Doing everything right…

…but still getting an imperfect result

Pet ownership is immensely rewarding but can be difficult at times. Most of us (yup, myself included) aren’t too keen on the constant upkeep for our exotic pets. I do generally recommend that if you want a reptile, measuring, logging and keeping track of details should be tasks you enjoy.

Regardless you can do everything right but still have a problem develop. I saw a young bearded dragon recently. Her owners notice a small bump on the top of her head, near her neck. They saw that is was increasing in size and brought her right in.

Missy 1

Based on her age and the size of the mass, it seemed most likely to be an abscess. However we couldn’t tell from the outside so the owners allowed me to get a surgical biopsy. At the time I removed as much of the mass as I could.

missy 2

Sadly the biopsy came back with a diagnosis of spindle cell sarcoma – a tumor and she wasn’t even 2 years old!

Next Steps

Based on her age and the fact that the mass returned during the healing process, the owners wanted to give surgical removal a go. This type of tumor is hard to remove completely because it has little finger-like tendrils that extend out into the surrounding tissues. Nevertheless, determined to give xxx the best possible chance, we went back in to hopefully remove it all.

Here are some before, during and after surgical shots – she looks great!

Missy 3 Missy 4Missy 5 missy 6

Again we got bad news from the pathologist. Some of the sarcoma was present on the edge of the removed tissue. This means there was still sarcoma present in the muscle tissue on her back.

At this point we always have a decision – continue treatments or call it quits. Since this type of sarcoma is traditionally slow growing (in dogs and cats), she may have several years before it becomes a problem. If it grows up through the skin she may be fine for a very long time. However, if it continues to extend down through the muscles, it could cause problems with the trachea or esophagus or even some of the pretty big vessels in the neck.

 Treatment options

Discussions with specialists revealed the possibility of 2 different chemotherapy treatments. We could try radiation treatment – but that only gets through a few layers. If the remaining tumor is more than a few millimeters thick the treatment won’t get to the bottom. The other option was to wait until the tumor came back and try to inject the growth with chemotheraputic agents.

Both options work in other species and other tumors…but we don’t have enough data on either treatment in bearded dragons with spindle cell sarcomas to know which would work better. Or if either one will work at all!

At this stage, the owners are monitoring their bearded dragon. They want the best quality of life for her and may have to make some hard decisions when the growth returns. Until then, this is one lucky dragon to have found such a wonderful home.

IMG_4853

Turtle Ear Infections – Yes, Turtles Have Ears

Look at this happy Red Eared Slider.

This is one of the most common species of turtle pet we see out here in the San Francisco Bay Area.  They are hardy, happy little guys.  But they can still develop problems.

Red Eared Slider

The Aural Abscess

Aural = ear (oral = mouth, yes they are pronounced the same…)

A very common problem we see is the turtle ear infection or abscess.  Turtles get infections just like us but unlike mammals, they produce a very thick pus that prevents antibiotics from clearing up some infections.  In this case, the ears.

In the picture below, there is a slightly blurry (sorry!) swelling or protrusion visible just under the human thumb.  Turtle ears should be flat – they aren’t meant to be “outies”.  Some turtles don’t show any signs, but many will feel ill, not want to eat or be in pain from this infection.

Red Eared Slider ear swelling

So what causes this?

Unfortunately that’s not always clear or may be due to a number of different issues.  Inappropriate temperatures, inadequate diets and improper care can set a reptile up to be more susceptible to opportunistic bacteria.  Cages that are not cleaned well enough or often enough and water that does not have a strong filtration system or just isn’t cleaned enough allow bacteria to flourish.  Exposure to that bacteria or even long term ingestion of it can lead to bacterial infections.

The most common dietary problem is not enough Vitamin A (hypovitaminosis A).  This changes how the cells lining the ears, mouth and other areas (from non-squamous cells to squamous cells) are shaped.  With this change, it is easier for bacteria to get a foothold.

So Basically..?

Something causes immunosuppression or changes to the cells shapes, then bacteria takes up lodging and finally the body responds and a thick caseous (or cottage cheese-like) plug starts to form.

Now What?

It’s time for surgical removal.  The surgery itself is not complicated but it would be horribly painful to perform on an awake turtle so we need to sedate or anesthetize them and provide pain control.  Here is an image of the “pus ball” being removed on a sedated turtle.

Red Eared Slider Ear Pus

The End Result

Changes in care (husbandry), temperatures and diet must be made, or the infection would be expected to return.  Antibiotics can be given – ideally they are based off of an aerobic (oxygen-loving) and anaerobic (oxygen-hating) bacterial culture.

Cappi and the Teflon Stent

Cappi

Meet Cappi.  He is a Yellow Naped Amazon currently owned by Mickaboo Companion Bird Rescue (MCBR).  Cappi is a great bird, very vocal and just loves his foster dad.

Cappi - a side view

In this picture, you can see Cappi’s problem – he has a large overinflated airsac.  It’s the fleshy looking bubble on his back.  Air goes in, but air doesn’t come out.

What’s Going on Here?

Birds have a very different anatomy when it comes to breathing.  They still have lungs, just like us, but they also have a system of air sacs that present throughout most of the body.  When we breathe oxygenated air goes into our lungs, drops off the oxygen and exits when we exhale.

The journey air takes through the bird’s respiratory tract is a little more complex.  It’s best described by following a single molecule.  On the first breath in, air travels past the lungs and into the caudal air sacs (caudal thoracic and abdominal).  This leaves oxygen-rich gas in what amounts to a storage tank.  This O2-rich gas is moved on the first exhalation into the lungs where gas exchange occurs.  On the second inhalation, the now O2-depleted air moves into the cranial air sacs (cervicocephalic, cranial thoracic) where it waits to finally exit the body with the second exhalation.

Avian_respiratory_system_2

Ok, it’s actually more complex than that because when a bird breaths in, only half the air goes straight down into the caudal air sacs…the other half enters the lungs.  It takes a bit to get your mind wrapped around that so I like to just follow one molecule at a time!

For more info, check out this explanation.

Why So Complex?

When a bird breaths in, oxygenated gases pass through the lungs allowing gas exchange.

When a bird breaths out, oxygenated gases pass through the lungs allowing gas exchange!

They are able to get oxygen into their bodies at 2X the rate of mammals.  This is a great adaptation for flight.

Back to Cappi…

Cappi’s cervicocephalic air sacs aren’t working right – they seem to have a one-way valve.  We don’t know why it happened to Cappi but physical trauma and infection are two common causes.

Medical Treatment

For many birds, poking a hole into that air sac and squeezing out all the air is a great temporary fix.  Birds don’t have a lot of nerves in their skin and the air sac is really quite like a balloon so it doesn’t hurt.  The problem is that this tiny hole heals over very quickly.  The procedure needs to be repeated frequently.

Surgical Options

Because Cappi’s air sac problem was so extensive (you really cannot see it in the photos) we decided to try a surgical option – a teflon stent.  This creates a permanent opening to allow air out.

Here is Cappi getting prepped for surgery.

Cappi

Look how that air sac deflated once we put a hole in it – the stent is already in place in this picture.  The close up shows the use of stainless steel suture (yes we want that suture to be permanent).  We use the sterile needle to pull suture through the skin.

Cappi Intra-op

All done – what a nice opening.

Teflon Stent

We placed the stent where Cappi can’t reach it, in case he tries.

Cappi's Completed Surgery

Here’s Cappi just an hour after surgery.  No more giant balloons under the skin.

Cappi - a side view Cappi Post Surgery (Before and After!)