LBAH Informational Articles

GI Stasis (hairballs) in Rabbits

Gastrointestinal (GI) stasis  is a common cause of digestive disease in rabbits (lagomorphs). In most cases at our hospital the cause is a diet that is too low in fiber. You will sometimes read the term “ileus” when talking about this disease. Ileus occurs when the normal intestinal movement of food through the intestines, called peristalsis, stops. Normal digestion is dependent on normal peristalsis of the intestines. Peristalsis is the movement of ingesta down the stomach and intestines. When this stops GI stasis is the result.

Sometimes a hairball (also called wool block) is considered a part of this disease. In reality, over many years of treating rabbits we have learned that any hairball in the stomach is a result of GI stasis and not the cause of it. Ingesting hair is a normal part of a rabbits life, and when fed the proper food this small amount of hair passes through the digestive tract normally.

This page contains graphic pictures of rabbit necropsy pictures. This is a good way to understand the rabbit’s digestive anatomy. It might not be appropriate viewing for all ages.

Digestive Physiology

Herbivorous animals like horses, rabbits, deer, cows, antelopes etc., obtain their nutrition by digesting food that carnivores cannot. A lot of this food is made up of cellulose. Neither carnivores or herbivores contain the enzymes necessary to digest this cellulose. The secret that herbivores have that allows them to digest this usually undigestible food lies in bacteria that reside in their GI tract.

Some herbivores are called foregut fermenters. This means the bacteria that help these animals digest cellulose reside at the beginning of the digestive cycle. Sometimes this occurs in the rumen, one of the so-called 4 stomachs in a cow. These stomachs are actually large fermentation chambers that contain the bacteria that can digest cellulose. Examples of this cellulose are hay and grasses.

In this anaerobic environment, the bacteria consume the plant material for their own metabolic needs and, as a result, produce end-products of fermentation called volatile fatty acids (VFA).  Additionally, the fermenting bacteria use nitrogen from plant material to produce amino acids and protein which can then be used by the animal. Once these bacteria digest this cellulose they produce volatile fatty acids (VFA’s) and amino acids. These nutrients are absorbed as they pass through the small intestines and into the large intestine.

In contrast, hindgut fermenters store these bacteria in the cecum (appendix) and large intestine. In the case of the rabbit, there is a complex interaction between the colon and the cecum(appendix) that gets this bacterial fermentation process started. The VFA’s and amino acids that are now the end product of bacterial metabolism pass into the large intestines and out the body. They do not get a chance to pass through the small intestines because of their location, and as a result, less nutrition is absorbed by the herbivore.

Here is a picture of the cecum taken during a routine necropsy of a rabbit. The top white arrow on the left points to just one of the 4 horizontal folds of this rabbits cecum. As you can see, it is huge and takes up a large amount of the abdominal cavity. For perspective, the arrow on the lower left points to the uterus in this female rabbit, and the arrow on the lower right points to the urinary bladder.

Another view with just a part of the cecum outside of the abdomen. Notice how the cecum has folds.

Here is an x-ray view of the abdomen of a rabbit. This rabbit is laying on its right side, and the head is towards the left. The cecum is that long and horizontal dark object at the bottom. It is dark because it is filled with gas from the digestive process. The white arrow points to it.  Notice also the folds that can be seen radiographically.

Hindgut fermenters have a problem that foregut formenters do not. As we mentioned earlier, since the bacteria are in the cecum they are at the end of the digestive system in the rabbit, and thus there is very little intestines to absorb the volatile fatty acids and amino acids produced by the bacteria before they get excreted by the body. The walls of the cecum can absorb some of the VFA’s that are produced. There is not enough intestine though to absorb the proteins and amino acids.

To get around this rabbits have evolved a sophisticated form of coprography (eating feces). In essence, and usually at night (they are sometimes called night droppings), the rabbit literally puts it mouth by its anus and eats some of its fecal matter. This literally brings the nitrogenous proteins and amino acids to the beginning of the digestive tract where they can get absorbed much more efficiently. Usually these droppings are soft in nature and are not the same firm and dry droppings you normally observe in abundance from your rabbit.

This whole system in the rabbit is designed around a high fiber (cellulose) diet. This is why feeding concentrated rabbit pellets is not healthy, and can lead to a shut down of this whole digestive process. This will lead to GI stasis and the potentialf or serious disease, pain, and even death in a rabbit.

Pathophysiology

As the intestines slow down food and hair can become stuck, leading to pain and a further slow down of the intestines (called ileus). A hairball can now form in the stomach adding to the problem. Harmful bacteria can now produce in great quantities and cause the intestines to fill with gas. They overwhelm the normal bacteria and can even produce toxins. This intestinal distention with gas causes even more pain and further ileus. It becomes a positive feedback cycle until the rabbit stops eating and becomes weak and dehydrated. It is at this point most people bring their rabbit in for us to give medical care. This whole process can take anywhere from several hours to several days. It can be slow and insidious or acute and quite apparent that something is wrong. In any case you need to seek immediate medical attention for your rabbit.

In the past this disease was erroneously thought to be a hairball problem. It was treated surgically where we literally did a surgery to open up the stomach and remove the hair and ingesta that was present. Unfortunately, most of these rabbits did not do well postoperatively. As time went on and we learned more about this disease it became apparent that the hairballs were a result of the GI stasis problem and not the cause of this. SInce then we have treated this disease medically with much greater success. Success depends on how soon in the disease process we treat your rabbit.

Cause

There are numerous causes to this problem:

  1. Dental Disease

    Rabbit teeth continuously grow. If their dental anatomy is imperfect an incisor or molar tooth can overgrow and prevent them  from being able to chew their food. This will cause the GI tract to stop working and lead to stasis. Our Dental Disease link can give you examples of overgrown teeth.

    This rabbit has overgrown incisors preventing normal chewing.

    Dougsie Doughty 7012

    Click here to learn more about rabbit tooth problems

  2. Adhesions from prior abdominal surgery

    Probably the most common abdominal surgery performed on a rabbit is an OVH (commonly known as a spay). On very rare occasions the healing process can cause adhesions between the uterus and GI tract, making the normal peristalsis movements abnormal.

  3. Infection

    A sick rabbit can easily spike a fever causing it to become anorectic (not eating). When food is not continuously present in the rabbit GI tract is shuts down leading to GI stasis.

    Some infections (urinary tract or abscess) can cause pain, which will also lead to anorexia. Pasteurella, a very common rabbit infection, can also has the potential to lead to GI stasis.

    Inappropriate use of antibiotics, especially home use with the wrong antibiotic at the wrong dose, can disrupt normal bacteria (called normal GI flora) and add to this problem.

  4. Pain

    A rabbit that is in pain will become anorectic, which can lead to GI stasis. The pain can be from numerous causes like fractures, bladder stones, infections, and post operatively.

    A fracture like this can be so painful your rabbit will stop eating. This fracture is in the front leg of a rabbit.

  5. Stress

    Overheating in the summer time, food that is not fresh, new pets or environment, or sudden changes in diet can lead to so much stress that your rabbit stops eating. This rapidly leads to dehydration and GI stasis. In a household with more than one rabbit the separation of the rabbits can be stressful.

  6. Intestinal blockage

    This is a rare cause of GI stasis in rabbits. Even though rabbits cannot vomit they don’t tend to eat foreign bodies like bones, needles, threads, and yarn like dogs, cats, and ferrets.

  7. Inadequate fiber in the diet

    This is the cause we see most commonly in our hospital. Your rabbit should be fed grass hay like timothy hay along with dark leafy greens. It should be feed mininal to no concentrated pellets. These pellets were formulated for convenience and for breeding rabbits that needed the concentrated energy. High fiber in the diet helps to properly wear down the rabbits teeth that grow continuously through life.

