A 6 month-old bearded dragon presents for shaking and not eating. Dr. Doug Mader walks us through the best way to approach this case and discusses why Metabolic Bone Disease (MBD) is a term we should think twice about using.
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LINKS
Dr. Mader’s Website: https://www.dougmader.com/
Follow Dr. Mader on Facebook: https://www.facebook.com/douglas.mader.9
Retain Your Team – Speak the Languages of Appreciation in Your Workplace: https://unchartedvet.com/product/appreciation-languages-101/
What’s on my Scrubs?! Card Game: https://drandyroark.com/training-tools/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Douglas R. Mader, MS, DVM, Diplomate ABVP (Canine/Feline), Diplomate, ABVP (Reptile/Amphibian), Diplomate, ECZM (Herpetology), Fellow, Royal Society of Medicine
Dr. Mader received his DVM from the University of California, Davis in 1986. In addition, he completed a Residency in Primate and Zoo animal medicine. He is the consulting veterinarian for the Monroe County Sheriff’s Zoo, the Key West Aquarium, Dynasty Marine, the Sea Turtle Hospital, the Everglades Alligator Farm and the Theater of the Sea. Previously Dr. Mader owned the Marathon Veterinary Hospital, a double AAHA accredited 24 hr emergency/referral hospital. Dr. Mader is an internationally acclaimed lecturer and is on the review boards of several scientific journals. He has published numerous articles in scientific and veterinary journals, national magazines, and, is the author/editor and co-editor of three textbooks on Reptile Medicine and Surgery. Dr. Mader’s latest project is his new book “The Vet at Noah’s Ark – Stories of Survival from an Inner-city Animal Hospital.”
EPISODE TRANSCRIPT
This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.
Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here today with a legend. The one and only Dr. Doug Mader. If you don’t know Dr. Mader, he wrote the book on exotic animal medicine.
Dr. Andy Roark:
The guy has been elected the Speaker of the Year for Exotics at the VMX Conference, which is one of the largest conferences in the world, something like seven times. It’s incredible. When you listen to this interview, you’re going to find out why. Because he knows his stuff and he breaks it down in a super useful, tangible way.
Dr. Andy Roark:
I’m not a big exotics vet. It’s a weakness of mine. I’m very upfront about that. And so, whether you do exotics all day every day and you’re just looking for pearls from the master. Or whether you are not real comfortable with exotics and you want to get the basics and understand the fundamentals.
Dr. Andy Roark:
Gosh, this is a great episode. Thank you to Dr. Mader for being here. Guys, let’s get into this episode.
Kelsey Beth Carpenter:
(Singing) This is your show. We’re glad you’re here. We want to help you and your veterinary career. Welcome to The Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the podcast, Dr. Doug Mader. Thanks for being here.
Dr. Doug Mader:
Dr. Roark, thank you so much for the invitation. I really appreciate it. It’s quite an honor.
Dr. Andy Roark:
Well, call me Andy. I’ve been a fan of yours for about 15, almost 20 years now. I was aware of you in vet school, because I went to Florida. Your practice was in … Was it Marathon, Florida?
Dr. Doug Mader:
Yeah.
Dr. Andy Roark:
You would take externs down there, and the people who went got to do these incredible things. You worked on alligators and sea turtles and just amazing stuff.
Dr. Andy Roark:
And then, I’ve seen you lecture a number of times. You have been the Speaker of the Year at VMX, which is one of the biggest vet conferences in the world, seven times for exotics. You’ve got a book coming out in June.
Dr. Andy Roark:
First of all, you have an amazing career, and you are also an excellent teacher. Thank you for taking time to be here. I really appreciate it.
Dr. Doug Mader:
It’s quite an honor to be invited. Thank you.
Dr. Andy Roark:
Well, I’ve got a case for you. And so, I have to start with full disclosure. Exotics are a weakness of mine. I am a general practice doctor. And so, they come across my desk and I want to be competent. At least get people started and do help where I can do help.
Dr. Andy Roark:
And so, it’s in that. Just know that’s my background. But I am coming to you with a case that I am looking at. I was wondering if I could walk you through it?
Dr. Doug Mader:
All right.
Dr. Andy Roark:
All right. I have got a bearded dragon. This pet was purchased from a pet store. It’s about six months old. The owners have brought it in and they’re not sure what’s going on with it.
