Exotic pet medicine-a case-based review (Proceedings)

More and more people in today's society are choosing to own exotic pets in addition to or in lieu of the traditional dogs and cats commonly seen in private veterinary practice.  Their small size and housing, ease of care, and human-animal bond potential make them the ideal pets.  Often owners of zoological species are as emotionally invested in these animals as owners of traditional species and will make every effort to provide their pet with the best veterinary medicine has to offer.  By offering service to exotic animal patients, you are meeting a tremendous demand that will be highly valued by your clients and/or employers.

Role of the veterinary team

Exotic pet practice offers the practitioner an opportunity to work with a large variety of species.  While professionally rewarding, this also represents a significant challenge.  The diversity of exotic pets kept in captivity dictates that the veterinary practitioner be versed with the health and husbandry of species commonly kept as pets.  Husbandry factors are often at the root of medical conditions seen in these animals.  A thorough history, including husbandry information, is necessary for appropriate case management.  Training of veterinary support staff will enhance the veterinarian's ability to accommodate these species in a busy schedule.  Providing adequate time for acquisition of a thorough history requires a minimum appointment time of 30 minutes.  Longer appointment times minimize stress to the patient and allow necessary time for client education. Knowledgeable front office staffs are also critical in facilitating exotic pet care.  Staff should be familiar with exotic pets commonly kept as pets and should demonstrate their interest to your clients.  Statements that are derogatory regarding ownership of certain species or the decisions of owners to spend money on pets that are deemed “inexpensive” should be avoided.

Equipment

Most of the equipment needed for exotic animal patients is the same that you use to see dogs and cats.  A few supplies, however, are essential and will make the transition to seeing exotic pets much smoother.  Most importantly, an accurate gram scale is necessary to weigh these small animals to help determine their health status as well as to determine appropriate dosing of medication.  Small plastic containers can be used to restrain the animals while positioning them on the scale.  Towels of varying sizes are useful while restraining exotic patients. Avoid towels with fringe or strings that could entangle an animal's appendage or nail.  General anesthesia is beneficial at times to thoroughly examine a patient or to perform procedures.  Isoflurane or sevoflurane gas anesthesia administered via mask or induction chamber is ideal for this purpose.   Supplemental heat is often required by compromised exotic patients and may be provided using an incubator or heating pad.  Finally, appropriately sized needles (25-27 gauge) and syringes (TB or insulin) will lend to efficient drug administration and venipuncture.  Once a practice is committed to caring for exotic animal patients, additional supplies will be identified which will expedite the care of these species.  Developing a good working relationship with a compounding pharmacy will help to avoid the stocking of an excessive drug inventory. Additionally, identifying a laboratory experienced in exotic animal hematology and diagnostic testing or establishing that ability in house is critical to case management

Basic skills

The best time to practice your skills pertaining to exotic animal species is when you are presented with a healthy animal.  By learning what is normal for the species, you will more efficiently identify abnormalities allowing you to direct your diagnostic and therapeutic efforts accordingly.  Often healthy animals are presented for routine examinations and grooming procedures.  Take this opportunity to speak to the owner regarding the importance of periodic health checks.  Many small exotic species have relatively short life spans making bi-annual exams ideal.  Grooming procedures, such as nail trims and wing trims, provide an excellent opportunity to practice handling techniques and to become familiar with what is normal.  Care must be taken to perform these techniques correctly so as to not stress the animal unduly and to avoid causing injury.   

Natural history and husbandry

It is important to educate yourself regarding species identification and the natural history of the species you're seeing.  Certainly years can be spent learning all there is to know about every species kept as a pet, but a general working knowledge of those commonly kept will lend confidence to your client interactions.  In addition, knowing the natural history of the species presented to you will help you identify the husbandry requirements of that animal when kept in captivity.  The goal in keeping any exotic pet is to maintain it in an environment that is as close as possible to that it would be living in if it were free ranging.  Often the problem that an exotic pet presents for is related to deficiencies in the environment or their diet.  Being familiar with the husbandry requirements of a species will help you identify potential problems and give insight in implementing treatment recommendations.  It will also allow you to help your clients determine if that particular species would make a good pet for them based on their circumstances. 

