Trioceros johnstoni bwindi

[Kent67]

What caused the paralysis? If I read the statements earlier correctly, didn't rear leg and tail paralysis begin immediately following being restrained at the vet? I agree the outcome would have been the same either way but that part still seems unexplained.

Just for clarity's sake, Bwindi is the locale of the chameleon, not his name.

 

[Dr O]

From watching this thread, I appreciate both Dr. O. jumping in and sharing some feedback and further information. That being said, your posts are seemingly moving from 'Here is some further info' to something more akin to active support of this vet.

frankly saldarya, i'm neutral since i don't know and i don't have the information to make a final decision. however, that doesn't mean i have forgotten all that i know re: medical care of chams, or the difference between a highly-trained exotic vet and another that has no business touching a cham. i have posted many, many times on this forum suggesting a certain member should look for a more competent vet for their situation. this happens to be one case where that's not even potentially possible given her credentials.

so as the facts have been laid out in this situation, there is a very common scenario vs. an almost unimaginable one. any "active support" that i have put out are meant to be regarding the situation that is most likely, not the individuals in question. i can see how it may read either way, but that is my intent.

 

[Dr O]

I don't want to provoke anybody, but why do you all bring the chameleons directly to the vet ? The process of the import is an huge amount of stress for them, even if it's organized by professionals like Jurgen. Especially when they land at the importers place and then are shipped for another time.

one of the many reasons why i have moved to housecall practice for exotics; certainly helps to minimize some of the potentially devastating stress we may see in this field.

 

[Dr O]

According to the vets anything but sticking a needle in his spine repeatedly.

really? is that what you're going to take from what we wrote? if so, i'm not going to try to change your mind, i speak in facts, not made-up thoughts.

for others that may be more interested in anatomy and how the nervous system works; any lesion to the spinal cord (which runs through the middle of the vertebrae, well protected by bones) will affect the area distal to the lesion. distal refers to the further points of an appendage, moving away from the body or head. so if a human breaks their back around mid-chest level, they will be paralyzed in their legs but be able to use their arms and head just fine (paraplegic). however if the injury is higher up, say in the neck, then anything distal includes the arms and legs (and everything else below the neck), and they will be quadriplegic. what does NOT happen is that an injury occurs and moves proximally, i.e.-higher up the body. (with the very minor exception of a few areas that may be at the most 1-2 vertebral segments proximal; not relevant in the tail).

let's look at lizard tail anatomy. the spinal cord (traveling through a literal tunnel in the vertebrae on all sides) begins at the base of the skull and generally ends around the pelvis, with many fewer strands that continue down the tail (for tail sensation and movement). these last fibers are collectively known as the "cauda equina" and while they have some diferences between species, it is still a very "stringy" component of the spinal cord, not a solid cylinder as one might usually imagine (cauda equina means "horse tail", which it somewhat visually looks like). additionally these fibers are virtually impssible to sever as they are relatively loosely held together; a needle in that area generally slips through the bundle without causing any damage (like sticking a needle in the hairs of a horse's tail--it will pass between the hairs and would be almost impossible to impale even a single strand). below the vertebral bone is the ventral tail vein which is the most common blood draw site in lizards and snakes. to draw blood the needle passes through the skin, a thin layer of muscle and connective tissue, and then it reaches the vein. if we go too far through the vein, we hit bone! i couldn't possibly get a needle into the spinal cord at that level due to the minuscule space between vertebra. if i did an "experiment" and hammered the needle through the bone and somehow managed to sever any of the cauda equina fibers, it would still only affect that area and further down to the tip of the tail!! it would not/cannot/will not move forwards to the nerves that control the rear legs and paralyze them.

using the image in the diagram below, the site of a blood draw distal to the hemipenes would be in the area about 2/5ths down the tail. i have made a red line to replicate the vein, and an arrow showing about where blood is drawn. as you can see, the site is quite far from the region that controls the rear limbs, and more importantly we know it cannot cause damage in that proximal direction. i think it would be very fair to say that not only has no one advocated "sticking a needle in the spine repeatedly", it's impossible to stick a needle in the spinal cord at that location, and it's impossible for it to cause damage proximally even if one were to try as best they could. and that is why both ferret and i keep saying that a blood draw could not cause rear limb paralysis, it is just not doable.