Symptoms

Symptoms can be subtle and easily missed, especially at the early stages. The two primary symptoms to watch for are complete or partial anorexia (lack of appetite) and a diminished amount of droppings. Sometimes these droppings will be quite dry and firm. Other symptoms could be lethargy and signs of discomfort when you pick up your rabbit or touch it. Bunnies that are painful will grind their teeth. They might start eating strange objects like paper and wood to increase the fiber in their diet.

Please keep in mind that GI stasis can occur simultaneously with other diseases, especially when these other diseases are the cause of the problem. We discussed some of these causes earlier.

Diagnosis

This is not a disease you should diagnose at home and then try a home remedy. This is because other diseases can mimic GI stasis, other diseases can be occurring simultaneously, and also because by the time you notice a problem the disease is already well entrenched. The longer you wait for an accurate diagnosis the poorer the prognosis becomes.

Our diagnosis of GI stasis follows the diagnostic process like it does for all our patients. You might want to link to the diagnostic process to learn about it before continuing on GI stasis.

  • Signalment

    GI stasis tends to occur in middle aged and older rabbits of any gender.

  • History

    Rabbits with this problem tend to be feed a diet that does not have enough fiber. There might be a history of prior surgery, trauma, or a stress related episode like boarding your rabbit in a strange environment. Maybe a home medication was used that disrupted the normal bacteria in the intestines  (GI flora).

  • Physical Exam

    Our doctors perform a thorough exam to determine the exact nature of your rabbits problem. This is important since other diseases can mimic GI stasis. We will weigh it and take its temperature as a start. We will check the molar and incisor teeth carefully for any problems. We will check lymph nodes and palpate the abdomen, along with checking the heart with a special stethoscope for small animals. We will also determine your rabbit’s state of hydration.

    When our exam is completed we will give you an assessment of your rabbits condition and review all the potential disease that might be affecting your bunny.

  • Diagnostic Tests

    Routine tests include a blood panel, urinalysis, and fecal exam for parasites. It is also common to take a radiograph to check for other problems and confrim the diagnosis.

    This is the radiograph of the abdomen of a rabbit that is laying on its right side. The arrow is pointing to a round stomach filled with ingesta. This could be normal food or it could be the result of GI stasis. If this rabbit has a history of not eating for several days then it increases the probablity of GI stasis.

    Different rabbit, different view. This rabbit is on its back, with the head at the top, arrow pointing to the stomach. The dark area at the top on each side is the lungs that are in the thorax. Everything below this dark area is in the abdomen.  Notice how large this distended stomach is. This has the potential to be a GI stasis problem just like the radiograph above.

    If one of our doctors suspect more than GI stasis he/she might want further diagnostic testing. This might include special blood titers and ultrasound.

Treatment

Most cases are treated in our hospital. These rabbits need medication and nursing care, at least initially, that can only be properly performed by our technicians. Some rabbits respond well in 1-2 days and start eating and producing droppings. Others can take 1-2 weeks to get back to normal function. Patience is importance because the rabbit GI tract is sensitive and overzealous treatment can do more harm than good.

  • Fluids

    Many of these rabbits are dehydrated and need fluids. We give them orally, intravenously or subcutaneously.  The fluids replace electrolytes, provide vitamins, and rehydrate your rabbit. Rehydration is important in general for any sick animal, and is especially important in GI stasis to help with normal peristalsis and movement of ingesta through the intestines.

  • Assist Feeding

    The GI tract needs to get back to normal function asap. I lack of food will shut down the GI tract and cause ileus, adding to the GI stasis. As we are rehydrating we will also assist feed special food called Critical Care. This stimulates the peristalsis movement of the intestines and adds badly needed nutrients.

  • Feeding a proper diet

    We give timothy hay along with dark green wet vegetables like Kale. The fiber and moisture present in this food is an aid in getting the intestinal peristalsis going again. Alfalfa hay is not recommended because of excess calcium and protein.

    Other good foods to feed are dandelion, mustard greens, parslely, carrot tops, broccoli, melon, oranges, mango, tomatoes, and kiwi.

  • Medication to stimulate the intestines

    The two primary medications used in rabbits to stimulate the intestines back to normal peristalsis are Cisapride and Reglan. They are highly beneficial and used in most cases.

  • Pain medication

    These rabbits are in significant pain due to the distention of the intestines. This pain needs to be addressed if they are to begin eating again. Typical medications include narcotic pain killers and the NSAID Metacam.

  • Antibiotics

    Antibiotics are sometime used.  If we determine your pet has an infection from its lab data or physical exam we will put it on a broad spectrum antibiotic. Common organisms the proliferates in the cecum in GI stasis are E. Coli and  Clostridium.

  • Anti gas medicine

    If there is more gas in the intestines than is normal we might give simethicone to help diminish it. This gas can make the problem worse and will cause pain.

    Once a rabbit is eating on its own partially and producing droppings we will send it home. We might use some of the medications described above. We will all send home Critical Care food to make sure it is taking in nutrition as it convalesces.

  • Treatments we do not do

    Some treatments have the potential to make the problem worse. Probiotics and yogurt have milk starches and sugar that can feed the Clostridium bacteria. Lactobacillus has not been shown to be of any benefit, and if it is stressful to give this orally to your bunny could actually be detrimental. The same applies when you try to feed your rabbit “night droppings”. The proper word for night droppings is cecotropes. Hairball remedies can also cause a problem. The enzymes in pineapple are unable to dissolve a keratin mass in the stomach, and might even provide the Clostridium with sugar so it can keep on proliferating in the cecum.

  • Home Care

    Once your rabbit is eating and producing droppings in increased frequency, and if the lab data is normal, we will send your bunny home with you to finish the nursing care. Our doctors will tell you what to do and our staff will demonstrate how to administer this home care. We are always here to help you, and if you cannot do it we will continue to hospitalize your bunny or treat it on an out-patient basis.

    If you have other rabbits at home let them interact together as long as you can monitor the eating habits and droppings of the sick one.

Prevention

Minimizing stress (heat, overcrowding), proper diet (high in timothy and other grass hays, minimal pellets), a clean environment, fresh drinking water at all times, can be a substantial help in minimizing this serious problem. Do not let your rabbit become obese.  Bring your rabbit in for an exam at the earliest sign of any problem with appetite or droppings.

Continue Reading

Rabbit X-Rays

Broken bone. This is a traverse fracture of the distal femur. It needs surgery

Rabbit-femurfxrad-3arrow

Rabbit-femurfxrad-4arrow

A bone plate along with an IM (intramedullary) pin was placed along with 2 cerclage wires

Rabbit-femurfxrad-2
Rabbit-femurfxrad

You can see the surgery of repairing this fractured femur by following this link

This is a side view of a rabbit’s mouth. The long front teeth and large back teeth are evident (arrows).

This is a view of a normal rabbit that is laying on its back. Notice how large the abdomen is in relation to the size of the chest. The larger R and larger L show which side is Right and Left. The two small L’s are the black lung tissue. The heart (H) is the round white object. Everything else below this is the abdomen!

This rabbit has a fractured spine (arrow). This is a relatively common problem in rabbits because they have thin bones in relation to powerful muscles. If they kick out hard with their back legs they can cause this fracture. Unfortunately, the prognosis for this problem is poor.

This is the U shaped distended stomach (arrow) of a rabbit that was diagnosed with hairballs. Compare it to the normal x-ray above. Feeding a diet high in fiber (timothy and alfalfa hay) with minimal pellets helps prevent this problem

A side view of this same rabbit shows the distended stomach (arrow). Again, you can see how large the abdomen is in relation to the chest. The lungs (L) are the dark triangle, the heart (H) is the round white object also in the chest, and the kidneys (K) are the two oval objects in the abdomen. The remainder of the abdomen to the right is made up mostly of the small and large intestines.

Continue Reading

Tortoise Bladder Stones (Uroliths)

One of the more interesting and unique surgeries we perform is the removal of a bladder stone (called a cystotomy) from California Desert Tortoises, and various other tortoise species like African spurred tortoises (sulfates) and leopard tortoises. It is usually a problem in captive tortoises, but it has been diagnosed in wildl tortoises on occasion. The stones tend to be smaller in wild tortoises.

