Help! WHAT does the clinical exam look like in exotics?

Hi, I'm Madonna Livingstone, and thanks for joining me on this for this session. Help. What does the clinical exam look like in exotics?

We frequently hear, and I've said it in the past, and you will read it and. Textbooks and then the literature that when you're doing a clinical exam and and familiar species just go back to basics, but what does that go back to basics? What does it actually look like because it's not uncommon for myself and other exotic vets, to get a phone call from a vet, asking for help.

When they're presented with an exotic species, and when you ask them what they found in the clinical exam, you find out that they've not actually done a clinical exam because they've been too scared to, and, and I think it's because a lot of vets are frightened that they're going to injure the animal, or they, they hit their panic button, so they've just got no idea where to start. And, but most of these animals are nowhere near as breakable as a lot of us worry about. OK, so let's start.

The data from the UK Pet Food Manufacturers Association that I took a look at, which is 2022, 2023, showed that the UK's 16.3% of households had an exotic pet, which equates to a minimum of 8.9 million exotic animals, and I excluded fish from this, OK.

And when I looked in a little bit more detail, there were more pet guinea pigs than pet horses in the UK. So these are not rare animals. Remember this is going to be an underestimation, probably quite a severe underestimation, because this was completely reliant on owners filling out a questionnaire.

And those of you who have had the misfortune of of hearing me talk before will recognise part of this slide, because one of my favourite sayings is the human-animal bond is not species specific, so it doesn't stop with a dog or cat. It literally can be any type of animal. And over in various, studies, over 90% of pet owners regard their pet independent species as a valued family member.

And what we we should remember is or realise I should say that to an owner they might misinterpret our fear of doing a clinical exam as the vet not caring, and we know that the veterinary profession is a very caring profession. Now I cannot teach you, it's impossible for me to teach you exotic medicine in an hour, but what I can do is give you the confidence to use the skills you absolutely already have. So let's go on this whistle stop tour.

So don't hit your panic button. That's the first thing to do, and this is where your husbandry forms, come into play, your species specific ones, because your front of house staff, your reception team can hand them out to clients to fill out in the waiting room because, you know, apart from. The husbandry, the rest of the history taking is not species specific when you think about it.

We ask how the animal is, we ask if the animal, what's the animal eating? Is it eating, has it got the same appetite as normal? Is it behaving normally?

How much exercise does it get? Where do you keep it? Do you practise any preventative health medicine?

What's coming out the other. End, is there any, what's the urine like? What's the faeces like?

If it's a species that can vomit, is it vomiting? What is worrying the owner? Is the animal still doing its happy behaviours?

Is it exercising normally? Is it sleeping normally? It doesn't really matter if it's a dog, a cat, or an iguana.

It, it's the same questions that you're going to be asking. And this picture, was kindly drawn for me by one of my students, Seb, and this is, this is me as a ferret, and because another Madonnaisms is it's just a body system. So I took a long time for me to realise that I, I don't think in species, I think in body systems because at the end of the day most body systems have a limited amount of responses to disease.

So if A body system has the same function in each species and has a limited amount of responses to disease, and it stands to reason that the clinical exam and the investigation is likely to be very similar. And if the clinical exam and the investigation is likely to be very similar, then the diagnostics is going to be very similar and then cheap options might be very similar. And yes, there are certain drugs, that you can't use in one species.

That, but you can use it in another, and yes, the doses vary between species, but when you get to your formulary, it tells you that stuff. But most vets don't get to the formulary stage because they've already hit their panic button as soon as they've seen something with scales or feathers or, fur in an animal that's not a dog or cat. And remember that all a clinical exam is, is an assessment of body systems, OK, so it really is just the eyes, the ears, the oral cavity, etc.

In a different wrapper. With exotics, remember that they are trying to lie to us, most of them are going to be prey species. And they've evolved to be food.

So if you've evolved to be food, that you, you live your life, think you're going to be eaten, so and that's not just actual predation, it can be perceived predation. And if you show that you're ill, then predators are more likely to pick you up. But you could also, depending on the species, be shunned by the group because you weaken the group as a whole.

So remember that any change in their behaviour or preferences, no matter how subtle, should be viewed as significant. Another question I frequently get asked is, is this animal painful or can they feel pain, but remember that all vertebrates have the same or similar anatomical and physiological pain pathways, and actually rodents are used as human models for pain, and a lot of studies in chronic pain and the effects of chronic pain in the brain, and we know that from an imaging studies that the same areas in the brain in humans that light up when people are experiencing pain. Are exactly the same areas that light up in rodents, so all that information that we've gathered from rodents for humans, well, flip it because we can actually use that to look at pain in rodents and how they experience it as well.

Avian and reptiles have have similar anatomical and physiological pain pathways to mammals. Yes, the receptors will vary. You'll have species dependent.

You've got different, opiate receptors, your new, your kappa, your delta. You'll have different variations of them. But ultimately, if it's a condition or procedure considered painful in another species, including humans, it should be considered painful in exotics.

Just because they hide it doesn't mean they're not experiencing it. So we'll start with our minimal clinical exam. We're going to watch the animal to see how it's breathing, look at the rate and the effort.

Look at the coat quality. Is the animal grooming properly? Remember that.

Coat is self, self grooming is a self-maintenance behaviour, and if this animal was in the wild, if it wasn't grooming its coat properly, that means it can't thermoregulate properly. That means it's not waterproofing itself properly. That means it's, it's going to die.

So I have been guilty of in the past, certainly when I was a younger vet, of going, all right, this court is is in really poor condition. It's not grooming properly, but not necessarily following that through to the logical conclusion of how serious a clinical sign that actually is. And regardless of species, I start at the front.

I work my way back. If you do it the other way around, that's fine. This isn't about doing it the way that I do it.

There's more than one way to do anything in veterinary medicine. But it's if you do the same clinical exam in the same order each time regardless of species, that's when you're going to find things that are wrong and you might not necessarily know what to do with that information, but that's when you can go to one of your trusted resources, pick up the phone, call a friend, call a specialist, get advice, OK, owners don't expect. You to be a walking encyclopaedia, but they do expect you to care, and some of the signs can be quite subtle, like this rabbit that's got a right hand sided facial grimace, because, and that was actually secondary on investigation to otitiss and turn a stroke media, and it was causing irritation of the facial nerve, which was, the right hand side, of the face was twisted.

OK, so I will view the facial symmetry from above, and also from in front, and I'm going to be palpating the skull too. I, I've sped up this video to 1.5 times for time constraint.

OK. OK, so to do a skeletal pain examination in a rabbit, you just need to not hit your panic button and realise it's just a skeleton. So we do it exactly the same way as we do in a dog or a cat.

I always perform them, on a towel because we need to ensure that they've got a grippy surface to minimise their panicking. I usually spend just a few seconds rubbing the sides of the rabbit's face because that's an evolutionary safe place to be touched if you're a rabbit, so it's usually, . And their pleasure centres.

So because it's me and I like to start from the nose and work my way back, I'm gonna do the neck flexion test first of all. So I put my hand underneath the sternum to stop the rabbit, going forward. We're gonna play a funny game for?

What, when you look up to the ceiling. He's like, no, we're not, we are, cause this rabbit has, does have, musculoskeletal pain is under, is on medication for that. You're not playing the ball, are you?

There we come on you, up we go. Nope. OK, so that is probably pain because he's not letting me lift his head all the way up, cos he should let me lift his head all the way up like this.

So now we're gonna try looking down and you can see he's letting me do that, no problem at all. And we're gonna turn our head round and touch our nose off, and point to the shoulder. And then I'm still, I just changed my hands.

There we go, and if I'm having to put more. Pressure to get them to move their head one way compared to the other, then that's, that's pain. Now we're gonna do leg extensions, we're gonna kick, we're gonna kick, Mum, go on and kick her, kick, yay, good boy.

And then we're gonna kick with this leg. Oh beautiful leg extensions, that's fine. And then we're gonna go into the spinal palpation, and remember the next part of their spine.

