Day 15

6-11-10

I was wrong. I should have volunteered to borrow a key and come in to feed the fawns overnight like my gut told me to, but I didn’t. When we arrived this morning, both fawns were extremely hypoglycemic and unresponsive. I was pretty upset with myself, but now I know when to go with my gut. I’ve been the primary caretaker for enough baby animals to know when they need to have around-the-clock care, and next time, I won’t make the same mistake. We did everything we could this morning to revive the fawns, but unfortunately, the little female was just too weak. After a couple of hours under intensive care, she died. It’s possible she would have died regardless of her overnight care, due to aspiration pneumonia, sepsis, or even some brain damage that occurred due to the severe hypoglycemia she had before arriving at the clinic yesterday, but it was still discouraging. The little male was still hanging in there so we devoted all our attention to him. We re-did everything we started yesterday and added some oral electrolytes to his tube-feeding. He came around very quickly when we got his blood sugar back to normal but he still didn’t have a suckling reflex, which worries me.

This afternoon, Dr. Leo had a bone surgery! I was pretty excited! A client brought her rabbit in for a broken leg. However, when we examined it, we learned very quickly that the leg had been broken for weeks. It was completely fractured, but it was a closed fracture, so the client didn’t realize that it was an emergency when it happened. This is my biggest frustration with private practice. Too many people either don’t notice when their pets are sick, or decide for themselves that the issue is “no big deal.” There was a lot of fibrous scar tissue around the break, and Dr. Leo was unsure whether it can be surgically repaired or will have to be amputated at the joint above the break. Amputating a rabbit’s hind leg is a risky business because rabbits have to sit up on their back feet in order to groom their face and head properly. They also use their back feet to clean out their ears regularly. With only one back foot, they have trouble balancing and grooming their face, and their ear on that side generally has to be cleaned out regularly by the owner. Suprisingly, many rabbits with amputated limbs find a place in their cage or around the house that they can sit in or against to balance themselves and groom regularly. Exotic animals are especially good at overcoming adversity, so it’s very likely that this rabbit, an otherwise healthy, middle aged animal, will do just fine with an amputated leg.

During surgery, Dr. Leo tried over and over again to place an intermedullary pin in the two pieces of tibia bone to line them up, but the fibrous scar tissue around the ends of the bone made it impossible to align them correctly, and without good alignment, the break would never heal. Dr. Leo chose to amputate. First, she had to have permission from the client who had left to run errands during the surgery. Dr. Leo asked me to call her and get the ‘ok’ to amputate. The client was very adamant about saving the leg and asked Dr. Leo to try again to align the bones. Dr. Leo took a deep breath and said she’d do her best. She tried three more times to wrench the bones into position, but the opposing ends just would not line up. They were almost at completely right angles to each other, and the large ball of scar tissue around them prevented her from placing them in a straight line opposing one another. Again, we called the client, and again she asked us to keep trying, against the advice of Dr. Leo, who told her that it MUST be amputated. Dr. Leo began to get agitated because the animal had been under anesthesia for an hour and a half at this point with no progress made on the surgery. She finally called the client back and told her she was either going to amputate the leg now, or close up and wake up her rabbit with a very painful broken leg. After about a ten minute conversation, the client finally agreed to let her amputate. Dr. Leo opened the leg slightly farther up to the femur bone, used lidocaine to block the sciatic nerve, and cut the bone in the middle. She also injected lidocaine into the end of the bone, which she said not only helps with pain, but also minimizes the phantom limb effect. She then sutured the ends of the muscles together around the cut end of the bone with horizontal mattress sutures for support. She closed her incision with a continuous intradermal (under the surface) suture so that the rabbit would not chew on the incision as they often do with external sutures. The rabbit recovered well and truly didn’t miss a beat. It seemed much easier for it to move around once we amputated that dangling foot, and was much less painful with all the drugs on board.

At the end of the day, the male fawn was doing great! He has begun suckling and is urinating and defecating normally while standing up in the outdoor pen. His navel looks much better and is drying up like we had hoped, and he even bounced around a little outside today. Now that he is suckling the full 90 mL of formula, he is ready to be sent to the rehabilitation center, where they can raise him to adulthood.