Some of these stones grow to tremendous size, and it is a wonder that these animals can survive with such a problem. Other animal species get bladder stones, but none of them are anywhere near as large as tortoise bladder stones.

Don’t miss the video of the beating heart at the end of this page.

This page contains graphic surgical pictures.


Physiology

The normal waste product for protein metabolism is ammonia. Tortoises convert thisi ammonia to uric acid, which is less toxic to the bladder wall and lets them hold water in their bladder for long periods of time. Tortoises are a desert species, so water conservation is a large part of their physiology as they have adpated to their arid environment. They can recycle water from their bladder into their system when they do not have access to drinking water.

If the uric acid builds up in high enough levels, a situation that might happen if the tortoise is not drinking and staying well hydrated, the uric acids combines with electrolytes like sodium, calcium, and potassium, to form urates. In a well hydrated tortoise these urates are secreted normally when urinating. In a dehydrated tortoise that is recycling its urine the urates are not secreted, and can slowly build up into a bladder stone.

When we analyze tortoise bladder stones chemically they are comprised almost exclusively of urates.

Cause

The exact cause is unknown. Dehydration plays a significant factor in this disease. Many people believe that tortoises get all the water they need from their food. This is not true, they need to drink water also, so make sure fresh water is available all day and also periodic soaking is recommended. Use lukewarm water, make sure the water level is no higher than the beginning of the top shell (carapace), and soak for up to 10 minutes. Dry your tortoise off before placing back in its normal environment. Do not soak if your tortoise has surgery unless confirmed by your veterinarian.

Diet is also a factor in this disease. For all tortoises the overwhelming majority of their diet is from plants. If the diet is too high in protein, which would be from feeding dog or cat food, there might be excess urate production, leading to an increased chance of a bladder stone being formed. Your tortoise’s diet should consist of a high percentage of grass and a lesser amount of green, lelafy vegetables.

Symptoms

There are no specific symptoms that tell us a tortoise has a bladder stone, and some of them don’t show any symptoms at all. The more common symptoms are nasal discharge, poor appetite, straining to have a bowel movement, inability to lay eggs, lameness in back legs, and lethargy. A tortoise can become paralyzed in the back legs due to mechanical pressure from the bladder stone, and the problem can even progress further and some tortoises can succumb to the bladder stone.

Some of these stones are diagnosed as incidental findings when we take an x-ray or perform an exam for an unrelated problem. The tremendous size of some of the stones indicates they may have been present for years before being diagnosed. Anybody that has ever had a kidney stone can sympathize with what these animals feel like with such large stones.

Diagnosis

There are two methods utilized to diagnose bladder stones. During an examination we can sometimes palpate a stone by gently rolling the tortoise back and forth while we feel in the soft spot by its rear leg.

To perform the palpation technique you need to understand tortoise anatomy and be experienced at palpation.

Some tortoise bladder stones are small land can be removal via the pre femoral approach. It is performed in the same area as the palpation picture above

 

Not every stone can be found on palpation. The other method to make a diagnosis, and usually more reliable method, is to take an x-ray. Even though the stone in this x-ray is large, this is not an unusual finding. Some of the stones are so large that we have to break them into pieces to get them out of the opening in the shell.

You can see the actual size of this stone measure in cm. It takes 2.5 cm to make up an inch.

Surgical Procedure

The usual treatment for a bladder stone in tortoises is to perform surgery to completely remove the stone. In this surgery we literally cut a hole in the bottom of the shell and remove the stone from the bladder. Most tortoises do fine postoperatively, and after a few days in the hospital and a few weeks of recuperation at home, they are back to normal. We tend not to perform this surgery when hibernation is near.

Prior to surgery our patient is prepared to minimize anesthetic risk. In some patients we place a feeding tube to insure adequate hydration and nutrition, both before and after the surgery. In other patients we insert an intravenous catheter (IV) to maintain blood pressure during surgery.

This tortoise has an IV catheter in its jugulare vein. We use this vein because it is relatively easy to insert the catheter and it is large enough to take the volume of fluid we need to give.

Once the tortoise is stable and ready for surgery we gently induce anesthesia with a mask.

When fully relaxed we gently inserted a breathing tub called an endotracheal tube (ET). This facilitates the administration of oxygen and anesthesia in a much more efficient manner.

 After the tortoise is anesthetized the bottom of the shell (called the plastron) is cleansed thoroughly. This may take several scrubbings with the use of a gentle brush to get clean enough for surgery.

Our surgeon prepares for this surgery simultaneously

_D2A8630

While our patient is being prepared Dr. Ridgeway is preparing his instruments

OVH-rabbit-3

A sterile dremel is used to cut into the shell

When the shell is clean our surgeon carefully commences the draping process. This is important to prevent contamination and infection. Infection is especially critical in this surgery because once the cut piece of shell is resealed to the bottom of the shell, an infection can fester on the inside without our knowing about it.

Our patient is prepped and ready to get this huge stone out of its bladder

The rest of the surgical team is preparing at the same time. These assistants are students in our externship program. They will be assisting the surgeon with flushing and suctioning of fluids, along with the administration of anesthesia.

Even though it is living tissue, which means it has feeling and bleeds, tortoise shells are tough. We use a special drill called a dremel to cut the shell. We have gone through many of them over the years!

This close up view shows the serrated edge. They wear down fast trying to cut through the tough (but living) shell.

Dr. Ridgeway starts his cut with his safety glasses on to protect him from particles brought on by the drill used to cut into the shell.

The blade spins at a high speed so sterile water needs to be constantly applied to the cut surface to minimize burning. The blade cuts at an angle facilitating replacement of the shell when the surgery is complete. If this angled cut is not made, the shell will just fall back into the abdominal cavity (it is called the coelomic cavity in a reptile) and the incision site will never heal.

The speed means you need to wear goggles  (and also keep the camera lens out of the line of spray)! Shell is living tissue which is why you see blood in this picture.

We have a short Quicktime video of this part of the surgery. Click on the link below to start it.

Dremel in use

When the shell has been cut in a rectangular piece it is gently pried up with an instrument called an elevator. There are muscular attachments that are gently separated from the shell to allow the shell to become completely free.

The rectangular piece of cut shell is removed and placed inside saline soaked gauze until it is put back at the end of the surgery. The cut shell is living tissue and needs careful handling. After it is removed it is kept moist with sterile saline until it is replaced at the end of the surgery.

A close up of the edge of the shell that was cut by the dremel. It is made up of a extensive blood supply with calcium, phosphorous, and a protein matrix. Since reptiles (ectothermic animals) have a slow metabolism in can take up to 2 years for the cut shell to completely heal.

The next layer encountered is the lining of the coelomic cavity. It is gently cut to give full exposure to the organs in the cavity.

Internal organs can be visualized easily through this large opening. These are egg follicles.

Before we proceed further fluids in the coelomic cavity are suctioned out for better visualization

The bladder is gently exteriorized through the hole in the shell

This stone was too large to fit the opening so the lining of the coelomic cavity had to be enlarged. For faster healing me make this opening just large enough to gently squeeze the bladder out of the cavity with the stone still inside the bladder.

Using instruments and gently traction the offending bladder finally gives up and out it comes

When fully exteriorized it is packed off so no debris falls back into the coelomic cavity

Before actual stone removal a “stay” suture is placed in the bladder at two locations. The suture is then attached to a hemostat and clamped to the towels. This prevents the bladder from falling back into the coelomic cavity when the stone is removed.

Dr. Ridgeway has made an incision into the bladder and the stone is starting to bulge out

Here is the culprit as it is being removed from the bladder. Can you imagine what this would feel like inside of you?

