Blood? At a loss. Pictures of poop- Good News

Keeping this as short as possible. 8.5 year old female dragon was passing red/brown liquid prior to evacuating poop. Always has trouble pooping, always looks like she is straining and in the past has passed significant amounts of blood in poop temporarily (suspected of having a fissure or stricture). She is a huge egg layer anywhere from 70-100 eggs between April and September. So it has been hard to keep weight on her, while also keeping calcium up, but she is gaining. Took her to the vet as I noticed this poop change but also to check her weight, calcium levels, and possible parasites. She has been laying for 4 years now.
Vet visit #1 - Stomach a little swollen, x-ray found area of calcification...but no clue what it could be, blood work for liver and kidney function - perfect, White blood cells or WBCs were elevated suggesting an infection somewhere, calcium levels - perfect, fecal - clear. Emmalee was sent home and put on critical care to up her fiber intake, 2 baths per day to encourage daily poop (that is never going to happen) and Baytril for two weeks.
Vet visit #2 - stomach not swollen - feels normal, clinically and medically Emmalee looked well. Poop consistency never changed - daily baths and massage - getting poop every three to four days, still looks like she is straining despite fiber uptake (but this is normal for her). Gained about 30
grms, sent home with 2 weeks more of Baytril.

Set Up - temp at basking area was raised to 100-103, Reptisun 10 changed July 2017, 75 gallon tank.

Temperament - Normal, basking, head is up, eyes are clear, hunts her bugs, not anymore sleepy that she usually is, brumation is coming soon.

Any idea as to what is going on here! Vet wants to proceed with ultrasound, but this sounds like a very expensive endeavor, and so far she has no clue as to what is happening and cannot ensure that ultrasound will give us anymore answers. Emmalee finished her 2nd round of Baytril yesterday. The vet has ruled out peritonitis, due to Emmalee's overall presentation. The vet is thinking there may be a reproductive issue, but can a reproductive problem cause this poop problem? Emmalee now weighs 516 grams and this is also continuing to go up.

A couple of pics of Emmalee today.


Poop as it comes out (no red/brown liquid shown as she passes this in the bath)

Urate and casing of poop dissected on paper towel (jelly like area is the sack around the poop or casing)

That doesn't look too far off from a normal poo. What exactly is her diet at the moment ? Good that she maintained weight + appetite while on Baytril. Best not to give any more of that for a long time, ep. when it's just given on a " precautionary, just in case " basis.

I agree that baths aren't necessary, 2-3X a week max.
To help her poo, find a natural laxative that she actually likes to eat.....any or all of these.
Canned pumpkin, prune, squash or sweet potato baby food[ or fresh cooked + mashed ] A few drops of veg. oil or raw honey to any of those. Small amount of natural fruit juice can also be added, try these things that can help her poo and find out what she likes. If she can poo more easily maybe that will help.

Other than that it doesn't seem too bad. Is the black beard from a recent bath or dose of meds. or how common is it ? She's miffed about something, huh ?

I agree, the only thing alarming here is the black beard...Is that a common thing, the black beard? Or is this due to something unrelated? And as AHBD already mentioned, please stop the Baytril, she has no bacterial infection and it's only going to make her sick. Her blood work is perfect, no need for meds. But I have a theory for you that explains ALL of her symptoms, if you keep an open mind (really it's not far-fetched, I've seen it before in dragons)...

As far as the "unknown calcification" seen on her x-ray, depending on where it was located it could simply be a vessel within her urinary tract/kidneys that has calcified, or maybe she has a kidney stone!! In all seriousness, they show up on flat x-rays and cause blood in the urine as they move throughout the urinary tract, so it's possible the bright red blood could be from a stone, as you said the blood was in the urate. Wouldn't be the first bearded dragon I've heard of having a kidney stone, and it explains not only the calcification on the x-ray and the blood, but it could also be the cause of her constant straining when she is trying to poop!!! Remember, they don't have a separate urethra that passes urine, their urates and fecal matter come out of the same place, and trust me, I speak from personal experience of having well over 100 kidney stones starting at the age of 19 (I'm now 37) and having had surgery twice to remove 2 I couldn't pass...But once the stone hits a humans urethra you literally feel like you have to pee all the time until you pass it, and you urinate blood off and on, like every time the stone moves a tiny bit it causes bleeding....Of course again, this depends on where the calcification showed up on the flat x-ray, I'm an expert at kidney stone imaging, and a flat x-ray isn't the best way of seeing them, unless they inject iodine and do a Pyleogram. But you can surely see them very well and get their measurements on either a CT Scan or an Ultrasound.

