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Zoo Call —
Interventional Radiologists Perform Fibroid Embolization on Female Gorilla Before September 18, Steven Smith, MD, was known as an interventional radiologist from Adventist La Grande Memorial Hospital located just outside Chicago. However, after performing a uterine fibroid embolization (UFE) on a female western lowland gorilla, aged 46, Smith added one more title to his name. “I’ve become known as the Gorilla Doctor,” Smith says. Smith and a team of interventional radiologists—Luke Sewall, MD, and Francis Facchini, MD—were called on by Susan Murrey, MD, to treat Beta, a gorilla with uterine fibroids. Murrey, a gynecologist who consults with Brookfield Zoo in suburban Chicago, sought the interventional radiologists to relieve Beta of her severe symptoms. An ultrasound exam showed she had an enlarged uterus and was suffering from abdominal discomfort and heavy vaginal bleeding. “The gorilla was becoming anemic from the amount of blood lost,” Smith says. “The zoo has various apes there with female issues,” Smith adds. “Gorillas menstruate and have reproductive lives quite similar to human females. And among the similar issues they face are uterine fibroids.” Uterine fibroids are noncancerous tumors that develop in the muscular wall of the uterus. They occur in 20% to 40% of human women aged 35 and older. Most fibroids don’t cause symptoms, and only 10% to 20% of women who have fibroids require treatment. Other Methods Failed For a human woman experiencing this level of complications from uterine fibroids, the next step would be a hysterectomy, Smith says. With a hysterectomy, there is usually a three- to four-day stay in the hospital and a six-week recovery period. This treatment course, considered difficult for women, is even more challenging in the case of a gorilla, Smith explains. “It’s difficult to perform a hysterectomy on a gorilla,” he says. “They’re not good patients, and there’s no good way to conduct follow-up care. You can’t ask a gorilla patient how she’s feeling.” That’s why Murrey considered the less invasive UFE procedure as a safe alternative to alleviating Beta’s symptoms. In women, UFE involves entering the uterus through a catheter inserted through the femoral artery. According to the Society of Interventional Radiology (SIR), women typically stay one night in the hospital after undergoing UFE and can be back to normal activity within seven to 10 days. On average, 85% to 90% of women who have undergone the procedure experience significant or total relief of heavy bleeding, pain, and/or other symptoms. Smith says the less invasive option was best for Beta, who is considered “fragile” for a gorilla because of her age. “The main difference between a female human patient and the female gorilla in this case was the age of the patient,” Smith says. “A 46-year-old gorilla is very old in gorilla years. To perform this procedure on a gorilla this old is like having a little old lady who is still menstruating as a patient.” Brachial Artery Access “We had to use the brachial artery in one of the gorilla’s arms,” he says. From there, a catheter was inserted and, using real-time imaging, guided into the uterine artery. Next, embolic particles approximately the size of grains of sand were released into the uterine arteries supplying blood to the fibroid tumor. These particles act as clotting agents, cutting off the blood flow to the fibroid tumors. Ultimately, this procedure causes the fibroids to shrink but keeps the uterus and ovaries intact. “Once we were inside, it was amazing to see how much her reproductive organs looked exactly the same as a human’s,” Smith says. “From that point forward, this was like a regular case.” The procedure took roughly 90 minutes to complete. Beta was given a spinal anesthesia to manage cramps and moved to her cage to recuperate on a bed of soft straw. When she woke up, she was able to move around and Smith says she “seemed OK.” On examination, she appeared to be “totally fine.” “There was no bleeding, and she was able to go back on exhibit four to five days later,” Smith says. “I would cautiously say this was the first successful uterine fibroid embolization performed on a gorilla.” Smith refers to the efforts taken to save the “beloved gorilla” as a true volunteer effort. In addition to the work performed by the interventionalists, technologists from the hospital also donated their time, GE Healthcare donated the mobile fluoroscopy equipment, Boston Scientific donated catheters for the procedure, and Biosphere Medical donated embolic materials. According to SIR, interventional radiologists have successfully used embolization of the uterine arteries for more than 20 years. Embolization to treat tumors has been performed since 1966, and UFE has been performed since 1995. Smith has been performing UFEs for nearly 10 years. However, this is still a little-known procedure, something Smith hopes will change with the publicity surrounding Beta’s UFE procedure. “Seventy-five percent of women with fibroids can be successfully treated long-term with UFE, but there hasn’t been a 75% drop in the hysterectomy rate for fibroid patients,” Smith says. “UFE is much safer than a hysterectomy. The risk of death from UFE is greater than 10 times less than for a hysterectomy. You can say that a gorilla received a high-tech, minimally invasive treatment that many American women with uterine fibroids have been denied.” — Kathy Hardy is a freelance writer and editor based in Phoenixville, Pa. Hot Flash: Gorillas Also
Experience Menopause This is gorilla menopause—the subject of a national study led by Illinois’ Brookfield Zoo and funded by the U.S. National Institutes of Health (NIH) National Institute on Aging in the hope of learning more about the human female reproductive cycle. Its cause is timely. By 2025, there will be an estimated 825 million women aged 65 and older—the largest-ever population of women simultaneously in menopause. The population of gorillas, which share many physical traits with humans, mirrors these demographics in U.S. zoos, according to Brookfield Zoo research scientist and primatology specialist Sylvia Atsalis, PhD, who developed the study with Sue Margulis, PhD, Brookfield Zoo’s former behavioral research manager and current curator of primates at Lincoln Park Zoo in Chicago. Like humans, gorillas in zoos are living longer than ever because of advances in scientific knowledge, nutrition, and healthcare. “The NIH was interested in our study because there’s a great deal of concern about maintaining the well-being of an aging human population,” says Atsalis. “As primates, humans and gorillas share many important physical traits. Our findings underscore those similarities and the parallel between humans and gorillas, our evolutionary cousins, who may be good models for an improved understanding of menopause.” But the first question that the biologists faced was do gorillas go through menopause? The gorilla menopause study began as a pilot project at Brookfield Zoo when Atsalis and Margulis wondered whether Alpha, an elderly western lowland gorilla born in 1961, should be contracepted to prevent pregnancy. They feared that an animal of her advanced age would not be able to properly care for a baby, though conception is rare among gorillas in their late 30s. And yet Alpha was very interested in Ramar, the group’s silverback. Although she usually kept her distance, once per month, Alpha would approach Ramar and stare at him intently, charged with desire, sometimes throwing hay and turning her back at him in a coy, sexual display. Alpha’s behavior would persist for a day or two, despite Ramar’s indifference. Then she would revert to her quiet and solo behavioral routine. — Reprinted with permission of the Brookfield Zoo
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