Shope fibroma of the eyelid margin in a domestic rabbit.

OBJECTIVE: To describe the clinical and histopathologic features as well as response to treatment of a solitary Shope fibroma affecting the eyelid margin of a domestic rabbit. ANIMAL STUDIED: A seven-year-old female intact domestic rabbit with a progressively enlarging firm, pedunculated, and encrusted inferior eyelid mass of the left eye of 1-month duration. PROCEDURES: Under general anesthesia, the crust was removed revealing an ulcerated mass that was excised via a house-shaped resection and submitted for histopathology. Purulent discharge associated with the mass was swabbed for aerobic and anaerobic bacterial culture and sensitivity testing. Histopathology revealed intraepithelial, cytoplasmic leporipoxviral inclusion bodies consistent with Shope fibroma virus. There was no growth on aerobic or anaerobic bacterial culture. The lesion was completely excised, and no recurrence was noted during a 3-month follow-up period. CONCLUSIONS: The solitary nature and clinical appearance of this eyelid margin Shope fibroma are unique. Shope fibroma should be considered a differential diagnosis for eyelid masses in rabbits even in the absence of other cutaneous masses. Thorough systemic evaluation to attempt to distinguish Shope fibroma from malignant myxomatosis should be performed.

A Scalable and Effective Course Design for Teaching Competency-Based Euthanasia Communication Skills in Veterinary Curricula.

Veterinary staff must be able to navigate end-of-life care with sensitivity and skill to create the best possible outcome for the patient, client, and veterinary team collectively. Despite the clear importance of euthanasia communication and procedural skills in veterinary practice, recent graduates of veterinary programs identified gaps between skills deemed important in clinical practice and skills emphasized in the curriculum. Little time is allocated to euthanasia procedural or communication training across the board in US veterinary programs. Thus, it is of paramount importance to establish intentional and well-designed instruction and assessment of euthanasia communication skills for veterinary trainees. A course on veterinary euthanasia communication skills was designed to emphasize themes and topics essential for a competent veterinarian. Through course evaluations, students expressed the sentiments that this course improved their euthanasia communication skills, that euthanasia communication skills are essential for their careers, and that the course content should be integrated into the core curriculum. This article presents a scaffold for the instruction and assessment of veterinary euthanasia communication skills in alignment with a competency-based veterinary education (CBVE) framework and outlines specific learning interventions used in the course that are scalable and may be extracted and incorporated into existing courses.

Pathology of the Bearded Dragon (Pogona vitticeps): a Retrospective Analysis of 36 Cases.

The bearded dragon (Pogona vitticeps) is a common species in the pet reptile trade and in zoological collections. Despite this, only a few reviews detailing common causes of mortality have been published. The goal of this retrospective study was to compile information related to the presence and prevalence of various diseases in bearded dragons in several private and one zoological collection. Findings from 36 animals, necropsied over a 20-year period were categorized on the basis of the cause of death or euthanasia and the organ system affected. Multiple contributors to death were identified in a subset of animals (n = 12; 33.33%) and were counted in more than one category. The most common contributors to death by category were inflammatory (infectious or non-infectious) diseases (n = 25; 69.44%), followed by chronic/degenerative diseases (n = 17; 47.22%). Diseases or conditions that were systemic, or affected the hepatobiliary system, were the most commonly implicated in death. The most frequent histological findings included hepatic fatty change, renal tubular epithelial pigmentation and the presence of faveolar hyaline-like material. Although Chi square testing did not reveal an association between these common findings and comorbidities, a statistically significant association was found between chronic/degenerative causes of death and renal tubular epithelial pigment. Chi square testing of categorical variables, including contributors to death, primary organ(s) affected, sex, age class and institution, identified statistically significant associations between males and chronic/degenerative disease (P = 0.043) and inflammatory contributors to death and private collection animals (P = 0.039). Death due to inflammatory contributors was significantly higher in the 1-5-year-old and >5-year-old age classes (P = 0.02).

Amniotic membrane grafting for traumatic complete spectaculectomy and keratomalacia in a Boelen's python (Simalia boeleni).

