Older (9yo) male beardie has edema with low appetite, skinny urates

[Sophielius]

Hi all,

I'm feeling a bit stumped about my beardie's health, his vets seem to be as well and I wanted to see if anyone had any input. My beardie Raxtus (ADV positive) has had a decreased appetite since the beginning of the year. We took him to the vet, and they found edema. We've added another liver supplement to his regimen (he's now on two). He's hard to get interested in eating on his own. He's on herbivore emeraid (he'll only take about 2-3mL a day but doesn't seem to hate it) and whatever dandelion greens I can shove in his mouth. He hasn't shown interest in eating more than a couple of smaller roaches on his weekly bug day. His bloodwork has returned normal, as has an ultrasound (except for noting the edema and its compressing effects on his blood vessels). A couple years ago, imaging showed some speckling on his kidneys for what that's worth.

Another somewhat recent (about 4months) symptom is skinny urates. They're the normal length and he's hydrated as far as I can tell with the skin pinch test, but they're about half the width as they used to be. My concern is perhaps some emergent kidney issues. The next step the vet will likely recommend is a biopsy.
What could be causing this unexplained edema? Could it all just be his ADV progressing over time? If anyone has any thoughts or similar experiences, please let me know.
(Husbandry consists of a 4x2x2 cage, Arcadia UVB tube 34", one of those bright Jungledawn bars, a basking zone (~100F), hides on both warm (~90F) and cool (~80F) sides of cage, substrate is mostly a mix of topsoil and sifted play sand)

 

[Claudiusx]

His bloodwork has returned normal

Can you post this for us to look over?

he's hydrated as far as I can tell with the skin pinch test

This isn't a good indicator of hydration status. Visual and physical examination of the urate and poo is the only real at home way. Do you ever try offering water? Does he drink at all?

Besides the decreased appetite, how has the activity levels been?

-Brandon

 

[Sue E.]

You mentioned he has edema ,skinny urates, and speckling on his kidneys' imaging. I am NOT a vet or experienced in beardie health, but in humans this combination is indeed an indicator for kidney failure of some concern. I think you are on the right track thinking his kidney function may be compromised. A healthy kidney's function is to filter whatever fluids needed into the blood and remove the rest (urine), and when a kidney is failing, these fluids arent being filtered and excreted properly, causing them to build up in tissues, also decreasing urine output. So, in a human, the issue isnt what they are taking in, but the fact that the kidneys are not doing their job. In humans, to prevent fluid build up in tissues and organs, overhydration becomes more of a concern than dehydration. Now, as I said, I DONT know beardies specifically...that is a question for more experienced keepers as well as your vet. You mention he is older. Was the ultrasound you had done of his kidneys? Definitely post the bloodwork if you can for the experienced keepers like @Claudisx and Tracie the vet tech to look at.
@Drache613

 

[Sophielius]

Can you post this for us to look over?


This isn't a good indicator of hydration status. Visual and physical examination of the urate and poo is the only real at home way. Do you ever try offering water? Does he drink at all?

Besides the decreased appetite, how has the activity levels been?

-Brandon

I've reached out to the vet for the exact records and will post them as soon as I get them!

I had no idea that wasn't a good indicator, thanks for the info. I haven't offered water in a while, I assumed that his liquid food diet and well-hydrated greens were enough but now that I'm typing this out I'm thinking I need to make a couple of changes.

When he's had a water bowl in the past he just ignored it so eventually it got phased out of his enclosure. I've made sure to always have his daily salads well misted with water and soaked the greens before chopping to be crisp and water-filled. I think I'll add a water bowl back in his cage for hydration's sake.

Since spring's arrival, he's been more active when taken outside. I've been taking him outside a few times a week and he's had lots of fun exploring the yard. He insists on being out there for about an hour and then he likes to come in and be held the rest of the day as he snoozes. Other than that, he likes to dig in his cave pretty much daily, and that's about the extent of his activity.