On occasion we encounter a stone that is so large it needs to be cut in half to be able to fit out of the opening in the shell

This was the worst stone we have ever seen!

It was huge and in many fragments. It is the same stone in the radiograph at the beginning of this page

Once we removed the large pieces there were hundreds of small fragments lining the bladder. They can be the basis for stone reformation.

We flush the bladder with saline and suction them out

Only when all stone fragments are removed do we suture up the bladder

It took almost 30 minutes to remove all the large pieces and fragments. They weighed .8 kg, almost 2 pounds!

The bladder is sometimes filled with a sludge like material. If the sludge is not removed healing will be delayed and the potential for recurrence of the stone increases. The larger clumps of sludge are removed with a special instrument called an angle spoon. This high tech instrument is made special in our lab by taking a regular tablespoon and bending it.

The smaller pieces are suctioned after the bladder has been flushed. This usually takes many flushings with sterile saline. Only when the bladder has been thoroughly flushed is it sutured back together. Notice how inflamed the inner lining of the bladder has become from the tremendous irritation from the stone. This bladder is also thickened for the same reason. A normal bladder is very thin walled, almost like tissue paper.

A special suture material is used to close the opening in the bladder. This suture is very strong yet causes minimal tissue reaction, and will slowly dissolve over several months.

The coelomic cavity is also flushed copiously with warm sterile saline, then the fluid is suctioned out. This process helps prevent an infection and aids in the healing process. If an infection is sealed into the coelomic cavity the outcome could be catastrophic.

The incision made in the tissue lining the cavity is sutured next, using the same type of suture material as the bladder. The muscular attachments to the cut piece of shell will gradually reestablish themselves to the underside of the cut piece.

While all of this was going on the piece of shell that was removed at the beginning of the surgery was kept moist by wrapping it with sterile gauze soaked with saline. Doctor R is removing the gauze before putting the cut piece of shell back in place.

When the shell is back in place bone wax is used to help seal the edges

Now the fun of putting the shell back together begins. The previously removed piece of shell is put back into position and a piece of fiberglass is measured and cut so that it just covers the cut piece of shell.

A special quick drying epoxy is poured on the shell. Once this epoxy hardens it can not be removed or reshaped, so we have to move fast. The first layer of epoxy is put directly on the shell.  When it gets tacky we are ready for the next step.

Before this first layer dries the fiberglass is placed on the shell and another layer of epoxy is layered.

When completed this is what the final result looks like

The epoxy becomes firm within a few minutes. During this time it is important that the tortoise does not wake up or breathe deeply because the pressure in the lungs will push the patch out. Cellophane is put over the patch for cleanliness.

Here is our friend just waking up from anesthesia. We remove the breathing tube when she is breathing on her own adequately.

At this point we will give her a pain injection and place her in a special room that maintains a temperature of 85 degrees. She will stay in the hospital for a few days until she is eating and active.

We have a short video of the beating heart of a tortoise during this procedure. You can see the heart beating during the surgery because reptiles do not have a diaphragm, the muscle that separates the chest from the abdomen. Since there is no abdomen, technically it is called the coelomic cavity.

Prevention

Keep your tortoise well hydrated with acess to drinking water and soaking as previously described. Feed mimimal amounts of green leafy vegetables and large amounts of grass. Do not supplememt with excess calcium or Vitamin D3 if your tortoise has access to direct sunshine as seen in our western and souther states. It is theorized that an active tortoise foraging in a large area will excrete more urates when it urinates. Keeping it in a small area can inhibit its activity and potentially lose this advantage when exercising.

A yearly exam (palpating for bladder stones), blood panel, and radiograph, goes a long way to detecting a stone early. If small enough these stones might be amenable to being flushed out or removed by a pre-femoral approach, which is obviously much easier on your tortoise than cutting the shell.

Continue Reading

Spay-Water Dragon

Chinese Water Dragons are fun pets that require very specific environmental conditions. When these conditions are not met problems can occur, in this case the pet was unable to lay its eggs and was feeling ill.

This page shows graphic pictures from an actual surgery.


Husbandry

These animals originate from Southeast Asia so they require high humidity with plenty of water and a temperature range of 82-97 degrees F. They are tree climbers so make sure their cage has plenty of branches.

They need large cages to feel secure. If the cage is too small they will constantly rub their noses to the point that they will rub the bone raw. Male Water Dragons are territorial, so only one male should be in a cage. Two females can be kept with each male.

Insects and other arthropods, along with small mice, fruits, and vegetables are good foods to give them. Always use a multipurpose vitamin powder in their food several times per week.


Reproduction

Approximately twice per year they lay 8-12 eggs. They should be incubated in vermiculite at 78-80 degrees F for approximately 3 months.

This is what we normally want to see, eggs laid on vermiculite.

vermiculite

In the case that follows the Water Dragon was unable to lay its eggs, which caused it to become ill. Surgical intervention was needed to correct the problem.


Surgery

An x-ray reveals the extent of the eggs in our patient. The coelomic cavity (reptile equivalent of the abdomen) is filled with eggs.


Anesthesia is very important, especially in such a small patient. To minimize the risk of anesthesia we insert a flexible breathing tube into the windpipe of our patient. This tube allows us to give oxygen and anesthesia in very refined quantities. It also allows us to inflate the lungs since reptiles commonly do not breathe on their own when anesthetized.

waterdragon-ovh


After the breathing tube has been placed and our patient anesthetized it is prepared for surgery. On the right side of this picture you can see a probe placed on its tail. This probe goes to a Pulse Oximeter, an instrument that measures oxygen saturation in the red blood cells. It is instruments like this, along with our extensive expertise with reptiles, that allows us to safely anesthetize such a small patient.

waterdragon-ovh-2


Great care must be taken when making an incision into the coelomic cavity. There is a large vein that lies just under the scales, if punctured, can cause extensive bleeding. Such a small animal can not tolerate blood loss that would be acceptable in other animals.

waterdragon-ovh-3


The coelomic cavity is filled with eggs that literally spill out when we make our incision. Each ovary with its associate eggs is isolated, and the shell gland with eggs is removed.

waterdragon-ovh-5


A special instrument called a hemoclip is used to clamp the blood vessels that lead to the ovary and shell gland. The hemoclip is used because it minimizes surgical time, so there is less risk of anesthesia. This instrument uses a small metal clip to stop the blood flow. The clip can be vividly seen on an x-ray because it is metallic.

waterdragon-ovh-6

This surgery prevents this Water Dragon from laying eggs in the future, so it will not encounter this illness again.

Continue Reading

Iguana Spay

Common green iguana’s frequently have a problem laying their eggs. Most of these problems are the result of poor husbandry. If the problem can not be rectified medically then the eggs are surgically removed because they can become toxic.

Cause

As in almost all diseases we encounter there are many causes.

In many cases it is environmental factors that are creating an inability for a female iguana to lay her eggs. Some of these causes are:

  • Environmental temperature below 90 degrees F
  • Humidity below 90%
  • Lack of exposure to direct sunshine
  • Housing that is too small or overcrowding
  • Loud noises and excess activity in the immediate surroundings
  • Inadequate substrate to lay eggs in
  • Inadequate diet

These factors closely correlate to the causes of iguana bone disease. Click here if you would like to learn about them in detail before continuing on with this page.

This is an example of the type of substrate that can be used for an egg laying iguana.

Medical problems can also be involved. Some eggs are deformed while others are too large to pass through the pelvis. Iguana’s that have previously been afflicted with bone disease might have deformed skeletons or inadequate strength to lay eggs

The pelvis on this iguana is too deformed for eggs to pass. This pet has a severe form of iguana bone disease called NSHP.

Some iggie’s have infections that cause problems with egg laying, and even on occasion a stone in the bladder (called urolithiasis) can prevent eggs from passing through the pelvis.

