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Yeah, the competency of your local vets with reptiles also has a role to play in that decision...I personally haven't found anyone here that I trust, so I rely on my handy high-powered microscope, book on identifying reptile parasites, flagyl and panacur, gram scale, and lots and lots of reading and research to get me through most problems. I've actually successfully treated mouth-rot with diluted hydrogen peroxide by swabbing out the mouth daily. My primary angst is the lack of availability of oral antibiotics in reasonable dilutions, and the lack of opthalmic antiobiotics.
Since there aren't any reputeable herp vets nearby, I took it upon myself to learn reptile medicine myself. Any problem I can't easily identify would mean a serious road trip...but most problems reptiles come up with involve parasites, or minor infections...easily treated.
I think it's something anyone who plans on owning more than a handful of herps should do--if you can't practically take your collection of 20 animals for an annual checkup, then you have to be able to do the checkup yourself.
I'm sure this is a somewhat controversial idea, but there isn't anything special or sacred about a veterinary education...and you don't need to go to vet school to identify mouth rot or spot an oocyst under a microscope.
Get yourself some text books, some guides made for veterinarians on reptile medicine, and self-educate.
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