Month: November 2015

Tortoise Bladder Stones (Uroliths)

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One of the more interesting and unique surgeries we perform is the removal of a bladder stone (called a cystotomy) from California Desert Tortoises (CDT’s), along with various other tortoise species like African spurred tortoises (Sulcatas) and leopard tortoises. It is usually a problem in captive tortoises, but it has been diagnosed in wildl tortoises on occasion. The stones tend to be smaller in wild tortoises.

Some of these stones grow to tremendous size, and it is a wonder that these animals can survive with such a problem. Other animal species get bladder stones, but none of them are anywhere near as large as tortoise bladder stones.

We have been doing surgery to remove bladder stones in tortoises since 1989. This page will give you a detailed description of this surgery, with high quality videos and photos, so you can see how we diagnose and treat this problem. It is one of the more interesting surgeries we perform.

Don’t miss the video of the beating heart at the end of this page.

This page contains graphic surgical pictures.


Physiology

The normal waste product for protein metabolism is ammonia. Tortoises convert this ammonia to uric acid, which is less toxic to the bladder wall, and lets them hold water in their bladder for long periods of time. Tortoises are a desert species, so water conservation is a large part of their physiology as they have adpated to their arid environment. They can recycle water from their bladder into their system when they do not have access to drinking water.

If the uric acid builds up in high enough levels, a situation that might happen if the tortoise is not drinking and staying well hydrated, the uric acids combines with electrolytes like sodium, calcium, and potassium, to form urates. In a well hydrated tortoise these urates are secreted normally when urinating. In a dehydrated tortoise that is recycling its urine, the urates are not secreted, and can slowly build up into a bladder stone.

When we analyze tortoise bladder stones chemically they are comprised almost exclusively of urates.

Cause

The exact cause is unknown. Dehydration plays a significant factor in this disease. Many people believe that tortoises get all the water they need from their food. This is not true, they need to drink water also, so make sure fresh water is available all day.  Periodic soaking is recommended. Use lukewarm water, make sure the water level is no higher than the beginning of the top shell (carapace), and soak for up to 10 minutes. Dry your tortoise off before placing back in its normal environment. Do not soak if your tortoise has surgery unless recommended by your veterinarian.

Diet is also a factor in this disease. For all tortoises, the overwhelming majority of their diet is from plants. If the diet is too high in protein, which would be from feeding dog or cat food, there might be excess urate production, leading to an increased chance of a bladder stone being formed. Your tortoise’s diet should consist of a high percentage of grass, and a lesser amount of green, lelafy vegetables.

Symptoms

There are no specific symptoms that tell us a tortoise has a bladder stone, and some of them don’t show any symptoms at all. The more common symptoms are nasal discharge, poor appetite, straining to have a bowel movement, inability to lay eggs, lameness in the back legs, and lethargy. A tortoise can become paralyzed in the back legs due to mechanical pressure from the bladder stone. The problem can even progress further, and some tortoises can succumb to the bladder stone.

Some of these stones are diagnosed as incidental findings when we take an x-ray or perform an exam for an unrelated problem. The tremendous size of some of the stones indicates they may have been present for years before being diagnosed. Anybody that has ever had a kidney stone can sympathize with what these animals feel like with such large stones.

Diagnosis

Every tortoise that has a problem gets a thorough head to tail exam. We start with the mouth and work our way back. They are ectothermic, so we do not take their temperatures. They also do not have external lymph nodes like mammals do, and it is pretty hard to palpate their abdomens or listen to their hearts with a stethoscope due to the shell.

A large part of our exam centers on the head

There are two methods utilized to diagnose bladder stones. During an examination we can sometimes palpate a stone by gently rolling the tortoise back and forth while we feel in the soft spot by its rear leg.

To perform the palpation technique you need to understand tortoise anatomy and be experienced at palpation

Only a few stones can be found on palpation. The other method to make a diagnosis, and usually more reliable method, is to take an x-ray. By the time we take a radiograph, many bladder stones are large. Some of the stones are so large that we have to break them into pieces to get them out of the opening in the shell the we do the surgery to remove them.

You can see the actual size of this stone measure in cm. It takes 2.5 cm to make up an inch. Click on the photo to make it larger. 

