Hi everyone and welcome to the 2nd of this 4-part webinar series on non-captive marine mammal medicine in the UK. In this talk, we will discuss the options available to seal pups in the UK that have been rescued and how we decide which option is best for each pup. We'll also look at the commonly seen problems in rescued seal pups and how to go about managing them in the initial stage after rescue.
First, I wanted to come back to your patient and go through the questions I posed at the end of the last talk. So firstly, this is a grey seal pup. We know this because of the longer snout, but also by the presence of some white coat, which only greys have when they are born, though I should mention the disclaimer that premature common seal pups can still have their white coat too, but this is actually quite rare to see.
So in terms of age, we have some white coat left, so the the pup might still be under about 3 weeks old and pre-weaning, but they do all moult and wean at slightly different rates, and some will hang on to some scrappy bits of white coat like this for a while. So I would estimate this pup to be around 3 weeks old based on looks alone. The respiratory rate is normally 5 to 15 breaths per minute, so at 32/2 minutes.
This is slightly elevated. The normal temperature is between 36.2 and 37.5, so at 38.5, it is definitely elevated.
This could be due to an infection or sometimes pups will overheat slightly as they travel in a car, which is why ventilation during transport is so important. But this temperature was taken on the beach, so it should be accurate. You can also consider the weather of course and if a pups you know been lying out on a warm beach all day, then certainly that could cause them to have a higher temperature.
At only 16 kg, it is definitely underweight for a grey, which we typically want to be at least 20 kg for us to not uplift. It's hard to tell from this photo, but looking at the size of the head and front flippers compared to the body, I'd say the body condition is poor. There's also a dip where the neck is and some loose rolls of skin to see too.
So, our list of concerns should include malnourishment, lethargy, dehydration due to the lack of those wet patches around the eyes. Elevated temperature, signs of respiratory disease such as an elevated respiratory rate and nasal discharge, and some minor injuries too. And on on examination, these turn out to be just some mild abrasions and cuts.
So what are the next steps for this pup, and if it requires further care, what is this going to involve? So there are a few options to consider for seal pups. Some are able to be released immediately after an assessment.
So it might be that a medic wasn't 100% sure about something and wanted a veterinary opinion, for example, before they released it. Others will need to be admitted for long term rehabilitation, and sadly some will require immediate euthanasia. Another option is to keep a pup overnight for monitoring and to decide if it's fit for release perhaps the next day.
So, for example, sometimes we'll have pups present exhausted after stormy weather and then they'll benefit from somewhere safe to rest for a night maybe before being released again. An option which is always available to yourselves is to call BDMLR and ask for assistance if you need help making a decision. If you call our hotline number, you will get through to head office or our out of hours team who may be able to assist themselves or we'll put you in touch with one of our veterinary consultants.
We're always very happy to help, so please don't ever hesitate to call if you need us. This slide helps to outline the criteria for those various options. A pup which is ready for release should be of a reasonable weight and body condition, preferably good condition, of course, and have no significant injuries or illness.
They should also be properly hydrated. A pup going to rehab may be malnourished or have significant injuries or illness, or a maternally separated pup which would otherwise not survive alone. And finally, pups which require euthanasia are clearly going to be severely unwell and not responding responding to treatment or with so little chance of recovery and successful release back to the wild, that we don't actually want to attempt treatment.
We must always remember that these are wild animals who are not used to being kept in captivity and being cared for by humans, so rehab is likely to be a stressful process, and we won't want to put them through that unless they are likely to survive long term back out in the wild. Now, seal pups can present with a whole array of different problems and this slide far from covers everything that we see. It does, however, highlight some of the most important and the ones I'd want you to be aware of after listening to this talk.
Firstly, malnourishment and dehydration, extremely common in our patients. Then we have a whole variety of wounds, such as the ones I showed you in the previous talk, ranging from very minor to very severe, and infections of these wounds are common. Other infections, particularly of the respiratory tract, are an important one, and we see both primary bacterial infections and primary parasitic infections such as lung worm, and we'll also see bacterial infections secondary to a virus or to lung worm, for example.
