Advice for my BEL and her RI

So my sweet 3 year old BEL came to me with an RI and I'm at a point now where I have to decide whether to wait a bit more or do a second round of antibiotics. I got her in early December and shortly noticed a slight popping sound. This became worse over the next few days and so I brought her in to the vet on the 8th. She was diagnosed with a mild RI and given a 14 day rx for Claforen to try and just catch it early and knock it out (while being a less potent antibiotic it had less risk of scarring on an all-white snake). 2 weeks later and she was not fully cleared up, though she was much better. Just a slight popping and a little fluid discharge if her head was below her body. Vet did a culture and advised to wait a couple weeks and see if it cleared up the rest of the way.

It's now been 2 weeks since the end of the antibiotics and the culture results are back. The main causative organism for the infection was one susceptible to the claforen and the vet thinks it was properly knocked out. They did find two more rare organisms: Stenotrophomonas maltophilia and Achromobacter xylosoxidans, which my vet said she had never encountered before, but are uncommon and usually associated with infections obtained while in a hospital or in wet/damp environments. At this point, my vet thinks we should try a stronger antibiotic, but she isn't in a huge rush.

I feel like I should wait another couple of weeks, as her symptoms are still improving and it seems like she is slowly getting better. She is acting normal and staying on her hot spot most of the time. She hasn't pooped since I got her and she hasn't peed even in several weeks (at least no noticeable urates. She did manage to eat a medium rat two nights ago and acts normal when I take her out of the cage. I raised her temps to a hotspot of 95 and ambient of 80 at the vet's recommendation and humidity is around 60%. She has not lost any weight either.

Any advice is appreciated.

Wintre says "thanks!"

https://dl.dropboxusercontent.com/u/...2011.11.09.jpg

I would go with the vet's recommendations and start on a stronger antibiotic that is appropriate based on the results of the culture. If your snake still has symptoms then any bacteria that didn't get killed off will be the ones most resistant to the Claforen - you don't want those taking hold and multiplying, since that's how drug-resistant strains of bacteria get created.

Good luck hope she feels better!

aawww poor baby.

follow the Vet's orders. and Bcr makes great points as usual. make sure she's comfy and her enclosure stays clean.

feel better soon Wintre!

So it's been another week and she isn't getting worse, but is also not getting any better, so I'm going to go with some more antibiotics.

So after doing my research and talking to my vet, the recommended antibiotic is TMS, which they only have in an oral solution. He says it's very difficult to give for ball pythons and injectables are much easier. Has anyone given oral meds before? I think I can do it as I've been getting more accustomed to holding Wintre's head and getting her mouth open in assessing her illness. They said they can order TMS in an injectible solution, but they don't know how long it will take to get.

The alternative is Zosyn, which he says may or may not work on the S. Maltophilia.

I think the oral is my only real option at this point. Time to watch some more youtube videos on it...

How often does it have to be given? If not every day get a small needle syringe and inject small prey items with the antibiotic. I never had to do it but have heard of people doing it that way

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Originally Posted by treaux

So it's been another week and she isn't getting worse, but is also not getting any better, so I'm going to go with some more antibiotics.

So after doing my research and talking to my vet, the recommended antibiotic is TMS, which they only have in an oral solution. He says it's very difficult to give for ball pythons and injectables are much easier. Has anyone given oral meds before? I think I can do it as I've been getting more accustomed to holding Wintre's head and getting her mouth open in assessing her illness. They said they can order TMS in an injectible solution, but they don't know how long it will take to get.

The alternative is Zosyn, which he says may or may not work on the S. Maltophilia.

I think the oral is my only real option at this point. Time to watch some more youtube videos on it...

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I know injection are no fun however they are far more effective than oral anti-biotics when it comes to snakes, if it was my snake I would get the injectable solution.

As far as length of time based on DR Stahl who is the best exotic vet in the country it is of his opinion that RI treatments should be no less than 30 days.

http://www.blogtalkradio.com/reptile...ile-veterinary

This may give you and your vet some other ideas, this boa was also diagnosed with a Stenotrophomonas maltophilia infection after a culture:
http://www.redtailboas.com/f16/tylos...g-sorta-44909/

I've read that thread before. Thanks for the advice. I got a prescription for the oral TMS for the next 21 days. If I don't see an improvement after that, I'm going to take her up to UC Davis and probably get a new culture done and see what they think should be done. I've heard they are a very good place to go, though they are expensive. I like my vet, but he is kind of nonchalant about the whole thing and didn't even come out to talk to me today when I came to pick up the meds. TMS should work on both the bacteria that she has and giving the first dose was pretty easy, so I'm hoping it will do the trick.

