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July 2024
Exotic Pet Care Deserts
We could define an “Exotic Pet Care Desert” as an area where there are no veterinarians with skills or interest in exotic animal medicine and surgery. In such an area, how can a general practitioner provide compassionate care to an animal they are not familiar with? Let’s start with some basics.
What Are Compassionate Practitioners to Do?
A client calls asking for emergency care for her lethargic, anorexic guinea pig; she’s called multiple practices in her area but received the same response: we don’t see exotics. The nearest hospital that will accept these patients is two states away.
“Veterinary care desert” is a newly introduced term for areas lacking high quality veterinary services. The term is a twist on the original “food deserts,” which referred to areas with no access to high-quality, nutritious food. The Journal of the American Veterinary Medical Association recently published an article with the goal of developing a formal definition of veterinary care desert in order to target intervention. The authors of the study determined that a veterinary care desert was “a geographic area where accessible, affordable, and available veterinary care is limited.”
In this light, we could also define an “exotic pet care desert” as an area where there are no veterinarians with skills or interest in exotic animal medicine and surgery. In such an area, how can a general practitioner provide compassionate care to an animal they are not familiar with? Let’s start with some basics.
What Are “Exotic” Pets?
The term “exotic” can be confusing. Domesticated rabbits aren’t really “exotic” in the general sense of the word. For this reason, the clearest definition of exotic pets is pets that are not dogs, cats, horses, or farm animals.
The American Board of Veterinary Practitioners (ABVP) currently recognizes three exotic specialties: Avian, Reptile and Amphibian, and Exotic Companion Mammal. The first two are clear and self-explanatory. The third specialty, Exotic Companion Mammal, was adopted for mammal specialists. The ABVP says that the approximate breakdown for this specialty equates to 40% rabbits, 40% ferrets, and 20% mice, rats, and other pets. A new ABVP specialty for fish practitioners is also on the horizon.
As exotic pet ownership and demands for veterinary care increase, the demand for exotics services increases. This coincides with an increase in demand for veterinary services in general, regardless of practice type. The American Pet Products Association reports that as of 2024, 65 million households own dogs, 46.5 million households own cats, and about 34 million households own some type of exotic pet. That means that 1 of every 10 US households owns an exotic pet.
Even so, it’s understandable why a practitioner would not want to offer medicine and surgery for unfamiliar species. Exotics-only practitioners feel the same way about being asked to treat a sick horse.
The AVMA professional liability trust (PLIT) does not offer clear guidelines for offering care for unfamiliar species for humanitarian reasons and refers questions on legalities and liabilities to individual state veterinary practice boards. So, the question remains, if a worried pet owner is out of options, what can a general practitioner do to help?
When owners request care for exotic pets—in particular for urgent care—and there isn’t a practice in the area willing to see them, three choices emerge:
- Simply turn these patients away, which never feels quite right.
- Develop a minimal compassionate skill set to provide comfort and, if necessary, humane euthanasia services. In addition, practices can maintain a list of referral centers that may be out of town or even out of state.
- Take steps to actually gain proficiency in exotic pet medicine.
For the purposes of this article, we will focus on the second and third choices: how to develop a minimal compassionate skill set and how to begin to pursue proficiency in exotic medicine.
Developing a Minimal Compassionate Skill Set
The goal of developing a minimal compassionate skill set is to provide some degree of comfort and supportive care for exotic pets while owners arrange to travel to see an expert, or in more serious cases, consider euthanasia.
This includes warming the animal to normal or preferred body temperature, administration of fluids for rehydration (often subcutaneously), and analgesia if indicated.
First-year exotic animal interns and residents are reminded not to wear “exotics blinders” and expect exotic pets to only suffer from their unique exotic diseases. Basic veterinary curricula and additional postgraduate training (e.g., rotating internships) are used as a basis for understanding basic body systems and diseases. This is particularly applicable for exotic mammals, but to a lesser degree for birds and reptiles with unique nonmammalian body systems.
The following two examples illustrate how a practice could handle a request to treat an exotic pet.
Example One
Owners call for help with a 6-year-old male neutered rabbit experiencing an apparent sudden 24-hour onset of respiratory distress. What do you do?
