11/16/2010

What is This and What Should I Do About It?! The Breakdown

• Actual cases seen at WCV – Transfers or new admits • INTERACTIVE ☺ – Rehabbers – Veterinarians – Technicians – Anyone else in Miranda Sadar, DVM attendance? Veterinary Fellow, Wildlife Center of Virginia Call of the Wild Conference November 14, 2010

Woodchuck 1803 Groundhog

• • Adult male Distant exam revealed patient was BARF! • Woodchuck Left sided head tilt present • • Presented August 15 th Unilateral epistaxis (bleeding from nose) • Anesthetized for a physical exam • Brought to us by a • Good body condition veterinarian • No fractures palpated • Suspected to have • Hemorrhages OU been hit by a car – Left more than right – Found dazed in the • What is this and what should we do about it? middle of the road

Diagnostic Tests and Treatment What We Did With the Whistle Pig

• Fecal exam • Sufadimethoxine – 35 mg/kg PO q 24 hr x 5 –Positive for Coccidia days • Blood work WNL • Meloxicam – • 0.2 mg/kg SQ first dose Treatments – 0.1 mg/kg PO q 24 hr x 5 – What do we need to days • be treating? Do we need to perform a recheck ophtho • Where do we go from exam? here? – Why or why not?

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Osprey 1785 Osprey 1785

• Adult Osprey • • Presented August 11th BAR • Brought in by a member • BCS 1.5/5 of the public • Osprey feel thin! • Found on the ground • No palpable fractures or unable to fly more than a few feet bruising • Standing in the box • No evidence of trauma without a wing droop anywhere on body appreciated • What should we do? • Blue feet!

Initial Radiographs Initial Radiographs

Initial Radiographs Initial Diagnostics

• CBC – Toxic heterophils present with a normal heterophil count • Chemistry Panel – Increased CK • Fecal – Negative • What treatments?

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Treatments Repeat Radiographs

• Fluids – LRS 60 ml/kg/day • Antibiotics – TMS 30 mg/kg PO q 12 hr • Anti-inflammatory/pain – Meloxicam 0.2 mg/kg PO q 24 hr • Antifungals – Itraconazole 10 mg/kg PO q 24 hr • Time – Repeat radiographs in one week

Osprey 1785 Osprey 1885

August 13, 2010 August 20, 2010 • Euthanasia • Why? • Necropsy • Suspect past trauma to the wing which affected the shoulder joint

Red-eared Slider 1864 Physical Exam

• QAR • Adult Red-eared Slider • BCS 3/5 • Presented August 25 th • Multiple fractures of the • Rescuer found turtle carapace • upside down on the side Most located caudally – of the road Some located over the spine • Fairly acute fractures with • Suspect hit by car moderate contamination • Sitting quietly in the box of wound with all limbs inside shell • Breathing created bubbles • What should we do?

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General Guidelines for Turtle Fractures Grey Squirrel 1838

• Beware of injuries over the spine • Young, male Eastern – Neurologic examination Grey squirrel • Penetration • th – Body cavity without lung penetration Presented August 20 • Fair prognosis • Brought in by a member – Body cavity with lung penetration of the public • Poor prognosis • Contamination • Suspected to have fallen – Body cavity without lung penetration, acute fracture out of the nest/tree • Fair prognosis • – Body cavity without lung penetration, old and contaminated Curled up into a ball in fracture (usually includes maggots) the box • Guarded to poor prognosis

Grey Squirrel Grey Squirrel

• BCS 3/5 • When head was palpated, • Left sided head tilt it was soft • • Fell to left side when placed on the floor Due to neurologic status, decided to euthanize • Dome shaped head – How? • No limb fractures appreciated • Necropsy • No deep pain in either hind limb – Hemorrhage under the – How to test superficial and deep pain? skin • What is wrong and what should we do? – Severe skull fracture

Mallard 1762 Physical Exam

• QAR • BCS 2/5 • Immature Mallard • No fractures palpated • th • Multiple pododermatitis Presented August 9 (bumblefoot) lesions • Transfer from a rehabber • Torn webbing left foot who had stabilized him (between digits 2 and 3) • Large, old, contaminated for 5 days flesh wound with sutures • Suspect predator attack present over left lateral tibiotarsus • Reluctant to stand • Black, leathery skin over majority of distal (lower) limb • What should we do next?

