Category Archives: Today I Learned

What I Learned This Week

Here’s a sampling of what I learned this week:

  • Chameleons can’t convert beta-carotene to vitamin A
  • There’s some kind of freeze-dried diet of cactus fruit for tortoises–cool!
  • Necropsy on a 5-year old guinea pig revealed a large tumor inside her uterus–never seen something quite like that before
  • Necropsy on a 3-year old budgie revealed one of the largest renal adenocarcinomas I’ve seen. The bird had demonstrated the predictable loss of use of its leg, mimicking a broken leg in the owner’s eyes.
  • Over the past several weeks, I’ve had a crash-course in Mycoplasma infections in rats. Usually, when I see respiratory problems in rats, they’re on an individual case-by-case basis. A rat-owning client of mine recently acquired two female rats, not knowing they were pregnant, until they delivered 20 babies (between the two of them) three weeks later. All of them have been plagued with respiratory difficulties since then, and two have died. This week, I came across this article, which helped shed some much-needed light on the subject for me: “Mycoplasma pulmonis in Rats,” by Drs. Jennifer Graham and Trenton Schoeb, Journal of Exotic Pet Medicine, Volume 20, Issue 4 , Pages 270-276, October 2011.
  • Palpated my first trigger point (see videos in my previous post)–wow, was it painful for the poor dog!!
  • Evaluated behavior of a young but socially mature English bulldog with unusual, but severe aggression. He was adopted from an area shelter last November. He doesn’t seem anxious or fearful like most of my aggressive patients, but we’re pretty sure he has hearing loss. His behavior seems totally appropriate, and he’s very social. But if he becomes over-stimulated, it’s like a switch goes off and he gets a “crazed look” in his eyes. He has attacked the owner herself and the owner’s mother, sending the mother to the ER with serious injuries of her arm. The owner realizes that euthanasia is appropriate, and may ultimately be necessary. We are going to try an 8-week course of fluoxetine to see if that helps even out his excitability (in addition to strict environmental management). If it does, he will need to stay on it for life. I’ve never encountered a dog with aggression quite like this before–it will be an interesting road that we walk together.

It was a pretty good week, one in which I was able to help people and beloved animals. I don’t feel like I had any “do-overs” this week.

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What I learned this week

Chinchilla

Photo Credit: Pachyblur

For me, doing is learning. Here’s a run-down of what I did this week that seemed noteworthy enough to list:

  • My first ferret fracture repair–a 10-month old ferret broke his R femur via unknown trauma. Placed an IM pin and two cross pins. Caused some splintering of the bone in the process but I was mostly satisfied with the result. Really, really hoping for the best for this little guy.
  • Gastrotomy/foreign body removal on a young Golden Retriever
  • Epidural on the same dog
  • Dealt with the worst chinchilla paraphimosis I’ve ever seen. After removing a fur ring constriction around the base of his penis (under sedation), I just kept him on metacam (and used lots of lubrication), and over the course of about 6 days, it has gone from possibly needing amputation (good thing we didn’t go that route) to returning almost completely back to normal.
  • Performed a molar grind on another chinchilla who has the worst teeth I have ever, ever, ever seen. I’ve been working with him for quite awhile, actually–this was one of our “routine” check-ups. He is also the only chinchilla I have extracted molars on before. I didn’t think he was going to survive this long, but he is such a trooper and his family is so committed to him!
  • Tried (and failed) to troubleshoot technical difficulties at a local CE presentation (as president of the local VMA, I feel a responsibility for making sure everything goes smoothly–this was painfully disappointing). The speaker did a phenomenal job of presenting off-the-cuff and I still learned a ton, including:
    • If a young, healthy dog has elevated liver enzymes but no clinical signs, the first step she recommends is trying a limited ingredient diet.
    • If performing an ultrasound-guided aspirate of the liver, use a 25-gauge needle. She’s never known a case to bleed excessively from that small of a needle, and sedation is not (usually) needed. The FNA can help indicate things like histoplasmosis or other potentially infectious causes.
    • If performing an ultrasound-guided biopsy (under sedation of course) of the liver, ALWAYS do a coagulation profile first. She said everyone at their specialty practice has been burned at one time or another by having a patient bleed excessively after a liver biopsy.
    • Her preferred antibiotics for liver infections are ampicillin or amoxicillin. But she said make sure these are given IV. The bioavailability of ampicillin when given orally is zilch.

I’ve also learned more about college basketball (maybe I’ll post how I did with my bracket when all is said and done), I’ve learned that I’ve got a LOT of work to do on our upcoming open house, and since we set a date for our annual staff retreat (and it’s less than a month away), I need to do some serious brainstorming for that.

What is one thing you learned this week?

