<img class="aligncenter size-medium wp-image-378" title="training_tails" src="http://aecetia.net/gws/aazk/wp-content/uploads/header_training_tails-300x64.jpg" alt="training_tails" width="300" height="64" />

<em>By</em>
<em>Mylisa A. Whipple, Primate Keeper</em>
<em>Saint Louis Zoo</em>
<em>Saint Louis, Missouri</em>

<strong>Introduction</strong>

It can be a challenge to treat any animal that is diagnosed as a diabetic, and non-human primates are no exception.   Treatment can be constrained by a variety of factors such as the environment, social situations, and the personality and temperament of the individual being treated, just to name a few. Every situation is different, and every animal is different.  But across the board, two of the most important things required to successfully treat that animal are to have a well thought out, but flexible training plan and to keep an open line of communication between all the people that are involved in the care and management of that animal including, keepers, veterinary staff, and nutrition staff.

In the past few years, keepers at the Saint Louis Zoo have been involved in the training and treatment of two different monkeys, both diagnosed with diabetes.  Though they were different species and their situations and personalities were also quite different, a similar approach was used to treat both of them.  The same flexible shaping plan was even adapted to train them both in order to better treat their diabetes.

<strong>Case 1: Bozo</strong>

In 2005, the Saint Louis Zoo housed 1.4 Hamadryas baboons (<em>Papio hamadryas</em>).  The male, named Bozo, was diagnosed with diabetes.  Keepers had observed Bozo showing signs of weakness when he walked, noticed sticky urine on the floors of the baboon enclosure, and observed the female baboons lapping up puddles of Bozo’s apparently sweet urine.  These observations suggested that something was going on with Bozo’s health and ultimately led to the veterinary work-up that resulted in this diagnosis.  In collaboration with the zoo’s veterinarians and nutritionist, Bozo’s diabetes was originally managed using oral medication and diet.  In order to test his glucose level, Bozo was trained to urinate on cue so that glucose levels could be tested in a sample of his urine.  The shaping plan for this required a keeper to observe Bozo until he urinated and then the behavior was captured using a whistle as a bridge the instant he started to urinate.  He was immediately rewarded with a jackpot item (preferred food item) and the verbal praise, “Good Pee.”  After initially capturing this, the training progressed to calling him into his holding cages and using the verbal cue “Bozo, Pee.” After giving the verbal cue, he was then observed until he urinated, which was then followed immediately with the bridge, a jackpot item, and the verbal praise, “Good Pee.”  Eventually, Bozo made the connection and would visibly try to urinate once he heard the verbal cue “Bozo, Pee.”  The success of this training allowed for regular testing of glucose levels in his urine.

Based on the progression of Bozo’s symptoms, the veterinarians decided that Bozo needed to start receiving insulin injections in order to manage his diabetes.  Because he was not injection trained, he initially had to be darted with insulin daily.  Injection training of Bozo was started so that he would not have to continue to undergo the stress of being darted for any longer than necessary.

A squeeze cage was custom built by one of the Zoo’s welders to use for this training.  It was installed as a permanent part of one of the baboons’ holding cages.  The outer dimensions of the squeeze cage were 92 cm in width, 104 cm in height, and 64 cm in depth.   It was composed of a metal

frame with the front wall, back wall, and ceiling made out of metal chain link fencing material similar to that of the front wall of the existing holding cage.  It had two aluminum doors that could be completely removed when not needed.  The squeeze mechanism was a movable plexi-glass wall with a metal frame that could be pulled using a handle by a keeper from outside of the cage and could be locked into place as needed.

The author became Bozo’s primary trainer and was charged with developing a shaping plan that would include squeeze cage-training and injection-training.  After researching examples of squeeze cage and injection-training shaping plans from other institutions and getting advice from other animal trainers, a shaping plan was developed that would work best for the situation and included multiple options that could be used depending on how the training was progressing.

