R E P T I L E   C A S E S   The Use of HEALx Sunshine Factor and Soother Spray in a Gecko with Skin Lesions Sergio Sarmiento Valiente, DVM Before After     The Use of HEALx Rain and Sunshine Factor in an Iguana with Dysecdysis Sergio Sarmiento Valiente, DVM Before After A green iguana (Iguana iguana) was presented with dysecdysis (abnormal shed). The skin had not regenerated properly because the animal was housed in a terrarium with poor heating and low humidity and was offered an improper diet. The iguana was hospitalized for 10 days with a daily shower of HEALx Rain. HEALx Sunshine Factor (0.2 ml per 100 g body weight) was added to its daily diet of broccoli and hibiscus flowers. The iguana showed improvement after only 3 days of treatment and appeared to like the taste of the Sunshine Factor. The eye that was compromised because of the skin condition returned to normal. _________________ The Use of HEALx Soother Plus and Booster in a Sulcata Tortoise with a Severe Bite Wound Ariana Finkelstein, DVM A juvenile sulcata tortoise was presented after sustaining a severe defect in its carapace following trauma caused by a dog. Its normal diet consisted of a herbivore mixture of hay, greens and selected red/orange vegetables. It was housed primarily outdoors in South Texas. The tortoise weighed 0.679 kg on presentation. It was immediately placed in an incubator for stabilization and started on warmed fluids (Reptile Ringer’s Solution, 20 ml divided in several areas subcutaneously and intracoelomically). After stabilization, wound care was initiated with dilute chlorhexidine scrub and chlorhexidine solution. The tortoise was started on injectable antibiotics: ceftazadime and meloxicam. HEALx Booster® was added to the diet (0.12 ml PO q24h), and HEALx Soother Plus® was applied topically 2 times daily to the affected tissues for pain management and healing. Topical treatment of the wound continued at home twice daily with the dilute chlorhexidine solution and Soother Plus.® Within 11 days, a good quality layer of granulation tissue was present. The tortoise is continuing to do well at this time. Before After  _____________________   The Use of HEALx Soother Plus in a Bearded Dragon with Exudative Crusts Victoria Hollifield, DVM and Kathy Waite, LVT Best Friends’ Veterinary Hospital Gaithersburg, MD Before - Day 0 Day 0 (Soother Plus applied) Day 11 Day 11 A young bearded dragon (Pogona vitticeps) was found outdoors in a dehydrated, emaciated and lethargic condition; it also presented with a shortened maxilla. Initially, it was not possible to determine if the left eye was present. In addition, the animal had avulsed facial skin, exudative crusts on the face, a small puncture wound on its head and Coccidia/pinworm infestations. Its metabolic bone disease condition and the parasites were addressed. Fluids were administered and Critical Care was fed. The face was treated with an application of HEALx Soother Plus twice a day. The crusts were removed, and a functional left eye was revealed. In the weeks that followed, the face slowly returned to normal. _________________________ The Use of HEALx Booster Concentrate, Sunshine Factor and Soother Plus in a Tortoise with Erythema Thomas Bankstahl, DVM   A 13.6 kg African spurred tortoise (Geochelone sulcata) was presented with erythema and mild ulceration of the ventral surfaces of the feet. Rule-outs included trauma, infection or inappropriate substrate. HEALx Soother Plus was used topically on the affected area q12h as the only topical treatment. The tortoise’s salad was supplemented with a top dress of HEALx Sunshine Factor (5.44 ml q24h 0.4 ml/kg) and HEALx Booster Concentrate (20 pellets q24h). The depth of the substrate was also increased during the treatment. The erythema improved within 24 hours and resolved within 72 hours. The ulceration showed improvement within 72 hours and was resolved by Day 10. _________________ The Use of HEALx Soother Plus and Booster in Severe Bite Wounds in a Tortoise Sergio Sarmiento Valiente, DVM Before After A Mediterranean tortoise (Testudo hermanni) over 40 years of age was presented with severe rat bites on its foreleg. Fluids and antibiotics were administered immediately. Following 2 surgeries, the animal was hospitalized and treatment continued with injectable antibiotics and bandage changes every other day. The lesions were treated topically with HEALx Soother Plus