iguana death

Question
QUESTION:
I have a question. I have a 12 year old iguana and 10 days ago I took him to the vet as he had stopped eating for about 5 - 7 days and was lathargic. They gave him shots of vitamins and they took blood and tested his kidneys it came back Negative 2 days later so we began feeding him through a syringe. Then they tested poop sample for parasites came back Negative. He still was not eating so we were syringe feeding him twice a day 15ml of critical care food mixed with water. And they said because his kidneys seemed fine we could give him calcium so we started with that. Yesterday I started to intoroduce him to fruit through the syringe to get him to try to eat again...the dr. said it was ok....so last night kiwi and this morning strawberries. I fed him and then put him under the hot light to help it digest. Well I went in to get him to take him outside for sun as they said this is good for him too and saw he had spit up liquid. We rushed him to vet and sat for 2 hours waiting because they thought it was not an emergency. I knew he was chocking or aspirated...they still seemed to take all of their appointments first and said he was stable and not critical....finally when we got so mad we were leaving to go to another vet and he was lifeless in my arms completely we rushed him back in and they basically said they put him in incubator with oxygen. and would give him shot of fluids...then they looked at his chart and said the kidney test from 7 days ago had come back high in phosphorus and he probably just had kidney failure. Well, my baby died today and I am feeling realy unsure of what happend. With no real explanation from the vet....but "iguanas are hard to take care of" If it was kidney failure isn't it bad to give him calcium shots and if it was why did they tell me it wasn't last week and not start me on some other med protocal. If he aspirated from the food I gave him was there anything I could have done to save him and why would he do that if he had swallowed it all and it was about 2 hours later when he spit up. The vet did say he had strawberries in the back of his mouth when he finally checked him but he said they were not choking him. I am just frustrated and looking for some answers.
Thank You.

ANSWER: Hi Jennifer, Let me start by saying how very sorry I am. I have a 14 year old male and would be devastated to lose him in such a way.

I do have some medical knowledge but I am not a vet and I hesitate to start second guessing vets, especially based on partial information. I also have access to some current reptile veterinary literature and will pass on what it says about renal failure in iguanas. I hope that can help you.
Diagnosing renal disease and failure in reptiles is different from diagnosing it in mammals and also a bit trickier. The usual renal markers used for diagnosing renal disease in mammals are blood BUN (blood urea nitrogen) and creatinine levels but these may remain normal in reptiles in renal failure. My first question would be whether your vet was experienced enough with reptiles to be aware of this or whether he/she applied "mammalian rules" to the blood results and subsequently determined that your iguana's kidneys were fine.
The more reliable markers for reptile kidney function are blood calcium, phosphorous and uric acid levels and the calcium to phosphorous ratio. The phosphorous is high, the calcium usually low and the calcium phosphorous ratio inversed. The uric acid level may or may not be increased depending on the stage of the disease. Physical exam may or may not reveal an enlargement of the kidneys. I would also be questioning why you were told that the kidneys were fine when a high phosphorous result was found. The literature I have states that kidney disease should always be ruled out or investigated when a high P level is found.
If the Ca:P level was inversed (more P then Ca) then a calcium supplement would be part of the treatment to correct that as well as possibly a phosphate binder. Severely low blood Ca levels can result in seizures and heart failure. Correcting this ratio is also necessary to prevent the release of parathyroid hormone. The PTH hormone is released in situations of low Ca and high phosphorous and triggers the release of calcium stores from the bone to boost the blood Ca levels. It will result in metabolic bone disease if left untreated.
I would also be asking how high the phosphorous levels were and why this was not specifically addressed in the treatment.
Nausea can also be present in renal failure in iguanas which may explain why your guy vomited, anti-nausea medications can be part of the treatment. I highly doubt that the fruit played any specific role in the vomitting and I don't know of anything you could have done about the potential aspiration other then what you did.....take him to the vet. I know that when I have lost an animal I often torment myself by thinking about the last thing I either did or didn't do that may have somehow contributed to the death. I think you are doing the same thing.

I assume that you have already googled and read much of the on-line info on kidney failure in iguanas. If so then you will have noted that the symptoms can come on quickly, even in iguanas who have had optimal care and diet ( Melissa Kaplans site anapsid.org outlines a couple cases) and treatment success is not high. It remains the most common health problem in older iguanas and I am practically assuming that it will claim my old boy one day as well.