 

[Kent67]

Sooooo, what COULD cause the paralysis? I don't think anyone would suggest that paralysis traveled proximally, given accurate information about the location of the injury/lesion/etc.

Unless I missed something I'm still reading: lizard went to vet with all limbs and tail functioning, lizard went home paralyzed starting at the pelvis. If the blood draw location was correct, then something else occurred, no? It probably had a long term respiratory infection but, just like a correct blood draw location, a respiratory infection wouldn't cause paralysis of the lower half of the body would it?

 

[ataraxia]

For the animal to go from that to near lifelessness in a matter of minutes seems odd to me. Again, I am not a vet clearly, but SOMETHING happen at that time.

I do agree a vet or vet tech can make a mistake no matter how educated they may be. I however dont think it is fair to assume either way.

To comment on the statement in the quote. This is honestly not entirely to uncommon. To give an example. A couple days ago, i was cleaning out the baby bins. I had a particular male montium that was doing flat out awesome, healthy, very active, wasnt terribly shy either. I picked him up to put him in another holding tote. When i was finished cleaning i picked him up to put him back into the original tote. Literally, from the time of picking him up to going back into his original tote. His colors went from a beautiful green to jet black. I sat him in the enclosure and he fell to his side. All of this in literally a few seconds.

 

[Dr O]

Sooooo, what COULD cause the paralysis? I don't think anyone would suggest that paralysis traveled proximally, given accurate information about the location of the injury/lesion/etc.

Unless I missed something I'm still reading: lizard went to vet with all limbs and tail functioning, lizard went home paralyzed starting at the pelvis. If the blood draw location was correct, then something else occurred, no? It probably had a long term respiratory infection but, just like a correct blood draw location, a respiratory infection wouldn't cause paralysis of the lower half of the body would it?

i have little doubt that the necropsy will give the answer. my understanding (again, one-sided; the OP has not answered my PM'd questions) is that the paralysis began approximately an hour after he left the appointment. i think we can generally agree that it would be relatively difficult to fracture the spine of a truly healthy chameleon other than a trauma such as a drop, or maybe folding him in half. as that has not been mentioned by either party, it presumably did not happen that way.

what usually DOES happen in a situation like this is usually one of two scenarios: a) that there was existing damage to the spine/vertebra from earlier trauma, infection, or MBD-type issues where the bones are weakened. will be easy to verify and distinguish via necropsy, including how long a lesion has been there.

b) more commonly, particularly this close to death, it's from a blood clot (or multiple). reptiles throw clots from infections all the time, it doesn't take much. in the same ballpark is the condition known as DIC (disseminated intravascular coagulation) which is very common in ALL animals as their body systems fail. the "clotting cascade" as it's known is an insanely complex system of checks and balances to keep blood liquid when it should be liquid, and to solidify and coagulate when it needs to be solid (think scab). virtually any species you can imagine that is sick enough to be in an ICU-state is very susceptible to DIC. the clotting cascade goes haywire, organs and mucous membranes begin to spontaneously hemorrhage, and at the same time clots form anywhere in the circulatory system and wherever they go, badness follows. additionally, DIC is not something that can be treated or stopped unto itself, it is caused by an underlying disorder which must be fixed for the DIC to begin to correct itself.

based on the timing, bruises, hemorrhages that were all noted, that's personally where my chips lie. nevertheless it's a very sad situation for that gorgeous cham, a dedicated owner who put a huge effort into trying to save him, and a vet who attempted to cure him. i don't think the answers can come soon enough!!

