Evening, everybody. So thank you very much for the introduction. This evening, we are gonna go through common conditions, in bearded dragons.
So I'm gonna take everyone through the kind of rough outline of, care for a bearded dragon before we hit the kind of the hard stuff and go through the most common conditions that we end up seeing, predominantly because one of some of the main reasons that we end up seeing these conditions is because people haven't sorted out their, the conditions that the animal is living in to start with. So. General information.
Bearded dragons are one of the most common reptiles that as exotic vets or even as non-exotic vets that we see in practise. They're diurnal. They're very easily handled, so they're often thought of as kind of like beginner's pets, and they're quite straightforward to keep once they're set up.
They have got loads and loads of personality, so they are, you can almost think of them as scaly little dogs in a way. And they're not particularly very demanding, so unlike a dog who needs to be walked every day, obviously a bearded dragon doesn't need to be. They can live 10+ years as, beginner's reptiles.
They are, however, expensive to set up a few 100 pounds to do it properly. And most importantly, and something that I will be repeating throughout the presentation is that they are a solitary species, and we'll get to the reasons why. So first off, housing, the absolute minimum a bearded dragon should be kept in is a 4 ft by 2 ft by 2 ft Bavarian.
And this is an absolute minimum. Now, this is kind of like for a a standard adult size bearded dragon, but the bigger the better. Ideally it should be a wooden viv with the glass fronts, not one of those solid glass vivs because unfortunately they do not hold the heat particularly very well.
We want the housing to avoid humidity. The humidity that we need to kind of between 30 and 40 to, tops of 50%, humidity. And if it is too high up.
Persistently too high it's respiratory infections. They are, again, a solitary reptile. So they are, it's, it's one of the most common reasons that we end up seeing them is that they've been injured by, one of their companions.
So cannibalistic. So if you're housing inappropriately sized, be the dragons together, if you're absolutely insisting upon it, just bearing in mind that there is a possibility that the bigger one will eat the smaller one. So one of the main reasons why we don't want them living together.
Ideally, we don't want them on a loose substrate. Loose substrates, we do see, an increased incidence of, impactions. Now this is multi-factor.
It's not just because they're on a loose substrate. This is often as a result of poor environmental humidity, temperatures, UV lighting. It's not just because they're on a loose substrate, but obviously, it's more likely to happen.
But. Dra naturally did with freedom to express natural behaviour, so we should be allowing them areas to dig. Now this is specifically important with females because we want an area for them to be able to lay eggs.
They do not need a male to lay eggs, so a small area for specifically females to dig, sand soil mix is really helpful, but personally, with the bearded dragons that I keep, they've all got an area that they can dig if they want to. We want items for them to climb and, and hide and, rocks and branches and fake plants can work really, really well. So heating wise, we want a radiant heat source, ideally, so we want it thermostatically controlled.
I've put a dimming thermostat here because a lot of the time it's normally a heat bulb that is used, and with a heat bulb, a dimming thermostat should be the thermostat that we use. If the client, for example, is using a ceramic heat emitter, then that would be most appropriately used with a pulse proportional thermostat. We want the heat source separate to the UV, purely so we can thermostatically control it and make sure that the temperatures that we're obtaining are the right ones.
We want the heat source to be protected, so we want it to be caged so that bearded dragon can't touch the bulb. And the reason that we recommend a radiant heat source is that they have very few to no heat sensors on the underside of them. So if they're lying on a heat map, for example, that malfunctions, they may not notice it, as quickly as they would do from, a heat source from above.
So a thermo gradient, is, is absolutely essential. So a thermogradient is basically a a temperature gradient where that reptile can move in and out of hot and cold areas to regulate their own temperatures. Now, bearded dragon's temperature should be between 35 and 42 degrees at the basking ends, that's directly underneath their heat source, down completely the opposite end of the enclosure, 25 to 28 °C.
And we want it absolutely no lower than 20 degrees at night. If we're finding that it is persistently lower than that at night, then adding a ceramic heat emitter, will help keep those temperatures up again, thermostatically controlled and caged and all of those things that we've already mentioned. In most central heated homes, that is really not an issue, but, other homes kind of like the, the older ones it potentially might be.
We want to monitor our temperatures with a digital thermometer, or even one of those infrared gun thermometers, which is even more accurate. And they will often darken their skin to absorb heat, and as a bearded dragon warms up, their colour lightens. It's a little baby basking.
Lighting wise, UVB is absolutely essential for the care of bearded dragons, and personally any reptile as far as I'm concerned. And it is essential for the production of vitamin D3, but loads of other things as well. Vitamin D3 maintains the calcium levels, so therefore, inadequate UVB can lead to metabolic bone disease.
They will get some vitamin D3 from their diet, but this isn't in sufficient levels, so they do need it. 10 to 14% tube bulbs are best, and these tube bulbs should span the length of the Bavarian. The Arcadia T5 bulb is a very, very good brand.
