Category: Reptile

Chameleon Bone Disease

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Metabolic Bone Disease (MBD), also know as Nutritional Secondary HyperParathyroidism (NSHP), occurs in many reptiles that are non-carnivorous. This page talks about MBD in chameleons, although it is most common in the green Iguana.

There are differences in why chameleons get this problem as opposed to MBD in the green iguana, but the main problem of inadequate husbandry stays consistent. You should visit our Iguana page on MBD for much more information regarding cause and treatment of this terrible disease.

Veiled chameleons are highly susceptible to stress, and usually do not do well in captivity. Therefore it is important to pay as much attention to proper husbandry as possible. Veiled chameleons do not drink from a water bowl, and need to be misted. They need a basking spot with a heat bulb that gives them a heat range of 72-80 degrees F. They should have exposure to direct sunlight, or else a full spectrum UVB (ultraviolet B) light. Adult chameleons should be fed gut-loaded crickets (feeding the crickets collard greens, mustard greens, and squash), dusted with calcium and vitamin powder.

This is what we prefer to see, a normal veiled chameleon with an attitude!

This female veiled chameleon came to us with a problem.  She was unable to eat or walk wellAny time we have an ill chameleon we handle them gently because they are fragile.

Notice anything wrong?

Maybe this picture will help in your diagnosis

Her MBD problem is so severe that her tongue just hangs out

She was dehydrated, so we rehydrated her medically with fluid injections We were worried her tongue would dry out, so we dripped water on her on tongue.

We kept her surrounded by warm blankets and soaked paper towels

She was able to pull her tongue into her mouth once she was better after our rehydration and medical treatment

We applied a temporary porous tape bandage to keep the tongue inside when we were not feeding her

MBDChameleonRad

In addition to the tongue problem, she is filled with eggs and has fractures of her bones. This chameleon is seriously ill, and if we can get the bone problem solved we would think about spaying it to remove the eggs.

The splint we put on her fractured leg

Their eyes are amazing!

This is another chameleon with MBD, although the tongue is not affected on this one.

This chameleon is weak and cannot walk

 It has a spine curvature, along with fractures in all four legs.

This is the radiograph of this chameleon, see if you can see the fractures on all 4 legs. The bones lack density, and do not show up well on this radiograph, further evidence of the severity of this chameleon’s MBD. Compare it to the normal uromastyx below.

The straight spine, and increased bone density, is apparent

Before we can correct the husbandry and nutritional problems that caused this, we need to stabilize these fractures. It will be done with custom splints that will stay on at least one month.

Talia, our ace RVT (Registered Veterinary Technician) went to work, and made custom splints

It is important to put lots of padding under the splints

The left front leg is getting its first layer of gauze wrap

Half way there, both front legs are done

Our finished product, a four banger splint

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Laser Surgery

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We have been using the carbon dioxide laser at the Long Beach Animal Hospital for over 20 years.  We are one of only a handful of animal hospitals in California that have this capability. It is a highly advanced and technical piece of equipment that we never dreamed about having while we were training to be veterinarians. Its one of the ways we offer state-of-the-art care at Long Beach Animal Hospital.

The laser is a high precision instrument 

It is carefully calibrated for each individual surgery

This video shows how we set up one for a dog neuter, and how the laser checks its circuits and calibrates itself.

You get to wear these cool glasses when the laser is on

Dr.P has taught many surgeons how to use the laser. Here he is teaching one of our externs.

GPig-EyeSx-11

Dr. Ridgeway is using the laser on a guinea pig for eye surgery.  He is using magnifying glasses due to the small size of his patient. Small patients cannot tolerate blood loss, so the laser has been a tremendous tool for surgery in animals that only have a few drops of blood in them to begin with.

Laser-Tortoise

Here he is teaching one of our externs on the use of laser in a tortoise. Veterinary students do not get exposed to the laser routinely while in veterinary school, which is one of the reasons they do an externship at our hospital. Our goal is to impart all of our knowledge to them as they start their careers.

Laser Theory

A carbon dioxide laser emits a high energy beam of infrared (invisible to the human eye) radiation in the form of light waves that has many veterinary applications. If you would like to learn more about the mechanics of lasers in general, including safety procedures, how they work, and why we use the carbon dioxide laser as opposed to other lasers, click here.

Graphic photos on this page.

Advantages

There are several advantages to the COlaser surgery:

  1. Pain Reduction

    Your pet will experience significantly less post operative pain in almost every instance. As a matter of fact, the pain reduction is so great that we perform declaws on cats only with a laser beam. This reduction in pain is a result of the unique characteristics of the laser beam as it cuts nerve endings, preventing the raw ends that are characteristic of scalpel blades.

  2. Swelling Reduction

    Whenever an incision is made in tissue with either a scalpel blade or scissors, inflammation is started in the affected tissue. This inflammation is a result of interaction with the circulatory and lymphatic systems. Because the laser beam effectively cauterizes the lymphatic system, there is much less post operative swelling. This makes your pet much more comfortable while it is convalescing from surgery.

  3. Control of Infection

    The laser beam operates at a temperature of over 200 degrees Fahrenheit. This makes it highly effective at killing bacteria that have the potential to cause an infection. This is particularly important in areas where it is difficult to prevent bacteria from contaminating the surgical site. Examples include abscesses and cat declaws.

  4. Minimal Surgical Bleeding

    When an incision is made with a scalpel blade, small blood vessels are cut in the skin and the layer of tissue just under the skin. These blood vessels can ooze throughout the surgery and even postoperatively. Traditionally they are taken care of by clamping them with hemostats, cauterizing, or holding gauze sponges on them until they stop. All of these procedures take time, which means the surgery takes longer and there is more post operative swelling. The laser beam is a highly effective coagulator of small blood vessels. Less bleeding during surgery means less anesthetic time and faster recovery time.

    Even though lasers are used effectively in many surgical procedures they are not used in every surgery. They are especially useful in oral surgery, neuters, growth removals, and amputations of small extremities. We also use it in small animals, especially birds, because of the laser’s great effectiveness at minimizing bleeding.

    The following sections give specific examples of the use of the carbon dioxide laser in our hospital.

