Interview with Ass. Professor Dr. med. vet. Michaela Gumpenberger

Diplovets: What is the advantage of specialized telemedicine for veterinarians?

Dr. Michaela Gumpenberger: A second opinion is always a benefit as four eyes see more than two. Even colleagues with profound knowledge in imaging diagnostics appreciate a second opinion, e.g. in more advanced cases.
For colleagues who are not specialized in imaging, it is certainly a relief to get the experts support to find the diagnosis and to take care for the patient as successfully as possible. Furthermore, staff shortages can occur due to, for example, vacation or illness. In order for a practice/clinic to continue operations as smoothly as possible, telemedicine helps regardless of time and place.
Exotics are no exception. In most cases, veterinarians specializing in reptile or avian medicine are rare. There are only a few Radiologists worldwide with such specialized knowledge, so veterinarians working with exotic animals usually have to educate themselves in imaging diagnostics. Diplovets strives to remedy this situation .

Diplovets: What do you believe are the advantages of telemedicine in the field of reptile and exotic medicine?

Dr. Michaela Gumpenberger: Especially with turtles, imaging is key to support for the correct diagnosis of diseases. These reptiles live like in a bony box, so they are less accessible to a classical clinical examination (palpation, auscultation, pulse measurement...). For example, dyspnea can be caused not only by a primary disease of the respiratory tract, but also by lung compression (e.g., due to urinary retention or constipation). Without complementary imaging, misdiagnosis is preprogrammed in such cases.

Even experienced exotic practitioners are not always confident in all cases of imaging interpretation. While ultrasound images or -videos are not very good for obtaining a second opinion, x-rays and CT images are an excellent media. It should also not be underestimated that in "exotic medicine" we are talking about thousands of different species. One person can never know all the species-specific anatomical variations!

With dogs or cats, one is "only" dealing with different breeds - and even these show an incredible variety of variants (just think of brachycephalics, which have their own "disease pool"). Via telemedicine, several specialists worldwide can be consulted simultaneously.

Diplovets: What do you need in order to make a sound diagnosis?

Dr. Michaela Gumpenberger: As correct as possible naming of the species. So not only "tortoise", but "Moorish tortoise". As they are different species, the physiological status is different (in this case e.g. egg count, shell density, nutrition,...).

In the anamnesis it is helpful if other existing animals are mentioned. The group composition when keeping several animals can give clues for differential diagnoses.
It is also helpful to list the differential diagnoses and therapies that have already been made.

Radiographs should always be taken in two views. In exotics, these are usually whole body radiographs in the lateral and dorsoventral/ventrodorsal projection. In tortoises, an additional craniocaudal image (in the horizontal beam path) may help.

It is important to take time for positioning to get the animals as symmetric as possible. In birds, wings and legs should be fixed in extension to avoid overlapping. The breathing phase, on the other hand, is hardly relevant. The animals do not need to fast either.
Although DV positioning is preferred by veterinarians, especially for lizards and turtles, the second imaging view contributes significantly to the findings!

In birds, it may be helpful to perform a per oral contrast study.

In CT studies, care should be taken to use sufficiently high exposure data. Findings are limited if image noise is too high. For turtles, mammalian head scan protocols can be adapted. Furthermore, reconstruction in the soft tissue AND bone window should be performed. With slice thicknesses of 1 mm or less, target-oriented MPR is possible during subsequent reporting.
If positioning aids are used, care must be taken to ensure that they do not cause artifacts.

Diplovets: Do you have any final advice?

Dr. Michaela Gumpenberger: Yes, I would like to have several:

- In my opinion, the clinical examination of tortoises is only complete with a supplementary X-ray examination in two views (excluded from this could be circumstances such as broken claws.

- CT examinations are usually superior to X-ray examinations in exotics. In order to be able to make the most effective findings with the usually more readily available X-ray examination, two imaging views are indispensable.

- From my experience, owners of exotics appreciate a second opinion, which is not considered a weakness here, but shows an effort to want to achieve the best for the animal. If you explain to owners the advantages of CT examinations (depending on the device and the patient, the examination is possible without anesthesia, gold standard for examination of the respiratory tract, relatively safest diagnostic for fatty liver disease...), they are almost always willing to pay the higher price for it.

- In reptiles, emergencies are less frequent than in avian patients. Nevertheless, rapid action is often necessary. Telemedicine can help here to support the veterinarian promptly, and thus to initiate the optimal therapy.

 
We thank you for the the exciting interview and the detailed answers to the questions. All the best to you!

Click here for the publication of Dr. Michaela Gumpenberger: "Diagnostic Imaging of the Respiratory Tract of the Reptile Patient"

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