Post Wound and Surgical Care for C. pyrrho juvenile

Hi All,
sorry I have not been around for a very long time - busy summer and all. This post is pretty much just an account of what I have done for an injured newt in the hopes that it may help others or if someone could point out better alternatives to what we did, but I do also have some questions. So here goes (and its going to be long).

To start, I have let my sister take 6 of my year old Cp juvies to work with her, and she has had them for a few months now. There was a slight size discrepancy in some of the animals when she got them, but I saw them yesterday for the first time since she has had them and was astonished how some had grown, and how some had not. 3 are very large, 2 a respectable size, but the sixth doesn't seem to have grown at all. And upon closer inspection, had a gaping wound on the lower left flank, several centimeters long with tissue protruding. Since I cannot think of anything in the tank itself that could have caused the wound, I am led to believe one of its very large siblings did it.

I took the animal home and placed it on clean wet paper towels and into the fridge. I work for a veterinary clinic, but have never asked my vets for help with my newts because we are strictly a dog/cat practice and I did not think they would know or feel comfortable treating a 'phib, and I also did not want to take advantage of them. But the last time I took a newt to an exotic clinic the Dr prescribed a medication that I learned from you great forum folks could be toxic to my animal. So instead of paying an office visit and possibly not getting great care anyway I took my newt to work with me, and my doctors said they would like to help.

I found a paper online published by Cornell on amphibian anesthesia and we followed those guidelines. The patient weighed 0.8 grams, so we decided to use Isoflurane as the anesthetic agent. We soaked a cotton ball in Iso, and held the cotton to the dorsum of the newt. The newt did experience an excitement phase but it only lasted about 5 seconds or so. What we considered deep anesthesia rapidly occurred. We did not prepare the surgical site with any scrubs or topical antiseptics. I held the animal ventral side up with the cotton ball still in contact with the back, and the doctor used a cotton tipped applicator wetted with sterile water to push the abdominal tissue back in place. She at first tried suturing with 5-0 PDS, but the skin would tear. So she switched to 6-0 Vicryl, and this worked much better. We first considered using no suture at all, and only trying cyanoacrylate, as we had read that was safe for amphibian use, but we also read that it may not hold well. We also were concerned about using the tissue glue where it would come in direct contact with an open body cavity. Thus, the suture. The entire suturing took about 15 minutes because the newt was so small and the doctor was very concerned about stitching organs. After 5 minutes or so I took the Iso soaked cotton ball away, but the patient started to move almost immediately, so we reapplied. We also frequently wetted the ventral side of the body with the sterile water. Once three stitches had been placed to the doctors satisfaction, we took the Iso away, and bathed the patient in sterile water according to the Cornell paper guidelines.

I was hoping the patient would start to move around again shortly after the anesthetic was taken away and the bath was given, but it did not. The Cornell paper said recovery could take up to 80 minutes following anesthesia but I was still pretty worried because the dorsum that had been in contact with the Iso looked really dry, as did the toes and limbs. I was afraid that it had dessicated too much to recover, and felt really bad that I had not paid better attention to wetting that part of the animals body. I thought for sure it had died, but placed it on more clean paper towels saturated with sterile water, and put it back in the fridge for another hour. After an hour it still looked dead, but after 2 hours and being out of the fridge for a few minutes it started to move around and I as well as all the doctors and my co workers cheered! It was nice how the whole clinic rallied around the little guy, and they asked that I keep them all updated. I am planning on offering black worms to the newt tomorrow. I do not know the last time it ate, but there was no regurgitation following anesthesia.

OK, so here are my 2 questions. I am planning on bathing the little one in an antibiotic solution twice daily for two weeks. I don't know if it matters but I have been debating between Tetracyline or Erythromycin. Does it matter? In this circumstance is one better than the other? The wound as of now is not showing any signs of infection (it looked like it was very fresh when I saw it yesterday and my sister swears up and down the animal was fine and whole that morning) but tissue was protruding out of the abdomen and I would rather treat with something as a preventative and not wait for infection to occur, unless none of you think it necessary. Also, 2 weeks sound about right for treatment as long as the wound looks good? Shorter? Longer?
And question two. I have been keeping the animal in the fridge because thats the old standby for an injured/sick newt. However, the newt is very lethargic and non responsive when it comes out of the fridge (I keep checking on it and pulling its container out to take a peek about every hour). After being out of the fridge for a few minutes, though, it starts looking and moving around a little. Should I keep it in the fridge? Is it just resting/recouping and therefore holding still, or is its lack of movement when cold something to be concerned about? My basement air temps are about 67degrees F, and the fridge is obviously much cooler than that. I am thinking the fridge is the best place, but it is very small and if you guys think its not the right thing I will forgo fridge cooling.