Surgery

On rare occasions some tortoise bladder stones are small enough to be removal via the pre femoral approach. It is performed in the same area as the palpation picture above. You can see this in the video below. 

The usual treatment for a bladder stone in tortoises is to perform surgery to completely remove the stone through a hole in the bottom of the shell (the plastron). Most tortoises do fine postoperatively, and after a few days in the hospital, and a few weeks of recuperation at home, they are back to normal. We tend not to perform this surgery when hibernation is near.

Prior to surgery our patient is prepared to minimize anesthetic risk. This might involve taking a blood panel to check for anemia and to check the protein level. In some patients we place a feeding tube to insure adequate hydration and nutrition, both before and after the surgery. In other patients we insert an intravenous catheter (IV) to maintain blood pressure during surgery.

This tortoise has an IV catheter in its jugulare vein. We use this vein because it is relatively easy to insert the catheter, and it is large enough to take the volume of fluid we need to give.

Once the tortoise is stable and ready for surgery, we gently induce anesthesia with a mask that has 100% oxygen and the anesthetic agent. We commonly give a sedative by injection prior to this for further relaxation.

When fully relaxed we gently inserted a breathing tub called an endotracheal tube (ET). This facilitates the administration of oxygen and anesthesia in a much more efficient manner.

 After the tortoise is anesthetized it is placed upside down on a warm water blanket. The bottom of the shell (called the plastron) is cleansed thoroughly. This may take several scrubbings with the use of a gentle brush to get clean enough for surgery.

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While our tortoise is in surgery being scrubbed our surgeon does he own scrubbing

Now that our surgeon and tortoise are both “clean”, the draping process can begin. This is important to prevent contamination and infection. Infection is especially critical in this surgery because once the cut piece of shell is resealed to the bottom of the shell, an infection can fester on the inside without our knowing about it.

Our patient is prepped and ready to get this huge stone out of its bladder

The dremel is now set up. It will be used to cut the shell. 

While all of this is going on the rest of the surgical team is preparing for their roles. These assistants are students in our externship program. They will be assisting the surgeon with flushing and suctioning of fluids, along with the administration of anesthesia.

Even though it is living tissue, which means it has feeling and bleeds, tortoise shells are tough. We use a special drill called a dremel to cut the shell. We have gone through many of them over the years, and should have purchased stock in Home Depot long ago!

This close up view shows the serrated edge. They wear down fast trying to cut through the tough (but living) shell.

Dr. Ridgeway starts his cut with his safety glasses on to protect him from flying particles brought on by the drill used to cut into the shell

The blade spins at a high speed, so sterile water needs to be constantly applied to the cut surface to minimize overheating and necrosing the shell. The blade cuts at a beveled angle, facilitating replacement of the shell when the surgery is complete. If this angled cut is not made, the shell will just fall back into the abdominal cavity (it is called the coelomic cavity in a reptile), and the shell will not heal.

Spraying sterile water and flying bone fragments means the front lens of your camera is going to get blessed! 

This short video shows us cutting the shell with the dremel

The final appearance of the cut shell before the shell is payed open. Shell is living tissue, which is why there is blood.

Now the shell is gently pried up with an instrument called an elevator. There are muscular attachments that are gently separated from the shell to allow the shell to become completely free.

These muscular attachments are very strong, and it takes gentle but persistent prying to start lifting up the shell
The shell is pryed up on all cut edges

The strong muscular attachment of the shell to the internal body are obvious in this photo. Tortoises are built like tanks!

This gives you an idea of the size of the cut shell

The cut piece of shell is living tissue and needs careful handling.The rectangular piece of cut shell is placed under saline soaked gauze until it is put back at the end of the surgery.  

A close up of the edge of the shell that was cut by the dremel. It is made up of  calcium, phosphorous, and a protein matrix. Since reptiles (ectothermic animals) have a slow metabolism, it can take up to 2 years for the cut shell to completely heal. Click on the photo to enlarge.

The next layer encountered is the lining of the coelomic cavity. It is gently cut to give full exposure to the organs in the cavity.

Internal organs can be visualized easily through this large opening. These are egg follicles.

