Hi, and, welcome to this, talk on dealing with the anorexic tortoise. This is being recorded in spring and, this is obviously a big topic at the moment. So firstly, let's start with what what a tortoise is because, we traditionally think of a certain type of tortoise as being a tortoise, but actually there are many available.
So here we have, two examples which would be classically thought of as having, that both were sent over to us as having, deformed shells. One is actually a hingeback, we can see down at the bottom left here, that's a perfectly normal hinge, and this is, this is, squashed person is called a pancake tortoise. And then that delivery that shape so they can shape into rock crevices.
So you do have to understand what's normal. And these are species that don't hibernate, so, and are, are rarely presented. So these are ones we're going to, skirt over and avoid for this talk.
Instead, what we're really talking about are ones which we typically think of as being Tudo group. There's a little bit more variety in the classification these days, but fundamentally, this group can be thought of together in many ways. So we think about spurtite tortoises, that's a big group from the Mediterranean.
Hermans from this sort of a northern and eastern Mediterranean, marginates from the eastern Mediterranean, and horse fields which range from the eastern Mediterranean right the way through Central Asia, Russian steppe and Afghanistan. So it's quite a, quite a broad group again, but similar, similar, some similar needs. So sort of find what torso we're going to talk about, we're going to talk about what anorexia is.
Well, in its literal sense, it just means failure to eat. But these reptiles, they will often not eat, for physiological reasons, for a period of time. .
And so how long do we mean anorexia? Well, we've got to look at a tortoise. So is it losing weight?
If it's not eating, losing weight, that is the problem going on. Is it well? So if it's not well, there's a problem going on.
Are there other clinical signs? Is it related to hibernation? And we'll talk about whether that's really in the same right, later on, but.
Those things are important in deciding whether this is, this is worth worrying about or not. In short, anorexia is not a disease in its own right. It is a clinical sign, and it needs to investigation to see what the actual cause of the anorexia really is.
I think that's the important message there. So where can you get help and stuff, basically man reptile's good. Stuart McArthur's, large book is still just about available and it is probably still the bible for tortoises.
Mader's latest edition is fantastic, and there's a small volume if you wish to help contribute to my retirement fund, please. So what are the causes of anorexia having said, this is a sign. Well, there's quite a few.
We can go through those first of all. So maybe husbandry or climate issues, maybe disease issues. A little question on be overgrowth, we often cited, and it isn't always a big part of it.
And we'll talk a little bit about blindness and sensory deprivation. So let's start with climate. These tortoises, as we said, are really coming from a Mediterranean area, Central Asia, but certainly Mediterranean really is a really unique climate area.
There's a fantastic TV series on it for another Attenborough, many years ago, which was just about the uniqueness of that particular climate. . And it does have these very hot long summers, these short springs, short sharp autumns, and very short cold winter.
And that's what these, these animals have evolved to live in. So the temperature needs the ultraviolet needs really are along the lines of thinking Mediterranean. If you don't have that, you end up with this, this, this syndrome called depletion.
And this is where body resources, body stores are depleted and run out, and they need them. You know, if you're going to go through hibernation during that cold winter, you're going to need a certain amount of resource to get your body through it even at lowered metabolism. You'll need some resource to wake you up at the end of it.
If you don't have that, then it's not going to happen properly, and then you're going to have a problem. And this is what happens over years and years when it's not going quite right. The body stores get less and less and less until we end up with a situation where we just no longer have enough to properly function.
We have depletion. And this is fundamentally linked into not having very short, cold winters, not having very long hot summers, but having something kind of wandering back in between. Post-hibernation anorexia is part of this, not a specific disease.
It can take years to develop, and it's often the result of depletion and stress. And often poor conditions in hibernation recovery. But this is why I probably try and wander away from calling this post-hibernation anorexia.
I'm more into anorexia in the post-hibernation period. Sounds a bit of a nuance, but actually, the problem is the anorexia happening post hibernation. It's more likely to happen then because it's a very stressful time.
We need your Body stores, but actually the problem is not linked to that hibernation. It may not even be linked to that particular post-hibernation period. This may have been building up for a long, long time, and maybe be more linked to a time when they're supposed to be awake and supposed to be active.
So it may be more a summer problem. You know, it's, it's not as simple as just a a a hibernation issue. So again, how it developed back to its poor condition, lack of body stores, going into hibernation, excess temperature, during hibernation, so we're using more energy and should do, and then this long slow post-hibernation recovery if you've got a cold spring.
Make it more likely to emerge at that time. But again, it's that poor condition lack of body stores going into it, that means this is not a simple issue with that hibernation in that year, just maybe the final trigger. Basically, in short, what we're talking about is the British climate.
This delightful island we live in is not the Mediterranean. We go, we, you know, this is why you see scenes like this back in pre-COVID days we saw these amazing crowds there of people trying to get out of British climate and into the Mediterranean climate because it's nice and ours is not. The tortoises feel the same way that they're not designed for our climate too.
We don't have indigenous tortoises. So basically, here we are, and this is April, . Proper hibernation actually starts now.
Because you need to have that long hot summer, that proper husbandry during the summer. This means that in Britain, you can rarely allow tortoises to free range outside. There are a few areas you can.
So if you look at somewhere on the south coast where you've got palm trees growing quite happily, probably you can let your tortoises have a longer time outside because it's a much more mild, warmer climate, as indicated by the plants that can grow outside there. But rarely can tortoise really be able to free range outside and certainly not at night. They do have a daily cycle.
They, they bask in the mornings, they feed, they bask again to get the fermentation chambers going, and then they generally that will keep them warm for the rest of the day. So really, when you need to supply heat to them, definitely is at night, even through summer period, first thing in the morning, and obviously on colder days they're gonna need heat sources all through the day. And you won't have a decent plane of nutrition.