OBJECTIVE: To describe the surgical repair of traumatic complete spectaculectomy and keratomalacia in a snake. ANIMALS: A 10.5-year-old, female, Boelen's python (Simalia boeleni) was presented with iatrogenic, near-complete spectaculectomy associated with bacterial keratitis, keratomalacia, and hypopyon. PROCEDURES: Corneal samples for cytological evaluation and bacterial culture were collected. Following medical stabilization of the bacterial keratitis, a double-layered dry amniotic membrane graft was placed. The first amniotic membrane layer was placed over the cornea with the edges tucked under the peripheral remnants of the spectacle and secured in place with fibrin glue. The second amniotic membrane layer was placed over the entirety of the spectacle remnant and secured in place with a combination of fibrin glue and sutures. Topical and systemic antimicrobials, topical ophthalmic lubricants, and systemic non-steroidal anti-inflammatory therapy were administered postoperatively. RESULTS: Heterophilic keratitis was identified by cytology and Enterobacter cloacae, Pseudomonas aeruginosa, and Staphylococcus sciuri were cultured from the corneal samples. The amniotic membrane grafts remained in place for several weeks. At 4 months postoperatively, the spectacle was completely regenerated, the subspectacular space restored, and the cornea was transparent. Spectacular vascularization and fibrosis then slowly cleared over the following 6 months. CONCLUSIONS AND CLINICAL RELEVANCE: Amniotic membrane grafting with fibrin glue is a relatively simple and effective surgical method to reconstruct extensive defects in the reptilian spectacle and to assist in the management of bacterial keratitis associated with spectacle avulsion.

Identification of a novel nidovirus in an outbreak of fatal respiratory disease in ball pythons (Python regius).

BACKGROUND: Respiratory infections are important causes of morbidity and mortality in reptiles; however, the causative agents are only infrequently identified. FINDINGS: Pneumonia, tracheitis and esophagitis were reported in a collection of ball pythons (Python regius). Eight of 12 snakes had evidence of bacterial pneumonia. High-throughput sequencing of total extracted nucleic acids from lung, esophagus and spleen revealed a novel nidovirus. PCR indicated the presence of viral RNA in lung, trachea, esophagus, liver, and spleen. In situ hybridization confirmed the presence of intracellular, intracytoplasmic viral nucleic acids in the lungs of infected snakes. Phylogenetic analysis based on a 1,136 amino acid segment of the polyprotein suggests that this virus may represent a new species in the subfamily Torovirinae. CONCLUSIONS: This report of a novel nidovirus in ball pythons may provide insight into the pathogenesis of respiratory disease in this species and enhances our knowledge of the diversity of nidoviruses.

Nasal adenocarcinoma and secondary chronic sinusitis in a hyacinth macaw (Anodorhynchus hyacinthinus).

An adult male hyacinth macaw (Anodorhynchus hyacinthinus) that presented for acute onset nasal discharge and dyspnea had purulent discharge from the right naris and serosanguineous discharge from the left naris on physical examination. Results of a complete blood count revealed severe leukocytosis with a mature heterophilia. Computed tomography scans showed a large amount of soft-tissue attenuating material within the infraorbital sinus and associated diverticula. Aerobic culture results of the nasal discharge showed a mixed population of Staphylococcus intermedius and Pasteurella species, including Pasteurella pneumotropica; all isolated bacteria were susceptible to enrofloxacin. Clinical signs did not resolve over the course of 9 weeks of antibiotic treatment. The macaw died after cardiopulmonary arrest while hospitalized. At necropsy, a 2 x 2 x 3-cm firm, tan, friable, space-occupying mass surrounded by a thick exudate was present in the left preorbital diverticulum of the infraorbital sinus. The cranioventral one-third of the trachea contained a 4 x 0.5-cm white-yellow plaque. On histologic examination, the sinus mass was diagnosed as a nasal adenocarcinoma, and the tracheal plaque was caused by fungal infection, most likely with an Aspergillus species.

Suspected primary hypoparathyroidism in a domestic ferret (Mustela putorius furo).

