Oncology of Reptiles: Diseases, Diagnosis, and Treatment

Veterinary Clinics of North America - Exotic Animal Practice

Volumn 20, Issue 1, 2017, Pages 87-110

  Christman, Jane ^a   Devau, Michael ^a   Wilson Robles, Heather ^a   Hoppes, Sharman ^a   Rech, Raquel ^a   Russell, Karen E ^a   Heatley, J Jill ^a  

^a TEXAS A AND M UNIVERSITY   (United States)

Author keywords

Cancer; Chelonian; Chemotherapy; Lizard; Neoplasia; Radiation; Snake

Indexed keywords

ANIMAL; NEOPLASMS; REPTILE; VETERINARY;

ANIMALS; NEOPLASMS; REPTILES;

EID: 84997471479     PISSN: 10949194     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.cvex.2016.07.003     Document Type: Review

References (113)

1. 1 Effron, M., Griner, L., Benirschke, K., Nature and rate of neoplasia found in captive wild mammals, birds and reptiles at necropsy. J Natl Cancer Inst 59:1 (1997), 185–198.
2. 2 Hernandez-Divers, S.M., Garner, M.M., Neoplasia of reptiles with an emphasis on lizards. Vet Clin North Am Exot Anim Pract 6 (2004), 251–273.
3. 3 Mauldin, G.R., Done, L.B., Oncology. Mader, D.R., (eds.) Reptile medicine and surgery, 2006, Elsevier, Toronto, 299–322.
4. 4 Sykes, J.M., Trupkiewicz, J.G., Reptile neoplasia at the Philadelphia Zoological Garden, 1901-2002. J Zoo Wildl Med 37:1 (2006), 11–19.
5. 5 Rothschild, B.M., Tanke, D.H., Helbling, M. 2nd, et al. Epidemiologic study of tumors in dinosaurs. Naturwissenschaften 90:11 (2003), 495–500.
6. 6 Ramsay, E.C., Munson, L., Lowenstine, L., et al. A retrospective study of neoplasia in a collection of captive snakes. J Zoo Wildl Med 27:1 (1996), 28–34.
7. 7 Catão-Dias, J.L., Nichols, D.K., Neoplasia in snakes at the National Zoological Park, Washington, DC (1978–1997). J Comp Pathol 120 (1999), 89–951.
8. 8 Dietz, J., Heckers, K.O., Pees, M., et al. Bone tumours in lizards and snakes. A rare clinical finding. Hiemtiere 43:1 (2015), 31–39.
9. 9 Hernandez-Divers, S.M., Orcutt, C.J., Stahl, S.J., et al. Lymphoma in lizards: three case reports. J Herpetol Med Surg 13 (2003), 14–22.
10. 10 Heckers, K.O., Aupperle, H., Schmidt, V., et al. Melanophoromas and iridiophoromas in reptiles. J Comp Pathol 146 (2012), 258–268.
11. 11 Collins, AC, Fenili RN; The modern U.S. Reptile Industry; Georgetown Economic Services White House Report. 2011.
12. 12 Schilliger, L., Selleri, P., Frye, F.L., Lymphoblastic lymphoma and leukemic blood profile in a red-tail boa (Boa constrictor constrictor) with concurrent inclusion body disease. J Vet Diagn Invest 23:1 (2011), 159–162.
13. 13 Cowan, M.L., Monks, D.J., Raidal, S.R., Osteosarcoma in a woma python (Aspidites ramsayi). Aust Vet J 89 (2011), 520–523.
14. 14 Schmidt, R.E., Reavill, D.R., Metastatic chondrosarcoma in a corn snake (Pantherophis guttatus). J Herp Med Surg 22:3–4 (2012), 67–69.
15. 15 Gumber, S., Nevarez, J.G., Cho, D.Y., Endocardial fibrosarcoma in a reticulated python (Python reticularis). J Vet Diagn Invest 22:6 (2010), 1013–1016.
16. 16 Langan, J.N., Adams, W.H., Patton, S., et al. Radiation and intralesional chemotherapy for a fibrosarcoma in a constrictor, Boa constrictor ortoni. J Herpetol Med Surg 11:1 (2001), 4–8.
17. 17 Stern, A.W., Velguth, K.E., D'Agostino, J., Metastatic ductal adenocarcinoma in a western hognose snake (Heterodon nasicus). J Zoo Wildl Med 41:2 (2010), 320–324.