This is what these eggs would look like on a radiograph

Before we proceed further fluids in the coelomic cavity are suctioned out for better visualization

After careful dissection the bladder with the stone in it is exposed

It is gently pulled out of the coelomic cavity

It is packed off with drapes as a first step

Before actual stone removal a “stay” suture is placed in the bladder at two locations. The suture is then attached to a hemostat and clamped to the towels. This prevents the bladder from falling back into the coelomic cavity when the stone is removed.

Dr. Ridgeway has made an incision into the bladder and the stone is starting to bulge out

The stone looks like a piece of concrete. Can you imagine what this would feel like inside of you?

Some small fragments of stone can remain in the bladder after the large stone is removed. The smaller pieces of stone are suctioned after the bladder has been flushed. This usually takes many flushings with sterile saline. Only when the bladder has been thoroughly flushed is it sutured back together.

Notice how inflamed the inner lining of the bladder has become from the tremendous irritation from the stone. This bladder is also thickened for the same reason. A normal bladder is very thin walled, almost like tissue paper.

A special suture material is used to close the opening in the bladder. This suture is very strong yet causes minimal tissue reaction, and will slowly dissolve over several months.

When we suture the urinary bladder back together we try to minimize the suture going into the lumen of the bladder, where it can cause more irritation to the already inflamed bladder. We try to place most of the suture in the outer layer of the bladder, called the serosal surface, for this reason. The inner and inflamed layer is call the mucosal surface. 

The final outcome of the suture bladder with our plication stitch

The coelomic cavity is also flushed copiously with warm sterile saline, then the fluid is suctioned out. This process helps prevent an infection and aids in the healing process. If an infection is sealed into the coelomic cavity the outcome could be catastrophic.

We flush and suction simultaneously 

Fluid fragments can be deep into the coelomic cavity, so every nook and cranny needs to be flushed and sanctioned. We do this repeatedly with warm sterile saline.

The incision made in the tissue lining the cavity is sutured next, using the same type of suture material as the bladder. The muscular attachments to the cut piece of shell will gradually reestablish themselves to the underside of the cut piece.

Part way there

What it looks like when the suturing is complete

While all of this was going on the piece of shell that was removed at the beginning of the surgery was kept moist by wrapping it with sterile gauze soaked with saline. Doctor R is removing the gauze before putting the cut piece of shell back in place.

Throughout the procedure additional sterile saline was added to the gauze over the shell to keep it moist. Time for this piece of shell to get back to where it belongs.

When the shell is back in place bone wax is used to help seal the edges

The bone wax has been inserted all around the cut shell

The fiberglass pieced is sized

Time to mix up the epoxy

The fast-drying epoxy is worked smoothly over the fiberglass


Applying it smoothly like this is a work of art!

The epoxy hardens within a few minutes. During this time it is important that the tortoise does not wake up or breathe deeply, because the pressure in the lungs will push the patch out.

Cellophane is put over the patch for cleanliness

Here is our friend just waking up from anesthesia. We remove the breathing tube when she is breathing on her own adequately.

At this point we will give her a pain injection and place her in a special room that maintains a temperature of 85 degrees. She will stay in the hospital for a few days until she is eating and active.

We have a short video of the beating heart of a tortoise during this procedure. You can see the heart beating during the surgery because reptiles do not have a diaphragm, the muscle that separates the chest from the abdomen. Since there is no abdomen, technically it is called the coelomic cavity.

Occasional we encounter a stone in the bladder that is so huge the we cannot bring the bladder out of the opening in the shell.

This is one of them!

In a case like this we need to break up the stone while it is still in the bladder inside the coelomic cavity. This is a tedious and long procedure. 

The thickened bladder needs to be incised with a scalpel blade

You can see the “stay” suture holding the bladder up for better access in the deep coelomic cavity

The highly thickened bladder is obvious


This bladder stone is dark, probably due to the chronic nature of it being in this urinary bladder for so long

The tedious process of breaking up the bladder stone with the osteotome being

Fluid in the center of the bladder is suctioned out

Some of the stone fragments are fragile and break up as they are being removed

Some pieces are large

The pile of removed stone and fragments was almost 2 pounds

Once we removed the large pieces there were hundreds of small fragments lining the bladder. They can be the basis for stone reformation and need to be removed.

