Medical Advice - Emergencies

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Katrina
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Medical Advice - Emergencies

Postby Katrina » Fri Jan 01, 2010 6:50 pm

Please read and consider this before giving or asking for medical type advice on these forums.

Please Note - Medical Advice

Please keep in mind that posts on this forum are from members of the public sharing personal opinions. It is not a replacement for qualified medical advice from a veterinarian who is experienced in treating reptiles. Many illnesses share similar symptoms but require different treatments. A medical exam is necessary for an accurate diagnosis, without which appropriate treatment cannot be given.

You should always consult your vet before following any suggestions for medication or treatment you have read about. The wrong treatment could make your skink worse or mean your vet is unable to give the correct treatment because of drug interactions. Even non prescription drugs can do harm if given inappropriately.

We are very grateful to members who take time to answer other members questions, but please do be clear in your replies that you are sharing personal experience and not giving instructions on what must be done.

Urgent Medical Advice:

If you need, or think you might need, urgent medical advice you should contact a vet. If it is out of working hours phone your vet's normal number and there should be an answer phone message with instructions on what to do.


Thanks again for passing this along!
Last edited by Katrina on Mon Apr 19, 2010 5:10 pm, edited 1 time in total.
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Postby Katrina » Mon Apr 19, 2010 5:09 pm

As you all can see, I'm editing this thread so that it is a bit more useful.

Just to be clear, this DOES NOT replace a qualified reptile veterinarians advice (and yes, there is a difference between a veterinarian and a qualified reptile veterinarian!!). This section is meant to be a reference for when quick answers are needed or while waiting for a vet appointment. I saw a couple time when questions were asked, i.e. about burn treatment, and everyone waited hoping that Lea would log in because not many have experience with burns. Rather than guess, make the poster wait days, or give out incorrect advice, we can slowly build a thread that has good advice that can be referred to immediately.

Moderators will add advice as it is needed or as reliable advice is found, but this is not meant to replace a vet visit or to be all encompassing. Please reread the first post if anyone is at all unclear - this is just a reference and it is still advice found over the internet. None of us are qualified vets, although some of us have more experience than others in certain situations. For those who have experience with rescue situations and feel they can contribute, we welcome your advice and will give credit to you as the author. :)

If anyone has any questions, feels anything in this thread is incorrect or unclear, or has any suggestions or feedback please PM myself or another moderator. This thread will be locked to ensure that all content is at least reviewed by a moderator before being added, although again - none of us are vets. :wink:

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Burns - information thanks to LeaBilby
1. Keep clean to prevent infection

2. Do not apply creams to broken areas unless directed by a specialist vet.
Silver sulfadiazine cream can be used on charred skin/scales. Broken or dirty burns can be washed with a 1% chlorhexidine solution, but should be used with caution as the long term effects of chlorhex on reptiles is unresearched, therefore unknown if there are side effects. If the skin is not broken, a gel such as Burnaid can be applied, but keep in mind that applicaton of creams traps moisture and bacteria and can increase the risk of infection, as well as trapping and increasing the heat.

3. Keep your lizard well hydrated, even if he is off his food. Water loss from burns can be significant and dehydration is as much of a killer as infection.

4. Where possible, reduce the temperature within your enclosure for 24 hours following a burn. As long as your lizard hasn't just eaten a big meal, lowering your temps by a few degrees will help decrease their core body temperature and their surface area, allowing the burned area to cool, therefore reducing heat damage. Burns retain latent heat, which continue to 'burn' tissue even after the initial injury. It's important to consider this when treating the burn, unless it compromises their health by decreasing the temperatures.

5. Consider prophylactic antibiotics. In the first 24 hours after a burn, prophylactic treatment can help prevent a potential infection and thus speed recovery time without complications. The negative side effects of antibiotic use should also be noted, as increased dehydration from a burn can lead to renal insufficiency which can be further exacerbated by use of medications. Discuss these options with your vet.



