Case of the Month

Click on the headers below to learn more about each case!

Captain is a five-year-old panther chameleon who has been a favorite patient at the Veterinary Center for almost as long. Recently, Captain developed two mysterious crusty brown skin lesions along his sides. Skin problems are common in chameleons and other reptiles, as they have very specific nutritional, temperature, and humidity requirements and often manifest inappropriate diet and environmental conditions as skin changes. Chameleons, in particular, have very delicate, complex skin, making them prone to a number of skin conditions. The doctors at the Veterinary Center examined Captain but were not sure what was causing his skin lesions, as Captain’s diet and environment were ideal. The veterinarians scraped off a small section of affected skin with a sterile scalpel blade to look at it under the microscope – a procedure called making an impression smear of the lesions to see whether any organisms (such as bacteria, fungus, or parasites) were present in the skin. However, only normal skin bacteria were present, so the cause of the lesions was still a mystery. The vets sent Captain home with a dilute iodine solution to keep the area clean, as well as topical antibiotic ointment to prevent infection and help the lesion heal.

At home, unfortunately, Captain's lesions continued to progress, and he started to lose his appetite and energy. Captain returned to the hospital for a biopsy of one of the lesions in another attempt to identify the cause. The vets were able to remove one of the two lesions completely for biopsy, and the surgical area healed well. Surprisingly, the biopsy results were inconclusive. The pathologist reported "necroulcerative tissue," or dead, inflamed tissue, but could not identify a cause, such as fungus or bacteria. The vets decided to take treatment for the remaining lesion in a different direction, opting to use a chemical debriding ointment that helps to slough off dead tissue and promote healing. After about two weeks of this treatment, the lesion scabbed and stopped growing and has remained the same size and shape ever since. Captain's owner takes weekly pictures of the lesion to make sure it doesn't start growing again and brings him in for regular checkups. Captain's energy and appetite have returned, and he is living happily at home.

Chameleons are especially difficult creatures to care for due to their specific temperature, humidity, dietary, and habitat requirements. Captain lives in a four-foot-tall cage, with live plants, an automatic water-sprayer, and special lights for heat and ultraviolet rays. As Captain’s case demonstrates, it is important to bring exotic pets such as chameleons in for regular check-ups, as they often will not show outward signs of illness until they are very sick. Luckily, Captain's owner was very attentive and noticed his skin problems before they became too much of a problem!

One interesting question about chameleon skin: Do they really change color? 
Yes! However, not in the way people usually think. Chameleons are not able to change color based on what they're touching. Their colors actually change based on their mood, environmental conditions, and surrounding temperature. Happy, healthy chameleons show bright vibrant colors, while angry chameleons may become uniform in color. Stressed, sick, and cold chameleons darken in color. So, next time you see a chameleon, you may be able tell a little about how it’s feeling based on how it looks!

knightKnight is a young male rabbit whose owner noticed he was having trouble using right his hind leg and seemed to be uncomfortable when placing pressure on it. After examining Knight, the doctors at the Veterinary Center were immediately suspicious of a bone fracture, so they took an x-ray to see exactly what was going on. The films showed a very pronounced fracture in his tibia, the equivalent to the human “shin-bone.”

The doctors put Knight on medications to treat his pain and prevent infection. To treat his injury, the doctors stabilized Knight’s fracture by placing his leg in a cast to enable it to heal. Due to the severity of his fracture, Knight remained hospitalized at the Veterinary Center so that the doctors could monitor his recovery. Although he missed his owners, he was treated like royalty at the Veterinary Center, receiving nearly constant attention and being showered with behind-the-ear scratches and yummy greens. The doctors and technicians changed Knight’s cast weekly and gave his leg cold-laser therapy each time to help decrease inflammation and promote quicker healing.

Despite the staff’s best efforts to save his leg, Knight’s fracture would not heal, so the doctors decided to take a different route; they took Knight to surgery to amputate his leg. Although this sounds very drastic, it was the best possible solution to spare him the pain from the fracture and to stop any risk of infection from the injury.

