Christopher K. Cebra VMD, MA, MS, DACVIM-LA
Veterinarians commonly attend to camelids for the first time when the camelids are in the end stages of a disease process. Predictably, treatment is often unsuccessful and both the owner and the veterinarian become frustrated. The lack of success has lead to a variety of negative mantras, like “all sick camelids die” or “a down camelid is a dead camelid.” Though I cannot deny the inevitability of death with many advanced diseases, treatment success and satisfaction of the people involved can be markedly improved by following a few simple guidelines.
1. Assess your animals often, subjectively and objectively.
Regular, systematic assessment results in earlier identification of abnormalities, and thereby the possibility for earlier medical intervention. This in turn leads to greater patient survival.
Subjective assessments include how bright the animal appears, whether it is maintaining itself with the herd and in its normal spot in the social hierarchy, and whether it spends adequate time at the feed bunk, dung pile, or chewing its cud. Every camelid is unique in how it acts in these respects, thus knowing individual behaviour is helpful. In general, I recommend seeing each camelid eat and/or chew its cud at least twice a day (once in the morning and once in the evening). Elimination behaviour (urination and defecation) is less fun to watch, and usually only noteworthy if the camelid is under surveillance for other concerns or if it spends too much time trying to complete the process.
The most common objective assessments are body weights and body condition scoring. These are important because camelids’ fibre coat can conceal many changes in body condition. Alpacas are especially vulnerable to misassessment. A general rule of thumb is that a 5% reduction of body weight (about ˝ a condition score) means the animal should be observed closely for the next interval, with special attention to feed intake, attitude, and general physical activity. A 10% reduction warrants veterinary attention, and a 20% reduction (a drop of 2 condition scores) warrants immediate action. Fleece weight and weight changes associated with pregnancy or parturition must be considered when assessing body weight.
Weights are also an important consideration when calculating necessary food and dosages of medications. Estimation can be dangerous in these regards.
The saying “the dullest pencil is better than the sharpest memory” comes into play here: record your findings (more often on computers than paper nowadays), do not expect to remember them.
2. Assume that abnormal animals are sicker than they appear.
Camelids have a reputation for being stoic. This is partially true. Like most prey species, they try to hide injuries and illnesses. However, we have many tools available to us that are not available to most predators, such as scales, blood analysers, ultrasound machines, the internet, and opposable thumbs. We can use these advantages as well as careful monitoring to identify camelids in the earlier stages of illnesses and injury.
Refusal to eat and inability to stand are common reasons for seeking veterinary attention in camelids. These are common endpoints from a variety of disorders, many of which presumably had some earlier manifestation, and also bear with them their own complications: weakness, debilitation, and mobilisation of fat reserves with feed refusal and pressure sores and muscle damage with recumbency.
Contributors to why camelids are first seen at these endpoints include stoicism and lack of monitoring, but they also include people not responding to the earlier manifestations, such as an abnormal gait or difficulty rising (preludes to full recumbency) or a loss of weight or partial decrease in appetite (prior to complete feed refusal).
We need to see and react to these earlier signs. In some ways, we even need to overreact compared to what we do in other species. In addition to showing subtle signs, we need to acknowledge that camelids seldom have illnesses that respond well to simple, short-term medication (like pain medications to a colic horse or a single dose of a long acting antibiotic in a coughing cow)– camelids take care of those minor issues themselves without any demonstrable signs.
3. Learn to recognize the signs of abnormality.
Knowing signs is very important, both for the owner and the veterinarian. Various specific signs include the postures of abdominal pain (legs kicked out to the side, animal laying on its side, rolling), signs of fluid or feed accumulation in the abdomen (distended abdominal contour), signs of irritation or blockage of the aesophagus (vomiting, salivation, gurgling, retching), signs of straining to urinate or defecate. The list is long, the message is short: know what is normal and what is not.
4. Learn to hit the jugular vein quickly and atraumatically.
This is more for veterinarians than owners, but still an important point. Complications associated with drawing blood from the jugular vein are relatively uncommon in most large animal species, and can range from minor hematomas to more serious deep infections. In contrast, complications in camelids are common and can be fatal. These complications can be completely avoided through practice and skill.
5. Do blood work.
This relates to animals’ being sicker than they appear (stoicism) and also to the fact that many of the illnesses we see are of an internal nature and poorly reflected by clinical signs. We are often surprised by blood work: some camelids have severe, unforeseen abnormalities (such as evidence of infections, kidney failure, or acid-base disturbances) that warrant aggressive, specific treatment. Others have no abnormalities in spite of severe clinical signs. In some cases of the latter, the lack of abnormalities are because we are running the wrong tests.
6. Treat with fluids, the right fluids, and not excessive fluids.
Although camelids showing illness often are suffering some degree of dehydration, experience has showed us that we frequently administer either too little or too much fluids. Too little is the result of not recognizing the severity of the illness or not running blood work. Too much comes from our conventions and formulae from other species. Camelids often tolerate high volumes of fluid poorly, because they frequently also have insufficient blood protein when they are sick.
7. Plasma is an essential part of sick camelid treatment
This point is definitely for the veterinarians. Plasma is necessary for advanced medical treatment of camelids. Neonates with failure of passive transfer will benefit from the immunoglobulin in plasma and adult camelids, approximately 50% of which at our clinic have some degree of hypoproteinemia, will benefit from all the proteins. Protein/plasma administration is especially important if you listen to point #6.
8. Do not surpass the animal’s stress threshold.
Overhydration and stressing camelids to death are probably the two leading causes of death of camelids in veterinary hands, superseding even euthanasia. Stress may also come from interactions with other animals, particularly dominant camelids or predators. The results can be worsening of their previous condition and even death.
Signs of stress include struggling, open-mouth, laboured breathing, rapid oscillations of the eyes, and the head bending over the back. Although instinct often tells us to do more in these situations, the correct response is often to do less, to back off and let the camelid recover its facilities. Once the camelid has recovered, procedures may be done in a measured fashion.
9. Use adequate restraint, physical or pharmaceutical.
Adequate restraint of the camelid during procedures is safer for the camelid and all humans involved. Rapid movement or struggling can lead to a variety of injuries, some of which are life threatening. Ropes, chutes, manual restraint and sedatives all can aid in examination and procedures.
10. Learn what is common and what is not.
Unlike twenty years ago, there is now a lot of reference material available concerning camelids, some in the lay literature, some in the scientific literature, and some in other places, such as the minds of colleagues or their web sites. Some of this information is even accurate.
There is a saying in medicine: “common things occur commonly.” Pretty straight forward and about as true as anything I have ever heard, however, it has only been with the compiling of our years of experience that we have truly been able to judge what is common and what is not in camelids. Geography and other factors certainly affect these lists too. The more we know and the more we exchange ideas, the better prepared we are to prevent and confront adversity.