CASE DESCRIPTION: A 4-year-old castrated male domestic ferret (Mustela putorius furo) was examined because of a 3-week history of intermittent seizures, signs of depression, hypocalcemia, and hyperphosphatemia. CLINICAL FINDINGS: Plasma biochemical analysis confirmed hyperphosphatemia (17.7 mg/dL) and low concentrations of total (4.3 mg/dL) and ionized (0.49 mmol/L) calcium. Serum parathyroid hormone concentration (2.30 pmol/L) was low or in the low part of the reference interval. TREATMENT AND OUTCOME: Calcium gluconate was administered (2.0 mg/kg/h [0.9 mg/lb/h], IV), followed by a transition to administration of calcium carbonate (53 mg/kg [24.1 mg/lb], PO, q 12 h) and dihydrotachysterol (0.02 mg/kg/d [0.009 mg/lb/d], PO). Attitude of the ferret improved and seizures ceased as blood calcium concentrations increased. The ferret was reexamined because of seizures approximately 1 year after oral maintenance administration of dihydrotachysterol and calcium was initiated. The ferret responded well to emergency and long-term treatment but then was lost to follow-up monitoring. The ferret died approximately 2 years after the initial evaluation and treatment. Hypertrophic cardiomyopathy was diagnosed during necropsy, but the parathyroid glands could not be identified. CLINICAL RELEVANCE: To the authors' knowledge, primary hypoparathyroidism has not previously been reported in a ferret. The condition should be considered for ferrets with hypocalcemia and hyperphosphatemia without azotemia. Treatment with dihydrotachysterol and oral supplementation of calcium appeared to be a viable option for long-term management.

Outcome for client-owned domestic rabbits undergoing limb amputation: 34 cases (2000-2009).

OBJECTIVE: To describe morbidity, function, outcome, and owner satisfaction associated with limb amputation in domestic rabbits. DESIGN: Retrospective case series. ANIMALS: 34 client-owned domestic rabbits. PROCEDURES: Medical records of domestic rabbits undergoing limb amputation for any cause between 2000 and 2009 were reviewed. The Kaplan-Meier method was used to estimate survival rate and median survival time, and variables were analyzed for relationship to risk of morbidity resulting in euthanasia and to outcome (survival vs nonsurvival [death or euthanasia]). Owners were interviewed to determine satisfaction with outcome of the procedure. RESULTS: 28 rabbits underwent pelvic limb amputation, and 6 underwent thoracic limb amputation. At the last follow-up, 18 rabbits were dead, 9 were alive, and 7 were lost to follow-up. Median overall survival time was 720 days (range, 4 to 3,250 days). Acute and delayed or chronic complications were observed in 22 of 34 and 19 of 32 rabbits, respectively, most commonly difficulty ambulating, hygiene issues, and pododermatitis (cutaneous ulcers at the hock). Six rabbits were euthanized because of complications at a median of 104 days (range, 4 to 399 days) after surgery. Risk of morbidity resulting in euthanasia increased with heavier body weight and concurrent disease affecting ambulation at the time of amputation. Weight, age, and pododermatitis at the time of amputation were significantly negatively associated with survival time. Thirty-one (91%) owners were satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Although limb amputation was tolerated by most rabbits and most owners were satisfied, complications resulted in death in 6 of 34 (18%) rabbits, and 19 of 32 (59%) developed chronic complications. Amputation in heavy rabbits or those with concurrent pododermatitis, musculoskeletal disease, or neurologic disease should be considered carefully. Because of the small sample size and retrospective nature of this study, results should be interpreted as exploratory and hypothesis generating.

Diagnosis and treatment of mesenteric volvulus in a red kangaroo (Macropus rufus).

CASE DESCRIPTION: An 8-year-old male red kangaroo (Macropus rufus) was evaluated with a 2-week history of vomiting and anorexia. Four days prior, the patient became refractory to medical management. The kangaroo was admitted for diagnostic testing and treatment including whole body CT, blood work, and emergency laparotomy. CLINICAL FINDINGS: CT findings of a severely enlarged stomach, splenic displacement, and a whirl sign were indicative of mesenteric volvulus with gastric dilatation-volvulus (GDV). Contrast enhancement of abdominal viscera suggested intact arterial blood supply; however, compression of the caudal vena cava and portal vein indicated venous obstruction. Results of preoperative blood work suggested biliary stasis without evidence of inflammation. Additionally, a tooth root abscess was diagnosed on the basis of results of CT. TREATMENT AND OUTCOME: Exploratory laparotomy confirmed the diagnosis of mesenteric volvulus and GDV. The volvuli were corrected by clockwise derotation, and a gastropexy was performed. Tissue samples were obtained from the spleen and liver for evaluation. The kangaroo recovered from surgery, and the abscessed tooth was extracted 6 days later. Eight days after initial evaluation, the kangaroo was discharged. CLINICAL RELEVANCE: In the present report, the CT whirl sign was used to diagnose volvulus of the abdominal viscera, which suggests that this diagnostic indicator has utility in veterinary patients. Mesenteric volvulus with GDV was successfully treated in a nondomestic species. The tooth root abscess, a common condition in macropods, may explain the historic episodes of anorexia reported by the owner and may have contributed to the development of mesenteric volvulus and GDV in this kangaroo.

