April 25, 2017
Seeing a wide variety of avian, reptile and small mammal exotic pets every day is exciting and stimulating. Ever wonder what a day in the life looks like for me and my staff? Our first case might be a rabbit with an abscess on its mandible, an iguana with front and rear leg tremors or a macaw with a metal clasp that penetrated the underside of its tongue and encircled its mandibular beak. For a real-time look at my typical caseload, I present a day in the life … the day I later sat down to recall its events and share its outcomes.
Today at 8 a.m., a seizuring ferret is presented. The whole staff knows what to do. The receptionist rushes to get one of my techs to bring the patient to the ICU. Another nurse gets a 1-cubic centimeter, 25-gauge syringe, a green top for a blood chemistry panel and a 25-gauge catheter for IV fluids and dextrose.
I complete my physical exam ASAP and wait for the chemistry panel. A-ha! Blood glucose is 62 milligram/deciliter—classic hypoglycemia due to beta cell pancreatic carcinoma—otherwise known as insulinoma.
The team administers the IV fluids and dextrose. Within 10 minutes, the ferret looks normal and is dooking in its cage, wanting to play. Now, it’s time to talk long-term treatment and the prognosis for resolution of clinical signs with the owner.
I tell the client that this disease is incurable but that her pet has a good chance of regaining normal activity for up to two years.
The ferret is discharged with oral prednisolone and diazoxide to be given twice a day for life. Next month’s recheck will evaluate the animal’s blood glucose level.
Next is an egg-bound cockatiel, which, until two months ago, had laid three to four eggs a month for the last year.
She is at the bottom of her cage, acting like she wants to lay. My RVT weighs the cockatiel; she’s at 129 grams.
After placing my patient gently in a towel, I begin my examination. Her abdomen is distended, and no egg is palpated. There’s a fluid consistency to the swelling. I surmise that she either has ascites secondary to a hepatic disorder or a large cystic ovary.
A radiograph shows her long bones whited out and two collapsed egg-looking structures in the abdominal coelom. I request a complete blood count, a blood chemistry profile to assess the possibility of an infectious process and the status of hepatic and renal function. The PCV, WBC differential, bile acid and blood chemistry profile results are all within normal range.
My diagnosis and recommendations to the owner: abdominocentesis and cytology, anti-inflammatory medication and a potential salpingo hysterectomy. The owner has had one cockatiel die from being egg-bound and wishes to press onward with surgery. Surgery is scheduled for tomorrow.
My third appointment is a guinea pig that stopped eating and has lost weight. His heart and lung sounds are normal, as is abdominal palpation, but an oral exam using a rabbit/rodent dental speculum reveals tongue entrapment by abnormal angulation of the lower right and left first cheek teeth.
I tell the owner that this is likely a congenital condition that will require tooth floats every eight to 12 weeks for the remainder of the pet’s life or a cheek teeth extraction. I recommend and perform Dremel-assisted tooth floats on the first lower right and left cheek teeth under isoflurane anesthesia.
Once the guinea pig is awake, the team administers a vitamin C injection and reviews with the owner proper nutrition and supplementation involving vegetables containing vitamin C. I schedule an eight-week dental recheck. The patient is sent home with a powdered herbivore diet to supplement his natural food until he is eating normally again (usually one or two days).
To round out my morning, I see an 8-month-old veiled chameleon that can no longer stay on its perch. Upon examination, I notice both front legs have abnormal bends between the wrists and elbows. Palpation of the mandible reveals a slightly pliable jaw. The chameleon’s muscle condition is average; the abdomen appears slightly distended.
Checking the history done by my veterinary technician, the client has been doing exactly what the pet store recommended: feed gut-loaded crickets or superworms and use a calcium vitamin supplement every other day. The vitamin supplement she brought with her contains calcium phosphate as the main ingredient. The chameleon’s cage was near a window, so when the ultraviolet light burned out two months ago, the owner figured it didn’t need replacing.
I recommend a blood chemistry profile and a whole body radiograph. The client is hesitant but approves. The profile reveals abnormal calcium and phosphorus levels (11.9 and 8.3 milligram/deciliter, respectively), which is indicative of metabolic bone disease.
My technician takes the chameleon’s radiograph and another technician informs me of a seizuring rabbit taken to ICU. I rush over.
The rabbit is rolling constantly and has horizontal nystagmus. The owner explains that Bun Bun has had a head tilt for several weeks and that her dog’s veterinarian diagnosed an inner ear infection and prescribed ear drops.
I quickly sedate the patient with midazolam and slow the rolling so I can discuss the case. I explain that while inner ear infections may cause the head tilt, the rolling is more likely from a protozoal infection that affects equilibrium.
I order skull radiographs to rule out bulla osteitis (inner ear infection), start the patient on meloxicam (an anti-inflammatory), meclizine (an anthistamine used to prevent dizziness) and fenbendazole (an antiprotozoal).
I submit a blood sample for Encephalitozoon cuniculi testing.
Bun Bun is hospitalized for two days until the rolling ceases and I can obtain the lab test results. The skull radiographs reveal normal right and left bulla.
Now, back to the chameleon.
The lizard’s radiographs reveal poorly calcified bones in all four legs and 20 to 30 spherical soft-tissue masses in the abdominal coelom. I tell the owner that the chameleon is female and pregnant, which severely complicates her calcium imbalance.
Treatment of her metabolic bone disease will involve UV light, reviewing calcium dusting of insect meals, administering oral liquid calcium daily and setting up a sandbox for nesting. If she doesn’t lay eggs during the next 30 to 60 days, a salpingo hysterectomy is recommended.
We show the owner how to medicate her chameleon, instruct her to purchase the calcium-only reptile vitamin we sell and schedule a medical progress exam for next week.
In follow-up with Bun Bun, the rolling has ceased but the head tilt remains. We keep him overnight for observation and continuation of treatment.
This Monday morning is a fairly normal start to the week for a veterinary hospital that sees only avian and exotic species.
Our afternoon looks fairly normal: two rabbit annual exams, a Moluccan cockatoo for an annual exam and wing/nail trim, two ferrets for distemper vaccines and dispensing of an oral heartworm preventive for home use, a hedgehog for its second Revolution quill mites treatment, and a Plymouth Rock rooster for its yearly exam and fecal parasite check.
The following morning Bun Bun is eating well and not rolling. Lab results confirm a diagnosis of E. cuniculi. The patient is discharged with meloxicam, meclizine and fenbendazole.
Surgery is readied for the cockatiel. I place an IV catheter in the jugular vein, administer butorphanol IM, anesthetize with isoflurane and place an endotracheal tube. A clear surgical drape covers the patient.
I perform a salpingo hysterectomy with the aid of hemoclips and remove two ectopic collapsed egg structures. The patient recovers in a heated avian ICU cage and is discharged the next day with instructions to remove mirrors from her cage and refrain from petting or stroking her on the back or rump.
Dr. Gregory Rich owns Avian and Exotic Animal Hospital of Louisiana in Metairie, La. He received the 2011 Oxbow Exotic Mammal Health Award and was named the 2016 T.J. Lafeber Avian Practitioner of the Year.
Originally published in the April 2017 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!
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