To make sure we get the right food going in to, to be able to use that properly, to get gut functioning properly and build those stores properly. In the autumn before you hibernate, get a physical check, make sure they are up to, up to speed. They have got good body condition.
You may want to pay with deworming and stuff, maybe talk about that later on, and you prepare what we call a hibernacular. So hibernaculum is, and this is a picture taken the internet. I do not advocate keeping human food in with the, in with the tortoises, well maybe that glass, a bottle of wine might be quite useful as an indic as a good reason to check them on a regular basis.
But I can basically an insulator unit that, that runs at 5 to 8 °C, a fridge. You should monitor the temperatures tightly. You can put an alarm on those temperature monitors, so you you indicates you're going too high or too low, but it needs to be constant.
Now, every worries about using a fridge, about what the airflow's like, but you've got to remember it's these, these tortoises, when they're up and around a high metabolic rate in the summer, I've seen tortoises regularly fall in ponds when they're walking about and fail to drown overnight. They can really take hypoxia well. And in a natural way of hibernating, they simply bury down in the soil.
Soil falls on top of them, and they fail to suffocate that way too. They take the metabolic rate right down, they're hardly using oxygen. So opening the fridge, once a week to have a look at them and weigh them and check them is perfectly acceptable to for oxygen flow.
Can you do the old fashioned way, where you put them in a box and and insulate them and put them somewhere cool? Yes, you can, as long as that's a tightly regulated area. So if you're lucky enough to have a cellar that runs at those sort of 5 to 8 degrees, as a good seller can do, then that's absolutely fantastic.
But putting them in the garage, in the spare room, in the attic, you're going to be subject to much more variable temperatures. And that's very, very rarely going to be a right rearranged for in many ways. Another problem doing the old fashioned way is this, and certainly, toss in garages and, and greenhouses and sheds may be open to rodent attack, when they're hibernating, and we do get many presented to us this time of year, with those rodent attacks, if they, they've been being found by the mouse or the rat during during hibernation.
So again, for preparation, opposed the check, don't hibernate, till 1 month post the worming if you're doing that. And then you slowly lower the temperatures. So we do like, if you like full metabolic rate temperatures, plus, food and a daily bath for 10 days.
Then take them down to room temperature in the house, with no food, but daily bath for 10 days, and then put them back in something like a garage or an outhouse, with no food as long as it's not too cold, with no food and no bath for 5 to 10 days before they're ready to go into the hibernaculum. Once you're in there, you put, just put a tray in there, don't need to have a box for insulation, the, the fridge or the whatever unit you use is gonna do that for you. Monitor whether they're producing feast and urine.
And please remember, they're not asleep, and we do use the sleep during winter, awake during summer, we all do that. They're actually metabolically active or metabolically inactive, and that's probably a better way of describing it, but they will be active. So when you touch them, they will move very slowly, but they will move.
That's not a problem. You do need to monitor weight though, and the big alarms during this period, or if they lose more than 5% of the starting weight, or if they continue to lose weight for more than 2 weeks after starting hibernation. And those are triggers you probably ought to abort the hibernation, you know, get them more actively and warm them up and keep going from there.
So, if in doubt, stop. The maximum hibernation length is 3 months. That really is about what they do in the wild.
That's absolute maximum. In the first hibernation, I would typically recommend that, not in the first winter, but the second one, so when they're probably about 18 months old, and do 6 weeks, then do 8 weeks a year after, and then go to 3 months after that, as, just, just for safety's sake. When they're coming out from hibernation, again, have your vivarium or a tors table.
We're gonna talk about that in a moment, ready. Put them straight in the heat, no slow warm up, just straighten the heat, bath them daily and provide food from day one. And they'll often be eating within a day or two.
Monitor the weight during this period again, you want to make sure we don't decline too much during that time. So, I said, we'll talk about that, what are we doing the rest of the year. We need Vivaria at a certain time.
And this is how we can control temperature, UV levels and day length, and also humidity levels. And we won't technically improvise all year round. And we'll talk about whether we need to hibernate in a moment too, but we can find that all year round.
If you really want to be clever, if you're controlling the temperatures for a reptile well enough, you should be able to hibernate in summer and keep them awake, active through the winter. I'm not sure why you'd want to do that, but you, you should be able to do that if you've got that level of control. So, how should we do this?
And just to go back a moment, while there is a big debate about how you, what these vary actually should be, that, many people favour the trays here, and these closed the area are often not very popular because they're deemed to be causing respiratory diseases are closed and therefore you may have altered humidity. The simple truth is that the rising from spirities has come in with the rise in farm tortoises. They come in from Eastern Europe, and intensive farming, as in all other species, will very often result in a number of respiratory pathogens being circulated through, and that's where that one's come from.
It's happening about the same time. Cloth of the area can be used pretty successfully. I keep mining at home.
And, you just have a little bit of ventilation, you can build that into there, and they'll do pretty well in that. The big deal is if you use the trays, and this is our tortoise ward and we actually, I like them a lot, but you've got to have a very high background temperature. So the minimum daytime temperature's gonna have to be somewhere around about, 25.
That's quite warm as any of our staff working there. Now that's fine in my tortoise, I don't mind that. And night time we didn't go below 2022, .
But at home, I don't want to live like that, so I use a clothes fit because I can insulate that and keep temperature in what, what, what in that zone, in that one area. Important thing about insulation. The average home is a lot cooler than 20 degrees at night, 25 degrees during the day.
So your background temperature may drop and so therefore we often see in trays, certainly in winter tor is getting too cool. So. Really got to work it out there, depending on how you want to live, what temperature you'd like to live in, as long as you monitor and control those temperatures it's fine, because that's really important.
