Savannah Monitor eye issue

Question

Sav's Eye  

Sav's Eye   Savannah Monitor, 180 gallon aquarium, topsoil/play sand mix, 50%-80% humidity, Bask 135f, ambient 80f day, 75 night.  3 75 watt zoo med basking spots, 24"zoo med reptisun 10.0 tube.  2 years ago infection of the left side of the face behind the eye and mbd.  Now swelling has come back.  Food offered are supers, pinky rats frozen, roaches and canned grasshoppers with eggs maybe 4 times a year.  Feeding 3 times a week.  Supplement worms with caclium powder without D3 and about every 2 weeks supplement with reptivite without D3.  Ate yesterday and water is offered in a large glass tray there daily.  Defecated yesterday while bathing.  Told was captive but really don't know.  Currently shedding right now.

Went to the vet because the swelling came back and had ct scans done etc and surgery because they insisted their was going to be dead tissue etc from infection.  Had surgery and they found nothing to shell out and took a culture and found samonella.  

Ever since the surgery she is unable to fully open the third eyelid and it is now really swollen.  Haven't seen her left eye ever since they cut her open.  

They found that the epiterygoid bone was malformed for reasons unknown and that is the site of the infection and swelling.  

Everything has progressed but I am super worried about the eye and the pressure on it.  

You can see in the pictures the tissue underneath the eye is visible and looks like a blood blister.  I raised this concern back to the vet and they said they could go back in again and shell it out but as stated previously there was not anything to shell out in the first place.  

All her signs when we first took her in were that she was very aware and is consistently being her.  Which they said was unusual being that there was such a big abscess but nothing to shell out?  This confuses me.  

Could maybe needle aspiration need to be done to the site?  

I virtually fought the fact that I said last time it went away with antibiotics so I just want to do that again but they wouldn't give them to us and said surgery is the only option and now we have a worse situation then before for the eye.  

Looking for more opinions because of the outcome of the surgery which unfortunately further reduced the tissue to expand because of the was reptiles need to be stitched.  

The stitches are putting strain on the tissues of the third eyelid and you can physically see the pull.  

If you can provide some insight in to maybe other avenues whilst looking at the pictures and reading this that would be great.  All in all something that should have cost 500 for everything is now over 2000.  

Thanks so much again for your time I really appreciate it

Sincerly Josh

Answer
Sounds and looks so far like they're taking you for a big ride and I'd question this vet's familiarity with reptiles, first of all. What credentials does he have? Member of and continuing education certificates in reptile medicine from ARAV? Is he board certified in exotic/reptile or even avian medicine from ABVP or a similar organization?

I'm not sure what you mean by "shell out", and you aren't starting from the top here with the history. You're telling me you went to the vet because swelling came "back". Well, you're not telling me anything really. Came back from what? And when?

I can see from here that the suturing technique doesn't look right. Reptiles require an everting mattress suture to prevent the skin from rolling inward. This incision site and suture looks poorly done and it appears the skin is rolled inward, which could have allowed for infection to worsen because as the skin rolls inward where scales are touching to scales, this allows a path of entry back into the wound. Also, problems would arise if the sutures were too tight as well and could cause tissue necrosis.

If they found evidence of infected bone, then obviously it should have been dealt with at the time when they were in there, otherwise nothing was solved. A misshapen bone in the head wouldn't be out of the question with MBD, but the question is whether the bone is actually INFECTED and undergoing oseteolysis, or is just formed poorly due to MBD. If the vet says the "source" of the infection is the bone, then I would take it that he is stating that the bone is infected. Is that in fact the case or not? But if no abscess debris was found in the surgery, other than the bone...then why does he want to go back in now under the assumption he will now suddenly find any abscess debris? It sounds more like he wants to go back in to correct what he screwed up.

Are you telling me this vet performed surgery and did not afterward prescribe antibiotics? I'm assuming pain medications were not prescribed either? If anything was prescribed I need to know that. I also need to know when and how this issue first arose and how that was handled.

No, you cannot deal with aural or other abscesses in reptiles with needle aspiration. If there is an abscess, there is going to be necrotic and caseous infectious debris which needs to be removed. That's also the case if the bone is dying and necrotic. You can't leave dead bone in there without it leading to septicemia. If only antibiotics were given to deal with the abscess the first time, this is likely why the infection returned. THAT was malpractice to not deal with it surgically, unless they offered you surgery the first time and you refused. Then that was on you. But after they performed a surgery, antibiotics and analgesia should have been prescribed to follow it, or THAT was also inhumane and malpractice.

As to an ultimate recommendation for how to best handle this now though, this is going to likely take several correspondences, along with several more photos of the wound, of before the surgery if any, of inside the mouth if possible, and more information on what was done and prescribed previously. When a situation is this serious and requires a consultation this in depth though I will have to ask you message me at https://facebook.com/reptilerescue but I do ask for a donation for my consult time. It's more than can be handled here. What I can tell you though is that she absolutely will not survive this with the status quo being maintained. Something better has to happen. Reptiles have outstanding innate immunity to prevent them from getting ill, but once they do get ill, their adaptive immunity is not as great and they seldom survive an infection without direct pharmaceutical intervention, and that often means bactericidals that can't be purchased over the counter. I was really hoping you were going to be in the US though, because I could have offered more significant help, but I can give you a comprehensive consultation.