4 11/16/2010

Diagnostic Tests and Initial Treatment Mallard 1762

• CBC • 5 days of bandage – Mature heterophilia • Antibiotics changes – Clavamox 125 mg/kg PO q 12 hr • Sutured wound closed • Anti-inflammatory/pain – – What is this type of Meloxicam 0.2 mg/kg PO q 24 hr healing called? • Wet-dry bandages – What is this and what is the • 13 days after admission purpose? the scab fell off and – Changed q 12-24 hrs PRN • Fight the urge to pick the scab!! duck was transferred • Special husbandry concerns back to the rehabber for healing waterfowl? • Medications?

Eastern Box Turtle 1862 Physical Exam • • QAR with fair BCS Adult female Eastern Box Turtle • Cranially on the carapace was • Presented August 24 th an old fracture which was stable • Found by the rescuers in the woods behind their • Wounds on bottom of both residence hind feet – Right-Large and contaminated • They noticed a wound on the carapace and with associated fibrosis and swelling preventing retraction brought her in into shell; foot flaccid – Left- smaller wound, flexed • On distant exam she was sitting quietly in the toes well box • Tail and cloaca flaccid • What should we do?

Radiographs Radiographs

Right Left

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Radiographs Radiographs

Right Hindlimb Left Hindlimb

Right Left

Grey Squirrels 1888 and 1889 Physical Exam • Two male, juvenile Eastern Grey Squirrels • Lethargic, quiet • Presented August 28 th • BCS 1.5-2/5 • Transferred from a • rehabber Matted hair coat with fecal material around anus • Brought to rehabber for • Severe diarrhea on exam being cat caught • – Treated with Amoxicillin Gassy abdomen – What is the bacteria of • concern in a cat’s mouth? Dehydrated – What is the antibiotic of • What is going on and what should we do? choice for this bacteria? • Brought to us for uncontrollable diarrhea

Side Note Grey Squirrel 1888 and 1889 • Rabbits and rodents gastrointestinal flora are • predominately gram-positive Diarrhea continued • Beta-lactams, Cephalosporins – Death (1) and euthanasia (1) – Amoxicillin • What can we give rabbit and rodent cat victims? – Clavamox – Ceftiofur (Naxcel) 1. TMS – Convenia 2. Enrofloxacin (Baytril) • Broad spectrum but focus on gram-positive bacteria • Use caution in young animals • In rabbits and rodents, allows gram-negative 3. Chloramphenicol bacteria to overgrow • Last resort due to human health concerns • Dysbiosis and death – May occur even if given by injection!

6 11/16/2010

Canada Goose 1724 Physical Exam

• Immature Canada Goose • Respiratory distress when began handling • th Presented August 4 • • Transferred from a Anesthetized for exam rehabber • Breathing normalized under anesthesia • Raised from a young • gosling BCS 1.5/5 – Was not flying with the • No fractures or bruising appreciated other geese – Breathing abnormally? • No obstructions over glottis • Resting quietly in box • What should we do? without an abnormal stance or a wing droop

Radiographs CAGO 1724 Radiographs CAGO 1724

Diagnostic Tests and Initial Treatment Diagnostic Tests and Treatment

• Radiographs • Clavamox • CBC – 125 mg/kg PO q 12 hr – Low PCV (28%) and TP (2.6 g/dL) • Enrofloxacin • Chemistry Panel – 15 mg/kg PO q 24 hr – Increase in uric acid and CK • • Aspergillosis panel LRS – Strongly positive – 60 ml/kg/day – Received 7 days later… • Antifungals • What treatments should we start? – Should we have started right away?

7 11/16/2010

Canada Goose 1724 Black Rat Snake 1604 • Waxing and waning • respiratory distress Adult Black Rat Snake – Seemed to stop responding • Presented July 20 th to oxygen therapy • Referred from a • Noticed she stepped on her feet and dragging both veterinarian wings – Received it from the • Repeat Chem panel rescuers who found it on th – No change (high uric acid July 19 in their chicken and CK) coop • Repeat CBC – Wooden egg missing – No change (low PCV/TP) • Large mass seen in the • Necropsy middle of the body – Aspergillosis

Physical Exam Radiographs

• QAR, BCS 2/5 • Skin severely stretched over area of FB – Scales cranial to area are wrinkled • Palpation of body is otherwise WNL • Eyes and oral exam WNL • What should we do?

Radiographs Diagnostics

• Surgery! – What problems do we need to watch out for? • Complete blood count – Mild anemia (taken after sx) • Chemistry panel – Increased glucose – Low calcium and phosphorus • Lead test – Why? • Any treatments? • Any other post-operative considerations?

