German Giant strange positions, deformed toe, swollen leg.

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Re: German Giant strange positions, deformed toe, swollen le

Postby AHBD » Fri Nov 10, 2017 2:23 pm

That's all very promising ! Is his leg still very swollen ? Can you post new pics of it from the front, showing a comparison to the other leg and also individual pics of each leg ?
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Re: German Giant strange positions, deformed toe, swollen le

Postby karlys » Fri Nov 10, 2017 9:46 pm

From personal experience when Ive had to take antibiotics and when we had to give them to my bf's beardie, I'm not surprised Pablo feels better after a couple doses! That's often the trouble with antibiotics. People will feel better quickly so they don't think they need to take the full course and they stop before the bottle is finished. Enough of the bacteria is killed to make you feel better but it's not usually 100% gone. The person either gets sick again as the bacteria multiply and/or the bacteria learns from the encounter and becomes resistant to the kind of antibiotics you took and you pass it along to somebody else. Like those scary antibiotic resistant MRSA cases you hear about sometimes on the news.
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Re: German Giant strange positions, deformed toe, swollen le

Postby GermanGiant3 » Fri Nov 10, 2017 9:52 pm

karlys wrote:From personal experience when Ive had to take antibiotics and when we had to give them to my bf's beardie, I'm not surprised Pablo feels better after a couple doses! That's often the trouble with antibiotics. People will feel better quickly so they don't think they need to take the full course and they stop before the bottle is finished. Enough of the bacteria is killed to make you feel better but it's not usually 100% gone. The person either gets sick again as the bacteria multiply and/or the bacteria learns from the encounter and becomes resistant to the kind of antibiotics you took and you pass it along to somebody else. Like those scary antibiotic resistant MRSA cases you hear about sometimes on the news.


I definitely imagined that to be the case, I'm just not certain if it is necessary to put him under general anesthesia if he can improve via medication. Quite indecisive here.. Could 30 days straight of Baytril and an entire bottle of amoxicillin not kill what is ailing him? I'm not 100% sure if there is even an abscess in the leg for when they cut into him...
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Re: German Giant strange positions, deformed toe, swollen le

Postby Drache613 » Fri Nov 10, 2017 11:18 pm

Hello,

That is very good to hear Pablo is at least feeling better & moving around more, bless him.
Definitely, if possible, post some pictures for us just so we can see.
I don't blame you at all for not wanting to have the surgery done. They have done x-rays,
right?
Have you spoken to the vet about this & how much better he seems to be feeling?
The doses look good. By my calculations, he is receiving roughly 10mg/kg on the Baytril
& 30mg/kg on the Amoxicillin. Those are within safe ranges for him of what is the normal
recommendations.

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Re: German Giant strange positions, deformed toe, swollen le

Postby kingofnobbys » Sat Nov 11, 2017 5:27 am

GermanGiant3 wrote:
karlys wrote:From personal experience when Ive had to take antibiotics and when we had to give them to my bf's beardie, I'm not surprised Pablo feels better after a couple doses! That's often the trouble with antibiotics. People will feel better quickly so they don't think they need to take the full course and they stop before the bottle is finished. Enough of the bacteria is killed to make you feel better but it's not usually 100% gone. The person either gets sick again as the bacteria multiply and/or the bacteria learns from the encounter and becomes resistant to the kind of antibiotics you took and you pass it along to somebody else. Like those scary antibiotic resistant MRSA cases you hear about sometimes on the news.


I definitely imagined that to be the case, I'm just not certain if it is necessary to put him under general anesthesia if he can improve via medication. Quite indecisive here.. Could 30 days straight of Baytril and an entire bottle of amoxicillin not kill what is ailing him? I'm not 100% sure if there is even an abscess in the leg for when they cut into him...


Actually - no
- if the bacteria / virus is protected / encapsulated in a puss filled abscess with poor blood supply into and through and the tissues surrounding it are dead , the antibiotic will never get to the pathogen as it doesn't transfer by diffusion across such boundaries.

