By Madison Diglio
Valerie and Dr. Aziz
On January 12, 2023, two staff members of County Ob/Gyn, traveled to Roger Williams Park Zoo in Providence, RI, to treat an extraordinary patient; Finley, an 8-year-old multiparous female howler monkey who was in need of gynecologic help. Tania Aziz, MD, and Valerie Ciavaglia, sonographer, were happy to assist the veterinary staff at the zoo. Dr. Jessica Lovstad, a veterinarian on staff, posted looking for assistance from an Ob/Gyn in a private One Health Facebook group. Dr. Aziz reached out to Dr. Lovstad explaining how County Ob/Gyn would be more than happy to help find the reason for Finley’s recurrent vaginitis.
Courtesy of Roger Williams Park Zoo
In December 2021, Finley had a possible pseudo pregnancy with suspected endometritis/vaginitis. Endometritis is inflammation of the endometrium, the inner lining of the uterus, while vaginitis is an inflammation of the vagina that causes symptoms such as itching, burning, odor, and large amounts of discharge. Between April and November of 2022, Finley had 4 instances of suspected urinary tract infections and vaginal infections. Dr. Lovstad performed a pelvic exam and obtained vaginal cytology and cultures, and it grew numerous bacteria. She treated Finley with antibiotics for 30 days and the discharge cleared. However, due to the numerous strains of bacteria growing on culture and Finley’s complex history, the veterinary team at Roger Williams Park Zoo was interested in having a second opinion to help them look for any abnormalities in the vagina as well as perform a uterine ultrasound.
Once Dr. Aziz and Valerie arrived at the veterinary hospital, Finley was put under anesthesia for the exam. Valerie set up the ultrasound machines using both the ultrasound owned by the hospital and a portable ultrasound from County Ob/Gyn. While Valerie was preparing for the ultrasound exam, Dr. Aziz performed a breast exam on Finley and the results were normal. Valerie then scanned to assess the anatomy of the ovaries, uterus and bladder. From the beginning of the exam, Valerie could see that the uterus looked abnormal as it was vascular and mass like. Her sonographic findings concluded Finley’s ovaries, adnexa and cul de sac appeared unremarkable as did the bladder.
Valerie, Dr. Aziz and Dr. Lovstad looking at Finley’s ultrasound on County Ob/Gyns portable ultrasound machine
Dr. Aziz began her exam on Finley by first looking at the external genitalia and she concluded it to be normal. Interestingly enough, the anatomy of a female howler monkey is the same as a human female but smaller. Due to the smaller anatomy, Dr. Aziz used a pediatric speculum which is narrower and shorter than other speculums, making it the most appropriate for Finley’s exam. Once the speculum was placed, Dr. Lovstad confirmed it was not a normal appearance of a monkey’s cervix and Dr. Aziz and the veterinarian team could see a polypoid mass was present. It was unclear if the mass was cervical or endometrial in origin and Valerie assisted by performing a uterine ultrasound. Dr. Aziz also took a yeast culture to detect the presence of a yeast infection.
Drs. Aziz, Lovstad and Valerie observing the cervical mass in Finley
Dr. Aziz performed a biopsy and obtained a 2mm tissue sample. Valerie scanned Finley post biopsy to ensure stability and the results were unremarkable. This concluded the exam on Finley.
Dr. Aziz taking a biopsy
In regards to the cervical mass, Dr. Aziz recommended a total hysterectomy as there is no need for future fertility since Finley has already had three babies, Tucker, Ryder and Piper. If the yeast culture is positive, a dose of Diflucan, the same drug used in human females, should clear it.
Dr. Aziz and Valerie in front of the rainforest exhibit
The staff at the zoo were extremely welcoming and kind to Dr. Aziz and Valerie and made the visit an unforgettable experience. After the exam, a tour of their beautiful facility was given. They were treated to meeting southern tamanduas and a giant anteater. Roger Williams Park Zoo opened in 1872, making it the country’s third oldest zoo, and is home to 121 unique and captivating species from around the world. At the core of their mission is conservation and environmental stewardship and each visit supports RWPZ ongoing animal care, educational programs and conservation conservatives. Each day, they strive to contribute to a healthier planet for us all by using the best practices in every operation. It truly was an excellent adventure for our staff.
County Ob/Gyn sends our very best to Finley in hopes she is recovering well! We were extremely honored to be asked to offer our opinion in helping Finley and the veterinary team.