It's the one that I normally tend to recommend, and it's the one that I personally use for my reptiles. And something that is kind of like specific to that reptile, so you can get different percentages for different reptiles, but these were bearded dragons, 10 to 14% is what I would recommend. So these are the ones that we normally recommend using.
We want to change the bulb every 6 to 12 months. Now, a lot of the times on the packages, they say change every 12 to 18 months, but in reality, between 6 and 12 months, that's when the UV levels stop dropping, start dropping below any useful level. And we want to, more importantly, use this for the reflector.
So you can imagine a reflector to be a kind of like a metal cap that sits around the bulb that reflects any UV light that's kind of moving away from the reptile back down to it. And incidentally, mesh screens and glass philtre out UV light. So a lot of the time I get owners say, well, he spends time on the windowsill, and all the sun's blaring for me.
He absolutely loves it. Well, that's fantastic. He's probably loving watching life go by on the outside world, but, he's not getting any useful UV light and even heat from that sort of situation.
Diet wise, so they are omnivorous. As hatchlings, they should be fed roughly 75% live food, 25% green food, and they should be fed more frequently when they're younger, so often multiple times a day. Adults, it's the opposite way around, so 75% greens and 25% live food.
This is where I find a lot of people mess up. They do not teach their bearded dragons, what foods are safe to eat when they're babies. 20% greens when they're based, they don't teach them at a very young age that this is the food that you should be eating.
By the time they're adults and they need 75% greens, they will have absolutely no clue what to eat and they'll probably just be hooked on bugs. So it's really, really important that when they're young to expose them to as many different types of vegetables and greens as as possible. We want to gut load the insects.
So what gut loading means is that we want to feed the food that we are feeding the bearded dragon, so. They often come in plastic pots with bran and cardboard in there. And that's great.
They'll, those insects will survive in there. But all they're eating is bran and cardboard. So, therefore, if we take the, the mealworm, or the cricket or the locust out, and we feed that bearded dragon, inside those insects is very, very little, nutritional content.
But if we feed them. Vegetables, leaf supplements, onto those greens, which will then be eaten by the insects. And all of those extra vitamins and minerals from the food and the calcium supplementation and all the vitamin and mineral powders is inside those insects, and therefore inside your bearded dragon.
So, mealworms and wax worms are two of the main foods that we often see people trying to feed, but they're not particularly The best as part of a varied diet, great, and in moderation, but they shouldn't make up the entire part of the diet. And insects should roughly be no bigger than the space between their eyes. Now, a lot of people misunderstand this saying, that's not the length of the insect, that's the width of the insect.
So an adult bearded dragon, could easily eat an adult cockroach, for example. There are many ways that you can feed them. You can feed them certain amounts a day, or you could feed them in a certain period of time, so however much they can eat in a 10 minute session, for example.
We want to remove any uneaten live food because unfortunately, crickets and locusts specifically can eat the bearded dragons. We see plenty injured by their their wannabe prey. And green leafy vegetables are best when we're feeding them the greens, and fruit should make up a very, very small part of their diet, more of a treat than anything else.
Water should be provided at all times again, one of the five freedoms. But we've already mentioned that we want to keep humidity down, so a small bowl down the cool end of the Bavarian is the most important way of doing it. Supplementation.
So again, we've already mentioned ultraviolet light is really essential, even with supplements, and we want to be careful not to overdo certain ones specifically like vitamin D and vitamin A. And one of the best supplements that we can use is Nutrial by Betok. So it looks just like this.
I normally do it 2 to 3 times weekly, and the days in between, I used to use a bogstaaniumium calcium supplements. So yeah, straight calcium supplements in between. And we want it in the live food, so like we said when we're got loading our insects, we sprinkle the food with the supplementation, so when they eat the food, it's in them, but we also want it on them as well, so we're ensuring that all those extra vitamins and minerals are getting into our bedies.
So, that is kind of a whistle stop tour of how to look after a bearded dragon, which, to be perfectly honest, I could do a presentation on all in itself. But just a general overview, I'm conscious that we've, not got much time. So the common issues that we're gonna be going through today are we're gonna go through burns and trauma, pre and post-ovulatory follicular stasis, parasites, GI obstructions of foreign bodies, paralapses, metabolic bone disease, gout.
We want to, be looking at shedding issues, periodontal disease, yellow fungus, and neoplasia. So, start with burns, really, really, really, really common. We often see these from un thermostatically controlled or guarded heat sources, malfunctioning heat source such as, heat mats.
What historically used to be used as heat rocks. Luckily, I'm seeing fewer and fewer of these being sold to people even, and they were awful, basically like a rock that you could plug in, but they would regularly hit temperatures over 100 °C. If you imagine your bearded dragon sat on there, it's just going to cook.
Now, fair warning, in advance, I do have some graphic photos in here, so I hope nobody's eating their dinner. There are 3 different degrees of, of burns. There's 1st, 2nd and 3rd degree burns, and this is obviously depending on what tissues are being, involved in that and the depth of the burn.
