Arm Injury, Not Sure What To Do

[kingofnobbys]

It took my taking George (the bluetongue skink) to another reptile vet who had access to a much more sensitive Xray machine in order to find a very fine spiral fracture which required a repair involving a specially made very fine stainless pin to reset the broken bone.

 

[Drache613]

Hello,

How is he doing today? Those are great pictures of him.
Does he have any trouble climbing, etc?
I read that you are giving both liquid calcium & powdered calcium correct?
I recommend giving just the liquid calcium but not the powdered calcium too.
Too much calcium can cause softening of joints & bones due to malabsorption
also.
It doesn't look like any other area at the moment has any swelling?
Is he eating any better?
Let us know how he is doing.

Tracie

 

[JLynn87]

He is a great eater, I just moved him up to 3/8” Dubai’s and he is eating about 20 at a time (he was eating anywhere from 40-50 1/4”).

I took him for a second opinion and X-ray, same response, no fracture. I was told this time of around that it may be a deformity and as long as he acts normal not to worry.

Just this morning I got him out of his home to give him breakfast and his other arm is acting funny. He doesn’t seem to want to put too much weight on it, there is no swelling, but that’s how his right arm started out. I am going to back off the calcium I fear I may have given too much and this is the result. I also may have rushed him this morning by not giving him enough time to warm up, he ate some but wanted to go back under the lights. I will give him time and at lunch I will see if he is still walking funny. I just don’t know what more to do.

He is shedding, could this caused him to walk funny with his left arm?

 

[EllenD]

As Tracie already asked you whether or not it is just the one arm that is swollen, and you just answered that now another arm/leg is bothering him, starting out the same way the first one did, I think what Tracie is thinking, as well as what I was thinking, is that this may be the early signs and symptoms of Gout. Gout is becoming more and more common in Bearded Dragons, both babies/juveniles and adults, and in my experience (many, many cases on this forum alone) whenever a dragon has one leg, one foot, or even one single toe swell up and seem painful, and x-rays are done that rule-out any sort of muscular/skeletal injury, you must suspect Gout. And in these cases when a second or more toe, foot, leg, etc. swells up and the exhibits the same signs and symptoms, it's almost always Gout, pretty much every time...

I'm going to have to go through and read the rest of this Post, as I didn't start from the beginning and I don't know the basic information about your dragon...but if he is an adult dragon, or if he is a large enough juvenile (how many grams did he weigh at his last vet appointment?), I highly recommend that you call and request having a simple blood draw done so that they can run a routine blood panel. Sometimes when the Gout is more advanced you can actually see the Uric Acid crystals in the synovial fluid of the joints on a regular, flat x-ray, and this does confirm Gout. However, while an x-ray positive for Uric Acid crystals in the joints does confirm a diagnosis of Gout, an x-ray negative for Uric Acid crystals should never, ever be used to rule-out a diagnosis of Gout, especially in a case like your dragon's, where he is still in the beginning stages of swelling in the extremities. Even dragons with very advanced Gout and extreme swelling in all 4 extremities, feet, and all toes have been known to have x-rays negative for Uric Acid crystals.

So if your dragon is large enough they should do a full blood panel on him, which will definitively confirm or rule-out a diagnosis of Gout by checking his Uric Acid level and his CPK level. The Blood panel will also confirm or rule-out an infection in his leg, which is another possibility, although if another leg is exhibiting the same early symptoms, then the likelihood of an infection is small. The other and one of the most important issues caused by Gout that blood work will show the extent of is kidney damage. With Gout the Uric Acid level in the blood becomes very high, and the kidneys become very overloaded while trying to flush the Uric Acid out of the blood, and the extent of the kidney damage will be shown in the blood work (as well as his liver function too).