Four days after surgery and one leg short, Knight was ready to go home! The surgical site healed very nicely, and Knight was hopping around his cage by the time his owner came to pick him up. Knight is now home, as happy as any four-legged rabbit, and he has fully recovered from his surgery.

The cause of Knight’s fracture is still unknown; however, he lived in an outside enclosure, and it is possible that a predator, such as a raccoon, reached in and tried to grab him, or he somehow got his leg caught and tried to free himself. Although many rabbit owners keep their pets outside successfully, it is important to consider the associated risks: predation, stress, parasites such as mites or gastrointestinal worms, and rapid temperature shifts due to weather changes. In general, rabbits are safer and live longer when housed inside where there are typically no predators, infectious diseases, or significant climate changes. Knight is happily living inside now and has not slowed down one bit in his new three-legged life.

MacawBuster is a blue-and-gold macaw who has lived with his owner for more than 32 years! Buster came to the Veterinary Center because of a large mass on his tail. He had previously been seen by a non-avian specialist veterinarian who recommended euthanasia. However, the doctors at the Veterinary Center were not convinced that Buster was a lost cause. Buster underwent several diagnostic tests, including a complete blood count, protein electrophoresis (an analysis of blood proteins, such as gamma globulins, to determine the status of the immune system), and a blood chemistry analysis, in addition to X-rays and a fine-needle aspiration of the mass to sample the mass’ contents to try to identify it. Overall, Buster’s blood tests were normal. However, the results of the aspirate suggested a sarcoma - an aggressive form of cancer - so the doctors took Buster to surgery to remove the mass. Fortunately, the doctors did not have to amputate Buster's tail, as they were able get nearly all of the mass off. Due to the aggressive nature of his cancer and that fact that the vets were unable to completely remove the tail mass, Buster will likely have to undergo further treatment with radiation and chemotherapy. Meanwhile, Buster is recovering well at home as he approaches his 33rd birthday!

tortLeo weighed 4.5 kilograms (almost 10 pounds) and had lost some weight since her last visit. Although a 10-pound tortoise may seem very big, some adult Sulcatas can weigh as much as 50-200 pounds! Sulcatas are a huge investment as a pet not only because of their huge size, but also because of their longevity. Healthy Sulcata tortoises can live 70 years or more!

Leo’s growth was likely stunted due to a condition called metabolic bone disease which occurs when reptiles don’t have enough calcium in their diet and usually are lacking exposure to ultraviolet (UV) lighting. Without appropriate calcium and UV light, reptiles can’t build their bones appropriately for normal growth. This causes their bones to be soft and prone to fractures and malformations and ultimately may lead to overall body stunting.

When the veterinarians saw how stunted Leo was, they took X-rays of her. Once the x-rays films were processed, it was easy to see Leo’s problem. She had a large stone called a urolith in her urinary tract! The stone was 5 centimeters wide and much too large to pass naturally. As a result, the doctors decided to perform surgery to try and remove the stone from Leo’s body.

peahen1Queenie, a 4-year-old female peahen, came to the Veterinary Center for Birds & Exotics because of her swollen eye. A peahen is a female peacock; collectively, males and females are called peafowl. Upon first glance, anyone could tell there was something wrong! There was a very large swelling, about the size of a super-sized gumball, in the inner corner of her left eye (see photo #1). The swelling was so large that it was difficult to tell if the eyeball was even there, but after close examination, the doctors determined that the eye was just fine. The sinus that sits just in front of the eye was actually where the problem was.

To determine the cause of the problem, the doctors inserted a needle into the swelling to collect cells to determine if the swelling was an infection or cancer. The sample they took was placed on a microscope slide and submitted to a specialized veterinarian called a pathologist for identification of the cells. The swelling turned out to be an abscess (a pocket of pus) in the bird’s infra-orbital sinus (the sinus in front of the eye).