We flush the bladder with saline and suction them out

Only when all stone fragments are removed do we suture up the bladder

Before we put everything back together we check the internal organs for any pathology. This is a lobe of the liver

Prevention

Keep your tortoise well hydrated with acess to drinking water and soaking as previously described. Feed mimimal amounts of green leafy vegetables and large amounts of grass. Do not supplememt with excess calcium or Vitamin D3 if your tortoise has access to direct sunshine as seen in our western and souther states. It is theorized that an active tortoise foraging in a large area will excrete more urates when it urinates. Keeping it in a small area can inhibit its activity and potentially lose this advantage when exercising.

A yearly exam (palpating for bladder stones), blood panel, and radiograph, goes a long way to detecting a stone early. If small enough these stones might be amenable to being flushed out or removed by a pre-femoral approach, which is obviously much easier on your tortoise than cutting the shell.

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Spay-Water Dragon

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Chinese Water Dragons are fun pets that require very specific environmental conditions. When these conditions are not met problems can occur, in this case the pet was unable to lay its eggs and was feeling ill.

This page shows graphic pictures from an actual surgery.


Husbandry

These animals originate from Southeast Asia so they require high humidity with plenty of water and a temperature range of 82-97 degrees F. They are tree climbers so make sure their cage has plenty of branches.

They need large cages to feel secure. If the cage is too small they will constantly rub their noses to the point that they will rub the bone raw. Male Water Dragons are territorial, so only one male should be in a cage. Two females can be kept with each male.

Insects and other arthropods, along with small mice, fruits, and vegetables are good foods to give them. Always use a multipurpose vitamin powder in their food several times per week.


Reproduction

Approximately twice per year they lay 8-12 eggs. They should be incubated in vermiculite at 78-80 degrees F for approximately 3 months.

This is what we normally want to see, eggs laid on vermiculite.

vermiculite

In the case that follows the Water Dragon was unable to lay its eggs, which caused it to become ill. Surgical intervention was needed to correct the problem.


Surgery

An x-ray reveals the extent of the eggs in our patient. The coelomic cavity (reptile equivalent of the abdomen) is filled with eggs.


Anesthesia is very important, especially in such a small patient. To minimize the risk of anesthesia we insert a flexible breathing tube into the windpipe of our patient. This tube allows us to give oxygen and anesthesia in very refined quantities. It also allows us to inflate the lungs since reptiles commonly do not breathe on their own when anesthetized.

waterdragon-ovh


After the breathing tube has been placed and our patient anesthetized it is prepared for surgery. On the right side of this picture you can see a probe placed on its tail. This probe goes to a Pulse Oximeter, an instrument that measures oxygen saturation in the red blood cells. It is instruments like this, along with our extensive expertise with reptiles, that allows us to safely anesthetize such a small patient.

waterdragon-ovh-2


Great care must be taken when making an incision into the coelomic cavity. There is a large vein that lies just under the scales, if punctured, can cause extensive bleeding. Such a small animal can not tolerate blood loss that would be acceptable in other animals.

waterdragon-ovh-3


The coelomic cavity is filled with eggs that literally spill out when we make our incision. Each ovary with its associate eggs is isolated, and the shell gland with eggs is removed.

waterdragon-ovh-5


A special instrument called a hemoclip is used to clamp the blood vessels that lead to the ovary and shell gland. The hemoclip is used because it minimizes surgical time, so there is less risk of anesthesia. This instrument uses a small metal clip to stop the blood flow. The clip can be vividly seen on an x-ray because it is metallic.

waterdragon-ovh-6

This surgery prevents this Water Dragon from laying eggs in the future, so it will not encounter this illness again.

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Iguana Spay

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Common green iguana’s frequently have a problem laying their eggs. Most of these problems are the result of poor husbandry. If the problem can not be rectified medically then the eggs are surgically removed because they can become toxic.

Cause

As in almost all diseases we encounter there are many causes.

In many cases it is environmental factors that are creating an inability for a female iguana to lay her eggs. Some of these causes are:

  • Environmental temperature below 90 degrees F
  • Humidity below 90%
  • Lack of exposure to direct sunshine
  • Housing that is too small or overcrowding
  • Loud noises and excess activity in the immediate surroundings
  • Inadequate substrate to lay eggs in
  • Inadequate diet

These factors closely correlate to the causes of iguana bone disease. Click here if you would like to learn about them in detail before continuing on with this page.

This is an example of the type of substrate that can be used for an egg laying iguana.

