Swollen Arms, Difficulty walking

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Swollen Arms, Difficulty walking

Postby aarondavidross » Tue Jun 09, 2020 10:44 am

Hello! Hoping someone here can help because our vet visits were not productive.

My bearded dragon (Zoot) is around 10-12 months old, ~16in, ~300g. We adopted her from a friend who couldn’t care for her so its possible her early-life husbandry was inadequate. We’ve had her about 7 months. She is in a 55 gallon tank with UVB ReptiSun 10 T8 and a basking bulb (temp gradient 80-110). She eats dubias, greens and superworms, dusted with a mix of 70% ZoomMed ReptiCalcium and 30% ZooMed Reptivite daily. Her substrate is excavator clay, which I know is controversial, but she is fed on a ledge away from the substrate and does not eat it. She does enjoy burrowing occasionally and spends her time on the rocks and logs in her enclosure.

A few months ago, we noticed a small lump forming on her front arm. A few weeks after, the lump had grown we noticed another one on her other front arm, around the joint, and a few small lumps on her digits. We took her to the vet, who suspected she had bone fractures as a baby that were healing and causing deformations during her growth spurt, but after looking at her x-rays it appeared she didn’t have any fractures. The vet then prescribed an anti-inflammatory that we gave to her orally, which didn’t seem to help. Zoot seemed to be healthy despite the lumps, she continued to eat and poop and move around normally, so we decided to hold off on any more vet visits during the pandemic...

We continued to monitor her health, and over the past couple of months her condition has worsened, the lumps are a lot bigger and now its definitely become difficult for her to walk / climb / use her front limbs in general. She spends a lot of time now laying around because she cant move easily, and is gaping instead of leaving her basking spot to thermoregulate. When she tries to move her arms they often look shaky and potentially painful, but she still will occasionally will run around, seemingly unaffected, however this is now rare. It has also now has spread to her rear legs as well. She eats and poops, but less, she is refusing greens, and is acting lethargic except for her energetic head and eyes darting around.

We took her to the vet again last week and got another set of x-rays, a blood test, and uric acid test. According to the vet, her results came back normal across the board- no calcium deficiency, no uric acid buildup / gout, and her bone density is better than it was on the last visit. The vet recommended we start a series of antibiotic injections, which would require us taking her to the clinic every 3 days for 2 weeks... She also offered an invasive procedure that would entail gathering cells from her joints to further examine the issue.

Both of these are possible but difficult for us and Zoot, the vet is far away and frequent transportation and injections are stressful to Zoot, so I just really wanted to get some other opinions before doing this, because the vet admitted herself not having much experience with bearded dragons and offering this as a last resort since she didn't learn anything from the tests we ran.

Photos, X-ray and test results here: https://docs.google.com/document/d/18KuHgJXJ36T33gqFIyyIclXs2Gt0-S7HpqLgIKnSmOo/edit?usp=sharing

Really appreciate anyones help with this!!
aarondavidross
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Re: Swollen Arms, Difficulty walking

Postby Drache613 » Thu Jun 11, 2020 1:15 am

Hello,

Your girl is a beauty! So sorry she is having trouble though, it is emotionally difficult when
they are ill & you can't find any answers.
Let me go over a little on the diet. Since she is a year or so, you can cut her supplementation
back some since too much of certain vitamins will cause some issues. The Reptivite, can you
look on the label & let me know whether or not it has D3 or Vitamin A in it? I remember it used
to but haven't seen a label lately.
Excess supplementation can sometimes can pseudogout which can be reversed if caught really
early on. Her bones look good on the x-rays, too so she seems to be absorbing her calcium at
the moment. From her blood work, the AST (liver enzymes) are in normal ranges, the calcium
& phosphorus levels & ratios are good. The uric acid levels, however, are too high. In most
instances, if the uric acid level rises above 5-8 mg/dl then you will likely start to see blood
saturation which will cause swellings. The reason that you don't always see tophi or uric acid
buildup/crystallization on x-rays is that it depends on the composition of them. The best test
for it is looking at the uric acid levels, but, also aspirating fluids from the joint or the surrounding
areas to be cultured. Most of the time, they should be able to detect any crystals if gout is at all
present.
The swelling, along with the uric acid level is most likely an indicator of gout.
The reptisun 10 T8 tube, is that on top of or underneath of a screen top?
Also for now, I would reduce the amount of dubias especially because they are very high in uric
acid. What type of feed do you give the dubias, before feeding them to Zoot? I would consider
silkworms, hornworms, or phoenix worms as primary sources, with some superworms, or dubias
& crickets. Keep her protein at a minimum, right now also.
I do not recommend antibiotic injections because there is no indication from the blood test that she
has an infection. It would likely cause more swelling or renal problems without due cause of her
needing antibiotics right now.
If they did do any other diagnostic test, I would just have them aspirate a bit of fluids on an area
that is swollen but it is somewhat painful but they don't put them under anesthesia.
I would consider getting her started on a gout medication, allopurinol, to help out her system. If
the vet wont prescribe that, I have an online store where you can purchase it.

