Puff needs help

My beardie Puff is 1 and a half years old. Ever since she has turned about a year old, she started suffering from swollen limbs. I took her to her vet and we xrayed her for MBD and gave her steroid shots, tested her feces and treated her for any parasites. She suggested I put a pinch of critical care in her water every day and make sure she got at least 5CCs of water a day. So even with that her limbs have gotten bigger and bigger. I have suggested to my vet that she has gout since she has one toe that is enormous especially. She isn't active at all, and neither would I be if I wouldn't even use one of my limbs from pain. I give her dark cherry juice mixed in with her water with a pinch of critical care but it doesn't seem to help. She has a reptisun 10.0 and a 55 gal. tank. She gets baths a few times a week and she potties pretty regularly. My vet said maybe she was swelling from an allergy to her main protein staple, which was dubias or crickets because I told her when I give her protein is when she gets worse, she suggested oxbow carnivore care, and even though she loves the taste, I fear even giving it to her. Her salads consist of mainly baby arugula, kale, sometimes cabbage and dandelions, squash or apples . I have a couple of questions: 1. I have a hard time keeping the temp up in her aquarium. Her basking spot is 8" from the top and I have two heat lamps on that spot. Sitting on top of a screen top. Should I switch to the double dome light fixture that sits inside the tank, do you think that would help keep the heat up? I don't have a photo of her tank as of late, but I have an older one so you can see the size and the domes on top. Her Reptisun is inside the tank using some command hooks. Second, since I'm having trouble with my vet looking in to her gout possibility and she's the only exotic vet here, can I treat Puff for it anyway and can you get the meds without going to the vet. I also want opinions here to see if anyone with actual experience (I have none!) can tell me whether they think she has gout. I also read you can feed them alfalfa on their salads and it has enough protein without giving her live food or the carnivore care and what is the best alfalfa to get? I'm attaching pics of Puff in the bath this morning. As you can see one of her toes is ridiculously large and she doesn't even use her left hand from the pain.

Have you requested a blood test from the vet? That should reveal uric acid levels which would indicate gout. Allopurinol is fairly effective at keeping it in check. It's possibly an infection or MBD but it seems more like gout I think you're probably right. Keep up with the tart cherry juice which should help a bit. Try to limit protein in the diet as much as you can. Since she's 18 months old you can get away with a variety of veges to take up most of her diet with bugs only once a week or so (maybe less if her weight remains stable and she's good about eating veges).

As far as lighting goes, at 8'' you should be able to easily reach basking temps. How are you measuring the surface temps? Do you have a probe on the basking surface or an IR temp gun? What wattage/type of basking light are you using? You may want to increase the wattage or change to a different brand and see how that goes.

Is your UVB light a T8 or a T5 bulb? If it's a T8 it should be 6-8'' (no further) from the basking site to provide effective UVB levels. A T5 is best for a 55gal tank and should be set at around 12'' (less if going through a mesh top) from the basking site.

Thank you for your help, she has a T8 and it's 8" from her basking site. It is under the mesh top since I read it could filter some of the good UVB. I have a probe temp, I thought I should get an IR temp gun in case the probe was wrong or slips, which happens a lot. I haven't requested a blood test, I'll call and see if I can set that up.

8'' is ok for a T8. A T5 a bit further up (10-12'' on top of the mesh or 12-14'' inside the mesh) would provide higher quality UVB in the long run. A temp gun is nice to have to spot check temps as the probes take quite a while to get accurate readings so they're better off as permanent. A blood test is probably worthwhile to get an idea about what her systems are doing. In addition to uric acid levels that could indicate gout, they could also tell the white blood cell count which could indicate an infection of some sort. They tend to be very helpful diagnostic tools.

thank you for your advice!