The tricky thing about birds’, herbivores’ (rabbits, guinea pigs, rats), and reptiles’ pus is that it is thick, like cottage cheese or toothpaste, because these animals lack the ability to break it down into a liquid, like our pus. This is the reason we have to perform surgery to remove the pus from these animals and not just cut the area open and let it drain out.

The doctors performed surgery to remove the giant ball of pus from the corner of Queenie’s eye. At first, she was sedated and given pain medication to ease her into anesthesia. Then a breathing tube was placed in her trachea to help us ensure she was able to breathe under anesthesia. The veterinary technicians placed a heart monitor on her to follow her heart rate. Then the area where the surgical incision was to be made was scrubbed with a sterile surgical preparation.

peahen2The eye is an area of the body that contains many nerves and blood vessels and has the potential to bleed significantly in surgery. Therefore, the doctors used a specialized surgical tool called an electro-cautery to make the incision, allowing the blood vessels to be cauterized instantly to prevent blood loss. Once the cut through the skin was made, the vets immediately saw thick yellow pus underneath. Very carefully, they loosened the ball of pus from the sinus pocket and removed as it one big solid chunk. Then they flushed the sinus with sterile saline to remove any excess infectious debris. They left the skin incision open so that the sinus could be flushed with sterile saline daily over the following days to try to prevent recurrence of infection. Since the eyes and nose connect via the sinuses, her nostril and the slit in the roof of the bird’s mouth, called the choana, had debris in them, as well; so the doctors cleaned these areas out, too, during surgery. They had to be sure to remove all the pus from the mouth and nose to try to prevent the infection from lingering.

Immediately after surgery, Queenie felt so much better! She could now breathe through her nose again and see out her left eye (see photo #2). Queenie stayed in hospital for the next few days so that the doctors could flush the surgical site. By the time she went home, the incision had already healed all on its own without the use of stitches. She was placed on antibiotics and pain medications to help with the remaining swelling. Today Queenie is doing great! The eye infection hasn’t returned, and she is back with her flock, living her happy peahen life, once again.

tikkiTikki, a 14-year-old female sulfur crested cockatoo, was brought to the Veterinary Center for sudden lameness. Tikki came in dragging her beak on the ground in order to move, as she could not use her right leg at all. The veterinarians at the Veterinary Center examined Tikki and saw that she couldn’t bear any weight on that leg, so they decided an x-ray was the first step to figuring out what was going on.

The x-ray revealed that she had no broken bones. However, her right hip was dislocated. Coxofemoral luxation – dislocation of the coxofemoral, or hip, joint - occurs when the thigh bone (the femur) is pulled from its hip socket and rests outside the socket inappropriately. Dislocation of the hip occurs most commonly from trauma, such when a bird gets its leg stuck in a cage and tries to pull it free. During traumatic events like this, the ligament that holds the femur into the joint socket is damaged, allowing the femur to dislocate. In Tikki's case, no one knows what exactly happed to cause her injury, but the x-rays confirmed that her hip was clearly dislocated.

Getting the femur back into its socket is not an easy task. The problem is that in birds, the hip joint socket is very shallow, and even when the femur put back into place in the socket, without the ligament to hold it there, it can pop back out easily. With this injury, surgery is often needed to suture the femur into the hip socket, effectively recreating the ligament, to ensure the femur stays put. This type of surgery, called an open reduction, is very involved not only because the skin and muscles around the hip must be cut through to access the joint, but also because there is risk for nerve damage, bleeding, and infection of the hip joint. In Tikki's case, before taking the risks associated with an open reduction procedure, the vets performed a closed reduction - attempting to get the femur to stay in place without surgical intervention. If the closed reduction didn’t work to keep the femur in the hip socket, the doctors would move to an open reduction, but since birds are at risk for significant blood loss at surgery, less invasive procedures in these animals are generally preferred methods of treatment.

