Common Questions About Dental Prophylaxis Answered By Doctors.

This Gorilla’s Caregivers Face Familiar Questions About Aging

This month, as the patient lay anesthetized on a table, a cardiologist made a half-inch incision through the skin of his chest. She removed a small implanted heart monitor with failing batteries and inserted a new one.

The patient, like many older males, had been diagnosed with cardiac disease; the monitor would provide continuing data on heart rate and rhythm, alerting his doctors to irregularities.

Closing the incision required four neat stitches. In a few hours, the patient, a gorilla named Winston, would rejoin his family in their habitat at the San Diego Zoo Safari Park.

“Winston, at 51, is a very old male gorilla,” said Dr. Matt Kinney, a senior veterinarian at the San Diego Zoo Wildlife Alliance who led the medical team through the procedure. With improved health care, new technology and better nutrition, “we see animals living longer, and they’re healthier for longer, too,” he said.

In “human-managed care” (the term “in captivity” doesn’t fly at zoos anymore), gorillas may live two decades beyond the 30- to 40-year life spans that are common in the wild, and longer than zoo gorillas did in decades past.

As with their human relatives, however, aging also brings chronic illnesses that require testing, diagnosis and treatment. Gorillas are prone to heart disease, the leading cause of death for them as for us.

So now the questions for Winston’s caregivers resemble those that doctors and older human patients confront: How much treatment is too much? What is the trade-off between prolonged life and quality of life?

Geriatric wildlife care “has gotten more and more sophisticated,” said Dr. Paul Calle, the chief veterinarian of the Wildlife Conservation Society, based at the Bronx Zoo. “The medical and surgical knowledge of people can be directly applied.”

It looks more like human geriatric care. To keep gorillas healthy, zoo veterinarians not only turn to technologies and drugs developed for humans, but also consult with medical specialists like cardiologists, radiologists, obstetricians and dentists.

Winston, for instance, takes four common heart drugs that people also take, though at different dosages. (He weighs 451 pounds.) The heart monitor he received, smaller than a flash drive, is implanted in humans as well. Winston received his annual flu shot this fall, and he is undergoing physical therapy for arthritis.

“We’re looking to provide comfort to these animals later in life,” Dr. Kinney said.

That doesn’t come cheaply: There were nearly 20 doctors, technicians and other staff in the operating room when Winston received his new monitor. But the San Diego Zoo Wildlife Alliance, parent organization for the zoo and the safari park, covers Winston’s care through its annual operating budget. Donors and partners offset some additional expenses.

“None of our animals have insurance, and they never pay their bills,” Dr. Kinney noted.

Several of Winston’s longtime caregivers, called wildlife care specialists, have retired. But Winston, who has achieved silverback status with age, remains on the job, managing his “troop” of five gorillas, keeping the peace and intervening in squabbles when needed.

“He’s such a gentle silverback, an incredibly tolerant father,” said Jim Haigwood, the curator of mammals at the San Diego Zoo Safari Park. “His youngest daughter, he’ll still allow her to take food out of his mouth.”

The zoo has twice introduced females with sons to the troop, which in the wild might lead to infanticide. But Winston’s caregivers believed he would be accepting, and he was.

“He raised those males as though they were his own sons,” Mr. Haigwood said. (Once they became rambunctious teenagers, however, they were resettled in their own habitat, an option that human parents might occasionally envy.)

Winston, a western lowland gorilla native to Central Africa, arrived at the San Diego Zoo in 1984. He enjoyed robust health until 2017, when his caregivers noticed “a general slowing down,” said Dr. Kinney, who arranged Winston’s first echocardiogram.

The test showed only “a couple of subtle changes, nothing alarming,” Dr. Kinney said. Everyone was relieved. Normal aging.

Then in 2021, the whole troop contracted the coronavirus, probably transmitted by a human. As in human patients, age mattered.

“Winston was the most severely affected,” Dr. Kinney said. “He had a cough, pretty significant lethargy, lack of appetite.” He began holding on to objects as he walked.

After an infusion of monoclonal antibodies, Winston recovered. Now the whole troop has been vaccinated and boosted against the virus.

But while Winston was being treated, the veterinarians and human doctors ran other tests that found concerning health issues. Winston’s heart had begun pumping less efficiently; that led to a daily regimen of blood pressure and heart drugs hidden in his food, and to the implanted monitor. He also takes ibuprofen and acetaminophen for arthritis in his spine, hips and shoulders.

