Tuesday 31 January 2012

Snakes...why did it have to be snakes?

The quote above, uttered by everyone's favourite archaeologist as he gazes into the Well of Souls and realises just why the floor appears to be moving,  is often parodied, drunkenly recited or just plain copied amongst the geekier corners of the planet. However, the line, or something very much like it, will go through your average friendly veterinary surgeon's head when he or she clicks on the next consult on the list to discover that 'Freddy' is actually a boa constrictor, rather than a poodle, as they had previously been hoping.

A boa may have been a bad example there, because it suggests that the problem is that the animal is dangerous. Not so - or at least, not entirely so. The vet is probably going to feel just as disheartened by a grass snake, to be honest, because it is an 'exotic' - a word whispered with dread in prep rooms and dispensaries up and down the country.

You see, doctors have one species to deal with. It's an odd species, I'll grant you, and tends to talk your ear off before getting to the point of exactly what is wrong with it, plus it has a tendency to mislead or just plain lie to you about what it's symptoms are - but it's still just one. Vets have technically got all the others to worry about, from aardvarks to zebras, and the 8 million or so other species in between (that's a very rough guess, of course...have a look here for a slightly less rough one. But still a guess).

Technically. In practice, of course, it doesn't quite work like that. Back in Herriot's day, pretty much all vets saw pretty much everything that was thrown at them, from pets to farm animals, but nowadays it's very hard to be a true 'mixed practice' vet. Kerry and I gave up 'large animal' work (farm animals and horses) many years ago, and a lot of vets that graduated since our time (I was a millennium baby, veterinary-wise) have never set foot on a farm since they packed their wellies away after their final year viva.

This is not such a bad thing - at least for small animals, though it is getting increasingly difficult to find large animal vets at all any more, and even in 'mixed' practices, the work tends to be divvied up between small animal vets and large animal vets, rather than everyone doing everything. Small animal vets, like me, are nicely within their comfort zone seeing dogs and cats. It's when an 'exotic' walks through the door that we're catapulted right out of that zone into ignoranceville.

'Exotics' (a term that always makes me think of cocktails and hula skirts. Maybe if I was brought up in Honolulu it'd make me think of bowler hats and double decker buses?) is bascially the veterinary term for any animal that takes us out of that comfort zone. In Herriot's day, and even when I had just qualified, this included rabbits, but no longer. Rabbits are getting more common, and are edging closer to dogs as Britain's second favourite pet (after cats). In my first few years in practice, what we now call 'small furries' (but what would be more scientifically called rodents and mustelids - mice, rats, ferrets etc) could have been described as exotic (though this seems a very strange adjective to use about a gerbil) but, as with rabbits, this isn't really the case any more.

(In fact, I seem to be encountering a whole new breed of client, recently - the internet savvy rat owner. These people absolutely dote on their rats, and will likely have researched the problem for quite some time before coming to see you. This isn't a complaint - I actually find it quite helpful. There's (sadly) reams of research of rat ailments, because they are the classic lab animal (unlike guinea pigs, which are strangely very rarely used as guinea pigs) which is difficult to keep up with in practice. Plus, I like rats. I know some people aren't keen on them, but I don't know why. Contrary to what you might have heard, they don't carry any more diseases that your average wild beastie, they're highly intelligent and very sweet. I'm far far less likely to get bitten by a rat than just about any other species I examine, and when I have been bitten by them, I almost always deserved it.)

What we basically mean by 'exotic' is this - feathers or scales. A carapace would do it too, as well as whatever an amphibian is covered with (which might give you some idea of the extent of my amphibian knowledge). The appearance of a reptile or a bird in the waiting room will usually lead to some tense prep room negotiations between the consulting vets ('You do it, please!' 'I did that macaw yesterday, it's not my turn' 'But I saw that bloody chinese water dragon last week.' 'Tell you what, you see it, and I'll do the next five anal glands.')

It's not that we're afraid of them as animals (well, I'm not. My wife might have a different opinion on the matter) - I'm fortunate (considering my job) not to have a phobia about any animals at all. Take me to the top of the Eiffel Tower and I'll scream and cower shaking on the floor like Scooby Doo, but I'm not automatically terrified of critters. It's more the fear that you won't know what's wrong, and even if you can work it out you won't have the slightest idea what to do about it.

Though it may seem like rather an obvious statement, reptiles and birds are very different creatures to mammals. That's why they're in a whole different class (I mean this in the taxoniomical sense, though you can take that sentence any way you like and probably still get the right idea). Let's take a bit of a look at birds to make the point.