Symptoms

For most owners the primary symptom is a pet that has stopped eating and has also become lethargic. A lack of appetite in an otherwise normal iguana with eggs can be normal. Many of these females will have distended abdomens, a strong clue as to the cause of their lack of appetite. Sometimes the female has layed a few eggs and stopped. These eggs might be normal in shape and size, or they might have deformities or calcium deficiencies.

The egg on the lower left is malformed, and could be an indication of a problem. The substrate in this case is vermiculite.

Diagnosis

An eggbound iguana usually has a distended abdomen (technically the coelomic cavity). Depending on the number of eggs and their level of calcification these eggs can actually be felt when the abdomen is palpated. Radiography is used commonly to verify the diagnosis.

Can you visualize the numerous round and subtle swellings in the coelomic cavity (reptile equivalent of the abdomen) of this female iguana?

The numerous eggs in this female are a little easier to visualize

Radiographs-IggieEggs

Treatment

Once husbandry problems are corrected medical therapy is usually the first course of action in an otherwise healthy iguana. Calcium injections and supplements, vitamin a injections, and even medications to contract the uterus are used.

If medical therapy is unsuccessful after 3-4 weeks, then surgical intervention is necessary. These eggs can cause an iguana to become ill, and since few pet iguana’s are used for breeding, along with the fact that we don’t want this problem to repeat itself next year, the iguana is spayed (OVH). Technically this is called an ovariosalpingectomy in an iguana. Lets look at a case where this occurred.

Anesthesia

Pre-anesthetic preparation is important in every surgery we perform, no matter how routine. All of our spays receive a physical exam prior to surgery. After this exam will we draw a small amount of blood for an in-hospital pre-anesthetic test. When everything is to our satisfaction we will administer a sedative. This will calm the pet down and make the administration of the actual anesthetic, along with post operative recovery, much smoother. Once a pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.

This is a sterile abdominal surgery, and our surgeon starts the pre-surgical process by using special soap to clean his hands

_D2A8630

While our patient is being anesthetized our surgeon is already in our surgical suite setting up instruments. Our surgeon is ready to start before our patient is at a proper plane of anesthesia. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around.  All of this is to minimize anesthetic time.

OVH-rabbit-2
OVH-rabbit-3

We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

Surgery-Monitor

In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters

Rabbit-femurfx-9

Surgery

The following area contains graphic pictures of an actual surgical procedure performed at the Long Beach Animal  Hospital.

You can click on the pictures to see a larger version for better for visualization. 

Zeke has had a distended abdomen and has laid only a few eggs. She is now becoming listless so its time for us to intervene.

This is Zeke with her mom

Do you see the eggs in this radiograph of Zeke?

Click on the picture for a larger version to help you visualize them. As it turns out there are 30 eggs in Zeke’s abdomen (the abdomen of an iguana is called the coelomic cavity).

Once Zeke was cleared for surgery with a blood panel it was time to get those eggs out. After giving her an injection of a tranquilizer called Telazol we administered gas anesthesia (lets hope she does not hold her breath for too long)!

When she has relaxed enough a special tube (called an endotracheal tube) is very gently placed in the windpipe. This opening is at the back of the tongue, and can be difficult to visualize due to the fleshy tongue. This tube allows us to inflate the lungs and supply adequate amounts of oxygen and anesthetic.

All of our surgeries are performed under sterile conditions. The skin is cleansed numerous times with a special antiseptic agent. The area is covered with a sterile drape and the surgeon uses sterile equipment for the duration of the procedure. In this picture Zeke has been scrubbed and is ready to be draped. You can see how relaxed she is under anesthesia.

The incision is made with a scalpel blade then extended with scissors

There is an important vein running under the skin that we don’t want to cut. You can see it running horizontally just under the skin. The two white structures (the left one looks larger than the right one)  below the vein is one of the 30 eggs we will be removing.

Once the incision is big enough we gently start exteriorizing the eggs (follicles) in the oviducts.

The first group of follicles above is just the beginning as we continue to exteriorize them out of the coelomic cavity. Its hard to believe that many eggs can fit in one iguana!

The blood supply to these follicles must be ligated before we can remove them. You can see how extensive the blood supply is along with how delicate these follicles are within the oviduct. This removal of these eggs is the salpingectomy part of this whole surgery called an ovariosalpingectomy. In a dog or cat it is called an ovariohysterectomy (more commonly known as a spay).

This part of the procedure takes a while because we carefully, gently, and methodically ligate all of the vessels to all of these eggs in the oviduct. When finished ligating we cut them out and check for any bleeding from these blood vessels.

In this picture (enlarge it if necessary) our surgeon is cutting one of the ligated blood vessels on the right with a scalpel blade. The remaining end that is now ligated with 2 knots will fall back into the coelomic cavity which is at the bottom of the picture. The eggs (follicles) in their oviducts are at the top of the picture and will now be discarded.

The right group of blood vessels has now been cut and our surgeon is getting ready to cut the group of blood vessels on the left. You can see the right group of blood vessels on the right with their two ligatures. We do not let these ligated blood vessels go back into the coelomic cavity until we are certain there is no bleeding.

Now that the eggs and oviducts are removed (salpingectomy) its time to remove the ovaries (the ovario part of our surgery).

This picture shows the left ovary, the nodular horizontal structure in the middle of the picture. The horizontal pinkish structure above it is the shell gland, the equivalent to the uterus in mammals. The vertical pinkish structure to the left of the ovary is the spleen. The white structure just to the left of the spleen is the stomach.

The ovary is pulled up for better visualization. It is attached to a large blood supply which is the horizontal bluish structure below it. This part of the surgery is very delicate due to this blood supply that is almost attached to the ovary. If we cut or nick it while removing the ovary there will be extensive bleeding.

We use a special instrument that puts on metallic clips (called hemoclips- hemo is short for hemostasis, which is latin for controlling bleeding). This is much easier than trying to ligate the ovaries with sutures and potentially cutting into the attached blood supply.

In this picture 3 hemoclips have been utilized. You can see the cut part of the ovary between our surgeon’s fingers.

Our surgeon has let go of the cut end of the ovary and it is laying back on the first 3 hemoclips. He has put on a hemoclip on the left side of this picture as he works his way towards the middle.

His 2nd hemoclip on the left has been administered as he starts cutting the ovary on the left

The final result when all hemoclips are in place and the ovary is removed. Now its on to the other ovary for the same thing.

The clips will remain in the coelomic cavity of this pet for the rest of her life. They can easily be seen on an x-ray because they are metallic.

Once our surgeon has confirmed there is no bleeding we sew her back together. We use a special suture pattern called horizontal mattress to make sure the skin edges are everted. You can see the start of the suturing as our surgeon works from left to right.

As he continues along he takes care not to put his needle through that large abdominal (sometimes called central) vein you saw at the beginning of the surgery.

When complete the skin edges are sticking up (everted). We do this suture pattern only in reptiles because the skin edges will fold in (and won’t heal properly) if we suture the same way as in mammals. Once the sutures are out in two- four weeks and this iggie sheds the scales will be flat again.

When the surgery is complete  and her pain injection is given one of our staff stays with her to keep her warm and administer oxygen until she is fully awake.

Final count is 30 eggs. What is even more amazing is the fact she layed 18 eggs at home before surgery!

For kicks this is what the eggs have inside of them.

Continue Reading

Snake Skin Conditions

Snakes are frequently presented to us with scale conditions. In most cases there are obvious husbandry problems that caused the condition. It is imperative to know the proper temperature, humidity, and substrate necessary for optimum health for each species of snake. Far too often we encounter problems that are easily corrected with only a little bit of effort on an owner’s part. Information on the proper environment for these animals is available through books, reptile associations, and the World Wide Web- ignorance of their needs is no excuse to house them in poor conditions.

Correcting scale conditions in snakes takes considerable time and effort. Many cases need antibiotics and care for at least one month.


Septicemia

This boa was presented to us with a poor appetite and mouth infection called stomatitis.