 

[Sophielius]

You mentioned he has edema ,skinny urates, and speckling on his kidneys' imaging. I am NOT a vet or experienced in beardie health, but in humans this combination is indeed an indicator for kidney failure of some concern. I think you are on the right track thinking his kidney function may be compromised. A healthy kidney's function is to filter whatever fluids needed into the blood and remove the rest (urine), and when a kidney is failing, these fluids arent being filtered and excreted properly, causing them to build up in tissues, also decreasing urine output. So, in a human, the issue isnt what they are taking in, but the fact that the kidneys are not doing their job. In humans, to prevent fluid build up in tissues and organs, overhydration becomes more of a concern than dehydration. Now, as I said, I DONT know beardies specifically...that is a question for more experienced keepers as well as your vet. You mention he is older. Was the ultrasound you had done of his kidneys? Definitely post the bloodwork if you can for the experienced keepers like @Claudisx and Tracie the vet tech to look at.
@Drache613

I'll definitely post the bloodwork once it's sent my way They did their best to ultrasound the kidneys but I was told it's hard to see them because they're tucked away in their pelvis, though they did try. Due to this, we elected to have a CT with contrast done and they looked at his liver and kidneys. We were told there wasn't anything seen of particular note but more colleagues will be consulted in the morning before we go to pick him up. (He's been slow to fully come around after being sedated for the CT)

 

[Sophielius]

Here is his most recent bloodwork, it was done in February. I can attach the bloodwork for January if that's of use, but I thought I'd start with this.

Here are the vet's notes from Raxtus's visit:

"Raxtus was seen for decreased appetite and narrow urate production. On physical exam we found recurrence of his coleomic fluid buildup that is also causing edema of the subcutaneous spaces (layer between the skin and muscle) of the head, around the eyes, and gular pouch. We also noted occasional tremors that increase after stressful events and handling, which are a result of his adenovirus infection. We performed a coelomic ultrasound first, which showed a large amount of free fluid in the coleom. The "feathery" changes I previously saw in the greater blood vessels of the liver were no longer present. As a next step, we performed a CT scan with IV contrast. He was sedated for this procedure and stayed overnight for post-sedation monitoring. His CT scan showed no obvious changes to the kidneys and his blood flow through the liver appears normal. His greater blood vessels appear tortorous in nature, but this could also be related to his fluid buildup. The next potential diagnostic steps would be an endoscopic exam and biopsies of the liver and/or kidneys, which I will email you an estimate for today (see attached). If these tests are also normal, I am inclined to believe that all of these symptoms are originating as a result of his adenovirus infection. Please let me know if you have any questions about this plan, or if you have any concerns about how Raxtus is doing."

 

[Claudiusx]

Hmm... the bloodwork is pretty unremarkable to be honest.. which is a good thing. But it does gives us a few cryptic clues as to what is going on.

BA is low, that is fine, it usually is in reptiles.

Icterus +1 is a yellowing of the plasma, and is associated with potential liver problems or bilirubin issues. Even though the BA is low, the Icterus +1 indicates some level of strain on the liver.


WBC is low, indicating a possible chronic illness, viral infection, or immune suppression (possibly all three... we will get to that later)

Basophils are low. This paired with the low WBC points strongly towards some type of immune suppression response.

All other blood counts look normal, which indicate no acute infections.

It's great your vet took good notes, it helps figure what their train of thought was too. Based on the CT scan and other tests you've done, it does sound like ADV is the major player here, but its not clear if it's the cause or if its just a contributing factor. The bloodwork indicates mild liver strain. Is it from the ADV or is it from something else? Impossible to tell at this point.

ADV isn't a death sentence, but it does complicate infections and sickness. Even with the edema, I would recommend on keeping up with the hydration (post a picture of the next BM if you can, we can get a good idea on the hydration levels just from the picture.) and consider supplementing with milk thistle, which would help the liver.

