Veiled Casque Question

[Light Yagami]

Hi everyone, I am new to this website. I have an almost 1 year old low white piebald veiled chameleon.
His cage is a repti breeze 18 x 18 x 36. It is a screen cage. I actually just bought him a larger one that I am setting up.
His lights are a 5.0 uvb linear bulb and a 100 watt deep dome bulb. They are one 12 hrs and off 12 hrs
He has an automatic mister that runs for 20 seconds every hour for those 12 hrs.
He has a humidifier on the 12 hrs.
I try to keep the humidity to 70-75%
He has an large plant water fountain on for those 12 hrs.
He has both fake and real plansts.
I feed him every other day. He regularly gets Calcium without phosphorus and D3. and twice a month he gets calcium plus with phosphorus and D3.
His diet consists on mostly super worms since he is a bit picky. He occasionally eats crickets but despises dubia roaches. He gets horn worms as a treat once in a while since his past doctor told me he was a bit heavy.
His food is gut loaded with mazuri (superworms) and crickets with veggies I have at home.
Now the issue. I left town for a week and left my boyfriends brother in charge. He fed him the wrong calcium's and I noticed his casque also looked to be slightly bent. (This unfortunately has progressed and now has a crack, I have been putting oiment on the casque which has sealed it up but that bent is there forever; which I know and understand.) So immediately when I got back I took him to the vet and his results were:
cbc- mildly elevated heterophils 5000
low monos and basos
profile elevated ast 294
elevated phosphorus 20.4
elevated glucose 304
elevated calcium 14.6
low sodium
elevated potassium- 8.6
Now I know that my calcium has to be double to the phosphorus which in this case its reversed and I though "kidney disease." But the doctor was not helpful at all! She told me "he needs veggies" and let me on my way. Keep in mind I waited 1 whole month just to get these results. So, now to present, his limbs look healthy, his spine looks healthy, his grip is strong, BUT he doesn't run out of his cage anymore when I open it to see him. He just stays put which makes me nauseous to think about if hes in severe pain.
This is before I left town:

And this is now:

(the white stuff is the antibacterial oitment)
This is his set up:

he's usually green all day and just a happy boy. The past doctor specifically called me and told me he didn't have MBD but I just know that is not the case because that casque looks like it causes him so much pain.
Please help and be frank with me on what I am doing wrong. Anything helps.
Also his poo is dark brown (solid) with a bit of yellow/orange and white dot.
This is how his arms and legs look right now:

 

[MissSkittles]

Hi and welcome to the forum. I do see some things in what you’ve said that might be contributing, but give me a little bit of time to better reply.

 

[MissSkittles]

