Obesity is a common problem for all of the pets that we see. It can also be a problem with our exotic animal patients and can create issues with mobility, grooming, gastrointestinal issues and other medical problems. Obesity affects quality of life and longevity of our patients as well. Clients are often fascinated by seeing their hedgehog eat waxworms (which have an excessively high fat content) or their monitor eat live prey. Practitioners should counsel their clients not only about what should be fed but also how much and how often to feed and to encourage them to provide foraging opportunities for food to increase exercise and mental stimulation.

Collecting urine can be a challenge in small mammals and more so with herbivores that have a very large thin walled cecum making ultrasound and cystocentesis much more difficult and potentially dangerous. I recommend taking radiographs first to make sure that cystic calculi are not present (especially in guinea pigs) before gently manually expressing the bladder onto a clean plastic sheet or divider. Some small mammals will readily urinate when placed in a clear plastic box. Ferrets will readily urinate and defecate in the corner of the exam room or in the exam room sink.

Growing reptiles will shed regularly and often. Dry shed that remains on feet, legs and toes can cause constriction and necrosis of feet, digits and even tails. 3–5 minute soaks in a small amount of baby’s bath warm water once per day during shedding can help to prevent this. Correct temperature and humidity for that species is also important to prevent dysecdysis.

Pain in reptiles can be evidenced by the dark beard, increased respiratory rate and stinting on palpation as seen in this bearded dragon who experienced obstruction secondary to the ingestion of many grasshoppers 3 months prior to presentation. The heads of the grasshoppers, which were not digestible, slowly made the way down the gastrointestinal tract until they became lodged as a group creating and obstruction. People will often feed inappropriately sized prey and vegetables, or too many prey items at once that can create obstruction in reptiles. Two examples are given here including the bearded dragon with the grasshopper heads and a bearded dragon with a large rectangular shaped piece of carrot that created an intestinal obstruction.

Reptiles frequently experience reproductive issues including pre-ovulatory stasis and egg binding. When they are having issues they will stop eating and may become lethargic if they are already suffering from environmental and nutritional inadequacies including a low calcium diet, inappropriate calcium:phosphorus ratio, or hypervitaminosis D. Advising owners to spay reptiles while they are young and healthy can be a good idea if they are not planning on using them to breed.

Nutritional secondary hyperparathyroidism in young reptiles, a very painful disease, can create significant deformities in those who survive as they become adults. This should be taken into consideration when opting to treat those that are severely deformed on presentation.

Many reptiles, and other species, can be tricked into staying still for radiographs by pacing their head in a plastic box. Because reptiles lack a diaphragm the best lateral radiographs are obtained by taking a standing lateral. When having digital radiography equipment installed you can have the company provide longer cables that allow you to place the detector plate in a vertical position so the radiograph can be taken with the reptile is in a standing position. This allows better visualization of lungs and air sacs and the ability to distinguish gas in the intestines from air in the lungs and air sacs.

When taking radiographs of any exotic species it is important to take views that extend beyond the pelvis so that a diagnosis is not missed if a calculus is present in the trigone, pelvis or distal urethra.

Iguanas and other reptiles are more easily intubated if slight pressure is put on the gular or dewlap area to elevate the trachea for better visualization. Intermittent positive pressure ventilation is needed during anesthetic procedures. For very small patients we replace the reservoir bag or rebreathing bag with a small balloon so the pressure they have to breathe against is lessened. It is important not to keep reptiles on pure oxygen during recovery from anesthesia as they need CO2 to stimulate breathing. We use an Ambu bag to provide IPPV with room air as we are recovering them from anesthesia. A tongue depressor is used to stabilize the patient’s head, endotracheal tube and its connection to the breathing tubes. To decrease torque on the patient’s head the breathing tubes are secured to the table with tape.

Don’t give up on the more difficult cases without trying as long as the owners know that you may not be successful but they still want you to try. The owners of this prolapsed hedgehog knew the prognosis wasn’t very good because the tissue was already becoming necrotic. When it was discovered that it contained the reproductive tract a ventral midline incision was made and an exploratory/OVH was performed which saved the hedgehog.

Adult male guinea pigs often have hair and sebum trapped around the penis. Routine exams should include examination of this area to prevent future problems. Older intact boars are notorious for developing deep perianal crevices that will fill with old feces, sebum and hair. In this case the boar would come in with paper bedding trapped in the perianal folds.

Hands off exams can decrease the stress associated with being in the exam room and having the owner’s help with this is essential. As we have become Fear Free at our practice with dogs and cats, we have implemented Fear Free techniques with our exotic patients too. Food is your friend when you are doing exams, weighing, ultrasound, acupuncture and even recovering sugar gliders from surgery to distract them from surgery sites.

Baytril injections can create damage to soft tissues. The effect is especially evident on light skinned reptiles. The lowest concentration possible should be used and it should be diluted with saline before being injected. I recommend a maximum of 1–2 injections before seeking an alternative route or antibiotic. The owner of this snake was given undiluted 100 mg/ml enrofloxacin by another veterinary clinic for the owner to inject the snake with daily and permanent damage to the skin is evident.

Guinea pigs not on a vitamin C supplement can develop DJD quickly especially if they are not eating and have been on an improper diet for an extended period of time before they became ill. Be sure to supplement vitamin C whenever a guinea pig is hospitalized or being boarded for more than a day or two. Counsel owners to provide vitamin C daily in the form of a pill or tablet and to syringe feed a crushed tablet in water if needed. Vitamin C should not be put in the water.

Reproductive issues including uterine adenocarcinoma, hydrometra, pyometra, leiomyoma are common in small mammals and clients should be counseled to have them spayed preventatively. Many practitioners tell clients that anesthesia and surgery is too risky but it is a bigger risk to take a small mammal to surgery after it is ill than to do it preventatively.

Remember to examine the whole patient and not just the symptoms it presents for. This sugar glider came to us for a second opinion after it had been on antibiotics for 2 years for a periodontal infection. The issue was created because of a peri anal gland infection that caused the sugar glider to suckle on the anal area. The infection was treated and a hemimandibulectomy was performed to remove the lower incisors allowing the glider to live a more comfortable life.

Patients that are difficult to examine awake like hedgehogs that roll when scared can be placed in a clear plastic container for better hands-off visualization.

Any disease process or procedure that is considered painful in other species should be considered painful in all exotic species. Always provide analgesics before doing any diagnostic or other procedures if it is appropriate.