Lump on Tortoise Head/Tumor? Cyst? Abscess?

[Nellie Rose]

Hello.
So i have an unfortunate update. The scab over the wound flaked off the day before yesterday, and underneath was thick cheesy puss. It wasn't as much as initially, but the wound had started to abcess again, so I assume there is still infection.

I think it was my own doing, I haven't been as attentive as I should have been after the initial two weeks because it was looking so good. So much is going on right now, and it just went to the back of my mind.

After the scab flaked off, I flushed it out with saline, followed by peroxide because it was all I had on hand. I used sterile tweezers to pull out any bits of puss.
I have flushed it with saline yesterday and this morning, and this morning there is no longer an easily accessed pocket to flush out and it is starting to scab.
I have been applying antibiotic ointment twice a day, as well as soaking him every morning.
He is still fully active, interactive, and will eat anything I give him. I am giving him leafy greens and soaked mazuri every day and he is eating almost all of it, I am basically giving him enough that he can eat whenever he wants all day.

This is his hospital tank. It was just repticarpet, but last week I added some cypress mulch bedding so I could reintroduce his usual water dish as I felt he was struggling with the shallow ceramic one I had in there previously. That was before I realized he hadn't been healing well.
He's got a 24 inch T5 uvb, and a 75 watt incandescent for heat, which keeps ambient temps around 75 with a hot spot of 80-85.
I'm unable to keep humidity at his usual 60%, so i was thinking of incorporating some moist peat moss in his hide so he has a humid hide.
I have also been covering the tank walls with towels so he doesn't get so stressed.
His usual enclosure is PVC and much larger, i moved him into this enclosure for ease of maintenence because I thought this would be short term, but now I may clean his usual enclosure and move him back.

I have a couple of questions.
One: should I incorporate some moss? Or leave the tank as bare as possible until he heals? Should I remove the cypress bedding?

Two: i have been applying antibiotic ointment, but today I found an unopened tube of Silver Sulfafadiazine ointment that had been prescribed for one of my lizards a while back. Would this be a better option for this initial infection phase? My understanding is SSD can slow healing if used long term.

Three: what does this mean? Is this a sign he is not going to heal? Does he need further medical intervention or do I just need to be more vigilant about his wound and applying ointment?

Four: i can get chlorahexadine solution or iodine from my work, should I get some and clean his wound regularly? Or just rely on the ointment?

 

[Nellie Rose]

Also I will post pictures of him later today, I meant to take them this morning but I forgot.

 

[Nellie Rose]

His bloodwork came back WNL. The doctor did say his kidney markers were borderline, but he said it was so mild he suspects it was dehydration secondary to pain making him hesitant to drink, and recommended I soak him more frequently, which is why I am soaking him daily for the time being.

Because his labs were normal overall, there are no more concerns about his xrays.

I am also wondering if his shell is causing repeated trauma to the area, as I am watching him and the wounded area gets scraped under his shell anytime he pulls his head in, it is really obvious with the ointment on.

 

[COmtnLady]

First, NO moss. It should never be used around tortoises as it can cause intestinal impactions/blockages.

Are you sure there isn't any foreign object (splinter, hair, etc) still in the wound?

Having water in with him is important, any chance you have a terracotta saucer instead of the plastic bowl? It would be more stable/less tip-prone, and be easier to get in and out of. (Also has the added perk of helping keep nails worn down to a good length.)



I'm sure others here who have more experience with wounds will comment soon, but my 2 cents are -
I'd try the Silver Sulfafadiazine for a day or two then continue with the antibiotic cream. That way you get the benefits of the silver but aren't using it long enough to cause damage.

It seems like the wound would need to heal from the inside out, that if the top closes too soon it will trap bacteria and act like you have described already above. Unfortunately I don't know how to prevent this. Let's ask @Yvonne G , @Markw84 , @zovick , @Tom




.


.

 

[Nellie Rose]

First, NO moss. It should never be used around tortoises as it can cause intestinal impactions/blockages.

Are you sure there isn't any foreign object (splinter, hair, etc) still in the wound?

Having water in with him is important, any chance you have a terracotta saucer instead of the plastic bowl? It would be more stable/less tip-prone, and be easier to get in and out of. (Also has the added perk of helping keep nails worn down to a good length.)



I'm sure others here who have more experience with wounds will comment soon, but my 2 cents are -
I'd try the Silver Sulfafadiazine for a day or two then continue with the antibiotic cream. That way you get the benefits of the silver but aren't using it long enough to cause damage.

It seems like the wound would need to heal from the inside out, that if the top closes too soon it will trap bacteria and act like you have described already above. Unfortunately I don't know how to prevent this. Let's ask @Yvonne G , @Markw84 , @zovick , @Tom




.


.

