Specialists team up for treatment first

LAST year I wrote about the manner in which we will often look to parties outwith the practice for help with more peculiar cases.

Farriers have created foot braces for bulls with cracked hooves, falconers have rehabilitated wild Buzzards after wing surgery, and local pharmacists have sourced medications we might otherwise have struggled to get hold of.

Recently one of my colleagues, who like myself has an interest in exotic pets, sought assistance in the treatment of a bearded dragon (a popular pet lizard) that had a tumour of its eyes. This type of tumour, a squamous cell carcinoma, is something we are seeing frequently in this type of lizard – we have seen four since Christmas. Effective treatment is difficult. Whilst the tumours need operating on, surgery alone is rarely, if ever, curative and the growth will grow back. My colleague Leanne researched cases involving the same tumour in different species. She contacted a renowned equine clinician who had trialled the use of a human chemotherapeutic drug in horses. Leanne was directed to papers he had published, from which she extrapolated an appropriate treatment regime for the lizard.

The next challenge was to source the medication in viably small quantities. Routinely the drugs would only be dispatched in quantities appropriate for the treatment of adult humans, or even 600kg horses, and the costs would be impossible to justify in a 400g reptile. However, an oncologist was able to come up with a small part batch returned to him after the treatment of an equine patient.

Use of chemotherapeutic drugs, even in microscopic doses, comes with significant safety considerations. The dragon was housed in a vivarium in one of our exotics wards and barrier nursed for the three weeks of treatment.

At the end of the course the tumours had reduced significantly, but were still present and we were confident that they would soon re-grow. However, we had already approached veterinary ophthalmologist Chris Dixon regarding the next stage of case management. We anaesthetised the dragon and, assisted by our exotic nursing team, Chris resected the remainder of the cancerous tissue and performed cryosurgery (freezing) on the surrounding tissue.

It remains early days, but initial signs appear encouraging and if successful may provide a new dual modality approach that can be adopted not only by ourselves, but by other exotic veterinary specialists. Great news if it works, but none of it would have been possible without the generous help and advice of the numerous other professionals we approached.