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Treatments Follow Up

• Antibiotics – Ceftazidime 20 mg/kg IM • Repeat CBC q 72 hr x 5 treatments – Anemia improved • Pain medications • Ate two small mice! – Buprenorphine 0.08 • mg/kg IM q 24 hr x 7 Had a huge poop! days • Release! • Fluids • What about the – Reptile Ringers 15 ml/kg sutures?! ICe q 24 hr x 2 days

Ferdinand Ferdinand Physical Exam • Approximately 2 YO male intact Opossum • Anesthetized PE • Presented to the WCV on September 28, 2008 • Extensive skin • Brought in by the rescuers who had found him on the inflammation, open side of the road, kept him for about 5 weeks to care for wounds, crusts on all him four limbs and head/face • Imprint • Clipped, cleaned with – Accepted as education animal on December 1, 2008 chlorhexidine • • August 26 th it was noticed that the top of his head was What in the world crusty should we do now?! – Diagnostics? – Skin firm, crusts with hair loss present, similar on forelimbs – Treatment? • What should we do?

Diagnostics Treatments

• Skin work-up • Antibiotics – Tape preps • Clavamox 13.75 mg/kg – Skin scrapes PO q 12 hr – Dermatophyte Test Media • Pain medications (DTM) • – Trichogram (hair plucks) Meloxicam 0.2 mg/kg SQ for one dose, then decrease • Evidence of secondary to 0.1 mg/kg PO q 24 hr bacterial and yeast • infection, no ectoparasites Wound cleaning daily • • Wait for DTM test (3 days) DTM positive! • • Any treatments? Now what?

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Outcome Goldfinch 1978

• Adult, male Goldfinch • Ketoconazole cream • th topically for 2 weeks Presented September 8 • Tried a bath with • Rescuers found him in their yard unable to fly; Malaseb shampoo… when caught up they saw there was also an eye • Kept inside during problem treatment • Had in captivity since September 5 th – Why? • Very quiet in the box with a wing hike of the • Resolution of signs ☺ right wing

Physical Exam Wing Positions

• BCS 1.5/5 • Right sided wing hike – Suspect coracoid fracture – What would make me suspect this? • All air sacs on right side of body were ruptured • Ruptured globe OD • What should we do?

House Finch 1863 Physical Exam

• • Adult House Finch Lethargic • • Presented August 24 th BCS 2/5 • • Rescuer found bird in No fractures or bruising their yard unable to fly appreciated • • Fluffed with head tucked Both eyes crusted over while sitting in the box • What do we suspect – No wing droop this is? appreciated • What should we do?

10 11/16/2010

Screech Owl 2156 Physical Exam

• Adult Eastern Screech Owl • Minimally responsive • Presented October 29 th • • Fair BCS Cat attack • • First seen at a veterinary Hazing to left eye hospital on the 27 th (suspect hypopyon) – Administered dexamethasone – IOP subjectively low and SQ fluids – • Transferred to a rehabber Corneal ulcer later on the 27 th who sent • Right eye appeared patient to us normal – Administered meloxicam and topical flurbiprofen • Otherwise exam was • Weak and did not try to resist WNL capture; holding OS closed • What should we do?

Side Note Diagnostics and Treatments • Steroid administration should be avoided in many exotic species • – CBC Birds may be sensitive to them (anecdotal) – – Prey species have high levels of endogenous steroids Mild anemia – – May become immunosuppressed with exogenous steroid Toxic heterophils with a low WBC count administration • Pain and inflammation • Examples of steroids: – – Meloxicam 0.2 mg/kg PO q 24 hr Dexamethasone – – Prednisone and prednisolone Butorphanol 2 mg/kg SQ q 12 hr – May be present in topical medications as well • Antibiotics • Do not mix steroids with non-steroidal medications such as – Clavamox 125 mg/kg PO q 12 hr meloxicam or flurbiprofen (topical) – Triple antibiotic ophthalmic ointment three times daily OS – In dog and cat patients, can cause gastrointestinal ulceration and perforation • Corneal ulcer resolved, but eye continued to worsen – Need a “wash-out” period between administration (avg. 5 days) • Now what? – Not proven to occur in birds

Magical Patient Any Questions?

• Evisceration surgery – Why not enucleation? • Died during surgery • Repeat blood work • Anemia and mildly increased WBC count • Monitor for sepsis

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