Reptile cardiology is in its infancy. Veterinarians treating reptiles should develop a basic knowledge of reptile cardiovascular anatomy and physiology. Cardiology is vital to interpreting the results of various diagnostic tests and planning an effective therapeutic plan for a case. This article will provide a review of the anatomy and physiology of the reptilian cardiovascular system, the common diagnostic tests used to assess cardiac function, and the common disease presentations associated with the cardiovascular system.
Pet rabbits and ferrets are increasingly presented to veterinarians, and new demands are placed on veterinarians to manage pain in these species. Relatively little data exist regarding the efficacy of analgesics in these animals. Rabbits and ferrets exhibit different behavioral and physiological responses to pain, and an understanding of the normal behavior of these species is critical to pain assessment. Although acute pain is relatively easy to identify, signs of chronic pain may be more subtle. Occasionally, simple husbandry corrections can help alleviate painful chronic conditions. The prevention of pain by minimizing tissue trauma with a gentle surgical technique and preemptive analgesia is critical when dealing with rabbits and ferrets in the clinical setting. Many of the same analgesic techniques and drugs used in dogs and cats can be extrapolated to rabbits and ferrets, though some of the drugs have specific indications and contraindications. Discussions of the clinical use of opioids, nonsteroidal anti-inflammatory drugs, local anesthetics, ketamine, and tramadol in rabbits and ferrets are presented. Reference to the current literature is made where possible. In addition, insights gained from the author’s experience with the clinical use of these drugs in rabbits and ferrets are presented.
Radiation therapy has long played a significant role in the treatment of cancer in people, dogs, and cats. Recently, this technology has been applied to small mammal, avian, and reptile species with some success. Radiation therapy may play an important role in the control of locally aggressive tumors and has been used in both definitive and palliative settings. However, there are some special challenges that must be overcome to successfully treat these species with radiation therapy and, in many cases, little is known about the natural behavior of the tumors being treated. This article introduces some of the basic tenets of radiation oncology, while addressing some of the aspects of radiation biology that are problematic when treating very small or air-filled patients. Much work needs to be done to define fractionation schemes and field geometries that will allow avian and exotic pets to be safely and effectively irradiated.
Lead toxicity is the most common heavy metal toxicosis in free-living birds, and one of the most important diseases of toxic origin in captive avian species. Falcons commonly ingest lead pellets or lead fragments concealed in the body of shot prey. Treatment of heavy metal toxicosis is an integral part of avian emergency and critical care practice. The primary treatment for lead toxicosis consists of the retrieval of lead particles from the digestive tract, and the secondary treatment consists of the use of chelating agents and support therapy. Lead retrieval from falcons with lead toxicosis should be undertaken immediately after the metallic radiodense particles have been observed in the gastrointestinal tract on survey radiographs. Lead pellets and lead fragments are retrieved using a combination of stomach lavage, rigid or flexible endoscopy, and long biopsy forceps. Copyright 2005 Elsevier Inc. All rights reserved.
The information gathered through arterial blood pressure measurement must be correctly interpreted for appropriate decisions to be made. Systolic blood pressure is the pressure exerted against the blood vessel wall during systole. Although direct arterial pressure measurement is ideal, it is not commonly used because of the need for specific technical skill, invasive nature of the procedure, and cost of equipment. All indirect blood pressure measurement techniques are based on detection of blood flow beneath an inflated cuff. Systolic blood pressure determination via ultrasonic Doppler flow detection (Doppler) has been found to correlate well with direct blood pressure measurements in ducks (Anas platyrhynchos). Clinical techniques and applications for Doppler blood pressure monitoring will be discussed., Treatment of hypotension involves monitoring blood pressure, removal of the underlying cause, and volume support for hypovolemia. Hypertension has not yet been defined in the psittacine species. The routine use of blood pressure monitoring in the avian species can provide the clinician with a better knowledge base about intravascular volume status to avoid or minimize long-term complications of hypertension. Copyright 2005 Elsevier Inc. All rights reserved.
