Possible Gout or Renal Failure

[Tili3115]

I think I may have posted about by Bearded Dragon, Hadron, a few other times in the past about his health but now it's starting to gradually worsen. I'll post the answers to as many questions as I can below then I'll explain more at the end:
How old is your dragon? I got him on May 1, 2015 as a baby (21g), estimated 8 months?
How long have you had your dragon? almost 6 months
How long is your dragon? 19 inches
What is the sex of your dragon? male
What size enclosure do you have your dragon in? slightly bigger than 45 gallons
What type substrate do you have on the bottom of your tank? clean play sand
Do you use UVB lights? Yes
If so, Is it a coil, compact, fluorescent tube, or Mercury Vapor bulb? flourescent
What is the brand name and number of your bulb? Wattage (if MVB)? Reptisun T8 10.0
How old is your UVB bulb? 3 weeks
How close can your dragon get to the UVB? 12-14 in
Do you use a separate basking bulb? What kind and what is the wattage? Is it a white or colored bulb? separate, ZooMed 50w, white
What are the basking temps? 97-100
What is the cool side temp? 85-90
Do you take the temps with a stick on thermometer, a digital thermometer with a wire and a probe end or a temp gun? Infrared Temp Gun by Nubee
Where exactly are you taking your basking temps? 2-3 inches from the rock
Do you use a heat rock or heat pad? no
What do you feed your dragon? Please be specific. Small/Med Dubia Roaches, Occasional Superworms, Mustard Greens, Spring Mix w/o Spinach, Basil, Occasional Strawberries, Blueberries, Grapes
How often do you feed and what time do you feed (morning, afternoon, night)? morning, afternoon
Do you gutload (feed) your crickets, worms, etc? Yes
Do you use vitamin or calcium supplements? What brand(s)? How many days a week do you use each of them? Reptivite every 2 days (vet said to stop rep-cal)
Is your dragon having regular bowel movements (poops)? More or less, always goes in his bath 1-2 times a week
Do you bath your dragon? How often? usually every 1-2 days, lately everyday as per vet instructions
Do you mist your dragon or offer water other than in the bath? water bowl always available
Have you gotten a vet check and fecal done? Yes (more on this below)
Does your dragon share an enclosure with another dragon? No

Rough Timeline:
- August 2015: Went to the vet for a wellness exam and fecal. Fecal came back with coccidia and a protazoa (don't remember name) treated for both with oral medication.
- September 2015: Took him to the vet for lethargy and a swollen joint on his middle front toe. They gave him fluids and sent him home with instructions to limit his movement by lowering his rocks/boxes.
- October 2015: Swelling in his arms and left leg, possible muscle loss. Past week or two it got much more severe, swelling is located around both of his forearms (not joints)-most severe and some in his hand/fingers, also swelling around his left ankle but none on the right. Mobility is far more limited-unable to jump, tends to scoot around with his belly slightly touching the ground. Doesn't want to eat as much, difficult to get him to eat very much if any veggies. Took him to the vet, they did an exam, full body and arm x-rays, and a blood test. He's on an antibiotic (Fortaz) that is injected into his tricep every 3 days, we've done 2 out of 5 doses so far. Uric acid came back slightly elevated so vet consulted with other specialists and thinks it is gout or possible kidney/renal failure. Also told us to soak him every day to try and increase water intake and I have started giving him black cherry juice diluted (haven't been able to find extract yet-is it a liquid or capsule?). He doesn't like to drink from a syringe (i put drops on his nose) and I only got about 1mL into him today over multiple attempts and a soak.

Questions:
- How can I get him to eat his greens?
- Is it okay to reduce the amount of insects(protein) he eats to give his kidneys a rest?
- Is there anything else that would explain the swelling around his forearms?
- How else can I get him to drink more fluids?
- Does his condition sound like gout or is it something more serious?
- The vet wants to do a needle aspiration of his joint fluid in about a week, do you think this is beneficial/necessary?
- I know this is really my decision but, is it fair/humane to continue trying to treat him? What would you do with your own beardie?
I'm worried that we're doing all of these tests and medications for me and taking away from his quality of life. I don't want him to suffer but I also don't know if he will get better. And I don't know how long we should keep trying to treat him. I have already decided that surgery is out of the question because it seems too cruel to put him through that and the long recovery process. Anyways, thanks for the help!