This I found out the hard way in person after I had a nasty fall going down my front steps and banged up by left shin very badly - corked it very badly and had a couple huge deep tissue haematomas which somehow became septic and two abscesses formed along with my developing a very bad case of cellulitis in the left lower leg ,then one of the abscesses ruptured and the corrosive puss found it's way to skin and was dribbling down my lower leg ,this despite my GP putting me on oral antibiotics ,I was admitted to hospital and taken by ambulance and the ER surgeon immediately cut my leg open under the knee under a local to remove the infected tissues -a triangular shaped hole 3in long , 2in wide and 4in deep (AND I FELT everything despite the half dozen injections of local anesthetic to deaden the area ) and I spent 4 weeks in intensive care on very powerful intravenous antibiotics, and despite all this the cellulitis was not responding .
So off for scans of the leg after having a radioactive substance injected , and I was put under a general to remove a second abscess lower down and much deeper in the leg tissues and to debride the infected flesh, another week on intravenous antibiotics and I was sent home with an 4 week course off oral antibiotics.
The surgeon advised me if they couldn't get the infection under control I was looking at loosing my leg to save my life.
Took 9 months for the surgical wounds to heal , daily repacking and redressing by a visiting wound specialist nurse .

The dragon will have an abscess that needs to be drained and debrided otherwise this will never heal and you are likely to either loose the dragon to a life threatening systemic infection or the leg becomes so badly infected it needs to be amputated. So please don't procrastinate on this.

A reptile vet surgeon will do a small needle aspiration of the material in the lump and should be able to tell what's in the lump. I'm betting if it feels firm - it's full of dessicated (waxylike) puss that full of bacteria or virus or if it's got give in it , it's full of liquid puss and likely under considerable pressure.
He will be in a lot of pain and feeling very unwell - I was.

Also - keep in mind reptiles such as bearded dragons have very slow metabolisms cf mammals so it will take much longer for antibiotics to work and for the dragon to heal and recover than a mammal would .
CBDs: Cleopatra & Caesar born 28Jan19.
Puff (RIP 10Dec15),Rex (RIP 16Mar17),Toothless (RIP 26Nov17).Peppa (RIP 22Mar19).
EBTSs : George & Mildred (born july 2010).
EWSs : Fluffy - 4yr rescued lawnmowing accident victim 14Nov17.
Lucky - cat attack rescue, fatal SI RIP 21Jul2010.
Wriggles - rescued injured ,thought she was a big lizard, over 8 yrs old, RIP 2Feb16. .
Gecko : Godzilla the hatchling GEHYRA GECKO (hatched May 2019)
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Re: German Giant strange positions, deformed toe, swollen le

Postby EllenD » Sat Nov 11, 2017 12:00 pm

I'm glad he's feeling better, but that's to be expected if you got the new UVB tube on him...There is a massive difference between a T8 UVB tube on top of a mesh lid and either a new T8 tube unobstructed and within the correct distance of him, or a T5 UVB tube. They do usually perk up very, very quickly after getting adequate UVB light after so long without it. I highly doubt the antibiotics are the cause of him perking up yet...

Did your vet do blood work or a culture from his leg, or is he just waiting to open him up to do this? Honestly, instead of putting him under, I would request a full blood panel and a needle aspiration from his leg and a culture and sensitivity on the fluid he gets. #1) He won't have to be put under for either, #2) The blood work will confirm or rule out Gout through the Uric Acid level and also confirm or rule out a septic infection through the blood cell counts, and the culture and sensitivity from the needle aspiration of his leg will show uric acid crystals and/or the exact bacteria that is causing the encapsulated abscess he definitely has in his leg, along with the correct antibiotics to treat it, instead of just putting him on broad-spectrum antibiotics that may not treat the specific infection he has...

I don't believe he has a "systemic infection" at all, because he's had this localized, encapsulated infection and/or swelling in his leg for so long that he'd be extremely sick by now had it spread to his bloodstream, and a systemic infection would not spread from a ling-time localized infection in one leg to another, second localized infection in a toe on another foot. He'd be extremely sick if he was septic, he'd be extremely lethargic and not eating, and since it's gone on so long he may even have died by now.

