Liver problems, need milk thistle advice

Norbert has a messed-up liver. Part 1 of this story (including husbandry information) is here: viewtopic.php?f=6&t=237287

I went back to the vet and asked for an ultrasound and blood panel. Blood tests looked pretty normal, but ultrasound showed a large, solid mass attached to her liver, as I thought. She had surgery six days ago to remove it and is recovering well - she's up and running around, her beard is consistently orange again, and this morning she ate her first dubias since surgery (I've been syringe-feeding her the last few days).

However, surgery revealed some bad stuff. Her liver was yellow instead of dark brown. We are waiting for results of tests on the mass and on a liver culture to find out exactly what's wrong with it. I'm encouraged by how well she appears to be doing, but really worried about how her liver is the wrong color and grew a big lump. She is on baytril right now because the vet suspects infection as one factor. He says he will make changes to meds when we get more information from the tests.

I want to hear from people who have used milk thistle as liver support. I'm going to go ahead and order some so I can start using it ASAP if it is indicated, though I want to hear about the test results first. What conditions is it useful for? How does the dosing work? Is there a form you recommend? Are there risk factors I should watch out for? I am doing my own research too, but there is a lot of conflicting information out there, and it's mostly about humans.

I'll send a p.m to Tracie [ Drache613 ] , one of the mods. here. She knows more about it than anyone here. In the meantime feed your dragon as much greens, including dandelion , as you can. Go easy on the dubias and also feed them an all greens + veggie diet as well.

Ring up your vet and ask them. They will know your specific situation and possible risks best.

As for experiences, Pepper was prescribed hepato-support when he has some liver issues a while ago. It is a formulated version of the active ingredients in milk thistle +vitamins. My vet even made it bacon flavored which pepper really liked.

Hello,

I can help with milk thistle dose, to some extent. Since it's a supplement there really isn't
any "set" amount of it to take. I normally recommend 15-20mg/kg of most supplements
Silymarin, which is the active ingredient in milk thistle is an antioxidant which helps with
detoxing the liver & boosting glutathione which is the primary antioxidant responsible for
the most detoxing properties. It helps with liver support & regeneration as well.
I can help figure a dose once you get the product, if you need.
How is she doing today?

Tracie

Drache613":2ppovn5v said:

Hello,

I can help with milk thistle dose, to some extent. Since it's a supplement there really isn't
any "set" amount of it to take. I normally recommend 15-20mg/kg of most supplements
Silymarin, which is the active ingredient in milk thistle is an antioxidant which helps with
detoxing the liver & boosting glutathione which is the primary antioxidant responsible for
the most detoxing properties. It helps with liver support & regeneration as well.
I can help figure a dose once you get the product, if you need.
How is she doing today?

Tracie

Click to expand...

Thank you! She is bright and alert and orange-bearded, in pretty good spirits for having seven stitches on her belly. And she's got her usual appetite--lots of interest in bugs, zero interest in greens. Per AHBD's advice, I gave her just one medium dubia this morning and then some collard greens and some green baby food. She ate the roach herself, but I had to force-feed her the other stuff. I'm going to try to find dandelion greens at the store today--the ones in our yard have died for the winter. I hate force-feeding her, though, as it clearly stresses her out. Maybe I should just deny her bugs for awhile and hope she'll eat greens if she gets hungry enough? This has always been a problem, and I worry that I've caused her liver problems by letting her get away with a diet that's heavy on bugs and light on greens. (If you need more background on her care, it is linked in the first post on this thread.)

I'm going to call the vet today and see if he has test results yet and what he proposes next. I don't 100% trust his expertise though, as he is a general exotics vet who just sees a lot of reptiles (could not find a reptile specialist in my area!), his explanation of what causes fatty liver was different from what I have read here, and he never listed milk thistle among potential treatments for Norbert. I ordered milk thistle powder. Do I mix it with water or anything else to give it to her? Are there any cases in which I should not use it? Thank you all for your advice.