    Neuter

    The laser is particularly advantageous in this surgery. Prior to using the laser we used a scalpel blade to make the scrotal incision and throughout the whole procedure. When using the scalpel like this, the scrotum would swell over several days post operatively as small blood vessels oozed. This was obviously very uncomfortable in such a sensitive area. The laser has eliminated this completely.

    Canine-neuter6

The laser is being use to cut through the outer layer of the testicle, called the tunica vaginalis

Canine-neuter7

The testicle is exposed, along with the epididymis and blood supply. Notice the lack of bleeding.

We neuter a wide variety of animal:

Cats

Rabbits

Dogs

Rats

Bladder Surgery

Bladder stones are not uncommon in animals. The bladder is usually inflamed and highly vascular, causing significant bleeding when we incise the bladder to remove a stone. The laser has revolutionized this surgery. This is a very sensitive internal organ, and anytime we can make an incision in such an organ without any bleeding, the healing period is much faster and less painful.

Surgery-CatLaserBladder

Here is the initial incision in a cat with no bleeding from the bladder

Laser-cystotomystone

This is a dog with the stone being removed from the bladder after the laser incision

Our bladder stone page has much more detail, including a movie of removing bladder stones from a dog. We also have pages that show removal of bladder stones in Iguanas and tortoises (you don’t want to miss this tortoise bladder stone page)!

Feline Mammary Tumor

These tend to be malignant and highly vascular, causing substantial time during surgery controlling bleeding, along with considerable bruising after surgery. The laser has revolutionized this surgery.

In the video note how diseased the subcutaneous tissue looks and the total lack of bleeding in this highly vascular area. Also notice as milk is excreted from the gland as the surgery progresses

Our web site has a detailed page on mammary tumors in animals.

Rat Mammary Tumor

Rats get a mammary tumor under the skin very commonly. The laser is huge when it comes to removing them with minimal bleeding, which is important in a small animal.

Surgery-RatMammary-3

Surgery-RatMammary-4

Click here to see the full surgery

Oral Tumor

A tumor that can be encountered in dogs and cats is called sqamous cell carcinoma. These pictures are of a dog that had one on its left jaw, called the mandible. The only way to completely cure this tumor is to remove the jaw on that side, a surgery called a hemimandibulectomy. In this case the owner decided against it, and will have the growth removed as much as possible with the laser, following up with radiation therapy.

The tumor is identified by the white arrow. It had been removed 1 year earlier, but as expected with this type of tumor, has recurred. This time the surgery will be with the laser for maximum comfort for Jackey.

The post operative appearance immediately after it has been removed by the laser. Minimal bleeding and swelling are apparent.

We were able to suture gum tissue over the defect left by the surgery. It is hard to tell in this picture that any surgery was performed at all.

This tumor is in a Tegu

LaserSurgery-IggieJaw

The arrow points to the tumor

LaserSurgery-IggieJaw-2

No sutures, no bleeding, no pain, and no inflammation

Declaws

This is a request from people that want to keep their cats indoors. Prior to a declaw, we advise keeping the nails trimmed short or the administration of Soft Paws on the nails, along with a scratching post. One of our nurses will gladly give you a demonstration of these options.

We prefer you use other options before thinking about laser declaw, and will show you how to gently trim the nails

If this does not work you need to make an appointment to have your cat examined by one of our doctors and determine if it is a candidate for the surgery. We do not do this surgery routinely.

Prior to the introduction of the carbon dioxide laser all declaws were done with a scalpel blade. It is a very precise surgical procedure that our doctors have performed thousands of times. Unfortunately, the post operative period was painful, the feet were bandaged, and most cats had to stay in the hospital for several days. On older cats this surgery was even harder on the pet.

The advent of declaws with the laser surgery has substantially minimized these drawbacks. There is usually no bleeding during the surgery so a tourniquet is no longer used. Most of them can even go home the day of surgery but we prefer to keep them for observation for 1-2 days. Most cats have so little pain or discomfort they are jumping and running before nature has had time to complete the healing process. Always restrict their activity at home for the first few days to prevent this problem.

This cat’s nails have grown into its pads due to the owner’s inability to care for it properly. This is a painful situation and makes him a candidate for a front declaw.

Feline-NecroticNail

Sometimes the problem is even more severe, and the severely infected toe (on the right) needs amputation. This is where the laser shines.

The following pictures are from an actual declaw that we performed at our hospital.

Surgery-CatLaserDeclaw

The nail is gently pulled forward prior to surgery to open up the area behind the nail where the incision with the laser will be. Bone is not cut during the procedure at any time, only tendons and ligaments are cut.

Surgery-CatLaserDeclaw-4

The laser beam (it is invisible to the naked eye) has started the incision at the top of the toe. It will cut through skin and tendons along with ligaments in between the digits.  The nail, with its attached bone (called phalanx 3), is removed.

The surgery is complete with no bleeding, swelling,  or trauma to any bone. The top arrow in this picture points to the bone at the joint of the 2nd knuckle. The bottom arrow points to the intact pad that has not been touched either. A drop of surgical tissue glue will be put on the pad to cover the end of the bone.

The foot immediately after surgery. There is no need for a bandage.

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Fluid Therapy

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Fluid therapy might just be the most important medical therapy we perform on sick animals. Dehydrated pets feel ill, cannot fight disease, do not eat well, and cannot metabolize drugs efficiently. Dehydration decreases the circulation to two very important organs, the liver and the kidney. These organs are then unable to perform vital functions, some of which include detoxifying drugs and removing waste products.

We give fluids to a wide variety of species in addition to dogs and cats. They can be ill, and need fluids for many different reasons.

This guinea pig being examined by one of our externs has a problem with overgrown teeth and cannot eat well. This has caused him to become dehydrated, and in need of supplemental fluids.

Before coming in for treatment this rabbit was painful from a broken leg and not eating well, so it became dehydrated. Supplemental fluids to correct the dehydration, and a splint to take away the bone pain and allow the healing, were needed to get him back to being a normal bunny again. You can see how we treated his fracture here

Yup, we even give fluids to 120 pythons when they are ill or dehydrated. This is probably not something you want to try at home!

Fun Facts

Before we get started on the specifics, lets go over a little background on fluids.

The body weight of a normal dog or cat is about 60% water, puppies and kittens are up to 80% water. These numbers show the importance of a proper fluid balance for normal physiology, especially in puppies and kittens when these animals become dehydrated.

