Is there hope? Should I Euthanize?

[puffyboy]

Hi all, I've been following the forums here for the past week. Just wanted to say that this is an amazing community.

My boyfriend and I have a beardie named Puff, male/10 years old. He's been feeling unwell since Tuesday, January 26. His last solid food was a big horn worm on Monday, January 25. At first I thought the horn worm was the issue and made Puff unwell, but after a visit to the ER - the vet thinks that Puff may have cancer or a slim chance that it is a serious infection. The prognosis for either is not good. I trust the vet but I want to verify before deciding to euthanize.

Detailed timeline:
Mon, 1/25: Puff ate 1 fat horn worm.
Tues, 1/26: Puff refused 3 medium sized horn worms, basked for the rest of the day. Had a poop/urate.
Wed, 1/27: Slight black beard, boyfriend brought Puff out to cuddle assuming he wanted attention. He refused horn worms today too. He had small pieces of solid urate with liquid absorbed in the newspaper around it. Gave him a bath.
Thurs, 1/28: Black beard intensifies, decided to go into the vet early the next morning.
Fri, 1/29 - 8pm-12:30am Exotic vet takes a blood test, x-ray, gives fluids/antibiotics in-facility and take-home.
*Vet left a voicemail* Puff's WBC is 18x higher at 180,000, the normal range is 8,000-10,000. 88% of the WBCs are unknown and sent to a reptile pathologist (see photos).
Sat, 1/30 - Fri, 2/5: Puff is very lethargic with a black beard. He was in his tank on newspaper with a heat mat underneath the tank and a towel around him to retain heat. His basking lamp with UVA/UVB was above him without anything blocking the light. We gave him medicine (listed below), fluids (Lactated Ringers) through IV, and food through a syringe (vet gave us Emerald C. Omnivore, we added baby food with grounded protein pellets on Thursday). I noticed some hiccup like breathing after feeding him. He's been having diarrhea every day since he hasn't had solid food and lactoluse is a laxative. We had a bad scare yesterday 2/4 and thought we lost Puff - Puff was cuddling with my boyfriend and his black beard disappeared and his color was like it usually was (yellow/tan/orange), he was not moving when we lifted him up to check if he was still with us. We put a warm water bottle underneath him and his black beard came back slowly. Today 2/5, we received a call from the vet saying that the 88% unidentified WBC may be cancerous (see photos).

Puff's condition is declining and my boyfriend just discussed euthanasia with me. Puff has been sleeping most of the day, occasionally will wriggle around in the blanket to get into his favorite position, lick his face. Occasionally, it looks like he's going to burp. He's still having diarrhea. I know that he's very weak and probably can't handle any more tests. I just want to confirm that there is absolutely nothing we can do before making this decision. I've included screenshots of the blood work, comments, and the vet's e-mail today. I'm not sure if these results are typical and if the results are so extreme that there was an error? Is there anything that we've missed? Is this common? I can't shake the feeling that the horn worm triggered all this. If this is cancer, why is it taking my boy down in a week? My boy is sitting next to me and just moved into his favorite position (with his head perched up on the blanket).

I've excluded husbandry details because I don't think that husbandry could lead to this. Let me know if it's necessary, I will provide details if so. Thanks everyone.

 

[Drache613]

Hello,

I just responded to your PM. I am sorry that your boy is so ill. It is always so difficult when
they become this critical.
How much lactulose is being given? That is somewhat hard on him to give too much.
I did look at the blood work & his uric acid levels are very low which can indicate that his
kidneys are not functioning optimally. Did this just start after he ate the hornworm? If he
does have cancer, that is usually not a very good prognosis unfortunately. There have been
some cases where they can recover but it depends on the severity.
Are you still giving oral fluids or the IV ringers fluids for him?
You could consider using some CBD oil to help, in case he does have cancer. You know him
better than we do, so he will let you know when he is ready. I know, you don't want him to
be in pain. I am always so undecided about euthanizing. I always feel that they are better off
with their owners at the end because they have comfort.

Let us know how he is doing.
Tracie

 

[puffyboy]

Hi! I responded to your PM Tracie, thanks for putting in the time to respond twice

I'm very confused at the moment. The vet diagnosed Puff with acute leukemia based on the blood work and blood smear. Does any one know if this diagnosis is usually a downward spiral or like a roller coaster?