Nearly all pups will have a gastrointestinal worm burden, leading to diarrhoea. We also see a lot of trauma to the eyes and mouth, leading to corneal and oral ulcerations. Thankfully, though the majority of these heal very well and quite quickly, particularly the the corneal ulcers can be very, very fast to heal sometimes.
On the right side of the screen, I've listed some of the most common emergency presentations that we see in seal pubs. They could present collapsed or seizing, in which case we should think about the possibility of hypothermia, hypoglycemia, sepsis, particularly from a meningitis, or head trauma. Dyspnea is another and commonly associated with a pneumonia, particularly when lung worm is involved.
We also see fractures, some of which may heal with time or be suitable for surgical fixation, or in the case of a broken digit, the digit can be removed, but other times the pup will require euthanasia. It's worth giving us a call if you do have a pup with a fracture, so we can help you with deciding a course of action suitable for the pup. The same goes for ocular emergencies like melting eye ulcers.
Surgery may be an option, and as I mentioned in the first talk, seals can be released with one eye. So, the next slides discussing treatments are going to be referring to a typical non-emergency patient, such as the one that you're looking after, and we'll talk about emergencies again briefly later. OK, now let's move on to look at how we tackle these various problems we might be presented with.
Rehydration is absolutely critical for these pups and importantly should be done before the pup is given any food. We typically provide oral fluid feeds 3 to 4 times daily for the 1st 24 to 36 hours before considering introducing either a kind of fish soup made from blended mackerel in very young pups or whole fish for older pups. Commons are given a slightly smaller volume than greys at about 250 to 300 mils and grazes up to 350 mLs.
We give the fluids via an or a gastric tube and use typical oral rehydration solutions like Life aid or lecttaid or Royal Canon rehydration solution, for example. Sometimes in very weak or malnourished animals we'll add a teaspoon of glucose powder to each feed as well. Again, placing the tube isn't something I can teach you here in this forum.
The actual tube placement is very similar to domestic species. It's just the handling aspect which is the tricky part. Essentially, you restrain the pup, as I explained in the previous talk, straddling it with your knees and using the towel edge to form a muzzle by pinching it together under the lower jaw.
While holding the towel together with one hand, you use the other to introduce the lubricated tube into the mouth and allow the pup to swallow it down into the oesophagus and to the stomach. You can usually see the tube passing down the front of the chest, confirming placement in the oesophagus, and pup should be able to breathe normally around the tube. Not all pups want to open their mouths, so this can be tricky and requires patience sometimes.
Not all of our medics are trained to do this, but it's something we encourage them to learn once they're happy with basic handling. So some pups will have already had fluids on the beach and others won't. If the pup has an abnormal temperature, then often you'll want to do something to help correct that.
But obviously the extent of your interventions will depend on how severe the change is. For pups with an elevated temperature, simply pouring some cool water on the rear flippers can help to start bringing it down. Then of course you need to consider if this is a hypothermia or a pyrexia that that you're dealing with and act accordingly.
Pups with hypothermia, again depending on the severity, will need warming up. Drying them with a towel if they are wet is helpful, and you can make use of towels, blankets, and heat lamps too, though clearly the temperature will need to be monitored carefully to prevent accidental overheating. Other than wounds created during surgery, such as during a digit amputation, we leave them to heal by second intention.
Wound management is kept very simple most of the time, aiming to keep the wound clean with dilute hippy scrub, and sometimes a blue alamycin spray is applied. Manuka honey has proved really useful in infected sluffy wounds in aiding debridement and as an antimicrobial. Abscesses can be lanced, drained, and flushed as in other species.
Often pups with significant or infected wounds will require systemic antibiotics and anti-inflammatories as well. And I can say that all of these wounds photographed here healed very well with time. Even the particularly deep one on the seal's back in the very left photo did eventually heal with with time.
I wanted to mention entanglement wounds specifically as we're seeing these more and more frequently. Very often the entangled material will be fishing line, which might be monofilament gill net, for example, or something thicker and heavier like trawler net, but we do see other things too, like plastic bands from packaging or hooped frisbees even. If the material hasn't been removed yet, you want to examine it and the wound first to decide the most appropriate locations to make it cut, preferably using a closed blade wherever possible.