Medical problems can also be involved. Some eggs are deformed while others are too large to pass through the pelvis. Iguana’s that have previously been afflicted with bone disease might have deformed skeletons or inadequate strength to lay eggs

The pelvis on this iguana is too deformed for eggs to pass. This pet has a severe form of iguana bone disease called NSHP.

Some iggie’s have infections that cause problems with egg laying, and even on occasion a stone in the bladder (called urolithiasis) can prevent eggs from passing through the pelvis.

Symptoms

For most owners the primary symptom is a pet that has stopped eating and has also become lethargic. A lack of appetite in an otherwise normal iguana with eggs can be normal. Many of these females will have distended abdomens, a strong clue as to the cause of their lack of appetite. Sometimes the female has layed a few eggs and stopped. These eggs might be normal in shape and size, or they might have deformities or calcium deficiencies.

The egg on the lower left is malformed, and could be an indication of a problem. The substrate in this case is vermiculite.

Diagnosis

An eggbound iguana usually has a distended abdomen (technically the coelomic cavity). Depending on the number of eggs and their level of calcification these eggs can actually be felt when the abdomen is palpated. Radiography is used commonly to verify the diagnosis.

Can you visualize the numerous round and subtle swellings in the coelomic cavity (reptile equivalent of the abdomen) of this female iguana?

The numerous eggs in this female are a little easier to visualize

Radiographs-IggieEggs

Treatment

Once husbandry problems are corrected medical therapy is usually the first course of action in an otherwise healthy iguana. Calcium injections and supplements, vitamin a injections, and even medications to contract the uterus are used.

If medical therapy is unsuccessful after 3-4 weeks, then surgical intervention is necessary. These eggs can cause an iguana to become ill, and since few pet iguana’s are used for breeding, along with the fact that we don’t want this problem to repeat itself next year, the iguana is spayed (OVH). Technically this is called an ovariosalpingectomy in an iguana. Lets look at a case where this occurred.

Anesthesia

Pre-anesthetic preparation is important in every surgery we perform, no matter how routine. All of our spays receive a physical exam prior to surgery. After this exam will we draw a small amount of blood for an in-hospital pre-anesthetic test. When everything is to our satisfaction we will administer a sedative. This will calm the pet down and make the administration of the actual anesthetic, along with post operative recovery, much smoother. Once a pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.

This is a sterile abdominal surgery, and our surgeon starts the pre-surgical process by using special soap to clean his hands

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While our patient is being anesthetized our surgeon is already in our surgical suite setting up instruments. Our surgeon is ready to start before our patient is at a proper plane of anesthesia. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around.  All of this is to minimize anesthetic time.

OVH-rabbit-2
OVH-rabbit-3

We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

Surgery-Monitor

In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters

Rabbit-femurfx-9

Surgery

The following area contains graphic pictures of an actual surgical procedure performed at the Long Beach Animal  Hospital.

You can click on the pictures to see a larger version for better for visualization. 

Zeke has had a distended abdomen and has laid only a few eggs. She is now becoming listless so its time for us to intervene.

This is Zeke with her mom

Do you see the eggs in this radiograph of Zeke?

Click on the picture for a larger version to help you visualize them. As it turns out there are 30 eggs in Zeke’s abdomen (the abdomen of an iguana is called the coelomic cavity).

Once Zeke was cleared for surgery with a blood panel it was time to get those eggs out. After giving her an injection of a tranquilizer called Telazol we administered gas anesthesia (lets hope she does not hold her breath for too long)!

When she has relaxed enough a special tube (called an endotracheal tube) is very gently placed in the windpipe. This opening is at the back of the tongue, and can be difficult to visualize due to the fleshy tongue. This tube allows us to inflate the lungs and supply adequate amounts of oxygen and anesthetic.

All of our surgeries are performed under sterile conditions. The skin is cleansed numerous times with a special antiseptic agent. The area is covered with a sterile drape and the surgeon uses sterile equipment for the duration of the procedure. In this picture Zeke has been scrubbed and is ready to be draped. You can see how relaxed she is under anesthesia.

The incision is made with a scalpel blade then extended with scissors

There is an important vein running under the skin that we don’t want to cut. You can see it running horizontally just under the skin. The two white structures (the left one looks larger than the right one)  below the vein is one of the 30 eggs we will be removing.

