Good evening everybody and welcome to day 3 of our 11th annual virtual congress. My name is Bruce Stevenson and I have the honour and pleasure of chairing this evening's exotic session with you. Just a little bit of exciting, news to start with.
The, early bird special on the gold tickets, for the virtual congress has been extended. Dawn will pop in the info into the chat box a little bit later. So just keep an eye out for that.
For those of you that haven't already got it. It really is a fantastic special offer, and as I say, it was meant to be finished already, but it has been extended until later on this evening. A little bit of housekeeping for those of you that haven't been with us before.
If you want to ask a question of our speakers, move your mouse across the screen. You'll see a little control bar pops up across the bottom. There's a little, normally a black bar, there's a Q&A box.
Just click on that, type in all your questions in there, and they will come through to us. We will hold them over to the end of the session. And those that we don't get around to, we will get through to the speakers and on email and get some answers.
So you won't lose out even if we don't get to your questions during tonight's session. So, Fabian, if you wouldn't mind sharing your screen for me in the meantime, please. But our first speaker tonight, is Doctor Fabian Rivers.
Fabian graduated in 19 in 2018. He's currently an exotics and companion animal vet in Birmingham. More recently known for the Deadly vet Dry vet initiative started back in 2013.
He's currently the British Veterinary Association recent graduate representative, and he's a keen contributor on topics surrounding mental health, racism, new graduate and student welfare, and the wider complexities of the veterinary community. In 2020, Fabian was awarded the BVA Young Vet of the Year award. Fabian is currently undertaking a certificate in exotics.
He is the lead exotic vet at an independent practise and his interests are in preventative welfare, particularly in reptiles. Fabian, welcome back to the webinar vet, and it's over to you. Thank you very much for a kind welcome and hopefully today will be a, a nice fruitful opportunity for everyone to kind of get their, their, their kind of toes dipped the tip dipped in the water with regards to something that I'm very passionate, passionate about, definitely more recently with regards to what we're seeing, especially in the UK with exotic animal er ownership, which is going through the roof.
And so, as, you know, the, the demand for, you know, chickens and all sorts of, you know, furry animals and avian animals, goes up, most definitely, it's really a, a nice opportunity to kind of share with my peers, everyone who's, who's listening in today and watching today about what it can mean to be, to be a chicken vet. And it's today's sessions really designed. To get people who would normally.
Kind of shy away from that necessary that that chicken vet responsibility, you know, if you're a GP and someone says, oh, I've got a, a bird, I've got a chicken, would you mind seeing them? Your nurse comes in, your receptionist comes into your room and says, would you mind seeing them? And we, so many of of us as a, as a in the community would be like, nope, not interested.
I'm gonna pass it on to someone else or say, I'm not a, I'm not familiar with birds, I can't do it. You should go to the N exotic practise and for sometimes you're very lucky cos that's around the corner, and sometimes that's miles away. And today is about really taking the edge off that particular, you know, fear.
To say. OK. So, the aims of today, so you're fully aware, so I've already kind of mentioned them, but it's, it's really just to, to, to let you guys know that I don't want to make this procedural.
This is, today is not about me saying this is a problem, this is what you see, this is how you fix it. It's, it's not about that, it's about building that, that confidence, it's about building that that base level of understanding, the types of things that you might see on a typical day. Anywhere, er er when you anywhere or any, any place where you might actually be asked to, to have a look at a chicken and assess what's going on.
And one of the things that I think is so important is to not make our job, our career procedural, because every day can be different. And that, that's, that's, that's true for all of us, and the techniques that we learn as vets are often quite universal and there's a huge amount of extrapolation, especially into exotic animals, by virtue of the fact that so often, you know, exotic animal er er vetting is an extrapolation of, of, of what we, we normally have to do and we're we're always trying to find new, funny and odd ways to do our job. Today is really to make, make us aware of things to be aware of.
And again, as I mentioned, that there's an inexhaustible list of conditions that we, we can focus on. And so the aim is to not go through every single one and have you bored out of your skulls by the end of this, because I ultimately have faith in the vector community to be able to learn some of the finer details and grow with your own interests, and it's, it's about building that curiosity. And lastly, with regards to confidence, one of the key parts of confidence in this particular field is being ready to make mistakes.
I can tell you in the 5 years I've been doing exotics vet's practise, pretty much, you know, 75% of my time, as a vet. I have consistently. But thought, what in the bloody hell is this?
And I have been surrounded by books day in and day out trying to find out, you know, find things, research articles, you name it, I've tried it, and even then every single day feels, you know, fresh, but also is, is, is an opportunity for me to learn. And so the exotics community really in the vet world is, is really quite open. So if you ever feel like you're confused, please reach out to me.
Reach out to your, your, your local exotics vet, and, you know, I am biassed, of course, but they tend to be really, really on board with helping out, in a, in a quite, you know, magnanimous way. So, first thing I want to talk about now, this is from firsthand experience, you know, I know so many people when they give me a call, or they know me from Congress, or they send me a WhatsApp message at their vet practise, and they say, you know, we've got a chicken coming down. What are they most concerned about?
Is it the, is it the disease, is it being able to at the right diagnosis? No, I, I'd say 9 times out of 10 handling. Fear of the wing.
The flapping, so many of us are, are so concerned with doing the right thing because again, if we can't do our basic clinical exam, by no means are we gonna be able to, first of all find out what's going on, or secondly, even demonstrate to whoever chicken this is, that we're able to do our job. And so again, like I said, top worry for many of us is the fear of doing the basics wrong. And often that's related to the wings.
They're so fragile, and what if they flap, what if they, can they fly, all these things. And so what I normally do is go through the basics. And so the first thing is how do I hold the chicken?
Ultimately, the basics is, is holding the wings, not with pressure, just holding them close to the body. That's all you have to do. I would normally, suggest that, you know, if you wanted to, you can by all means, have a, have a thin towel to support you there.
But it, but the basics is really as seen above. You're just holding on either side, holding the wings close to the body, not putting pressure on. You need to be able to allow for that sternum to move because, just contextually, I'm sure many.
If you know this, birds do not have a diaphragm. So what you're doing is when you're putting pressure, onto the, those, those peed muscles onto that keel there, they're going to they're definitely going to struggle to breathe. So again, very light pressure to hold the, fix the wings in place, and that is the basics.
And usually, if you can get someone to help to support you, you can do a full clinical exam there and then. The other way is really, as seen here in number 2, is by holding the other way. So holding underneath the keel or their version of the sternum, and then having one hand on top to hold the wings again lightly in place, just so we can have a little movement.
And then you or someone else can most definitely have a look at that, that vent, so that the backside there, the croaker, and make an assessment there. So we all know that, right? So, what do we not do?
Now it's funny that I've got this picture here because this is actually something that I was taught a while ago as being appropriate handling. And the reason why it is not appropriate handling is because, and it's probably no surprise to any of you, wings are exceptionally fragile. And by exceptionally fragile, I'm gonna put this very large red symbol here, because I've seen this.
Dislocation from handling in that very same way. And so you can see there is a nice chunky bone sticking out there. And that is purely by handling, and that is a, a sadly a, a, a chicken that had to be, put to sleep for, for poor handling.
And this is just a. The example of, of making sure we're not holding the wings away from the the body at any particular point, unless it's really, really deemed necessary. Or you have someone holding the other wing and holding in place, and you're able to manipulate with a certain level of control, with both hands, the wing to extend it to kind of assess the feathers and things of that nature.
But again, please. None of the, the, the previous at any point, because it's only a matter of time before you find yourself, having a very unhappy carer, a very unhappy chicken, and a very sticky situation, and, I've been called on, on several occasions, for to deal with such. And it's, it's a little bit difficult, as you can imagine.
Lastly, again, something that is, is, is relatively common practise within. Production centres is, is, is where we, you know, for, for meat or or eggs and things of that nature, and transport is holding upside down. Now, .
As we may or may not know, chickens tend to have a very large crop, which is, I, I'd like to call it a priest stomach, but, it's to to help it make it clearer, but effectively it's an area where it's, some of the starting points of digestion are, are, are made, and it's just usually just at the base of the neck. If you've ever seen a chicken with a very large crop, it's basically a, it's like a pouch and it's very, very full and often after they've eaten a, a large amount of, of grain of some sort, corn, or whatever pellet they're, they're eating, it can, you know, dilate quite large, and that's where it normally is situated. But again, there is no sphincter, there is no protection, from that coming all the way back up, and, and, and if we hold them upside down for a variety of different reasons, if they have any content in that crop, that can come back up.
So never hold them upside down. I think it's pretty clear, clear stuff why we wouldn't do it, but, you know, you'd be surprised about what you hear, so please never do that. That's also by virtue of the fact that it's a welfare issue, but also, more medically because of aspiration pneumonia.
So, So history taking. So we've got a, we've got this chicken coming down, whatever it is, and the real question is, is what should we, should I be asking? What, what are the kind of relevant questions, what is the direction that I want to go in?
And I, I feel like there's often a confusion about where to start, and we tend to, to. Get ready with the bait rol, it's a very famous thing, we get ready with the bait roll, if we're lucky we get ready with the meloxicam, . And we're, we're ready to, to look over and have a once over and then, and then give them some bait rill and a pat on the back and go home and, and see a relevant event and come back in 5 days, or whatever.
But I, I, I wanted to make this easy because there is, again, an inexhaustible list of questions that we, any of us could be asking. And I, I, I feel that there's usually just a couple of questions which really progress a typical clinical exam for me, . And, and, and I'm just gonna share those with you today.
So, what should every chicken carrier be asked? Now we've got the obvious ones, the generic age, sex, time scale of disease, you know, when did it happen? Anything else, you know, the generic questions that we would ask for any, any, any, any mammal, reptile, zebra, if you've got zebras coming in, whatever, whatever animal, we, we want the basics, we wanna get the kind of basic history, and we have a, an, an idea.
But when we're developing that, what within a what should we be asking a chicken carer? Well, is it a pet or is it for production? And there is a very clear reason why, because finance is available when it comes to chickens, you will, on a typical day to day, have a very, very, very, very varied line, a long line of people who, who will spend.
Nothing, or want to spend nothing, and some that will spend thousands. And I, I mean this, I have, I had a particular chicken that ended up having a, a bill after the best part of, of two weeks, and we, and sadly we had to euthanize that chicken, in the end anyway. 2000 pounds.
2000 pounds, we did all sorts of investigations, surgeries, corrective surgeries, and, and for the most part, I had a, a bad feeling about it. And they still wanted to try, they still wanted to try X, Y and Z and ultimately we came to a, a juncture where we couldn't, we couldn't actually fix this, the, the issue that was progressing unfortunately. And there was a, there was a really, there was a welfare concern.
But within this context at least. Finances, finances, finances, you can save yourself a lot of time with working out whether it's production, where you, I would suspect most of the time, money is going to be tight by the very second you're gonna walk in. Or sometimes when it's a pet, people will spend hundreds and hundreds of pounds, for worker.
Whether or not you're going to be the one who's going to be doing that, or you're going to ref refer, at least it gives you a base idea of where you're at. The next question, reproductive history, so most of the chickens that you're going to be seeing are gonna be hens. And being female, most of them will be egg laying.
And many, many, many, many of them, cos that's tends to be the ones that are able to, to live that long. Broilers as, as we know, you know, meat production chickens tend to carry a huge amount of weight, don't tend to last very long, and have a very particular kind of trajectory of purpose. So many of the hens you'll be seeing will be, egg laying.
So what you're going to be asking is, what is the reproductive history of the hens? You know, have we been laying for long, have we come out of lay, you know, have we had a decrease of egg production? And have we had an abnormal egg production.
And we're gonna be talking about that or looking at an example of abnormal egg production, er er later, but usually when you have someone who's, you got a an egg laying hen. They'll be able to tell you very clearly what is the standard, and, you know, it, you know, normally of, of, of holdings, you know, anything between 1 to 5 is the typical amount that you'll normally see. But, yeah, it's, it's good.
It's really good, it's really good to ask those questions because the large majority of the chickens that you will see will be egg laying, hences. And they have very specific problems that you'll normally see. We have to always remember with chickens, by design, nearly all of them that we see on a regular, on a day to day basis are mostly are bred for a purpose, a specific purpose, unless they're showing chickens.