Dr. Andy Roark:
It’s shaking and it can’t walk. I’m not … They’re telling me that it’s also not eating. I’ve taken some radiographs. I don’t really know what I’m looking at. To be honest, I don’t see anything obvious. It seems, to me, to be relatively decent.
Dr. Andy Roark:
It doesn’t look like an emaciated lizard that hasn’t eaten in an extended amount of time to me. But that’s what I’m looking at. Can you help me get started in this case and at least take it in a useful direction?
Dr. Doug Mader:
All right. That’s good to know. There are a lot of, especially with bearded dragons, there are some diseases of high concern. Such as adenovirus. That hits them when they’re about four months of age. Anywhere between four and 11 months of age. It shows up as kind of a chronic wasting.
Dr. Andy Roark:
Okay.
Dr. Doug Mader:
Oftentimes, they develop some neurologic symptoms. They can’t walk and of course they don’t eat. But usually, these animals are emaciated when they’re advanced. What you’re describing sounds almost acute, in terms of the anorexia or the hyporexia.
Dr. Doug Mader:
Young, growing animals, especially insectivores and herbivores like Iguanas … Insectivores, of course, like the bearded dragons. Of course, keep in mind, beardies also eat a lot of vegetation. And then, insectivores like chameleons, for instance. We see this frequently in those.
Dr. Doug Mader:
You have to worry about something called nutritional metabolic bone disease. Or the proper term, the veterinary term, is nutritional secondary hyperparathyroidism. If I can jump on my high horse here for a minute. That is … You hear veterinarians talk about MBD. Metabolic bone disease.
Dr. Andy Roark:
All right.
Dr. Doug Mader:
There is no such thing as MBD. MBD is a category. Metabolic bone disease, for instance, covers a whole variety of different metabolic pathologies of the bones. Osteoporosis, osteomalacia, panosteitis, hypertrophic osteodystrophy. A whole litany of them.
Dr. Doug Mader:
The two main ones that we deal with, especially with reptiles, is nutritional secondary hyperparathyroidism, which I coined the term, “NMBD,” years ago. And then, the other one is in adult animals. And that’s renal secondary hyperparathyroidism or RMBD. Based on what you told me, we have to look at the obvious.
Dr. Doug Mader:
If it’s got hoof beats, you think horse first. A young, growing insectivore, less than a year of age. They’re in a rapid growth phase. They’re having difficulty ambulating. They’re not eating well. We have to assume … You’re in South Carolina, right?
Dr. Andy Roark:
Correct.
Dr. Doug Mader:
I’d imagine in the winter, it gets cool?
Dr. Andy Roark:
Yeah.
Dr. Doug Mader:
Not like where I live here, where it’s 85 degrees in the winter. All right. We have sunshine year round. We’re probably looking at nutritional secondary hyperparathyroidism, which is NMBD. And that’s by far the most common cause.
Dr. Doug Mader:
How does that fit your patient? NMBD. It’s a triad of vitamin D3 from the sun, calcium in the diet, and temperature. One of the big things that a lot of people tend to neglect is temperature. And I’m going to use the iguana as an example. Because we have wild iguanas in my yard where I live on the island.
Dr. Doug Mader:
You’ll not uncommonly see them out basking. And it can be 95 degrees outside. If you go and catch that animal and you take a core body temperature … Just take a thermometer, dog and cat thermometer, and slide it in the cloaca carefully. The body temperature going to be 105.
Dr. Doug Mader:
Everybody assumes, “Well, these are cold blooded animals. The body temperature is going to be the same as the ambient temperature.” It never is. So if they have proper husbandry, if their cages are set up with focal heat spots and warming areas … I hate to use the term, “hot rock,” because those dangerous.
Dr. Doug Mader:
But if you have a heating area, so they have a thermal gradient in their cage. They, via temperature regulation behavior, will thermoregulate. Typically, their body temperature is much higher than the ambient temperature of the air.
Dr. Doug Mader:
Getting back to that. The iguana’s ambient normal temperature range is 88 to 104 degrees. You live in South Carolina. They have a pet iguana or they have a pet bearded dragon. They let it run around the house. Well, what’s the temperature in your house?
Dr. Andy Roark:
70.