Small psittacines, such as cockatiels, budgerigars, and lovebirds, and passerines, such as canaries and finches, are commonly presented to the avian veterinarian on an emergency basis. Their diminutive size makes accurate assessment and initial supportive care essential for a favorable outcome. Techniques for handling, emergency procedures, and supportive care of small psittacines and passerines are reviewed in the first part of this article. Most birds in this group weigh less than 100 g, limiting the diagnostic tests and procedures that can be performed. Familiarity with common diseases affecting small psittacines and passerines and their presentation will allow for timely assessment and maximization of diagnostic tests increasing the probability for an accurate diagnosis. Common causes of emergency clinical presentations, recommended diagnostic procedures and treatment protocols are reviewed in the second part of this article. Lastly, quick reference tables that overview normal biological parameters, guidelines for tube feeding, etiologies of dyspnea, oral and respiratory medication regimens, emergency drugs, and the equipment necessary for handling the small avian emergency patient also are included to facilitate emergency care and treatment of these species. Copyright 2005 Elsevier Inc. All rights reserved.
Tracheostomy is a routine procedure used in human medicine to maintain a patent airway in cases of severe tracheal trauma, neoplasia, congenital abnormalities, or disease processes requiring long-term mechanical ventilation. Tracheostomy has been documented in veterinary medicine, including a single case in a prairie dog. However, use of this procedure in birds had not been previously described. The following report describes similar permanent tracheostomy procedures in two parrots, with slightly differing outcomes, and illustrates that tracheostomy can be considered in avian patients with nonresolving obstructive tracheal disease.
Reptiles are a diverse, complex group of animals that present unique challenges to the practitioner delivering anesthetic and analgesic care. A review of the current literature addressing the physiology and anatomy pertinent to the administration of anesthesia and analgesia to a wide variety of reptiles is presented in this article. Current clinical techniques in sedation and analgesia, the induction and maintenance of anesthesia, perianesthetic support, and monitoring are discussed.
Prior studies have found conflicting results when evaluating the association between rheumatoid arthritis (RA) disease activity and bone mineral density (BMD). Whether or not cumulative RA disease activity is associated with BMD remains unanswered.Data were from the University of California San Francisco RA Cohort from years 2006–2018. Those with BMD measures and at least two study visits prior to BMD measure were included in the study. The association between low cumulative disease activity, as measured by DAS28ESR, with the primary outcome of femoral neck BMD was assessed using multivariable linear regression. Sensitivity analyses were performed substituting CDAI for the disease activity measure as well as total hip and lumbar spine BMD as outcomes.161 participants with RA were studied. The cohort was 62.4 ± 10.2 years old and 88% female. Hispanic/Latino (N = 73, 45%) and Asian (N = 59, 37%) were the most common racial/ethnic groups in our cohort. Mean RA duration was 10.5 ± 7.3 years and 83% were ACPA positive. Low disease activity was independently associated with higher femoral neck BMD compared to the moderate/high disease activity group (β= 0.071 [95%CI: 0.021 to 0.122], p = 0.020). The relationship between low cumulative disease activity was similar when CDAI and other BMD sites were substituted in the multivariable models.Low cumulative disease activity as measured by DAS28ESR was associated with higher femoral neck BMD, independent of traditional osteoporosis risk factors (e.g., age, sex, BMI) in a unique RA cohort. Results were similar when evaluating cumulative low CDAI and other BMD sites.
Respiratory distress due to pneumothorax and/or pleural effusion is an emergency situation that must be quickly resolved. Thoracocentesis can be an invaluable lifesaving technique in these patients. This article describes how to perform thoracocentesis in ferrets for therapeutic and diagnostic purposes, with an emphasis on the unique thoracic anatomical differences between ferrets and other domestic species and on potential complications of thoracocentesis. Copyright 2005 Elsevier Inc. All rights reserved.
Photodynamic therapy (PDT) is a novel form of treatment for solid cancers. It relies on the systemic administration of a light-reactive drug (photosensitizer) to the patient. Through various mechanisms, the photosensitizer localizes to the malignant tissue. The photosensitizer is then activated by visible red light, often provided by a laser. The drug and light alone do not cause tissue damage; when the photosensitizer, light, and molecular oxygen are present together, the reactive oxygen species generated locally lead to apoptosis, vascular stasis, and subsequent ischemic necrosis, and inflammation. PDT is potentially useful for the treatment of exotic animals, because it has fewer adverse effects than radiation therapy or chemotherapy. Because PDT is typically a single session, there are fewer issues with repeated general anesthesia and vascular access. To date, experiences with PDT in exotic animals are limited, but preliminary reports suggest it will become a useful treatment in these species. Further knowledge of photosensitizer pharmacokinetics and tumor biology in exotic animals will be necessary to develop PDT into a useful cancer treatment modality.