And tend to have a short life. And by short life, we, we're looking at anywhere between, typically after 18 months with egg laying hen is, is a pretty good innings, unfortunately. You know, if I see an egg laying hen that's 3 or 4, then I'm thinking, wow, you are a miracle.
Sometimes you can get them as old as 678, but they tend to be. Either very, very lucky or have some very devoted, er, a very devoted er carers. Or they were bred slightly for a different purpose, their bodies are not designed for longevity.
So after 18 months, every day is a bonus sadly. So we're asking these questions, but again, like I said, why laying hens when you have reproductive issues, and we'll talk about that a little bit later. And the last one that I like to ask routinely is what's being fed and are they grazing?
And the reason why I like to ask this is because. Typically in a production environment, their food is, is, is being watched. With a hawk eye and because what we want to do is have the most amount of conversion from our food.
Two eggs or meat or whatever. And so when they come into a a kind of a holding environment, you know, you know, Lucy down the road, who got 2 chickens because her daughter really likes chickens, you know, the food starts to, to be very an interesting thing, but also with grazing. As we can imagine, Why, cos there's stones around and there's metal, and there's grass, and grass is a big one, grass is a really big one, but also like I said before, high production, high requirement.
And it's an easy thing to to notice this. You know, there's a lot of designer diets out there and you know, it's, it's very, it's very easy to get lost between that. And so having an idea about what they are feeding, is, is, is important.
So yeah, but again, often with regards to the transactional nature that a lot of people buy chickens, like I said, using Lucy down the road as an example, people don't tend to think about chickens in a, an environment where they think about their, their nutrition being difficult or complex. And as a result, it's very easy and it's very common that it, it goes a little bit left. So clinical exam.
I am flying through this, and this is really again it's about giving you guys a taster, but clinical exam. So adspection. So, looking at a distance basically, not touching the chicken.
Chickens like to put on a show as prey species, as a species that are, are, are looking to hide every single sign until the, the very last moment. Please, please, please, please, please, please, do not touch them. If they can stay in the car and be chill and relax.
They've got the Euron in the background or, you know, they've got their, their, their affirmation scene in the background, then please keep them there. And the reason why is because you can get a huge amount of information from a calm chicken in the background. I, I can tell you this.
So if, if there's chickens outside, it's in the car, go outside. Open the door very quietly and measure the respirates, or see if there's any signs of, of bleeding. And I, I tend to apply the three B's in my own head, because even though belly is not the right word, it's just, it just sounds better, breathing, bleeding belly.
That's how I remember it as my kind of basic, I'm looking from a distance thing. As we know, the abdomen is called a yum. But it, it just, it just sounds better and hopefully that will, will ring better for you if and when you do, eventually see a chicken in, in your practise or wherever you are.
But again, do your respirates, have we noticed anything else that looks odd? Do they have open eyes? Is there any signs of faeces?
Is it solid? Is there any blood in it? Are they willing to move and you know, are they being inquisitive, all those things.
And sometimes if even if they're bringing the chicken at this point into your your consult room, open the top really quietly, go to the very corner and see what happens. You can learn so, so, so much from a distance with, with birds generally speaking, to be honest with you, but chickens in particular, and I've seen chickens that they, they look like they were on death's door, and I've moved two or three steps closer to them, and they, and they're. They're, they're, they're kind of walking around, they've got a bit of swagger about them, so please, please, please, please, just, just, just take, just take a step back.
Probably gives you some time to, to ring in a nurse and a, and a towel and a and a hot drink for the panic that you're about to ensue as seeing your first chicken. So next thing, restraint. So before you even do any type of restraint, prep all your equipment, you can do so much, and I'm sure hopefully, you know, if I, if I pique your interests, there is, you can look into this yourself, but you can do shit on a tier test, you can use a tonne of metre, you can use this, you can use, there's so much you can use.
But get, get all your basics together. Your ophthalmoscope, your otoscope, you know, your stethoscope, your, OK, I would say thermometer. But I don't need to use that so often, but I'll explain that a little bit later.
Get your towel ready, you know, and how, you know, how long would you need to hold? If you've seen breathing issues, you don't wanna be holding too, too, too long, to stress them out even more because like I said, they get very stressed extremely quickly. And whatever it is, which is, again, I am preaching to the choir, I am fully aware of this, whatever method you do decide to take, just be methodical and just have the same pattern each time.
But we're gonna be going through, through a typical route or plan with regards to the clinical exam. So, we move the head first, where we start. So, next thing I'm looking for is the eyes.
Now, The reason why I've put a this particular mating er er membrane here is because this is the thing that . Most people er er are really confused about because again it's not typical at all. So for those who don't know, this particular membrane, it, it flies across the eye, it lubricates the eye, but it often flashes across the eye in a typical exam.
And it's, it's an important part because it is a, it is a kind of a, a backup system for lubrication, but also a backup system for protection from the eye. It's fantastic because if you are, you know, and this is kind of going on a bit of a tangent here when you're a general anaesthetic, you can use it as a barometer of how deep your anaesthetic is, . And, you know, it's also a really good platform for looking at eye infections as well, because it, it can be inflamed, it can be quite vascular, and you know, I've seen lacerations of this particular membrane.
So it is, it's, it's an important thing to, to assess. But again, when you're manipulating the head and having a look or someone else is doing it for you and holding the head, you know, this will fly across the eye. But it'll also, it restricts your view of the the the cornea.
But also something to be aware of with the eyes as well, apart from this membrane I'll just put it here as as a highlighting point, is the symmetry in, in the eyes. So, and there's a picture I'm gonna show you a little bit later about this. But just as a, as a, as a word of warning, there is a particular disease called Mare disease, and a, a, you know, a lot of chickens that come into the GP practise.
Or come to my practise will have Marro's disease. Mare disease is pretty grisly for a variety of different reasons. But one thing you can definitely see, and I'll I'll, I've got a picture on it later, which I'll show you, is the lighter colour of one of the eyes.
So you'll see two eyes, you'll have a look at both of them, and you'll notice that one eye is a nice dilated pupil. It's got an orangey red colour typically. And he'll look to the other side and it'll be meiotic, very, very small pupil, and it'll be grey or grey bluish.
There's no, there's no response to any reflexes, and we might be a little bit aloof on that side where we have that now. It looks very odd, and like I said, I'm gonna show you a picture, but, it's very typical sign of Mare's disease. And at that particular point, you, you can already tell the carer at that particular point that we probably have Marex disease and Marras being grizzly, you may want to have that conversation already about quality of life or the or the trajectory of things, and considering, you know, PTS at that particular point.
And that's directly the first thing you can do with the at the eyes. So is they do have them. Yes, I have been asked that question.
They tend to be in a, a, a ventralcaudal, position compared to the lateral cancers of the eyes. sometimes, and quite often they are hidden, you should always look at them in the same way that you'd look at any other ear in any other animal. If you get the opportunity to, typically issues of the of the ears, or the ear canals almost, or the oral canal is that they can get infected, and they can be a little bit grizzly to deal with, but always give them a good check.
Beak, sometimes we see them trimmed. Now, beard trimming, beard trimming, beak trimming is, isn't illegal in this country, but, it shouldn't happen in, in, in, in chicks old and 10 days old, in, in laying birds with over 350 birds. They often use an infrared, beet trimming method.
So if you do see a, a kind of trimmed beak, you know, you don't necessarily have to lose any sleep over it. It's relatively, I wouldn't say it's relatively common, but it, it's, it's common enough that you do see it, and it is legal. I had a couple of people ring me about that if they weren't sure.
But, going back to beats generally. Facts, we're looking for that they're nice and rigid, that they're nice and aligned. You know, if you see any looseness or laxity in that beat.
You know, you're, you're thinking of oh why could we have a or demineralized beak and er you know, things of things of that nature, just kind of basic once over. Chrome and wattle, so the thing on the top and the wobbly bits on the bottom. Yes, just give them a once over basically, sometimes they're missing, parts of the wattle, so basically on the, on the bottom of the neck, they have these two very kind of pendulous looking things, and sometimes they are missing one, it's absolutely fine, .
What's great about that, and again I'm gonna show you some of the pictures later, so don't worry too much about how I'm explaining this, I'll come back to it. But you can use it like a typical mucous membrane, look at your, completely refill time, so your CRT. If it's under, if you give it a good press, and it's nice and red, but like a mucous membrane, give it a good press, and with and, and it goes back to its normal colour in about 1, 1.5 seconds, usually.
Absolutely fine peripheral circulation. If it's 2 seconds, basically you can see that the blood is spilling back into that wattle, that cone within 2 seconds. Normally, obviously in, in, in, you know, mammals and cats and dogs and things like that.
We we're thinking that's absolutely fine, typically. In chickens, that is not, it's it it's, that's an indication of a reduced peripheral circulation. It should also not be pale or dark.
Again, I'm gonna show you this later. Next thing, next thing on my, my clinical exam tick list, looking at the crop, as I mentioned before. When you have a feel, you want it to, it feels a bit like a beanbag, effectively.
Very, very loose corn filled beanbag. And if you can, and it sounds absolutely vile and disgusting, cos they sometimes can be vile and disgusting smell, you can have a look inside the mouth, and have a little jiggle of this, this, this crop. If there is an off smell, or if there is this, if there is a someone who's willing to volunteer to smell.
God awful horribleness, then, then this is, this is the place to, to, to get them to do it, basically, because, a, and, and, and I'll mention this later as well, with a crop which is a little bit off, it's got a bacterial smell in there, we call sour crop and various other names. The smell is, is, is killer, to be honest with you. But if you get a whiff of something coming from the mouth, you can already say that this is a potential issue that might be, that needs to be, escalated.
The keel, the keel is a sternum. Now most, unless it's a, a broiler or, or it's like a meat production chicken of some sort, they, the keel is effectively a very large, bone, which is, effectively where the pectoral muscles are attached to. Now in egg laying chickens, and most chickens across the board, to be honest with you, they will have a, a, a very recessed V shape.
And by all means I can, you know, send some bits and bobs over to you if you, if you guys want a clear idea of what that feels like. But what you're looking for is quite a prominent central midline bone, sticking out, and then maybe just some nice, a relatively kind of a firm muscle, below that. You know, typically about 1 centimetre or 2 below that line of where that keel started.
So nice sticky out bone of the keel in the middle, and then maybe a couple 2 like 1 or 2 centimetres behind that, some firm well musculated pectoral muscles there. If you find that actually you're feeling the keel bone all the way down, you know, to where it starts to kind of separate out. Split into two, then you might have a, a, a concern on your hands.
But again, I'm, it's probably easier to, to share with pictures, and we have a couple of those coming up. You can do your, your heart and lung auscultation. He can be listened to, on the pectoral side.
And sometimes you can listen to, you know, the, the kind of air sacs and the lungs, the lungs are not so well. The air sacs just from the, dorsal aspect, just between, just between the wings there on the top. So .
So important, can't tell you how important this is. Feeling their version of the abdomen is so important because you'll find so many issues so quickly. What you want to be feeling, technically speaking, is something soft and doughy, you might be able to feel a little bit of a hard, kind of maybe, you know, a, a, a hard stomach, usually on the left side of the cowel aspect of the, of the, of the irle.
And that can be a little bit more firm because there's a muscular part, but again, you just want it soft and doughy, you don't want it to be fluid filled, you don't want it to be any really large hard masses in there, obviously, and that's it. Next thing is the vent, looks like a slit. If it doesn't look like a slit, it's probably something that's going wrong.
Extremities, wings, again, typical things you would expect for your, you know, joints, crepitus, swelling, anything that looks odd, . And legs, similar, similar thing, however, something that you will need to look for if you feel comfortable, it'd be great. Look at the underside of the plantar surf, the plantar side of their feet, because as we may or may not know, bumblefoot or poto dermatitis or whatever you wanna call it, is so common in these guys, and then once you've found that out, you can, you know, start building your, your clinical exam towards dealing with that as well.
OK, so I've rushed through that. So, what's the probability? Now, what do I mean by what's the probability?
Here is a lovely, lovely pie chart, about primary causes. This is from some research came out in 2019 and said below, primary causes of mortality in backyard poultry. You will be seeing, and you know, in my own anecdote, I have, I have definitely, I definitely feel the same.
You will be seeing that nearly half of the things that you see with the chicken when it comes and it's not eating, it's not moving, it's probably going to be some type of neoplasia. Typically we're looking at neoplasia. Of some major organ, typically, they they're reproductive organs.
