The vet suggested a treatment and I'm concerned

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The vet suggested a treatment and I'm concerned

Postby dafaher » Sat Oct 29, 2016 5:14 am

Before I start, I must apologize for my english because it's quite rusty... Hello everyone, this is my first post on this community and unfortunately it's not a happy one. I was wondering if you could help me with some advice.

I have a 30 years old male turtle (chelonoidis chilensis) named Martino. 40 days ago he awoke from his hibernation with discharge on eyes, nose and mouth (with bubbles in the nose; see a picture here https://drive.google.com/file/d/0BzIP3s ... sp=sharing), he acted weird, didn't eat, pee or defecate, and started to spin in circles, backwards.

I took him to a vet and after a long time checking everything he said that overall he was well, but he also spoke of a possible respiratory obstruction and hypovitaminosis A. He gave Martino a shot of vitamin A, and on the other hand an antibiotic and a pulmonary decongestant, as prevention. He recommended a treatment with an antibiotic called "Bactroprofen" (Tetracycline hydrochloride 90 mg, Chloramphenicol 90 mg; Prednisolone 2 mg, excipients q.s. 300 mg.): 1/8 tablet daily for 7 days mixed with a dietary supplement. Martino started to feel great, got active very slowly, began to eat and regularized his other functions.

I thought everything was finally over, but today I saw him "yawning" twice (for 4-5 seconds each time), and I think I heard that he sneezed, though I'm not sure because he never did that before. I phoned the same vet to set an appointment but he's out of town and will be returning in 20 days (he's the only vet specialized in exotic animals where I live -3 small towns from here-, so you can imagine my despair).

I told him what happened and he said I should buy enrofloxacin 50 mg (tablets) and recommended 1/3 tablet every 48 hours for 10 days, orally (he's not here to give Martino a shot, so I think that's why he advised this kind of treatment: I must spray the pill, mix it with water and make Martino drink it with a needleless syringe).

I have no problem with that. But my question for this forum is: is it posible that enrofloxacin cause any kind of damage (irritation on mucous membranes, kidney or digestive problems, etc)? Because I know it is nephrotoxic and very strong, and I would like a second opinion. He is the vet and I suppose he knows what is best, but I don't know, perhaps it's my ignorance speaking but for some reason this treatment makes me feel uncomfortable; and that's why I wanted to ask for your opinion, guys. He is the one vet here, there's no one else.

On the other hand, my tortoise weighs 1 kilo and a half (1500 grams), and the vet told me that I should administrate Martino 15mg every 48 hours (1/3 tablet=16mg). With yawns and all, he ate very well and sunbathed a bit today, but I'm deeply distressed. I don't want to harm him, it's just I never heard that enrofloxacin is administered this way to tortoises. Martino has been my friend for 30 years, I know you can understand my concern.
With al that uncertainty, this afternoon I gave him the first dose because I didn't want to waste time, in 48 hours I'm supposed to repeat it (I'll try to mix it in the food directly so I don't stress him opening his mouth... as long as he lets me, here the weather is very unstable and sometimes when it gets a little colder Martino prefers to sleep instead of eating).

I would appreciate any opinion or suggestion you can provide me. Of course, many thanks in advance!!
dafaher
 
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Re: The vet suggested a treatment and I'm concerned

Postby Tortoise Trust » Sun Oct 30, 2016 10:31 am

The treatment will not cause these symptoms.

It does sound to me as though there is an underlying. continuing respiratory infection, however.

I would suggest caution with oral antibiotics, for several reasons:

1) It is difficult to get the dose correct in reptiles
2) They are slower acting
3) They can cause severe disruption of the digestive tract

Treatment by a series of injections is likely to be far more effective and is also safer.

Is there anyone who can prescribe or give you the necessary medications in injection form?
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Re: The vet suggested a treatment and I'm concerned

Postby dafaher » Sat Nov 12, 2016 6:06 am

Tortoise Trust wrote:The treatment will not cause these symptoms.

It does sound to me as though there is an underlying. continuing respiratory infection, however.

I would suggest caution with oral antibiotics, for several reasons:

1) It is difficult to get the dose correct in reptiles
2) They are slower acting
3) They can cause severe disruption of the digestive tract

Treatment by a series of injections is likely to be far more effective and is also safer.

Is there anyone who can prescribe or give you the necessary medications in injection form?


Andy, I'm very sorry for this delay! I wasn't notified by email as I was supposed to (actually, I'm having some problems since I signed up because I didn't get the verification email either, but a post in the site suggested I should try logging in and I had luck).

