Urgent Care :: Swelling and Eating/Digesting Issues

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Post Posted: Mon Dec 28, 2015 9:55 pm   Swelling and Eating/Digesting Issues

[Sorry this is a really long post!]

My turtle (Samuel) seems to be having a strange mix of symptoms that don't point to a clear cause, based on my findings after lurking on the forums here for a few months and combing the archives over the past week. I'll explain them below, and I've added a tl;dr list at the bottom of the post, along with some pictures. We have a vet appointment at 9 AM tomorrow, so I'm really asking to see how to prepare for our visit tomorrow, and to see if I can worry less in the meantime.

Samuel has been reluctant to eat over the past two weeks, and only ate yesterday when he got some freeze dried crickets and worms. My parents watched him for two weeks before that (as he's been at his "vacation house" for a month now, and was set to go back to his normal house on Friday); they said he was reluctant to eat the red leaf lettuce, but ate everything else happily. (I suspect he may have been over-fed a couple of times during those two weeks). Others have noted that even indoor turtles can have lower appetites in the winter, so I chalked up his low appetite and irregular pooping to the changing seasons. However, this week I've noticed some other symptoms: he has fanned his penis twice this week, not seemed to pass any digested food (unless he's eaten it before I saw it); and today, he has been kicking at his tail, and now has some weird, non-localized puffiness/swollen flesh (see pictures below). The swelling doesn't look like the cases of edema that I've seen online, but maybe that's because this is in the beginning stages? I also see that one person suggested that fanning can be symptomatic of constipation, but that doesn't seem to be repeated much here, so I'm not sure how much to worry about that.

My two main fears are impaction or constipation and kidney problems. Both seem unlikely to me; he doesn't have any substrate in his tank (although he has had some cuttlebone before I realized how to remove the backing--he usually only pecks at the soft part, though, and doesn't eat much of it at all), and his diet seems balanced to me. The vet we're seeing tomorrow specializes in exotic animals, and works at the same vet office as our usual doctor, so hopefully they will know what to do.

(One other note: I had been treating him with diluted chlorohexiderm, a disinfectant prescribed by my vet for his excessive shedding. (She tested the shedding pieces to make sure that they were not symptoms of a bacterial or fungal infection, so it can't be either of those). This meant that I applied it to his skin and shell with a q-tip and dry-docked him for one hour every 2-3 days.)

Here are my three questions, but feel free to add any thoughts you might have:
1) Do you know what these symptoms might point to (especially the swelling), and have you had experience treating them? I've tried putting him in a bath of warmer water once today, but it didn't seem to help, since he didn't have any bowel movements. I've read about people using mineral oil, but since he's reluctant to eat his pellets, I'm not sure that will work.
2) What should I should keep in mind when we go to the vet tomorrow? I know that vets are quick to recommend Vitamin A shots, which can be risky, but is there anything else I should watch out for?
3) Also, should I be dry-docking him overnight (or keeping him in a smaller water-filled container)? He doesn't have any tank-mates that might attack him, and I don't want to stress him out by moving him and changing his habitat any more than I already have.

Thank you so much for your help! Answers to standard questions and pictures are below.

How big is your turtle? 5 inches
How long have you had it? 8 years, since he was a hatchling (from family friend, not pet store)

What is the water temperature? 75 degrees Fahrenheit
Did you use a thermometer? yes
Are you using a water heater? yes (installed Eheim heater two weeks ago, just bumped up temperature dial from 73 to 77 F)
How much water is in there? 20 gallons (usually lives in a 40 gallon breeder tank with 30 gallons of water)
Are you using a water conditioner? no (I've been testing the water weekly with strips, and everything seems to be in the normal range)
Are you using any filtration? yes, Zoo Med 511

What is the basking temperature? 82 degrees Fahrenheit
Is there a basking light? yes
Is there a basking platform that is easy to climb on? yes (a bit more difficult than his usual diving-board-style platform, but he's climbed it multiple times each day)
What kind is it or what is it made out of? mercury bulb (combination UV A, B, and heat)
Is there a UVB light? yes

What have you been trying to feed it? usually eats 50% red leaf lettuce and occasional carrot shavings, 30% Mazuri pellets, and 20% frozen aquatic turtle diet cubes from Healthy Herp (mix of protein and vegetables)
When was the last time your turtle ate? yesterday (after a week of ignoring most food, ate dried crickets and worms), and possibly today (seemed to take two bites of green leaf lettuce)

How big is the tank/pond/enclosure? 20 gallons full, with ATBA (temporary small tank at parents' house; usually lives in 40 gallon breeder)
Is the tank near a window? no
Is the tank in a room with a lot of activity? moderate activity-- in family room with TV, two parents in 60s, and couch potato dog

Have you read the Basic Care section? yes
Have you searched the forums for similar situations? yes