Dr. Doug Mader:
Room temperature when we have the heater on. It’s 68 degrees. The 88 degrees is the low end for the iguana. Guess what, Andy? That vitamin D pathway. Reptiles need vitamin D3. And if you remember your physiochemistry, there’s that whole cycle where sunshine heats the skin.
Dr. Doug Mader:
It changes ergocalciferol into cholecalciferol. It goes to the liver, where it becomes hydroxycholecalciferol. And then, it goes to the kidney where it becomes dihydroxycholecalciferol. Those reactions … They’re enzymatic reactions and they have a temperature peak.
Dr. Doug Mader:
The temperature at which it gets the second hydroxylation is 88 degrees. So if you’re keeping that iguana or you’re keeping that bearded dragon in your house at 72 degrees or 68 degrees or wherever you sit your thermometer … Even if you give them proper lighting, even if you give them proper calcium in the diet, they’re too cold.
Dr. Andy Roark:
Right.
Dr. Doug Mader:
They can’t metabolize the vitamin D. If they can’t have metabolize the vitamin D to the active form of D3, they’re not going to absorb the calcium from the GI tract. People forget how complicated it is.
Dr. Doug Mader:
It’s really, really basic. But it’s really important. All of the DVM degrees that we have aren’t going to help if the owner doesn’t meet husbandry. Getting back to your question. You need to talk to the client. Find out, “How do you house this animal?”
Dr. Andy Roark:
Okay.
Dr. Doug Mader:
First off, you need to know what the normal temperature range is for a bearded dragon. It should be somewhere between 80 and 90. They’re not nearly as hot as an iguana. If they’re keeping it in their house and it’s not 80 degrees, it’s not going to grow properly because it can’t process.
Dr. Doug Mader:
All right. What are you feeding it? “We’re feeding it crickets.” That’s not their natural diet. In the wild, these guys are heavy herbivores. They eat a lot of vegetables. They do eat some crickets. You’ll find a lot of the pet stores will just sell crickets.
Dr. Doug Mader:
You say, “Okay. Well, crickets are in a balanced diet.” And then, the client will tell you, “Okay. Well, we got loads of crickets.” Well, again, that’s a contrived diet. There’s a lot of different insects available and I don’t have the time on this podcast. Maybe I can come back and we can talk about nutrition.
Dr. Doug Mader:
But the bottom line is they need to be feeding a balanced diet. Let’s just encapsulate that for now. They have to have the right temperature, the right diet. Then, they have to have the proper lighting. And the UVB lights are extremely important. The UVB range is about 290 to 320.
Dr. Doug Mader:
All of these reptile bulbs that are on the market … They have UVA, UVB, and UVC in it. Interestingly enough, if you can see my hands … Let’s say this is a light. The amount of UVB that’s produced by a bulb this big is only in the center about 2%.
Dr. Andy Roark:
Got you.
Dr. Doug Mader:
That’s it. And that only travels about 18 inches. So if they’ve got a light on the ceiling or it’s an old light? The phosphorus will wear out on the inside. It doesn’t produce any UVB.
Dr. Andy Roark:
Got you.
Dr. Doug Mader:
Again, everything interacts with itself. A big part of what you do as the doctor, when you talk to this client, is you got to play detective. You got to get all these facts. Because you can give them all the right medicine.
Dr. Doug Mader:
I can tell you what dose and what milligram to give, but if they don’t do their homework, everything you do is not going to work. And then, they get upset with you as the vet. Because, “I spent all this money and it’s still not getting better.” Well, you did everything right. But it’s the teamwork.
Dr. Doug Mader:
X-rays. Sometimes it’s hard to tell. You take an X-ray and some of these reptiles, especially the bearded dragons, they’ve got all those spikes and thorns and everything. It’s hard to see what’s on the inside. It really is. So if you can’t tell, don’t feel bad. Because a lot of us can’t tell.
Dr. Doug Mader:
Especially, in the young, growing animals. They don’t have fully calcified bones anyway. Because they’re still young and growing. But then, if you add in, on top of that, an animal that’s got nutritional metabolic bone disease … The bones are softer and they’re not as radiodense, so it’s hard to assess.
Dr. Andy Roark:
Got you.
