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.

Day 8

6-2-10

Today was a very slow day. All in all we practiced restraining Constantine the iguana, vaccinated three Macaws, helped a leopard gecko shed its skin, vaccinated four ferrets, and did a new pet exam on a cockatiel. All of these were great learning opportunities, but nothing too crazy.

Day 7

6-1-10

This morning I did a bird blood draw by restraining, holding off the vein, and drawing the blood by myself! I’m getting better and better at it. The blood test results on this particular patient came back with increased uric acid levels, which can be indicative of several diseases, and further tests are required before we can make a definitive diagnosis.

Last night, the emergency clinic took in a bearded dragon having respiratory difficulties. This beardie came in with the same problem two years ago, was diagnosed with a heart problem, medicated with pimobendan, and seemingly recovered. Therefore, after having been on oxygen overnight, Dr. E decided to put it back on the pimobendan to see if it would improve.

Dr. E also did a surgery today on a guinea pig to remove a bladder stone. After removing the stone, she sutured it closed so that the edges of the incision will turn inward. Because the bladder is a distensible organ, it’s best to turn the edges in to allow it to expand regularly without incident.

After lunch, Tyrone and I treated a box tortoise that was rescued because it had a missing hind leg. I flushed the wound and closed the skin around it with suture glue, being extra careful not to glue its leg to its shell.

At the end of the day, I watched Dr. E do a tooth trim on a chinchilla, and treat a guinea pig with pneumonia by teaching her owners how to use a nebulizer and oral antibiotics. A nebulizer is like a vaporizer that puts the vapor into a box containing the animal. This allows the animal to inhale its medication for a more direct delivery into the lungs and alveoli.

Day 6

May 29, 2010

Today was a particularly rough day for me. This morning, a lady brought her cockatiel in as an emergency appointment. The bird was suffering from a condition called egg-binding. The bird was trying to lay an egg which got lodged in her reproductive tract due to either the size and/or positioning of the egg, lack of proper motility and contractions, or a number of other reasons. The bird was sitting in a sternal position, but was having trouble breathing. We immediately placed the bird in an oxygen chamber.

Once its breathing slowed a little, we took radiographs to try to visualize the size and position of the egg inside her reproductive tract. It was much larger than a normal egg and was positioned perpendicular to the way it should be. The egg was not only immovable; it was impinging on the air sacs, causing the bird to be unable to fill her lungs with adequate amounts of air. Our only option was surgery to collapse the egg while it was still inside the bird, and then remove it in pieces. We explained the situation to the owner, who then became very concerned about the cost of surgery. She was facing at least $900 for surgery and anesthesia, and that’s only if everything goes according to our plan.

When we started anesthesia, the bird was severely distressed. I monitored anesthesia while Dr. Dan began his procedure. His plan was to make four scratches in the shell of the egg, collapse the egg to allow the bird to breath, and then remove the pieces tomorrow or the next day, once the bird has stabilized. Unfortunately, within the first few moments, the bird suddenly stopped breathing! As I told Dr. Dan, he realized what I was saying and stopped everything to try to resuscitate it.

He managed to get it to start breathing once more before it crashed again, but this time its heart stopped too. We tried for another few minutes, but ultimately decided it was over. The owner took it fairly well because the bird had been acquired recently, and wasn’t considered a family member yet. Still, I was pretty upset. Although I didn’t show it, I did not like the idea that I had been the one running anesthesia on someone’s pet when it died on the table. The bird dying wasn’t what bothered me so much as watching the owner cry over it, and having to be the one to console her. That part was definitely not something I liked doing. With more experience, I'm sure I'd be better at helping people handle these difficult decisions and times of loss, but my first time in this situation was pretty rough. I know it’s all part of the whole pet vet job, but it definitely took its toll on me emotionally.