I'll let Tracie chime in to give her own opinion, she's the resident Gout expert, and you should definitely trust her and follow her advice on this subject. In the meantime, I would highly recommend forcing as much hydration by mouth as you can to help out his kidneys, and if you can pick up some Pedialyte or the generic version, the extra hydration and electrolytes are going to help him tremendously. Also, if you can find either some Tart Cherry Juice/Extract or Black Cherry Juice/Extract, or if you cannot find the already mixed juice (usually found at either a health-food store or a grocery store with holistic and natural foods like Wegmans, Whole Foods, Harris Teeter, or Trader Joes) you can easily find Tart Cherry tablets at any Walmart in the people's Vitamin Aisle. I found a bottle of "Tart Cherry Extract Tablets" at Walmart while looking for a different supplement and I bought them just so I had them, I think it was a bottle of 100 tablets for $6. The brand was Spring Valley, that's the major Vitamin/Supplement brand that Walmart carries, they have green bottles with yellow and tan labels, and the "Tart Cherry" tablets are in alphabetical order in the Spring Valley shelf, easy to find. You can crush up the tablets/dissolve them as the instructions on the bottle say and substitute the unflavored Pedialyte for water, or if you can find a bottle of already mixed Tart Cherry or Black Cherry Juice use it, and use an Oral Syringe (also available at any Walmart or drugstore) to drip the juice on his snout and see if he'll lick it off. Offer this too him along with several offerings of straight water or Pedialyte throughout each day. The extra hydration will help to flush out his kidneys and take the load off of them, and the Tart/Black Cherry Juice/Extract helps to reduce the swelling from the Gout.

The other thing you might want to do is order some live Silkworms online and use them as a replacement for his normal live staple feeder insect, as Silkworms contain a natural enzyme in the inner lining of their gastrointestinal tracts called "Serrapeptase", which is well known to help relieve the swelling and pain of Gout. Amazon.com seems to be the only place that has live Silkworms in stock for sale in bulk, and they are pretty cheap on Amazon too. All of the other major online live insect sources seem to have been out of stock of live silkworms for a while, they only sell silkworm eggs, and you obviously don't have the months and months it takes to hatch eggs and grow silkworms up to size, lol. But several members on here who have dragons with Gout have been ordering live silkworms from Amazon.com in bulk with no issues. If you normally feed your dragon live insects that are very high in purine-based protein, such as dubia roaches, this is typically a main cause or at least an influence on Gout, the purine is the cause. People who gut-load their roaches and crickets with high-protein food like dog food end up having dragons with Gout quite often. So reducing the number of live roaches he eats, if that's what he eats, and replacing them with the Silkworms (the best option because of the Serrapeptase) or with BSFL/Phoenix worms, and offering Alfalfa meal, which is high in purine-free protein so he'll still get his protein but it won't influence the Gout or make it worse is a very good idea. You can also buy Serrapeptase capsules online at several different retailers and then mix the powder with his fluids, and this can directly help him with the swelling and pain...

The main this here is to get him back to an experienced reptile vet and either get blood work done if he's large enough to do so, and if not they should do a fine-needle aspiration of the area with the swelling, collect a bit of the fluid, and test it for Uric Acid crystals to confirm Gout.

 

[JLynn87]

Thank you so much for all your details, after a couple weeks I began thinking that maybe it was not an arm injury and possible gout, but he did not seem to be in pain. Aside from limping, what are other signs that a bearded dragon is in pain?

I do in fact feed him to be a roaches! I switched him to those from crickets because they are easier to manage and I was told they are healthier. I will get right on Amazon and order him some silkworms, I have often times been thinking of switching him to the phoenix worms, but the last time I gave those to him he wasn’t as enthused as he was with bugs. Either way he eats the worm so he will eventually get used to them.

He weighs about 46 grams and I am guessing his age is 3-4 months, it is difficult to measure him, but he is roughly 9” long head to tip of tail. Is he big enough for lab work?

I sent Tracie a private message a little bit ago, I said that his left arm had no swelling. Well it is now beginning to swell. I will do some shopping to find the extracts or tablets with Pedialyte. How often should I give him the extract or tablets? Also how much should I give him at one time?

 

[JLynn87]

So I searched Amazon and could not find silkworms in bulk, The best deal they had was 30 silkworms for $18 +7.99 shipping. I cannot afford to get him the silkworms as he would eat 30 in one sitting. I ordered BSFL and will look for the serrapeptase capsules as well as the extract.

 

[JLynn87]

It took my taking George (the bluetongue skink) to another reptile vet who had access to a much more sensitive Xray machine in order to find a very fine spiral fracture which required a repair involving a specially made very fine stainless pin to reset the broken bone.

I live in a town of about 60,000, most vets here are for live stock, cats, dogs, etc. The ones that I’ve actually gone to who claim to be reptile or exotic specialist all seem to not know very much about bearded dragons. What are good ways to tell that a vet is capable of treating a bearded dragon? The only way I knew wit The ones that I’ve actually gone to who claim to be reptile or exotic specialist all seem to not know very much about bearded dragons. What are good ways to tell that a vet is capable of treating a bearded dragon? The only way I knew some were not very good was because they had bearded dragons in their lobby and their husbandry was all wrong. The main one that I go to seems to know quite a bit, but I still have my doubts. I am willing to drive if necessary but I don’t know what to look for. Do you have any suggestions?