You're not gonna break a rabbit's back by doing a spinal palpation. As far as you're concerned, this is now a Jack Russell terrier, because that's the kind of pressure you need to put on the patrial muscles. If you do not do it firmly enough, you are gonna miss pain.

And remember, it's very rare for rabbits to vocalise or turn around and look at you if you do something that's sore, we're looking for that jugger, OK. Much more subtle, so you might need to come in a little bit. So we're gonna start, and again, I've always got a hand underneath the rabbit when you start on the neck.

Oh, and I'm pressing down on the neck. Oh yeah, there, and we'll check it's repeatable because sometimes they just go, Oh, and we don't, I don't like you doing that. So let's see if we can do it again.

Yeah, repeatable in the same bits that that's pain, and that's why he's not wanting me to lift his head up. So we go down, pressing between his scapula and I press down and often rub back and forwards, oh look at that. See that vibration?

One more time, yeah, repeatable, that's spinal pain. OK, here. Oh, so we're there.

And then we're gonna do hind limb, and I can feel that there's a bit of muscle spasm on this side but not on that side, because it's not as severe, which is why you're not seeing it, but you feel the spasm in the muscle. What we can remember with the hind limb extensions is that the rabbit's femur is horizontal, OK, so it's the same as what we do in our dogs and cats, but the, where I see a lot of vets and students get it wrong is that they, they're, they press. On the leg, the bone that they think is the femur, cause in dogs and cats it's at more at an angle, but actually what they're doing is they're pressing on the tibia, so of course they don't get the extension because it just puts the leg up.

So I, I've got the rabbit cuddled into me, anchor my thumb on the rump of the rabbit, there's the point of the stifle, roll my fingers round the femur, then push backwards, and you should be able to extend the limb all the way back. Well done, handsome. Spinner rooney, yay!

Right, let's do this side. Anchor my thumb on the rump of the rabbit, rotate my wrist. Here's the point of the, the stifle.

Run my hands round the femur. And get the legs all the way back, and so no pain in his hips. I'm gonna check for thoracic compliance because rabbits should have a springy thorax and that's good.

And then I'll go into the rest of my clinical exam where I'm listening to their, their chest for their heart, for their lungs, and the abdominal palpation, looking in the ears, palpating the the base of their ears just where they attach to the skull to look for those asymmetric swellings associated with, ear-based abscessation, checking, the eyes, the nostrils, the teeth, and the genitalia and the feet. So that is obviously quite a quick run through of the skeletal exam in rabbits for those eagle-eyed ones amongst you, you've noticed that that rabbit has some boldness on its legs and that's because this rabbit was over grooming due to referred pain. And its fur had already started to regrow, and once we fully, so this this video was taken during one of the pain reviews, and once we'd fully got on top of his pain with multimodal analgesia, his coat completely came back, because just like we just like a dog will sometimes or a cat will overgroom a painful area, your small furries can do that as well.

And a little bit of deja vu here. This is the, the skeletal exam in Iraq just to show you it's exactly the same. In my arms, and on my knee, and they absolutely love their, their ears hello down and being tackled, so I usually just spend a wee second, making them feel safe.

But for the purpose of this that I'm going to do it on the towel just because it'd be easier for people to see. The first check I do with rats in particular, is I check the flexibility of their tail because rats have a partially prehensile tail and when we, move it through our fingers, they should curve, thank you for my kisses, darling, they should curve their tail round and they lose that as they start to get osteoarthritis of the tail, and then you give them medication and it comes back. So it's, it's a really quick and easy way to see if we've got so many underlying osteoarthritis in the tail, and it's a nice way for owners to check as well.

You are particularly lucky, my darling. You are indeed. OK, so other than that species specific, .

Check the rest of the clinical exam for skeletal pain in a rat is exactly the same as it would be for a dog and cat, so personally I'll always start at the head and work my way back, so we're gonna do, hi baby, I know this is weird, we're gonna play a funny game, we're gonna look up to the ceiling and then we're gonna look down and then we're gonna touch our nose. Off her shoulder and we're gonna do the same on the other side and then we're gonna kick and we're gonna kick and what we're doing is we're checking for resistance moving in one direction compared to the other or we're having to put more pressure behind one limb to get it to extend compared to the contralateral limb which could indicate pain. OK, and then we're gonna do a spinal palpation so I'm just bringing this gorgeous little creature towards me and there's, there is a slight flinch there.

And I'm just gonna check and see if that's repeatable cos if it is repeatable then that is the first sign of spinal pain, which could be osteoarthritis. It isn't repeatable, so this little rat was just given it. Nope, fed up Aunty Madonna, I don't want you poking there.

And then we check range of movement in the hind legs, so we're just pushing on the femur which is quite high up in rats. So push, kick and spin round, baby. OK.

OK, so this next rat is a different rat, same colour, same owner, and it was just to show you how floppy the tail can be when they have pain there. Curving round my fingers, the way it should be doing, it's kinda acting flaccid. And that's what you, you'll tend to see, and with pain relief.

The so that tail wasn't paralysed and with analgesia with that individual we did get the the partial prehensileness back. So this is a rat with a spinal pain. If you have a look at its eyes while the video's playing, you'll see that its eyes are squinting because we know from grimace scales that they can with pain have squinty eyes.

And you can see it's repeatable and the rat is actively trying to move away because that was really sore pain. And here in the hamster I've cut the video down to show you, I think it was the left hind limb in this hamster. So I'm doing the right hind limb full extension, and yet when I go to do the left hind limb extension I can't get that limb all the way back, and it's coats in, in a relatively poor condition as well.

This, this wee hamster wasn't grooming itself properly and then once it had a multipledal analgesia and it was in for its pain. And check those things improved, OK, but Madonna, what if it's bity, because a lot of people worry about rodents understandably. They've got blinking big teeth.

Just use a dishcloth, cover the animal, and examine through it, or you can put them in a Tupperware dish and watch them from underneath to watch how they're moving, their gait, their weight distribution. When you know, when they're moving or they're leaning more to one side, or if you're worried that it's in pain, if there's been a change in behaviour, if it's suddenly become aggressive and it's normally really nice or it started as a social species like that, then they normally sleep in a big pile and they're suddenly sleeping separately, then therapeutic analgesic trials are a valid option. Also take the lungs and 2 or 3 different areas, even if they've got a small lung field in each side, it's the same noises you're listening for as you would expect with a dog or cat and listen to the heart.

Just remember, in the ferret, the heart is not medial to the elbow the way it is, with the other small mammals and dogs and cats. It's much further caudally. So in this picture in the ne sized ferret where my pinky is.

Here, is the medial aspect of the, the, elbow, but the heart is actually where my index finger is. Do your abdominal palpation, do, do that gently because the organs, especially if they're, they're unwell and they've got maybe fatty infiltation of their liver, their organs can be quite friable. So I tend to do it more like a massage and just gradually increase pressure until I'm feeling things.

You can listen for gut signs. I don't tend to. Basically, the reason that I don't listen to gut sounds very often is because I can find them misleading if that animal, if it's a herbivore or a fibrivore, and the animal is not eating, its guts are not going to be moving completely normally anyway.

But in cases of foreign bodies, especially in rabbits, initially the gut signs can actually increase because the guts are trying to push that foreign body through, so it can be misleading. We're gonna look and see what the faeces are like. We're gonna ask the owners about them for your herbivores is the same number, shape, size and colour is normal.

We can take the temperature, the rectal temperature of them, just make sure if you're going to do that, that you're using a flexible, soft-tipped thermometer. Rabbits especially have a very thin-walled rectal mucosa, and it just, it frightens me in case a rabbit kicks off. At the the and starts kicking while you're taking that temperature that it could injure itself, but there are some studies that have shown that it's got prognostic indicators so if it's got a low temperature, then there's a higher chance of the individual not making it.

I tend to go down the route of if it's not well, I'm going to give it thermal support. Check the sex of each patient, that's so important. Owners don't always know.

I got a gerbil referred to me for a swollen abdomen for 5 years, sorry, not 5 years, 3 years, the owners thought the gerbil was male, and it was actually a female gerbil, and the most common cause of a distended abdomen in a female gerbil is cystic ovaries. So it's important that we double check the sex of the patients and we're going to check the feet too. So oral exam, we'll just lift the lip and fed it much like cats and have a look at their teeth.