It's possible that the powder you are giving is a bit too intense for the system right now. You might want to try offering squash babyfood for now as the bulk of the diet if he isn't able to eat on his own. While the powders are chocked full of nutrients, sometimes it's too much densely packed nutrients that put strain on the metabolic system.

It would be interesting to see bloodwork repeated in two weeks or a month, to see what the trend is looking like. Especially if dehydration is found to be a contributing factor.

-Brandon

 

[Sophielius]

Hmm... the bloodwork is pretty unremarkable to be honest.. which is a good thing. But it does gives us a few cryptic clues as to what is going on.

BA is low, that is fine, it usually is in reptiles.

Icterus +1 is a yellowing of the plasma, and is associated with potential liver problems or bilirubin issues. Even though the BA is low, the Icterus +1 indicates some level of strain on the liver.


WBC is low, indicating a possible chronic illness, viral infection, or immune suppression (possibly all three... we will get to that later)

Basophils are low. This paired with the low WBC points strongly towards some type of immune suppression response.

All other blood counts look normal, which indicate no acute infections.

It's great your vet took good notes, it helps figure what their train of thought was too. Based on the CT scan and other tests you've done, it does sound like ADV is the major player here, but its not clear if it's the cause or if its just a contributing factor. The bloodwork indicates mild liver strain. Is it from the ADV or is it from something else? Impossible to tell at this point.

ADV isn't a death sentence, but it does complicate infections and sickness. Even with the edema, I would recommend on keeping up with the hydration (post a picture of the next BM if you can, we can get a good idea on the hydration levels just from the picture.) and consider supplementing with milk thistle, which would help the liver.

It's possible that the powder you are giving is a bit too intense for the system right now. You might want to try offering squash babyfood for now as the bulk of the diet if he isn't able to eat on his own. While the powders are chocked full of nutrients, sometimes it's too much densely packed nutrients that put strain on the metabolic system.

It would be interesting to see bloodwork repeated in two weeks or a month, to see what the trend is looking like. Especially if dehydration is found to be a contributing factor.

-Brandon

Thank you so much for your thorough response!
He's had his ADV diagnosis since 2019, and has been on milk thistle ever since. A couple months ago we introduced a new supplement that the vet clinic calls "liver happy" and from what I understand, it's an herbal blend that's supposed to help the liver function better. Since being on it (and having primarily dandelion greens for salad), his edema has improved, and he experienced a shed on his limbs, beard, and tail tip in February (where usually he sheds once a year in late summer).

The vet recommends doing a biopsy, but I am hesitant since he's been slow to recover from sedation and I'm concerned about the potential for serious complications or death from anesthesia. I'm worried that the potential cons outweigh the seemingly small pros in having this procedure done. I've asked some follow-up questions regarding their recommendation and hope to hear back soon. I'd be much more on board with repeating bloodwork in a month or so to see how things are on that front.

Raxtus can eat alright (he ate two dried soldier fly larvae today!), he just refuses his salad and eats fewer bugs on Bug Day. He lets me know when he's had enough slurry, as he'll move away from the syringe once he's had a mL or two. He's gained about 30g since being on this slurry, I think I'll give that squash babyfood a try to help keep him from gaining lots of weight. (Tangentially related, but he went on a greens strike for an entire year from 2017-2018, and I blended greens and droppered them to him a couple times a week. I'm somewhat hoping this may be just a recurrence of that, though it's doubtful given the edema issue.)

He pooped while outside today and I didn't think to take a pic, though I did note that his urate was longer and had a more bulbous end to it than normal. I'll take him outside tomorrow, and will post a pic once he provides a sample.

Thanks again for taking the time to discuss this and offer advice, it's very much appreciated.

 

[Sue E.]

Just my 2 cents, for what its worth...I think since he is eating and seems comfortable, Id just repeat the bloodwork in a month or so too. The biopsy is invasive, it may tell them whats going on, but it wont really change the course of treatment for him. Hes not going to get a liver transplant i.e. they cant "fix" him as a result of the biopsy. Keeping him hydrated and helping his body do what it needs to do on its own with supplements, good nutrition and conservative care is probably going to give him a better quality of life. Again, just my opinion...sounds like he has had and will continue to have a good life with you. Wishing you and your beardie all the best!