I don't know what it is about birds. I mean, they are fascinating creatures - they can fly, for heavens sake! An animal adapted to doing what mankind could only, until the last century, dream about. But, for some reason, they just don't float my boat. I can't find myself excited by, or even especially interested in, birds. I don't actively dislike them, because I don't really actively dislike any animal (except wasps. Bastards.) but they just don't interest me, and I'm not sure why because they really are quite amazingly different to mammals. On the face of it, they do seem similar - or rather, more similar to mammals that reptiles are - but sadly that isn't really the case. Let's just outline a few of the differences that really cause vets problems.

First (and foremost) - outward signs of disease, or lack thereof. Birds are really not good at looking ill, at least until they are so ill that they don't really have any choice. The practical upshot of this is that if a bird is taken to their local vet, they are normally very, very ill indeed. In the case of budgies, they are often so ill that merely the act of clinically examining them can be enough to get them to squawk off their mortal coil, which is an unfortunate experience for both vet and budgie.

The second problem is diagnosis. Birds have a vastly different anatomical and physiological set-up than mammals; although they do have lungs, they are tiny and don't expand, and the principle means of air flow is via air sacs. They don't have a stomach, instead they have a crop (well, some of them do), a proventriculus and a gizzard. They don't have external genitalia (well, most of them don't); checking the sex of a bird usually involves an anaesthetic and a laparoscope, except for budgies which have nicely colour-coded ceres (the bit just above the beak - blue for boys and pink for girls, satisfyingly. Except it's more brown than pink in girls, but let's not spoil it). They have a 'renal portal system', which means that anything you inject into the back legs ends up passing straight through the kidneys at much higher concentration that you would normally expect. I could go on, but I won't - there are many many more. 

All of this means that it is often hard, if you're not experienced in looking at birds, to even know where to start. Is that poo normal? Are the eyes supposed to be that colour? Does that air sac sound unusual? This problem is compounded by the lack of interest in teaching about the exotic species at university. My lectures on birds were almost entirely about chickens, and the vast majority of them focused on the twenty different types of ventilation systems used for housed birds, as well as what lighting protocol you should follow to pump as many eggs as possible out of the poor things. Consequently, my notes of avian medicine consist largely of unhelpful tips like 'If there's something wrong with the birds, sacrifice one and send it for post mortem to find out what it is.' Rather callous, and unlikely to go down well in a consulting room.

Thirdly, their metabolism. Birds have quite a bit faster metabolism than mammals, and if you try and use your drugs at a normal dose scaled down, you'll likely be underdosing. Add to this that almost all medicines are not licensed for use in birds, and that different sources will tend to recommend different doses, plus the simple difficulty for an owner to get medicines into them, and you're having problems even if you do manage to work out what is wrong with them.

With reptiles, things only get harder. They are creatures that shed their skin, that only eat every third day or less, that don't bother with the trouble of keeping warm, just letting the environment do the job for them (which makes you wonder quite what a tortoises opinion of living in Britain in mid-January is). Another big problem with reptiles is...how can I put this delicately? The average reptile owner is, and I'm only saying generally, not perhaps the most well-to-do member of society. Because I'm a typical vet - i.e. a very poor businessman - I always cringe when I have to point out that people have to pay for our services, because we are a business, but the sad fact of the matter is that reptile owners quite often can't afford any tests or diagnostic aids that might help us work out what is going wrong, and certainly can't afford to be referred to a specialist reptile vet.

There is, however, one saving grace with exotics work, that I can sum up in one simple word; Baytril. Baytril is the trade name for enrofloxacin, an antibiotic that is licensed for just about any species that you can imagine would walk through the door, comes in a liquid formulation that can be mixed with drinking water, and is highly effective for many of the infections we see. It's also relatively cheap, and as a consequence of this, it becomes the back-up option for many a vet who otherwise doesn't really know what is going on. I'm not proud of this, but I guarantee many vets reading this will be nodding their heads, and possibly even getting down on their knees to thank Bayer for Baytril.

My personal approach to exotics work is be unashamedly honest with the owner's when they bring in their bearded dragons. 'I don't claim to be reptile specialist,' I'll say, 'But I'm happy to have a look!'. I also make no bones about the fact that I'm 'going to have a look in my exotics manual to see if it's got anything about this'. It might make me look a bit dumb, but I'd rather the owner knew where they stood than try and pretend I'm some sort of lizard magic-worker (a lizard wizard, if you will). As least they won't be too disappointed when the Baytril doesn't work.

This will be my last post for a couple of weeks - Kerry and I are off to Tanzania (if I can shake off this ruddy chest infection. Maybe I should take some enrofloxacin?) in a few days, to meet some exotics in person. I just hope we don't have to treat any of them...

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