elevated or there is obvious muscle trauma then AST may be of muscle origin. Also AST may falsely increase if the sample is hemolyzed. ALP Alkaline phosphatase is also found in all cells with the highest levels in liver, bone, kidney, intestine, and placenta. ALP is not a sensitive indicator of liver disease in the horse and this probably holds true for elephants although research would be needed to confirm this assumption. ALP may increase with disorders such as rickets. ALP levels are normally higher in young animals including elephants. ALP may indicate colostrum absorption. Non-steroidal anti-inflammatory drugs may cause ALP to elevate. GGT Gamma glutamyl transferase (GGT) is liver specific in horses and pigs. Whether it is liver specific in elephants is unknown. GGT is an indicator of cholestasis (the interruption of bile excretion). GGT has been shown to increase in musth bulls and it has been used together with ALP as an indicator to evaluate passive transfer of antibodies to neonates via colostrum. Bilirubin There is not much information about bilirubin in elephants. There are two forms: unconjugated and conjugated bilirubin. The unconjugated is the main form in horses so this may be true for elephants but we don’t know for sure. Unconjugated (indirect) bilirubin is mainly hemoglobin released from old erythrocytes. It is bound to albumin and transported to the liver where it is conjugated. Conjugated (direct) bilirubin is secreted into bile, transferred to the intestine, converted to urobilinogen by intestinal bacteria, and excreted. Elevated bilirubin may be caused by hemolysis; hepatocellular disease that results in reduced functional mass; and intra - or extrahepatic cholestasis or bile duct obstruction. Unconjugated bilirubin predominates in horses with hyperbilirubinemia regardless of etiology whereas in ruminants unconjugated bilirubin is typical. In one report, elevated total bilirubin (4.94 mg/dl) was observed in a female Asian elephant with colic caused by over-zealous feeding of produce. Values for indirect and direct bilirubin were 3.7 mg/dl and 1.2 mg/dl respectively. Tests of hepatic uptake, conjugation and excretion of bilirubin. Diagram from Lattimer, K.S., Mahaffey, E.A., and Prasse, K.W. 2003. Clinical Pathology 4th edition. Blackwell. P.199. Bile acids Bile acids assist with fat digestion. In most species, bile acids are stored in the gall bladder and released into the intestine. However, elephants do not have a gall bladder. There is controversy whether elephants have bile acids. In several cases bile acids were shown to increase in elephants with TB. Bromsulphthalein (BSP) excretion test In the BSP test a dye is injected IV and measured at several points in time post-injection. In the horse, the half-life is 3.5 minutes. Slow clearance time may indicate cholestasis. Although levels have been shown to increase with liver flukes in elephants, it is not a very practical test. Kidney Blo od Urea Nitrogen ( BUN) and creatinine are the main enzymes used to evaluate kidney function in mammals. BUN Elevations in blood urea nitrogen concentration may be due to prerenal causes like inadequate renal perfusion, shock, or diminished blood volume; renal causes like glomerular-nephritis; or postrenal causes like urinary tract obstruction. Blood Urea Nitrogen makes up approximately 75% of the total non-protein nitrogen (NPN) fraction of the blood. BUN is the major end product of protein nitrogen metabolism. It is synthesized by the urea cycle in the liver from ammonia which is produced by amino acid deamination. Urea is excreted mostly by the kidneys, but minimal amounts are also excreted in sweat and degraded in the intestines by bacterial action. Creatinine Creatinine only elevates when disease is severe and there is marked kidney damage. Unfortunately, in elephants these enzymes are not always useful to predict kidney disease. Creatinine may be lower in young elephants; higher in musth bulls. Serum osmolality/urine osmolality. The osmolality reflects the total number of electrolytes in a fluid. To keep the number constant, the kidney excretes the surplus that is present in the liquid fraction of the blood and the osmolality ratio between these two fluids should be <1. If the kidneys fail to maintain this equilibrium, the serum-urine