Thank you all for reading. I know it was long, but I do hope others can find something useful in it. Any tips or suggestions are so very much appreciated. The little guy has made it through quite a bit thus far, I sure hope it makes a full recovery. Dr Kris, the "newt surgeon," suggested I name it Phoenix, as it certainly seems to have risen from the ashes. Fingers crossed...

Sorry but I cannot answer you about the medicines.
I think the fridge is the right solution until the antibiotic make its effects. I would keep it in the fridge still few days. Also it will need food soon and I don't think it will eat and digest normally in the cold fridge.

What you do is great and instructive.
Thanks to share this with us and thanks for that newt.

Hi Heather,

Interesting to read!

I realise that treatment options may be limited in such a small animal, but I have to say that I would not go with either antibiotic listed - a third (or higher) generation cephalasporin such as ceftazidime would be my first choice, possibly in combination with a fluoroquinalone. Ceftazidime would need fairly extreme (and thorough) dilution and application by drop on skin, while a water bath dose for ciprofloxacin is available. Tetracycline relies on the animal's immine system functioning well which may not be the case here, and in any case there is an awful lot of resistance to it around. I can't find a dose for erythromycin off-hand, and the spectrum is not ideal for likely amphibian pathogens (mainly gram negatives). It's also prone to causing stomach irritation, though I've no experience of it in amphibians.

I know this is against some of the advice here, but I would stop fridging, at least after a couple of days of antibiotic treatment. The slower metabolism will affect possible drug toxicity as well as slowing any healing reaction, so I would go with the normal temperature for the species. In view of the behaviour you're describing, I would feel that normal temperatures (a wider thermal range than normal, to let it choose) would be best. Still to find any paper suggesting healing is better at lower temperatures as described - still would appreciate any references.

Hope this helps, and I hope the little guy makes it.

Bruce.

Thanks for the replies. Bruce, your information is very helpful, but I am worried it may not be needed now. I kept the animal in the fridge all night, and this morning it seems pretty lifeless. I am not completely giving up yet, though, since this is what it looked like following anesthesia yesterday. I hope the cooling is not what pushes it over the edge, but I should have taken more heed after it would become so lethargic from cooling yesterday. I will keep you updated.

The little newt died. I really regret that I did not take better cues from its behavior when cold after anesthesia. Maybe it would have died regardless, but if I were to have this to do over again I think that would be the only thing I would change. I do not regret doing the "surgery," as I think the newt could not have recovered from such a wound had it been left open, but maybe also surgery was just too traumatic. I do not regret euthanising said newt, which is what I was first going to do when I saw the gaping wound with fair amounts of tissue protruding, and I feel that I gave it the best chance at recovery. In others experience have you had such badly injured newts recover with just antibiotic baths and separation/quarantine? Does anyone think I was too extreme with this procedure?

I have also learned HOW VERY IMPORTANT it is to separate newts according to size even in such a peaceful/gentle/benign species as Cynops pyrrhogaster. Live and learn *sigh*

Sorry that he passed, but thank you for posting this story. I know I'm not alone when I say this was fascinating.

Interesting thread, sure to be helpful to others. Thanks for posting.

Heather,

Sorry to hear that.

If the coelomic cavity was open, I would say that surgical suturing was absolutely the best choice. In theory it might have been nice to use analgesics and fluids to reduce the shock/trauma of the surgery, but I appreciate the difficulties with such a small patient, and trying to give analgesics would have risked overdose.

Bruce.

Bruce, which analgesics are safe to use? I am hoping to never have to repeat this, but I want to learn as much from this experience as possible. In regards to administering fluids - let the patient soak in a bath of amphibian ringers or saline? If so for how long would you soak them?
Thank you very much Bruce,
Heather

This is a really great anecdote, Heather. I appreciate you taking the time to post it and hope it may be educational in the future. I'm also sorry that you lost the newt in the end.

Could I make one recommendation? Could you split up your big paragraph into smaller ones? It's really hard to read a chunk of text that large on the computer.

Sure thing Abrahm.

jewett said:

Bruce, which analgesics are safe to use? I am hoping to never have to repeat this, but I want to learn as much from this experience as possible. In regards to administering fluids - let the patient soak in a bath of amphibian ringers or saline? If so for how long would you soak them?
Thank you very much Bruce,
Heather

Click to expand...

Hi Heather,

There's pretty limited data on analgesics in amphibians, but anecdotally carprofen, meloxicam and various opioids have been used with no apparent problems. Opioids are the only ones that have been experimentally shown to have analgesic effects, as far as I know.

I'm not aware of any that have been used in baths, which is why I made the comment about difficulty of dosing - such extreme dilution would be needed for such a small animal that the risk of over or underdosing would be quite high.

Fluids yes, just using amphibian ringers solution. It can be used as a continuous bath (i.e. as the animal's water), although various dilutions (10-100%) can be used as well.

Hope this helps,

Bruce.

Thanks again Bruce. I feel that at least this has been a learning experience for me. Though I hope I never have to use any of this again.
Heather