Puff has been getting 0.05ml lactulose+100mg/mL milk thistle. I've since stopped giving Puff the lactulose/milk thistle mix but still continuing with antibiotics/antiprotozoa. He's been more energetic and his black beard reduces when he is warm on top of a warm Nalgene bottle in the blankets with me.

Found out some information from my boyfriend today as well - apparently Puff had an undigested poop last week that had the skin of the big horn worm and the exoskeleton of a cockroach. He was in his basking spot after eating, so I'm not sure why it's not fully undigested? He's been pooping well on and off the lactulose. Could the leukemia or an infection cause indigestion? Is it possible the horn worm was too big and irritated his gut and immune system? I'm shooting as far as I can here in hopes it's not cancer.

Good thing though, we fed Puff baby food an hour ago. He was squirming in my boyfriend's hand and when he reached our bed.. he ran across it to his little bed (on top of a warm water bottle) and left a trail of good-looking urate and slightly watery solid dark green poop. I was so happy I didn't even care we had to clean it up. He's since gotten in his favorite spot in his tank with his face pressed against the glass.

I'd appreciate any advice/experience with undigested buggies! and more serious diseases :?

 

[puffyboy]

On another down in my roller coaster, Puff was putting his head upwards on the glass. He started wheezing shortly after and exhaling what sounds like a puff of air if you inflate a balloon.

Telltale signs of respiratory failure or URI? :|

 

[Drache613]

Hello,

I did send a PM this evening.
They are sure it is leukemia or just suspecting?
A lot of dragons seem to have trouble with respiratory infections during the winter. Is his
breathing labored or erratic right now?
Be sure to keep him warm overnight right now to help boost his system since he isn't feeling
well. I am glad that he did have some baby foods, that does help.
Let us now how he is doing.

Tracie

 

[ComicBookMama]

Sending positive vibes and prayers your way... I've had to help three pets "cross the Rainbow Bridge" so far, and it's never something you can be 100% certain of. A part of you almost always wants to know if there's more than can be done, or done differently, or helped. I hope you can come to some decision that will give you peace, whether it be to allow Puff to live out his life for as long as he's got, or to help him go in a kind and gentle way. Whatever decision you make, we support you.

Hope Tracie can help you with the medical side of things. She's the best!

 

[puffyboy]

Here's the PM I sent to Tracie also, hopefully it will help others just like when I scoured through dozens of threads. Thanks for bearing with me through my lengthy posts, Tracie and all! I was hesitant to post here at first, I was still coming to terms with reality.
----
Puff's right kidney is fully calcified I believe. The vet said he has about 35% function in the kidneys and that's all he needs. The last time he had an x-ray was about a year and a half ago, no issues noted then. He went in for mouth rot at the time (treating it since 2018-now).

His urates look normal, a little more gooey I assume from the poop attached to it. They're characteristic of a normal urate with the white coating neatly wrapped in a elongated oval shape.

He's been drinking water on his own through a stream in the sink faucet usually before and after he poops. He's also getting fluids (Lactated Ringers) every day through IV. I think the laxative may have made him more lethargic. I've noticed that since he's been off of it for 4 days now and he can perch up on his arms and open his eyes to look around more often. It would be nice to give him milk thistle but it's combined with the laxative. I'm contemplating on purchasing milk thistle and diluting it to 100mg/mL myself.. I'll try to get the vet's advice on this as well.

There is no current amount of time that Puff should be on his current medications (Enrofloxacin, Metronidazole). The vet prescribed more medications if we choose to pick them up:

-Azithromycin (200mg/5mL = 40mg/mL)
Dose: 0.1mL by mouth every 3 days

-Acyclovir (250mg/mL)
Dose: 0.1mL by mouth once a day for 3 days then every 3 days

I'll message the vet to ask about the medication plans, we didn't get a clear end date. She advised us to go to UC Davis Vet Hospital to get further testing (chemotherapy, kidney biopsy) and in the mean time prescribed the above. I don't have any plans at the moment... I definitely do not want to proceed with anything invasive such as the biopsy.

I'll post a picture of Puff to the thread I've been posting on. I took it this morning before heading to work, he looks a little tired but overall he doesn't look like what I'd expect a beardie with serious acute leukemia to look like. My boyfriend just told me that Puff has a slight interest in food. He was eyeing a protein pellet to hunt but backed off when he saw it wasn't moving.