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Great discussion on the physical consequences of declawing

As a member of the International Veterinary Academy of Pain Management (IVAPM), I enjoy following the many interesting discussions on this favorite topic of mine. Today, a post on the discussion forum caught my attention, and I want you to check it out:

Physical Consequences of Declawing by Dr. Jean Hofve of Little Big Cat

This illustrated post shows how removing P3 shifts P2 into a weight-bearing position, and over time, the tendons contract, the cat walks differently, and arthritis develops. It definitely gives you some things to think about.

Dr. Hofve posted some additional articles/resources on the topic of declawing, which you should also check out:

I have performed declaws myself, but it has been awhile. I do not like doing them, and I try hard to talk people out of it, but I like that I can present this additional information to owners (especially the pictorial guide) and give another perspective.

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Assimilating my knowledge about Aspergillus

I’ve been wanting to write this post for awhile, because I view part of the purpose of this blog to share what I’m currently learning about. I have been working on a case that has been puzzling and frustrating me, and I think part of my frustration has to do with my inefficiency in looking up important information in a timely manner. In any case, I’m learning a lot from this situation, although some of it should not need to be re-learned in this way.

The patient I’m writing about is a 25-year old Timneh African Grey parrot. The owner acquired him from her father, and although the bird has been well-loved, it has not been particularly well cared for. I’m the first vet the bird has ever seen. She brought it to me because his nostrils keep getting clogged up (one was completely closed with dried debris). He’s been on an all-seed diet his whole life. That right there is a big problem.

I’ll cut to the chase, because there’s no sense in sharing my experiences step by step, when I can do a summarized version. The bird has localized nasal aspergillosis. No, I did not know that right off the bat. For almost two months, I’ve been seeing the bird every 2-3 weeks because I’ve been struggling with reaching a definitive diagnosis and finding effective treatment. It seems like anytime cost is a concern, I try so hard to avoid unnecessarily spending a client’s money, that I probably end up wasting more of their money in the long run. This because I’m trying to do things so piece-meal (one little thing at a time), that I waste valuable time in reaching a diagnosis and implementing effective treatment. This is just as frustrating for me as it is the owner (perhaps more so).

Here’s a general summary of how this case has played out:

  • Visit #1: Flushed the nares, performed a gram stain on the very gross, white goopy discharge (yes, that’s the technical term!) from the nares, had no idea what I was looking at (see below) but sent in a sample for aerobic culture and sensitivity, performed a Standard Avian Profile blood panel (through Antech Laboratories), and started on drops of gentamicin ophthalmic solution in the nostrils twice daily and crushed Baytril (enrofloxacin) tablets in the water because the owner was concerned she coudn’t get the meds in his mouth (mistake #1).
  • Visit #2: Zero improvement, repeated the sinus flush, tons more white goop, switched to baytril given directly by mouth. The culture had grown: Providencia rettgeri (never heard of it before), Serratia Marcescens, Klebsiella Oxytoca, and Enterococcus species. (Mistake #2 = not requesting a fungal culture.)  We had discussed doing an aspergillus titer on the first visit, but since the WBC was normal (total count 4100, heterophils 2700), I didn’t think asper was likely our culprit (mistake #3), so I elected to have us stay the course with oral meds (rather than in the water, where he likely wasn’t getting enough).
  • Visit #3: Slight improvement (nostrils not as clogged up). Flushed nares and was absolutely horrified at how much debris I dislodged. I mean, I couldn’t believe it. And afterwards, you could see clear through one nostril to the other–that is not normal, I repeat, not normal! I was thinking to myself, what on earth is going on here?! I am missing something really important and obvious! So I made another slide of the discharge using diff-quick. I also convinced the owner to spend the money on an asper titer (mistake #4). Here is what I saw on my slide and why I didn’t need to waste the owner’s money on an asper titer:

Branching aspergillus hyphae from African Grey's nasal discharge

The picture is one I took through the microscope at 40x, and at 100x, you can actually see the little conidiophores (sorry, I don’t have that picture). After having looked at that slide multiple times over the course of several days, I finally began to make sense of it. I built up my confidence in knowing what I was looking at. I can now say, yes, that’s asper.

However, when the aspergillus titer came back, it was totally normal. And now I know (though I should have already known) that when a bird has such a localized infection like my patient had, they usually don’t get the heterophilia/leukocytosis and can have normal titers. Now I also know how to better recognize asper on cytology.

Luckily, when I called the bird’s owner to inform her that I had confirmed asper, she reported that his nostrils were finally staying clear! We’ve been working on the diet, among other things, and I think we’re finally on the right track. Unlike systemic aspergillosis, which is much more serious and life-threatening, I don’t think (at this time anyway) that I will need to use systemic anti-fungals for this bird. I switched from using topical gentamicin to topical clotrimazole (an anti-fungal), and increased the baytril dose from 10 mg/kg to 15 mg/kg PO BID. I’m looking forward to our next recheck because I finally have a sense that we’re headed in the right direction.

If you want, you can read another blogger’s account of aspergillus in their African Grey Parrot, Coco. She had a more serious form of the disease and nearly died (but made a full recovery!).

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