I don't know enough about a dragon's anatomy to know where the intestinal tract and the urinary tract (or whatever they have that's similar) meet, but I know I've seen more than one post about a dragon diagnosed with a Calcium Oxalate stone. She could be excreting extra Calcium in her urates if you've upped her Calcium due to all the eggs, which I'm sure you have since she started laying all the eggs a few years ago, so her forming a Calcium Oxalate or Calcium Phosphate kidney stone isn't far fetched at all, especially with the calcification showing up on the x-ray, the blood in her urates, and the constant straining (which would also explain why the extra fiber you've added to her diet has not helped her pass more stools or stop her straining, she isn't straining to poop, she's straining to get that stone out!)

If you have a digital copy of her flat x-ray and can post it here, or if they told you where the calcification is located, this will either rule a kidney stone out completely, or pretty much confirm it's possibility and the need for an ultrasound to diagnose it...

Thanks for the responses, and concerns...yes..Emmalee as usual does not follow the norms for a bearded dragon in a lot of cases. Case in point the black beard, she does this a lot. I mean a lot. If I did not know her better I would constantly think she is ill or angry. She usually will have darker or black area along her jaw line, rather than not. However, in her defense this photo was taken about 15 minutes after a bath, which made her quite angry (super black beard) and after poop, in where she always black beards.

I am feeding her a mix of my own baby food slurry now, which varies, she gets alfalfa, kale collard, dandelion, butternut squash, parsnip, sweet potato and pea, quite regularly 5 days per week. She gets fruit about two days per week, blueberry, apple, cantelope and her diet is also supplemented with various other veggies/fruit on rarer occasions. She is now fed smaller juvenile, self raised dubias. Two days per week. I have stopped feeding full fledged adults during this time for easier digestion.

I will try to add oil, and I do also have some pumpkin I can add. Do you have any suggestions for what type of honey I should add?

I was really concerned about the reddish fluid passed prior and of course the red in the urate. She has not been fed anything red at all during this time, no strawberries or berries of any kind, no beets, no commercially prepared food has ever been fed to her. So this red is not diet related.

I just phoned the vet to obtain a copy of this x-ray which I have never seen and will attach if this is at all helpful once it is received. A stone may be possible....I do have to feed her quite a ton of calcium during egg laying season. Poor Emmalee seems to produce eggs in brumation that are ready to lay two weeks after she wakes which always results in hind leg weakness. So as soon as she is up from brumation calcium is given to her in almost over dose fashion (Rep-Cal NO Vit D3), throughout her egg laying season.

NOTE: Baytril was given as there was an elevated WBC count in her blood work and some changes to cells, suggesting an infection, but who knows where. So this was not entirely cautionary. As there were no changes in poop ease, color or consistency after the first two weeks the vet put her on another two week dose.

If you can please post the x-ray, as there are a few members who can read them very well...I'm interested to see where this calcification is located, since as you confirmed you give her a lot of Calcium when she's laying eggs, as we all would/do. If the calcification is located anyway in the kidney or bladder, or near her cloaca, it's quite possible it is a kidney stone causing her straining and blood in the urate.

I did some reading after I originally posted, and it's actually quite common for bearded dragons to get 2 different types of stones: #1) Kidney Stones, either Calcium Oxalate (Kale contains a lot of oxalates), Calcium Phosphate, or Uric Acid Stones; all of which seem to show up in either the kidneys themselves, in the duct that leads from the kidneys to the cloaca, or in the bladder, and then #2) Urate Stones. I wasn't familiar with "Urate Stones", but they are quite common I guess, and they are basically Urate that hardens into a stone and they cause the exact same symptoms as the Kidney Stones do. It seems that the common symptoms of either of these types of stones in bearded dragons are Blood in the urates, constant straining to "go" either right before, during, and/or after they have a bowel movement, passing of very small stools, and black beards at odd times that go away and come back for short periods of time...So since they saw a calcification on her x-ray and based on her symptoms, it may very well either be a Renal Calculi (kidney stone) or a Urate Stone...

Hello,

Poor Emmalee, she sure does lay a lot of eggs, how frustrating for you both!
Her diet is excellent. If you wanted to add honey to her diet, you could add the raw type that
is unpasteurized just to give antibacterial/antimicrobial help in case her GI tract needs some
help. She could just have some minor irritation of the lining for some reason also.
I hope she doesn't have any stones to pass, that would be pretty difficult on her.
The urates didn't appear too hard, were they?
You could maybe include some probiotics in her regime either daily, or a few times per week
to help out her system. What insects do you feed her right now?
Definitely try to post the x-rays if you can, maybe we can see something from them.
I am happy so far, that they have ruled out peritonitis then!