Step 1: The Basics
First, use what you know. In general, you know that increased inspiratory effort likely reflects upper airway disease (nasal cavity, trachea). Increased expiratory effort likely reflects lower airway or cardiorespiratory disease.
You discover that this rabbit is showing increased inspiratory effort. Once again, you can refer to your general knowledge and consider what would be a reasonable diagnostic list for suspected inspiratory distress in any species.
Upper respiratory issues involve the nasal cavity, trachea, and all related structures. Check for signs of infection, neoplasia, or foreign bodies. Don’t forget that mixed presentations are also possible, so even if you find one issue, keep looking until you have ruled out all possibilities.
Step 2: Research
Turn to Blackwell’s 5-Minute Veterinary Consult, look up “Rabbit” and “Dyspnea/Tachypnea.”
The first paragraph advises that rabbits are obligate nasal breathers, and dyspnea-related disease of the nasal cavity is much more severe in this species than one capable of mouth breathing.
Use the general knowledge of causes of dyspnea in traditional mammals and read the next sections on physical exam findings, causes, and risk factors. What is unique to rabbits?
Step 3: Treatment and Handling
In any species, what initial treatment/handling is appropriate?
5-Minute Consult suggests oxygen support, quiet environment, maintenance of hydration; at a minimum consider warmed fluids administered subcutaneously (see image below).
Turn to Clinical Veterinary Advisor’s chapter on upper respiratory tract disorders in rabbits: A differential diagnosis list includes nasal foreign bodies, rare neoplasia, primary bacterial rhinitis, etc.
Step 4: Diagnostics
In any species, what diagnostics might be helpful?
Both references suggest diagnostic imaging and blood work and culture in case of nasal discharge (deep nasal culture).
If radiographs are chosen, what modifications might be made for radiography in any severely dyspneic animal (including a cat)? Sedation, dorsoventral instead of ventrodorsal radiographs, and horizontal-beam radiographs to reduce stress of handling and positioning.
Step 5: Infection Control
The Exotic Animal Formulary gives suggested safe doses for antimicrobials if an infectious etiology is suspected.
Final step: Referral
Prepare to refer the patient to an exotic specialist. I regularly treat exotic patients from six surrounding states and Canada. You may be surprised how willing owners are to travel when given the option.
All three professional organizations for exotics have websites with find-a-vet functions:
- Association of Avian Veterinarians: aav.org
- Association of Exotic Mammal Veterinarians: aemv.org
- Association of Reptile and Amphibian Veterinarians: arav.org
The American Board of Veterinary Practitioners maintains a similar search function for board-certified specialists in avian, exotic mammal and reptile/amphibian medicine; see abvp.com
Example Two
Owners call for help with a barely responsive bearded dragon who has been increasingly less active for the last week and has not taken food or water for 48 hours. What do you do?
Step 1: Stabilization
What can you offer this patient while the owners arrange a visit to an exotics specialist?
First, warm the patient to their preferred optimal temperature zone. Ideal temperature zone data is available in The Exotic Animal Formulary.
Next, give subcutaneous (SQ) fluids to rehydrate the patient. The Exotic Animal Formulary gives information on routes and volumes of fluids for rehydration.
Step 2a: Referral
If the patient can be stabilized and euthanasia is not warranted, the next step would be to find an exotic expert for referral. See the previous example for resources on finding an exotics expert near you. Hopefully this patient will be able to be seen by a specialist. However, if the animal is suffering and euthanasia seems like the most humane option, below details best practices for handling this unfortunate situation.
Step 2b: Euthanasia for Exotic Pets
Euthanasia for exotic pets is not difficult and relies on non-IV injection techniques only, which can be accomplished with minimal familiarity and skills.
The following is the euthanasia technique for birds, mammals, and reptiles (this is appropriate whether or not the owner wishes to be present). Pets must be warm and ideally well hydrated for best effect.
1: Administer a high dosage of anesthetics combined into a single syringe intramuscularly (IM) or SQ using minimal restraint techniques. (See table for agents and dosages.)