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Toe Loss - information compiled from various members as well as veterinarians at Park Veterinary, Alberta, Canada
*PM or email Katrina with questions or concerns

Toe loss can be caused by several reasons and proper care involves identifying why the problem occurred to ensure it does not worsen. Was the BTS exposed to other reptiles and was bitten? Is there a husbandry issue? Is the BTS on carefresh or carpet and small fibers are getting caught on the toes and constricting blood flow? Is there stuck shed on the feet constricting blood flow to the toes (commonly seen in rescues)? If none of these fit, it may be a fungal problem, and a vet should be contacted to check if the issue may be fungal.

A BTS that has recently lost or damaged toes should be kept on paper towel in a clean enclosure to ensure that no infection is contracted. If the enclosure is not clean and there are open wounds then infection can spread to the blood (septecemia - blood infection), which could be fatal if not treated. If the BTS seems lethargic or otherwise sick it is recommended that a qualified reptile veterinarian see it as soon as possible. However, in most cases of toe loss (assuming no other health issues are present) the BTS will heal fine without any medical assistance. Feet should be kept clean and dry. Lukewarm, saline (epsom salts work well), shallow baths can aid in loosening stuck shed and keeping the feet clean and free of infection. Polysporin ointment or similar can be used to ensure that the toes do not get infected, although in most cases it isn't necessary.

If the feet are kept clean and dry for several weeks, most wounds should have healed. If toe loss continues or no improvement is noted one should see a veterinarian.

A blue tongue skinks that is missing some or all of its toes will still be able to walk and climb with minimal impairment and should not be adversely affected by its injuries once properly healed. In cases where the feet have healed but over time become dry and cracked, emu oil is a good moisturizer. When toes are lost the area of amputation may not heal cleanly and moisturizing periodically may be necessary.

An interesting article regarding toe loss and fungal issues is:
Progressive Digital Necrosis in the Eastern Blue-tongued Skink (Tiliqua scincoides) by Hazell and Eamens. PM / email me for a copy.

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Mouth Issues

It seems that some skinks get a build up around the edges of their mouth. If this seems to be the case look for any signs of discharge or if the inside of the mouth is affected - if there is any discharge or swelling, please see a veterinarian immediately. If there doesn't appear to be any sign of infection, ensure that the skink does not eat too many wet / sticky foods. Try to remove build up / stuck scales with a damp wash cloth. If it does not come easily, do not force it. When the skink sheds, ensure that area sheds completely. If it is not worsening and does not appear infected then it is ok to keep clean and hope to clear it up with the next shed. It seems that some skinks have damaged / dented scales around the mouth that do not go away, but are not a cause for concern.
Last edited by Katrina on Fri Mar 18, 2011 6:26 pm, edited 2 times in total.
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Postby Lea » Mon May 03, 2010 12:33 pm

Respiratory Infections



Any infection can quickly overwhelm a small lizard, but respiratory infections can go from mild to deadly within hours. Their ability to clear mucus and debris from the airways is limited, due to skinks lacking a diaphragm and therefore have no expulsive cough reflex. They can sneeze, but other than clearing the nasal passages, it is ineffective in preventing mucosal buildup in the lungs.



Getting your lizard to a vet is a priority as initiating early treatment could end up saving their life.





Recognizing an Infection


Any of the following could indicate an infection:



    Laboured breathing/Use of accessory muscles to breathe (ribs, shoulders)

    Panting

    Deep huffing breathing pattern

    Excessive mucus in nasal passages or oral cavity

    Unusual or excessive drooling

    Frequent sneezing

    Lethagy or decrease in activity level

    Poor oral intake

    Watery eyes/dull eyes



Seeking veterinary advice and/or appointment ASAP is vital, as it could prevent serious illness and may end up saving your animal's life.



Your vet may prescribe antibiotics, treatment will be lizard specific, depending on weight and your vet's preference. You may need to continue administraion of medicines at home.



ALWAYS finish a course of medicines unless your vet tells you to stop them. This will prevent your animal developing a resisitance to antibiotics.