Thanks for the well wishes :)

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Originally Posted by treaux

I've read that thread before. Thanks for the advice. I got a prescription for the oral TMS for the next 21 days. If I don't see an improvement after that, I'm going to take her up to UC Davis and probably get a new culture done and see what they think should be done. I've heard they are a very good place to go, though they are expensive. I like my vet, but he is kind of nonchalant about the whole thing and didn't even come out to talk to me today when I came to pick up the meds. TMS should work on both the bacteria that she has and giving the first dose was pretty easy, so I'm hoping it will do the trick.

Thanks for the well wishes :)

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Excellent! Hopefully the TMS does the trick.

So this poor snake is going through hell now. Her RI hasn't changed much after starting the TMS, but she seems to be having a reaction to the medication. She started out developing some black spots about the size of a pea all over her body that have now developed into swollen hives. The only explanation seems to be a reaction the the TMS so I'm taking her off it to see if the hives go away. She is still moving around, but looks miserable like the hives are causing her pain. If they don't start clearing up tomorrow my vet advised to give some Benadryl or to bring her back in.

Meanwhile, my other snake Tweak who I got at the same time as Wintre appears to have come down with the same RI. He's now on broad spectrum antibiotics as well. My T8 has become the snake infirmary.

Thankfully, all my other snakes are doing well and I'm making sure to keep the sick ones isolated and to not touch anything they come in contact with before working with my healthy ones. Hopefully things will start looking better for Wintre and Tweak.

That's odd. I've heard of Baytril causing reactions at the injection sites, but you said the TMS is administered orally, yes?

Yeah, she's had about 8 doses orally.

Bumping this thread back up since I never updated it.

So I stopped the TMS administration after her allergic reaction started and it went away on its own over the next week or two along with her wheezing and popping (just kept her temps up that whole time).

It's now been 6 months and she is acting normal and healthy (just found her wrapped around the water bowl even), but she still will drool a little bit clear fluid if her head gets below her body while being handled. I don't hear any popping and her breathing isn't labored at all. Is this normal? Should I be concerned? I was thinking of pairing her for breeding, but I'm worried that her drool will contain that bacteria that caused such a bad infection for her before. I'm thinking I want to go have that cultured one more time just to see.

Any input would be appreciated.

i'm glad she's doing better but that drool is a concern. is the drool watery? or does it have some viscosity? get the culture done. i think she should still be in QT until it's all sorted out and shes 100% strong.

Yeah, it's a light, watery drool. I opened her mouth and didn't notice any excessive mucus or anything. I was not so happy with my last vet, so I'm trying to find a new one who can take a look at her.

u live in the Bay? the famous Brian Gundy of For Goodness Snakes is in the South Bay and posts on the forum randomly and mostly likely knows a good herp vet. AbsoluteApril also lives in the area and would know. she's an Mod over at Fauna and posts here too.

good luck, keep us posted. i hope lil white noodles are in her future. :)

I got her an appointment to see a specialist Monday at UC Davis. Hopefully they can figure out what's going on.

So just an update on Wintre. We went to UC Davis Exotics clinic and she was examined and they did a cytology test of the fluid coming from her mouth.

Their initial observations are that her trachea seems clear and the fluid is coming from behind it; possibly from the esophagus. Since she is behaving and eating normally, it seems like RI is low on their suspicion scale. The issue is it's still a decent amount of fluid that's constantly in her mouth and is most likely the result of some sort of inflammation.

The next steps for the vet are to do blood work and x-rays to try and get a better idea of what's going on. This of course is going to cost another $500 and my fear is they will do it all it will all look normal. So far I've spent about $500 on Wintre at the vet and this will up it to $1000 overall, which is considerable if I don't get any results.

Otherwise, she is acting normally and has shed, pooped and eaten all within the last week. She also has been wrapping her water bowl recently when I have checked on her.

I'm about to make the appointment for the extra tests, but I'm very nervous I may just be wasting money.

Here's poor Wintre after a day of being shuttled around and harassed at the vet. Still pretty as ever:


https://dl.dropboxusercontent.com/u/...2013.29.01.jpg

u seem anxious to breed her and have made several mentions of her bowl wrapping. it’s your animal(s), your money and u will ultimately decide what to do. but let me ask, if u can’t trust a specialist, who can u trust? it's concerning that she did not drool prior to her illness which makes me think something is wrong. maybe it will turn out to be no biggie and it will be like how some peeps walk with a limp. sure something’s wrong but u can still live with a limp and do stuff, live life, etc.


Wintre looks great BTW. really glad she lost the black spots u had mentioned from her allergy to medication.


Edit: there's vet recommendations on the forum including this one here in the bay - http://ball-pythons.net/forums/showt...=1#post2464964 if u are looking for other options.

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Originally Posted by Ax01

u seem anxious to breed her and have made several mentions of her bowl wrapping. it’s your animal(s), your money and u will ultimately decide what to do. but let me ask, if u can’t trust a specialist, who can u trust? it's concerning that she did not drool prior to her illness which makes me think something is wrong. maybe it will turn out to be no biggie and it will be like how some peeps walk with a limp. sure something’s wrong but u can still live with a limp and do stuff, live life, etc.


