Beardie with fluid in abdomen, around liver

[Sophielius]

Hi guys! My bearded dragon Raxtus has been having some troubles lately and I was wondering if I could ask for any advice.

I'll start off by saying that Raxtus is 7 years old, tested positive for adenovirus at age 3, and has been on milk thistle ever since.

A month ago (3/21/23) I took him to the vet because of some coughing I'd noticed, and the vet did some xrays and found enlarged lungs. I was sent home with meloxicam, enrofloxacin, and nebulizer mix. He lost his appetite as soon as he went on those meds, esp with the enrofloxacin. We returned two days later because he seemed to be doing so poorly, and they determined that he was constipated. I was sent home with some slippery elm to help move things along. We returned to the vet on 4/5/23 because of his appetite loss and he was constantly black-bearding. They also did a CT scan and it appeared that his heart was enlarged and he had little lung space so he was also put on pimobendan. We got a referral to NC State to meet with a cardiologist and get him an echocardiogram.

We went and did that, and it turns out his heart is fine! Is it common to misread a CT scan like that? They did find excess fluid in his abdomen (I'd noticed a couple days prior, his belly feels squishy like a water balloon), esp around his liver. We have a follow-up appointment tomorrow (4/20/23) with the referral vet at NC State and he'll be getting an ultrasound. They'll also be aspirating some of the fluid to see what's up with that and try to get a sample from his liver as well. His bloodwork shows that his liver values are doing well, but they said that the values can appear normal in bloodwork but the liver is actually abnormal. Is this true? Will he need to be sedated for the ultrasound? I'm just not feeling super confident about them poking holes in my boy, I've only ever been there once and they don't quite have my trust the way my regular exotic vet does. Any recommendations?

I will note that since about April 5th when he was taken off the enrofloxacin he has been doing much better. He still doesn't have an appetite for greens (but he's done this a few times before) will still eat his bugs, and is on critical care omnivore to help keep his weight/nutrition up. He's dropped about 30g (was 634g on 3/21/23, and 602g today), is it healthy to lose 5% of his body weight in a month? His activity levels seem nearly normal again (he's been moderately active his whole life). He has been incredibly regular with his pooping schedule and has been going daily with healthy white urates for a bit over a week now.

Husbandry:
-salads of collard, dandelion, mustard, and turnip greens daily. The toppings are mostly butternut squash but switch around to carrot or bell pepper if he needs a change of taste.
-calcium dusted 2-3x/week (without d3), herptivite once a week
-bug day once a week, mostly superworms (3-4 of them) that I've raised and occasionally dubia roaches depending on how my colony is doing at the moment
-4'x2'x22" melamine with plenty of ventilation, on reptile carpet
-Arcadia T5 34" Desert, purchased and installed about 2 weeks ago (previously a 36" T8 fixture of either a Reptisun 10.0 or Arcadia Desert)
-heat lamp is a mini halogen bulb, it's about 105-110 directly under it
-cage temps are 76-80 (76 in winter, up to 80 in summer) on the cool side, and 80+ on the warm side

 

[xp29]

Basking is a bit warm for an adult. I don't think he has to be asleep for the ultrasound.

 

[hdochow]

quick question, when you changed to the T5 from the T8, did you adjust the distance from the light to the basking decor? just a random question that popped into my head while reading.

 

[Sophielius]

quick question, when you changed to the T5 from the T8, did you adjust the distance from the light to the basking decor? just a random question that popped into my head while reading.

I did, but thanks for the heads up! The T5 is so much stronger than the T8 that I had to make his decorations short lol

 

[hdochow]

I did, but thanks for the heads up! The T5 is so much stronger than the T8 that I had to make his decorations short lol

ok good. wish I had input for your specific situation. i'll be keeping an eye on how things progress for you though, so keep us updated.