Dr. Doug Mader:
Things like pathological spinal fractures, which may be why it’s not walking. You may not see it just because it’s really hard. Don’t feel bad about that. I’m glad you took the radiographs. Because oftentimes, if they’ve got really good bones, that’s important. But oftentimes, it’s iffy. It can be a challenge.
Dr. Doug Mader:
Other things that you can do. I hear about veterinarians, “Well, let’s take some blood and do an ionized calcium.” You can do that. I’m a pet owner too. I’m actually a retired veterinarian now. When my pets get sick, I got to go to the doctor.
Dr. Doug Mader:
And I do look at the cost. All right. Do we need to run an ionized calcium? That’s an expensive test. Or do we say, “Young, growing herbivore in South Carolina that’s housed inappropriately …” Come on. If you hear the hoof beats, it’s going to be nutritional metabolic bone disease.
Dr. Doug Mader:
We can run ionize calcium, so that we can go, “I’m a good exotic vet, because I ran ionized calcium.” You don’t need to do that. Respect your client’s wallet. They’ll respect you for that too. It’s not going to change how you’re going to treat this.
Dr. Andy Roark:
That was my question. Am I getting information there that’s going to change how I treat it?
Dr. Doug Mader:
No. Not at all.
Dr. Andy Roark:
Okay.
Dr. Doug Mader:
You’re going to go, “It’s slow. It’s slow. I’m so brilliant.” Come on. Yeah, you can do it. If you’ve got the Titanium American Express card and the client says, “Do everything.” Do it. Do you need to do it? No.
Dr. Andy Roark:
Got you. Okay.
Dr. Doug Mader:
I wouldn’t do it. Blood work … Usually, you can run a CBC/chem. And that’s nice. I don’t think you need to. Again, look at what’s in front of you. Use your experience or rely on what you learned from other people.
Dr. Doug Mader:
If you suspect this animal is ill, that’s different. If you think he might be septic, let’s run blood work. Let’s look at the leukocyte morphology. Let’s go and get a PCV.
Dr. Doug Mader:
Make sure that he’s not anemic. Blood’s a nice backup. I do like to do blood work. I think it’s important. Can you still treat this animal without it? Yes. If the client is financially restricted, you can treat it without it.
Dr. Andy Roark:
Hey, guys. I got to jump in here real quick with just a couple of quick updates. First, I got to give some love to Banfield Pet Hospital. Guys, they’ve been making possible transcripts for this podcast for a while. They’re doing it for the whole year.
Dr. Andy Roark:
It is something that I really wanted to have happen. And it’s something they stepped up in the name of increasing accessibility and inclusion in our profession. Providing information so that everybody can have access to it. Anyway, it was a wonderful thing that they did not have to do, that they said was their mission.
Dr. Andy Roark:
And then, they followed through and really made this thing possible. Anyway, spread the word for anyone who would take advantage of transcripts of the episodes. We are so happy to offer them. You can find them at drandyroark.com. There’s links in the show notes below down to that.
Dr. Andy Roark:
Guys, let’s see. What else have we got going on? We have got, over on the Uncharted Veterinary podcast … If you’re a podcast listener, you might be interested in the other podcast that I host with my friend, Stephanie Goss.
Dr. Andy Roark:
Last week, we did an episode on, “What happens when your direct boss’s style is the polar opposite of yours?” How do you survive? How do you bridge the gap? How do you work effectively? If that’s of interest to you, check out the Uncharted Veterinary podcast. The link is in the show notes.
Dr. Andy Roark:
This week, it came out yesterday, we’re talking about, “Do you really need an online pharmacy? How do you make it worth your while?” Anyway, guys, those are some episodes over at Uncharted Veterinary Podcast. Take a listen. See if they’re for you. With that, let’s get back into this episode.
Dr. Doug Mader:
All right. Where are we going to go with this? Number one. This is where your technicians are really important.
Dr. Andy Roark:
Okay.
Dr. Doug Mader:
Make sure your technicians are well-versed with this. You said you’re not 100% comfortable with exotics. Well, when you start getting into exotics, it’s a good idea to get a good technician that’s got a good background in it. Understands the biology and the husbandry.
Dr. Doug Mader:
Pay them really well. They’re going to save you a ton of money and make you a ton of money. The clients are going to love it, because they’re a source of information. They’re great support for veterinarians. We all need really good technicians.
Dr. Andy Roark:
Agreed.
