Please see these X-ray pics. Infection or Cancer??

[nbaragon]

Hello all -

I am posting this on behalf of my friend in Japan, whose 2 1/2 year old female beardie, Nico, is very ill. My friend has been taking Nico to one of the most respected reptile vets in Tokyo, but the vet hasn't been able to identify what's causing it exactly, even after taking X-rays, so I thought to ask here in this forum too. Any help will be appreciated!!

ABOUT NICO:
2 1/2 years old
Female
370g
16 inches (nose tip - tail tip)
*Nico has been given Calcium with Vitamin D3 regularly, and all the setups are correct.

In the end of July, my friend noticed that Nico was dragging her hind legs, so she thought Nico might have MBD, and took her to the vet immediately. The vet took some X-rays, and pointed out that a lower part (belly side) of her lumbar spine was missing/melting. Please see the arrow in the picture.

The vet suggested 3 different possibilities:
1) Bone fracture resulting from a traumatic injury;
2) Some type of an infectious disease; or
3) Some type of a cancer.

The vet confirmed that other than the affected site described above, there’s no indication of Calcium deficiency, so he ruled out the possibility of MBD.

(I’m trying to have my friend ask the vet again for his exact reasoning why he thought there’s no indication of Calcium deficiency in other parts of Nico’s body. They didn’t have a blood test at that time. Maybe these X-rays can tell?? I don’t know… Does anyone know??)

Considering the way Nico has been kept in the cage, my friend did NOT think the external injury was a possibility, so they are looking into either infection or cancer.

Nico is currently taking medications (probably some type of antibiotics – My friend will find out the exact name of the medicine soon), and the vet says if these medications work at all, the diagnosis will officially be infection, and the possibility of cancer can be ruled out. If the medications don’t work, the official diagnosis will, unfortunately, be cancer.

They are still waiting to see what happens with the medications, but my friend recently (middle of August) noticed that Nico seems to be dragging her hands as well, not just hind legs. Please note that Nico is NOT having tremors or twitches, but it’s more like she’s having a hard time walking. She won’t lift up her belly either.

Also, following the vet’s instructions, my friend is giving her a rehabilitative massage for about 5 minutes every morning, which means she moves Nico’s legs and hands back and forth. Nico doesn’t like it -- maybe it hurts??

Other than not being able to move freely, Nico is eating just as much as she has always been, and pooping once a week.

The last blood test Nico had was in March this year, and according to the vet, all the numbers looked good. She hasn’t had any blood test since the issue started in the end of July.

One more thing to note -- This may or may not be related to the current issue, but Nico had some infertile eggs in February – March this year (which was confirmed by the vet at that time), but the eggs later got "absorbed" (also confirmed by the vet), and Nico ended up NOT laying them. As we all know, around that time in Japan the devastating earthquake/tsunami happened, which caused some nuke plants to shut down there, and people had to have so-called "planned/rolling blackouts" for a few weeks, where each district/area took turns and intentionally knocked out power for 3 hours or so, once or twice every day, in order to avoid a total blackout. Therefore, while it must have been tough enough already for Nico for carrying eggs, she had to be put in a not-so-perfect condition in terms of lights/heating at that time.

So, our questions are:

1) Does the vet’s observation/analysis/strategy seem appropriate and reasonable?

2) If there’s someone out there who went through something similar, is there anything my friend can do to make Nico feel better?

Any help or advice will be greatly appreciated!!

 

[QuincyAndI]

Sorry to hear your friends Beardie is in trouble - those X-rays are certainly interesting & if one of Tokyo's most respected herp's is struggling I'm not sure you'll find definitive answers here. To me though, it does look like blunt trauma, and if the remaining lumbars aren't being affected yet it'd have to be a very slow form of cancer to be so localised. I hope you find all the help you need here!

 

[Cammy]

Let me preface this by saying: I am not a vet or vet tech, nor am I a radiologist. I only have amateur experience working with sick and injured animals under the direction of an actual veterinarian. Please don't take what I say as anything close to a professional diagnosis. Now that I've gotten that on the table...

