'Pumpkin knows something is up': Orangutan pines for her cancer-stricken twin

An orangutan called Peanut, suffering from non-Hodgkin lymphoma, has become the first in the world to be treated with aggressive chemotherapy just like a human.
Peanut, who lives together with her fraternal twin Pumpkin at Miami's Jungle Island, has received numerous treatments to combat the aggressive lymphoma since August.
Pumpkin is not sick, but she knows something is wrong with her sister.
Both are highly intelligent and have been taught to use sign language and an iPad to communicate with their trainers, but doctors have found it difficult to fully explain the cancer to Peanut or Pumpkin.
''I cant speak for what Pumpkin knows, but she most likely can sense that there's something is different with her sister,' veterinarian Jason Chatfield, Jungle Island's general curator, told MailOnline.

Sisters: Peanut, an eight-year-old orangutan with a fraternal twin sister named Pumpkin, has been diagnosed with non-Hodgkin lymphoma, but she's got a fighting chance at beating the disease as she is the first orangutan to be treated with chemotherapy like a human

Help: In this Sept. 5, 2012 photo, Jungle Island volunteer Linda Jacobs comforts Peanut, one of the orangutans from a private zoo, as she is treated with R-CHOP therapy, a combination of drugs used in chemotherapy to treat her aggressive non-Hodgkin lymphoma in Miami

Peanut's diagnosis came by chance when her veterinary team found she had an intestinal obstruction and further testing revealed the cancer.
The private zoo had no board certified veterinary oncologist on staff and turned to the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.
A team there, along with UM's Division of Comparative Pathology, which specializes in wildlife, confirmed the diagnosis and is now providing guidance for Peanut's treatment.
'I've never had the same combination of fear and enthusiasm in one patient before,' said Dr. Joseph Rosenblatt, one of the doctors treating Peanut.
'We don't know what to expect and yet we're intensely curious and potentially hopeful that we can help the animal.'
Working on an orangutan is a first for Rosenblatt, who has never worked on an animal larger than a mouse.

Tired: Peanut is highly intelligent and has been taught to use sign language and an iPad to communicate with her trainers, but doctors have found it difficult to fully explain the cancer to her

First: Human medical specialists are treading new ground in applying a standard chemotherapy regimen to treat cancer in an orangutan

'When the animal looks at you in the eye, it's both a sympathetic as well as a look that radiates intelligence,' he said.

Peanut and her fraternal twin Pumpkin are the youngest of six orangutans at Jungle Island and a hit with park visitors.
Peanut is welcoming and demanding, offering her doctor a twig in return for his water bottle. Pumpkin is quiet and her hair hangs low over her forehead.

'We made it a point not to even talk about the cancer in front of her because she may not comprehend cancer, disease, lymphoma and all these fancy words.

She absolutely knows something is wrong, something is different with her.'

Veterinarian Jason Chatfield

Pumpkin has not been diagnosed with the disease.
'Pumpkin knows something is up,' Dr Chatfield, told MailOnline.
'All Pumpkin wants to do is play with her sister, but Peanut just wants to rest.'
After Peanut returns from her treatments, she has to stay in isolation so the chemicals from the therapy do not make the other animals sick.
The second she returns to her pen, however, Pumpkin wants to get straight to playing with her sister.
'It's good for Peanut to get her strength back up,' Dr Chatfield said. 'After a few days, she's back to normal.'
And while most of the doctors are paying close attention to Peanut, they are concerned that Pumpkin may fall ill next.
'They are genetically very similar,' Dr Chatfield said.
Rosenblatt said doctors chose a plan for treatment that has been most effective in humans, adding that they are treating Peanut's lymphoma with slightly reduced doses in an effort not to overshoot.

Babies: Born in captivity, Peanut and Pumpkin came to the zoo when they were six months old

The process that might take four to five hours in a human takes about three hours in Peanut, who will get six doses – 21 days apart – unless her body can't handle it.
Peanut's doctors caution against raising expectations about her future and how effective the treatments will be.
'They work very well in human beings, but we don't know if they will work as well in this setting,' Rosenblatt said.

Unlike humans, Peanut must be sedated for her treatments at an animal clinic in Miami. And although doctors know anesthesia causes nausea in animals, it is not clear if that or the chemo caused Peanut to vomit after her first treatment.
She stays indoors out of sight of park visitors soon after the treatments and comes outside into an enclosure only when she feels up to it.

Intubate: In this Aug. 8, 2012 photo provided by Jungle Island, Dr. Joseph Rosenblatt, second from right, an oncologist from the University of Miami Miller School of Medicine and Jason Chatfield, DVM, right, general curator for Jungle Island, prepare to intubate Peanut, an orangutan, prior to receiving her first round of chemotherapy treatment at Knowles Animal Clinic in Miami

Sick: In this Sept. 5, 2012 photo, an IV line is stuck in Peanut's arm as she undergoes R-CHOP therapy, a combination of drugs used in chemotherapy to treat her aggressive non-Hodgkin lymphoma in Miami

Her caretakers say explaining cancer to a human is difficult, but explaining it to a highly intelligent animal such as Peanut who communicates with her trainers and park visitors is nearly impossible.
'That is one part of cancer we do not have to deal with,' said veterinarian Jason Chatfield, Jungle Island's general curator.
'We made it a point not to even talk about the cancer in front of her because she may not comprehend cancer, disease, lymphoma and all these fancy words. She absolutely knows something is wrong, something is different with her.'
He said the team wants to keep a positive attitude around her.

Healthy: Orangutans share about 96 percent of a human's genetic makeup, and Peanut's treatment plan is closer to that of what a human would receive for the same type of cancer, making this the first documented case of an orangutan being treated with this type of therapy

Born in captivity, Peanut and Pumpkin came to the zoo when they were six months old.
'I have been with her since she was born,' said Linda Jacobs, Peanut's trainer, holding back tears. 'So I really am very sensitive to her needs and her moods.'

Sister: Pumpkin, Peanut's fraternal twin sister, has not been diagnosed with the disease

Jacobs said Peanut is fatigued but hasn't lost much of her reddish-orange hair 'and she still has that twinkle in her eye.'
Despite possible complications and an uncertain outcome, Rosenblatt said Peanut is still a model patient 'and God willing, she will be a cancer survivor.'
Peanut is not the first great ape to be treated for cancer like a human.
An orangutan with advanced stage cancer at the National Zoo in Washington had surgery to remove a cancerous intestinal tumor in 2000.
In 2009, two female gorillas at the North Carolina Zoo underwent radiation therapy. All three cases involved much older apes, in their 30s or 40s, and all had to be euthanized.
But while other animals are treated with chemotherapy, it's not common among orangutans.
Dr. Ryan DeVoe, senior veterinarian at the North Carolina Zoo where the two female gorillas lived, said he has found no record of other great apes being treated with chemo.
But he also noted that many cases involving great apes with cancer are not reported or documented.
DeVoe said another unique aspect of Peanut's case is that, unlike the older apes, she has age on her side for either being cured or at least experiencing remission and living normally and comfortably for a long period of time.