Descending Head Tremor Senior Beardie

Hello all,

Say hello to my boy. He's 10.5 years old, and until recently had been doing well. He's on some treatments currently but is rapidly deteriorating and I would value your experience and ideas! We are now on day 11 of his illness.



PLEASE NOTE - I work as a registered veterinary nurse at a vets which does not specialise in exotics. A nearby exotic vet I was recommended has just retired unfortunately and with the lockdown restrictions and sudden onset of symptoms I opted to test and treat at my own practice with my vet colleague who is super helpful and researching more into this as I type. I have also managed to have a phone consult with an exotics vet who isn't local but gave some of the ideas for testing/ treatment below.. Differential diagnosis isn't looking good. I said I'd try here too for ideas as he is deteriorating.

He started with a mild tremor in his head approx 1.5 weeks ago (see video 1) which prompted me taking him to the vet the next day. Bloods and X-ray taken, including faecal testing. Weight stable at this point (385g) and 5g up on previous years health check/ blood screen. No changes to eating or faecal output. One loose stool produced at vets.
Note - throughout life he has always has very loose stools. I got him when he was 6 months old and he had a heavy burden of pinworm/ coccidia (treated with Fenbendazole/ Panacur) and numbers reduced significantly. He only occasional has fully formed stools throughout his life. I was given the impression this is normal for him and it's not seemed to cause any problems in 10 years.

Test Result concerns - high creatine kinase, VERY high white blood cells. Faecal gram stain shows high levels of bacteria >1000 hpf.
Liver and kidneys all good. Calcium within normal limit (I was initially thinking MBD). X-ray confirms no bone degradation - although a previously unknown kink in his tail is visible.

Treatment: Enrofloxacin (Baytril) started orally every 48hrs. Emeraid critical care started as a supplement but not tolerating well. Bathing daily now for 10-15 mins.

Day 3 - lesion noticed on ventral chest when cleaning after passing faeces and giving bath... seems to incorporate 1 scale? Abscess? Shed issue? Granuloma? I have no idea on this one. Not bothered by it, not sure when first appeared but it seems to have been in 2021 at least.

Day 7 - His tremor has started descending (see video 2, shoulders and legs mildly affected) and Day 8 it is slightly visible alongside his spine (see video 3). A day of inappetence, no greens consumed and even turned down live feed. Weight now 370g (15g loss in 1 week) and seemingly started to appear dehydrated. Antibiotics? Lack of eating? Emeraid upped massively despite his protests.

Treatment Added: Metacam orally once daily.

Additional tests:
FAECES: Egg count done - coccidia present (23o.p.g.). Giardia and cryptosporidum negative. Awaiting salmonella and Campylobactor results. Another 1 to 2 days.
SWAB: Taken of pharynx and sent off for Adenovirus PCR. 2 - 5 day turnaround from today.

Treatment Considering:
Baycox for coccidia.
Changing or adding antibiotic to Fortum (Ceftazidine) injection every 3 days (exotic vet suggested this. Arriving in stock tomorrow so will start then).
Adding a probiotic to try and counter the side effects of these drugs and try and improve his appetite.
Anything to be concerned by with the strange scale on his underside?pp

Husbandry - temps are stable at high end 35 C and cool end 28 C in a 4ft viv. 2 x reptisun 10.0 desert UV lamps changed within the past month running length of viv front and back at a max distance of 12 inches (closer when climbing). Always kept on newspaper. Large rock slab for basking and nail management! Always ate his greens well (fave is rocket, also squash, carrot, endive) and occasional crickets/ locusts gut loaded and calcium laced. Bathed once weekly and enjoyed a swim! Faeces passed 1 to 2 times per week.

Have any of you experienced anything similar?

His prognosis is guarded. If these treatments do not work, the only other option is a CT scan, which to be honest I am reluctant to do because I don't believe he would survive a sedation at this point, plus if it is cancer or neurological brain centred then the outcome isn't good anyway.
I'm giving him another week with support and hoping to see an improvement. Will reassess then. If he continues to lose weight, tremors become worse, etc, then I will have to be brave and say goodbye.

Video 1, Day 2 - https://youtu.be/QdZI82yD0_M
Video 2, Day 7 - https://youtu.be/WLc0pw0TVsc
Video 3, Day 8 - https://youtu.be/WfHw2A3sdNw


Lesion on scale. Excuse the poop marks, I noticed this whilst bathing him after a messy poop and was mid-clean.