If they do a needle aspiration on his leg along with blood work and it comes back as Gout, this explains the swelling in his tow as well. Then you know you're simply dealing with Pseudogout due to the husbandry issues, which is causing the usual, random swelling in different extremities along with a resulting localized infection in his leg. Then they treat the gout with short-term Allopurinol and give him one specific, confirmed to be effective antibiotic to treat the localized infection in his leg that is secondary to the Pseudogout...

Why did your vet so quickly rule out Pseudogout as the cause of the random swelling and the localized, encapsulated infection and go right to a "systemic infection" that he needs to put him under for in order to cut open? I hope he didn't base that on the x-ray, as Uric Acid crystals rarely show up on a flat x-ray. You have to do a simple blood panel to confirm or rule out both gout and a septic infection, so that would seem like the logical next step to me, not surgery...Not that I think he's in any danger if you choose to follow what the vet is saying he wants to do, I'm sure he'll be fine. I just don't think it's at all necessary.

Just my opinion, I'd rather give it than not so you can hear all the sides of this and make a decision. If this was one of my guys, I would not have the surgery done that he's wanting to do, I'd request blood work be done to look at his current blood counts and his Uric Acid level, and I'd request a simple needle aspiration to remove some of the fluid in his arm and have it cultured to determine what specific bacteria is causing the infection. He doesn't need to open him up to look for Uric Acid crystals, the blood work definitively confirm or rule both Gout and a systemic infection. No need to take this huge jump that presents more risk to your dragon when these simple steps that will most likely give you the answers you need are being skipped . Just my opinion...
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Re: German Giant strange positions, deformed toe, swollen le

Postby GermanGiant3 » Sat Nov 11, 2017 12:30 pm

EllenD wrote:I'm glad he's feeling better, but that's to be expected if you got the new UVB tube on him...There is a massive difference between a T8 UVB tube on top of a mesh lid and either a new T8 tube unobstructed and within the correct distance of him, or a T5 UVB tube. They do usually perk up very, very quickly after getting adequate UVB light after so long without it. I highly doubt the antibiotics are the cause of him perking up yet...

Did your vet do blood work or a culture from his leg, or is he just waiting to open him up to do this? Honestly, instead of putting him under, I would request a full blood panel and a needle aspiration from his leg and a culture and sensitivity on the fluid he gets. #1) He won't have to be put under for either, #2) The blood work will confirm or rule out Gout through the Uric Acid level and also confirm or rule out a septic infection through the blood cell counts, and the culture and sensitivity from the needle aspiration of his leg will show uric acid crystals and/or the exact bacteria that is causing the encapsulated abscess he definitely has in his leg, along with the correct antibiotics to treat it, instead of just putting him on broad-spectrum antibiotics that may not treat the specific infection he has...

I don't believe he has a "systemic infection" at all, because he's had this localized, encapsulated infection and/or swelling in his leg for so long that he'd be extremely sick by now had it spread to his bloodstream, and a systemic infection would not spread from a ling-time localized infection in one leg to another, second localized infection in a toe on another foot. He'd be extremely sick if he was septic, he'd be extremely lethargic and not eating, and since it's gone on so long he may even have died by now.

If they do a needle aspiration on his leg along with blood work and it comes back as Gout, this explains the swelling in his tow as well. Then you know you're simply dealing with Pseudogout due to the husbandry issues, which is causing the usual, random swelling in different extremities along with a resulting localized infection in his leg. Then they treat the gout with short-term Allopurinol and give him one specific, confirmed to be effective antibiotic to treat the localized infection in his leg that is secondary to the Pseudogout...

Why did your vet so quickly rule out Pseudogout as the cause of the random swelling and the localized, encapsulated infection and go right to a "systemic infection" that he needs to put him under for in order to cut open? I hope he didn't base that on the x-ray, as Uric Acid crystals rarely show up on a flat x-ray. You have to do a simple blood panel to confirm or rule out both gout and a septic infection, so that would seem like the logical next step to me, not surgery...Not that I think he's in any danger if you choose to follow what the vet is saying he wants to do, I'm sure he'll be fine. I just don't think it's at all necessary.

