Please help with very serious health issue

Neuro · Member Joined: Aug 03, 2005 Posts: 35

Hi this is my first time here, and i would like to make a question to the vets reading this forums:

In the past 20 days one of my tegus (Minos) is having a very bad time, he was having trouble breathing and we went to the vet, he told us that it was a respiratory system infection and give him Baytril 5% to him for 8 days, in that occasion we told him also that there was some kind of thread in his glottis and he told us that it was normal, it must be some kind of sinew. 8 days of baytril and he was just a bit better than the first time, he told us to stop giving him baytril for 7 days and then we must restart the medication again.

We did it for 5 days, the first 3 days he gave us an antiinflammatory and some kind of homeophatic medicine, but it got worst, so we restarted the baytril now for 12 days and he got better for some time, but the infection didnt seem to be eradicated.

We went to see another vet, told him all the case and the strange thing in his glottis, she told us that it was a vein, and make him this analysis, culture of bacteria thing and wait for 5 days for the results, and the end this were the results:

Positive: staphylococcus aureus positive and Enterobacteria agglomerans negative.

i went to the vet to get his medicine, he told me how to give it to minos and she went to the phone because there was something from another state calling her, at that time minos started choking, i called the vet and he was all confused, she told me that he was choking because of the gerber that i gave him yesterday, you know they move their head when they cant breathe and "the vein" just came out, i was so scared and i screamed "omg he just broke his vein!", she take the vein and tells me "thats not a vein, its a hair". "the vein" was strangling the glottis of minos, she took it out but it was too late, his heart stop beating.

Then she takes this medicine and she injected it in his heart, for a second he looks like hes coming back but he wasnt breathing i told her "but him a tube or something to give him oxygen" but she just had this huge tube for dogs he tried to give him massage but it was useless, and then she told me that minos was dead, " no way!, his mouth its still pink, give me that tube" and i started to give him air very carefully, after less than a minute he was back again, breathing and his heart beating, alive.

This was a horrible experience and im just disappointed of all this vets that i've visited, she took him x-rays to see his lungs and confirm that them wasnt filled with something and he was just fine, i came to my house and called this guy at the zoo, give him the results of the analysis and he says "uh, staphylococcus and Enterobacteria? thats normal in a reptile, he must have stomatitis and that can be reversed with..." after the normal in reptiles thing i just stop listening, i came to the net to check this things on minos and it seems that the medication that the last vet give us is the right one and they are resistent to baytril -_-.

Im so scared for the health of minos because of all this normal in reptiles, the vein and his dead because i cant put a tube in his mouth thing, im sticking with the new medicines and the special care (high temp, procesed food, iodine for the ulcers in his mouth) but i would like to hear another opinion for vets that have experience with tegus and another owners and i think that this is the right place.

So please, give me your opinion and share your wisdom, hes 3+ years old weights 1.650 kg, tumpinabis nigropunctatus, he was treated with baytril 5%, the new medication is Cefuroxim and amikacin (Amikacina, Cefuroxima)

Please help.

ElliotJasChief · Posted: Wed Aug 03, 2005 8:48 pm Post subject:

YIKES... there really needs to be some more stringent requirements and some sort of GOVERNING BOARD for "Exotic Vets" I am getting REALLY sick of hearing stories like this.

You have my sympathy and although I'm afraid I'm not knowledgable enough in reptile pathology to offer you any advice I sincerely hope your tegu recovers.
_________________
Elliot

1.2.0 blues
1.0.0 red
0.2.0 family

...and way too many fish

Rick · Posted: Wed Aug 03, 2005 9:30 pm Post subject:

I must admit that I have never run into anything like that with my tegus or even any that I watched over. The one I know here who has the most scientific knowledge of the tupinambis species is "tupinambis". Though he is not a vet, he does have some hands on experience with captive and wild tupinambis and may have an opinion.

I can state that in my local area none of the 'trained professionals' know jack about tegus. The last one I tested (I visit for a checkup and just ask questions I know the answer too) tried to tell me adult tegus need large(tall) enclosures with plenty of climbing room. He claimed to have dealt with lots of tegus when I called him on the phone yet when I was done the poorly done checkup I found that "Tegu" nor "Tupinambis" were even in the billing computer. The results of a fecal I had done was that the "Tegu Iguana was clean"

Anyways, I hope all goes well and please keep us informed of the progress.

Just for reference the scientific community renamed T.nigropunctatus to T.teguixin (Colombian Black Tegu). The formerly named T.teguixin is now called T.merianae (Argentine Black & White Tegu)

Rick
_________________
Sisco Reptiles - Proud Breeder of the Tamest & Most Social Tegus. See www.SiscoReptiles.com

Neuro · Member Joined: Aug 03, 2005 Posts: 35

Its so frustrating not finding a good vet, the first that we visited (i talk in plural because the tegus, minos and ada, are belong to my girlfriend and me) was the vet from this huge pet store were lions, tigers, pumas, and all kind of animals were sold, 20 days with baytril and he told us that the treatment can be extended to a month or two, the zoo guy told us that the results in the analisys were normal, and the "your pet is dead because i cant use this tube" its working on this huge specialized pet store, the best ive found in my city.

