Reptile & Amphibian Forums

The patients are doing well. I just handed out pain meds again this morning to some much livelier looking snakes. Mambas get awfully wiggly when they are feeling better. LOL
Slide show - mamba mouth injury treatment

that nobody was bitten during treatment. Keep up the good work.

Your concern is appreciated. I hope I don't get bitten either. I have plenty of SAIMR in the fridge but absolutely no desire to use it.

We probably don't have a lot to worry about from our patient with no fangs, but the other two are fully loaded with both fangs intact. We are taking good safety precautions during handling for medication, even with our poor fangless patient.

Morning mouth check and medication was fun. These guys are getting remarkably lively and squirmy, which I'm glad to see even though it makes working with them a wee bit more challenging.

Glad to hear the mambas are responding well to the treatment. I was given a large female viridis last year with the purchase of a male from a gentlemen here in Arkansas. She had been afflicted with a severe oral infection for around a month before I received her. My vet prescribed a course of treatment basically consisting of daily oral rinses, an antibiotic salve to be applied to the infected area, and an injectible antibiotic given every 2 to 3 days. You don't know fun until you're restraining a nearly 7' viridis in the bathroom trying to get a decent rinse. The snake really wasn't that bad to deal with though, likely due to her less than pristine condition. Initially she seemed to be responding well to the treatment, but her system finally just couldn't take it any longer and she eventually died. She hadn't eaten in probably two months, and with such a high metabolism at work, combined with the sever infection and stress of importation and captivity, it just became a bit too much to handle (can you blame her?). It was very unfortunate to finally loose her, as even in that state she still commanded complete awe and respect. This is why I'm so glad for the work you are doing in helping these snakes. Heaven knows imported mambas and other dangerous snakes can take all the help they can possibly get. Keep up the excellent work.
-Chance

Chance,

I am a big big fan of using humane sedation, anesthesia and pain management protocol in reptiles. In short I'm a drug pusher. LOL Most folks (especially veterinarians) that I discuss these protocols with assume that the most important factor in using sedatives is handler safety. Which it really is not, for me personally anyhow. There are many snakes I don't sedate before handling for non invasive exam because it isn't necessary for the patient. Healthy mambas and cobras would be one example. Elapids have nice thick supporting musculature and can be grasped and restrained with far less risk of injury to the animal than a viper can. So it doesn't worry me to nab them up for non painful procedures (giving antiparasitical meds, etc) with no sedation. Painful procedures are a whole other story though.

A mamba with severe stomatitis and maybe oral trauma, broken bones around the cranial area, inflamed mouth tissue, etc, is an absolutely top candidate for humane sedation when you are cleaning and debrieding the wounds. For one, the animal is in pain. Relieving that pain will speed the animal's recovery and its return to normal behaviors. For another, conscious restraint of an animal with trauma injuries is a serious risk to the patient. I would sedate a corn snake under the same circumstances.

Your vet should not be at all concerned about sending you home with the amount of Diazepam it takes to sedate even the largest of venomous snakes, because that amount could not possibly be abused by a human. I suggest 0.1 to 0.3 mg/kg to reduce stress on handling but still have a reasonably responsive snake, and up to 0.5 for profound relaxation and near immobility. We have given up to 5.0 mg/kg in one green mamba case, titrating up slowly from 0.5, because extreme pain does appear to significantly lessen the sedative effect of this drug. We are also using Buprenorphine 0.2 mg/kg for long term pain relief in these animals.

I usually just snitch up a mamba tail while the head is busy in cage foliage and deliver the low volume injection before they can turn around, but you can also use a pole syringe for rapid and nonstressful delivery that does not involve full body restraint.

I've had both good luck and bad luck with batches of mambas coming in with severe stomatitis. When the animals were massively septic because they had been left in this condition for too long, I generally have not been able to save them despite intensive support care and antibiotics. When the injuries were relatively fresh I have had excellent success. I attribute a lot of that success to the fact that I am not stressing my patients and causing them pain and terrified struggle every time I treat them. Humane sedation takes away the pain and the struggle and helps the animals recover much more quickly.