The fluid in the bodies of normal animals resides in 3 areas:

Inside the cells of an individual organ, called the intracellular space. 65% of the total fluid in the body resides in this intracellular space.

In the bloodstream, called the intravascular space. 25% of the total fluid in the body resides in bloodstream.

In the tissue surround the cells, called the interstitial space. 10% of the total fluid in the body resides in the interstitial space.

When the intravascular fluid is low hypovolemia results. Hypovolemia means the body cannot deliver adequate oxygen to the cells, and a pet can go into shock. If not treated death can ensue. We assess this low oxygen problem with an instrument called a Pulse Oximeter, which measures the oxygen saturation of the hemoglobin molecule in the red blood cells. It should be in the 90 percent range.

This pot-bellied pig, with a 92 % oxygen saturation, and a heart rate of 82 beats per minute, is normal

Pets with hypovolemia are very ill and can exhibit some of the follow symptoms:

Elevated heart rate, called tachycardia.

Slow heart rate, called bradycardia. This occurs when your pet is in the act of dying.

Weak peripheral pulses. We detect this on an exam by palpating the femoral pulses while simultaneously listening to the heart.

Prolonged capillary refill time (CRT). For a normal animal this should be under 2 seconds.

This is how we check the CRT. This pet is under anesthesia, a time when we carefully monitor this parameter

Cold extremities

Low blood pressure (hypotension).

Hypothermia (low body temperature)

When the interstitial fluid is low dehydration results. This is not usually life threatening until the dehydration progresses to around 10%, which now causes hypovolemia. Dehydration is detected during an exam when any of the following occurs:

Tacky or dry mucous membranes (the gums)

Skin tenting

Sunken eyes

Elevated BUN or Creatinine on a blood panel

Elevated hematocrit and total protein

blood sample will also give clues to dehydration, especially the total protein level and the hematocrit.

This is the hematocrit test, checking the percentage of red blood cells in the serum, giving us information on the state of your pet’s hydration

After the hematocrit is measured we break the tube in the middle and place the serum on an instrument called a refractometer to check the protein level. In conjunction with the history, exam findings, and hematocrit level, the protein level helps us determine the degree of dehydration.

Hypovolemia and dehydration can occur independently. A dehydrated patient might not be hypovolemic, and a hypovolemic patient might not be dehydrated.

Our doctors decide on how much fluid to give your ill pet based on the following:

The normal (called maintenance) amount of fluid your pet needs every 24 hours to maintain normal physiology (called homeostasis).

For a dog this is 60 ml for each kg of body weight. For a 20 pound dog this is 545 ml (1/2 of a liter, or 30 ounces) per 24 hours.

For a cat this is 45 ml for each kg of body weight. For a 10 pound cat this is 204 ml (0.2 liters or 7 ounces) per 24 hours.

The degree of dehydration of your pet

A 20 pound pet that is 7% dehydrated needs 600ml to correct this dehydration. This is more than pet owners realize, and why proper fluid therapy is so important when we hospitalize your pet.

Ongoing fluid losses like vomiting or diarrhea. As pet that has been burned has tremendous fluid losses due to seepage of serum at the burned skin area. This ongoing loss is subjective, but it needs to be added to the calculation above if your pet continues to have these fluid losses.

Symptoms of Dehydration

Signs of dehydration include lethargy, anorexia (poor appetite), sunken eyes, sticky gums, constipation, and a general feeling of malaise. It is diagnosed based on a history of anorexia, vomiting, diarrhea, or extra fluid loss, in combination with a physical exam and diagnostic tests. During an exam a dehydrated pet will shows signs of dehydration when the problem is greater than 5 %. The page talks about the two primary methods used to give fluids to pets. The first is intravenous, and is performed only by us in the hospital. This is not a treatment method you will do at home.

Types of Fluids

The type of fluids we will be describing are called crystalloids. This are the kinds most people are used to, and are usually lactated ringers solution (LRS) or sodium chloride (NaCL), and variations thereof that we might use in specific situations.

These are some of the ingredients in LRS

Another type of fluid is called a colloid (hetastarch or hydroxyethyl starch). Colloids are used only in specific situations, which are not common. For the remainder of this page we will be referring to crystalloids.

Intravenous (IV) Fluids

I.V. (intravenous) catheters are used extensively in pets that are sick or those pets that are about to be anesthetized. These catheters allow us to administer medication directly into the venous system for rapid distribution to the whole body. Medication given this way acts faster and is more controllable, a significant advantage for an ill pet or in an emergency. IV administration of fluids is critical in pets that are hypovolemic.

Intravenous fluids are important during surgery. We monitor this closely in many ways, especially with the blood pressure.

If your pet is ill and staying in the hospital, or about to undergo anesthesia for any reason, an I.V. catheter to allow fluid administration is one of the most important therapies we can institute, and can literally be life saving.

This dog getting his teeth cleaned was put on IV fluids before the procedure to stabilize the kidneys for the anesthesia. The fluids are continued for the duration of the procedure, and will be administered until this pet is fully awake and its owner is picking it up.  

The placement of the catheter requires technical skill and knowledge, particularly in small or dehydrated pets (the veins in these pets are small and damage easily). Improper placement of the catheter can literally cause more harm than good. Our nurses excel at placing I.V. catheters in all species.

Because the catheter is introduced directly into the venous system, it must be placed in an aseptic (sterile) manner. The hair over the vein is shaved, and special tape is placed over the catheter. 

Comfort is also important when placing the catheter due to the small nature of some of our patients, and the duration the catheter must stay in the vein. This tape and catheter is constantly monitored by our staff for comfort and sterility. After 3-5 days we usually replace the catheter in order to minimize the chance of the catheter causing an infection. 

I.V. catheters are usually placed in one of three veins:

Cephalic Vein-This is by far the most common vein to use. It runs along the top of the foreleg of dogs and cats. The illustration below shows the placement of this catheter in a large dog.

Jugular vein-This vein is in the neck. A catheter placed in this vein allows longer term use and the ability to give larger volumes of medication with different viscosity’s.

Saphenous-This vein is on one of the back legs. It is mostly used when the cephalic vein is unusable, but can be used at any time.