Once the shaping plan was approved, Bozo’s training started. The shaping plan included an acclimation period, followed by several training options for how the squeeze cage could be used during the training.  Depending on how training progressed, one or more of these options could be skipped. The first option was to use the squeeze cage as a narrowing tunnel or chute in which the space that he was asked to enter was simply narrowed each time prior to him entering it, until his hip and callosity were close enough to the front wall to begin injection training.  The second option was to be used if he did not want to stay in the narrowed cage for longer periods without being closed in. This option included working towards closing the doors of the squeeze cage on both sides of him. First he would be trained to allow one door to close and then the second door would be added in.  The third option was to be used if the hip and callosity were still not close enough to the front wall. In this third option the training would involve actually working towards using the squeeze mechanism to “squeeze” Bozo into the position needed for the next step of his training. Once proper positioning of Bozo’s hip and callosity was achieved, the final step in the shaping plan, injection-training, would follow.  The injection-training portion consisted of several steps including desensitizing him to the presence of a syringe, touching him with a capped syringe, touching him with needle, poking him with the needle, and then injecting him with saline (in place of insulin).

The first step in the training plan, to acclimate the baboon group to the squeeze cage, began in mid-July, 2007. In Bozo’s case, the second and third options of the shaping plan were never needed, and the training process went rather quickly. By the end of August, Bozo was accepting hand injections of insulin.

Up to this point, the squeeze cage and injection-training was only used to give Bozo his insulin injections.  Urine-training was the method being used to obtain glucose measurements.  However, Bozo began to have trouble with the urine-training (he was having difficulty urinating on cue even though he was clearly trying).  Because of this and the lack of accuracy with urine glucose tests it was decided that his squeeze cage-training could also be used to obtain blood samples for blood glucose testing.  This method of sampling would be a more accurate measurement of his glucose levels.  Blood samples were obtained by using a needle to lance the skin of his callosity and then testing a drop of his blood with a blood glucose meter.  Unfortunately, the test strip of the blood glucose meter was too short to reach the drop of blood on his skin, so the blood drop had to be collected on the plastic sleeve of the syringe in order to be tested.  By the end of September, his blood glucose was successfully tested using this method.  At the beginning of October, these behaviors were transferred to secondary trainers.

Bozo’s training was a success for both the trainers and for Bozo, in that it made it easier to treat his diabetes.  As mentioned earlier, the animal’s situation and personality<img class="alignright size-medium wp-image-2629" title="insulin_inject" src="http://aecetia.net/gws/aazk/wp-content/uploads/insulin_inject-300x262.jpg" alt="insulin_inject" width="300" height="262" /> can affect how its training progresses.  Fortunately, Bozo was the dominant animal in his group, he was already comfortable being separated from the girls for short periods of time, and he was a highly food-motivated individual.  Because he was a diabetic, the typical rewards we used for him that were nutritionist-approved included the limited fruit from his diet and a small amount of mixed nuts or peanuts.  Some sugar-free treats were tried as jackpot reward items, but Bozo did not like them so the fruit portion of his diet was used as his jackpot items.  Because Bozo was eager to train for these items, his training progressed even more smoothly.

In March 2008, Bozo started showing signs of weakness in that he was having trouble walking.  He was immobilized for blood work and given fluids.  In order to prevent him from having to be immobilized for fluids daily, attempts were made to give Bozo fluids subcutaneously using his trained squeeze cage behavior.  The plan was to have a veterinary technician and one of Bozo’s trainers work together to get him into his normal training position and then administer the fluids subcutaneously.  Bozo was amazing and allowed fluids to be given in this manner for several days.  Unfortunately, despite these efforts Bozo’s health continued to decline and it was decided that Bozo should be humanely euthanized on April 15th, 2008.  Because Bozo had been an amazing animal that loved to train, he accepted an injection for anesthesia in the squeeze cage just as if he was being trained for his insulin.

It was not stressful at all, but rather calm and normal for him.  Once anesthetized, the veterinarian was able to humanely euthanize him.  The training program had successfully prolonged and improved his quality of life.