osmolality ratio becomes > 1. Serum dimethyl arginine (sDMA). In domestic animals sDMA is a marker for endothelial dysfunction and early diagnose of renal disease (declining glomerular filtration rate). In one case report it was associated with kidney failure (polycystic kidney disease). To page top These values are from an Asian bull elephant with capture myopathy. The elevations in SGOT and CK are dramatic. ALT (SGPT) did not increase as much but is probably significant. The elevations in BUN and creatinine may have been related to capture myopathy however this bull was chained to a tree and not given access to food or water post-capture so these changes may reflect dehydration. Muscles Muscle enzymes are: Creatine Kinase (CK) Lactate Dehydrogenase (LDH) Aspartate Aminotransferase (AST; SGOT) Alanine Aminotransferase (ALT; SGPT) Evaluating muscle enzymes can help to diagnose muscle pathology. Conditions that may cause elevated muscle enzyme levels include prolonged recumbency, rhabdomyolysis (also called over-exertion, or tying up syndrome), and clostridial myositis. Bacterial endocarditis, and aortic thrombosis are other causes as well as Vit E/Se deficiency and capture myopathy. Working elephants may be at risk for muscle over-exertion disorders especially as the planet heats up. In all of these conditions, muscle cell membranes rupture and enzymes are released into the blood. Conditions that may lead to increased muscle enzymes in serum are: Prolonged recumbency Rhabdomyolysis Clostridial myositis Bacterial endocarditis Aortic thrombosis Vitamin E/ selenium deficiency Capture myopathy Creatine kinase (CK) CK is critical to muscle energy production. Highest levels are in skeletal muscle, cardiac muscle, and brain. Most CK in the serum is of muscle origin and it is the most sensitive indicator of muscle damage. CK rises quickly – within hours. It also returns to normal quickly as long as there is no on-going damage. Levels that remain high indicate an on-going disease process. Hemolysis interferes with the test and causes falsely elevated values. Lactate d ehydrogenase (LDH) LDH is present in all tissues. Muscle, liver, and red blood cells are the usual sources. LDH is not as useful for determining muscle damage because it is not muscle specific. If LDH is elevated and there is no muscle injury then liver problems should be considered. Like CK, LDH will be falsely elevated in the presence of hemolysis. Aspartate aminotransferase (AST) AST was previously known as serum glutamic oxaloacetic transaminase (SGOT). Muscle and liver are the major sources. It is another enzyme to check if muscle damage is suspected. Alanine aminotransferase (ALT) ALT, also known as serum glutamic pyruvic transaminase or SGPT, is considered muscle specific in large domestic animals. Increased levels have been associated with myopathies in a number of species. ALT will increase in recumbent elephants that are down for a long time. Severe muscle damage can occur in case of Capture Myopathy: To page top Calcium Ionized calcium This electrolyte that is involved in many chemical reactions in the body. The active form is ionized calcium (Ca2+) and this parameter gives the best impression of the available calcium. To measure ionized calcium, special heparinized tubes are needed . Ionized calcium should be > 1.5 mmol/L (>5 mg/dL). Low ionized calcium levels are associated with prolonged parturition and dystocia. Total calcium Non-ionized calcium is predominantly conjugated with albumins and expressed as total calcium. Higher levels of total calcium have been reported in very young elephants and in elephants with TB and severe kidney disease. Many pregnant captive elephants develop subclinical hypocalcemia if calcium is not supplemented during pregnancy. When parturition starts, the demand of calcium is high as it essential for uterine contractions that open the cervix and help expel the calf. Calcium is also high in milk. Calcium supplementation during pregnancy is recommended to form a stock supply. However, releasing stock-calcium ions from the bones is a very slow process, so the blood itself should contain enough calc ium conjugated to albumin to supply the uterus and body muscles for these hours of high demand. Total calcium levels lower than 1.5 mmol/l (6 mg/dl) result in