Various other veins are sometimes used, by they are reserved for some of the more unusual species of animals we deal with. In some of these pets like birds, that have minuscule seized veins, we cannot give the necessary emergency fluids intravenously. In these cases we use what is called an intraosseous catheter. This catheter goes directly into the bone marrow, and allows us to give the necessary fluids to a small creature rapidly and effectively. In birds it is put in what is called the tibia tarsal (tiboitarsus) bone. This is equivalent to our tibia or shinbone. It is put in at the knee joint.

This radiograph shows the placement of an intraosseous catheter. It is going down the shaft of the tibiotarsal bone in this bird that came in collapsed and in shock. The bird responded and recovered completely after we administered fluids through this catheter. 

Your pet’s catheter will stay in for the duration of its hospitalization or procedure, and will not be removed until you return to pick up your pet. Your pet may go home with a small piece of tape and cotton where the catheter was. It can be removed several hours later after you return home.

We use many different types of fluids, the most common one being Lactated Ringer’s Solution. The amount of fluids given are calculated and  monitored carefully.  We use a special fluid pump that gives a consistent amount of a period of time.

Each patient receiving fluids has a custom fluid chart outside its cage for close and constant monitoring of the fluids. Our doctors make adjustments in the type and amount of fluids as diagnostic tests like blood panels, and your pet’s response to treatment, are analyzed. 

Subcutaneous (SQ) Fluids

The second method used to administer fluids is subcutaneously (under the skin) between the shoulder blades. The administered fluid slowly absorbs over several hours. In this hospital and on an out-patient basis, this method is used for pets that are not seriously ill, but just need some additional fluids to maintain hydration, fight a fever, or stimulate the appetite.

If your pet needs to be on SQ fluids on a long term basis due to a chronic disease, think of it as bonding time and make it a positive experience

This section on SQ fluids contains  detailed step-by-step descriptions on how to give fluids at home on an ill pet, an older pet, or a pet with kidney disease. When you first read it you might think there is no way I can do all of that. Once you observe us do it in front of you, and then do it yourself, you will realize it is not anywhere is difficult as you think when you read about it the first time.

This video is how we give sq fluids at our hospital. Notice how calm this dog is.

SQ fluids are of special benefit for pets that need long term fluid administration at home, usually older (geriatric) cats or those with kidney disease. This is the animal version of dialysis in people, and it works extremely well. These fluids at home are highly beneficial, and have had cats with chronic kidney disease do well for years with this treatment at home.

If your doctor feels your pet needs SQ fluids at home you will be taught how to administer them by our nursing staff. At first it might seem an impossible notion to give your pet fluids at home. Not only is there the psychological fear of using a needle, or worry about hurting your pet, there is also a worry that your pet will not stay cooperative long enough for the few minutes it takes to give the fluids.

Rest assured that you will not be forced into giving these fluids if you feel uncomfortable, although we have yet to encounter a client that was not able to perform this procedure at home. This is because we have extensive experience in this area, and we teach you at your own individual pace. Only when you feel you are ready will you proceed on your own.

You will be given as many personal demonstrations as necessary, and can return to the hospital at any time for further demonstrations or to make sure you are performing the procedure properly. You are welcome to bring your pet in at any time for assistance in giving the fluids, so do not feel you are on your own. If you are out of town, your house sitter can bring your pet in for these fluids. We consider you part of our nursing team and are willing to give any assistance needed. Before you are given a live demonstration the following basics will help prepare you.

The scariest part of the whole procedure for most people is the actual insertion of the needle into the skin so that the fluids flow under the skin (SQ). You will watch us do this as many times as you need to overcome any fear you might have. When you realize it is not all that difficult by watching us do it, we will hold your hands when it is your turn if needed.

Practicing by inserting a needle into an orange or similar fruit can be helpful. Different sized needles, ranging from 22 gauge to 18 gauge, are used to give SQ fluids. During the demonstration we will show you which one works best for your pet.

The 18 gauge needle, at the top, has the largest diameter. Fluids flow fast through this needle, taking less time to give them. If this size needle is uncomfortable for your pet, we will try the 20 gauge next because it is smaller, although the fluids will flow more slowly. On small pets we might even use the 22 gauge needle. 

During this demonstration you will be told exactly how much fluids to give. For most cats with chronic kidney disease, this is 100ml once or twice daily. The fluid bag has 1000ml (1 liter), so for the average cat you will be able to give these fluids for ten days. This might vary depending on many factors, and your doctor will determine the amount and frequency. Do not change this unless instructed to.

Keep children and other pets away if they are disruptive during the process of giving the SQ fluids at home. Have all of your equipment readily available, usually on the same table as your pet. Depending on the size of your pet, the table should be around waist to chest high. It is helpful to set up one area of your house to give the fluids. Hang the fluid bottle in this room for easy access. It should be at least a few feet above the table for optimum flow. You will be shown how to set this up by one of our staff.

Store the fluid bag at room temperature and cover the bag so no light hits it. We sometimes add medications like vitamins and electrolytes to the bag, and light can affect them.

When you purchase a fluid bag from us it needs to be set up with the IV line. We will show you how to do this in person. You only need to set it up when you purchase a new bag. After that, you give the fluids with a new needle each time, keeping the IV set attached, until the bag is empty.

Never use the needles more than once since they are sterile and very sharp when first opened. Repeated use could cause an infection in your pet, and makes the needles dull, causing discomfort on administration. Needles are inexpensive, so don’t take the chance by re-using them.

When you purchase the bag it comes wrapped in a plastic wrapping. Remove the wrapping at home when you are ready to set it up to give fluids to your pet. After you remove the outer wrapping lay the bag on your table or hang it from a coat hanger. 

Open the sterile IV set and lay it on the table


These are the components of the IV set

The large white end with clear receptacle goes into the fluid bag once the white cap is removed. The clear container above will be filled part way with fluid once attached. 

 At the opposite end of the IV line is a small blue cap. You remove this blue cap when you attach a needle, which you will learn about later. 

The large blue plastic piece in the center allows you to turn the flow on and off, and also adjusts the rate of flow. Make sure the white wheel is in the off position like this when first setting it up. 


Remove the white plug from the bottom of the bag. The cap is in solidly, so you will need to pull hard to remove it.

 You can do this while the bag is hanging, or while it is laying on the table. Discard the white cap, it will not be used again. 

