It’s one of the reasons why I like to work in academia and at Tufts [Cummings School]. At Tufts [Cummings School], we have access to this network of veterinary specialists literally around the corner. When we have a complicated case and need extra tools from other services, we reach out to them. We can communicate with them the same day and make plans for our patients.
Foster Hospital’s Internal Medicine and ZCAM Teams Join Forces to Treat Tegu
Clinicians break up lizard’s colonic stones by laser, a technique more commonly used in dogs and cats
When one service needs additional expertise or tools to treat a patient, they head down the hall to a another service at Henry and Lois Foster Hospital for Small Animals (FHSA) at Cummings School of Veterinary Medicine at Tufts University. FHSA’s medical teams work together to provide the best care possible for patients—and the most minimally invasive, sometimes trying treatments effective in one species to see if they might be successful in another. That was the case for Stoner, an Argentine black and white tegu.
“It’s great to have the expertise of each service. We frequently collaborate on atypical cases or pathologies that they may not see as often as we do,” says Dr. Emmanuelle Butty (she/her), on FHSA’s Internal Medicine team and assistant clinical professor in the Department of Small Animal Clinical Sciences at Cummings School.
When canine and feline patients have urinary stones that cannot be dissolved with medicine and are too large to pass, the Internal Medicine service can laser the stones in a procedure called lithotripsy. Stoner was FHSA’s first tegu, and possibly lizard, to undergo lithotripsy.
Stoner arrived at FHSA's Zoological Companion Animal Medicine (ZCAM) service without having had a bowel movement in three weeks. Her owner describes her eight-year-old, foot-long pet tegu as, “A beautiful and unique part of our family. She is very much loved. She’s incredibly smart and even managed to escape her tank as a baby, she’d pop the locked lid off with her nose. She also lives with our three cats, and surprisingly they all get along.”
The ZCAM service found on X-ray that Stoner had two mineralized structures in her gastrointestinal (GI) tract, likely made up of urates or uric acid salts. Colonic obstructions can often be treated with laxatives. Dr. Marjorie Bercier, MG24 (MPH) (she/her), on the ZCAM team at FHSA and an assistant professor in the Department of Clinical Sciences at Cummings School, explains that in situations where the obstruction is complete, the stones can no longer be treated with medicine. Typically surgery is warranted, to cut into the GI tract and remove the material.
“The stone was large enough that we didn’t think she could pass it on her own, that’s why we needed interventions,” says Bercier. “It’s quite invasive to go into the belly and cut organs to access the problem, but because one the stones was quite close to the cloaca, we felt she was a good candidate to go in with an endoscope. It’s something we can do in ZCAM, but we don’t have the laser to break the stones, so we needed help from the Internal Medicine team.”
The ZCAM team researched cases similar to Stoner’s, and found one of a tegu with a colonic obstruction, resolved using an endoscope and a dentistry tool instead of surgery.
Lithotripsy is performed by the Internal Medicine team to treat dogs and cats with urinary tract stones by inserting a cystoscope (a tool with a light and camera that transmits images) through the urinary tract to visualize the stones and guide a laser that applies shock waves to break stones into smaller fragments that the animal can naturally pass.
Though the ZCAM service could not find a case of a tegu treated with lithotripsy, the Internal Medicine service agreed to apply their expertise and tools to laser the stones blocking Stoner so that she could avoid surgery. They had previous success treating a tortoise patient from the ZCAM service with urate stones via lithotripsy.
“It was a combination of looking at the scientific literature to see what the options were and discussing with the other specialists a treatment plan that’s the least risky and invasive for the patient,” says Bercier. “We don’t see these cases too often for lizards. It was a first for me and for Dr. Butty.”
A Urology/Nephrology fellow and resident with the new American College of Veterinary Nephrology and Urology (ACVNU), Butty has performed lithotripsy on dogs and cats many times. In tegu’s case, she inserted the endoscope through the lizard’s cloaca (under her tail) into the digestive tract to image the stone and direct the laser.
“We were able to find the stone relatively quickly and broke it down nicely with the laser,” says Bercier. “It’s the first time I’d seen Internal Medicine use the laser on one of my patients. It worked beautifully.”
Stoner recovered well from anesthesia and stayed overnight at FHSA, passing the stone fragments (the largest four by one centimeters) before heading home the following day.
With so many specialties in one hospital, FHSA clinicians have the flexibility to try new approaches when needed. FHSA’s services include Anesthesia, Behavior, Cardiology, Dermatology & Allergy, Diagnostic Imaging, Emergency Medicine & Critical Care, Internal Medicine, Neurology, Nutrition, Oncology, Ophthalmology, Surgery, and ZCAM.
“It’s one of the reasons why I like to work in academia and at Tufts [Cummings School],” says Bercier. “At Tufts[Cummings School] we have access to this network of veterinary specialists literally around the corner. When we have a complicated case and need extra tools from other services, we reach out to them. We can communicate with them the same day and make plans for our patients.”
These collaborations benefit both current and future patients.
“Minimally invasive procedures in veterinary medicine more readily available in the past 10 to15 years have improved outcomes and decreased morbidity in dogs and cats. It’s great to be able to apply those to other pets,” says Butty.
Stoner’s family is keeping a close eye on her and returning to FHSA when needed for any digestive issues.
“Every time we bring Stoner to Foster Hospital, the experience is overwhelmingly positive,” says her owner. “Stoner is always treated with such genuine care, interest, and respect. People are naturally curious about her, and she tends to draw a crowd. Whether it’s the staff, students, or doctors, they’re always excited to see her and make her feel like a VIP. It’s comforting to know that she’s not only getting expert medical attention, but she’s also seen and appreciated for who she is. It means a lot, especially when you have a pet that’s a little different from the usual.”
Bercier admits that tegus are one of her favorite species of lizards. “We don’t see tegus every day. They are like big teddy bears. Stoner is a lovely patient, a special girl. I’m so glad she got better.”
Department:
Foster Hospital for Small Animals