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Nursing sick tortoises.

A C Highfield

A number of considerations apply when faced with the requirement to accommodate sick animals; some are obvious, some not so:

Environment

Sick specimens require adequate heat and light. They should not however be subjected to dangerously high temperatures and in most cases an overnight fall in temperature is still desirable (in a few instances animals on certain antibiotics should be kept at a stable temperature). Good quality lighting helps in the recovery process - natural daylight-type lighting is best. True-lite or an equivalent full spectrum tube can help here. Good ventilation is also vital. Tortoises are badly suited to typical 'vivarium' conditions and can rapidly develop secondary problems if kept in inappropriate, badly ventilated 'fish-tank' type vivarium units. Respiratory problems are especially common under such circumstances as are problems with sore eyes. Our preferred method of accommodation for sick tortoises is describedbelow.

Hospital Pen

This consists of a 500mm X 500mm square pen constructed of plywood. The sides measure 200mm high and prevent the animal climbing out. A 40W mini spot-lamp affixed to one end of an overhead rail provides basking facilities, and an 18" full spectrum fluorescent tube provides natural daylight-type background illumination. For overnight use, a small tubular heater affixed to one of the side walls is available. The base of the unit is best covered with vinyl tiles which are very easy to clean and sterilise.

Managing sick tortoises

There are two major requirements when dealing with sick specimens. The first is to ensure that the disease is accurately diagnosed and that the correct surgical procedures and drug therapies are employed. This task is the responsibility of the veterinary surgeon. The second aspect involves maintaining the animal's normal metabolic functions and ensuring that it is optimised for recovery during the treatment phase. This task is often shared between the veterinary surgeon, veterinary nurses and owner.

DEHYDRATION

Not infrequently tortoise enthusiasts are confronted by acutely dehydrated specimens. It is extremely important that persons who encounter dehydrated reptiles recognise the symptoms, metabolic implications and support therapy required to overcome the condition. Symptoms:- Dehydrated tortoises are usually underweight compared to a healthy specimen of similar proportions, although an obese animal may not be so. The eyes are almost always sunken, and in very acute cases, the centres of the cornea may be depressed. On manual examination, muscular tissue will lack resilience and the skin may also be unusually dry and the surface powdery. With the possible exception of cases of pneumonia, the oral mucous may be unusually viscous and turgid.

Prevention and supportive therapy: For practical purposes it can be useful to divide dehydrated reptiles into two groups. Group A animals may have acute dehydration but blood urea levels and uric acid precipitation has not yet reached a critical level. Renal function has not been impaired. Such dehydration is often encountered following a protozoan or similar G.I tract infection which has resulted in diarrhoea and excessive cloacal voiding. Animals of this group are also encountered following short-medium term failures of husbandry. The problem can usually be corrected by oral dosing with a compound sodium chloride, potassium chloride and glucose oral rehydration combination (e.g, 'Dioralyte' or ' Lectade'). Group B animals are much more problematic. Here, in addition to the usual external signs of dehydration, blood urea is elevated and renal function is impaired to a greater or lesser degree. Victims of long term neglect, inanition and dehydration or animals which have been on an excessively high protein diet for their species are those most likely to fall into this group. The first objective, even before inanition is dealt with, must be to restore renal function as quickly as possible. Oral dosing with Hartmann's Solution (compound sodium lactate) at up to 5% bodyweight daily has been highly successful. It is a common mistake upon confronting an animal suffering from inanition and dehydration to overlook the dehydration and concentrate upon the inanition. In chelonians, large quantities of high protein force feeds are often administered. This is in fact extremely dangerous and can result in mortality. If renal function or nitrogenous waste excretion is impaired additional protein input can only exacerbate the problem.

FORCE FEEDING

With all tortoises there are times when it may become necessary to resort to either force or hand feeding; particularly so in the case of anorexia, sight damage or where a tortoise for some other reason is unable to feed itself. Fortunately tortoises do not find this as distressing as mammals, and from the owner's point of view the procedure is both safe and relatively simple. We classify force-feeding in three basic stages; hand-feeding, which is really no more than an encouragement to feed normally; syringe feeding, which is less time-consuming and where alternative foods can be employed; and finally, stomach-tube feeding, where semi-liquid food matter is introduced directly into the digestive system by means of a tube passed down the animal's throat.

