How severe is this impaction? (x-ray picture)

[CathyJ]

Good evening, beardeddragon.org, I am in a bit of a pinch and I would appreciate some advice.

I brought my dragon to the vet a few days ago and after taking a blood test and an x-ray, it was determined that she has gout and is impacted.
She's currently taking medication for the gout (omega 3, allopurmol, colchicine and hydromet for the pain) and for the impaction she's taking a laxative (for people) called goLytely.

All seemed well until this morning.
She had been passing normal to smaller sized poops every morning for the last few days which is great, but this morning she had 2 tiny tiny specks of poop (with urate) and lots of gas.
It made some sense since yesterday she refused crickets, which was odd, as she usually doesn't.
I still feed her (via oral syringe) about 1tspn of babyfood squash+juiced collards mixture so she can have something in her stomach at least and I would offer 4-5 crickets because she seemed to like those a lot. Well, today she threw up twice. Mostly all the crickets I had been feeding her the past few days, all undigested as well as some of the squash+collards mixture I gave her this morning. I'm guessing the crickets were hard on her stomach..

Well she seemed alright before she went to bed but I am worried. My follow-up visit to the vet is the 31st. Should I just wait to see if she manages to pass it with the laxative stuff or should I consider going back to the vet ASAP? She is awake during the day and pays attention when I walk past, she's not nodding off but also doesn't move much due to the gout being painful on her legs.

Sorry this is so long, I included the x-ray my vet took if anyone knows what to look for.

EDIT:
bloodwork results:
AST: --><10 (3/23/2015, 4:00 PM)
Ca+:
-->11.8 (3/23/2015, 4:00 PM)
CK: -->464 (3/23/2015, 4:00 PM)
Phos: -->2.2 (3/23/2015, 4:00 PM)
Uric: -->14.9 (3/23/2015, 4:00 PM)
Glucose: -->256 (3/23/2015, 4:00 PM)}
pcv 20%

 

[AHBD]

Hi Cathy...I'm sorry that your girl is having these health issues. It may be a combination of all the meds. making her sick. I don't really see impaction....can you circle what area the vet pointed out to you ? If she is pooing regularly there shouldn't be an impaction. Was she kept on sand or loose substrate, or was there something else that would have caused it ? If so, remove it ASAP + put down newspaper. How is she getting around, and can you post pics of her feet ?

 

[CathyJ]

If you wouldn't mind waiting, I can post pictures of her legs tomorrow, right now she's asleep and I wouldn't want to mess with her.

She lives in my room, free roam, I have her under my desk with a regular carpet and a pillow, no substrate. She gets around awkwardly, she essentially wiggles/drags herself around, her front left leg seems to bother her as she doesn't put pressure on it but I can see her moving it. Other legs seem alright. I only noticed her weird walking within last week.

The vet never actually showed me the x-ray during my visit.. She only emailed it to me after I asked her to please see it. I will say, though, she does have something that I can feel in her stomach. Something hard that moves around here and there, so I do believe there's something.. But her spine seems to be bump free and such.

 

[AHBD]

Sure, post the pics when you are able. Are her feet notably swollen from the gout ?

As far as free roaming, how long has she been set up that way ? That may be why she is ill and also why she vomited. She may not have enough heat to digest her food. How do you have her heat + UVB set up ? That is critical for digestion and good health.

 

[Drache613]

Hello,

The pictures don't look too bad. I can somewhat tell that there is some swelling, but if you could take some pictures of her body that would be helpful. There are a few areas that look like they could be impactions, but not positive.
How long has she been on allopurinol & colchicine?

Tracie

 

[CathyJ]

The free-roaming probably played it's part but it has been changed up. Previously, I had a rock and put it under the heat lamp, which was about 10" higher up than it is now. When my dragon started showing problems, I moved the lamp closer and changed the rock out for a pillow. Now the temps are higher: basking area is around 100-116C
UV, not using anything. I was under the impression that UV and calci-powders were necessary when young so I stopped her on those maybe 2 years ago or so (shes 9 years old). I recently started her up with the repti-cal+VD3 and multivitamin powder, but still no UV light.

She's been on the meds since the 20th. The vet told me 2 30min baths a day which I have adhered to religiously (bath temps go from 90-97C), colch+allo are given twice a day (7am and 7pm) the other meds are given once a day. I was told she didn't have to eat with the medication, so she can supposedly have them on an empty stomach.

I also want to add the bloodwork results to the main post. The urate lvls were supposedly very high and that's how the vet determined she has gout. Also by how she moves around.

The swelling is not detectable for me, I really have no experience with it.