Treatment wise, we want to treat them as aggressive fluid therapy. If anyone's ever burnt themselves, you end up with a big blister full of fluids. These guys are absolutely no different, so aggressive fluid therapy to address those losses.
We want to be providing them with appropriate analgesia. We want to be giving them broad spectrum antibiotics, but we should always be basing this, . Cultural sensitivity.
So I always take a culture swab first, even if the client doesn't want to go ahead and do it, I've got it ready just in case. Broad spectrum antibiotics, ideally based on culture sensitivity, barrier creams are really helpful. Something like flamazine cream, for example, is great for burns, and unfortunately in some severe cases, euthanasia, like this one.
So this was a bearded dragon that had unfortunately sat on a malfunctioning heat mat and what had actually happened is that it it burnt all the way through and actually through her intestinal wall that was lying underneath, so unfortunately this little one was put to sleep. And as a result of burns or just infections in general, they can develop septicemia. So traumatic injuries, often see these with other pets, so, bearded dragons running around the house, along comes the cat, or companions when they're people are insisting on keeping them together, like with, accidents happen, so I've had people stand on their bearded dragons or or shut them accidentally in the Bavarian doors.
If the bearded dragons are kept at high stocking densities, we often see these at pet shops. So kind of like 5 or 6, or even more bearded dragons living together, they're inevitably gonna have arguments. And tain shed is another way that we can see, traumatic injuries.
The wounds can be really, really significant. So this is quite a mild one. But what had actually happened is that the bearded dragon had been, living with its companion for 5 years, and just one day they decided to have a bit of a disagreement.
So a friend bit its foot. Now, bearded dragons crocodile roll. They grab, they bite down real hard, And they twist and what had actually happened is that this foot was completely shattered and required a higher a high limb amputation.
So sometimes wounds we need to explore under judgement, sometimes amputate like we've already mentioned, cultural sensitivity again, broad spectrum antibiotics in the meantime, analgesia, nutritional support because if they're hurting, they're not going to be wanting to eat. Iodine bathing, in simple cases can work really well, but unfortunately, again, euthanasia is something that depending on the extent of the disease, the willingness for the owner to go down the route of doing investigations and treatment. Unfortunately, euthanasia does need to be considered.
And then the prognosis will depend on the severity of the wounds. So pre-ovulatory follicular stasis, we often see this in younger rather than older bearded dragons. There are many, many causes, but it's most often associated with inappropriate husbandry, and we can see it alongside metabolic bone disease and pathological factors as a result of that.
So inappropriate husbandry wise, we will often see it with kind of inappropriate, length of time the lights have been on, poor heating, poor dietary supplementation. Clinical signs, we can sometimes see a distended salamic cavity, so their abdomen, or the reptile's version of their abdomen is very big and bloated, but often anorexia and lethargy, which is kind of the bog standard sick bit of dragon symptom. Diagnosis, really doing bloods is a really, really helpful indicator, and we can often see renal disease alongside this.
We will probably see, biochemical changes such as increases in albumin and your phosphorus and calcium and total proteins and things, but haematology is really important because a lot of the time we can see secondary infections as a result of it. And imaging is also really, really important. So what hopefully you guys can appreciate from this X-ray is that we can see some kind of spherical, Structures in the middle of the slamic cavity of this bearded dragon.
Now this bearded dragon actually came to us as a second opinion, because apparently he wasn't feeling very well. Well, he had a very distended abdomen, and you can actually palpate these follicles. Took, actually quite some convincing to tell the owner that he was, in fact, a she, and it wasn't until we showed him the X-rays, that he actually finally believed me.
Treatment, early surgical inter intervention is your. Best bet. But what we actually first need to find out is that, well, is this follicular stasis that we are seeing?
We can be suspicious of that if we see an abdomen or salamic cavity full of follicles, and that they are anorexic and lethargic. We don't want to be messing around. We want to be stabilising that patient and getting them into surgery, because those follicles then can desiccate, they can rupture and they can cause a, a yoke slomitis.
I opened up plenty of bearded dragons and had yolk just pour out of them. But follicles can do one of three things. They can grow and regress, and nothing happens.
They can grow and they can turn into eggs, or they can grow and grow and grow and grow and grow, and that's when we get that follicular stasis. So early surgical intervention, once that has been definitively diagnosed, is really the best, best, best way of going forward with it. So, this is actually quite a mild case.
We got in there before it got to a stage where it was too big. But these follicles were causing this bit of dragon quite some discomfort. The tape around her tail that you can see in the picture is where we've placed the intravenous catheter so we can give her fluids and appropriate analgesia throughout a lot easier than a lot of people think.
So it's a really simple way of of placing that. But this is what their ovaries tend to look like once they're removed. And this is Billy dragon went home the next morning.
This is what it looks like if you leave it for too long. So this is, a postmortem, and what you can actually see here is many, many more follicles, but they are, they, they've ruptured. We've got kind of infected puss on the right hand side of the screen that's part of the reproductive tract and a lot of necrotic tissue, and even the, the liver in this instance isn't looking particularly too healthy.