And that's, that's just the way the cookie crumbles unfortunately. And again it comes back to this idea of er er they're not designed to, to, to live long, they're designed to produce as much as possible at a fast enough rate and the body has a way of, of getting its own back. The other things will be infectious.
So, you know, lots of respiratory problems, lots of infections of the feet, lots of infections of, of anything, to be honest with you. And, and non-infectious, you know, there's, there's, there's a variety of things basically. But again, most of the time, if it's not a growth, you're looking at some type of infectious, line.
All right? So, now this is the, the some of the fun things. I'm, I'm going to just go through some of the typical things we might see.
And again this is, this all of this is to familiarise yourself with things that you might see, so you, so you're not doing what I had to do initially, which is saying, I've never seen this before. I don't know what this looks like, so I've panicked. I'm not going to be able to look at birds ever again.
So these are some of the things that you may or may not see on a regular basis, so. Here we have two pictures of effectively sinusitis. So, this is very, very common, very, very common.
Now, around, it's kind of a periorbital er er positioning, quite often, just below the eye, just vent to the eyes where they tend to get really large faous lumps of, of pus and all sorts effectively in there. And I'm, I'm sure some of you or many of you would have seen it before. Ultimately, there's lots of terms, there's lots of feelings about which bacteria's overrepresented or underrepresented in chickens and turkeys, and ducks, and so on and so forth.
But typically, if you're able to get past, you know, someone comes in and brings you a chicken that looks like this, if you're able to get past the finances, just do a culture sensitivity. Just do a PCR just do a virus isolation test, just do, just, just find out what it is you're dealing with, because, you know, ultimately it's, it's so hard to even get those initial workups done. Typically if, if those signs, suggest to me for whatever reason, that there's a bacterial involvement, sometimes the eyes will be watering, sometimes there's a little fistula with a little yellow goodness coming out of it.
Then, You know, I, I, I tend to reach for things like Tylacin, Thailand, you know, anything which is, which is kind of something that could be put in the water, and, you know, wait for the culture sensitivity to come back. These can progress quite quickly. And also, as you may or may not know, with regards to birds, is that erial infections can get very hard and verycaceous.
They become like chalky almost. If you feel a chalky lump around kind of this, this sinus in this area, then you are looking at surgery, and there's a bit of a poor success rate with that, it's very hit and miss. So yeah, something to be aware of.
Next. This white I'm gonna try and hurry up a little bit. This white ubiquitous stuff around the face.
Again, please do a a skin scrape, you can do it. It's the exact same principle. Have a look under a microscope because often it is parasonics as well.
But in this particular case, this is called avus, which is basically er er er it's it's, it's like a type of white fungus, basically. It's a white scale. And so I do a skin scrape treatment.
It's usually the F10, so I tend to use just F10, and get them to, to apply F10 cream onto those areas twice a day, you know, for 10 days, and typically that's all you need to do. But sometimes people will give some, you know, things like meconazole, topical treatments as well. -huh.
So this is something I mentioned earlier, this is Marrick, this is a perfect example. This is exactly the difference, it's night and day, and I've seen this so many times and say to myself, you know, it sounds terrible. So much time, from, er, er, having to extend my consult, because Mark's disease is quite a debilitating disease, as I mentioned before, and, you know, it, it can, it will escalate, .
You know, it, it can sometimes cause cataracts and then cause glaucoma, but rarely. But also it's it's a neurological issue that affects other parts of the body, particularly our a locomotory capacity, or musculoskeletal capacity as well. It is also quite an agonising progression, and so what I typically suggest when I see this is, is, is, I don't know the timeline, we're going to suffer.
I think we should consider euthanasia, to be honest with you. And how they deal with that at home is good hygiene, could be good clean. But again, you know, if you see something like this, you're already starting to think we need to escalate this, and isolate all the other chickens that we believe don't have it.
Next, again, this is kind of a, a blue comb and blue wattle. Again, I'm, I'm, you know, preaching to the choir what that could be, but you know, long story short, this chicken was, had an echo done. I know, it had an echocardiograph done, and it had a heart condition.
So again, pretty, pretty basic stuff. But again, the transferable nature of er er our small animal or large animal things is, is really clear, it's really patent, it's really easy to be honest with you. And then last but not least, this very weird looking thing.
Now this is, this is just genetic. So if you see something like this, it, I'd be surprised if you do, but I've seen this a couple of times. It is genetic.
Do not worry about it. There's no need to have any type of surgery, there's no infection. It's just an inverted category.
Typical things that you'll see on the body. My favourite, I'm gonna come on to this and try and smash this quite quickly. So this is a fluid filled serum.
Very typical for two different things, carcinoma of the reproductive tract or egg peritonitis, and we'll talk about it a little bit later. Here is an impacted crop, and you can sure you can see it's, it's got a very, it's almost a boxing glove shape, and this kind of ledge. Tends to happen when the kind of muscular capacity and the elastic capacity of the crop tends to fail, basically.
So if you, and when it tends to fail, what do you typically have to do? You have to give them something to either, you either say, well, actually the, the prognosis isn't looking very good, or you put on a crop bra, which is an interesting contraption to kind of keep the crop in place. Typical things, as I mentioned before, with regards to what could be in the crop, and with regards to grazing in particular, is they, if I, you know, often it's lots of grass, basically, lots of grass, and lots of grit, and that can get into the crop and it gets stuck there.
And so it tends to get larger and larger and larger, and then they come to you and it'll need surgery to remove all that grass, and surgery is very routine, and you know, it's, it's, it's just, it's just so, so common. This parasites, ex-parasites, the lice, you know, Demanis Galilee, you know, red mite, you know, all sorts of er er er er bits and bobs, basically, . You'll find them in most poultry in some capacity as far as I'm concerned, unless you have a fantastic, fantastic er husbandry at home, but most chickens that come to me will have in some shape or form, some form of lice or mite somewhere.
However, it is important to understand that. If they have loads. And I mean lots.
It can either be, especially in red mite, it's, which is actually the number one reason for anaemia in chicken, which is red mite, these kind of bloodsucking mites and they're not particularly nice, but very, very common. Is a sign of it, but ultimately any type of overwhelming of parasites is often a sign of, of, of poor thrift, poor health generally, and is often, as far as I'm concerned, secondary to an inferred weakness or illness or condition somewhere else. So if you have a very pale looking chicken.
And we're, we're very flat and you're just not sure where to go with it, and you see loads of lice and loads of mites crawling all over your hands, and the last thing you wanna do is, is, is, is hold any longer because there's there's lice and mite everywhere. Then I, the prognosis is, is quite often poor. You can treat it.
There's a couple of things out there. I like a product called Dergal, which is pretty ubiquitous, but there's also something else which is very expensive. It's called Exalt.
It's got flu fluoranarin, and so we're, we're, we're, you know, I have been dispensing that a lot more, recently, but it's, it's quite, it's quite expensive. So, yeah, Durga's a good shout. And then lastly is a prolapse.
We're thinking of, you know, cancers and tumours of the gastrointestinal tracts, again, don't just replace a prolapse, you've gotta find out why it's why it's happened, you know, and that's just, that's really important. OK, extremities, bumblefoot, this is what it looks like. If it looks like this, you're likely going to need surgery.
But again, you can have a conversation about husbandry, substrate, how long has it been like that. And those, those things are, are, are really, really good conversation. Just to develop that.
If you, if the, if the contents do fall out on their own, and sometimes they will do in entirety, sometimes you can just effectively take out the, the centre part and make a bit of a, a pressure bandage. And then, clean up the centre of a bit of a hippy scrub. Give it a good flush with some F10, or, or some saline, and, a bit of a pressure bandage, so they're not putting all that pressure on the base of the, the, the kind of surface there.
And you can do a lot with a bandage, and again there's loads of literature out there to, to show which way and how to do that bandage as well. But again, also things like ammonia and poor conditions are very common reasons for, for bumblefoot. Next we have this very, Interesting looking shaped leg.
This is a typical sign of chondrodystrophy. So more common in growing, very fast growing chickens, so we usually they, they get affected by this when they're quite young. Effectively it's, it's a joint disease, and a lot of joint diseases in chickens, as you can imagine when they're so fast growing, and they have all these pressure.
To, to grow as fast as possible, is based on nutrition. Zinc, choline, biotene, folate, niacin, etc. Etc.
Etc. Yeah, long story short, if you see this, it, it's going to take a lot of work. And more times than not, you're not able to do anything except, except support and manage.
And sometimes people will, will, you know, have them on, all sorts of different, you know, slings and things of that nature. But again, you know, at this particular point, you by all means, you can do further workup for, you know, arthritis, and if you think it's infected, and rickets and so on and so forth, valgus, ruptured ligaments, you name it, more times than that. It's too late, and you know, it's usually based on nutrition, and all, and management, pain relief and things like that is what you can do, typically, .
Next one. Here is an example of the, the eye issue, Marrick disease. So typically you'll see one leg that's, it's kind of paresis, or typically of later on, they have one leg forward and one leg back.
Very typical signs of Marrick disease, as I mentioned earlier, if you see this, quality of life is completely compromised. It's quite an agonising thing. We should be recommending euthanasia relatively typically, .
And then lastly, Is when chickens use their wings for balance, this particular chicken had egg peritonitis, so we're a nice round circle here. And we're so full of fluid, so incredibly full of fluid because of this egg peritonitis. We're now using our wing as a balancing, a balancing act really, it's a bit of a tripod situation going on here.
If you see this. We know there is something profoundly wrong, and, you know, but again, if you, without even having to, that's what I mentioned earlier, without even having to, to touch this, this, this, this poor hen, we know something is, is an issue in regards to balance, and we're overcompensating, and egg peritonitis or a leg issue, again, some type of of issue like that. It's very, very common, it's very, very, it's very, very common to see that as well, and they will employ it quite readily.
OK, so we're gonna do some crash through some case examples because I know gotta hurry up a little bit, so. First of foremost, we have this lovely hen's come into our practise, Betty, she's 2 years old, and the, the, the synopsis we've got from the receptionist and the, and, and, you know, is, is that we're breathing fully and not moving, just it's always so helpful when you're seeing a chicken, because that goes for pretty much 85% of the cases you will, you will see. .
So, Again, we're going back to the questions that I mentioned earlier. So is it a pet or is it production? Well, in this particular case, the answer was pets, but previously production, which is most of the cases that you will see.
Reproductive history of hens, decreasing egg production, abnormal egg egg production, not produced an egg for a while. So, I'm sure there's some thoughts, you know, kind of a listing on the er the back of the mind there. But again, so we've basically got a species or a breed almost, of a, of a bird that is designed to produce eggs at a high rate is now longer, no longer producing any.
And there's usually a couple of things that we're looking for. Well we're not gonna tell you that just yet. So, we've done a clinical exam, we found salamic distention, remember, breathing, bleeding, belly.
So we had to look at the belly and we thought, oh, it's very full, it's very full. It's like a, it's like a balloon, and often they can be genuinely, they, it feels like if you, you're, if you move too quickly, so they may pop. That's how tight some of them will feel.
No obvious masses felt, but again we are full of fluid and no desire to move up a couple of steps. Mild mouth breathing, and otherwise, nothing's abnormal detected. So in the odd occasion, you take this chick to the back and you think, you say to your nurses and your colleagues, I have no idea what's going on, we're just full of fluid.
And we, I, I hope we've probably heard all those cases and hopefully the managers haven't seen, and we've pulled out an ultrasound when we're not supposed to because we don't have a clue. And we'd rather have the er er confirmation from an ultrasound, a quick, cheeky one, whilst the manager's not looking to find out what's going on, just to help guide us in our, in our in our workup. So we've done an ultrasound now, and this is what we see.
What do we see? Fluid, brilliant. We've learned so much.
But again, we've got this, anechoic free fluid is a technical term. No obvious masses, nothing, just fluid. And we're thinking to ourselves, well, that's really helped us not.
Well, in this case, I would say probably 8 times out of 10, we're looking at a peritonittis or your accelerittis, to be honest with you. But I'll come on to 11 factor that, that could be a confounding variable in this situation, in a second. .
Without further workup, which is going to be the most of them, this is a working diagnosis, but it, it happens so often, that it's just, it's just, it's so important that we kind of are leaning towards that and give them a better idea, because I can tell you 9 times out of 10, it will be this or the other option which I'm about to tell you about. But again, just a quick breakdown of what this is, it's when the egg, effectively or or or a follicle at least, kind of breaks out. Into the into the abdo abdomen or the salammic space.
