{"id":1088,"date":"2013-03-21T20:41:07","date_gmt":"2013-03-21T10:41:07","guid":{"rendered":"https:\/\/theveterinarian.com.au\/?p=1088"},"modified":"2013-04-07T22:49:27","modified_gmt":"2013-04-07T12:49:27","slug":"an-emergency-caesarean-with-a-twist","status":"publish","type":"post","link":"https:\/\/theveterinarian.com.au\/?p=1088","title":{"rendered":"An emergency caesarean with a twist"},"content":{"rendered":"\"\"<\/a>Urban sprawl may allow us to actualise the \u201cgreat Aussie dream\u201d of a big house with a big back yard, but at worst it can be a nightmare for our\u00a0 wildlife, with motor-vehicle accidents and predation by domestic animals resulting in countless injuries and fatalities daily. <\/span><\/span>\r\n\r\n<\/a>According to Robert Johnson, based at South Penrith Veterinary Clinic in Western Sydney, veterinarians play an important role in treating and rehabilitating wildlife that has come off second best in such encounters.<\/span><\/span>\r\n\r\nJane Doe, a female pink-tongued skink (Cyclodomorphus gerrardii<\/em>) presented to Johnson following a dog attack in a suburban back yard. For the uninitiated, pink tongued skinks are extremely similar in appearance to Eastern Blue-Tongue lizards, distinguished by a more slender body, a narrower tail, striking cross-band markings and of course a pink \u2013 as opposed to blue \u2013 tongue, hence the name. They\u2019re just a lot less common.<\/span><\/span>\r\n\r\nThey typically inhabit forests and woodlands, sheltering below leaf litter, under rocks and other crevices. Populations occur in the Blue Mountains in New South Wales, around the NSW central coast and along the Eastern coastal ranges to Cairns in Far North Queensland. <\/span><\/span>\r\n\r\n\u201cWe have a unique population in Springwood,\u201d Johnson said. \u201cWhen we had the old surgery in Springwood we had a couple living under the building, but they often hang around in rooves. Unlike bluetongues, they are very good climbers.\u201d<\/span><\/span>\r\n\r\nTheir culinary preference for snails and slugs ensures that suburban gardens are the ideal haunt for these critters \u2013 just as long as these are free of dogs and cats. Pink tongue skinks will use their climbing skills to escape predation, but not always fast enough to avoid injury.<\/span><\/span>\r\n\r\nSuch was the case with Jane, who had been enjoying a meal of slugs in a lush suburban garden when she was suddenly disturbed by a curious dog. The dog picked her up in its mouth, biting into her flank. She was prised from the offending jaws immediately by the dog\u2019s owner but the damage had been done \u2013 the bite had penetrated her coelomic cavity, and what appeared to be a solid, kidney shaped organ herniated through the defect. <\/span><\/span>\r\n\r\nJane was rushed to the clinic, where Johnson examined her. Close inspection of the hernia revealed a thin sac containing a silver and black striped mass. It wriggled. The mass, it turned out, was a live young pink tongued skink. Jane was pregnant. After a gestation period of just over 100 days, pink tongue skinks are known to produce large litters of 20-30 young (although there are reports of litters containing as many as 67 offspring).<\/span><\/span>\r\n\r\nIf these were to survive, Jane would require an emergency caesarean. Johnson premedicated her with a combination of morphine (2mg\/kg) and midazolam (1mg\/kg) via intramuscular injection.<\/span><\/span>\r\n\r\n\u201cIf it is a small volume you can give it in the front leg, otherwise in the epaxial muscles or subcutaneously.\u201d<\/span><\/span>\r\n\r\nInduction can be challenging as venous access in skinks is not always easy.<\/span><\/span>\r\n\r\n\u201cSkinks tend to required higher doses of alfaxalone when compared with a lot of other reptiles,\u201d Johnson said. \u201cIf we don\u2019t premedicate them they may need up to 20mg\/kg IV, but in this case after premedication I gave 10mg\/kg via the ventral tail vein, and then left her for ten minutes.\u201d<\/span><\/span>\r\n\r\nIntubation is difficult because of the large, slippery and in this case pink tongue obscuring view of the epiglottis which is just caudal to the main body of the tongue. Johnson routinely applies lignocaine and uses an intravenous catheter (with the stylette removed) as an endotrachael tube. In this case, he chose an 18 gauge catheter. Jane was maintained on isoflurane in oxygen using intermittent positive pressure ventilation.