Q&A: A zoological specialist on what veterinarians commonly see with exotic species

S. Emi Knafo, DVM, DACZM, is a zoological medicine specialist and assistant clinical professor of zoological medicine at the University of Tennessee (UT) in Knoxville. She grew up in New York, New York, riding horses with dreams of becoming an equine veterinarian. In high school, she conducted an independent study that brought her to the Central Park Zoo as a zookeeper intern studying birds. It was then that Knafo realized that zoological medicine brought together different interests that included wildlife conservation and equine medicine. During her time as a veterinary student, a field research project in Kenya that focused on zebras further fueled Knafo’s interest in zoological animal care. She later went into private practice as a veterinarian in Red Bank, New Jersey, before joining the UT faculty.

In a dvm360 interview, Knafo discussed treating exotic companion animals such as rabbits, reptiles, and birds, as well as zoological medicine. She shared the types of conditions and injuries that can be emergency cases requiring immediate care and, in some instances, referral to an exotics or zoological specialist. She also discussed care that general practitioners can often do on their own and when they should seek support from specialists.

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dvm360: What are some exotic species that you commonly see as a zoological medicine specialist?

S. Emi Knafo, DVM, DACZM: Our specialty is kind of weird in that we kind of joke about ourselves—”jack of all trades, master of none.” My residency was zoological and wildlife medicine, and yet here I am at University of Tennessee. I'm mostly doing…zoological companion animal medicine, which is like the exotic pets, but there's so much bleed over. Zoos have petting zoos, so they have rabbits, rats, and ferrets. And…in the reptile collections, we're going to see lizards, turtles, snakes, and frogs. So there's a lot of crossover of species. And you can be a zoo veterinarian who sees a lot of exotic pets, so to speak. Then, within zoo medicine, there's the aquatic specialty, and wildlife as well, but I'm mostly companion animal right now in my day to day.

Most of the species that come in are going to be pet rabbits, parrots, chickens. We do see reptiles, like tortoises, aquatic turtles, [and] a variety of lizards. Probably the smallest proportion is going to be our amphibians and fish, but we still do see those, and sometimes even invertebrates, like tarantulas or pet hissing cockroaches [and] things like that. Veterinarians are also now charged with honeybee medicine since a 2017 FDA change, so we kind of see it all. And then on our companion animal side, we will still see what's considered an exotic cat, so a serval, a pet kangaroo, or wallaby.

Pet primates are a whole other controversial topic, but that also kind of falls under that purview. So any exotic animal, legal or illegally owned, that's not part of a zoological institution could walk through our doors, with a couple exceptions. So every day is a little unpredictable.

dvm360: What are some emergency conditions that are commonly seen with exotic animals?

Knafo: Probably the most common thing that we see is GI [gastrointestinal] stasis, or GI syndrome, in rabbits, guinea pigs, and chinchillas—all the hindgut fermenters, which is a syndrome. It's not a specific disease. It's kind of a collection of symptoms. But it's really just [that] they're not eating [or] pooping as normally as they should be, [which] can lead to dehydration and can snowball into potentially fatal presentation. So it can be as mild as a little upset stomach, they're not eating quite as much, or they haven't eaten at all in several days and [are] potentially septic or obstructed and need to go into the critical care unit…. It really runs the gamut of how severe that could be, and that is probably the most common thing we see the small mammals for.

We see a lot of birds for either trauma—like [a] broken wing, broken leg, attack by [a] dog in the house—or sometimes [they’re] just not doing well. We get the sort of nebulous bird that…[is] still eating but not quite as much or regurgitating. Then true emergency would be respiratory distress [and] things like that.

For our reptiles, we [say] that there's very few true life-threatening reptile emergencies because they do everything very slowly. But there are a couple. Usually it's not eating [or] constipation—they haven't gone to the bathroom in a long time. None of those things on their face seem like they need to come in emergently, but usually…they haven't done this for several weeks or months, so now we're at a kind of a tipping point where they're in a critical period.

dvm360: What types of injuries do clinicians commonly see in exotic pets?

Knafo: As we get into spring, we're going to see hit-by-car turtles on a daily basis, because we do receive wildlife as well. But as far as the owned pets, we've had a run of tortoises attacked by dogs…and dogs can do a lot of damage to the shell. It's living bone, so…[there is a] risk of osteomyelitis. So we consider those emergent; we need to get treatment initiated promptly. There are a couple classic hazards for birds in homes. Ceiling fan is the classic one, but also being shut in the door. Sometimes they'll perch on top of an open door, and someone may not realize and close the door. We've had…a bird being around something…like aerosolized toxin, [which] could be an emergency presentation. Then for the small mammals, we see a lot of handling mishaps, like small children who aren't really well versed in handling. These small mammals can be a little bit flighty. We can see broken legs, broken backs. They get dropped, or they leap out of arms.

dvm360: What are some unique injury cases presented in exotic pets?

