RI Treatment

One of my normal girls has had an RI for just over a week now. Last Thursday, the vet gave saw her, gave her a Baytril injection and sent me home with 6 more Baytril shots to administer daily. I put her in QT and set her entire tub to 92* (per the advice from many experienced breeders). I change her bedding every 3 days and her water everyday. Yesterday was day 7 and she still has a lot of liquid/saliva (bubbles too) in her mouth. Should I give the temps and Baytril a chance to fight the RI or should I bring her back in to the vet? I understand an RI is not an infection that gets better in a day or two and can take over a month to lose the symptoms. I am thinking I should wait until the middle of next week and let the high temps, along with the Baytril in her blood fight out the RI. What do you recommend?

well RI's can be tricky. baytril is very strong so be careful injecting, i hear it can cause necrosis. also be aware of dehydration, if its too bad it can shut down her kidneys and she can die. good job changing the water, thats one of the biggest places for the bacteria to hang out and go back into ur snake. u should prolly go back to ur vet and get another exam and more than likely some more injections. my normal had a bad RI last year and it took 3 times the normal amount of amikacin injections for her to get better.

EDIT-its better to go back to the vet sooner than later, if that bacteria starts to come back u will be back to square one

I would give the vet a call. They'll tell you whether or not it is necessary to bring her in. Most vets are pretty cool about giving advice over the phone rather than having you go in and drop another bunch of cash.

Keep her temps up and go back to the vet. Baytril is a broad spectrum antibiotic however it does'nt always get everything you may need a different RX, try calling first though the vet may just give you a new RX

Be sure to keep her on newspaper for substrate during treatment so that she doesn't accidentally ingest wood shavings.

I could not get off work so it looks like I will have to wait until Tues to take her in. I took her out this morning and her mouth seemed a bit dryer, so maybe she is getting better. Hopefully she pulls through this and hopefully she doesn't have more saliva so I don't have to take her to the vet again. I will take her again in a couple weeks no matter what regardless.

She is on newspaper substrate and I usually put a slightly damp paper towel in to keep the humidity up, along with her water bowl. I am going to feed her for the first time in two weeks (she usually eats every week) tonight........she is a ferocious eater usually. Thanks for the advice.

Is there a website or threat/sticky on RI's anywhere? Something detailed with advice on treatments, how long to QT/treat for, etc?

The humidity is the problem.......put a SMALL amount of water for the snake to drink.....the high temps are to dry up the mucous, as the snake can't cough it up. If the humidity is too high, the secretions increase and the snake will drown in it's own fluid. I have cured many babies with just high temps/low humidity, as babies cannot handle antibiotics. Good Luck!

It really didn't seem to matter so I actually stopped putting the very slightly damp paper towel in with her (usually crumpled up). The heat throughout dries it up quickly anyways. Her water bowl is a plastic 8oz bowl in a large pvc connector. So basically, I would say the humidity stays pretty low anyways.

I fed her yesterday and for the first time, since she is such a great eater, I let the rat soak in water without a bag........so she would get extra hydration in her with a water soaked rat. I know it probably didn't make a difference, but she struck it and ate it with no problem. Since she ate yesterday (Fri), I am going to wait until Sun night or Mon morning to change her tub and handle her. HOPEFULLY her mouth is dryer. Is that the best sign I can look for to see that her RI is getting better?

to see the RI disappearing just look for the signs that were there in the beginning. stargazing, bubbles, excess mucus. hold ur snake up to ur ear and listen from head to stomache, u shouldnt hear any popping or bubbling. it should sound clear. how did u first spot the RI??

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Originally Posted by Sammy412

The humidity is the problem.......put a SMALL amount of water for the snake to drink.....the high temps are to dry up the mucous, as the snake can't cough it up. If the humidity is too high, the secretions increase and the snake will drown in it's own fluid. I have cured many babies with just high temps/low humidity, as babies cannot handle antibiotics. Good Luck!

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Actually, the newer thinking and recommendations from the top herp vets is that higher humidity is better, because it helps to break up the mucus.

It's more unusual for babies to get RI's than adults, they're pretty hardy.

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Originally Posted by Sammy412

The humidity is the problem.......put a SMALL amount of water for the snake to drink.....the high temps are to dry up the mucous, as the snake can't cough it up. If the humidity is too high, the secretions increase and the snake will drown in it's own fluid. I have cured many babies with just high temps/low humidity, as babies cannot handle antibiotics. Good Luck!

