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veterinary undergraduates though, and provide a referral service for exotics. This at least means that students passing through their clinical rotations are able to spend a period of time working with exotics and learning the necessary practical skills to treat them. However, it is important for hobbyists and pet owners to be aware that a typical cat/dog vet has had an extremely small amount of training with regards to exotics generally, and certainly in terms of reptiles specifically.

This can make it very difficult for them

No special interest – cat/dog/large animal vet:

Vets in this group have received very little in the way of training about reptiles, but they are obligated to provide first aid in an emergency, and should then refer to a colleague who is more familiar with the patient concerned and its likely treatment needs.

Special interest – BVZS member:This group of vets has a special interest in exotic animal medicine. The BVZS is the acronym for the British Veterinary Zoological Society and forms a branch of the British Veterinary Association (BVA), with responsibility for exotics. Any exotics vet practising in the UK would normally be expected to be a member.

It is likely that they will have pursued

Many of the vets who see a high percentage of

reptile patients will have experience of keeping –

and handling – these animals themselves.

IntroductionReptile medicine and surgery can still be regarded as a relatively “young science”, in terms of veterinary care. This means that there is still a lot to learn, when compared with other veterinary sectors - not just dogs and cats, but also other exotic fields such as avian medicine, which is a lot more advanced.

Nevertheless, you only need to look at the size and feel the weight of the standard textbook Reptile Medicine and Surgery by Douglas Mader, extending to 1264 pages, or Medicine and Surgery of Tortoises and Turtles by Stuart Macarthur, which is still huge at half that length, and features over 1000 colour photographs, to see that over the past few decades, we have come a very long way and that a wealth of information exists already.

It is inevitable that with time, this field will continue to develop further. Today, all pet reptiles and larger collections should be registered with a veterinary practice

to recognise what might even be common ailments in this group of creatures, or to be familiar with the latest therapies and dose rates. It therefore pays dividends to seek a vet who is more informed about exotics, with a number of additional qualifications now available to practitioners who are active in this field. Understanding the background when it comes to qualifications is not always straightforward however, but as a guide, the following categories can be used to differentiate between different qualifications:

that is able to offer its services in the unfortunate event that an animal(s) were to fall ill, just as is the case with dogs and cats. This is now reasonable and worthwhile, as the provision of veterinary services for so-called “exotics” continues to expand.

Reptile vetsAlthough the situation is improving though, it is still sadly the case that exotics are largely neglected in the veterinary curriculum for undergraduates, with most of the teaching being directed towards cats, dogs and food-producing species. As far as the veterinary profession is concerned, “exotics” is the branch of veterinary medicine dedicated to any “non-core” species. This includes animals that are not traditionally considered “exotic” by the general public, including rabbits and backyard poultry.

A couple of universities are leading the way with regard to exotics teaching for

Veterinary knowledge about tortoises and other reptiles has grown very significantly over recent years.

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Faced with a sick reptile?

Here in the first part of a new series, reptile breeder and veterinary surgeon Tariq Abou-Zahr provides advice about what you need to consider when seeking a vet to treat your reptiles or amphibians, and the methods that are now available to help diagnosis.

Many practices obviously concentrate essentially on treating dogs and cats, rather than exotics.

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Any veterinary surgeon holding a DipECZM however, such as someone with a DipECZM (Avian) or DipECZM (Small Mammal) for example, would normally be extremely competent across most aspects of exotics. American diplomas are also achievable; however, they are not as common in Europe. A diploma or fellowship is needed for a clinician to become an RCVS recognised specialist. In fact, vets cannot formally refer to themselves as specialists unless they appear on this list.

FellowshipInstead of the typical MRCVS (Member of the Royal College of Veterinary Surgeons) at the end of their qualifications, veterinary surgeons holding a Fellowship display the letters FRCVS (Fellow of the Royal College of Veterinary Surgeons). This is an alternate form of specialist qualification and usually involves the submission of a thesis on a particular specialist subject, on which they are examined. Having an FRCVS in a particular area potentially allows that vet to become a recognised specialist.

animal’s husbandry, which in many cases will be inherently linked to the presenting problem.