Wintre looks great BTW. really glad she lost the black spots u had mentioned from her allergy to medication.


Edit: there's vet recommendations on the forum including this one here in the bay - http://ball-pythons.net/forums/showt...=1#post2464964 if u are looking for other options.

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Thanks for the input. I agree that at this level of diagnostics, I wouldn't want to go anywhere else and feel like I should follow through. Even if they don't give me an answer to what is causing it, it makes me feel better about continuing with my first breeding project. I've been planning this for a while now and it got delayed about 9 months after Wintre got sick, which makes me happy she's showing some good signs lately and appears to be in good health other than this drool thing. The upsides are that they didn't find anything contagious in the fluid and she doesn't have any outwardly signs of infection. The blood work should confirm that and at that point I feel comfortable breeding her. She is also a pet for me so I want to lower the chances of risk for breeding as I want to have her a long long time.

As for the black bumps that turned in to hives, there doesn't appear to be any scarring or marks left over. The vets at UC Davis were very intrigued by her reaction as they also hadn't seen it happen before and had me send them all the pictures of it for them to study.

Working on a return appointment still and will update this thread when I have more info.

So another Wintre update. Upon having blood work done and x-ray, it appears everything is normal other than a slight white count elevation and the fluid in the back of her mouth. Doesn't look like an RI, but there is definitely inflammation somewhere and a possible infection still. Vet prescribed Ceftazidime and Meloxicam injections which I started tonight. Will collect a stool sample and have it checked for parasites when I can. Otherwise, poor Wintre is in for another month of injections. Hopefully this will clear her up fully!

sending well wished to Wintre. i got my fingers crossed for u guys and my snakes got their tails crossed as well.

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Originally Posted by Ax01

sending well wished to Wintre. i got my fingers crossed for u guys and my snakes got their tails crossed as well.

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Thanks for the well wishes. We are a week into the injections now and I can tell she's not feeling great. She tends to just camp out on the hot spot and not move at all when she's on antibiotics. I guess that's a good sign since the vet recommends elevated heat (simulating a fever in humans I assume) to help fight infection. I have her back in the T8 (now dubbed the infirmary) where the temps are a little bit more stable and sure enough she has not moved from her hide on the hot spot (now set at 95 degrees, with an 80 degree cool side). I'm not going to offer food until after the Meloxicam as it can cause GI discomfort and irritation. I doubt she will eat anyways at the moment.

Here's her current state:

https://dl.dropboxusercontent.com/u/...2016-09-06.jpg

Hoping for the best! There's so much about snakes even vets don't know so this is really a giant learning experience for everyone involved. Just reading this has been a learning experience. It's still unfortunate poor Wintre has to go through this mysterious illness [emoji53]She looks gorgeous as ever tho!


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Honestly I wouldn't pair her with any males until she has been symptom-free for at least six months. Yes, waiting stinks. Having two sick snakes stinks even more.

The reason I thought of it was a poster on the boa forums who only waited four months after her boa's RI cleared up to pair it, and the problem ended up being a viral rather than a bacterial infection. Now her whole collection is on lockdown.

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Originally Posted by bcr229

Honestly I wouldn't pair her with any males until she has been symptom-free for at least six months. Yes, waiting stinks. Having two sick snakes stinks even more.

The reason I thought of it was a poster on the boa forums who only waited four months after her boa's RI cleared up to pair it, and the problem ended up being a viral rather than a bacterial infection. Now her whole collection is on lockdown.

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I agree and she's out of breeding plans for this year for sure. The vet wasn't overly concerned with her being contagious as they didn't find anything "worth culturing" when they did the cytology, but I'd worry more about the stress of breeding making her run down and having whatever it is come back full force. She's really my pet first and I plan on keeping her in the bedroom from now on in her own T8.

I was excited at the thought of breeding her for my first breeding project, but I also have my Lessers reaching breeding size this year and one has already locked with our pretty Lemonblast male. Second lesser is almost up to size (they are all eating like pigs lately) and will pair with our Crystal dude, so still might make white snakes in the first season.

I just want to see Wintre get better. She seems to be popping more since I started the antibiotics, which is worrying. I fear the month will go by and she will not have gotten any better. I am still looking for a better vet as UC Davis seems very clinically knowledgeable and great at diagnostics, but lacking experience and interest in dealing with snakes.