Take the patient from the owner briefly. (Explain as we cannot inject a small pet while the owner is holding due to risk of needle stick or a bite/scratch from the pet during the injection). Return the pet to the owner soon after the injection.
2: Determine that the patient is absolutely unconscious and not responding to noxious stimuli, such as a toe pinch.
Be aware some patients may die from anesthetics alone. Also be aware some may require additional dosages, e.g., poor distribution in cold, hypovolemic patients with poor organ function.
3: Administer euthanasia solution intraorgan or simply IM. For mammals: intrarenal, intrahepatic, intracardiac, intracelomic or IM. For birds: IM into the pectoral (breast) muscle (not intracelomic due to the presence of air sacs). For reptiles: intrahepatic, intracardiac, intracelomic, or IM.
Table: Agents and dosages useful for anesthesia before euthanasia
Agents and dosages useful for anesthesia before euthanasia in exotic pet species. Selected agents (usually 2–4) are combined into a single syringe and injected IM or SQ using low-stress, minimal-handling techniques. This is best accomplished in a warm, optimally hydrated animal. (Dosages are based on the author’s own personal preferences.)
| Agent | Dosage (mg/kg) | Comment |
|---|---|---|
| Xylazine | 10–40 | Inexpensive and effective, pain upon injection is likely to be minimal |
| Opioids | Standard therapeutic dosages (see Exotic Animal Formulary) | Enhances effects of other agents, analgesia |
| Dexmedetomidine | 0.02–0.10 | Very effective in high doses but is relatively expensive |
| Ketamine | 10–20 | Effective when combined with other agents, but produces pain upon injection. Not preferred for this reason |
| Alfaxalone | 5–20 | Lower doses are highly effective when combined with other agents. Much higher (up to 10x higher) dosages required when used alone; relatively expensive. |
| Alfaxalone | 10–20 mg/L H2O | Fish |
| Tiletamine-zolazepam | 20 | |
| Midazolam | 1–2 | Antianxiety; to enhance other agents listed above |
| Acepromazine | 0.5–1 |
Take Steps to Gain Proficiency in Exotic Pet Medicine
By far, the best way to serve your clients and their exotic pets is to gain proficiency in exotic pet medicine. True mastery of exotic medicine can take a long time, but even learning some basic skills can help.
A good first start is membership in one or more of the exotic pet professional organizations, such as the Association of Avian Veterinarians (AAV), the Association of Exotic Mammal Veterinarians (AEMV), and the Association of Reptile and Amphibian Veterinarians (ARAV).
By far, the best way to serve your clients and their exotic pets is to gain proficiency in exotic pet medicine. True mastery of exotic medicine can take a long time, but even learning some basic skills can help.
Each one sponsors an outstanding conference with basic and advanced topics; all include wet lab and practical hands-on opportunities. In addition, the AEMV and AAV websites offer Registry of Approved Continuing Education (RACE) and non-RACE approved online lectures.
Other opportunities for high volume/quality exotic continuing education include large national veterinary conferences and a number of regional conferences.
Call an exotic specialist or expert and ask to shadow for a few days or more. You would be surprised how many exotic colleagues would be happy to accommodate.
A few basic skills and resources can help owners in Exotic Pet Care Deserts and go a long way to reducing stress and suffering in this unique and growing class of pets.
Exotic Resources
Free content including performing safe physical exams and basic procedures are available online at the following websites (both require setting up an account):
Exotic companion mammals: Oxbow Animal Health, oxbowanimalhealth.com
All exotic species: LaFeber Vet, lafeber.com/vet
Texts
These textbooks are specifically designed for searching by species and sign/symptoms with in-depth clinical details.
- Blackwell’s 5 Minute Veterinary Consult: Small Mammal, Wiley/Blackwell
- Blackwell’s 5 Minute Veterinary Consult: Avian, Wiley/Blackwell
- Clinical Veterinary Advisor: Birds and Exotic Pets, Elsevier
- Carpenter’s Exotic Animal Formulary, 6th ed., Elsevier, contains a wealth of information on drug dosing, and also contains normal physiologic data (including body temperatures, clin path reference ranges, and other parameters) for many exotic mammals, birds (including poultry), and reptiles.
Photos by Katie Lennox-Philibeck