I’ll put my feedback in bold.
His cage is a repti breeze 18 x 18 x 36. It is a screen cage. I actually just bought him a larger one that I am setting up. Yes, bigger please. Minimum is 2x2x4’ for adult and I encourage bigger if able.
His lights are a 5.0 uvb linear bulb and a 100 watt 100w is strong and I wonder what basking temps are deep dome bulb. They are one 12 hrs and off 12 hrs this is good
He has an automatic mister that runs for 20 seconds every hour for those 12 hrs. Not good. 20 seconds isn’t long enough to do more than moisten the plant leaves or trigger his drinking response. Additionally, it doesn’t give the enclosure time to dry out and keeps humidity high. Much better is to mist/spray for 2 minutes right before lights go on and then off. If his urates are looking dark or mostly orange, indicating he needs more hydration, you can either add another misting in afternoon or use a dripper for 15-20 minutes daily.
He has a humidifier on the 12 hrs. Hopefully this is only at night and only with night temps below 68.
I try to keep the humidity to 70-75% This is way too high. Ideal for veiled is between 30-50% during the day. High heat + high humidity = greatly increased risk for respiratory infection.
He has a large plant water fountain on for those 12 hrs. Not recommended. No matter how clean you keep it, it is a reservoir for bacterial growth and just yuck.
He has both fake and real plansts. Since veileds often like to nibble their plants, it’s important that they have only safe live clean plants. One bite of a fake leaf can cause bowel obstruction. This is a great guide. https://chameleonacademy.com/plants/
I feed him every other day. Ok, but how many feeders and what kind of feeders? He regularly gets Calcium without phosphorus and D3. How often is that? and twice a month he gets calcium plus with phosphorus and D3. Do you mean Repashy calcium plus - the one with the leopard gecko on the label?
His diet consists on mostly super worms since he is a bit picky. Ah…ok. This explains what I’m seeing. His casque is puffed out, which is one of the ways that they show obesity. Superworms are very fatty and should only be treats. Plus, they are addictive and can cause chameleons to reject healthier food while holding out for the supers. It’s like feeding a child candy. He occasionally eats crickets but despises dubia roaches. For many chams, roaches seem to be an acquired taste. He gets horn worms as a treat once in a while since his past doctor told me he was a bit heavy. Hornworms are great treats. I’ll attach feeder and gutloading graphics for you. You’re going to need to cut your guy’s food way back to maybe 2 feeders, 3 days a week, plus the occasional treat. I suggest getting some grasshoppers. 1 decently sized grasshopper would be a whole meal for him. https://feedmychameleon.com/ Add more variety to his diet.
His food is gut loaded with mazuri (superworms) and crickets with veggies I have at home. This is great
Now the issue. I left town for a week and left my boyfriend’s brother in charge. He fed him the wrong calcium's and I noticed his casque also looked to be slightly bent. (This unfortunately has progressed and now has a crack, I have been putting oiment on the casque which has sealed it up but that bent is there forever; which I know and understand.)Yes, unfortunately it’s doubtful his casque will straighten. You did great in helping the crack to heal. So immediately when I got back I took him to the vet and his results were:
cbc- mildly elevated heterophils 5000
low monos and basos
profile elevated ast 294
elevated phosphorus 20.4
elevated glucose 304
elevated calcium 14.6
low sodium
elevated potassium- 8.6
I’m not good with chameleon lab values without doing some research, which unfortunately I’m a bit too wiped out to do atm. However, let me tag in @JacksJill who I believe is knowledgeable on these. Now I know that my calcium has to be double to the phosphorus which in this case its reversed and I though "kidney disease." But the doctor was not helpful at all! She told me "he needs veggies" and let me on my way. So sorry! Sadly for us, many exotics vets aren’t all that experienced or knowledgeable about chameleons. Even some who are lack correct husbandry knowledge. When I think about the amount of knowledge they do have to have, I can’t fault them. Keep in mind I waited 1 whole month just to get these results. So, now to present, his limbs look healthy, his spine looks healthy, his grip is strong, BUT he doesn't run out of his cage anymore when I open it to see him. He just stays put which makes me nauseous to think about if hes in severe pain. I’m not so sure that he’s in pain and wonder what specifically is making you believe that he is. I do think he’s probably not feeling so great. If you do use the Repashy Calcium Plus and he was getting that every day, or even every other day, he has a build up of vitamins A and D3. These are fat soluble vitamins which take time to be processed and eliminated so can easily build up to toxic levels. Only time can eliminate them from his system, so I wouldn’t be giving him any of that supplement for about a month. Just use lightly the phosphorus free calcium without D3. If you live in a warm area, you could take him outside for a short time for natural sun. I don’t know how correct it is/isn’t, but I do recall it being said that natural sunlight and natural D3 can help reduce supplemental D3 a bit. Just never ever leave a chameleon outside unwatched. A predatory bird can swoop him away before you know it. Also, his obesity is also likely affecting him. Chameleons don’t have a tolerance for being obese the way we do. Then there is also his age. Young veileds are often quite friendly and accepting of us. Once they reach maturity, that all changes and they want nothing to do with us.
Have you had him checked for parasites? If not, call the vet you went to and ask about dropping off a fresh fecal for testing. Since they just saw him, that should be fine. Often parasites can cause a picky appetite. They can also be somewhat under control until the chameleon is stressed by something and then they go out of control and cause symptoms. We’ll see what @JacksJill says about the labs. I’m also adding a video about chameleon obesity. There is another, but it is graphic and I’ll only post it if you would like to see it.

 

[Beman]

@MissSkittles covered husbandry issues that should be corrected. But that casque has a thermal burn from the wattage of the heat bulb being too strong and him being able to get too close to it... Betting the swelling is from infection in the casque. I would go to a real reptile vet. He will need antibiotics... By the look of the casque it is starting to die off which means he may very well loose a chunk of the top portion. Silver sulfadiazine is the cream that would be used on the outside. If you need a vet list @elizaann2 can post one for you. Need to reduce the wattage of the bulb down to like a 60 watt regular white incandecent bulb. Temps at basking should be 80-85 max.