Any fractures or sign of dental disease for our mice, rats, gerbils, hamsters, there, it's all their incisors that grow continues throughout life. So I do, check their incisors, conscious, but I don't look at their cheek teeth conscious. They can get dental abscesses.

So if worried, about the rural cavity, I will anaesthetize them. Guinea pigs chill is degus. It's common to have food in their mouth.

So if I'm looking in their mouth conscious with an otoscope, I'm going to use cotton buds to swab their mouth out first of all. And in rabbits, it's rare for them to have food in their mouth. So if I'm using an otoscope and there's food in their mouth, that that raises concerns for me unless they've literally just been eating, that it could be an indicator that we have, some dental disease there and the rabbit's trying to pack food around a painful area.

Just remember that they are obligate nasal breathers, the rodents and rabbits. So if you're covering their naries over, then you're essentially going to make the animal feel like it's suffocating and it's going to throw its head out even more, and you are going to miss 50% of dental disease cases in conscious animals due to them chewing the scope. So if you strongly suspect it's dental disease, then.

Advise a sedation or an anaesthetic and a full examination underneath. If the animal's anorexic, stabilise it first. That's really important.

But don't be frightened of doing this. But every single the way to get good at it is repetition. So every animal, every rabbit that you get in every guinea pig that you get in, regardless of why it's in, do an oral clinical exam.

Now we've provided these PDFs and your resource section. But remember that fat is biologically active so it worsens pain. It's not just about the increased, load bearing of the fat on the joints or the increased concussive force.

It actually releases inflammatory cytokines, so it will make any pain feel that much worse and often that can be used once owners understand that as a way to bring weight reduction if appropriate into part of the treatment plan. Mammal venal puncture. Remember, any venal puncture site can be, or the vast majority of them can be also used for, euthanasia as well as blood draws, as well as placing IV lines.

OK. But for mammals, the maximum volume would be 1%, of the, yeah, 1% of body weight in grammes. So that equates to you could take 10 mL of blood safely in a 100 gramme animal, and I get a lot of vets that will say.

Oh, Madonna, yeah, I wanted to do bloods in the guinea pig, but you know, it's only, only 800 grammes. I, I couldn't get enough blood or I couldn't take enough blood safely. And just reassuring you, and an 800 gramme guinea pig, you could take, you could take 8 mils.

If it was ill, then I would advise dropping it. But even if, if you took 5, half of it, that's 4 mils. That's way more than you actually need.

So my in-house biochemistry machine runs on 0.3 mils of blood. And if you're external sent to the external lab, you can phone them and ask what the absolute minimum is.

But even if you just got 1 mL of blood from a guinea pig, you're going to get the results you need. So I do perform venal puncture conscious in rabbits and guinea pigs and ferrets. I strongly advise performing conscious if at all possible because with any anaesthesia you're going to get splenic contraction.

Oh sorry, splint, not contraction, sequestration of the PCV, so, of the red blood cells, so you're gonna get a decrease in your PCV. You're gonna get a decrease in your haemoglobin, your total white blood cells, you're decreased parameters such as albumin. Chinchillas, I'll usually do conscious, but not always.

If it's a very stressed out chinchilla, then I'm going to anaesthetize it. And for rats and anything is smaller than rats, I'm going to do underneath general anaesthesia. Your needle size, you pick your needle size based on the size of your vein, not the size of your patient.

OK. We know that German shepherds are big dogs, but they have rubbish veins, generally speaking. So just be aware of that and if you are not aware of Emily cream, it is now your new best friend.

It is a local anaesthetic cream that you can put on to numb the cream, help facilitate the venal puncture, and it also results in venodilation. So with the rabbit ear veins and something's happened here, apologies because that this is a video that wasn't supposed to come up just now so I tend to go for the lateral ear vein which you can see that I've just popped a needle in here and I'm dripping it, we're dripping it out, notice that's a 21 gauge needle, OK. But if the marginal or or lateral ear vein has been scarred, like this rabbit in the middle that it's had, a lot of previous surgeries due to dental disease, so our, lateral ear vein here was scarred, skin was scarred, and it was very difficult to get an IV line in.

We can actually use the medial, marginal ear vein. We just don't use it very often, but that's it highlighted there. The reason I often, if I'm taking a blood sample, I will just pop a needle and let it drip out.

Although the veins are big, they are sometimes more fragile and I, I tend to find that I can sometimes be a little bit impatient when I'm aspirating, and it can collapse down the vein, whereas just popping the needle in and aseptically dripping out your sample, I get my sample a lot faster. I will choose the ears over the limbs in rabbits purely because the vast majority of rabbits will have some sort of musculoskeletal pain. They're a species that only only evolved to live, for about a year in the wild, so you do tend to see signs of osteoarthritis from a year on.

Does that mean every single rabbit from a year of age is going to have osteoarthritis? No, it just means that a lot of them do, and there are studies that have shown that. But the lateral cephenus would be my next go to vein, and you can see it here, and that's, it's a beautiful vein.

I've put IV lines in there as well. The guinea pig, I will tend to go for the cephalic. You can see that this is the cephalic here.

I will put, I will, I will put a blue catheter in that. So I tend to use a 23 or a 21 gauge needle if I'm taking blood from the cephalic. Some guinea pigs have a more lateral cephalic, but this individual had the cephalic exactly the same place where you're expecting dog and cat, and for the lateral cephenous veins.

And guinea pigs, you tend to get two presentations. You because they actually both of them are branching, but you can get this presentation where you have a large lateral cephenus with a tiny branch coming off it, or you can get the, the, the more equal branching lateral cephenus here, but it can throw you if you're unfamiliar with it. But equally, you can take blood from either of them.

And rats, look at that lateral cephenus. That is a thing of beauty. That vein is huge, absolutely huge, and that is, that is my favourite vein, but my colleague Laura absolutely loves the lateral tail vein.

And that's where she will put her IV lines when she's operating on rats in the the lateral tail vein. I tend to find the lateral tail vein looks as if it's very superficial but it's usually deeper than it looks. The gingival vein is is a beautiful vein as well for blood sampling to take from if you're not familiar with it.

Low incisors, I've put a yellow dot over exactly where you would, put your needle through. So the needle, as soon as it enters the gingiva completely midline, I start to aspirate, and you get very little bruising at that site and it doesn't impact their appetite, so it is a good site to try if you've never used it before. And I tend to use a 25 gauge needle for that.

Chinchillas, . Depends on the individual. Sometimes I'm going to use a 25 gauge needle, sometimes I'm going to use a 23 gauge needle.

It really depends on the size of the vein. And your ferrets, so the picture on the left, this is a hob. They, their thin is very thick, but this is the cephalic here, and that is my vein of choice in ferrets, and this is how I'll restrain them, partially burritoed them, keeping a good hold of the head and, dripping it out.

The lateral sphenus is another vein that is, is quite nice to use in ferrets. If I'm putting in an IV line, I tend to use the cephalic in ferrets, but you can use the lateral cephenus. I very rarely use the jugular in ferrets, but you can, you restrain them very like cats, but remember that in ferrets the jugular vein is more lateral than you would expect in a cat.

So for the reptile clinical exam, what you need to be aware of is that some species, if they get freaked out, scared, they will drop their tails, OK, and crested geckos are the worst for it in my experience. But then leopard geckos can do it and gargoyle geckos do as well. So I always warn owners before I even touch the animal.

The tail thrash is about, as you can see in the video, and that is an evolutionary adaptation to escape predation or perceived predation. So the tail thrash is about, and the hope is that that distracts the predator so that the animal can run away, but if the owner's not aware that that's something that can happen, then they basically think you've pulled their animal's tail off, and that's, it's quite distressing. That particular individual was in for euthanasia and it dropped its tail as soon as I picked it up.

And that's why I took the video to show you there. If it does happen, they, they don't, they don't tend to bleed, because it's autonomy, and, it's designed to do that. You don't want to try and stitch the wound over.

