Building your exotic animal caseload (Proceedings)

Exotic animal medicine is an exciting and rapidly growing part of companion animal practice. Exotics represent roughly 25-30% of the companion animal market for veterinary services. Pet owners readily seek out veterinary care for birds, small exotic mammals, reptiles and amphibians.

Generally speaking, the most popular exotic pets meet some need that dogs and cats do not fill: more compact, low maintenance, entirely indoor-pet, can be left alone for long periods, novelty, hypoallergenic, able to talk, etc. Awareness of exotic animals has been enhanced by cable television and the internet, and the marketplace has responded so that birds and exotic animals are easier to obtain, house and care for properly.

Veterinarians have been slow to capitalize on this segment of the pet population. Caring for exotics can provide a unique service that sets a veterinary practice apart. Today's vet school graduates are often eager to pursue this niche, and there are more opportunities than ever today for learning about exotics. Practitioners with an interest in exotics can quickly get up to speed by going to continuing education for these species. The good news is that you don't have to be an expert in all areas of exotic animal medicine to begin caring for them. The key is making exotic animal owners aware you have something that they really need.

Marketing

Properly naming your practice plays an important role in building public confidence. To do so, a stand-alone exotic animal hospital will usually incorporate the terms "Avian", "Bird", or "Exotic" into the practice name. Similarly, a companion animal hospital that offers competent avian and exotic animal care should distinguish that service with a name that effectively communicates the level of expertise offered (i.e. "Westover Animal Hospital and Exotic Animal Clinic", or "Pet Bird and Exotic Animal Service of Westover Animal Hospital"). Having a "separation" of the exotic practice from your dog/cat practice is less threatening to your referral base, is more appealing to your exotics clientele, and allows you to position yourself as the avian and exotic animal expert in your market.

Let your current clients know that you see exotics. Your practice logo should communicate that birds, reptiles, and small exotic mammals are seen at your hospital. The reception area should contain artwork and products that reflect your interest in exotic animal medicine. Place exotic animal brochures and client education materials in the exam room and on the countertops. There should me reminders that you treat exotics throughout the office.

Your exam room computer can passively communicate to clients which species you treat and what services you offer. Place a number of your best, most interesting photographs together in a single folder. Then, use the computer's screensaver to play a slideshow of those photographs. For Windows XP this would be: <Settings>, <Control Panel>, <Display>, <Screen Saver>, <MyPicturesSlideshow>; then, <Browse> and select the folder of pictures you have compiled. If you want to get really fancy, you can produce *.jpeg images on presentation software (e.g. PowerPoint) advertising specials, new products or services, and include these in your slideshow folder, as well.

Setting appointments

Triage for exotic animals requires skill. In general, birds and exotics are much sicker than dogs and cats are before they begin to show signs of disease. Compounding this, many exotic pets do not get the daily close attention that traditional pets do. Often, exotic animal owners have had to call 2-3 veterinary practices before they find one that will treat their pet. As a result, many pet birds and exotics present in advanced states of disease.

A high percentage of avian and exotic cases present as emergencies. Practitioners should train the front desk to properly triage cases and schedule exotic pets accordingly. Exotic animal illness should be addressed immediately; waiting to be seen can be detrimental to the patient. If time will not allow an emergency same-day appointment, a referral should be offered.

The majority of problems that arise with exotics are husbandry related, have simple solutions, and are easily managed by practitioners whose primary caseload are dogs and cats. For more difficult cases, an in depth understanding of exotic animal physiology is needed. If this expertise is not available, a referral should be considered.

Exotic hospital setup

Exam rooms should be small, with a low ceiling, and lights that can be dimmed easily. It is best if there are no windows, or high places such as planters for birds to escape to. The ability to dim the lights helps you in capturing your avian patients. Exam rooms will need to be ferret proofed to prevent ferrets from getting beneath and behind your base cabinets. Check the space under the door to make sure a small rodent or ferret couldn't possibly sneak through. Given the opportunity, they will.

The exotics ward should be stocked with ball-tipped feeding needles for force feeding, flushing wounds, and reptile sexing. A Welch-Allyn bivalve nasal speculum will make for better oral examinations in small herbivores. Some other things you may need are a Littman pediatric stethoscope, a gram scale (1g/5kg is best), a scale perch, wire mesh cage tops for weighing, small plastic pet carriers, and hand towels. A 10 or 20 gal aquarium with wire lid and a heat lamp will suffice for many cases. Supplemental heat is very important for exotics. An electrical heat pad with a towel over it will do. Keep an eye on animals that could chew electrical cords! Heating pads should be used on the low setting only.