Let us know how she is doing.
Tracie
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Re: Swollen Arms, Difficulty walking

Postby aarondavidross » Thu Jun 11, 2020 8:17 am

Hello, thanks so much for your helpful analysis!

The reptivite we use has D3 and vitamin A. We will reduce the supplements and dubias, the dubias currently eat high calcium cricket powdered diet by flukers, hydration cubes and veggie scraps now and then. The T8 bulb is mounted below the screen, with no barrier, about 6-20 inches from the surfaces in her cage. We have an additional UVB coil bulb to fill in some extra areas where the T8 doesn't cover, but she doesn't spend much time over there. That one is above the screen.

Picture of her enclosure: https://docs.google.com/document/d/1aM0HKf_pD0VOlxfxuhsTCFL8T-Y4qoO0woH1WofwvRM/edit?usp=sharing

She seems much less interested in food that doesn't crawl around these last few days, it's been hard getting her to eat any greens at all. We will hold off on giving her any bugs to get her hungry for greens and reduce protein for now, while I get some horn worms to use as a staple. Is it okay to feed dubais in moderation? We have a lot and they are her favorite.

Thanks for your suggestions about treatment. If we move forward with allopurinol and a lower protein/less supplemented diet, do you think the aspiration is necessary? Also, can you provide a link to the product you sell on your webstore? I'd love to support your business.

Thanks again for all your help. We've reached out to a lot of professionals and your comments have been by far the most thoughtful and helpful, we really appreciate you!!
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Re: Swollen Arms, Difficulty walking

Postby Drache613 » Fri Jun 12, 2020 1:06 am

Hello,

How is Zoot doing?
Thanks for checking the label for me. Definitely cut back on the supplements, that should help
out some. The Flukers feed likely has corn & soybean in it which is pretty much guaranteed to
be genetically modified & those are hard on the body's organs, too. I would consider changing
to an organic, non-gmo feed like chicken laying mash for dry feed for your insects.
The water cubes, do they have calcium also, or what are the ingredients of them?
The tank looks nice & bright, also. I think the lighting should be fine right now.
When they develop most health problems they tend to lose interest in greens & only prefer to
eat protein. It is ok to feed dubias, in moderation, but you will need to try & get her to eat some
vegetation or you can make nutritious greens slurries a few times a week for her. Try getting
some black or tart cherry juice to give to her daily as well to help with flushing out her kidneys.
At the moment, the only benefit aspiration of the fluids would be is just to confirm a diagnosis. It
isn't necessary really, as her symptoms & swelling, along with the climbing uric acid levels are
enough to be suspicious of gout.
Sure, here is a link to my store. Let me know if you have any questions!

www.bug-de-lite.com

Tracie
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Re: Swollen Arms, Difficulty walking

Postby aarondavidross » Fri Jun 12, 2020 9:32 am

Hello, thanks again for the info!

Zoot is just okay, her energy is low and her feeding response has slowed down, especially while we try to lower her protein. She didn't really eat yesterday and has only had a few mouthfuls of kale today. for greens, we typically feed kale, collards, chards and mustard greens, but often kale is the only one available at our grocer and I know this isn't the best... could that be a factor?

She still has a hard time moving herself around, which is sad to watch and makes it harder for her to thermoregulate. Will treating her gout/pseudogout help her get mobility back in her limbs and reduce the swelling? Or is it mostly preventative so it doesn't continue to get worse?

