Swollen Limb - Update Dec 21/11 - Uh-oh...

Hi everyone, it's been a while since I've been on bd.org as life has been busy. I recently went away for a month and left Squishy in the capable hands of a neighbour/co-worker. She was in good health when I returned 3 weeks ago. Now over the last couple of days her right front foot and right rear foot have become swollen. They also look like they need to shed - as do some patches on her lower abdomen. I suspect she may have gout and has an appointment with the vet on Saturday (the dog is also going in for her rabies vaccine). Any suggestions? She has had MBD since she was very young - her wrists used to be bent inwards completely...

Here are some pictures of her feet...

Her right rear foot: (probably in the worst shape of them all)

With her stress lines (I just gave her a bath) and her soon to shed patches


Her right front foot:



Her left front foot - no problems there:


And her right rear foot:


Let me know if there is anything I can do for her.

I've seen MBD do that to a dragon, make the limbs swell. My dragon Delilah ended up with MBD after a huge health ordeal... I would notice her front legs start to swell up. Upping her calcium and UVB made the swelling go down.

I saw on another thread a beardie with gout, it looks like that too.

Hope you get the answer soon and your beardie feels better

Thanks, it could be a side effect of her MBD or gout but either isn't going to be the greatest either way. I'd love to just keep her happy and pain free. She is only coming up on 5 years so she is relatively young still...

Hello,

I do see the swelling. It is hard to tell if it is gout or metabolic bone disease, as both can do the same type of symptoms. I would wait until after she gets the shed off to see what the areas are looking like.
In the meantime, you could get a blood test done on her to determine calcium levels, & uric acid levels.

Tracie

Thanks Tracy,

It seems to only be on her right side that things are having issues however her left rear foot is starting to go white (impending shed) but it is not swollen. My concern is the right rear foot as you can see in the picture of her belly her right ankle area is all swollen. There is a lump where her ankle is supposed to be that is relatively hard and it feels soft around it. Her back foot does not seem to be in any discomfort as she will allow me to manipulate it. Her front foot she is a little sensitive about so I try not to do anything with that.

She is one of those beardies that has a tough time shedding as it is always such a thick layer that needs to come off. I hope she does shed soon as the outside toes on her front right looks constricted a bit. Time for some daily foot soaks :|

This morning Squishy's left rear foot is starting to swell as well. I'm hoping all will be weel once I get her to the vets.

I am going to be heading off to the vets in a few hours but I realized I don't know what to put Squishy in to get her there... I have a large cat carrier but that seems like it is overkill... any suggestions? I don't really want to put her in a box...

Hello!

Let us know how she is doing.
If the foot is swelling more, then, something could be going on for sure. It could be a retained shed causing the swelling, or pseudogout symptoms due to supplemental or nutritional problems, or just articular or plain gout.
A blood test will help to determine what is going on.
How is her shed coming along?


Tracie

Ready for a long post? I have never taken a reptile to a vet before and I have a lot of stuff below - comments and questions.

Okay, so we are home (and someone is very unhappy about the whole ordeal)... The vet took a look at my husbandry (I printed out bd's list of questions and brought them with me...) and some baby pictures of Squishy. They took a radiograph of Squishy and her bone density is actually looking really good (yay me!). They are happy with her bone density and looking at the joints she felt there was no gout happening. She is worried about infection or fungus.

So we put in (I say we because I am a tech and helped) a local anesthetic and made a small incision. She took a couple of swabs of the 'blood' that she was able to milk out of there and she is sending one to the lab for bacti and one she used to make some slides and she is going to have a look at one under the microscope and the other she may send off to the lab as well. I call it blood but it was actually relatively clear (with some blood from the incision) and gooey looking (more like clear snot with blood mixed in). It was not what the vet was expecting to come out of there either - she expected more pus-like looking stuff.

In the mean time... Squishy is on 3 different drugs - 4 kind of (Tracy I do not know what the dosages are for reptiles so please let me know if they are wrong - she is 382gm):
Metacam (anti-inflammatory) 0.5mg/ml - 0.04ml PO SID (by mouth once daily) until treatment and diagnosis are decided
Metronidazole (antibiotic) 50mg/ml - 0.15ml PO SID for 10 days unless directed otherwise
Baytril (antibiotic) 50mg/ml - 0.04ml SQ SID for 10 days unless directed otherwise.
Flamazine (like polysporin) - apply to incision SID - BID until healed

She detests the injection of Baytril and her black beard has not gone away since the oral Flagyl (Metronidazole) but she doesn't seem to mind the Metacam (yay!). So I was wondering if there is any way to flavour the flagyl to make it so she does not hate me for the next 10 days or until we get the results back. I could try the crickets again (I injected them with baytril when I gave them to my leopard gecko a while ago) as she loves to eat them even if only a leg is moving... I am also to push 5-8 mls of fluids into her everyday (maybe some diluted apple or cranberry juice would help?). Also - probiotics... being on 2 antibiotics I know her gut is not going to be happy. I have Acidophilus with BIFIDUS and FOS capsules for myself. Can I give her some of the powder from in one of those in her fluids or is there another type I should get her?