It will heal fine. Crested geckos do not regrow their tail, but leopard geckos do. Remember that these are, these are animals that are completely reliant on temperature for everything, so digestion, immune function, reproductive status, growth.

So if they're cold, they're not going to act normally. So try to get owners to bring them in with a hot water bottle wrapped in a towel or train front house staff to provide them with snuggle safes, again wrapped in a towel because we want to make. Sure we don't have any thermal burns.

Many reptiles carry salmonella, but let's face it, a lot of the species we deal with can carry salmonella. So I tend to only wear gloves if I've got open wounds or scratches on my hands, because if I'm handling bearded dragons, they've got sharp nails, and if I'm wearing gloves, they, and they're scrabbling, they tend to just shred the gloves, and then my hands are, and that stresses the animal out. So, and we should be scrubbing our hands and cleaning our hands as well in between patients anyway.

Ideally you want to know the commonly kept species and their husbandry requirements, but again, unless you're a complete geek like myself, you don't have to. There are places that you can go to quickly get this information. Just Exotics is a great resource.

They have, free husbandry guides for many species. Le Faber vet is another free resource. I use that a lot in my career or send the client to a husbandry consultant and that's what we do now we this we use Thomas Griffiths and he's great, and the clients send to him pictures they get a consultation with them and he tells them exactly what setup, they should be using or how to adapt their current setup if that's appropriate.

There's so much advancement being made in the knowledge of reptile husbandry that it can be overwhelming even for an experienced reptile vet like myself to try and keep on top of. So we're gonna do a hands off initially for the the clinical exam, and look at the respiratory rate and effort and again, You can see. That the bearded dragon and the oh you can hear in the background that the bearded dragon is clearing its throat, and that's not normal, .

These videos, when I tested it earlier, were not lying on top of each other, so apologies for that, and with tortoises they breathe by moving their front limbs in and out, you can see how this is actually quite subtle. So if you see it much more obviously than that, then it could be that this animal has a respiratory problem. So what I'm gonna do is I'm just gonna come out of my presentation very quickly because I'm gonna move this and I want to show you this video here.

OK, just so that you can see that there. Because I think it's important that you, you see, so they, they don't have a diaphragm, it's trying to clear respiratory secretion from its glottis and there is a wrinkling of the skin. OK.

So it's important for these guys to know what's normal. How are we going to open their mouths? Well, grumpy lizards are so much easier because they want to bite you, but it means you can get a really good oral exam.

Just try not to get bitten with your bearded dragons because they're, they're spiky, even if they don't want to hurt you, that I can sometimes find, the spikes quite irritating to my hands. So if I'm looking in their mouths, I tend to wrap them up in a towel. And then what I'm going to do is gently squeeze.

On the commissures of their lips, OK, and I'm trying to bring my thumb and my forefinger together, and I start off gentle and then just increase pressure as required until they, they tend to drop their lower, jaw so their mandible, and then you can have a look at their teeth, because bearded dragons are really prone to dental disease to have a look and see, and their tartar tends to show up as black. It is completely normal for bearded dragons to have a pale tip to their tongue. That's not pathology.

It's completely normal, and they have a split in their tongue. And in reptiles in general, their mucous membranes that if they're pink, they're going to be a paler pink than mammals. So be aware of that.

And their, their mouth should look moist but not wet. But some bearded dragons, and especially their colour morphs, have yellow or orange oral cavities. So this is not actually, jaundice.

So, that can catch some people out. And other reptiles, the oral mucosa actually can vary dramatically between species and colour morphs. So it can be worthwhile asking the owner if they know if this is normal for their individual animal.

Crested geckos, especially the females, should have full calcium sacks, and they're found on the roof of the mouth, OK, where the hard palate would be, so these are not abscesses. This is completely normal structure. In fact, if I look in their mouths and they don't have them, then I know that that diet is insufficient because they're not getting enough calcium in their diet, and it could be at a higher risk of metabolic bone disease because of it.

Leopard geckos have a darkened tip to their tongue. Again, that's completely normal, that is not pathology, and the angrier they get with you, the more purple it goes, and that's owners often find that quite amusing when I point that out to them. If anybody heard that noise in the background, that was just me moving on the stool.

And it's normal in snakes to have this asymmetrical palatine vein. This is not pathology. This is not an aneurysm.

This is a completely normal structure. Here is the other palatine vein. It's very, very small, OK.

And plastic glue spreaders that some of us used to use as kids when we were making glue paintings, are very good for opening it snake's mouths. This is the entrance to the ska and the snake, and the tongue is in a wee sheath underneath here. So with the tortoises or your terrapins, how I get the head out is basically I tickle its bum.

The toys are a turpine or a turtle that's reluctant to put their head out because most of them are a really handy tip is if you tickle the bum, they often, will stick their head out, and of course she was doing this much faster before, I took the video, and then you can use that to get your fingers behind their heads. And once my fingers are behind their head, if I've managed to catch laterally, that's great. If I haven't, and I've, I've only managed to catch it because it's a much shyer individual on, on like dorsal ventrally and I've not fully extruded the head, then what I do is I just hold the head still and I let, and I tell owners that's what I'm doing, holding the head still and I'm letting the animal tug against me.

I'm not going to get into a tug of war on the head with, a chelonian because you're gonna be a real risk of damaging that animal. But what I will do is, as soon as I feel that animal relax, I will then start to extend the head again. Then if it starts pulling against me, I just hold its head still, and what I'm doing is I'm tiring those neck muscles out.

Can you notice the, the kind of pink reddish flush to the plaster, and that's actually a septic flush, but I will mention that later. And this is how I'll open the beak in a tortoise or I will gently wiggle the beak side to side or the lower jaw, the mandible side to side, and what I'm doing is I'm tiring the muscles, the masticatory muscles, because once you've tired the muscles down by, by gently moving it side to side, then you can open the beak quite easily. So rather than pulling pulling on that gular fold or the gular region which is this region here, which to be honest.

If somebody did that to you, it'd be painful, and I wonder how many of you have grabbed that area under your chin and are, are doing it just now to see because I've just done it myself, but we don't want to potentially injure these animals or, or hurt them. I oops, oops. So, but these tips are only safe to perform in the smaller species because if when you start getting up to this is a this is a juvenile, .

Salcata, juvenile, as in it's, it's, not fully grown, Silcata is the 3rd largest land species tortoise in the wild, also called African spurred tortoise. They can grow up to 80 kg. I think this one was like 35 kg, but yeah, and your leopard tortoises, which are, you know, fully grown, they're bigger than a large dinner plate, you're gonna need to sedate them to safely perform oral examination or inguinal palpation in those species.

The inside, tortoise or terrapin or turtle beaks, you're gonna get these plates, and they, they use them to help when they're, you know, biting on plant material to cut through them, so that is normal. In snakes, if you've heard of blowing up, this is what it is. Basically when a snake's getting ready to shed, or any reptile's getting ready to shed, it's just seen more obviously in the snake, they put lymph between their new skin and their old skin, and that.

What you're seeing over that spectacle there remember the spectacle is are fused eyelids that have become transparent, OK, so they should come off with each shed and if you're examining the eye, and you see, . A scab on a species that's got a spectacle and you've seen a, you see a scab on that spectacle, that means that there's been some sort of injury. We're gonna look at again deja vu facial head symmetry, visual and palpation.

We're going to examine the oral cavity. There shouldn't be any excess saliva or mucus. We're going to check for dental disease and species that got teeth, and, I've given you a few examples there that you can look at more closely at your leisure.

What you may see, so if I see that, so the excess saliva and mucus here, these are animals that have got respiratory infections. Secondary nutritional hyperparathyroidism or or most commonly known as a metabolic bone disease. I've put our renal because in your older animals, well, it's more common to be in your older animals but it could happen in any age, I suppose.

You can get renal hyperparathyroidism, so you need to be aware of this, this crested gecko, bless it, you can see that we've got, a fracture here. And the, we've got some limb fractures. The spine is, peaked because the muscles were stronger than the bones.

OK. So if I'm putting this is a postmortem picture, taken, of a young monitor, if I'm pressing on the rostrum, the skull should not bend. So that's just something to be aware of.