recumbency and levels less than 1 mmol/l (4 mg/dl) will result in death. Low total calcium levels are associated with prolonged parturition and dystocia. Total calcium should be 2.8 +/- 0.2 mmol/L (11 +/- 0.8 mg/dL). Other minerals and electrolytes Sodium (Na) Potassium (K) Chloride (Cl) The reference ranges of these electrolyte in elephants are similar to other species and can best be compared with horse values. To page top Proteins Elephants have a higher to tal protein serum level than most mammals; albu min is lower, and globulins are higher. The ratio of albumin to globulin was shown to be lower in one study that compared elephants with and without TB however the number of TB positive elephants in the study was low. Protein electrophoresis separates the albumin and globulin fractions. There are not many reports in elephants. Protein electrophoresis may be useful to monitor inflammatory conditions or problems like TB, herpes, and others. Acute Phase Proteins Acute phase proteins (APPs) are components of the innate immune system that are markers for infection, inflammation, neoplasia, and tissue injury in humans and domestic animals. APPs are produced by the liver in response to cytokines released from leukocytes. They are initially released into serum 24–96 hr following an acute inflammatory stimulus, where they function to promote healing, reestablish homeostasis, and inhibit microbial growth. The main ones are C-reactive protein (CRP) , serum amyloid (SAA) and haptoglobin (HA) . In one study serum samples from 35 healthy Asian elephants were analyzed for these 3 APPS and levels between the values in healthy and unhealthy elephants were compared (Isaza et al., 2014). From this and other studies it seems that SAA may be the most responsive APP in elephants. The APP values in this study in Asian elephants are shown here: C-reactive protein 12.4-122 nmol/l (1.3-12.8 mg/l) Serum amyloid 0-47 mg/l Haptoglobin 0-1.1 mg/l Glucose Glycolysis of glucose in serum or plasma will decrease the glucose level starting shortly after blood collection. Serum or plasma should therefore b e separated from the red blood cells within 30 minutes after collection. Glycolysis can be prevented by using a Na-fluoride tube for blood collection. Significantly lower levels have been noted in one study comparing TB culture positive and negative elephants. In horses, hypoglycemia may be seen with hepatic failure or bacteremia. There is one report of diabetes mellitus in a 50-yr-old Asian elephant (van der Kolk 2011). Hyperadrenocorticism and hyperthyroidism have not been reported in elephants. Increased blood glucose in elephants is likely to be transient. Some of the causes of transient hyperglycemia could be a cute severe colic acute stress, p ost-postprandial, certain drugs (s teroids, x ylazine, p henothiazine) . Hypoglycemia can occur in n eonatal elephants and in cases associated with m alnutrition, m alabsorption, s epsis, e xtreme physical exertion, a dvanced liver disease or n eoplasia. Amylase and lipase Ranges for these enzymes vary tremendously depending on the methodology and the lab so at this point in time they are not very useful tests for elephants. Amylase may increase in case of pancreas, gastro-intestinal, liver and kidney disease Lipase may increase in case of pancreas or kidney disease. One case of pancreatitis in an elephant has been described so far (pers. comm. Susan Mikota, 2023). Lactate Lactate is an important serum parameter to monitor severe, life-threatening conditions in elephants, like septicemia, Disseminated Intravascular Coagulopathy in a EEHV-HD case. Normal values are between 0--0.11 mmol/L (0-1 mg/dL). Values >0.44 mmol/L (4 mg/dL) are indicative for perfusion problems due to DIC. EEHV-HD patients often have lactate value > 0.22 mmol/L (2 mg/dL) (Wiedner, pers. comm. 2022). A comprehensive elephant serum chemistry panel should include: Total protein Albumin BUN Creatinine AST (sGOT) ALT (sGPT) GGT Bilirubin Bile acids (?) CK LDH Na Cl K Ca P Lactate To page top References Steyrer C, Miller M, Hewlett J, Buss P and Hooijberg EH (2021) Reference Intervals for Hematology and Clinical Chemistry for the African Elephant (Loxodonta africana). Front. Vet. Sci. 8:599387 Santos DJ, Franco dos J, John, Nyein UK, and Lummaa VM. 2020. Sex differences in the reference intervals of health parameters in semi-capt ive Asian elephants ( Elephas maximus ) from Myanmar. J.Zoo&Wildl Med 51(1): 25–38 Debbie JG and Clausen B. 1975. Some hematological values of free-ran ging African elephants. Journal of Wildlife Diseases, 11(1):79-82. Isaza R, Wiedner E, Hiser S, Cray C. 2014. Reference intervals for acute phase protein and serum protein electrophoresis values in captive Asian elephants (Elephas maximus ). J. of Vet. Diagn. Invest. 