 

[Drache613]

Hello,

I agree, biopsies while helpful, are invasive so unless it really is needed I would hold off for now.
Adeno definitely causes issues with the liver since it does tend to target the liver. However, liver
cells can regenerate & keeping him on the Milk thistle mix that should really help him out. The AST
levels are within range but the BA is somewhat low. I would try to keep his diet relatively low fat. The uric acid levels are low which can indicate stress, renal issues or infection. I don't think he is
dehydrated at the moment. As mentioned his white blood cell counts are low which could simply
mean his system is fighting some type of infection.
His calcium to phosphorus ratio is good! The Glucose readings are within range, thankfully.
The squash baby food is usually well tolerated so he should enjoy it & he will get adequate nutrition
from that as well.
They can be very stubborn about eating their greens, too! So he loves dandelion greens?
I hope he is feeling better soon!

Tracie

 

[Sophielius]

Thanks so much for the input everyone! Having more eyes on his situation helps me feel a lot better. He's still recovering from the sedation from two days ago now, so I believe I will go ahead and do bloodwork in a month or so and revisit options then.
My vet recommended that dandelions comprise 50% of his greens to help mitigate edema and whatnot, though he still shows no interest in greens or his previously beloved dandelion flowers. I've been able to gently force him to eat a one-inch piece of dandelion green a day, and will be starting up with the squash baby food.

I took him outside today. He unfortunately had a spook and got a black beard that took a while to go away with cuddles indoors. Before that, he pooped as per his recent habit, and I've uploaded a photo in the spoiler. The skinniness of the urate is what's been typical for him the past few months. The extra liquid that comes out along with the poop is typical as well, and can be seen staining the rock.

Spoiler: Fecal Sample Photo

 

[Claudiusx]

Hydration looks ok based on the stool picture. Urate is a little off white, could be due to the supplements. No real concern there though

-Brandon

 

[Drache613]

Hello,

Oh they can definitely get scared outdoors! A large bird or any shadows
that they don't know what it is will do it.
I hope he starts feeling better. It does take a few days sometimes for the
anesthesia to completely metabolize & pass through their system.

Let us know how he is doing.
Tracie

 

[Sophielius]

Hey all,

Raxtus is still doing okay today. It still looks as though he's recovering from the sedative.
However, he gave us a horrible scare last night when he was suddenly not responding to us after we retrieved him from basking (he didn't care when we tipped him backwards or sideways, and gently scrunched his eyes when we tried softly prying them open). His breathing was severely depressed. We were concerned enough that we rushed him to an emergency vet, and when we got there, he perked up. He even got a gray beard when being messed with and fought the vet when they opened his mouth (all good news!). They didn't find anything immediately pressing and sent us home after giving him a B12 injection to hopefully help his appetite. We stayed up much of the night just watching him breathe.

Today, he is much more alert than yesterday. He ate 2mL of slurry (might've eaten more, but I didn't want to press it), and we called our regular vet. We've set up an appointment for Monday, where we'll likely get some bloodwork done since it was last done in Feb. It still appears as though he's more mentally alert than physically capable, like he's taking a while to fully process the sedatives out of his system. I'm glad to know that it can take a few days.

 

[Drache613]

Hello,

Wow, that IS a scare, they can really worry us to death. I'm happy to hear he has pulled through. I'm
not sure what happened, but maybe he was still just having trouble with the anesthesia. It sounds like
the B12 injection helped him out some.
At least he did eat some for you, that should help with hydration. That might be a good idea to get a
blood test done on him. Are you keeping him a little warmer overnight, to help boost his system, since
it seems to be taking awhile to get that out of his system?

Keep us posted on Raxtus.

Tracie