The vets and technicians anesthetized Tikki so that her leg could be touched without hurting her. They carefully manipulated her femur back into its socket. Because the femur ligament was severed, the femur would not stay in place in the hip joint without a little help. The vets made a cast for Tikki's leg that extended from her toes to up and over her hip to help keep her femur in place in the socket. Ideally, the cast would prevent her leg from moving and her hip from dislocating again. Over time, Tikki’s hip muscles would strengthen, and scar tissue would form in the joint where the torn ligament was, helping effectively to keep the femur in place, as the ligament would have.

After the closed reduction, Tikki was placed on strict cage rest and remained in her cast for 3 long weeks! This was difficult, as cockatoos are very active and don’t like being caged. After 3 weeks, the cast was removed. Without the cast on, Tikki still had to rest for another 1-2 weeks, but she began standing on her leg and using it to perch. Like a human who has had a cast on and has not used his leg for a long period, Tikki was very weak on her leg when the cast first came off. With the vets’ guidance, Tikki’s owner started Tikki on daily physical therapy consisting of several cycles of passive range of motion exercises in order to strengthen her leg muscles and increase flexibility of her injured leg. Once she was gripping well with her foot and able to perch normally, Tikki was allowed to walk for only short periods of time each day at first. Initially, she was very tired from walking just a few feet. Slowly, over a few weeks, Tikki’s walking time was increased, until she regained normal function of the leg without getting tired.

Today, Tikki is happy and healthy, once again standing on her own two feet. She was one lucky bird to have avoided surgery! Thanks to the team at the Veterinary Center and to the dedication of her owner, enforcing both the cage rest and physical therapy, Tikki can now live a normal active bird life again.

happyHappy, a 9-year-old female rabbit, came to the Veterinary Center for examination of a possible broken leg. The previous night, her owners were awakened by her frantically running around her cage, and the next day, she wouldn't place weight on her back right leg.

The doctors at the Veterinary Center assessed Happy and saw that her left leg was obviously broken. They took an x-ray to determine where the limb was fractured. Rabbits have very fragile bones, and often their bones shatter into multiple fragments. Fortunately for Happy, her right tibia (shin bone) was fractured almost in half but was broken only into 2 pieces. Surgical repair of bones in rabbits can be trickier than in dogs and cats, because rabbits’ bones can more easily shatter with manipulation, and fracture sites can become easily infected. Therefore, Happy’s owner elected a cast instead of surgery to keep Happy’s bone stable so that it could heal. It takes about 3-4 weeks for most fractured bones to heal in rabbits.

A good veterinarian knows to perform a full physical examination on all patients, even if the patient has an obvious problem such as a broken leg, so that they don’t overlook other abnormalities. In Happy’s case, it was a good thing she did get a full physical exam because the doctors discovered a problem more serious than her broken leg. In the middle of her abdomen, the doctors felt a firm and bumpy mass that they determined was her uterus. Rabbits over age 4 years have a greater than 80% chance of developing uterine cancer if they are not spayed early. This scary statistic, taken with the large number of rabbits the doctors at the Veterinary Center see with uterine cancer, is why our vets recommend spaying all female rabbits, preferably at 4-6 months of age or shortly after.

The most common type of uterine cancer in a rabbit is uterine adenocarcinoma. This particular type of cancer likes to metastasize, or spread, most commonly to the lungs. Therefore, the vets took x-rays of Happy’s chest to check for spread of cancer. They emailed copies of the x-rays to a board-certified veterinary radiologist for interpretation. Thankfully, the radiologist did not see any evidence of metastasis to Happy’s lungs.

Since the cancer seemed to be localized to her uterus only, the doctors decided that Happy needed to be spayed to remove the cancer before it could metastasize. Surgery in a bunny as old as 9 years is not commonly performed but was recommended in Happy’ s case, as spaying her gave her the chance to be cured of cancer.