Also, here are some pictures I just took of her, so you can see how she's looking today. They're not great because the only camera I have right now is the one in my laptop.
She is looking and acting pretty much as she always does (bright-eyed and wiggly)! I don't think she knows she's sick. :?

She does look quite good. Poor girl was wanting more dubias....how many does she usually eat ? It should be a reduced amount now but more than 1 dubia for your hungry Norbert. And it's best not to stress her by any force feeding but if you can slip a leaf in while she's chewing her bugs that's a good thing. And remember to feed the dubias with good greens as their diet, then she will get some that way as well.

AHBD":3b667oz4 said:

She does look quite good. Poor girl was wanting more dubias....how many does she usually eat ? It should be a reduced amount now but more than 1 dubia for your hungry Norbert. And it's best not to stress her by any force feeding but if you can slip a leaf in while she's chewing her bugs that's a good thing. And remember to feed the dubias with good greens as their diet, then she will get some that way as well.

Click to expand...

She eats 6-8 most days. I'll give her a couple more! She's very good at pushing leaves out of her mouth with her tongue if I trick her and pop one in. Once in awhile she'll eat a leaf only if I let it sit in her enclosure for a couple days and get all dried up. I'll see her eating it and put fresh ones in and she won't touch them. She's impossible! She will also never drink plain water, which I've tried giving to her a million ways. I have to mix a little baby food in before dripping it on her snout to get her to take it.

But she's my baby, and I'm very grateful for this forum community with all its support and advice.

Hello,

She does look quite content there, great colors. Poor thing, the stitches probably don't feel
the greatest, but she will be just fine.
Norbert thinks she is a human. LOL It's hard getting them to eat more greens sometimes.
A few more roaches will be fine, no problem. I don't really like force/assist feeding them
either, it stresses them out quite a bit.
I can't think of any cases where milk thistle wouldn't really be safe to use on a regular basis.
Dandelion greens sound good, does she like those? You can mix the milk thistle powder in
water, juice like apple, grape or cranberry, or just sprinkle it on her food, or in her slurries.
Be sure to keep her a little warmer overnight, to help boost her immune system while she is
recovering. Keep us posted on her!

Tracie

Updates:

The results came back from the tests. The mass they took off her liver was a tumor, and an aggressive one. I'm glad I didn't accept the initial diagnosis of "Oh, it's probably nothing" and went back and insisted on an ultrasound! The vet says it looked like it was self-contained and hadn't spread, and she wasn't showing signs of cancer anywhere else in her body, and now we just hope that he got it all and that it doesn't come back.

Also, she has fatty liver disease. The vet's explanation is that beardies get fatty liver disease when they are undernourished or lose weight quickly. That is not consistent with what I have read about it. My understanding was that they get it from a diet too high in fat. That would make more sense to me in this case, as she hasn't lost weight recently, doesn't eat greens very reliably, ate fattier insects for a bit when she was a juvenile, and has had olive oil (mixed with baby food) as a laxative occasionally. Though she did have eating problems as a youngster, and grew slowly. I don't know if that's maybe related.

The milk thistle powder has not arrived yet, but it should in the next couple days and I will start giving it to her. I'm trying to find as much information as I can on treating fatty liver (and also anything I might do to minimize the risk of her tumor coming back), and appreciate any guidance in that area. The vet's advice was basically just to feed her plenty, which I was already doing, I think. I don't know if she should be on some medication that he didn't prescribe. Maybe I should make a separate thread for fatty liver advice?

She is continuing to act like she's fine. Orange beard, white belly, interested in her surroundings, hungry for bugs. She even ate a very small bit of dandelion greens on her own this morning! When she does eat greens, it's usually a bite and then she loses interest. Better than nothing, though.

