Second opinions? How can I help her?

[Oxymiocysu]

Pancake (7, almost 8 y/o female) has been through a very hard time recently and I need a second opinion on what's going on and how I can help her.

4/9/25 - pancake was seen for random swelling observed in her back foot. An x-ray and bloodwork were done. The x-ray revealed bone decay in one of her toes but nowhere else on her body. The bloodwork showed very low liver values. She was started on metacam every other day. A prescription for enrofloxacin was sent to a compounding pharmacy.

4/17/25 - enrofloxacin filled and shipped.

4/25/25 - pancake was seen for a recheck. The xray of her foot showed no change in the bone, but an xray taken of her full body suggested we do an ultrasound. The ultrasound showed free fluid, which we usually see with pancake around the time she starts getting follicles. Bloodwork showed higher liver values, suggesting the previous levels may have been erroneous. She was started on calcium gluconate daily. Enrofloxacin finally arrived and started daily.
The theory at this point is that frequent inflammation of her reproductive tract may have sent a bacterial embolus to her foot, so this is what we're trying to treat.

5/9/25 - recheck with no improvements to her foot. Started on ceftazidime injections every three days.

Between 9th-23rd - double antibiotics has left her with minimal appetite, barely touches her greens. Eventually have to start assist feeding repta-boost with nutribac mixed in for probiotic support but she won't take much. Ordered reptophilus in hopes that will help too.

5/23/25 - recheck. Very dehydrated. Down 25 grams. Ultrasound reveals possible fully formed eggs with some follicles still present. The swelling in her foot has reduced, but could be because she's dehydrated. Decide having her on antibiotics is doing more harm than good and discontinue enro and ceftaz. Subcutaneous fluids administered. Meticam increased to daily.
Vet gets a second opinion on ultrasound results and orders oxytocin injection and tramadol.

Very shortly after the oxytocin injection Pancake starts black bearding. Once we get home she basks for a short while and vomits some greens from the day before (first time she's ever done this in her life). I'm not sure if this is from the oxytocin or the stressful day, or a combination, but the immediate black beard makes me think the oxytocin didn't sit well with her.

Once she stopped looking like she was going to throw up again I offered her .25ml water and reptophilus/nutribac mix to see if she would keep it down before trying to administer the tramadol. So far she's tolerated it and her beard is starting to lighten up. I will try another .25ml soon. If you handles it, I will give another .25ml with the tramadol mixed in so it's not so bitter.

Can someone provide a second opinion on what could be going on with her? Is this the result of egg binding or is something else going on inside her abdomen? Unfortunately I do not have her bloodwork or many pictures of her ultrasounds, but I'll attach what I do have.

I'm looking into ordering horn worms for their hydration and wax worms for their calories - she never turns down insects. A new uvb bulb will going in today just in case, even though it shouldn't need replaced yet. Nighttime temps are elevated with a CHE. How can I further support her?

 

[Oxymiocysu]

Here's how she's looking right now. Very sunken in, even after the fluids at the vet.

 

[Sue E.]

Maybe these folks can help
@AHBD
@Claudiusx
@Drache613

 

[xp29]

Maybe these folks can help
@AHBD
@Claudiusx
@Drache613

That was who I was going to flag also

 

[Oxymiocysu]

Thank you guys for flagging people who can help.

She stomached more of the diluted probiotic, so I mixed in her tramadol and gave her that which she fortunately also handled well. After that I used the diluted probiotic to mix up a small amount of repta boost and added her calcium gluconate and metacam. She kept this down as well. No more vomiting after that one incident, thankfully.

Her beard is still dark, but not jet black anymore. She's been fairly sedentary, staying on the hot side of her enclosure, but she doesn't seem entirely lethargic in her actions. She's still curious, looking and moving around. I've noticed she has been holding a moderate amount of air inside her, maybe to help her be in a more comfortable position.

 

[Drache613]

Hello,

Ok, so she is on both Ceftz & Enroflaxin & Tramadol?
That is a lot of antibiotics though, which I can see why that would upset her system.
As far as giving Oxytoxin, was the vet positive that the egg placement had dropped to the point to where she was ready to lay or almost ready? If it is given too early that can cause premature labor & possible harm.
I am glad that the Reptophilus & Nutribac are helping. Definitely try to get her hydrated as much as you can.
Are you keeping her a little warmer overnight right now to help boost her immune system?