Now this can be caused by anything, rough handling can can perforate er er the the vitallin membrane. Oh yeah, it says there, and too much activity, some type of trauma. Effectively, the contents which are supposed to be in the reproductive tract get out into the abdomen and the abdomen goes, oh, so this, don't like it.
And then you've got this, this huge reaction, it fills up with fluid. Now, if you have a working diagnosis, the treatment for this is, is, is plausible, it is possible, but depending on the stage, it's often a, a pretty poor prognosis, to be honest with you, because, again, they try to hide their signs. I have drained abdomens before.
I've had phone calls from people saying, well, my vet just drained the abdomen, and he was fine. And he said he'd have to do it every 3 weeks. I don't always believe them, .
But again, there's a lot of, of, of misinformation about just draining the abdomen, it's absolutely fine. But I have taken fluid off the abdomen before, the most I've ever taken off one chicken, so just pure fluid is a litre. So you think about this, you know, 223 kilogramme chicken, it looks like a, a, a, a volleyball effectively.
You put a, a, a, you know, a, I don't know, a, a, a 2021 gauge catheter or something pretty large in, put it just a little bit. How oldly, just maybe, I don't know, 5 to 10 centimetres eventually to the midline of the vent, so at the back of the cloaca, and you basically put it in just just underneath the skin. So we're away from the, the liver and.
You know, you tap it off and, and you, you can take out huge amounts of fluid, huge, huge, huge, huge amounts of fluid. But again, even then, you know, you, you're really unsure about whether or not it's the right thing to do, because often it will come back pretty much straight away. The other options ahead of time, Deslaelian implants, I'm sure some of you may have seen it before.
Really surgery in these situations is recommended. The reason why surgery is recommended is basically to flush everything out. Because you usually are going to miss 100 mL, 200 mL of fluid, from the abdomen of a chicken, even if you kind of tap it off.
And I'll show you a picture of an example here of that type of setup, effectively. And below that is a picture I took, when I was, I think I was 300 mils down, of fluid. And you can see it's got this yellowy, it's, that's, that's the, that's the egg yolk, basically.
And that's what's been swishing around. And I caught this quite early. Something to be aware of, not all these cases are egg peritonitis, they are this horrible gunky nasty stuff.
Now, the difference between diagnosing this with your cheeky ultrasound really is that if you do an ultrasound. You'll see fluid again, let's say hypothetically, and what you'll see is, is, is these nodule nodules, these lovely little nodules all around after kind of scoping around. So every time you do an ultrasound of these, fluid filled balls of, of chicken.
What you want to do is see fluid, and if you see very, you know, odd shapes, lots of little nodules somewhere, usually on the left side, or ultimately on the left side, in that type of region in the cranial kind of cranialish portion of the, of the serum, then you, you know, you can make a relatively presumptive, differential of some type of neoplasia of the reproductive tract. And in, in the, in regards to cancer and reproductive tract cancer surgery is suggested. .
Let's go on to the next one, trying to snap through this really quickly. So we've got Narla, she's a 1 year old hen. She's putting soft eggs.
Egg production has stopped and now she's she's acutely lame. Again, we're going back to our three questions. Is it a pet production?
It's pet, great, reproductive history hens. Increase of egg production, abnormal egg production, used to produce eggs every day, marry 5 to 6 days, 1 to 2 eggs. And you're thinking, oh, OK, so you're thinking, hm, there's a production problem here, maybe there's something I need to look into that.
Was being fed, grazing mainly. We're fed a little bit of pet from time to time. So we do a clinical exam and we're refusing to walk, we're very weak, we're not biting back.
Chicks can be er very clear about their space, they're like boundaries, and we've got slightly swollen looking joints. We have a look at the eggs, and the eggs look like this. Pretty, pretty crap, basically, they're really soft, really pliable.
And they, they can sometimes look like this. Ultimately, eggs, when they're soft, can have, it can only be described as a weird sperm looking thing, and you'll remember it now for that exact reason. I have seen this kind of tail portion be so long and it almost looked like a worm.
And so I've, again, like I said, sometimes when you have, really odd things happen and you think, so I've got a worm, look into that and because exotics and chickens in particular will present, present to you very, very odd things on a regular basis. But you have all these soft eggs. And you're thinking, oh OK, well why could that be?
Well, typically it's caused by. Hypocalcemia, caged layer fatigue, it's another name for it. It's pretty common, it didn't tend to be an issue, but often it's related to poor nutrition, as we, as we could probably expect.
Usually low calcium. Because again, they're producing so many, they're losing all the calcium, and as a result, they're unable to first of all replenish it for themselves, but also they're unable to put more into the shells of the eggs they are producing. It can be transient, and by transient I mean is that they just come into lay, the first couple are soft.
I tend to not worry too much, but. If it continues to be an issue, more chronic issue, then we're looking at, you know, like I mentioned, you know, nutritional er er concerns. Prevention, balanced feed, balanced feed ration, layer pellets, layered pellets, need to be in a higher proportion to be honest with you, especially if we're laying a lot, because again, grazing is, is, it's a bit like, It's a bit like the, it's not the same really, but it's a bit like the, oh I feed the home cooked meal energy that we we we we always a little bit concerned because it's not a complete diet.
It's the same thing here. So if we're laying, we need to have a very nutrient, vitamin, mineral, dense food, to help replenish us. Sometimes I, I've seen this as well, that they've bought the right food and they're still having this outcome.
Now sometimes I've just given them the supplement which I think they're missing. However, sometimes I've asked them to bring some of their food in, and it's all separated and it's mouldy and it's horrible. And people will buy, because often, you know, you're buying layered pellets for, I don't know, 1000 chickens or whatever.
Sometimes people buy really huge bags and it sits there for genuinely years. And at the bottom you've got this kind of separated moulding of rubbish, and they're still feeding to the chicken because they want to buy another, you know, 400 litre bag or whatever it is. So yeah, something to be aware of.
With regards to, treatment, calcium supplement supplements, Zocal D is what I tend to use, but there are other brands out there I think. Oyster shells, there's something I did years ago, I haven't seen it very often. Something I like to do, is give eggs.
So if you've got a nice solid chicken egg. And you're not, you know, making an omelette that evening. I, I, you know, giving the eggs back, sounds ridiculous, great protein sauce, decent fat sauce, of course, and they all eat the shell, and that's a really great calcium supplement, and it kind of has that, you know, that full cycle back to, to, to the origin, .
And also just to be aware of with regards to the reason why we had sore joints again, if the calcium, we're losing the calcium from the bones, again, you know, things like er er er osteomalacia and things of that, that nature is, is gonna pop up and joint disease and so on and so forth. Make sure in these cases that you suspect that lower purchase that we don't fall. And the prognosis can be very good for, and also all these signs can pop up with infectious bronchitis.
Again, this is just to tickle your fancy in regards to that. Many takeaways, rushing here, a lot of what you'll see was pretty routine. The skills we collectively have and 95% of what we need to be able to do this.
And honestly, with all things new, let's re-engage with our curiosity. Let's re-engage with the fact that this isn't something that's necessarily scary or or or worrying because it's new. Chickens are fantastic, they are so, they have so much character and you can go a long way from from very little.
So much, so much so. And it's, you know, it's, it's testament to you today to being part of this for, to show that you're actually interested in doing it. It's a growing area, but we're going.
To see lots more er er er chickens as pets in the UK and around the world. I'm, I'm pretty sure of that. And they're gonna be more popular, popular.
And as people start to pivot them away from just being production animals to also being pets, there's also opportunities for, for, for making them more profitable as well. OK, so these are my resources can be very quick. These are two fantastic books.
If you're interested, go and get them. Both brilliant, and I've used some of the pictures from them today. British Ham Welfare Trust, fantastic.
Big shout out to Sonia who's next. Just exotics care sheets. This is all for all the exotics.
I've been using her exotics, care sheets for a while now. Sonnya don't hurt me, but fantastic resource. And lastly, the chicken vet, also brilliant as well.
Thank you very much. Thank you, Fabia. And that was fascinating insight into, into chickens, which scares most of us vets, as you well know.
And, but you've given us a, a lot of really clear thought and approach to, to the, the workups and the diagnostics. So thank you for all those, tips and everything else you gave us. Folks, we've had loads of really good questions coming in.
Unfortunately, we don't have time. To go through any of them at this stage. We will pass them on to Fabian, and we will get as many of those answered via email as what we can.
But, yeah, it's loads of questions and, and thank you for being so engaged, but we do need to move on. Sonia, if I can ask you to share your screen for us in the meantime, please. So, our next session on the emergency reptile patient.
Is going to be presented by Sonia Miles, who qualified from Bristol University in 2013. In 2015, she started working for Highcroft Exotic Vets and now leads a busy first opinion and referral level department. Sonia became an RCVS recognised advanced practitioner in zoological medicine in 2018.
And then in 2020, she became a WAVMA certified aquatic species veterinary surgeon. Sonia enjoys all aspects of working on exotic species, specifically reptiles, amphibians, and fish. She particularly enjoys performing soft tissue and orthopaedic surgery, as well as teaching her interns and veterinary students while seeing practise in her department.
Sonia, welcome back to the webinar, vet, and it's over to you. Thank you very much for the introduction. And thank you, Fabian, for the, plug.
Much appreciated and love the chicken talk as well. It was amazing though. Thank you very much for that hard act to follow.
Hopefully, you can see all the slides, OK, and not essentially the notes that I have written. Let's do it. Hopefully the guys that are, chairing these sessions will give me a shout if anything is, is coming up.
So first off, I wanted to start with. So, sorry, it's Dawn. We can't see your next slide.
So do you mind just swapping it around at the top? 2 seconds. Let me have a look at doing this instead.
Does that work? That's it, that's perfect. Thanks so much.
You're welcome. That's OK, thank you. Cool, that's fine because perfect because I have my laptop next to me exactly for this reason, so I can actually see what I'm supposed to be talking to you guys about as well.
So hopefully that works. So yeah, I just wanted to start with a little introduction first. Into reptiles specifically, and then we'll obviously go into, more in-depth information.
So, reptiles, there are more than 10,000 species, on the planet. They pretty much distributed globally, apart from Antarctica. And this means that they are living in multiple climates and multiple ecosystems.
There's a massive variety in them, so, you see, one snake is very, very different to another snake, for example. So very many different sizes and different shapes. And knowing the species ahead of time is gonna make your life so much easier.
And this is where reception training and getting your front of house team on board is really, really important, because, yeah, you can hopefully swat up as to the care that that individual species needs prior to doing anything else, essentially. And there are various different diets that need to be catered for when we're dealing with various different reptiles. And for this webinar specifically, I'm gonna assume that you guys know the basics so that heat and UV lighting, etc.
Are absolutely essential. And it's pretty much beyond the scope of this webinar to specifically go into the individual details of requirements for each individual species. So it's when I do discuss the kind of care requirements that we obviously do need to go through in a a consultation, it's gonna be kind of general gist for it.
So, from an overview perspective, what we're gonna go through today, we're gonna go through the importance of hygiene and zoonosis, how to do a clinical history and clinical examination. We're gonna touch on cardiopulmonary cerebral resuscitation in reptiles because it is possible, though limited in comparison to mammal our mammalian species. What diagnostics we have available, fluid therapy and nutritional support options, we're finishing up with some case examples.
So, as promised, hygiene in practise. Well, wear gloves wherever possible. And, I'd also like to point out that there's probably some of my pictures in, this lecture, that I'm not actually wearing gloves.
So when you're not wearing gloves, wash your hands thoroughly. Make sure that you're not eating and drinking around your species. Don't kiss your patients.
She might be watching this evening, but I definitely have one intern that you couldn't stop from, being very affectionate with them. So don't do that. Handle samples appropriately, cover cuts and scrapes, and obviously keep your patient's hygiene optimised as well.
Now if you are ever unwell, you obviously want to consult your GP as well and let them know that we are working with patients that often have many zoonotic diseases that we have to bear in mind. So, zoonosis. Well, there's various ones that we're going to be working with or that we have to worry about.
Salmonella specifically is one of the main ones, that we have to worry about. And I do apologise in advance. I quite possibly have some gory pictures in here.