Knafo: I did see one where…a vacuum cleaner fell onto a rabbit and broke its jaw. That was a pretty memorable trauma injury that we saw. I had a frog that had a broken leg because the owner was taking pictures of the frog and dropped the iPhone on the frog.

Traumatic injuries can be strange. I had a ferret with head trauma because it was asleep in the bed, and the owner didn't know and changed the sheets and gathered up all the sheets and threw them off the bed [with] the ferret. I couldn't have thought that one up.

dvm360: What are the first steps for a general practitioner in treating an exotic pet?

Knafo: Being able to do at least an initial exam with full physical and vitals, temperature, [and] respiration and heart rate is the first critical step because you actually get a lot of information from that. You can assess their pain.

Pain, in most of these species, is pretty well hidden. So when you are getting into your exam and you're seeing that animal bracing when you do the abdominal palpation or other signs that they're uncomfortable, you know that even though they're not showing you a lot, they're telling you very subtly that they're quite ill or that they need your attention.

We know that if the temperature in a rabbit is low, that is a significant prognostic indicator. So all those things can inform how you assess this animal's condition. Then you can explain to the owner, given the degree of pain that this animal is in [or] given the low temperature, this is an animal that probably needs to go into [the intensive care unit] with some fluids…and maybe you should go to a specialty hospital. Or [say a pet has a] normal temperature, soft abdomen, [and] hasn't been eating that well, but because we have all these other normal vitals, let's do outpatient treatment. We can handle that here.

So getting that initial exam and those vitals really helps you know which way you need to go with a case…. We [often] get calls before the veterinarian has actually looked [at] or touched the animal. They have the case history, but they are maybe a little hesitant to get their hands on [the patient]. I would say [to] just jump in there [and] do the exam. Realize you know a lot more than you think, and have that information, because that is really going to tell you which way…you're going. Are we stable enough for outpatient, or do we need to refer to specialty? Or maybe they're a general practitioner who's very happy to do blood work, x-rays, put an [intravenous] catheter in, and deal with something a little bit more critical in that case, [and] that's awesome.

dvm360: Which exotic species are best cared for by a specialist?

Knafo: Anything that is potentially dangerous to your staff, so things like pet caimans [and] venomous snakes. I mean, we don't see venomous snakes. We leave that for the zoo collections….

Pet raccoons can be a real challenge if you don't have a squeeze cage or a pull syringe. That can put people at risk. They will not hesitate to bite you.

I [would] say anything that potentially could be a threat. A serval, while they're nice with their owners, are definitely a challenge in the back. [Often], we hear stories [like], “Oh, well, my usual vet will just let me hold them while they do all the injections and stuff.” Now, I guess that's up to them, but we know that's a liability if the owner were to get injured, so we always say, ‘You know we have to have you put the animal into the squeeze cage for us, and then we're going to administer the injection safely without anyone holding [them].”

Parrots—that really depends on if you have people comfortable holding [them], because you can be the most skilled avian vet in the world, but if you don't have a reliable person to hold and restrain that bird safely, you're not going to get very far. In fact, things could go south if you're not holding that bird safely. We do know that you can manually cause a lot of trauma to birds if you're not holding them well, and people can get bitten if you're not controlling the head well. So having your staff comfortable and trained is really important if you're going to see these species.

dvm360: What else would you like veterinary professionals to know about caring for exotic animals in an emergency state or otherwise?

Knafo: Don't forget about those zoonotic diseases, [such as] avian influenza [and] rabbit hemorrhagic disease. They're out there, and we're seeing them. I [recently] got a call from a regional emergency [department] asking for a consult on a rooster that was having respiratory signs and neurologic signs. I was like, ‘I can't really give you a treatment plan right now. I think you need to call the state vet [because] now you have that rooster in your emergency room with cats around,’ and we know that cats have been dying from avian influenza. So keep those differentials in mind. Don't forget about them. They're really important, and they'll sneak up on you when you're not thinking about them.

The classic one for us with rabbit hemorrhagic disease is a female rabbit that's bleeding. Whether that's a reproductive tract emergency or a potential infectious disease exposure, we just don't know until we do more [testing and examination]. For any rabbit that's bleeding, we have a protocol that [the patient] goes into a specific exam room, and the people who go in there are wearing [personal protective equipment] and deal with it as an isolation case until we know that it's not high risk for rabbit hemorrhagic disease. Dame thing with all our bird patients. We have them wait outside in their car, and we ask [pet owners] a series of questions: Does this bird have outdoor access? Are there any other outdoor birds on the property? Because sometimes a parrot owner has chickens. Have you had any deaths, etc? We have a whole list in a questionnaire that screens them before they come in the hospital, because we see a lot of cats. We see domestic cats and big cats from the zoo and from other places, and we need to keep those patients safe as well.