After helping the client out the door with her little birdie box, we had another sad case to deal with. A client brought their rabbit in for weakness in the hind limbs. However, when they arrived, the rabbit’s back legs weren’t working at all, and its back end was soaked with urine and feces. They claimed that it had only gone on for a short amount of time, and that they had given it a bath the day before. However, when we took the rabbit back and began washing and shaving the matted hair from its back end, we realized its skin had been totally scalded from the urine-soaked hair, and was just sloughing off. It was incredibly difficult to get the hair off without taking the skin right along with it, and shaving the mats was also nearly impossible. I soaked the rabbit in warm water to try to loosen up the mats and dried feces, and after an hour of work, we finally made a little progress. We sutured the pieces of skin that were left and covered the raw places with SSD to prevent infection and promote healing. Dr. Dan informed the clients that the situation with their bunny was much more severe than they had thought, and that the rabbit needed to be cared for and cleaned at least twice daily. I’m still not convinced they fully understood what would be involved with their special needs pet, but they took it home promising to take better care of it.

Day 5

May 28, 2010

Today, I went on house-calls with Dr. Dan! We visited a nursing home and a rehabilitation center. At the rehab center, we did annual check ups on a conure and a cockatoo. Dr. Dan taught me how to do an entire physical exam, blood draw, and fecal without the help of an assistant. By the end of it, I could do everything one-handed, while restraining the bird with my left hand. Pretty cool, I thought, since Dr. Dan started out as a traveling veterinarian with no assistant, and began his practice solely out of his van! I was thoroughly impressed, and happy to learn some valuable techniques! At the nursing home, we encountered a cage full of canaries, a grassland tortoise, and a parrot. The canaries were fairly easy to handle. We caught them in a fishnet and carefully examined each one for mites. They have been medicated for a mite infestation, and now seem to be mite-free! We trimmed each toenail, and examined their feet and beaks, and freed them into the other side of their divided cage.

Next came the tortoise. This was a serious case because the lady in charge of all the animals had taken the advice of the pet shop owner, and was feeding and housing her tortoise all wrong! A grassland tortoise needs grass to eat, grass or cotton bedding, and a UV/ heat lamp. This tortoise had fruit to eat, cedar shavings for bedding, and only a heat lamp for lighting. It was a quarter of the size it should be at four years old, and its shell was flexible and concave in shape! Luckily, all of these things can be remedied and partially corrected with the correct husbandry practices. The lady was devastated that she had caused her tortoise to be in such poor shape. We informed her that not every pet shop keeper, or Petco/PetSmart employee, knows the correct information about their animals, and we gave her some good resources to study up about her animals. Her parrot was in pretty good shape, aside from a few attitude problems, but Dr. Dan had her sitting on his hand in a few short moments. He’s kind-of the bird whisperer! We drew blood and clipped her nails, gave her a bath, weighed her, and trimmed her wings. Dr. Dan restrained her while I did all the dirty work! It was nice to start practicing the things they have been teaching me all week!

When we returned to the clinic, it was already fairly late in the day, so I did the fawn’s pm treatments before heading home.

Day 4

May 27, 2010

This morning, when I got to the clinic, Dr. E was preparing for surgery. Evidently, last night a sugar glider got its leg caught in its cage, and in order to break free it began chewing its leg off. This morning, the owner found the animal with a mangled rear leg. Dr. E decided the best treatment would be amputation. The surgery was very interesting for me because I had never watched a limb amputation surgery before. She carefully transected the muscles of the leg just above the knee, using stay sutures to keep track of which muscles were which. She then cut the femur, slightly higher than where she cut the muscles, in order to leave enough space to suture the muscle bellies together over the end of the bone.

By the end of the surgery, Dr. E had neatly sutured the skin back together over the tiny stump, and there was only a nice, neat line of sutures left to show for it. When the little critter woke up from his surgery, he resumed his frustrated chirping noises and recovered normally for the rest of the day. We checked on him every five minutes for the first hour and every fifteen minutes thereafter to make sure he didn’t begin chewing his sutures out, as sugar gliders commonly do after surgery.