History

A complete history is of paramount importance in providing you with all the information needed to adequately assess the health of the exotic patient.  Developing a pre-printed history form will facilitate this process by identifying problems in husbandry to help focus your exam and make specific care recommendations.  Additionally, if concerns regarding the patient's husbandry are addressed prior to the onset of problems, you have provided your client with excellent preventative health care for their pet.  Sample history questions should include: How long have you owned this pet?

• Where did you acquire this pet?

• What is this pet's diet (be specific)?

• Are vitamin supplements or medications used for this pet?

• Is water provided for this pet?  In what manner?

• How is this pet housed? Describe any cage furnishing the pet has access to.

• What substrate is used in the pet's enclosure?

• How often is the cage/enclosure cleaned?

• What is the temperature & humidity of the pet's environment?

• What light is provided for the pet (be specific)?

• What other animals have your pet been exposed to? 

• Have you recently added any new pets to your household (within the last year)?

• What problem is your pet currently experiencing?

Physical exam considerations

The key to performing a thorough physical examination on any species, traditional or exotic, is doing it the same way every time.  Thorough physical examinations can be done in any number of ways, including proceeding as you would for a dog or cat patient. Consistency is the key.  Always be sure to record an accurate weight.  Remember that most exotic species that are kept as pets have not been domesticated as a whole and have retained the instincts that protect them in the wild.  A sick animal in its natural setting would most often be predated so most exotic species hide their illness.  Having an idea of what is normal for a specific species will help you detect the subtle changes that could indicate a problem.  Try to plan ahead and have all needed supplies available so as to complete your exam efficiently and safely.

Case plan

The basic principles of case management are applicable to the management of exotic animal patients.  Often a physical examination reveals the underlying presenting problems, giving clues to the veterinarian to develop an informed diagnostic or treatment plan.  At times, however, the cause of the clinical presentation is masked and diagnostic testing becomes even more critical.  When ancillary testing is not available or non-diagnostic, understanding disease prevalence can help the practitioner direct treatment of the patient to the most likely etiology.  Begin by noting the problems which may be described by the owner, identified in the history, or assessed during physical examination.  Review the problems and develop a differential diagnosis list to include basic diseases.  For instance, if a 3 year old male castrated ferret is presented for a 2 day history of diarrhea and the history included appropriate husbandry, free time play, and the addition of a new cage mate, it is not necessary to have extensive knowledge about ferret diseases to proceed. The problem list might include: 1. Diarrhea, 2. New cage mate, 3. Access to potential foreign body. From this problem list, you could create a differential list of enteritis (inflammatory diseases including IBD, or infectious causes including clostridial, corona virus, and helicobacter enteritis), foreign body ingestion, and neoplasia.  Once you have created your differential diagnosis list, you can choose the diagnostic tests that will help you hone in on the underlying etiology and reference specific information to help develop a treatment plan for that patient.  Armed with your complete case data, you will be able to discuss treatment options with your clients confidently and implement therapy efficiently.

Resources

Avian Medicine and Surgery in Practice; Companion and Aviary Birds. Doneley B. 2011. Manson Publishing Ltd., London, UK.

Exotic Animal Formulary, 3rd ed. Carpenter J.W. 2001. Elsevier, St. Louis, MO.

Ferrets, Rabbits, and Rodents; Clinical Medicine and Surgery, 2nd ed. Quesenberry K.E., Carpenter J.W., eds. 2004, Saunders, Philadelphia, PA.

Manual of Avian Practice. Rupley A.E. 1997. W.B. Saunders Co., Philadelphia, PA.

Manual of Exotic Pet Practice. Mitchell M.A. and Tully T. N. 2009. Saunders, St. Louis, MO.

Reptile Medicine and Surgery, 2nd ed. Mader D.R., ed. 2006. Elsevier, Philadelphia, PA.