I often spend about ten minutes talking through the animal’s husbandry, to include issues such as enclosure type/size, heating, lighting, substrate, diet, supplementation etc. The most effective histories are obtained from those clients that are honest and open to discussing various elements. Always be honest. The vet is trying to help you and your pet.

This discussion about husbandry is not meant to catch you out in any way. Its purpose is simply to highlight any areas where improvements can be made, ultimately leading to better health and welfare for your animals, as well as potentially tracking down the cause of the problem. Indeed, many vets may not be as familiar with husbandry as a vet that keeps reptiles personally. In some situations, it can be the case that an experienced hobbyist has a better understanding than a vet, in terms of husbandry requirements for a particularly unusual species.

Once the vet has a good appreciation of its background care, the next step will be to take the history of the issue of your

pet’s health. When did the problem first start? How has it progressed? What have you noticed about the symptoms? Your vet will combine this with the results of the clinical examination that will follow, in order to come up with a list of potential problems and make a plan for further diagnostics and treatment.

■ Step 2: Physical examination:Once the history has been taken, so your vet will then need to handle the patient to carry out a physical examination, although it is usually helpful to observe it from a distance first. When it is picked up, the reptile will be carefully examined, in a systematic way, typically starting from the head and working backwards, but the order does not really matter. It would normally be the case that a vet looks inside the animal’s mouth, particularly considering the high prevalence of stomatitis – mouth infections – in reptiles, which represents a condition that makes them reluctant to eat. The eyes and nostrils are also normally inspected closely.

A vet may also palpate (feel) the animal’s abdomen. In some species, such as leopard geckos, shining a very bright light through the animal, known as “trans-illumination”, allows for quite a good view of some of the internal organs. I perform this as a standard procedure in all such animals.

A stethoscope can be useful, particularly in species such as bearded dragons where a heart beat is readily heard. The clinical examination in snakes may include sexing the animal by popping or probing. Ideally, a faecal

additional training beyond what is provided to the average veterinary undergraduate, in terms of additional courses (known as CPD) in subjects related to exotics, usually including reptile medicine. Many of these vets keep reptiles personally (myself included) and have a good knowledge of the husbandry requirements of many species, which can be critical when treating them.

Certificate holderThis is the first level of additional qualifications available to veterinary surgeons practicing in exotic animal medicine. Certificate holders represent a “middle tier” between vets with no additional qualifications and recognised specialists. The RCVS (which is the governing body of the profession) oversees the awarding of the CertAVP (Zoological Medicine) to vets who are at least three years qualified and who have met the requirements, in terms of cases seen and passing the necessary examinations.

DiplomateThis is the next step up from a certificate. While the RCVS used to issue its own diplomas (DZooMed), this is no longer the case. Instead, vets may now enrol on to a European diploma course, after which (assuming you pass!) you become a European specialist in Zoological Medicine and have the letters DipECZM after your name. Several designations are available, including the DipECZM (Herpetology).

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Some veterinary surgeons are more interested in reptiles than others. Their qualifications can act as a guide in this regard.

What to expectHaving arranged to take a reptile to your chosen vet, there are a number of different possibilities, when it comes to investigating the cause of the problem. In all cases though, you need to have information available about your pet, its origins and care, including the temperature range at which it is kept and the lighting system in use. Many health problems affecting reptiles have environmental links, and so a good understanding of an patient’s background, including when it last ate, will be essential to your vet, in helping to track down the potential cause/s of the problem. ■ Step 1: History takingThe first step for the veterinary surgeon when presented with any animal, and reptiles are no exception, is to take a thorough and relevant history. The first questions are usually broad and relate to the origin and age of the animal(s) and might include how long they have been in your possession, where they originally came from and whether you has other animals in your collection. As far as reptiles are concerned, the history should include a comprehensive review of the

Once the vet has a good appreciation of its background care, the next step will be to take the history of the issue of your

pet’s health

Taking photographs of your pet’s housing on a mobile or tablet may be of value to

your vet.