Reading over your description, I wondered if some beginning form of arthritis was a possibility. Could the damage to the spine be from inflammation of the surrounding tissue causing wear and tear on the bone? Osteoarthritis in humans often affects the lumbar spine...I know that arthritis is usually associated with the elderly, but young people and animals can have it, too. If antibiotics don't work and he rules out infection, could he try antiinflammatories before jumping to cancer? Like I said, I'm not a professional. I realize the fact that it is a young animal with damage to only an isolated area, and there are no spurs that I can see forming on the bones, so arthritis could be a silly guess; it's just what came to mind. I recently worked with a juvenile Chinese water dragon with arthritis, so maybe I just have arthritis on the brain, haha.

To answer your questions:
1.) The veterinarian's course of action seems very reasonable to me.
2.) As for what may help the beardie feel better, it really depends on the root cause of the problem. You did mention that the beardie seems to be in pain during the daily exercises. Has she been placed on a painkiller of any kind? Beardies don't show annoyance easily, so I'd imagine the pain would have to be pretty significant for your friend to be able to tell the beardie doesn't like the excersizes...She should probably let the vet know about this if he doesn't already know.

You also asked whether or not the vet could rule out MBD from an x-ray. The answer is yes. In fact, I'm pretty sure that's one of the most accurate ways to check for calcium deficiency. MBD sufferers' bones will typically come up as almost "foggy" or overly "grey" due to insufficient bone density.

You also mentioned that your friend doesn't think Nico was injured physically as she is being kept in a secure cage. However, even caged animals can experience physical trauma. Even a simple jump off of the cage furniture or twist in the wrong direction could have caused an internal injury. We all know how beardies love to frantically climb and scrape at the walls of their enclosures. She could have easily put too much pressure on the back of her spine while doing this.

I hope Nico feels better soon. I REALLY hope it isn't cancer. Yikes. Keep us posted on how she is doing from time to time.

 

[Drache613]

Hello,

I am so sorry to hear that your friend in Japan has had to go through that horrible catastrophe over there!
Is she able to use a UVB light right now & what type & brand is she using? How long is the dragon able to have a basking light?
How often does she take the calcium with D3? If she had eggs & reabsorbed them, then that does use a lot of calcium.
Based on the x-rays, it appears to be an injury & doesn't suggest any tumors that I can see.
It could also be arthritis, which Cammy suggested, or degenerative arthritis for some reason.
Does she have a copy of the blood tests by chance that I could look over? I would recommend getting another blood test though to see if her calcium levels have changed since the egg reabsorption occurred to ensure nothing has changed since the last test.
It sounds like the vet is doing a good job & actively working towards a diagnosis.
The bones look good, nice & white overall. I don't think she has metabolic bone disease either. She could have low calcium which would affect her ability to have strength, but that is just a possibility. They can have hypocalcemia without having weak bones yet. An injury seems more ilkely to me though. I hope that it is not cancer. If it is, then it is hopefully localized to that one area in the lower lumbar region.
Is there anything in the tank that could have resulted in an injury like this?

I know that there is a lot of radioactivity over there now. I hope that this is not related to that any.
Let us know the antibiotic that she will be on & the dose, etc for her. Thanks.

Let us know how she is doing.
Tracie

 

[nbaragon]

Dear QuincyAndI, Cammy, and Tracie -

Thank you sooooo much for your input!! I translated every word of your replies into Japanese and relayed them to my friend. When/if she gets more information, such as blood test results, new X-rays, and details of the medications, I will post them here again.

It's already been so helpful and encouraging to know that the vet is doing a good job. If not for this forum, we would have no choice but just believe what he says.

Thank you, again, for your help!! I will keep you posted. Pray for Nico's quick and complete recovery...

 

[Drache613]

Hello!

Please keep us posted on Nico & I hope she will be alright. I will keep her in my thoughts & prayers.

Tracie

 

[nbaragon]

Hi all -

Thank you everyone for your prayers for Nico. Here are some updates.

Last Friday (Aug 26), my friend took Nico to the vet again. The good news is that the medication seemed to have worked, and it looks like a new piece of bone has formed/developed around where it was “melting” earlier on the lower part of her lumbar spine. The vet took an X-ray, and my friend took a picture of the X-ray on her cell phone too, but it wasn’t saved properly, so there’s no picture I can post here… Sorry

But the X-ray looked good, and it does seem like Nico’s hind legs and tail are moving better now. Yay!

The bad news is, her arms are both broken now... Please see the X-ray below. The outer side of her right elbow and the inner side of her left elbow are fractured.

This is exactly why Nico seemed to be in pain when my friend tried to give a rehabilitative massage on her arms... (So my friend stopped doing it immediately.)