But this bearded dragon, unfortunately, passed away before, the, the consult, but the owners wanted to find out specifically what was going on. So, yes, husbandry review is the other treatment that we should be looking at because we've already mentioned that inappropriate husbandry, is a potential cause, but we want to be providing them with appropriate analgesia. It is an uncomfortable condition.
Antibiotics, if they're indicated, hopefully already done the haematology to find out if we got, signs of infection, and other supportive care such as nutritional support through therapy. Post-ovulatory stasis. So this is egg binding.
It's a failure to pass full formed eggs, and this can happen for many, many reasons that a bit of drug can be low in calcium, for example. They've not been given an appropriate nesting site. So if the latest craze is actually or not having any loose substrate whatsoever, must be kept on, on tiles or carpet or whatever.
You. But what I'm actually seeing is like, granted, I'm seeing less than impactions, but what I'm seeing issues or the the they just can't. Yes, some bearded dragons will just plop them out in the corner, but some are quite fussy and need an area to dig.
So we should be providing them with nesting sites. Sometimes we can have functional obstructions, whether that is an infection of the oviduct, whether that is a torsion. So I had a case recently where The other doctor had got into one dirty great big knot and got everything, stuck in there that way, or even when we've got an absolutely humongous egg as well.
Diagnosis, we can often feel these eggs. You can often see them from the outside, but radiographs are also really helpful. So, in contrast to the other X-ray, you can see that these structures in the middle of the salamic cavity are, more, elliptical rather than round.
So oxytocin in these guys does not work, do not waste your time. It is unlikely to make a great deal of difference. Cases just, improving the environment, providing them with a nesting site, making sure that their calcium levels are all OK, is really, really helpful.
Providing them with multiple nesting areas can help, making sure that they're left by themselves. They haven't got any kind of, companions in there that are getting in the way that can really. Help in some mild cases, but sometimes we have to, go in there surgically, and operate to remove the eggs that way.
We'd always want to stabilise our patient first. We never want to be rushing into surgery, and this will involve analgesia and support feeding and often antibiotics as well. Ideally, we would also be, doing blood tests in these guys as well, same as with the pre-ovulatory stasis.
The parasites really, really, really common. One of the most common things that I see in bearded dragons, any bearded dragon that, comes to me in practise, fantastic receptionists are trained to ask them for a faecal sample, that they bring with them to their consult. It just saves time, and, and money hopefully down the line.
So there are many, many species that we see. We've got endo and ectoparasites. So this is one of the most common ones.
It's a blurry picture on this. This is a pinworm eggs. That's one of the most common parasites that we'll end up seeing.
But you've got protozoal parasites, coccidia as well, that we'll often see. But we will also, also see external parasites like mites, for example. And in bearded dragons, you can see on this little one, they tend to cluster around the eyelids of them.
So we'll see them often around the face, but we're seeing in the rest of the body as well. So long numbers of certain species of parasites are thought of as normal, not the external ones, more the internal ones. but numbers can cycle up quickly at high stocking densities or poor hygiene.
We often see it at, if they're loose substrate as well. We'll see higher levels of them. It often causes straining and straining can lead to prolapses.
Diagnosis is always based on, direct and faecal flotation, so. We'll get a little bit of faeces, mix it with some distilled water and look at that underneath the microscope for a direct and with a faecal flotation. We'll use zinc sulphate, for example, to do that, and we'll use both of those methods to assess everything.
But we can also base it on a clinical exam, as part of our clinical exam we pay special attention to the eyelids. Mite wise, treatment, can be mechanical extraction or fipronil. So, frontline can work quite well.
Now, this is not spot on. This is kind of spray and not sprayed directly onto the reptile, more like sprayed onto a cloth and then gently wiped onto the reptile. We want to be doing exactly the same as we'd be treating fleas on a cat and dog.
We want to be treating the environment as well. An ended parasite treatment is dependent on the species. So it's all very well going.
I think my bearded dragon's got parasites, can I have some panicure please? That might be completely inappropriate for certain species of parasites, so always do a faecal test. Gastrointestinal obstructions of foreign bodies, common, but I must admit they are becoming less common, which is great.
We will see this with an increased risk of loose substrate, but again, it's not just because it's got loose substrate in there, it's probably because there's other things going on as well that temperatures aren't right, humidity's not right, etc. So this is a bearded dragon that you can see at the bottom part of its abdomen, that it is, it's got quite a large faecal impaction here that was trying to move medically, but we weren't able to. Now this bearded dragon also incidentally, has had a dislocation and fracture to her shoulder at some point and is missing her foot.
So this is affectionately known as stumping, but this was as a result of, an injury by a companion. Increased risk if the husbandry is incorrect, like we've mentioned, we often see this alongside, nutritional secondary hyperparathyroidism or metabolic bone disease. Diagnosis, well, this is where it becomes really important to know what a bearded dragon's salamic cavity feels like.