As soon as the sugar glider surgery was finished, we began prepping a guinea pig for a mass-removal surgery. During the surgery, Dr. E discovered that the mass under the pig’s jaw was indeed an abscess, but after expressing it, she found yet another firm mass inside of the abscess. She decided to leave the incision open to help it drain and after consulting the client, decided to aspirate the second mass and send samples for cytology. The removal of the other mass, which Dr. E suspects to be a lymph node, will have to wait until the results come back from cytology, and until the client can consult with her husband about the price of additional surgery.

Just before lunch time, a family came into the clinic carrying a fawn that had been abandoned. It was obvious it had truly been abandoned because it had maggots feeding on its skin. Dr. Dan and Dr. E were just heading out for lunch, so they put me in charge of debriding the wounds and cleaning off the maggots. We used a topical solution of Capstar to kill the maggots and make it easier to flush them out of the wounds. When I finally got them completely cleaned out, I realized the maggots had made wounds that were about a quarter of an inch deep. We dressed the wounds with Silver sulfadiazine and flushed her navel with dilute chlorhexidine. The fawn was extremely malnourished, so we started fluids, made up a very weak concentration of goat’s milk, and fed the fawn via stomach tube.

We placed her in an incubator at 80 degrees and gave her cephazolin, an antibiotic, to get a head start on any infection she may have. Later, we took her outside to exercise, and when she urinated I realized she had a patent urachus. A patent urachus occurs when the tubes that carry waste urine away from the fetus in-utero do not close properly after birth. Therefore, quite simply, the fawn urinated from her urethra and from her navel. Dr. Johnson says this is likely due to the maggot infestation, and may possibly close up on its own or can be surgically corrected once the fawn is a little older and more stable.

After lunch, we had two ferret appointments. One had an insulinoma, which is a common tumor in ferrets. It is located in the pancreas and it produces extra insulin which can cause the ferret’s blood glucose to plummet after eating. This condition is basically the opposite of diabetes, but has the same outcome. It just occurs due to different causes. Diabetes is when there is not enough insulin, or the insulin receptors are not responding correctly, so blood glucose spikes and then drops. In the case of insulinoma, the tumor produces too much insulin, so it drops the glucose levels in the blood immediately. This particular ferret is well regulated for the time being. The other ferret had an adrenal gland tumor, which is also very common in ferrets. Adrenal gland tumors cause an over-production of cortisol, which can lead to Cushing’s Disease symptoms such as hair loss and a pot bellied appearance.

At the end of the day, Dr. E did a tooth trim on a rabbit, extracted one tooth, and showed me again how to do a nasolacrimal flush. As part of this patient’s check-up, we did a full blood panel (because it’s an older rabbit), a fecal exam, and a nail trim. This is all part of many rabbits’ annual visits.

Oscar playing

Day 3

May 26, 2010

Today has been a little more relaxing. This morning, we saw a sun conure with a sore foot. It had a leg band that must have gotten caught in the cage and rubbed the skin on his leg. To remove the band, we used lots of water to keep the metal band cool while Dr. E cut it off with a tiny diamond saw. Once the band was removed, we send the client home with some antibiotic ointment to soothe and protect the tiny little wound.

Next, we saw an egg-bound Amazon parrot. Egg-binding happens often in captive birds for some unknown reasons, but also for insufficient nutrition, lighting, husbandry, etc. This particular bird was a middle-aged, strong, healthy bird that was not in distress, and the egg was not abnormal in size or shape. Therefore, Dr. E decided to try to medicate the bird and lubricate its reproductive tract in hopes the egg will descend on its own, to avoid surgery.

Today, we had another guinea pig check up that resulted in the discovery of a submandibular mass. These are surprisingly common in guinea pigs and require surgical removal. The treatment is the same whether the mass proves to be a foreign body abscess, an abscessed lymph node, or lymphoma. All require surgical removal and most likely, daily wound flushing and the application of topical antibiotics to the open wound. This client however, was too squeamish to do the daily wound flushes herself, so she was willing to pay for daily treatments for the first week and bi-weekly treatments thereafter until it heals. Once again, a lucky little pig!