She still cannot feel her rear foot (although it is very nicely coloured yellow right now - her happy colour) and is otherwise all dark. She is currently sitting in the windowsill (window open, screen closed) on her snugglesafe (like a heating pad) as it is still cool outside.

Now regarding her sutures - she has 2 sutures in the top side of her rear right foot, she also has some dried blood around the incision. Can I give her a bath or should I wait until tomorrow so the incision has a chance to seal with the serum? Can I take a piece of gauze and give it a wipe down? I would love to clean it up as blood is a great bacteria medium and I would prefer to do it while she is still frozen so she doesn't feel it.

Thanks for your help in advance - her shed has not started but she has quite a few large patches that are going to go when it gets started.... Hopefully she will be a bit happier when the taste of the flagyl is gone and she has shed a bit (maybe I will go and get her a couple of treats from the store)

Hello? You can tell it is spring when the forums go a bit quiet... :lol:

Hello!

I didn't forget about you.
I am looking over the doses today. I am working too, but will do it in between.
That is quite a bit of medication for one lizard, but, the doses appear to be fine.
How is Squishy doing right now?
At least her bone density looks great!
It could just be an infection, so hopefully, if it is this will help the swelling. When do your blood test results come back?


Tracie

No worries Tracy, I realize you have to have a 'real' job as giving out advice doesn't usually pay the bills too well. It just seemed odd as the forums seemed extra quiet.

We decided to forgo the blood work on yesterday's visit based on her husbandry and because there was no evidence of gout in her radiograph and her bone density looked okay as well. She was quite stressed by the time we came home and wouldn't even look at a superworm... She had a large bout of diarrhea when we got home and nothing since. Because this swelling came on suddenly the vet is concerned about fungal or bacterial infection and wanted a swab from inside her joint asap. Once those results come back she is going to look at the options - cure vs treatment vs palliative care. She knows money is not an issue for me and I am willing to put some change into Squishy. She is on the 2 different antibiotics as one is for anaerobic bacteria and the other is for aerobic bacteria. Then there is the metacam for pain as we are both sure it isn't comfortable for her.

As for how she is doing - she doesn't seem to be phased the slightest. She still has her appetite and is basking and continuing with her normal 'busy' schedule of being a beardie. She took her Baytril like a champ (it is the injection not the needle poke that she hates so much) and she still likes her metacam at the moment. I injected 2 superworms with her dose of metronidazole which worked well - she didn't seem to mind; unlike yesterday. She will take about 0.5cc apple sauce/water mixture at a time before she has had enough.

Can I give her some of my acidophilius capsules? Even just sprinkling it into her apple sauce or do I need to get her different ones?

Hello,

I have checked the doses & I am happy to say that they are fine! They are extremely conservative doses too.
The Metacam is usually used at a dose from .5 to 1.2mg/kg approximately. The Metronidazole is usually dosed at 50mg/kg & it is only dosed at 20mg/kg so that is good to see. The Baytril is normally dosed at 5mg/kg so that is fine, as well.
Three medications is hard on her though. Make sure that she gets plenty of water right now, with all of those meds.
Well, I hate to say but quite often, gout goes unrecognized on radiographs. Sometimes, it depends on what the build up is comprised of, either sodium or calcium, etc. An ultrasound may show tophi, possibly.
The type of medications are important, especially depending on what the swab tests reveal. It could be a fungal or bacterial infection. Can you think of anything she could have eaten that would have been bad food possibly? Hornworms or Silkworms? Does your public or tap water have fluoride in it? The aerobic & anaerobic medications are specific & target their bacteria well most of the times. When will the swab test come back?
Really, the best way to determine early gout is a blood test. If the uric acid levels are unusually high, then, it is most likely going to be gout. If this round of medication does not show any progress fairly quickly, I would get a blood test. Waiting on the swelling to go down if it is gout, will just get worse & make it harder to treat.
Yes, you can give her the acidophiliz is it is non dairy for her. That is no problem at all.
Great that she is taking her meds like a good girl.
Do you use the Reptisun 10 tube bulb?