18. 18 Suedmeyer, W.K., Bryan, J.N., Johnson, G., et al. Diagnosis and clinical management of multiple chromatophoromas in an eastern yellowbelly racer (Coluber constrictor flaviventris). J Zoo Wildl Med 38 (2007), 127–130.
19. 19 Steeil, J.C., Schumacher, J., Hecht, S., et al. Diagnosis and treatment of a pharyngeal squamous cell carcinoma in a Madagascar ground boa (Boa madagascariensis). J Zoo Wildl Med 44:1 (2013), 144–151.
20. 20 Gull, J.M., Lange, C.E., Favrot, C., et al. Multiple papillomas in a diamond python, Morelia spilota. J Zoo Wildl Med 43:4 (2012), 946–949.
21. 21 Bera, M.M., Veeramachaneni, D.N., Pandher, K., Characterization of a biphasic neoplasm in a Madagascar tree boa (Sanzinia madagascariensis). Vet Pathol 45 (2008), 259–263.
22. 22 Anderson, E.T., Kennedy-Stoskoph, S., Sandy, J.R., et al. Squamous cell carcinoma with vascular invasion in a diamondback rattlesnake (Cortalus adamanteus). J Zoo Wildl Med 41:1 (2010), 745–748.
23. 23 Matthews, M.E., Eshar, D., Delk, K.W., et al. Splenopancreatic ductal adenocarcinoma with multiorgan metastasis in a northern water snake (Nerodia sipedon). J Zoo Wildl Med 45:2 (2014), 437–440.
24. 24 Thompson, K.A., Campbell, M., Levens, G., et al. Bilaterally symmetrical oral amelanotic melanoma in a boa constrictor (Boa constrictor constrictor). J Zoo Wildl Med 46:3 (2015), 629–632.
25. 25 Comolli, J.R., Olsen, H.M., Seguel, M., et al. Ameloblastoma in a wild black rat snake. J Vet Diagn Invest 27:4 (2015), 536–539.
26. 26 Sharpe, S., Lamm, C.G., Killick, R., Intracoelomic anaplastic sarcoma in a Madagascar tree boa (Sanzinia madagascariensis). J Vet Diagn Invest 25:1 (2013), 153–157.
27. 27 Dadone, L.I., Klaphake, E., Garner, M.M., et al. Pituitary cystadenoma, entrolipidosis, and cutaneous mycosis in an everglades rat snake (Elaphe obsoleta rossalleni). J Zoo Wildl Med 41:3 (2010), 538–541.
28. 28 Baron, H.H.R., Allavena, R., Melville, L.M., et al. Gastric adenocarcinoma in a diamond python (Morelia spilota spilota). Aust Vet J 92:10 (2014), 405–409.
29. 29 Gérard Stumpel, J.B., del-Pozo, J., French, A., et al. Cardiac hemangiosarcoma in a corn snake (Pantherophis guttatus). J Zoo Wildl Med 43:2 (2012), 360–366.
30. 30 Needle, D., McKnight, C.A., Kiupel, M., Chondroblastic osteosarcoma in two related spiny-tailed monitor lizards (Varanus acanthursus). J Exot Pet Med 22 (2013), 256–269.
31. 31 Hannon, D.E., Garner, M.M., Reavill, D.R., Squamous cell carcinomas in inland bearded dragons (Pogona vitticeps). J Herp Med Surg 21:4 (2011), 101–106.
32. 32 Irizarry Rovira, A.R., Holzer, T.R., Credille, K.M., Systemic mastocytosis in an African fat tailed gecko (Hemitheconyx caudicinctus). J Comp Pathol 151 (2014), 130–134.
33. 33 Brot, S., Sydler, T., Nufer, L., et al. Histologic, immunohistochemical and electron microscopic characterization of a malignant iridiophoroma in a dwarf bearded dragon (Pogona henrylawsoni). J Zoo Wildl Med 46:3 (2015), 583–587.
34. 34 Irizarry-Rovira, A.R., Wolf, A., Ramiros-Vara, J.A., Cutaneous melanophoroma in a green iguana (Iguana iguana). Vet Clin Pathol 35:1 (2006), 101–105.
35. 35 Sander, S.J., Ossiboff, R.J., Stokol, T., et al. Endolymphatic sac carcinoma in situ in a tokay gecko (Gekko gecko). J Herp Med Surg 25:3–4 (2015), 82–86.
