Liver failure or bacterial infection?

Question
QUESTION: Hello Tracie, I see that you have some experience with regard to Beardies and liver failure so please bear with me for my questions. I took my Lupe, approx 5 years old, to a vet that also claims to be "able to treat herps" but is clearly not a specialist (something I discovered during the appointment). I brought him in because he has been having foul, liquid diarrhea for a while now. He has never had dry pellets, but only very recently did they get really watery and smelly. He is a horrible eater when it comes to greens but loves his crickets. He is a rescue and when I got him he had MBD and has never fully recovered. He is well below size for age and has always looked "saggy" and dehydrated. He does drink, eats 30+ crickets at a sitting 2-3 times/week and I can get him to eat dandelions and greens and collards. Anyhow, at the vet they brought him back and came back later and told me he is in bad shape and is actively dying of liver failure. He is cream and gray with yellow eyelids and yellow on his mouth. He has always looked like this. I called his previous owners and asked. The entire clutch was yellow/cream and gray with yellow eyelids. They were telling me that their proof of liver failure is the yellow or jaundice. I asked if I can bring in a stool sample because I'm pretty sure he has coccidiosis and they said at this point it doesn't even matter. They gave him 300 cc of sc fluids and sent me home with him. I asked them about any supportive treatments but they didn't know what we could use. I inquired about milk thistle acidophilus lactulose etc. I am a human nurse but in my gut, if this were one of my patients in the hospital, I would be advising them to get a second opinion. I guess what I am asking you, is based on the info, what direction do I head in? Put him down? Try and help him supportively? Second opinion? He is my baby and my buddy and I have finally pulled my head together long enough to write for help. I love him so much. Thank you in advance. Melissa and Lupe.

ANSWER: Hello Melissa,

Oh geez, that is rough.
It is almost impossible to diagnose liver failure just from looking at a bearded dragon.  Did they not do a blood test?
If not, then I wouldn't fully trust that vet's opinion.  I would get a blood test done on him first.  That will tell more of what is going on.  If he has always had the yellow, then, the coloration probably does not indicate any liver failure just pigmentation.
Do you have any pictures of him for me?
They gave him 300cc's of fluid?  Really?  That is quite a bit from a bearded dragon, is he bloated up?
Based on his stools being watery & smelly he most likely has parasites.  A fecal exam should be done to determine what is going on there & to treat those symptoms.

Does he "act" like he is dying of liver failure?  Usually they are very ill & don't have much of an appetite.  
One change I would make though would be his number of crickets.  He is an adult so he really only needs 50 or so feeders per week.  Continue to get him to eat his greens, those are excellent for him.  
No, don't put him down yet as I feel it is a misdiagnosis.  I would be happy to look over the blood test results if you do get a blood test done on him.
Those agents, the milk thistle, lactulose & acidophiliz are great for liver function & help with fatty liver, etc.  I am not sure that need them.  

Let me know how Lupe is doing.
Tracie

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Lupe L.   QUESTION: Hi Tracie,
So the vet called back and said she spoke with a specialist who confirmed what I was saying- that Lupe's type is supposed to have yellow eyelids and mouth. His lab tests came back.  His CBC was entirely WNL. His BMP showed elevated phosphorus- she didnt give me the number but I can pick up the results Tuesday.  She said that elevated phos can be indicative of renal failure.  However, I know it is also indicative of dehydration just from being an RN.  She wants to recheck it after supportive care and forced feedings of 10-13 ml of liquified food per day. She recommended fruit and veggie baby food and chicken/veggie babyfood blends. He is finally de-bloating and has had multiple liquid stools today (after which he puffed up, turned black, and ran all over the house). In two of the stools there were large, undigested cricket pieces (wings, legs, etc) and something that looks like snails. With the passage of that excess SC fluid, he has stopped gaping as much (only did it twice today).  He was gaping and gasping around his enormous belly. The stools continue to smell horrific (almost like cat spray the last two times). He can clear the room. I will drop his feeders down but I am perplexed as to why there appears to be so much undigested cricket- its almost as though he is having some malabsorption issues as I found a small piece of peach which came out the same size it went it. Isn't malabsorption frequently caused by parasite issues?  If its the same as it is in humans, they irritate the intestines which are the part that absorb nutrients and also steal the nutrients prior to the person being able to get them. His lethargy is still present, but now only intermittently- as I said, he tore around the house several times today- and then naps on the heating pad and then will resume being wild. It doesn't appear to me that he is acting like he is dying from anything.  He acts/looks like he is malnourished/anorexic which that + the diarrhea is why I brought him to the vet in the first place.  Thank you for your help Tracie. I will gladly take any help you care to offer.