Good to know about the insect feed being a potential issue. The hydration cubes we've been using are the flukers "orange cubes" which advertise a "complete cricket diet with food, water & vitamins" and "at least .05 calcium". Both products (dry feed and cubes) are advertised as healthy gut-loaders for feeder insects, but that must be wrong... so frustrating! I'll switch to vegetables for gut loading for now and moving forward i'll get some organic non-gmo feed as you suggested. The cubes are used primarily for hydration, maybe we're better off using a wet paper towel or sponge instead?

I purchased gout-ease and black cherry powder from your webstore, thank you for providing this vet-free. I will plan to make greens slurries for her this week and begin treatment as soon as the meds arrive. Will the black cherry powder work the same way as something like the tart cherry juice you recommended? For the slurries, should these be only vegetables or also include a reduced amount of insects and supplements?

Thanks again for your time and suggestions, we're really happy we have some things we can actually do to help our little loved one!!
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Re: Swollen Arms, Difficulty walking

Postby Drache613 » Sat Jun 13, 2020 1:05 am

Hello Aaron,

Poor girl, hopefully she will start to feel better soon. The allopurinol is very effective in
getting the uric acid levels down which in turn will reduce swelling once the system gets
flushed out. That should improve mobility & help decrease pain she may be feeling in her
joints. Time will tell if this is pseudo gout or visceral gout. Hopefully she will respond very
quickly & it will be pseudo gout which is mostly caused by secondary husbandry issues.
Kale is perfectly fine, no problem. Just do your best with the greens variety, it's really out
of your control a lot of times what is at the local areas.
Assuming her kidneys are still functioning optimally, the medication should keep it from
progressing absolutely & get the levels back to normal. If you caught it early on, she has
an excellent chance at coming through it very well.
When making the slurries, you can add in some insects here & there, so she gets some
protein. Alfalfa leaf powder is a good non purine source of plant protein you could get to
use for her slurries, also. Yes, the black cherry powder can be used in the same way that
the juice extract will. It can be used daily or every other day.
Yeah, the commercialized feed & many of the supplements have way too much synthetic
vitamin sources in them. The dry feed is mostly genetically modified which is harmful but
they wont advertise it as that.
What type of bin do you keep your insects in, a large plastic tub? You can get a chicken
watering system with a round sponge that fits into it (donut shaped) for watering them, or
simply get a plastic dish & cut a sponge to fit & keep it wet daily.

Let us know how Zoot is doing!

Tracie
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Re: Swollen Arms, Difficulty walking

Postby aarondavidross » Sun Jun 14, 2020 5:53 pm

Thanks so much! Great, looking forward to starting her on allopurinol when it arrives and the cherry extract as well. Thanks for shipping them. Yeah, the feeders are in a plastic tub so i'll be sure to get a water dish and some organic food sources for them. Zoot's been eating a few mouthfuls of greens each day and a 3-4 insects every few days, while we wait for her meds, and then we'll start the slurries. Really hope we can get her mobility back!

Thanks again for all the great information, anything else we should keep in mind while treating her?
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Re: Swollen Arms, Difficulty walking

Postby Drache613 » Mon Jun 15, 2020 12:49 am

Hello!

I hope you get your meds quickly & that they help her out also.
I am sure that the insects will do well with some better feed. That's great Zoot has been
eating some greens willingly, on her own, too.
The main thing with gout is to just to monitor the amount of urates to be sure she is excreting
adequate amounts indicating her kidneys are working well.

Keep us posted on her!
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Re: Swollen Arms, Difficulty walking

Postby aarondavidross » Mon Jun 15, 2020 1:34 pm

Hi Tracy, Thanks again!

Zoot is doing okay. We got her meds (great service, thank you!) and started her on allopurinol, kidney support and black cherry today. We've been able to dust horn worms (her fav) with kidney support and black cherry, so we haven't had to do slurries yet, but we will if she starts to refuse food. Shes' still been eating greens a bit each day which makes me happy to see. We're planning on feeding greens and horn worms everyday (the worms come shipped with their food, described as "healthy gutload food for hornworms" by joshsfrogs.com, do you know if this is ok?) and dubias (fed organic veggies) every 2nd or 3rd day in smaller quantities to mix it up. Is this a decent feeding approach while we treat her? And if everything goes well, can she go back to dubias as a staple if they are fed properly? They are just so much less expensive.