Pictures:

 

[AHBD]

Hi there....so sorry that you are going throuh this with your beardie ! First off, if it's gout then the antibiotics will do more harm to his kidneys . The cherry juice would be helpful and there's a medication called Allopurinol made for humans that has been dosed for beardies. A needle aspiration wouldn't be too painful and it would help determine if this really is gout, which it sounds like it is.

How long, how much and what kind of meds. was he on for his parasites ? Sometimes those can cause kidney problems which could lead to gout. You can still feed him protein, but a reduced amount. Find out wat veggies he likes best with a tiny bit of fruit, mke smoothies with extra water or just add honey or something [ unsweetened fruit juice, but just a bit ] to get him to drink his water. Send a p.m to Tracie [ username Drache613 ] She'll be helpful on this subject. I truly wish the best outcome !

 

[Tili3115]

For some reason the vet wants to finish the round of antibiotics but I will consult with him again and ask his reasoning for it. Hadron seems to like the cherry juice and I will definitely ask about the Allopurinol at our next vet appointment which is coming up soon.

I will have to dig up the vet bills but I believe he was given 2 doses of ponazuril 48 hours apart for coccidia and 3 rounds of a deworming agent 2 weeks apart. The smoothies sound like a great idea and much better than baby food so I will definitely try them. I didn't have 100% juice on hand today but I put a few drops of "Stage 1" apple baby food in some water and he seems to have been more interested in drinking it. Thank you so much for the help!

 

[AHBD]

You're welcome ! Thanks for adding the pics, they are helpful. And yes, ask the vet what the antibiotics are for because they are going to cause dehydration , especially right after the deworming meds. which can also be dehydrating. I would cut out the antbiotix and increase hydration and the black cherry juice [ if it's all natural ] .....and it's good that you found something that makes his water appealing to him so he drinks. [ the baby apple food ] By the way, has he received injections in those legs ?

 

[Drache613]

Hello,

That looks very suspicious of gout to me.
I would continue with the black cherry juice daily, absolutely. It helps initially with uric acid levels, but will not ultimately "cure" or manage it like the allopurinol will.
You can decrease his insect level to a 25-30 per week, but focus on hydration & greens. Since he wont eat greens very well, you will have to try making him smoothies/slurries with greens. Try the best you can with getting him to take fluids.
Did the vet not do a blood test yet? I would highly recommend getting a blood test done to determine uric acid levels & to see if there is an infection going on. Did he suspect an infection since he put him on antibiotics? Which antibiotic is he on?
Aspirating some fluids on or around the swollen areas can help, too so they can culture the fluids to see if it has uric acid crystals present or not. An x-ray can sometimes show uric acid deposits, called tophi, on a gout case.
I cannot stress enough how important it is to get started on treatment for gout immediately if he does have gout. It is still early & early detection means he can recover very nicely. If it goes on for too long, it will become much worse making the recovery rate much lower.
Sometimes oversupplementation can lead to pseudo gout & can be corrected with supplementation adjustments. The Reptivite may not be the best choice due to it having synthetic Vitamin A & D in it which is stored more readily than non synthetic sources. Previously how often were you supplementing, 4 times per week?
I would recommend giving just plain calcium without D3, 3 times per week, without any Reptivite right now.
The Reptisun 10 tube bulb can be moved to a 6-8 inch distance & be mounted underneath of the screen for maximum exposure. Also, you might want to consider lowering the temperatures on the cooler end to a range of 78-82 instead, he may not be able to regulate his temperatures very well without a temperature differential from the basking spot area.

