Second opinions? How can I help her?

[Sue E.]

From veterinary partner website: this applies to long term use in cats particularly but long term Meloxicam use can cause the same effect in humans and dogs with impaired or borderline kidney function, so maybe in beardies as well? Meloxicam is the effective ingredient in Metacam.

 

[Sue E.]

The problem is, upon further reading, the condition whether gout or pseudogout, is not really curable, rather it is managed with the use of antiinflammatory agents for pain management like the Metacam, possibly joint aspiration. So it becomes a case of keeping her comfortable, which she now is? The Allopurinol only works to lower uric acid levels in the blood, not to reduce swelling that is not a direct result of elevated uric acid levels. So, really, your vet's conservative approach is correct at this point.

 

[Drache613]

Hello,

How is your girl today? Thanks for posting more pictures. I am glad to hear she isn't limping on the foot then, hopefully it isn't hurting her too much.
I am not positive how long medications stay in their system. Their metabolisms are slower than mammals, so based on experience, I would say several weeks to get residual out of the system. It might be a good idea to cycle the Metacam to make it easier on her system.
It could be septic arthritis possibly that causes the swelling & inflammation or infection in a localized area. It is hard to clear up. Excessive uric acid, usually at levels of 10mg/dl it seems to start swelling in & or around joints due to the build up. Depending on how long the levels are elevated, is how much crystallization build up is caused. Sometimes if it is caught early the crystals don't really become established & can easily be treated & reversed. Unfortunately, most of the time gout is missed & too much time is wasted to treat it.
Are you giving some black or tart cherry juice extract right now?

Let us know how she is doing.
Tracie

 

[Oxymiocysu]

For Pancake's birthday we got some good news.

The follicles observed in her ultrasound are much darker, much more quiet, and there's minimal free fluid. We believe stasis can safely be ruled out as a concern now.

We aspirated her swollen ankle to see if we could check for septic arthritis because she's more swollen this time. She didn't mind the needle poke at all, which tells us if she is in pain - it's minimal. Unfortunately we weren't able to get a lot for a sample, and the sample we did get wasn't taken from the joint. What we did get didn't resemble what you'd see in gout, and her last bloodwork wasn't indicative of gout. Bacteria wasn't visible on the slide, but if I remember correctly the vet said lymphocytes were. She thinks this could just be because of all the swelling. It's hard to rule out septic arthritis or a vascular cause at this moment.

There was talk of getting her back on just the ceftazidime injections in case it is bacterial, but because of how she handled the antibiotics last time and considering she's not eating well enough on her own, we're going to try something else first.

We had been giving her metacam primarily to help with the swelling of her ankle and her ankle has only increased in size, we decided to stop the metacam and reassess during her next visit in 2 weeks. Hopefully in this time her appetite will return somewhat, if the metacam has been causing her any tummy issues.

In the meantime, I'll have to either reup her assist feedings or offer more insects, as she's down about 20g from the last visit 2 weeks ago.

She is not currently on black/tart cherry juice extract.

 

[Sue E.]

What is her current weight if you dont mind me asking? I ask because 20 grams would be a significant loss in a 150 gram dragon; in a dragon over 400 grams, not so much. A 20 gram loss could be due to the decline in free fluid, along with a large poop, the shrinking of the follicles, etc. Its great news that she doesnt seem to be in pain and that the egg binding issue has been put to rest. What does she eat for you on her own right now? (# of insects, any greens, etc.).

 

[Oxymiocysu]

What is her current weight if you dont mind me asking? I ask because 20 grams would be a significant loss in a 150 gram dragon; in a dragon over 400 grams, not so much. A 20 gram loss could be due to the decline in free fluid, along with a large poop, the shrinking of the follicles, etc. Its great news that she doesnt seem to be in pain and that the egg binding issue has been put to rest. What does she eat for you on her own right now? (# of insects, any greens, etc.).

She's a big girl, weighed high 490s at the vet.

She'll eat at least 5 medium dubias on her own (I haven't tried offering more than that) and when she does take greens she'll eat a leaf the size of the palm of my hand torn up into smaller pieces. Her interest in food is very minimal unless it's moving protein.

 

[Sue E.]

You can offer her a couple more dubias a few times a week if youd like, since you feed the medium size. 490 is a little high but overall a good weight, so I wouldnt worry about a 20 gram loss. If you want, you can track her weight on a kitchen scale that weighs in grams, just to see any trends. The amount of greens shes taking sounds good too.