Let us know how she is doing.

Tracie

Great to hear that they are conservative doses - particularly because she is getting 3 drugs that will be taxing on her system.

I can't think of anything that she may have eaten that would have been bad. Silkworms are very hard to come by here and I have yet to see hornworms. Her staple feeders are crickets (on occasion) and superworms - more often. How long would it take for the effects of ingesting something to affect her? The reason I ask is that I was away for a month and I had a neighbour (and co-worker) and her children come over to take care of the beardie and gecko. They are all very good with them and the kids were never here alone however they had them out alot - on the windowsill, floor, laps, etc. There is the possibility that she may have eaten something while out and about with them. Her regular feedings and baths were sorted out before I left so they knew what she could have (and how often for the feeders).

Our tap water does not have fluoride added to it although apparently it has 0.05ml/L of naturally occurring fluoride in it. Should I look at getting her some sort of filtered water?

The swab results will vary depending on what (if anything) grows. I work in a diagnostic lab and I know if there is no growth after 48 hours we consider it negative. If there is growth we have to make a pure colony of bacteria and then run it through a number of tests. It can take up to a week (especially for fungus). I'm hoping she will call mid-week and let me know any preliminary test results.

So far the swelling is not getting worse and if everything comes back clean I think we are going to do blood work and then see what happens from there. She has mentioned beardies with missing limbs seem to fare well in the event amputation is necessary as a last resort - I guess prepping me for the potential prognosis. However she feels confident that Squishy will be fine in the long run - as it may take a long time to treat (beardies are slow at doing everything that requires healing).

I will start mixing in some probiotic with her apple sauce/water mixture tonight so her stomach can settle a bit. I gave her the Baytril the am about 10 minutes before her light is scheduled to come on (so she wouldn't notice the poke and injection as much) and it went fairly well. I notice that although I'm only injecting 0.04cc SQ that in about 15 minutes the area looks like I've injected 0.1cc fluid there. Is it normal to have swelling after the SQ injection? We don't see it in larger animals but maybe it is too subtle? I'm bringing home some smaller needles from work today to see if I can make it a bit more comfortable for her. We are using 27g needles now but if I can get 30g through her tough skin than it will hurt less. I will give her the metacam when I get home from work in a few hours and attempt the metronidazole in some superworms (I hope she doesn't catch onto my secretive plan).

I do use the reptisun 10 tube. I've had it about 4 months now so it should still be good and my oh-so-loving-husband just bought me a fancy, expensive infared temp gun so I can verify my probe temperatures are correct

I wil update once I am home and have attempted the oral meds... :? I will take some pictures of her tonight if I get the chance.

Here are a couple of new pictures. She seems to be doing much better on the metacam - much more alert and interactive again. She hasn't caught on yet that her superworms are pumped full of drugs - and I give her an extra afterwards to ensure there is no bad taste in her mouth.

Here are a couple of pics in the bath:




And one of her rear foot:


If I haven't heard from the vet by Wednesday I will probably give them a call and see if they have anything back from the lab.

Hello!

How are things today?
Well, that amount of fluoride shouldn't do much, if it is naturally ocurring & not added. They are different, chemically speaking, so the added fluoride is so much worse.
If he did eat something while you were away, it probably should have already affected him before now, I would think, after 1 months' time.
I am not sure why this would have happened. Maybe a bad worm, possibly. Things happen with feeders sometimes, with no explanation.
Maybe start filtering your water that you give her, just to be on the safe side.
Hopefully she wont figure out that her worms have some drugs in them. Poor worms though. That is an effective way to get the meds into her. How long will she be on all 3 medications for? I hope a short period of time.
That is true, it is a 48 hour window. So, if nothing grows then, I guess your next step is a blood test for her. At least the swelling is not getting any worse then. I certainly would not amputate anything yet, be patient as we know, it does take time for them to get better.
I think you have caught the condition early so hopefully it will be able to be treated properly & fixed relatively quickly now.
I figured that you probably did use the Reptisun 10 tube bulb, but thought I would check anyway.
Ah, poor girl, do try to get the 30 gauge needles, or insulin needles. I forget the gauge of the insulin needles but, they should work. It is normal for there to be localized swelling at the injection site. You could try massaging the area, to see if you can try to get it to disperse a little more evenly. It is a small amount so she should be absorbing it just fine.

Let me know how she is doing!
You will love the temp gun, they are very accurate! That was nice of your hubby to buy one for you.

Tracie