When the cuts are made, it's important to then make sure that you gently peel the material away and out of the wound rather than pulling on one section and allowing it to drag through, which is clearly going to be really painful and traumatise the tissue further. These wounds can be deep and extend down into the muscle layer, most often located across the back of the neck, but we also sometimes see more minor wounds on the muzzle and front flippers and occasionally elsewhere on the body. Some of these animals will have the material cut away on the beach and then be released immediately as the wound tends to heal well out in the salt water.
But we only advise doing this when the seal is otherwise bright, hydrated, a good weight, and with no other significant issues. Unfortunately, a lot of the time these seals will be underweight and unwell as a result of the entanglement, so often will be picked up for rehab. The top two photos are the same seal, and you can see he has the wound over the back of his neck and an imprint over his muzzle where another part of the monofilament was digging in and had actually cut into his lips as well on either side.
He made a full recovery and healed really well. The two photos at the bottom are another seal with a more severe gaping entanglement wound. The photo on the left was taken on admission, and the one on the right only about 5 days later, and you can see how well it's contracting down already.
And this seal, seal also made a full recovery thankfully. I've listed here some of the commonly used drugs in seal pups. It's certainly not a comprehensive list, but gives you an idea of what we are routinely using antibiotics such as amoxicla, clindamycin, and enrefloxacin, trying to reserve the fluoroquinolone, of course, where we can.
NSAIDs such as meloxicam and Carrafn are a good choice in seals for reducing inflammation and providing pain relief, with of course the usual red flags about use when the animal is very dehydrated or suffering with gastrointestinal disease, for example. Opioids are generally avoided due to their potential to trigger the so-called dive reflex in seals, which leads to marked bradycardia, apnea and peripheral vasoconstriction. However, some vets report success with tramadol in managing pain.
Mucolytics like romhexane are great in really snotty and congested pups. And I'll add that this past season steam therapy seemed to be beneficial to the pups we tried it out on too, who were very congested. When treating corneal ulcers, we've generally found in the past that it is gram-negative bacteria which are mostly involved, and hence use gentamicin fairly routinely for these ulcers.
Gingival ulceration generally heal well on their own, but anecdotally, the benzidamine spray seems to reduce their discomfort and speed up healing. For severe ulcerations and infections, an oral rinse like hexarinse can be beneficial too. The vast majority of meds are given at the same dose rates as dogs, although injectables are typically given IM into the lumbar muscles.
Subcutaneous injections are usually contraindicated, as there's a moderate likelihood you may end up injecting into the blubber layer where drug absorption will be poor and there is a risk of abscess formation. The route most commonly used to gain intravenous access in foids, that is the true seals, is the extradural intravertebral vein. This can be accessed by putting a needle straight down into the gap between L3 and L4 with the needle at right angles to the skin.
You can see it illustrated very nicely in the photo here taken at postmortem, and you can see it's quite a large space. An 18 to 21 gauge needle is appropriate and I find a 1.5 to 2 inch needle is suitable for most seal pups with needles up to 3.5 inches long, required for adults.
It's very easy to draw blood quickly from this space and it's convenient because someone can restrain the seal safely while you can focus on the procedure and stay away from the sharp end. Keeping an IV fluid line in place at this location is very difficult in all but the sickest of pups, but as in the photo on the right, a needle can be balanced in this space and fluids given until the pup brightens up and starts to move around. Then oral fluids will be required instead.
At this point, I just wanted to mention the difference there is between treating greys and commons. Although very similar in many ways biologically, it does seem that commons are generally the less resilient of the two in regards to immune function and susceptibility to disease. For this reason, we have to be particularly mindful when treating commons, monitoring them carefully for any deterioration.
We'd also generally recommend that all commons coming into rehabilitation should undergo an initial course of antibiotics, even if there is no obvious indication for their use, just due to the likelihood of developing an infection or having something underlying going on. Greys on the other hand, do not always need antibiotics depending on their condition, but they should be monitored for signs of deterioration. Now, worming is an important topic to mention and make you aware of, even though it's not something we generally recommend doing in the first couple of days after rescue.