More worrying was a CT scan and biopsy showing a cancerous tumor damaging Winston’s right kidney. That prompted the kind of risks-versus-benefits conversation that should inform decisions about invasive treatment for older patients, but that is often skipped for humans.

“Do we do a surgical procedure?” Dr. Kinney recalled wondering. “The big concern was, what would the recovery look like?” After considering Winston’s age and life expectancy, and determining that the tumor wasn’t growing, “we were comfortable with continuing to monitor him,” he said.

For now, “we’re at a good balance,” he said. That is not entirely a medical issue, but reflects Winston’s ability to lead his troop — including a female, Kami, with whom he has had “a very devout partnership” for 25 years, Mr. Haigwood said.

Some aspects of healthy aging might come more easily for zoo primates than for people; their keepers provide only healthy choices. “They’re not smoking,” said Marietta Danforth, the director of the Great Ape Heart Project, a research effort at the Detroit Zoo. “They’re not eating cheeseburgers.”

Winston’s vegetarian diet consists primarily of tree branches and root vegetables. The half-acre Gorilla Forest where he lives, with its hills and pond and climbing structures, promotes exercise.

Still, geriatric care necessarily involves end-of-life decisions. Winston could die a natural death one day like Ozzie, a gorilla who died at Zoo Atlanta two years ago at 61, or Colo, who was 60 when she died at the Columbus Zoo in Ohio in 2017.

But if his quality of life declines, if he stops interacting with the troop and his caregivers or begins suffering, parallels with human care end. Even in California, with its medical aid in dying law, euthanasia remains illegal for humans. It is an option for Winston.

“It’s a privilege in veterinary medicine,” Dr. Kinney said. “It also comes with great responsibility.”

If Winston’s doctors, specialists and caregivers conclude, after extensive discussion, that a painless death would be preferable to a diminished life, “it’s a very calm process,” Dr. Kinney said. After an overdose of anesthesia, he said, “within minutes, there is cardiopulmonary arrest.”

About 350 gorillas — and 930 great apes in total, including bonobos, orangutans and chimpanzees — live in U.S. zoos, Dr. Danforth said. However well cared for they are, some animal rights activists and primatologists argue that they don’t belong in zoos.

But even People for the Ethical Treatment of Animals, whose position is that wild animals belong in the wild, acknowledged in an email that zoos like San Diego’s, accredited by the Association of Zoos & Aquariums, meet high standards of animal care.

Winston “has had high-quality years,” Dr. Kinney said. The gorilla has also become a beloved media personality. San Diego will mourn his loss, whenever and however it happens.

For now, “we want to be sure Winston is living a good life, that he’s fulfilled,” Dr. Kinney said. “We have a good understanding of what makes Winston Winston.”

Best travel insurance if you have a medical condition 2024

Yes, in many cases, but it could mean a higher premium and an exclusions added to policies (meaning you can't make claims that relate to the condition).

When we surveyed 2,458 policyholders with a medical condition or a history of one in March 2023, 36% reported problems buying cover because of the condition(s) – most commonly around expensive premiums.

Here, we've outlined your options, how to make specialist providers part of your search and rated the cover offered by some of these insurers.

Please note that the information in this article is for information purposes only and does not constitute advice. Please refer to the particular terms and conditions of an insurer before committing to any financial products.

Specialist providers focus on trying to provide affordable cover for customers who struggle to find it elsewhere.

Specialists may be more able to cover you if you've been refused insurance elsewhere because of medical conditions, or only been offered high premiums.

Members can log in to see how medical specialist insurers compare when it comes to cover. We've rated All Clear, Avanti, Explorer, Free Spirit, Good2Go, Good to Go, Holiday Extras, Insurancewith, Insure and Go, Rothwell & Towler Ltd, Saga Services Ltd, Staysure and Travel 4 Medical.

If you're not already a member, join Which? to get full access to these results and all our reviews.

Declaring a medical condition doesn't automatically mean that you'll struggle to get insurance as many are fairly straightforward to cover, but these tips will also help:

Unlike car or home insurance, a quick search on price comparison sites may be concealing an important segment of the market from your view. 

Some insurers – known as 'specialists' – focus on covering people with medical conditions and can sometimes provide better prices than more ubiquitous brands. They're worth checking as part of your search if your conditions add significantly to what you pay.

Fortunately, there are two official directories to help you track them down:

When applying for insurance, you're obliged to answer all questions accurately and honestly, which means if the insurer asks about your medical conditions, you need to be forthcoming.

If, when you come to claim, you're found to have withheld information requested, the insurer could consider the policy to be invalid.