It happens in tortoises as well, not as commonly in my experience, but it just happens. We want to check the shell if it's a very young. Tortoise, it's a hatchling or, you know, a year or two of age, there will be some flexibility in the carapace being the top shell, the platron being the bottom shell.

You do get some species, your hingebacks that have got a hinge joint on their plastrons, you'll have some degree of flexibility. So, but other than that, the rest of the shell should be pretty solid. Snakes are less likely to develop metabolic bone disease due to their diet.

However, and we, it's important that we check that. So I tend to press on the, the nose, the rostrum, to have, have a feel, because we don't want to be performing a full skeletal pain examination in metabolic bone disease cases because these animals break their limbs just by walking normally and bearing their own weight. So if we're actually putting their, their limbs through the range of movement that they should be going through or be able to go through, we could injure them further.

Spectacles, which I've mentioned before in snakes, some snakes, especially your royal pythons or also known as ball pythons, can have a slightly wrinkled appearance to their spectacle. That is not a retained spectacle unfortunately. Some owners think it is, and this is what happens when they try to remove them, and this was the scab that I had mentioned previously, and you can see that area of stomatitis.

Other than that, they're just eyes. Here's a water dragon with a corneal ulceration. It presented with, it kept blinking its right eye, more frequently than its left.

And if that was a dog, you would stick some fluorocene in. It's no different because it's got scales instead of fur and You can see that the corneal erosion or ulcer is highlighted quite easily there. Another water dragon that's got pus in its anterior chamber, snake with a cataract.

So other than retain spectacles, investigation treatment options are just the same, it's more familiar species because they're only an eye. The one thing I would note to you is that bearded dragons are really prone to squamous cell carcinomas of the eyelids. So if I see a lump, no matter how small, on a bearded dragon's eyelid, I want that off, OK, and that was the same animal post-surgery, and it did come back on histopath is.

Squamous cell carcinoma, and, that beard, that was a couple of years ago and the bearded dragon is still going strong, but if you don't jump on them fast, we know that squamous cell carcinomas are very invasive. So if you don't get them when they're really small, it can be very hard if not impossible to completely cure. So we're gonna check the skin.

It's just a body cyst, remember. So we're gonna check for lumps, bumps, parasites, septic flushes, and any lesions. So sometimes the septic flush can look like bruising and this, terrapin here, the, the pink skin actually should be yellow.

Check the toes as well for any swellings. It's not uncommon to get abscessation of the toes, and unfortunately leopard geckosis has almost become normalised in the hobby, which is soul destroying for me because this is retained shed, OK, and it's causing constriction injuries. To all the toes and it amputates their toes.

So can you imagine if I put elastic bands around all your fingers and toes and basically waited until you get dry gangrene and your and your your digits fell off? How painful would that be? You're aware that's not protecting these animals' welfare.

So it's just to be aware So if we're going to do a little exam, ideally what I want to do is assess the gait. I do the same with the, the small mammals, especially my rabbits and my guinea pigs, and this is monitored that, had skeletal pain, and this was a pain recheck because previous to going on analgesia, the animal was refusing to eat and was barely walking. And this is how we perform a skeletal pain examination and an animal that doesn't have metabolic bone disease.

Pain scoring in reptiles is, challenging. They don't give a huge amount of. You really have to look for it.

But if you remember that at the end of the day it's just a skeleton, the skeletal pain checks exactly the same regardless of species, and we're going to do range of movements. So we start with this left 4. I'm just going to steady this gorgeous wee guy and move the limb back and forth, straighten the elbow.

Well done, darling. And then we're going to do the same on the right hand side. Oh, OK, right, let's try that again, son.

And just for comparison, So you can see there's a big difference. It's repeatable when I straighten the right forelimb, especially the elbow. If he actually is flinching, I can feel it in the muscles and he's moving to get away from me.

That's pain. So we do a neck flexion test. We're gonna play this funny game where you look up to the ceiling.

This is a weird game, isn't it? We're gonna look down to the ground. I know you didn't like that, darling.

I know. I know. We're gonna look over our shoulder.

We're gonna look over our shou oh, don't like it in that direction, do we darling? Let's try it again. In case you're just getting fed up with me, not bothering in this direction.

Right, can we have a look in another direction, son? You're just getting fed up with me, so it's important to see if it's repeatable. Because if it's pain it's going to be repeatable.

And let's do a spinal palpations, we're pressing on the paxal muscles as we go down the back. Right, are you, are you getting fed up or is it the fact that I'm getting tested for that? You're getting fed up.

Oh, that clicked, that's fine. And it's just a bit of his back that was stiff. Good boy.

So sometimes if they've got a bit of muscle fatigue or a bit of arthritis, it's just like yourself, your back can crack when you're when you're moving. Right, let's check range of movement in your hind limbs. Oh, OK.

Right, repeatable. Trying to get away from me. Not bothered on that side.

Let's try again, son. Yeah, soon as I get to there. And tail, oh yes, he says I didn't like that Auntie Madonna.

I'm sorry son. Side, side, now you're just getting angry at me, baby. But up to repeatable pain.

And remember that a lot of lizards or if not all lizards raise their tail when they're passing faeces. So just the same way in your small furries and your rabbits that you might get faecal staining or urine staining to the fur in the perineal region because they're not posturing properly when they're doing the toilet. With your lizards, they can sometimes become constipated because they're holding on for too long before they do the toilet because it hurts to do it and the colon is just a colon, so one of its functions is to absorb water, so then it dries out the faecal matter, it dries out the urates, the solid urine, it can make it a lot harder for the animal to pass it.

OK, so the heart, we don't use a stethoscope to listen to. We do use a Doppler, and in the lizards their hearts are situated in thoracic girdle. Most practises these days have a Doppler, for taking blood pressure measurements, but if you don't, the one I'm using in this picture is actually a human foetal, Doppler.

I just got an 8 megahertz robe for it and said. Of a 2 megahertz probe and that works beautifully. It's actually got a smaller footprint than my big Doppler, and here is with leopard geckos, you can often trans illuminate them.

You can use, your phone, your phone torch to look through them, but you can actually see the heart beating in this individual there and these are the lungs that are trans illuminated, and this is the liver shadow here. Torts, they also have their heart near the thoracic girdle, and I, if I'm going to listen to them, I, it would be in the prehumeral fossa. And snakes, it's the cranial third of the animal.

Now this snake is into to be euthanas. It's anaesthetized, so you can see there's a lot of retained shed, but you can see that you, when I'm running my finger down the ventral scales, which when they're conscious, you're going to get some tension because, you know, it's, it's salomic musculature there, but you can see the heart play in between my fingers. And thank you to my lovely friend the amazing Sarah Pelle for this video because you can use the temporal orbital artery in snakes, lizards and tortoise, so just the soft bit just at the back of their head to put your Doppler probe on and listen to the heart.

OK. Ideally we want to sex if possible. Not all of the species are, are you are you're able to sex visually and sometimes it depends on the size of the animal as well, but it does help narrow down your differential list because if you've got a salomic distention in a female bearded dragon, then I'm going to be worried about pre-ovulatory follicular stasis, for example, but you're not going to find that in a male one, so that's why it can definitely be important.

To tell, so with your males, or your mature males, you're going to get very large prefemoral pores, and male lizards and male snakes are greedy. They have two penises, not one. So they're called hemipean, and you're going to get these bulges laterally here.

And the females have, do have the pores, the prevenum pores. They're just smaller. Word of warning, in really old or really dominant females, you will get, larger pores than expected.

And that can catch you out when you first start doing, reptiles, but they lack the, the lateral, hemipene bulges. OK. It does vary a little bit on their, on the species of lizards, how to sex them, but you can look that up in the resources, and tortoises rule of thumb is the tail length.

So, the males, they've got a much longer tail and they can pick it up and tuck it to the side, and on the plastron, the last two scoots have a more of a, a U shape to them, whereas the females, the last two scoots of the plastron are more V shaped. They've got a shorter tail and the cloaca is more asterisk shaped. And with snakes you have to probe them, OK.