I tend to be pretty bad at doing that. So, here's one specifically. So salmonel, it's carried by the gastrointestinal tract of reptiles and is shed intermittently.
Now it can cause issues in reptiles, but mostly you can have asymptomatic carriers. And in humans it cause gastrointestinal issues, but also things like septicaemia, arthritis and pneumonia amongst other issues in humans. We've got mycobacteriosis, pretty uncommon in reptiles.
I tend to see it mostly or worry about it mostly in amphibians, and the differential, it has to be a differential whenever we've got a granulomatous lesion, and it predominantly causes issues in immunocompromised individuals. Campylobacter again causes gastrointestinal signs in humans. Aeromonas and pseudomonas is a gram-negative bacterias, and we can see them on the skin of reptiles but can cause issues in humans too, with again, predominantly immunocompromised individuals.
E. Coli, we have lebsiela, seriata and chlamydia as well. But also leptospirosis.
We tend to predominantly see that in imported reptiles, but also some weird and wonderful stuff like pentosomiasis as well, which is a respiratory parasite and also can cause respiratory issues in humans. So, our clinical history, we hopefully know ahead of time, thanks to our fantastic reception team, what individual we are actually dealing with, and then what we need to know is, how to perform our clinical history. And this is essentially gonna start with.
Triaging our individual. Because quite frankly, if you have a collapsed individual, you are gonna want to get a wiggle on with things. So either you take that patient away and start immediately assessing it, or have somebody and and have somebody else take the history or you do the history and give your patient to a nurse to hopefully do the initial triage.
We want to be knowing information about the enclosure type. Obviously, some reptiles are going to require a terrestrial, so, a long and and a long live that is longer than it is tall, or an arboreal, so like a chameleon, for example, is gonna need a taller viv than it is long. We want to know information about the heating, specifically the type of heating, the temperatures, and not just the hot and cold temperatures, but the ambient temperature, the temperature that that enclosure drops to at night.
Does that enclosure have a thermostatically controlled heat source? Spoiler alert, it should do, unless that owner, is particularly fond of house fires. So that's something that we definitely want to, be using with any heat source that we're using.
And even despite the fact that you're using a thermostat, which is obviously a machine that keeps that temperature consistent, you wanna be double checking that actually that temperature stays consistent by using a thermometer. And what times are those various heats provided for? UV lighting, how old is that bulb and what percentage is it being used?
From an age perspective, most bulbs kind of go out of date by 6 to 9 months, but it does depend on the manufacturer. How far away is that from the reptile and what time again is that provided? What's the humidity and how are they measuring it?
What substrate, if any, have we got in there? And what diet is being provided, as well as what diet specifically is being consumed. So a bit of a bit of dragons, for example, they might give it a lovely bowl of beautiful veggies and as an adult be a dragon, absolutely it should it should eat 75% veggies as an adult.
However, If it's just eating the live food and it's just getting fed loads and loads of grubs and doesn't touch that veg, sort of a little bit irrelevant as to what's actually been given. And then we also need information on supplements, the type, the brand, and that age and how they store those supplements. From your clinical examination, I always start with a distance exam.
So I'll normally get that reptile out. If it's one that I can allow to safely ambulate around my consult room, I will then allow that while I'm taking the clinical history, and I'm sort of surreptitiously keeping an eye on that individual and making sure that, I'm taking a resting respiratory rate, checking that it actually is able to ambulate appropriately, and that it is alert and engaging with its environment. We can take this respiratory rate and assess its effort at that same time as well.
Again, assess its ambulation, make sure that we get an accurate weight for that individual. We can ausculate the heart. No point in using a stethoscope with reptiles.
There's gonna be far too much noise, from the scales, and I will genuinely question your sanity if you try and use a stethoscope on a tortoise, for example. But many of us have Dopplers in practise. We use them a lot for blood pressures in cats and dogs, and they work amazingly for listening to the heart of that.
Individual. And it's something that can, one quiet children down in the consult, because they become fascinated with it, which is always a bonus. But also, it gets the owner involved as well.
They can actually hear their individual patients, in the individual pet's heart rate as well. So, something that can really kind of get them involved in the consult and engage with you. And then we want to be doing a head to tail examination and assessing all reflexes.
We can perform a sallonic palpation in individuals where you can actually have a salon, a salonic cavity to palpate. I appreciate with elonia specifically, a box of bone is what you're working with, with a few little fleshy bits. And there's not much that we can actually palpate in those individuals, but what we can palpate, we should.
Now when it comes to those true emergencies, well, what are we specifically dealing with? Well, any collapsed reptile, any reptile with traumatic injuries, one that is actively bleeding and in or one that is in respiratory distress. If we have fractured limbs like this individual here, large, Argentine tegu that, was allowed to free roam around the living room, climbed up somehow onto almost like a wardrobe type cabinet.
And decided to throw herself off of it. So that didn't end well, obviously. If they have prolapses or are unproductively straining, or if they have any evidence of foreign body ingestion, and we do have, we'll go through the specifics, and, like I said to you earlier, we'll go through case discussions, and I do touch on these specific true emergencies.
But these are ones if you're owner phones, that we can train our reception staff to go, OK, we've got a Take you that's thrown itself off of a wardrobe, that that's something that probably has got a broken bone, and we need to see that as soon as possible. And that is going to allow you to gauge how quickly you need to see those consults. And again, I cannot stress how important it is to get your reception team on board, minimises the time that you have to worry about things.
So what are our initial steps? Well, we've had that emergency individual brought into us. We want to place that species at its preferred optimum temperature zone.
Now this is a range of temperatures in which that individual's metabolism is optimised to its best abilities. We want to provide analgesia. Now, analgesia in reptiles is a vastly evolving area.
It's not like there's one analgesic that fits all. The morphine, for example. Morphine can work quite well in lizards and elonia species, but actually the evidence that we have in snakes is that, no, it doesn't seem to work particularly brilliantly, whereas tramadol does seem to.
And trabogesic doesn't work within a vast majority of individuals. However, at very high doses in corn snicks, it does seem to yield an analgesic response. Same as dexedotomidine.
And one thing that is given, I, I find this as standard by many first opinion, vets in practise, is something that we, we all tend to to jump for the non-steroidal anti-inflammatories. But the evidence of meloxicam specifically in reptiles, is that there's actually very little evidence that this has a great deal of analgesic effects in these guys. Oxygen therapy, however, we do need to be very, very careful.
In our mammalian species, we often jump to, if we've got a, a rabbit, for example, that's in respiratory distress, we often jump to popping them into an oxygen rich environment. However, in reptiles, as opposed to our mammalian species, their brain tells them to breathe at low levels of oxygen rather than high levels of carbon dioxide. So putting a reptile into an oxygen-rich environment, or recovering a reptile from an anaesthetic while it's still on 100% oxygen, rather than room air, will actually slow down an anaesthetic recovery, and also can impede an reptile that's got respiratory issues.
So, by all means, give it some oxygen, just don't gun it with it. We want to be performing diagnostics as quickly as possible, which we will go through, in a few moments' time. Give them fluid therapy, nutritional support, and everything.
Everything that we are going to discuss today pales to insignificance if we do not have a home environment that is improved. So this is where understanding what is normal requirements for these individuals at home, finding those deficiencies in your clinical examination and your clinical history. And adjusting those is absolutely imperative.
It's all very well doing all this fun stuff with these reptiles whilst they're hospitalised, but one thing that I nail home, and it might be a bit of a hard stance with my clients, is that essentially, absolutely, I can attempt to fix your reptile, and I can do fancy orthopaedic surgeries, etc. However, this is all utterly pointless if you do not sort stuff out at home, and it sort of wastes my time and their money, ultimately. So it seems a little bit diff it seems a little bit ridiculous, but when we're dealing with the collapsed individual, you're gonna want to check that it's actually alive.
So this was a really, really sad case. The owners had actually refused to come into an appointment, earlier in the day. They said my bearded dragon isn't moving particularly very well, or much, and they were told, OK, yeah, yeah, probably do need to bring that in sooner rather than later, and a few hours later they brought it in and this individual has actually passed away quite a while ago.
It was complete rigour. And they had no idea, absolutely no idea, because this individual hasn't moved for a few days. And yeah, it was a bit of an interesting concept to have a conversation with them and know that your reptile is, is stiff as a board, it has passed away, there is no heart rate.
This is. I don't think that actually the probe actually popped it on my, one of my blood vessels. You could hear my heart beating over the top of the bearded dragon's heart.
We could not. So it was a way of helping the owner understand that. It does sound silly, but in some reptiles, we do have to double check that that individual was actually still alive.
So we can put a Doppler probe on a tongue depressor, and place that over the heart. Or some Dopplers actually come with a pencil probe, which is absolutely amazing for our small Cellonia species, and I would not be without mine. You can even use an ECG, but be aware there's obviously movement artefact.
And if we have deemed that patient is actually still alive, and as a, a general rule of thumb, a heart rate that is below 10 beats a minute. Odds are that reptiles are not coming back. It is probably died and just hasn't got around to kind of finishing the job a little bit is probably a good way of thinking about that.
So it's just a way of managing your owner expectations that if the heartbeat is below 10, odds are things are pretty dire. But if it's above 10, then absolutely, we can consider cardiopulmonary cerebral resuscitation in these individuals. But we really do need to be realistic with our owners' expectations, because the general consensus is that, well, if a reptile plant presents in a collapsed state, unfortunately, those owners have probably missed the boat, and that it is likely to have been incredibly sick for a long period of time.
And unfortunately, in many instances, euthanasia absolutely has to be considered. So what do I mean by cardiopulmonary cerebral resuscitation in reptiles? Well, in an emergency situation, a quick clinical examination is going to be needed to determine cardiovascular and respiratory stability, mentation, evidence of trauma or blood loss.
Or if this reptile is not breathing, then CPCR should be started and basic life support, basic life support should be started. The, from the ABC approach, essentially, as we would do with our other species. And the normal approach to CPCR could be followed.
We want to secure a patent airway. So, I'm having an absolute nightmare with my mouse. I think the battery's dying, which is why things are flicking backwards and forwards.
I apologise in advance. I'll try and figure something out as I go. Actually, I've got another one plugged in.
I do have another one plugged in. Fantastic. So, we want to secure an airway and start IPPV.
Now this picture on the left-hand side here is a bearded dragon's glottis. Reptiles in general are pretty damn easy. I find them easier to intubate than I ever used to in cats and dogs.
So I think it's something that, a lot of people find daunting, but actually is incredibly straightforward, and we want to secure that airway as quickly as possible. Now, ideally, we would ventilate them. With room air.
So we have a small ambu bag to hand that works really, really well. If you're using 100% oxygen, then obviously we want to be careful. Again, we talked about previously, high oxygen environments can actually depress a reptile's respiratory effort and rate.
Now when we are doing IPPV we're aiming for about 4 to 6 breaths per minute. The heart can be pretty difficult to auscultate, with the stethoscope that we've touched on previously, and I will genuinely question your sanity if you try and listen to the, a tortoise's, heart, with a stethoscope being essentially a box of bone, you may be able to get away with it in a soft, soft shelled chelonia species, but most, absolutely not. You can definitely use a Doppler, like we touched on in a previous slide, we can go down the route of ECGs, but it really can be quite difficult to identify electoral activity.
Especially in, in cold reptiles, but also there's a lot of movement artefacts that we can get. Now, it also should be noted when talking about ECG that some dead reptiles can continue to exhibit cardio electrical activity for many hours after central nervous system collapses as well. So just bear that in mind that it might not be a true representation.
And if no heartbeat is detected, well, adrenaline can be administered endotochially where a catheter inserted down that endotracheal tube if intravenous or intra-osseous access is impossible. Now for endocu administration, that dose and emergency drugs should be doubled and diluted in sterile saline to 1 mL per 100 gramme of body weight to facilitate the delivery of the drug to that vascular respiratory epithelium. We can also consider atropine at those doses that you can see on the screen.
And I personally, I avoid doxara. It can increase, the oxygen requirement for the cerebral tissue. So actually, I think it's something that, correct me if I'm, I'm wrong, but, the cat and dog vets are moving away from as well.