I appreciate any ideas, any support and/ or sharing of similar experiences.
Will keep you updated on his response to the coccidia treatment start tomorrow.

Thank you.

Hi. I've read your reply on my post and checked out your videos. I can see the tremor in yours, mine has something similar but more of faster tremor than a slow movement whenever he raises his head. There seems to be no spasms/tremors anywhere other than his head today. He doesn't seem alert either or able to focus. No appetite or movement today, he has mostly slept. My beardie also came with pinworms, was treated for it and fecal exams done, but unfortunately he always seemed to have very loose, watery stools even after another round of fecal tests came back clear. He was given the all clear everytime he had been in but they could never figure out what was causing it, he never had any health issues they could see. The only vet in my area that had limited reptile experience is no longer practicing as a vet, we don't have many vets in Ireland with reptile experience. Hope everything turns out alright with yours

I have managed to source 25mg/ml Zorabel (aka Baycox/ Toltrazuril) in case it is coccidiosis.

So much conflicting information on dosing!

Hello,

Sure, I can help with your dose for the Toltrazuril, but need your dragon's weight.
Do you think he has coccidia?
Those tremors are very strange indeed. I do realize that he is older but those movements
are quite odd. Did this come on rather suddenly?
What vitamins do you currently use?
It is possible that he has a mineral deficiency but not sure. Did the Baytril work somewhat?

Tracie

Hi Tracie.
Yes, they came on quite suddenly. The first video was not quite 2 weeks ago and that was the first day I saw it. Video 2 and 3 was earlier this week. Thankfully no further progression as yet, but no improvement either.
Baytril - no change to the tremor which seems to have plateaued out, but his faeces were more solid when passed 3 days ago - could be dehydration side effects though. To counteract this I've been giving additional water now on top of his daily baths so will see what his next faeces are like.
Vitamins - Exo Terra multivitamin 1-2 times weekly. Since onset of symptoms, I've started giving Emeraid Omnivore+Carnivore mix as per manufacturer guidelines to up calories and vitamins. I'd considered vitB deficiency too but was hoping to see an improvement on the tremors if this was the case due to the content of the Emeraid solution.
Weight is now 370g (he has lost 15g since this started) however since this I have upped the Emeraid to give additional calories. Yesterday he took solid food (albeit only crickets x 6) so an improvement on eating for the past few days. Keep offering greens as usual.
I found a source about 12hrs after posting here from an exotic vet not local to me who kindly got in contact. They prescribed a dose from an exotic animal formulary which states 5-15mg/kg q24hrs x 3 days. On the 25mg/ml solution we've sourced, it would make his dose 0.18ml daily. His coccidia count was 23 o.p.g. so I'm not sure if that's a large burden or not, but given his symptoms (tremor, loose faeces, sluggish) and severity of onset it's worth trying don't you think? Unfortunately I'm still awaiting the probiotic despite paying for expedited delivery - pandemic delays! Do you think it's ok to give the meds to him without the probiotic whilst I'm waiting for it to arrive as long as I continue supportive feeding?
Also sent off for the adenovirus PCR, so I'll let you know what comes of that.
Thank you.

So his faeces are drastically improved. No diarrhoea at least. Either the Baycox has helped or he is dehydrated, which I don't believe he is.
Still no improvement on the tremor though, but it's not gotten worse at least (the previous 7 days leading up to my first post saw a drastic onset)

I'm managing to get him to eat about 6-10 crickets daily (literally have to hold it by the leg and he takes 2 or 3 tries to get it from me - the tremor seems at it's worst during feeding time/ when concentrating on something). Occasionally manage to hide rocket leaf under it as he isn't taking greens willingly. He's put on 5g in a week with support (still down 10g in total though) but he's starting to wise up to the syringe with medications so everything is starting to take longer!

Awaiting Adenovirus PCR results still.
Considering adding vitamin B support and ceftazidime antibiotic.
For now, continuing with baytril every other day and daily metacam/ emeraid/ baths.

My trooper!

Hello,

How is your boy doing? Let us know what the Adeno tests reveal.
Is he done with the medications for now?
Does he seem to enjoy the Emeraid? For now, if he isn't eating much on his own, you can
continue using the Emeraid to help support his nutritional status. Is he maintaining his weight?
Yes, once you are done with the antibiotics you can start with the probiotics. You can go ahead
& start his medications without starting him on the probiotics. Just make sure you are keeping
him hydrated to ensure his kidneys are functioning optimally.

Let us know how things are going!

Tracie