The vets took Happy to surgery to remove her uterus and ovaries. She recovered well from surgery and went home the next day. Happy has been doing well at home since surgery and has even gotten the hang of walking with her cast which is due to come off soon. Happy’ s case demonstrates how a comprehensive physical examination in a rabbit can be as life-saving as it is in a cat, dog, or a person. Her broken leg was a blessing in disguise, as without it, she might have died of uterine cancer – a completely curable disease if caught and treated early. Never underestimate the importance of preventative medicine, even in a bunny.

hootyHooty, a young male great horned owl, was brought to the Veterinary Center by a trained professional bird rehabilitator from a local nature center. Sadly, Hooty was hit by a car and suffered a broken wing, so he was brought to the veterinarians at the Veterinary Center for assessment.

When the vets first saw Hooty, it was obvious that the bones of his right forearm – the radius and ulna - were broken. Hooty had what is called an open fracture, meaning the broken bones cut the skin right over them, making the fracture very visible. He also suffered from head trauma and dehydration. To better evaluate the fracture, the doctors took an x-ray of Hooty’s wing, as well as of his whole body, to check for internal damage. Thankfully for Hooty, there was no internal damage.

Hooty stayed in the hospital for care. Right away, he was given pain medication for his broken bones. It was important to wrap the wing in a cast to make sure the bones would not move and cause him more pain. He was also given fluids to re-hydrate him and fed via a syringe to make sure was getting proper nutrition. He was also started on antibiotics to prevent a bone infection from the open fracture site. Once Hooty was on antibiotics and fluids for a few days, he started feeling much better and was stable enough for surgery.

Hooty was taken to surgery to fix his broken wing. A metal pin was inserted into the middle of the bone to keep the two bone fragments lined up. This would allow less motion from the bone fragments and faster healing time. The pin placed in the bone gave him more strength to hold his wing up once it was healed. Unfortunately, the break on his arm was too severe for him to ever fly again, but with the pin placement, he will be able to live comfortably in captivity.

Hooty recovered from surgery very well. His wing was bandaged for 3 weeks. Twice a week, Hooty was anesthetized, and the bandage was removed for physical therapy of his healing wing. Physical therapy consisted of extending the wing and moving the shoulder in a normal range of movement. This step was vital to his recovery, as his muscles must remember how to move in a normal fashion. Cold laser therapy – in which a red laser light is shined over the healing fracture site for several minutes each day - was also used to decrease inflammation, decrease pain, and speed cell division, so that the bones heal faster.

Today, Hooty’s wing is completely healed - no more bandage. He now spends his time in a nature preserve educating people on the importance of wildlife conservation and the majesty of great horned owls.

Speedy is an almost 3-year-old male Russian tortoise that was brought to the Veterinary Center for Birds & Exotics after taking a tumble down the stairs! In consequence to the fall, Speedy unfortunately had cracked the left side his shell. Thankfully, the doctors at the Veterinary Center knew just what to do to help Speedy.

Cracking the shell can be a big problem in turtles and tortoises, because a cracked shell is a broken bone. Since the shell is made up of living bone, when it breaks, it needs to be repaired, just like a broken arm. You can think of the shell of a turtle or tortoise as the protective armor of bones outside the body that works in unison with the rest of the turtle's skeleton. In fact, their spinal cord is actually fused to the top of the shell, making some shell injuries through the top of the shell very serious. Luckily for Speedy, his shell injury was located at the bridge between the carapace (top half of the shell) and the plastron (bottom half of the shell), and not along the spine.

Because a shell fracture is a broken bone, Speedy’s shell needed to be fixed using a lot of the same principles a doctor would use if you broke one of your bones. The fragments of bone must be placed back next to each other and kept very still so they can heal optimally. The edges of the broken shell were aligned as close together as possible, and then zip tie mounts were placed on each side of the fracture. The mounts were adhered to the shell using glue and epoxy. Zip ties were laced through the mounts and pulled tight to hold the fracture fragments in place. And voila, the fracture could now heal!

Since Speedy had a fracture exposing the muscles and layers under the bony shell, the fracture site was at a high risk for infection. Therefore, Speedy was sent home on a course of antibiotics to try to prevent this from happening.