Tracie

 

[Tili3115]

Ok so the earliest we can get in to see the vet is this coming Monday but he wants to continue the antibiotics (Fortaz) "to see if it helps". He has eaten hardly any roaches this week but I have been making him smoothies in the NutriBullet with his greens and 2 or 3 blueberries plus some diluted black cherry juice for the liquid. I made a mistake with his multivitamin, it's called Herptivite with Beta Carotene but either way, I will switch to just calcium.
We did do a blood test, which indicated (according to the vet) elevated uric acid levels but everything else was within the normal range. Shortly before that we did x-rays, he didn't see anything significant in the swollen areas and said it didn't appear there was extra growths/crystals/calcification around the bones.
I'm not sure if I can move the light much closer because it is adhered to the wall but I have been leaving the screen off the tank for several weeks now and he seems to be within its range or for the majority of the day. The cool side is 82 right now but I tend to have a problem keeping it cool in the late afternoon because I don't have an air conditioner and the weather in Southern California has been fluctuating between relatively cool and extremely hot days (I usually just have to turn the basking light off).
Thanks so much for the help!

 

[Tili3115]

So we went to the vet twice this week on Monday and Thursday. On Monday we went for a recheck and he did a needle aspiration and looked at it under the microscope to see if he could identify any bacteria or reason for the swelling. He called us back and said that he didn't see any bacterial cells or organisms, only inflammatory cells and that it most likely isn't gout. He gave us the option to try another round of antibiotics (it could be they were already working and had killed the bacteria he didn't see) or do surgery to open up both legs and try to get a deeper sample. Ultimately, we elected to do antibiotics because at this point the surgery was exploratory and our biggest concern was his quality of life considering how progressed this problem already was. So Thursday we went back to pick up the antibiotics and he did another aspiration to send to pathology to culture. Now we're waiting for the results of that and his repeat fecal pretty much hoping they find something so at least we know what we're dealing with.

 

[Drache613]

Hello,

I am a bit concerned with placing him back on antibiotics since they have not worked at all yet.
If his uric acid levels were very high but nothing else was out of the ordinary, it sounds more like gout than an infection. An infection would yield out of proportion white blood cells. The culture yielded no bacteria at all, or you have not gotten the culture back yet?
Do you have a copy of the blood tests I could see? Really, with that type of swelling, it seems more typical of gout than anything else. Gout is sometimes extremely hard to diagnose.
Are you using black cherry juice to help with the uric acid levels?
How is he doing, is his appetite doing ok?
Also, on the UVB light, it would be optimal to try & mount it directly overhead to allow the UVB emissions to properly refract downward instead of outward & away from him. He may not be receiving enough UVB. Do you have a screen top?

Tracie

 

[Tili3115]

I will try to get a copy of the blood work from the vet but I still give him the black cherry juice. We haven't gotten the culture results back yet but he just looked at a sample in the office to see if he could pick out anything unusual. Another sample was sent to pathology to be cultured which we're still waiting for. His appetite is still okay, he eats roaches every few days on his own and veggies are always accessible but he doesn't each much if any so i end up offering baby food/green smoothies every day to supplement. I will try to upload a picture of his tank tomorrow so you can see the lighting. The UVB is directly above his basking spot and I don't put the screen lid on because he has to stay near the bottom so he doesn't get hurt (he has some difficulty moving around/climbing)
The vet told us he ruled out gout because of something related to the way the cells lysed? Or the way he was seeing the inflammatory cells? But now I'm starting to wonder because I get what you mean about the lack of white blood cells or obvious signs of bacteria.
Thank you so much for taking the time to help me, honestly I really hope that whatever this is, we can find out soon. I think it's worse not knowing what we're dealing with or if his course of treatment is even helping him.

 

[Drache613]

Hello,

I am glad to hear he is getting the black cherry juice. Even if it isn't gout, it will still help his kidneys since his uric acid was elevated.
That makes sense in a way, but if he wasn't seeing any bacteria at the moment, then he should hold off on any antibiotics until the culture comes back, to keep from stressing the kidneys.
In an infection, his white blood cells should be elevated, but I guess there are always exceptions. Reptiles do love to hide their illnesses from us very well!
That would be great if you could get a copy of the blood test. I would just like to take a look over it, if that's ok.
Great, his UVB Light placement is perfect, no problems there at all. He should be receiving adequate UVB exposure then, so it shouldn't be metabolic bone related in any way.
At least he is still eating right now, that is good news. Supplementing with a smoothie should help him out as well as give some extra hydration for him, too.