1-6 Perrin, KL, Kristensen AT, Gray C, Nielsen SS, Bertelsen MF, Kjelgaard-Hansen M. 2020. Biological variation of hematology and biochemistry parameters for the Asian elephant (Elephas maximus ), and applicability of population derived reference intervals. Journal of Zoo and Wildlife Medicine, 51(3) : 643-651. Van der Kolk JH, Hoyer MJ, Verstappen FALM, Wolters SABI, Treskes M, Grinwis GCM and Kik MJL (2011). Diabetes mellitus in a 50-year-old captive Asian elephant (Elaphas maximus ) bull, Veterinary Quarterly, 31:2, 99-101. Https://doi.org/10.1080/01652176.2011.585793 To page top

Locomotion problems in elephants are usually symptoms of degenerative joint diseases and lesions of the pad or nail. This chapter describes (1) the diagnosis of orthopedic problems (observationa and video recording, radiology, thermology), (2) nail issues, (3) sole/pad issues, (4) degenerative joint disease and some miscellaneous problems related to lameness. Continue Orthopedic problems This chapter consists of the following paragraphs: Normal features of the locomotion system Sole-related clinical problems Nail-related clinical problems Lameness / abnormal locomotion Prevention of orthopedic problems Radiography elephant foot Regular foot care Elephants do not often show signs of lameness. Nevertheless, orthopedic problems are quite common. A survey about the causes of death in the European studbooks of African and Asian elephants over 5 years of age, revealed that in 12% and 30% respectively of the cases, orthopedic problems played a major role in the cause of death (Hess 2022). The most frequently reported problems are related to the feet, joints and muscles. A special issue is the occurrence of metabolic bone disease in bottle-raised young elephants. Normal features of the locomotion system Normal featurs Anatomical features of the skeleton The elephant has some special features that distinguishes them from other mammals. The long bones are massive, lacking the typical bone marrow cavities. Instead, the long bones of elephants are completely filled with dense cancellous bone, where hemopoiesis is taking place. In the standing elephant, the angles of the joints are almost straight. The neck is relatively short. Figure 1: Asian elephant (Green Hill Valley, Myanmar). Figure 2: African elephant skeleton (Veterinary Faculty Utrecht University, the Netherlands) Foot anatomy terms Front foot = fore foot = manus Hind foot = rear foot = pes Phalanges = toes = digits Pad = sole = slipper Palmar = front pad Plantar = back pad Carpus = wrist Tarsus = ankle Nail = horn wall + nail pad horn Fat cushions Each foot of the elephant is equipped with a large subcutaneous cushions which play an important role in distributing forces during weight bearing and in storing or absorbing mechanical forces. One study about these cushions in the African elephant was published by Weissengruber in 2006 . In both the forelimb and the hindlimb a 6th ray, the prepollex or prehallux, is present. These cartilaginous rods support the metacarpal or metatarsal compartment of the cushions. None of the rays touches the ground directly. The cushions consist of sheets or strands of fibrous connective tissue forming larger metacarpal/metatarsal and digital compartments and smaller chambers which are filled with adipose tissue. The compartments are situated between tarsal, metatarsal, metacarpal bones, proximal phalanges or other structures of the locomotor apparatus covering the bones palmarly/plantarly and the thick sole skin. Within the cushions, collagen, reticulin and elastic fibres are found. In the main parts, vascular supply is good and numerous nerves course within the entire cushion. The high concentration of sensory receptors such as Vater–Pacinian corpuscles within the cushion and Meissner corpuscles in dermal papillae of the