Lecture 6, Sea Turtle Medicine _ Rehabilitation.pdf

Sea Turtle Medicine & Rehabilitation Avian, Fish & Exotic Animal Diseases PTHB 516 Sea Turtle Learning Objectives Bluvias and Eckert (2010)...

Sea Turtle Medicine & Rehabilitation Avian, Fish & Exotic Animal Diseases PTHB 516 Sea Turtle Learning Objectives Bluvias and Eckert (2010) Marine Turtle Husbandry Manual 1. Demonstrate clinical assessment and diagnostic techniques for sea turtles including applicable anatomy and physiology 2. List common clinical presentations of wild sea turtles 3. Differentiate the treatment, rehabilitation, and release protocols for adults and hatchlings  Carapace Sea Turtle Anatomy Bone and muscle Plasteron Carapace and plasteron shell Heart: two chambered atrium and single ventricle partially separated by a septum Lacrimal salt gland allows salt excretion Spinal cord, lungs, and kidneys are very dorsal  Clinical Examination Restraint Small turtles picked up midbody and large turtles grasped on cranial and caudal portions of the carapace Safe restraint with immobilization of the front flippers and support of the body Turtles will bite and scratch and hawksbills have sharp shells! Clinical Exam Baseline Data Morphometrics Carapace length and width (estimate age as juvenile, subadult, or adult) Weight if possible Temp, pulse, and respiration – continued tomorrow Flipper and passive integrated transponder (PIT) tagging Clinical Exam Gender Temperature-dependent sex determination based on nest temps Adult turtles can be identified using morphology Males: relatively longer tail and cloacal opening near tip Females: shorter tail and cloacal opening closer to base Juvenile and subadult turtles need endoscopy to examine gonads Clinical Exam Body condition assessment Body condition index (bodyweight / (Carapace length)3) Subjective body condition score (1-5) Look at curve of plasteron Look at fat/muscle of dorsal neck, axillary, and inguinal areas BCS 3 BCS 1 BCS 4 BCS 1  Physical Examination Start at the head and work to the tail Epibiota – chronic floating on surface Tumors Lacerations/Strangulations Shark Bite To Tail Shell Injury -> Osteomyelitits External Parasites- Leeches Scarring From Previous Injuries  Imaging Lungs Similar to mammals, often useful for diagnosing GI abnormalities (foreign bodies) and tumors, air pockets Radiographs Dorsoventral, craniocaudal, and lateral views Portable radiograph machine Lungs Ultrasound Dorsal or ventral recumbency but gotta deal with the shell! Physiologic Assessment Same issues with biochemistry reference intervals as fish Affected by species, environment, and life-stage Nesting turtles – vitellogenesis and prolonged anorexia Bromcresol green dye-binding method (used by many analyzers) for albumin underestimates concentrations and throws off globulin calculations Move towards using gel electrophoresis for protein quantification Blood gasses useful but need to adjust temperature calibrations What biochemistry analytes would be expected to be increased in nesting sea turtles due to egg production? Total protein Albumin Globulin Glucose Cholesterol Triglycerides Uric Acid AST GGT Creatine kinase Calcium Phosphorus Sodium Potassium Chloride  Complete Blood Counts Total WBC counts: hemocytometer (Natt- Herricks stain or Avian Leukopet Kit) Manual differential WBC counts RBCs, heterophils, eosinophils, lymphocytes, monocytes, basophils Immature RBC stages not uncommon and increased during anemia Toxic heterophils common with inflammation and may not see heterophilia Normal Toxic Changes Bloodwork Venipuncture ▪ Dorsal cervical sinus/Internal jugular vein ▪ Leatherbacks: Interdigital vein of back flipper ▪ EDTA (CBC) and lithium heparin (biochemistry)  What are common presentations of sea turtles? 1. Trauma 2. Ingested foreign bodies 3. Abnormal buoyancy 4. Infectious disease 5. Cold stunning Trauma Entanglement in nets, fishing gear, kite string, etc. Drowning, soft tissue injury, amputation Sharp and blunt trauma (e.g. boat strikes)to flippers, carapace, head A juvenile green turtle presents with a fractured carapace from a boat strike. In addition to a spinal fracture, would other organ would you prioritize diagnostically as having been at high risk for damage based on the location? A. Liver B. Spleen C. Stomach D. Lung E. Kidney A juvenile green turtle presents with a fractured carapace from a boat strike. In addition to a spinal fracture, would other organ would you prioritize diagnostically as having been at high risk for damage based on the location? A. Liver B. Spleen C. Stomach D. Lung E. Kidney Abnormal Buoyancy Syndrome (Bubble Butt Syndrome) Air pockets in shell, coelomic cavity, and/or