Kiara Lion’s surgery was a learning opportunity for veterinary students

Photo of Kiara Lion by Kim Pyne

Photo of Kiara Lion by Kim Pyne.

This spring, our staff noticed that one of our sweet, elderly, attention-seeking lionesses—Kiara—began behaving in uncharacteristically aggressive and worrisome ways. It became clear that something had changed Kiara’s habits and temperament.

We determined that changed hormonal cycling patterns we had been monitoring were likely part of Kiara’s drastically changed personality. Our lead veterinarian, Dr. Doug Ray (whom we all call “Dr. Doug”) of The Animal Hospital of Mebane, told us a medical issue with Kiara’s ovaries could be causing abnormal hormone levels. Since Kiara is geriatric and there was no need for her reproductive tract, Dr. Doug suggested we try to alleviate her issues with a spay and exploratory surgery.

Dr. Doug, a graduate of the North Carolina State University College of Veterinary Medicine (NCSU CVM), is committed to providing vet students hands-on experiences to complement and expand their education. Therefore, we invited the CVM’s Carnivore Team—a student-run organization that aims to familiarize students with the research, care, and husbandry of wild and captive carnivores—to participate in the surgery. We have worked with this team and their faculty advisor, Dr. Suzanne Kennedy-Stoskopf, on several educational projects over the years; most notably, a surgery on one of our binturongs that was so interesting it is the subject of a story on the CVM’s website.

The students from the Carnivore Team who joined us were:

  • Heather Brown, DVM Candidate Class of 2017, Carnivore Team Exotic Animal Medicine Service Shadowing Chair
  • Katie Cassady, DVM Candidate Class of 2018, Carnivore Team Co-President
  • Kyle Farmer, DVM Candidate Class of 2018, Carnivore Team Member
  • Hannah Gardner, DVM Candidate Class of 2018, Carnivore Team Captain
  • Liz Hyde, DVM Candidate Class of 2017, Carnivore Team Co-President
  • Ashley Kirby, DVM Candidate Class of 2018, Carnivore Team Junior Preventative Medicine Chair
  • Adeline Noger, DVM Candidate Class of 2017, Carnivore Team Enrichment Committee Senior Chair
  • Sarah Roberts, DVM candidate, class of 2018, Carnivore Team Enrichment Committee Junior Chair

After Kiara’s surgery we asked the students and Dr. Doug for feedback about their experience. Some of their comments are included in this story.

Dr. Doug prepped the students before the procedure.

Dr. Doug prepped the students before the procedure.
(L to R, going clockwise): Katie, Ashley, Heather, Sarah, Kyle, Liz, Dr. Doug (his back is to the camera).

Big cat surgeries require a large amount of coordination, including ensuring we have the appropriate staff ready for specific roles and that all of our equipment and supplies are ready and available. We set up a surgical tent close to Kiara’s enclosure to protect our patient, staff, equipment, and supplies from the elements and insects. I worked closely with our Veterinary Services Assistant, Alexandra Paschall, to ensure she had what she needed. She, in turn, ensured that everything was in place before Dr. Doug arrived.

Dr. Doug first met with the students to explain the procedure, discuss each person’s role, and answer questions. Then our Co-Founder, Doug Evans; our Operations Director, John David Wagner; and Dr. Doug went to immobilize Kiara. To minimize distractions, the students and the rest of our staff awaited my radio call alerting them that Kiara was ready to be moved.

Dr. Doug and team check Kiara’s reflexes to confirm that she has remained fully unconscious before she is moved to the surgical table.

John David (left) and Keela (facing camera) watch while Dr. Doug, Alexandra, and Doug check Kiara’s reflexes to confirm that she has remained fully unconscious before she is moved to the surgical table.

When the students joined the team they helped us lift Kiara onto a stretcher, then rolled her from her enclosure to the surgical tent. Our staff and the vet students lifted Kiara onto the operating table, where we had to reposition her for anesthesia. “Surgery on a big cat takes a large amount of teamwork and communication,” said Sarah. “Just the movement of Kiara took many hands and coordination.”

