Prolapse

leighton · Apr 3, 2004

As a couple of you will know from the chat last night (and many thanks for your patience and advice), our female (Peely) went into cloacal prolapse last night. We're probably lucky in that it wasn't (after some initial doubt) swollen, and was transparent, without any obvious blood beyond the vessels that were running through it.

We transferred her to a small quarantining tank with some tank water, and kept her in the fridge overnight (to avoid bacterial growth, and to slow her metabolism) with no filtration or substrate.

The prolapse hadn't improved or worsened this morning, so we looked for a vet in the area who could advise, and happily enough found one. They consulted with a specialist in Edinburgh, who advised pushing the prolapse back in with cotton buds (Q-tips) and KY jelly, then application of a purse-string suture. Three-quarters of the prolapse was replaced by the vet before we felt that Peely had been out of the water for long enough, and the suture was not put in place, erring on the side of caution through inexperience with thin axolotl skin.

We have antibiotics to administer, and are now monitoring her for two days; if the prolapse doesn't retract further of its own accord, we have a referral to the specialist. We'll let you know how we get on.

matthew · Apr 3, 2004

Leighton,

Sorry to hear of your bad luck.

I think cloacal prolapse in amphibians is one of the most distressing and dramatic conditions a keeper can face. (Pity the poor doctors and nurses who must contend with prolapses in human beings.)

(At the risk of going off-topic a tad, I have seen this in treefrogs before, on a couple of occasions, one of which I happened to be the owner of. I have learned from my vet and his textbooks that the most frequent causes are trauma (e.g. a blow), infection (e.g. nematodes)or straining. I have also heard it said that genetics may make an individual animal more prone to this problem. There is always that difficult choice for the owner - a surgical intervention with the prolapse replaced or wait-and-see. The key thing with frogs, unlike axolotls, seems to be a temperature *raise* and keeping the animal in water; the last case I saw - again a frog, kept aquatically - retracted by itself in 72 hours.)

Anyway, what I wanted to say is that sometimes these things really do resolve naturally and spontaneously. Well done for getting specialist help. Fingers crossed...

leighton · Apr 3, 2004

Thanks, Matthew. It was rather distressing to see, even though it is apparently relatively common (the vet we saw had rectified one for a snake last week). We were told that potential causes could include straining through egg-laying and large quantities of poo. Peely had a history of both, this week.

The antibiotics we've been given are, apparently, for oral administration... does anyone have any advice on how to give these other than by attempting to ease the axolotl's mouth open, because we are having no luck so far. The antibiotic is in solution, and we have a small syringe (no needle).

matthew · Apr 3, 2004

Any chance of getting a needle for the syringe?

If you are not of a queasy disposition, an easy way to give the antibiotics, in the right strength / solution & in the right amounts / dosage, is by injecting it into a waxworm, just before you offer it. I know, I know it is a horrid thing to do, but a vet showed me this and it works.

I always worry about clients leaving vets with medication for amphibians that is neither to be injected, nor to be given topically, nor via a bathing solution... so how do you do it? With frogs (and lizards!) there is a way to open the mouth and put medication in - I've seen a vet do it - but there is a knack to it and it is a process that really worries me.

I'd ask your vet for a "sharp" and try to use food items as a delivery vehicle.

leighton · Apr 4, 2004

Using food as a delivery vehicle is a very good idea, Matthew - I don't get queasy over worms, and I'd definitely try it if we had a needle, or the vet's was open on a Sunday (if I still worked at the university, I'd have nipped in to get one). We haven't been able to administer the antibiotic orally, so at the moment we have Myxazin at half dosage in the quarantine tank. This was partly also to fend off what looked like the beginnings of an opportunistic fungal growth (the tank is not currently refrigerated).

The good news for us is that the axolotl is not off her food, and the partially-retracted prolapse has not worsened. She seems comfortable, but if the prolapse doesn't retract completely over the next 20hrs or so, we'll be off to the vet school in Edinburgh tomorrow.

matthew · Apr 4, 2004

Some miscellaneous thoughts, Leighton.

*I've never tried to use a red earthworm so can only recommend waxxies (used for a lizard who'd snagged a toenail!). If you do use a waxxie, I'd suggest injecting away from the head, in the direction of the tail (it will balloon up but still wiggle) and wiping the worm before you offer it so that if there is any contact with the water you don't get a film of medication on the surface. It sounds like you really know your onions so suggestions to be careful about not injecting straight through the food item rather than into it, or to put the sharp onto the needle after filling the syringe would be deeply patronising.
*I think myxazin is a great medication.
*It may not be a fungal infection (if this is the area concerning you). The prolapse may change colour a little even if it is not filled with blood vessels.
*Should stitching be required, this is a crucial process. It needs to be done so carefully if function is to remain there.
*So far, so good... she seems to be in the best possible hands. There are probably quite a few animals in shops that develop this and suffer in silence, especially frogs who crawl away into a corner when just treatment with warm water and an antibiotic would probably save them. Keep us posted!!!

edward · Apr 4, 2004

Another cause of rectal prolapses is calcium deficency, I would not rule this out. This is a common cause of prolapses in anurans. Purse string sutures if done properly work very well in amphibians and can help prevent the prolapse from reoccuring.

Ed

leighton · Apr 4, 2004

Thanks for the thoughts, Matthew. I don't mind being patronised - like everyone else, I forget things, even if they were once routine. And, while I can occasionally smell onions, I'm still firmly on the learning curve

. I share your concern at pet shop 'care', too...