 

[Drache613]

Hello,

Let us know how he is doing & how the vet visit goes.
He wont have to be sedated or anesthetized for an ultra sound. Were they talking about just a
needle aspiration for fluids or a biopsy?
If they just do a needle aspiration then they might give him a sedative but he wont have to be put
under anesthesia. However, if they did a biopsy to gather a tissue sample from the liver then he
would have to be put under anesthesia.
The liver values can appear normal while the liver could be having trouble or have an abnormal
appearance, yes.
I would continue giving the Milk thistle, it is very good for the liver. Dandelion root is also great for
blood cleansing & circulatory help, too.
Losing some weight sometimes is ok, but I would watch the weight loss so it doesn't get too much.
If a person is trained in reading CT scans then it shouldn't have been misread to that extent if at all.
That is quite a medication elixar which alone is hard on him especially with adeno. I usually don't
recommend too much unnecessary medication, because the Baytril has a tendency to be hard on
the liver & kidneys.

Traci

 

[Sophielius]

Hello,

Let us know how he is doing & how the vet visit goes.
He wont have to be sedated or anesthetized for an ultra sound. Were they talking about just a
needle aspiration for fluids or a biopsy?
If they just do a needle aspiration then they might give him a sedative but he wont have to be put
under anesthesia. However, if they did a biopsy to gather a tissue sample from the liver then he
would have to be put under anesthesia.
The liver values can appear normal while the liver could be having trouble or have an abnormal
appearance, yes.
I would continue giving the Milk thistle, it is very good for the liver. Dandelion root is also great for
blood cleansing & circulatory help, too.
Losing some weight sometimes is ok, but I would watch the weight loss so it doesn't get too much.
If a person is trained in reading CT scans then it shouldn't have been misread to that extent if at all.
That is quite a medication elixar which alone is hard on him especially with adeno. I usually don't
recommend too much unnecessary medication, because the Baytril has a tendency to be hard on
the liver & kidneys.

Traci

Thanks so much for your input!

I was reassured by the vet seeing him today and she helped calm me down a lot. She assured me that they'd put him on the lowest dose possible of sedation if needed and that they'd only sample the fluid and liver (not a biopsy of it, but like trying to get a few liver cells with a teensy needle) if absolutely necessary. He had to be sedated for the ultrasound because he was very upset and not cooperating. He wasn't completely under though so I was glad about that. It appears that everything looks normal. His liver appeared normal, so they didn't see it necessary to take a sample, nor did they see excess fluid to sample either. There's some minor speckling with his kidneys that they believe is age-related, and I'm gonna ensure that he is well-hydrated going forward. They noticed some irregularities with his pancreas/spleen, but it's not likely that anything is actually wrong there. His esophagus appeared perhaps a bit thick but that's not well reported on in beardies so it could be normal as well. I asked what could've caused the excess fluid they saw last week and they said that it could be that since lizards have more fluid in there, and the angle he was at for his echo, it could've just appeared to have more fluid than normal. I got the impression that they don't see tons of beardies for these sorts of things.

They recommended that he be taken off the Meloxicam, and the calcium gluconate 23% in one week (I think I forgot to mention that part, his bloodwork showed low calcium levels on 3/30 so he was put on it, and bloodwork at the referral vet on 4/14 showed the levels are back to normal). They think it's okay to discontinue the critical care too. They also recommended taking him off of the milk thistle since his liver appears fine, but I don't think I'll do that. From what I understand, the milk thistle is a good preventative for any damage that might happen from his ADV and he's been fine on it for years.

I didn't know that about dandelion root! Would I just chop it like I would his butternut squash toppings, or does it need any special prep to make it palatable? Hopefully, the dandelion roots from the dandelion I've had to grow indoors will work all right.

He was pretty skittish coming home and got spooked easily. He didn't have a good time there, poor boy. He had some odd head shivers for a bit once we got home that I think were just side effects of coming off the sedation, and he had an episode of getting spooked by nothing and sprinting away from me (which never happens) so I think he was having some sort of mild hallucination where he thought the still ceiling fan was a bird. He accepted cuddles for a bit and then napped the rest of the day in the safety of his tiny tent.

He is doing really well today! He did his morning yawn and bearding, had a healthy poo, and did some house exploration. He's currently relaxing in his cage under his UV and his beard is light. Until he deigns to eat his greens again I'm gonna offer him daily soaks. I'll make a smoothie of greens and offer him that mixed with some canned pumpkin if he doesn't want salad in the next couple of days, and I'll be carefully monitoring his weight.

Thanks so much to everyone who chimed in, it helped a lot