Veterinary Clinics of North America

In my experience, exotic pet patient management usually involves innovation and creativity. Many aspects of exotic pet medicine and surgery are either unexplored or new, which implies that the clinician must extrapolate from small animal companion medicine or think outside of the box. One of the great examples in our field is the advent of endoscopic coelioscopy in the avian patient. This examination method was a perfect blend of anatomic specificity knowledge, use of a technological device (a rigid cystoscope) deviated from its original purpose, clinician technique, and imagination. This innovation is now considered a standard procedure in most avian practice.

This issue develops several aspects related to new technologies in exotic pet practice. “New” is always a relative term, and it is expected that techniques developed in each article will become more and more common until they become completely integrated in our practice. Some of those technologies described may fall into oblivion, probably because of their limited use, or because we would have found another way to treat disease. Some other major technologies not mentioned in this issue may arise in the next few years and become very important. Future is a difficult prediction.

The issue focuses on all aspects of veterinary medicine: diagnostics (diagnostic imaging, endoscopy, clinical pathology), surgical aspects such as development of bone plating, 3D medical printing, permanent implantable medical devices, soft tissue surgery, wound management, and other conventional aspects, such as anesthesia and therapeutics. A special article has been created for herpetology, which may benefit from the technological advances. More specifically, this issue also develops some aspects related to smartphones use in veterinary medicine and Internet.

Most of the data developed in this issue are not specific to the exotic patient. Evidence-based data and research still need to grow. I hope that reading this issue will encourage creativity, help to communicate with medical engineers, give perspectives, and stimulate research projects for providing enhanced medical care in the exotic pet patient.

Ultimately, I will never stress enough that technology cannot replace veterinarian skills. The art of veterinary medicine is based on experience and clinical sense, not on technology. Care must be taken to treat clinical signs rather than data and to use the best technique rather than the newest technique.

As discussed in our 2013 issue of emerging diseases of nontraditional exotic species, the “discovery” of new diseases not only encompasses newly reported pathogens and disease conditions but also includes known pathogens of 1 species that have spread to a novel host, pathogens that have new geographic ranges, and pathogens with changes in virulence, morbidity, and mortality. For example, Ranavirus has long plagued amphibian species, leading to global population decline, but has now been documented to infect chelonians with high morbidities and mortalities. Reports have now documented the potentially zoonotic pathogen Pseudomonas luteola in ferrets worldwide, thereby expanding its geographic range. Streptococcus equi subsp zooepidemicus is an emerging pathogen in chinchillas, while Pseudomomas aeruginosa continues to cause significant disease. Finally, new variants of some pathogens, such as Rabbit Hemorrhagic Disease virus 2, has led to increased morbidity and mortality in rabbits in Australia, and infection with 1 variant does not confer protection for the other.

Emerging diseases in our exotic species also have noninfectious causes. We have seen recent changes in the characterization of some diseases, such as the sudden switch of primarily struvite to cystine urolithasis in ferrets in the United States within the last decade. Bromethalin toxicosis, which has long been recognized in dogs and cats, has now been documented as the cause of neurologic signs in feral conures based on histologic lesions in the brain and positive fecal tests for desmethylbromethalin.

We are delighted to have participated in the publication of this issue of Veterinary Clinics of North America: Small Animal Practice on Euthanasia: Updates on Clinical Practice. This issue is unique in that it is the first of its kind to focus exclusively on the clinical practice of companion animal euthanasia. Increased demand for services focused exclusively on hospice, palliative care, and home euthanasia for companion animals has brought scrutiny to the technical and procedural aspects of small animal euthanasia. Empirical evidence in this context, although sparse, is emerging to guide best practices. The weight of emotional burden coupled with the ethical and moral responsibility practitioners and pet owners face when euthanizing family pets warrants interdisciplinary evaluation and scientific support. The study of small animal euthanasia requires attention from various disciplines. Such a comprehensive approach ensures that the profession devotes the appropriate relevancy and importance the practice of euthanasia requires in everyday clinical practice. This issue evaluates small animal euthanasia from varying perspectives: clinical and technical application and social and psychological impact on the family as caregiver. It also pushes the boundaries of scientific understanding regarding transitional states of consciousness and new areas of study relevant to euthanasia decision making. We intentionally did not include sections on the impact of the practice of euthanasia on veterinary practitioners in the form of compassion fatigue and burnout nor did we address the affects of pet loss and bereavement on caregivers. In addition, we excluded euthanasia techniques and practices for small mammals, birds, and exotics. Although these are worthy topics, we opted to exclude them because of extensive existing professional and academic literature on these topics. This issue seeks to explore areas that have previously been overlooked, such as comparison to the terminology and practice of medical aid in dying in human medicine and our current understanding of brain states in the context of euthanasia. We hope this issue proves fascinating in its own right and at the same time is relevant to everyday practice.