� Providing a good case history to your vet is vital at the outset.

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sample should be collected if available, and this can then examined under a microscope for evidence of internal parasites.

This tends to be very easy in tortoises, as they will often produce a sample when being handled, but it is not so easy in snakes, as they often do not relieve themselves in the consulting room! In certain cases where a faecal sample is particularly vital, and where the animal has not produced an appropriate sample, it is often worth flushing via the cloaca to try to obtain one.

Based on the history and findings of the clinical examination, the vet will make a decision about what to do next, whether treatment is justified at this stage, or whether there would be value in doing some further diagnostic tests. In many cases, there will be several options, none of which is necessarily correct. Often the decision is influenced by the finances that are available.

■ Step 3: DiagnosticsThere are now a number of different tools available, which can help to identify and isolate the cause of a health problem. They include:● Blood testingBlood sampling is a very useful technique, especially as there are many potential tests that can be carried out on blood. It is unlikely that a practice will be able to process reptile blood in-house as usually, specialist equipment beyond what is needed for routine cat/dog blood testing is required, and so samples are usually sent out to an external laboratory.

Basic organ and systemic screening, to include haematology (blood cell counts) and biochemistry studies are usually very quick to run, with the results will often being available within 24 hours. These will provide lots of useful information about different systems within the body,

such as the liver and kidneys, and will often flag up potential areas where there might be a problem. Other tests that can be run on blood include more advanced PCR and serology testing for various diseases, such as adenovirus in bearded dragons.

Sampling is normally carried out in most reptiles without an anaesthetic being needed, and various sites can be used. In many lizards, a vein on the underside of the tail is often chosen, while in chelonians, a jugular sample is usually taken. Snakes, however, have always proved a challenge as far as blood sampling is concerned. Tail samples can be obtained from larger boas and pythons, but in all other snakes, the only reliable way to obtain blood is to collect it directly from the heart, a process called cardiocentesis. A special piece of equipment called a Doppler may be used to locate the heart, which is usually positioned approximately a third of the way down the snake’s body.

● ImagingThere are several imaging systems available, including more advanced options such as CT and MRI that are better-known through their use in human medicine. In the majority of cases however, either radiography (X-rays) or

ultrasound examinations are employed – and frequently both. The great thing about reptiles in terms of taking X-ray images is that they are much more likely to stay still than other animals, and so only very rarely do they need to be sedated or anaesthetised in order for this purpose.

The benefit of X-rays is that they provide an actual visual image of structures inside the animal that otherwise could not be examined. There are several situations where X-rays may be helpful, as for example in reproductive issues such as dystocia (egg binding) where eggs can be visualised, or in the case of potential foreign bodies, which may be the result of the reptile ingesting its substrate. Typically, whenever radiographs are taken, at least two different views are obtained, so that the images can be interpreted in three dimensions.

Ultrasound is becoming more and more beneficial in terms of reptile examinations now, and many of my bearded dragon cases get an ultrasound examination as standard nowadays. Situations where ultrasound may be useful include cases of distended beards in these lizards, helping to work out whether the distension is caused by a build up of fluid. In cases of enteritis that

involve diarrhoea, ultrasound enables the intestinal tract to be examined closely, and abnormalities such as any increase in the thickness of the gut itself can be appreciated. In certain cases though, CT or MRI scans may be the most appropriate method of imaging reptile patients and this may have to be carried out at a specialist centre.

