Melissa Kaplan's
Herp Care Collection
Last updated January 1, 2014

Health Care for Box Turtles

©1997, 2002 Tess Cook, Box Turtle Care A-Z

This section deals with the illnesses and medical issues that can affect your box turtle. If your turtle is maintained in a clean and proper environment and is well fed, you will have few medical problems. Box turtles that are kept outdoors will get plenty of sunshine and exercise. Both are important for good health. Sunshine activates cells in the turtle’s skin and shell to produce vitamin D3. Exercise helps keep the turtle’s bones and muscles strong. Without exercise, the bones may become weakened and constipation problems may occur. But accidents happen, and parasites, bacteria, and fungi are everywhere just waiting for an opportunity to take advantage of a weak or stressed-out turtle. It’s good to know when you can do something to help the turtle yourself or when it’s necessary to take it to a reptile veterinarian.

How can you tell when your turtle is sick or injured? Try to observe your turtle daily. Regularly look at its shell and skin for any abnormalities, cuts and lumps. Watch it when it eats, when it is in the water and as it walks around. You will begin to know your turtle and its normal behavior so when it does get sick, you’ll be able to notice the change in behavior and activity. Weigh the turtle, and do it often enough so you can tell if it begins to lose weight. Occasionally look at the turtle’s feces. Is it well formed and is the food being digested? Turtles don’t get a fever, or start to moan or make faces. The first signs of illness are usually a change in eating pattern or activity levels. If the turtle has a respiratory infection, it may start to gasp or breathe with its mouth open. It may blow bubbles from its nose or it may have diarrhea. If it has worms, it will begin to lose weight or you might see white worms in the feces. None of these symptoms are very noticeable unless you are observant and make it a habit to check on the health of your turtle.

Following is a checklist of problems you can take care of yourself.

Superficial scratches and cuts
Many minor injuries can be treated from a homemade first-aid kit. It should contain disinfectant solution, for example, chlorhexadine or Betadine solution, triple antibiotic ointment, cotton tipped applicators, surgical tape and gauze pads.

Clean all cuts, even ones on the carapace and plastron, with disinfectant. Use diluted chlorhexadine or Betadine solution diluted weak. Clean daily until healing is well along. If the wound is deep, it should be covered with a Band-Aid or gauze and surgical tape. If any signs of infection appear, like redness, pus or foul smell, begin to apply antibiotic ointment immediately. If deep wounds do not look better in a few days, take the turtle to a veterinarian for stronger medication. The turtle should also see a vet if the injuries are caused by dog bites. These types of injuries often expose bone and expert attention is warranted.

Insects or fly eggs on skin
Remove chiggers, ticks or fly eggs with tweezers and clean the area with disinfectant and apply antibiotic ointment. Remove any source of insects from the enclosure. Don’t keep food in the enclosure for more than an hour or two. Clean and protect any open wounds on the turtle quickly so flies won’t lay eggs on them. These flies are attracted to the smell of blood and flesh. If larvae or maggots are already under the skin and eating away at flesh, it is better to see a veterinarian about removing them as the wound may be large and shots may be necessary to combat secondary infections. Mites can be washed off with soapy water. Place small pieces of pest strips that kill mites in the enclosure. Be sure to place them out of reach of the turtles and away from food and water sources.

Irregular shell growth
Irregular shell growth may be the beginning of metabolic bone disease (MBD) and can have serious long term effects for your box turtle. The shell may look lumpy or grow only on one side or the head may look abnormal. Note the box turtle in the picture cannot close it's shell due to MBD and has lost it's tail when another turtle bit it. Also see the overgrown beak and long nails, all are signs of irregular shell growth. This is an indication that something about your turtle’s care is not correct or adequate. Look at what you are feeding your turtle. Is it getting the proper kinds and amounts of food? Are you feeding it too much protein and fat? Are you giving it the correct amounts of vitamins and minerals? Is it getting enough sunlight? Changes in husbandry and diet may correct the deformity and stave off MBD.

Irregular shell growth
Irregular shell growth may be the beginning of metabolic bone disease (MBD) and can have serious long term effects for your box turtle. The shell may look lumpy or grow only on one side or the head may look abnormal. Note the box turtle in the picture cannot close it's shell due to MBD and has lost it's tail when another turtle bit it. Also see the overgrown beak and long nails, all are signs of irregular shell growth. This is an indication that something about your turtle’s care is not correct or adequate. Look at what you are feeding your turtle. Is it getting the proper kinds and amounts of food? Are you feeding it too much protein and fat? Are you giving it the correct amounts of vitamins and minerals? Is it getting enough sunlight? Changes in husbandry and diet may correct the deformity and stave off MBD.

