Health Care for Box Turtles
Article by Tess Cook

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.
Scratches & cuts
Insects or fly eggs on skin
Irregular shell growth
Shell rot
Overgrown nails
Altered feeding behavior
Eye problems
Respiratory illnesses
Mouth rot
Lumps on cheeks
Cracked shell
Abnormal behavior in females
Paralyzed legs
Overgrown jaw
Organ problems
Finding a Vet

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.

Shell rot:  Check the turtle often for signs of shell rot. Shell rot is caused by fungus or bacteria. The bacteria that cause shell rot often enter small cuts or cracks in the plastron. Once under the keratin layer of the shell, bacteria begins to grow on the bone. Soon the keratin layer separates from the bone and a smelly, slick area of shell rot is exposed. The best way to prevent this is to clean and disinfect any cuts on the turtle’s shell. I regularly wash my turtles with betadine cleanser. I apply triple antibiotic cream on cuts to shell and skin. Also, the turtle living area should be kept as clean as possible. All feces and uneaten food should be removed as soon as possible. The water should be changed daily. Don’t give bacteria a place to live and thrive. Shell rot can be hard to detect in box turtles unless you inspect for it. If shell rot is found, a vigorous regimen of cleaning and medication is
necessary. Remove any peeling keratin from the area. The thin keratin layer usually pops right off. What is exposed is bone with bacteria growing on it. Gently clean the area with betadine cleanser and apply triple antibiotic cream to the area. Protect the area so it stays clean. Do this for several weeks until the bone has had a chance to calcify. The bone is a living, porous material and will heal and protect itself if given the opportunity. If the area of shell rot is large, the turtle should be taken to a reptile veterinarian for possible injectable antibiotics. Other diseases of the bone or blood can develop from shell rot.

Overgrown nails: The nails of wild turtles are worn down as they forage for food. However, our pets often don’t get enough exercise and their claws may grow so long that walking is imparied. Before the nails get too long you should trim them with a sharp pair of regular toenail clippers. Be sure to trim them a little at a time as the blood-filled quick of each nail can be easily cut. As the nail shortened, the quick will also shorten or withdraw. Overgrown nails can also be caused by nutritional deficiencies. If there are several other symptoms such as an overgrown beak, soft bridge or shell, or dry peeling skin, you should take the turtle to a reptile veterinarian for diagnosis. Modification to its diet may be required to correct the problem.

Off feed: Going off feed or not eating is a very common occurrence and is something that will probably happen to all box turtles sooner or later. What your turtle once loved and gobbled up with relish is now sniffed at, and with a quick flick of the head, the turtle turns away and will not have anything to do with the food. You end up scrambling to find something else the turtle will eat with regularity. The best defense is to never let your turtle become fixated on one thing. Make each meal unique by adding one or two different food items each time. I always select a different fruit and protein at each meal. The vegetable and leafy greens may be the same from day to day for several weeks, but even that is changed frequently. Turtles in the wild are seasonal eaters, meaning they eat what is available. There aren’t too many foods that are available year round. You should try to mimic the natural feeding habits of box turtles, especially if you have an adult that was wild. Many turtles will not eat old food. Feed only the freshest food to your turtles. Fresh foods also have the most

Be sure to check the temperature of the turtle. A cold turtle will not feed. The core body temperatures of a hungry turtle will be about 75-80° F. It sometimes takes a while for the turtle to reach this temperature, so feed the turtle after it’s had a chance to warm up.

Turtle will only eat one thing:  Another common lament I hear over and over is that someone turtle will only eat one thing.. The turtle will only eat bananas, or cantaloupe or beef. Actually, this is a problem that is easy to solve, but it’s going to take some effort on your part to break the turtle of its addiction to one food. To do this, you mix of the turtle’s favorite food with other foods you
want your turtle to acquire a taste for. You simply chop all the food into tiny, tiny pieces and mix it well so the turtle cannot help getting a bite of what it doesn’t eat with what it loves. Use a high portion of the favorite food initially, but during the weeks of retraining, reduce the amount of it until the turtle is eating a balanced diet. The process may take awhile but it is possible. A Three-toed box turtle I have took two years to retrain. He now eats whatever I put out for him.

Eyes are closed and turtle won’t eat: If the eyes are shut and can’t be opened without soaking the turtle in warm water, then you have the turtle in an environment that is too dry or in bedding that is irritating its eyes. Keep the humidity up with a daily misting of water. Place more plants in the enclosure so humidity will naturally be maintained. There should be clean water available for the turtle to walk into anytime it needs to. If your turtle is indoors, there may be additional considerations. Is there a draft on the turtle that is drying it out? What kind of substrate are you using? Is it something that is sucking the water right out of the turtle, such as shredded paper or corncob bedding? Use something that retains water like terrarium moss or orchid bark. Don't use cedar shavings or cedar bark as it contains harmful oils that are toxic to most reptiles and can cause swollen eyes, running nose and respiratory problems to box turtles.

If the eyes are closed and puffy, or there is a discharge from the eyes or nostrils, this is not caused by dryness and the turtle should be taken to the veterinarian. The turtle may have a respiratory infection or vitamin A deficiency. Once the illness is diagnosed and taken care of, you need to make changes in your husbandry to ensure it doesn’t occur again.

If the eyes are closed and sunken in, the turtle may be suffering from severe dehydration. It should be taken to a reptile veterinarian for medical attention. Your pet turtle should never be allowed to develop this kind of condition, but you may come across it in a pet store. Complain to the store management if you think ae turtle is being cared for improperly or is sick.

The following are problems that require immediate veterinarian care.

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
      Can of Pedialite ® 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.

Respiratory illness:  Injectable antibiotics are usually required to cure respiratory illness. The symptoms of respiratory illness are labored breathing with the mouth open and mucous forms in the nose or mouth. The turtle usually will not eat. However some turtles can get the sniffles from environmental stresses like cold water or from a draft. Check for these things and eliminate them. If the turtle is outdoors bring it inside and place it in a "hospital aquarium". This is a large tank that is floored with clean white cotton towels and contains a water bowl and hide box. Supply it with a basking lamp and an under-tank heater. Adjust the heat to 90 ° F for several days and nights. (Invest in an accurate thermometer for the hospital aquarium. You want the turtle warm but you don’t want to overheat it.) If the sniffles are gone, good. But don’t try to cure the turtle yourself if it is breathing hard, gasping for air or blowing bubbles from its nostrils. You should take it to a reptile veterinarian.

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:  Take the turtle to a reptile veterinarian immediately. It is important for all broken  pieces to be removed from the cracked shell and for injectable antibiotics to be given. The vet may be able to repair the break with a fiberglass or epoxy patch. Turtles can get a serious disease called peritonitis and septicemia from bacteria that enters the blood stream from open wounds in the shell. The first signs of the disease may be reddening or pooling of blood on the plastron.

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 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 or a birth defect. Sometimes it is reversible, most times it is not. The turtle may live if the paralysis is not degenerative.

Overgrown jaw:  A veterinarian can file down an overgrown beak down. An overgrown jaw is usually caused by a diet of too soft foods. However, it is often one of the symptoms of metabolic bone disease and one of the causes can be improper diet. Check to make sure your turtle’s diet has enough calcium and that vitamin D3 is supplied if the turtle is not living outdoors. A good source of calcium is cuttle bone and will also help keep the beak trimmed.

Organ Disease:  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.

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.

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 euthaization 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.