<\/span><\/span>\r\n\r\n\u201cYou can hook them up to a ventilator but we used a trusty veterinary student called Katrina,\u201d Johnson said.<\/span><\/span>\r\n\r\nTypically he performs midline caesareans, but in this case the dog had already created a defect. <\/span><\/span>\r\n\r\n\u201cWe opportunistically used the incision that the perpetrator had inflicted and went for it,\u201d Johnson said.<\/span><\/span>\r\n\r\nThe wound was cleaned, prepped and extended to facilitate a flank caesarean.<\/span><\/span>\r\n\r\nExploration of the coelomic cavity revealed ruptured oviducts, with several injured and deceased young floating freely. However, the majority (27 out of 30) remained in utero, and were delivered via multiple incisions.<\/span><\/span>\r\n\r\n\u201cWe don\u2019t tend to suture the oviducts in skinks and pythons as it does not affect their reproductive ability in my opinion,\u201d he said. \u201cThe oviduct is so thin and fragile that you would have to use 7.0 or 8.0 suture material, but you need to get in and out, flush out the coelomic cavity and save the life of the patient.\u201d<\/span><\/span>\r\n\r\nAnd her offspring of course. The neonates were placed together in a Tupperware container placed on a heating pad. Gradually they came to life, slowly animating their limbs and tails. All were attached to large yellow-red placentas, approximately the size of their head. Once mobile, each neonatal skink tucked ravenously into its placenta.<\/span><\/span>\r\n\r\nThe wound was closed routinely with nylon skin sutures. As her young reanimated in their tiny cr\u00e8che, Jane recovered slowly from an anaesthetic. Post-operatively she was kept in a warmed vivarium and given enrofloxacin every two days for antimicrobial coverage, after all the flank wound was the result of a contaminated bite. For analgesia she was given meloxicam (0.2mg\/kg SC) every second day for around ten days, after which she was released back into the wild.<\/span><\/span>\r\n\r\n\u201cWe let the babies go virtually the next day,\u201d Johnson said. \u201cAt least those which were lively. They have so many babies because there is a high attrition rate \u2013 from marauding kookaburras to red bellied black snakes and anything else that wants to eat a juicy neonatal reptile.\u201d<\/span><\/span>\r\n\r\nMum didn\u2019t exactly pine for her offspring.<\/span><\/span>\r\n\r\n\u201cThere is very little maternal behaviour exhibited by any reptile with the exception of crocodiles which are closer to a bird than a gecko,\u201d Johnson said. \u201cThey have a four-chambered heart, they almost have a diaphragm (two membranes, a part pulmonary and post-hepatic membrane that act as a diaphragm) and they guard their nests like birds. But pink tongued skinks are born live so the mother needn\u2019t worry about incubating eggs.\u201d<\/span><\/span>\r\n\r\nAfter being born live and dining out on a placenta, these kids are on their own in the big, bad world.<\/span><\/span>\r\n\r\nInterestingly, egg laying is more typical in reptiles that live in warmer climates. <\/span><\/span>\r\n\r\n\u201cElapids like tiger snakes tend to have live bearing young because it\u2019s just not warm enough for eggs to incubate in their usual habitat. But pythons and bearded dragons can lay eggs because they live in a warmer climate.\u201d<\/span><\/span>\r\n\r\nJohnson was mindful to hospitalise Jane in a temperature controlled environment until she had recovered her appetite and appeared livelier, but tries to avoid keeping reptiles in hospital for too long.<\/span><\/span>\r\n\r\n\u201cWe released her with sutures still in place as you have to weigh up the potential stress and risk of infection in hospital against the risks of being released. The sutures should not be a major problem as skinks shed their skin in part, not whole. We need to try to avoid keeping free ranging wild animals in captivity for too long.\u201d<\/span><\/span>\r\n\r\nBy the time of release, 15 out of 30 of Jane\u2019s offspring were thriving.<\/span><\/span>\r\n\r\nJohnson will be presenting at the World Veterinary Congress in Prague this year. For further information or to register visit <\/span><\/span>www.worldvet.org<\/span><\/span><\/a><\/span><\/span>\r\n\r\n \r\n\r\nHerpetologist and veterinary anatomist Glenn Shea provided information about the distribution of pink tongued skinks.<\/em><\/span><\/span>\r\n\r\nANNE FAWCETT<\/strong><\/span><\/span>","protected":false},"excerpt":{"rendered":"