 

[puffyboy]

Sending positive vibes and prayers your way... I've had to help three pets "cross the Rainbow Bridge" so far, and it's never something you can be 100% certain of. A part of you almost always wants to know if there's more than can be done, or done differently, or helped. I hope you can come to some decision that will give you peace, whether it be to allow Puff to live out his life for as long as he's got, or to help him go in a kind and gentle way. Whatever decision you make, we support you.

Hope Tracie can help you with the medical side of things. She's the best!

Thank you so much for your support and compassion You said exactly what's been on my mind, I'll continue to update! I'm against euthanasia mostly because I can't be by Puff's side due to the pandemic, we have to wait outside in the parking lot most likely.

 

[puffyboy]

The vet suspects acute leukemia but is not 100% sure. Puff started to feel unwell after the horn worm last week, and did poop it out partially undigested with a cockroach exoskeleton. He's been pooping well by himself. Could this be a misdiagnosis? Really praying that is the case.


Photo from August 2020. This is Puff's usual home, he has a log where he basks. Newspaper lining the bottom of the tank.
Heating pad below the log area.

Puff as of this morning, he pooped in our bed so he's in his tank. We took out the log so we can see him. This may have exposed him to dust built-up? He was gaping and puffing his throat last night for about 2 minutes. No mucus though.. I hope his lungs are okay. It's pretty humid where we live, lots of fog and rain lately. We could also do a better job of cleaning his tank, will do that when I get home.

Puff this morning, he's looking around.

Took him out for medicine (this photo is from Saturday, but he's radiating here)

 

[Drache613]

Hello,

Oh he does look a little tired but surprisingly good for a leukemia diagnosis.
As far as the calcified kidney, I am not sure how that actually happened. They are positive
his kidney is fully calcified?
If you can maintain his renal function, he should hold out for awhile, depending on the severity
of damage. I would definitely not go through with a kidney biopsy simply because a surgery such
as that is pretty invasive so he would be better off not going through that. You can start him on
black or tart cherry juice extract as well to help with flushing out his kidneys.
Those medications for now, should be ok. I agree, keeping him on a laxative for too long is hard
on his body. I would consider milk thistle though, alone instead.
His colors look pretty good actually. Can you look at the color of his gums, are they pale or a
nice pink color?
Are hornworms part of his normal diet? Where did you get them & what do you feed them?

Keep us posted on him!

Tracie

 

[puffyboy]

That's my bad, he has 35% function in his right kidney.** The vet said his left side gums were pale, I haven't gotten a good look since. I'll check tonight. He usually eats horn worms, cockroaches, crickets, greens, prickly pear, peas, sometimes mango. I wish I was there to snap a picture of his poop with the undigested horn worm and cockroach.

Thank you for the recommendations also, I'll look for milk thistle and cherry juice extract after work.

After Puff drinks water, he looks like he's swallowing or burping. A little puff of air comes out when he opens his mouth. It's very similar to @Jacob1289's video: https://youtu.be/7Z2b7nYDXF8 (borrowed your video, I hope that's okay!)

I dropped off a fecal sample to check for parasites at a nearby vet different from the previous vet. The previous vet rejected a fecal sample initially but now I would like peace of mind knowing it's not parasites. Will update after

 

[puffyboy]

Hi all, Puff was negative for parasites. I wanted to get him some solid, live insects today. Any recommendations to start him off easy again? Still continuing with baby food but hopefully he regains his interest in food.

Puff's beard isn't as dark of a black as it was before. It's like a grey mixed with his normal color. I can see his hip bones, hopefully feeding him will help him regain some strength and keep fighting.

 

[Drache613]

Hello,

I am glad to hear he seems to be doing better right now & that his fecal was negative.
Is his beard still looking better?
I would avoid roaches for the most part, maybe a few here & there. They are high in uric
acid & protein so it's best to go easy on those. Silkworms or hornworms are both very good
or even the phoenix/calcium worms, too. Crickets are good as well. I would however, keep
the protein at a minimum. Continue giving oral fluids & I hope you are able to get him on the
cherry juice & some milk thistle, too.
The vegetation you are giving is perfectly fine. Does he like the prickly pear?

Tracie