 

[Todnedo]

really? is that what you're going to take from what we wrote? if so, i'm not going to try to change your mind, i speak in facts, not made-up thoughts.

for others that may be more interested in anatomy and how the nervous system works; any lesion to the spinal cord (which runs through the middle of the vertebrae, well protected by bones) will affect the area distal to the lesion. distal refers to the further points of an appendage, moving away from the body or head. so if a human breaks their back around mid-chest level, they will be paralyzed in their legs but be able to use their arms and head just fine (paraplegic). however if the injury is higher up, say in the neck, then anything distal includes the arms and legs (and everything else below the neck), and they will be quadriplegic. what does NOT happen is that an injury occurs and moves proximally, i.e.-higher up the body. (with the very minor exception of a few areas that may be at the most 1-2 vertebral segments proximal; not relevant in the tail).

let's look at lizard tail anatomy. the spinal cord (traveling through a literal tunnel in the vertebrae on all sides) begins at the base of the skull and generally ends around the pelvis, with many fewer strands that continue down the tail (for tail sensation and movement). these last fibers are collectively known as the "cauda equina" and while they have some diferences between species, it is still a very "stringy" component of the spinal cord, not a solid cylinder as one might usually imagine (cauda equina means "horse tail", which it somewhat visually looks like). additionally these fibers are virtually impssible to sever as they are relatively loosely held together; a needle in that area generally slips through the bundle without causing any damage (like sticking a needle in the hairs of a horse's tail--it will pass between the hairs and would be almost impossible to impale even a single strand). below the vertebral bone is the ventral tail vein which is the most common blood draw site in lizards and snakes. to draw blood the needle passes through the skin, a thin layer of muscle and connective tissue, and then it reaches the vein. if we go too far through the vein, we hit bone! i couldn't possibly get a needle into the spinal cord at that level due to the minuscule space between vertebra. if i did an "experiment" and hammered the needle through the bone and somehow managed to sever any of the cauda equina fibers, it would still only affect that area and further down to the tip of the tail!! it would not/cannot/will not move forwards to the nerves that control the rear legs and paralyze them.

using the image in the diagram below, the site of a blood draw distal to the hemipenes would be in the area about 2/5ths down the tail. i have made a red line to replicate the vein, and an arrow showing about where blood is drawn. as you can see, the site is quite far from the region that controls the rear limbs, and more importantly we know it cannot cause damage in that proximal direction. i think it would be very fair to say that not only has no one advocated "sticking a needle in the spine repeatedly", it's impossible to stick a needle in the spinal cord at that location, and it's impossible for it to cause damage proximally even if one were to try as best they could. and that is why both ferret and i keep saying that a blood draw could not cause rear limb paralysis, it is just not doable.

I guess the" sticking needles in the spine repeatedly" was a little harsh but I'm with Kent, Jason's chameleon came home from the vet visit in far worse shape.
Jason did state that the paralysis set in while at the vets office.
The problem I have with this vet is she failed to draw blood then did no other tests, but still prescribed meds for an infection she could not confirm.

 

[ferretinmyshoes]

And if she had sent home nothing instead? Then she'd be raked over the coals for charging for the exam and 'doing nothing but sending the cham home to die'. I've heard that one before. But is that what you would have preferred if it had been yours? (Genuinely asking, not challenging)

 

[Todnedo]

And if she had sent home nothing instead? Then she'd be raked over the coals for charging for the exam and 'doing nothing but sending the cham home to die'. I've heard that one before. But is that what you would have preferred if it had been yours? (Genuinely asking, not challenging)

I think the vet vist was pointless considering the results.
Jason could have called in meds for a URI in this case and had way better results.
If this was a person that was sent home with meds without test results then died, there would be lawyers involved.

 

[ferretinmyshoes]

Wait so you say she shouldn't have given meds without doing any tests but now she should have given meds without doing any tests or even seeing the animal? We don't even know yet that a URI was present.