After lunch, we did three ferret annual check ups, a nasolacrimal flush on a Dwarf rabbit, and a healthy pet check up on a baby prairie dog. We did a recheck on a rabbit that once had a corneal ulcer that was completely healed today, with only minor scarring of the cornea, and another recheck on a chinchilla that had a urethral stone removed. This was an interesting case that was surgically corrected before I started working at AEAC. Today the chinchilla is recovering well, however he still tries to chew at his incision site and sutures, so he has to continue wearing the e-collar.

AEAC got a new addition to their resident collection of animals today! Skipper, a senegal parrot (or African parrot) was adopted by the clinic today, because his owner could no longer spend adequate time with him. She cried when she dropped him off, but the staff at AEAC was thrilled to have him. Skipper is the sweetest bird I’ve ever known! He sits in his cage, or on top of it, and whistles at the girls when we walk by! He says his name, along with “pretty bird” and a whole vocabulary of other affectionate terms for himself. He lets you pick him up, examine his wings, scratch his head, pet him, and even turn him upside down and hold him like a baby! It’s all very entertaining!

Day 2

May 25, 2010

This morning we had an endoscopic exam for the Blue and Gold Macaw scheduled for 8 am. We put her under anesthesia to scope her cloaca to check for any abnormalities that might cause her diarrhea. Since her fecal came back negative, and the antibiotics were almost totally ineffective, Dr. Leo decided that the next step in discovering her problem, and making a diagnosis, is endoscopy. However, when we scoped her cloaca, we found nothing remarkable aside from her papillomas. Dr. Leo cauterized the papillomas with silver nitrate to eliminate any possibility of them causing some unforeseen irritation to her GI tract.

After the endoscopy, UPS brought three large boxes to the clinic, which I assumed were medical supplies that Ms. Sandy had ordered. However, when Will and Dr. Leo went rushing out the door to meet the UPS guy, I realized something else was arriving. Then I noticed that each of the boxes had words like “perishable” and “this side up” and “handle with care” written on the sides. Within minutes, it was like Christmas morning at the clinic! Everyone on staff rushed into the treatment room where Will immediately sliced through the tape on the smallest box, rummaged through the newspaper packing material, and pulled out a cheesecloth bag that moved on its own! When he opened it, out crawled a lime-green prehensile-tailed (or “monkey-tailed”) skink. Will informed me that monkey-tailed skinks are originally from New Zealand, and run about $2000 to buy. These animals were obtained by a reliable source who was trying to find the animals a good home after rescuing them.

Then came Dr. Leo’s present! Will took the initiative to begin opening the medium-sized box, while Dr. Leo stood by with anticipation. Once again, he pulled out a ridiculous amount of newspaper from around another cheesecloth bag, and opened it. This one, he opened a little more carefully. When he was ready, he released the beast into one of the large bathtub-like sinks in the treatment area. A beautiful grey-blue colored iguana with silvery scales came lunging out into the tank. She was surprisingly feminine in appearance, and even became lighter and more beautiful as she calmed down. Dr. Leo was thrilled! This iguana is called a Blue Hybrid Iguana. It is a hybrid of both a Blue Iguana from the Grand Cayman Islands, and a breed of Cuban Iguana, and is worth about $700.

Then came the largest box. This one was about four feet long and three feet wide. Will continued through the same exciting, almost ridiculous ritual with all the newspaper and the cheesecloth bag (which, I later learned, is the proper way to ship a reptile overnight via UPS!) until he revealed a massive, very dark, strong, handsome iguana with two horns on its nose that made it look extremely prehistoric and mean! This guy was Will’s new prized possession: A Rhinocerous iguana, which can be found on the island of Hispaniola, Haiti, and the Dominican Republic, worth about $1000 to buy and even more to house, feed, and properly care for.

