Rosy-Boa Abscess

[Starbuck]

Hi all,
I just wanted to make a 'journal' of sorts as my rosy boa and I tackle her tail abscess, so others can know what to look for, and the approach me and my vet took.

Neki is at least 15 years old; i got her in november 2012 from one of her many previous owners, and now she has a permanent forever-home with me. Prior to her previous owner, she was housed with a heat rock (bad!!!!!) and suffered pretty serious burns to her tail (post cloaca). Luckily, it was only involving the soft tissue of the tail, and none of her internal organs. Apparently, she was taken to a vet at that time and given a clean bill of health, and the owner was told that it would just take a good deal of time to heal (as many reptiles do).
The first picture (vertical, in my hands) is how her tail looked when i first got her. There was no obvious pocket/infection/swelling that i noted when i got her. I wanted to document the progress of the scar as she shed, to get an idea of how it changed.
fast forward to 2 weeks ago, and she finally shed for me for the first time. There was no difficulty, no skin stuck to the edges of the scar, and the skin over the scar even came off in a clean, smooth section. However, I did notice a few small, thickened, crusty 'plugs' attached to the shed, and a very VERY foul odor associated with the shed. When I picked her up to handle her, I noticed that the area closest to her vent, on the border of the patch of scar tissue, had an opening that was not bleeding or seeping, however there was a thick, pale yellow pasty plug in it. I immediately suspected abscess, and gently palpated the area. There seemed to be no signs of pain, though the tail did seem to be more swollen than before; i think because she had been soaking immediately after her shed, and the abscess was now re-opened.
I called my vet and made an appointment for her, which was earlier this week. They did a needle-aspirate to test the bacteria for antibiotic susceptibility, and then an x-ray of her tail, to ensure that the abscess was not involved with any of her caudal vertebrae.
There are three treatment options at this point:
treat with antibiotics and wait and see
amputate the tail after the vent (necessary if vertebral involvement)
open and debride the site, and continue with antibiotics

We are still waiting the results of the bacteria sensitivity test, and she has a recheck next week, at which point we will decide a course of treatment. For now, she is getting meloxicam (anti inflammatory and analgesic) and Ceftazidine (antibiotic) to see if this produces any changes.
I will update with any changes, but i'm just curious if/how others have dealt with snake abscesses before? As an aspiring exotic vet, I'd really like to hear what worked/didnt work and why, for others.
-Erin

[stephanbakir]

That actually looks pretty clean, assuming its healing inside... can't see well in the photo.
Take her off the wood chips and put her on paper towels till shes healed and keep doing what you're doing.

[drewkore]

I agree with the above post. It doesn't look too badly infected(judging by the pics) and keep on paper towels instead of wood.

[Starbuck]

An update: she is currently getting meloxicam every other day, and ceftazidine every three days, she had her first shots today.... which was an interesting experience. The meloxicam definitely seemed like it stung a bit, but she did really great for both injections. Both of them are delivered sub-cutaneously on the cranial half of the body, i am alternating sides per injection day. So far I haven't noticed a change in the abscess itself, though i'm not really expecting to at this point. She is still eating and thermoregulating like a pro. Her recheck appt it next week, where x-rays will tell if theres been any internal change (im not expecting any...) and results will be back from the sensitivity test.

[Starbuck]

Hi all, Neki went back for her recheck appointment today.
It turns out the bacteria present in the abscess were not susceptible to the ceftazadine, so she is now switched to Amikacin, which is effective against all the bacteria present. She is also started up again on Meloxicam, the anti-inflammatory.

I noticed over the last week and a half that the meloxicam definitely seemed to help; on off days (no meloxicam) she was more ouchy around her tail, and held it above the ground as she moved. She continued to eat and defecate normally during the time, and use both ends of her terrarium. Over the last week, it seemed also that her tail was a little more swollen when i brought her in this week; i think this may be rather that the swelling was more concentrated over the area of the abscess, instead of diffuse around the entire tail.

The vets decided that the best course of action was to open up the abscess (it wasnt currently draining), get as much junk out as possible, and then flush it with saline and betadine. They used lidocaine, a local anesthetic, just over the area of the abscess where they were going to make the cut. They cut in between the scale rows, laterally, on healthy tissue in the hopes that this would make it heal quicker. Almost immediately thick, yellow, tooth-paste like pus oozed out. There was almost 2 TBS worth when all was said and done, and it smelled absolutely gross :P The lidocaine seemed very effective, as neki behaved perfectly and wasnt trying to get away or anything during the procedure. Afterwards, the flushed it out and gave her more meloxicam and antibiotics. Her tail was noticeably 'deflated' and seemed much thinner at this time. We dressed the wound with a tegaderm patch (baisically a giant band aid).
The wound is to be flushed every other day, and continue with a course of anti-inflammatories and antibiotics, recheck in 3-4 weeks.
I brought her home, and set up her new tank with all freshly washed decor and paper towel bedding, and some better lights to keep the temps up. She will get fed again on saturday, as long as shes up for it. When i dress her wound again i will get some pictures of the surgery site etc.