17131 Boda Chyratus Rostral Infection
17131
Boda Chyratus
Rostral Infection

This is typical of what stomatitis looks like in a snake

 

 

 

17131 Boda Chyratus Rostral Infection
17131
Boda Chyratus
Rostral Infection

After we removed necrotic tissue


 

A thorough exam revealed problems in other locations. This is the underside at around mid body. This red area of inflammation is caused by septicemia, a spread of infection through the bloodstream to other parts of the body.


 

Other locations on this snake’s underside also had lesions.


Diagnostic tests were performed to assist us in diagnosis and treatment. We cultured the lesion in the mouth and took a blood sample.

This is a picture of the same area as the above picture 2 weeks after we started treatment. This snake is now is eating on its own and the lesions in the mouth and scales are almost completely gone. It will be treated for an additional 2 weeks to prevent recurrence of the problem. The initial husbandry conditons that set up this infection were also corrected.


Rat Bite

It is a common fallacy to think that snakes need to eat live prey. If a snake is not hungry, or if it is not kept at the proper temperature and humidity, then its stimulus to kill and eat live prey is diminished. A common outcome is the rat attacking the snake, leading to serious infection and often times death. All rats and mice fed to snakes should be killed before introduction to a snake. Stunned rodents can be used but should be removed if not eaten in a short period of time

This snake had been ill and off food for about one week before it was brought in to us. The owner was not aware that the rat he fed attacked the snake because he was not observant after he put the rat in the snake’s cage. In this picture the back 1/3rd of the scales were infected.


 

A close up view reveals the extent of the skin infection. This snake has septicemia also because the infection has spread from the scales into the bloodstream. This pet required extensive medical therapy to save it.


Thermal Injury

Many snakes are kept in cages with inadequate ambient heat. A common source of heat in many cages is a hot rock. When improperly used it can burn the snake

The underside of this Burmese python shows extensive burns. It is a serious condition that requires immediate care if this snake is to survive.


 

A close up view gives a better feeling for the severity of the problem.

Continue Reading

Snake Impaction

This page shows two snakes that are constipated. The first one required surgical removal of the impacted feces (fecalith).  The second died and was necropsied.

The symptoms of an impacted snake are a lack of appetite along with lack of bowel movement for many weeks. This is a serious condition that could result in the death of the snake if not treated, which is exactly what happened to the second snake.  Medical therapy, consisting of warm water baths, lubricants, and fluids have not helped at all. Surgery is a last resort in these cases because of the potential for post operative complications.

Graphic surgical and necropsy photos on this page


Diagnosis- Snake #1

Most snakes that are impacted will not be eating or passing any feces. We use radiography to help us in our diagnosis.

This is the radiograph of a Burmese python that has several fecaliths in its intestines. They are the large circular and whitish objects in this view.


Treatment

We anesthetized it and made an incision over the fecalith on the underside of its body. In this picture we are carefully dissecting through tissue to get directly to the intestines.

 


We have completed our dissection and have adequate exposure of the bulging intestine filled with hard stool.

 


The intestine is brought out through the incision in the scales and two stay sutures (the blue sutures) are placed to allow gentle handling and placement. An incision has been made into the intestine and some of the dry and hard fecal material is being removed with a hemostat.


There is so much impacted stool in this intestine that we need a sterile spoon to scoop it out. We spend 30 minutes of this procedure scooping stool out of intestines.


This is the appearance of the inner lining of the intestines (called the mucosa) after all the feces have been removed. It is inflamed and fragile, and is a major part of why this snake is ill.

Diagnosis- Snake #2

You can see the bulge in its posterior coelomic cavity in the ver center of this picture

SnakeImpaction-Bulge

A radiograph confirms the impaction

SnakeImpaction-Radiograph

The necropsy gives you a complete picture of the impaction

SnakeImpaction-Necropsy

 


Prevention

This case illustrates the importance of proper husbandry and observation. If these snakes had been kept in an enclosure with adequate humidity and temperature there is less of a chance that this problem would have occurred.

In addition, if it had been brought to us sooner we probably would have been able to treat this problem medically. This brings up the importance of daily observation of reptiles concerning normal health parameters like appetite, activity level, and bowel movements. Reptiles do not show obvious signs of disease like mammals, so careful observation of daily habits is important in order to notice subtle changes.

Continue Reading

Iguana Infection

It is common for Iguana’s to be brought to us for infections. Often times they are minor and easily treated. Sometimes the infections are deep seated, and can result in death even when treated. To prevent infections in Iguana’s it is imperative that their husbandry is adequate.

Cause

Poor husbandry is at the root of many infections, therefore it is critical that proper humidity, temperature, and nutrition are optimum. Click here to learn more about adequate husbandry.

Iguana’s can get infections from trauma, especially to their delicate digits. The can also get infections from bite wounds and being in a dirty environment that exposes them to greater numbers of bacteria than is normal. Housing too many of them in close confines increases their stress level to the point that their immune system can be compromised, and they can pick up an infection that normally they could fight off with no ill effects.

Symptoms

Most Iguana’s with infections are not eating well or are not active. In some cases there is obvious swelling, especially around the jaw or the limbs and feet. Their skin might show discoloration, especially if we suspect Salmonella as the cause.

This poor Iguana has been kept in a cage that is inadequate. As a result it has traumatized its rostrum and caused a chronic infection. This preventable problem is inexcusable since it is so obvious.

This Iggie has an abscess in its mandible. Again, the problem is obvious, and should have been brought to our attention long before it got this large.

These dark blotches on the skin could be an indication of an infection. Diagnostic tests would be indicated in this case.

The swelling on the forearm of this sick Iguana could be a sign of an infection. This is another case were diagnostic tests are needed to make a diagnosis.

Diagnosis

In many cases the diagnosis is obvious based on the symptoms. In other cases we need to perform diagnostic tests to help us determine if there is an infection.

A common test to perform is a blood sample. It lets us assess the red and white blood cells along with important internal organs like the liver. When we suspect and infection we pay particular attention to the white blood cells. A normal blood sample on a sick Iguana does not mean there is no infection or internal organ problem since sick reptiles commonly have normal blood samples.

Radiographs

Radiographs are used to give us a better indication of what is occurring internally. They are especially helpful when we suspect a problem with the bones.

These are the radiographs from the Iguana above with the swollen forearm. The picture on the left is the normal leg, the picture on the right is the swollen leg. The large arrow on the bottom points to the appearance of the swelling radiographically. The swollen spot does not necessarily mean there is an infection because other diseases and problems can appear this way radiographically. The small arrow on the top points to a reaction that has been noted on the ulna bone.

This reaction at the ulna bone gives us a clue that it might be an infection.


This radiograph is from a different Iguana. Its femur has an infection. The bone is thin and there is inflammation in the tissue surrounding the bone. This is a serious problem that is difficult to treat.

Cytology

When we encounter an area that we suspect has an infection an important test to perform is analysis of the cells in the suspected area. In the swollen jaw above we can see the infection with our unaided eye, so the diagnosis is straightforward. In many cases the diagnosis is not so obvious, and we need an exotic animal pathologist to analyze the cells to help us make a diagnosis. This expertise is especially important when we are trying to differentiate cancer from an infection.

A tiny needle with syringe is used to obtain samples for cytology. This sample is from the swollen forearm you saw above. The cells from this syringe will be put on a microscope slide for analysis by an exotic animal pathologist.

This is the cytology report from this pet

Culture

In addition to cytology the same fluid that is removed is cultured for bacteria. any bacteria that we grow and suspect as causing the infection is also analyzed to determine its sensitivity to different antibiotics.

The culture report in this case told us there was not any significant bacteria in the fluid we submitted.

Biopsy

In most cases the above tests give us our diagnosis. Sometimes more sophisticated tests are needed. We reserve these tests when we still do not have a diagnosis after we utilize the above tests, or the pet is not getting better in spite of our treatment.