The fungal infection (if it was one) wasn't really localised to that area - it was a generalised furring along the side that had been in contact with a dampened towel at the vet's. It looked much like the furring that we found on our male's tail a while ago (there's another thread about that one) - which is why we suspected fungus immediately. It may well have been something else, but the Myxazin caused it to dissociate, and cleared it in minutes. I should take a sample into work (I'm in a mycology and bacteriology department).

The prolapse has now turned white (constricted blood flow?)but the axolotl seems responsive, and is definitely interested in food (as judged by going for my finger), if a bit tired.

Ed, calcium deficiency is an interesting possibility. Our pellets don't mention calcium in the ingredients or analysis, and I'm unsure how much would be in earthworms. Would the calcium in Holtfreter's solution be sufficient to prevent deficiency, do you think?

matthew · Apr 4, 2004

The last prolapse I saw turned pale white... it still went back in nicely.
Your tip is fascinating, Ed.
My axxies get "earth" worms (mostly), waxworms and gutloaded crickets - no pellets - how can I ensure sufficient Ca? How can you get Ca into worms?

edward · Apr 4, 2004

Actually increasing the calcium level in earthworms is very easy. Just add some calcium to the soil with the earthworms. The calci sands are a good for this as the sand grains are easily ingested by the worms. Some people use ground calcium carbonate mixed with the soil but I prefer the other method. In addition earthworms and (If done exactly correct) pinhead crickets and mealworms are the only feeder insects in which a positive calcium to phosphorus balance can be achieved through feeding the invertebrate calcium rich foods.
Depending upon the manufacturer, you can get a more complete nutritional analysis on request but with these types of foods the ingredients and ingredients can vary widely between batches.

Ed

edward · Apr 4, 2004

I forget to comment on the Holfreter's solution. As this contains calcium, it will prevent calcium loss to the surrounding solution (and I suspect the animal can scavenge some calcium from the solution but do not have any references documenting this ability off the top of my head.).

Ed

leighton · Apr 5, 2004

We're back from the 'Dick Vet' (Edinburgh Hospital For Small Animals). It proved possible to replace the prolapse without surgery or suture (at least in part thanks to the good work done by our regular vet), and we now have more oral antibiotics - but at least this time some sharps to place them in food. Peely seems quite happy, despite the long trip, and suffering my driving, and is not off her food even after all the attention.

We're to keep her on antibiotics and in Myxazin for five to seven days, as a precaution, but it looks like she's out of the woods (touch wood).

Thanks for all the advice and help - you set our minds at rest while we were quite worried.

On an aside, while at the Dick Vet, they mentioned that Edinburgh water, at least, has moved from chlorine to chloramine disinfection, and that this has been throwing up problems both for pets and at the zoo. They provided us with a handy sheet indicating which proprietary products do and do not deal with chlorine/chloramine and ammonia, which I'm happy to share - perhaps on a more general thread.

edward · Apr 5, 2004

Hi Leighton,
If you filter the water through a filter containing activated carbon this will remove the chlorine from the water.

If I am in a hurry and I am changing less than 25% of the water I will occasionaly use tempered tap water into the aquarium as the chlorine will be quickly removed by the carbon filters I have on the systems.

Ed

leighton · Apr 5, 2004

Thanks, Ed. I've since put the list in the Enclosures/vivaria forum, just for info. We've been using Tetra Aquasafe ever since we got our axolotls, and this handles both chlorine species, though we have a couple of emergency filters (ion-exchange, rather than carbon, I think) to remove ammonia in case we lose biological filtration.

leighton · Apr 5, 2004

Hmm... too optimistic, too soon...

Three hours after we got back, there was a slight recurrence of the prolapse - not as bad as before today's treatment, but still there. The good news is that the axolotl is in no way off her food, and doesn't seem distressed at all. I'll have to call the hospital again tomorrow, and see what they suggest

.

matthew · Apr 5, 2004

I'm not surprised.
My frog's recurred slightly less than 24 hours after surgery.
Hang on in there!

leighton · Apr 7, 2004

Peely's now in the Dick Vet for a couple of days. They'll be trying non-surgical procedures (e.g. replacement and inserting KY Jelly to extend the bowel) first, and suture/stitch as a last resort. Our fingers are crossed.

edward · Apr 7, 2004

Hi Leighton,
Given how many times the prolapse has reoccured, I am doubtful that it will stay in on its own. In the various frog species I have seen with prolapses, if it reoccurred after the first replacement it usually needs to be sutured.
Good Luck,
Ed

leighton · Apr 8, 2004

We had an update from the vet this afternoon. The prolapse recurred again, so they took X-rays and noted that Peely's skeleton seemed under-calcified (looks like you might be on to something there, Ed), and also that she'd swallowed a lot of sand - possibly in an instinct to obtain minerals from the substrate.

She can pass still faeces through the prolapsed bowel, so they're looking to 'encourage' the sand to leave the bowel before any more suture/stitching/replacement attempts. In the meantime we'll be looking about for a slate substrate for the main tank, and working out how to get more calcium in her diet.

edward · Apr 8, 2004

Hi Leighton,
As a general rule you want the calcium to phosphorus ratio to be between 1 and 2 to 1. Also an improper ratio of vitamin A to D3 has been implicated in poor calcifucation of bones in axolotls so the food items should have a vitamin A to D3 to E ratio as close to 10 to 1 to 0.1 as possible.
Ed

Prolapse

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