Dr. Doug Mader:
You get the technician in there to talk to them and educate them. And then, you can go off and see your next client. They’re going to discuss the husbandry. We already talked about that. Temperature, diet, and light. Those are extremely important.
Dr. Doug Mader:
What can we do, medically? If the animal has pathological fractures, which oftentimes they do, because they have soft bones. Because of the calcium deficiencies. Analgesics. We tend to forget that animals hurt. If we see an animal that, let’s say, has a broken limb. And that’s not uncommon.
Dr. Doug Mader:
Even a broken back … I’m going to circle back to that in a second. But analgesics and NSAIDs. There’s nothing wrong with giving NSAIDs. I like Ketofen, personally. I know a lot of people use Meloxicam. I don’t know that you need to jump into the opioids, but I certainly use a lot of NSAIDs for these guys.
Dr. Doug Mader:
Supplements. Make sure they get calories. There’s a lot of good commercial herbivore and insectivore diets on the market. I don’t need to mention names, but we all know who the big players are. They’re excellent. They’re great diets. Vitamin D3 supplements. There are some very good commercial reptile vitamin supplements. But when you get them, make sure you get one that has D3 in it.
Dr. Andy Roark:
Okay.
Dr. Doug Mader:
You also want to give an oral calcium supplement. There are multiple different types and the best ones are the liquid ones. Unfortunately, they stopped making them. They pretty much all come as a tablet now, which you can have compounded through any of the compounding pharmacies into a liquid.
Dr. Doug Mader:
The only reason I say that is because, A, they’re easier to give. You can flavor them like a banana or something like that. B, the liquid forms tend to be more bioavailable. For instance, calcium glubionate. If you give it in the liquid form, it’s about 60% bioavailable.
Dr. Doug Mader:
Whereas calcium gluconate is only around 10% to 20% bioavailable. Give a good calcium supplement that the owner can give. If they try and give the calcium supplement and the patient fights it, we both know the owner’s not going to give it.
Dr. Andy Roark:
Yep.
Dr. Doug Mader:
Okay. Analgesics, if needed. Calcium supplements, absolutely necessary. Vitamin D3 supplement, absolutely necessary. If the animal has some pathology … Let’s say, it’s got a long bone fracture. Like a femur or humorous. Put a splint on it.
Dr. Doug Mader:
A wiggling bone is very painful. And these splints shouldn’t be big and bulky. A simple paper tape splint around the humorous or the femur or the distal limb really makes that animal comfortable by immobilizing the fracture. And it can take them six to eight weeks or more to heal.
Dr. Doug Mader:
One of the other things that works really well too, is you take them out of the cage or get a smaller cage and limit their mobility. In other words, you don’t want that bearded dragon feeling better, and then crawl up a rock, and then slip and fall down and re-injure itself. Limit their mobility.
Dr. Doug Mader:
Oftentimes, they’ll put them in a smaller terrain until they’re healed. Now, I just want to bring up the chronic case. You’re going to have some of these, where you have got the gold star client that does everything Dr. Andy tells them to do. They worship you. Everything you say, they write it down. They go home and they do it and that animal is still not getting better.
Dr. Doug Mader:
Chronic nutritional secondary hyperparathyroidism results because when the calcium levels drop … I won’t go too deep into physiology. The parathormone level, PTH, increases. That’s an emergency response by the body to make sure that there’s enough circulating calcium in the blood.
Dr. Doug Mader:
Because you need that for nerve conduction. Things like heartbeat, which is important. And so, the body will sacrifice the calcium in the bone, mobilize it so that it’s circulating and ionized. To keep the nerves moving, the brain functioning, the heart functioning and things like that.
Dr. Doug Mader:
But what happens is parathyroid hormone is extremely powerful. And the only thing that can turn it off is elevated calcium levels or elevated calcitonin levels. Calcitonin will shut off the parathyroid. Completely cut off parathyroid production from the brain.
Dr. Doug Mader:
In human medicine, they use something called salmon calcitonin. Miacalcin is the trade name. In these chronic cases, where you do everything right and the client does everything right. The animals are still … Their bones are staying like Gumby. They’re not getting better.
