There are times when doctors refer their patients to a specialist. That is what Dr. Susan Murrey, an obstetrician/ gynecologist at Adventist Hinsdale Hospital, did for one of her patients, Beta, who happens to be a 46-year-old menopausal western lowland gorilla at Brookfield Zoo.
In late 2005, Dr. Natalie Mylniczenko, an associate veterinarian for the Chicago Zoological Society, which manages Brookfield Zoo, contacted Dr. Murrey about Beta's condition: abdominal discomfort and heavy vaginal bleeding. An ultrasound led to the discovery that a small fibroid, or benign tumor, in the muscular layer of the gorilla's uterus was contributing to the bleeding. After little success of shrinking the tumor with birth control bills, Dr. Murrey and a team of technicians and nurses made a house call to the zoo in early April 2006 to perform the first-ever documented hydrothermal ablation, or HTA, on a nonhuman primate. This procedure, which is much less invasive than a hysterectomy, coagulates the endometrium, or inner lining of the uterus.
The HTA showed promise at first but, due to the size and location of the fibroid, alleviated the problem for only a few months. A more permanent solution was necessary. Prior to pursuing invasive surgery that could result in a long recovery period, CZS veterinary staff once again collaborated with Dr. Murrey, who helped organize an advanced procedure called uterine fibroid embolization (UFE), which will hopefully shrink the mass.
Dr. Murrey referred Beta's case to Dr. Steven Smith and his partners, Drs. Luke Sewall and Francis Facchini, who are interventional radiologists at Adventist La Grange Memorial Hospital. In this specialized field, doctors use X-rays and other imaging techniques to see inside the body and guide micro-tools to treat conditions without surgery.
In addition to the doctors and technicians from Adventist La Grange Memorial Hospital donating their time, GE Healthcare/Surgery OEC provided the mobile radiology equipment, called a C-Arm, for the procedure. "We are extremely grateful and appreciative to the doctors, nurses, and technicians from both hospitals and to GE Healthcare for donating their time and equipment to help Beta," said Dr. Mylniczenko. "This kind of teamwork illustrates the amazing collaboration between human and veterinary physicians in providing the best care for the animals in our care."
The interventional radiology team from Adventist La Grange Memorial Hospital did the first UFE procedure on a human in Illinois almost 10 years ago, and on September 18, they performed the first-ever documented UFE on a nonhuman primate.
"Beta received a high-tech, minimally invasive treatment, an option that many American women with uterine fibroids aren't aware of because they are still being steered toward surgery," said Dr. Smith.
During the one-and-a-half-hour procedure, a catheter, or tiny tube, was inserted into an artery in Beta's left arm and was then guided into the uterine artery. An arteriogram (an X-ray in which a dye is injected into the blood vessels) was performed to map the artery feeding the fibroid. Next, tiny microscopic particles (hollow plastic spheres about half a millimeter in diameter) were injected through the catheter and into the fibroid, cutting off its blood supply. The procedure will cause the fibroid to shrink much as they do after menopause, but the uterus and ovaries are spared. "The similarities in the anatomy and pathology between humans and gorillas suggest UFE was a viable alternative to a hysterectomy," Dr. Smith said. "We are thrilled to have been given the opportunity to bring this relatively new technique to Brookfield Zoo to help Beta."
Over the years, Beta has had her share of specialists assisting in her health care. CZS Animal Programs staff affectionately refer to her as the "poster child of gorilla firsts." In addition to receiving the first UFE and HTA on a nonhuman primate, she was also the first gorilla to give birth to an infant born through artificial insemination/assisted reproduction while on a breeding loan at Memphis Zoo in 1981. Then, in 1986, she was the first and is still the only gorilla to have had bilateral hip replacement surgery due to severe osteoarthritis.