Tracie

Hello Tracie,

Urates are usually soft and semi-formed to loose and then normal in consistency afterwards when it comes along with the poop. She mostly gets home raised dubia roaches and sometimes superworms.

I will post the x-rays when and if I get them, in the meantime here are the full blood work results. Not sure what CK- muscle damage refers to...she had not been injured. Plus I notice +++ Lipemia, the vet did not point this out as a concern though.

I will try that honey, should be able to pick some up at my local health food store.

On October 3, 2017

BIOCHEMISTRY
Glucose 7.8 mmol/L
Uric Acid <6 umol/L
Result verified by repeat analysis
Phosphorus 2.2 mmol/L
Calcium 3.58 mmol/L
Sodium 170 mmol/L
Potassium <2.0 mmol/L
Result verified by repeat analysis
Chloride 130 mmol/L
Total Protein 48 g/L
Albumin 18 g/L
Globulin 30 g/L
A/G Ratio 0.6
AST 25 IU/L
ALP 75 IU/L
CK 1041 IU/L
Hemolysis ++
Lipemia +++

HEMATOLOGY
WBC 9.6 x10E9/L
Manual PCV 0.33 L/L
Differential % abs.
Heterophils 45.0 4.3 x10E9/L
Bands 20.0 1.9 x10E9/L
Lymphocytes 29.0 2.8 x10E9/L
Monocytes 6.0 0.6 x10E9/L
Azurophils 0.0 0.0
Eosinophils 0.0 0.0
Basophils 0.0 0.0
Morphology
WBC Morphology - Toxic Neutrophils Mild
RBC Morphology - Normal
PLT Morphology - Clumped Platelets Mild
Normal
PLT Assessment -Platelet Count Adequate
Slide Review - Path Review Completed

Hematology Slide Review - There is an increased heterophil-to-lymphocyte ratio with a left shift. Some heterophils appear to have toxic change characterized by darker, more rounded granules. these findings support an acute inflammatory leukogram. Rule out yolk peritonitis with history. Monitor. Hematocrit looks OK and no RBC morphologis abnormalities are seen. Throbocytes (platelets) appear adequate.

Biochemistry - CK--muscle damage

Hello!

How is Emmalee doing today?
Those blood values don't look too bad. The CK is usually from muscle trauma & can easily
become elevated from a blood draw actually. The uric acid looks good to me also, which
is terrific, no gout right now.
Now what did they say she had, an impaction, or possible stones, etc? I can see something
on there but not sure exactly what it could be. It could be mineralization of something,
maybe stones. It couldn't be an impaction, correct?
It could also be a gas pocket too, but not sure. Did they not make many remarks on the
x-rays yet?
Were you able to find any raw honey?

Tracie

Hi Tracie. The vet said her blood work was all good as well, except for the infection that showed up. So I can only assume that the spot on the x-ray is responsible. Just like you she was not sure what the spot actually was.

She gave me a couple of suggestions. Something she ate or impaction. However, although Emmalee had a very large poop after with a lot of bugs (dubia wing and plates), she was no suffering from signs of impaction.

Now that yolk peritonitis is ruled out, she really feels this is a reproductive issue....such as calcified follicles. She told me specifically that it was a calcification. No other remarks or comments were made. This is why she wanted to move to ultrasound if the poop remained the same and it does.

Other than that Emmalee is good. She was hunting bugs two day ago, but is ready for brumation. She never left her burrito when temps outside hit -5 and the snow fell.

Hello,

I agree, just an infection was all that appeared off to me, too. I was happy to see that her
kidneys & liver enzymes & counts were all good. Hopefully she can get that infection all
cleared out also.
I was thinking some type of calcified egg hanging out, etc. I'm glad that peritonitis was not
the cause. No impaction is present either? It could also be a gas pocket perhaps from some
type of digestive issues possibly. Have they mentioned a tumor? Bloodwork didn't indicate,
nor did she have an elevated calcium level either which can sometimes mean a tumor, too.
That's great she did some hunting today! I am sure she probably is thinking about brumation
with the weather turning cold.

Let us know how little Emmalee is doing.

Tracie

Just curious, you mentioned that because of her egg laying that you gave her lots of calcium. Can you sprinkle the amount of calcium on a table to show how much you were giving her ? It may be that she was getting too much , but of course you would have been doing so out of concern when she was forming all the eggs which takes a lot of calcium. Better too much than too little in most cases.

Emmalee is sleeping and for now I am letting her. It is cold and snowing and after all this she needs her rest.

The vet did say the spot may have been something she ate. Then about 5 days later Emmalee passed a lot of bugs in her poop. In that poop there were pieces of Dubia wing and Dubia shell. When I say a lot I mean about 2 to 3 times the amount posted above. However she still continued to have the same poop consistency and look to it which is why the vet felt that there was something else going on.