Kiara weighs about 450 pounds, so it takes a lot of people to safely move her.

Kiara weighs about 450 pounds, so it takes a lot of people to safely move her.
Those visible, L to R, clockwise: John David, Alexandra, Dr. Doug, Keela, Ashley, Heather, Sarah, Katie, Doug (with back to camera).

As soon as Kiara was in position, Dr. Doug put an anesthesia mask on her to keep her immobilized while he prepared to intubate her.

We needed to move quickly from the time we removed Kiara from her enclosure until we had the anesthesia mask on her.

We needed to move quickly from the time we removed Kiara from her enclosure until we had the anesthesia mask on her. But the mask is just a temporary means of delivering anesthesia.
L to R, clockwise: Dr. Doug, John David, Kyle, Alexandra, Hannah, Keela, Liz (farthest back on right), Heather, Sarah, Katie.

Sarah was in charge of holding the anesthesia equipment that would be attached to the endotracheal tube. While Dr. Doug was preparing the endotracheal tube, Doug showed Sarah how to adjust levels on the anesthesia machine. Throughout any surgery, it’s critical that someone monitors this machine to ensure that the patient is receiving the right amount of gas and to determine when it is time to rotate oxygen tanks. “The Iso (anesthesia machine) has been an amazing addition to the facility,” said Dr. Doug. “It allows us to perform these procedures more safely and with much more precision from an anesthetic perspective, and it allows for quicker recovery.”

Doug teaches Sarah about the anesthesia machine.

Doug teaches Sarah about the anesthesia machine. It was donated by a dedicated group of Lifetime Adopters who wanted to ensure good surgical outcomes for our geriatric residents, who are the most at risk when we must administer anesthesia.

Tracheal intubation requires placing a flexible plastic tube into the trachea (windpipe) to administer anesthesia. “Observing Dr. Doug put his entire arm into Kiara’s mouth made everyone nervous for him,” commented Hannah.

Hannah holds Kiara’s head still while Dr. Doug begins intubation.

Hannah holds Kiara’s head still while Dr. Doug begins intubation.
L to R: Hannah, Doug, Kyle, Dr. Doug.

Although the students realized Dr. Doug would need to stick his arm in Kiara’s mouth, they were impressed by just how much of his arm it would require! “I knew that intubating big cats can be a challenge because it is done blind since you cannot see the epiglottis and arytenoids, which are your typical landmarks for guiding the endotracheal tube safely into the trachea,” said Adeline. “It was great to have the opportunity to watch how you feel these landmarks by sticking your arm in the animal’s mouth.”

Alexandra holds Kiara’s mouth open wide while Dr. Doug places the endotracheal tube.

Alexandra holds Kiara’s mouth open wide while Dr. Doug places the endotracheal tube.

After the group settled Kiara into place on her back, Alexandra shaved the surgical site.

Dr. Doug shows Alexandra how large an area he wants shaved.

Dr. Doug shows Alexandra how large an area he wants shaved.

Adeline assisted while Dr. Doug performed the spay. “I have assisted in several other procedures at the Center when animals needed to be sedated for examination or certain procedures, but this was my first surgical procedure,” said Adeline. She volunteered at the Conservators Center for several years as an animal keeper and tour guide before she entered vet school. That experience led her to focus on zoological medicine.

Hannah, Taylor Hattori, and Heather watch Adeline and Dr. Doug perform the spay.

Hannah, Taylor Hattori (our staff photographer, who videotaped the procedure for educational use), and Heather watch Adeline (L, with mask on) and Dr. Doug (R, with mask on) perform the spay.

After the spay was completed, Dr. Doug focused on a mass he wanted to biopsy. He taught Heather how to make the incision to collect a sample. “The most interesting part of the experience for me was being involved in a procedure that involves such a complex network of people,” said Heather. “For everything to go smoothly we all had to be prepared for our tasks and continually communicate updates. This procedure required incredible in-depth planning in order to have all the supplies available for any number of situations that could occur.”