Just before closing time, we had a call from an iguana breeder that wanted to bring his iguana that had recently died for us to do a necropsy and determine the cause of death. He brought it in a large cooler, and when we pulled it out, it was enormous! Dr. Leo began her incision carefully so that we could close it back up, because the breeder wanted to take him back when we were finished.

When she opened him up, she extracted about 2 liters of blood tinged serous fluid from his abdominal cavity. He also had multiple focal nodules in his lungs and liver, but other than that, we found no additional pathology leading to his sudden, unexpected death. We took samples and preserved them in formalin to be sent to the lab, which will hopefully help us to obtain a more definitive diagnosis and to determine the cause of death.

After we were finished, it was my job to close the incision, which was about two feet long from chin to tail. His scaly, tough skin required some heavy-duty cutting needles to puncture it. I placed each suture a little less than 1 cm apart and, to my surprise, finished fairly quickly! I was happy with my suturing and I was glad to have the practice. Hopefully the junior surgery program this year won’t be too much of a nightmare now that I have had Suturing 101 ad nauseum today!

Well, it’s the end of my last day at Avian and Exotic Animal Care, and I had a phenomenal experience. I learned so much from the doctors and the technicians, and I know that the information I learned in such a short time will be very beneficial in the years to come. I even learned things I never expected to learn about practice management, people skills, and public relations from Dr. Dan and his wife Mrs. Sandy. Needless to say, I feel confident that I can care for sick or injured neonatal wildlife with much less guidance than before, and I am much more proficient in the safe handling and restraint of some of the more dangerous pets. Most importantly, I came here to get some experience working in a private practice exotic pet clinic because I wanted to know if I would enjoy this as much or more than zoo medicine. I have always wanted to be a zoo veterinarian, but I chose this internship to keep an open mind about my career. I discovered that although I loved the people and animals at AEAC, and learned a lot in a very short time, my passion still resides in the zoo.

Day 14

6-10-10

Early this morning, some good Samaritans brought in two fawns that had obviously been abandoned.

Sometimes people get confused as to whether the doe was just “parking” her fawn, or actually abandoning it. A doe will regularly park her fawn (or fawns) in an open field, bedded down in the tall grass so that she can find better forage without risking her baby being seen by a predator. Fawns have almost no odor, so unless a predator stumbles across them while walking through an open field, they won’t be detected. The problem is that people will stumble across them and assume they’ve been abandoned because they don’t see the mother anywhere. In the case of a parked fawn, it will be bright and alert, clean, healthy, and very still.

An abandoned fawn will be obviously sick, dirty, and possibly even be covered in maggots, as was the case with the two we got this morning. Dr. Dan and I started IV catheters of 5% dextrose, gave them subcutaneous fluids (LRS), cleaned their wounds, flushed their navels with dilute chlorhexidine, and packed their wounds and navels with SSD. We then placed them into a large incubator together and tube fed them with our newly engineered baby fawn formula.

After we finished caring for the fawns, we tended to Dr. Dan’s appointments, because they were really beginning to pile up. He sent me in to take care of a simple appointment to recheck a wound on a guinea pig. Dr. Leo and Dr. E had removed an abscessed lymph node from this guinea pig’s neck about a week ago, and the client was not comfortable caring for the wound herself. Therefore, for a small fee, we do it for her! Kelsey and I flushed the wound and packed it with an herbal antibiotic powder called Golden Yellow. The client was pleased to learn that the wound was healing well and that she only needed a few more treatments.

Also this morning, we had another appointment with the rabbit belonging to the lady-with-the-seven-year-itch. It still wasn’t back to normal so Dr. Dan decided to do a barium study to see if we could visualize anything abnormal with her digestive tract. We had to take radiographs at time zero, thirty minutes, one hour, three hours, four and a half hours, and six hours after we administered the barium. It took all day! By the end of the day, the barium study showed us nothing more than a bunch of what Dr. Dan calls “doo-doo balls” in her digestive tract that were larger than they should be. He decided to try a method called transfaunation. It’s pretty gross, but it’s the best way to introduce good bacteria into a rabbit’s digestive tract. Dr. Dan collected fresh “doo-doo balls” from one of our healthy donor rabbits, and mushed them up with some water. He then added the mixture to some herbivore critical care hand-feeding formula, and drew it up into two 10cc syringes, and fed it to the sick rabbit. Hopefully he will be able to form regular-sized “doo-doo balls” in the next day or two.