Is there any other unusual activity/symptoms? Here is a brief list of symptoms described above:
- swelling that appears to move slightly when turned from side to side (see first and third picture below); not visible when head is fully extended
- low appetite that only changed when offered dried insects
- seemed not to be digesting food, especially carrots
- fanning twice over past week, and once before then; when this happens, he's lying on the bottom of the tank with his back legs extended
- today, kicking back legs at tail
(Still alert and active)



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Samuel T Jackson
 
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Post Posted: Mon Dec 28, 2015 10:46 pm   Re: Swelling and Eating/Digesting Issues

I have some vet related concerns/questions here: http://www.redearslider.com/choose_vet.html

I'm not sure what's wrong here. You've analyzed the situation as I would have. The fanning is a bit odd, I'm guessing they rarely do it once they are mature. I would think you will want a blood test for any infection.

I'm not sure about the prior chlorohexiderm treatment for shedding, I can't recall reading that before or see how that can help.

If he's generally normal in the tank without swimming/coordination/respiratory issues, I would not dry dock him. Dry-docking, especially overnight is usually fine and I do it every time I conduct a complete water change.

Samuel's a beautiful turtle, I hope the visit goes well!
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Post Posted: Mon Dec 28, 2015 11:16 pm   Re: Swelling and Eating/Digesting Issues

Thank you so much for your response! I'm glad there isn't any obvious problem right now; hopefully that will give the vet enough time to fix anything that might be wrong. I'm also wondering if his tail/cloaca is swollen, but having a hard time getting a picture of it, so I guess that will be a questions for the vet to solve. I'll report back if the vet has any ideas that might help others.
Samuel T Jackson
 
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Post Posted: Mon Dec 28, 2015 11:19 pm   Re: Swelling and Eating/Digesting Issues

The tail looks normal from the picture. I'm concerned about the swelling, but they turtle does look a little overweight as well.
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Post Posted: Fri Jan 08, 2016 12:32 am   Re: Swelling and Eating/Digesting Issues

So I wanted to wait to give an update once I'd been to the vet and gotten all of the test results, but two vet visits later (and three vets in on the conversation!), I'm still not sure if anything was really wrong with Sam. Here is the saga, although you probably don't need to read it to answer my question (in the last full paragraph below).

On our first visit last week, the doctor didn't see anything that could be causing impaction on the x ray. She also noted that his lungs looked clear, which was good to hear. She sent some blood to be tested, and in the meantime prescribed some antibiotic shots to be on the safe side (.07 ml of Ceftazidime injected every 72 hours for 3 weeks). Sam isn't a biter, but he sure wasn't a fan of those shots! Three days after that visit, we moved back up to Santa Barbara to the 40 gallon tank.

Less than a week after we left, I finally saw a noticeable stool. I scooped it up in case we could test it, and while I did that I noticed a tiny wriggling red worm in the water I had fished out. I took a closer look at the tank (bare bottom), and noticed a bunch of tiny white things inching along the bottom. (I could only see about 2 or 3 at a time, but they were definitely spread out across the tank floor). I didn't see any in his filter or in his poop, but I thought that worms/parasites might explain his butt-kicking, fanning, irregular eating, and so on. I tried contacting the only reptile vet in SB, but he wasn't available until next week and wouldn't test the sample without an exam, so Sam and I hit the road to our regular vet in Orange County.

This time at the vet, we saw another exotics doctor who was new to the practice (although I did catch our regular vet in the lobby and asked some questions). She didn't find worms in his stool sample, but said that they could easily be present without showing up in each stool, so she gave him some de-worming medicine ("Panacea and Flagyl," according to the receipt). She and my regular vet also said that his blood work showed that everything was at normal levels, so those tests plus the X ray would seem to rule out impaction, septicemia, and organ problems. She advised me to finish up the round of antibiotics, even though the blood work looked good, and to test his water more accurately/frequently. I was happy at the time, but it makes me anxious that I didn't get any definitive answers for why he started acting strange.

That night, we made the trip back up to SB during rush hour, and Sam was camped out in his 10 gallon tank (from his hatchling days) while I thoroughly cleaned the tank and everything in it. I've ordered a new filter (I've read about using bleach to clean the mechanisms, but he could use the upgrade anyway); until it arrives in about a wee, I suppose I'll be doing regular partial changes to keep everything super-clean. He has been pretty active most of the day, and wolfed down about 7 of his Mazuri pellets a couple hours ago. Shortly after that, he seemed very tired. Now, he's sleeping on his basking ramp in a pretty bare tank (just basking area, MVB and water heater); he seems very tired right now, laying around with his eyes closed, but heck I guess I feel the same way after running back and forth so much. (And I haven't had to get any shots!)

Now, I'm wondering how long it might take for Sam to get back to his normal self. I know it's best to go to the vet when you first see multiple strange symptoms, but I think all these treatments, habitat changes, and handling might be stressing him out, doing more harm than good. (It doesn't help that I can't tell if he's breathing when he's asleep, either). Any ideas about how long it might take a stressed-out turtle to feel like him or herself again, if generally left alone (with the exception of the remaining 4 injections) and kept in water a few degrees above normal?