Once the incision is big enough we gently start exteriorizing the eggs (follicles) in the oviducts.

The first group of follicles above is just the beginning as we continue to exteriorize them out of the coelomic cavity. Its hard to believe that many eggs can fit in one iguana!

The blood supply to these follicles must be ligated before we can remove them. You can see how extensive the blood supply is along with how delicate these follicles are within the oviduct. This removal of these eggs is the salpingectomy part of this whole surgery called an ovariosalpingectomy. In a dog or cat it is called an ovariohysterectomy (more commonly known as a spay).

This part of the procedure takes a while because we carefully, gently, and methodically ligate all of the vessels to all of these eggs in the oviduct. When finished ligating we cut them out and check for any bleeding from these blood vessels.

In this picture (enlarge it if necessary) our surgeon is cutting one of the ligated blood vessels on the right with a scalpel blade. The remaining end that is now ligated with 2 knots will fall back into the coelomic cavity which is at the bottom of the picture. The eggs (follicles) in their oviducts are at the top of the picture and will now be discarded.

The right group of blood vessels has now been cut and our surgeon is getting ready to cut the group of blood vessels on the left. You can see the right group of blood vessels on the right with their two ligatures. We do not let these ligated blood vessels go back into the coelomic cavity until we are certain there is no bleeding.

Now that the eggs and oviducts are removed (salpingectomy) its time to remove the ovaries (the ovario part of our surgery).

This picture shows the left ovary, the nodular horizontal structure in the middle of the picture. The horizontal pinkish structure above it is the shell gland, the equivalent to the uterus in mammals. The vertical pinkish structure to the left of the ovary is the spleen. The white structure just to the left of the spleen is the stomach.

The ovary is pulled up for better visualization. It is attached to a large blood supply which is the horizontal bluish structure below it. This part of the surgery is very delicate due to this blood supply that is almost attached to the ovary. If we cut or nick it while removing the ovary there will be extensive bleeding.

We use a special instrument that puts on metallic clips (called hemoclips- hemo is short for hemostasis, which is latin for controlling bleeding). This is much easier than trying to ligate the ovaries with sutures and potentially cutting into the attached blood supply.

In this picture 3 hemoclips have been utilized. You can see the cut part of the ovary between our surgeon’s fingers.

Our surgeon has let go of the cut end of the ovary and it is laying back on the first 3 hemoclips. He has put on a hemoclip on the left side of this picture as he works his way towards the middle.

His 2nd hemoclip on the left has been administered as he starts cutting the ovary on the left

The final result when all hemoclips are in place and the ovary is removed. Now its on to the other ovary for the same thing.

The clips will remain in the coelomic cavity of this pet for the rest of her life. They can easily be seen on an x-ray because they are metallic.

Once our surgeon has confirmed there is no bleeding we sew her back together. We use a special suture pattern called horizontal mattress to make sure the skin edges are everted. You can see the start of the suturing as our surgeon works from left to right.

As he continues along he takes care not to put his needle through that large abdominal (sometimes called central) vein you saw at the beginning of the surgery.

When complete the skin edges are sticking up (everted). We do this suture pattern only in reptiles because the skin edges will fold in (and won’t heal properly) if we suture the same way as in mammals. Once the sutures are out in two- four weeks and this iggie sheds the scales will be flat again.

When the surgery is complete  and her pain injection is given one of our staff stays with her to keep her warm and administer oxygen until she is fully awake.

Final count is 30 eggs. What is even more amazing is the fact she layed 18 eggs at home before surgery!

For kicks this is what the eggs have inside of them.

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Snake Skin Conditions

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Snakes are frequently presented to us with scale conditions. In most cases there are obvious husbandry problems that caused the condition. It is imperative to know the proper temperature, humidity, and substrate necessary for optimum health for each species of snake. Far too often we encounter problems that are easily corrected with only a little bit of effort on an owner’s part. Information on the proper environment for these animals is available through books, reptile associations, and the World Wide Web- ignorance of their needs is no excuse to house them in poor conditions.

Correcting scale conditions in snakes takes considerable time and effort. Many cases need antibiotics and care for at least one month.


Septicemia

This boa was presented to us with a poor appetite and mouth infection called stomatitis.