The vet speculates that the problem on her lumbar spine was in fact some type of an infection, which is apparent from the fact that the medicine did work. Her arms, on the other hand, are probably a separate/unrelated issue. The vet says that it’s unlikely for the same infection to develop on her arms while on medication, so the fractures on her arms were more likely just plain injuries.

My friend and I were talking over the emails -- it makes sense because:
A) Nico couldn’t use her hind legs or tail, so more weight/stress was on her arms; and
B) since more Calcium had to be consumed to form/develop a new piece of bone on her lumbar spine, the rest of her bones, including her arms, were getting weaker.
Is it possible? Please note that this is not what the vet suggested or anything, but my friend and I were just guessing…

By the way, the medicine Nico’s currently taking is a mixture of Anti-biotics, Anti-inflammatory Steroid, and Vitamin B. Sorry, I don’t have the exact names…

The vet's plan is to keep her on the same medication for 2 more weeks, and then take another X-ray in the following week. If her arms are healed by then, the vet will take the Steroid off the medication.

Also on Friday, the vet decided to conduct a blood test on Nico to see if her Uric Acid level has increased due to a decline in renal function -- He suspected a possibility of gout for the condition on Nico’s arms. My friend asked him to check on Calcium and Phosphorus as well:

Ca (mg/dl): >16.0 (Normal Range: 9.0 – 25)
P (mg/dl): 2.4 (Normal Range: 4.0 - 8.0)
UA (mg/dl): 4.7 (Normal Range: 1.5 - 6.0)

The vet said all the numbers looked good. My friend asked him about the Phosphorus number (2.4) not falling within the range (4.0 - 8.0), but he said not to worry. Hmm…?

I’m probably thinking too much, but I was just re-reading my post from last year (http://www.beardeddragon.org/forums/viewtopic.php?f=6&t=133353&start=0 -- By the way, it was so educational!! Thank you, Tracie!) – and Tracie says, “The desired Calcium to Phosphorus ranges are 2:1 or at most 3:1”.

If I’m understating this correctly, Nico’s Ca ratio will be: 16.0:2.4, that is, 6.67:1. Is this okay? Isn’t it too much Calcium or too little Phosphorus?? Does it have to do with the current medicine, perhaps?? Honestly, I don’t even know what I’m talking about here, but I’m just wondering...

My friend re-arranged Nico’s cage setting, and eliminated all the elements that may potentially cause an injury (although she didn't have much to begin with). She also keeps Nico on a web cam all day, and checks all the footage every night. Hahaha. Nice!

Thank you sooooooooo much for your help. Please keep Nico in your thoughts and prayers!

 

[Drache613]

Hello Naoko,

Thanks for posting the new blood test results!
Did you ever find out which UVB light she was using? I am glad to hear that she has rearranged the tank a little so that she is not able to hurt herself by climbing too much.
So the back area is looking better now? That is good news. She is moving her body a little more too?

As for the blood test readings, the calcium is very high. Hypercalcemia can be indicative of several things. It could be egg production, cancer or early metabolic bone disease. If a good UVB light is not being used, then her system could be drawing calcium from her bones to help stabilize her blood calcium which would make it hard. This will throw off the calcium to phosphorus ratios.
The Parathyroid hormone helps to regulate the levels of calcium as well as controls the excretion of reabsorption of phosphate from the proximal tube of the kidneys.
If she is not getting enough UVB lighting, then she is not able to absorb her calcium properly thus creating the imbalance. So, the calcium taken in doesn't really get utilized very well. Too much calcium can cause weakening of the bones or calcification, etc. I don't think this is the case though.
That would explain the breaks in the bones, they are weakened right now.

The uric acid levels are slightly elevated. That could simply be from the stress & slight dehydration.
I really hope that this is not related to the increased levels of radioactivity in that area.
Is he going to do another blood test also? I have no reason to fully suspect gout yet, but we need to watch the uric acid levels though because they are getting close to 5. If the uric acid levels increase, she needs to be taken off of the antibiotics as they are harsh on the kidneys & can affect the uric acid levels.
Is she giving extra oral fluids & probiotics daily?
Let us know how she is doing!
I am keeping Nico in my thoughts & prayers!

Tracie

 

[nbaragon]

Hi Tracie -

Thank you so much for replying. I will relay your message to my friend, but should she keep giving Nico Calcium with Vitamin D3? Or, is it better to stop for now?