adjacent skin might rank an elephant’s foot among the most sensitive parts of its body. Together, the mechanical and sensory functions of the feet enhance the ability of elephants effectively to move through and analyse their physical environment. The micromorphology of elephant feet cushions resembles that of digital cushions in cattle or of the foot pads in humans but not that of digital cushions in horses. Copied illustration of the foot anatomy from Weissengruber et al., 2006 (doi: 10.1111/j.1469-7580.2006.00648.x Normal locomotion Elephants predominantly support on their pads (foot soles). The nails are not used to force locomotion. This is nicely demonstrated in the slow-motion video below (BBC). During walking the head of the elephant shows minimal movements. If there is any form of lameness, especially in one of the front legs, the animal might use its head to facilitate the movement of the front leg in cranial direction. In the absence of orthopedic problems, the hind feet are placed cranial to the foot step of the front foot on the same side. This is clearly demonstrated in the slow-motion video of African elephants in the Namibian desert below (BBC) and the normal-speed video of an adult Asian elephant bull in Vietnam. Elephants can't trot, canter, gallop or jump. They always walk in normal gait, placing their hind foot in the foor print of the front foot or even slight more cranial. When they walk slowly, their speed is approximately 4 km/h (2.5 miles/h). However, they can reach a speed of 25 km/h (15.5 miles/h) over a short distance (Hutchinson 2006). Higher speeds are often mentioned in publications, but there is no scientific evidence for such statements. Normal anatomical features of the elephant foot Usually the forefeet of the Asian elephant have 5 nails and the hind feet only 4. The African elephant has 4 nails on the forefoot and 3 on the rear one. The weight of the body is evenly distributed over the toes by means of a thick cushion , placed between the sole and the phalanges (photo African elephant foot Kruger National Park, South Africa). The digits form a ±45° angle with the sole, as shown in the radiograph below (Fowler and Mikota 2006). This photo shows the longitudinal section of the elephant foot with the sole, nail, phalangeal bones, cushion and tendons. Note the short distance between the nail and the distal phalangeal bone (Fowler and Mikota 2006) The nails are numbered medial to lateral. If there are 4 nails in front they are numbered 2,3,4,5. The bones don’t change – there are always 5 digits so digit 1 is still there but there in no associated nail. In Asian elephants there are typically 4 nails on the rear foot so they are numbered 2,3,4,5. The African elephant's toes are numbered 5,4,3,2 (front) and 5,4,3 (rear) respectively. This diagram shows the bones of the front foot and the respective phalanges of an Asian elephant (Fowler&Mikota 2006) This diagram shows the bones of the hind foot and the respective phalanges of an Asian elephant (Fowler&Mikota 2006) Radiograph of the left front foot of an Asian elephant, showing the phalangeal bones P1,P2 and P3 (Fowler&Mikota 2006) Sixth toe The elephant has unique cartilaginous structures in the feet that are thought to have a stabilizing function. In the front foot the structure is is called a prepollex. It attaches between the first carpal bone and the first metacarpal bone and extends to the sole. In the hind foot it is called a prehallux. A recent study has claimed that this structure should be considered a sixth toe because over time the tissue becomes hard like bone. The healthy sole The sole (pad or slipper) of the elephant's foot is a thick cornified but flexible integumentory structure, with a surface relief that looks almost similar to the skin. It is important to respect this surface when performing pedicure. The thick sole must protect the elephant from penetrating trauma by foreign bodies. A healthy sole is maintained by providing a dry environment. Long periods in muddy and humid circumstances can lead to sole injuries and even sole detachment. The photos show the nicely structured sole of a (dead) wild African elephant (Kruger National Park, South-Africa) and the sole of a captive Asian elephant. The sole of the elephant foot should have a minimum thickness