Remove the white cover from the IV set receptacle. It is sterile, so do not touch it to anything at this point. 

Hold the hanging bag steady, or lay it flat while doing this, so you can put it straight in without touching anything else. 

Insert it all of the way into the fluid bag 

Hang the bag, then squeeze the receptacle until the fluid fills half of the receptacle

It should look like this when you are done

Lay the needle next to the end of the IV set that has the blue cap

Remove the clear plastic at the base of the needle by twisting it either direction. The open base of this needle is sterile, so do not touch it to anything until you insert it into the IV line. 

Remove the blue cover at the end of the IV set. Turn the fluids on and let a few seconds of fluids flow through the IV line to remove the air. Let these few drops flow into a small bowel or on to a towel. Do not touch the end of this line to anything. 

A few air bubbles left inside the IV line will not cause any problems 

Insert the needle straight into the opening. Hold you left hand still as you twist clockwise with your right hand to lock it tight

Hang the IV set over the fluid bag. You are now set to give the fluids. 

Every pet reacts differently to the actual giving of the fluids, and they feed off of your emotions, so cool and calm usually works best. If either one of your gets worked up, stop and try again later.

Make sure the location to give the fluids is subdued and calm, with no excessive lighting or noise to alarm your pet. Take your time by bringing your pet to the table and interacting with it by petting it and holding it. You can even feed it while giving the fluids. A towel for restraint, or another person holding the head, might even be appropriate.

Hold your pet to the side, make a small tent of the skin between the shoulder blades, remove the cap over the needle, and rapidly insert the needle between the shoulder blades in one motion.

Insert it all of the way in until the hub touches the skin. Turn on the fluids completely on by moving the white wheel all the way to the top, and give the prescribed amount of fluids. For most pets, this takes only a few minutes of your time daily, a few minutes of your time that will be highly advantageous to your pet. 

When you are finished giving the fluids remove the needle from your pet and cap it. Remove the used needle and place a new sterile needle at the end of the IV set, and hang the IV set over the bag as before. You are now ready to give the fluids again the next time one of our doctors prescribes.

Finally, pat yourself on the back for a job well done, have a seat, and breathe deeply (or get a stiff drink if needed to calm your shaking hands).

Place all used needles in a safe place with no access to children or pets. A sharps container to hold these needles is the best place to put them until disposal. Dispose them according to the guidelines in your community. Here are some local disposal centers for needles. If you are not near one of these areas call us at 562-434-9966 for other locations:

EDCO Recycling and Transfer Center

2755 California Ave.

Signal Hill, CA 90755

562-597-0608

L.A. County Sheriff- Lakewood Station

5130 N. Clarke Ave.

Lakewood, CA 90712

Huntington Beach Collection Center

17121 Nichols Lane

Huntington Beach, CA 92647

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Symptoms of Diseases

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Here are 5 basic areas you should observe on a daily basis.

Eating

Watch your pets daily eating habits for :

  • difficulty chewing
  • odor
  • swelling
  • pawing at its muzzle

Since dental disease is so prevalent please follow the link to learn how this can affect your pet’s eating.

Breathing

When your pet is at rest count the number of times it breathes per minute (watch it for 15 seconds and multiply that number by 4). A typical dog or cat breathes 30-40 times per minute, although this can be variable based on breed and external temperature. The important thing to watch for is an increase in its respiratory rate over a period of time. Trend this on a piece of paper weekly so you can see this trend as it gets going. This can be a subtle but very important parameter to measure since an increase here can be for many serious reasons.

Urination

Look for any changes in the following:

  • Urinating more often or in greater amounts than normal
  • Urinating small amounts frequently
  • Straining to urinate
  • Inability to urinate
  • Licking at genitals

In female dogs it can be difficult to assess some of these parameters, so try to pay close attention when she squats to urinate.

Defecation

Any significant change here is important:

  • Continual diarrhea of any type
  • Straining to defecate
  • Licking at anus
  • Scooting
  • Any blood on feces

Walking

Obvious lameness is readily noticed. Also look for a pet that is leaning more towards one leg or the other, tires easily after walking or playing, is slow at getting up after resting, or is reluctant to go up or down any type of elevation like stairs or jumping into a vehicle.

Now that you have observed your pets daily habits lets look at how you can look for problems that are not so apparent by going to our In Home Exam page.

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Anesthesia

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One of the most important tools available to veterinarians to thoroughly and painlessly treat pets is the advent of modern day anesthetics. These anesthetic agents allow us to sedate and anesthetize a wide variety of animals with negligible chance of serious side effects.

Modern anesthetics allows us to safely anesthetize high risk animals like this duck with a fractured wing. You can see her surgery in our Wildlife Care page.

The lack of significant complications from anesthesia is due to a combination of expertise, thorough pre-anesthetic testing, and state of the art anesthetic and monitoring equipment. We are equipped to anesthetize any pet from a finch that weighs 15 grams (it takes 454 grams to make up one pound), to pets that weigh several hundred pounds. We are also particularly proficient in anesthetizing senior pets and pets with medical problems like liver and kidney disease.

The most important part of monitoring your pet while it is under anesthesia is our nurse technician that is with your pet the whole time it is under anesthesia

The goals of anesthesia are to minimize anxiety and eliminate pain. In addition, from the surgical point of view, anesthesia allows profound muscle relaxation. This is helpful in every surgery because the procedure will go quicker and incisions can be made smaller when the muscles are relaxed. In certain types of surgery like fracture repair, this muscle relaxation is crucial for success.

It is normal for you to have concern if your pet is about to undergo a procedure that requires anesthesia. Because of this fact, we invite you to be a part of our anesthetic team. Your primary responsibility is to let us know of your concern. You will have access to your doctor to discuss any of your concerns and to set up a custom protocol for your pet, taking its specific needs into consideration. Only when you are comfortable with the situation will we proceed any further. Also, to alleviate your concern on the day of actual anesthesia, we will call you immediately after your pet wakes up, if you so desire. Please leave a number where we can reach you on the day of surgery.

Pre-Anesthesia

A pre-anesthetic exam is performed just prior to anesthetizing any animal. We are looking for any problems, particularly with the heart and lungs.