during bandage changes. HEALx Booster was added to the top of the tortoise’s salads (0.5 ml q12h with the assumption that some will not be eaten). After only 1 month, the skin had epithelialized and bandages were no longer necessary. This animal is still able to walk. Once the animal had recovered, the owner started to give HEALx Sunshine Factor (0.4 ml q24h mixed with its salad twice a week) as a natural vitamin supplement. _________________ The Use of HEALx Soother Plus, Soother Spray and Booster in a Ball Python with Blistering Skin Lesions Laura Wade, DVM, Dipl ABVP (Avian) and Dawn Trainor Specialized Care for Avian & Exotic Pets Lancaster, NY Before - DAY 90 (The wounds at the onset appeared similar to the Day 90 photographs.) DAY 106 DAY 189 A 340-g, adult male ball python (Python regius) was surrendered in July because of poor body condition (BCS: 1.5/5) and prolonged anorexia due to unexplained blistering skin lesions. The snake was pale, and there were several patches of fluid-filled pockets that would break open and allow the skin to slough/separate from the body wall; this was most noticeable near the tail. It was suspected that husbandry factors, thermal or chemical burn, or possible bite wounds from prey were the probable cause. Fluid analysis from the blisters showed mostly mononuclear infiltrate with some heterophils and sporadic bacteria (rods).     Initial treatment included careful debridement of crusts, antibiotic therapy (an initial enrofloxacin injection followed by ceftazidime and gentamicin), pain therapy (meloxicam) and topical wound therapy (daily soaks in dilute chlorhexidine solution, with topical Silvadene® ointment and protective bandaging). The snake resumed eating 2 days later.    After 1 week, some new areas of redness had developed but skin sloughing had decreased. Antibiotic and meloxicam injections were continued.  It was decided to switch to daily soaks in dilute F-10 solution (1:500) and HEALx Soother Plus cream topically. A B-complex vitamin injection was given. In addition, HEALx Booster (0.6 ml PO twice weekly) was administered after meals to supplement immune system function.    By the third week, gentamicin was eliminated and by the fourth week, meloxicam was eliminated. Soaking and bandage changes were reduced to every 72 hours. However, the skin was still very thin and easily torn. Because it was believed there could be some deficiency in collagen formation, vitamin C injections were given, initially as an IM injection then directly into killed prey twice weekly.    By the beginning of September, ceftazidime was stopped, but the Soother Plus® cream was continued daily, and Booster and vitamin C injections were given twice weekly. By the end of September, F-10 soaking was done every other day, followed by HEALx Soother Spray without bandaging. Vitamin C injections were given directly via a killed mouse weekly.    By October, the snake had gained 64 g and was improving overall but continued to develop full-thickness lesions, mostly on the right side after shedding. Soother Spray application, twice weekly F-10 soaks and vitamin C and Booster administration were continued every other day (Figs 1-5; Day 90).    By November, the snake was eating well and shedding twice a month, and new shed-associated lesions were less frequent and less severe. Older lesions were starting to scab and resolve. At this time, soaking and vitamin C therapies were discontinued, and topical treatment was continued daily to several times a week with Soother Spray (Figs 6-9; Day 106).    The snake’s condition improved slowly over the next 3 months and by February it had a normal shed. By March, the skin lesions were completely healed, and the snake had gained 149 g since presentation (Figs 10-13; Day 189).    One year later, the snake had grown and had doubled in weight from presentation. To date, the snake is leading a normal life. _________________________ The Use of HEALx Booster for a Turtle with Hipovitaminosis A Sergio Sarmiento Valiente, DVM Before - Day 0 Day 14 A water turtle presented with blepharitis due to lack of vitamin A in its diet. Due to the absence of vitamin A, the tissues have difficulty regenerating and therefore show signs of otitis, inflammation of the eye lids and pneumonia. A change in diet was recommended and HEALx Booster was added as a daily dietary supplement (1 Tbs/kg food). _________________________