of 2 cm. This can be measured by ultrasound examination. Its surface should be rough with a distinct relief. The growth of the sole epithelium is from 0.5 to 1.0 cm per month. If the sole does not wear sufficiently, it becomes thickened, and because the thickening is seldom uniform, defects are produced that lead to pocket formation and overgrowth, which sets the stage for infection. The healthy nail The nail consists of two parts: the wall and the sole part, which are connected at the sole side. This junction is an important area where infections can emerge if its integrity has been severed by excessive abrasion on hard floors (concrete stable, tar roads) or wrong pedicure. This connection site is comparable with the so-called 'white zone' in hoofed mammals. The white line (or white zone) structure is illustrated in the figures and photos below (Benz, 2005). The nails should be shorter than the pad, without cracks and U-shaped. The skin in between 2 nails should be clean and flexible. When there is hyperkeratosis in this area, this may cause discomfort to the elephant as the hard hyperkeratotic tissue acts as a foreign body by pinching the interdigital skin an dirt can accumulate into the interdigital space. There should be room for at least one finger between 2 nails. The thermographic images of a healthy nails shows a regular distribution of the temperature dispersed over the entire nail. Like in hoofed mammals, the nails are connected with the underlying phalanges by lamellae or horn leaflets. Benz (2005) describes the different parts of the nail: a: corial part of the horn wall: cuticle area b: lamellae (horn leaflets) c: white zone d: sole horn Cuticle and sweat glands The cuticle of the nail is the keratinized skin at the junction with the nail. They should be soft and flexible. This is a vulnerable area as microorganisms may pass this natural barrier after (micro)trauma. The elephant seems to maintain the cuticles by rubbing them gently against objects. Elephants that are kept in moist, muddy conditions, are likely to develop problems with the cuticles. They may overgrow and become hardened when they dry, resulting in cracks and infection. During pedicure, one should be well aware of the protecting function of the cuticles and never remove more than necessary. References Benz, A. 2005. The elephant’s hoof: Macroscopic and microscopic morphology of defined locations under consideration of pathological changes. Master's thesis, Veterinary Faculty of the University Zürich, Switzerland. Fowler M.E. and Mikota S.K. 2006. Biology, Medicine, and Surgery of Elephants. 271-290. Hess A. 2022. Lesions found in the post-mortem reports of the Asian (Elephas maximus) and African (Loxodonta africana) elephants of the European Association of Zoos and Aquaria Master's thesis, Department of Exotic Animal and Wildlife Medicine University of Veterinary Medicine Budapest, Hungary. Hutchinson JR, Schwerda D, Famini DJ, Dale RHI, Fischer MS, & Kram R. (2006). The locomotor kinematics of Asian and African elephants: changes with speed and size. Journal of Experimental Biology, 209, 3812-3827 . Nigam, P., Sarma, K.K., Kumar S. and Pandey, R. (Eds.) 2025. Healthy Feet, Healthy Elephants: A Guide to Foot Care in Captive Asian Elephants . Project Elephant Division, MoEF&CC, GoI- Wildlife Institute of India. Schiffmann C. 2021. Posture Abnormalities as Indicators of Musculoskeletal Disorders in 12 Zoo Elephants – a Visual Guide. Gajah 53 (2021) 20-29. Weissengruber, G.E., Egger, G.F., Hutchinson, J.R., Groenewald, H.B., Elsässer, L., Famini, D. and Forstenpointner, G. (2006), The structure of the cushions in the feet of African elephants (Loxodonta africana). Journal of Anatomy, 209: 781-792. https://doi.org/10.1111/j.1469-7580.2006.00648.x To page top

This page directs you to the following reproduction-related topics in elephants: -estrous cycle -normal birth process -vaginal vestibulotomy -tumors and cysts in the reproductive organs -cesarian -dystocia -fetal retention -infertility (female) -infertility (male) To dashboard Reproduction Estrous cycle Endoscopy urogenital tract Pregnancy confirmation Normal birth process Dystocia Vaginal vestibulotomy Fetotomy Tumors and cysts I need your input to write these chapters: Cesarian Infertility (female) Infertility (male)