When you're doing a salamic palpation on, on these animals, the, we tend to call the abdomen the sum because the lack of diaphragm, with your bearded dragons they're flattened dorsoventrally and same with a lot of your geckos, so you're just gently palpating them ventrally. Don't get caught out by your, abdominal fat pads. So especially in your bearded dragons, you get very large abdominal fat pads.

They're situated caudal and ventral, and there's two of them. They're very lateral, and when I'm palpating, you can feel them. They're usually bigger than your thumb, on either side, but in, in some species I can actually feel the liver, so you can start to get used to feeling things with your, laterally compressed species like your chameleons.

I find salomic palpation quite difficult in them because the, ribs, take up most of the body. The faeces, they have 3 components to their faeces. They've got the, the faecal component, or sorry, 3 components to their droppings, I should say, the faecal component, they've got the, you've got the water, urine, and then the solid urine.

So you'll some owners talk about these calcium deposits, they're not calcium deposits, that's urate, that's their solid urine, and we do recommend parasite screens at least twice yearly. Reptile venal puncture sites maximum volume would be 0.5 to 0.8 mL per 100 gramme body weight.

OK, we use heparin because EDTA can lace the red cells in a lot of species, and, but we, and we also want to make a fresh smear, for haematology because reptiles and birds have a nucleated red blood cells, so the machines can't cope. Cope with doing the haematology there. So if you're wanting to do them in-house, great, make smear or send them out to your external laboratory, and they can have a look at the smear for you and give you a haematology on it.

You can do a hand spun PCV. With reptiles there's a much higher risk of lymph deletion, and the risk level varies between sites. And that's because the lymph vessels and reptiles run really closely to the, the blood vessels, and this is the same tortoise.

I tried to take the sample. It was the subcarapechal sinus, and this came out, and I thought, hm, this tortoise does. Not look visually on clinical exam anaemic enough for this to actually be blood for this tortoise that came out, got a new needle, new syringe within a few millimetres to either medially or laterally can't remember which and this was what the actual blood samples like so be aware of that.

Prep the skin with a toothbrush and your skin disinfectant, I tend to use a lot of povidene iodine in reptiles and your needle size, well it varies on the species and the size, and often I'll try one size needle and if I'm not successful, I'll change to another. So. My my two most common sizes I'm going to use are a 23 gauge and a 25 gauge, and as soon as I've penetrated the skin, I start to aspirate as I also advance the needle so that way, since blood comes into the hub of the needle, you know that you've entered the vein.

In lizards and snakes, I like the ventral tail vein, but you just have to remember that in the males you've got the hemi pins, so you want to make sure that you're not going to injure them. This is a bearded dragon. I was amputating the tail, and, I took this picture of my dog, or I got my nurse to take the picture, I should say, and you can see that the, there's the ventral tail vein there.

So that, so it's very deep in. That's what we're aim for. If you take blood from the tail vein in the cow, you can take it in a reptile.

So you're going in midline at 90 degrees, and as soon as you're through the skin, you start to aspirate, and I tend to say think of the tail vene as a string of beads. Sometimes we hit the string, sometimes we hit the bead, because, it, it can, it does have, wider components to it as it goes along the tail. So if I can't get it in one area, I literally just go up or down, the tail, or along the tail to another bit and try again.

I, I always try to keep the animal in a normal sitting position rather than turn it upside down because that's gonna create stress. If you turn them upside down. And that's me taking it from the tail vein in a corn snake.

And in chameleons, just warn the chameleons that you can get a change of colour at the venal puncture site. Apparently it can sometimes be permanent. I've never seen it be permanent, but it isn't recorded in the literature, so I always warn owners.

In Chelonia, although subcarapechal sinus does have a higher risk of lymph dilution, it is my favourite site in Chelonia because it's rare for me not to gain access, and you can do it with the needle, either, sorry, the needle, the head either in or out. So in this individual you can see that we've pushed the head in. The green dot is where I'm going to enter.

So just as the skin, some millimetres after the skin meets the shell, I'm aiming for where this yellow arrow is. So that this is the neutral scoot, and that is the first vertebral scoot, and I'll go into why that's important. In a minute, if it's when you're maspirating clear, slightly pink tinged liquid enters the needle, you've got a blood vessel come out, sorry, you've got hit a lymph vessel, come out, get new equipment, go again.

So this is the same tortoise. This is my one of my final year vet students taking the sample. You may read in the literature that this technique can be potentially associated with spinal issues.

I've been using this technique for 24 years and touch, touch wood, never had an issue, and I think it's because I tend to aim here, whereas if you aim. Further end, so if you aim for like the second vertebral scoot, so you go in at a different angle, then you are much more likely going to hit something you don't want to. But I use the plastron as a guide because it helps balance your gives your your strength something to balance on as well.

I'm not a jugular fan. I find it really difficult, to hit jugulars and tortoises, but some of my colleagues like it, so I've put it in for completeness sake. You, you're usually going to have to sedate them for this, because you need to get the head out and.

It's usually easier if you've got the head, flecked away from you, OK, and the jugular, this is the tympanic scale, so this is their eardrum essentially, and the yellow line is where the jugular would run. The dorsal tail vein can be used in chelonia. This animal was being euthanized, which is why the tail is, is still dirty, because it's an area that's frequently heavily contaminated with faecal material.

So you really have to do a really good skin prep there. And you, and snakes you can go into cardiac but only do that under general anaesthetic because we consider cardiac, scentesis painful in any species, so snakes should be no exception. So we're going to a clinical exam.

We're going to watch the birds while we're taking our our history. She picked up some really subtle signs. So birds should have, or you're certainly parrots should cross their primaries like my cocktail here is doing, where's this cocktail, which is 25 years old at the time, you See, the left wing is in a normal position, but the right wing is slightly drooped, and that was the only sign the bird was showing.

And on clinical exam we found that it did have actually pain associated with the shoulder joint. And once we've got it multimodal analgesia, it was started holding its wings in the more normal position. Just have a look at how the bird's standing.

Subtle signs are easy to miss unless we actively think to look at them. Some birds may require oxygen before we handle them. So if you've got a bird that's tail bobbing.

I would seriously consider giving it some supplementary oxygen by literally just flow by, putting it, in its cage, the nozzle in its cage to or putting it into, a chamber, . A Tupperware dish with a homemade induction chamber if that makes sense to give it supplementary oxygen before you handle these birds. The reason the tailbone is because birds use their keel bone to breathe so they move their keel bone up and down and the increased effort with that causes the tail to move.

And even if it's a bird that's breathing normally, the first time I meet a bird owner, I'm going to warn them that there's a risk of death on handling. And how I put it is that your bird, whenever you catch a bird to examine it, and I have to catch the bird to examine it, there, there's always a risk of them taking a panic attack and losing them through that. It's very rare to happen, but it can happen.

It's better to warn them and not have it happen than say nothing, and then the worst happens, and then they might not necessarily believe you. It's a recognised risk of handling. Ideally we want sex if at all possible.

It's not always possible to sex them visually. With your common species that your budgies. The females have this brown ear.

The males have a blue ear. The grey cockatiels, it's easy sex because the males have this bright yellow face with a very vibrant, ready. Orange cheek patches.

The females are much duller and drabber, but they do have tail barring. The colour morphs are harder to sex. These eclectic females on the left, males on the right.

Your African greys are very difficult to visually sex. Some people are good at sexing them with something like 70% accuracy, on the venture tail covers, because the females can have grey galloping around the red feathers, but If you're not sure, look it up before you get them in. Normal faeces varies dramatically with birds.

It depends on the species. It depends on what diet you're feeding it. If it's eating a lot of vegetables, or salads or it's a lot of key, it's gonna have a really liquid diet, sorry, liquid faeces, and, and the color's gonna vary depending on, on what's been eaten, and hormones too.

If they're, if they're in breeding condition, they can often have produced more urine. But often you're looking at three components. You've got the faecal component, you've got the solid urine component, you've got the liquid urine component.

So ask the owner if they're different from what's normal for that individual. And if they don't know, ask for a picture, of the cage from last year, and hopefully you'll be able to see. The pattern of faeces is important.

