Septic Arthritis - Leg Amputation

[Drache613]

Hello,

How is your boy today, did he come through surgery without any complications?
I am sure he will adjust but it will take some time for him. Hopefully he will heal up quickly. Be sure to post some new
pictures of him soon. Definitely no baths for awhile.
The blood test don't look too bad. The calcium to phosphorus ratio is a little off but when they are stressed, etc that can
cause imbalances. The infection should clear up too so he will feel better soon. The AST (liver enzymes) are in normal
ranges so that is good & so is the Uric acid (kidney enzymes) level so he should recover nicely.

Let us know how he is doing.

Tracie

 

[GraphicTortoise]

Hello,

How is your boy today, did he come through surgery without any complications?
I am sure he will adjust but it will take some time for him. Hopefully he will heal up quickly. Be sure to post some new
pictures of him soon. Definitely no baths for awhile.
The blood test don't look too bad. The calcium to phosphorus ratio is a little off but when they are stressed, etc that can
cause imbalances. The infection should clear up too so he will feel better soon. The AST (liver enzymes) are in normal
ranges so that is good & so is the Uric acid (kidney enzymes) level so he should recover nicely.

Let us know how he is doing.

Tracie

Surgery went extremely well and he even woke up earlier than expected. He's definitely grumpy this morning and a little wobbly as to be expected, but walking around and accepting bugs (other food isn't an interest to him atm, but I'm prepared to make slurries if need be) a little gray showing through his beard but after he rests for a minute he goes back to normal. I've noticed in the past that he twitches areas of his body a tiny bit when he's in pain. I'm seeing a little bit of that near the base of his tail but I haven't given him his medicine yet today.

 

[CooperDragon]

That's great news! He looks really good with the bright beard and it's also encouraging that he is interested in bugs. Hopefully the wound will heal quickly and he'll be able to adapt his balance without issue.

 

[Drache613]

Hello,

He does look very good for just going through that type of surgery. I think he will be just
fine, just give him a bit of time to adjust to his limb loss.
His colors do look bright so that is a very good indication he isn't feeling too bad!

Let us know how things are going.
Tracie

 

[GraphicTortoise]

Smaug is still doing extremely well so far. He has gone a little darker in color a few times before it's medicine time and is opening his mouth a lot out of discomfort and probably anger, but overall he's staying pretty light colored and no completely black beards. He's alert and way more active than I was expecting. He's accepting high reward foods like live feeders and fruit, but I'm able to sneak a few greens into his mouth too. My goal is to slowly get him to eat more greens and less high reward items, but for now just eating is good enough for me! The wound is being kept dry and pooping isn't an issue at all. Luckily the wound and sutures are on his side away from his vent. I'm still disinfecting his tail as needed though and using absorbent reptile pads as substrate which has worked wonderfully. The pads lock liquids in better than paper towel in my opinion. I probably won't update again until we get his leg biopsy results back, or if there's a drastic change. I'll probably update the post name at that point too if possible since this is no longer about arthritis. Thank you guys for the support! It has been a very stressful time, but I feel a lot better knowing my guy is pulling through and doing so well.

 

[GraphicTortoise]

The results came back and smaug is cancer free! He ended up having septic arthritis caused by a bacterial infection. Here's what the specialist vet sent me...

-"The histopathology results have returned, and they indicate that Smaug's joint was severely affected by an inflammatory proccess that likely started as a bacterial infection (septic arthritis) that progressed despite Smaug's very appropriate prior treatment medically. There were numerous micro fractures of the bones interfacing with the joint, and the joint itself was quite severely inflamed with evidence of changes associated with chronic infection and inflammation. This is all great news as it indicates that not only is this free from any noticable cancer, but it also indicates that without the amputation this would have progressed and caused chronic pain and infection.

With this information, it is unlikely that this infection will spread to other locations since it was surgically removed. It is possible that other joints could develop their own indepedent pathology. The best way to prevent further health challenges is to continue providing the most ideal husbandry possible, and I'm always happy to discuss and help ensure Smaug's husbandry is great."-

Now... My big question is what caused the initial bacterial infection? I'm guessing poor husbandry as a baby since he's initially from a pet store, but I'll probably never know for sure.

 

[GraphicTortoise]

Hello,

He does look very good for just going through that type of surgery. I think he will be just
fine, just give him a bit of time to adjust to his limb loss.
His colors do look bright so that is a very good indication he isn't feeling too bad!

Let us know how things are going.
Tracie

Smaug is finally willingly taking greens! He is slowly getting used to the missing limb, but I think he occasionally gets "phantom pains" or "phantom limb" because he'll revert back to trying to use the missing leg and getting frustrated. The muscles in the area move when he does this. Otherwise he's using his tail to help lift himself and balance and is walking pretty good overall.

 

[AHBD]

That's good to hear ! In general they don't have too moving trouble moving around when they lose a limb.

 

[GraphicTortoise]

I have noticed his front right hand is a little swollen, and to me it looks a little off in the previous xray compaired to the front left. Hopefully I'm just being a paranoid pet parent, but I'm going to have the vet look over his xrays again Just to be safe. If it's also septic arthritis, we might be able to stop progression. He really can't afford to lose another limb.

 

[Drache613]

Hello,

How is your dragon doing, any progress on the right hand?
I hope it isn't septic arthritis, I am not sure why they develop that. Did they ever try the AZT for him?
That particular medication is very effective for that ailment.
I hope he continues to improve for you.

Tracie

 

[GraphicTortoise]

Hello,

How is your dragon doing, any progress on the right hand?
I hope it isn't septic arthritis, I am not sure why they develop that. Did they ever try the AZT for him?
That particular medication is very effective for that ailment.
I hope he continues to improve for you.