17131 Boda Chyratus Rostral Infection
17131
Boda Chyratus
Rostral Infection

This is typical of what stomatitis looks like in a snake

 

 

 

17131 Boda Chyratus Rostral Infection
17131
Boda Chyratus
Rostral Infection

After we removed necrotic tissue


 

A thorough exam revealed problems in other locations. This is the underside at around mid body. This red area of inflammation is caused by septicemia, a spread of infection through the bloodstream to other parts of the body.


 

Other locations on this snake’s underside also had lesions.


Diagnostic tests were performed to assist us in diagnosis and treatment. We cultured the lesion in the mouth and took a blood sample.

This is a picture of the same area as the above picture 2 weeks after we started treatment. This snake is now is eating on its own and the lesions in the mouth and scales are almost completely gone. It will be treated for an additional 2 weeks to prevent recurrence of the problem. The initial husbandry conditons that set up this infection were also corrected.


Rat Bite

It is a common fallacy to think that snakes need to eat live prey. If a snake is not hungry, or if it is not kept at the proper temperature and humidity, then its stimulus to kill and eat live prey is diminished. A common outcome is the rat attacking the snake, leading to serious infection and often times death. All rats and mice fed to snakes should be killed before introduction to a snake. Stunned rodents can be used but should be removed if not eaten in a short period of time

This snake had been ill and off food for about one week before it was brought in to us. The owner was not aware that the rat he fed attacked the snake because he was not observant after he put the rat in the snake’s cage. In this picture the back 1/3rd of the scales were infected.


 

A close up view reveals the extent of the skin infection. This snake has septicemia also because the infection has spread from the scales into the bloodstream. This pet required extensive medical therapy to save it.


Thermal Injury

Many snakes are kept in cages with inadequate ambient heat. A common source of heat in many cages is a hot rock. When improperly used it can burn the snake

The underside of this Burmese python shows extensive burns. It is a serious condition that requires immediate care if this snake is to survive.


 

A close up view gives a better feeling for the severity of the problem.

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Snake Impaction

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This page shows two snakes that are constipated. The first one required surgical removal of the impacted feces (fecalith).  The second died and was necropsied.

The symptoms of an impacted snake are a lack of appetite along with lack of bowel movement for many weeks. This is a serious condition that could result in the death of the snake if not treated, which is exactly what happened to the second snake.  Medical therapy, consisting of warm water baths, lubricants, and fluids have not helped at all. Surgery is a last resort in these cases because of the potential for post operative complications.

Graphic surgical and necropsy photos on this page


Diagnosis- Snake #1

Most snakes that are impacted will not be eating or passing any feces. We use radiography to help us in our diagnosis.

This is the radiograph of a Burmese python that has several fecaliths in its intestines. They are the large circular and whitish objects in this view.


Treatment

We anesthetized it and made an incision over the fecalith on the underside of its body. In this picture we are carefully dissecting through tissue to get directly to the intestines.

 


We have completed our dissection and have adequate exposure of the bulging intestine filled with hard stool.

 


The intestine is brought out through the incision in the scales and two stay sutures (the blue sutures) are placed to allow gentle handling and placement. An incision has been made into the intestine and some of the dry and hard fecal material is being removed with a hemostat.


There is so much impacted stool in this intestine that we need a sterile spoon to scoop it out. We spend 30 minutes of this procedure scooping stool out of intestines.


This is the appearance of the inner lining of the intestines (called the mucosa) after all the feces have been removed. It is inflamed and fragile, and is a major part of why this snake is ill.

Diagnosis- Snake #2

You can see the bulge in its posterior coelomic cavity in the ver center of this picture

SnakeImpaction-Bulge

A radiograph confirms the impaction

SnakeImpaction-Radiograph

The necropsy gives you a complete picture of the impaction

SnakeImpaction-Necropsy

 


Prevention

This case illustrates the importance of proper husbandry and observation. If these snakes had been kept in an enclosure with adequate humidity and temperature there is less of a chance that this problem would have occurred.

In addition, if it had been brought to us sooner we probably would have been able to treat this problem medically. This brings up the importance of daily observation of reptiles concerning normal health parameters like appetite, activity level, and bowel movements. Reptiles do not show obvious signs of disease like mammals, so careful observation of daily habits is important in order to notice subtle changes.

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