Will and Dr. Leo had each spent the last few weeks building cages, adjusting and testing their heat and UVB/UVA lamps, acquiring foodstuffs, and researching their new pets so they would be completely set up and ready for them when they arrived. (If only every person interested in obtaining a new exotic pet would be as diligent as these two… well, then again, we’d all be nearly out of a job if that were the case so… we’ll just concentrate on education) After Dr. Eckerman-Ross, aka Dr. E, got to enjoy the company of the skink, and the rest of us got to take about a million pictures, Will and Dr. Leo packed up their reptiles, and took them home during their lunch breaks.

After lunch, it was back to work! We had a rabbit arrive with a clogged naso-lacrimal duct, which is very common in pet rabbits. We flushed out her ducts using sterile saline and catheter tubing which Dr. Leo inserted into the puncta, or the openings to the lacrimal ducts. In order to know if our flush was successful, we watched the bunny’s nose for dripping saline. This lets us know that the ducts are open, and/or that we removed any debris, mucous, etc. that was blocking them.

After the eye-flush, we did an annual visit with a Serval Cat. A Serval is generally a little over twice the size of an ordinary house cat and looks a little bit like an Ocelot. The owner walked the cat in on a leash with a harness, and it behaved surprisingly well for a wild feline.

Later in the day, we did wing and nail trims on a blue and gold macaw and an African gray, we saw a boa constrictor with a nose lesion and a mild respiratory infection, and a hedgehog with a severe tooth abscess which was euthanized due to the cost of the surgery and supportive care that would be needed afterward.

We also saw a very sick parakeet that was acting lethargic and was constantly puffed up, which is a sign of illness in birds. This particular parakeet, however, was actually eating constantly and losing weight quickly which is a hallmark sign of a disease caused by megabacteria, which is actually a yeast organism, and not bacteria at all. The yeast overgrow in response to stress and other factors, and can be treated with a special formulation of amphotericin B which is added to the bird’s drinking water and labeled especially for the treatment of megabacteria.

At the end of our evening, we saw a leopard gecko with swollen joints. This condition is fairly common in captive leopard geckos because of a couple of reasons (such as metabolic bone disease or a systemic bacterial infection causing abscesses in the joints), but most commonly due to poor husbandry practices. However, this particular gecko was less than a year old, and had been kept correctly, according to the history and the explanation of husbandry practices from the owner. Therefore, it is possible that this gecko had a congenital kidney defect that caused it to be unable to filter uric acid (the metabolic waste product of reptiles) out of the blood. This leads to the accumulation of urate crystals in the joints and sometimes the organs. The treatment for a condition as progressed as this is generally palliative and can include surgery, allopurinol (to reduce further accumulation of urate crystals in the joints by decreasing the uric acid levels in the blood) and pain medication. Dr. Leo lanced one of the swellings for a cytology exam to look for urate crystals to confirm her diagnosis. The view under the microscope was of textbook quality, and definitively diagnostic of gout. Although the disease cannot be cured, the prognosis is grave, and Dr. Leo’s best recommendation was euthanasia, the owner decided to take the gecko home on allopurinol and pain meds to wait out the inevitable. Dr. Leo thinks it will be less than a week before the owner brings it back for euthanasia.

Day 1

Here I am in Raleigh! I’m both excited and nervous about starting this internship, but I am dying to just get in there and put my hands on something after all the book work I’ve had to do for school. Too much time in the classroom and not enough in the field!

May 24, 2010

When I arrived today, I met Will who is one of the many technicians that work at Avian and Exotic Animal Care. He immediately took me under his wing and began showing me around. He and Andie, one of the other techs, were hustling around to finish cleaning cages before the doctors started seeing clients. I met the residents at the clinic: Oscar, a ferret, Constantine, a green iguana, and a few birds and bunnies. These guys are all part of the clinic’s little family of animals, and are mostly used as blood donors and waiting room entertainment for the visitors.