The Iggie with the swollen forearm did not respond adequately to initial treatment. We biopsied the tissue and muscle in the area of swelling to give us more information.

After it was anesthetized an incision was made in the scales directly over the swollen spot in the forearm.

A special biopsy instrument was used to obtain a sample of the muscle and tissue in the area.

We sutured the small hole in the skin to aid in the healing process. Diseased tissue heals poorly so we want to make every effort to minimize traumatizing the area.

This is the report we received from the muscle biopsy

It turns out this Iguana had an area of dead tissue deep within its muscles.The original source of this problem was probably an infection. The infection might have been transferred to this point in the body through the bloodstream, maybe from an external wound.

Treatment

We have many treatment modalities depending on the cause of the problem and the extent of the infection. Antibiotics are used in most cases. They are especially beneficial when we have a culture report telling us the type of bacteria causing the problem and the appropriate antibiotic to use.

It is very common for well intentioned owners to use antibiotics on their pet before bringing it to us. This is fraught with several potential hazards, not the least of which it can be the wrong antibiotic to use. This will delay the healing and it might even decrease bacteria that are normal inhabitants and advantageous to the healing process. In some diseases like Salmonella we do not treat because all we end up doing is breeding Salmonella organisms that are resistant to antibiotics. People commonly use the incorrect dose of antibiotic, causing one of 2 problems depending on the dose. If they under dose their pet they increase the chance of the bacteria developing resistance. If they overdose they run the risk of making their pet ill from the antibiotic. Antibiotics are also misused when there is no infection present to treat at all because of ignorance or misdiagnosis. Again, all that is being accomplished is a delay in the proper diagnosis and treatment, and the potential to develop resistant organisms, making the antibiotic less useful when it is really needed at a later date.

Reptile infections behave differently from infections we are used to treating in mammals. Their white blood cells fight off infections differently, resulting in abscess material that is more like cottage cheese in consistency. This thick type of pus necessitates minor surgery to remove abscess material that normally in mammals would drain out of the body because it is more fluid in nature. Click here to see pictures of laser surgery to correct an infected abscess in an iguana’s jaw.

In the more involved cases we sometimes have to amputate an infected limb or body part to prevent further spread of an infection that is not under control. Click here to see such a surgery in a Gecko with an infected tail.

Reptiles can get infections that are hazardous to humans, the most notable of these is Salmonella. Any time you treat a reptile with an infection you should assume it has a bacteria that can be spread to people. Keep children and adults that might have ongoing diseases away at all times because their immune systems are most susceptible. Always use disposable gloves and wash your hands after every encounter with your infected reptile, and never put anything in your mouth that has possibly been contaminated.

Prevention

Too many animals housed together increase the stress level to the point that the immune system can be compromised, making them more susceptible to all types of infections. Keeping your reptile in the proper enclosure and utilizing correct husbandry practices go a long way to making them less susceptible to infections. Since reptiles are so dependent on their environment it is critical that you learn about their specific needs in order to house them in an environment that is optimum for their health. This particularly true in Iguanas because they are vegetarians and because their environmental requirements are so specific.

Other reptiles commonly get infections, most notably snakes. Click here for more information on skin infections in snakes.

Continue Reading

Iguana Bone Disease (NSHP, MBD)

The most common reptile brought to our hospital is the green iguana. The primary reason owners bring in their ill green iguana’s is because they have developed a disease called metabolic bone disease (MBD), also known as nutritional secondary hyperparathyroidism (NSHP). The cause of this disease is poor husbandry, especially an inadequate diet. Unfortunately, the literature abounds with erroneous information on the precise needs of these creatures. This outdated an incorrect information continues to be propagated by individuals and organizations with good intentions but limited knowledge.

Iguanas are not the only reptile that encounters this problem. We find it in many types of lizards, turtles, and tortoises. It does not occur in carnivorous reptiles like snakes and monitor lizards very often because the whole prey they consume provides a proper diet.

We have a short Quicktime movie on an Iguana with twitching muscles. You need Quicktime from www.apple.com to view it.


Cause

This disease has many factors that work together in causing this condition. The primary reason iguanas develop this disease is due to a diet too low in calcium. More specifically, the ratio of calcium to phosphorous (usually the phosphorous is too high) in their diets is inadequate to promote growth and sustain normal physiological functions. As a result, they become very ill, and can even succumb to the disease.

Other factors that exacerbate the poor diet problem are common in most households that have iguanas. Inadequate exposure to direct sunlight (not through glass), not keeping the humidity at 90% and not keeping the temperature at 90 degrees F all add to the problem:

    • Sunlight of a specific ultraviolet frequency is needed to produce vitamin D3 by the iguana’s skin. This vitamin is needed for the absorption and utilization of calcium in the diet. No matter how much calcium there is in the diet, without this vitamin the calcium would not be be absorbed or utilized . This is why milk that we drink is fortified with vitamin D. Black Lights and other artificial ultraviolet lights are helpful, but they can not replace sunshine.
    • In order to maintain normal bodily functions (ability to digest food, fight infections, etc.) an iguana needs to maintain a high body temperature. Since they are reptiles, they maintain this temperature by absorbing the heat from their environment. They can not produce enough internal body heat like birds and mammals can when placed in a cold environment. also, the precursor to vitamin D needs to be at the proper temperature to be converted to the active form of the vitamin.

In the semi arid environment in some parts of the country, or the heat needed to warm homes in the winter, many iguanas live in a perpetual state of dehydration. This dramatically interferes with their physiology and predisposes them to many problems.

This is a typical Iguana cage that is inadequate. There is no branch with leaves to bask on, no access to any sun, let alone through the glass, and inadequate humidity. The bowl of water does not give enough moisture, and the heat lamp that is present in the corner does not supply proper ambient heat. Putting dirt in the bottom of the cage is a good idea.

Symptoms

Iguanas with this disease have many problems. The bones might be swollen, soft, or even fractured. In severe cases the blood calcium level becomes so low that tremors occur. The jaw might be swollen (called lumpy jaw by some people) because nature is trying to bring in supporting tissue to make up for the lack of strength to the bones of the jaw. The same thing happens to the bones of the legs, and when the problem is severe enough, or has gone on long enough, the bones of the arms and legs can fracture (called a pathologic fracture) all by themselves.

Some of these iguanas will be unable to walk properly due to spinal cord damage, and many of them will be more susceptible to common infections because they are too weak to develop a proper immune response. As the bones of the jaw become weaker it becomes impossible to eat, further exacerbating the problem.

They might have distended abdomens and bones leading their owners to the erroneous conclusion that their pet is fat and sassy, and receiving an adequate diet. Growing iguanas and females laying eggs have a greater need for calcium and might be more prone to this problem. Females with eggs might not have the strength to lay them, and sometimes even require surgery if they become egg bound.

Lumpy jaw occurs when the body brings fibrous tissue to the area to stabilize the weak bones. A lump at the jaw can also be caused by an abscess.

The fold of skin on the side of this iguana is evidence of dehydration.

This Iguana has such a low calcium level that the muscles are twitching. This is called tetany, and is a serious sign. The two most common causes of tetany in an Iguana are MBD and Kidney failure.

This Iggie is so weak it cannot move properly

 

Diagnosis

A diagnosis of NSHP is made based on history, physical exam findings, and radiography. The history might indicate a diet of iceberg lettuce, dog or cat food, or packaged iguana meal. Swelling of the jaw and legs, low body weight, weakness, dehydration, poor appetite, and lethargy all might be noted on physical exam. X-rays are very diagnostic. Even though this is a problem of low calcium level, blood samples show normal calcium levels commonly.

This is the femur (thigh) bone of a healthy iguana. Compare it to the diseased one below.

This is the thinning (arrow) that occurs in this disease. In addition to poor bone strength, this iguana has an infection.

This iguana has a severe form of the disease. The spine is deformed which has interfered with the nervous system, so it is unable to walk or eat well. This creature is gravely ill. To let a creature deteriorate to this point is a crime.