One quick question about allopurinol - When we got the ineffective anti-inflamatory meds originally got from the vet, they told us we had to stick the syringe way down her throat to administer them. Is the same true for allopurinol? Or can we simply squirt it into her mouth?

Thanks again for all your helpful info! You've been such an awesome resource and Zoot will be very happy as a result :)
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Re: Swollen Arms, Difficulty walking

Postby Drache613 » Wed Jun 17, 2020 12:55 am

Hello Aaron,

How is your girl Zoot doing?
I am happy to hear you got your meds so quickly. The mail seems to be moving better
lately.
That's great you are using the powder to coat & dust her worms, that will work just fine.
So she is eating her greens? The hornworms from joshsfrogs.com are usually very good,
from what I understand. The food is most likely mulberry leaf based, for the majority of it,
so it shouldn't be bad food.
I don't see why you wouldn't be able to go back to dubias, once she has gotten better that
she can't have a limited amount of dubias as long as the feed is organic only. Staying away
from genetically modified corn & soy will help improve not only the health of the insects but
for her too when she eats.
No, you can simply squirt the meds into her mouth, or, try dripping the liquid onto her nose.
She might surprise you & just drink it or lick it off of her nose.
Let me know how she is doing!

Tracie
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Re: Swollen Arms, Difficulty walking

Postby aarondavidross » Wed Jun 17, 2020 3:18 pm

Thanks again Tracie! She's taking the meds well and after two days already seems to have a bit more pep, maybe i'm imagining it but shes eating greens on her own and seems a bit more active in general. I'm feeling optimistic about her treatment and recovery!

One additional question - we haven't been using any calcium or vitamin supplements since you told us this may be making things worse, but every care guide I see talks about how important they are. When would you recommend to re-introduce supplements? And are there any specific brands you think would be safer to use?

Thanks again!
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Re: Swollen Arms, Difficulty walking

Postby Drache613 » Wed Jun 17, 2020 11:53 pm

Hello Aaron,

That is wonderful she is seems to be a little more active. I hope that she's feeling better, it
does take time. She's eating greens on her own, really? Actually, that is pretty surprising!
You can start giving her calcium without D3 now, a few times per week. Which ones do you
have currently, I cannot remember.
For now, I would stay away from synthetic vitamin A & D but you can use a vitamin that has
beta carotene instead.

Keep us posted on her!
Tracie
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Re: Swollen Arms, Difficulty walking

Postby aarondavidross » Sat Jun 20, 2020 6:59 am

Hi Tracie,
Thanks for the info! Zoot is doing pretty good, and yes! she has been eating greens on her own. Just a few chomps each day, but i'm happy to see her move around and eat them. We've still been giving her the kidney support and black cherry powder on horn worms, a few per day in addition to her veggies. The swelling in her limbs seems about the same, but her energy and mobility seems to have improved a little bit already! So excited to get her back to her hyperactive self.

I just ordered some calcium powder without D3 (the one we have has D3), and a beta carotene vitamin supplement as well, which i'll start her on a few times a week once they arrive.

Thanks again for all your help!
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Re: Swollen Arms, Difficulty walking

Postby Drache613 » Sat Jun 20, 2020 11:49 pm

Hello Aaron,

That's great she is doing well & eating her greens.
I'm happy to hear her activity level has increased, so hopefully her joints are feeling
better. It does take a bit of time for swelling to start going down.
Keep us posted on her progress, I really hope she has improved health!

Tracie
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Re: Swollen Arms, Difficulty walking

Postby aarondavidross » Wed Jul 01, 2020 11:27 am

Hi Tracie,

Hope you are well! It seems Zoot took a turn for the worse today, she is now limping and seems to have much less mobility :( . The swelling may have gotten worse? its hard to tell for sure, but it seems to be affecting at least 3 of her joints, the front arm is the worst and as of today she is kind of dragging it around and can't really move around her cage.

We've been treating her with Allopurinol, and she is still eating some greens and a few insects dusted with kidney support and black cherry powder each day. we're also providing water. We've used crickets, superworms, hornworms and dubias, all in moderation. I also replaced her calcium and vitamin supliments with the ones you recommended, and have been adding those to the dusting mix every few days.

Is there anything else you recommend at this stage? Typically, how long does it take for Allopurinol to help reduce the swelling?

Thanks again for all your help throughout this, we are really grateful for your expertise!
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