Hello,

Poor girl, I am sorry about them having to remove the tumor but if it was self contained then
hopefully it hasn't spread anywhere else!
I am sure she feels much better now though. If she hasn't shown any signs of illness then maybe
it was all caught in time.
Fatty liver can be caused by bouts of anorexic behavior or sudden weight loss, then gaining
some weight because that taxes the liver & causes the body to release too much fat. Eating
some fattier foods may or may not cause fatty liver, but, if fed on a consistent basis could
contribute to that however. Some could also be just due to genetics perhaps.
The milk thistle should help quite a bit with cleansing the liver & detoxing it too. I would
give that to her daily, also.
If she doesn't eat many greens then you can make slurries out of the greens & mix her milk
thistle & any other supplements in with the slurries to make it easier to get everything into
her.
I'm glad that she has a nice orange beard & a beautiful white beardie belly. LOL
Let us know how she is doing.

Tracie

The milk thistle powder came a couple days ago, and I've been mixing the tiniest pinch into 5 ml of baby food for her. I'm not sure the best way to measure the 15-20 mg/kg; that would mean 8 mg for her and my kitchen scale isn't sensitive enough, so I'll take any suggestions for measuring it! How precise does it have to be? Is there anything else I should be doing for her liver?

I'm glad she's doing well after such an invasive surgery, it's very encouraging when they are active and have a good appetite after a major surgery like that... Hopefully the vet hot all of the tumor...Did he say what the pathology on the tumor revealed? Was it just a fatty tumor? Any malignancy? Hopefully it was due simply to the fatty liver disease and not anything else.

Your vet isn't wrong with his explanation of how fatty liver disease develops in dragons, as if they stop eating or lose a large punt of weight quickly, their body kind of freaks out and thinks it's in starvation mode, and it automatically starts sending all of the fat it can't metabolize to the liver, which causes fatty liver disease. However, that's only one of many reasons/causes of fatty liver disease in dragons, as Tracie already mentioned, and she would have had to have list a lot of weight quickly in the first place, which she didn't, so that isn't the cause in her particular case. It can be caused by genetics, it can be caused by them eating a high fat diet continuously over a long period of time or a lack of any exercise, it can be caused by stress or their appetites slowing down (but eating doesn't totally stop), and it can actually be caused by them not going into brumation or not reproducing (usually the fatty liver disease in these cases is secondary to another physiological disorder that is preventing them from brumating or ovulating). So there are a ton of reasons, and starvation/rapid weight loss are just 2 of many...

I wouldn't cut off his roaches, as AHBD already mentioned, she needs the calories, vitamins, minerals, protein, and especially the fluids right now to help her heal. Slowly work her back up to her normal food amount, but I'd at least feed her half of what she usually eats, and honestly if she's an adult, which I'm assuming she is, you may want to start force feeding her healthy greens on a daily basis from now on.

My own Certified Herp Vet once had a discussion with me about Fatty Liver Disease (years ago when I had my first dragon, a male who lived to be almost 13 years old and I was worrying about diseases and age-related health issues), and he told me that most people think that dragons develop Fatty Liver Disease because their owners feed them a diet that is high in fatty insects like mealworms, wax worms, butterworms, etc., which certainly doesn't help, but he told me that it's not so much a diet high in fatty insects as it is a diet low in healthy greens. It's not uncommon for adult Bearded Dragons to never switch over from the 80% live insects and 20% greens/veggies to the total opposite, and some dragons never start eating greens or veggies. And of course most owners aren't going to withhold live insects from their dragons for long if they are refusing to eat anything else, and they shouldn't because starving a dragon to try to encourage them to start eating greens/veggies rarely works anyway, and starvation can cause Fatty Liver Disease itself.

So he told me the best way of avoiding and/or treating Fatty Liver Disease in an adult dragon who refuses to eat fresh greens and only wants bugs is actually force-feeding the stubborn adult dragon a good amount of fresh, healthy greens every single day before feeding them any live insects at all. After you force-feed them a good amount of fresh, healthy greens and veggies only then do you offer them healthy, staple feeder insects, that way they won't eat as many live insects because they'll be full from the fresh greens. I hate force-feeding my dragons too, but I find it much less stressful for me and them to syringe feed them. So if using a blender and making the fresh greens and veggies into a slurry that you can add her multivitamins, Calcium, and any other supplements to (like the milk thistle) works better for her, that's the way to go.

