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.

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Evidence Based Medicine

What is Evidence Based Medicine (EBM)?

ferret-46650_1280It is an applied aspect of clinical epidemiology…??? What that means is that the practice of medicine should be based on valid, clinically relevant research data whenever possible.

The way I like to think of EBM, and why I think it is relevant to my veterinary practice, is that it is a tool to improve my medicine.  There is a variety of information “out there” and we need to rank its usefulness.  Basically, as Dr. McKenzie described it, EMB creates a pyramid of data with super-duper extensive reviews of all the data on the planet at the top…and what is affectionately known as “In My Experience” at the bottom.

Great!  That Makes Everything Easier Right?

Nope!

Human medicine has oodles of data and studies and reviews of studies and compilations of reviews of studies available to sort through.  Veterinary medicine has not so much.
Exotic veterinary medicine has way less.

Well, How Does EBM Help Then?sneaker

Data has to come from somewhere.  It may well start with an “In My Experience” which turns into a case report or a case series.  Then someone tries to get more information through a study (double blinded is the best!).
Eventually we’ll have enough studies to be able to summarize the data in a great big review.

But until then, EMB reminds us to critically evaluate where our information comes from, not to discard the lower levels but understand they are incomplete.

For more information, check out the Evidence Based Veterinary Medical Association.

VetCadducus

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.