Exam rooms should be small, with a low ceiling, and lights that can be dimmed easily. It is best if there are no windows or high places such as planters for birds to escape to. The ability to dim the lights helps you in capturing your avian patients. Exam rooms will need to be ferret proofed to prevent ferrets from getting beneath and behind base cabinets. Check the space under the door to make sure a small rodent or ferret couldn't possibly sneak through. Given the opportunity, they will.

Birds, rabbits, and small exotic mammals are very sensitive to noise. In the hospital wards, limit noise due to barking, etc. to reduce patient stress. Create a visual barrier between these animals and their predatory species, dogs and cats. Reduce drafts from air conditioning vents. Choose the warmest part of the building for birds and exotics. The hospital will also need a sink or tub large enough for waterfowl and iguanas to swim in. The isolation ward should be dark, warm, and away from all noise. Under ideal circumstances, there should be an incubator with a nebulizer, oxygen, heat, and humidity control.

The majority of medications needed for exotic species are probably already present in most companion animal pharmacies. To make your pharmacy exotic animal friendly, there are a few items you may need to add. It will be important to keep on hand 0.30cc U-100 Insulin syringes to permit accurate dosing down to 0.005cc, as well as having certain drugs on hand:

• Ceftazidime is widely used in reptiles. It is a cephalosporin with: broadened spectrum to include G(-) bacteria and anaerobes, a small volume of injection, q72hrs dosing, and a wide margin of safely. Dose is 20mg/kg, q72hrs in most reptiles. Keep doses frozen.

• Leuprolide acetate blocks sex hormone production and therefore it is used in chronic egg laying, egg yolk peritonitis, feather picking and sex linked aggression in birds. In ferrets, leuprolide is used for adrenal gland disease and is especially useful for male ferrets presenting with urethral obstruction secondary to sex hormone-related prostatic enlargement.

• Silver sulfadiazine cream 1% is used for topical applications in reptiles, fish and birds. It is typically used for burns, bite wounds, self-mutilation, and ulcerative lesions. Do not use Panalog or other steroid products indiscriminately. Corticosteroids have profound negative effects in many exotic species.

• Meloxicam is used in small mammals for pain, GI stasis and torticollis in rabbits, and in birds for pain.

• Buprenorphine is used for post-op pain in exotic companion mammals. Anecdotally, it seems to cause less depression in small mammals than butorphanol.

• Pharmacist's compounding syrup can be used to suspend almost any drug that must be given in liquid form. This includes metronidazole, carprofen, and enrofloxacin.

• Trimethoprim-Sulfa suspension 48mg/ml (Septra) is safe and widely used in small mammals (including those prone to dysbiosis), reptiles, and birds.

• Chloramphenicol 50 mg/ml suspension can be compounded and stocked. It is one on the author's favorite medications for small herbivores; it is broad-spectrum, it had good tissue distribution across the blood-brain barrier, and penetrates into abscesses

In the surgery suite, the author uses sevoflurane or isoflurane for inhalant anesthesia, a non-rebreathing system (such as a Norman Elbow), and a waste gas scavenger. A circulating water pad, with a pad protector, provides supplemental heat during surgery. Cole endotracheal tubes down to 2mm ID, and Cook endotracheal tubes down to1mm ID may be needed for smaller species. Alternatively, red rubber catheters may be cut to size and fit onto endotracheal tube adapters. 5-0 and 4-0 PDS suture is widely used for all layers of closure. Transparent surgical drapes (Vet Specialty Products), Doppler heart monitoring, pulse oxymetry, and mechanical ventilation make monitoring easier and anesthesia safer to administer.

Grooming

Routine grooming procedures (wing and nail trimming) are a vital aspect of any veterinary practice. Wing, beak, and nail trimming give the veterinarian and staff regular contact with the patient and the owner. These appointments allow staff members to maintain proficiency and confidence in handling birds and other exotic pets. They also provide for a cursory examination and a record of body weight so signs of disease can be detected and discussed early in the course. Grooming visits provide a chance to sell wellness exams and routine testing. Finally, they provide a steady source of revenue.