Let us know how she is doing.
Tracie

 

[Oxymiocysu]

Hello,

Ok, so she is on both Ceftz & Enroflaxin & Tramadol?
That is a lot of antibiotics though, which I can see why that would upset her system.
As far as giving Oxytoxin, was the vet positive that the egg placement had dropped to the point to where she was ready to lay or almost ready? If it is given too early that can cause premature labor & possible harm.
I am glad that the Reptophilus & Nutribac are helping. Definitely try to get her hydrated as much as you can.
Are you keeping her a little warmer overnight right now to help boost her immune system?

Let us know how she is doing.
Tracie

Thanks for your reply.

She is now completely off ceftz and enro. Now she's only on tramadol, calcium gluconate, and metacam.

The boarder of the eggs and solid black fluid within that's seen on the ultrasound pictures originally led her to believe that she was looking at something malignant, which is why she sought out a second opinion. The second opinion suggested that it was a combination of formed eggs and follicles we're looking at, and they suggested an injection of oxytocin. I asked if there were any risks, was told it's relatively safe and is what she would recommend, so I trusted the vet.

It's worth noting that at no point within the last two months has she exhibited any egg laying behavior, but her energy has been very low so that's likely a contributing factor. Regardless, she has a lay box in her enclosure now.

I personally am not sure what I'm seeing in the ultrasound images, other than that it's starkly different than what we saw the previous time. Can you, or anyone else, tell what we're looking at in the US pictures?

She's very sensitive on her tummy, recoiling and pulling away with touch which isn't normal for her.

As for overnight temps - yes, she's being kept warmer now. The ambient temp of the room is increased, and when I can figure out a safe mounting situation for a CHE she'll get that too.

 

[Sue E.]

