Ricki does not want any medicine today!

[Jo00]

PART 2 OF RICKI’S VET REPORT AND LAB RESULTS

Patient:	Ricki
Species:	Reptile
Breed:	Chameleon, Veiled
Sex:	M
Age:	4.67 Years Old

None 2023-06-08 10:52:23 AM Accession ID: 28600
Test	Results	Reference Range	Units
DVM Assessment - CBC	0	0 - 0
PCV	33 (JGL)	0 - 0	%
TP	6.6 (JGL)	0 - 0	g/dL
Serum	M1/2 icteric	0 - 0
WBC, Total	3137 (61 + 62 JGL)	0 - 0	x 10^9
Heterophils	68	0 - 0	/100
Left Shift Heterophils	0	0 - 0	/100
Lymphocytes	9 (~10% reactive)	0 - 0	/100
Monocytes	22	0 - 0	/100
Eosinophils	1	0 - 0	/100
Basophils	0	0 - 0	/100
Thrombocytes		0 - 0	avg/oil
< 2/oil (M1 clumping)
Reticulocytes	0	0 - 0	x 10^9
WBC Morphology	0	0 - 0
RBC Morphology		0 - 0

M1 polychromasia, M2 aniscocytosis/poikilocytosis, M2 cells folded

Avian/Reptilian Profile Plus 2023-06-08 9:10:27 AM Accession ID: 28602
Test	Results	Reference Range	Units
CK	4485	0 - 0	U/L
PHOS	2	0 - 0	mmol/L
GLU	16	0 - 0	mmol/L
NA+	145	0 - 0	mmol/L
UA	728	0 - 0	umol/L
ALB	39	0 - 0	g/L
K+	5.9	0 - 0	mmol/L

BA	35​	0 - 0​	umol/L
AST	423​	0 - 0​	U/L
CA	3.8​	0 - 0​	mmol/L
GLOB	33​	0 - 0​	g/L
TP	72​	0 - 0​	g/L

2023-06-08 2:45:18 PM Accession ID: 28620
Test	Results	Reference Range	Units

DVM Assessment - CBC 0 0 - 0
6/8/23 wbc wnl high azuro/mps, morphology wnl, elevated pcv mild with mild incr pr - dehydration, chr inflammation, no overt sepsis

Vitals Results
2023-06-08 2:40:47 PM	Weight - xgm	238.0000
2023-06-08 2:40:55 PM	Heart Rate (BPM)	60
2023-06-08 2:40:57 PM	Respiratory Rate (BPM)	eupnic

 

[Jo00]

You can post the labs and some of us may be able to tell you what the different values are, but to interpret them all together as a whole requires higher skill such as that of a veterinarian. You may want to call to go over all of the abnormal values with your vet and have him/her explain them and how they all fit together into the diagnosis given.

Done. Posted today. Post #20 and 21.

 

[Jo00]

Done. Posted today. Post #20 and 21. Any insight would be more than welcomed.

 

[MissSkittles]

I am not a vet or a vet tech. However, looking at your guy’s labs, it is as the vet interpreted in their notes. There’s some immune or inflammatory response going on but his white blood cell count does not indicate infection. His worst lab values are for his liver and kidneys as well as uric acid (which is related to kidney function). The vet has him on the antibiotic as there has been some info that it can help with kidney infection that isn’t showing an elevated white blood cell count. His uric acid will need to be rechecked and if it remains high, he may need to be started on medication for gout. The lactulose can help not only with constipation, but also helps to flush out ammonia that the liver may not be able to.
Honestly, imo I think you’ve got a decent vet. I see they advised warm soaks. Yeah…I think they were all taught that in school - ignore that advice.
It helps to keep in mind that both the kidneys and liver work to eliminate toxins from our body, so when they aren’t working 100%, those toxins can cause some problems or symptoms that you wouldn’t think are related and will definitely affect the appetite and cause weakness. Constipation can also affect the appetite with the feeling of being overly full/bloated and nausea. Keep doing as your vet advised (except for the warm soaks) and hopefully your big beauty will be back to feeling 100% soon.

 

[Jo00]

I am not a vet or a vet tech. However, looking at your guy’s labs, it is as the vet interpreted in their notes. There’s some immune or inflammatory response going on but his white blood cell count does not indicate infection. His worst lab values are for his liver and kidneys as well as uric acid (which is related to kidney function). The vet has him on the antibiotic as there has been some info that it can help with kidney infection that isn’t showing an elevated white blood cell count. His uric acid will need to be rechecked and if it remains high, he may need to be started on medication for gout. The lactulose can help not only with constipation, but also helps to flush out ammonia that the liver may not be able to.
Honestly, imo I think you’ve got a decent vet. I see they advised warm soaks. Yeah…I think they were all taught that in school - ignore that advice.
It helps to keep in mind that both the kidneys and liver work to eliminate toxins from our body, so when they aren’t working 100%, those toxins can cause some problems or symptoms that you wouldn’t think are related and will definitely affect the appetite and cause weakness. Constipation can also affect the appetite with the feeling of being overly full/bloated and nausea. Keep doing as your vet advised (except for the warm soaks) and hopefully your big beauty will be back to feeling 100% soon.

