Step right up! Behold a Two-headed Snake!

Clients of mine who breed corn snakes recently had this very unusual baby hatch out of an egg in their incubator, a two headed snake! The hatchling appears to be a pair of conjoined twins which is very rare indeed. We occasionally see two-headed snakes hatching and it is usually a random event; a freak coincidence causing fusion during early embryonic development known as polycephaly.

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In any case, most two headed snakes look to all intents and purposes like a single snake body with two heads side by side on a single neck. This hatchling however is conjoined much farther down the body, just above the level of the heart so it appears from X-rays I took that each head has a separate throat, windpipe (or trachea) and oesophagus that carries food to the stomach. This most likely resulted from fusion of monozygotic or identical twins during the early stages of development within the egg. It was extremely difficult considering the tiny size of the creature to obtain good diagnostic quality X-rays especially as the animal was conscious and difficult to keep it still to take a shot, so the exact anatomy is still unclear. I didn’t want to risk anaesthetising such a fragile, tiny creature just for interest sake to look at its anatomy but from what I can make out it seems like there is one dominant animal with relatively normal anatomy and the other has fused just above the level of the heart. I think there is a single heart, stomach and other abdominal organs, although there is a lot of air so there may be two lung spaces, unusual in that snakes usually only have a single functional lung.

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Other problems that are evident are that the spine is kinked in a few places, which may cause problems down the line, although plenty of minor kinked snakes do lead perfectly normal and pain free lives. The good news is that the little snake has now eaten its first meal, and appears to be doing well. Whether it survives long term is still unknown however. There could be invisible problems we are not yet aware of. If it does survive it would be very interesting to perform more advanced imaging such as MRI to determine the anatomy, but of course this is all academic as there would be no benefit to this little snake, or should I say snakes! Surgical correction is not possible and would result in the death of one or both animals. The main concern in the near future is whether quality of life can be maintained.

More information on the underlying causes can be found here:

http://genetics.thetech.org/ask/ask299

http://news.nationalgeographic.com/news/2002/03/0318_0319_twoheadsnake.html

Kestrel Karma

Female kestrel patient

I recently got back from a very lovely ‘beat the January blues’ break in Marrakesh, Morrocco with a friend for a few days and had a great time exploring the Souks and Medina of the old town. The hustle and bustle, spices, lamps, lanterns, olives and other rich foods provided plenty to take in, but sadly there were also some sights I didn’t find so enjoyable. In the main square ‘snake charmers’ had various snakes on display on the baking hot ground for entertainment of tourists and local alike. Egyptian cobras and puff adders were proudly displayed, the cobras being repeatedly goaded so they would rear up and display their hoods for photo opportunities. Both these species I learned are now threatened due to over collection in Morocco, and both are highly venomous. The secret to these snake charmers ability to handle them is that they have their mouths sewn shut so they cannot bite soon after capture from the wild. Because they cannot open their mouths they cannot eat or drink and therefore slowly die of starvation and dehydration. I saw one large cobra tossed aside having perished in the heat.

Copyright Getty Images

Copyright Getty Images

In the markets themselves there were countless animals and animal products for sale, mainly reptiles and a few birds. Stacks of cages containing wild collected tortoises, chameleons and spiny-tailed lizards (Uromastyx spp) were displayed in the baking heat, many of their occupants dead or dying again through stress and dehydration. The merchants were keen for me to stop and take photos or handle the animals, for a small fee of course. I purposely avoided eye contact or photographing any of these animals as to do so would only encourage the practice in future. So as heart-breaking as it was, I had to ignore the obvious distress and suffering of these creatures. Perhaps most heart-breaking of all was the sight of a beautiful wild kestrel panicking in a tiny cage as countless passers-by came through the laneway into a busy square. On my first morning at breakfast I had seen kestrels flying over the city, and admired the freedom and majesty of these charming birds of prey. To see one locked in a tiny cage for sale with broken tail feathers was a sorry sight. I contemplated buying the bird and releasing it, but knew it was the wrong thing to do as they would just go out and recapture her or another falcon to sell again.

Copyright Flickr.com

Copyright Flickr.com

Copyright Flickr.com

Copyright Flickr.com

Copyright flickrhivemind.net

Copyright flickrhivemind.net

I thought of the bird a lot over the following days, as I have a longstanding fascination and awe for birds of prey. Bizarrely on my return to work the following week I got a call from a receptionist in a nearby practice asking for advice on what to do with a bird of prey a member of the public had found on the roadside. I gave first aid and shock treatment advice to give it the best chance overnight, and collected it the following day to bring to my clinic, investigate it’s injuries and hopefully rehabilitate it back to the wild. It turned out to be another female kestrel! She was a beauty, and thankfully just appeared to be concussed and in shock from a suspected collision with a vehicle. I X-rayed her to rule out any fractures or gunshot injuries, and treated her with some fluids, tube feeding and anti-inflammatories.

Examining for broken bones or wounds

Positioning for Xray kestrel  Xray kestrel

Tube feeding her a high calorie recovery formula & rehydration solution

Tube feeding her a high calorie recovery formula & rehydration solution

The following day she was much more sprightly and enthusiastically ate several mice and chicks. I fed her up for two days and then released her back to the wild as you can see in the video on the link below. I like to think I was given the opportunity to repay some karma for the captive kestrel in Morocco that I couldn’t save!

http://www.getsurrey.co.uk/news/surrey-news/laleham-bird-release-sees-kestrel-8592698

Renal Tumour in a Chameleon: A Case Study.