You can't give meds without an exam - that is a legal issue with our license. There has to be a valid client patient relationship in place for a vet to prescribe medications, which necessitates an exam. Otherwise the lawyers get involved. And I've seen plenty of people who just want the meds because they think they know what's wrong and it turns out to be something different entirely when I actually see the pet. The last one was someone who wanted nausea meds for his dog because 'he ate something bad but it will pass' and he was absolutely convinced of that and unhappy that I required an exam first. Turns out the dog was actually bleeding internally, which can sometimes cause nausea as a side effect. Queue lawyers because the pet would have been treated incorrectly with the wrong medications because the vet couldn't see the animal to determine it was the wrong medication. It's the same with human physicians. You can't just call your doctor for medications, they always require an exam first.

 

[Todnedo]

Wait so you say she shouldn't have given meds without doing any tests but now she should have given meds without doing any tests or even seeing the animal? We don't even know yet that a URI was present.

You can't give meds without an exam - that is a legal issue with our license. There has to be a valid client patient relationship in place for a vet to prescribe medications, which necessitates an exam. Otherwise the lawyers get involved. And I've seen plenty of people who just want the meds because they think they know what's wrong and it turns out to be something different entirely when I actually see the pet. The last one was someone who wanted nausea meds for his dog because 'he ate something bad but it will pass' and he was absolutely convinced of that and unhappy that I required an exam first. Turns out the dog was actually bleeding internally, which can sometimes cause nausea as a side effect. Queue lawyers because the pet would have been treated incorrectly with the wrong medications because the vet couldn't see the animal to determine it was the wrong medication. It's the same with human physicians. You can't just call your doctor for medications, they always require an exam first.

My point was she didnt know what was wrong but still prescribed meds.

 

[pigglett79]

Wait so you say she shouldn't have given meds without doing any tests but now she should have given meds without doing any tests or even seeing the animal? We don't even know yet that a URI was present.

You can't give meds without an exam - that is a legal issue with our license. There has to be a valid client patient relationship in place for a vet to prescribe medications, which necessitates an exam. Otherwise the lawyers get involved. And I've seen plenty of people who just want the meds because they think they know what's wrong and it turns out to be something different entirely when I actually see the pet. The last one was someone who wanted nausea meds for his dog because 'he ate something bad but it will pass' and he was absolutely convinced of that and unhappy that I required an exam first. Turns out the dog was actually bleeding internally, which can sometimes cause nausea as a side effect. Queue lawyers because the pet would have been treated incorrectly with the wrong medications because the vet couldn't see the animal to determine it was the wrong medication. It's the same with human physicians. You can't just call your doctor for medications, they always require an exam first.

Except that there are vets prescribing over the Internet. I have a vet who helped with my frogs via email from another state as I couldn't find a vet who knew about frogs at the time and didn't want to transport the frogs either.

In my case it turned out great and the Frog was saved. I'm just saying it's not 100% of vets who won't treat remotely.

I am the fence with this issue as I do at times treat from home rather than risk a vet out of fear that the vet visit may do more harm than good (whether due to the stress of the visit or an issue w the procrdures).

 

[ferretinmyshoes]

Oh there are those who do, and I know that. But they open themselves up to liability by doing so.

 

[rshewfel]

The problem I have with this vet is she failed to draw blood then did no other tests, but still prescribed meds for an infection she could not confirm.

This is very common practice for all the vets I have been to. If the vet had sent me home without medicine, in this case, I would have been very upset. The other chameleons that have died so far, passed within a couple days. This is very common from what I've seen. He, most likely, would not have got a second chance.

I personally don't care if the vet accidentally dropped the chameleon and stepped on it. I could not blame her for his death. You can't take a sick chameleon, especially a wild-caught chameleon, known to do poorly in captivity, just after importation, and expect a miracle. Then you certainly cannot blame the vet for its death, even if a mistake was made. If you do this, we will have no chameleon vets left.

