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Hemipene Prolapse- summary

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  • [Health-General] Hemipene Prolapse- summary

    here is a summary of the Hemipene prolapse condition that occurred on the night of the 28'th of October 2009 to a male Boa Constrcitor Imperator. "Spiritus" is a 2008 male who proved himself an eager breeder since the 4'th of the same month.
    Several confirmed copulations were observed during this period without unexpected occurrences, a warm and cool side were maintained in their proper spectrum.

    On the night of the 28'th, after a lengthy copulation of roughly 4 hours the Boas separated at around 10:30 PM.
    On 10:45 PM I noticed that Spiritus had his tail slightly bent, so I went over to check it out and I saw that his Hemipene was exposed and bulging.



    I phoned my vet friend and told him of the condition. His advice was to leave the male be and wait until morning- if by then the condition persists, to put him in a tub with lukewarm water.
    Due to the late hour I could not send over a picture nor did I know to identify the severity of the condition.
    I have decided against my better judgment to let it remain as it is until morning- I rinsed in the water bowl and made sure that Spiritus remained nestled on the female, thus preventing contact between the tissue and the aspen. The vet assured me that it was normal and that by morning it should correct itself.
    With hiis conclusive answer and my own wish not to separate the breeding pair- I decuded ti wait until morning.
    In retrospect the vet agreed that it was a bad call on his part, however, he couldn't have been made aware to the severity of the condition because I was not yet experienced enough to differentiate one hemipene prolapse from another.

    on 5 AM of the 29'th, I woke up(for the third time that night) and went to see if the condition persisted- the hemipene was still prolapsed.

    I decided to act and contacted some Boa keepers at RedTailBoas.net and read articles about hemipene prolapse.

    I have received two main suggestions:

    1- use ice/ice-cold water directly on the tissue and reduce the swelling.
    2- apply sugar paste(mix a lot of sugar with a bit of water) or honey to cause negative Osmosis, the high concentration of glucose will force the fluids out of the swollen tissue and thus allow it to reduce in size.

    I have tried them all, and found the application of honey most efficient- though the swell did not disappeared, it receded by 20-30%.
    I then tried to gently push the hemipene back in, but was unsuccessful.

    The prognosis of a hemipene prolapse if left untreated is infection, which will lead to necrosis of the tissue which would result in need to amputate- if it is not amputated, the hemipene can either fall off or cause blood poisoning and death.

    There is a crucial importance to keeping the tissue clean, moist and vital while it is left exposed, and the snake should be kept in a clean tub with very moist paper towels.



    I phoned the vet yet again and he sent me to buy an ointment named "Hemo" which is used to treat hemorrhoids. The ointment can be bought without a prescription and is highly efficient for not only helps with the swelling, it also has general antibiotics that help prevent infection.
    The ingridients are: Bismuth subgallate, Benzocaine, Zinc Oxide, Zinc Sulfate and Chloroxyleonl solution.

    It's Avocado green and oily, so it helps well with keeping the tissue alive.
    However, it was impossible to reinsert the hemipene.

    A vet interference was needed and so I took an hour an a half drive up north to the clinic.

    Meanwhile he studied similar cases(in which the snake is incapable of retracting the hemipene on his own) and the general consensus in the literature was to put the snake under anesthetics- Isofloren was specified, and it is considered the best type of anesthetics in vet practice. After the snake is sedated, to re-insert the hemipene back into place.

    However when I got there we understood the full scale of the problem. Spiritus had in fact prolapsed -both- hemipene, thus jeopardizing his ability to reproduce and becoming sterile if it the tissue is infected- Boa Constrictors normally use just the tip of a single hemipene when breeding. Spiritus was so eager that he tried both, or mayhap the excitement caused him to do so.

    Sadly we did not have Isofloren available so we used a mix of Ketamine and Valium- I will not go into detail about the dosage. I will say however that we had to administer possibly twice or even three times the suggested dosage in the literature- because some of those books are relatively old(2002 or so) and because the spectrum suggested per kilo was very broad.
    Make sure you work with an experienced herp vet who can properly evaluate the correct dosage- we played it safe, injecting and waiting to make sure we did not over-medicate him.

    We also used a Lidocaine gel on the hemipene itself to loose it.

    I will now try to explain what physically happened. You see, the base of the Hemipene is actually in the Cloaca, and it built like an inverted sock, ending in two tips, like the letter Y. when retracted, the hemipene is tube like, but when it is inverted and outside, it "blossoms" out and looks a bit like an unfolded flower. The issue was that in Spiritus case it was fully inverted, meaning that we had to both fold it back -and- reinsert it.
    That is why anesthetics were essential for it is a painful procedure and the snake's own reaction wouldn't allow us to properly handle it.
    Try as we might, we remained unsuccessful and so we had to resume our efforts the following day.