Irregular shell growth
Irregular shell growth may be the beginning of metabolic bone disease (MBD) and can have serious long term effects for your box turtle. The shell may look lumpy or grow only on one side or the head may look abnormal. Note the box turtle in the picture cannot close it's shell due to MBD and has lost it's tail when another turtle bit it. Also see the overgrown beak and long nails, all are signs of irregular shell growth. This is an indication that something about your turtle’s care is not correct or adequate. Look at what you are feeding your turtle. Is it getting the proper kinds and amounts of food? Are you feeding it too much protein and fat? Are you giving it the correct amounts of vitamins and minerals? Is it getting enough sunlight? Changes in husbandry and diet may correct the deformity and stave off MBD.

Swollen or sealed eyes and turtle won’t eat
If the eyes are swollen or sealed shut, they are probably filled with pus. The hardened pus will need to be removed, and this is best done by a reptile veterinarian. You can try soaking the turtle in tepid water twice daily so the pus can soften. The turtle will rub its eyes under water, thus helping to clear the harden pus out of the eyes. This process can take several weeks. The eyes may still need antibiotic medication. Sometimes injectable antibiotics are given to the turtle in the front legs if the infection is severe. If the turtle is very weak, it may need to be hand-fed or forced-fed. A formula for force-feeding is presented here:

Small jar of pureed chicken baby food
1/2- 1 cup of Pedialyte® or Gatorade ®
1/4 teaspoon cod liver oil
1 tablespoon calcium powder

Mix well and feed via stomach tube and syringe at a rate of 1.5 ml per 100 gms every 7 days. Veterinarians also have commercial syringeable food and can provide you with a syringe and stomach tube. These items can also be purchased from pet supply companies.

The most important information the doctor can give you is the probable cause for the swollen eyes. It could be a vitamin A deficiency or a bacterial infection. Usually, access to natural, unfiltered sunlight and a complete diet will eliminate swollen eye occurrences. It’s important to correct the underlying problem so the turtle doesn't get the illness again.

Mouth rot
Mouth rot is usually an opportunistic disease and affects a turtle that has a weak immune system. It can be caused by a fungus or bacteria. Mouth rot can look like cheesy white stuff growing on the tongue, or look like hardened pus and dead skin around the mouth, or it can make the tongue spotted red with blood blisters. Take the turtle to a reptile veterinarian immediately. A veterinarian is needed to cure mouth rot, but after it is cured you need to check how you've been caring for your turtle and correct any problems. Are you giving it nutritious foods? Is its living area clean? Is it warm enough or too warm? Some turtles come out of hibernation with mouth rot, suggesting they weren't healthy enough to go into hibernation. Never let a sick or underweight turtle go into hibernation. It should be kept indoors and kept warm and fed all winter long.

Lumps on cheeks
Lumps on the one or both side of the turtle’s head are actually ear abscesses caused by infections of the middle ear, and requires lancing and removal of the infectious debris. Antibiotic shots are usually given as well. Some people do this procedure themselves, but I feel my pet turtles deserve to see a reptile veterinarian if they get sick enough to require any kind of surgery. Ear infections are often the result of prolonged low-grade respiratory infections and can be avoided if colds the turtle gets are detected early and properly treated. After the infected material from the ear, the turtle should spend some time in the hospital aquarium to help combat the infection.

Cracked shell or dog bites
Take the turtle to a reptile veterinarian immediately if any of the wounds appear to have entered the turtle's body cavity. It is important for the wound to be thoroughly cleaned and all loose pieces to be removed from the cracked shell. Injectable antibiotics should be given. Turtles can get a serious disease called peritonitis and septicemia from bacteria that enters the blood stream from dog bites and open wounds in the shell. The first signs of the disease may be reddening or pooling of blood under the plastron. The vet may be able to repair the break with a fiberglass or epoxy patch.

If the wounds are superficial, clean the shell damage with a chlorhexadine cleaner several times a day. Keep the wounds clean until the turtle can be seen by a vet.

Internal Worms
Every two weeks you should look at your turtle’s feces to see if it looks normal. It should look digested, firm, and dark. If it does not, you should take some fecal samples to a veterinarian for testing. The vet can tell you what type of parasite your turtle has and what will kill it. This link will give you some idea of the types of internal parasites turtles can get. Tortoise Land's parasite article.