While attaching hardware to a shell sounds like an easy fix, it’s not! If you ever find a turtle or have a pet that cracks its shell, make sure you bring it to an experienced exotic animal veterinarian like those at the Veterinary Center right away so your friend can heal the best way possible.

The mounts and zip ties were left on Speedy’s shell for at least 6 months, and the fracture appears to have healed well. Speedy is doing great since the repair. He’s eating, drinking, and climbing again – hardware and all! Before long, we’ll take off all his accessories, and he’ll be as good as new.

turtle-case

Snowy, a 20-year-old male sulfur-crested cockatoo, was sent to the Veterinary Center by another veterinarian for a second opinion. Over the previous 1-2 weeks, Snowy’s owners had noticed that he was quiet, not eating very much, and losing weight, and they were very worried about him. The veterinarian they originally brought him to had run blood work (which showed a slightly high white blood cell count, indicating the presence of infection or inflammation) and taken whole body x-rays. The x-rays showed the presence of an enlarged organ in the coelom (which is the body cavity of the bird, which is not divided into abdomen and chest, as it is in mammals, as birds don’t have a diaphragm separating these 2 regions); however, the origin of the enlarged organ could not be determined from plain x-rays alone. At this point, Snowy’s original veterinarian referred him to the Veterinary Center for a further work-up.

At his first exam, Snowy was stable but a little quiet. The doctors hospitalized him for supportive care, including an antibiotic injection that had a 5-7 day effect, a vitamin injection, and syringe feeding, since Snowy wasn’t eating much. His stool was evaluated under the microscope by one of the technicians and was found to have an excess of yeast, suggesting a mild yeast infection in his gastrointestinal tract. Snowy remained in the hospital overnight, and the following day, the doctors performed a barium contrast x-ray study. This is a special type of x-ray study where barium contrast material – the white chalky liquid - is first given through a tube into the bird’s crop (the dilated pouch of the esophagus in the neck), and then a series of x-rays are taken as the contrast material makes its way down through the stomach and intestinal tract. The doctors gave Snowy barium in the morning, and then took a series of x-rays over the following few hours.

Birds have two stomachs: the first stomach (called the proventriculus) is very similar to our stomach, while the second stomach (called the ventriculus, or gizzard) is a very thick-walled, muscular organ used for grinding food. The barium study (in which barium fills up the stomach and intestines and appears white on x-rays) showed that Snowy’s proventriculus was dilated and larger than normal (note the arrow on the x-ray). There are many causes for a dilated proventriculus, including the ingestion of foreign material in the intestinal tract, lead poisoning, cancer of the intestinal tract, and bacterial or viral infection. One serious infection in birds that can cause a dilated proventriculus is called proventricular dilatation disease (or PDD), caused by a virus called bornavirus. The virus causes inflammation of many nerves but especially the nerves going to the intestinal tract, which can cause the proventriculus to dilate, to contract poorly to digest food, and to function improperly. The doctors drew a blood sample to test for this virus, and unfortunately, Snowy tested positive. While it is impossible to say definitely that a bird has this disease without taking a nerve biopsy, Snowy’s clinical signs (such as weight loss and decreased appetite), dilated appearance of the proventriculus on x-rays, and positive test result all support PDD as the underlying problem.

Unfortunately, as of yet, PDD is not a curable disease, and it generally is ultimately fatal. Some birds, however, appear to test positive and may not develop signs of disease or die but can spread the virus to other birds through their droppings. The doctors started Snowy on an anti-inflammatory medication called Celebrex to decrease inflammation of infected nerves, and they may start him on additional supportive medications if he starts to show further symptoms. At some point, the doctors will recommend retesting Snowy to see whether he remains PDD positive or whether the virus could, by chance, be passing through his system. For now, Snowy’s owners are just taking it one day at a time, and Snowy is being a trooper, taking his medication and still enjoying his head scratches.