Minos is doing fine now, it has been like 9 hours since he meet saint peter and hes stable, breathing while opening his mouth just a little bit from time to time but unable to sleep yet, i think that the resurrecting medicine its some kind of adrenalin so that may be the cause.

Its so sad that the vets dont have the experience but its also because of the people, in the store that i got minos they were selling like 10 tegus, i bought 2, just minos and zatara (minos brother) saw the vet while still alive, so no people taking care of their pets, no vets studying reptiles.

ElliotJasChief · Posted: Thu Aug 04, 2005 4:57 am Post subject:

I'm blessed with not one but two vets in AZ (that I know of at least, there could be more...hopefully) who really know what they are talking about when it comes to reptiles in general and specifically tegus.

Lucky me...well hey I know a few guys you can see if you want to fly your tegu and yourself over here

_________________
Elliot

1.2.0 blues
1.0.0 red
0.2.0 family

...and way too many fish

tupinambis · Posted: Thu Aug 04, 2005 7:25 pm Post subject:

Thanks for the praise, Rick, but this is one area of animal husbandry where I have to admit I am rather inexperienced in. Generally, I work to avoid having problems in the first place.

What little I do know is that Staphylococcus is frequently associated with dermatitis (ie. it is typically skin disorder bacteria), but coagulase negative Staphylococcus are commonly thought of as normal airway flora/fauna. Enterobacteria are also common in healthy animals, but at the same time many species are also seen as pathenogenic. I know, not really helpful, these bacteria may or may not be hazardous little tourists in our pets.

On the subject of the medicines, however, I know a little bit more. Baytril, in case most people haven't figured this out yet, is NOT a wonder drug that cures everything, it is the rallying cry of the woefully ignorant vet who doesn't really know better. I'm not saying Baytril doesn't work, but it's like aspirin - they use it to treat so many illnesses whether it is highly effective or not because they know it isn't likely going to harm anything either. Most vets don't have a lot of exotic animal training, but the one thing they've all been taught is "when in doubt, proscribe Baytril". Baytril is known to work in reptiles, a lot of other medicines are still being worked out. It's one of my "key indicators of a good herp vet"; if after a brief examination I hear the word "Baytril" without a damned good explanation for why (as I said, it does work, it just isn't the answer to everything), I go elsewhere. Baytril is common and cheap, but it doesn't mean it is necessarily the best.

Amikacin (and Gentamicin, both Aminoglycosides) IS a good antibiotic and it has been highly effective at treating broad spectrum, most specifically, though, gram-negative bacteria (it is ineffective, though, against anaerobic bacteria). The Aminoglycosides are nephrotoxic, although Amikacin is less so than Gentamicin, and it tends to be more effective anyhow. With proper hydration, the nephrotoxicity is of little concern. I've used it with 100% success on many occassions (knock on skull).
Cefuroxime, however, I know very little about, other than it is sometimes used for treating respiratory related illnesses.

This all being said, it should also be noted that antibiotics should not be proscribed unless it is known what is being treated. Admittedly, there's a bit of a catch 22 that when you've got a really ill reptile, you don't want to wait a week to get proper identification on the bacteria in question, hence why Baytril jumps to the front. But nonetheless, it is dangerous to be giving unnecessary medications and vets should know this.

It is very, VERY worrisome that these vets did not see the hair, or worse, misdiagnosed it. I'd be very tempted to have a look at said hair under a microscope to make sure it indeed is a hair and not a parasitic worm of some sort, just to be on the safe side. Sounds like your tegu basically had something lodged in it's throat for a long time, and that was the source of the illness (however, I'm not a vet so I'm guessing here).

Another concern I see is the lack of resuscitation skills in the vets. Whereas the best method for ventilating the lungs during respiratory failure is a tube down the glottis, it is not the only method. In absence of suitable tools, it is easy enough to give mouth-to-snout ventilation, you simply hold the jaws shut, put your mouth over the nose/mouth, and gently blow. With enough force you will get air into the lungs, but you don't want to blow too hard as too much force will rupture the lungs (their lungs are MUCH more delicate than ours). It is easily enough done, though, I've done it many times on animals ranging from large anole size (very very gentle) to adult tegus (doesn't work so well on crocs, their mouths don't seal, making it necessary to blow strictly through the nares, and these are often closed shut - plus you can imagine the inherent risk in "kissing" a croc

)

And lastly in this diatribe, whereas I don't have a clue what they may have injected in the heart (adrenaline seems to be a good guess, but I have no idea how effective it is in reptiles), it seems very surprising that they gave up so fast. Reptiles have been known to switch to anaerobic metabolism under certain conditions and will survive so often for SEVERAL HOURS. In fact, it is one of the biggest concerns of vets who are properly trained in herps and have to euthanize a reptile. There have been many unfortunate incidents where a reptile was given an injection that would be lethal to a mammal, only to find the poor reptile awake and in severe pain in the "fridge" several days later when it had recovered from the injection. For these vets to have simply said "oops, guess it's dead" so fast shows a big case of ignorance and negligence.