Changes to the environment, transportation, technology, and our attitudes toward the animals that we share our lives with have occurred at breakneck speed since the last Small Animal Infectious Diseases issue in Veterinary Clinics of North America: Small Animal Practice in 2011. The phenomenon of climate change has made natural disasters a regular occurrence, resulting in emergency transport of animals to localities that are sometimes unprepared for their arrival. Domestic and international pet transport is now an everyday reality, making a thorough travel history a mandatory component of any veterinary visit, and demanding much broader expertise in infectious diseases that were once considered irrelevant beyond our own neighborhoods. New diagnostic modalities have revised traditional notions of reference standard tests, challenging researchers to pit one test against another to determine where each one fits in optimal case management. The human-animal bond continues to strengthen as we depend on companion animals increasingly for companionship and emotional support. This bond not only means that our physical proximity to our pets is closer than ever before but also demands that we aim to provide the same standards of health care for our pets that we receive from medical providers. The One Health movement, which held its first international congress in 2011, links physicians and veterinarians to achieve better health outcomes for people and animals, by improving communication and knowledge exchange, especially concerning zoonotic diseases and combating antibiotic resistance. Information has never been as readily available or as boundless as it is today, but there is also a minefield of misinformation for unwary consumers. Our ability to discriminate high quality scientific evidence from opinion or ill-founded assertions is a skill that keeps yielding dividends for us and for our patients.

Throughout the history of fracture repair, there are numerous descriptions of minimally invasive repair implants and techniques that have fallen in and out of favor. In 1886, Carl Hansmann invented the first plate and screws (which were locking) for use in humans. They were placed externally with the plate above the skin and the screws going through the skin into the bone, ultimately an early example of minimally invasive fracture repair (MIFR). Eventually the plates and screws made their way under the skin, and over time the preferred techniques of fracture repair involved opening the fracture site and precise anatomic reduction. Through research and education, the biologic fracture environment came into focus in the late 1980s, and in 1990, the limited contact dynamic compression plate was introduced, with the goal of minimizing the plate damage to the periosteum. This led to the resurgence of locking implant use in the mid 1990s with further emphasis put on reducing damage to the periosteum and disturbance of the perifracture environment.

Sometimes we request diagnostic tests out of a desire to be thorough even though the outcome of that test may not change the outcome for the patient. To this, there is an article on when to use new tests, when to stick with old tests, or whether to run tests at all, which addresses some of these concerns.

Veterinarians (and veterinary nurses) go into animal care because of a love for animals and desire to help them. Part of our ability to be good caregivers is to maintain this passion throughout our careers. The fact that we work for our clients rather than for our patients can lead to medical compromises that cause disappointment, moral distress, or worse. The final article addresses the need to balance the art and the science of veterinary medicine in a moral and ethical way.

I hope you will look forward to the second issue. It includes articles on feline nutrition, updates on infectious diseases, select digestive tract problems and endocrine disorders, use of genetics and stem cell therapies in practice, an update on feline oral health, as well as new neurologic entities in cats that have a stress/environmental component.

Geriatric medicine is a major growth area in the veterinary profession. Advanced diagnostics and equipment, once reserved for universities and specialty referral centers, are currently accessible to these progressive primary care veterinarians. Those hospitals can now provide their older patients with the high-quality health care that even the “average” pet owner expects. Enhanced senior diets, improved dental care, pain management plans, safer preanesthetic protocols, new drugs, advanced surgery techniques, cancer chemotherapy protocol, drug-monitoring schedules, and the use of multimodal management strategies have changed the senior health care landscape.