Evidence-based Medicine in Small Mammals

Evidence-based medicine in small exotic mammals is often considered challenging because of a lack of information related to reference data, validated diagnostic tests, treatment outcome, side effects, long-term prognosis, and financial constraints of the owner. However, despite this lack of information, it is still possible to provide good medical care to small exotic mammals and confirm a disease diagnosis that can be properly treated. With many small exotic mammal cases, the condition of the animal and, ultimately, the disease diagnosis, may not be familiar to the attending veterinarian, and in some cases the disease itself may not have ever been described in that species in the scientific literature. This article describes the process of diagnosing hyperthyroidism in a guinea pig using a recommended patient assessment, diagnostic, and treatment protocol.     

Future directions in training of veterinarians for small exotic mammal medicine: expectations, potential, opportunities, and mandates

Small exotic mammals have been companions to people for almost as long as dogs and cats have been. The challenge for veterinary medicine today is to decipher the tea leaves and determine whether small mammals are fad or transient pets or whether they will still be popular in 20 years. This article focuses on pet small-mammal medicine, as the concerns of the laboratory animal are better known and may differ profoundly from those of a pet. Dozens of species of small exotic mammals are kept as pets. These pet small-mammal species have historically served human purposes other than companionship: for hunting, for their pelts, or for meat. Now, they are common pets. At present, most veterinary schools lack courses in the medical care of these animals. Veterinary students need at least one required class to introduce them to these pets. Currently, there are no small-mammal-only residency programs. This does not correspond with current needs. The only way to judge current needs is by assessing what employers are looking for. In a recent JAVMA classified section, almost 30% of small-animal practices in suburban/urban areas were hiring veterinarians with knowledge of exotic pets. All veterinarians must recognize that pet exotic small mammals have changed the landscape of small-animal medicine. It is a reality that, today, many small-animal practices see pet exotic small mammals on a daily basis.     

Clinical Technique: Endoscopic Oophorectomy in the Rabbit (Oryctolagus cuniculus): The Future of Preventative Sterilizations

Laparoscopic surgery is entrenched within human medicine and offers many advantages over traditional laparotomy procedures. Such techniques have filtered down into veterinary medicine, with some practitioners now routinely performing endoscopic oophorectomy in dogs. However, until the recent development of miniature laparoscopy instruments for human pediatrics, such procedures were not possible in small exotic mammals. By combining the commonly used 2.7-mm endoscopic system with 3-mm instruments, laparoscopic surgery has now become a reality in exotic mammal practice. This article summarizes the required equipment and the surgical approach to performing endoscopic oophorectomy in pet rabbits, and serves as a useful model for endosurgery in small exotic mammals.     

Emergency and Critical Care Procedures in Sugar Gliders (Petaurus breviceps), African Hedgehogs (Atelerix albiventris), and Prairie Dogs (Cynomys spp).

Less common exotic pet mammals are gaining in popularity. The Australian Sugar Glider, African Hedgehog, and prairie dog are seen regularly in exotic animal practices. They are subject to the same types of medical emergencies as more traditional pets, with the unfortunate addition of all too common underlying nutritional and husbandry-related disorders. Emergency stabilization and critical care are important first steps before collection of diagnostic test samples and administration of definitive medical care.     

Critical care monitoring.

Critical care monitoring in exotic practice is limited by the small size and the physiologic diversity of many patients. However, many of the principles applied to humans and other mammals can be extrapolated to monitoring in exotic animals. Advances in the monitoring of human patients offer the potential for more practical, low-cost monitoring in critical exotic patients in the future.     

Skin diseases of rodents and small exotic mammals.

Small exotic mammals and rodents are becoming popular pets in the United States. Like most other exotics, the popularity of these animals has vastly preceded the accumulation of practical husbandry and veterinary information available about them. Several dermatologic conditions have been described in most rodents and small exotic mammals; however, the practitioner can assume that more exist that have not yet been diagnosed or documented. It is not unreasonable to assume that rodents and small exotic mammals could be affected by many of the same dermatologic conditions well described in other animals. Veterinarians are encouraged always to apply the same diagnostic protocols used to work up skin problems in dogs and cats when presented with an exotic pet with a dermatologic disease.     

Emergency Presentations Associated with Cardiovascular Disease in Exotic Herbivores

Exotic animals, including small herbivores, are increasing in popularity as companion animals. Commonly owned exotic herbivores include guinea pigs, chinchillas, and rabbits. These animals fall into the category of prey species with an inherent instinct to hide their illness until severely affected by the disease process. Therefore, any of these animals presented as an emergency case must be carefully evaluated for chronic underlying illness. Cardiovascular emergency and critical care principles are similar across all mammalian species. However, specialized techniques and adaptations are occasionally required because of the unique physiology and natural behaviors of these animals. It is essential to evaluate and stabilize these patients before attempting definitive diagnostic plans. Emergency cardiovascular presentations, as in other mammals, consist of congestive heart failure, arrhythmias, pericardial effusion, and toxicities that can result in cardiac and pulmonary arrest. Cardiac disease is a relatively common finding in small exotic mammals, but there are few peer-reviewed reports regarding diagnosis and treatment of heart disease in these species. Diagnostic testing and treatment options are generally based on knowledge of small animal medicine.     

