Swollen, possibly infected shoulder; in dire need of advice.

[oneiro]

Hello, members of beardeddragon.org - I've lurked around this forum for a long time but never posted before. You guys seem like helpful, wonderful people and I'd really appreciate it if someone could take the time to try to help me out.

Firstly, my boyfriend and I own two bearded dragons named Rukh and Jaime. Rukh has never had any trouble whatsoever and she is now over two years old and thriving. Jaime is a bit of a different story. My boyfriend and I rescued him from a Petco roughly two years ago, a few months after getting Rukh, when I saw that he'd lost two feet and no one had noticed. Upon closer examination, we found that his one good front arm was badly damaged at the shoulder, but we didn't worry about it because he didn't seem to mind using the arm and we figured we'd keep an eye on it. He was only a couple of months old at this time. I should also probably mention that since then he's always been very skinny and it is hard to get him to put and keep on much weight. However, he's got more energy than any bearded dragon I've ever seen, so it seemed like that was just the way he is. He is always active, alert, running around and wanting to jump on everything, so it didn't seem like a cause for worry.

Now, however, there are some big problems, apparently. We went on vacation two weeks ago and boarded our bearded dragons with our vet, but we noticed on the morning that we left to drop them off that his shoulder seemed to be inflamed. I thought it might be a minor infection, but not that big of an issue because he had mostly been behaving normally. He had been eating slightly less over the past couple of days, but until I saw the shoulder I hadn't thought much of it.

We dropped them off at the vet and asked about the shoulder and if someone could take a look at it. The nurse who took them said it did look worrisome and slightly discolored, and agreed with me that it might be infected. She said she would have the vet call us as soon as they'd examined Jaime. The next day we got a call saying Jaime was being put on a critical care diet and regimen with some antibiotics and pain medicine, but they never told us exactly what was wrong (they never put an actual vet on the phone, but just relayed information through nurses or interns). However, we didn't get a call after approving treatment, and every time we called back the vet said they were doing okay, though Jaime wasn't eating and they had to force-feed him. Overall, though, it seemed like he was okay.

Then we got back yesterday and went to pick them up. I was happy to see that Jaime had gained weight, but when asked about his condition, the nurses said that the vets were still concerned about his previous injuries, and that because he was a rescue, there was still a chance of losing him. No vets were in at the time we picked them up, and I did not get answers to the questions that I had. They told us we'd have to keep force-feeding him, and gave us a veggie and critical care food formula to give him. They also gave us the meds they'd put him on, even though they said he was done taking them.

We were worried, and went and got some wax worms and super worms when we got home because we wanted to see if Jaime would eat them. He normally loves worms, and he only gets them once in a very rare while, so if he didn't want those then something was definitely wrong. Also, we figured feeding him worms would help him put on weight. However, when we got him home and warmed him up, he went back to being his normal self - running around, looking alert, etc, and he was very, very excited to see the worms. He ate them as fast as we could feed them to him.

Now I'm starting to wonder if the vet was doing something wrong. When we picked the dragons up, they were both very cold, and Rukh was so happy to see us that she jumped immediately onto my shoulder to get warm. These people have always seemed to know what they were doing when it came to bearded dragons; I'd been to a few vets and no one had ever been able to give us a single piece of useful information about them, but this one had always seemed to know what they were talking about. I'm starting to think I was wrong, though. There was no reason at all for Rukh (the other lizard we own) and Jaime to have been so cold, they were in cages until we got there and we didn't linger very long. I'm also skeptical about Jaime not eating. He is typically very finicky about salad, though he really loves squash, but he loves crickets and although he'd been eating slightly less at the time that we dropped him and Rukh off, I am really surprised he stopped eating completely so quickly. I haven't tried feeding him crickets or vegetables yet as I haven't been to the store, but given his enthusiasm about the worms, I really have no idea if the nurses/interns were taking care of them correctly. I have also been reading that for infections like the one in Jaime's arm, bearded dragons are typically put on antibiotics for months, not a few days, so I am not sure if the vets gave Jaime enough medicine. They never told us if they even ran a blood test and it bothers me that they haven't been very forthcoming about answering questions or giving information.

So I'm asking you guys. Does the vet sound full of ****? What should I do about Jaime's shoulder? Should I find a different vet? There's a reptile rescue organization in the area that I'd really like to go see or get a recommendation from, but for some reason they are really hard to get in touch with; I guess because it's a small startup run by four people. But regardless, I'm running out of places to turn and look for advice. Should I go back to the vet and get them to give Jaime more medicine? I think he can come out of this just fine if given proper treatment, since his behavior is nothing like what they said since we got back. All I had to do was get him warmed up and now he is acting mostly like himself, although I am worried that he's been very dark and mottled almost all the time since returning yesterday.

I'm posting pictures of the shoulder that is inflamed. The medicine the vets had him on while boarding were as follows:

Baytril Suspension 1/2 Oz bottle; give 0.1 mL orally every 12 hours for 7 days
Meloxicam; 1.5 mg/mL bottle; give 0.02 mL orally once a day for 5 days

The foods they seemed to be giving him primarily (and gave to us yesterday when we left) are as follows:

Critical Care Fine Grind and Carnivore Care, both made by Oxbow Animal Health.