Thank you SO much for the input. . Hopefully she will recheck his uric acid on Thursday. He seems to WANT to eat…when I open his lips slightly, he opens them a little more to take the worm and gets it down (sometimes it falls out of his mouth but he tries again.). Hoping for the best. I’ll do whatever I need to to get him well.

 

[kinyonga]

As I’ve said…I’m not a vet, but I agree with what @MissSkittles has said in post 24.

 

[Jo00]

As I’ve said…I’m not a vet, but I agree with what @MissSkittles has said in post 24.

I'm very grateful to you both for your support, knowledge and encouragement. My boys mean the world to me

 

[Jo00]

I'm very grateful to you both for your support, knowledge and encouragement. My boys mean the world to me

UPDATE on Ricki. We went to a follow up visit with the vet on Thursday.She was very happy with his progress. An ultrasound showed his kidneys were much less swollen. He was less lethargic and he stilled loved the RVT but just tolerated the vet. When they were out of the room, I was holding Ricki and I heard a “squeak” from him. When they came back and I told them that, the vet opened his mouth and heard a click and when she gently touched the outside of his jaw, he flinched.
She switched out his injectable antibiotic for an oral one (Enrofloxacin 0.15 ml every 48 hours for 4 weeks).
She added a pain med (Gabapentin starting at 0.01cc and working up to 0.05 as tolerated without being too sedated).
She said to continue the Calcium Gluconate (until he is eating on his own) and Lactulose (even though he is pooping because it helps flush out ammonia; just like Miss Skittles said)
He is still on the CC formula mixed with the Repashy Grub Pie and will sometimes eat from 1-3 silkworms if I put them in his mouth. Sometimes they “fall” out of his mouth but I don’t know if he’s doing that intentionally or if he can’t work it down his throat
We go back July 27 for a recheck.

 

[Jo00]

Ricki was showing improvement and now he seems to have relapsed. Could it be one of his new meds?
AntIbiotic enrofloxacin?
Pain med gabapentin?

He’s not due for Enrofloxacin until tomorrow.
Not sure if I should give him the gabapentin today. On a scale of 0.01 to 0.05, he is at 0.02.

Any suggestions?

 

[MissSkittles]

I would advise to call your vet and ask.

 

[elizaann2]

View attachment 339733

He is stunning BTW.

 

[Jo00]

I would advise to call your vet and ask.

I’ll be calling tomorrow. WAIT…I thought today was Sunday. Long weekends mess with me!. I’ll call right now!

 

[Jo00]

I’ll be calling tomorrow. WAIT…I thought today was Sunday. Long weekends mess with me!. I’ll call right now!

Nope, not open til tomorrow.

He is stunning BTW.

 

[Jo00]

Nope, not open til tomorrow.

Yes. He’s a big beautiful boy and very friendly

 

[kinyonga]

You said…”Ricki was showing improvement and now he seems to have relapsed”…relapsed in what way?

 

[kinyonga]

I don’t know if any of this is true for chameleons…
“Use extreme caution when prescribing this medication to a patient with kidney problems, as Gabapentin is removed from the body through the kidneys”…
”Gabapentin should not be stopped abruptly because withdrawal can precipitate seizures or rebound pain”…
”Gabapentin should not be administered within two hours of oral antacids or the antacids will hinder absorption of the Gabapentin, making it less effective”…calcium is an antacid.
https://www.wedgewoodpharmacy.com/medications/gabapentin/#:~:text=Gabapentin is an anticonvulsant prescribed,Dosage can vary widely.

There are quite a few side effects…but who knows what ones will apply to chameleons?!?

 

[MissSkittles]

Nope, not open til tomorrow.

Are you in the US? Tomorrow is the 4th of July and I imagine US vets will be closed.

 

[MissSkittles]

Gabapentin is an odd choice for a pain med, but I assume (without checking) that meloxicam is hard on the kidneys as most NSAIDs are. Gabapentin in humans is used for nerve pain, amongst other things such as seizures.

 

[kinyonga]

Gabapentin is an odd choice for a pain med, but I assume (without checking) that meloxicam is hard on the kidneys as most NSAIDs are. Gabapentin in humans is used for nerve pain, amongst other things such as seizures.

That’s what I was just reading too. I have a feeling the side effects will be strange for chameleons too.

 

[Jo00]

You said…”Ricki was showing improvement and now he seems to have relapsed”…relapsed in what way?

Lethargic and having trouble moving around.