Keep us posted on him.
Tracie

 

[Tili3115]

Below are the links to a copy of his blood test results. The first link is the numbers and values for each measurement and the second link is the microscopic findings by the pathologist.
https://drive.google.com/file/d/0B-O2Xno97ukKSWlhTXZaeUYwNXlPSnJncVFPU21aV3V3RUZF/view?usp=sharing
https://drive.google.com/file/d/0B-O2Xno97ukKai1aNGVXVUZVa2ljVURrSG9rel9BM1NVYy00/view?usp=sharing

Thanks for taking a look at them!

 

[Drache613]

Hello,

Thanks for posting those!
I do see the uric acid levels, they are relatively high, yes. I wish I knew how long they had been at those levels. On average, those levels should be at 3-4mg/dl for optimal health. At those levels, if it is truly gout, that explains the swellings. The uric acid builds up causing the swelling. We need to get those levels down before kidney damage starts happening.
I wish they could get more definitive. When is the culture supposed to be back?
Continue with the Black cherry juice right now, hopefully that will help out the kidneys.
Everything else looks pretty good. The only other thing I saw was that the Monocytes were slightly elevated, but hardly anything to be concerned with. They could be elevated maybe from stress due to the uric acid levels being too high. His body is having to work hard to filter right now.
How often does he excrete urates & are they white & hard or soft in nature?
The AST levels look fine, but a little low but that can indicate a possible B6 deficiency, or a mineral deficiency of some type.
How is he doing today?

Tracie

 

[Tili3115]

At the time of the blood test the swelling had just worsened significantly so the uric acid levels may have been increasing for about a week? and now it has been about 2 weeks since the blood test. I have been doing black cherry juice regularly and daily soaks. I also have encapsulated black cherry concentrate (is this extract?) by the brand GNC. Do you think this is better or more effective? And if so, what would be a good amount to give, I believe each capsule contains 500mg of the powder.
We're still waiting on the culture, hopefully it will come back sometime this week. When I called about getting a copy of the blood work they said the culture results still hadn't come back.
His urates are white and soft but hold their relative form (he tends to go in his baths so they seem to break up/disintegrate with water movement). I'm a bit concerned that he hasn't pooped in a few days though since he did eat enough roaches and greens that should constitute a decent poop by now. However, this doesn't seem to be slowing him down.
Overall, I have to say he is about the same today. Maybe a little happier that I got him some new pavers so he can move around a bit easier. I think it also helps that the weather has cooled down and relatively stabilized so he doesn't have to move as much or as often to regulate his temp.
I really appreciate the help and thank you so much for taking the time to look over everything and offer advice!

 

[Drache613]

Hello,

You are welcome.
I hope he is feeling a little bit better!
Maybe the culture will come in pretty soon also, to help get more answers.
Usually I go by a 15mg/kg on supplements like the black cherry. That would be a bit challenging using powder, unless you have a tiny scale. I could help dose according to his weight, or you could just give a small pinch daily. Any extra wouldn't hurt him at all. You could mix it with water, apple or cranberry juice, or sprinkle it on his food/greens if he eats any of those.
The powder would be fine, or you can stick with liquid, they would both be good. Whichever is easiest. Does it say how strong the liquid is?
It sounds like he is doing pretty well overall, basking & being active. You can give extra oral hydration to help in case he is dehydrated. Some sugar free applesauce, or canned pumpkin with olive or coconut oil can help too if he is a little backed up also.

Keep us posted on him.

Tracie

 

[Tili3115]

Sorry for the late reply but the culture came back negative which is somewhat frustrating and relieving. So, now he's going to treat it like gout and we're going in Monday to pick up new meds, I'm assuming allopurinol. I just wish he would have started that sooner because i'm worried it might be too late to have prevented kidney damage or be able to reverse his condition.
I have been mixing the black cherry powder with his baby food since he seems to like it better that way. I use the rounded part of the capsule to measure out about that much powder then mix it with 1-3mL of baby food or blended squash. The juice is 100% black cherry juice but the concentrate doesn't say the strength.
He did finally poop today, I used watered down applesauce and a bit of benebac to get him going and it seems to have worked pretty well. It also seems to have improved his mood and appetite since he was quite excited about getting a few roaches and some grated butternut squash with his greens.

Thanks for the help!