Another reason to force-feed her the fresh greens daily that she won't eat on her own is because it's also a way to get ample fluids into her daily, which is extremely important to effectively treating Fatty Liver Disease. In fact, a lot of reptile vets put dragons newly diagnosed with Fatty Liver Disease on daily fluids and electrolytes, like giving a daily subcutaneous injection of Lactated Ringers. So mixing some unflavored Pedialyte into her fresh greens slurries on a daily basis would be a great way to also get her a daily dose of electrolytes and fluids.

The other thing a lot of reptile vets treat dragons who are newly diagnosed with Fatty Liver Disease instead of using milk thistle/silymarin is Thyroxine, which is a throid hormone that stimulates the metabolism of fats in the liver.

The reason a lot of reptile vets are starting to not recommend milk thistle for Fatty Liver Disease is that milk thistle/silymarin helps more with reducing inflammation and reducing the reuptake of toxins by the liver, but it does little to nothing to help metabolize lipids in the liver. Thyroxine does promote fat metabolism in the liver, and so do corticosteroids, specifically Nandrolone.

So the new course of supplements/medications for dragons who were just diagnosed with Fatty Liver Disease is increased daily fluids with electrolytes, daily Thyroxine, and daily Nandrolone, with natural supplements daily being amino acids such as Carnitine, Choline, and Methionine, and upping their intake of Vitamins B and C, per my Certified Herp Vet. Something you should discuss with your vet. Not that the Milk Thistle isn't a great liver detoxing agent, it just doesn't help specifically with Fatty Liver Disease.

Norbert goes in next week to get her stitches out and I will ask the vet then about Thyroxine and Nandolone. I am not optimistic, though, about him prescribing me anything, because when he talked to me about her FLD diagnosis, the only treatment he recommended was a healthy diet. I think it's again the problem of him being a general exotics vet, even though he is the most reptile-qualified in my area. :?

If he won't prescribe what she needs (I'll give him the benefit of the doubt until we talk, though I hope that's not keeping her waiting too long!), I want to get it on my own. But I did some googling, and the only sites I can find for getting those drugs online look super sketchy. I don't know how to make sure the product is safe. If anyone has experience buying medicine online that is usually a prescription, I'd love any input.

I don't know how to advise you to get prescription medications online such as the ones that would benefit Norbert, and typically the sites that you can get prescription drugs from are super sketchy and actually illegal. They usually import the medications from pharmacies in Canada, Mexico, etc. where the stuff is available over-the-counter. So I don't advise that.

The best way to go about this is to either find a different vet, one that is either an experienced reptile specialist or one who is actually a Certified Reptile Vet. You may have to drive a couple of hours one-way, but it's so well worth it. I cherish my CRV of 15 years, he's amazing. So that's one way of approaching this.

The second way to go about this, and probably the first thing you should try to save you time and money, is to go online and find professional journal articles and articles from reputable reptile magazines, groups, associations, etc. discussing the different treatments for Fatty Liver Disease, especially any that actually list the dosage instructions of each. Print as many as you can find out, and bring them to your vet (I didn't realize that your vet is a General Vet, I assumed he was at least an "exotics" vet, not that an "exotics" vet is much better if any better than a General Vet). If your vet knows that you put in the time and research then he's more likely to do the same. it's actually his job to put in the time and research, not your job, that's what you're paying him for. And I would think that a General Vet who knows very well that he has no special education or experience in the treatment of reptiles/Bearded Dragons would just automatically do the extra research to educate himself on what reptile specialists and Board Certified Herpetologist Vets are doing to treat Bearded Dragons with Fatty Liver Disease.