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Actually low humidity can cause an RI and or make it worse/take longer to go away. The main cause for RI in BP's is temps too low and not enough humidity.

It is more unusual for babies to get an RI, however in the 12+ yrs of rescue/rehab, I've had plenty. I've also heard of the higher humidity being recommended, but after not losing one snake to the old way, I think I will stick to that. It does loosen the secretions, however since snakes can't cough, that increases the risk of the snake drowning in it's own fluid. More specifically, if the snake is over 6 months and can be given antibiotics, it might be OK to increase the humidity, but I wouldn't take the chance.

About humidity causing RI I don't know where I read it but I was reading about how keeping herps from drier climates in high humidity causes RI. However it is not a bacterial RI it is actually fungal. Very interesting read I will see if I can find the article again.

I didn't hear the word 'culture' mentioned once here, SO:
If your vet did NOT do a culture to determine the strain of bacteria causing the RI, 1,. he's a moron, and 2. you can spend a million dollars of Baytril, and inject it every day for 16 years, if the bacteria that is causing the RI is resisitant to Baytril, you're killing your ball python and wasting both your money and time.

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Originally Posted by mykee

I didn't hear the word 'culture' mentioned once here, SO:
If your vet did NOT do a culture to determine the strain of bacteria causing the RI, 1,. he's a moron, and 2. you can spend a million dollars of Baytril, and inject it every day for 16 years, if the bacteria that is causing the RI is resisitant to Baytril, you're killing your ball python and wasting both your money and time.

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Good vets know that the bacteria that causes most RI's are already present in the mouth. So doing a culture can many times give false positives. Treating the animal with baytril is the first step toward treatment. After a round of treatment and no improvement the vet will most likely pursue other means of treatment.



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I did request a culture and vet advised that the infection was in the lungs and a culture from the saliva may or may not have any bacteria in it.

I noticed the RI when I was checking the cages and heard a "sniffle." I pulled my girl out (she is an 08 female and about 1200 grams)......a sub-adult. I opened her mouth a their was a lot of saliva and bubbles. For the first two days or so when I would pull her out for her Baytril injections, I could hear the weezing/liquidy breathing in her. After 3-4 days of treatment, I have not heard it. I gave her one Baytril injection for 7 days straight and that was all the vet gave me. Today is day 10 and she still has a lot of saliva/bubbles in her mouth but I have not heard any liquidy breathing in a week.

I have still been putting a slightly moist paper towel in with her so she is getting some descent humidity along with her water bowl. She is also in a 32q tub instead of the normal 41q tub she is usually in so that should provide a little more humidity. Still, with about 85% of the tub being at 92, it keeps things fairly dry.

She pooped (normal) on day 4 of the RI, she ate a small F/T rat as normal on day 8 of the RI, and she doesn't seem too irritated when I briefly handle her to check her mouth or remove her to clean her tub. The last thing I want to do is stress her out with another vet visit, exam, and more medications if the RI is going away. I left her at the vet for a couple hours last time and she bit one of the vet techs......which is abnormal for her but understandable since she is not feeling well and was in a strange environment.

I was just wondering if her having a lot of saliva/bubbles is ok. The vet explained the RI is like the flu, the Baytril will kill the bacteria and she will have to just fight the rest on her own.....let the RI take its course and her body should handle it.

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"Good vets know that the bacteria that causes most RI's are already present in the mouth."

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That's why a 'good vet' doesn't take a culture of the saliva from the mouth. A 'good vet' would do a lung wash.

That said;

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"I did request a culture and vet advised that the infection was in the lungs and a culture from the saliva may or may not have any bacteria in it. "

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You NEED to find a 'good vet'.

How do they do a culture on the bacteria from the lungs? About how much should I expect the vet to charge for a lung culture.