Urban sprawl may allow us to actualise the \u201cgreat Aussie dream\u201d of a big house with a big back yard, but at worst it can be a nightmare for our\u00a0 wildlife, with motor-vehicle accidents and predation by domestic animals resulting in countless injuries and fatalities daily. According to Robert Johnson, based at South Penrith Veterinary […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[29],"tags":[30,953,954,1797,955,952,122,956,129,951,957,794,958],"class_list":["post-1088","post","type-post","status-publish","format-standard","hentry","category-clinical-zoo","tag-anne-fawcett","tag-blue-mountains","tag-cairns","tag-clinical-zoo","tag-dog-attack","tag-kink","tag-nsw","tag-pink-tongued-skinks","tag-queensland","tag-skinks","tag-south-penrith-veterinary-clinic","tag-surgery","tag-western-sydney"],"rise-blocks_total_comments":0,"rise-blocks_categories":[{"term_id":29,"name":"Clinical Zoo","slug":"clinical-zoo","term_group":0,"term_taxonomy_id":29,"taxonomy":"category","description":"","parent":0,"count":13,"filter":"raw","cat_ID":29,"category_count":13,"category_description":"","cat_name":"Clinical Zoo","category_nicename":"clinical-zoo","category_parent":0}],"rise-blocks_excerpt":"Urban sprawl may allow us to actualise the \u201cgreat Aussie dream\u201d of a big house with a big back yard, but at worst it can be a nightmare for our\u00a0 wildlife, with motor-vehicle accidents and predation by domestic animals resulting in countless injuries and fatalities daily. According to Robert Johnson, based at South Penrith Veterinary Clinic in Western Sydney, veterinarians..","blog_post_layout_featured_media_urls":{"thumbnail":"","full":""},"categories_names":{"29":{"name":"Clinical Zoo","link":"https:\/\/theveterinarian.com.au\/?cat=29"}},"tags_names":{"30":{"name":"Anne Fawcett","link":"https:\/\/theveterinarian.com.au\/?tag=anne-fawcett"},"953":{"name":"Blue Mountains","link":"https:\/\/theveterinarian.com.au\/?tag=blue-mountains"},"954":{"name":"Cairns","link":"https:\/\/theveterinarian.com.au\/?tag=cairns"},"1797":{"name":"Clinical Zoo","link":"https:\/\/theveterinarian.com.au\/?tag=clinical-zoo"},"955":{"name":"dog attack","link":"https:\/\/theveterinarian.com.au\/?tag=dog-attack"},"952":{"name":"kink","link":"https:\/\/theveterinarian.com.au\/?tag=kink"},"122":{"name":"NSW","link":"https:\/\/theveterinarian.com.au\/?tag=nsw"},"956":{"name":"pink tongued skinks","link":"https:\/\/theveterinarian.com.au\/?tag=pink-tongued-skinks"},"129":{"name":"Queensland","link":"https:\/\/theveterinarian.com.au\/?tag=queensland"},"951":{"name":"skinks","link":"https:\/\/theveterinarian.com.au\/?tag=skinks"},"957":{"name":"South Penrith Veterinary Clinic","link":"https:\/\/theveterinarian.com.au\/?tag=south-penrith-veterinary-clinic"},"794":{"name":"surgery","link":"https:\/\/theveterinarian.com.au\/?tag=surgery"},"958":{"name":"Western Sydney","link":"https:\/\/theveterinarian.com.au\/?tag=western-sydney"}},"comments_number":"0","wpmagazine_modules_lite_featured_media_urls":{"thumbnail":"","cvmm-medium":"","cvmm-medium-plus":"","cvmm-portrait":"","cvmm-medium-square":"","cvmm-large":"","cvmm-small":"","full":""},"_links":{"self":[{"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=\/wp\/v2\/posts\/1088","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1088"}],"version-history":[{"count":5,"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=\/wp\/v2\/posts\/1088\/revisions"}],"predecessor-version":[{"id":1111,"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=\/wp\/v2\/posts\/1088\/revisions\/1111"}],"wp:attachment":[{"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1088"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1088"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1088"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}