Now again with temperature, do you want surround heating or overhead, tortoises get a temperature through the car or heat through the carapace, and they're used to basking, so overhead heaters are really appropriate. Heat mats aren't that appropriate and certainly we see low level burns more commonly, . Where we have tools to just sit on the heat mats they're too cool.
All reptiles have a thing called a pot, a preferred optimum temperature zone, and that's why I'm talking about these ranges. So really you're looking for most of these med species between about 25 and 35, during the day, 20 to 25 at night. And that'll be give them a chance to find out which zone they want to be in, so they can move around, have choice to be in their preferred, temperature at that time.
And they can sense those temperatures, they'll seek them, and they'll do whatever. Now, so your price range. The big deal that we keep on about is control, control, control.
Now, to control the temperature to measure it, it's not as simple as having a thermostat. A thermostat's a safety device. So basically you set it for 25, if the temperature goes below 25, it turns the heater on.
If it goes above 25, it turns it off. It's a safe device. All you can safely say is that the heat is on, is the temperatures below that thermostat setting, maybe just below or maybe a long way below, but it's below.
The heat is off, it's above, maybe a long way above, maybe a short way above, you can't tell. So you need to measure as well. And so this is we recommend maximum minimum thermometers.
You can do things like heat guns. This is a flur device, for mapping, a viiv working, . Great, but you've got to be able to do that.
You want to do it continuously. And most of us don't really want to get up in the middle of the night and measure the tortoise's temperature every hour. So, maximum minimum thermometers work much better for that.
You have one of the hot end, one of the cool end, and you measure that range you're getting, and that'll give you an idea whether what you're setting, what your room's like, whether you're getting the right temperature, and that's really important to measure, and then you can control properly. Well, on light as well, a full spectrum UV light, if you're using a fluorescent tube, then you do want to make sure it's no more than about 10 inches from the animal, . And generally on 1212 light cycles, absolutely fine.
So rushing tubes, again, they'll, they'll expire quickly. So typically only change every 6 months. So mercury vapours can go much longer.
But ideally measure it, use a solar metre and actually measure, that, that, that UV level, that'll tell you when it's right time to replace. Be aware of going above some like UVB 5.0 because you get really quite high levels in some of these lamps, and be watch out for eyes, and they can damage both the torto's eyes and your eyes as well.
So make sure you're not going for turning too intense. And if you're choosing what size of the bulb, there's a really good website, run by a lady called Frances Bains, and every year she reviews all the bulbs on on the market and produces the guide to which we're best to get. It does vary a bit too, so it's well worth checking that before you purchase.
Mention humidity, and this picture of this flow device, you see it's black, very dark stone here of low temperature. This is actually one of the things we do for our ward and we produce, they have a little microclimate tortos now is very close to the floor, and that little microclimate is down right on floor level, it's very important things like substrates and, and, and, and maybe the dust and stuff. So we can't detect it our height, but they can certainly take down their height.
That's why someone get problems from that. But we can produce a humidity gradient for them by putting a wetted towel at one end of a vi so that you get, obviously 100% humidity there, and that can reduce down to virtually zero down or or room humidity down at the far end there. So again, it's all about creating zones and creating gradients and therefore giving choice for the animal to choose where it wants to be and what it wants at that time.
OK, we mentioned nutrition as well. Don't forget this group are herbivores, and they have a high fibre requirement. They're really designed to eat absolute crud.
Where if you look at the habitat they come from, it's very fibrous, dry, semi-arid type of land, and you know, they're eating really high fibre material. So how can we mimic that? And we often, one of the big mistakes we make, we actually give them too much.
So things like fruit and veg are very rich and should only be used sparingly. Yeah, we've got a big drive to take them, because they find that in the wild, they really want that. We can use grass, we can use weeds, and dark green leaves are pretty good as well.
Again, mixed types, don't concentrate on just one or you can get dietary imbalances and stuff. And really, . And try and, and, and, not feed too much of those.
And hay feeding is really good. We want a dry, high fibre food. Hay is great.
And what I generally recommend is thinking about fibre and calcium, with your diet, and again, not overfeeding. There's no race to produce the biggest tortoise as quick as possible. There is a race to produce the best smooth shell that's grown consistently and slowly through a tortoise's life.
That's definitely a bit of a race. That's the thing you want to be conscious of. Slow those growth rates down because a lot of problems we see are linked into excess growth rate.
So What I generally recommend doing is giving hay every day, and then giving grass, weeds, dark green leaves, mixture, probably every 2nd or 3rd day. If it's a very young tortoise may be bit every day, but otherwise, for older tortoises every 2nd or 3rd day only with the hay. And they can feed if they want to, and they can, they can really slow them down.
And especially if you are not hibernating, keeping a tortoise active during the winter, again, just slow down that feeding, slow down that growth. One final note is when I was taught, tortoises many years ago, they we were taught to give him a spoonful of cat food every now and then, really don't do that. Cats are obligate carnivores, torso obligate herbivores, there's a real contraindication there, and certainly, cat food can lead into gout.
It may take 20 years to produce gout in them, but it will produce gout in them. And that leads nice on to things like internal disease. And this is sort of things we're gonna see.
We can see hepatic problems occasionally, especially fatty liver. That's a problem because in parts of reproductive cycle, physiological fatty liver is absolutely normal, but we do get pathological as well. We may see, kidney problems, infectious disease, nutritional disease, and just plain gout, where original cause has long since been obscured.
And we'll see acute and chronic infections, we'll see respiratory infection a lot, often linked into these, herpes viruses and stuff. So these can also affect and also put them off their food. So again, thinking of starting with spirit's disease, typically this thing called runny nose syndrome, RNS really it's a real misnomer because actually a runny bit of a nose is that is often, you can see this very wet tortoise here, it is very often, saliva.