If the faeces are all over, then that means the bird's active. If it's only on one side, it means it's inactive, unless the bird's toilet trained, which can happen with the birds, but not commonly, in my opinion. Sorry, not in my opinion, in my experience, when you look at the droppings, the colour consistency, and is it a stress poof, for example, because remember we're travelling, they get a release of cortisol, and we know that steroids can cause a polyuria.

Well, it happens in birds as well. You'll sometimes get owners tell you that the birds get diarrhoea, when it's actually polyuria, so just be aware of that. So this, this bird was hospitalised owner did think of diarrhoea and, and it, it didn't.

It actually had excess urine production. Here's the faecal component here. Initially when the bird first came in, you can see that this faecal, component here is a much darker.

Or green. That's because it was eating enough and birds have biliverdon, not bilirubin, so it's green coloured, so it wasn't absorbing its bile. But don't confuse that with the green urates that can indicate liver disease in birds.

So because the urate should be creamy, to white coloured, whereas this bird's urates are lime green. Actually you can see that there's like almost blacky green faecal component there as well. Dangerous to handle his birds, your parrots, they have a hinge joint between their skull and their upper bill, which is why they can bite so strongly.

I mean that that Hyacinth McCaw is a sweetheart, but, and it, it. It chose to throw itself down on its back and my arms. I didn't purposely do that, the, but that's a, that's a finger breaker right there.

So you want to control the, the head first with your birds of prey unless it's a vulture with birds of prey, you're going to control the feet first, OK. Tips for catching, get everything ready that you think you're going to need. I always use an infant stethoscope, with birds, because they've got a smaller footprint.

When you cover the cage just because if it's a bit darker, it's easier to catch them. They seem to be calmer, dim light if possible. Don't use gauntlets.

You can't really feel the bird properly, and you increase risk of holding them too tightly and talk to them. Talk to them. I will use a towel, to slowly approach the bird, and you can see here with this Amazon, I'm grasping just below the cheeks on either side, so I'm actually, it's the point of the jaw that I'm, I'm aiming for, and sometimes that means like covering them up with the towel and, and gently push them against the side of the enclosure before I catch them.

They don't have a diaphragm, so don't restrict the keel because it can make them suffocate. To with the smaller, anything smaller than a cockatiel, I tend to handle it myself or cockatiel down I should say. Anything bigger than a cockatiel I'll get an assistant and I'll either use a modified ringer's grip or a ringer grip and allow the birds to perch on my finger.

The clinical exam, it's the same body systems and more familiar species. I'll talk to them if it's a friendly bird, and especially if it's a bird that knows me, I will often just do the clinical exam on my knee, as as I'm doing with this African grey, in the left picture. But if it's a bird that doesn't know me, if it's an aggressive bird, it's not used to being handled, so it's being aggressive probably because it's frightened, then I'm going to do it in a towel, and if it's extremely scared and getting extremely stressed, I will give advice sedating that bird for the clinical exam.

And you just go through your body systems, you know, it's just eyes, it's just naries, this is, this is a nasal discharge. You'll often ask owners if the bird's been sneezing. They'll tell you no, but that bird will have been sneezing.

They just didn't hear it, . And I'll, I'll let you look at those pictures at your leisure because I'm running out of time. So where are we gonna to auscultate?

OK, then, the first thing I'll do is check above the head to make sure that the, we've got cyano, my love, we've got symmetry, of the head because they have a sinus around their eye. So sometimes when you think that they've got, an eye infection, it's actually a periorbital sinus infection. I know you love your auntie Madonna, don't you?

Your mummy gets jealous. Yes, -huh, yes, she does. Yeah, she does, right, my love.

And then we're gonna look into the beak. Can you open up your beak, and come on, sweetheart, go, there we go, and I'm trying to look right at the back of the beak, because parrots should have a very dry mouth, because they produce very little saliva, and this wee one has, moisture at the back unless they've literally just drank something or eaten some vegetables or fruit just before you've picked them up, the, the back of their mouth should be totally dry. This is a good darling.

Yes, it is. So that gives an indication that there's excess mucus being produced, which can be the sign of a respiratory infection. Now we're going to listen to the bird's respiratory system.

Remember that birds don't have a diaphragm. They've got about, it's a little bit species dependent. They've got 9 air sacs, generally speaking, and the air sacs act is bellows to pull the air through the lungs.

It takes 2 air changes or 2 breaths to get one full air change, and, a bird's respiratory tract, which is why they're so sensitive to anything in the air. The air sacs are not gas, an area of gas exchange, and the lungs are, but the lungs don't inflate the way ours do. They're kind of static.

So I'm, I'm just, I know, I'm just tickling your ears at the moment, because their ears are just behind. Their eyes. OK, there we go.

And in some species you can get ear infections, but jeez, I tend to see that a lot more common line, right? We're gonna have a wee listen to your chest. Yes, we are.

You should listen to the same noises that you'd hear in a dog or cat, same adventitious noises, crackles, wheezes, rails, right, my love, mhm. And then listening to 2 or 3 different bits over all the air sacks, which you'll be able to see in one of my slides. Oh, you're gonna invite me on a stethoscope, right, my love, I need to listen between your legs.

Oh, I know it's rude. I know I'm being rude. That's the caudal abdominal air sac, which is where most of the air goes in when they breathe in.

00, come on, darling, right, Ile bum. OK, so parrots that like to perch, so I always try to allow them to perch on my fingers because that helps them feel a bit more secure. And then I listen to their lungs by listening over their back.

I know, I know. Oh, did, oh did I stop patting you, how rude. How rude.

So they are incredibly sensitive to air pollutants, and that's why, the miners took canaries down the mines because canary would faint at a level of natural gas way lower than humans could detect. So as soon as that happens, miners knew that it wasn't safe, and that they had to evacuate. So just think about some of the, the things that people use in their own houses and if they've got birds, the damage that it could potentially be doing.

So I mentioned that I'm looking for the symmetry because sometimes because birds is one of the species specific anatomy things that you need to be aware of is this periocular sinus and it can look like conjunctivitis, so you get this kind of swelling there. Sometimes you'll get a nasal discharge associated with it, as you can see in the African grey hair and the canary, and birds have more cases pus than dogs and cats, and severe sinusitis is likely going to need foster surgery, but other than that it's just an ocular exam. The oral cavity should be dry, but the birds have a slit in the roof of their mouth, so they've, they've not got a solid hard palate.

It's called the choanal slit, and they've got, projections into it called papillae, to check that it's a good site for discharges, if you've got an oral, oh sorry, an upper respiratory tract discharge, I would be swabbing that area. And this is how you do the skeletal exam. OK.

So when we're doing a clinical exam, especially, a musculoskeletal pain examination in birds, what we've got to remember is that first and foremost it's just a skeleton. So, it's very similar to more familiar species in birds. However, there's only two areas of the vertebrae that are mobile, and that's the nerve, the cervical vertebrae and the neck vertebrae, and the picostyle, which is the, the tailbone essentially where the tail feathers go into.

The rest of the bird's vertebrae, are fused, except apart from sysacrum, which I will show you on another site. So. When, when I'm checking the mobility of the neck, often I'll just be watching how the bird moves in its enclosure, but I can actually get them to, you know, turn their head and I'm making sure that they can get the full range of movement.

And whereas with mammals and reptiles, when you're doing the forelimb extension, it's forward and back. With the birds, it's more of a lateral movement, although you can manipulate the shoulders forward and back as well. I let them perch on my finger.

Cause that tends to make them feel a little bit more secure. We've got to remember that they don't have a diaphragm, so you, you've gotta be careful not to restrict the movement of the keel bone. So what I'm doing is, here's the wrist joint.

I'm supporting the primary wing feathers, and then just very slowly and gently I'm pulling laterally. OK, and then I'm comparing that. With the contralateral limb limb, limb, sorry, to ensure that I'm.

Getting equal movement on both sides and then I still do, although the spine is fused at the vast majority of the, the, the body, I still do a spinal palpation. To see if there's any pain. And then move the tail again to see if there's any pain.