Here are some photos of her:
legs:
http://i.imgur.com/xHu3VUL.jpg
http://i.imgur.com/WmyfFcR.jpg

body:
http://i.imgur.com/dEBza4L.jpg
http://i.imgur.com/i5dcfWp.jpg

poop:
http://i.imgur.com/CdbfJXp.jpg

She's pretty underweight, I noticed this right before we went to the vet. She was making what seemed like a nice recovery but since throwing up I notice her tail is getting skinny again.

Also one of the photos shows a poop she did this morning during her bath. A little strange looking but at least it's something, I suppose. She hasn't been fed yet, I'm going to give an oral syringe of babyfood squash+collards and hope she keeps it down.

 

[AHBD]

Hi Cathy....she does look a bit thin, but hopefully you can get things sorted out. The baby food squash + collard greens is a good idea. I'm pretty sure most of her problems are from the lack of UVB and not enough heat because there can be no proper absorption of nutrition [ including calcium ] without these. Her lethargy + difficulty moving are probably because of this.You must set her up with a good UVB bulb ASAP and also make sure she's warm enough. If she isn't, she can't digest anything. I'm not sure she has gout, but black cherry extract may do better in her situation right now. As for the strange poo, it's most likely because she's being given a laxative which is causing her to expel everything even if she has had nothing substantial to eat. I want to emphasize that she really needs simple proper nutrition and lighting, then she will poo normally without the laxative, and it does not need to be daily, especially since she's old and not eating much.

It's obvious that you care for your little girl , and just heard/read some misinformation. It would be best to set her up in a tank where you can be sure she has proper UVB + heat [ about 100 is fine for basking area, 82 on the cool side] I don't think she can recover if you don't get her set up that way. Feeding her squash, greens and medium sized insects should help her poos, I don't think she is impacted. I'm hoping for the best for your old girl !

 

[CathyJ]

I can honestly say I am extremely confused. Not that I doubt what anyone is saying, but to hear so many different diagnoses is certainly concerning.
The vet I went to who diagnosed her with the gout was informed that she had been off calci-powder AND UV for the last 2 years or so but didn't mention anything about it being a problem. When I brought the lizard in I even suggested that maybe it was a case of calcium deficiency but the idea was never entertained.
Anyway, that vet was a bit rude and not available when I have questions, so I've been sending emails to try and get my dragon to a new vet.. Now I am wondering if she just outright scammed me -__- how very depressing..
Even more concerning because the vet mentioned that surgery might have to be an option to remove the supposed hard thing in her stomach.. The day I was there the vet suggested we could use laxatives to see if she could pass it herself and when I called in yesterday to inform her that my dragon threw up she seemed to suggest that surgery was our only option o_o
The success rate for the surgery was supposedly 75% and the vet had performed it "dozens" of times, but post-op stress seems a lot more dangerous than her "impaction" at this point.
Right now I'm freaking out.

I will get her a UV bulb today (I'm pretty sure the one I used to have is probably no good anymore). I know there's a certain brand you should get, I'll research it when I get back from work.

I am a bit scared to discontinue the medications, though. Not without at least getting her checked by another vet, anyway. Supposedly her urate levels were 3xs as high as normal and the medication is supposed to level it out. I saw improvements during the first couple days, but now it seems like she's bouncing back and forward between energetic and lethargic.

 

[AHBD]

Oh my, I can feel for you. The last thing you want is a rude and uncommunicative vet or Dr. I personally would seek another, and I personally would discontinue the laxative [ irritates the stomach, can cause cramps ] and the pain meds. Also, one daily bath is always enough, 2 baths raises the risk of getting too chilled and also causes stress. The vet's not saying she needs UVB + calcium raises the biggest red flag. Any breeder will disagree with that, and a long time breeder is almost always more knowledgeable than a vet that sees a few dragons a year. If you need help with lighting there's an artice on the right side of this page ; lighting help ] I'm not 100% positive that there's no impaction, but I'm leaning toward it not being one. If there is, lights, heat + soft foods may shift it. I can only give you my opinion, but I've owned beardies for over 20 years and raised many babies as well. Your dragon's age [ did you say she's 9 ? ] factors in, too. She is pretty old....think about what you want her to go through. I'm sure Tracie will chime in with her thoughts as well.

 

[CathyJ]

Thank you so much for all your help so far. I will get her UV switched over and cut the 2nd bath and laxatives. Pain meds too? Its hydrocone I think

I suppose theres no way but up from where she is now.. And I'm trying to get her to a vet soon anyhow so even if **** hits the fan I'll just have to re-explain the story to the new vet and start over.