At eight AM, the doctor on duty started seeing patients. Dr. Leonatti told me to just follow her around all day and if she is in a room with a client, to just knock and come on in! So I did! Our first appointment was with a Bearded Dragon. The owner said she had noticed him sitting with his eyes closed constantly since two nights ago when her son fed him and rattled some dust off the top of his cage down onto him. (This whole story required probing the client for more information over the course of about 20 minutes!... guess this is private practice for ya!) Anyway, Dr. Leo (her affectionate nickname among the techs and other doctors) decided we needed to flush out the lizard’s eyes. She held them open with an eye loop, and I flushed them out with saline. Pretty fun for my first appointment! The “beardie” immediately started to keep its eyes open a little better and became more active as we watched him, so I think we fixed the problem.

Next we saw a hamster with diarrhea, to which we gave fluids and prescribed chloramphenicol. Hamsters can get a disease called “wet-tail” which is diarrhea caused by a specific combination of bacteria. Untreated, it can lead to dehydration and death in only a day or two. Dr. Leo seemed confident that we caught it early enough to treat the problem and avoid any severe consequences.

Also this morning, we saw two guinea pigs. One was a recheck after an abscess removal, and the other was a regular patient in for her monthly tooth trim. The guinea pig that had the abscess removed was doing well. Dr. Leo and the pig’s owners were very pleased with the home treatments they had been administering, and her incision was healing as they had hoped, from the inside out. Her owners had to flush out the hole daily and apply an antibiotic ointment to the opening, to allow drainage of the abscess, and to prevent it from healing over on the outside and recreating the same infection on the inside. The other guinea pig that came in for the tooth trim had severe jaw malalignment. This can be a serious problem in guinea pigs because they have teeth that grow continuously. Any surface of a tooth that does not perfectly oppose the opposite arcade of teeth will become overgrown, and can even begin growing into the roof of the mouth or the cheeks. Just like horses, some guinea pigs have to have their teeth filed down periodically to prevent the wearing of their teeth into sharp points. This particular guinea pig’s teeth were so malaligned that the bottom teeth frequently grow together over the tongue because they don’t oppose the upper arcade of teeth at all. They basically grow almost perpendicular to the upper teeth. Therefore, her owners bring her in almost once a month to have her teeth filed down. Luckily, she has very dedicated owners who don’t mind spending the money, time, and energy bringing her to the vet once a month and hand-feeding her every day. Luckly little pig!

After lunch, we saw a couple of healthy rabbit and guinea pig annual exams. Then came a ball python with what the owner was describing as “multiple splinters between her scales.” When Dr. Leo examined her however, she decided that the scales were simply damaged by the cedar shavings the owner had used as the snakes bedding. Since none of the “splinters” needed to be removed, Dr. Leo educated the client on some other husbandry ideas and to watch for the next ecdysis (shedding) to monitor for any problems with retained shed.

Next, we examined a Blue and Gold Macaw with a chronic feather-picking problem and cloacal papillomas. Captive birds need a great many parameters to be met in order for them to live a happy, healthy life in captivity. If a few, or sometimes even one, of these requirements are not met, it could lead to a feather-picking episode where the bird plucks out its own feathers due to either disease (its abdomen is sore so instead of biting at its belly like a horse or dog may do, the bird picks out all its feathers in that area), boredom, malnutrition, etc. In the case of our patient, she was a rescue animal from a home where the lady’s husband died and she was afraid of the bird, so she kept her in the basement alone. Most often, once a bird begins feather picking, unless it is addressed very early, it is nearly impossible to reverse, and the bird will continue its habit for the rest of its life. This bird is now being cared for correctly, but will always look like it is sick because of its ragged appearance. She was visiting the doctor today because of unexplained diarrhea. Her fecal float came back negative, and her cloacal papillomas, which she has had for a long time, seemed to be fairly idle with minor inflammation. The cloaca acts as a bird’s collector for urine, feces, and/or reproductive secretions. The cloacal papillomas, contrary to what we vet students would like to think, are actually caused by a herpes virus, and not a papilloma virus. We examined the bird briefly and scheduled an appointment for an endoscopic exam of the cloaca for tomorrow morning. That should be very interesting indeed!