High phosphorus, uric acid, and calcium

[dragonbarbudo]

Hello fellow lizard lovers,

I have seen lurking on here for a couple years. I have four rescue beardies that have been doing great until recently. I took my newest rescue(have had her 4 months) to the vet for swollen limbs last week. I was expecting goat. Blood/urine testing showed that she has:

High Uric Acid level of 21, high phosphorus, and high calcium.

The vet also did an ultrasound and x-rays. We found out that she has eggs as well. As of he vet appointment last week, the eggs did not have shells yet. This means they are preovulatory correct? The vet said the high calcium may be related to having eggs, and the high uric acid may be gout. The vet insists that we must do surgery to remove the eggs which is risky, especially because of the kidney issues she is having, or euthanize her.

So this pretty much leads me to think euthanasia is the only reasonable option here.

I am just wondering if anyone out there has any more knowledge about this and can weigh in some more information and opinion.

If anymore info is needed feel free to ask.

Thank you

 

[Tonja]

Personally at this point I would not euthanize her. I would get some black cherry juice <not from concentrate and sugarless> and give that to her to help bring down the uric acid and if she has the beginning of gout it will help break up the uric acid crystals in her joints. I don't know about the eggs as my female has never developed eggs or laid them, she is just 2 years old. If you can get a copy of the blood panel results from your vet, you can pm it to Drache613 and let her look at it and give her recommendations. She is excellent in beardie health and problems of this type. You can message her with any questions about her high calcium and phosphorous.

 

[dragonbarbudo]

Thank you Tonja. I really appreciate the response.

I also feel that it is not time to euthanize her. If the time comes, I will let her go to end her pain, but I don't feel like that is what it has come down to yet.

I had read about black cherry juice and was wondering if it was worth getting. I will go look for some at the store tomorrow and request a copy of the test results.

Thanks again

 

[CooperDragon]

There is medicine available to treat gout, unfortunately it is a treatment that is continuous and the condition can't be cured completely.

 

[Drache613]

Hello,

I am sorry to hear that your dragon has gout.
Perhaps it isn't full blown gout but pseudo gout. My main concern is that the uric acid come down as quickly as possible to avoid more renal damage. It could have been set off by eggs or egg issues maybe.
As Tonja suggested, go ahead & get some black cherry juice & give .5 to 1ml daily. Also, try to get 4-6mls of oral fluids into her daily as well to help flush out her kidneys too.
Gout is not necessarily a death sentence, but, it does need to be managed daily as you would with a human.
Since the eggs are not shelled or haven't dropped yet, they are pre-ovulatory. Does she feel she is having any egg problems or just wants to remove the eggs due to the renal issues?

I agree, I wouldn't euthanize her just yet, give her some time to react to meds & see what type of treatments will immediately work for her. They can live with gout for a long time, if managed properly.
If you have a copy of the blood tests that would be great to see.

Tracie

 

[jarich]

Ouch, ya 21 mg is very high for a uric acid content. I'd have to agree with the vet though. Either you need to bring her out of cycle or the uric acid levels will remain high. They will naturally increase when they are cycling, so while the juice may help, it won't address the problem. Gout is incredibly painful too, so it really is fair to say that if you don't take her out of cycle, the compassionate thing to do is euthanize her.

 

[dragonbarbudo]

Thanks everyong for your input. I would be inclined to want to start giving gout medication to see how she reacts but the vet did not even mention starting to treat for grout. His only options were putting her to sleep or risking surgery to remove the eggs and which might kill her anyways.

I have uploaded the test result to Google docs.
Hopefully the link works.
https://drive.google.com/file/d/0By_nFTQX2WQTMmpRWlZSc1ZiVXM/edit?usp=sharing

 

[jarich]

Again, that is sort of like giving Tylenol to someone with a screwdriver stuck in their head. It might treat a symptom, but would do nothing for an underlying cause. Some vets will use Allopurinol to lower uric acid, but there isn't a lot of testing done on its use in reptiles, especially long term, which is what would be required.

Your vet sounds like a pretty good one. They are recommending either some necessary treatment or an end to the animals considerable pain. That is a very disturbing lab result, and you should take into account the quality of life in making this decision. You have an incredibly stressed, sick, cycling female. Recovery will not be easy

Again, that is sort of like giving Tylenol to someone with a screwdriver stuck in their head.

Added by moderator: This is where this thread started heading in the wrong direction, due to this unfriendly sarcasm which is NOT tolerated on this forum.

 

[dragonbarbudo]

If her quality of life was that bad I would put her to sleep. I would never force her to endure pain just because I can't let go of her myself. I accepted the fact that I may have to make that decision the day I got her, as with any animal.

I have seen cases of beardies with gout that have been medicated and maintained a quality life. That said, I understand that in severe cases euthanasia may be the best option.