The following is from veterinarian practice news (although she mentions the green iguana as an example, bearded dragons have similar reproductive anatomy) If any of the medical terminology is confusing, post here and I will explain it in layman's terms to the best of my ability (I am a nurse for humans so I cant explain bearded dragon specifics, but I do know meds and anatomical terms that are not species-specific):
From veterinary practice news:
By Margaret A. Wissman, DVM,
One of the most common reptile reproductive problems is dystocia. Female lizards have paired ovaries and oviducts. Ovaries vary in size depending on the stage of oogenesis. The oviducts possess both an albumin-secreting function and a shell-secreting function. There is no true uterus. The oviducts connect to and open directly into the cloaca through papillae. Both sexes possess a cloaca. With the onset of a breeding cycle, the female will begin to undergo vitellogenesis. The reptilian follicle begins to mature as yolk accumulates around the ovum. Vitellogenesis occurs as estrogen stimulates the liver to convert lipid from the body's fat stores to vitellogenin. During vitellogenesis, the liver enlarges dramatically and takes on a characteristic orangish color. The follicles selectively absorb the vitellogenin from the bloodstream, plumping the follicle with yolk. Once the ovum has ovulated, it will have albumen and the shell added in the oviduct; at this point, it becomes an egg. Prior to ovulation, the mature follicles will appear as a cluster of grapes and are of soft-tissue density on radiographs. Once the female has ovulated and the eggs have been completed by the addition of the shell, the eggs will be visible on radiographs due to their calcification.
Dystocia Treatments, Surgery
It is very important for the herp veterinarian to be able to discern between pre-ovulatory follicles and actual eggs, as the course of treatment will vary according to the different conditions. Gravid iguanas requires a suitable nesting site, as females engage in specific nesting behaviors, including digging a rather deep hole in order to oviposit their eggs. Lack of a suitable area for digging, which stimulates oviposition, is a major reason why many gravid females develop dystocia.
In addition to the female green iguana's retaining her eggs because she does not have an adequate location and substrate for digging, there can be many other causes of dystocia. Nonobstructive dystocias, where the eggs appear to be of normal size and shape, and the female appears to have normal anatomy, usually are the result of poor husbandry (including not having an appropriate nesting site). Other causes of nonobstructive dystocia are malnutrition, improper temperature, dehydration, poor physical condition and possibly oviductal infection. In some cases, a female suffering from malnutrition or poor physical condition will begin oviposition and will lay the majority of the clutch, but may retain one or more eggs.
Obstructive dystocias occur because of an anatomic inability to pass one or more eggs through the oviduct and cloaca. Eggs may be oversized, malformed or possessing an irregular surface, making expulsion difficult. The female may have a misshapen pelvis, oviductal stricture or masses such as abscesses or cystic calculi. Other causes of obstructive dystocias can be a malpositioned or damaged egg. In rare cases, a female may develop eggs before she has grown to a sufficient size to be able to successfully pass them.
Surgery for dystocia is straightforward. However, deciding when a gravid lizard is suffering from dystocia is difficult. A normal, gravid female iguana will develop an extremely swollen abdomen, and individual eggs may actually be outlined. Prior to performing surgery, it must be ascertained if the female does indeed have a suitable place to oviposit. A healthy gravid female will often cease eating as her belly fills with eggs. This is normal. Some gravid females will continue to eat minimal amounts of favorite foods right up until oviposition.
It takes about eight weeks for a female to go from beginning production of enlarged follicles to actual egg laying. Most iguanas will cease eating during the last four weeks of being gravid. Some females will develop large follicles, then resorb them if the conditions are not favorable for oviposition. This cycle may then repeat in subsequent seasons. It is important for you to ascertain if the follicles have been ovulated or not, as medical therapy, including calcium injections and oxytocin, will be ineffective. If the ova in the follicles do not ovulate and do not resorb, the mature follicle membranes will adhere and coalesce, resulting in a large agglomeration of friable yolk. This mass may rupture and the free yolk mass in the coelom can cause severe inflammation and peritonitis, resulting in severe illness and death.
Post-ovulatory eggs will have albumin, membranes and shell applied in the oviducts. These are usually visible on radiographs. If eggs are visible and the female has been anorexic for four weeks, she should be close to oviposition. At that time, she should be kept at the high-end of her temperature range, in the mid-nineties (degrees Fahrenheit) and she should be provided with an appropriate nesting box for oviposition. Hopefully, she will already have been on an excellent diet and she will have received additional calcium (calcium glubionate, Neocalglucon) at 1 ml/kg PO BID or calcium carbonate (Tums) at an equivalent dosage during at least the last four weeks of her "pregnancy" to provide her with enough calcium to produce eggshells (which are soft-shelled and less radiodense than parrot eggs) and to contract her oviducts when the time comes.
Your challenge is to determine if: 1. She is normal and pre-ovulatory, 2. She was pre-ovulatory and resorbed her yolks, 3. She is pre-ovulatory and there is follicular stasis, 4. She is gravid with post-ovulatory eggs and is not yet ready to oviposit, or 5. She is gravid with eggs and the eggs are retained (for some reason, she has not oviposited).
The conditions requiring your care are pre-ovulatory stasis and dystocia. If radiographs or ultrasound shows a female has shelled eggs in the oviducts and that she should be able to physically pass her eggs, treatment can be attempted with injectable calcium (100 mg/kg 10 percent calcium gluconate IM every 6 hours) and oxytocin (1-10 IU/kg IM one hour after the calcium injection). The dose for oxytocin may be repeated in increasing increments 20 to 60 minutes apart, until oviposition is achieved. As in cats and dogs, if there is an obstructive dystocia, oxytocin should not be given.
Surgery should be considered if there is pre-ovulatory follicle stasis or if eggs are in the oviduct for an extended period of time. A gravid female not eating for four weeks is normal, and most healthy females can tolerate this anorexia quite well. So when does a gravid female become a surgical candidate? I usually recommend surgery if a female has been off feed for at least four to six weeks, medical therapy has failed after four or more weeks of anorexia, or if a gravid female suddenly crashes. Once I have ascertained that the female should be at term, I will usually attempt to induce oviposition in the hospital for 24 hours. If her condition hasn't changed during that time frame, I consider surgery. A normal, gravid female is active and alert. If she suddenly becomes depressed, lethargic or unresponsive, this should be an indication she may require surgery as soon as possible (I will still attempt medical therapy for 24 hours if the conditions warrant it). Tremors, a change to a dull skin color or weight loss are also indications for surgery.
Time permitting, running a CBC and chemistry panel is valuable pre-op. For pet iguanas, I recommend an ovariosalpingectomy, which will preclude any further reproductive problems. A female that has had one dystocia is predisposed to having it happen again.
With retained follicles, the cluster of ovulated ova and the ovary should be surgically removed. In the case of an owner wanting to preserve reproductive capabilities, it might be possible to salvage the ovary, however, I usually urge the owner to consider spaying the female. If the female is a pet, it is best to remove both ovaries and oviducts to prevent future problems. Never leave an ovary and remove the oviduct; with future ovulations, coelomitis—often fatal—can occur.
Surgery is usually performed under isoflurane anesthesia. Keeping the patient warm during and after surgery is important for the immune system.
If pre-ovulatory follicles are present, the ovaries are removed using the same technique for ovariectomies in dystocia surgery. Depending on the wishes of the owner (and the condition of the lizard) the oviducts and shell glands may also be removed or left intact.
Once the procedure has been completed, the muscle layer is closed with 2-0 or 3-0 absorbable suture in a simple interrupted pattern. Sealing the incision site with surgical tissue glue helps prevent postoperative infection.
Sutures should remain for approximately six weeks before removal. For at least 10 to 14 days postop, the lizard should remain in a warm and dry environment, with no swimming. Fluid therapy may be necessary to prevent dehydration after surgery. If the patient is anorectic, it may require force-feeding to prevent weight loss and nutritional deficiencies.