So you can often feel it on palpation. I've had countless bearded dragons, referred to me for salamic abnormalities, they've actually just turned out. To be their fat pads, in there, so they run bilaterally, in the cordal salamic cavity.
So that is completely normal. And that, that, that should be present in a healthy bearded dragon, but it's, getting to know what else is in there that they need to know. Radiographs are also really, really helpful.
So this was, another one. Now, she was, impacted with faecal material because she had follicular stasis. So you can see the small round circular objects at the bottom.
They get in the way, and we often see, constipation alongside follicular stasis. This was, a bit of, sand, a bit of dragonhead got hold of, that had actually, almost like pebbles and stuff in the sand that they'd eaten. And this is one that had eaten quite a bit of its, its substrate as well, unfortunately.
We can always try and do it medically first, so, vibration is a fantastic technique. This is where people start normally sniggering at me because there are some inventive ways of getting some, vibration onto your reptiles, and there's certain things that we've seen on social media. A suggestion is that an electric toothbrush, for example.
If you sit the bearded dragon on an electric toothbrush, then that can help move some certain, obstructions. But making sure that they're hydrated is really, really important. Lactulose in some instances can help, but unfortunately, sometimes we have to go down the route of surgery.
And unfortunately, that can sometimes lead to euthanasia. Often I've opened intestines of bearded dragons to remove obstructions, and those intestines have been so grossly stretched that they've never been. They've never shrunk back to normal again, cos that's something that unfortunately isn't gonna.
So this is exactly one of those cases. This, like the small intestine, at the top, and this is the large intestine down the bottom that was grossly distended with faecal material that actually, only had, a few. Wood chips, blocking the bottom, but it was enough to cause a massive backup.
Unfortunately, this owner didn't want to take it to surgery, but we found this on postmortem, and actually probably the intestines, wouldn't have returned to normal anyway, even if we had attempted to do surgery on her. So prolapses, we regardless of the reptile, we need to know what tissue has prolapsed. So is it oviducts, which we often see like longitudinal striations with these.
Is it a hemipes, so, bearded dragons have two penises, . Is it one of those? Is it intestines, which look like this, unfortunately, and intestines, you'll often see, they'll, there'll be a lumen in the sometimes faecal material might be passed.
Is it cloaca? So is it something that's quite minor that is poking out? We need to know why.
So, There is always a reason for a prolapse, and it is finding out what that reason is that is really, really important. It's all very well poking the thing that should be in back in again, and hoping for the best, but if you don't get on top of that underlying reason, then you're, you're never going to have a successful outcome. So we can see it with enteritis, parasites, hypersexual activity, specifically in the males, or even reproductive disease.
So we see in egg bound females a lot as well. Diagnosis, well, this involves faecal parasitology. We'll see.
X-rays are really, really helpful. Blood testing specifically looking at ionised calcium, and even a clinical history is helpful. And treatment, we want to fix that underlying reason.
So whatever that reason is, try and fix it. We can place two simple interrupted sutures either side of the cloaca to narrow that. Purse string suture is not particularly recommended anymore, but unfortunately, sometimes like that intestinal one that I showed you, that tissue is, is so devitalized or necrotic that actually there is nothing that we can do at that stage.
So, metabolic bone disease, something that actually, pleased to say, I'm not seeing as often anymore. I saw my first case of it in months, the other day, so that was a, a refreshing change. So people are genuinely are looking after their reptiles a lot better, but we still do see those few cases happening.
We can often see it alongside poor husbandry. We see it with lack of calcium, vitamin D, UV light, or too much phosphorus. Incidentally, we can also see it with renal disease as well.
Clinical signs include tremors, seizures, swollen limbs. So this was a bearded dragon, absolutely emaciated, but also seizuring, sadly, because of metabolic bone disease. We'll often see lethargy and weakness, but we can see soft bones, pathological fractures, loss of their teeth, kyphosis and scoliosis of their, of their spine, and also osteomyelitis as well.
So this bit of dragon had actually been put to sleep at this point, but up until about 5 minutes before the picture, she was actually still alive. And Not wanting to sound gross, but you could fold this bearded dragon in half. She was so soft.
It's one of the worst cases of metabolic bone disease that I had seen. And this is the reason why it's often known as rubber jaw as well, because her mouth was there was barely any, firmness to her mouth at all. It was like jelly.
It was awful. So we'll often see anorexia, dyspnea, I've put tongue paralysis in here as well. This is predominantly a chameleon thing, but I have seen it in a few bearded dragons.
And we'll often see foreign bodies as well when these bearded dragons are trying to self-supplement. Diagnosis, biochemistry and haematology is really helpful to assess kidney function, but ionised calcium in there is really, really helpful. Imaging can be really helpful, as well.
I mean, a lot of the time in these really severe cases, you just look at them and you can see what it is. The imaging is also really helpful. So this is actually a bearded dragon that came into the rescue that I run and is again one of the worst cases that I've seen.