To evaluate the efficacy and cardiopulmonary effects of ketamine–midazolam for chemical restraint, isoflurane anesthesia and tramadol or methadone as preventive analgesia in spotted pacas subjected to laparoscopy.Prospective placebo-controlled blinded trial.A total of eight captive female Cuniculus paca weighing 9.3 ± 0.9 kg.Animals were anesthetized on three occasions with 15 day intervals. Manually restrained animals were administered midazolam (0.5 mg kg–1) and ketamine (25 mg kg–1) intramuscularly. Anesthesia was induced and maintained with isoflurane 30 minutes later. Tramadol (5 mg kg–1), methadone (0.5 mg kg–1) or saline (0.05 mL kg–1) were administered intramuscularly 15 minutes prior to laparoscopy. Heart rate (HR), respiratory rate, mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), end-tidal CO2 partial pressure (Pe′CO2), end-tidal concentration of isoflurane (Fe′Iso), pH, PaO2, PaCO2, bicarbonate (HCO3−), anion gap (AG) and base excess (BE) were monitored after chemical restraint, anesthesia induction and at different laparoscopy stages. Postoperative pain was assessed by visual analog scale (VAS) for 24 hours. Variables were compared using anova or Friedman test (p < 0.05).Chemical restraint was effective in 92% of animals. Isoflurane anesthesia was effective; however, HR, MAP, pH and AG decreased, whereas Pe′CO2, PaO2, PaCO2, HCO3− and BE increased. MAP was stable with tramadol and methadone treatments; HR, Fe′Iso and postoperative VAS decreased. VAS was lower for a longer time with methadone treatment; SpO2 and AG decreased, whereas Pe′CO2, PaCO2 and HCO3− increased.Ketamine–midazolam provided satisfactory restraint. Isoflurane anesthesia for laparoscopy was effective but resulted in hypotension and respiratory acidosis. Tramadol and methadone reduced isoflurane requirements, provided postoperative analgesia and caused hypercapnia, with methadone causing severe respiratory depression. Thus, the anesthetic protocol is adequate for laparoscopy in Cuniculus paca; however, methadone should be avoided.
Echocardiography in birds is a useful intravitam technique for morphological and functional cardiac assessment, although the technical equipment has to be advanced to examine the avian heart. Probes with small coupling surfaces and frequencies of at least 7.5 MHz are necessary, and ultrasound devices should be able to produce at least 100 frames/s. A bipolar ECG is used to examine the heart in endsystolic and enddiastolic state. Two approaches for coupling the probe are are described. By using the ventromedian approach, two horizontal longitudinal views present the chambers, the interventricular septum, and the valves of the heart. Reference values for B-Mode and spectral Doppler are available for different species, but experiences with Doppler examinations in diseased birds are still rare. Common pathological echocardiographic findings in birds are hydropericardium, hypertrophy and/or dilation of the right ventricle, and hypertropy of the muscular right atrioventricular valve. Copyright 2005 Elsevier Inc. All rights reserved.
Avian pain is likely analogous to pain experienced by most mammals. Approach to pain management for the avian patient involves considering the duration, type, and extent of injury along with physical, environmental, and behavioral management. Invasive, painful procedures should always be accompanied by appropriate analgesia and anesthesia. Although pain management in birds is in its infancy, research and clinical studies demonstrate benefit for use of opioids, steroidal and nonsteroidal anti-inflammatory drugs, as well as other analgesics such as α2-agonists, ketamine, and local anesthetics. Ongoing assessment of pain and analgesic efficacy is extremely important, because the dosage and choice of analgesic may vary widely between species.
Neurological dysfunction is a frequently presenting sign in avian and reptile patients. Clinical neurological signs are rarely pathognomonic, often requiring the attending veterinary surgeon to perform more involved diagnostic tests to achieve a diagnosis. Variations in patient anatomy, physiology and demeanour present unique challenges to the veterinarian evaluating the bird or reptile that has neurological disease signs. Despite these challenges, a well-structured physical and neurological examination can often be accomplished with minimal equipment. A structured neurological examination is essential to formulate an appropriate investigative plan and therapeutic regime for these difficult cases and to provide the owner with an accurate prognosis.
Amphibians are being kept in increasing numbers as pets and in zoological and research collections. As we learn more about the diseases that affect these animals, our knowledge of emergency medicine has grown. When faced with an amphibian emergency, the rapid collection of a history, appropriate selection and execution of diagnostics, and immediate administration of critical care will increase the likelihood of a successful outcome. Common emergency presentations of amphibians also will be reviewed, including red-leg syndrome, edema, emaciation, gastrointestinal obstruction and prolapse, neurological disease, and trauma. Copyright 2005 Elsevier Inc. All rights reserved.