As you can imagine, worms are very common, gastrointestinal worms in particular, but lung worm is also seen frequently and is a big cause for concern. The two lungworm species that we see are Otostroullus circuitti and Parifilaroids gymnori. Ottotroylus resides in the bronchial tree mostly, and they are quite a large worm, which can actually cause a physical obstruction to airflow.
Parahylaroides is found in the lung parenchyma and alveoli. It's a much, much smaller worm and causes pulmonary edoema, inflammation, haemorrhage and excessive mucus production. Both will present with high respiratory rates, dyspnea, a wet productive cough, and blood coming from the nose, the nose and mouth rather, sorry.
And of course, you may see worms being er coughed up too. Some pups develop mild clinical signs and others with very serious signs. Commons are generally worse affected than the greys.
We need to be really careful treating pups suspected to have lung worm. As in other species, a mass die-off of worms in the respiratory tract can have serious consequences such as anaphylaxis. So there are many different thoughts on the topic of when pups should be wormed after rescue, particularly when lung worm is suspected.
I'm aware of some very experienced seal vets who have quite different opinions on the issue, so I guess I want to make you aware that this may be more of an art than a science at this point, and I can't tell you the exact right thing to do, but I can give you my general thoughts based on my own experience. So here it is. I recommend stabilising pups for at least a couple of days before giving a wormer.
If only GI worms are suspected, I would carry on and worm them without any concern. But for lung worm, I personally like to wait around 3 to 5 days before starting an anthomintic to make sure they are stable and well hydrated first. For greys, I use ivermectin when GI worms only are present, but will prescribe a fenbendazole course first if I suspect lung worm and follow up with ivermectin later if the pup's still stable.
For commons, I would generally stick to fenbendazole alone, regardless of which worms are present. Just again because they tend to be more susceptible to a more severe version of the condition. Managing lung worm can be really challenging, and they require a lot of supportive care as well as the wormer itself.
So again, please do give us a call if you'd like to chat through the case that you're presented with and get some advice from us. This photo shows a pup's lungs with a severe otostrous infection. You can see all the worms in the trachea and bronchi, and it's, you know, clear to see why these animals are so unwell.
So moving on to very briefly consider what should be done when presented with an emergency, such as those that I mentioned earlier. Unfortunately I don't have time to go into any serious depth on the topic, but I hope what I can tell you now is helpful. When presented with a pup which is seizing or collapsed, I'm always thinking about hypothermia, hyperglycemia, sepsis and head trauma as starting points because they are commonly seen.
Obviously, you're going to carry out a full examination to give you clues as to what might be going on and how to, you know, deal with that and how to proceed from there. And of course, there could be a combination of these problems going on that need resolving. Clearly, hypothermia needs correcting by active warming measures and temperature monitoring, and hypoglycemia will need glucose supplementation.
This can be provided via an IV glucose bolus, such as what I've detailed on this slide. You can then assess the response to the bolus and respond appropriately, possibly moving on to a continuous glucose infusion, and then oral fluids supplemented with glucose when the pup is responsive enough for tubing. Hyperglycemic pups can present tremoring and twitching and sometimes have presented doing a kind of rhythmic side to side swaying action, which corrects after glucose administration.
So it's just to note that it's not always full blown seizures that you'll see. Pups with hyperglycemia and hypothermia without an underlying sepsis or other issue can respond really well to treatment. But as you can imagine, they will remain unstable for a day or two and require a lot of supportive care, monitoring and staff time.
Sadly, we do see pups presenting collapsed and unresponsive who die very rapidly, normally within a few hours of admission, who later at postmortem have been shown to be suffering from a sepsis due to perhaps a meningitis or a pneumonia. You can attempt treatment with these pups, but I found their prognosis to be very poor generally, despite even the use of IV, amoxiclav and a refloxacin, and intensive supportive care, including intravenous fluid therapy. I've never needed to use benzodiazepines with seizures, as they've usually either died from sepsis or recovered quite promptly from their hypoglycemia, but they can be used effectively in seals.