Just my opinion, I'd rather give it than not so you can hear all the sides of this and make a decision. If this was one of my guys, I would not have the surgery done that he's wanting to do, I'd request blood work be done to look at his current blood counts and his Uric Acid level, and I'd request a simple needle aspiration to remove some of the fluid in his arm and have it cultured to determine what specific bacteria is causing the infection. He doesn't need to open him up to look for Uric Acid crystals, the blood work definitively confirm or rule both Gout and a systemic infection. No need to take this huge jump that presents more risk to your dragon when these simple steps that will most likely give you the answers you need are being skipped . Just my opinion...



I ordered his UVB but it has not came yet. He is still under the same coil bulb. The fixture despite being ordered via prime will not be here until Thursday or so when the light could be here by Monday.

I asked about the leg being aspirated to figure out what was going on, he referred to it as "unnnecessary puncturing of the armor." He was x-rayed in August when there were no signs of MBD and something small difficult to see possibly in the front left leg but unsure if that could have been scar tissue from an injury or what at that time. I will update this thread with pictures of him and legs at different angles ASAP. He said he did not appear to be exhibiting signs of gout or MBD. Still no blood work or culture done, he gave a rather lengthy response when I asked. Basically if a culture was to be done and it is infected like he believes it to be, he would have to clean the leg etc out anyways. General anesthesia terrifies me, I have had numerous surgeries myself and can't picture my buddy going to sleep with a mask or tube :|
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Re: German Giant strange positions, deformed toe, swollen le

Postby GermanGiant3 » Sat Nov 11, 2017 1:03 pm

OK, I just took pictures.

Front swollen left leg: https://imgur.com/a/RGgVa

Front right leg: https://imgur.com/a/BbX1F

Back left leg with swollen or deformed toe https://imgur.com/a/Xwg3S

Back right leg https://imgur.com/a/kPOrC

Face/Some angles of his legs https://imgur.com/a/BgwO4

Update: I just found a picture of his original leg swelling when he was in the bath that were dated June 23rd! I had no idea the swelling started that long ago. The pus did not come out until August. Please compare this photo from June 23rd to the current angle of his left leg and let me know what you think. https://imgur.com/a/HGqNx

Is this something that is likely safe to wait it out in terms of surgery and see how he responds to these antibiotics given current swelling levels?

Thank you
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Re: German Giant strange positions, deformed toe, swollen le

Postby Drache613 » Sat Nov 11, 2017 11:17 pm

Hello,

I truly believe that is gout. It is a classic look, plus, it is affecting more than just one
foot, etc. Gout will cause club looking feet. I highly doubt that it's an infection, but
a blood test really needs to be done, immediately before surgery, in my opinion.
All of his feet/hands are going to be swelling & out of control soon, if it's gout. The
antibiotics are going to make it much worse.
Can you get a blood test done?

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Re: German Giant strange positions, deformed toe, swollen le

Postby kingofnobbys » Sat Nov 11, 2017 11:38 pm

Is a like cause , a blood test would help if this issue is gout or some kind of infection.

At least he's BBing (in the picture) but this really needs proper treatment to resolve it.
CBDs: Cleopatra & Caesar born 28Jan19.
Puff (RIP 10Dec15),Rex (RIP 16Mar17),Toothless (RIP 26Nov17).Peppa (RIP 22Mar19).
EBTSs : George & Mildred (born july 2010).
EWSs : Fluffy - 4yr rescued lawnmowing accident victim 14Nov17.
Lucky - cat attack rescue, fatal SI RIP 21Jul2010.
Wriggles - rescued injured ,thought she was a big lizard, over 8 yrs old, RIP 2Feb16. .
Gecko : Godzilla the hatchling GEHYRA GECKO (hatched May 2019)
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Re: German Giant strange positions, deformed toe, swollen le

Postby GermanGiant3 » Sun Nov 12, 2017 12:53 am

Drache613 wrote:Hello,

I truly believe that is gout. It is a classic look, plus, it is affecting more than just one
foot, etc. Gout will cause club looking feet. I highly doubt that it's an infection, but
a blood test really needs to be done, immediately before surgery, in my opinion.
All of his feet/hands are going to be swelling & out of control soon, if it's gout. The
antibiotics are going to make it much worse.
Can you get a blood test done?