It had over 50 fractures throughout its entire body. And this bearded dragon was immediately euthanized. This is a postmortem x-ray.
To demonstrate. I don't know if you guys can see that, well, or can't see, for want of a better way, is that there's barely any bone density, specifically in its, it's toes and its lower limbs. But these kind of bulbous bits on her bones, those are actually, pathological fractures that have attempted to, to heal.
So this poor girl, arrived, alive, and God knows what sort of pain that poor thing was in. So treatment wise, if treatment is even possible, we want to be assessing their husbandry and correcting any deficiencies. Calcium therapy is really helpful, so Zocal D and analgesia, these guys have got pathological fractures that are going to be in pain.
But unfortunately, there's cases that are. I've, I've shown you are the extremes that unfortunately, sometimes the kindest thing to do is euthanasia. And just because we can fix a reptile does not mean that we should.
We really have to be thinking, is this ethical to put them through all the pain that is gonna cause them to fix them at the end, and what sort of quality of life are they gonna be getting at the end of it? So gouts we often see alongside metabolic bone disease and kidney disease. We see it with high levels of uric acid, and this can be as a result of diet, renal disease, or even severe dehydration.
The lovely client come in recently that had been told that she needed to keep a bearded dragon's hot, so she kept her at 45 degrees because that was about. Asking temperature that she had been told, but she kept the lights on 24/7, 365 days a year. And what she essentially did is dehydrated her bearded dragon to the stage that its kidneys failed.
Fortunately, severe dehydration is something that gout is often articular and visceral. Diagnosis, it's based on clinical signs, so you'll often see, a bit of dragon when I'm doing a clinical exam. I will put it on my table, and it should, I, I should be struggling to keep it on my table.
It shouldn't just sit there. These gout cases are often really obvious because they will not move, and when they try to move, it is obviously painful for them. They'll have swollen limbs, lameness, dehydration will often see loss of skint or sunken eyes.
This is a bearded dragon, and if you can see the foot in the picture is really quite swollen at its wrist joints basically. This bearded dragon was also attempting to bite me at the time. Bearded dragons aren't naturally, aggressive, but they will do when they're hurting, they will bite you.
So blood testing is very, very helpful. We will often see high serum uric acid and an abnormal calcium to phosphorus ratio. Treatment wise, well, we can use allopurinol.
It's not gonna make things better, but it will stop things getting worse. Fluid therapy, so we want to be replacing any losses over a few days, and these are potentially cases that we will hospitalise, place intravenous or intraosseous cathe catheters, if we think it is OK to do so. We want to really be reviewing husbandry, but sadly, euthanasia is, is often warranted.
So shedding issues, causes inadequate environments. So we're seeing a picture here, so this is why we went through the husbandry to start with. So we'll often see this with an accurate, an accurate heating or humidity.
We can see it alongside ectoparasites as well. Diagnosis where we can see that they're not shedding properly because we, we're obviously performing a clinical exam, or have a history of it and it can lead to abscess formation. So this is another little bit of dragon, you can see if you look closely in this picture, you've got a few stitches there, which is where I've just removed an absolutely massive abscess.
There's some other ones further down on his back that just kind of craters basically where these abscesses have just popped out. This can end in loss of limbs, digits or tail. So this is a bearded dragon that had a retained shed so tight around the tail that actually it cut off the circulation to the bottom half, and this was like cardboard, it just it just snapped off in the clinical exam, unfortunately.
Treatment wise, we want a full husbandry review. We want, regular baiting. Regular bathing is what that is supposed to say.
So specifically around the, the limbs, the tail, and the feet, these areas that we really want to be paying close attention to. Amputation can be warranted, surgical debridement specifically of the abscesses. We want to be giving them antibiotics, ideally again based on culture and sensitivity, and appropriate analgesia.
Periodontal disease, so something that we see again, fairly commonly, causes include trauma. So there's a bearded dragon bitten and scratched inside his mouth. We see it alongside metabolic bone disease if their teeth are becoming damaged, or most commonly within an appropriate diet.
So these are the bearded dragons that have not been taught that greens are a good thing to eat and that have been hooked on bugs and probably wax worms or mealworms because they're the easiest things to get hold of and they're quite palatable, so the beard eats it and therefore the owner feels happy that they're eating. So soft, sugary foods, bearded dragon chews them, sticks on their teeth, we end up with tartar build up and we end up with infection. So, diagnosis-wise, we can see this on a clinical exam.
When we are clinically examining our bearded dragons, we should be pulling down their gum line and we should be having a look inside there and assessing their their teeth and their soft tissues inside their mouth. And in severe cases, this can turn to stomatitis and osteomyelitis. So we have some cases where the bearded dragons come in and their mouths are almost sealed shut.
Or we can have cases like this, so this bearded dragon had multiple issues going on with it, but one of the things that it did have was, a really, really, really bad stomatitis. And actually when we looked inside the mouth of that bearded dragon, it was actually missing part of its tongue because it had such a big infection. So treatment wise, bridement is really helpful.