They've got no palate, so everything in your mouth comes up through. If you look at these all got these very inflamed mouths, often with some crust and exudate. And these are producing, discharges and stuff.
Swollen eyes are often a feature of this, and again we just about see that in this old picture here, and, . So, you know, it really is almost an up respiratory tract disease, with a headit is probably even better. And it's got a lot of different causes.
And typical reptile, these aren't just this thing comes on and causes disease. There are a lot of factors involved, so you may see primary factors, which will often be husbandry linked. That may be mixing with, with the, with the wrong type of tortoise, because they all have their own little viruses and they, they'll exchange them and they're not necessarily benign in some species, they might be in others.
We may be down to to temperatures where too low, lowering immunity and therefore make it even more open to problems. We'll see secondary problems like mycoplasma or colonid herpes virus, which can, which can just sit their lifelong carriage, and when they're run down, out will come signs of infection, a little bit like a cold sore in people. And we even get tertiary facts where we get bacteria or yeast overgrowth.
And this is why when you see these cases, simply giving them some antibiotic generally is not going to do very much at all. We see la respiratory tract disease sometimes for the same reasons. Now, diagnosis can be really quite complicated, .
So we, if we do have suspicion of this, we do need to do radiographs, and the torsal lung fields on the dorsal part of the body. So we do have to do horizontal beam pictures to get a proper, proper view of these, and we can see different types of pneumonia. We see very diffuse pneumonias, we can see very focal pneumonias either in one side or even a particular abscess.
Now, very important we find out what's causing this, we have sample accurately. So for these, we can do something like a lung wash, and we can then do. Generalised treatments, systemic antibiotics.
We can nebulize that type of thing. Or we may see something like this, where if we do lung wash, we wash that the lung, we can see nothing. We see that, then we might do, or we might just simply wash around the outside of this big abscess here and see even less.
And that's what we need to do is focal sampling, where we can actually drill in over the top of that, lesion and use an endoscope to sample, and, and, and, and swab and do cyto and do histopathology and stuff. And then also this whole enables us to do topical therapy because we can give systemic therapy this tortoise, but it's gonna take a long time to get in the middle of that. Where if we make a hole in it and break into it, we're gonna get treatment much quicker.
We see parasitic disease too. Now, it's important to bear in mind that we're knowing normal. So if we see a lot of protozoa in, in some of these species, certainly excessive trichomonads, flagellates will be a bit of a problem.
But if we see a lot of ciliated, protozoa, that's can be pretty normal for these herbivorous species. They're part of a digestive process. They're very active gut fauna as well as flora.
But they do have, have nematodes and things too. And These vary in pathogenicity, the most common probably is, is this, the pinworm, . Low pathogenistic, but if you've got a torso who's actually depleted, who's not having a good time, having one more thing taking stuff away from them, can actually also be just one of the things that tips them over the edge and it's worth knowing about.
We do from time to time pick up blood parasites still, typically these will be in the old wild caught ones, but again, finding those not a sign of saying that directly a pathogen, but often a sign of a rundown to the immune system, we can't quite cope with them anymore. And we see reproductive disease, especially in the females, . And this may take the form of a tension or follicular stasis, and this is linked into their reproductive cycle.
A tension, why does that cause anorexia? It can get space occupying effects, can often lead us to misjudge body mass. So again, we'll talk about the moment always can combine body mass measurement with body condition measurement.
We may get normal eggs, which are nice and easy to induce. We may get really abnormal eggs, we've been there for years, and these are really gonna be very hard to get out through, through the normal, channels. And we suddenly even see eggs in the bladder have been laid into the cloak and then, retropulsed into the bladder.
And the abnormal broken eggs, which may be causing pain or infection around the uterus. So flickerate probably is our major problem we're dealing with. Now the reason we see this is because again, our tortoises have a reproductive cycle based on the Mediterranean year.
So what happens with them in their natural surroundings is the rise in temperature in spring induces folliculargenesis, meaning that the ovaries and these are induced ovulators are ready for action, end of May, end of June, during mating season. Typically the male come along, he'll butt them, he'll bite them, depending on the species. He'll release his pheromones, and those are responsible for inducing ovulation, .
After ovulation, we should lay eggs, they should then go into the, oh we should go quiescent through the summer. Start to pick up a little bit of activities as temperatures cool in winter in autumn, and then in winter go quiescent again. Now if you think about the British climate, temperatures up and down, up and down, up and down.
So you have a lot of periods of folliculargenesis. We have very few periods of long spells of hot weather to allow the eggs to develop and go on, or to allow atresia and regression of follicles. So often we get these huge buildups.
Now I've seen talks where 15% of body weight has been ovary, and you often gets picked where we've got many different ages of follicle has been produced year after year after year. This problem is exacerbated by how many tortoises are kept as lone animals, and the lone female tortoise is typically the . It's typically the one that's who's gonna have these problems where there's no male to stimulate.
So this causes problems, anorexia, space occupying effects when they've got that much ovary. Fat metabolism are constantly cycling around fats for making, follicles. And of course, that leads to switching off of, of appetite.
So what do we do about it? Well, hormone therapies have been tried and been really unsuccessful. I'll talk a little bit about how we've been preventing them, later on when we get to some of the other things we're doing.
And typically, these are ones where we actually go and have to ovarectomize and remove those, those ovaries. GI tract, again, we may see things like foreign bodies, so beware a lot of these buildups of stone, maybe something reflecting a low mineral balance, rather than actually being a direct foreign body themselves often the transverse colon has a lot of stones in it. But this bit of metal is not normal.