My question is what evidence is there that she needs surgery to remove the eggs right now. We do not know that she has preovulatory stasis. She may just be in the early stages of egg development.

 

[jarich]

It's not the stasis that is the issue immediately (though that seems like a likely issue that could arise soon too), it's her blood results. Her cycling has naturally elevated the levels of the minerals in her blood, as well as the uric acid levels, and will continue to until she stops cycling. Since the organs are already taxed and likely heavily damaged (swelling of the limbs happens after it has progressed quite far) those increased levels cannot be supported. Add to that the sustained high levels of corticosteroids she is displaying and you have an even worse situation.

 

[Tonja]

I still would not put her down, many a dragon has come through worse, and no one said she was in pain. Black Cherry juice can keep the uric acid in check. She may do fine, its a wait and see, and as for quality of life, we don't know that she doesn't have one. I don't think putting her down at this point is necessary. Phosporus isn't that high just out of normal, her calcium is high and her uric acid is very high. I would still proceed with the black cherry juice and see if those levels come down. Everything else is mid range and normal.

 

[dragonbarbudo]

I got some black cherry juice today. I think I will give her that and keep her nice and hydrated over the weekend and just see how she does.

Thanks again everyone for taking the time to respond.

 

[Drache613]

Hello,

That is great you are going to try the black cherry juice & extra oral fluids.
What exactly prompted you to take her to the vet the swelling mainly? Is she black bearding?
You could also request the vet to give allopurinol also to help get that level down too. She wasn't interested in prescribing it though?
Does she feel she is having egg issues or just developing the eggs right now?
Can you post pictures of her so I can see the swelling?
I treated a male with gout for over years successfully on allopurinol, whom I rescued from a store. He passed away but not due to gout, but old age. I don't have an exact age but he was roughly around 12 or slightly older.
I personally think it is worth a shot as she is so young & should be strong.

Let us know how she is doing.
Tracie

 

[jarich]

Sorry I wasnt meaning to make it seem like I was suggesting euthanasia as the only course of action. Personally, I think that the surgery should be performed instead, but either way something needs to be done immediately. Of course its up to the owner (OP) on the decision, but Im surprised to hear you both be so nonchalant about the situation of this animal. Cherry juice (either black or tart) is only useful in around half to two thirds of the cases IN HUMANS. Also, its most useful function seems to be as an anti inflammatory as opposed to reducing the levels of uric acid in a massive way, but again the testing is far from conclusive. There is no evidence that it breaks up already formed uric acid crystals or that it would reduce levels this high to safe or manageable levels. Furthermore, its effects seem unlikely to go beyond mammals, since it mainly seems to work by boosting the functioning of monocytes. Reptiles typically have much reduced levels of these cells compared to humans, and that is especially true of this particular reptile. In other words, there is absolutely no evidence to suggest that cherry juice would do anything for this particular animal. Allopurinol at least has some evidence of working in reptiles, but again does not address the underlying cause of the problem in this case.

Suggesting that "everything else is mid range and normal" is really not at all true, and Im not sure how you could reasonably suggest that. I understand your specialized knowledge, but please look more carefully at the differences in blood chemistry between a human and a bearded dragon. There is little that is normal in that blood test. As its a cycling female that has a history of bad husbandry however, that is not that surprising. Saying that a male was saved who had gout is one thing, but using that to suggest that its as simple in a cycling female is a poor comparison. Cycling is taxing for even a perfectly healthy female and her organs, much less one that has a history of poor husbandry and organ damage, especially one where the symptoms show progression. Beyond this, the vet has actually examined the subject, seems to know what they are talking about, and has a much better understanding of the situation. While there are many non specialty vets that dont know much more than a hobbyist, the only evidence we have from this thread appears like this vet knows what they are talking about. I agree that it seems somewhat odd that allopurinol wasnt given right away, but there could be valid reasons for that too. Suggesting that after a few paragraphs of very limited information someone on a forum knows better than the vet who has actually seen the subject seems rather presumptuous.

I would like to see a picture too though. Swollen limbs caused by gout mean that the disease has progressed far enough to significantly affect organ function. Its no longer just about crystal formation in the joints. By the time the limbs become swollen, a positive prognosis in reptiles is rare; not unheard of but very rare. If the swelling is caused by gout, there is absolutely no question of whether the animal is in pain or not. Regardless of that, the blood work shows that the stress levels of this animal are through the roof and have been for some time. Again, Im not saying that I think the animal should necessarily be euthanized, but a conjectural juice treatment and a wait and see attitude is merely promoting the continued pain of a sick animal.

 

[Tonja]

If you look at the normal ranges within in the blood tests..they are mid range normal or within normal parameters. The only highs are calcium, phosphorus and uric acid and YES Black Cherry juice helps and is recommended.