Keep your skink warm and decrease humidity, if raised artificially. A temporary drop will not have long term negative effects.



Consider a 24 hour heat cycle, particularly if you experiencing colder temperatures, until your skink has recovered.
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Postby Lea » Mon May 03, 2010 1:17 pm


Treatment Of Wounds



Wounds can be anything from minor abrasions to dog bites or burns, so this is a broad topic! As we have covered burns already, I will not include them here.

Obviously, we all try to prevent things happening, but as with us humans, accidents do happen, dogs will still bite and cats will still hunt, so knowing what to do in an emergency, particularly if your vet is unavailable, might prove useful.



Minor Cuts and Abrasions.



For example: Skinky getting wedged between basking rock and dinner plate and shearing scales off a 10x10cm area. A minor wound I will classify as one with a depth of no more than 0.5mm and of not greater than a 5% total body area.



    Sheered scales

    Shallow <0.5mm depth

    Less than 5% total body area

    Small or no blood loss

    No fissure or cavity


Mild wounds can be treated by cleansing with warm water or normal saline, drying the wound thoroughly and preventing contamination of the area by removing substrate or debris from enclosure until healed. Covering with a light dry dressing such as primapore, may be necessary if you skink refuses to stop bathing in his dinner plate, for example and keeps making the wound dirty.



Monitor for increase in moisture in wound, or a smell developing which might indicate infection.



Stating the obvious, but consider removing or rearranging the offending item that caused the injury to prevent further problems!


ANY wound should be observed closely for infection as a break through the surface provides a portal for infection and allows for bugs to get in.



Moderate to Severe wounds.


Dog bite over hips, lacerated to bone.

image.jpg


# Remember, these are guidelines only, that can be used in emergency situations and to suggest options for ongoing treatment, they should not replace or override the care and advice from a qualified veterinarian #



    Wound greater than 5% body area or greater than 0.5mm in depth.

    Dog bites/cat claws or teeth and other animal attacks

    Ulcers

    Any infected wound
    Unexpected injury



Each wound is pathologically and physiologically different and thus should be treated uniquely and these guidelines are therefore not set in stone. Largely they are based on my experiences and evidence-based practise as a carer for sick lizards. (I have pictures of wounds to show progression of treatments to help assit you in caring for your animals, but unfortunately I have to insert these later, just bear with me!)



My advice is based on my experiences, but should not replace that of your vet.

Treatment



    Where possible, calm animal by keeping it low to ground or solid surface, table/floor etc.

    Consider covering head with a towel to keep calm

    Clean wound with normal saline or betadine (iodine) solution. Ideally use 10 parts water to 1 part betadine, as idodine has been known to cause toxicity with topical application to open wounds. It is very effective as an antibacterial, but be cautious with prolonged use.

    Allow wound to dry

    If wound is 'sloughy' ... dead tissue buildup ... then a topical agent to assist with slough removal can be used.

Intrasite, aquagel, solusite are all water based agents.

SSD, silver sulfadiazine, is an effective antibacterial on dead skin and can prevent or help prevent a wide spectrum of yeast and bacterial infection.

Medihoney, sterile honey, Manuka or similar, can be bought in chemists for a reasonable price and I advocate it as a successful treament in bacterial infections, although it is not widely accepted as a treatment by many vets due to lack of research.

DO NOT USE alcohol or chlorhexidine based products to bathe or cleanse wounds. While they are effective antibacterial agents, they macerate the wound bed and healthy tissue and should therefore not be used on broken areas.

Iodine has also been known to macerate healthy tissue, particularly with prolonged use, therefore should be used with caution.


(Dressings will depend on the wound's pathology. I will continue to write more in this section when I have access to my documented photos, so please be patient for now. I apologise for the wait, but it will be easier to explain further with the use of pictures.)


Burnum's Story

Burnum had a dog bite over his hips, with a depth penetrating to bone, degloving of tissue and near complete removal of flesh. The wound was severe, quickly became infected and subsequently adversely affected Burnum's health.