 

[Sue E.]

Oxytocin is given to stimulate uterine contractions in humans; however, beardies do not have a uterus, but I believe it stimulates contractions of the oviducts? (not sure here). If it does this, that could well be why her belly is sensitive..contractions hurt. The tramadol is a pain reliever, it is classed as a controlled substance, so that may be why she is sleepy, but you need to differentiate sleepiness from lethargy. Please follow very closely with your vet, in case she needs to go the surgical route. Hope that helps!

 

[Oxymiocysu]

The following is from veterinarian practice news (although she mentions the green iguana as an example, bearded dragons have similar reproductive anatomy) If any of the medical terminology is confusing, post here and I will explain it in layman's terms to the best of my ability (I am a nurse for humans so I cant explain bearded dragon specifics, but I do know meds and anatomical terms that are not species-specific):
From veterinary practice news:
By Margaret A. Wissman, DVM,
One of the most common reptile reproductive problems is dystocia. Female lizards have paired ovaries and oviducts. Ovaries vary in size depending on the stage of oogenesis. The oviducts possess both an albumin-secreting function and a shell-secreting function. There is no true uterus. The oviducts connect to and open directly into the cloaca through papillae. Both sexes possess a cloaca. With the onset of a breeding cycle, the female will begin to undergo vitellogenesis. The reptilian follicle begins to mature as yolk accumulates around the ovum. Vitellogenesis occurs as estrogen stimulates the liver to convert lipid from the body's fat stores to vitellogenin. During vitellogenesis, the liver enlarges dramatically and takes on a characteristic orangish color. The follicles selectively absorb the vitellogenin from the bloodstream, plumping the follicle with yolk. Once the ovum has ovulated, it will have albumen and the shell added in the oviduct; at this point, it becomes an egg. Prior to ovulation, the mature follicles will appear as a cluster of grapes and are of soft-tissue density on radiographs. Once the female has ovulated and the eggs have been completed by the addition of the shell, the eggs will be visible on radiographs due to their calcification.
Dystocia Treatments, Surgery
It is very important for the herp veterinarian to be able to discern between pre-ovulatory follicles and actual eggs, as the course of treatment will vary according to the different conditions. Gravid iguanas requires a suitable nesting site, as females engage in specific nesting behaviors, including digging a rather deep hole in order to oviposit their eggs. Lack of a suitable area for digging, which stimulates oviposition, is a major reason why many gravid females develop dystocia.
In addition to the female green iguana's retaining her eggs because she does not have an adequate location and substrate for digging, there can be many other causes of dystocia. Nonobstructive dystocias, where the eggs appear to be of normal size and shape, and the female appears to have normal anatomy, usually are the result of poor husbandry (including not having an appropriate nesting site). Other causes of nonobstructive dystocia are malnutrition, improper temperature, dehydration, poor physical condition and possibly oviductal infection. In some cases, a female suffering from malnutrition or poor physical condition will begin oviposition and will lay the majority of the clutch, but may retain one or more eggs.
Obstructive dystocias occur because of an anatomic inability to pass one or more eggs through the oviduct and cloaca. Eggs may be oversized, malformed or possessing an irregular surface, making expulsion difficult. The female may have a misshapen pelvis, oviductal stricture or masses such as abscesses or cystic calculi. Other causes of obstructive dystocias can be a malpositioned or damaged egg. In rare cases, a female may develop eggs before she has grown to a sufficient size to be able to successfully pass them.
Surgery for dystocia is straightforward. However, deciding when a gravid lizard is suffering from dystocia is difficult. A normal, gravid female iguana will develop an extremely swollen abdomen, and individual eggs may actually be outlined. Prior to performing surgery, it must be ascertained if the female does indeed have a suitable place to oviposit. A healthy gravid female will often cease eating as her belly fills with eggs. This is normal. Some gravid females will continue to eat minimal amounts of favorite foods right up until oviposition.