Here are some pictures I've taken of both shoulders for comparison [EDITED] :
Good shoulder: http://i1340.photobucket.com/albums/o731/elrounds/CentralCoast-20130105-00028_zpsfc8ab7ab.jpg
Good shoulder: http://i1340.photobucket.com/albums/o731/elrounds/CentralCoast-20130105-00021_zps95c49de0.jpg

Bad shoulder: http://i1340.photobucket.com/albums/o731/elrounds/CentralCoast-20130105-00026_zps76a72a04.jpg
Bad shoulder: http://i1340.photobucket.com/albums/o731/elrounds/CentralCoast-20130105-00024_zps504a9779.jpg

Overheard view of Jaime: http://i1340.photobucket.com/albums/o731/elrounds/CentralCoast-20130105-00031_zps642df5ff.jpg

I love my lizards more than anything in the entire world, and I really want to do what is best for Jaime. Thank you in advance for your time and help.

 

[AHBD]

Hi Oneiro....you seem to be very dedicated to your babies, hopefully someone can help you here. Anyway, I can't open the pics....I tried to view the bad shoulder, it opened for a split second then it disappears. Is there another way you could post, like photobucket ? For the split second that I saw it, it almost looks like a possible fungus. If it is a fungus, you can apply Lamisil, Monistat or Lotrimin anti fungal cream. I'm sorry that your vet doesn't seem to know exactly what it is, it's important to feel comfortable with your vet, and good communication is really imperative. You can call and respectfully but firmly ask exactly what they are treating him for, and what they feel his diagnosis/prognosis is. Ask if you can speak with the vet who treated him. On this site, you can p.m. one of the mods. like Drache613, Goonie or Sweetiepie. They are usually very helpful [ especially Drache, who's name is Tracie] with reading blood tests, etc. Hopefully you can get some help for your boy. Thankfully he is active and alert. If he's thin, it's probably good to keep up with the Critical care along with the worms that he loves.

 

[Drache613]

Hello,

That is quite a story!
How is he doing today, still active & basking I hope?
I tried to view Jaime's pictures but couldn't view them. Is it still swollen & discolored?
How much does he weight & is he still on the Baytril or was it discontinued now?

Sometimes vets have a tendency to be overeager with their medications & give too much or when it really is not warranted. They should have given you information on his initial blood test before medicating. The metacam is fine for help with pain relief. I can take a look at the blood test if you would like, if you have or can get a copy.
The critical care food is good for helping him with nutritional intake if he is not eating enough. If he is eating greens & insects on his own then it sounds like he has a pretty good appetite.
Were they not keeping them at optimal basking temperatures so they were cold when you picked them up? If he was too cold at the vets then his system was not able to metabolize the medication in his system which could have left him lethargic & not feeling well.
Has his beard been black or no?

Does his shoulder seem to bother him any? How long is he going to be on the Metacam?

Tracie

 

[Esther19]

I had to close the error message, then click the down arrow for download, then open it.

Wow. That shoulder pad is really swollen. That white stuff sure could be fungus. Could it be retained shed?

 

[Irwinshealth]

Aww! The poor thing does not look comfortable. My advice is to listen to whatever Drache613 (Tracie) tells you. She is great at helping out people. She seems to know than most peoples vet and has a heart of gold. Good luck. Please keep us posted with the progress

 

[oneiro]

Hey everyone, thanks so much for the replies. I've edited the links above using photobucket and bolded them as an indication that they were changed; sorry about the google drive ones not working, I think my privacy settings were off or something but this is easier anyway.

Tracie: He is still active and basking. He is actually wanting to be in the heat as much as possible; every time I've taken him out he's always run back to where he knows his cage is, or tried to find a warm spot somewhere else. I think I read or heard somewhere that this means he's probably trying to fight off the infection?

I weighed him today; he's pretty underweight at about 315 grams and is somewhere between 18 and 19 inches long, but I'm stuffing him full of food. He ate six or so superworms and a few waxworms before I started stuffing him with the critical care formula...I stopped because I think I got overzealous and he was so full he couldn't move. He's been basking ever since, and hasn't wanted more food.

I can't see that the shoulder is still discolored, but it is very definitely swollen.

I don't know whether or not a blood test was done. When we picked them up, I asked if I could call when the vet was in and they told us he'd be there on Monday, and would leave a message with him that I wanted to talk about Jaime's condition. I intend to ask about the blood test then, as well as for a formal diagnosis, if they have one, and I will explain what has happened since we picked them up. I will relay all of this information to you as soon as I know, and will get a copy of the blood test if possible/if there was one. If there wasn't one, I'll try to get one done. I will also ask all the relevant questions about average temperatures in the cages they were kept in.

As for coloration, he seems better today. Yesterday his beard was pretty dark, and today he's looked fairly normal - not perfectly white and content, but not totally dark, either. The only time his beard really got black today was when I was feeding him the formulas; he got pretty upset when I insisted on shoving the syringe in his face.