36. 36 Folland, D.W., Johnston, M.S., Thamm, D.H., et al. Diagnosis and management of lymphoma in a green iguana (Iguana iguana). J Am Vet Med Assoc 239:7 (2011), 985–991.
37. 37 Stacy, B.A., Vidal, J.D., Osofsky, A., et al. Ovarian papillary cystadenocarcinomas in a green iguana (Iguana iguana). J Comp Pathol 130 (2004), 223–228.
38. 38 Jankowski, G., Sirninger, J., Borne, J., et al. Chemotherapeutic treatment for leukemia in a bearded dragon (Pogona vitticeps). J Zoo Wildl Med 42:2 (2011), 322–325.
39. 39 Schilliger, L., Selleri, P., Gandar, F., et al. Adenoid hepatocellular carcinoma accompanied by an uncharacterized eosinophilic intracytoplasmic inclusions in a green iguana (Iguana iguana). J Herp Med Surg 22:3–4 (2012), 70–75.
40. 40 Salinas, E.M., Aguilar Arriaga, B.O., Lezama, J.R., et al. Oral fibrosarcoma in a black iguana (Ctenosaura pectinata). J Zoo Wildl Med 44:2 (2013), 513–516.
41. 41 Patterson-Kane, J.C., Redrobe, S.P., Colonic adenocarcinoma in a leopard gecko (Eublepharis macularius). Vet Rec 157 (2005), 294–295.
42. 42 Vasil'ev, D.B., Solov'ev, luN., Ganglioneuroblastoma in Yemenite chameleon (Chamaeleo calyptratus): the first recorded case of a tumor of neuroectodermal histogenesis in reptiles. Arkh Patol 68:4 (2006), 45–47.
43. 43 Cruz Cardona, J.A., Conley, K.J., Wellehan, J.F., et al. Incomplete ovariosalpingectomy and subsequent malignant granulosa cell tumor in a female green iguana (Iguana iguana). J Am Vet Med Assoc 239:2 (2011), 237–243.
44. 44 Jacobson, E.R., Reese, D.J., Berry, C.R., et al. Vet med today: what is your diagnosis. J Am Vet Med Assoc 243:11 (2013), 1533–1535.
45. 45 Santos, E.D., Silva Filho, J.R., Machado, T.P., et al. Oral fibrosarcoma in a jaracara (Bothrops pubescens) anatomopathological and immunohistochemical aspects. Pesq Vet Bras 35:7 (2015), 664–670.
46. 46 Gardhouse, S., Eshar, D., Lee-Chow, B., et al. Diagnosis and treatment of a periocular myxosarcoma in a bearded dragon (Pogona vitticeps). Can Vet J 55 (2014), 663–666.
47. 47 Darrow, B.G., Johnstone McLean, N.S., Russman, S.E., et al. Periorbital adenocarcinoma in a bearded dragon (Pogona vitticeps). Vet Ophthalmol 16:1 (2013), 177–182.
48. 48 Rivera, S., Crane, M.M., McManamon, R., et al. Surgical treatment of pulmonary melanophoroma in a beaded lizard (Heloderma horridum exasperatum). J Zoo Wildl Med 46:2 (2015), 397–399.
49. 49 Hadfield, C., Clayton, L.A., Clancy, M.M., et al. Proliferative thyroid lesions in three diplodactylid geckos: Nephrurus amyae, Nephrurus levis, and Oedura marmorata. J Zoo Wildl Med 43:1 (2012), 131–140.
50. 50 Gyimesi, Z.S., Garner, M.M., Burns, R.B., et al. High incidence of lymphoid neoplasia in a colony of Egyptian spiny-tailed lizards (Uromastyx aerogyptius). J Zoo Wildl Med 36:1 (2005), 103–110.
51. 51 Bielli, M., Forlani, A., Nardini, G., et al. Mucinous melanophoroma in a northern red-bellied cooter (Pseudemys rubriventris). J Exot Pet Med 24 (2015), 71–75.
52. 52 Schumacher, J., Toal, R.L., Advanced radiography and ultrasonography in reptiles. Sem Av Exotic Pet Med 10:4 (2001), 162–168.
53. 53 Lanza, A., Baldi, A., Spugnini, E.P., Surgery and electrochemotherapy for the treatment of cutaneous squamous cell carcinoma in a yellow-bellied slider (Trachemys scripta scripta). J Am Vet Med Assoc 246:4 (2015), 455–457.