We may see stasis problems, and again, beware of the excess use of metronidazole when we affect that bowel fauna. This, this, this case here presents to a respiratory problem for obvious reasons, a very restricted lung. And this was linked to over usage of metronidazole, and we had to replace the gut fauna.
And occasionally we get very rare case of enteritis. We do see metabolic bone diseases in particular, linked into, problems with skeletal collapse, if they've been growing too fast, and imbalance in too much protein, not enough calcium phosphorus there. We'll often get things like this, where you can see the back ends collapsing down here.
This will lead to very flattened pelvis and even on very more minor level, you'll see the shell can rub onto the leg like that too. Sometimes lead in spinal deformities, weaknesses, in the walk, and collapse occasionally. But I mentioned we were talking about beak, overgrowth occasionally.
From time to time this will cause problems. It's certainly got a splitting beat like in this, I did say we wouldn't mention silatters and things like that, but we are. So, you know, it can actually can interfere and it's always worth trimming just to make sure.
A lot of them would come down to, problems in early growth, where the beak deforms due to metabolic bone disease. Surprisingly, they often cope very well, they eat, eat very well, and they maintain their beak themselves without need for regular trimming. But bear in mind too, also have natural variations.
Some of these tools do have a natural hooky beak, when you're shaping them. This is an overgrown beak and this is is having problems, eating, but when you're actually trying to shape it back to normal, bear that in mind, don't just simply flatten them all off. So know what's normal.
And typically I'll use a Dremel tool, so I get a smoother finish and also when you're clipping, you can often get split, and this helps to avoid it. Other jaw problems can happen. So here we're looking at, you can get fractures in the beak here, and we can, we can address those with, typically in this type of thing, the suture cross is stabilise.
And also we can get infections and gout in the, jaw joints. And if you see this type of swelling, it's worth doing some cytology and seeing what's going on. I mentioned blindness, tortoises do, very interesting they do use sight to find food.
They're actually eating directly in front of me, they can't actually see what they're eating. And the main problem we'll see is this is one of my old tortoises had keratiti, but the main problem we'll generally see is due to low temperatures during hibernation, changes in the lens, and, that basically an induced cataract. Now, it is interesting, it does appear it's probably not.
The, actual lens change that's causing them not to be able to eat. But if you think about it, the torsohead's very small, and in between the eyes, you've got the big olfactory lobes, in here. So actually very often you've got concurrent got freezing, you've got concurrent damage to, both the olfactory lobes of the brain and probably also to the actual areas within the nose, and that's definitely going to lead to major problems in them sensing and finding their food and eating it.
So how do we investigate the, the, these cases? Well, tip away we do history and signalment, we do weights and measures, we do body condition scores, we do clinical examination. What do we want in history?
Well, we want a full husbandry review, and we really want to find out when we do, especially temperatures, I really have to think about temperatures. People always tell you the temperature's OK, because they think it is. They're not doing it on purpose, they really think it's OK.
Find out what the temperatures are, find out what they're like during the day, during the night, hot and cool ends, and also how they're measuring them. Because it's gonna be done right. It's amazing how often you'll find even a small defect in that.
When we go through weight history, most torterns do have a very good history of weight, or contact with others in case of, passage of pathogens, medical history, feeding history. And really it's interesting food. Tos will actually huff over top of food, but stand over it, huffing away, looking at the food they want to eat, they just can't quite do it.
And those are actually usually very quick to treat. But it's just a case they're often a very minor husbandry, issue about why they can't quite do that. Look at urine and faeces, are we producing those, good signs of AR activity levels, and also things that respiratory noises and very rarely you get one who's really vocalised, not in pain.
So I mentioned about weights and things, about when we compare body condition. It's got a picture of a very fat tortoise. We want to check the pads between the head and the, and the, the legs.
These big fat pads here for an obese tortoise, and they may want you put your finger right in and feel the bones very clearly, and again in front of the backing its pads are fat, they're really overweight. And you use those to assess body condition and probably more accurate than using the formula they're available, which are somewhat limited in what spec they apply to and what range of a range of size within those. So when it comes to examination, again, it's a problem we're talking, what can you actually do?
Because there's a big shell over them, that really does hinder clinical examination a lot. Well, we can assess the, demeanour and strength of the animal, you know, if you could, if you're having to really hold the leg out to look at bits, that's a strong animal, that's a good sign. We can do this condition scores I mentioned the last slide.
We can palpate, so we can put our fingers into the, prefemoral fossa, where we're looking at fat pads, and we can actually feel. And if you've got a female, you can gently rock them, just gently rock from side to side, and you feel eggs bumping against your fingers. That's can be quite useful.
We can auscultate, stethoscopes are of little use, but we can use ones like 8 megahertz Doppler devices that we use for cat blood pressure. And we can listen to the heart that way. We can pick up murmurs, and blood flow disturbances that can be quite useful too.
We can look at your mouth, we can look at the ears, we can check with cloaca, you've got a big enough tortoise, who's, who's been reasonably willing, and sometimes we can actually even do, per cloacal, palpation in the abdomen. However, where we can limited is actually feeling much more internally. And this is where blood sampling comes in.
And so for virtually every single anorexia case, I'll be looking to blood sample and pick up some clues from there. We've got a number of sites we can take from, and we'll go through a few of these later. The occipital, by the way, and ventral tail, probably my desperation site, and I'm really in a bad way if I'm having to use those.
Collecting heparin, again, you can collect a pretty good volume from these guys. Definitely about 2 to 3% of body weight, is, is absolutely fine. So Let's go back sorry, we have a look at the typical sites that we use is the jugular, which is basic gold standard.
We have two branches, the dorsal branch and the ventral branch, and it's very superficial. It does take a bit of holding, and during 2 for 2 or 3 operators doing this, because they don't like it very much and they, we draw the head and you've got to keep your head pretty straight. It is, I say, it's is very superficial to avoid going too deep.