Near the end of the day, we tube fed the fawns for the third time, cleaned their wounds, and disconnected their IV pumps. They seemed to be doing much better now because they could finally hold their heads up and were responsive to touch, sight, sound etc. I was a little uneasy about letting them go the whole night without a feeding, but the last fawn did fine overnight and Dr. Dan didn’t seem concerned, so I guess they’ll be okay.

Day 13

6-9-10

Today was a nice day, and very relaxing (sortof) because we did only house calls all day. Dr. Dan started his practice in the back of a van, so he tries to keep offering that service for his clients’ convenience. We traveled to the house of an elderly lady to do a beak, nail, and feather trim on her Amazon parrot. Dr. Dan coaxed the parrot onto his hand and wrapped him in a towel; however the bird was NOT happy and voiced his opinion of us very loudly. Dr. Dan restrained the bird while I did the nail and feather trim, and then he proceeded to do the beak trim while I restrained. We noticed its beak had a large crack in it, and Dr. Dan was hoping it wouldn’t be a problem since it was an old crack. Wrong! While he was trimming it, it cracked all the way up into the cere (the most proximal part of the beak – closest to the bird’s face)… and then there was blood… a lot of blood. Plus the bird was screaming, and it only got louder when the beak cracked. For about 30 seconds, it was pure chaos and Dr. Dan’s daughter gasped and said “oh my god it’s bleeding!” so then the client came rushing in, along with her daughter, and the whole thing became one big bloody mess! Dr. Dan and I got everyone calmed down, including the bird, and loaded him up into the van to bring him back to the clinic. There, Dr. Dan placed the bird under general anesthesia and repaired his beak with epoxy, while I monitored its anesthesia. The parrot’s beak looked as good as new when Dr. Dan was finished, and I’m sure its owners were pleased because he waived they’re appointment fee.

While we were at the clinic, we got the results from the fox’s rabies testing. Luckily, she was negative for rabies and we didn’t have to pass around the post exposure prophylaxis cool-aid. I am still glad we went forward with the euthanasia and submission of the head for testing. Better safe than sorry, when you’re dealing with a 100% fatal zoonotic disease.

Our last appointment for the day was at the home of a young lady who owned two sun conures. One of them was named Loki, and the other was Jack. We grabbed Jack first because he actually wanted to be held. We did a wing and nail trim, and a physical exam on Jack with no problems; however, Loki was a different story. Loki had not been handled nearly as much as Jack because she was a new bird, and was very scared of us. Dr. Dan is especially good with timid birds, and after a little chase, he had her in a towel. She started screaming as soon as he had her restrained and continued screaming for the entire process. When we were done, Dr. Dan placed her on the floor and asked her to step up onto his hand. When placed on the floor, a bird that can’t fly will do anything possible to get to higher ground. Even if the bird is scared of you, it usually will not hesitate to use you to get to higher ground. It’s instinctual… get higher or be eaten by something on the ground. Something we didn’t expect occurred when we put her back on top of her cage with Jack. The once sweet Jack became very aggressive. Evidently he did not appreciate us making his new mate scream like that! He actually pushed her behind him and came charging at Dr. Dan with his beak open and his wings spread! All I have to say is that some birds are definitely smarter than we think.

Day 12

6-8-10

When I arrived this morning, I was pleased to note that the fox had eaten all of the kibble I left for her, but as I expected, she hadn’t regained the use of her back legs.

At about 10 a.m. Dr. Dan did surgery on an egg-bound parakeet. It was a very interesting surgery, and I learned a lot about the anatomy of the bird’s cloaca in the process. The egg was caught in the uterus as it was traveling to the cloaca. Therefore, instead of passing into the cloaca and out of the body, it got caught at the junction of the uterus and cloaca and it consequently prolapsed the cloaca. It had been prolapsed for so long that some the mucosa of the cloaca had become ischemic and dry. Dr. Dan ligated the healthy tissue above the egg, cut away the egg and the dead tissue around it, and reattached the uterus tissue to the correct opening of the cloaca. Once he pushed the healthy tissue back inside the bird, the cloaca returned to its original position with the uterus attached correctly. (See diagram for clarity)

Our second surgery of the day was a toe amputation on a Cockatiel. The bird in the adjacent cage had bitten his toe almost completely off the night before, so his owners brought him in when they noticed it this morning. Dr. Dan amputated the rest of the toe at the metacarpophalangeal joint. He bandaged the bird’s foot and then wrapped the foot in duct tape, which is beak-proof! This prevents the bird from tearing the bandage apart.