Is there a website with good recommended herp vets? Is there a website with proper ways to treat an RI? I have looked and I could not find one. I live in Dallas-Fort Worth so I would think finding a good herp vet in the area should not be a problem, but it seems I am not looking in the right place.

http://www.herpvetconnection.com/texas.shtml

maybe one of these are near you

Unfortunatly there are no herp vets that are certified in the DFW area. In order to do a trans treacheal wash on a snake it needs to be sedated so.... (not really the best option on a snake with breathing issues). That being said if the mucus has not cleared up, the infection is not gone. The baytril may need longer to work. If there is still an issue after a longer or different round of ab's a trans treacheal wash is then something that should be done to rule out fungal lung infectons such as asperigilosos etc. I have worked with many herp vets and as a tech at the bronx zoo. I was really dissapointed at the lack of specialist in general in the DFW area. It seems that if you want really good quality veterinary medicine in texas you need to drive to A&M.

If you are uncomfortable with your current vet and would like to try another one you can come to North Tollway Pet Hospital 972-733-3340 and make an appointment with Dr. Maxwell. He is ok with reptiles but also takes my advise even though I am a tech he values my experience with exotics.

If you have any other questions about this or are curiouse about the clinic please feel free to IM me

Ed

Well, I just went and checked my girl. I opened the left side of her mouth and it was fairly dry......normal looking. She was pulling pretty hard to get out of my grip but I had to give it a good, thorough check. I opened the other side and as she tried to pull away, a little saliva came out of the side of the mouth. I have no doubt their is a lot less saliva then she had 10 days ago, but still too much. I will call the vet and ask what he thinks, but I definetely cannot afford to drive to Texas A&M and put her under for the procedure, especially if their are breathing concerns. Maybe the vet will give me another round of meds or another type of med. If that does not work and she is not better after it (and another week) and she is suffering, I may have to put her down.

Thanks for the advice and I just hope my other BP's don't get an RI. I have been checking their mouths every 3-4 days (when I clean tubs/water) and so far, they are all good. My tubs are not wet at all and humidity is 57-60%. In a couple tubs, the humidity gets up in the high 60's and even low 70's but it is still dry. Other then them getting it from my sick girl, I don't see how they can get an RI. Thanks again.

A lung wash (or trans tracheal) wash can and is done while the snake is awake and alert. The vet will take a syringe filled with a few cc's of sterile saline attached to a long, flexible tube the width of a pencil lead. The snake is held up and once the opening to the lung opens (that little esophagus-looking thing at the bottom of the snakes mouth) the tube is fed into the lung.
When the tube is fully inserted, the saline is pushed into the base of the lung, and with the tube still in, the snake is rolled and rotated to allow the sterile saline to mix with the mucous and fluid already in the lung. When this is completed, the fluid is sucked back up into the syringe and is sultured to determine what bacteria is in the lung.
I would imagine that this method is slightly stressful on the BP, but really the only sure way to get a good fluid sample from the lungs.

a minute of stress is worth a good culture in my book. but why would the bacteria in the lungs be different than the bacteria in its mouth??

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Originally Posted by mpkeelee

a minute of stress is worth a good culture in my book. but why would the bacteria in the lungs be different than the bacteria in its mouth??

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Some RI's are caused when the Bacteria from the mouth and nose moves down into the lungs and upper respiratory area. The reasons this happens is because of a lowered immune system either due to stress, injury, breeding, poor nutrition, the list goes on and on. Doing an oral swab is pointless since the bacteria is always present.

Not sure what a lung wash is but it sounds way more trouble that its worth all the stress its sure to cause on an already compromised snake..In the end trust your vet but rule #3 is Never believe what you're told always double check.

If the vet is not going to do a culture, then their is no point in taking her there. If the culture can be done as stated, then I would love to have it done to find the cause and the cure. I am going to call the vet later today and talk to him about what needs to be done. At this point, if Baytril did not work, isn't one of the only other options I have Fortaz?

On another note, I am focusing some of my worries on my other BP's. My hot spot is at 92* (3" flexwatt across the back of the tub) and my cool side is at 82-84. My humidity is in the 65-70% range now as I lowered my ceiling fan to low (the entire tub is dry with this humidity).....humidity was 55-65% before. I moved my rack from an area that was about 2 feet from where my ac came out to the corner of the room, a good 8+ feet from the ac vent. I cleaned all tubs with a 5% bleach solution and then another wipe down with Chlorohexadine. I clean the water weekly and I disinfect my tongs after every feeding.

Thanks for the replies. It seems all the vets I call either do not want to do a culture on a snake or they may just not know how to do it.