I'll typically use the subcapaceal vein. This is where you, angle the needle up into a shell, where the skin joins a shell, in the dorsal midline. I put a needle in there, feel if it hit the, spine, and then we, we move around a bit, we could should be able to get some blood.
There's an increased chance of lympho dilution this site. If you do see lymph coming out, then abandon and start again. Dorsal tail is an interesting vein.
It's not really a true vein, it's more sort of plexus of small vessels, but can be used almost guaranteed for dilution if you're using this site. So do tell the lab that's what's happening so you can interpret it in that light. And again, another side for you, especially in very big tortoises, the brachial vein can be quite useful.
I use this more and more. So here we got the foot, here we got the carpal joint, raised down there here. There's a big tendon going across the back, and in this triangle behind the carpus, you'll find the brachial vein.
You can hold the leg out, put the needle into there, and move it around until you find that vein. Now, what parameter we look at, typically for haematology, we're gonna look at, our, our, red cells, or white cell differentials. We look at, morphology of the cells, but we're gonna look at counts, because often activity is, is picked up by, by, by the, by what the cells doing.
Very often these are run down tools with very low counts, and it's important what they're doing. And make sure we can look for blood parasites. I'll look at my protein parameters, I'll look at a range of enzymes, see if I can pick up something in the liver.
It's pretty inaccurate for liver, but, you know, sometimes we'll get some clues. Bile acids can be useful, as a measure of function, and those, those we definitely check. We look at calcium and phosphorus and ionised calcium as well.
Uric acid and urea, we'll talk about a little bit more in a moment. Elerites are useful, and also I like beta hydroxy butyrate. A lot of these tools are ketotic, they're burning fat.
To produce glucose, and that's a real indicator you need to pay a lot of attention to critical nutrition. Many of these tortoises are dehydrated and assessment dehydration is not so straightforward in this species, these species. Can of clinical signs, but do you know what, tenting is difficult to assess in something that has sort of like very inelastic skin.
We can certainly look at a mouth, it gets very stringy mucus, just like in cats and stuff that we can pick up that's probably a dehydrated animal. So that's useful. And again, sticky membranes is definitely a thought.
We can look at bloods and we can look at uric acid. Uric acid will rise in dehydration, but it'll also rise in renal failure. So, it's not always a true indicator.
So it's a very low, a small rise, Pros dehydration, but you can never quite work renal. What we tend to look at is urea a lot, and urea is really, really useful. And basically, about 20-25% of her body weight can be stored as urine in the urinary bladder.
And they use this partly to urinate on unsuspecting vets. They do this to get rid of predators, but also, as a, as a body still, and again, to use during their hibernation period. And as they withdraw water from there when they're feeling dehydrated, so they will also withdraw small molecules like urea.
So the urea levels are an assessment of how much bladder, bladder water they're actually using. So the higher it is, the more they're using. In extremists, it's really, really high levels can be linked to renal disease, but fundamentally, urea is a good measure for dehydration.
We can look at things like proteins, and they will hemo concentrate. So you got to bear in mind dehydrates are often very run down, so we've got low protein levels, and low hematocrits from that. And so hema concentration doesn't show that well in them.
Technically use urine atmospheric gravity, but of course, many of them aren't urinating. If they do, they'll do it in bathwater. It's hard to measure.
We will look at prognos in there too, and these are the ones that really give you an idea about how bad things are. So certainly we've got really high potassium levels, and I'll stress that potassium should be measured patient side or in spun heparin gel, not in the posted heparin sample, because it will rise with, with some cellular breakdown. But potassium's high, that's a bad sign.
Uric acid, 1/2, 2.5 1000 the, the, the prognosis is really pretty poor. And urea, again, if you're starting at urea in the 40s and 50s, that's probably going to be showing this renal pathology, and again, a very, very poor sign.
We can also pick up reproductive activity. So if we have a female tortoise or unknown sex tortoise, not always easy to sex. And look at the, look at these on the panel.
So, we've got high protein levels, we've got rises in these enzymes, certainly high total calcium and phosphate, typically in good ratio, so more calcium and phosphate, and also got rise of fat parameters. That's a really good indicator, this tortoise is trying to produce follicles and is reproductively active. It doesn't show you've got stasis, it just shows you've got reproductive activity.
But it's good indicator to go and do some oceanography or some X-rays and see what the ovaries are actually doing. So, we can do that, we do other tests too. We can do radiography, again, looking for, things like, respiratory disease.
And important we do a range of different views, your cytology, endoscopy, ultrasound, urine and fes those kind of things can be useful. I said, sound of views dorsoventral. Perhaps we should do that in all cases, certainly in females, we're, we're suspicious about eggs being present.
You're gonna get a lot of information about what's present, how many, what age, what, what state of, state they're in. But if you want to assess lung fields, you've got to do those horizontal beam views. I would typically do these if we've got any sort of suspicion of respiratory signs.
So real hard breathing, the cyanosis of membranes, respiratory noise, or certainly if I'm getting on my bloods, and I'm getting an active white cell count, then I'll be looking at doing, lung assessment. We certainly ultrasound all our female tortoises, doing a reproductive assessment, looking for state of the ovaries, and if we're suspicious about liver, we may well ultrasound that. Very hard to, sample, via the prefemoral fossil.
We can certainly image it and see anything on there. And it gives us some idea we can actually do some gut assessment, some assessment of any sorts of things like urus and stuff in the bladder, that kind of thing. And of course, we can always ultrasound the heart as well.
So here's what things look like. These are follicles. This is one just undergoing a little bit of trees here we can see a little black an area in there too.