GI tract cause turtle to float at an angle and unable to dive, blown to shore Numerous causes including penetrating injuries to the shell or lung (pneumocoelom), congenital or healing abnormalities, impactions causing gas buildup in GI tract, lung infections Abnormal Buoyancy Syndrome Clinical diagnosis by presentation and etiologic diagnosis with imaging (radiographs, ultrasound, CT) Abnormal Bouyancy Syndrome Clinical diagnosis by presentation and etiologic diagnosis with imaging (radiographs, ultrasound, CT) Abnormal Bouyancy Syndrome Clinical diagnosis by presentation and etiologic diagnosis with imaging (radiographs, ultrasound, CT) Ileus Abnormal Bouyancy Syndrome Clinical diagnosis by presentation and etiologic diagnosis with imaging (radiographs, ultrasound, CT) Abnormal Bouyancy Syndrome Clinical diagnosis by presentation and etiologic diagnosis with imaging (radiographs, ultrasound, CT) Bloat Abnormal Buoyancy Syndrome Clinical diagnosis by presentation and etiologic diagnosis with imaging (radiographs, ultrasound, CT) Abnormal Buoyancy Syndrome Clinical diagnosis by presentation and etiologic diagnosis with imaging (radiographs, ultrasound, CT) Carapace Fracture  Treatment Remove excess air and treat underlying cause: Coelomic aspiration Antibiotics GI symptoms: Simethicone (excess gas) and mineral oil (impaction) Issues sustained for > 1 month can permanently change confirmation of the lungs (i.e. the lungs shift to be able to expand or undergo hypoplasia) External weights used to maintain correct lung confirmation while issue resolved Can take months/years of rehab and may be deemed unreleasable Hypothermia (Cold-Stunning Events) Epizootics generally occurring with water temperatures < 50˚F (10˚C) Lethargy, anorexia, floating on surface, stranding Causes issues with circulation, organ function, immunosuppression (opportunistic infections common), directly damage the skin, shell, and eyes Can recover quickly with short exposure but may require extensive rehab when prolonged Foreign Bodies Intestinal impactions Treat with mineral oil, Metamucil, fluids prior to surgical options Ingestion of hooks and string/fishing line Plicated and perforated intestines Surgical (more tomorrow) Viral Diseases Difficult to characterize due to lack of sea turtle cell culture Herpesviruses compose majority of diseases Chelonid alphaherpesvirus 5 (CHV5)- Fibropapillomas Maricultured turtles Lung-Eye-Trachea virus (CHV1) – Pneumonia, tracheitis, conjunctivitis Grey Patch virus – Blister-like lesions in the epithelium  Neoplasia Not that much different than mammals Fibropapillomatosis (FP) epizootic in green turtles but described in other species Associated with chelonid alphaherpesvirus 5 (ChHV5) infection which has latency however… Koch’s postulates not done Virus isolated in healthy turtles so likely multifactorial presentation (co-infection?, environmental?, stress?) Tumors will regress on their own, but if advanced or causing impairment, surgically remove tumors to support regression Parasitic Diseases GI trematodes very common and usually incidental Vascular trematodes (Sanguinicola spp.) with eggs deposited in organs, especially lung and kidney Leeches, also shown to carry ChHV5  Bacterial Diseases Pseudomonas fluorescens, Aeromonas spp., Vibrio spp. Streptococcus spp., Mycobacteria spp. and others Often secondary to cold-stunning and secondary infections causing bronchopneumonia, soft tissue infection, sepsis/vasculitis Antibiotics mostly based on dosages in other reptiles A subadult green turtle found by EcoDive off of Grand Anse presents moribund with a stricture ulcerations on both front flippers and neck from fishing line. The carapace is covered by a thick mat of algae. What body condition score would you subjectively assign to this turtle (1-5)? A. 1 B. 2 C. 3 D. 4 E. 5 A subadult green turtle found by EcoDive off of Grand Anse presents dull, alert, and lethargic with a stricture ulcerations on both front flippers and neck from fishing line. The carapace is covered by a thick mat of algae. What body condition score would you subjectively assign to this turtle (1-5)? A. 1 B. 2 C. 3 D. 4 E. 5 The lesions are observed to have exposed necrotic muscle with evidence of fibrous connective tissue around the edges. There is hyperemia and edema of the flippers which makes you consider that the turtle may be septicemic (vasculitis/lymphangitis). What pathophysiologic change in sea turtles is most consistent with septicemia and systemic inflammation? A. Hypoproteinemia B. Heterophilia C. Increased creatine kinase D. Toxic heterophils E. Hyperkalemia The lesions are observed to have exposed necrotic muscle with evidence of fibrous connective tissue around the edges. There is hyperemia and edema of the flippers which makes you consider that the turtle may be septicemic (vasculitis/lymphangitis). What pathophysiologic change in sea turtles is most consistent with septicemia and systemic inflammation? A. Hypoproteinemia B. Heterophilia C. Increased creatine kinase D. Toxic heterophils E. Hyperkalemia A subadult green turtle presents moribund with a stricture ulcerations on both front flippers and neck from fishing line. There are signs of septicemia based on clinical signs and toxic heterophils seen on CBC. What other diagnostics do you want to do?  