Anesthesia and Analgesia in Rabbits and Rodents

Rabbits and rodents are popular pets and are often presented to veterinarians for evaluation and medical treatment. Anesthesia in exotic pets is required for many diagnostic and surgical procedures and is associated with a higher perioperative risk in rabbits and rodents when compared with dogs and cats. Inhalation anesthetic agents are commonly used as the sole source of anesthesia in small rodents, whereas injectable agents in combination with inhalation anesthesia are often used for rabbits and larger rodents. Analgesia is an important component of exotic pet medicine. Although it may be difficult to recognize signs of pain in companion exotic mammals, adequate pain management should always be provided. Opioid and nonsteroidal antiinflammatory drugs are the analgesic medications of choice, but others should be considered (e.g., local anesthetic agents). This article provides an update of the current literature regarding anesthesia and analgesia in rabbits and rodents.     

Arterial Catheterization,Interpretation, and Treatment of Arterial Blood Pressures and Blood Gases in Birds

Blood pressure monitoring of patients has become increasingly common in companion animal veterinary hospitals, especially during anesthesia, surgical procedures, critical care, and general health assessments. Determining an animal’s blood pressure has become a standard part of the routine diagnostic evaluation for monitoring hypertension in geriatric patients or patients affected with renal insufficiency, cardiac disease, vision loss, or endocrine disorders. To increase the standard of care in exotic and zoological medicine, new diagnostic techniques must be identified and implemented. Blood pressure measurements in avian species are more challenging because only direct blood pressure techniques have been reported to be accurate. Arterial catheterization and interpretation can be daunting without the knowledge of avian physiology and anatomy; however, techniques for placing arterial catheters are not difficult once clinicians have gained sufficient experience. This article describes the techniques, anatomy, and appropriate interpretation of blood pressure results obtained through arterial catheterization in birds.     

Critical Care Nutrition for Exotic Animals

Exotic animals presented to the veterinary hospital are often malnourished, particularly when ill. Sufficient levels of energy and protein need to be provided for debilitated patients along with important amino acids and vitamin supplementation. For raptor species, a clinical condition described as refeeding syndrome also complicates medical and surgical success. It is important to understand malnutrition and nutritional support to improve treatment outcome of weakened exotic animal patients that are presented to veterinary hospitals. Many of the critical care principles described in this article are derived from mammalian studies.     

Critical Care of the Exotic Companion Mammal (With a Focus on Herbivorous Species): The First Twenty-Four Hours

The number of pet herbivorous exotic mammals is increasing, and their owners are demanding quality medical care. Successful treatment of the critical herbivorous exotic mammal patient is complicated by small patient size, physiological diversity, and a lack of research and clinical data regarding therapeutic response to disease conditions. Despite these impediments, the same principles and techniques used in other domestic animals, such as dogs and cats, can be applied to the herbivorous exotic mammal patient.     

Nonreproductive surgery in small mammals.

The sophistication of soft-tissue surgery techniques in small mammals is increasing rapidly. Exotic animal practitioners must be familiar with the diseases, conditions, and anatomic variations of each small-mammal species. The small size of these patients should not preclude the use of technologic advances available for other small animals. Despite these challenges, successful resolution of surgical problems in small exotic mammals is not only possible but also should be the expected result of veterinarians' efforts in such cases.     

Small mammal critical care.

In emergency situations, veterinarians often are presented with critical patients of any species. The principles for critical care in traditional species such as the dog or cat can be applied to other small mammals. Although there are many unique aspects of the anatomy and physiology of different species, emergency care of small mammals can be instituted with the adaptation of products found in many general practices. Careful assessment of the patient, prioritization of the injuries, and rapid intervention can be life saving in any species.     

Surgical sterilization in small mammals. Spay and castration.

The intrinsic physiologic and anatomic differences between small exotic mammals and the species that are more familiar to veterinary practitioners (i.e., dogs and cats) are substantial. This discussion is limited to rabbits, mice and rats (murid rodents), hamsters and gerbils (cricetid rodents), and guinea pigs and chinchillas (hystricomorph rodents). In addition to their anatomic and physiologic differences, differences in behaviors, such as their reaction to stress and pain, exist. Preoperative and postoperative care, basic surgical techniques unique to these species, and useful materials are discussed.     

Suture Materials and Suture Selection for Use in Exotic Pet Surgical Procedures

Exotic animals are becoming increasingly popular and more exotic pet owners are seeking veterinary care. This has led to a demand for properly trained veterinarians who are capable of providing quality, up-to-date medical and surgical treatments. Many surgeries are now performed on exotic pets, and selection of the appropriate suture material is an important part of the treatment protocol. An understanding of different available suture materials, healing times of different tissues, and knowledge of different anatomic and physiologic characteristics in different species is important in the selection of the most appropriate suture material. This review will summarize important aspects of suture selection in exotic animals.     