I'm a little disappointed that your vet, who knows very well that he has done absolutely zero continuing education in Herpetology and who has never had ANY specialized education or training (such as an internship, a fellowship, or being mentored by a Certified Herpetologist) in reptile medicine at all (why would he, he chose to be a General veterinarian because he wanted to treat dogs and cats, nothing wrong with that at all until you start trying to treat reptiles with potentially life threatening diseases) told you that the only way of treating Fatty Liver Disease in a Bearded Dragon is to try to get him eating more greens and less live insects. That's not cool at all. In fact, even the very few General Veterinarians and "Exotics" Veterinarians that I know of personally who have attempted to treat a reptile who they have seen as a patient have all at the very least contacted a Certified Reptile Veterinarian or a very experienced reptile specialist veterinarian for a consultation and advisement on the diagnosis and the treatment plan, and they have all sent the reptile's medical chart to the reptile specialist that they were working with so that they could read the reptile's medical history, exam notes, test results, etc. and develop a treatment plan to advise the General or Exotics Veterinarian of. The few times I've seen this or been involved in this ALL worked this same way. So I'm very surprised that your General Veterinarian didn't do the same and contact a reptile specialist for advisement. (In addition to having 3 dragons currently, 1 a rescue with severe MBD who I adopted at 8 months old, and having my first dragon from a month old until he passed away at 12 years and 10 months old, and having a Green Iguana from 2 months old until he was almost 12 years old when I rehomed him, I have volunteered at an Exotic Rescue who specializes and only accepts reptiles, amphibians, and birds for about 7 years, and I am their Supervisor of Health and Medicine, so on the occasions where we have had a critical reptile or bird brought in to the Rescue in the evening or at a time when our regular Certified Reptile Vet or Certified Avian Vet was not available and we've had to take them to the local 24/7 Animal Hospital, which employs several General Veterinarians and a few Exotics Veterinarians who have some specialized experience, each time I've been involved in this they have done whatever they could to stabilize the reptile or bird, run any basic tests that they can like x-rays, fecal testing, blood work, swabs, etc., and given fluids, oxygen, pain meds, etc., all while trying to contact any of the reptile or avian specialists they have on-call or on a consultation basis).

Anyway, I think what you should try to do is take some professional research on the treatment of Fatty Liver Disease in to your General Vet and try to convey to him that you'd really like to be proactive about Norbert's care and try some of the FLD treatments that Certified Reptile Vets are currently using on a regular basis and that they are getting positive, long-term results from, and if he still says that he "Isn't comfortable prescribing anything for Norbert's FLD" or something similar, that's when you ask him if he could please recommend either a Certified Reptile Veterinarian or a very experienced Reptile Specialist Veterinarian that you could take Norbert to, even it they are a couple of hours away.

Unfortunately it's becoming extremely common for veterinarians (and human doctors for that matter) to not want to listen to their patients at all and totally disregard anything and everything they request and simply just say "No" and that's it. We all must be advocates for not only our own health and medical treatment, but also for the health, welfare, and medical treatment of our children and our pets (who I very much consider my own children). Norbert should have many happy, healthy years ahead of her with you and the rest of her family, and you should not let an uneducated/inexperienced Veterinarian steal those years away from you when there are so many available treatments out there that are inexpensive, safe, and effective for Fatty Liver Disease in Bearded Dragons...

If you would like, I can contact my own Certified Reptile Vet and see if he can send me some professional journal articles and other information on the current treatments they are using in Herpetology for Fatty Liver Disease in Bearded Dragons, and I could then email you the files so that you can print them out to take to your General Vet. My CRV is a great guy, I've known him for the past 15 years and he's actually called members on here for me before to give them advice, listen to their stories, and he's also found several local Reptile Specialist Vets for members here. So I know he'd be more than willing to at the very least send me some journal articles and information. He has to do Continuing Education Courses all the time to keep his Board Certification active, and I know for a fact that he has done many graduate classes at both Penn State and University of Pennsylvania School of Veterinary Medicine (that's where he went to Veterinary School originally) that dealt with current treatments for FLD, Gout, and certain common cancers in reptiles, so I'm sure he has a lot of information that he could send me.

I'll shoot him an email right now and he'll most likely get back to me with at least a yes or no pretty quickly I'm sure. I'll keep you posted.