As far as I know, he is no longer on the Metacam or Baytril; they were only going for about a week and they started the treatment the day after we dropped them off, so I think he's been off both medications for at least a week. They gave us more just in case he needed them, though.

With respect to the possible fungal infection that a couple of you have mentioned - I think it is scabbing and/or retained shed (as Esther19 mentioned). That arm has been healing since we got him and I give him regular baths to try to get that skin to fall off, but it hasn't yet. The vet has assured me on previous visits that this is normal and it can take years for that skin to fall off. I think if it was fungal, they would have picked up on that, but maybe not. I can try using an anti-fungal anyway, if it can only help.

Overall updates:

Today he did pretty well, spent the vast majority of his time basking, and returned to a much more normal coloration. He was not as active, but as I have been feeding him off and on all day and he hasn't gone to the bathroom, I think he's just overfull - will see tomorrow, though. He is still alert and paying attention to things around him. His cage is set up in front of a window and he loves staring out of it, and often reacts to birds flying by, or to movement outside; I noticed no differences from how he usually is in terms of these responses.

I do think he is uncomfortable, but I can't tell whether or not the arm is in pain. Last night when he was sleeping, he never turned white, but was pretty dark with stress marks every time I checked on him, which concerns me and makes me think there may be some pain - I will keep a close watch on him tonight to see if this does not change.

I have one question - I was going to give him a bath tomorrow because he smells pretty terrible from the carnivore care formula; is this a good idea or can it worsen the infection? I would have done it today but that possibility made me hesitate.

Thanks again to all of you for the responses; I will keep posting updates.

 

[DaVinci]

aparently i m the only one that can see his pics his arm was very swollen and pus or fungus was like oozing out most of his shoulder :!: i would reccoment fungus cream or try neosporin or something
if this doesnt work try giving him a bath at last resort i would try calling that rescue again or visiting if possible

 

[Esther19]

Yes, do give him a bath. Glad to hear he is improving.

 

[oneiro]

DaVinci: Nothing oozing out of his shoulder, actually...there's no pus or anything, it's just swollen. What you are saying is pus is probably the crusted-over necrotic tissue that hasn't shed. If my vet is to be believed, this is normal and may take years to heal.

 

[DaVinci]

well that is good please give him a bath and i am glad he is improving

 

[DaVinci]

i just read that if they get bumped they can get a swollen shoulder did you find anything knocked over in your tank right before you left
he may have been cut or something

 

[AHBD]

You might consider having a scraping done to culture it and see if there is a fungal infection. If you go to the infectious diseases forum and look at the thread about Dino's yellow fungus, then go to page 4, scroll down to about the 5th post where there is a picture of Dino's shoulder area. There is a real similarity to your pics. Also, just to go over what you've already mentioned about his condition since you got him when he was a baby, did that shoulder always have trouble shedding, since it had been injured , and was it a bloody injury from a bite ?

 

[DaVinci]

this could be tail rot but on his shoulder

 

[AmberC]

I was thinking some kind of joint infection? Has anyone tried to drain it or xray it? I would definitely try to contact your reptile rescue guys they usually have the in on a good vet (I actually did this for my beardie). As for the not eating, not to stick up for your vets because it all sounds a little fishy, your guys might have just had some serious stress over being left there and refused to eat for that reason. I would also keep up on the force feeding since its stuff good to help gain weight. Good luck!

 

[oneiro]

Hello everyone, sorry there has been such a delay in posting updates.

Our vet still hadn't given us very clear answers after calling them. She had us put Jaime back on the antibiotics and said that they hadn't done a blood test because he wouldn't be able to survive the loss of the amount of blood they would need. She did say that a fungal infection was a possibility, and to follow up later to see if he was responding to them.

Today we took him in for his follow-up visit and his shoulder had gotten more swollen...however, Jaime gained a fair amount of weight. We are having some trouble making him keep weight on, but he is still behaving well (basking a great deal, moving around, etc). Our vet was pleased to hear that this was the case, and decided to put him back on the Baytril as well as an antifungal*, since his skin issues seem systemic. She checked him for other odd lumps as well, and found none, so we are optimistic about this combination. Jaime is due back in a week to see how he is responding. If things aren't going well, then I think she will take a tissue sample to check for a tumor...however, I'm a lot less worried than I was before since people here thought it was fungal to begin with.

So that's what's going on; Jaime seems to be in no immediate danger. They also told us that the nurses and interns are told to tell clients the worst-case scenario so as not to raise expectations too high, so he wasn't in any terrible trouble to begin with.

If anyone has any advice on getting Jaime to put on more weight, though, I would be much obliged. Feeding him the formulas is difficult; he doesn't much care for them and force-feeding him has bruised his mouth up a bit and I am reluctant to keep making him take them. I've been forcing him to eat squash and greens instead. He eats insects fairly willingly, but I'd feel better if he was eating more food in general. Thank you all for your advice and help.

*Sporonox, .15 ml daily.