 

[Drache613]

Hello,

Sorry his swelling is increasing now. It is very aggravating I know.
As far as knowing whether or not a vet is good or knowledgeable for reptiles is challenging.
They should be certified Avian or Reptile & actually see reptiles on a regular basis, not just
once or twice a year.
As you stated, their husbandry should be correct if they do happen to keep any in the lobby.
You can always ask basic questions to test their knowledge to see how they answer also. If
they don't know much, it will be evident in their answers. He is too small for a blood test
yet.
I will PM you tonight also.
As suggested by EllenD, try to get him started on the tart or black cherry juice as soon as you
can. Give .5ml, full strength, daily right now along with 1-2mls of oral fluids if you can.
The phoenix worms will be fine, hopefully he will like them. You could try getting some organic
chicken laying mash to feed your roaches with instead of dog or cat food or just use alfalfa or
barley pellets, along with greens for them also.
Were you able to find serrapeptase?

Let us know how he is doing.
Tracie

 

[JLynn87]

I started him on the tart cherry extract full strength yesterday, I’m not too sure how much he had but he seem to really like it. I also got him unflavored Pedialyte and have been giving him extra water, he doesn’t seem to mind any of this surprisingly.

I actually feed the Dubia roaches the same vegetables that I am feeding him, lately that has been yellow squash. I picked up some yams last night for the roaches as I read that they seem to like that. I have looked all over and I cannot find any sort of alfalfa, health food stores in this area are not very good I need to go to a bigger town.

I ordered the serrapeptase off of Amazon, I could not find any in town, the capsules should be here tomorrow.

His limping significantly lessened last night and his left arm appears normal physically. His right arm is just as swollen.

 

[EllenD]

You can buy Alfalfa meal and/or the Alfalfa pellets that you can easily crush into powder to add to his food/slurries at any Tractor Supply store, they sell them as feed for Cattle and Horses, as well as for Rabbits, and they are pretty cheap. Just be sure that you buy Alfalfa meal or pellets that are not already "medicated", as a lot of the ones meant for livestock are already medicated with medications for parasite, such as Panacur. I don't believe the Alfalfa pellets meant for Rabbits are at all medicated, and if I remember correctly they also sell Alfalfa pellets for Rabbits at both Petco/PetSmart and even maybe at Walmart in the small animal pet section.

Alfalfa is a great replacement for the protein you will be taking away by reducing the number of live roaches he eats, as the protein in Alfalfa is very high like the roaches, but it is purine-free, which is what causes the Uric Acid to build up in his blood after he eats his roaches. You want to limit the number of roaches he eats daily and replace them with both the Alfalfa and the BSFL to keep his Uric Acid down...

As Tracie already said, he is far too small for a blood test to be done to confirm Gout, but in my opinion it's pretty clear that he does in fact have Gout, based on the swelling in multiple extremities. A very experienced Reptile Vet can do a "Fine-Needle Aspiration" to collect a tiny bit of the fluid from the swelling to look for UA crystals, but honestly I'd seriously consider just putting him on the correct dose of Allopurinol for him and see if it helps. It usually takes a few weeks of them being on the Allopurinol until you'll see drastic improvement in the swelling, pain, etc. but the good new is that if he does get drastically better after taking the Allopurinol, you'll know for certain that he does in fact have Gout. I'm very comfortable saying that he does in fact have Gout, just based on the entire picture as a whole. Gout is becoming so extremely common in Dragons, especially babies and juveniles, it's getting out of control. Someone on here took their young baby to an "exotics" vet after he exhibited the same classic symptoms of Gout, and the "exotics" vet that they took him to refused to do any testing at all, saying that "he definitely does not have Gout, he's too young and we never see Gout in Bearded Dragons unless they are much older adults".