I hope this info has been of some use to you. I've included a link to an informative veterinary study as well. I hope you feel better soon. Take care.

http://vfu-www.vfu.cz/acta-vet/vol71/pdf/71_333.pdf  


---------- FOLLOW-UP ----------

QUESTION: thanks so much for your information. It is just so hard not to blame myself and I am just devastated.  I really appreciate your thoughts, time and help.  I am going to get Lewis's records from the doctor this weekend to try to figure some of this out myself and hope to speak to the owner of the vet clinic, who was the first dr. I went to 2 weeks ago about the way we were treated. That is another story in itself. The clinic was referred to me and the first Dr. (owner )was very nice and helpful with the first bloodtest and stool sample that came back negative so I thought the clinic was reputable and they claim to know about iguanas.  I saw him twice.  However the last day when I returned that Dr was not there and it was a different treatment.  They made us sit in the waiting room for 3 hours waiting for a Dr. to see Lewis "IN BETWEEN" appts.  however my pet is dying in the meantime and they tell me he is stabilized in an oxygen incubator.  I thought he was in the back getting treated. Then when I asked to see him 3 hours later they brought me back and just brought him in and laid him on the table and walked out...nothing to say.  The whole time telling us he was stable and they were waiting for the Dr. whenever they got a minute to look at him.  At this time I realized they had not done anything and asked if they weren't going to see him to refer me to someone else...the receptionist brought me an address of a vet about 1 1/2 hours away with traffic here in LA.  I stormed out and then realized my baby would not live as he was barely there at this point and turned around and walked back in and finally the receptionist said " he does not look good"  and my husband screamed at them that is what we have been trying to tell you.  So now the same Dr. that said he could not look at Lewis he was waiting for the expert became the expert and told us he would give him fluids that he probably had kidney failure.  He told us to go and they would keep him do some test and if needed keep him in the incubator through the night that it was best for him.  Well they called us 1 hour later and said he died.  Probably my biggest mistake was not being prepared ahead of time and keeping him checked up regurally.  He was always so healthy I never thought to take him in.  He was such a lovable great guy...never whipped his tail once, never bit, loved everyone.  I should have been prepared and found a GOOD Clinic. I assumed they would take care of me or send me to someone who could if they did not know what to do.  So beside the loss I am dealing with the inhumane treatment from the Vets it was as if he did not matter.  And he was my everything.  SO I have guilt for this too.  I am suspicious it was kidney failure but feel there might have been something they could have done to help.  

Would the Kidney Failure make him vomit his food up?  Is that why I found him with the liquid by his mouth?  What makes them open their mouth as if gasping for air?  maybe his lungs going out too?  He was doing that on the drive to the vet.  Also, do you think he could have died because of the vomit making him aspirate and go back into his lungs.
I don't think they even did X-rays to see any of this.  I just feel like I might have fed him too much or maybe they told me to feed him too much.  

Anyway...when I get his records can I e-mail you with other questions.  I know I have the first Xray and do not see any swollen kidneys.  

Thanks Again
Jennifer

Answer
Hi Jennifer, It does sound like you experienced very shoddy treatment at this clinic which certainly makes your loss even harder. One of the main advantages of finding a clinic that really specializes in exotics (in addition to their specialized equipment and medical knowledge) is that they fully understand that reptile pets can be just as cherished and loved as furry/feathered pets. It sounds like your clinic considered Lewis to be "just a lizard" and was therefore a low priority.

Kidney failure can apparently cause nausea (anti-nausea meds is part of the treatment by some vets) which I suppose could have caused the vomiting. I don't know if an x-ray would pick up evidence of an aspiration, that may need a necropsy (autopsy). When I worked in the exotic retail trade people would sometimes bring their dying reptiles to us rather then to the vet even though we completely discouraged this. I certainly witnessed the type of gasping that you describe in reptiles that had not vomited or aspirated.

Truthfully, I don't think that focusing on that particular aspect is helpful or healthy for you right now. I would try to focus on the bigger picture which is the poor medical treatment and attitude that you experienced at this clinic. When (and if) he aspirated you did exactly what you should have done and took him to the vet where he was not given the immediate attention that his condition obviously demanded. A gasping animal cannot be considered medically "stable" That inaction is what contributed to his death, not your actions.

The really inexcusable part to me is the fact that they concluded from his blood work that his kidneys were fine, and then somehow from this same result later concluded that he had kidney failure? That would be the point I would be pressing with the clinic owner.

I would be interested in seeing Lewis's results and will provide any further info that I can, you can flag the question as private if you would prefer and only I will see it.