Dr. Doug Mader:
You need to break the parathyroid hormone influence. Salmon calcitonin does two things. Number one, it’s a powerful bone analgesic. It’s used a lot in women with osteoporosis that get lordosis and spinal fractures and they’re an intense pain. Salmon calcitonin takes that pain away. Number two, and this is the biggie, is that salmon calcitonin is a PTH antagonist.
Dr. Doug Mader:
And so, you can give all the vitamin D, all the supplements of calcium you want. That PTH is still being produced, because the body thinks it’s in crisis until you give the salmon calcitonin. And then, all of a sudden, it shuts off. Just like that. Literally, you will see a difference in a week or two.
Dr. Andy Roark:
Wow.
Dr. Doug Mader:
The only downside of it is it’s very expensive, because it’s a human drug. But if you get those chronic cases, where the client wants to do everything?
Dr. Doug Mader:
Salmon calcitonin is going to be the savior. The doses are in Carpenter’s book and you can find it in my book. It’s everywhere. But anyway, that’s the last therapeutic I’d recommend.
Dr. Andy Roark:
Right.
Dr. Doug Mader:
Let’s just talk about a couple other things. Did you have a question?
Dr. Andy Roark:
No, I was going to ask … Generally, we talked about if you’ve got a long bone fracture. Six to eight weeks in healing. We talked about these chronic cases. How long should I … I like to set realistic expectations for the pet owners as well.
Dr. Andy Roark:
When are they going to start to notice improvement in the symptoms in their bearded dragon? For example, if we can correct the temperature problems. And I’m making sure that we are controlling pain, and that we’re getting good calories.
Dr. Andy Roark:
We’ve got some D3 supplementation. Some calcium supplementation. We’re doing all of the things. How quickly do we expect for pet owners to see significant improvement? I don’t want them to have wildly out of whack expectations.
Dr. Doug Mader:
I’m glad you asked that. I was going to get to it, but I’m glad you brought it up. Because I’m sure others are thinking the same thing. Remember, these are reptiles. They do everything slow.
Dr. Andy Roark:
Right.
Dr. Doug Mader:
You might treat a dog or a cat or a bird and you’ll see some improvement in a couple or three days. It’s not going to happen that fast in a reptile. You got to give it at least four weeks.
Dr. Andy Roark:
Okay.
Dr. Doug Mader:
I tell clients, “Four weeks and you’re going to start seeing a turnaround. Don’t get frustrated a week and a half, two weeks down the road and think nothing’s working. It probably is. You’re just not seeing it. Please, trust me. Follow the instructions. In a month, we’re going to be doing a happy dance.”
Dr. Doug Mader:
Full healing? Depending on how bad it is and depending on how advanced it is when you catch it … Three, maybe six months. But most of these animals come completely back to normal. Some of them will have some deformities. They may have some angular limb deformities from their long bones.
Dr. Doug Mader:
Sometimes they get that bowing in the jaw. They call it rubber jaws. That’s the term that came from primate medicine years ago. But they’re fine. They have a quirky look to them, but they’re still great pets. They’re fully functional. Excuse me. I do want to mention a couple other things too.
Dr. Andy Roark:
Sure.
Dr. Doug Mader:
And that is one of the knee-jerk responses that a lot of veterinarians give. This goes, in the literature, back literally to the 70s. You know how it is.
Dr. Doug Mader:
When something’s in the literature that’s correct, it’s really hard to get people to buy into it. You put something in the literature that’s wrong? Everybody believes.
Dr. Andy Roark:
That grabs them.
Dr. Doug Mader:
It’s like wildfire. Back in the 70s, it was published that, when these animals come in, you can put them on injectable calcium. Because it increases their calcium quicker.
Dr. Doug Mader:
Absolutely, positively not. Think back when you were a kid and you fell off the bike and broke your arm. Did the doctor give you injectable calcium?
Dr. Andy Roark:
No.
Dr. Doug Mader:
No. They sent you home on a quality diet, a cast, and some good vitamins and you’d get better. Same thing. You don’t use injectable calcium unless you have a pregnant bitch in tetany, a cow with milk fever. Or if the bearded dragon comes in, and it is in fact in tetany, where the whole thing is twitching like this … You might want to put him on a very controlled dose.
Dr. Doug Mader:
Seven units per kilogram per hour of calcium until the tetany resolves. And then, you switch to oral. Injectable calcium is emergency, life-saving only. It is not for treating broken bones or chronic osteomalacia. I wanted to make sure. That’s important. Because people still do it.