I couldn't believe it, instead of doing any testing at all of any kind, this inexperienced "exotics" vet, who had no reptile experience at all (that was obvious, as we see new cases of young babies and juveniles with Gout every week) just decided that this poor baby dragon "Must have a bacterial infection, probably a systemic infection", which made absolutely not one bit of sense based on the months and months of time he was dealing with "localized" swelling (a systemic infection would have killed him by this time, lol), and this stupid "exotics" vet put this baby dragon on a broad-spectrum, oral Antibiotic (Baytril, of course), without doing any testing to confirm a bacterial infection, let alone one that would respond to Baytril. He could have done a simple Fine-Needle Aspiration of the swelling and then done a Culture and Sensitivity on the fluid to diagnose a bacterial infection, what strain of bacteria was causing the infection (if he had one at all, which he didn't), and what Antibiotic would work to treat this specific bacteria. This vet did nothing but put him on a Broad-Spectrum antibiotic on a "Just in Case Basis" and sent him on his way.

The problem with this is that putting a Dragon who is suffering from Gout and in the middle of an active flare-up on a strong Antibiotic can actually kill them by causing them to go into Kidney failure. And after much ado this dragon was finally given a blood test (he was a juvenile who weighed over 100grams, that seems to be the cutoff for doing a blood draw) and his Uric Acid level was 40, which is extremely high. So this is why it is extremely important that you advocate for yourself and advocate for your dragon when seeing a veterinarian who is not either a Certified Reptile Vet or at least a very experienced Reptile Specialist Vet, as it seems that unfortunately most "Exotics" Vets (which in the United States simply means they are a General Vet that is "willing" to see animals other than just Dogs and Cats, that's it, the label of being an "Exotics Vet" requires no additional education, training, or even mentoring beyond graduating from Veterinary School in the US, where as someone who calls themselves a "General Vet" is simply the same thing, they just generally refuse to even see any other types of animals other than dogs and cats, which is the responsible thing for them to do)....

Now that's not to say that there aren't a lot of veterinarians who are labeled as being "Exotics Vets" who do in fact have additional education, training, and even special internships and fellowships in Herpetology and Reptile/Amphibian Medicine, or Avian Medicine, etc. There are many "Exotics Vets" who have gotten the necessary education and experience in Reptile Medicine, they simply have not done ALL of the required education and/or training that they need in order to qualify to take the Herpetology Board Tests, or they just haven't bothered to take the Board Tests (or pass them) for one reason or another, so they can't call themselves a "Board-Certified Reptile Vet" or a "Board Certified Avian Vet", and it's very important that if you happen to find one of these uniquely qualified "Exotics Vets" that you hang onto them, but this is also the reason that you must stand your ground and advocate for your dragon and it's health. Insisting that you suspect that he is suffering from Gout and that you want him to try a month of daily Allopurinol (which will not cause him any negative effects, so why not try it as not only a way to make him better, but as a way to confirm or rule-out a diagnosis of Gout).

Just a final FYI, Allpurinol is a very common human medication that is available at any human pharmacy as a very inexpensive generic medication. Most all Certified Reptile Vets or Reptile Specialists will simply weigh your dragon and then call in a prescription for the correct dosage of Allopurinol prepared in solution so you can give it to him every day orally, and your regular human Pharmacist will prepare the correct dosage of Allopurinol in a liquid suspension for your dragon from the same Allopurinol tablets that are prescribed to people. There is no veterinary formulation of Allopurinol at all, and any veterinarian that either stocks Allopurinol in their own offices or that orders it from a Veterinary pharmaceutical company is giving their patients human-grade Allopurinol, the same brands or generics that are sold at human pharmacies.

I point this out to you because of a recent situation we ran into her at I believe the end of October/beginning of November. Now keep in mind that as attested to by several members here who have dragon's with Gout and that are taking a liquid preparation of Gout daily that they get filled at their own human pharmacy after having it called in to their own human pharmacies by their Reptile Vets, they pay at most $25 for a 2-month supply of Allopurinol for their dragons, and that's the proper dose for their dragon's once every day, and that price includes their pharmacist's preparing a liquid suspension for their dragons from the human-grade Allopurinol tablets, based on the dosage that their Reptile Vets have called in to their human pharmacies. I've seen as high as $25 for a 2-month supply (giving their dragons a single liquid dose every day for 2 months straight), and as low as $15 for the same 2-month supply...Sooooooo, lol, we had a poor soul here who's dragon was displaying classic symptoms of Gout, and long story short, their veterinarian is an "Exotics Vet", who was hesitant to diagnose Gout or even run any tests at all, but the member was persistent, calling and leaving messages for this vet daily, insisting that they were going to stop giving their dragon the Antibiotics that they prescribed "Just in Case", blah blah blah, and they really stayed on their vet's back and made her listen to them. Finally this member came on the forum and happily posted that they finally got their vet to agree to prescribe a daily liquid dose of Allopurinol, and we were very happy that this poor dragon was finally going to get the correct medication that we all knew that they needed...however, they were told that this vet "did not have any Allpurinol in the correct dosage for her very small dragon, nor was it liquid, so the vet had to order it for them, 2 months worth, and it wouldn't be shipped to the vet office for at least a week or two"...this puzzled us all, because all this vet needed to do was call in the correct dosage and quantity into the owner's personal, regular human pharmacy and they could prepare it for them and they could pick it up that day, rather than making their poor dragon suffer and wait even longer to get started on the correct medication...then we find out that this member had to I guess "Pre-Pay" for the vet to order in the correct dosage and liquid preparation of Allopurinol for her dragon, and that she had just paid $223 for a 2-month round of liquid Allopurinol!!!!