A one year old male Panther Chameleon presented to the clinic following a one week history of progressive hind limb weakness, loss of motor function, swelling of the left knee and sleeping with his back legs dangling from his branch. He was still eating although his appetite was reduced. His owner was very knowledgeable and experienced in keeping reptiles, and his husbandry and captive care sounded excellent when taking a full clinical history and appraisal. There had been no changes to his routine or care, and no known history of trauma. His left knee joint however was visibly enlarged and swollen compared with the right hand side.

Hind limb paresis unilateral swollen stifle

On clinical examination, the joint was swollen but didn’t appear painful on palpation. However he was demonstrating bilateral hind limb paresis, or loss of motor function. Gripping was much reduced in the back feet compared to the front, and he appeared much weaker on the pelvic limbs also. Similarly he was reluctant to bear weight on the left hind compared with the right. Sensory function was intact and present in all limbs. This examination allowed me to form a reasonable diagnosis of a neurological problem, most likely a spinal lesion in the lumbar region or an intra-abdominal mass placing pressure therefore impinging on the nerves in this area resulting in compression and subsequent loss of motor function. I should mention here that I had seen a photo of this chameleon on a forum I am a member of the previous day when the owner asked for advice. From a photo alone it would have been impossible for me to pinpoint the problem or give a reasoned diagnosis as I could when the animal was in the clinic and I could perform a full neurological examination. For this reason I would always warn owners to beware accepting an online diagnosis based on a photo alone. If in doubt, a vet visit with a reputable reptile vet is really worthwhile.

Hind limb paresis perching

I explained to the owner that based on the issues I was seeing, I suspected an abdominal mass was the worst case but highly likely scenario, so we decided an X-ray was the next step. I took a dorso-ventral view after giving the chameleon some anaesthetic gas to allow me to tape both legs in position so I could get the best image possible to compare the knee joints in the same position. The X-ray however showed a very serious and obvious problem quite apart from the swollen joint. The entire abdomen of the lizard was full of air and the internal organs were all compressed. Air on an X-ray is black, and in normal chameleons the lung shadows demarcated by free gas extend a little over halfway down the length of the abdomen. Chameleons are fairly unique in that they also have finger like extensions or air sacs extending very far back towards the tail end of the body which are lined with a very thin transparent tissue almost like cling film. Therefore this is very prone to rupture from trauma, infection or damage during surgery for example.

DV view

I took a lateral view to confirm the organs were compressed ventrally (towards the bottom or belly of the abdomen), which highlighted that in fact a lung or both lungs were ruptured and air had leaked into the free space within the abdomen. I was also curious to gain another view of the very dense whitish-grey mass in the caudal or tail end of the abdomen just before the pelvis, which was occupying the entire width of this section of the abdomen. Unfortunately, on the lateral view this corresponded to the site of the kidneys and confirmed my worst fear that a kidney mass of some description was responsible for the nerve impingement and neurological signs on presentation. The kidney mass may have been an abscess or a congenital problem such as hydronephrosis present from birth which was gradually causing a growth in size over time. Similarly it may have been a tumour but it was difficult to tell from X-rays alone. The swelling of the joint in the left knee could have been explained by trauma associated with reduced motor function, the assumption being that he injured it in the preceding days whilst dragging it behind him.

Lateral view

The prognosis based on a renal or kidney mass of that size no matter what the underlying cause was unfortunately quite grim, not to mention the issue of air within the abdomen causing breathing problems and compression of other vital organs. After lengthy discussion with an upset owner, it was decided that it would be fairest and most humane to put the chameleon to sleep and prevent further suffering. Any treatment or further diagnostics would have had to be very invasive and highly unlikely to bring a resolution to the problem. In order to bring a resolution to the case and for the sake of education, the owner kindly allowed me to open the abdomen following euthanasia in a post mortem examination to confirm my diagnosis of a renal or kidney mass, and ascertain the nature of the lesion. Sadly my suspicion of a renal tumour was confirmed; quite a surprising diagnosis in such a young animal you might say. However renal lymphoma, which is one of the more common cancers in reptiles, is unfortunately not exclusive to older animals as in many other cancers. Several other cancers are also reported in reptiles. In this case, the classification of the tumour would not affect the outcome of the case so I did not send any tissue samples for pathological classification. A very sad case, but the positives if any can be taken from it were that I and hopefully other veterinarians can learn from this little chameleon’s death. I’m therefore very appreciative to the owner for allowing me to write this up and share the case study.


WARNING: THE FOLLOWING PICTURE IS GRAPHIC IN NATURE, SHOWING THE POST MORTEM FINDINGS. PLEASE DO NOT VIEW IF YOU ARE SQUEAMISH OR EASILY OFFENDED. I INCLUDE IT HERE FOR EDUCATIONAL PURPOSES ONLY SO THAT SIMILAR CASES MAY BE DIAGNOSED EARLIER IN FUTURE WITH THE EXPRESS PERMISSION OF THE OWNER OF THE ANIMAL IN QUESTION.

PM findings labelled