Tracie



I am having a hard time figuring out what may be causing this since it has been ongoing for about 5 months now. The left leg is definitely not as swollen as it was even back in August.

He is currently on the surgery schedule for Tuesday, I have already been to 2 separate vet visits both trusted vets who did not end up culturing/aspirating for a blood-test.. I wish they just did it that day when I asked about aspiration. He seems to be doing well on the antibiotics right now. Is it a possibility that the one toe on his back left foot is/was broken since I am unsure how long it has been like that, and he has something localized in the front left leg? I'm just having a very hard time figuring out what this may be, but I definitely don't want to be doing the wrong thing with him being on antibiotics.. Ugh :/ - it has improved in appearance since the photo taken on June 23rd by a lot, seemingly calloused over or something of the sort. He is very alert, I am just so torn. He has been to 2 different vets, I don't know if antibiotics are right or wrong, if surgery is right or wrong.. This vet has been in practice for a very long time seeing beardies and other reptiles and almost immediately ruled out gout after seeing him. I know he could definitely have it. I'm so lost on how to approach this. I know for a fact that the leg was infected back in August at the least when pus came out of the same spot that is now somewhat swollen and not normal looking. :/
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Re: German Giant strange positions, deformed toe, swollen le

Postby kingofnobbys » Sun Nov 12, 2017 4:49 am

GermanGiant3 wrote:
Drache613 wrote:Hello,

I truly believe that is gout. It is a classic look, plus, it is affecting more than just one
foot, etc. Gout will cause club looking feet. I highly doubt that it's an infection, but
a blood test really needs to be done, immediately before surgery, in my opinion.
All of his feet/hands are going to be swelling & out of control soon, if it's gout. The
antibiotics are going to make it much worse.
Can you get a blood test done?

Tracie



I am having a hard time figuring out what may be causing this since it has been ongoing for about 5 months now. The left leg is definitely not as swollen as it was even back in August.

He is currently on the surgery schedule for Tuesday, I have already been to 2 separate vet visits both trusted vets who did not end up culturing/aspirating for a blood-test.. I wish they just did it that day when I asked about aspiration. He seems to be doing well on the antibiotics right now. Is it a possibility that the one toe on his back left foot is/was broken since I am unsure how long it has been like that, and he has something localized in the front left leg? I'm just having a very hard time figuring out what this may be, but I definitely don't want to be doing the wrong thing with him being on antibiotics.. Ugh :/ - it has improved in appearance since the photo taken on June 23rd by a lot, seemingly calloused over or something of the sort. He is very alert, I am just so torn. He has been to 2 different vets, I don't know if antibiotics are right or wrong, if surgery is right or wrong.. This vet has been in practice for a very long time seeing beardies and other reptiles and almost immediately ruled out gout after seeing him. I know he could definitely have it. I'm so lost on how to approach this. I know for a fact that the leg was infected back in August at the least when pus came out of the same spot that is now somewhat swollen and not normal looking. :/


You'd need access to a medical high resolution ultrasound and or a imaging scanner to work that found without doing anything invasive such a small needle aspirations and bloodwork or explorative surgery.

I'm flabbergasted neither vet bothered do any small needle aspirations and bloodwork , I'd have my suspicions about their credentials / experience and agenda / motivation (which may well be maximize money taken from you).
CBDs: Cleopatra & Caesar born 28Jan19.
Puff (RIP 10Dec15),Rex (RIP 16Mar17),Toothless (RIP 26Nov17).Peppa (RIP 22Mar19).
EBTSs : George & Mildred (born july 2010).
EWSs : Fluffy - 4yr rescued lawnmowing accident victim 14Nov17.
Lucky - cat attack rescue, fatal SI RIP 21Jul2010.
Wriggles - rescued injured ,thought she was a big lizard, over 8 yrs old, RIP 2Feb16. .
Gecko : Godzilla the hatchling GEHYRA GECKO (hatched May 2019)
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Re: German Giant strange positions, deformed toe, swollen le

Postby AHBD » Sun Nov 12, 2017 5:03 am

Is there any chance you can find a vet that will do the aspiration + bloodwork ?
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Re: German Giant strange positions, deformed toe, swollen le