Central diabetes insipidus in an African Grey parrot.

CASE DESCRIPTION: A 5.5-year-old sexually intact female African Grey parrot (Psittacus erithacus) was evaluated for a 1-year history of pronounced polyuria and polydipsia. The bird also had a 1-month history of signs of mild depression and mydriasis. CLINICAL FINDINGS: Physical examination revealed a thin body condition and incomplete bilateral mydriasis. Other examination findings as well as CBC and screening radiography results were unremarkable. Plasma biochemical analysis revealed mild hypernatremia. The bird had a 3.3% loss in body weight over 170 minutes during a water deprivation test, and urine osmolality remained low. After IM administration of 0.9 microg of desmopressin, the rate of weight loss decreased substantially and urine osmolality increased 300% over the following 200 minutes. TREATMENT AND OUTCOME: Initial attempts to treat the bird with orally administered desmopressin failed to correct the polydipsia and polyuria. Ultimately, IM administration of 24 microg of desmopressin/kg (10.9 microg/lb) every 12 hours yielded a noticeable reduction in water consumption and urine production over a 6- to 8-hour period. Eight months later, the bird was returned for a recheck examination, at which time it was in good health and continued to respond to the medication. Despite continued response to the medication, right-sided internal ophthalmoparesis was detected 16 months after the initial diagnosis. CLINICAL RELEVANCE: To the authors' knowledge, central diabetes insipidus in birds has not been reported. The condition should be considered in birds with clinical signs of disease similar to those in mammals. Long-term IM administration of desmopressin may be a viable treatment option.

Extrapyramidal side effects in a blue and gold macaw (Ara ararauna) treated with haloperidol and clomipramine.

A diagnosis of adverse extrapyramidal symptoms (EPS) was reached in a 14-year-old female blue and gold macaw (Ara ararauna) that presented with disseminated dystonia (manifesting as pacing, head bobbing, and circling), intermittent ataxia, and coarse-muscle tremors of 60 hours duration. The patient had been treated 23 days previously with haloperidol decanoate (1.7 mg/kg IM once), and for 3 days before hospitalization with clomipramine HCl at a prescribed dosage of 3.9 mg/kg PO q12h. The patient was treated with supportive care, a gradual reduction in the clomipramine dose, and intramuscular and oral diphenhydramine (2 mg/kg q12h). As commonly observed in human patients with drug-induced EPS, a dramatic resolution of clinical signs was observed within 2 hours after the first intramuscular administration of diphenhydramine. It is recommended that EPS be considered in macaws experiencing neurologic signs secondary to clomipramine administration and, in particular, in those treated concurrently or previously with haloperidol.

Pituitary-dependent hyperadrenocorticism in a cockatoo.

CASE DESCRIPTION: A 13-year-old female intact Moluccan cockatoo (Cacatua moluccensis) was evaluated because of coelomic distention, presumed to be secondary to an abdominal hernia. The patient also had a history of rapid weight gain and polyuria and polydipsia. CLINICAL FINDINGS: Ultrasonography was used to confirm the existence of a pseudohernia that appeared to contain the small intestines, pancreas, and reproductive tract. Results of plasma biochemical analysis revealed hyperglycemia, hypophosphatemia, and high nonfasting bile acid concentrations and aspartate aminotransferase activity. A CBC revealed a relative heterophilia with a concomitant lymphopenia and mild monocytosis. Histologic evaluation of a liver biopsy specimen indicated chronic hepatic lipidosis. Despite a strong clinical suspicion of hyperadrenocorticism, ACTH stimulation test results were equivocal. TREATMENT AND OUTCOME: The pseudohernia was strengthened with a prolene mesh. Despite ongoing medical and surgical care, the patient developed complications associated with the herniorrhaphy and was euthanatized. The clinical suspicion of hyperadrenocorticism was confirmed on the basis of histologic evaluation of the pituitary gland by use of special stains. CLINICAL RELEVANCE: To our knowledge, pituitary-dependent hyperadrenocorticism has not been previously confirmed in Psittaciformes. The condition should be considered in birds with clinical signs consistent with those observed in mammals. For the cockatoo of this report, ACTH stimulation test results were equivocal and additional diagnostic tests should be developed for avian patients.