We perform this exam just prior to anesthetizing your pet

Even our more unusual patients get an exam prior to surgery

One of the precautions we take to minimize the risk of anesthesia is to perform pre-anesthetic diagnostic tests. A pet can pass its pre anesthetic physical exam and still have significant internal problems, so it is important that we perform more than just a physical exam. This is because animals cannot tell us of their problems, have high pain thresholds in comparison to people, and have defensive mechanisms allowing them to hide symptoms. Pre-anesthetic diagnostic tests are designed to alert us to internal problems that are occurring without any symptoms.

We prefer to perform an exam and blood panel about one week prior to surgery. We send this blood panel out to our lab for a thorough analysis of important organs like red blood cells, liver, and kidney.

 This report is showing a kidney problem

 

In an emergency, or when we cannot send the blood out to our lab several days prior to surgery, we can perform an analysis in our hospital by our blood analyzer

We can have this report in 30 minutes. This is how it checks the CBC (Complete Blood Count). It also gives us a biochemical report like the one above that checks the internal organs like the kidneys.

Those pets that have infections (especially tooth infections) might be put on antibiotics ahead of time. They make pets feel better, and help support internal organs.

Older pets, or those with medical problem,s are given intravenous (IV) fluids prior to and during the anesthetic procedure. Giving fluids prior to the surgery greatly reduces anesthetic risk. This is particularly important in older pets and those with kidney or liver disease. Most pets that have significant dental disease will also be given IV fluids.

IV fluids are one of the most important treatment modalities we have for a wide variety of medical situations in addition to surgery

Pre-Anesthetic ECG

For elderly pets, those with heart murmurs or heart conditions, we perform an electrocardiogram just prior too surgery.


This one has a potential problem that needs to be addressed

Blood Transfusions

For those pets that are anemic, or in surgeries where we anticipate significant blood less, we give whole blood before, during, and after the surgery. This is important in surgeries like splenectomies.

This is what anemia looks like in a CBC from our in house blood machine

Dog do not have iso antibodies, so in an emergency, and if the dog has never received blood before, we can give blood from most any dog donor. It is not our preferred way of doing a blood transfusion.

Before we give the blood we prefer to do a cross match

We use whole blood that is specially prepared and stored

Injectable Anesthesia

Injectable anesthetics are used for many purposes. One of their primary uses is to sedate pets before giving the actual anesthesia (called pre-anesthetic). By sedating ahead of time we dramatically minimize anxiety, cause a smoother recovery, and minimize how much anesthetic we need to administer during the actual procedure. In addition, some injectable anesthetics minimize vomiting, a common problem when waking up from anesthethesia.

Injectable anesthesia is given intravenously, and rapidly induces relaxation so that we can put in a breathing tube

Injectable anesthetics are also used to give complete anesthesia for short periods of time. This is used for C-sections and minor surgical procedures. Injectable anesthetics are ideal to sedate a pet for radiographs (x-rays).

As new anesthetic agents evolve, the trend is towards using injectable anesthetics more and more for complete surgical anesthesia. They are very effective, very safe, and allow for rapid recovery from anesthesia. They also protect the environment because there are no anesthetic gases vented into the atmosphere.

Gas Anesthesia

The mainstay for general anesthesia is gas anesthesia because it is very safe and highly controllable. We use a safe and effective gas anesthesia  called Isoflurane. It is so safe it can be used in creatures as small as tiny birds.

Lisa is watching carefully as this budgie is being anesthetized for a surgery to remove a growth on its cloaca

Gas anesthesia requires specialized equipment and training. Several precision components are used to administer and monitor anesthesia:

Oxygen

All pets put under gas anesthesia are given 100% oxygen from the moment they are anesthetized until they wake up, dramatically increasing the safety of the procedure.

We have a special machine in surgery that generates 100% oxygen

As a backup,  oxygen is stored in large tanks under high pressure. The oxygen in these tanks is delivered to the anesthetic machine via special piping throughout the hospital. This allows us to have anesthetic machines in several hospital locations.

A pet can be brought into radiology after its surgery and still be kept under gas anesthesia, while the surgeon reviews post operative radiographs to ensure everything is in order. This is especially helpful when orthopedic surgery is performed.

Keeping a pet under anesthesia is important in orthopedic surgery to make sure the plates, pins, or screws are properly placed and in alignment. If they are not, this can be corrected before a pet wakes up completely. 

Endotracheal Tube

Oxygen is routinely delivered to your pet by a breathing tube (endotracheal tube) in its windpipe. It is the preferred method to administer oxygen because it is very efficient, will prevent any vomitus from entering the trachea (vomiting rarely happens because of fasting and pre-anesthetic sedation), and allows us to gently inflate the lungs during surgery so that they work at maximum efficiency. Besides oxygen, the anesthetic gas (Isoflurane) is also administered through the endotracheal tube. Medications can even be administered via this special tube.

 

The endotracheal (ET) tube is placed directly into the windpipe

This x-ray shows the breathing tube (follow the arrow) as it passes over the tongue and down the trachea (windpipe)

We can easily breathe for your pet and inflate your pet’s lungs by gently squeezing the bag connected to the tube, monitoring the amount of pressure we are exerting with a gauge on the anesthetic machine. Each size and species of pet requires a different sized endotracheal tube. The tube is not removed from your pet until it is literally waking up. This ensures that the swallowing reflex is present, and your pet is now safely able to breathe on its own.

Vaporizer

An instrument called a precision vaporizer is used to deliver the Isoflurane anesthetic gas within the oxygen. It is a very precise instrument allowing us to make fine adjustments in anesthetic level. Without this vaporizer we would not have the wide safety margin that we currently enjoy.

We can precisely and easily change the level of anesthesia during the procedure as needs change

For most surgeries we administer the anesthetic at a setting of 1-3 %. This small percent of anesthetic, added to the 100% oxygen the pet is breathing, is all that is needed to achieve complete surgical anesthesia. Before the surgical procedure is finished the anesthetic is lowered before it is turned off completely. As the surgeon is finishing the procedure your pet is in the beginning stages of waking up. This decreases anesthetic time,  another way we minimize anesthetic risk.

Monitoring

Our surgeon is one of the best monitors, because he/she is literally visualizing the blood in the circulatory system. Any change in the blood is readily noticed because pets that are breathing 100% oxygen should have bright red blood.