Transfer the bird into a ringer's grip to palpate up and down the legs and check the range of movement. And you feel all the joints. When you're listening to the bird's chest, for with your stethoscope, if you listen along their back, you're listening to the lungs and the heart, and if you're listening, to their, their belly or their the ventral aspect of their chest, that's where you're gonna hear the air sac noises.

You palpate the abdomen, which is the, where the, the gap between the keel bone and the pelvis. Check the vent. And depending on the species, you can check the preen glands.

Not all species have green glands, but beaky budgies do. So the green glands at the base of the tail. You're looking at the eyes and then the beak to make sure that we don't have, a lot of liquid because, parrots should have very, very dry mouths.

We check the sear and the nostrils. Now, the, I had a bit of a brain fart in that video because as you can see from the this radiograph of an Amazon parrot that I've marked up for you, this sens sacrum is fused here, so it's the pelvis, with some of the vertebrae, OK, but where. I've labelled with the white arrow, this is the only vertebrae or intervertebral space in the, the trunk of the bird that there's a slight degree of movement there, so they are more prone, especially if they've flown into something, to get injury there.

So just keep a close eye on it. We're going to weigh the bird and body condition score it. You have access to, this from the UK Pet Food Manufacturers Association, the PDFs and your resources, if it's not a friendly bird, then I'll weigh it in a Tupperware dish.

And it's important to body condition score because sometimes like this poor budgie, the owner thought it was an acute condition and it wasn't, it was actually a chronic condition, but it was an acute decompensation of it. With truly acute conditions their body condition score is usually normal, whereas you can see this bird was emaciated. Your ex-battery hens or your caged hens, rescue hens, they're always skinny, so just be aware of that because it's, that is normal for egg, high egg producing hens because they put all their energy into egg production, not putting down muscle.

We look for your lumps and bumps, which you can look at these examples at your leisure. Note that your amazonths, your hyacinths because your pigeons and doves don't have a reen gland, so, don't go looking for a preen gland in those species. Your feather quality will, will help, you give you some indication if I've got a green bird that's got black feathers where it shouldn't have, you know, I'm gonna be really worried about, liver, for example, malnutrition, viruses, equally if I've got a grey bird that's got red feathers but it shouldn't.

Stress marks or feet marks are an area where that bird was either ill or didn't have enough nutrition when it was growing, when the feather was growing, and it results in a weak spot that meaning the feather can break, but it can also indicate that we've had a chronic issue going on there. We're going to check the feet, the soles of the feet, and we've got flattening of the dermal papillae, which can be a sign of vitamin A deficiency. You can see the shinines bit here and the bruising.

When you look at the nail quality, you can see here this, this parrot has been rocking back on its ankle joint. It's not, so it's not been, . Sitting normally, this is the first stage of bumblefoot in a chicken.

Have a look if they've got a ring at the, the year coat because it's not rare for an owner to be, lied to when they're sold a bird. And I've had owners that think they've bought a 5 year old bird and the bird was actually 15 or 20. So 22 means that it was hatched out in 2022.

We're going to check the hens and lay pin bones are the caudal bones of the pelvis are that's where the yellow circles are, and they, the hormones cause them to spray, spray, sorry, spread if they're hormonally ready to lay eggs, and that's so that there's enough of a gap for the egg to pass through. The fingers are not going into the cicca because my husband asked if that's what was happening there, but no, they're. Not just that the the the pitch, the fingers are being held vertically between those pin bones.

If I can only get 1.5 to 2 fingers between those yellow circles, that bird is not hormonally in lay, and it helps differential. It helps narrow your list because if that hen is in lay and has a Selloic ascites, the fluid in the selum, then that increases the risk that it's going to be, ey peritonitis, for example, instead of cardiac disease.

So it can help narrow your differential list and guide your tests and remember that in the UK chickens are legally classed as food production animals. So that can have impact on your prescribing. So avian venal puncture, chickens, waterfowl are usually perform conscious.

Passerines and parrots, I usually stay or do general anaesthesia. They can get very, very stressed unless they've been trained to allow it. And actually I've seen cases of liver disease in parrots where it's taken 20 minutes for their blood to clot.

And if you're having to put pressure on a venal puncture site for 20 minutes in a parrot, you're going to really stress that animal out, OK. The maximum volume is 1 ml per 100 gramme body weight. If they're ill, you want to take less, but in a 500 gramme bird, which most African greys are going to be that, that's 5 mL of blood maximum in a healthy individual for my in-house machine, I only need 0.3 mil to run an avian profile, so don't be scared of taking it.

I can. You know, I, I, I take blood off budgies and run it. Heparin, again, because the same as the reptiles, the EDT can lie some of the red blood cells, make a smear for your haematology.

And if I'm worried about liver disease, I, I'm, I tend to not use a jugular the jugular because although it's the biggest vein, it also has a dissensible space round about it. So if the vein lacerates for any reason, potentially you could, have the bird to exsanguinate. So the medial metatarsal vein is my favourite vein.

And checking blood sample we're gonna put the seal in the plunger. Using the medial metatarsal vein in this chicken, we're going to aseptically prebend. The needle.

So this part has particularly thick skin, so you can't see the medial metatarsal vein very easily, but I can feel it bouncing just here. OK, so Jody, can I get you just to turn that way slightly, thank you, yeah, so. So then we just went over into the blood vessel.

We don't want to be moving the needle excessively. Thank you. And if you notice, what I was doing is I aspirate, release a little bit, aspirate and release a little bit, aspirate, release a little bit.

The vein is being raised by, holding the, the limb above the stifle or, or sometimes distal to the stifle the way you would raise a lateral senus in a dog or a cat. And the water fowl, as I will, I love that vein as well, but you tend to go distal to the hock or the ankle joint, sorry, and it's a bit thicker, the skin, I tend to use a 23 gauge needle. The basilic or the ulnarring vein, same vein, two different names.

Here it is in an eclecus, and, this is me taking blood and steadying the syringe, between my index finger and my thumb, to prevent excess movement at the venal puncture site, but you can use it in budgies and it, it, you can also put IV lines in it. The jugular vein, birds have two jugulars. The right jugular is bigger than the left jugular.

This is a, this is a chaffinch that we caught in our back garden. My husband's a bird ringer. It's a hobby, and the, the bird had trichomoniasis, so we treated it, and then let it go.

But I took this picture just on the day it was getting let go. Sorry. But look how big that vein is, so it is a vein that you can readily access.

A lot of many species apart from your waterfowl have a feather track over the jugular. OK. And if what I tend to find with your birds is that if you hold the site for 2 minutes, time it because us vets tend to be impatient, so time it and don't lift your finger just up, slide it off, because I tend to find if you lift it just up, you disrupt the clot and it starts to bleed again.

If it doesn't stop, you can use. A hemostatic agent like Clotavet, which is even hemostatic sponge or vet gel, or you can actually put a pressure bandage on, or you can just hold it for longer, I've never had to put a pressure bandage on. I have sometimes just held it for longer, and as I say, the longest I've ever had to hold was, was, 20 minutes.

So some resources, that you can have a look at. I love that my favourite formula is the Carpenter's exotic animal formulary because it's split into species and then drug classes so it makes it a little bit easier, especially if you're not familiar, whereas the BSAV formula, which is very, very good, but you need to know what drug you're looking for to look up, your doses, exotic made easy my textbook, for mammals, for rabbits and small mammals. And there's, some other options there as well that are really good, and I do like the BSAV manuals.

They're all of them are really, really good too. Some online resources. Just Exotics is a great resource.

It's run by Sonia Miles and has a lot of free resources for vets on it as well. The Faber vet is great as well. I, I use that a lot.

We've got the BVZS, the British Veterinary Zoological Society, that we've got some resources on that part. Awareness Week, Arcadia do have quite a good lot of resources on it. Just bear in mind, take it with everything with a slight pinch of salt if they're trying to sell you something, but it's worthwhile looking and colleagues, your colleagues pick up the phone.

There are, there are forums online, the only forums where we can all discuss cases with owner's permission, and help support each other. So thanks for watching. I'm sorry I have run over time.

It's a it was a big topic. Feel free to contact me with any questions. I hope you enjoyed it.

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