 

[Light Yagami]

I’ll put my feedback in bold. Thank You so much!
His cage is a repti breeze 18 x 18 x 36. It is a screen cage. I actually just bought him a larger one that I am setting up. Yes, bigger please. Minimum is 2x2x4’ for adult and I encourage bigger if able. I have upgraded him to the 36 x 18 x 36 double door repti breeze
His lights are a 5.0 uvb linear bulb and a 100 watt 100w is strong and I wonder what basking temps are (The 100 watt is in a dome holder so the bulb isn't directly touching the cage and burns my chameleon. It makes it be about 5-6 inches above. The temperature is about 97 at the top and lowers towards the bottom of the cage.) deep dome bulb. They are one 12 hrs and off 12 hrs this is good
He has an automatic mister that runs for 20 seconds every hour for those 12 hrs. Not good. 20 seconds isn’t long enough to do more than moisten the plant leaves or trigger his drinking response. Additionally, it doesn’t give the enclosure time to dry out and keeps humidity high. Much better is to mist/spray for 2 minutes right before lights go on and then off. If his urates are looking dark or mostly orange, indicating he needs more hydration, you can either add another misting in afternoon or use a dripper for 15-20 minutes daily. (I have removed the fountain and i am currently making a dripper using a clean plastic container. I have also setup the mister to two minutes 3 times a day. I really appreciate the feedback on the water source.)
He has a humidifier on the 12 hrs. Hopefully this is only at night and only with night temps below 68. (The humidifier is on during the day, but by your response I have turned it off. Should it only be used at night?)
I try to keep the humidity to 70-75% This is way too high. Ideal for veiled is between 30-50% during the day. High heat + high humidity = greatly increased risk for respiratory infection. (I have noted this, thank you. I will make sure it is not too moist.)
He has a large plant water fountain on for those 12 hrs. Not recommended. No matter how clean you keep it, it is a reservoir for bacterial growth and just yuck.
He has both fake and real plansts. Since veileds often like to nibble their plants, it’s important that they have only safe live clean plants. One bite of a fake leaf can cause bowel obstruction. This is a great guide. https://chameleonacademy.com/plants/ (I have removed the fountain and I am going to go buy more real plants for his new enclosure)
I feed him every other day. Ok, but how many feeders and what kind of feeders? (He eats about 8 worms every other day along with 5 large crickets but sometimes he does not finish it.)He regularly gets Calcium without phosphorus and D3. How often is that? and twice a month he gets calcium plus with phosphorus and D3. Do you mean Repashy calcium plus - the one with the leopard gecko on the label? (yes the one with the gecko and red container. That is used twice a month.)
His diet consists on mostly super worms since he is a bit picky. Ah…ok. This explains what I’m seeing. His casque is puffed out, which is one of the ways that they show obesity. Superworms are very fatty and should only be treats. Plus, they are addictive and can cause chameleons to reject healthier food while holding out for the supers. It’s like feeding a child candy. He occasionally eats crickets but despises dubia roaches. For many chams, roaches seem to be an acquired taste. He gets horn worms as a treat once in a while since his past doctor told me he was a bit heavy. Hornworms are great treats. I’ll attach feeder and gutloading graphics for you. You’re going to need to cut your guy’s food way back to maybe 2 feeders, 3 days a week, plus the occasional treat. I suggest getting some grasshoppers. 1 decently sized grasshopper would be a whole meal for him. https://feedmychameleon.com/ Add more variety to his diet. (I will be changing his diet completely! I cannot believe I was this careless. I will be ordering him food from dubia and get him everything you have suggested)
His food is gut loaded with mazuri (superworms) and crickets with veggies I have at home. This is great
Now the issue. I left town for a week and left my boyfriend’s brother in charge. He fed him the wrong calcium's and I noticed his casque also looked to be slightly bent. (This unfortunately has progressed and now has a crack, I have been putting oiment on the casque which has sealed it up but that bent is there forever; which I know and understand.)Yes, unfortunately it’s doubtful his casque will straighten. You did great in helping the crack to heal. So immediately when I got back I took him to the vet and his results were:
cbc- mildly elevated heterophils 5000
low monos and basos
profile elevated ast 294
elevated phosphorus 20.4
elevated glucose 304
elevated calcium 14.6
low sodium
elevated potassium- 8.6
I’m not good with chameleon lab values without doing some research, which unfortunately I’m a bit too wiped out to do atm. However, let me tag in @JacksJill who I believe is knowledgeable on these.(Thank you so much) Now I know that my calcium has to be double to the phosphorus which in this case its reversed and I though "kidney disease." But the doctor was not helpful at all! She told me "he needs veggies" and let me on my way. So sorry! Sadly for us, many exotics vets aren’t all that experienced or knowledgeable about chameleons. Even some who are lack correct husbandry knowledge. When I think about the amount of knowledge they do have to have, I can’t fault them. Keep in mind I waited 1 whole month just to get these results. So, now to present, his limbs look healthy, his spine looks healthy, his grip is strong, BUT he doesn't run out of his cage anymore when I open it to see him. He just stays put which makes me nauseous to think about if hes in severe pain. (I say this because I know a bent casque is like having a broken bone and it continues to grow broken, so I can only assume the pain it is casuing him)I’m not so sure that he’s in pain and wonder what specifically is making you believe that he is. I do think he’s probably not feeling so great. If you do use the Repashy Calcium Plus and he was getting that every day, or even every other day, he has a build up of vitamins A and D3. These are fat soluble vitamins which take time to be processed and eliminated so can easily build up to toxic levels. Only time can eliminate them from his system, so I wouldn’t be giving him any of that supplement for about a month. Just use lightly the phosphorus free calcium without D3. If you live in a warm area, you could take him outside for a short time for natural sun. I don’t know how correct it is/isn’t, but I do recall it being said that natural sunlight and natural D3 can help reduce supplemental D3 a bit. Just never ever leave a chameleon outside unwatched. A predatory bird can swoop him away before you know it. Also, his obesity is also likely affecting him. Chameleons don’t have a tolerance for being obese the way we do. Then there is also his age. Young veileds are often quite friendly and accepting of us. Once they reach maturity, that all changes and they want nothing to do with us. (I will be taking him out from now on. I live in houston so its hot and humid. I will also stay outside with him. I will not be giving him the calcium pluss (the one with the gecko for at least a month like you suggested))
Have you had him checked for parasites? (No, but we are about to go to the vet in an hour so I will collect some and take it with me. I have also requested blood analysis again, as well as an x-ray just to be confident there is no underlying problem. I am a very paranoid person)If not, call the vet you went to and ask about dropping off a fresh fecal for testing. Since they just saw him, that should be fine. Often parasites can cause a picky appetite. They can also be somewhat under control until the chameleon is stressed by something and then they go out of control and cause symptoms. We’ll see what @JacksJill says about the labs. I’m also adding a video about chameleon obesity. There is another, but it is graphic and I’ll only post it if you would like to see it. (I appreciate all the help. I have taken everything you've said into consideration)