So we're doing a a a a scale and polish, as it were, minus the polish, can help rid some of the, the kind of like the, the tartar buildup on the teeth. So this is a bearded dragon, you can see the tartar build up this black material on there, we try to remove that as much as possible. We want to be again doing cultures and sensitivities, on any of the discharge that is in there and based on our antibiotics on that, but potentially starting them on a broad spectrum antibiotic first.
Iodine bathing inside the mouth can be helpful, appropriate analgesia, and a dietary modification if necessary. So we're coming towards the end of the, of the presentation now, so we've got a couple more slides left. So yellow fungus was thought, of, I think that is, I, I would say has emerged.
So we see it in bearded dragons mostly, but I do see, I'm starting to see it in a lot of other species. I've seen it in iguanas, guromastics, leopard geckos, . Something that is becoming more and more of a common issue.
And so it causes an equrotizing dermatitis. So, it might not be the clearest picture in the world, but, the skin along the underside of this bearded dragon's salamic cavity along his legs and along his tail was actually, completely necrotic, oozing and very, very painful for the, for the poor thing. This bit of dragon came in, late one evening for a wound to face, which I think is a potentially a slight understatement, for this poor little girl.
But, they, we ended up putting this bearded dragon to sleep, but she did live with others, so we did end up doing cultures and sensitivities and biopsy. What can happen is that this can get into di it become, it can become a systemic problem as well. Diagnosis-wise, when a basis on biopsies and cultures and treatment, aggressive topical and systemic antifungals, antibiotics based on cultures, we will often have secondary bacterial infections on top of this, a husbandry review and analgesia, and we want to be really disinfecting this environment as well.
And prognosis, unfortunately, is, is guarded to, to poor. And I believe this is our last slide. So we see several neoplasms reported in bearded dragons.
So, ovarian neoplasia. So this was a, an ovary and a bearded dragon that we performed surgery on. Ideally we would have performed imaging on this bit of dragon before going ahead with surgery, but we didn't have the finances to do that.
So we, we, we opened the salamic cavity up and this is what we discovered. So the big mass that was in there was a dirty great big ovary, and that ovarian, cancer had actually already spread to the liver as we can see in this picture. Osteosarcomas, I love this X-ray.
I think it shows perfectly exactly what is going on here. So this is, an osteosarcoma, in a, a bearded dragon. Actually, I did a, a high limb amputation, and this bearded dragon lived a further 8 more years.
Liver cancer, so this was actually, a melanoma. We had an abnormal skin growth, that we removed. The owners declined histopathology, but we were suspicious that it was a melanoma, and 6 months later came in with a salamic mass, and it looked like it metastasized to its, to its liver.
This was another late night consult that came in for lump on face. Again, a bit of an understatement, but dirty great big tumour, inside of it, so yeah, I believe that this was some sort of sarcoma, from memory. So most, common cancers that we see, squamous cell carcinomas, we see these, predominantly around the head of the bearded dragons.
We see it around the eyes. So if you see a lump on a bearded dragon's eye, it should be one of the top differentials, for them. Specifically in bearded dragons that are, are the more fancier morphs, so maybe your leatherbacks or your silk backs.
So these are, scale alterations and silk backs are virtually missing their scales, or they are. In their scales in some instances, and they, they have essentially lost their UV protection, and we're giving them 10 to 14% UV light for 12 hours a day, and I'm seeing more and more cancers as a result of it. And that's not because we're providing them with, inappropriate UV lights, because we've broken the bearded dragons by inappropriately breeding them as, as far as I'm concerned.
So the, the silk backs and the leatherb bearded dragons, I'm seeing some serious cancer issues in these guys, less so in the kind of your bog standard ones. So this was a squamous cell carcinoma. We had removed part of the eyelid, diagnosed squamous cell carcinoma from the mass that we had removed, and this was a year later, and they decided to, to bring it back for its post-op check, and things had obviously gone a little bit awry.
So diagnosis wise we can base this on fine needle aspirates. Obviously we're taking a small sample from a small thing, so we might not get a diagnostic answer, but biopsies are very, very helpful. And in some instances we've got surgery to, to go down the route of treatment.
Unfortunately, obviously in the cases that I've put up there are the extremes, but euthanasia is something that we do have to consider. And in reptiles, these cancers are often refractory to, chemotherapy and radiotherapy. That is it.
Thank you very much, everybody, and let me know if you've got any questions. Thank you very much, Sonia, really, really good talk. We're just waiting to see if any questions come through.
We don't have any so far. If you do have any, just hover over the top or the bottom of your screen, depends on where your toolbar is and click the Q&A box and send that through to me, and I'll ask Sonia any questions you might have. Some must say, yeah, I'm a veterinary nurse myself, but I don't deal with exotics.
It's really interesting to see some of these unusual photos that you have. These are the tame ones as well. And some of the, the surgeries that you perform as well, you know, you kind of, you take it for granted that we do these in dogs and cats, but abdominal surgery and a, a bearded dragon or different lizards.