Im fairly certain there's no foreign body, I was pretty thorough with both manual debridement and flushing the wound. Whether there was one and that's why it abscessed again, Im not sure.
I dislike terracotta saucers, ive found them difficult to clean and since its a porous material it can't be sanitized, but that is just my preference. I was using a shallow ceramic dish, but I felt it was too shallow to allow him full access, so I added the cypress bedding and put in his old dish, which he really enjoys and has been taking short soaks in. I feel better too because I can disinfect it regularly.
I put the SSD on him this morning, I had the same thought to use it for a few days then discontinue and use antibiotic ointment.

 

[The_Four_Toed_Edward]

His bloodwork came back WNL. The doctor did say his kidney markers were borderline, but he said it was so mild he suspects it was dehydration secondary to pain making him hesitant to drink, and recommended I soak him more frequently, which is why I am soaking him daily for the time being.

Because his labs were normal overall, there are no more concerns about his xrays.

I am also wondering if his shell is causing repeated trauma to the area, as I am watching him and the wounded area gets scraped under his shell anytime he pulls his head in, it is really obvious with the ointment on.

Adding to what COmtnLady said, it might be necessary to gently file the shell if it really is sharp. Try feeling the edge with your finger.

I will let more experienced to comment on your questions.

 

[Nellie Rose]

Adding to what COmtnLady said, it might be necessary to gently file the shell if it really is sharp. Try feeling the edge with your finger.

I will let more experienced to comment on your questions.

It's not sharp, but it does hit his head where it is swollen every time he pulls his head in. I dont think I could safely file it down enough to stop it.

 

[COmtnLady]

How about pictures. Possibly by seeing exactly what you are dealing with an idea for a fix might occur.

 

[TammyJ]

His bloodwork came back WNL. The doctor did say his kidney markers were borderline, but he said it was so mild he suspects it was dehydration secondary to pain making him hesitant to drink, and recommended I soak him more frequently, which is why I am soaking him daily for the time being.

Because his labs were normal overall, there are no more concerns about his xrays.

I am also wondering if his shell is causing repeated trauma to the area, as I am watching him and the wounded area gets scraped under his shell anytime he pulls his head in, it is really obvious with the ointment on.

The scraping of the wound on the shell is what I was thinking about as I read through these posts.
Silver Sulfadiazine is great stuff for reptile wounds to prevent and treat infections.

 

[Nellie Rose]

How about pictures. Possibly by seeing exactly what you are dealing with an idea for a fix might occur.

Sorry i thought I sent this yesterday.

 

[TammyJ]

I would stop the soaking and keep him dry on just clean newspaper or paper towels for now.
Give him a small, heavy shallow dish of water just for drinking, in the corner of the enclosure.
Try to smooth down the edge of the shell where it's scraping the wound if possible or cover the shell edge firmly with duct tape and keep an eye on it.
Use the Silver Sulfadiazine cream.
Please keep us updated!
Good luck.

 

[Nellie Rose]

The scraping of the wound on the shell is what I was thinking about as I read through these posts.
Silver Sulfadiazine is great stuff for reptile wounds to prevent and treat infections.

Yeah, I dont know how I would prevent it unfortunately . I am just trying to be really vigilant with cleaning and applying SSD twice a day.

 

[TammyJ]

Yeah, I dont know how I would prevent it unfortunately . I am just trying to be really vigilant with cleaning and applying SSD twice a day.

Ha, you posted same time as me

 

[Nellie Rose]

Ok so this is what it looks like tonight vs yesterday evening. It's hard to know if it is looking any better unfortunately. The silver look yesterday is from the cream. He's gotten it all over his head and his arm. I will probably switch over to antibiotic ointment again in a day or two.
Should i try to get prescription ointment? Like mupirocin or prescription antibiotic ointment? I'd need to check with the doctors but I may be able to take some hospital stock.
The actual wound is looking okay to me, but I am a little concerned about the swelling more towards his neck. I tried to pull his head out a bit to show it, but as you can imagine he did not like that haha

Yesterday:

Today:


And just for comparison, original pictures post-op and from the day of/day after

 

[COmtnLady]

Agreeing with the constant irritation from rubbing on the shell. That looks like what used to be called "proud flesh". It is a build up of scar tissue.

There's no need for prescription cream. You have the heavy-duty silver, and the neosporin and other OTC creams. What is needed is a way to stop the rubbing-on-the-shell.

Because the skin in the neck and head area is so fragile, its gonna be tricky to give it a chance to heal up unmolested. And there will probably always be a bump of scar tissue there once it is healed over. We need to make a covering that allows it to breathe, but provides protection from the constant in-and-out-scraping. The problem is if a bandage is adhesive enough to not be rubbed off during regular daily motions, when you do want to take it off it may damage the skin where it was stuck onto. He'll probably try to rub at it with a foot no matter what, anyhow.