In addition to all the high tech monitoring equipment we have, our anesthetist is hands-on in monitoring your pet. Here Brianna is using  her stethoscope to check the heart, even though the heart monitor behind her is doing the same thing. 

After listening to the heart she keeps a close tab on oxygen flow and the anesthetic level of our precision vaporizer

We keep detailed records of fluid rate rates, anesthetic and oxygen levels, and physiologic parameters, during the surgery

We keep a close tab on the heart with the stethoscope on all of our more unusual surgical patients

Since our small patients can easily become hypothermic due to the anesthesia and surgery, we monitor temperature continuously.

Surgery-GPigWaterBlanket

Surgery-GPigWaterBlanket1

All of our patients, especially the smaller ones like this guinea pig, are kept on warm water water blankets to prevent hypothermia before during, and after any anesthetic procedure.

Anesthetic Monitor

This highly accurate and sensitive monitor gives us detailed information on your pets physiologic status while under anesthesia.

It is a sophisticated instrument that gives us an early warning sign of impending problems with your pet’s physiology

It is calibrated prior to surgery to ensure accuracy

Watch it in action, and see if you an figure out what all these numbers mean

We sometimes use other instruments to monitor you pet while it is under anesthesia, even though the Surgical monitor does this also. It pays to be redundant. The two most important additional instruments we use are:

Pulse Oximeter (Pulse Ox)

The portable pulse oximeter is an instrument that measures the oxygen saturation of you pet’s red blood cells (to be more specific, its hemoglobin). It is an extremely sensitive instrument that gives us an indication of problems that may be arising long before your pet suffers any ill effects. In addition to measuring oxygen saturation, it measures heart rate, pulse character, and respiration.

This instrument does its magic by measuring the hemoglobin that is oxygenated, and comparing it to the hemoglobin that is not oxygenated. It does this by shining a light on an artery, and then measures how much of this light is absorbed. It gives us an answer in PaO2– the partial atmospheric pressure of oxygen.

This Guinea Pig has the pulse oximeter sensor attached to his foot in preparation for surgery

The Pulse Oximeter measures oxygen saturation of 92%  and a heart rate of 87 beats per minute (BPM). Both of these are normal on this pet, which is a pot bellied pig.

The pulse oximeter has several different types of sensors that can be attached in various locations depending on the procedure being performed.The pulse oximeter can also be used on pets that are not anesthetized. It is useful for pets that are having difficulty breathing (dyspnea) from many different causes. It is also used to monitor pets that are in a state of shock. One of the most common reasons for pets to be presented to us in a state of shock is from trauma, especially being hit by a car (HBC).

Blood Pressure Monitor

We also monitor the blood pressure when pets are under anesthesia for the longer surgical procedures. This is done with our anesthetic monitor.

Blood pressure can also be checked manually at any time

Our hypertension page has a video of the doppler blood pressure monitor in action when we use it in an exam room.

Capillary Refill Time

To complement these high tech methods of monitoring, our anesthetist technician uses several hands-on techniques as a backup. One of the easiest of these is called capillary refill time (CRT). By pressing on the mucous membranes in the mouth, and noting how long it takes for the blanched area to turn pink again, we get a basic assessment of your pets cardiovascular status. A normal pet’s pink color returns within 2 seconds. This technique is used in other situations besides anesthetic monitoring. It is especially helpful when a pet is in shock or is dehydrated.

Capillary refill time on this pet is less than one second

Pain Medication

We complete the anesthetic process by giving your pet a pain injection before it wakes up from the anesthetic. Since the gas anesthesia has a small amount of residual analgesia (ability to kill pain), the pain shot kicks in as the gas anesthetic is wearing off. This allows for a very smooth and pain free recovery. We monitor this closely, and will give additional injections as needed. This pain injection will keep your pet calm its first night home from any surgery. We will also send you home with oral pain medication also for several days.

Local Anesthesia

Another excellent way to prevent the pain encountered when your pet first wakes up is to use a long acting local anesthetic at the incision site. We administer it prior to completion of the surgery so it is in full effect when your pet wakes up.

We use the long acting version of this drug which eliminates pain for up to 8 hours

We even have a local anesthesia patch that is used in some cases to bring long term relief for several days if needed.

Pain Patch

We also use Duragesic (Fentanyl) patches for general pain control in the more serious cases. It is preferable to apply it 12 hours before the surgery for maximum effect postoperatively. It provides pain relief for 3 days. It is important to make sure that no children or other pets are allowed to contact the patch in any way. Bring your pet back to us for proper removal and disposal.

The patch is applied in different locations depending on the surgery. Wrapped around one of the legs and between the shoulder blades are common locations. If we put it on the leg it is covered with a bandage. It will be bandaged for protection and to minimize the chance of contact with other pets and children. Please return in 3 days for us to remove it and dispose of it properly.

One of our nurses is applying it in this picture using gloves to ensure she does not come into contact with the active ingredient.

We will commonly staple the patch to the skin if we put it between the shoulder blades

Our surgical patients are monitored closely immediately after surgery. We will verify the pain medication is working, and that there are no ill effects from the anesthetic. It will also allow your pet to completely wake up and walk normally in a controlled environment where it cannot hurt itself.

Our technical staff monitors your pet post operatively until we are certain it is ready to go home

Long term pain control at home is also important during the next several days. We will routinely send you home with an anti-inflammatory medication or pain suspension for long term pain control. The two most common medications we use are Rimadyl and Torbutrol suspension.

Laser Surgery

Even though it is not an actual pain medication, using our carbon dioxide laser when indicated during a surgical procedure dramatically minimizes pain because it decreases inflammation, swelling, and cauterizes nerve endings. By using the laser and stopping the pain cascade before it even begins there is a dramatic influence on decreasing post operative pain.

This video shows you how we calibrate and set the laser for a neuter surgery

Companion Laser Surgery Post Op

For additional pain control we use our  Companion Laser on the incision line before your pet wakes up from anesthesia. This decreases post operative swelling and pain, and makes your pet much more comfortable.


You get to wear cool glasses when we use this laser

Watch it in action

Returning Home after anesthesia

When you bring your pet home after anesthesia it is helpful to follow some common sense suggestions:

Keep contact with other pets and children to a minimum for at least the first 12 hours. Confine it to an area where it cannot hurt itself  because it may not be steady on its feet for up to 24 hours. It might be groggy the first night due to the pain injection it was given.