Again, very large follicles visible in this view, and we will pick up eggs as well. But if you do pick up eggs, do go an X-ray because what the ultrasound can't do is it's bouncing off the shelf. You can't tell you how many eggs and it can't tell you whether there's any broken or not.
So we can do the heart as well. And for some of these mystery cases, we do see cardiac disease in these guys. And we can pick up pericardial effusions, we can pick up, the blood flow within the heart.
We can pick up wall thicknesses and that kind of thing, and it can be quite useful. So we can, next stage we mentioned endoscopy. When do we do these?
Well, again, if we want to look into cavities, again, if we want to, we find we have got lung disease. It's really good for going as shown earlier. We can do, an approach, via the shell.
We can't even go in via the pre-paral force if we want to, and we can pick up the information, we can pick up areas of past and the nasal sampling and sometimes application of therapy and stuff. It's also, if we are really worried about liver disease, we can go into the peritoneal cavity. We can do some laparoscopy and have a look around that way.
It's a little bit harder entry site, but, we can go into, into the prefemoral fossa, . Again, often need a period of support because they are going to need anaesthetic for this. And that can be quite useful.
And we can pick up things like we can, this is ovarian necrosis, and although our ultrasound can pick up ovarian activity and the follicles there, it can't tell you whether you've got necrosis, infection of those, those, those ovaries. And here we have a nice fatty liver, and this, this route enables us not only to see the livers fatty, and, and they've got a problem, but also we can take biopsy samples, and that, that can be diagnostic. We do a lot of cytology, so we go from expensive endoscopy to very cheap and easy cytology, and this is something which, you know, we can, we can all do in practise very simply.
And any lesion we can do this on, we can take aspirates, we can do impression smears and all kinds of stuff too. One of typical presenting things we'll see is swelling of the joints, so we can stick needles in them, we can take samples out, and we can see whether we can get got septic arthritis. Of course, we can take a sample of the culture as well.
We can see where they've got, gout, and some sort of arthritis from that. We can see with osteoarthritis, which does happen as well. So we can get those too, and we can then even use those, those entry points for antibiotic in to flush out material, or to put anti-inflammatories in as well.
We look at feasts and urine, again, it can be difficult getting stuff. There are some obvious things we can see, and appearance is very useful. So here we've got biliveden ura.
So what our liver results saying, we know we've got a bit of a liver problem going on with that tortoise. We mentioned about parasitology, probably more useful in bacteriology in the majority of cases. Don't forget we do bacterology, we are going to pick up a lot of things like salmonellas and colis as part of a normal flora in there, and don't worry too much about those.
The big deal with all these cases is we've got a lot we can do today, we can investigate. We're gonna have to hospitalise these. And hospitalisation is really critical with these cases.
They are not outpatient cases by any stretch of imagination. Why is this? It gives us control.
We can actually provide correct husband again, if we're hospitalised, we need the correct husbandry in place. Can't just stick them in a cage with a, with a lamp on them and hope that's enough. We really do have to get them, looked after properly.
So we can give them the correct husbandry, and as this is often the basis of many of the problems, that's given a chance to recover. It also means it gives us time to get the owners to get their situation right as well, that's useful. And of course, allows us to give direct therapy.
Tortoises, especially those who are under temperature, run down, ill, are not always going to, absorb drugs orally very well at all. So oral medication often does not work. So, .
We're gonna need to do direct therapy, we're gonna need to inject stuff, we're gonna need to tube feed, do that kind of thing too, so we can do that and sometimes for a reasonable period of time. Support therapy, really important, biological support. Don't forget all these tortoise are gonna need heat, being ultraviolet, they're gonna need rehydration, they're gonna need nutrition, and that's real fundamentally where we're coming from.
They're also all gonna need barrier nursing. Because many of these will be carrying things like cloned herpes virus, mycoplasma, they can be run down, and if they're not run down, the tortoises next to them they will be run down, and this is a good time to be exchanging pathogens if you're not really careful, with, with keeping them apart. Now, you, it's useful having together we can have one warm room, so therefore it comes down to behaviours and how you treat them and not going from one to another to another.
Make sure you're cleaning, change any PPE and stuff in between. So rehydration, we can do it in various ways. We can do oral rehydration are fundamental.
Bathing is really useful. Just stick them in a deep bath once a day, baby bathwater type of temperature, just give them time to soak in there 1015 minutes, give them a chance to drink either through the mouth or even through the cloaca. And just get a chance to rehydrate from there.
We can do it by stomach tube, we'll talk about esophagostomy tubes in a moment. We can use our fluids intrasilomic, epistolamics, which that cypolemic membrane, intravenous or intrasseous. Intravenous is very rarely use, it's really hard to maintain.
And so if we, we go back to the level, we'll probably go intraosseous. Stomach tubing taught a very useful technique, essential for these guys. Pre-measure your tube, before you place it about 2/3 of the body back into the deep part of the stomach, stretch your head out, put fingers in the corners jaw, then you can introduce a tube down into the oesophagus down the right side, of the neck and, .
And then you can you can insert, you can place the materials. I often tend to use metal tubes, . And, babies are quite nice when you've got an extra stretch out there because you don't have to push at all.
So you can just let them drop under their own weight and that that can be quite a, a nice way of giving, placing a tube with that with minimal chance of trauma. One technique we don't use enough probably is esophagostomy tubes. Now, this is when you've got a really difficult tortoise, who resents being stomach tube, and every day is a bit of a fight.
You don't want to do that too long. And also, there are times when, you do, a person has got the husbandry right, they can't afford hospitalisation. So once they've had the initial period of hospitalisation with you to where they got the husbandry corrected, then you can put an esophagostomy tube, and they can give a lot of nutritional and fluid support at home.