Neuro · Member Joined: Aug 03, 2005 Posts: 35

Thanks for your replys, Minos is fine after 32 hours, hes just too tired, this morning he drank water like crazy and rested with his mouth underwater (trying to open his mouth the vet got bited and he left a tooth in his nail so i think that he feels the fresh water in his mouth just comfortable), and just an hour ago i gave him some gerber and jump start, a very good supplement.

I went to the vet today to pick up the medication and i asked her the name of the adrenalin stuff, its called dopramine, and the other medication its amikacin and cefotaxin, i spelled wrong the second one.

The thing is that the breathing problem dissapeared without the hair, so its very possible that the hair just made the stomatittis problem worst than it was in the first place, this makes me very angry because when we went to the first vet minos wasnt ill the day before, that morning he just started with this noise, open mouth and the lack of air, so it seems that the hair was the only serious problem at that time, the stomatittis was in there too, but it was in the a very early stage.

Like Elliot said, if they go baytril without further investigation, kill them before they kill your pet!.... erm, go for a second opinion.

By the way, its just me or they teeth regrow with the time?

I will post pictures of Minos and his pretty gf Ada when i find out how.

alex · Valued Member Joined: Aug 03, 2005 Posts: 106

S. aureus is an extremely common commensal bacteria, this is true, but there is an enormous variation in the factor assortment of different strains & variation in virulence is not necessarily explained - the coagulase +ve S. aureus is not necessarily more pathogenic than penicillinase +ve or hyaluronidase +ve strains. Like most opportunist/commensals, it is often able to invade as a secondary pathogen or as a primary when the animal is immunosuppressed or has altered flora - really, it doesn't tell you much that it's there other than something else is wrong, but it is one of the major bacteria of concern for veterinarians. S. aureus is a major problem for surgeons, as it is nearly impossible to eradicate as "normal" flora, with potentially serious consequences for the patient if the doctor manages to shed a few into a surgical site.While Staph aureus is most commonly seen as a pyogranulomas (botryomycosis) or ulcerative dermatitis when contracted from fomites or other animals, it is a good opportunist and frequently becomes bacteremic with subsequent spread to multiple internal sites.

Enrofloxacin is a wonderful drug in reptiles - fairly safe, easy to dispense and very highly effective as it is actually bactericidal, has a high bioavailablity, and a high volume of distribution with good concentration in phagocytes. The only real side effect in reptiles (other than sterile abscess formation from repeated SQ/IM injection) could be the interference with the P450 system. Unfortunately, it does tend to be a knee-jerk reptile drug, like Colin said. We actually have never been taught to prescribe ANY antimicrobial when in doubt - the veterinary profession is more heavily criticised for antibiotic resistance than human medicine with less cause. It simply is a drug that has worked quite well in many, many cases of different diseases, and so if you don't know much, it's a safe choice if you think an antimicrobial is called for. It has an AMAZING spectrum of microbes (not just bacteria) that it targets. Amikacin and gentamycin are actually some of my favourite drugs for reptile respiratory tract infections, but they have more serious side-effects (i.e. they are highly nephrotoxic and ototoxic) and are a bit more tricky to administer as they have a dose-dependent curve of resistance - they should be kept for cases of serious disease

The moral of the story is never, ever let your animal take drugs without proper culture (or yourself, for that matter). It does NOT take a week to get culture results - often 24hrs to ID the culprit, and perhaps 48 to determine sensitivities. It is appropriate to start a wide-spectrum antibiotic (i.e. Baytril) while awaiting results, and the animal can be switched to another drug in 24 or 48 hours if need be. Really, the problem is taking your animal to an inexperienced veterinarian - it is worth it to pay more or travel more to find an experienced vet (check out www.arav.org, phone around to local herp societies, zoos, etc) to avoid the sort of situations you have gone through.
As well, just because your animal is currently conscious and breathing, just monitor it carefully for signs of disease - it's entirely possible the yanking out of the hair damaged fragile tissue, or the rescusitation introduced pathogenic bacteria (not blaming you, it's unavoidable at times) and if you see signs of disease take it to a different vet.... sorry you had to go through something like this.