It takes about eight weeks for a female to go from beginning production of enlarged follicles to actual egg laying. Most iguanas will cease eating during the last four weeks of being gravid. Some females will develop large follicles, then resorb them if the conditions are not favorable for oviposition. This cycle may then repeat in subsequent seasons. It is important for you to ascertain if the follicles have been ovulated or not, as medical therapy, including calcium injections and oxytocin, will be ineffective. If the ova in the follicles do not ovulate and do not resorb, the mature follicle membranes will adhere and coalesce, resulting in a large agglomeration of friable yolk. This mass may rupture and the free yolk mass in the coelom can cause severe inflammation and peritonitis, resulting in severe illness and death.
Post-ovulatory eggs will have albumin, membranes and shell applied in the oviducts. These are usually visible on radiographs. If eggs are visible and the female has been anorexic for four weeks, she should be close to oviposition. At that time, she should be kept at the high-end of her temperature range, in the mid-nineties (degrees Fahrenheit) and she should be provided with an appropriate nesting box for oviposition. Hopefully, she will already have been on an excellent diet and she will have received additional calcium (calcium glubionate, Neocalglucon) at 1 ml/kg PO BID or calcium carbonate (Tums) at an equivalent dosage during at least the last four weeks of her "pregnancy" to provide her with enough calcium to produce eggshells (which are soft-shelled and less radiodense than parrot eggs) and to contract her oviducts when the time comes.
Your challenge is to determine if: 1. She is normal and pre-ovulatory, 2. She was pre-ovulatory and resorbed her yolks, 3. She is pre-ovulatory and there is follicular stasis, 4. She is gravid with post-ovulatory eggs and is not yet ready to oviposit, or 5. She is gravid with eggs and the eggs are retained (for some reason, she has not oviposited).
The conditions requiring your care are pre-ovulatory stasis and dystocia. If radiographs or ultrasound shows a female has shelled eggs in the oviducts and that she should be able to physically pass her eggs, treatment can be attempted with injectable calcium (100 mg/kg 10 percent calcium gluconate IM every 6 hours) and oxytocin (1-10 IU/kg IM one hour after the calcium injection). The dose for oxytocin may be repeated in increasing increments 20 to 60 minutes apart, until oviposition is achieved. As in cats and dogs, if there is an obstructive dystocia, oxytocin should not be given.
Surgery should be considered if there is pre-ovulatory follicle stasis or if eggs are in the oviduct for an extended period of time. A gravid female not eating for four weeks is normal, and most healthy females can tolerate this anorexia quite well. So when does a gravid female become a surgical candidate? I usually recommend surgery if a female has been off feed for at least four to six weeks, medical therapy has failed after four or more weeks of anorexia, or if a gravid female suddenly crashes. Once I have ascertained that the female should be at term, I will usually attempt to induce oviposition in the hospital for 24 hours. If her condition hasn't changed during that time frame, I consider surgery. A normal, gravid female is active and alert. If she suddenly becomes depressed, lethargic or unresponsive, this should be an indication she may require surgery as soon as possible (I will still attempt medical therapy for 24 hours if the conditions warrant it). Tremors, a change to a dull skin color or weight loss are also indications for surgery.
Time permitting, running a CBC and chemistry panel is valuable pre-op. For pet iguanas, I recommend an ovariosalpingectomy, which will preclude any further reproductive problems. A female that has had one dystocia is predisposed to having it happen again.
With retained follicles, the cluster of ovulated ova and the ovary should be surgically removed. In the case of an owner wanting to preserve reproductive capabilities, it might be possible to salvage the ovary, however, I usually urge the owner to consider spaying the female. If the female is a pet, it is best to remove both ovaries and oviducts to prevent future problems. Never leave an ovary and remove the oviduct; with future ovulations, coelomitis—often fatal—can occur.
Surgery is usually performed under isoflurane anesthesia. Keeping the patient warm during and after surgery is important for the immune system.
If pre-ovulatory follicles are present, the ovaries are removed using the same technique for ovariectomies in dystocia surgery. Depending on the wishes of the owner (and the condition of the lizard) the oviducts and shell glands may also be removed or left intact.
Once the procedure has been completed, the muscle layer is closed with 2-0 or 3-0 absorbable suture in a simple interrupted pattern. Sealing the incision site with surgical tissue glue helps prevent postoperative infection.
Sutures should remain for approximately six weeks before removal. For at least 10 to 14 days postop, the lizard should remain in a warm and dry environment, with no swimming. Fluid therapy may be necessary to prevent dehydration after surgery. If the patient is anorectic, it may require force-feeding to prevent weight loss and nutritional deficiencies.