54. 54 Abu-Seida, A., Saeid, S., Cutaneous adenocarcinoma in a desert tortoise (Gopherus agassizii). Int J Vet Sci Med 1 (2013), 48–50.
55. 55 Gonzales-Viera, O., Bauer, G., Aguiar, L.S., et al. Cutaneous fibroma in a common snapping turtle (Chelydra serpentine). J Comp Pathol 147 (2012), 574–576.
56. 56 Santoro, M., Stacy, B.A., Morales, J.A., et al. Mast cell tumor in a giant Galapagos tortoise (Geochelone nigra vicina). J Comp Pathol 138 (2008), 156–159.
57. 57 Clabaugh, K., Haag, K.M., Hanley, C.S., et al. Undifferentiated sarcoma resolved by forelimb amputation and prosthesis in a radiated tortoise (Geochelone radiate). J Zoo Wildl Med 36:1 (2005), 117–120.
58. 58 Heckers, K.O., Schmidt, V., Krastel, D., et al. Malignant melanophoroma in a Hermann's tortoise (Testudo hermanni). Tierarztl Prax Ausg K Kleintiere Heimtiere 39 (2011), 45–50.
59. 59 Bezjian, M., Diep, A.N., Matos, R., et al. Chinese box turtle (Cuora flavomarginata) with lymphoid leukemia characterized by immunohistochemical and cytochemical phenotyping. Vet Clin Pathol 42:3 (2013), 368–376.
60. 60 Lombardini, E.D., Desoutter, A.V., Montali, R.J., et al. Esophageal adenocarcinoma in a 53-year-old mata mata turtle (Chelus fimbriatus). J Zoo Wildl Med 44:3 (2013), 773–776.
61. 61 Gál, J., Jakab, C., Szabo, Z., et al. Haemangioma in the oesophagus of a red-eared slider (Trachemys scripta elegans). Acta Vet Hung 57:4 (2009), 477–484.
62. 62 Gál, J., Jakac, C., Balogh, B., et al. First occurrence of periosteal chondroma (juxtacortical chondroma) in Uromastyx maliensis (Reptilia: Sauria: Agamidae). Acta Vet Hung 55:3 (2007), 327–331.
63. 63 Martorell, J., Soto, S., Barrera, S., et al. Case report: ovarian teratoma in a Mediterranean tortoise. Compend Contin Educ Vet 31:4 (2009), 193–196.
64. 64 Pees, M., Ludewig, E., Plenz, B., et al. Imaging diagnosis – seminoma causing liver compression in a spur-thighed tortoise (Testudo graeca). Vet Radiol Ultrasound 56:2 (2015), E21–E24.
65. 65 Gál, J., Demeter, Z., Palade, E., et al. Harderian gland adenocarcinoma in a Florida red-bellied turtle (Pseudemys nelsoni) – case report. Acta Vet Hung 57:2 (2009), 275–281.
66. 66 Eyarefe, O.D., Antia, R.E., Abiola, O.O., et al. Rhabdomyosarcoma in a terrestrial tortoise (Geochelone nigra) in Nigeria: a case report. J S Afr Vet Assoc, 83(1), 2012, 300.
67. 67 Jacobson, E.R., Seely, S.J., Novilla, M.N., Lymphosarcoma associated with virus-like intranuclear inclusions in a California king snake (Colubridae: Lampropeltis). J Natl Cancer Inst 65:3 (1980), 577–583.
68. 68 Herbst, L.H., Fibropapillomatosis of marine turtles. Annu Rev Fish Dis 4 (1994), 389–425.
69. 69 Jacobson, E.R., Buergelt, C., Williams, B., et al. Herpesvirus in cutaneous fibropapillomas of the green turtle Chelonia mydas. Dis Aquat Organ 12 (1991), 1–6.
70. 70 Marschang, R.E., Viruses infecting reptiles. Viruses 3:11 (2011), 2087–2126.
71. 71 Waltzek T, Reavill DR, Kelleher SA, et al. Characterization of a novel poxvirus from an argentine tegu (Tupinambis meriana). Assoc Reptilian and Amphibian Veterinarians. Conference Proceedings, 2014.
72. 72 Watson, M.K., Mitchell, M.A., Vitamin D and ultraviolet B radiation considerations for exotic pets. J Exot Pet Med 24:4 (2014), 369–379.