Dr. Doug Mader:
The other thing too is don’t throw Baytril at them. They come in and they’re not eating. “Let’s put them on Baytril. Just in case.” No. Antibiotic stewardship. We don’t want to be just throwing antibiotics out there. Unless you can see that this animal has some evident infection, don’t just give them antibiotics. They don’t need it. This is a husbandry issue. It’s a supplement issue.
Dr. Doug Mader:
Just to wrap this up. Again, most of these cases in the signalment that you presented are going to be nutritional or they’re going to be husbandry. 90% of the homework is going to be the owners following your instructions and correcting the problems on their end. You’re just helping them along.
Dr. Doug Mader:
They will do really well. Even some of these lizards that come in with pathological spinal fractures. Reptiles are neat. That’s why they’ve been around for so many millions of years. They have spinal ganglia. You can take the lizards back and cut it right in half and the spinal ganglia will allow them to walk.
Dr. Doug Mader:
Their front feet do this. The back feet may do this. In other words, the back feet and the front feet don’t talk to each other. But they still manage to get around. Because of the spinal ganglia, where they’re located, they can still defecate and urinate.
Dr. Doug Mader:
Just because it has a broken back, don’t say, “This animal is going to have to be euthanized.” If the owner wants to keep trying … Man. As a veterinarian, we owe it to them to hold their hand and get them through this. Because a lot of these reptiles will get through it. You just have to be patient.
Dr. Doug Mader:
That’s what a lot of people … They don’t have the experience enough to know that, “Hey. Let’s hang in there for three or four months. This animal will probably turn around.” I want to end with that on the happy note. The majority of these animals will do well, if you identify and correct the problems.
Dr. Andy Roark:
That’s amazing. Thank you so much for that. Let me ask you one more quick question when we talk about pain control. I thought that was really a great point. Things that people may not think about that are truly important.
Dr. Andy Roark:
If we’re going to see slow resolution of symptoms, we’re looking at four weeks. Things like that. How long do you manage pain control? Is that also a four-week process? Things like that? Walk me through some analgesia during this process. Because I don’t want to overdo it, but I also don’t want to under-serve them.
Dr. Doug Mader:
That’s a super good question. Because anything you give an animal, there’s a potential side effect. In long-term use of NSAIDs, you worry about liver disease, kidney disease, potential GI ulcers. That’s a good question.
Dr. Doug Mader:
That’s where I think you, as the eyes on the ground, when that animal starts looking more BAR. The owner’s going to be able to tell that, because they see that animal every day. And you’ll check it on re-checks. And then, I usually say eating.
Dr. Doug Mader:
When they start eating again, oftentimes, they’re feeling good enough that they can stop the analgesics. But clearly, if they start eating … You stop the analgesics and eating stops? You may want to put them back on it. But I oftentimes use appetite as one of my gold standards. That’s a great question. Thank you.
Dr. Andy Roark:
No, I appreciate it. Doug, where can people find you online?
Dr. Doug Mader:
Well, I have a website. It’s dougmader.com. I have a public Facebook page. It’s Douglas Mader on Facebook. From there, you can reach out. If you have questions, you can email me. And I’m pretty good about getting back to people. Feel free to reach out, if you need some help.
Dr. Doug Mader:
You know what? Andy, I just want to say thanks again for having me on. I think we have one of the greatest professions in the world. I hear a lot of people say, “I would never do this again.” I’ll tell you what. I’ve been doing it for nearly four decades. I would do it all over again. Starting tomorrow.
Dr. Andy Roark:
I love it.
Dr. Doug Mader:
I love what we do. That human-animal bond is so special. Anything we can do to keep that thing going, and your podcast and helping educate veterinarians, technicians, and then the pet owners is the way we do this. Thank you.
Dr. Andy Roark:
Thank you, my friend. And that is our episode. Guys, that’s what I got for you. I hope you enjoyed it. I hope you got a lot out of it. I got a lot out of it. I don’t remember the last time I took as many notes as I took on this episode.
Dr. Andy Roark:
Anyway, thanks again to Dr. Mader for being here. Man, that guy is incredible. Anyway, that’s enough of me fanboying over Doug Mader. You guys take care of yourself. Have a wonderful week and I’ll talk to you later.
Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram
