Green (Chelonia mydas)
Stranding Location: Myrtle Beach State Park Fishing Pier
Arrival Date: 10/13/23
Age: juvenile
Sex: unknown
Weight: 3.37 kg (7.43 lbs)
Case History
This little juvenile green sea turtle was accidentally caught by a fisherman at Myrtle Beach State Park Fishing Pier. This angler’s gear caught onto monofilament that had previously entangled this turtle and had likely been there for quite some time, which led to the loss of this turtle’s right front flipper.
Treatment
Upon admit, Ricotta underwent a thorough physical exam with our veterinary care team. In addition to having a missing right front flipper, there were also old entanglement wounds on the left front flipper, the right side of the mouth and beak and encircling the neck. This patient arrived with monofilament still attached to them, which was leading into the mouth. Based on these findings it was decided that Ricotta needed several types of diagnostic imaging. We took radiographs to determine if there was a hook attached to this line that may have been swallowed — thankfully, there was not. A CT scan was taken of Ricotta to get a better idea of how far into the GI tract the monofilament went. This imaging showed us that the monofilament more than likely extends past the esophagus and into the stomach and lower GI tract. In addition, the CT scan also showed that Ricotta has an infection in the right ear. Ricotta received antibiotics, vitamins and fluids and based on this turtle’s energy levels it was decided the best overnight set up would be a wet dock. Once Ricotta is more stable, the plan is to perform an endoscopy to trace the path of the monofilament down the esophagus and into the GI tract.
Updates
October 19, 2023: Ricotta has had a lot of ups and downs over these past week. Many life saving measures were taken from intubation, medications, imaging and surgery. This patient has had a rough start in life, and we are so thankful that s/he made it to the STCC to receive treatment.
Over the weekend, Ricotta remained quiet, alert and responsive for the most part. However, s/he was never strong enough to make it into a tank. In fact, the patient became weaker with fewer respirations and a slower heart rate. Our vet team sprang into action and gave this turtle the best opportunity to bounce back.
Monday morning Ricotta was stronger based on the efforts of the day before. At this point we felt that it was important to move forward with our treatment plan: perform an endoscopy, a gastroview study and an enema. During the endoscopic procedure, we were able to identify that there were several separate fishing line pieces that went deep into the esophagus and that there was a large clump of algae entangled around this line. Several attempts were made to remove some of the algae, but it was tightly wrapped around the line and we did not want to do more damage. After this procedure we moved forward with a gastroview study. This is a study that involved administering a radiographic contrast liquid orally to identify any blockages on CT or x-ray. This allowed us to determine where throughout the body we could expect to find monofilament and potentially other algae blockages. It essentially provides us with a “map” of our problem spots. Later in the afternoon an enema was performed to help hydrate the bowels and loosen fecal matter to hopefully allow us to easily remove the monofilament in surgery.
Tuesday morning Ricotta was sedated and prepped for surgery. This patient needed more sedation medication than usual, so we knew ahead of time that we needed to be very mindful of the amount of time under anesthesia. Once the turtle was fully sedated, we began the esophagostomy surgery. A small incision was made in the throat and another into the esophagus to attempt to remove the algae clump and some of the fishing line. Once we were in the correct location our veterinarian was able to remove several large pieces of the algae but a lot of it was severely entangled and would have caused too much tugging to remove the rest. We cut as much of the line and algae as we could to make things easier for Ricotta to hopefully pass on her/his own. The fact that the line was so taught gave us even further proof that the monofilament went deep into the GI tract. Our initial hope was to also go into the lower GI tract via a separate incision and remove the line from that angle as well. However, based on the time under anesthesia, it was decided that the best approach would be to attempt a second surgery at another time. When a sea turtle is under anesthesia it can take them an incredibly long time to wake up, so we wanted to give Ricotta time to recover well. The surgery site was closed and reversal medications were given to wake Ricotta up. Over the next several hours STCC staff took turns breathing for Ricotta and s/he was still not waking up, but heart rate was strong. A strong heart rate is always a good sign, the turtle was just still very “sleepy”. Medications were given to help Ricotta recover, but by the end of the day Ricotta was still not breathing on her/his own. Staff decided that the best course of action was to place Ricotta on a ventilator overnight.
Wednesday morning Ricotta was finally able to be extubated and was starting to breathe on her/his own. It took a while for the patient to be fully awake, but by the afternoon staff felt Ricotta was strong enough for very shallow water in a kiddie pool. Thankfully, Ricotta did well in this set up and could be left in the water overnight. Sea turtles are incredibly resilient but this little one has a lot going against her/him and we are grateful for how much Ricotta has overcome thus far. That being said, there is still a long way to go and the prognosis for this little green is very guarded.
November 15, 2023: Based on Ricotta’s previous surgery and diagnostic imaging that was taken, our team highly suspected that there was additional monofilament throughout Ricotta’s lower gastrointestinal (GI) system. We were originally hoping that Ricotta would be able to pass this line on his/her own, but after multiple days, ultrasound showed no signs of GI motility. Due to this, we decided a second surgery was necessary to remove as much of the monofilament as we could in order to assist Ricotta in their recovery. This surgery, called an enterotomy, required a small incision to be made in Ricotta’s left inguinal (hip) region. The vet then gently brought small sections of intestine out of the incision site in order to visualize and palpate thoroughly. Once our vet located a spot of concern, she gently incised into the bowel and was able to find and remove a section of monofilament! Luckily, part of it was an end, which we believed to be the lowest section. We removed as much as we could, but once we felt tension in the line we immediately stopped pulling. We cut and removed the line, stitched up the bowel, and moved upwards through the GI to incise a more cranial, or closer to the head, section of bowel. Once we opened this section, we were able to remove what we believe to be all of the remaining monofilament in Ricotta. This was a huge success for our team, and for little Ricotta it definitely improves the potential prognosis. This little survivor is recovering post-surgery and is starting to eat and have swim time in a half-tank! Ricotta has even defecated and been seen resting on the bottom!