We had a ferret appointment this afternoon, and I learned that in ferrets, mast cell tumors are common, minor, and self limiting. I thought that was very interesting, considering the fact that many other species can be severely, and even fatally affected by mast cell tumors.

I also got to do a rat euthanasia and necropsy this afternoon! It was a lumpy pet store rat, so I actually got to perform the euthanasia myself. On necropsy, I discovered that the lumps were actually abscessed lymph nodes and the infection extended into the mesenteric lymph nodes as well. As much as I hate pathology rounds, and the smell of the necropsy floor, finding out the cause of a problem myself was pretty interesting.

At the end of the day today, I finally convinced Dr. Dan that I thought the fox needed to be euthanized and sent in for rabies testing. He was reluctant to grant my request, and said that if I wanted to send it in for testing, I would have to be the one to remove the head. I reassured him that I would do that. I did what needs to be done, and even in retrospect, I believe the risks outweighed the benefits, and I did the right thing.

Day 11

6-7-10

Today has been very interesting. Dr. Dan is allowing a camera crew to visit the clinic today to film a documentary on exotic animal veterinarians. They plan to call it Exotic Pet Vet, and then pitch it to the Discovery Channel. Who knows if it will ever actually air, but it was interesting to think about.

Along with our normal appointments, check-ups, vaccinations, tooth trims, etc., we had another exciting wildlife case. Some people found a baby fox on the side of the road that looked like it had been hit by a car.

There are multiple problems with this situation, all of which began swimming through my head as soon as they walked in the door. First of all, the patient is a wild fox, and the etiology of his illness is entirely unknown. In North Carolina, there are four types of animals that private practices are not allowed to treat due to the high risk of them being carriers of rabies: foxes, raccoons, bats, and skunks. (In Oklahoma, we also include coyotes in this list, but NC has very few coyotes.) This fox presented with hind limb paralysis and excessive drooling… HELLO!!! Prime rabies suspect from the first glance! Yes, this fox is incredibly young (around 3 to 4 weeks – which is very close to the minimal incubation time for rabies to be showing clinical signs… so she would have had to be infected immediately after birth, which is highly unlikely, in order to pose a risk to us). She is not aggressive, and is technically fairly unlikely of having rabies, but Dr. Dan’s son has not been vaccinated against rabies. Therefore, even minimal risk is more than I would like to expose him to. Dr. Dan however, didn’t think it was a major risk, and told me to take over the case and treat the fox. I put on gloves, (which must be done at the very least… and I should’ve had a mask on as well) I cleaned the fox, and gave her a full physical exam. She had a spinal abnormality in the lumbar region, which would explain the hind leg paralysis, and many broken teeth, which would explain the drooling, so once again, it’s not likely that these are signs of rabies. She also had an open fracture of the tibia bone that was full of maggots.

I cleaned her wounds, applied SSD, bandaged her leg for the evening, and administered pain medication and antibiotics. Dr. Dan is still trying to decide how he wants to treat the paralysis and the broken tibia, so I gave the fox some softened kibble and placed her in an incubator for the night.

Day 10

6-4-10

This morning, we did the mass removal surgery on the rat! Dr. Dan’s anesthetic protocol included Ketamine + Midazolam, IM and Buprenorphine, SQ.

It was a very interesting surgery, and Dr. Dan taught me about radio cautery, mass removal in general, and mammary tumors in rats. After removing the mass, Dr. Dan located two smaller tumors that were not palpable because of the larger one. He wanted to remove those as well, but the rat had lost so much blood during surgery, he decided to wait until a later date.

A few of the technicians at the clinic have a pretty interesting sense of humor. Need I say more?

Later this afternoon, we did a healthy pet exam on a Savannah Cat and scheduled a later appointment for a FeLV/FIV test and a neuter.

Then, a rescued rabbit arrived with only one eye. Miraculously, the third eyelid, called the nictitating membrane, had covered the socket sufficiently, and the injured eye had shriveled up and receded into the socket, which is exactly how nature had intended. The so-called “wild” rabbit was doing fine without his eye, and the eye itself hadn’t gotten infected, so Dr. Dan wasn’t worried. He simply treated the rabbit for the ear mites he found on its physical exam and discharged it to a good home.