73. 73 Ahmad, M., Taqavi, I.H., Radiation induced leukemia and leukopenia in the lizard Uromastyx hardwickii. Radiobiol Radiother, 3, 1978, 353.
74. 74 Chandra, A.M., Jacobson, E.R., Munn, R.J., Retroviral particles in neoplasms of Burmese pythons (Python molurus bivittatus). Vet Pathol 38 (2011), 561–564.
75. 75 Stenglein, M.D., Sanders, C., Kistler, A.L., et al. Identification, characterization and in vitro culture of highly divergent arenaviruses from boa constrictors and annulated tree boas: candidate etiological agents for snake inclusion body disease. MBio 3:4 (2012), e00180–e00212.
76. 76 Keck, M., Zimmerman, D.M., Ramsay, E.C., et al. Renal adenocarcinomas in cape coral snakes (Aspidelaps lubricus lubricus). J Herp Med Surg 21:1 (2011), 5–9.
77. 77 Ball, R.L., Brichard, S.J., Ray, L.R., et al. Ovarian remnant syndrome in dogs and cats 21 cases (2000-2007). J Am Vet Med Assoc 236:5 (2010), 548–553.
78. 78 Jacobson, E.R., Long, P.H., Miller, R.E., et al. Renal neoplasia of snakes. J Am Vet Med Assoc 189:9 (1986), 1134–1136.
79. 79 Pereira, M.E., Viner, T.C., Oviduct adenocarcinoma in some species of captive snakes. Vet Pathol 45:5 (2008), 693–697.
80. 80 Schultze, A.E., Mason, G.L., Clyde, V.L., Lymphosarcoma with leukemic blood profile in a Savannah monitor lizard (Varanus exanthematicus). J Zoo Wildl Med 30 (1999), 158–164.
81. 81 Romagnano, A., Jacobson, E.R., Boon, G.D., et al. Lymphosarcoma in a green iguana (Iguana iguana). J Zoo Wildl Med 27:1 (1996), 83–89.
82. 82 Abou-Madi, N., Kern, T.J., Squamous cell carcinoma associated with a periorbital mass in a veiled chameleon (Chamaeleo calyptratus). Vet Ophthalmol 5:3 (2002), 217–220.
83. 83 Von Deetzen, M.C., Muller, K., Brunnberg, L., et al. Non-metastatic squamous cell carcinoma in two Hermann's tortoises. Vet Sci Dev 2:e5 (2012), 17–19.
84. 84 Frye, F.L., Diagnosis and surgical treatment of reptilian neoplasms with a compilation of cases 1966-1993. In Vivo 8:5 (1993), 885–892.
85. 85 Wenger, S., Simova-Curd, S., Great, P., et al. Ovarian teratoma in a Fiji island banded iguana (Brachylopus fasciatus) and a green iguana (Iguana iguana). J Herp Med Surg 20:1 (2011), 20–24.
86. 86 Stacy, N.I., Alleman, A.K., Sayler, K.A., Diagnostic hematology of reptiles. Clin Lab Med 31 (2011), 87–108.
87. 87 Suedmeyer, K., Noninfectious diseases of reptiles. Sem Av Exot Pet Med 4:1 (1995), 56–60.
88. 88 Fereidooni, F., Horvath, E., Kovacs, K., Humoral hypercalcemia of malignancy due to bipartite squamous cell/small cell carcinoma of the esophagus immunoreactive for parathyroid hormone related protein. Dis Esophagus 16 (2003), 335–338.
89. 89 Eatwell, K., Calcium and phosphorus values and their derivatives in captive tortoises (Testudo species). J Small Anim Pract 51 (2010), 472–475.
90. 90 Divers, S.J., Reptile diagnostic endoscopy and endosurgery. Vet Clin North Am Exot Anim Pract 13:2 (2010), 217–242.
91. 91 Alleman, R.A., Kupprion, E.K., Cytologic diagnosis of diseases in reptiles. Vet Clin North Am Exot Anim Pract 10:1 (2007), 155–186.
92. 92 Lyons, J.A., Newman, S.J., Greenacre, C.B., et al. A gastric neuroendocrine carcinoma expressing somatostatin in a bearded dragon (Pogona vitticeps). J Vet Diagn Invest 22:2 (2010), 316–320.
93. 93 Ritter, J.M., Garner, M.M., Chilton, J.A., et al. Gastric neuroendocrine carcinomas in bearded dragons (Pogona vitticeps). Vet Pathol 46:6 (2009), 1109–1116.