 

[Light Yagami]

@MissSkittles covered husbandry issues that should be corrected. But that casque has a thermal burn from the wattage of the heat bulb being too strong and him being able to get too close to it... Betting the swelling is from infection in the casque. I would go to a real reptile vet. He will need antibiotics... By the look of the casque it is starting to die off which means he may very well loose a chunk of the top portion. Silver sulfadiazine is the cream that would be used on the outside. If you need a vet list @elizaann2 can post one for you. Need to reduce the wattage of the bulb down to like a 60 watt regular white incandecent bulb. Temps at basking should be 80-85 max.

Thank you so much for your help. I did in fact take him to a real reptile vet in my city. It had some of the best reviews as well. I am about to change the bulb. I just want to clarify that the bulb does not directly touch the cage. It is lifted about 6 inches. either way I will be making modifications asap. The antibacterial ointment I use does in fact have Silver sulfadiazine. The affected side of the casque does look blackish but the other side looks super healthy so I really hope it is not dying. Now I am extra worried. Thank you for your help!

 

[Beman]

Thank you so much for your help. I did in fact take him to a real reptile vet in my city. It had some of the best reviews as well. I am about to change the bulb. I just want to clarify that the bulb does not directly touch the cage. It is lifted about 6 inches. either way I will be making modifications asap. The antibacterial ointment I use does in fact have Silver sulfadiazine. The affected side of the casque does look blackish but the other side looks super healthy so I really hope it is not dying. Now I am extra worried. Thank you for your help!