Update: I changed the vet and now I'm having another problem. The previous vet gave Martino a "not too wise" prescription, just like you said (my concern was well-founded). He began to show signs of rejection to medication, especially vomiting and diarrhea. So I decided to stop because -it sounds awful- I felt I was intoxicating him. I started to despair.
Then, I found a vet hospital in a city far away from here. I organized my schedule and I went there the day before yesterday (wednesday). They were very kind, I explained everything since he woke up from hibernation, what the previous vet prescribed (the new vet didn't criticize but she didn't seem happy about it), I also showed pics and videos so they could see symptoms, etc etc. She made him some x-rays because she suspected pneumonia and unfortunately she was correct. But... the good news: she said I shouldn't be worried because it was quite mild and it was just beginning, so the diagnosis was early. Actually, it's located only in the right lung (upper section) but the left one is clean and full of oxygen. I started to breathe again and returned to life... The last month has been a constant concern because -I don't remember if I said it in my previous post- there are not vets specialized in exotic animals where I live. The previous one lived also a few towns from here but after what happened I don't trust him anymore (oh, before I forget answering your question: yes, there are some places to buy medicine but mostly for dogs and cats).

Now... the new problem. The new doctor prescribed antibiotics (I won't be specific on this because I don't want to break the forum rules, but if you want I can provide you with further details by private message) for 15 days, intracoelomic route.

She gave him the first dose and taught me the procedure and technique to do it safely at home because -as I said- I live far away from the hospital and I can't take him there daily. But today I realized she didn’t mention some important topics. For example, she showed me how to do it using my tortoise’s right side but I was wondering if I can also use its left side, next to its left leg (thus, I could alternate).

On the other hand, yesterday I gave Martino the second dose and I felt confident, when I aspirated with the syringe to check as she taught me there was no liquid. But, I couldn't aspirate with the siringe at all, I felt an opposing force that stopped me and I don't know if that's ok.
The worst happened a few hours ago when I gave him a new dose. I missed the right spot two times (this time when I aspirated with the syringe it started to fill with liquid and I freaked out because I knew I had probably punctured his bladder, and I had to do it again because I had no choice… I had to throw the syringes to the basket and fill a new one, thank God I think I did it well the third time).

She also told me that nothing wrong would happen if I missed the right place and punctured the bladder but explained me that Martino would urinate the medicine and he would be missing his dose. Nevertheless, I just did some research by my own and I read that I could’ve also punctured his lungs… and now I’m even more worried! It never stops, Andy. Maybe I'm just being paranoic, she said it was a safe procedure and that's why she was suggesting it. But I feel I'm doing everything wrong, I just want to see him healthy again.

If you know anything about this kind of procedures, I would appreciate so much any tip or suggestion on this matter to improve the technique and do it correctly the next time. I’m obviously not a vet so it’s quite hard to me to do all this because I don’t want to harm him (and I think that's my biggest mistake, since I don't feel confident about it). I’ve seen that it’s true that this procedure can be performed at home by owners but after what happened today I think she should’ve let me try it in front of her so she could check if I was doing it in the right way or not and I could see which was the right spot.
Today I felt awful when I missed the first injections because he wasn’t having a good time (he started to "talk" quite loud). This vet works -as I said- in a vet hospital and I can’t reach her without an appointment (she only works there 3 times a week and I must wait 7-10 days for a new appointment, which is really bad because Martino already started his treatment and I shouldn’t suspend it). As if this were not enough, they're not open on weekends. But they became Martino's only chance.

I've been reading a lot of articles for the last 5 hours, but there are not much information about it or it's too technical :\

Thanks again for everything, Andy.
dafaher
 
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Re: The vet suggested a treatment and I'm concerned

Postby Tortoise Trust » Mon Nov 14, 2016 11:22 pm

Hi,

A few points.

1. You do not need to put a needle for injection in deep. The standard method is just enough to get it under the skin and into some muscle tissue. So, no more than, a few mm.

2. If you go deep it will hurt the tortoise, and does risk serious damage. Intracoelomic is rarely needed, and if it ever is, should not be carried out by anyone who is not fully trained and experienced. The risks are too great. IT IS NOT A SAFE PROCEDURE.

3. There is no need to aspirate. Simply inject under the skin. You can use either side - the top of the back legs are easier, less painful, and safer.

4. You can post which antibiotic is being used. No problem.
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Re: The vet suggested a treatment and I'm concerned

Postby dafaher » Tue Nov 15, 2016 4:44 am

Tortoise Trust wrote:Hi,

A few points.

1. You do not need to put a needle for injection in deep. The standard method is just enough to get it under the skin and into some muscle tissue. So, no more than, a few mm.

2. If you go deep it will hurt the tortoise, and does risk serious damage. Intracoelomic is rarely needed, and if it ever is, should not be carried out by anyone who is not fully trained and experienced. The risks are too great. IT IS NOT A SAFE PROCEDURE.

3. There is no need to aspirate. Simply inject under the skin. You can use either side - the top of the back legs are easier, less painful, and safer.

4. You can post which antibiotic is being used. No problem.


Oh boy, I just wrote a huge reply and the session timed out (I'm quite slow when writing in english). Here I go again! First of all, thanks for your reply and fixing the problem with my main post.