 

[AHBD]

You're welcome....I only hope that I really can help. My suggestions of cutting the laxative + pain med. is because they can both contribute to nausea....most meds. do, and if she is not actually impacted then it would just be 2 more things to make her feel ill. I think the gout meds. may be necessary, at least for a while, but all the meds. on top of it might be why she vomited, along with possibly temps. that are too low to digest her food. She only threw up after she started the meds, so that is a logical conclusion.

By the way, what was the reason that you brought her to the vet the first time ? Not eating ? Or swollen foot + hard time walking ?

Also, what state are you in....some of the members here may be able to recommend a vet for you. Two of the members, Cooperdragon and Taterbug [ I believe it's those 2 ] also might know a website that lists good vets by state. You might p.m. them, they post here quite often.

I'm really pulling for your girl !

 

[CooperDragon]

I'm pulling for her as well! I've been watching the thread but I haven't had anything to add to what AHBD and Tracie have been saying. In my experience, the inflamed tissue from gout can be seen on the x-ray but that may not always be the case. My dragon was diagnosed with gout by having a blood sample drawn and then the vet identified gout crystals. The same medication was prescribed. My word of caution is that gout can be a symptom of another issue. The only thing I can see in the x-ray that could be identified as impaction are the two dark spots along the right side below the lungs. I can't say what those are for sure though. Did the vet do an abdominal exam by hand to see if any lumps could be felt? A severe impaction (and even a full colon) can be felt pretty easily from what I know. The site I believe AHBD was mentioning is this: http://www.anapsid.org/vets/#vetlist If you can tell me where you are, I'll also be glad to help look for a reptile vet near you.

 

[Taterbug]

It doesn't sound like you vet is experienced with reptiles. I have had similar experiences with poor advice, try not to diapare and look for another, at the very least one you can form a better communication with.

Here are some more links to try. They may be outdated so it's best to call and ask if the listed doctor is still with the clinic or if there is more recent contact information. Not all vets at a practice are as qualified either, so it can be important to request a doctor by name or with the most experience. A good vet will also take a a lot of husbandry information at your first visit

http://www.arav.org (I'd try this one first, but they seem to have very few listings)
http://www.herpvetconnection.com/
http://www.reptilesmagazine.com/Reptile-Vets/
http://www.herpcenter.com/reptile-vet-finder/
http://www.reptilecare.com/herpvets.htm - some tips on finding vets

I do agree with ABHD, it's important you get her properly setup in a more controlled environment. Free roaming sounds nice from a freedom and space point of view, but it is very hard to provide a suitable thermal environment for many reptiles this way. Low temperatures can impact immune system and organ function as well as digestion. These are things that take time to start to be apparent.

Calcium and UV provision do need to be life long. Calcium because the diets we offer (insects particularly) are not adequate to prevent calcium diffidence. UV to keep the D3 levels where they need to be. Baby dragons do need more supplementing because they are growing so fast. With adults even though their bodies can maintain a stable level for quite a while eventually they use up their stores and then they slowly deteriorate. I'm also really surprised the vet didn't seem to bat an eye at this.

Kidney function can be linked to both low temperatures as well as diet/supplementation so the uric acid levels could be related to either or both. Hopefully a change to the diet and lighting/temps can help improve that as well.

I'm not trying to be critical but just to clear up some of the confusion. I wish you the best finding a new vet and her improving

 

[CathyJ]

Thanks everyone.

Just a quick update, just got home from work and she has thrown up again.. I know of a vet that is open past 5 I think I will take her there unless I get any suggestions within the next 20 minutes or so. It's called the "pet emergency center".

 

[CathyJ]

Anyway to answer your questions:

I live in the south Florida area. The vet I visited was in deerfield beach, her name was Dr Kelleher and the place is called Avian and Exotic or something like that. That place was pretty far.. It was like 40 min north of my location, but I didn't have a choice because the vets I know of were unavailable.. One was closed for reconstruction and the other Dr separated from the office he was at previously to open his own place and it's not there yet.

I visited because of a couple reasons. The first and primary reason was because I fed my dragon (her name is Meryl) hornworms and she actually passed one that was not digested.. Well I actually had to gently pull it out of her because she was straining, giving up, and it would go back in. (http://i.imgur.com/pgtaSaN.jpg)
I had fed her hornworms before with little problems so it was unusual. I emailed my vet, found out they weren't located in the area anymore and couldn't give me an appointment, but they told me to just soak her and make sure she keeps pooping.

Well, after I emailed the vet I had noticed she was walking strangely along with that.. I maybe mistook it for her hobbling around trying to get the poop out, so I don't even know exactly when it started. I ALSO noticed her head was concave and the bone was showing in her tail.. I made an appointment for the far-away vet at that point.