94. 94 Gál, J., Mándoki, M., Sátorhelyi, T., et al. In situ complex adenocarcinoma on the femoral part of the hindlimb in an Asian leaf turtle (Cyclemys dentata). Acta Vet Hung 58:4 (2010), 431–440.
95. 95 Jakab, C., Rusvai, M., Szabó, Z., et al. Claudin-7-positive synchronous spontaneous intrahepatic cholangiocarcinoma, adenocarcinoma and adenomas of the gallbladder in a bearded dragon (Pogona vitticeps). Acta Vet Hung 59:1 (2011), 99–112.
96. 96 Shoemaker, M., Barrie, M., Holman, H., et al. Pathology in practice. J Am Vet Med Assoc 248:2 (2016), 153–155.
97. 97 Kent, M.S., The use of chemotherapy in exotic animals. Vet Clin North Am Exot Anim Pract 7 (2004), 807–820.
98. 98 Graham, J.E., Kent, M.S., Theon, A., Current therapies in exotic animal oncology. Vet Clin North Am Exot Anim Pract 7 (2004), 757–781.
99. 99 Gibbons, P.M., Advances in reptile clinical therapeutics. J Exot Pet Med 23 (2014), 21–38.
100. 100 Spugnini, E.P., Baldi, A., Electrochemotherapy in veterinary oncology: from rescue to first line therapy. Methods Mol Biol 1121 (2014), 247–256.
101. 101 Chinnadurai, S.K., DeVoe, R.S., Selected infectious diseases of reptiles. Vet Clin North Am Exot Anim Pract 12:3 (2009), 583–596.
102. 102 Jacobson, E., Calderwood, M.B., French, T.W., et al. Lymphosarcoma in an eastern king snake and rhinoceros viper. J Am Vet Med Assoc 179:11 (1981), 1231–1235.
103. 103 Brunner, H.M., Dutra, G., Brunelli, C., et al. Electrochemotherapy for the treatment of fibropapillomas in Chelonia mydas. J Zoo Wildl Med 45:2 (2014), 213–218.
104. 104 Siegel, S., Cronin, K.L., Palliative radiotherapy. Vet Clin North Am Small Anim Pract 27:1 (1997), 149–155.
105. 105 Mauldin, G.N., Shiomitsu, K., Principles and practice of radiation therapy in exotic and avian species. Sem Av Exot Pet Med 14:3 (2005), 168–174.
106. 106 Leach, M.W., Nichols, D.K., Hartsell, W., et al. Radiation therapy of a malignant chromatophoroma in a yellow rat snake (Elaphe obsoleta quadrivittata). J Zoo Wildl Med 22 (1991), 241–244.
107. 107 Greenacre, C.B., Roberts, R., Effect of strontium-90 on squamous cell carcinoma in an eastern box turtle (Terrapene carolina); discussion of alternative treatment modalities. 3rd International virtual conference in veterinary: diseases of reptiles and amphibians. 2000, Georgia University, Athens (GA).
108. 108 Roberts, W.G., Klein, M.K., Loomis, M., et al. Photodynamic therapy of spontaneous cancers in felines, canines and snakes with chloro-aluminum sulfonated phthalocyanine. J Natl Cancer Inst 83:1 (1991), 18–23.
109. 109 Serella, F.P., Sabino, C.P., Fernandes, L.T., et al. Green turtle (Chelonia mydas) cutaneous fibropapillomatosis treatment by photodynamic therapy. Mar Turt News 142 (2014), 6–10.
110. 110 Mosley, C., Pain and nociception in reptiles. Vet Clin North Am Exot Anim Pract 14 (2011), 45–60.
111. 111 Sladky, K.K., Miletic, V., Paul-Murphy, J., et al. Analgesic efficacy and respiratory effects of butorphanol and morphine in turtles. J Am Vet Med Assoc 230:9 (2007), 1356–1362.
112. 4(a) receptors avert opioid-induced breathing depression without loss of analgesia. Science 301 (2003), 226–229.
113. 113 DeVoe, R.S., Nutritional support of reptile patients. Vet Clin North Am Exot Anim Pract 17:2 (2014), 249–261.