Tracie

I'm still waiting to hear back from the vet about the right hand. Since the leg that got amputated was confirmed septic arthritis I'm hoping the arm isn't, but I'm staying on the side of caution until we know for sure.

He originally was on baytril I think? That was before he was taken to the specialist and all we knew there was some type of infection that was continuing to worsen. I don't know what ATZ is, but since his leg was too far gone to try to save by the time the specialist examined it, nothing was really done specifically for septic. He is currently on Ciprofloxacin antibiotic for his amputation wound, I don't know if that's helpful at all. I'll ask about ATZ once the vet gets back to me and we figure out what's going on in his hand. Could you let me know what ATZ is and what it stands for?

I'm glad we tested the amputated leg, if it's the same thing in the front arm they'll know exactly how to treat it. I may not hear anything until after Thanksgiving though.

He's still using his right arm, it just looks a little swollen and he's favoring it a bit. Other than that he's eating, alert, and his wound is healing up nicely. It looks like he's getting ready to start his first healing shed soon and tomorrow he's allowed to start climbing again. I'm going to hold off on the climbing though until his hand is looked at.

 

[Drache613]

Hello!

How is he doing today? That arm/hand does look a little swollen. Does he have any idea as to why he would be
developing septic arthritis?
So sorry, I should have named the medication. The AZT is simply Azithromycin or aka the Zpack. It is an anti-microbial
or anti-bacterial agent but, not an antibiotic. Did the Baytril seem to work pretty well or was it caught too late?

Let us know how he is doing.

Tracie

 

[GraphicTortoise]

Hello!

How is he doing today? That arm/hand does look a little swollen. Does he have any idea as to why he would be
developing septic arthritis?
So sorry, I should have named the medication. The AZT is simply Azithromycin or aka the Zpack. It is an anti-microbial
or anti-bacterial agent but, not an antibiotic. Did the Baytril seem to work pretty well or was it caught too late?

Let us know how he is doing.

Tracie

I'm unsure about the baytril. He was on it for a few months and it seemed like it was working, but we may have stopped treatment too early before the infection was completely gone. He had been off it for about 6 months before getting rechecked. My regular vet doesn't have the best xray machines so it's hard to say what all happened before the specialist retook xrays.

I just got an email last night from the specialist about the right arm and possible causes of septic in the back leg. This is what he said:

-"Thanks for sending over Smaug's update, photos, and the concern with his right forelimb. I'm very happy to hear and see that Smaug's surgery site is healing well. I don't appreciate anything on the radiographs that would indicate an inflammation or infection present at the right wrist joint at the time these were taken. The extra "blackness" on the outer aspect of the right wrist joint is an artifact of the radiograhic technique.

If you're noticing new swelling in the right forelimb, I'd recommend we get Smaug started on some antibiotics and see him back sooner than his previously anticipated re-evaluation. I can have some antibiotics put together for you to pick up tomorrow. Please call our office tomorrow morning and let's get an appointment on the books to look at Smaug's joint. In the mean time, let's take some serial photographs (roughly 1 or 2 a week) with the joint of concern and a small ruler or object of a standard size so that we can monitor progression of any swelling present.

With regards to why this happens, the really frustrating thing is that we probably won't ever have a definitive answer. Some theories as to why septic arthritis develops is transient or prior immunosuppression and spread of bacteria from the GI tract, microabrasions near or around the affected joint, and penetrating trauma. Unfortunately, in most cases we never see or can positively identify the predisposing factor. The best thing we can do in terms of prevention is providing the most appropriate husbandry possible and performing regular wellness exams and regular monitoring at home."-

That makes me hopeful that the right arm isn't septic. I'll be calling during my lunch break and probably picking up antibiotics later today. Now that I think about it, I'm wondering if the swelling could be from the weekly iron injections. I don't get to see the vet tech administer them, and I'm unsure which arm or where in the arm it gets done, but she said he wasn't happy during the last injection. I can imagine he probably put up a fight. He probably won't be seen again by the specialist until next week, but I'll be taking pictures and monitoring the swelling the best I can.

 

[Drache613]

Hello,

That does sound like good news. I agree, it is hard knowing exactly why some are more predisposed to getting
a condition than others but likely genetics plays a huge role in that!
It seems the vet doesn't feel there is any septic arthritis conditions going on but just wants to be proactive at the
moment. As long as the antibiotic given doesn't have to be given long term right now. Do you think the iron shot
has been given in the same arm or injection site without being rotated on injection sites?

Let us know how he is doing.
Tracie

 

[GraphicTortoise]

Hello,

That does sound like good news. I agree, it is hard knowing exactly why some are more predisposed to getting
a condition than others but likely genetics plays a huge role in that!
It seems the vet doesn't feel there is any septic arthritis conditions going on but just wants to be proactive at the
moment. As long as the antibiotic given doesn't have to be given long term right now. Do you think the iron shot
has been given in the same arm or injection site without being rotated on injection sites?

Let us know how he is doing.
Tracie

I'm pretty sure they are rotating the iron injections. He got it in his left arm this time and that arm seems totally fine. I honestly have no clue why his right arm is swollen. He has an appointment this Thursday. Hopefully it's nothing and I'm just paranoid. They're continuing meloxicam and ciprofloxacin in the meantime (he was supposed to stop both last week). They also gave me baytril if I run out of ciprofloxacin because they were out of it. I think I have enough cipro to not have to use the baytril though.

His appetite has gotten a lot better and he's eating really well. He is also a little more active. It's still going to take a bit before he fully trusts me again, but we're working on it.