As for the light she's using, my friend says it's "Power Sun 100W", which apparently serves as both a basking light and UVB light. It's about 16 inches away from Nico. I think they sell ReptiSun 10.0 in Japan too (I live in Los Angeles, but I've seen them sold at some Japanese online stores), so I will tell my friend to get one.

I will tell her about extra oral fluids and probiotics too. Thank you so much, Tracie!

 

[Mach10X]

Depending on when the powersun was made it could be one of the good ones or one of the ones that puts out little to no UVB (due to manufacturing issues). 16 inches is probably too far, I'd move it more to 11" or so maybe even 10". The only way to tell for sure would be a Solarmeter 6.2. I own one of these and I swear by it. A reptisun 10 would help but for intensive UV 1+ hours of direct sunlight a day is a good jump start, weather permitting. ReptileUV ships overseas, I think Japan uses the same voltage (approx) as the US (100V). The Self ballasted bulb from http://www.ReptileUV.com may not work right but the Externally ballasted one should since it will transform and regulate the voltage. Unfortunately ReptileUV is completely backordered on all their UV products right now, so that's a bust.

Drache613 analyzed the bloodwork beautifully and proposed what may be causing it. Although I have to background in animal medicine, I think the bloodwork may be off in this way due to insufficient UV, this would account for the higher calcium levels, although what Drache613 said is more likely. It wouldn't hurt to work on supplementing the UV input to their dragon in the mean time, and then get another blood test to see how things are progressing.

 

[Drache613]

Hello Naoko,

I wish that I could test her Powersun. In the past, it has been a decent bulb, but too has fallen prey of poor UVB emission. How old is the bulb, do you know?
Since it is a 100 watt you could have her move it closer to her at the 10-12 inch range. Is there a screen or plastic/glass in between her & the light?
I would still supplement calcium with D3 but maybe only 1 time per week right now. I would use plain calcium the other few times per week. Try to order the Reptisun 10 tube bulb as well, in case the Powersun is not emitting the proper light for her. She can mount the Reptisun 10 tube bulb at 6-8 inches from her, with a bright white basking bulb directly beside the tube bulb.

Let me know what your friend decides to do regarding the lighting. Since there have been a few breaks in the bones, I believe her bones have been weakened probably by poor calcium absorption.

Tracie

 

[nbaragon]

Hi Mach10X, Hi Tracie -

Thank you so much for your messages!! Again, I translated every word and relayed them to my friend. She really appreciates your help too!!

So, my friend took the PowerSun away, and placed a ReptiSun 10.0 tube light instead, at about 11 inches away from Nico (I told her she could put it even closer, as you suggested) with a white basking lamp next to it. We will see if this helps... Here's a picture of our beloved Nico:

One question -- Will it be too much UVB if she uses TWO ReptiSun 10.0 lights? It's just that the lighting fixture works for two tube lights, so she's currently using one ReptiSun 10.0, and one regular fluorescent light that came with the fixture (no UVB, just for the brightness), but she already has an extra ReptiSun 10.0. So, if it works better for Nico with two, she would like to use two of them, but if it's too much, she will just stick with one. The cage is W36" x D18" x H24", and it's a 24" ReptiSun 10.0.

Another unrelated question -- Sorry, it's gross, but please see Nico's poo below:

What is the yellow part? Is it possibly an infertile egg??

Thank you, again, for all of your help!! This forum is awesome!!

 

[Gail]

Stick with just one UVB bulb, 2 would be too much. Thats just yellow urate, not sure what would cause it though.

 

[Mach10X]

11 inches is a bit too far, I've always said that you can double up on the reproduce, however it would be cheaper to keep the second bulb for 6months from now when the current one reaches the end of its life in six months. Try to move it 7-8 inches away. I actually prefer 6 inches distance.

 

[Drache613]

Hello,

You could technically use both lights, but in this case maybe use just one & save the other one to help with costs.
Try to get it mounted at 6-8 inches alongside of the basking light on one end.
As for the stool, I don't think that the yellow portion is an egg though. It could be something she has fed her that has caused the discoloration of the urates. What type of vitamins does she use?
Is she eating anything at all? If not, she needs to intervene & begin feeding her some chicken or turkey baby food along with some squash baby food through a plastic syringe or dropper to help her get her strength back up.

Keep us posted on Nico!

Tracie