So it's a very simple technique. We can if a debilitate tools, we can do some local anaesthetic, for, a slightly stronger tors so we can sedate. Basically, hemostats in through the mouth and tent the skin.
We cut over the, hemostats and push through. Grasp the stomach tube again pre-measured, of course, pull back through into the mouth, then loop it out through the mouth there, loop it back in and pass down into towards the stomach to a pre-measured length, and then we can place a Chinese finger trap suture, to secure that, onto the skin. And then we can place that onto the shell, and then it's really easy, some to use.
The important thing we do pre-measure is make sure you measure it so that it's actually a safe length when the tortoise withdraws its head. And similarly when you're taping on, make sure a tortoise can fully remove, withdraw itself there. Important things too is try and get that tube up and over the middle part of the shell, not too much in the way of the eyes and things that it gets in the way.
But they are little demons at using their legs to, to, to step on the tube and pull it out. And if you've got a tortoise with big scales here, they often use those to pull out there, it may be worth just putting a light bandage over there to stop them scratching. Mention about putting fluids, epistlemic inlaic.
The root here is via the prefemoral fossa. Again, bear in mind the dorsal part of here is the lungs, so we can go ventrally, tilt the torso was to the bladder and the viscera, fall away from the, the, the skin site and just pop the needle through. If you're epistlemic, run through the, run, scrape it along the edge of a shell on the inside, in slamic just go a little bit deeper.
Always aspirate, make sure you're not hitting something and then pass your fluids. For in osteo we same sort of position, into this, area in front of it, of the legs, hind legs. We drill into the shell, a bridge between the carapace and a plastron, and we pass a needle into there.
But don't forget you have to do this under pressure, so either a spring fusel like this or a syringe drive will be perfect. What do we use? Well, orally, we like hypertonic solutions.
So typically just plain water. We can use reptor boost, or critical care formula from a company called Vet Arc, are really good, for using slightly diluted, to over diluted to, to give a hypertonic solution. Systemically, we use Hetmans or saline, ideally based on electrodete measurements, but if in doubt use saline.
Now we can, we're talking about stomach tubing, of course pass our nutrition from there too. And typically, we'll start by using Vettar's critical care formula. It's very high glucose mixture, and very often these depleted tortoises don't have great glucose levels, so you try and top that up.
When they're doing it better, we can move them on to, herbal critical cares or oxbo fine grind, to, pass down there and get the gut working a bit better on some fibre. There are also products from Lefe but. We're really lucky these days, we've got loads of different, herbivore, feeds, which are suitable to use in tortoises, and that, that's great, we've got choice now.
We can also offer pellets. I don't like pellet feeding during normal living. They're too rich, they grow too fast, but they do like them.
And again, if you've got an anorexic tortoise, offer some, because they'll often start eating these, in advance for everything else. Another tip is to ask the owner what the tortoise's favourite treat is. Offer that.
It may not be the greatest nutrition in the world, you know, I don't like torto-fed banana. If it's anorexia and gets eating, great. Give it banana, we can get clever later on.
And again, always go for natural herbage, but very often we'll switch on to dandelions and grass before anything else. So go and pick some fresh grass, fresh dandelions off of those. And of course you can actually pop this down there.
So dandions are really good for her, just assist feeding, force feeding, just because it's such a nice long thin shape, you just poke them into the mouth and feed them down there and just try and get the tortoise going that way. While they're in monitor, monitor weight, monitor body condition, always monitor faecal and urine output. This is a typical post bath picture.
It's got some urine, we got some faeces. It actually was the first with this to pass. So you get a lot of whooping and hollering from a from the ward, as you see in that first pass we that's a really good prognostic sign.
And from time to time, repeat the bloods. That if you are getting no response clinically, after about 57 days, re-bleed, see what's changing. That may show you things aren't worsening, or make sure things are actually improving more than you think they are, and that's quite a good thing to know.
So that's treating. What about prevention? Well, the real prevention is you've probably got the idea is to have good husbandry, when they're active, when they're hibernating, and also good monitoring of that husbandry, otherwise you don't know when things slip and don't go quite where they are.
Regular health checks from our point of view also useful, so we can check weights, we can, do an examination and deworm on a regular basis if we want to do that. We typically do this pre-COVID, with tortoise parties, and we're often getting these tortoise together spring and autumn. We have about 250+ tortoises come to these.
People like them because you a chance to talk to other tortoise owners, to share experiences and things like that, which is great. It brings the cost down. We can have an environment away from clinics that becomes more of a social thing, and people seem to be happy with that and have tea and a cup of coffee and talk tortoise.
. And so compliance is really, really good with it, all our preventive, I think the tortoise, prevention, and, well tortoise, say checks do do very well. And also that's the matchmaking. And this is one of the interesting things when we started doing this, is that we exposed all these lone females to male pheromone twice a year.
And we can actually, as we want a part of our check is, we actually do, scan the ovaries, looking for follicular status developing as we saw a lot of these tortoises who'd been. Not active for a while, suddenly start to regress their ovaries and do something with them. And I think that's exposure to the males of these things too.
So, and we actually do see people loaning their male tortoises, to others, so don't ask what goes on. One important thing is if you're going to do mass meeting like this, make sure it's clear, it's only for well animals for, for, for a health check. If people do have a sick animal, they should make an appointment away from that, so you're going to reduce the chance of getting an actively excreting pathogen carrier there, because that is the main disadvantage that you could potentially lead to more disease spread.
So just make sure you screen people in and make sure you're careful with them. So in summary, I said anorexia is not a single disease. Each case is gonna require full assessment and diagnostic workup.
You've got to address the underlying disease has issues if you're going to treat this successfully and provide that full biological support throughout the treatment period. I said, these are not outpatient, treatments. Thank you.