tupinambis · Posted: Thu Aug 04, 2005 10:56 pm Post subject:

I'd like to introduce my "better" half, folks. Alex is currently in vet school after completing her B.Sc. in biology. If it involves drugs and vet stuff, I bow to her expertise (well, admittedly not always, I am pretty stubborn). Pitty she thinks lizards, particularly tegus, suck

however, she is a fellow reptile enthusiast, her interests are just predominately chelonians and serpentes.

alexisonfire · Posted: Fri Aug 05, 2005 6:38 am Post subject:

my IQ just upped about 25 points

Diegar · Posted: Fri Aug 05, 2005 7:11 am Post subject:

I think that actually made me feel a lot less intelligent. I envy your brains. If i ate them, would i get smarter?
_________________
The Jay

Teiidae · Posted: Fri Aug 05, 2005 7:38 am Post subject:

alex · Valued Member Joined: Aug 03, 2005 Posts: 106

Thanks for the complements, though I should warn you - considering the number of infectious agents I'm exposed to on a daily basis (including prions!) it could be quite interesting to eat my brain & you'd probably want a rabies vaccine first considering I was playing with a number of dead skunks last week and they're the main carrier of the area. Colin's brain, on the other hand, would be quite safe if a little blond.
And it's true. Lizards ain't my favourites.... probably the least interesting group of reptiles for me... however, I still seem to have seven of the little monsters (not tegus). I'm kind of curious about this site, since I keep hearing about threads in it...

Neuro · Member Joined: Aug 03, 2005 Posts: 35

Thanks for the advice alex, 60 hours after shock and today hes like any other day, it just seem to be a little tired now, i check his mouth and the inflammation its disappearing, i just administrate him his cefotaxin via leg muscle.

Can you explain a little bit more about this ototoxic and nephrotoxic issue with the amikacin? how can check if his not getting this backslash, and for an animal of 1.650kg how many doses would you think that it'll be appropiate? the vet said that it will be 8 days of amikacin .05 ml every 24 hours, and the cefatoxim in a dilution of 1/100 every 48 hours with a doses of .02 ml for 30 days, 15 shots, she give us the medication diluted to avoid the risk of kidney damage.

alex · Valued Member Joined: Aug 03, 2005 Posts: 106

Hi,

I can't really comment on your antibiotic regime - a) I'm not lisenced yet, b) you actually have different drug formulations in the US and I have no idea what the concentrations that were dispensed to you are, and c) I haven't actually ever used a cephalosporin in a reptile, so I have no idea what I'd see. Some of the cephalosporins (which are a group of drugs that include cephotaxime and work similar to penicillin) are quite effective against Staphylococcus and Streptococcus. However, they too have potentially serious nephrotoxic effects - rarely in humans they have caused kidney damage through two mechanisms. In animals, they have been shown to be protective against the potentially nephrotoxic effects of aminoglycoside antibiotics like amikacin, as well as displaying a synergistic effect, which I suspect is why your vet is mixing the two.

Amikacin, like all aminoglycosides, can damage the kidney by accumulating in the proximal tubular cells of the kidneys. It basically just builds up in lysosomes until they burst, which kills the cell. The risk factors for this are extended therapy (i.e. over 10 days), electrolyte imbalances, shock or other loss of blood volume, concurrent nephrotoxins, pre-existing renal disease (which you often don't see until 75% of the kidney is lost) and a bunch of pharmacokinetic stuff I don't know if I could explain adequately at this point unless I have an idea of how much chemistry and physiology you have learned

Anyway, there are certainly ways t reduce the risk. One is what it sounds like your vet is already doing - doses at daily intervals. Feeding a high Ca+ diet, especially high protein/high Ca+ diet, can be quiet beneficial as the Ca competes with the antibiotic to bind to the cells in the kidney for uptake, and a high protein diet basically increases the rate of kidney filtration. Make sure your tegu is drinking lots, and if you have any doubts perhaps bathing it would be good. When I use gentamycin/amikacin in aquatic turtles, I only give it after they've just had a good soak and eaten (in water I'm pretty sure they're getting a good swallow of water with their food) in front of me.

It's very difficult to monitor this. You can take blood an hour after the dose is given and/or 8 hours later, which is a little pricey, so sometimes other blood work can be done. Again, it's expensive and usually not done unless there's concern of pre-existing renal disease... just make sure your pet is well hydrated and the diet is correct (most tegus are likely already on high protein/high Ca diet).

In mammalian pets studied, amikacin can damage the auditory division of cranial nerve 8, resulting in permanent hearing loss. I haven't heard of a way to prevent this yet. Staistically, at least one of my turtle rescues should be deaf as I don't think reptile cranial nerves should be that different, but I've seen nothing that would indicate to me which one.

Did I get it all?

Alex