I was floored, so was Tracie, but not as floored as the poor person once other people chimed in and told her that their dragon's also had Gout and were taking a dose of liquid Allopurinol daily, and that 2 months worth of Allopurinol prepared into a liquid suspension by their own regular pharmacist cost them at most $25! Now I don't know what this vet actually paid for this Allopurinol in relation to what they charged this member, but it sure as hell was not anything close to $223! I had told her she was basically paying for the the correct dosage to be prepared and put into a liquid suspension, like she was paying for the "labor" for some veterinary pharmaceutical warehouse to prepare the prescription for her, but the more I think about it I'm sure it was just her "Exotics Vet" getting upset with her for her insisting that she take control of her dragon's medical care (and this was confirmed after she called and requested that her vet cancel that order for the Allopurinol, refund her $223, and she call the prescription in to her own local pharmacist at once so that he could prepare it and she could pick it up that day for around $20 instead of $223, lol, and she ended up picking it up that day instead of having to wait another week or two; after she made that phone call and picked up the $20 prescription at her pharmacy that very day, her "Exotics Vet" completely stopped returning her phone calls or replying to her voicemails and emails...nice vet ).

So the moral to my long rant is that you must advocate for your baby, be sure to ask any and every question you think of, and if you don't think of a question or anything else until after you've left the vet's office then you need to immediately call them and keep leaving messages until they call you back; you need to be sure to not leave your vet's office after an appointment without getting a hard-copy of EVERYTHING that happened during the visit, all of your dragon's vital signs, length, weight, etc. and then any and all of the notes made by the vet, and ESPECIALLY A COPY OF ANY AND ALL TEST RESULTS, all fecal testing results, blood work results, needle aspiration and any culture results, and a digital copy of any imaging they do including all flat x-rays and/or ultrasounds, as they can email you a digital copy of all of these imaging tests immediately, so make sure that you request that they email all x-rays, ultrasounds, CT Scans, MRI's, etc. to you immediately after they do them, and then a list of any and all Prescription Medications, Injections, Vitamin/Mineral/Supplements, Fluids, etc. that they give your dragon either while at the vet's office or as take-homes, and that they list not only the names of all of these but also the dosage and frequency...Basically, do not EVER leave your vet's office without getting a hard-copy of his entire chart that documents everything they did to him, gave him, and prescribed to him, both the paper copies and the digital files of any imaging tests, and make sure that they email them to you before you leave the office, as it's amazing how often they refuse to send them after you leave...

 

[JLynn87]

Thank you, I searched the internet for board certified reptilebet or avian, I could not find any in my area; I will do a state check, I live in MT so anywhere will be a lot no drive. I will continue with his current vet, she does not seem too far off, but even I suspected gout and I know very little in comparison. I am trying to make contact with our state reptile rescue, they may know of a reptile vet who is board certified. I am more than okay for being an advocate for my guy, he deserves proper treatment. I will call the vet tomorrow and ask for a script, I do kit see the need to make another appointment. I completely misread Ellen’s post post from yesterday, I was looking for alfalfa sprouts, not pellets! I will do some more shopping today, BSFL should be here by T or W. I will make some slurries to replace the number of roaches, are crickets okay to give in the meantime? Either I was seeing things yesterday or the swelling in his left arm has gone away!

I research bearded dragons often, I thought I was doing everything right, maybe even going the extra mile. It seems like I am always having some sort of an issue, what can I do to improve the health and happiness of Mufasa and any future guy/girl?