When we see black like that it almost always indicates that the tissue is necrotic. The problem with this is once it goes necrotic it is dying off. The infection from the thermal burn has to be treated because a topical just does not do it all especially with extreme burns to the casque. They look bloated and that is due to the puss inside from the burn. This is why oral antibiotics are very important. You have to get the infection under control so it does not impact the entire body. From what I can see in your image the fixture sits directly on the cage which is going to have the same intensity of heat exposure even though it might be a deep dome and the bulb is higher in the fixture then where he can rise up his casque can get way too close to it. 100 watt bulbs can easily produce temps over 100 this is where you are in thermal burn risk. The repeated burning of the tissue then compounds the issue. And they just do not know to move to get away from the heat. So another vet visit is advised in this situation to get oral antibiotics. And then you want to overhaul your husbandry to get everything on point. With the high humidity and fogging during the day he is at extreme risk of developing a respiratory infection. Hot air and moisture are no good with chameleons. With his system already being compromised from the thermal burn infection he would be at a higher risk because his immune system is compromised already.

 

[Light Yagami]

Okay I understand, yes we are going to a new vet in an hour and I will also provide this information so I do not get sent away again like last time. I will reduce the heat and have turned off the humidifier as well. I really really appreciate your feedback.

 

[Light Yagami]

When we see black like that it almost always indicates that the tissue is necrotic. The problem with this is once it goes necrotic it is dying off. The infection from the thermal burn has to be treated because a topical just does not do it all especially with extreme burns to the casque. They look bloated and that is due to the puss inside from the burn. This is why oral antibiotics are very important. You have to get the infection under control so it does not impact the entire body. From what I can see in your image the fixture sits directly on the cage which is going to have the same intensity of heat exposure even though it might be a deep dome and the bulb is higher in the fixture then where he can rise up his casque can get way too close to it. 100 watt bulbs can easily produce temps over 100 this is where you are in thermal burn risk. The repeated burning of the tissue then compounds the issue. And they just do not know to move to get away from the heat. So another vet visit is advised in this situation to get oral antibiotics. And then you want to overhaul your husbandry to get everything on point. With the high humidity and fogging during the day he is at extreme risk of developing a respiratory infection. Hot air and moisture are no good with chameleons. With his system already being compromised from the thermal burn infection he would be at a higher risk because his immune system is compromised already.

Okay I understand, yes we are going to a new vet in an hour and I will also provide this information so I do not get sent away again like last time. I will reduce the heat and have turned off the humidifier as well. I really really appreciate your feedback.

 

[Beman]

Okay I understand, yes we are going to a new vet in an hour and I will also provide this information so I do not get sent away again like last time. I will reduce the heat and have turned off the humidifier as well. I really really appreciate your feedback.

It is hard with vets... If they do not understand how to treat a chameleon then they miss things or do not know how to address things. Also most do not know up to date husbandry guidelines that the hobby follows. Issue with the casque burn is it will never look the same. There will be some type of die off it just comes down to what extent. This is where the oral antibiotics are important to try to stop the infection. you may notice oozing from the casque as well. I have seen the entire top of a casque come off to just a tip. But the casque never goes back to what it should look like. Additionally it is very common that they have issues shedding in the areas of prior healed thermal burns.

Great resource for you would be https://chameleonacademy.com/chameleon-husbandry-program-getting-started-with-chameleons/ and if you like videos then neptune the chameleon.

 

[MissSkittles]

You want your basking temps to be no higher than about 85. There’s so very much old and incorrect husbandry info out there that it’s too often difficult to know what is right and best for our chameleons. So I’m very glad that you found your way here and are making the needed changes to give your guy his best life.

 

[Light Yagami]

Hi! I have news! We went to the vet and they did X-rays. His casque is a bit damaged in the front due to the heat of the bulb. It was a pretty bad burn. They also showed super early signs of MBD and super early signs of a bit of pneumonia. They gave me antibiotics in form of injections to give him for a month. They said it’ll get rid of the pneumonia and help the casque if there is any infection. They also gave me some antibiotic ointment for his casque. It has Silver sulfadiazine only since the one I had, had other things. The doctor was super helpful and even went over the blood analysis the other doctor had done. They told me I have to give him D3 once every 2 weeks, calcium without D3/multivitamin every feeding (except for the times I do the other calcium’s) and then the multi calcium once a month. She gave me a list of insects to feed him that will rise the calcium to phosphorus ratio which was very helpful. I feel semi hopeful. I have changed the bulb to 50 watt and have turned the humidifier to only on at night. I have also set up his mister to 3 times a day. Morning: 2 minutes, afternoon: 1 minutes, before lights are off: 2 minutes. I have also bought a new hydro meter to be super sure. It had 50% right now so that’s good! I’m done with his dripped so I will be adding that in as well. Thank you so much for the help.