 

[Drache613]

Hello,

By the sound of things, it is most likely some type of stubborn infection. So for the moment, you will
just try to see if it clears up without antibiotics? They do tend to affect the appetite quite a bit, depending
on the antibiotic & the duration of giving it.
At least though it doesn't seem to be gout! Let us know how she is doing.

Tracie

 

[Oxymiocysu]

You can offer her a couple more dubias a few times a week if youd like, since you feed the medium size. 490 is a little high but overall a good weight, so I wouldnt worry about a 20 gram loss. If you want, you can track her weight on a kitchen scale that weighs in grams, just to see any trends. The amount of greens shes taking sounds good too.

I should've specified that she'll eat that amount once every three days, whereas she used to eat at least double the amount daily or every other - that big decrease concerns me.

I do have a kitchen scale that I weigh her with, I just don't want to weigh her too often because I know weight will naturally fluctuate. It's good that 20g isn't something to be concerned about. Her mom was also a big girl, 550g even missing most her tail.

Hello,

By the sound of things, it is most likely some type of stubborn infection. So for the moment, you will
just try to see if it clears up without antibiotics? They do tend to affect the appetite quite a bit, depending
on the antibiotic & the duration of giving it.
At least though it doesn't seem to be gout! Let us know how she is doing.

Tracie

We're going to try to see if getting Pancake off the meloxicam will improve her appetite and if the swelling will increase. Because of the hard hit the antibiotics had to her system, we want to get her to a good spot before putting her through that again.

We've tried smz in the past, which resulted in immediate black beard every dose that lasted for at least 12 hours. There was another common one we tried in the past that made her feel unwell also, but I don't remember the name. Enro and ceft she's tolerated better than the others, minus the severe appetite loss.

 

[Drache613]

Hello,

The SMZ is sulfa based so it's no wonder that she had a black beard from the beginning! It is very hard on them. Antibiotics, in general are usually somewhat hard on them, leaving their appetites decreased.
Hopefully you can successfully get Pancake off of the Meloxicam soon. At least though, she is still eating some right now.
Keep us posted on her!

Tracie

 

[Oxymiocysu]

Hello,

The SMZ is sulfa based so it's no wonder that she had a black beard from the beginning! It is very hard on them. Antibiotics, in general are usually somewhat hard on them, leaving their appetites decreased.
Hopefully you can successfully get Pancake off of the Meloxicam soon. At least though, she is still eating some right now.
Keep us posted on her!

Tracie

That makes sense! We've got her off the meloxicam for 2 weeks and then we'll reassess.

I've noticed she has a taste for blueberries and raspberries, and will readily eat them on her own. She's also showing vague interest in bell peppers, but I have to get her to open her mouth and slip a piece in for her to actually eat it. She won't take it from me on her own, but she won't spit it out once it's in her mouth.

 

[Drache613]

Hello,

Yes, sulfa drugs can dehydrate them & essentially affect the appetite, too.
That's great she is eating blueberries & raspberries on her own. I'm sure eventually, she will start to
eat more greens & veggies hopefully on her own.

Tracie

 

[Oxymiocysu]

I'm very happy to report she's starting to eat greens on her own again! I'm not sure if it's because she's off the meloxicam or if it's for some other reason, but I think I'll continue to keep her off it for the foreseeable future, as that's the only thing that's changed alongside her appetite.

It's also worth noting the swelling in her foot/ankle doesn't seem to be increasing despite being off the meloxicam, which we were originally using for pain and to decrease swelling.

 

[Drache613]

Hello,

That is great news to hear she is eating some greens again. I think it is most likely she feels better from not being on the meloxicam for awhile. It can definitely upset their system & cause a reduction in appetite, too.
I'm happy the swelling hasn't increased in her foot area from her being off of the meds.
Keep us updated on her progress!

Tracie

 

[xp29]

I'm very happy to report she's starting to eat greens on her own again! I'm not sure if it's because she's off the meloxicam or if it's for some other reason, but I think I'll continue to keep her off it for the foreseeable future, as that's the only thing that's changed alongside her appetite.

It's also worth noting the swelling in her foot/ankle doesn't seem to be increasing despite being off the meloxicam, which we were originally using for pain and to decrease swelling.

I'm glad her appetite is getting better meds tend to really mess up their systems.