He was a wild eastern, living in the rockery garden of someone's house. Their dog had attacked him. The safest thing for Burnum was to remove him completely from the area and it was obvious that reintroduction to his habitat would not be appropriate.

His wound was weepy and inflammed, seen below. Because Burnum had quickly deteriorated and wasn't eating or drinking, he was dehydrated and malnourished, though fortunately, still at a reasonable weight, but it made treatment with medications more risky.

image.jpg


He was given a low dose course of baytril injections, a broad spectrum antibiotic, based on his current weight. His wound was deep and because of the position, posed difficult to treat. The risk of losing the tail were high, as were the potential threats of necrosis, bone infection and septicaemia.

Burnum's wound was initially cleaned with a 10 % betadine solution. The wound was irrigated 3 times daily and left open. Animal bites are notoriously difficult to treat without antibiotics/low doses, due to the high bacterial content of the mouth, so betadine was used as a parallel treatment to assist with healing, although, as mentioned, it carries it's own risks.

Once the wound started to dry out, I used an antibiotic based powder, which is applied topically to the wound.

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The greyish, dry, dead areas are dying scales. It is common for scale death to occur following a traumatic injury. One theory suggests it is a protective mechanism to help isolate infection and prevent bacterial DNA replication in healthy tissue. Small areas are managable, larger areas can result in extensive tissue or limb loss. It is usually isolated to scales immediately surrounding the wound.

Over time, the powder proved to be ineffective and as Burnum was being syringe fed water and food, it was a poor outlook. His resistence was low and ability to withstand another course of antibiotics, questionable.

I decided to try something different, which is not wholly supported by vets, but I personally advocate it in such situations. Manuka honey, or medicated honey is not widely used, but research in humans deems it a viable treatment for open wounds. It is an all natural product, unlikely to adversely affect a compromised renal system and was a treatment I was willing to chance. Burnum was very sick, but there seemed nothing to lose.

I applied a thin layer over the infected tissue and kept him warm and dry, continued with small syringe feeds of food and water and kept my fingers crossed. Incredibly, he started to respond and within days the wound was receding and the depth reducing. His appetite picked up and he started to take an interest in his surroundings.

Image
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It took several months, but eventually, the only evidence of his ordeal was the round scar over his behind.

Image
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As a nurse, I do have experience in wound care and I have many lizards under my care as rescues. Just be reminded that these pictures should be used as a guide only and under no circumstance should my experiences replace that of a vet. Please feel free to PM me for advice, but I will always strongly encourage anyone with a sick animal to have them under the care of a veterinarian.
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Last edited by Lea on Wed Jul 28, 2010 9:03 am, edited 2 times in total.
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Postby Lea » Fri May 07, 2010 1:10 pm

Malnourished/ Underweight/ Anorexic Skinks


This section should be used as a guide and is only to advise and not diagnose a problem or medical condition. Please remember to seek veterinary advice regarding any sick animal.


Skinks can become underweight or malnourished for many reasons, so investigations in to the underlying cause are essential. Many diseases/parasites can cause a skink to become lethargic and/or anorexic and therefore increase the risk of starvation or dehydration.
They can also be picky by nature, off their food when shedding or coming out of/going in to brumation .... and they can go for several days, even weeks, without food and it won't affect their state of health! This section is for the refeeding of seriously malnourished animals and those deemed to be 'at risk' from starvation or dehydration, not our naughty skinks who think it's fun to make us very worried by not eating for a week or so! Use your common sense to assess your individual animal's needs for supplemental feeding.

It can be an existing condition, for example, a rescue or neglected animal that is underweight and needing refeeding, or acquired, such as through a medical condition (herniated gut, blockage, constipation, parasites). Severe mite infestations can cause anaemia, which in turn can lead to lethargy and loss of appetite ...

Your first action will always be to treat the underlying cause, or else any efforts to refeed or rehydrate, may be futile and short-lived.



Feeding an animal in a malnourished state.