This is an excellent source of information, thank you for taking the time to share it. It helped provide some insight.

 

[Oxymiocysu]

Oxytocin is given to stimulate uterine contractions in humans; however, beardies do not have a uterus, but I believe it stimulates contractions of the oviducts? (not sure here). If it does this, that could well be why her belly is sensitive..contractions hurt. The tramadol is a pain reliever, it is classed as a controlled substance, so that may be why she is sleepy, but you need to differentiate sleepiness from lethargy. Please follow very closely with your vet, in case she needs to go the surgical route. Hope that helps!

This makes sense! Yesterday after giving her the tramadol she was dosing off a lot. Today she's able to keep her eyes open and is holding her head higher, so I'm assuming she's feeling a bit better and the tramadol has worn off. I've been instructed to give it to her every 24-48 hours as needed. This vague dosage somewhat confuses me, as I'm not entirely sure what it looks like when she needs it. I guess when she starts getting sensitive to touch on her abdomen again?

Her beard is no longer black. She's still dehydrated. She took down about 4.5 ml of repta boost with medicine, water, and probiotics mixed in. It's easier to get her to take everything in one go like that. How much oral fluid should I try to get her to take in a day for rehydration? Can I use the reptophilus to flavor the water to make it more appealing, even if it goes over the 1ml recommended dose? She seems to like it. I'm thinking there would be no harm in giving extra probiotic, but I just want to be sure.

Unfortunately the replacement uvb bulb came in shattered, but a new one is on the way. Fortunately, this one doesn't need to be replaced yet - it's just a precautionary measure.

Attached is how she's looking today. Not much a difference, except her beard which I didn't show yesterday.

 

[Sue E.]

The Reptophilus would be good for her. Offer as much fluid as she will take (not forced). If she will take the hornworms, yes, they are a good hydration source and have a good Ca-P ratio, but she may not want to eat. Is she eating anything on her own? You can moisten her veggies too if she will take them. Not sure about giving extra Reptophilus, @Drache613 can chime in on that. Do you have another vet appointment soon for follow up? Ask your vet if you can have a copy of the bloodwork please and post them here...there are people here who can interpret the results. Best wishes to you and your girl!
@AHBD
@Drache613

 

[Sue E.]

Remember that your laybox needs to be filled deep enough for her to bury herself in, about 8" or so (using organic topsoil mixed with play sand, moistened to a sand castle or thick cookie dough consistency), with a partial cover over it. Im sure you know this since you've dealt with her eggs before. Crickets or dubias are better protein sources than waxworms if she will take them, calcium dust them as she will need the extra calcium for egg laying. She will also get some moisture from the bugs.

 

[AHBD]

Poor girl, I hope she makes it through this. Glad to hear that she's feeling a littlre better but she does still look pretty rough. Any or all of those meds. could have caused the vomiting, including the metacam but it's impossible to say for sure.

One thing that could help clear up the question about if or where the eggs are is to have an xray done from above. The side view ultra sound does not show clearly at all. If you Google " x- ray of bearded dragon with eggs " or Xray of gravid bearded dragon" you'll see how it can show eggs + follicles more clearly.

 

[Oxymiocysu]

The Reptophilus would be good for her. Offer as much fluid as she will take (not forced). If she will take the hornworms, yes, they are a good hydration source and have a good Ca-P ratio, but she may not want to eat. Is she eating anything on her own? You can moisten her veggies too if she will take them. Not sure about giving extra Reptophilus, @Drache613 can chime in on that. Do you have another vet appointment soon for follow up? Ask your vet if you can have a copy of the bloodwork please and post them here...there are people here who can interpret the results. Best wishes to you and your girl!
@AHBD
@Drache613

I do mist her veg but she's only willing to eat insects on her own - so right now she's only really consuming the reptaboost and dubias. Could increasing the frequency of dubia feedings help her?

She has a follow up on the 5th, I'm going to try to see if I can get her in sooner but the vets availability is hard to work with. I'll email them and see about getting bloodwork results.

Thank you!