This afternoon was particularly hectic for me. Two days ago, Dr. Leo performed a tooth trim on a rabbit that had presented with diarrhea and anorexia. Today, the owner claims that the rabbit is doing worse than before, still not eating, and is now grinding its teeth constantly. The client it still managing to force feed her, but less than the recommended dose of food, and she is getting her medications regularly. The owner said that she acts as if her teeth hurt, she is resisting the force feeding more today, she’s less active, and she’s depressed. Dr. Dan became a little overwhelmed this morning, so I told him I would take over the case and the client. I called her personally and got all this information from her over the phone. However, when she finished telling me the current condition of her rabbit, she proceeded to tell me about how upset she was with AEAC and that she considered not bringing her rabbit in at all. I asked her why she was upset. She said that when this rabbit got spayed (seven years ago!) she got burned on her belly during recovery from surgery on a heating pad (which we don’t use anymore). The client went out of town for a week, and when she returned to pick up her rabbit, the technicians supposedly didn’t tell her about the burn on the rabbit’s belly. However, in the computer medical records, it shows that they did. They even showed her how to apply the ointment to the burn. When she brought the rabbit back upon noticing the black spot on her belly, the interim veterinarian told her to please tell Dr. Dan about her concerns; but she failed to do so… until now… seven years later! Therefore I told her how very sorry I was about that and how glad I am that she has told us everything, and that I would do everything I can to make the situation better. By the end of the day, about four hours after our initial phone conversation, and after a couple hours worth of apologizing, I finally had her calmed down enough for Dr. Dan to come in and examine her rabbit once more, listen to her rant for awhile longer, and teach her how to force feed her rabbit correctly. Hopefully, the rabbit will begin to get better, in the client’s opinion, and we won’t have to deal with this problem again.

Our last patient of the day was a duck that someone had brought in from their farm pond. A fox had gotten ahold of it a few days before, and nearly ripped its leg off. However, the duck was truckin’ along just fine on only one leg! It hopped right into the clinic with the other leg dried up and dangling off! Dr. Dan just pulled the dried leg off, which didn’t even phase the duck, and we debrided the gaping hole that was left with forceps, carefully removing the scabs and dirt, while still watching to see if the duck felt anything.

No reaction whatsoever from the duck! We lathered it in SSD and put the duck in a run to hold him a few weeks until it heals over completely. Dr. Dan named her Ilean... Ha-Ha Dr. Dan. It’s pretty amazing how some animals can overcome the loss of a limb in such a short amount of time with almost no veterinary care!

Day 9

6-3-10

We had a rat appointment today with a critter that looked just like Cricket! Also, the rat had a mass on its abdomen that was almost identical to Cricket’s mass. Dr. Dan scheduled a $700 surgery to remove the mass, so tomorrow will be an exciting day.

Later this morning, I got to do a nasolacrimal flush on a rabbit! I really enjoyed getting to do this myself under the supervision and instruction of Dr. Dan. I flushed it’s ducts without a problem, so I think he was happy with that.

We also had a parrot with diagnosed liver disease that came in for a beak trim and blood work. Its blood was surprisingly cloudy and even cream-colored, which according to Dr. Dan, is standard for a bird with a liver problem.

Dr. Dan did surgery on a guinea pig with a trichofolliculoma, which is a tumor of the hair follicle; a very common problem in guinea pigs that is most effectively treated with surgery. It was basically a mass-removal surgery, and Dr. Dan carried it out very smoothly.

This afternoon, I got to examine a Great Horned Owl with an eye injury. He was brought in by a raptor rescue. After numbing his eye, I debrided it carefully, making sure to remove the caseous material that had collected between the eyelid and the conjunctiva. I found no traces of injury to the eye itself and no foreign body, so hopefully the debridement and antibiotic eye drops will be sufficient treatment.

At the end of the day, Dr. Dan got a little disappointed upon his recheck appointment. He had recently done bone surgery on the leg of a Barred Owl, to repair a broken tibia. Due to poor blood supply, the repair was not successful. The client/rehab center should have brought the bird in earlier, however that issue was inconsequential at this point in time. This Barred owl was never going to be releasable, and the leg was completely dead, so the best option, according to Dr. Dan, was euthanasia.