Why Evidence-Based Exotic Veterinary Medicine is the Future

Is Exotic Vet Med Still the Wild West?

We’re at a pivotal moment in exotic veterinary medicine. Historically, the field felt like the Wild West, marked by a lack of evidence-based data, leaving practitioners to rely heavily on anecdotal accounts or extrapolation from more heavily-studied species.

The Rise of Evidence-Based Medicine in Exotic Vet Med

Today, the landscape has changed significantly. We have more exotic specialists than ever, more research being conducted and published, and greater opportunities to practice high-quality medicine - thanks to advances in technology and growing client awareness. With these advances, however, comes an increased responsibility to provide exceptional care for our patients and their owners.

Why General Practitioners Play a Vital Role in Exotic Pet Care

I’ve always believed in advocating for general practitioners (GPs) to treat exotic pets, even now that I have achieved specialty certification. The reality is, there simply aren’t enough specialists to meet demand as exotic pet ownership soars, not to mention the steps to gain certification are not always practical for DVMs. Many GPs have developed incredible expertise in exotic veterinary medicine without the “letters” after their name, and their contributions to the field are invaluable. That said, encouraging GPs to step outside their comfort zone comes with a caveat: exotic species deserve the same standard of care as any other patient, and practitioners should rely on evidence-based medicine and know their limits.

A Cautionary Tale: The Cost of Delayed Exotic Veterinary Care

At a recent locum appointment, I treated a middle-aged Amazon parrot who immediately stole my heart. He was goofy, demanding, and endearing - a perfect example of the charm that draws so many of us to exotics. But he was also severely ill, with elevated renal values and emaciation.

Several months earlier, he had been seen at the referring clinic for acute weight loss. Lab work at that time showed a uric acid of 16 mg/dL. For context, uric acid values above 10 mg/dL in most birds (in the absence of significant dehydration) warrant intervention. Yet no treatment was initiated - only a recommendation to monitor clinical signs and recheck labs in a month.

When the recheck occurred, his uric acid had risen to 24 mg/dL - equivalent to a dog with a creatinine of >5 mg/dl. The calcium-phosphorus product was over 100, well above the threshold for concern (70), which risks metastatic mineralization of tissues with prolonged exposure. Once again, the same monitoring recommendation was given.

Frustrated and worried, the owners sought referral on their own. By the time I saw him, his values had begun to improve, but he was emaciated, and had bilateral renomegaly with mineralization in his kidneys and testicles. Although he’s making progress, he likely has long-term kidney damage and a shortened lifespan. Whether or not earlier referral would have changed this outcome is unknown, but delayed intervention certainly didn’t help in this case.

When to Refer: Recognizing Your Limits in Exotic Medicine

I share this story not to criticize the referring practitioner but to highlight the importance of recognizing when referral is necessary. It’s possible that referral was recommended but declined, yet neither the records nor the owners indicated that was the case. The owners were eager to do whatever it took to save their bird, but the delay in care came at a potential cost.

Cases like this are why some specialists discourage GPs from treating exotic species. Picking up the pieces when cases go awry is not only challenging but heartbreaking. It also puts the specialist in a difficult position. In this case, the owners specifically asked me why the referring DVM had not intervened and I let them know I really couldn’t say and that the important thing is that we are working towards a diagnosis and treatment now - shifting their focus to the ‘now’ and what we can do moving forward, rather than dwelling on the ‘what ifs’. It is never my desire to throw blame on another colleague - specialist or not. Most of us have been in the situation where we have adverse outcomes, no matter the species we treat. But ultimately it is up to us as practitioners to hold each other and ourselves to a higher standard. 

Moving Forward

If you’re a GP who sees exotics, you’re inevitably going to face cases that stretch your comfort zone - I’ve been there myself. But times have changed. The days when shotgun medicine was the norm for exotics are over. Standards of care now exist, and we must rise to meet them.

This means:

• Knowing when to refer: If you lack the resources or knowledge to manage a case appropriately, it’s not only OK but essential to refer.

• Keeping up with the literature: Research in exotics is advancing rapidly. Textbooks are a great starting point, but ongoing CE, membership in exotics organizations, and regularly reading current literature are crucial to staying up-to-date.

• Adapting to new evidence: Veterinary medicine is a constantly evolving field. It’s not enough to rely on anecdotal evidence or old habits. We should seek out new knowledge and be willing to shift our perspectives as the science advances.

The Power of Saying “I Don’t Know” in Exotic Vet Med

As practitioners, it’s natural to want to help every patient that comes through the door, but providing substandard care is never the answer. It’s OK to say, “I don’t know.” It’s OK to take time to research or consult with a specialist. And it’s OK to say no if you aren’t comfortable treating a case. 

Top Resources for GPs Treating Exotic Pets

So if you’re a GP that wants to provide excellent, evidence-based care, there are some great resources I can recommend:

• The Association of Exotic Mammal Veterinarians, Association of Reptile and Amphibian Veterinarians, and Association of Avian Veterinarians each have tons of free resources, members-only Facebook groups and regularly scheduled free and paid continuing education. Membership also grants you access to their respective journals which are leading publications in exotic veterinary medicine.

• LafeberVet and Oxbow VetConnect are websites that have free resources vetted by exotics specialists

• Take a look at my blog post on my Top 10 (+1) Exotic Vet Med Textbooks and if you haven’t already, join my email list below where I share all my best exotic vet med tips and tricks

• Check out my course Exotic Vet Med Essentials.

I created this introductory course to help veterinary professionals in the trenches - in GP, urgent care, and ER, become more comfortable seeing exotic patients. 

This course and the accompanying coaching calls are what I wished I'd had as a new grad, and honestly for many years after that. While I can't be available for consults 24/7, I can help DVMs/LVTs feel more confident in their knowledge and skills with exotics by teaching the essential knowledge needed to incorporate exotic pet care into your practice. I don't want anyone to feel that same desperation I felt when I was in over my head.

• Finally, join my email list below for updates and first access to my newest offerings. If you are beyond the basics, but still need support, keep an eye out for my new program, The Inner Circle, for regular access to me for practical exotics advice, case support and more, in a small group setting.

We owe it to our patients and their owners to provide excellent, evidence-based, compassionate care, no matter the species. Let’s hold ourselves and each other accountable as we continue to raise the standard of care in exotic veterinary medicine.

FAQs

1. Can general practitioners (GPs) treat exotic pets?

Yes! Many GPs have developed extensive expertise, however, providing evidence-based veterinary medicine is crucial, and knowing when to refer is essential.

2. When should a veterinarian refer an exotic pet case to a specialist?

Referral is recommended when a case is beyond a practitioner’s knowledge, requires advanced diagnostics, or isn't responding to treatment. Exotic animal specialists can provide more in-depth care for complex cases.

3. What are the best resources for learning exotic veterinary medicine?

Great resources include:

• The Association of Avian Veterinarians (AAV)

• The Association of Reptile and Amphibian Veterinarians (ARAV)

• The The Association of Exotic Mammal Veterinarians (AEMV)

• LafeberVet and Oxbow VetConnect for free research-backed guidance

• Continuing education courses like Exotic Vet Med Essentials

4. How can veterinarians stay updated on exotic pet medicine?

Veterinarians should regularly read peer-reviewed exotic veterinary journals, attend continuing education (CE) courses, and join professional organizations for exotic pet medicine to stay current on best practices.

5. What are the biggest challenges in exotic veterinary medicine today?

Some challenges include the growing demand for exotic pet care, limited access to specialists, and ensuring high standards of care for exotic species. The shift towards evidence-based veterinary medicine is helping improve outcomes. 

The accompanying image to this post is AI-generated.