Use pain medication as prescribed and keep your pet in a warm and quiet area. You can spend time giving unlimited TLC

Even though your pet has probably been fasted for the anesthesia, feed it only a small amount of food and water when first returning home. Give it more later if it eats well and does not vomit (emesis). Most pets return to a normal appetite within 24 hours. If your pet has not fully recovered from the anesthetic by the next day then please call our office.

Please call us in the evening if you have any questions when your pet returns home from surgery or any anesthetic procedure.

To learn much more about how we do surgery at the Long Beach Animal Hospital please visit our Surgery Page and our Diseases Page.

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Tortoise Bladder Stones (Uroliths)

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One of the more interesting and unique surgeries we perform is the removal of a bladder stone (called a cystotomy) from California Desert Tortoises (CDT’s), along with various other tortoise species like African spurred tortoises (Sulcatas) 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.

We have been doing surgery to remove bladder stones in tortoises since 1989. This page will give you a detailed description of this surgery, with high quality videos and photos, so you can see how we diagnose and treat this problem. It is one of the more interesting surgeries we perform.

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 this 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.  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 recommended 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 the back legs, and lethargy. A tortoise can become paralyzed in the back legs due to mechanical pressure from the bladder stone. 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

Every tortoise that has a problem gets a thorough head to tail exam. We start with the mouth and work our way back. They are ectothermic, so we do not take their temperatures. They also do not have external lymph nodes like mammals do, and it is pretty hard to palpate their abdomens or listen to their hearts with a stethoscope due to the shell.

A large part of our exam centers on the head

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

Only a few stones can be found on palpation. The other method to make a diagnosis, and usually more reliable method, is to take an x-ray. By the time we take a radiograph, many bladder stones are large. 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 the we do the surgery to remove them.

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

Surgery

On rare occasions some tortoise bladder stones are small enough to be removal via the pre femoral approach. It is performed in the same area as the palpation picture above. You can see this in the video below. 

The usual treatment for a bladder stone in tortoises is to perform surgery to completely remove the stone through a hole in the bottom of the shell (the plastron). 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. This might involve taking a blood panel to check for anemia and to check the protein level. 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 that has 100% oxygen and the anesthetic agent. We commonly give a sedative by injection prior to this for further relaxation.

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 it is placed upside down on a warm water blanket. 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.

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While our tortoise is in surgery being scrubbed our surgeon does he own scrubbing

Now that our surgeon and tortoise are both “clean”, the draping process can begin. 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 dremel is now set up. It will be used to cut the shell. 

While all of this is going on the rest of the surgical team is preparing for their roles. 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, and should have purchased stock in Home Depot long ago!

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 flying 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 overheating and necrosing the shell. The blade cuts at a beveled 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 shell will not heal.

Spraying sterile water and flying bone fragments means the front lens of your camera is going to get blessed! 

This short video shows us cutting the shell with the dremel

The final appearance of the cut shell before the shell is payed open. Shell is living tissue, which is why there is blood.

Now the shell 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.

These muscular attachments are very strong, and it takes gentle but persistent prying to start lifting up the shell
The shell is pryed up on all cut edges

The strong muscular attachment of the shell to the internal body are obvious in this photo. Tortoises are built like tanks!

This gives you an idea of the size of the cut shell

The cut piece of shell is living tissue and needs careful handling.The rectangular piece of cut shell is placed under saline soaked gauze until it is put back 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  calcium, phosphorous, and a protein matrix. Since reptiles (ectothermic animals) have a slow metabolism, it can take up to 2 years for the cut shell to completely heal. Click on the photo to enlarge.

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.

This is what these eggs would look like on a radiograph

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

After careful dissection the bladder with the stone in it is exposed

It is gently pulled out of the coelomic cavity

It is packed off with drapes as a first step

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

The stone looks like a piece of concrete. Can you imagine what this would feel like inside of you?

Some small fragments of stone can remain in the bladder after the large stone is removed. The smaller pieces of stone 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.

When we suture the urinary bladder back together we try to minimize the suture going into the lumen of the bladder, where it can cause more irritation to the already inflamed bladder. We try to place most of the suture in the outer layer of the bladder, called the serosal surface, for this reason. The inner and inflamed layer is call the mucosal surface. 

The final outcome of the suture bladder with our plication stitch

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.

We flush and suction simultaneously 

Fluid fragments can be deep into the coelomic cavity, so every nook and cranny needs to be flushed and sanctioned. We do this repeatedly with warm sterile saline.

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.

Part way there

What it looks like when the suturing is complete

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.

Throughout the procedure additional sterile saline was added to the gauze over the shell to keep it moist. Time for this piece of shell to get back to where it belongs.

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

The bone wax has been inserted all around the cut shell

The fiberglass pieced is sized

Time to mix up the epoxy

The fast-drying epoxy is worked smoothly over the fiberglass


Applying it smoothly like this is a work of art!

The epoxy hardens 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.

Occasional we encounter a stone in the bladder that is so huge the we cannot bring the bladder out of the opening in the shell.

This is one of them!

In a case like this we need to break up the stone while it is still in the bladder inside the coelomic cavity. This is a tedious and long procedure. 

The thickened bladder needs to be incised with a scalpel blade

You can see the “stay” suture holding the bladder up for better access in the deep coelomic cavity

The highly thickened bladder is obvious


This bladder stone is dark, probably due to the chronic nature of it being in this urinary bladder for so long

The tedious process of breaking up the bladder stone with the osteotome being

Fluid in the center of the bladder is suctioned out

Some of the stone fragments are fragile and break up as they are being removed

Some pieces are large

The pile of removed stone and fragments was almost 2 pounds

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

We flush the bladder with saline and suction them out

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

Before we put everything back together we check the internal organs for any pathology. This is a lobe of the liver

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.

Return to Reptile Diseases Page

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Spay-Water Dragon

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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.

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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.

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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.

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Iguana Spay

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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

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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.

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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

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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.

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Snake Skin Conditions

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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.

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Snake Impaction

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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

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A radiograph confirms the impaction

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The necropsy gives you a complete picture of the impaction

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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.

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