    On the 30'th we decided to use Ketamine and Xylazine initially(Xylazine being reversible by administrating a counter-shot). Today too we had to administer two more shots before he was fully sedated. It required a lot of caution because snake's liver is very susceptible and it takes them a long while to clear the anesthetics- so we had to consider the fact that he still was medicated from the previous day.

    We decided to create a cut angled roughly 90 degrees from the cloaca and upwards towards the tip of the tail in order to make the gap bigger and make it easier to re-insert the hemipene- It was unnecessary however, with the method the vet came up with. We used two catheters and pushed in the tip of both hemipene simultaneously. The lidocaine gel and general anesthetics neutralized the hemipene from contracting and we managed to push it all in.

    We spent around 6 hours in total before coming up with that method.

    The cloaca vent was loosely stitched in order to make sure that the hemipene does not pop back out.
    The stitches will be removed within a month's time- as for this year, I can only hope that the month he spent breeding will be fruitful but... it matters little. I am just happy he is alive and that amputation was not necessary.



    Conclusions:

    1- Once detected, a prolapse should be immediately treated. Leaving the snake on Aspen is a bad call as the tissue can easily be punctured and dry out.

    2- The tissue should be kept moist, the snake should be kept on wet paper towels.

    3- The use of honey, ice, sugar paste or hemorrhoid ointments are all applicable- try everything to reduce the swelling.

    4- In most cases the snake -is- able to retract the hemipene. The use of anesthetics on reptiles is always dangerous and it is best to try and correct the condition without their use- however if the hemipene cannot re-enter by the use of the methods stated above- anesthetics are in order for the contractions will not allow you to re-invert the hemipene.

    5- stitching the Cloaca is highly recommended to prevent the hemipene from again inverting itself outwards.

    Spiritus is now well and sound, still awakening from the heavy doses of anesthetics.



    I hope this piece of info will prove useful.

    Oren

  • #2
    Re: Hemipene Prolapse- summary

    Thanks for the post! It was very informative. That tissue certainly doesn't look too happy; do you know how long it had been outside the body when you discovered it?

    Just curious if your little guy got an analgesics? I'm not sure what you all have available over there, but what's fallen into favor here is much the same as what we use in companion animal medicine. Many vets like to give an opioid (e.g. morphine, hydromorphone) and a benzodiazepene (e.g. midazolam, since Valium can cause tissue inflammation if given into a muscle and is poorly absorbed due to the propylene glycol base) 10-20 minutes before the induction agent is given. This usually relaxes the snake, provides analgesia, and should reduce the amount of induction agent and concentration of maintenance gas needed. Due to the prolonged recovery times with things like Telazol and xylazine, propofol is getting popular and is very safe. Of course you do have to have easy tail vein access. I know some vets will still induce with isoflurane (or sevoflurane which is slowly beginning to replace iso in exotic medicine), but that is generally frowned upon by the anesthesia gurus. Get your friend to check out Veterinary Information Network (VIN) - For Veterinarians, By Veterinarians. The vets I work for and most that I know are "Vinners" and it really keeps them in the loop on what treatments are considered the standard of practice in most areas now since it is always changing. I forget how much it costs per year, but they always feel it is well worth it.

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    • #3
      Re: Hemipene Prolapse- summary

      it was discovered roughly 15 minutes after copulation- it's actually healthy in those pics, that's the color of the tissue when it is not swollen with blood.
      It's always purple'ish though... it's swollen because of the pressure he put on it with his body laying on it.

      We had to do with what we have. Exotic pet awareness here is laughable and he has to work in a clinic that mainly treats dogs and cats.

      Out of the medications he had, he decided to use these. I don't know what else he stores there, and it would have been a bit rude to "argue" over which anesthetics to use I think.

      Most things happen in severe delay here... I will try and refer him to the site you suggested, he may find it to his liking.

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      • #4
        Re: Hemipene Prolapse- summary

        Wonderful post Oren thanks for writing it out and detailing so much information
        Joley who responded above is the person I wanted us to talk to to that morning
        when we were dealing with this problem. Joley is an invaluable source of
        information here on RTB.com. Not the least of which is veterinary medicine
        advice. This thread is one that I will keep marked. As I believe even
        Herp Vets with experienced but limited may not have dealt with this
        issue before.
        I hope I never have to deal with this issue but this thread
        will come in handy if I do

        I'm glad Spiritus is well and on the mend Oren !!

        . . . Lar

        Lar M
        Boas By Klevitz

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