But to be perfectly honest, in saying that, I've not touched a cat or dog in a decade, so I, I don't actually know. But I remember talking about it with one of our EC EC specialists, and they were, avoiding it as much as possible. To improve the circulation, well, if they're hypovolemic, or they've got suspected blood loss or severe dehydration, for example, hopefully, we can place intravenous and intraosseous catheters, which I will take you through a little later, and we can apply them with fluids, which, again, I will go through a little later as well.
And keep checking with the Doppler. I had this webinar once, and somebody asked me about non-invasive blood pressure in these guys as to whether that was a good way, of assessing it. In fact, this is actually pretty rubbish in reptiles, so it's really not accurate, not even helpful for a trend, so don't even bother.
And trends in lactate and pH can be assessed, er helpful in assessing the improvement in circulation, but I do appreciate that's probably a bit niche for, for many individuals. So, on to diagnostic testing, and I just wanted to start, start real quick with our blood sampling. So, as a general rule, you can take 1 mL per 100 gramme of a healthy individual.
If it is a sick reptile, we can take 0.5 mL per 100 gramme. We would want to be avoiding putting this blood into calcium EDTA.
This can cause hemolysis in many reptile species, predominantly acheonia species, so we use heparin instead. And there's an absolute minimum, we want to be looking at PCV total protein, a complete blood cell count and ionised calcium. But biochemistry and a full haematology is obviously very, very helpful as well.
In some individuals, if you're worried about systemic infections, blood cultures can work fantastically too, and there are various different serological tests and PCRs that we can perform as well. So where do we take blood samples, where do we take a blood sample from, essentially. Now, this is going to vary massively, depending on the individual that we are working with.
So these are kind of broad generalisations for lizards. My personal site that I would tend to go for in the vast majority of the lizards that I work with is a ventral coccygeal vein, and you can do this through the ventral or the lateral approach. This picture on the left hand side here is a bearded dragon that's having a blood sample taken.
Essentially those of you that have taken a blood sample from a cow can absolutely nail it in a bearded dragon as well. So what we do is that I tend to have the bearded dragon belly towards me. I'm holding the tail completely down the midline, in between the scales, I will orange needle attached to a 1 mil syringe into, a 90 degree angle into the tail, and I will just gently tap it into the vertebrae, and that blood vessel sits about 1 millimetre or two, above, just back from that vertebrae.
So I'll put a little bit of negative pressure, on the end of my syringe and just pull that back ever so slightly until I get a bit of flashback, and you can fill a 1 mil syringe pretty quickly. We've also got the ventral abdominal vein that can be accessed in various species like leopard geckos, for example, but I would only ever do that under sedation. We've got the brachial plexus in some species, the heart, which actually, I would only ever consider in lizards as a terminal procedure.
So we perform a lot of postmortems. If I've got an individual that is, unconscious, I will take a blood sample from the heart for diagnostic testing, and then, obviously, euthanas that individual for a postmortem. But what about in snakes?
Well, in snakes, I actually do predominantly take it from the heart. And in a well restrained, well-behaved snake, this can be done completely conscious. However, there are some individuals where a little bit of sedation would be worth considering.
We can do that, in some snakes by literally just turning them upside down and seeing that beat of their heart. Certainly in the smaller species, probably up to royal python, that's pretty straightforward. We can use a Doppler to locate that heart or ultrasound guidance.
Again, in many snakes, we've got the ventral coccygeal vein, and I would predominantly use this in larger species. But we also have the palatine vein as well. So this was, a corn snake, that had, I was actually still sedated at this point, but I thought it was a very good example of where you could see this palatine blood vessel.
Now, on Obviously, sampling this in a wake snake is never going to end well. So this is a place that, again, I would only ever access under general anaesthesia. But it's a quite a nice juicy one, and if you needed a blood sample in a pinch, that's one that you can consider doing.
And like I said earlier, I promise I washed my hands after holding this individual because I'm not wearing gloves. What about tortoises, well, Shelonia in general, there are various different sites, and as to which one is the most relevant, personally, I go for the jugular vein first. The right jugular tends to be easier to hit than the left.
Now the reason that I go for the jugular vein is that it has very little lymphatic dilution. These guys have got lymph vessels that run alongside their blood vessels, and if you inadvertently stick your needle into that, you will get a sample that is contaminated with lymph, and that will change many of your parameters from biochemical parameters to your haematological ones as well. And jugular vein, you get the least risk with this.
It's something that you just have to restrain that. Tortoise's head, there is no point in fighting a tortoise. So gentle retraction of that head out of the shell.
You can see here, one of my nurses is holding the tortoise, one is popping a finger just at the base of that jugular to raise it. But a little trick that works really well. So if you manage to exteriorize that individual's head, if you pop the leg in on the side that you are taking the sample from and sort of push it into the shell so it sits in a natural position and hold it there, The tortoise raises its own jugular, which makes your life a hell of a lot easier, especially when you're short staffed, cos let's face it, what vet practise is in it at the moment?
So dorsal and the jugular vein first, then I would tend to go for tail vein as the next one. Now don't jump to this straight away, because again, we've got lymphatic dilution and don't know if you've seen many tails of tortoises and and turtles, but they're pretty minion, and that's the last thing I want to do is be sticking a needle in there and contaminating my blood sample. And you've got various different other sites such as the subcapacial sinus, a blood vessel that sits on the underside of the shell, above the head.
I only ever use this for terminal procedures. I don't really take blood samples from here, but you can, but there is a hell of a lot of lymphatic dilution. And in some of our larger species, such as our Soulcatis, or our dabins or our Galapagos tortoises, we've got the brachial vein, femoral vein.
Part can be considered in small juveniles and soft shelled turtles, but again, I stress that's for terminal procedures only. And if you really want to get fancy about it, you can take arterial samples from the carotid artery, but I warn you, it absolutely blows like a mother. So, we want to be very, very careful with that one if you are considering it.
Intravenous cannulation in lizards. Well, it's possible, and we do it as standard in a wide variety of our individuals. It's actually one of the first things I teach my interns to do when they arrive.
Ventral coccygeal vein. So the blood vessel that we were talking about a second ago, placing our, or taking our blood sample from, we can place a cannula into here too. However, when I do this, I don't introduce the cannula or a 90 degree angle to the tail like I did with the blood sample, more kind of like a 30, 45 degree angle.
So it kind of like slides in quite nicely. One thing I do warn my owners about, however, is that it can potentially cause a tail tip necrosis. Now I've never seen it, however, I've heard of other vets being worried that the IV cannula they that they placed caused it.
So it's something that I do just gently warn them about and say, look, it's a potential possibility. We've got that ventral abdominal vein that we touched on, and we can enlarge a species such as iguanas, place an IV cannula in a cephalic, but it does require a cut down, so this patient is obviously going to be sedated with lots of local anaesthesia in place. And again, jugular, but again, cut down technique.
My lovely colleagues, if they're watching, I'll be very upset that I've posted a picture in here of, my fantastic kennel assistant Ali. So, her intravenous canniulation in snakes, it is possible, certainly in the large snakes, this python on the left hand side here that everyone got very excited that we were seeing, for a respiratory tract issue in this instance. It was very straightforward to place an intravenous cannula in his ventral coccygeal vein.
But we can place them in jugglers and we do on a regular basis. If a patient is sedated and we're doing a long anaesthetic, let's say for example, I'm spaying a female corn snake, which is a pretty common thing to do. We can do a jugular cut down and place a cannula there.
And we've got that palatine vein, but again, this is cannulated whilst under general anaesthetic. Now the reason that I've put these two snakes in is that it's all very well me saying, oh yeah, there's an intravenous site that we can use in a snake, can't I fancy. However, we do have to be realistic with the individual size of that snake.
So we've got an absolutely ginormous python on the left-hand side here, who was very well behaved. We were doing a lot. We really straightforward to do that.
But in comparison to the hognose that is on the right hand side here, that's literally just curled around my thumb, no, that's not going to be realistic. So just because we can place an intravenous cannula in it, doesn't necessarily mean we should be. And then again, we've got the heart.
So, I have placed cannulas into the heart that have stayed in place whilst we are performing, surgery. Saw a, a, a video of it. Someone was doing it, the other day on, on, Instagram, one of the pages that I was following as, as well.
And it works an absolute treat, but this is obviously in an anaesthetized patient, and we are being very, very conscious of what we are doing in and around that cannular area. One thing we also do a lot in Tilonia is placing these, an IV cannulas into that jugular vein, and it is pretty straightforward. We mentioned in one of the previous slides that obviously, we were, pushing that leg in, and holding it in place, that tortoise is raising its own jugular, gets your fingers out of the way, and it means you need one less nurse, essentially.
And it works really, really well when you're placed in the IV cannulas. So jugular is absolutely, pretty much. Always my sight that I would end up placing an ivy cannula.
In the larger species, certainly the males, who tend to have a larger tail, the dorsal tail vein, but we can also consider it in our brachial and femoral veins as well, and the subparpacial sinus, but again, really only for terminal procedures. One thing that's actually far more straightforward than placing an intravenous cannula is actually placing an intraosseous cannula in reptiles. But we would only ever do this under general anaesthesia or heavy sedation with a lot of local anaesthesia.
We've got a lot of evidence that local anaesthetics work very well in reptiles, so we perform quite a few procedures under local anaesthesia, actually. In lizards, we're aiming for the distal humerus, distal femur, or proximal tibia. In snakes, obviously it's not reported, a little bit of a joke putting that in there.
And in the tortoises you've got the quartoplastral carapaceal pillar, essentially the bit of bone that joins the top and the bottom of the shell. Now, you can see this picture here. Funnily enough, a completely collapsed female chameleon that is absolutely chocker full of eggs.
These guys will most of the time die of reproductive disease if metabolic bone disease hasn't got them before they develop it. And one thing that we've become quite comfortable doing is place in osseous cannulas, and we can see I've placed that into the distal femur in this instance. In chameleons, whenever you stab them with something, normally a needle, obviously, the chromatophores that are on the outside of them become quite damaged, and you can see around the base of that needle, it's become quite dark.
I will always explain this to owners that if I stick a needle in your chameleon, I'm going to make it black. It doesn't mean it's dead. It doesn't mean it's gonna fall off that tissue.
It just means I've really upset it. And this can actually stay in place for a few days if you secure it appropriately. But I stress, it is under sedation.
And local anaesthesia or general anaesthesia, and they are placed in a sterile way, the same way we would be doing it in our mammalian species. And we always want to check that they're in place with radiographs, and one thing I do want to stress is that if we are worried about metabolic bone disease, there's obviously going to be an incredibly high risk of iorogenic trauma when doing that. Now what other injection sites do we have in lizards?
Well, we've got intramuscular, but we only ever do this in the cranial half of the body. So the front legs, for example, are gonna be the easiest. And this is because of the renal portal system.
So the blood supply from the caudal half of the body, including the bone marrow, the subcutaneous tissues, musculature of the hind limb, the lumbar region, the tail, all passes via the renal portal system which bypasses the glomeriofiltration and perfuses the area of renal tubules. And is thought to be an adaptation for water retention, so preventing ischemic tubular damage if glomerular blood flow is reduced and possibly allowing for some tubular secretion of waste products such as uric acid, even in the absence of significant through of glomerulla filtering. Now it is thought that depending on the hydration status, blood may flo flow through the system or bypass it and pass directly to the systemic circulation.
So fluids can be safely administered anywhere you want, basically, but drugs that are potentially tubulartoxic, so things like penicillins or aminoglycosides or drugs that are excreted by renal tubular secretion, should be ideally administered into the cranial half of the body to avoid any of this first past consequences of that renal portal system. So as a general rule of thumb, because essentially we don't really know the pharmacokinetics and pharmacoeconomics of various different drugs that we use. If it's fluids, put it anywhere, if it's meds, front of its body.
Just stick with that in any reptile that we're dealing with. You've got subcutaneous, however, reptile skin is poorly elastic, to be perfectly honest. It's really, really hard to get much, material into the subcutaneous space.
And again, we want to be doing this in the cranial part of the body. We can give it intrasolamically, however, reptiles lack a diaphragm, if you filled them intrasollomically with, with fluid, if any of you have ever seen the air sacs, which are the lungs of a bearded dragon, for example, it's literally like this beautiful bag of lace that is in them. But if you fill the salamic cavity with water or fluids that you are giving it, you are going to compress that pretty damn quickly, so you can compare you can impair their respiration.
We want to avoid that obviously as much as possible. The organs tend to be in weird and wonderful places in comparison to our mammalian anatomy. So if you're not familiar with where organs live within the salamic cavity, there's a very high risk to puncture those organs.
