Hello
Well first laet me say the vet visit is needed so its good you have an appointment.Since the reptiglo10.0 is linear and 11 inches away you dont have to turn it off as long as you have a bright white light beside however JScott is correct in telling you the bulb is not a good one.At the distance you have you are fairly safe in avoiding damage to the eyes however at tat distance it isnt emitting the uvb needed to get him or keep him healthy.I would still get the reptisun and try to arrange for him to be able to get within 6-8 inches of it OR you could go with an MVB which is what I recommend.A mercury vapor bulb emits both high quality UVB and heat at the same time and has a distance requirement of 12 inches for the 100 watt or 18 inches for the 160 watt.In a tank your size I would go with the 100 watt.The tree top brands IMO in order from best to worst are the Megaray(reptileuv.com),the TRex Active Heat,Power Sun and SolarGlo(dont confuse with sunglo).You are correct the compacts are not good bulbs at all is definately stay away from those.In regards to the sand get rid of it,around her we call it death sand.It has HUGE impaction risks and since he hates it he wont miss it.Stick with solid substrates like papertowels,repticarpet(not my fav),non adhesive shelf liner,or ceramic/slate tile.The towel for sleeping is great and I would leave it in there even after you switch out the sub.This also could be a neurological issue but the vet will have to determine this would bloodwork.He will most likely prescribe liquid calcium but if he doesnt you should consider ordering some online to help boost him up.