If you had a dog or a cat that had a broken jaw and a terrible mouth infection, NOBODY would consider it a good idea to hold the animal down by brute force and clean out its mouth while it struggled and suffered. Yet this is done routinely to snakes, even by veterinarians. Modern research has clearly demonstrated that snakes have essentially the same physiological and chemical pain perceptor mechanisms that mammals do. Unfortunately not all veterinarians are keeping up with modern research in this particular field.

The current trend in reptile medicine is urging veterinarians to give reptiles the benefit of the doubt and to give pain medication under all of the same circumstances that mammals would recieve it. There are a lot of papers out on this particular subject, and it's a fairly hot topic on the reptile programming track at vet conferences. Hopefully the knowledge will eventually trickle down from the reptile specialists to the general veterinary population, and from there to the keepers.

we have people like you Tanith who are experienced enough AND care enough to help these amazing animals...I agree that it is very unfortunate that even vets are ignorant to reptile pain management. Hopefully through education and awareness, more people will realize that these are not animals who feel no pain, but vunerable and delicate creatures who deserve equal considerations given to a cat or dog.

AP

...written by somebody who knows a lot more than I do about pain management in reptiles.
Perception of pain in reptiles

Yes, I've read that article, pretty informative...thanks anyway though

AP

You would be right about my vet not taking into account possible pain and discomfort the snake was going through. Her stomatitis was so progressed though and had been that way for so long, it's doubtful that much in the way of intact nerve endings still existed in her mouth. Much the same way humans will "turn off" pain receptors if they begin to overload from intense pain lasting over a long period (such as a person having his arm involuntarily yanked or blown off, they say it really doesn't hurt much), I would imagine that she had stopped having sensation in her mouth long before I acquired her. She actually didn't struggle or show signs of stress at all during treatment. She was always very lethargic and self-sedated, of course attributed to her awful condition. If she had shown any signs of discomfort at the procedure, I probably would have contacted my vet and asked about what pain meds would be appropriate. I'm going to copy-paste and save your responce so that I will have that information in the future if ever I need it, because I sort of doubt that he would know about those medications without any prompting on my part. He is much more of a cow/horse vet, which is by far the majority here in rural Arkansas, but he is also the only experienced reptile vet in the area and doesn't mind at all treating my venomous snakes. Anyway, thanks for the information. I'm sure it will at some point become quite useful.
-Chance

"I would imagine that she had stopped having sensation in her mouth long before I acquired her. She actually didn't struggle or show signs of stress at all during treatment. She was always very lethargic and self-sedated, of course attributed to her awful condition. If she had shown any signs of discomfort at the procedure, I probably would have contacted my vet and asked about what pain meds would be appropriate."

I'm sure you would have. In reptiles pain and response may be dissociated, which is why there is such a high incidence of thermal burns. The animal does feel pain from the burn but may not be able to associate the pain with the hot rock and consequently does not react by climbing off of it. In sudden acute onset pain you will usually see a reflex, but in chronic pain or slow onset pain the reptile may not have a visible reaction. That does not mean the animal is not suffering, only that the visble response is subtle or nonexistent.

I would not venture to say that a reptile in chronic pain does not feel it any more. It may be unable to respond due to its debilitated condition, but it is very probably suffering. If you can put a chronic pain case on pain medication you may see a return to normal behaviors like perching and voluntary thermoregulating, which contributes greatly to recovery.

One really good way to educate your vet goes like this. Tell your vet that you will pay for him or her to have a consultation with Doug Mader on the next case you bring in. This will cost you $75 extra and will have the end result of teaching your vet all kinds of good stuff directly from one of the best known and most widely published reptile medicine researchers. The Marathon Veterinary Hospital is listed in Marathon, Florida and easy to find a phone number on (I don't have it offhand).

The Buprenorphine dose is 0.02, not 0.2. Misplaced my decimal point there. Sorry.