But if you insist on it, then yeah, fluids and other drugs can go intra-salamically. However, I'm telling you now, if you can avoid it, and you can give it intravenously and intraosseously, which I promise you is quite straightforward, then great, added bonus. When it comes to snakes, well, again, we've already talked about, placing it intramuscular and why we do that in the cranial half of the body.
So I'm not gonna tell you again about the renal portal system, just put it in the cranial half of the body if it's a medication. And we want to do that in the apaxial muscles. Subcutaneously, again, really poor space, probably even less than in lizards.
So you can't really put much there. And then intrasollamically, then, yeah, absolutely. We can do that in snakes, but they're even more complicated to understand where their, internal anatomy is.
So we just want to be real careful what we're doing with that. But I would say that from a medication point of view in a state, they're probably one of the hardest ones to get IV access in, obviously intraosseousate happening. So intramuscular tends to be how we do this, and as you can see this picture on the left hand side here.
We've got the apexxial muscles. This snake's actually really, really skinny, but I thought it was a really good example of, how you can see the spine down the middle and the muscles either side. And whenever we inject any reptile, we go in between the scales, not through them.
And we'll just have prepared the skin with just some tamadine, so iodine solution, just to make sure that it's as clean as we can possibly make it. And then our injection sites in Tilonia, again, if we're doing intramuscular, we've got the forelimbs, subcutaneous, really not that much space, but probably more so than lizards and snakes. Intrasalamic, real issues with organ damage again, but these guys, episilamic is what we want to consider.
So episilamic is, it's a potential space. It's basically a potential gap between the, the tissues within, just outside of the salamic cavity, and we can inject large volumes of fluid into this epistalammic space. So this was actually a heartbreaking case, a really, really poorly horsefield tortoise that had Really bad mycoplasmosis and was hospitalised with us for a long period of time.
Now, eagle eye viewers of you will see that there's a feeding tube placed here, and why on earth aren't we giving it oral fluids? Well, his tube would become blocked, unfortunately. So we're giving him some epistalamic fluids before taking him to surgery again to place it in on the other side.
And what we would normally do is halfway between the front leg and the heads, so where you can see this needle going in, along the underside of the shell, we can basically inject that individual's daily fluid requirement, but I tend to do half and half either side. And again, clean the skin with some tamidine first. So onto our diagnostics, well, imaging, absolutely one of the things that we tend to do the most of in these guys.
Radiographs are really, really important for the vast majority of the species, but there is very few instances where a single radiographic view is helpful, to be perfectly honest, in any individual, whether that's a rabbit, a guinea pig, or, a, a, a reptile. The only time that I would go down the route of doing a single, dorsoventral view is to go, eggs or no eggs? Bladder stone or no bladder stone in those individuals that actually have a bladder.
And even then, I want, like really want some more information as to the position of those eggs, but tends to be something that we do in tortoises, at the pre-hibernation check. All females of reproductive age will get a, quick X-ray to say whether there are eggs present or not. Now, from a, radiographic point of view and Tillonia, well, the vast majority of reptiles you want orthogonal views, so a DV and a lateral, or in a snake, many DVs and many laterals, so you've got the entire, picture to hand, which is why we do a lot of CT scanning in snakes because it makes our lives a hell of a lot easier.
But in tortoises, you want to be doing a DV, a lateral and a cranial cadal. Now, because reptiles lack a diaphragm. There is next to no point in you doing radiographs on them if you do not have horizontal beam radiography.
If you're tilting that individual to take a lateral, you're turning a tortoise on its side, for example, all the internal organs are just gonna flop around and you are not gonna have a particularly helpful radiograph to interpret. So in my opinion, radiographs should only ever performed with horizontal beam radiography. I do a lot of ultrasonography, it's really good for assessing things like slamic fluid, we do heart scans in reptiles as well.
But one thing and my main area of interest is actually reproductive diseases in reptiles. So we do a lot of scanning looking for follicles and looking for eggs. Endoscopy, love a little bit of endoscopy.
As a general rule of thumb, a 2.7 millimetre, 30 degree rigid endoscope is going to be your most versatile scope telescope for a, pretty much all exotic species. So if you're if you're looking at doing, exotic species, endoscopy, then that's gonna be your main one.
And this can be used for tracheoscopy, gastroscopy, clochoscopy, celioscopy, like, literally anywhere you want to put the scope, that's gonna kind of do you pretty much. And the only time that I've ever really needed anything bigger is when we had, a 12-foot Burmese python decide that all of the vegetation in its enclosure, which had been there for a substantial period of time, now looked incredibly enticing and edible, and he snuffled a lot, and I spent, 2 hours with a long flexible endoscope, removing plastic plants from the intestines of a very large and initially very, very upset Burmese python that had recently been fed a rabbit as well. So decomposing rabbit inside there as well was absolutely delicious.
And CT scan and an MRI are absolutely options. I appreciate that many first opinion practises now are starting to get more and more of these too, so it's definitely something that is becoming more of an option, not just in referral practises like the one that, that I run, but also in first opinion too. Other diagnostics include faecal testing, as standard, as far as I'm concerned, a faecal test, a direct examination, and a faecal flotation should be part of every single reptile console, as just as a, as a complete standard test that we do.
We've got various different PCR testing such as adenovirus, which we see a lot in bearded dragons, arena virus, so causing inclusion body disease and bovis, mycoplasma and herpes in ourchellonia species as well. And then we've obviously got, things like our microbiology and our cytology as well, which are incredibly important too. Now, while I'm on this side, big plug to pals who do all of our, or vast majority of our, exotic labs.
They are fantastic, brilliant service, as well, and they will run pretty much all of these tests for you as well if you don't have the ability to do them yourself. So, fluid therapy and roots, well. It's general principles are pretty similar to mammals, to be perfectly honest, if you can give it orally, give it orally, but bear in mind that a sick patient and certainly a reptile is probably gonna have poor gastrointestinal perfusion, so you do have to bear that in mind.
Intravenously, we've touched on that. Intraosly, we've touched on that. We can give them intrasilamically, however, risk of rogenic trauma.
Episilamic, we've already touched on as well, and subcutaneous, really poor elasticity to their skin and slow absorption. But if you've got an individual that has got a feeding tube, you can place fluids down the feeding tube and soaking in certain. Reptile species can work an absolute treat too.
But you do have to bear in mind that for some individuals, it is incredibly, abnormal for them to be in standing water. So, for a tortoise, for example, yeah, great. Absolutely, they love to wallow.
As long as they're not getting too stressed with it, it can work really, really well. And the bladder of Tilonia is predominantly But some lizards is also incredibly large and thin walled. It's more thought of as an out pouching of the cloacal mucosa.
Now it has been suggested that this bladder and probably the wall of the uroderm and those species that lack a defined bladder, rather than being simply a storage organ like it is in mammals, can provide an important part of the fluid and electrolyte osmatic mechanism. Now, after voiding urine, many reptiles, if soaked in a warm bath, will aspirate a volume of fluid back into the cloaca and into the bladder from that environment. And this, in some individuals can involve a considerable volume of fluids.
So, let's say, for example, a 1.5 kg testtuo species tortoise, that's 300 mL, that they can suck up their backside back into their bladder, which can be very, very helpful, bit gross, but very, very helpful. Simply bathing a reptile for 20 minutes twice a day in a water and electrolyte solution such as Betux Repto Boost, for example, which is something that we'll probably give out like candy, to be perfectly honest, can be really, really beneficial on their hydration status, especially for these really, really poorly ones.
But bear in mind that severely debilitated or ill individuals, you're probably gonna have to supplement this elsewhere as well through intravenous or intraosseous routes that we talked about previously. But in reflection in a chameleon, for example, really abnormal for them to, be sat in standing water. They're not going to drink it.
And a bearded dragon, for example, they can get pretty stressed. They can bathe them all you want. It's not gonna absorb enough fluids to be particularly very helpful.
Certainly not through their skin or their cloaca, they physically have to drink it. So you have to understand how that individual receives water naturally, chameleons licking it off plants, for example, when there's dew and stuff in the environment, versus a tortoise that, yeah, absolutely, will crawl into a a muddy puddle in the wild and, and drink from it. Now, whatever fluid we are using, which I'm going to go on to the choice of fluids in a second, we need to make sure that it is warmed appropriately to that individual species preferred body temperature.
So there are various different cocktails of fluids that we can use. Now there's loads of them here, you guys can read, you don't need me to read it for you. But in a pinch, if you are not wanting to get fancy about it and you've got an individual that you're like, I don't have do for light, or I, my brain's working today and I can't work out the percentages that I need.
Lactated ringers, so Hartman's in a pinch. Will do. It's something that we would use, as a go to.
Yeah, OK. There are some studies that have suggested that fluids containing lactate should be avoided in reptiles that, because of lactic acidosis, which is commonly seen in sick tortoises, for example, but you read another paper and say, actually, no, we proved that wrong. So a lot of it's controversial.
Quite frankly, we are still learning a lot about these individuals, so we do have to bear that in mind too. From a fluid rate point of view, well, anywhere between 10 and 30 mL per kg per day. 10 you see towards desert species, 30 more towards our rainforest species.
In severely dehydrated individuals, you can sometimes go up to 40 mL per kg per day. But I would become real cautious with that with a desert species. And ideally, yeah, of course, we would base this on bloods.
Shock rate fluids in these guys, anywhere between 3 to 5 mL per kg per hour, but you want to reassess this, and a surgical rate of 10 mL per kg per hour can be considered as well. So what about blood transfusions? Well, they are absolutely possible in these guys, but we do tend to use them as a last resort, only because there is very minimal information about blood transfusions in reptiles in the literature.
Anecdotal reports stands up, I've done it and it went really, really well, but I've done it very few times, and all the times I have done it is been in bearded dragons. But it's very much been extrapolated from, from other species. Reptile blood tests tend to clot faster than in mammals, so we do have to bear this in mind when attempting to to perform this.
And reptile PCV can vary massively between species as a general rule of thumb. If you've got a PCV of 10%, yeah, nah that's pretty low. But I'm tend to really only consider a blood transfusion if I've got a PCB hovering around 5, which in the vast majority of species that I work with, that would not be compatible with life.
But reptiles are here still from prehistoric times. They don't tend to listen, to what we think they, what we need to worry about with other individuals. So yeah, BCV of around about 5, is when I would be considering a blood transfusion.
Blood groups are not described in these guys, but as a. A general gist, you wanna be taking blood from as healthy an individual of the same species as you could possibly find. Now, let's face it, what healthy individuals with 100% health do we have out there that we know from an infectious disease point of view, where there's no blood parasites, there's no viruses knocking around in this individual.
We've got full biochemical and haematological profiles of them beforehand, it's often not realistic, but same species, same household. We can take 2% body weight in blood, can be taken and 1 to 2 mL per kg is given to the recipient recipient at a rate of between 5 to 10 mL per kg per hour. From a nutritional point of view, well, pretty much everything is covered with reptiles, to be perfectly honest.
They will eat absolutely everything in various different ways. But you want to be feeding them the food that they are most familiar with. When it comes to critical food, Emirate is your way forward, and this link.
That I've put here. There are different types of every age. You've got your herbivore, omnivore carnivore as your general ones that we'll probably use.
This link gives you the proportions of each that work best for those individual species. So like 3 parts omnivore to 1 part carnivore, for example. So you could nail it down even further.
And whatever food that we are feeding them, hydrate them first, make sure that they are fully hydrated before you start feeding them because absolutely refeeding syndrome is a thing and warm that food as well. So when we are feeding them in hospital, we can gavage feed them. And if we're doing a one-off, then this works quite well.
I would always consider placing a feeding tube in that individual if you're gonna have to be doing this on a regular basis because it is stressful to handle them and you can cause some damage. In Tilonia, maximum volume of 5 to 15 mL per kilo. And as you can see in this picture, we are measuring about halfway down and I'm using a metal gavage tube.
We want to start at the low end and move up to the higher end, especially in patients that have been anorexic for a long period of time, because refeeding syndrome that we see in our other species occurs in reptiles too, so always bear that in mind. Some species are gonna require sedation. There's no way that you're syringe feeding a sulkarta tortoise, for example, and gavage feeding them.