<strong>Case 2: Ike</strong>

The 4.0 lion-tailed macaques (<em>Macaca silenus</em>) housed at the Saint Louis Zoo were moved to the exhibit that once housed the baboons in January 2011.  Because they were an aging group and the squeeze cage was located in one of their holding cages, the squeeze mechanism would be a valuable tool in helping with future medical procedures.  Acclimation to the squeeze cage began in March with the goal of working towards injection training each of the macaques.

The shaping plan from Bozo’s training was easily adapted for this new training endeavor.  However, one of the lion-tailed macaques, Ike, was diagnosed as a diabetic in May. The keepers had noticed sticky, dried urine on the exhibit floor.  A urine sample from Ike was tested with a urine glucose test strip and the results showed high glucose values.  The diagnosis of diabetes followed a veterinary work up.  As with Bozo, it was decided to try and treat Ike using oral medication and diet first.  It also became a priority to get him squeeze cage and injection-trained to help with his treatment.

Ike was already used to being separated from the other members of his group and because of the training that was already started he was used to entering the squeeze cage at a fairly narrow width.  From this point, training continued following the same shaping plan that had been used with Bozo in the past.

Ike’s shaping plan once again included several options for how the squeeze cage could be used during the training, and these options could be taken or skipped depending on how the training progressed.  Starting with the first option, Ike was asked to enter the cage at narrowing depths until it was as narrow as it could be, yet still allow him to enter the squeeze cage comfortably.  However, because Ike’s hips are much narrower than that of a baboon, both the second and the third options in the training plan had to be used.

The second option included steps working towards closing Ike into the squeeze cage.  The steps involved putting the doors back on the cage, then working towards closing one door while he was in the cage, then closing both doors while he was in the cage, and finally lengthening the amount of time he was closed in the cage.  The third option included steps working towards actually squeezing the cage down so that his hip and callosity area could be easily reached by the trainer for both lancing and injections.  The steps for this included getting Ike used to the movement of the squeeze mechanism by narrowing the area he was in by small increments, and lengthening the time he was “squeezed.”  Once Ike was desensitized to the squeeze and his body in the correct position, progress could be made towards the final steps in the shaping plan.  This included lancing/injection-training for both blood glucose testing and insulin injections.

By the end of September, Ike allowed his blood glucose to be tested.  By mid-October, he was reliably allowing his blood glucose to be tested daily.  This allowed for a secondary trainer to be trained to obtain blood glucose measurements from Ike as well.  By mid-November Ike was accepting injections with saline (in place of insulin).  This behavior was transferred to the secondary trainer and soon after, other primate keepers were trained to be secondary trainers as well.  It was important that several keepers were able to train Ike so that blood glucose measurements could be taken daily and that injections could be done daily if needed in the future.  Because of the importance of consistency in training, a protocol was written that included the steps to Ike’s training, the schedule for his daily training and medications, and any other important information regarding his treatment and training.  This protocol was posted near the squeeze cage so that it could be easily referred to and updated as needed.

As with Bozo, Ike’s situation, personality, and preferences were added components that had to be considered when planning his training.  Ike was the second most dominant animal in his group and unlike Bozo he was not as trusting of keepers.  But like Bozo, he was a food-motivated individual.  Another difference between Bozo and Ike was that Ike liked sugar free treats, so his nutritionist-approved rewards for training consisted of a small amount of peanuts, the fruit from his diet, and sugar free jack pot items including red licorice, Hershey’s York Peppermint Patties® and a variety of flavors of sugar-free powder drinks.

A further complication that did not occur with Bozo was that Ike started developing cataracts, which occurred after he had already been training for some time.  Training had to be adjusted slightly for this because the cataract in his right eye was worse than in his left.  It seemed that Ike preferred to have his left side facing the trainer during training sessions.

At the present time, Ike’s diabetes has been managed with diet and oral medication.  But, if Ike ever needs to start receiving insulin injections, it can be done right away because he has already been injection-trained.  The keeper staff keeps track of…

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