It is always better to encourage, rather than force food upon your skink. The blue tongue, like many skinks, has a very delicate oropharyngeal system and the oesophagus and trachea are closely juxtaposed. Force feeding risks food going down the airway and this can cause them to aspirate.



Encouraging 'Natural' Forced Feeding

It will depend on the size of your animal as to how large you can cut up your food or what volume of puree to try them with. Remember, skinks may look hungry when healthy, but they still have tiny tummies! Even when well, we often overestimate how much they will eat ... a little will go a long way!


Adult Skinks

Using your fingers is better than tweezers, as they are soft and will cause no harm ..... umm, well, not to your skink ...
Tweezers can be used but under no circumstance should they be placed inside the mouth.

If your skink is not eating and drinking and you have investigated any problems, you may wish to 'help' them to eat. If simply placing the food in their cage fails to get them interested, try the following.

Use a small piece of food, such as fresh meat, fruit or hard boiled egg yolk and press along the lipline. You can use your fingers or the food to gently prise the jaw open to pop the food just on the inside of the mouth. Varying the site where you press or prise the jaw will ensure no injury occurs, just be gentle!

N.B. Ensure skink is alert enough to swallow prior to attempting a force feed. A skink that is too lethargic to swallow, should be under the care of a vet.

It sounds mean, but making your skink cross enough with you that you elicit a 'bite' response, can actually allow you to feed a little food at a time. Repeating the annoying move, such as touching the face or nose, particularly the ear area, will eventually make most skinks a bit annoyed! A few bites will be sufficient as the last thing you want is a stressed out sick animal, so make him a bit cross, not wildly anxious and angry.

The food only needs to be just inside the mouth, not in the centre. It may be messier this way, but there is less risk of aspiration. Skinks have no cough reflex, due to the absence of a diaphragm and therefore can not clear their airways effectively if food goes down the wrong way. It can be far more serious for a skink, than for us expectorating humans.

Dehydration is serious, but forcing liquids into an anorexic skink is a delicate operation and feeding juicy or wetter foods is safer and still an effective way to hydrate. Try melon.


Using a syringe

You may find that solid foods forced on to your skink, will be spat out. If this happens and you are seriously concerned, you can attempt feeding with a syringe, but this should be discussed with your vet as it is potentially harmful.


Preparing a syringe feed


A smaller volume, more frequently, is going to be better tolerated than large volumes. Stomachs shrink when not used, so take it easy.

Prepare a small dish of puree, around a toothpaste consistency, thin enough to push from a syringe, but thick enough not to rush over the tongue in to the back of the throat.

Aim for part meat, part vegetable and part fruit, but anything is better than nothing and energy intake is more important than actual volume or type of food if seriously malnourished.
Even for a lage skink, a 2ml volume will be sufficient to fill a tummy for a 24 hour period.

Touch the tip of the syringe to the lipline, nearer the mid to front of the jaw, not the back and press gently between the lips. Even a clenched jaw will allow the tip to be pressed carefully between the lips. VERY SLOWLY depress the syringe an 1/8 to a 1/4ml at a time. You may spill a little, but you are probably getting in far more than you realise. .

You may find the skink becomes more licky in an effort to clean up the mess you are making! Take advantage of this and keep dropping more on to the tongue as they lick. Feeding like this once daily should be sufficient, but 2, 3 or even 4 times would be ok if you have a large skink.

You will probably start to see an improvement in appetite fairly quickly after a couple of days ... if not, then hop to it back to the vet.

Unless under guidance by a vet, DO NOT attempt to syringe feed water. The liquid poses a huge risk for aspiration. Instead, include foods with higher water content, or soak a piece of cloth or cotton wool in water and get the skink to bite down on it. It doesn't seem like a lot, but will be sufficient to maintain fluids and prevent further dehydration in the short term.


(Baby Skinks to follow! )
Shinglebacks - Nippy, Lava, Suunto, Lutea, and Hermione
Easterns - Kiah and Jade

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