Postby GermanGiant3 » Sun Nov 12, 2017 5:46 am

No other qualified vets in the area. I may have to resort to taking him back to the one who wants to operate and insist on aspiration and bloodwork.. But I already did that at the last visit.. Two vets, two office fees for them doing basically nothing for him :|

Compared to June, the left leg is much much smaller. I can definitely note that in the photos. I don't know if the left leg sustained some sort of injury which transitioned into infection in August or what. But I really have no clue what's going on now other than his leg never went back to completely normal looking. :silent:

I suppose the next course of action will be to call Monday morning, get him off of the surgery schedule and see about another appointment there and be very persistent about bloodwork etc.
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Re: German Giant strange positions, deformed toe, swollen le

Postby EllenD » Sun Nov 12, 2017 6:53 am

Drache613 wrote:Hello,

I truly believe that is gout. It is a classic look, plus, it is affecting more than just one
foot, etc. Gout will cause club looking feet. I highly doubt that it's an infection, but
a blood test really needs to be done, immediately before surgery, in my opinion.
All of his feet/hands are going to be swelling & out of control soon, if it's gout. The
antibiotics are going to make it much worse.
Can you get a blood test done?

Tracie


EXACTLY! Blood work should be a must before any general anesthesia or surgery anyway, just to make sure he doesn't have a bleeding issue, respiratory issue, or kidney/liver or other issue that could result in complications. So the question becomes "Why not rule out gout first?" I too believe it's gout, it's classic signs and symptoms of gout, not of sepsis.

I wouldn't "wait and see if the antibiotics work" at all, no, to answer your question, he can't wait that long. The reason I'm saying this is because if it is gout the antibiotics will not help and may make it worse, and him taking 2 unnecessary, broad-spectrum antibiotics for no reason can cause a host of other issues too, like killing his appetite and energy.

So no, I wouldn't wait for the antibiotics to work, I would get blood work done immediately and once you get the results back, if it is gout you can stop both antibiotics and start treating the gout. If it is an infection THEN you can pursue debridement, cultures, and putting him on the correctly identified antibiotic for the specific infection that he has instead of guessing and just picking a broad-spectrum antibiotic that may not help at all but only make him sick.

The bottom line is that a very non-invasive blood test will tell you exactly what is going on with him and will allow you to make an informed decision as to what to do, and not just throw him into a possibly unnecessary surgery. It's quite possible (probable in my opinion) that he needs nothing more than to be put on a short course of Allopurinol and possibly a specific antibiotic if there is an infection secondary to the gout. That's it. Well, and some pain meds. Blood work will definitely not hurt him and will tell all that is going on...And honestly he should be having this done before surgery or general anesthesia anyway...

And I'm not even talking about doing a needle aspiration to his leg and then cultures on that fluid at this point, it doesn't sound like you have access to a vet willing to do that right now. I'm just talking about regular old blood work done by a lab that will show his CBC (rule out or confirm infection, certainly a septic infection), Uric Acid level (rule out or confirm gout), and kidney panel (shows any damage done by the Uric Acid)....That's it. Then you can make an "Informed Decision"...

That's just it, this isn't fair to you to have to make this decision at this particular point, because this vet is just skipping a really huge, normal, routine step (simple blood work) and automatically putting him under general anesthesia and opening him up. I don't know why this vet is doing this, I don't know him and hate to accuse him of doing what a lot of vets do, which is performing expensive, unnecessary procedures for money, but this makes no sense at all. When you said that the vet said "He could identify Uric Acid crystals in his leg after he opens him up" that's the point I thought something was up. That makes zero sense. A simple blood draw will tell him every single thing he's saying he is going to figure out by putting him under and cutting him wide open. That's not right.

My problem is that by skipping the simple and routine blood work, you don't have enough information about what's going on to be able to make the decision you're struggling with, and that you should be struggling with. Think about it, not many people have to decide about whether to put their pets, their kids, or themselves under the knife without having simple blood work done first to rule out or confirm what's going on, not even exploratory surgery without blood work first. How could you make a comfortable, informed decision? I couldn't, and I wouldn't...
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