Snake skin lesion

Re: Snake skin lesion

Rob Davis — Tue, 13 Aug 2013 13:57:27 GMT

After discussing things further with the owner, he has decided to go for referral. Many thanks for the rapid and comprehensive responses.

Re: Snake skin lesion

Rob Davis — Tue, 13 Aug 2013 12:24:51 GMT

Any idea what sort of time scale we are looking at for this to heal? Would you continue analgesia and antibiosis until it's fully healed?

Re: Snake skin lesion

Rob Davis — Tue, 13 Aug 2013 11:21:41 GMT

Thanks Marie. I will need to discuss all this with the owner - he did not appear to be very confident handling the snake, let alone injecting it....

Re: Snake skin lesion

Marie Kubiak — Tue, 13 Aug 2013 10:58:51 GMT

Oral meloxicam absorption rate is less reliable as snake GI transit time is prolonged, I prefer to inject 0.2mg/kg sc in the front half of the body (avoids any potential for shunting through renal portal system), same with antibiotics, inject in the front half. Most owners are happy injecting once shown how and it is less stressful to the snake and avoids repeated head and jaw manipulation.

You will often find a subtle creasing of the skin, or skin slackness in a markedly dehydrated snake and tacky/stringy saliva when you open the mouth. In an obese animal the skin changes are often harder to evaluate.

I will usually hospitalise them on 30ml/kg of normal saline/hartmanns initially, then mixed 4:1 fluid to duphalyte after 24hrs of just fluids. If losing much fluid from the wounds then you'll need to increase the fluids proportionally. Ideally add hyaluronic acid to sc fluids to speed absorption if available. I split the fluids into boluses of around 5ml at multiple sites in a snake this size. I'm not a fan of intracoelomic fluids - it's painful, risks visceral damage and introduction of bacteria into a body cavity and uptake is not necessarily any faster than sc with hylase. If it is critically dehydrated then you're better off placing an IV catheter into the jugular (but this requires sedation and a cut-down technique) to get fluids in rapidly.

Marie

Re: Snake skin lesion

Rob Davis — Tue, 13 Aug 2013 10:10:14 GMT

[quote user="Marie Kubiak"] I tend to use sc fluids and butorphanol while hospitalised and discharge them on meloxicam injections when I'm happy they are properly hydrated.[/quote]

This is probably a really dim question, but.... how do you tell if a snake is dehydrated? How much fluid do you give SC and is there any particular region you should inject?

Re: Snake skin lesion

Rob Davis — Tue, 13 Aug 2013 10:00:50 GMT

Many thanks (as always) for the advice. You're right, Mark, this is an obese snake!

[quote user="Marie Kubiak"]discharge them on meloxicam injections when I'm happy they are properly hydrated.[/quote]

Can you use oral meloxicam, and if so what dose do you use?

[quote user="Marie Kubiak"]marbocyl (10mg/kg sid)[/quote]

Is this oral or SC?

Re: Snake skin lesion

Mark Rowland — Tue, 13 Aug 2013 09:12:30 GMT

In picture 1 the tail area behind the lesion can be seen. This looks like a fat snake to me.

Re: Snake skin lesion

Evelyn Barbour-Hill — Mon, 12 Aug 2013 22:55:50 GMT

Mark, serious question.

How can you tell it is obese from those two pictures?

Re: Snake skin lesion

Mark Rowland — Mon, 12 Aug 2013 22:40:16 GMT

This may be a burn but I wouldnt jump in to call it one myself.

I have seen several corn snakes with a septicaemic ulcerative condition that present in a similar way to this and the prognosis is guarded to poor in the cases I have seen.

I would check the husbandry and certainally would not treat this snake as an out patient. This is a full thickness infected lesion. It requires fluids, analgesia (imperative not advisable), covering antibiotics (as a necessity) and very importantly covering of the wound to prevent contamination. I like to use allevyn thin as it is sticky but daily changes are required following an initial surgical clean up with a swab for culture and sensitivity.

Intra coelomic fluids to replace fluid lost are imperative. i would also be after some blood also to check renal parameters/sepsis. Flamazine is great and I use it too but for a chronic full thickness penetration such as this, more aggressive treatment is required.

Nb this snake is obese so husbandry and particularly evaluation of the heat source need to be assessed.

Goodluck

Re: Snake skin lesion

Ian Mostyn — Mon, 12 Aug 2013 22:29:50 GMT

+1 for Flamazine (and everything else above)

I use that for all my snake burns and I have had some really deep wounds heal. It is amazing what you can get to heal given a bit of time

Ian

Re: Snake skin lesion

Marie Kubiak — Mon, 12 Aug 2013 21:16:24 GMT

Looks like burns - usually from an unprotected heat source or one without a thermostat. Snakes don't respond rapidly like mammals to changes in temperatures so will happily sit and cook in inappropriate conditions. If primary infection or humidity issues you'll usually find other patches or blisters, more commonly on the ventral scales.

I would gently bathe away any loose areas and crusts to reduce bacterial load, or GA and surgically debride necrotic areas if they aren't loose (I often wait a few days when I'm happy the snake is stable).

Post-cleaning I apply topical cream (I quite like flamazine as it sticks and forms a barrier which is important in snakes as most things don't stay put long). It would help to move this snake on a clean, dry substrate (kitchen roll/blue paper works ok) and have it back in every 3-4d for wound cleanings and evaluation with the owner bathing the areas and applying topical treatment in the interim.

Analgesia is advisable, butorphanol is shown to be useful in corn snakes, but needs high doses of 10mg/kg bid which may cause slight sedation. Metacam is preferable once hydration is improved - I tend to use sc fluids and butorphanol while hospitalised and discharge them on meloxicam injections when I'm happy they are properly hydrated.

Antibiotic use depends on extent of injury and any evidence of infection. Covering antibiotics are not a bad idea with a large area of open tissue and what appear to be full thickness burns - marbocyl (10mg/kg sid) or ceftazidime (20mg/kg q3d) are commonly used. Baytril is not ideal injected as the alkalinity causes skin damage.

It will take a while for this to heal and it's likely to have loss of scalation with flattened scar tissue covering the deficit eventually. Certainly looks like there's already granulation starting so hopefully it has a reasonable chance of healing without too many complications but they need close monitoring for infection and secondary dehydration/shock until healing is well under way.

Marie