● EndoscopyThis involves the use of an instrument called an endoscope, which is essentially a fine probe connected to a very bright light, and sometimes a camera, that can be inserted into the body to allow visualisation of different structures/organs. Endoscopy may be carried out under surgical conditions, with the reptile receiving a general anaesthesia first, so the instrument can be inserted through an incision to allow an internal examination of the coelomic (body) cavity. Alternatively, it may be performed in a conscious patient, such as a snake that is undergoing a tracheal examination, perhaps because of a suspected respiratory infection. Many endoscopes have a distinct channel which allows for samples to be collected with special forceps, or by instilling fluid and then suctioning it out.

● MicrobiologyMany disease processes are related to infections with microbes, be they bacterial, viral, fungal or protozoal. Even in primary illnesses that are not caused by one of these pathogens, there is always the risk of secondary infections when a particular tissue or the reptile’s immune system as a whole is compromised. Swabbing for culture is extremely useful, and in the case of bacterial infections especially, it allows sensitivity testing to be performed. This indicates which antibiotic would be most appropriate for the treatment of a

particular infection. We tend to find that in reptile patients

in particular, many bacteria are often very resistant to a lot of antibiotics. Therefore to carry out culture and sensitivity testing is money well spent, particularly considering that everything in reptiles happens slowly, and this extends to their healing and recovery.

Cytology and histologyCytology involves the examination of cells, whereas histology involves the study of tissues. Collecting such samples for analysis is often very useful. A cytological examination may be performed on fluid that is aspirated from within the body for example, using a syringe or endoscope, whereas histological examination may be carried out on a tissue sample taken by biopsy. It is usual for samples of this type to be sent to a specialist pathologist at an external laboratory, who will report the findings back to the practice.

I think it is well worth emphasising at this point that to allow the veterinary surgeon to perform the most appropriate work up, and to allow for all the diagnostic tests that might be necessary, this can be costly for the owner. Therefore, it is always worth considering getting insurance cover for any animals from the outset, and there are now companies that specialise in insuring exotic pets. ✥■ To be continued: Next month, Tariq considers the potential options for treatment.

� A blood sample from a snake, with the red blood cells appearing pinkish with the nucleus in the centre being stained a purple shade. It is not just looking for abnormalities in the cells, but counting the different proportions of the white and red blood cells that can be significant for diagnostic purposes.

Both ultrasound and X-rays can be useful when dealing with bearded dragons.

Tariq Abou-Zahr BVSc MRCVS is a veterinary surgeon with a special interest in exotic species, as well as being both a keen herpetoculturist and aviculturist. He currently practices at Great Western Exotics, Unit 10, Berkshire House, County Business Park, Shrivenham Road, Swindon, SN1 2NR. Tel: 01793 603 800, email: swindonreferralsexotics@vets-now.com

Further information

Bacterial culturing can reveal which antibiotic would be most appropriate for treating a particular case. The bacterial sample is cultured on a dish, with antibiotic discs being added to the cultural medium. In this case, the antibiotic on the disc in the bottom left would be most appropriate for treatment purposes, as the light area here shows it has stopped the bacterial growth, in contrast to the antibiotic in disc labelled NOR10, which would be ineffective in this instance.

If you start off using an antibiotic that proves to be ineffective, you can waste a significant period of time on a course of treatment that does not work, before then changing to a different one, which also may not be effective! Meanwhile, the reptile’s condition will not be improving. Having said that, culturing is not always appropriate and there are situations where it may be preferable to treat with antibiotics without doing a culture, particularly where it is difficult to get a sample that is not contaminated.

Culturing in action

� In many cases, histology and cytology are carried out in specialist laboratories.

Further reading Macarthur S, Wilkinson R, Meyer J (2004). Medicine and Surgery of Tortoises and Turtles. United States: Wiley Blackwell. Mader D (2006). Reptile Medicine and Surgery. Missouri: Saunders Elsevier. Girling S, Raiti P (2004). BSAVA Manual of Reptiles. 2nd ed. Gloucester: British Small Animal Veterinary Association.

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