Radiographs demonstrate no significant findings (no signs of pneumonia or bone involvement around areas of strangulation) Pseudomonas aeruginosa and Klebsiella pneumonia are cultured from skin lesions and are susceptible to enrofloxacin and ampicillin. Biochemistry showed: Analyte Value Reference Interval Packed cell volume 44 28-58 Total protein (g/dL) 8.5 2.6-6.0 Albumin (g/dL) 3.6 0.7-2.1 Globulin (g/dL) 4.9 1.7-4.4 Glucose (mg/dL) 209 19-91 Uric acid (mg/dL) 0.5 0.1-0.3 Interpretation:  Radiographs demonstrate no significant findings (no signs of pneumonia or bone involvement around areas of strangulation). Pseudomonas aeruginosa and Klebsiella pneumonia are cultured from skin lesions and are susceptible to enrofloxacin and ampicillin. Biochemistry showed: Analyte Value Reference Interval Packed cell volume 44 28-58 Total protein (g/dL) 8.5 2.6-6.0 Albumin (g/dL) 3.6 0.7-2.1 Globulin (g/dL) 4.9 1.7-4.4 Glucose (mg/dL) 209 19-91 Uric acid (mg/dL) 0.5 0.1-0.3 Interpretation: Moderate dehydration (in the face of anorexia), hyperglycemia (stress), keep an eye on PCV and protein as hydration status resolves It is assessed that the turtle should be hospitalized for treatment and rehabilitation.. Rehabilitation and Basic Treatments Prepare for the long haul Adequate holding tank size, including depth Clean, temperature-controlled water Lighting with diurnal and nocturnal timing Food and stimulation  Enrichment/Stimulation Try to mimic natural environmental behaviors Hiding spots Basking mat that’s still in the water Be careful if turtle is wearing weights or external fixators Natural-ish feed: crustaceans, fish, squid, lettuce  Nutrition Free-feeding—foraging/normal feeding behavior Assisted feeding—pole, forceps… Tube-feeding in the right scenario Feed blended fish/squid with vitamin supplementation Ensure hydration status Radiograph to ensure no blockages Monitor defecation Dry-Docking Turtles may need to be kept out of water depending on condition Reduce pressure sores with padding Maintain adequate temperature and keep skin protected from drying (mist, Vaseline, wet towels)  Fluid Therapy Lactated Ringer’s solution + 0.9% NaCl Maintenance is 20-30 ml/kg/day IV in dorsal cervical sinus Subcutaneous (top picture) or intracoelomic (bottom picture) based on amount and intracoelomic absorbed quicker Green sea turtle is dull and lethargic and has signs of trauma with secondary infection and septicemia (P. aeruginosa and K. pneumonia ), dehydration, and hyperglycemia What is your treatment plan? 1. The turtle is dry-docked five days during treatment and then added to tank 2. Treat lesions: Debrided, flushed with dilute iodine, and covered in unpasteurized honey for 5 days. 30 mg/kg ampicillin SQ SID are provided BID for 10 days. 3. Support physiologically Fluid therapy 200 mL LRS + NaCl intracoelomic SID until biochemistry analytes resolve (took about 3 days). The turtle begins to become more BAR and granulation tissue forms over the lesions by end of antibiotic treatment. What type of checklist would you go through to feel confident releasing the turtle? Fit for release checklist ✓ ✓ Off all medications ✓ Active, swimming, and hopefully eating ✓ Defecating normally ✓ No significant open wounds and all hardware off ✓ Blood parameters within normal limits although often find HCT is slow to rise Let’s talk hatchlings ▪ Can become disoriented from artificial light or barriers ▪ Best chance of survival if enter the sea at night ▪ Maintain in DAMP SAND and monitor temperature ▪ Periods of activity and quiet ▪ Can supplement with subcutaneous (SQ) fluid but yolk sacs available for nutrition Hatchling Release Release at night (avoid disorientation, predation, heat) On sand, not directly in water which should help with imprinting for female turtles to return to nest! Useful References Norton and Mettee, 2020. Marine turtle trauma response procedures: A veterinary guide. WIDECAST Technical Report No. 20. (Free on-line) Manire, 2017. Sea Turtle Health and Rehabilitation. (In the library)