The antibiotic is cefalotin (0,3 ml a day, for 15 days) and it seems to be helping Martino. He's doing way much better since the treatment started, I think he's starting to recover. He's been very active for the past few days, eats (not "that" much yet, but I know it's part of a process) and drinks by his own, pee and poo are normal. Weird fact: he escapes from sunlight and I have no idea why. He stays under the sun for a few minutes and then hides behind the first thing he finds. He also tries to bite my toes every time he has the chance, so I think that's an improvement haha. Today he climbed over some wooden tables, standing on his back legs and hanging with the armpits of his front legs. I never understood how he is capable of doing that, the woods were about 20 cm high. He also loves to ram things up, all these things are a normal trait among males of this species.
Yes, the vet told me that I should introduce the needle just 5 mm in the tissue (the needle isn't much bigger). She also told me that I should introduce it next to the plastron (parallel) and pointing its edge to the opposite front leg, holding him with his head lower than his butt thus the viscera are separated from the point of contact.
And now I know why I failed the second dose -of course it was my fault, I think I was nervous and my mind went blank-: I completely forgot that she had asked me to extend the leg... but I just put it aside. I remembered after I wrote you, and when I did it again the next day it was a huge difference because I had a full visual of the skin and I could notice where the right spot was. Since then, Martino seems more relaxed during the procedure and he doesn't pull his legs anymore (which I think, it's a good sign). I know this whole situation is far from ideal for him, but I don't have many options and I'm feeling more confident now.
I found a group on facebook and they also recommended me this hospital, it has a great reputation in the region. It seems that intracoelomic route is quite standard here (and after what you told me, I have no idea why).

Andy, I wanted to thank you once more for your reply and all the help you' gave me and Martino. I'll keep you posted!
dafaher
 
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Re: The vet suggested a treatment and I'm concerned

Postby Tortoise Trust » Fri Nov 18, 2016 8:39 am

That is a good antibiotic, and we use it here.

I still feel that the IC route is not really appropriate unless you are very experienced at giving injections. There is too much that can go wrong. Subcutaneous or intra-muscular are much safer routes.
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Re: The vet suggested a treatment and I'm concerned

Postby dafaher » Sat Dec 17, 2016 4:40 pm

Hello Andy (and everyone in the forum)! I just wanted to let you know that Martino is fully recovered, it was a rough time but we got through it. I took him to the vet 15 days after the treatment started because the vet wanted to see him again. She took more x-rays to check, and his lungs were all clean and full of oxygen. He started to eat very well, drinks water by his own, sunbathes (a lot) and is very active (he started to climb stones, woods, etc like he used to before).

I am fortunate to have an organic garden for personal consumption since I moved here, and I have a corner destined for him to eat too. So he goes there and eats what he wants as he needs it. He's eating chicory (it gives them superpowers or something haha) and other green leafy vegetables such as chard, basil, spinach. Also (but in less quantity) pumpkin, zucchini, apple, pears, peach, plums, raspberries and also carrots and tomatoes. I try to rotate his food during the week, but always his food base is chicory and green leafy vegetables.
I have found him eating my gazanias and I didn't know if he could do that, so I consulted his vet and she said yes, but mainly the flowers because the stem and leaves contain a lot of fiber and "they could" cause some occasional diarrhea to some tortoises. He also eats dandelions, dichondra repens and other grasses of my garden that I brought here from Buenos Aires (these last ones are all native from Chaco, I did some research with my dad many years ago in an attempt to recreate his natural habitat and I planted some of them). For anyone interested, some of them are: echinochloa polystachya, grama rhodes, panicum maximum, panicum coloratum and urochloa mosambicensis. An additional data: the vet advised me to put some sand in a corner, Martino has a drier place if he needs it. It makes sense, since the composition of the land in Chaco has a high amount of sand.

So I'm very happy, the year is ending with good news. On the other hand, the laboratory studies all got well and his levels of calcium, phosphorus and vitamins are excellent, so he doesn't need vitamin supplements. In fact, the vet told me that she rarely uses them in her patients (only in crytical cases) because what needs to be done is to educate the owners, modify the diet and not compensate it with transient solutions. I must continue bathing him 3 times a week with water at 40ºC, a habit I have had since he was a baby. Oh, and he's parasites free :)

So yes, it was a tough time but it ended well and I learned a lot in the process. The temperatures here are already ideal for him, today 35ºC and by tomorrow they said that it will reach 37ºC. We are on the verge of dehydration, but he is extremely happy and that's what matters lol.

I just wanted to let you know the good news! Thanks for everything, Andy!! :)
dafaher
 
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Re: The vet suggested a treatment and I'm concerned

Postby Clara » Mon Dec 19, 2016 8:59 pm

Wonderful to hear that everything has turned out well.

Best wishes,
Clara
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