Osteomyelitis advice?

[Spider8ait1994]

I just got some unfortunate news from my vet about my eldest rescue dragon Spike (a 4-5 year old male Central) some quick backstory: his original owners had no idea what they were doing and as a result one of the issues he was suffering from was calculus buildup on his lower jaw.
Recently he seemed to have an ulcer and was on antibiotics for that (Ceftazidine). This seems to be lessening the inflammation however dental X-rays were reccomended to check for bone involvement.
Results confirmed that yes there is bone involvement.
I’ve been informed that all I can really do is keep up regular dental checkups and cleans and do long term antibiotic courses with the anti-inflammatory painkiller Meloxicam every 2 days.
If anyone has any insight into this (for example treatment options, dealing with long term antibiotics specifically Ceftazidine given intramuscularly, outlook for the future etc) it would be greatly appreciated.
At this point he’s still eating greens and insects just fine which is great.

 

[Shinryu]

@AHBD, do you have any experience with this by chance? I'm afraid I'm a bit out of my depth with something like this.

@Spider8ait1994, I wish I had some advice. I tagged someone who may be able to help. I'm sorry to hear that Spike is dealing with these issues. I hope he starts feeling better soon!

 

[Spider8ait1994]

Ok so here’s an update on Spike.
I picked him up this afternoon from the vets and I also was able to get a copy of his X-rays.
The relatively good news is that it appears the affected patches of bone aren’t massive. As for the lump the antibiotic treatment he’s been on has been slowly improving it, while he was under for the X-rays I consented to having the vet surgeon take a biopsy which has been sent away for analysis though the theory we have with this confirmation of osteomyelitis is that the lump is likely a secondary symptom of it.
I have read that with appropriate treatment the outlook is often pretty good.
As I said in my original post he is still eating insects and vegetation in addition to calcium supplements and time almost daily outdoors in the natural sunlight weather permitting.
He’s definitely a strong and otherwise healthy dragon particularly compared to his condition when I first got him.
The plan we have for now is to treat it with the anti inflammatory painkiller Meloxocam given orally every 2 days and continuing the antibiotics, Ceftazidine, given intramuscularly every 3 days for at this stage 6 months. He has a post proceedure checkup on the biopsy site in 7 days and a follow up/antibiotic refill in a month. We also plan to schedule regular dental checkups and dental cleaning whenever it’s necessary.
I’ll attach his X-rays here for anyone curious.

 

[AHBD]

Hi Spider, can you post pics of the dragon as well ? It's good that he's still eating well so hopefully that won't stop during treatment. Long term antibiotics can do harm to beardies , so I'd want to be sure that they were really necessary. Also, if he's eating well then he must not be in pain. Calculus build up per your vet's diagnosis is excess build up + hardening of dental plaque. Is that what you see in his mouth or is is beard sagging ? Pics will be very helpful.

 

[Spider8ait1994]

Hi Spider, can you post pics of the dragon as well ? It's good that he's still eating well so hopefully that won't stop during treatment. Long term antibiotics can do harm to beardies , so I'd want to be sure that they were really necessary. Also, if he's eating well then he must not be in pain. Calculus build up per your vet's diagnosis is excess build up + hardening of dental plaque. Is that what you see in his mouth or is is beard sagging ? Pics will be very helpful.

Of course. I actually keep logbooks for both my dragons since they’re rescues (and it’s just good keeping practice in general) so I’ll include some snaps from that too and hopefully my handwriting is legible.
I think I mentioned he was diagnosed with a calculus buildup last year so he had a dental proceedure for cleaning where the vet surgeon removed as much of it as she could.
He has had that brown coloration on his lower jaw since he came into my care in 2018 so really all the issues he’s had have been resulting from the improper care of the original owners. I’ll also include a photo of him from a couple days after I got him as reference for his condition back then and his condition now.
In the photo of one of the logbook pages that lists date, food, supps + meds, poop most of the days with no poop were days he couldn’t get outdoor time because of weather, (he hates having to poop in his enclosure so will hold it until he’s outside or tap his enclosure doors to let me know he’s gotta go lmao)
Another thing to note what with the biopsy of the lump he had yesterday he may be a bit swollen.
Ok so details about the photos:
1: lower jaw coloration + buildup BEFORE dental cleaning procedure.
2: lump/mass in mouth progression with antibiotic treatment.
3: reference page from logbook
4: background page
5: latest page in logbook
6: current condition head right side
7: current condition head left side
8: current condition
9: condition upon acquisition 2018

 

[AHBD]

Wow, he was really skinny and in bad shape when you got him ! He sure gained a lot of weight under your good care and that mess in his mouth didn't keep him from his grub. That brown stuff looked just like thick dark molasses, was it liquidy ? So now there's an abscess in the back of his mouth that the vet is trying to figure out exactly what has caused it ? BTW, you keep VERY good records, excellent job !