Some insurers will allow you to not declare conditions on the understanding that these conditions are automatically excluded. This may reduce the premium, but could leave you with far less cover than you need.

In some cases, information received via a handful of questions online isn't enough for an insurer to make a rounded decision about how much of a risk your condition poses. 

If you have a complex condition, it's worth calling the insurer so it can make a more detailed evaluation of your circumstances.

Some insurers will offer single-trip insurance to customers they wouldn't offer annual policies to, so it's useful to look at prices for both types.

Check you're getting a great deal and search for a new travel insurance policy using the service provided by confused.com. Get a quote now

Almost all travel insurers will cover some medical conditions, so don't rule out more mainstream providers.

But the Financial Conduct Authority (FCA) has created a directory of insurance companies that have a proven specialism in covering people with medical conditions. BIBA has its own directory , which the FCA endorses. Some of these specialise in a specific condition, such as cancer, while others specialise in various conditions.

When we surveyed policyholders who had made use of these directories, most said they had found them to be useful, with nine in 10 saying they had found better prices through them than elsewhere. While this isn't a guarantee you'll find cheap cover that meets all your needs, it does show that the directories are worth trying as part of your search.

Firms listed in the directory may be able to help if:

If you're having trouble tracking down insurers online, an alternative is using brokers to search the market.

BIBA hosts a 'find insurance' service, which will put you in touch with brokers that specialise in cover for medical conditions.

When searching for quotes, you may have answered exactly the same questions over and over. The reason for this is a handful of companies perform the task of 'medical screening' on behalf of most insurance providers.

Medical screening means collecting information from customers about their medical history and turning it into a risk score.

The insurer uses this risk score to help decide if it will cover you and how much to charge. Two insurers may make different decisions about you based on the same screening process and score.

Much of the industry, including leading price comparison sites, use a firm called Verisk to medically screen customers.

You can't assume that subsequent changes in your health will be covered by your policy.

Many policies come with a clause – often referred to as an 'ongoing duty of disclosure' – which means you need to contact the insurer if there are any changes to your health.

Your insurer will reassess the terms of your cover in light of this. It may decide not to change anything about your cover and premiums, but may change the terms by which you're covered (including hiking the premium) or decide it can't cover you.

In the last instance, you should be refunded premiums paid, and should be able to make a cancellation claim if you have to rearrange or cancel your holiday because of the cancelled cover.

Don't delay - If you've failed to report a change in your health at the earliest possible point, the insurer might decline to pay any claim resulting from it.

Technically, a wide range of events could be described as a change in health, from catching a cold to being diagnosed with diabetes.

Insurers have different requirements on what needs to be reported to them – and this can vary depending on the type of policy you buy.

Some insurers don't require you to update them about your health unless you've been advised by your doctor not to travel.

Others require you let them know if your symptoms have led to tests or a medical investigation and others expect you to get in touch if you've received any medical advice. If you have any concerns, check your policy wording or contact the insurer.

If you've had Covid and recovered from it, it's highly unlikely to impact your ability to obtain travel insurance or the price.

The vast majority of insurers will also cover you if you catch it while travelling or test positive and it disrupts your plans.

Most insurers will provide some cover for losses if certain uninsured parties, such as a relative, close friend, travel companion, business partner or person with whom you've arranged to stay falls ill, and you have to change your plans as a result.

There are subtle differences in the criteria set by insurers for when this cover applies, so check the T&Cs if this is of concern to you.

Insurers typically list in their policy documents which relatives count as 'close' and are within the scope of the policy. These include spouses, siblings and parents.

Not all insurers cover nieces/nephews or uncles/aunts within the definition. Similarly, while many cover unmarried partners and inlaws, the close family of unmarried partners won't always be included.

The insurer is unlikely to pay out claims arising from the ill health of a close friend or relative considered to have been caused by a pre-existing condition.

But how 'pre-existing' is defined depends on the insurer.

With some insurers, a condition, such as a heart condition, is thought of as 'pre-existing' if it predated buying the policy regardless of whether or not the policyholder was aware of it.

With other insurers, the policyholder has to have been aware of the condition when buying the insurance for it to count as 'pre-existing'.

If you feel like you've been caught out by an unexpected clause in your insurance when it comes to claiming, don't be afraid to make a complaint.

Do so in writing (or email) if you can, using the insurer's complaints process.

If the insurer isn't proving helpful, take the matter up with the Financial Ombudsman Service by calling 0800 023 4567 or visiting its website .

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