Snake care and husbandry.

The snake has long been a contradictory species; you either love them or hate them. In the United States, these reptiles are popular pets.There is also a significant amount of energy placed into developing captive breeding programs to produce different color morphs for many species. In some cases, such as the ball pythons (Pythonregius), these color morphs can sell for 20,000 dollars to 30,000 dollars each. In comparison to domestic mammals, snakes are long-lived. It is not uncommon for corn snakes (Elaphe guttata guttata) to live for 15 to 25 years and for ball pythons to live 35 to 45 years. Because of the longevity and value of these animals, more snakes are being presented to the veterinarian to manage medical and surgical problems,as well as for routine medical care. Veterinary personnel working with snakes should familiarize themselves with the specific husbandry and medical requirements of these animals so that they can make informed decisions regarding their management.     

Clinical approach to prostatic diseases in the dog

In small animal practice, prostatic diseases are increasingly encountered. All dogs may experience prostatic disease, but particular care should be addressed to breeding dogs, in which prostatic affection may lead to decrease in semen quality and fertility. The most common prostatic disease is the benign prostatic hyperplasia (BPH) followed by prostatitis, prostatic neoplasia and prostate squamous metaplasia. These diseases do not have pathognomonic symptoms, therefore, making a correct diagnosis may not be easy. An accurate clinical examination and a correct diagnostic protocol are essential in order to begin the most appropriate treatment, and also to do a good prophylaxis where it is possible. BPH therapy is usually recommended when mild‐severe signs are present or if symptoms disturb the patient. New therapeutic approaches, both medical and surgical, allow to maintain fertility in most animals with prostatic disorders. Prostate cancer is relatively infrequent. Elective therapy is the surgical one, but it is considered palliative and can result in important post‐operative complications. The aim of this paper is to lay down the most appropriate diagnostic process describing the aetiologies of prostatic disease, their symptoms, the right investigative tools and therapy.     

Common procedures in reptiles and amphibians.

Reptiles and amphibians continue to be popular as pets in the United States and throughout the world. It therefore behooves veterinarians interested in caring for these exotic species to continually gather knowledge concerning both their proper husbandry and the conditions that require medical and/or surgical intervention.This article covers husbandry, physical examination, and clinical and diagnostic techniques in an effort to present guidelines for the evaluation of the reptile or amphibian patient. Gathering clinical data will aid veterinarians in arriving at the proper diagnosis,increasing the chances of success with treatment protocols, and educating the clients in proper nutrition and husbandry for their pets.     

Blood Collection Techniques in Exotic Small Mammals

Blood collection from small exotic pocket pets can be difficult to achieve. The individual collecting the blood must know both the anatomy and behavior of the species to obtain suitable amounts of blood for diagnostic testing. Given the animals' small size, it is often difficult to collect large volumes of blood. A clinician serious in developing an exotic small mammal practice should understand the limitations of blood sample collection and the risks involved with the procedure. Unlike domestic animals, these pets are often not comfortable with being handled and are often prone to induced complications when presented to a veterinary clinic and restrained for examination. For some cases, the clinician will have to determine if the risk of getting the sample is better achieved by anesthetizing the patient, and if doing so will have a detrimental effect on the animal. One will also need to consider the effect of the anesthetic versus the stress the restraint may have on the blood results.     

Survey of Zoonotic Dermatoses in Client‐Owned Exotic Pet Mammals in Southern Italy

Several ‘exotic’ mammalian species (e.g. rabbits, rodents, ferrets and hedgehogs) live in close proximity to humans as companion pets. Skin diseases (SD) are frequent causes of morbidity in exotic pet mammals, and most of those SDs have a zoonotic potential. The purpose of this study was to determine the frequencies and types of zoonotic dermatosis (ZD) in client‐owned, exotic pet mammals in Southern Italy. Six‐hundred and fifty‐five medical records of exotic pet mammals examined between 2011 and 2012, across twenty private practice veterinary clinics around the Naples area (Italy), were retrospectively evaluated and screened for animals diagnosed with SDs (rabbits n = 455, guinea pigs n = 93, ferrets n = 64, hedgehogs n = 19, chinchillas n = 13 and rats n = 11). The records of animals diagnosed with SD, whose causative agents had a zoonotic potential, were selected for analysis. The Mann–Whitney independent test was used for statistical analysis. A P value ≤0.05 was considered statistically significant. Eighty‐two records (12.5%) of animals with ZD were identified. Of those, 56.1% (46/82) were affected by fungal infections and 42.7% (35/82) by parasitic infections. No zoonotic bacterial or viral infections were diagnosed. Dermatophytosis was significantly diagnosed more frequently in younger animals. The results of this survey indicate that exotic pet mammals may serve as active carriers for many highly contagious pathogens with zoonotic potential. Awareness and vigilance by the veterinary practitioner is crucial in the prevention of occurrences of ZDs. Children frequently come in close contact with exotic pets. To prevent the unplanned transmission of pathogen from pet to human, an active routine screening examination and preventative treatments are strongly recommended for every newly purchased pet mammal.