 

[Spider8ait1994]

Wow, he was really skinny and in bad shape when you got him ! He sure gained a lot of weight under your good care and that mess in his mouth didn't keep him from his grub. That brown stuff looked just like thick dark molasses, was it liquidy ? So now there's an abscess in the back of his mouth that the vet is trying to figure out exactly what has caused it ? BTW, you keep VERY good records, excellent job !

No it wasn’t liquidy but rather predominantly firm hence the diagnosis of calculus and the dental proceedure to scrape as much off as possible.
The vet surgeon who did the proceedure said they were able to get a good chunk off but not all of it and he was given a course of ceftazidine post proceedure.
The first date in the pic of the mass is the day I noticed it when he was out basking with his mouth open. Initially I assumed it was from a cricket bite as he did attempt to store a live cricket in his beard a couple days previous which obviously didn’t go well.
The following day he had a vet appointment to check the mass out ~3 months ago and was given Meloxocam and ceftazidine. Since then he’s had 3 further vet appointments to monitor the mass which resulted in a continuation of the antibiotics so as of yesterday he’s had 3 courses and I’ve been given a fourth course to continue with so he has been on antibiotics for a good amount of time now but the actual osteomyelitis was only diagnosed yesterday with X-rays and as I said originally the biopsy of the mass was done. From what I recall the type of analysis of the biopsy sample is hystriology (?).
Diet wise he’s pretty good, doesn’t have anything larger than the space between his eyes, calcium every third day (alternating with 2 consecutive No D3 followed by with D3), his primary insect now is wood roaches which I dust with the supplement and he gets a variety of vegetation of which I homegrown what I can so I know it’s fresh and chemical free for him)
When I first noticed the mass his appetite had decreased but with the antibiotic courses after the first course it did pick back up again and has remained ideal.

 

[AHBD]

Wow, he's doing quite well despite all the meds. and the mass at the back of his throat. His jawline looks normal to me and I'm not sure about the diagnosis of osteomyelitis. Can you ask exactly what in the xray shoes that it is ? I'm not a vet but have seen very many cases here where certain dragons were misdiagnosed and suffered by excessive and aggressive treatment. Not saying that this is the case with Spike but it's good to question everything and know exactly why something is determined and what causes it. It's odd that the mass has not grown nor decreased in size, I understand the reason for the antibiotics in that case and hope that Spike can endure the months of treatment without other serious side effects such as kidney or liver problems. Keeping him well hydrated will always be helpful. Keep up the good work and give Spike a pat for me.

 

[Spider8ait1994]

Wow, he's doing quite well despite all the meds. and the mass at the back of his throat. His jawline looks normal to me and I'm not sure about the diagnosis of osteomyelitis. Can you ask exactly what in the xray shoes that it is ? I'm not a vet but have seen very many cases here where certain dragons were misdiagnosed and suffered by excessive and aggressive treatment. Not saying that this is the case with Spike but it's good to question everything and know exactly why something is determined and what causes it. It's odd that the mass has not grown nor decreased in size, I understand the reason for the antibiotics in that case and hope that Spike can endure the months of treatment without other serious side effects such as kidney or liver problems. Keeping him well hydrated will always be helpful. Keep up the good work and give Spike a pat for me.

He’s going back to see the vet on Monday so I’ve been doing some research in on the condition in the meantime and have put together some questions for the vet.
Vets are still working with covid restrictions here so I have to wait outside and they talk to me over the phone so I’ve written my questions down on some paper to be answered.
I’ll definitely add a question about the X-rays to the list but as of now my list of questions to the vet includes long term effects of the condition, any impact on lifespan, alternate treatment options or trying a different antibiotic, possibly taking a swab/sample of the affected area to culture and find the specific bacteria strain and tailor treatment to it, long term effects on the kidneys/liver and what I can do to minimise that etc
He does stay pretty hydrated so I make sure he’s always got a water bowl in his enclosure, I usually give him a bath every 10 or so days (or less if it’s required) and when he’s having outdoor time I’ve built a drop down enclosure for him so he stays safe but can still get that natural sun and in that he’s got a basking rock but also a pot plant saucer I put fresh water in, it’s shallow enough he can’t get into trouble but holds enough water that he can sit in it and splash it around (which he loves doing) I also always keep an eye on his poops particularly since he’s previously had a parasite issue and so far his urate hasn’t been showing any yellowing which I’m aware can be an indicator of dehydration and/or kidney issues.

 

[AHBD]

That all sounds very good, you seem to really be on top of things . I'd love to see the outdoor enclosure !

 

[Spider8ait1994]

That all sounds very good, you seem to really be on top of things . I'd love to see the outdoor enclosure !