Nail trimming

Nail trimming is the most common service requested for exotics and pet birds. When performing a nail trim, use styptic powder on all nails, as some pets only begin to bleed after being released. Ferrets, rabbits, guinea pigs, and hedgehogs are among the most common mammals presented. Ferrets are typically scruffed for nail trimming. Distracting with Nutrical or Laxatone also helps. Rabbits and guinea pigs are "burrito" wrapped, if necessary. Note the unique cornified growths extending from the foot pads of some guinea pigs; these may be carefully trimmed as well. Hedgehogs are more of a challenge. They may be anesthetized, coaxed out by setting in shallow water, or nail trimmed while standing on a wire mesh (aquarium lid or tennis racquet). Sugar gliders are trimmed while wrapped in a hand towel, exposing one limb at a time. Note the specialized grooming digit, without a nail, on each hind foot.

Wing trimming

Wing trimming is important in order to protect birds from many hazards: flying into windows and ceiling fans, landing on stoves, drowning, escaping, etc. Wing trimming also makes birds easier to hand tame, however overaggressive trimming may result in keel trauma and other injuries. Patterns for wing trimming vary, but the goal is to remove enough of the primary flight feathers to limit flight, and at the same time allow a safe landing to the floor.

Wing trimming is painless. The first four or more primaries can be trimmed from each wing. Alternatively, the first three may be spared, and the next five or more removed, leaving a more natural, cosmetic appearance when the wings are folded. Avoid damaging blood feathers: only mature feathers are clipped. Each feather should be trimmed on the shaft between the clear and white portions, proximal to the vane, with cat nail trimmers. This allows the cut-end of each feather to hide behind the coverlets, and will prevent irritation to the bird when the wings are folded. Always trim both wings and forewarn your clients that their bird may still be able to fly.

Beak trimming

A bird's beak should not normally need to be trimmed. Parrots routinely wear their beaks through regular use, and they actively file them on hard surfaces. The beak is a sensitive organ. Unnecessary or excessive trimming can cause pain, bleeding, and loss of appetite. Beak trimming should only be attempted by someone with experience. A Dremmel, nail trimmer, and rongeur can be used to shape an overgrown or maloccluded beak. Similar techniques are sometimes used in chelonians. The beak grows fast, like a large toe nail. Thus, trimming a bird's beak once a year at its annual visit makes very little sense. Recurrent beak overgrowth is a medical problem: nutritional, orthopedic, metabolic, behavioral, or otherwise, and should indicate further workup by a veterinarian.

Bathing

Birds are usually bathed by misting, spraying, or taking them into the shower. Occasionally, a bird must be thoroughly cleaned. To do this, place the standing bird in warm water up to its vent. Wet him by cupping your hand and dropping water onto the plumage. If feces, oil, etc. must be removed, a mild shampoo may be utilized sparingly. Any shampoo must be completely rinsed off, and the bird should be allowed to dry in a warm environment. A hair dryer may also be used with caution.

Small mammals are cleaned in a similar fashion, using mild shampoo. Rabbit skin is very delicate. When removing mats from rabbits, be very careful not to lacerate the skin with clippers or scissors. If injuries do occur, repair with tissue adhesive.

Broken blood feather

All new feathers grow in as blood feathers, having a blood supply. Over several weeks, the feather matures then loses its blood supply. Blood feathers are easily broken if the wings are trimmed too short, leaving new growth exposed. Broken blood feathers must be pulled out carefully so as to remove the entire calamus, and the follicle should be held for 1-2 minutes while clotting occurs. Inspect the pulled feather to ensure that the entire shaft has been removed. If part of it remains inside the follicle, it must be surgically removed to avoid further hemorrhage. Blood feathers that are bleeding from the tip may not require removal. Do not apply styptic to broken blood feathers or feather follicles. Never pull healthy blood feathers as part of routine grooming.

Boarding

Even if you don't normally offer veterinary care for exotics, you can board them. You can offer your clients reliable caretakers who will closely watch their pets and intervene on their behalf if a problem arises. Exotic pet boarding is an easy service to offer for most species so long as owners provide all supplies and bring enough food to last the entire visit. Problems usually occur when there is an abrupt change in the pet's routine or the type of food offered (e.g. when food runs out and is replaced with different brand), or when subtle signs go unnoticed (e.g. no new droppings for several days). Make sure your staff learns to properly set up cages and keep them clean. Most exotic pets are natural prey items for carnivores. Keep your birds and other exotics from line of sight with dogs and cats. If possible, house them in a warm, quiet section of hospital, away from dog and cat noise and odors.