If you're interested in X rays of an RES, here you go! (I also have low-ish quality pictures of the worm things, if you feel like being grossed out.)
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Samuel T Jackson
 
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Post Posted: Sat Jan 09, 2016 9:13 pm   Re: Swelling and Eating/Digesting Issues

I think you're doing all the right things. I'm glad all the test results are coming back normal. What kind of water tests are you doing?

I'm not familiar with Panacea and Flagyl but it's usually best to identify the worm before prescribing anything. Are you going to put him on a diet once he's feeling better?

Thanks for the X-Ray pic, very fascinating!
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Post Posted: Sat Jan 09, 2016 11:13 pm   Re: Swelling and Eating/Digesting Issues

For water testing, I've been using the Tetra EasyStrips (the combination ones with pH, nitrates/nitrites, hardness, chlorine, and alkalinity, as well as the individual ammonia ones). I've heard that those aren't precise (probably because you have to kind of eyeball the colors), but I was hoping they would be sufficient to help me keep an eye on any spikes in those levels. Should I get a different type of test? I also got some "Prime" water treatment (made by Seachem) when I filled up his tank today and got the filter running; it's supposed to help with chlorine and heavy metals (both problems I've notice with my water), as well as ammonia, and nitrate/ites.

I will definitely put him on a diet, although he used to eat pretty well before this all started: 50% lettuce (red or green leaf), 40% Mazuri pellets, and about 10% frozen brine shrimp or veggie/protein combos. I can cut back on the protein to twice a month, but I've been giving him a couple crickets after each shot as a treat and to boost his energy. I'm still a little confused about his weight, though, because his back end doesn't look puffy at all, and he doesn't look puffy when he's above water--it just looks like there's loose skin. Would fat "disappear" above water like that?

As for the type of worms, I couldn't get a sample of them to the vet because they were so dang tiny, and no worms or eggs showed up in his stool sample. I did show her pictures and video of them. Hopefully she made the right call!

A quick behavior update: Sam's been much more active over the past two days, eating his pellets and even taking a nibble at the lettuce (I think), and following us around his tank. He has developed a couple of weird habits, though; he pokes his head/nose out of the water more than usual, and he's slept on his basking dock the past couple of nights (he seemed to always sleep underwater before). I haven't seen any classic symptoms of RI, so I"m hoping that this is just his way of exploring his new digs. He still seems to be fanning often too, but maybe his smallish size has something to do with it?

Thank you for your help!
Samuel T Jackson
 
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Post Posted: Sun Jan 10, 2016 4:51 am   Re: Swelling and Eating/Digesting Issues

In regards to the diet, when you say 50% lettuce, 40% pellets.... how many pellets is that? There might be a small change in the puffiness when he's out of water, but I wouldn't there is much. The fanning might be a bit weird, as I don't think they do it much once they are older.
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steve
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Post Posted: Sun Jan 10, 2016 3:08 pm   Re: Swelling and Eating/Digesting Issues

For pellets, I usually estimate about half the size of his head, and normally only give him that every other day, unless he gets a protein treat (in which case I skip the pellets). He usually wolfs that down in a couple minutes, although lately he's been more finicky. Do you happen to have a link to where you can buy the chip clips with suction cups, or is that something you have to DIY?

My big fear with the puffiness was organ damage, but I'm assuming that would've shown up in the blood work, so hopefully it's nothing serious. When he fans, it seems like he's concentrating (covering his tail with his back legs and closing his eyes), which made me think of the possibility of impaction (and straining); but since there was nothing on the x ray, maybe he's just going through a phase. I guess we'll just hang tight, and I'll update if I find out anything else!
Samuel T Jackson
 
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Post Posted: Sun Jan 10, 2016 11:49 pm   Re: Swelling and Eating/Digesting Issues

You can probably scale down the pellet amount a little bit.

I usually suggest something like this: http://www.amazon.com/Two-Little-Fishie ... B0006JM0KS or http://www.drsfostersmith.com/product/p ... catid=4446 which is like $2-3 at a local store.

Does he fan after being out of water or is it somewhat random?
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steve
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Post Posted: Mon Jan 11, 2016 1:49 am   Re: Swelling and Eating/Digesting Issues

Thanks! I don't know why Google and Amazon didn't turn these up. The fanning might happen more in the evening, around his bedtime, now that I think about it... I'll try to keep better track of it to see if there's a pattern.
Samuel T Jackson
 
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Post Posted: Mon Jan 11, 2016 1:23 pm   Re: Swelling and Eating/Digesting Issues

No problem, sometimes the searches are looking for specific phrasing I guess. My earlier searches were showing the clip with the magnet for $15... that's very unnecessary.
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