There was never any mention of any tumor identified. She highly suspects after peritonitis was ruled out that there is a calcification in her follicles. Which she did seem very concerned about. I gather if this is something that is there it will not go away on its own which is why she wanted to move to ultrasound as the next step in preparation for a possible spay surgery.

I am concerned because this is a big step financially number one number two she didn't know if this would give us any further answers. I am not sure how bloody poop as a symptom would point to an egg problem or reproduction issue. I guess we could also repeat a xray to see if that spot remains consistent. Again an expensive move.

For a little history on Emmalee's egg-laying, she's been laying eggs for 4 years now going on her fifth year. When she lays eggs she lays a lot 70 to 100 per year, every year. For the last two to three years after waking up from brumation she has hind leg weakness and shakes consistently. Due to this hind leg weakness I do have to intake her calcium levels quite considerably for it to correct itself. I will put a pinch of calcium in about a teaspoon of water and feed it to her orally as well as generously sprinkling (powder donut) every meal with calcium until the hind leg weakness goes away. Once the hind leg weakness is gone the sprinkling of every meal will continue but much lighter and the oral water calcium is stopped. Once she wakes from brumation it's only about two weeks later that she'll lay her first batch of eggs so she seems to be making these eggs while brumating. It has been very difficult to keep Emmalee's weight up during this whole process she has lost some weight over the years. It has also been quite difficult to keep her calcium levels up with this as well because when she is full of eggs she does not want to eat. It has been quite a vicious cycle.

I really took her to the vet in the first place because I thought the poop looked a little odd. I suspected that she might have had a parasite infection from all the stress of losing weight laying eggs etc. I was not expecting there to be something showing in her stomach as otherwise she was generally acting normal and she has had pooping problems consistently throughout her life.

Before Emmalee ever laid an egg she weighed 565 grams. The first year she laid her eggs she went down to 517 grams. It is very hard on her. So when I say weight loss after 4 years going on 5 years of laying these eggs Emmalee's total weight was 465 grams. At last weigh i she was back up to 517 and now she has brumating and I'm letting her. At least for a bit...I will wake her for a bath in a few days.

Hello,

That is a lot of eggs for her to have to shell & lay! I can see how she could be having some
trouble with her weight & especially her calcium levels, too.
I know it would be costly, but have you considered getting her spayed? I think that is a good
idea & the vet already mentioned it. If there is a calcification of an ovary that wouldn't be
good. I"m glad that she doesn't feel there is a tumor though.
The egg development could be causing some digestive issues, possibly contributing to some
type of impaction problems.
How is she doing today?
Let us know how things are going!

Tracie

Tracie and all. I talked to the vet today and was so infuriated. I am pretty sure she has never heard a thing I said. Today she tried to lead me to a husbandry website, and accused me of not providing Emmalee with proper basking temps after I told her that Emmalee was brumating. I am going to get a second opinion. I do not feel comfortable with putting my trust in a doctor who cannot even get the history correct. She said, Emmalee had a swollen belly, then forgot she told me this and told me it felt fine. She told me it may be impaction, or calcified follicles, but is sure it is a follicle problem despite not doing any other testing, she was not sure if the red/brown liquid passed prior to the urate was blood, or whether it was just poop colored. She constantly tells me it is a problem if Emmalee has stopped eating (told me this twice in recent conversation) and I am telling her her appetite is fine. Then she said that ultrasound would not be worth doing at all unless I was going to have her spayed. Even though I told her I was interested in getting a quote for this. She then suggested we put Emmalee on Baytril again and this time for a longer period of time. I am not against treating my pet, but at the same time do not want to medicate without knowing if there is still an infection, or knowing what we are medicating for....am I wrong? Cause she made me feel like I was not wanting to care for my pet. Anyway, I have another vet visit on Tuesday, with another vet. Maybe I will have more answers then.

I woke Emmy up from her week of brumation and she ate her dubias with gusto. She is currently basking, but I did notice she did lose some weight. about 10 grams, so this is strange.

Husbandry - 75 gallon viv, with Reptisun 10.0 UVB 4 feet long changed in July, basking temps 95-103F, plain calcium in food 5 days per week (vet thinks twice is good enough) and multivitamin 2 times per week. Eats hand raised dubias and superworms occasionally. Emmy never eat veggies or enough to matter as a meal so homemade slurries are made. She licks slurry from her nose and has been eating 5-15 mls a sitting.

That would be very frustrating. It seems that despite Emmalee's nagging symptoms that she does quite well and is not in any real danger [ most likely ] . But I know you'd like more definitive answers and I hope the new vet will figure things out, whether there is any real problem.