ANSWER: Hello Melissa,

Thanks for the picture of Lupe.  He is a cutie pie.
I am pretty sure he has metabolic bone disease.
What type of UVB light are you using, a tube bulb or a compact/coil light?  How old is your UVB light?  
Can he fully support his entire body weight when walking or running?  Has he had any trouble climbing or with balance that you have noticed?
If you will notice, his lower jaw is not quite properly aligned, or at least it appears that way in the picture.  That would explain the calcium to phosphorus ratio imbalance.  The phosphorus is too high due to poor absorption of calcium.  What was the calcium level?
Great, please send the entire blood test to my home email at:
Drache_613@hotmail.com

Malabsorption can be caused by parasites, yes so I highly recommend getting a fecal done.  Any regular vet can do a fecal for you, or since you are a nurse, you can probably get access to fecasol & a slide to do a fecal float & or a smear or both, & look under the microscope to see if you see anything.  It does sound like he needs Albon or Metronidazole.
I don't think it is probably renal failure though.  I think it is going to be caused by the nutritional problems.

He doesn't look like he is dying, no.  His colors are normal, as they have color like that often.  

What type of calcium do you use?  As an adult he needs calcium 3 times per week, but at this point, after looking at his blood tests, he is probably going to need a liquid calcium supplement.  
The baby food diet is fine, for right now.  
Let me know how he is doing.

Tracie

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recent lupe   QUESTION: Ok- lighting exo-terra solar glo 125W self-ballasted light (think floodlight) and before that the repti-something coil light which I disposed of because I read that it was not the best choice. I've had this solar-glo for 1.5 months. Calcium- Zilla's liquid spray calcium.  Reptivite twice a week. Dragon Dust for dusting the crickets. Cricket food + vitamin dust for the crickets for gut loading. He also eats dandelion for additiona foodsource calcium. When I took him from his previous owners he had MBD and had a deformed tail and jaw. I have been monitoring and it does not seem to be getting worse. He can support himself on his own legs and is a big fan of running around when he is free and climbing when in his terrarium. If not climbing though, when in his enclosure, he just basks. He also does not self-regulate but will gape when too hot and wait for me to move him. I can't think of what else I can do to help with his calcium or what could be causing this. The only strange thing that comes to mind is that up until several months ago we had well water and although he did not drink from it, he did bathe in it.  The water was treated with a de-mineralizer and softener. Maybe that interfered with calcium absorption? I'm at a loss. This morning he is sleeping in my lap on his heating pad after stuffing his belly. He also was doing that strange thing again- He was sitting in his enclosure and as soon as he saw me he started swishing his tail from side to side in a slow controlled manner. Watching closely it looked like he was gyrating to itch his bottom on the mat. It did not appear to be like a tic or a twitch as it was slow and purposeful and he does the same thing when swimming. Any ideas?

Answer
Hello Melissa,

I am sorry to say that the Reptiglo products are subpar for UVB lighting, unfortunately.  While the Solar Glo mercury vapor bulbs look nice, their UVB output is horrid.  So, most likely what is going on is since he was under a coil previously which puts out practically no UVB & now is under this bulb, he is unable to absorb his calcium due to poor UVB exposure.  
He probably did not have UVB before you got him.
This is not your fault.  The reptile lighting industry is terrible.
He will need either a Reptisun 10 tube bulb, or you can try the T-rex Active UV heat mercury vapor bulb.  
Here is a site that sells them.  Don't mistake the Active UV heat for just the UV Flood.  It is the more expensive one, because the UVB is higher, or it should be.  
http://www.creativepet.com/index.php?main_page=product_info&cPath=4_12&products_

Right now, once you get this light, or the Reptisun 10 tube bulb, he will probably need to get on some liquid calcium for a little while to help with his absorption.
Twitching or swishing their tail, means they are just interested or intrigued with the situation or watching intently.  
I would use filtered water for him, just to make sure he does not absorb too much sodium through his skin & vent area.

Perhaps he is not too calcium deficient, but I recommend getting a better bulb.  I know it is more money, but I think he does need it.  

Let me know how he is doing.
Thanks.

Tracie