Haha yeah I’ve always had an interest in reptiles and actually took a herpetology/reptile zoology course last year so I could learn more and give my boys the best care possible.
As for the outdoor enclosures they’re pretty simple but work really well.
They consist of some sturdy wire mesh panels I’ve cut to size and attached together with some thick wire I coiled but wrapping around a screwdriver. On one side I’ve secured it via 4 U brackets, bolts and wingnuts. The reason for that is that when you unscrew the bolts the whole thing folds flat for east transport and storage and it quick to set backup again.
With the construction being wire mesh there’s an option to secure it into the ground with tent pegs if need be.
I’ve also got some synthetic turf mats I sit underneath the enclosures to help protect their feet from getting too hot but also to protect the back deck. To add shade when required I sit a cushion or something on top which casts a shadow into the enclosure and since I have two dragons I also put up an old picnic rug between the two enclosures so they can’t see each other.

 

[AHBD]

Those are really nice, I see him lounging in his pool ! I like the idea of cages being collapsible. Beardies really benefit from being outside, I put all my beardies out from the time they hatched . Here's one outdoor cage, I have a long basking stick for climbing and a piece of plastic trellis that serves as a basking spot or shade underneath.

https://www.beardeddragon.org/media/40059-484323539-jpg.29954/full

 

[Spider8ait1994]

Those are really nice, I see him lounging in his pool ! I like the idea of cages being collapsible. Beardies really benefit from being outside, I put all my beardies out from the time they hatched . Here's one outdoor cage, I have a long basking stick for climbing and a piece of plastic trellis that serves as a basking spot or shade underneath.

https://www.beardeddragon.org/media/40059-484323539-jpg.29954/full

Oh wow that looks pretty fancy.
I also just got a bit of an update from his vet regarding the biopsy.
The pathology isn’t fully complete but they have found so far that the mass is inflammatory in nature so that’s good news considering what it could have been.
They’ve also said they’re currently doing what they’ve called staining to see if they can ID any specific infectious agents.
From the information I have now it does seem my recent theory of it all being linked to the osteomyelitis is correct.
With any luck we’ll be able to tailor a treatment to maximum effect.

 

[Drache613]

Hello,

I am very impressed with his progress, bless him! I am sure that he loves his outdoor enclosure, too that is great you
have done that for him.
They don't think that the infection will clear up anymore than they already have, in his mouth/jaw area? How long has
he been on the Ceftz? Does the Meloxicam seem to help him out?
Are you giving a probiotic for him, too since he has to be on an antibiotic for long term? You can definitely do dental cleaning weekly at home, to help keep bacteria & oral infection down.

Tracie

 

[Spider8ait1994]

Hello,

I am very impressed with his progress, bless him! I am sure that he loves his outdoor enclosure, too that is great you
have done that for him.
They don't think that the infection will clear up anymore than they already have, in his mouth/jaw area? How long has
he been on the Ceftz? Does the Meloxicam seem to help him out?
Are you giving a probiotic for him, too since he has to be on an antibiotic for long term? You can definitely do dental cleaning weekly at home, to help keep bacteria & oral infection down.

Tracie

September was when I noticed the lump and he was able to get in the day after I noticed it so it’s been around 3 months on Ceftazidine. He’s just finished his 3rd course and each course is 10 injections he has a 4th course ready to go.
As someone who also undergoes regular injections I know they can be unpleasant so I do alternate which thigh I give it to him in to give each muscle a break for a bit.
You’ve probably seen the photos I added to one of my earlier replies which show the lump. As you can see it was pretty red and big but has lost that redness and shrunk down some. As of now it’s slightly smaller than the final state it’s shown in on the photo.
The Meloxicam definitely seems to help him out, he had a dose of it this morning and while his appetite has been pretty good still he definitely eats more enthusiastically on the meloxicam.
I haven’t given a probiotic but that is something I plan to ask his vet about when he goes back on Monday (2 days time).
Considering the appearance of the mass from what it was to what it is now the ceftazidine has definitely done at least something and the pathology is currently conducting a stain to try and find out what specific bacteria is responsible which will give a better idea of what antibiotic it will respond best to.
I do plan on asking about alternate antibiotics as I have come across a lot of success stories in my research in which the dragon affected was on Baytril.
I do also give his teeth a bit of a clean usually weekly by giving them a wipe with a q-tip provided he lets me but he’s usually pretty good with letting me do stuff with him.
For whatever reason I’ve always had a way with reptiles and they’ll call right down for me. When this guy was rescued he wouldn’t let anyone so much as think about touching him let alone pick him up and then I showed up and he did a full 180 like he’d decided HE wanted ME.
I like to think that in some way he knew that I’d help him get better and we’re almost there. This mouth/jaw issue is the last damage left to sort out so fingers crossed we get there.