It's, it's unusual. It's interesting to hear. Yeah, it's a it's keeps us busy, which is a is a good thing I guess.
So we do have one question. How do we draw blood? So the main place that we would, draw blood from would be the ventral coccygeal vein.
So, done when holding the bearded dragon sort of belly and underside of tail towards you. And the best place to take it is kind of like, an inch and a half below the cloaca, midline of the tail, and the needle goes in between the scales, midline at a 90 degree angle to the tail. You'll feel.
Like, you hit the bone, and the blood vessel that you take the sample from, is literally 1 millimetre or 2, above that. There is some anatomical variation, so some will have it, slightly off midline. But that's the easiest way of, of, of doing it.
You can do it. So I've, I've had to be in situations where I've had to do it by myself. Having the bearded dragon sat on a flat surface and, you kind of approaching from behind and lifting the tail, and putting the, the needle in exactly the same place, underneath the tail, to get about 100 per 100 gramme of, of reptile, basically.
It's kind of like your, your standard go to blood sampling. Excellent. Is it quite tough to penetrate the skin with a needle?
Not really, no. I mean, if you, if you went through a scale, then yes, but we're aiming to go in between the scales. So actually it's, it's easier than, it's easier than a lot of people think.
We, we work a lot with, students from various different, universities, and they always are surprised that it's easier than they think it is. OK. And then this the same place to place an intravenous catheter.
So we place an intravenous catheter in an almost identical way that we would, be getting a blood sample. So every bit of dragon that undergoes surgery with us or is hospitalised will have an intravenous or an intraosseous catheter placed. Oh, OK, that's interesting.
And that was actually one of the other questions, so you've already answered that one. Sorry. And somebody else has asked, what is your success rate with performing surgery?
A lot of the examples that you've used have unfortunately been autopsies or euthanasia. So I mean that that probably doesn't paint me in the best of lights, really, but it does, it does get the the, the, the point across of some of the severe pathologies that we can actually you can actually find. With regards to success rates, honestly, that entirely depends on the surgery.
I would say that the, the cases that we've posted today are, almost like the, the peak and shriek surgeries, potentially, that we know that there's been something bad in there, but the owners have wanted to try as much as possible, to, to try and remove whatever is, is going on in there. But unfortunately we've kind of always had a feeling that it's, it's not gonna be a, a, a good thing, but. With your kind of, let's say a space surgery, that's probably one of the most common surgeries that I will, I will see, in the last year we did a recent audit and actually we've lost, in over 100, I think it was 150 cases that we'd seen, in the last year, we'd lost two patients, and those patients were, presented in a very late stage of the disease.
Oh, wow, that's excellent. So we have Rachel asking, is alfaxan your preferred GA choice? Yes, I love Alfaxan, in reptiles.
I normally use 10 meg per gig IV, but what is the best take home message I can give you for, Anna. Anaesthesia in reptiles is that they need to be at the right temperature. So if you're not set up to hospitalise a reptile, if you haven't got the appropriate heat, even the appropriate UV light, your anaesthesia is gonna be really tricky and it's gonna be unstable, as well.
And so what I, I do a lot of kind of troubleshooting for other practises and and other vets, and one of the most common things that they say is that my reptile just doesn't go to sleep. When you speak to them is actually because they haven't got them even remotely at an appropriate temperature, . And their metabolism is, is geared by their temperature.
So, if they're not at an appropriate temperature, those drugs will not be working, and you will not be getting a nice smooth anaesthetic. So, if you are, seeing reptiles in practise, getting yourself, even if it's just a small, simple viv, it's something that's really, really important. Brilliant.
And what pre-meds do you like? Rachel said she prefers midazolam and buprenorphine. So buprenorphine in reptiles is actually not a very good analgesia, unfortunately.
Morphine, however, is really, really good. So we would or none of our, our, all of our reptiles get morphine, as part of their pre-medication. Midazolam wise, I guess it depends on your, on your reptile.
I've used, morphine and meatomidine before. I've moved away from ketamine combinations now, just because I don't like the unpredictability of ketamine. But a lot of the time, I'll give a morphine pre-med, and alfaxolone induction.
Midazolam, I Potentially might considering something that is particularly more, fractious. So, like in this picture, an iguana, they are, something that may, might do well with something like that. But really, most of the time it's, it's morphine.
Leave it in an appropriate temperature for an appropriate time, and then induce within, intravenous alfaxolone. Excellent. And Rachel said thank you very much for a great talk, and she will make sure that she's changing her buprenorphine.
Oh thanks. It's always good to hear. So that looks like it's the last of the questions.
So on that note, I'd just like to say a massive thank you to JHP recruitment and Tails.com again for sponsoring tonight's webinar. Thank you to all of our attendees for listening tonight, and finally, thank you very much, Sonia, for taking your time out of your evening, and we've really enjoyed your webinar, and I hope you enjoy the rest of your evening.