 

[MissSkittles]

Hi! I have news! We went to the vet and they did X-rays. His casque is a bit damaged in the front due to the heat of the bulb. It was a pretty bad burn. They also showed super early signs of MBD and super early signs of a bit of pneumonia. They gave me antibiotics in form of injections to give him for a month. They said it’ll get rid of the pneumonia and help the casque if there is any infection. They also gave me some antibiotic ointment for his casque. It has Silver sulfadiazine only since the one I had, had other things. The doctor was super helpful and even went over the blood analysis the other doctor had done. They told me I have to give him D3 once every 2 weeks, calcium without D3/multivitamin every feeding (except for the times I do the other calcium’s) and then the multi calcium once a month. She gave me a list of insects to feed him that will rise the calcium to phosphorus ratio which was very helpful. I feel semi hopeful. I have changed the bulb to 50 watt and have turned the humidifier to only on at night. I have also set up his mister to 3 times a day. Morning: 2 minutes, afternoon: 1 minutes, before lights are off: 2 minutes. I have also bought a new hydro meter to be super sure. It had 50% right now so that’s good! I’m done with his dripped so I will be adding that in as well. Thank you so much for the help.

Well, I’m sorry for all that your guy has going on but it is a relief and I’m glad that you were able to get some answers and appropriate treatment for him. Also super happy that you are making improvements for him.
Most feeder insects have an imbalance of phosphorus to calcium, which is one of the reasons that we dust every feeding with calcium. One of the only feeders that I’m aware of that has more calcium than phosphorus is bsfl, aka Pheonix worms, calci worms. They are a great addition to the variety of staple feeders that you give. If you wait and let them pupate into flies, they are fun little treats to give and let your cham hunt them down. Even my old girl who can’t shoot her tongue very well gets excited and hunts them down efficiently.

 

[Beman]

Hi! I have news! We went to the vet and they did X-rays. His casque is a bit damaged in the front due to the heat of the bulb. It was a pretty bad burn. They also showed super early signs of MBD and super early signs of a bit of pneumonia. They gave me antibiotics in form of injections to give him for a month. They said it’ll get rid of the pneumonia and help the casque if there is any infection. They also gave me some antibiotic ointment for his casque. It has Silver sulfadiazine only since the one I had, had other things. The doctor was super helpful and even went over the blood analysis the other doctor had done. They told me I have to give him D3 once every 2 weeks, calcium without D3/multivitamin every feeding (except for the times I do the other calcium’s) and then the multi calcium once a month. She gave me a list of insects to feed him that will rise the calcium to phosphorus ratio which was very helpful. I feel semi hopeful. I have changed the bulb to 50 watt and have turned the humidifier to only on at night. I have also set up his mister to 3 times a day. Morning: 2 minutes, afternoon: 1 minutes, before lights are off: 2 minutes. I have also bought a new hydro meter to be super sure. It had 50% right now so that’s good! I’m done with his dripped so I will be adding that in as well. Thank you so much for the help.

Overall thorough and accurate information sounds like you found a good reptile vet. Only thing I would like to further go over with you is this piece... They told me I have to give him D3 once every 2 weeks, calcium without D3/multivitamin every feeding (except for the times I do the other calcium’s) and then the multi calcium once a month. So the all feedings would be a phosphorus free plain without D3 calcium Nothing else. The wording they gave you is weird. You would want to do a multivitamin like repashy calcium plus LoD version 2 times a month this has your D3 and your vitamin A along with other vitamins. You would not give a multivitamin every feeding because if it has D3 or A in it you will overdose the chameleon.

 

[JacksJill]

I don't know what to make of that blood work except the elevated portion of the white blood cell count could be an indication of infection. If all of the other indicators don't show MBD I would assume trauma or infection of the casque. The trauma could be from a burn or a fall.