HAND FEEDING

Ideal in animals which are not in a serious condition, and where encouragement to take food into the mouth is all that is required. It is frequently highly successful with sight-damaged animals. Technique: simply open tortoises mouth, and place food within. To open a tortoise's mouth efficiently and safely, simply grasp animal firmly behind the ear-flaps and jaw with the thumb and second finger of one hand, and firmly force down the lower jaw with the thumb and first finger of the other hand.

SYRINGE FEEDING

Obtain a 5 ml or l0 ml syringe from your veterinary surgeon. Alternatively suitable syringes are often sold in pet stores as baby bird feeders. This method can be used in conjunction with the hand-feeding (above). Technique: open tortoise's mouth manually (as above), and simply syringe small quantities of food onto the tongue to be swallowed naturally.

STOMACH-TUBE FEEDING

This sounds more drastic and difficult than it actually is. However, care must be taken a) not to cause physical damage, and b) not to spread infection. To avoid the former proceed slowly and gently, to avoid the second sterilise all implements thoroughly in 'MILTON' or 'BETADINE'. The method is invaluable with very debilitated or sick tortoises who are unable to swallow, or who need food by the quickest possible route. Special diets can be given using this method, and the precise quantity of food taken can be carefully controlled. It is also possible to deliver vitamins, drugs or other substances in exact quantities where required. Suitable foods:  We are opposed to the use of 'COMPLAN' or similar milk-based high protein food preparations , even in severe cases of undernourishment. We have often noted serious side-effects where these are employed. Our general policy with ALL feeding is LOW protein,HIGH vitamin and mineral content, LOW fat and HIGH fibre.

In early years we used to use baby foods for tube feeding, but now, much better options are available. Once such product is the Oxbow Hay Company ‘Critical Care’ assist feeding formulations. The ‘fine ground’ version is especially suited to tube-administration. This is available in both herbivore and carnivore formulas. Soak the powder as directed, then administer by tube slowly and carefully.  Obviously, for Mediterranean tortoises species, the herbivore type is used. You can also use fully hydrated, mashed commercial tortoise pellets as the basis for a tube-feeding regime. The Testudo Pro-Alpin range is especially suitable. Many normal commercial pellet diets can have dangerously high protein levels and a poor overall balance, so be careful.  This is a very different situation from normal feeding, and used carefully in such a role, such products can be both safe and effective. They are quite high in fibre, and although not as easy to tube as he Oxbow Critical Care, they can add some much needed variety to a potentially long-term tube feeding regime. With juvenile tortoises in particular, we recommend adding some extra calcium in the form of Nutrobal or Zolcal-D to the tube feeding formula. You can also use a kitchen liquidiser to produce a mash of suitable flowers, and green leaf material to supplement the prepared formulas.

Technique: Obtain a 5 ml or l0 ml syringe, also a dog catheter. Cut to size and fix to end of syringe (length of tube = just over 1/2 length of tortoise). Lubricate lightly with vegetable oil. Place tortoise in an almost vertical position, extend neck and head fully in a straight line. Gently and slowly pass tube down throat, carefully avoiding the trachea, which is located just behind the tongue. Gently and slowly empty the contents of the syringe into the tortoise. The amount of food which should be introduced in this fashion has been the subject of some confusion. Our general recommendations are as follows.

  • VERY SMALL TORTOISES Between 75-l20 mm long - 2 ml twice per day semi-solid food.
  • SMALL TORTOISES Between l50-l80 mm long - 3-4 ml twice per day semi-solid food.
  • MEDIUM TORTOISES Between l80-220 mm long - 4-5 ml twice per day semi-solid food.
  • LARGE TORTOISES Between 220-260 mm long - up to l0 ml twice per day. Very large tortoises will require more. Monitor weight daily.

Alternatively, give 10ml per Kg total bodyweight maximum per 24 hours plus fluids. Remember, these are approximate guidelines only. If the tortoise has been starved for a long time prior to beginning tube feeding reduce the quantity initially. Liquids should be provided in addition, preferably by inducing the tortoise to drink voluntarily. In cases of severe dehydration, begin hydrating with fluid at a rate of 4-5% of total bodyweight daily. If oedema (puffiness, or swelling) is noted, and urination is not present, reduce level and seek expert advice.