Why did the Vet administer Baytril, without doing a Culture/Sensitivity test? How did your Vet know the RI would respond to Baytril? Baytril is the least harmful antibiotic compared to Amakacin and Fortaz, but it is also the least effective. Also 6 injections sounds way too small. When treating my Green Tree Pythons with Baytril, the schedual is 1 injection every other day for a month(14-15 injections).
I would have a culture(make sure your Vet gets the sample from the animal's Trachea, and not it's mouth) and sensitivity test done on your BP. This can be done by waiting for the BP to "take a breath", when the Trachea opens the Vet can slide a steryl swab in and get a sample.
Mouht and Lung bacteria may NOT be the same.

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Originally Posted by BluEyedLeu

Why did the Vet administer Baytril, without doing a Culture/Sensitivity test? How did your Vet know the RI would respond to Baytril? Baytril is the least harmful antibiotic compared to Amakacin and Fortaz, but it is also the least effective. Also 6 injections sounds way too small. When treating my Green Tree Pythons with Baytril, the schedual is 1 injection every other day for a month(14-15 injections).
I would have a culture(make sure your Vet gets the sample from the animal's Trachea, and not it's mouth) and sensitivity test done on your BP

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Baytril is a wide spectrum antibiotic used for many different types of treatment's in reptiles. I've used it to treat wounds, RI's and even to ward off infection from Belly Rot.

Many vets will start with this as it is merely the first step in a treatment. As for the number of injections it all varies from vet to vet. I've given as many as 10 and as few as 4 before it depends on how bad the RI is and the over all health of the snake. A snake that is relativity healthy will be give Baytril to supplement it's own immune system where as a snake in poor health will be give Baytril piggy backed with something like Fortaz and maybe even an appetite stimulant.

So would I dis-agree with the vets decision nope..

My vet swears that Nebulization of the meds works great. He said by the snake having to inhale the meds they go deep into the lungs and treat the source directly. The problem is it cost $20 per treatment so bringing her in for 2 treatments a day for 3-4 days is going to cost me $120+. I have said that the cost is not a big concern, but I do not want to spend hundreds of dollars if I can handle it on my own with a series of shots. Also, I know the stress is not good for her while she is sick either.

Your thoughts on nebulization (not sure of the spelling)?

Freakie Frog, sorry but the Vet is wrong. To send him home with Baytril injections and not even do a culture and sensitivity.... wrong

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Originally Posted by BluEyedLeu

Freakie Frog, sorry but the Vet is wrong. To send him home with Baytril injections and not even do a culture and sensitivity.... wrong

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What other drugs are available and proven to treat URI in Ball Pythons??

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Originally Posted by Freakie_frog

What other drugs are available and proven to treat URI in Ball Pythons??

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Tylan works wonders with URIs!

Fortaz is my favorite, as long as the snake is over a year.

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"Baytril is a wide spectrum antibiotic used for many different types of treatment's in reptiles. I've used it to treat wounds, RI's and even to ward off infection from Belly Rot."

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I'm sorry Sir, but you are a contributing factor to why MANY RI's are Baytril resistant these days.
OVERUSE.
Not only overuse by the vets (as in this case) but overuse by the general public who;
1. should not be allowed to HAVE this drug in their possesion, and
2. don't have ANY medical training or experience.
The keepers who self-treat their ball pythons with Baytril for 'wounds, RI's and even to ward off infection' are completely irresponsible in my opinion.
If you care enough to rake in the cash you get from the babies they produce, then you should by responsible enough to treat them PROPERLY when they get sick.

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Originally Posted by mykee

I'm sorry Sir, but you are a contributing factor to why MANY RI's are Baytril resistant these days.
OVERUSE.
Not only overuse by the vets (as in this case) but overuse by the general public who;
1. should not be allowed to HAVE this drug in their possesion, and
2. don't have ANY medical training or experience.
The keepers who self-treat their ball pythons with Baytril for 'wounds, RI's and even to ward off infection' are completely irresponsible in my opinion.
If you care enough to rake in the cash you get from the babies they produce, then you should by responsible enough to treat them PROPERLY when they get sick.

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I'm glad you think so highly of me to think I'm

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a contributing factor to why MANY RI's are Baytril resistant these days.

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Don't forget I also got "Friends" canceled, Caused Gobal warming, invented the internet and..Yes I am BigFoot

Come off it, Baytril needs a prescription by a Trained and licensed Vet..So I have nothing to do with it's use or over use. I'm a humble Ball Python Breeder.