Two common mammal dewormers have been proven fatal or toxic to turtles and should not be used. They are Ivermectin and Piperazine.

Abnormal behavior from female
A female turtle can become eggbound, a disorder which is life threatening. If you think your mature female has eggs and she has good nesting sites, yet she begins to pace and strain, stops eating and otherwise acts different, you should have her x-rayed for egg binding. A female just looking for a nesting site will also pace but will still eat. A veterinarian will sometimes induce expulsion of the eggs.

Paralyzed legs
Immobile legs are a serious problem and can happen for several reasons. A veterinarian may be able to determine the cause. It could be a vitamin or mineral deficiency that affects the bones or nerve function. It could also be an injury, tumor or a birth defect. Sometimes it is reversible, most times it is not. The turtle may live if the paralysis is not degenerative.

The kidneys and liver are susceptible to disease. Kidney failure can be caused by a diet too high in protein. Liver dysfunction may cause calcium to not be absorbed properly, and unfortunately there isn't much you can do about it once damage to the liver occurs. Liver damage can be caused from vitamin A overdose, medications, parasites, or prolonged ill health.

Organ Prolapse
Organ prolapse is a life-threatening problem and a reptile veterinarian should see the turtle immediately. Prolapse can occur for various reasons and different organs may be involved; the intestine, cloaca, or penis being the most common. Male turtles will sometimes evert their reproduction organs while in water. They will stand tall on the hind legs and strain to evert and expand their penis. This is normal behavior and the organ will retract in a few minutes. This is not organ prolapse. Organ prolapse will not retract into the cloaca and is dragged along as the turtle walks. The turtle will often not be eating and may have spent a lot of time straining or digging prior to the prolapse. A turtle that is often constipated, or ingests bark or stones while eating may be more prone to prolapse, but this is just a guess. Be careful about accidental ingestion of flooring, and make sure your turtle drinks well so constipation won’t be a problem. I set my turtles in tepid water twice a week for 15 minutes to observe them drinking and to induce them to defecate.

Euthanasia
Putting down a severely injured or sick animal is never an east task, but sometimes it must be done to relieve the suffering of the animal. Box turtles can survive amputations and other serious injuries that other animals may die from, therefore it is important to get the opinion of a reptile veterinarian before making any decision to euthanize. He will also be able to perform the euthanization with an injection of barbiturate if it becomes necessary to put the box turtle down. Other methods of euthanization is not recommended for box turtles. Decapitation or gassing does not kill the turtle quickly enough to prevent suffering, and freezing is not a reliable method of killing box turtles.

Finding a Veterinarian
You may be wondering how to find a veterinarian that is knowledgeable about turtles. Look in the phone book and call around. Ask them if they work with reptiles. Ask if they are a member of the Association of Reptile and Amphibian Veterinarians. Call the zoo and speak to the reptile keeper and ask him or her who they use as a veterinarian for their reptiles. Join a turtle club and find out which veterinarians the members recommend. Box turtles are interesting animals to keep as pets and like all pets, deserve expert veterinary attention when they are sick or injured. They also need daily attention from us. If we take care of little problems, they may not become big problems. By anticipating problems, we can usually figure out a way to avoid them, and the results will be a healthy and long-lived pet.

Avoiding Salmonella
Salmonella poisoning is something all reptile owners should be aware of since it is a disease that can cause severe diarrhea and even death to children and people with weaken immune systems. Some box turtles (as well as raw eggs, chicken, beef, flies) are carriers of the germ and can spread it to humans. Always wash your hands with an antibacterial soap after handling box turtles or any reptiles. Never feed raw chicken or beef to turtles. Never let small children play with your turtles. They may try to kiss the turtle or stick fingers in their mouths before you have a chance to tell them to wash their hands. Never clean turtle items near food preparation areas, like the kitchen sink. Use an outdoor faucet and washpan. If you keep in mind the need for cleanliness and hand washing, you will lessen the chances of Salmonella poisoning.

Disclaimer: A knowledgeable reptile veterinarian should be consulted before using any advice contained in this section.

For illustrations to this article and more information on box turtle care and health issues, see Tess Cook's Box Turtle Care and Conservation site.

Copyright by Tess Cook. 1997. www.boxturtlesite.info. Used by permission

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Box Turtle Housing

Shell Rot