These are not humans, these are wild-caught animals packed in boxes and shipped around the world, for our own personal enjoyment. We as keepers are responsible for their deaths, not the vets

 

[Kent67]

Dr. O, thank for offering some ideas as to what could have caused the paralysis. It sounds like there's not really any reason to speculate until the results come back.

 

[Dr O]

I guess the" sticking needles in the spine repeatedly" was a little harsh but I'm with Kent, Jason's chameleon came home from the vet visit in far worse shape.
Jason did state that the paralysis set in while at the vets office.
The problem I have with this vet is she failed to draw blood then did no other tests, but still prescribed meds for an infection she could not confirm.

My point was she didnt know what was wrong but still prescribed meds.

todnedo, i appreciate the toning down of rhetoric; we are all here for the same reason, our joint love of chams.

to address your existing question---it's lovely when a disease is textbook-classic, tests are in agreement (and can even be run due to cost), and we have a fix for the issues, whatever it might be. unfortunately, that's not often the case, particularly in reptilian medicine. however, we do know that most herps which are crashing are extremely susceptible to a secondary invasion of Gram negative bacteria (which can be the primary reason for the illness as well), and those secondary invaders often wind up being the actual killers. when an organism is seriously ill (particularly ectothermic animals), it's immune system either is not functioning well anymore (if at all), or is literally involved in the fight of it's life and seriously needs reinforcements.

taking those facts into account, it is considered absolutely appropriate to use an antibiotic in those instances. it appears that ceftazidime (Fortaz) was used which has the best coverage of that group of bacteria along with the least amount of side effects. and not only is it considered appropriate and would be backed by virtually any other vet in the field, NOT giving that medication could actually be more likely to a) potentially get a vet in trouble with their state board, and b) certainly detrimental to the vast majority of patients who would die without those meds.

in medicine, we do what we can to help the patient before us. to help focus on the main issue we rely on history, examinations, and tests. if it becomes a situation where we cannot find all of the answers that we need, we are left with what we know and experience. and when we know that 80-90+% of crashing herps are being overrun by secondary invaders, those scenarios ofttimes become part of the treatment plan. imagine this common scenario in an MD's office during flu season: patient enters, coughing and febrile, doc believes it's influenza and sends them home with a "take 2 aspirins and call in the morning" advice. his next patient has an almost identical history, but is coughing worse and tells the doc his sputum has become very yellow-green in the past day or so. doc will typically put that patient on a course of antibiotics as secondary invaders from influenza in the lungs are what usually make the difference between a mild or life-threatening case. in both of these instances he is using the history and exams, but actually making his treatment decisions based on the influenza population as a whole and experience treating past influenza patients.

there's probably better examples that i could have used, but i hope the point is made. in many ways, all medical fields use probability in every step of care. the battle for idealistic medicine and realistic medicine will never meet, there are too many complicating factors, at least at this point in time.

 

[biffle]

I'll publish the necropsy as soon as the original vet has a chance to read it.

I'm also sad to announce that my female virunga passed. The vet said the she was egg bound. We removed the eggs, I stored them at 67.8. They turned yellow and have started to mold.

I caught he closing her eyes, a few hors later she fell into her laying bucket.

She passed in my hand. You can see the difference between bwindis and virungas in this photo. Virungas have yellow on both the top and bottom almost like a Bird beek.

I immediately took her to the vet to try and save the eggs.she was packed with 16 massive eggs.

She was stuffed with eggs.

The eggs on the right are 8 month old ambilobe eggs that hatched right after the photo.

Virunga eggs vs 6 month ambanja eggs.

RIP mama Virunga.

 

[qdude46]

So sorry to hear that. RIP mama virunga

 

[leo]

Sorry for your loss. I've been following this thread to see how things would turn out with your virunga jhonstonii. They were both extremely beautiful, it's sad to know they perished. Good luck with your other ones.