Dr. Doug instructs Heather while she takes a sample for biopsy. Ashley intently observes.

Dr. Doug (right) instructs Heather (left) while she takes a sample for biopsy. Ashley (center) intently observes.

After the surgery we positioned the stretcher and discussed exactly how we were going to move Kiara onto it once Dr. Doug removed the endotracheal tube. The team quickly moved Kiara back to her enclosure and settled her in a comfortable spot for recovery.

Doug holds a police baton and watches Kiara while Dr. Doug checks her vital signs.

Doug holds a police baton and watches Kiara while Dr. Doug checks her vital signs. If Doug saw Kiara move, he was prepared to angle the baton between her mouth or paw and Dr. Doug to protect him from being bitten or scratched.

Surgical photos by Mandy Matson.

We all had a long day and I was really pleased with how well the students performed. They were professional and serious about their roles, but clearly had fun working with a lion. “We do not get a chance to work with large cats in our core curriculum at the vet school, so it was a tremendous benefit to have this experience,” Heather told us. Katie was fascinated by how similar to a domestic spay the entire process was: “Dr. Doug taught us how we can apply what we learn from small animal medicine to exotic species.”

“It was especially gratifying to provide experiences to the students that I would have loved to have had when I was in school,” said Dr. Doug. “We always like to include as many people who will benefit from these procedures as possible, whether that be students or other veterinarians. We knew this would be a great opportunity for students because it would provide ample opportunity for them to assist—which is always better from an educational standpoint than just observing.”

Although this was the first time any of these students had assisted with a surgery on a big cat, half of the team had previous experience working with Kiara. Adeline is a long-time volunteer; Ashley, Hannah, and Sarah are former interns. “My internship at the Conservators Center had a significant impact on my decision to pursue a career in veterinary medicine,” Ashley explained. “After my internship, I was sure that I wanted to pursue a career working with animals and sought out opportunities to gain veterinary experience. I am so grateful that I had the opportunity to help care for the Center’s amazing animals that summer and learn from the knowledgeable staff at the Conservators Center.”

Our lead animal keeper, Hollie Wiegand, and I stayed onsite until the next morning so we could observe Kiara through the night. We checked her breathing at least every hour and did not settle down to sleep beside her enclosure until after midnight, when we were confident she was awake and sternal (able to hold her sternum up and turn her head, which is very important for breathing). Recovery can take a very long time for big cats, so I was very pleased she was up and sternal by midnight.

Portrait of Kiara

Kiara Lion
Photo by Kim Pyne

Before Hollie and I went to sleep we set an alarm to awaken us every hour. We were glad to see that Kiara was wide awake in the early hours of the morning. When our 3AM alarm went off, I rolled over and found Kiara staring directly at me—sternal and laying down, but staring me down. That look was a good reminder of what all of our animals truly are: wild.

Although Kiara was less awake later that morning, she was totally normal by that afternoon. She has since recovered beautifully from her surgery. The biopsy results from the mass were really interesting. It was a benign cyst of a type that has only previously been reported in humans. Adeline, whose area of interest is pathology, is already at work on a case report that she plans to submit to major veterinary journals.

In the days leading up to Kiara’s surgery I worried about so many details of this procedure. But I wasn’t nervous at all on the day of the surgery. I had great confidence in our team, and was certain the vet students would be fantastic help. We were so pleased with how well things went that we are already planning to invite them back to shadow Dr. Doug when he does preventive care and other procedures.

By Keela Kennedy
Animal Husbandry Supervisor

Editor’s note: Like many on our staff, Keela is also a former intern. 

 


Although our tent works well for field surgeries, we look forward to completing our animal health center, which will offer us much greater flexibility in scheduling surgeries. Currently, weather plays a big role in planning procedures. If it is too hot, too cold, or raining, we have to postpone surgery for the animal’s safety.

Here is a rough floor plan of the health center, which we hope to complete next year.

Animal Health Center plan

The plan for our future animal health center.

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One thought on “Kiara Lion’s surgery was a learning opportunity for veterinary students

  1. Pingback: The Conservators Center Update

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