There is some stuff called liquid bandage, but I'm not sure if it is ok for reptiles - and, the location is close to eyes so will be tricky to put on the damaged area without getting into his eye on that side.

I think once some sort of rubbing protection is successfully settled on, it would be good to leave it alone for three days at a time to give any soft new tissue time to get stronger. Then have it off for a few hours and on again for two to three days.

@Yvonne G is there a way to do this. Or better yet, what is a better way to get this to heal up?





.

 

[Nellie Rose]

Agreeing with the constant irritation from rubbing on the shell. That looks like what used to be called "proud flesh". It is a build up of scar tissue.

There's no need for prescription cream. You have the heavy-duty silver, and the neosporin and other OTC creams. What is needed is a way to stop the rubbing-on-the-shell.

Because the skin in the neck and head area is so fragile, its gonna be tricky to give it a chance to heal up unmolested. And there will probably always be a bump of scar tissue there once it is healed over. We need to make a covering that allows it to breathe, but provides protection from the constant in-and-out-scraping. The problem is if a bandage is adhesive enough to not be rubbed off during regular daily motions, when you do want to take it off it may damage the skin where it was stuck onto. He'll probably try to rub at it with a foot no matter what, anyhow.

There is some stuff called liquid bandage, but I'm not sure if it is ok for reptiles - and, the location is close to eyes so will be tricky to put on the damaged area without getting into his eye on that side.

I think once some sort of rubbing protection is successfully settled on, it would be good to leave it alone for three days at a time to give any soft new tissue time to get stronger. Then have it off for a few hours and on again for two to three days.

@Yvonne G is there a way to do this. Or better yet, what is a better way to get this to heal up?





.

That's what i was wondering about was proud flesh. I've seen it in many mammals and it didn't occur to me until recently it might happen in a tortoise.
I emailed the doctor who did the procedure, and they responded this AM. I'll attach the response.
The SSD is actually prescription strength, I just wasn't sure if a different topical would be recommended at this time. Seems like the doctor agrees SSD is good to use now.
In the photos he thinks it is granulation tissue, but agrees the amount is concerning, and I will be monitoring. If the swelling doesn't start to reduce I'll have to take him somewhere.
I am trying my hardest to be patient, vigilant, and conservative as I don't have any extra funds right now, and I also don't want to put him through the stress if possible, but definitely if it worsens or doesn't improve I will likely make an appointment at a specialty hospital in Virginia that is very well respected.

I am not sure how to prevent it from rubbing on the shell. I will brainstorm, and I'll also shoot the doctor an email to see if he could provide a solution.

 

[The_Four_Toed_Edward]

Perhaps @zovick has some ideas.

 

[zovick]

Perhaps @zovick has some ideas.

You could take a small piece of adhesive tape or duct tape and put it over the sharp part of the shell which rubs on the head wound. Or you can take a file and file the sharp edge of the shell down. It won't hurt the tortoise, although I saw in another post you said you were reluctant to do the filing. You can use a coarser emery board or even a metal woodworking file to do this. I can say from personal experience that it works.

 

[Nellie Rose]

You could take a small piece of adhesive tape or duct tape and put it over the sharp part of the shell which rubs on the head wound. Or you can take a file and file the sharp edge of the shell down. It won't hurt the tortoise, although I saw in another post you said you were reluctant to do the filing. You can use a coarser emery board or even a metal woodworking file to do this. I can say from personal experience that it works.

So i am hesitant because it is not sharp, the shell is already smooth, so I'm not sure how much good it will do. I'm definitely open to it.
I can possibly wrap a piece of tape around the shell where the wound it, maybe it will be more slick than his shell and keep it from getting traumatized further.

 

[COmtnLady]

I only agree a little bit with the Vet's statement that the swelling will go down as it heals. There will be residual scar tissue that stays. Yes, it will be less/lower than what we are seeing at the moment, but scar tissue is stubborn and without the normal skin's blood supply and such, a scar stays for the rest of a lifetime.

The constant re-irritating needs to be reduced. In another location it could be bandaged, but torts pull their heads in too many times per day. These next few ideas are just brainstorming, so anything needs discussed a lot with the long-term members before being done, because there is a lot I don't know about tortoises.

Filing the leading edge of the shell would be a good idea, but it won't grow back much, and will always have that same general shape from here on out.

Could some silicon be "painted" over that front edge to "pad" the edge?
Or several layers of fingernail polish (which would wear off after a few weeks)?

Create a mini "collar of shame"? (Might be impossible to situate so it doesn't cause more problems rubbing somewhere else...)

An old-fashioned corn plaster, the type that pads and has a hole in the center, though the moleskin type could be adapted with some creative scissor work. It will get rubbed off very easily (which could become your tortoise's new hobby), but might provide enough of a break from irritating the open wound that it helps.




@zovick , @Tom , @Yvonne G , @Markw84 , @Maggie3fan , @wellington




.