She is pretty good and wriggling out of her bandage; anyone have a possible solution for this? After a few weeks if she's healing well she probably wont need a bandage at all.

[rmfsnakes32]

I'm glad the vet drained it.

[Jules1618]

I'm glad they drained it too, it looked nasty

[Starbuck]

day one post-op
She wriggled out of her bandage in about 30 minutes of being home :P I let her be after the stress of the vet visit, and saw her drinking, so i know it was tough on her
today, i was planning to flush out the wound and re-dress it. It had closed over a little bit, so i had to re-open it with a blade. I then flushed it out with a betadine solution, it seemed like very healthy tissue, not inflamed, and the site did not have much pus or purulent material.
She gets her next course of anti-inflammatory tomorrow, and antibiotics continued for the month.

I also set her up with some better, new heat lamps to get a more optimal basking site, as i am not comfortable using the heat pad with only paper-towel as substrate. She is now at about 90+ during the day, 85 at night. Cool end is ambient temp, 72, with a water bowl.

[Jules1618]

Sounds like its getting better

[Starbuck]

Had to re-dress her wound today, and flushed it out since i had her restrained. I had some help with the bandaging, so hopefully this time it stays on a little longer. I need to call my vet monday to discuss alternatives, because the tegaderm patches stick to the glass walls and come right off. Im thinking large plastic band-aids, as the material will slide over the glass better, but i want to clear it with the vets first. Whenever it remains unbandaged it heals over slightly and closes up, which is not good for such an early point in the treatment. I'm going to try feeding her later tonight after the maloxicam has a chance to get going and she feels a little better.

[Starbuck]

She ate well yesterday, grabbed her mouse right away and wolfed it down And, her bandage seems to be staying on much better, since i had help wrapping her up yesterday. I'm still going to call the vets and ask about alternatives, but at least she's kept it on so far!
She also got her first dose of the antibiotics at home today, I much prefer the Amikacin to the Ceftazidine, because she needs much less, only 0.03 mL, so i think the injection itself is much less painful. She has been spending most of her time in the warm hide, which is good because the vet said the meds will work best (and be metabolized better) at a temperature closer to mammalian body temp.
I have removed the undertank heater for now, because without a few inches of substrate that was there before, i feel it gets too hot. When we are in the healing phase of treatment, in 3-4 weeks, and i can have her on wood chips again, I will turn the pad back on. She is still acting great and seems in good condition

[Starbuck]

Changed the bandage today and gave her next dose of anti-inflammatory. No changes, but i thought i would post some pics of how it looks (after she slipped her bandage the other day), and the general routine we go through each day over the kitchen sink :P

[Starbuck]

We are continuing with the antibiotics and anti-inflammatories, which i think really help. Neki really doesnt like her bandage being on, but i notice a distinct difference in dryness and irritation to the wound when she is able to get out of it, and i think for now it needs to stay. The wound itself has a small pocket of scar tissue from the original burn that pokes out (even more need for the bandage), but the vet said this may die and fall off, or at her recheck in a few weeks they can surgically resect it, depending on her condition. It also seems like her tail is much less swollen since the regular regime of meds, so i'm hopeful about her condition.
I just got her a new eco water bowl, 100% recycled plant material, with a bowed edge and lip so that she can hide under it on the cool side, i think she misses being able to burrow in the aspen since she is on paper towel now.

There still has not been a BM since i took her to the vet on the 21, but she pooped due to stress at the end of it, so im thinking her body is just playing catch up. Also, she was fed a fairly small mouse last saturday, so hopefully by the end of the week.
She is such a great snake, she barely flinches for her injections; i can't imagine any of my other snakes being as well behaved as she is, and even after being restrained and poked and prodded, she still isnt head shy or anything. Im barely handling her at all, only for the injections etc because i dont want to stress her out, but she is really taking it all like a champ

[Starbuck]

Literally sitting in the vets office after Neki's final checkup, and she has a clean bill of health!!! She will get her LAST dose of amikacin tonight, and now no longer needs a bandage. I will be posting some pictures when i get home to compare the difference between before the surgery and now.
Over the next 3 weeks, I am to keep an eye on her incision site, and monitor it for any swelling indicative of a bone infection or resurgence of the infection. The other option was a 140$ radiograph to see if there is any bone changes. I opted out of the radiograph since the first one did not show much activity/the information wasn't clear. As long as the swelling doesnt reappear, there is no reason to suspect any latent infection.
Over the next few weeks i am looking forward to her site healing even more, and getting her back on aspen shavings.
One thing to look out for on future sheds is that the incision site could have some trouble, which may require some soaks/help.
Hopefully after her next shed she looks even better!

[rmfsnakes32]

Very cool glad she is doing so well