In pups presenting with severe dyspnea, again, there are obviously many things that could be happening, but generally infectious causes are very common, such as the bacterial and parasitic pneumonias as we've already discussed earlier. Some may present so severely ill that euthanasia is required immediately. With others you can attempt treatment.
This would include a combination of antibiotics, NSAIDs, bronchodilators and mucolytics. Flow by oxygen may be possible in very sick patients, and as I mentioned earlier, this last season we had some success using steam to aid congestion in some pups using, actually a steam cleaner of all things. And it was actually pretty good because we could add meds to it too.
And the pups generally seem to like it and approach it to lie near it, or just didn't really seem fussed by it at all. If you do sadly need to put a pup to sleep, then it's pretty simple. You're again using the extradural introvertible space as we do for generally anything IV related in seals, and you can use pentobarbital at the same dose rate as you would for dogs, so about 0.7 mL per kilo.
It's quite easy to quickly inject the drug volume into that space, so it's usually fairly quick, though fingers crossed you obviously don't end up needing to do many of these. And finally, I wanted to cover the topic of overnight care of seal pups in veterinary practise, which can happen quite frequently, particularly when pups are rescued in the evening and transport to rehab won't be available until the next day. Of course, we don't expect all practises to be able to accommodate a seal at short notice, but it is massively appreciated whenever you can help.
They aren't too complicated to care for in the very short term. They need a walking kennel, preferably in a quiet area and separate from other species. The room it's kept in should be kept cool, as generally we're more concerned about pups overheating when kept inside, though obviously this advice will differ if you have, you know, an emaciated hypothermic pup.
They can be kept in outbuildings in appropriate pens, but need to be properly sheltered from the elements, and a heat lamp should be considered too. A rubber mat for them to lie on is excellent if you have one, but we appreciate many practises won't, and that's fine just for an overnight stop. As I've said previously, for the 1st 24 to 36 hours post rescue, they're on fluid feeds only, and hopefully by the time they're being moved on to fish, they should have made it to a specialist rehab facility where they're gonna have fish routinely in stock.
So really just having some oral rehydration solution at the practise is absolutely fine, which most practises will hopefully have. Use a veterinary disinfectant when cleaning their pen. We use it about 1 in 100 for routine cleaning and then at 1 in 50 to disinfect the pen after the pup leaves.
Do take care when cleaning around the pups as they can lunge and bite quite suddenly. We tend to use a broom where we can to keep ourselves at a distance or to clean when someone else is already restraining the pup. In regard to monitoring, how frequently checks are carried out will depend on the pup, but routinely we check them 3 times daily, and we assess demeanour, their respiratory rate and character, and their temperature as a minimum, as well as noting down any new clinical signs, changes to fecess, etc.
Otherwise, we try to leave them alone as much as possible and away from too much noise and human contact, essentially just remembering that they are wild animals and hence we need to try and keep them wild. And here we are again with your patient. Hopefully you agree that the best course of action for this pup at the moment is to send it off for rehabilitation.
It's significantly underweight and has signs of a respiratory infection, so we definitely wouldn't want to advise releasing it. We'd focus on oral fluids to correct the dehydration and perhaps put some cool water on the hind flippers to help bring its temperature down. Antibiotics would be appropriate and an NSAID too perhaps when the pup is better hydrated.
A mucolytic could help with the nasal congestion, and the minor wounds should be cleaned. We would want to monitor it closely for signs of deterioration and get in contact with BGMLR to ask them to arrange onward transport for the pup to a rehab centre. So that concludes part two of this webinar series and the seal pup section of the talks.
I hope you found it informative and that you feel more confident about seeing a pup out in practise. Do remember of course that we're always here to give you a hand if you need it. You can just give us a call on our hotline number, which is here on the slide, er or you can find it on our website and our head office team will be able to assist you.
Don't worry about having to find a rehab centre to take a pop on for you. We work closely with a network of rehab centres all around the country, and we'd be happy to help with this and arranging transport too. We are the largest, but certainly aren't the only rescue organisation in the UK of course, so if a pup is brought in by another organisation, then they may be able to help you too.
Many thanks for listening and I will speak to you again in the next talk.