This is part 2 in a multi-part series about exotics care. Read part 1 — Getting Started in Exotics Medicine — here.
So you did it — you took a minute to do some light briefing on the species you are about to see, and you have a great history and husbandry information on the pet. Now it’s time to go into the trenches!
But wait — what about actually examining it!? The scariest part for most of us! How do you hold and handle it? What if it strikes or bites or flaps?
No one wants to accidentally hurt a pet so it’s totally understandable to be a bit hesitant. But also keep in mind — and I will sometimes tell owners this if the pet seems fairly debilitated — if a pet passes suddenly in your hands then it had something else going on and was going to soon pass away if you did nothing at all.
You were still its best chance for help!
Beginning the exotics exam
Now that we got the jitters out — look around and see who you have to help. Ask who in your staff is comfortable handling exotics. Not everyone is afraid and some may have handled them before.
Also, grab a towel in case you need it — appropriately sized per pet. The small surgical towels work great for small birds and rodents.
Second, start hands-off. Hopefully, the owner brought their pet in in a container/carrier of some sort — but I have definitely had an owner that carried her lizard in her cleavage (and swore that was the lizards’ favorite place to be) and even an owner that used a cake pan to hold their mite-riddled hamster.
Anyways, I digress…Start hands off!
If the pet is still in its carrier, then it stays there until I am ready to handle it. You don’t want to have a loose exotic in the room — they can be a nightmare to catch sometimes. However, if the owner can hold them and pass them off then by all means!
Start by observing the exotic pet
Whether the pet is on the table and hanging out, with the owner, or in their carrier — observe before you mess with them. This is the most important part of the exam, in my opinion. And I communicate this with the owner.
I tell them that I want to see how they interact with their owner and their environment.
You want to see the pet exhibiting what their normal behavior would be in a new environment. They should be interested, sometimes timid, of what is going on around them. They may try to hide or stay out of sight.
Some do “freeze” instead of fight or flight but they should have a normal breathing rate and effort. They shouldn’t have any distressed open mouth breathing (hissing doesn’t count ? ).
They shouldn’t be in a corner, listless and lethargic. They should have all of their limbs and toes and no fur/scales/feather loss. They shouldn’t have any wounds or crusts. Their bodies should be fairly symmetrical — so use the other side to compare if you are unsure how something should look.
Their eyes should be similar and should not have any severe swelling or redness or discharge. If something looks odd, write it down — it may end up being normal but you can always check after!
Do they seem to be an appropriate body condition? Any bony prominences/appearance or signs of sudden weight loss or dehydration (loose skin). A bird with their owner will sometimes be comfortable enough to preen and stretch their wings — I can get a good look at many things by just looking!
Use what you know
Also, remember that you may have seen some of these pets at some point in your life — at a pet store, in a video or in a picture, maybe another doctor seeing them. Use what you know — even if it’s fairly rudimentary.
I will sometimes look at a new patient and think “you know, I’ve seen a tree frog in the wild before (though not for an exam) — I should theoretically know what one looks like. I don’t remember them having a prominent pink hue to their belly.”
Then I go look in my book or on VIN and see, “oh! A pink belly can mean septicemia! Oh… septicemia …oh no!”
What to watch for with exotics
Rodents, rabbits, and (most) pet birds (parrots are likely the most common type of bird you may encounter) may clean themselves/prean if they are comfortable or try to actively hide or escape since they are prey species.
A snake may slither around or lick the air and look around. Some may curl up and try to hide and stay warm.
A bearded dragon or gecko may tilt its head in curiosity, have short bursts of running around on the table…etc.
Water turtles always try to run away and break out of their carrier in my experience and tortoises typically try to hide in their shell.
An exotic pet should have SOME sort of response to you being there and attempting to interact with it — whether it be scared (fight/flight/freeze) or interested depending on its species and how socialized they are.
I get very concerned when an exotic pet does not care at all about my presence. A listless animal in the corner of it’s carrier is always an “uh oh” moment for me. But more on that later!
Weight and strength of exotic pets
Alright, now let’s get more hands-on! Get a weight on them next (weight loss is the most common first sign of illness in the majority of exotics).
Some owners do weigh them at home — so ask them and see if there is anything to compare to.
When starting my hands-on portion, I always check weight first and “strength” second. They should have good grip, be able to hold themselves up, and especially right themselves (or try to) if (gently) turned over.
A bird should be able to balance on my arm or finger (if it’s an aggressive one then note how they stand on their owner instead. They shouldn’t be struggling to balance). Or once you wrap them in a towel let their feet grab your finger to check this.
A lizard should be able to grip your hand or arm and hold itself at steep angles. Sometimes I’ll let them try to climb up my hand or arm to assess that. A lizard should want to flip to sternal when being rotated (gently!). Don’t let them thrash about or hurt themselves or anything but just gently assess their grip strength.