Difficult interactions with veterinary clients: working in the challenge zone.

As veterinarians, effective interactions with clients and coworkers are fundamental to our professional satisfaction and success. This article first reviews the basis of a difficult interaction and provides specific communication skills to help the veterinarian more successfully manage situations that he or she may find difficult. Then, the authors offer exercises to assist veterinarians in practicing these skills. The information in this article relies closely on the work provided through the Bayer Animal Health Communications Project.

Effects of melatonin administration on the clinical course of adrenocortical disease in domestic ferrets.

OBJECTIVE: To evaluate the effect of oral administration of melatonin on clinical signs, tumor size, and serum steroid hormone concentrations in ferrets with adrenocortical disease. DESIGN: Noncontrolled clinical trial. ANIMALS: 10 adult ferrets with clinical signs of adrenocortical disease (confirmed via serum steroid hormone concentration assessments). PROCEDURES: Melatonin (0.5 mg) was administered orally to ferrets once daily for 1 year. At 4-month intervals, a complete physical examination; abdominal ultrasonographic examination (including adrenal gland measurement); CBC; serum biochemical analyses; and assessment of serum estradiol, androstenedione, and 17alpha-hydroxyprogesterone concentrations were performed. Serum prolactin and dehydroepiandrosterone sulfate concentrations were evaluated at the first, second, and last examinations, and serum cortisol concentration was evaluated at the first and last examinations. RESULTS: Daily oral administration of melatonin greatly affected clinical signs of adrenocortical disease in ferrets; changes included hair regrowth, decreased pruritus, increased activity level and appetite, and decreased vulva or prostate size. Mean width of the abnormally large adrenal glands was significantly increased after the 12-month treatment period. Recurrence of clinical signs was detected in 6 ferrets at the 8-month evaluation. Compared with pretreatment values, serum 17alpha-hydroxyprogesterone and prolactin concentrations were significantly increased and decreased after 12 months, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that melatonin is a useful, easily administered, palliative treatment to decrease clinical signs associated with adrenocortical disease in ferrets, and positive effects of daily treatment were evident for at least an 8-month period. Oral administration of melatonin did not decrease adrenal gland tumor growth in treated ferrets.

Common procedures in the pet ferret.

The domestic ferret is an increasingly popular pet in North America and Europe and may easily be incorporated into the structure and workings of most small animal hospitals. Not only does treatment of ferrets provide case diversity and intellectual challenges to the veterinarian but it may increase revenue, because most ferret owners have several ferrets. The diagnostic and supportive care procedures used commonly in ferrets are similar to those used in dogs and cats. This article presents the common diagnostic and supportive care procedures used in ferrets, with special emphasis on some of the unique aspects that make these procedures easier to learn and perform.

Sarcomatoid renal cell carcinoma in a binturong (Arctictis binturong).

An adult, female binturong (Arctictis binturong) was examined due to lethargy, inappetence, and an abdominal mass. Diagnostic investigations, including radiographs, abdominal ultrasound, clinical laboratory findings, and a fine-needle aspirate of the mass, were suggestive of a sarcoma with metastasis. Necropsy and histopathologic findings confirmed a widely disseminated sarcomatoid variant of a renal cell carcinoma, likely originating in the left kidney, with metastasis to the right kidney, spleen, pancreas, liver, mesenteric lymph nodes, and lungs. This is the first report of this neoplasm in a binturong and only the second report in the veterinary literature. Sarcomatoid renal cell carcinoma is a rare histologic variant of renal cell carcinoma that is aggressive, commonly metastatic, and associated with a very poor prognosis in humans. Accurate antemortem diagnosis of this tumor may be complicated by its biphasic morphology, which may resemble carcinoma or sarcoma (or both), often necessitating the use of immunohistochemical techniques.