Absolutely no way, unless it's really, really sick and then you've got other things you need to worry about. Exteriorize the head, keep the neck straight, re-measure that tube to the midpoint on the plastrum, which is the underside of the shell. And I normally hold the neck up until they've swallowed, once I've removed that tube, and then put them back in their enclosure and leave them alone.
Don't mess with them. The more you mess with them, the more likely they're to regurgitate. And they can do this through their mouth and move the nostrils, and we can end up with ERA the lungs, and that's obviously not where it's supposed to be.
So we want to avoid that as much as it's possible. In lizards, again, we can give anywhere maximum volume between 10 and 20 mL per kilo. We can use a gag, so these are nice little set of gags I've picked up on eBay.
Hold the mouth open quite nicely, but again, you want to be careful because if this patient was particularly collapsed in this photo, just to, be able to actually show you how the gags work, if you pin it in place and force it in place, and that individual is awake, which it wasn't in this instance, but if it was awake, they bite down, they're gonna break their teeth. So just go easy with it as well. We want to monitor stall production and gradually taper off the feed where possible.
And in snakes, maximum volume of 15 to 30 mL per kilo, regurgitation is gonna be common with the higher volumes, and we want to insert a smooth tube. I'm using a dog urinary catheter in this instance for this small boa who we were worming. We want to insert that tube approximately 33 to 50% of the snout to vent length of that individual, because that's where the stomach sits.
Hold that snake vertically, vertically, and when you look inside their mouth, their glossal glot is incredibly rostral, really, really easy to differentiate and therefore inadvertently stick a tube in it. And gags can be used the same as in lizards, but you can also insert that tube blindly fill the filtrum as well. I would just always double check by opening up to make sure that it's not inadvertently gone down that airway.
Lubricate that tube just to avoid damaging the oesophagus, and avoid damaging the teeth, especially with the withdrawal as well. Minimise handling, do not handle that individual for 24 hours afterwards. And like I mentioned to you, we, if we're doing this on a regular basis, if we are medicating that individual with any sort of regularity.
Then we want to place a feeding tube. Now, sometimes you really do need to get inventive when it comes to doing this in smaller individuals, and this is predominantly because, well, many tubes aren't quite small enough, so I use cat urinary catheters to great effect in many instances. But these NutraSafe ones tend to work quite well for the vast majority.
This individual is sedated pretty heavily, using local anaesthesia as well. Get everything ready ahead of time. Saves yourself time as well.
Pre-measure your tube, so halfway on the platron as we can see in this picture on the top right hand side here. I'm placing this as thoroughly as I possibly can. we want to clean the site with iodine using curved hemostats.
We want to put these through into the mouth, tent it up along the inside of the oesophagus, about halfway between the ear and where the neck joins the body, essentially. We then incise over the top of those curved hemostats, pop them through, grab the end of the tube, and then pull it back out of the mouth. We then turn that tube around and feed it back down into the stomach so we kind of reach that pre-measured point that we've, we've done already.
Now, what I tend to do as well is I take the top of the shell and I take the leg on that side, and I tie it in with a Chinese finger trap suture. Once it is in place, I'll then always double check with the radiograph that it is indeed in the right place, very rarely isn't, but with a Chinese finger trap su you can sort of move it up and down, it allows you to adjust that tube if you need to. So, as promised, there's case examples.
One of the first things that I want to talk to you about is this absolutely amazing paper that I am very, very privileged to work with these fantastic, people within various different respects. Nothing to do with the paper, but these people are awesome and have done us a massive solid sorting this paper out. And Antibiotic stewardship in reptiles is complicated at the best of the times, but I strongly recommend that any of you working with reptiles in practise, this paper is absolutely for you.
So, when I'm talking about antibiotics in general, I'm not going to talk about the specifics in these few slides because it's all written in this paper. It is amazing. So, trauma, various different causes, you've got other pets, dog fights, for example.
Funny enough, didn't end well for this individual. I do apologise again for the pictures, but I do like them gory. Wildlife, tortoises, in my opinion, inappropriately, completely and utterly inappropriately hibernated outside, rats are gonna eat them.
Autonomy. So, tails being dropped by various different lizard species. This is a cave gecko, and they've actually utilised its ability for it to drop its tail, because, it's got a necrotic tip.
I think one of those insects prey that it had been, fed, had nipped the end of it and it got infected, dry gangrene. We just induced it, under a very, very light plane of anaesthesia to drop its own tail. And these guys will regrow another tail afterwards.
Cohabitation. Tortoises really shouldn't live together. They come together in the wild to breed, and that's about it.
This girl was kept with two males, who basically hammered her constantly for about 4 decades. And she got substantial damage as a result of the courtship that it's natural for these guys, but she just had no way of escaping it. And she had it from two dudes as well, which is, unfortunate.
Mhandling, as we talked about earlier, the take that threw itself off of a wardrobe, which is obviously not particularly very helpful. And then pathological fractures as well. Often seen in crested geckos with broken jaws, but individuals with metabolic bone disease, you can see that this leg is not facing an appropriate direction and is as a result of nutritional secondary hyperparathyroidism.
Analgesia the whole way, so important. We talked about in the previous slides, making sure that that analgesic is appropriate for that individual. Making sure that we're doing imaging, so we are assessing the true extent of those disease processes and assessing for fractures and the extent of the damage that has been caused.
Baseline biochemical and haematological profiles including ionised calcium and culture and sensitivities of any wounds prior to cleaning so we can target our antibiotic approach in the most appropriate way. Wound care and fracture stabilisation pretty much follows everything that it does in in mammals, but we always need to be providing them with nutritional support and fluid therapy. So these fractured limbs, we need to determine whether it's trauma versus pathological.
Now this individual, the teku that threw herself off the wardrobe, there was very, very limited financial, ability from the owners in this instance. So we attempted, despite my better judgement, to, the Yeah, to, to, to try and stick it to his side, basically bandage it to her body. I basically explained to the owner, this is an incredibly powerful lizard.
I promise you this is not going to work within 30 minutes of going home, she'd literally yanked her arm out. Which was really unfortunate, really sad for the owners, who actually ended up handing her over to the practise. And I ended up amputating, the limb in the end and finding her a new home, of which she's now doing amazingly well and is under the care of my lovely colleague Sarah Pallett, who was one of the authors of that paper as well.
We want to be providing them with analgesia again, identifying and classifying that fracture like we would do in any of our other species, stabilise that fracture while simultaneously stabilising that patient. We can perform orthopaedic surgeries, modified external fixators work in a great deal of exotic species, but you do want to obviously tailor that to the individual case and the type and position of that fracture. Amputation can always be considered as well, and as can splinting in some instances, but I would avoid that in a dirty great big tegu who doesn't want to keep her leg attached to her body.
Respiratory distress? Well, clinical signs include respiratory discharges and increased respiratory rate and effort. The diagnostics that I would consider would be biochemical and haematological profiles, imaging.
Remember in the imaging side, we were talking about doing a cranial caudal approach in our chelonia species. This is the exact reason why. This is a tiny little musk turtle that the owner reported was swimming in a lopsided way.
The reason it was swimming in a lopsided way is because it had a stonking pneumonia on one side of its lung fields, which we can see really, really clearly from this radiograph and I'm still kicking myself that this is a photo of an X-ray, not the actual one, which is frustrating. We can perform nasal, tracheal, and lung washes for culture sensitivity testing, cytology and PCR testing, and treatment is often going to be a combination of analgesia, antibiotics based on culture sensitivities, F10 nebulizer, and again, care without oxygen therapy, because again, reptiles are stimulated to breathe at low levels of oxygen, not high levels of carbon dioxide like our mammalian species. Prolapses, sometimes, like in this instance, immediate euthanasia is required, especially if we have extensive tissue damage.
Clinical signs, well, something on the outside that should be on the inside is probably gonna be a bit of a giveaway, but if there's also unproductive straining, I would worry about that too. Whilst you're trying to figure out why on earth that individual has pushed whatever the hell it is out, you want to protect that tissue, identify that tissue and provide appropriate analgesia for that species. Now, in trying to find out why that is out, imaging, bloods, faecal testing, so we're looking for things like bladder stones or parasites, low levels of calcium, whether that individual is got dystopia or pre-ovulatory follicular stasis.
And treatment, but it's all very well replacing that tissue, because it's a great way of protecting it. However, you really do need to not just shove it in and then pretend everything's OK. You need to find that underlying reason.
Some tissues can be amputated and there are obviously advanced surgical procedures as well. We want to correct that environment, and we wanna fix that underlying cause. Foreign body ingestion, well, sometimes it's really obvious.
So free range reptiles, this bearded dragon grabbed hold of the owner's lighter and ripped off the button that we pressed. We weren't able to grab it endoscopically, unfortunately, because they left it a little while before bringing it in, which is unfortunate. But this is him recovering after his surgery, and you can see livid that we confiscated his, new little toy.
We can see it in substrate, calcy sand, literally the bane of my existence and thankfully I've seen very few instances of it now, but it's something that was supposed to be designed that they could eat it and some supplement, and isn't that amazing? But no, no, no, it turns to concrete inside their intestines and absolutely fills them up. I mean, that this leopard gecko was just substrate.
And then those of you that kind of are familiar with looking at it, you can actually see her front legs, she's got folding fractures because of the metabolic bone disease that she'd got, and that's why she was eating her substrate. And this is a really interesting case. This was one that was referred to us for, eating a nail, but she was full of eggs.
She had pre-ovulatory follicular stasis as well. She'd been self-supplementing by smashing a load of stones from the garden and had hands down one of the largest bladder stones I've ever seen. So this tortoise ended up Having an ovario salpingectomy, so I spayed her.
We performed a gasttrootomy to remove the stones and the pebble, and the small pebbles that she'd eaten, the nail, but also a cystoomy as well, to remove the incredibly large bladder stone. So that was quite some surgery and my back definitely hurt afterwards. Clinical signs include a lack of faeces, anorexia, painful salamic cavity and straining, with sometimes respiratory effort too, because they are quite frankly, just so full.
Or the owners saw it actually happen. You want to remove it ASAP. So that bearded dragon had come to us a few days earlier, I could have literally anaesthetized and nabbed it out with my scope within a few minutes, or sometimes salamic and gastrointestinal surgery.
But post-operative care, nutritional and fluid therapy support, antibiotics if you're concerned. About contamination, but most importantly, analgesics are very, very important too. And then finally, only a few minutes over, I am sorry.
Sadly, some cases are hopeless, and euthanasia is not a welfare issue, but a realistic option in many cases. We want to check that it's actually alive, that if it has a heart rate of under 10 beats a minute, that ain't good. And swift and effective diagnostic testing, whilst you're simultaneously stabilising that individual, and effective treatment is going to be your way forwards.
Correct all environmental deficiencies. As I said at the very, very beginning, all of this is fantastic and great to do, but if it is rubbish at home, you're just sending it back to suffer again. So whilst you're doing all of this, it is essential to get that owner on board with correcting any of those environmental deficiencies.
And that's it. Thank you very much for listening. Imagine we've got lots of questions to go through, but I'm not sure if we're gonna have time, so this is my email address if anyone wants to contact me directly.
Sonya, thank you very much. That was absolutely fascinating. Really, it was.
And unfortunately, you are right. We don't have time for questions. But those that have come in that haven't been answered already, will be sent through to you.
So, we will do our best, folks, to get Sonia to answer all of those questions for you. I would like to take this opportunity to thank both of our speakers tonight, Fabian and Sonia, both did a fantastic job, and gave us some great, great insights. Dawn has popped into the chat box, the Link for the early bird special that's left until 9:30 tonight, on those tickets.
And then, also the link for the survey monkey. We really do want to hear what it is you have to say and give us feedback on these sessions because as I always like to say, The webinar vet is our channel. It is designed for us.
And if you don't tell us what you want, then we can't bring you more of it. So for example, bring Sonia back repeatedly. I think that would be a good survey monkey option to have.
Thank you very much. So, Sonia, thank you. Fabian, I know you're still on.
Thank you as well. And once again, thank you to all of our sponsors. Thank you to everybody who attended.
Obviously, these are put on for you, and it is really lovely to see so many people attending. I hope you have enjoyed it as much as I have. To Dawn and my other, people working in the background tonight, as always, a huge big thank you.
And we look forward to seeing everybody tomorrow at, day 4, I think it is tomorrow. So thank you from myself, Bruce Stevenson. Good night.