Hi all,

I'm the other half of the "we" Treaux references above. I'm just popping in to say thanks for the well wishes for Wintre and for the resources you all offer and create here. Being a part of this community, has given us lots of incredible food for thought as we consider our husbandry and pairings, etc.. So... thanks, everybody, and keep up the good work and exciting discussions!

xoxo,
Beks

Wow! The saga continues and she seems like she's been through so much. Hoping to see her fully healed and ready for the next breeding season. Good luck. Wintre is a amazing ball python. :gj:

Another update on Wintre. Unfortunately, as I come to the last couple doses of Ceftazidime and almost a month of treatment, her condition has only worsened. She now has thicker mucus production and a noticeable work of breathing when exhaling and her scales have become really dry (despite normal humidity levels). She doesn't seem in distress and is still acting normally (no stargazing or anything), but clearly whatever low level infection we thought was there has reared its head fully.

I spoke to the UC Davis vet who wants to test for Nidovirus (though after reading about it seems unlikely) and I found a local vet who can do the test, Dr. Louisa Asseo. I have an appointment scheduled for October 3rd which will give Wintre a week off from the injections to recover. I would like to get the opinion of this new vet as she comes recommended from Anapsid.org and is a reptile enthusiast. I am debating having a new culture done since there is more congestion to see if there is anything we can fight specifically.

For a while, Wintre was staying on the hot side at 95 degrees, but during the injections she moved to the cool side, which is at 80. I'm debating raising the overall temps so 90-95 degrees to force her to stay in the heat, which has been recommended to me by my first vet and another local breeder that I trust.

I'm wondering if this is still the original bacteria that were very resistant to antibiotics and if maybe Wintre needs more of the TMS (maybe injections this time).

At this point I'm just frustrated and want her to feel better. Seeing her get worse is very worrying and I would hate to lose her after all we've been through. She has such an amazing personality and is an ambassador snake for those who are not familiar. My mom went from being scared to touch her to raving about her on Facebook to all her friends after just one visit.

Keep those fingers and tails crossed for us!

Her mucus has now turned brownish and she is holding her mouth open periodically to help with breathing. She's moving slower and I'm worried. She just had her last dose of antibiotic last night, but I think tomorrow I'm going to be getting her in to see a vet.

Oh no :( I'm so sad to hear that she's not improving. I really have my fingers as toes and tails crossed for you! I hope that the vet can help get her on a regimen that helps her beat this nasty RI. Keep us updated my friend, were all here for you


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:( poor baby ! Hope everything goes well , an she starts a speedy recovery soon . Shes pulled through all this time , so I have high hopes , she will get out of this as a beautiful healthy thriving snake ❤️

Coming into the thread late....

Really sorry to hear this. Did they do a culture to pinpoint the organism? Blood work?


Dave

The last culture was "unremarkable" according to UC Davis. Her blood work was normal with a slightly elevated white count. This is why they prescribed broad spec antibiotics as there is some sort of underlying infection or inflammation. She started looking worse and worse over the month of antibiotics.

Got her an appointment at 3:30 today. We'll see how it goes.

Another update: First off, a big yay, as I have finally found a vet who will now be my permanent one. I found a local vet (Dr. Louisa Asseo) who really knows what she is talking about and has lots of experience with reptiles and a genuine interest in them. She actually listened to me as I gave the (now quite long) history of Wintre's illness and confirmed my suspicions that the things UC Davis was wanting to look for were both rare and unlikely in Wintre's case (IBD and Nidovirus).

Wintre spent the night as the appointment was late in the day and the next morning was sedated, had blood drawn and her lungs flushed to both clean her out and get a deeper sample of her infection. Dr. Asseo ended up finding a big mucous mass that she took for culturing along with the fluid from the lung lavage (unfortunately had to pay for two separate cultures). She also threw in a set of x-rays for free which she said looked good. Wintre is seeming better simply from the procedure, though she is still doing some open mouth breathing and has clear mucous in her mouth.

So now we are in the waiting stage to hear back with results. Hopefully something will culture out that we can treat for.

I'm also greatly disappointed with my trips to the UC Davis Exotics vet. I understand it's a teaching hospital, but it appears that despite their high level of knowledge and acclaim, they do not excel at the basics of treatment when it comes to reptiles. We spent around $1000 and in the end they never cultured anything out and just gave broad spectrum antibiotics. Just goes to show that finding a good and experienced reptile vet is absolutely essential if you have a sick snake. I found Dr. Asseo on the Anapsid.org recommended vets list and I think I feel much more at ease after our first visit.

And more follow-up:

Dr. Asseo just called with some results. Impressively, her lungs were completely clear and cultured out nothing. The gunk from her nasal passage, however, cultured out a pure culture of Stenotrophomonas maltophilia, which was the original bacterium we cultured and treated when she got sick almost a year ago now.

Since she had an allergic reaction to the TMS, Dr. Asseo has her lab looking for sensitivities to other antibiotics that will be effective in killing it. She thinks she will have something by the end of the week.

I'm so happy that we finally have an idea of what's going on and I hope this next round of antibiotics will knock it out for good.