Category: Reptile

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.

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 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.

We have a short video on monitoring pets during anesthesia. You will need QuickTIme from www.apple.com to be able to view it.

Precautions

One of the best precautions we take to minimize the risk of anesthesia it 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.

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

Older pets or those with medical problems 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.


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 anesthetic.

Little Bit is receiving an intravenous injection of an anesthetic before his teeth cleaning. It is being given through an I.V. catheter in the cephalic vein of the forearm.

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.

The primary anesthetic in this category is called Propofol. It induces anesthesia rapidly, and pets wake up almost immediately.

Gas Anesthesia

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

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 the 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.

Endotracheal Tube

With rare exceptions, oxygen is 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 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.

After Little Bit was given an injectable anesthetic a breathing tube was placed in his windpipe and Isoflurane was administered.

We can easily inflate your pet’s lungs by gently squeezing the bag connected to the tube and 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.

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

"Chase Summerville" 2/2/98

Vaporizer

An instrument called a precision vaporizer is used to deliver the 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.

For most surgeries we administer the anesthetic at a setting of 1-2 %. This small percent of anesthetic, added to the 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 is another way we minimize anesthetic risk.

Monitoring

During the procedure your pet will be monitored in several ways. One of the best monitors is the surgeon because he 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.

Also, we have an anesthetist nurse in the room monitoring anesthesia. She monitors oxygen flow and anesthetic settings on the precision vaporizer, along with heart rate and respiratory rate. She also uses several tools to aid her in keeping a close watch on important anesthetic parameters:

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.

Surgery-GPigWaterBlanket Surgery-GPigWaterBlanket1

 

Anesthetic Monitor

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

It is calibrated prior to surgery to ensure accuracy

Esophageal Stethoscope

Our anesthetist technician can also use an esophageal stethoscope to listen to the heart. This sensitive instrument is passed into your pet’s esophagus while under anesthesia and placed right at the level of the heart, thus greatly enhancing our ability to hear the heart and detect any problems.

Pulse Oximeter

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 pulse oximeter shows a pet with an oxygen saturation of 94%, a heart rate of 157. It is breathing 27 times per minute, and its heart rate is steady.

This is Little Bit having his teeth cleaned under general anesthesia. The pulse oximeter is attached to his rear leg.

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).

The esophageal stethoscope and the pulse oximeter can be used simultaneously. In this dog, undergoing a neuter operation, Denise, our nurse anesthetist, is taking a reading with both instruments.

The blue tube on the anesthetic machine suctions exhaled gases from our patient and vents them outside the building. The white particles in the canister absorb exhaled carbon dioxide, and the round gauge measures the pressure at which oxygen is being introduced into the endotracheal tube when the technician inflates the bag.

Techa 1

We have a short Quicktime movie showing a pulse oximeter in action on one of our volunteers. The top number is the oxygen saturation, the bottom number is the heart rate. The vertical bar gives us a clue as to the strength of the heart beat. Click on the link below.

Pulse Oximeter

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.

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

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. Those of us that have had even minor surgery know how important pain medication is after a procedure. This pain injection will keep your pet calm its first night home from any surgery.

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, and its affects last for 6 hours.

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

If we put it on the leg it is covered with a bandage. We will commonly staple the patch to the skin if we put it between the shoulder blades. 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.

To ensure your pets complete safety, it will stay with us for at least several hours after it is awake. We will verify the pain medication is working and there are no ill effects from the anesthetic administered. 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.

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.

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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, and various other tortoise species like African spurred tortoises (sulfates) and leopard tortoises. It is usually a problem in captive tortoises, but it has been diagnosed in wildl tortoises on occasion. The stones tend to be smaller in wild tortoises.

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

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

This page contains graphic surgical pictures.


Physiology

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

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

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

Cause

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

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

Symptoms

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

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

Diagnosis

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

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

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

 

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

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

Surgical Procedure

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

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

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

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

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

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

Our surgeon prepares for this surgery simultaneously

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

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A sterile dremel is used to cut into the shell

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

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

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

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

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

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

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

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

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

Dremel in use

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

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

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

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

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

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

The bladder is gently exteriorized through the hole in the shell

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

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

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

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

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

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

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

This was the worst stone we have ever seen!

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

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

We flush the bladder with saline and suction them out

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

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

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

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

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

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

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

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

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

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

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

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

When completed this is what the final result looks like

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

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

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

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

Prevention

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

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

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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.

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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.

OVH-rabbit-2
OVH-rabbit-3

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

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

Surgery-Monitor

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

Rabbit-femurfx-9

Surgery

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

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

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

This is Zeke with her mom

Do you see the eggs in this radiograph of Zeke?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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

SnakeImpaction-Bulge

A radiograph confirms the impaction

SnakeImpaction-Radiograph

The necropsy gives you a complete picture of the impaction

SnakeImpaction-Necropsy

 


Prevention

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

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

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Iguana Infection

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

Cause

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

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

Symptoms

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

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

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

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

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

Diagnosis

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

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

Radiographs

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

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

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


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

Cytology

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

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

This is the cytology report from this pet

Culture

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

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

Biopsy

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

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

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

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

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

This is the report we received from the muscle biopsy

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

Treatment

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

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

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

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

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

Prevention

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

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

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Iguana Bone Disease (NSHP, MBD)

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The most common reptile brought to our hospital is the green iguana. The primary reason owners bring in their ill green iguana’s is because it has developed a disease called metabolic bone disease (MBD), also known as nutritional secondary hyperparathyroidism (NSHP).

The cause of this disease is poor husbandry, especially an inadequate diet. Unfortunately, the literature abounds with erroneous information on the precise needs of these creatures. This outdated an incorrect information continues to be propagated by individuals and organizations with good intentions but limited knowledge.

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

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


Cause

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

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

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

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

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

Symptoms

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

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

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

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

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

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

This Iggie is so weak it cannot move properly

 

Diagnosis

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

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

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

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

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

Treatment

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

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

A typical splint applied when both rear legs have pathological fractures

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

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

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

 

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

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

MBDChameleonRad

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

ChameleonTongue

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

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

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

Prevention

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

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

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

Foods That Should Be Fed

Collared Greens

Mustard Greens

Green Leaf

Red Leaf

Butter leaf

Dandelion Greens

Mango

Papaya

Broccoli

Non toxic flowers

Foods That Should Not Be Fed

Dog Food

Cat Food

Rodents

Eggs

Iceberg

Lettuce

Pizza

Meat

Insects

Prognosis

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

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Iguana Bladder Stones

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

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

Graphic surgical photos on this page.


 

Symptoms

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

Diagnosis

 

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

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

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

 

Treatment

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Iggie Bladder Stone Surgery

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