Page 4 - Clinical Connections- Summer 2021

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Page 4 - Clinical Connections- Summer 2021
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ºÚÁÏÉç RESEARCH    STUDY    VETERINARY SERVICES       ºÚÁÏÉç.AC.UK
         Exotics

        REMARKABLE RHEA’S ºÚÁÏÉç REFERRAL

        Vicki Baldrey, Lecturer in Exotic Species and Small Mammal Medicine and Surgery and Jo Hedley,
        Senior Lecturer in Exotic Species and Small Mammal Medicine and Surgery
               eorge the pet rhea was presented   Jo Hedley performs an ophthalmic examination of Geeorge's left eye
               to the ºÚÁÏÉç Exotics Service at the
        G Queen Mother Hospital for Animals
        (QMHA) for assessment and treatment of
        left-sided periocular swelling. The Exotics
        Service runs weekly clinics at QMHA and
        often collaborates with the Ophthalmology
        and Imaging services on cases.
          George was brought by trailer to the
        QMHA and was examined in a padded
        equine knock-down box. Her owner
        reported reduced vision and swelling
        around her left eye. A brief conscious
        ophthalmic examination revealed the
        menace response was present in the
        right eye and intermittent in the left eye.
        Dazzle reflexes were intact bilaterally.
        Further examination was limited by her
        temperament, so the team proceeded
        directly to anaesthesia for a full ophthalmic
        examination and further investigation. This
        allowed minimal stress to George, which is
        important, as rhea can suffer from capture
        myopathy with prolonged manual restraint.
          After an initial ‘quad’ protocol comprising
        intramuscular butorphanol, medetomidine,
        ketamine and midazolam, George was
        anaesthetised with IV propofol via her
        basilic vein and then intubated and
        maintained on sevoflurane in oxygen.
          Ophthalmic examination of the left eye
        revealed marked conjunctival hyperaemia.
        There was a soft mass in the medial aspect   aqueous humour flare. The pupil was round   the medetomidine was antagonised with an
        of the orbit, compressing the globe. The   and mobile, and the lens was transparent.   equal volume of atipamezole IM. George
        corneal examination was unremarkable.   The fundic examination was unremarkable   made a smooth, rapid recovery and was
        The anterior chamber was formed without   and the ophthalmic examination of the right   standing within 15 minutes.
                                            eye was unremarkable. The intraocular   Samples from the sinus were submitted
         EXOTICS AND SMALL                  pressure readings were 12 mmHg and 22   to the ºÚÁÏÉç laboratory for culture and
         MAMMALS SERVICE                    mmHg in the right and left eye, respectively.  sensitivity, cytology and histology. Cytology
                                                                                and histology revealed pyogranulomatous
         The ºÚÁÏÉç’s Exotics and Small        Advanced Imaging                    inflammation and thankfully no evidence
         Mammals Service is the only specialist   A CT was performed with IV contrast and   of neoplasia. Culture grew two species
         exotics service in central London   revealed multiple pockets of fluid in the   of E. coli and an unidentified anaerobe.
         and the only full-time exotics service   left periorbital sinus, with concretions of   George was treated with oral marbofloxacin
         at an English veterinary school. The   solid material with areas of mineralisation   and metronidazole based on the bacterial
         team treats a wide variety of species,   compressing the left globe. Ultrasound-   sensitivity results.
         including rabbits and other small   guided fine needle aspiration was   After discharge George continued to
         mammals, reptiles, birds, amphibians,   performed but yielded a limited amount of   improve. Antibiotics were continued for
         ornamental fish and invertebrates. The   fluid. Following surgical preparation and   six weeks and she was very compliant in
         service has been steadily growing since   instillation of 2mg/kg lidocaine, an incision   taking these in her favourite egg sandwich.
         being established in 2014 and will soon   was made over the swelling, into the   The swelling has so far not recurred so we
         expand further and comprise of six vets   dorsal aspect of the periorbital sinus and   hope George will continue to do well.
         – including one new intern and one new   a large amount of caseous/mineralised
         resident – and six registered veterinary   material curetted out. The pocket was
         nurses. The team’s presence at the at   then copiously lavaged with sterile saline.     For the ºÚÁÏÉç Exotics and Small Mammals
                                                                                     Service, please call: 020 7554 3528
         the QMHA will be increasing from one   Further pain relief was administered with     Email:
         to two days a week for referrals.  IM meloxicam. At the end of the procedure,   londonreferrals@rvc.ac.uk

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