An x-ray reveals the extent of the curvature problem to the spine.

Treatment

Iguanas that are diagnosed with NSHP are usually very ill and often need to be hospitalized. During hospitalization they are given fluids to correct dehydration, a special liquid diet, injections of vitamin D3, injections of calcium, oral calcium, and antibiotics if they have an infection. Those that have pathologic fractures are splinted.

After they are stabilized in the hospital they are sent home with calcium supplements, antibiotics if needed, and their dietary deficiency is corrected. They need to return weekly for at least several weeks for vitamin D3 injections and calcitonin injections.

A typical splint applied when both rear legs have pathological fractures.

An x-ray of this splint shows the padded paper clips that are used for support.

This different case was referred to us. The splints on these front legs are inadequate, as evidenced by the displacement of the fractured ends.

We performed surgery in order to correct this problem. These pins will be removed in 1-2 months.

 

This disease occurs in other lizards, like this young chameleon with numerous pathological fractures. There are differences in why this species gets this problem as opposed to the green iguana, but the main problem of inadequate husbandry stays consistent.

We routinely take radiographs to assess the problem. This chameleon has problems in all four of its legs. Do you also see the eggs? These eggs cannot be laid normally due to this disease, and they can become toxic. This chameleon is seriously ill, and if we can get the bone problem solved we would think about spaying it to remove the eggs.

MBDChameleonRad

Click on the radiograph to make it larger so you can see the bone problems

ChameleonTongue

In some cases the bones that allow the tongue to move normally are permanently injured and the tongue is rendered useless.

We had to splint all four legs on this little guy with MBD

This disease also occurs in tortoises.The shell is soft due to inadequate nutrition.

Prevention

It must be fully understood that iguanas are ectothermic animals. This means they are highly dependent on their environment for their normal physiological functions, much more so than birds and mammals. They come from Central america where the temperature and humidity are consistent- 90% humidity and 90 degrees F. In addition, they bask in the direct sun many hours each day. If these conditions can not be replicated then these animals should not be kept in captivity. Ignorance of their needs is no excuse.

Their diet should consist heavily of dark green leafy vegetables in order to have the proper ratio of calcium to phosphorous. Contrary to what you may read elsewhere, these animals are not omnivores, they are strictly vegetarians, even when they are young. Therefore, high protein diets (dog food, cat food, protein supplements) are not to be fed to them. These high protein diets will cause them to grow bigger and faster, but will also cause their kidneys to fail. Vitamin supplements that contain calcium should be given weekly.

The following list describes would should and should not be fed. A combination of several items from the “Should Be Fed List” need to be fed, not just one or two items. For small iguana’s it is helpful to dice up your vegetables into very small pieces so that they don’t eat only a few items.

Foods That Should Be FedCollared GreensMustard GreensGreen LeafRed LeafButter leafDandelion GreensMango and PapayaBroccoliNon toxic flowers Foods That Should Not Be FedDog FoodCat FoodRodentsEggsIceberg LettucePizzaMeatInsects

Prognosis

This disease is correctable and preventable. If a pet iguana is brought to us in an advanced state of the disease then the prognosis is not good. Otherwise, we are able to return a large percent of them to relative normalcy if our full treatment regimen is followed. After the immediate problem is corrected it is mandatory to provide the optimum environment for their proper quality of life.

Continue Reading

Iguana Bladder Stones

Common Green Iguana’s occasionally have a problem with bladder stones (the medical term for bladder stone is urolithiasis). It is difficult to determine exactly why they have this problem. Just like in tortoises, the bladder stone can be very large. In addition to learning about the surgical removal of a bladder stone in an Iguana in this page, we also have pages that show a bladder stone removal in a dog and a tortoise. They also show pictures for interesting surgeries to remove them.

At the end of this page we have a short movie on the removal of a bladder stone from an iguana.

Graphic surgical photos on this page.


 

Symptoms

In dogs and cats there are several clues as to when a pet has a bladder stone. These include straining to urinate, blood in the urine, and lethargy. In reptiles the symptoms are not so clear cut since they don’t have the same habits as mammals and they easily hide symptoms of disease. Sometimes they don’t have any symptoms, in which case the diagnosis is made accidentally while looking for other problems. In general, the symptoms of a bladder stone in an Iguana might include lethargy and a poor appetite.

Diagnosis

 

A diagnosis of a bladder stone in reptiles is usually made by taking a radiograph.

This is the radiograph of Elvis, an Iguana with a very large bladder stone that is easily visualized as the large and circular white object

Another view gives some additional perspective as to the size. It has probably been there for years to progress to this size.

 

Treatment

The treatment of choice for this bladder stone is surgery. It takes about an 90 minutes from start to finish.

Its a meticulous surgery that requires a very gentle touch to an inflamed and sensitive bladder. It is performed under sterile conditions to minimize any chance of infection.

Here is Dr. Ridgeway working on his skin incision at the start of the procedure.

 

Anesthesia is initially induced with a face mask. Sometimes Iguana’s are given a tranquilizer before we given them anesthetic via the face mask. The anesthetic works rapidly, as long as they don’t hold their breath!

When she has relaxed enough, a special tube (called an endotracheal tube) is placed in the windpipe. This tube allows us to inflate the lungs and supply adequate amounts of oxygen and anesthetic.

The endotracheal tube is gently passed into the opening to the windpipe. This opening is at the back of the tongue, and can be difficult to visualize due to the fleshy tongue.

All of our surgeries are performed under sterile conditions. The skin is cleansed numerous times with a special antiseptic agent. The area is covered with a sterile drape and the surgeon uses sterile equipment for the duration of the procedure.

Iggie-AbdominalPrep

While our nurse prepares our patient our doctor is doing the same cleansing of his hands.

_D2A8630

This is a major abdominal surgery, so our surgeon is fully gowned and masked

Rabbit-femurfx-3

A scalpel blade is used to nick the skin enabling us to use a special scissors to extend the incision. The incision is around 6 inches long in order to have an opening large enough to remove this stone from the coelomic (the reptile version of abdominal) cavity.

Great care must be taken when extending the incision with the scissors. Immediately below the skin is a large vein that must be avoided. You can see it here as the dark blue object running horizontally.

The bladder is then localized and brought out through the incision. It is carefully assessed to determine the correct location to place sutures and to make an incision. Notice the large number of blood vessels that cover the surface of the bladder.The bladders wall is quite thin and can easily tear, especially when inflamed because of the large stone.

The opening is draped with moistened sterile gauze to minimize contamination and keep the bladder moist. A small suture (called a stay suture) is placed at each end of the bladder to keep the bladder in position and to minimize handling during manipulation of the stone. The arrow is pointing to the suture as it is being placed at one end.

When the bladder has been properly stabilized an incision is made at an area where there is minimal blood supply. The incision is made just large enough to squeeze out the stone.

The stone is carefully squeezed out of the bladder. You can get an idea of its size in relation to Dr. Ridgeway’s hands. It is hard to imagine what type of pain this must be causing.

Internal organs like the bladder have to be kept continually moist when they are not in their usual position inside the body cavity. Here we are moistening the bladder with sterile saline just prior to suturing.

The bladder is sutured with a special suture material that will slowly dissolve over several months. This suture is very strong and will hold the cut edges together during the time the healing is progressing.

Reptile skin is sutured differently than mammalian and avian skin. For reptile skin to heal properly the edges must be “everted”. Within a month these sutures are taken out and within three months the scales are back to normal.

Iggie-AbdominalSutures

Here is Elvis immediately after surgery and just prior to her pain injection. She is being kept warm to aid in her recovery. She went home the next day and is healing fine. We will be monitoring her condition to help prevent the recurrence of this stone.

Click on the link below to see a video of bladder stone removal in an iguana.  The sound you hear at the beginning and end is the Doppler monitoring the heart rate.

Iggie Bladder Stone Surgery

Continue Reading