A snake will want to coil around your hand and wrist — it should not be limp. Typically as I gently hold them I will lightly and slowly rotate them (just a little bit) to make sure they grip and hold on and they should!
Remember: A weak exotic pet is an ill pet.
Body systems checklist for exotics
Finally, slowly make your way down your body systems checklist and look them over head to tail.
Remember the basics — every species has the basic systems — a respiratory system, a cardiovascular system, a lymphatic system, an integumentary system, an intestinal system…etc. So take the principles of your cat/dog exams and translate.
It may not be perfect at first — so focusing on any potential asymmetries may help first — and that’s ok. You can refer to the more specific resources and species specific for more exact things to look out for.
But start general, then get more specific. The more you see the more you’ll feel comfortable with what is normal and then you can pick up the abnormalities better. And don’t be afraid to use chemical restraint when warranted. Some of these guys can get feisty!
A quick anesthesia gas, or reversible injectable (becoming more preferred) can be extremely helpful. Try to have a game plan of diagnostics (if needed) prior to sedation so you can get it all done in one go as well.
Also if the species is sexually dimorphic or can be sexed — confirm it is the sex the owner says it is as well. There have been many times that I have found testicles on a “female” rabbit or rodent.
Don’t forget the towel
The rest of the exam is where a towel can come in handy — especially if they are a bit squirmy! Making pet burritos is very helpful when needed.
I find treating my hands more like a “cage” to restrain (as opposed to gripping the pet’s body) is useful and also keeps my mind at ease so that I won’t worry about crushing the pet if they wiggle (I have big hands).
If you are unsure about handling you can refer to more specific species sections. I find auscultating reptiles is not particularly useful — I tend to watch their heart beat and look at rate and rhythm, breathing rate and efforts. I use a doppler if I need it or have access to one.
Some birds’ hearts beat too fast to count as well. So I record what I can and document what I can’t. If it’s a small bird and I can easily count its heartbeat then something not-so-great is probably going on.
Honestly, this is probably the shortest part of my “exam”! I really take my time with my observational exam as it can help me gather a lot of information with the least amount of stress on the pet.
With exotic pets, client education is key
The BULK of the appointment time is client education: fine tuning their husbandry, letting them know what to look out for and when to see me versus an ER versus an exotic specialist, and things to prepare for down the road as they grow and age. Set them up for success!
Even if it’s a species you have not worked with (or not worked a lot with) — you are still your client’s greatest asset at the moment.
It’s ok if you don’t know everything. However, you are more than capable to at least use your resources to give them the most accurate information for their pet.
For most owners, their last information came from a well meaning (but usually incorrect) pet store employee or some random website. I have seen very beautiful, professional looking diagrams that owners have printed out or screen-shotted that are just plain incorrect! We are in a time where specialists are booked out and overwhelmed.
I feel us GP vets are a bigger asset than ever for exotic patients. I would much rather be the general information resource — the one that starts the education and proper husbandry process — and save that time for the specialists to see the complicated things that the specialists really need to be seeing.
What should pet owners be looking for?
It’s important to tell pet owners what good care looks like. What are some things that would be concerning to see at home? When is it ok for them to wait to see you? When do they need to go to an ER? When do they need to go to an exotics specialist?
This may greatly depend on who at your practice is all willing to see exotics, what you are comfortable with addressing and what equipment you all have.
There is no wrong answer for this — but I do feel it’s important to know your own boundaries so you can set your staff and clients up for success and so that everyone is on the same page.
Some quick tips to remember:
- You are smarter than you realize — you can do it!
- Know your resources — always quickly rebrief on a species before going in.
- Get a very accurate history on their husbandry.
- Start hands off! Majority of what you need you will likely find by just watching and observing the pet.
- Get a weight. Weight loss is commonly the first part of any illness with an exotic pet.
- Use your staff and grab a towel sized appropriately for the pet.
- Go through all your systems AND head to tail for your exam — don’t forget to use your basic exam principles that you already have!
- Educate! Send home report cards and all the husbandry information they will need to help set them up for success. Give them the names of local ERs and Exotic specialists for when things go awry as well — and tell them what that may look like.
- ER examples: Open mouth breathing/ increased respiratory effort, obtunded, bleeding, active seizures…etc. Similar in a sense to the “ABCs” of cats/dogs.
- Specialist examples: This may depend more on what you are and aren’t comfortable with. If you are willing to take on a Rabbit GI Stasis (as described by Dr. Cathy Emery ) then do it! If a sneezing rodent is out of your wheelhouse — then that’s ok! It may even be that you feel comfortable starting an initial workup and then refer.
At the end of the day, don’t be afraid to know your limits. Just because you have limits doesn’t mean you aren’t a great asset!
Dr. Rebecca Timmons is an Associate IndeVet practicing in North Carolina.