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The keepers who self-treat their ball pythons with Baytril for 'wounds, RI's and even to ward off infection' are completely irresponsible in my opinion

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And what about those who do so at the advice of the direction of their vet. Remember Baytril needs a prescription by a Trained and licensed Vet

If you want to whine and moan because you feel it is over used or improperly use I suggest you start with the veterinarian schools and Vet's themselves and leave me out of it..

We tell people to see their vet.. why?? Because they are the professionals..is baytril always the answer HELL NO! I've also used Fortaz, Neosporine, Chlorehexidine, and a few other things to treat wounds and other stuff.

Your vet should always take a culture and identify the organism when an infection is present. It's fine if they send you home with a good antibiotic while they wait for the results, but the results are necessary to make sure the snake is on the right meds.

Keep the cage warm--as high as 100F basking, 85 cool. That is hot, but it IS safe. It's the equivalent of giving your snake a low-grade fever, and it suppresses the growth of some of these organisms. Keep the humidity high. Soak the snake in nice warm water every other day, and then hang it upside down afterward--mucous may run out, so have paper towel handy. You'll find the snake appears much more comfortable after this treatment, and breathing is easier. Good hydration is best for ANY infection, and high humidity helps with this. It also helps prevent liver damage from the meds. When I have had snakes with RIs, I found that hanging them head-down once a day would help them clear mucous from their lungs, and they would breathe much easier afterward.

Keep sick snakes in strict quarantine, and be particularly wary of any RI that does not resolve with antibiotics within a week. Use bleach to carefully sterilize the rack shelf, bin, and anything the snake contacts. Wash hands strictly after touching anything around the sick snake.

If the appropriate antibiotic is prescribed for the identified organism, the snake completes the course of antibiotics and is still sick--suspect a virus. Keep the snake on a strong antibiotic (switch to another one that the organism was sensitive to), continue soaking, tube-feed if rapid weight loss occurs, and cross your fingers. Recovery may be hit or miss with a respiratory virus, and may take a long time. Some choose to euthanize to avoid the risk to other animals in the household, while others consider recovered snakes to be immune and to not pose a risk. It depends on the virus. Do your research!

Proper quarantine of new animals introduced to a large collection should be 12 months...not just 3. Some of the bad bugs can incubate for over 10 months, on record. Always be aware of the chance you are taking if you put snakes in with your collection after just 3 months, and take careful precautions with them for their first year--no feeding leftovers to other snakes, no transferring cage furniture or bowls, etc etc.
Chlorhexedine kills bacteria, it's great for that. It doesn't kill the bad bugs--use bleach to disinfect things contaminated by any suspect snake.

READ UP--with a growing collection I have so much invested it, I read up on these things extensively, from multiple sources. I don't want a tragedy in my collection, as some others have endured. Prevention is the best way.

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Originally Posted by rj1204

My vet swears that Nebulization of the meds works great. He said by the snake having to inhale the meds they go deep into the lungs and treat the source directly. The problem is it cost $20 per treatment so bringing her in for 2 treatments a day for 3-4 days is going to cost me $120+. I have said that the cost is not a big concern, but I do not want to spend hundreds of dollars if I can handle it on my own with a series of shots. Also, I know the stress is not good for her while she is sick either.

Your thoughts on nebulization (not sure of the spelling)?

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My vet and I love nebulization coupled with injections. If you have more than a couple animals, it's probably worth it to pick up a little nebulizer and put together a chamber easily. I picked up a portable one for less than $50, although my husband gets stuff at cost since he works there part time. Your vet can give you the doses for it, show you how to use it if need be, and you should be good to go.

Sounds like you're doing the best you can. Kudos!

So, today I brought my girl back to the vet. The herp vet was off when I originally brought her in so I got bad advice/exam before. The vet took a culture and gave me 5 Amakacin injections to give every 3 days. The culture should be back within 72 hours. Hopefully the new meds work but the culture should tell us what will work for sure. Thanks for all the advice guys.

Do you guys think my other 7 BP's can beat the RI out? I increased the hot spots to 93-94* and the cool spot side is 82. I guess I can only keep my fingers crossed at this point. I am going to get them hide boxes this weekend......only a couple shy girls have hide boxes since the only open part of the 34" x 18" tub is the front 18". The sides are melamine and back is pegboard.