Blood Panel Explanation for Edema and Tongue Problems

DanoHeinkel

Member
◦ Your Chameleon - Male Ambilobe Panther, 9 month old. 6 inches N/V; 125 grams. Still growing. I bought Mingo 6 months ago from Kammurflage Kreations. I’ve had a stellar experience with them! They have been incredibly helpful!

◦ Handling - About once a week.

◦ Feeding - 6 Crickets and 1-2 Dubia Roaches daily--6 days a week. Gut loading using Repashy Bug Burger, Oranges, Melon, Zucchini, Grapefruit, Carrots, Apples and Bananas. I always have Bug Burger, one veggie and one fruit in the cricket enclosure at a time. (In the last few weeks I have stopped using carrots due to their high vitamin A content.)

◦ Supplements - Repashy CalciumPlus. Initially, I dusted at every feeding for the first 3 months. When the Edema formed, I stopped supplementing entirely for 6 weeks to see if I was over-supplementing (per the breeder’s advice). Now using a Low-D formula calcium powder.

◦ Watering - 1 nozzle Mist King system set to shower 10 minute at 8:30; 3 minutes and 10:30, 12:30, 2:30 and 4:30.

◦ Fecal Description - Stool is firm with white urate. Had a smear and float done: negative for bacterial infection and parasites. It has been smellier than usual for the last week and a half.

◦ History - About 4 months ago, Mingo’s urates were slightly yellow for about a week. He’s had previous health issues that I know of.


Cage Info:

◦ Cage Type - 18x18x36 all screen enclosure. Pictures below.

◦ Lighting - Up until 2 months ago, this was my lighting setup: 50 watt zoo-med basking bulb; 12” zoo-med t5 HO 5.0 UVB bulb. in April, I changed to a 75 watt basking bulb, and swapped UVB bulb to a 26watt zoo-med 5.0 CFL bulb. Lighting is on a 12 hour timer (7am-7pm).

◦ Temperature - Cage floor sits about 75, with the basking spot at 94 (the basking spot was 85 before the recent bulb change). Lowest overnight temp is 70. Measured using dial thermometers.

◦ Humidity - Humidity ranges from 30% to 55% after mistings. Measured using a dial hydrometer.

◦ Plants - 1 live Golden Pothos and 1 Croton Nervia at the bottom of his enclosure. He doesn’t have much contact (if any at all) with this plant.

◦ Placement - Mingo’s enclosure is located in a spare bedroom that doesn’t receive much foot traffic. The air vent is across the room, about 10’ away. The top of the enclosure is 6 feet from the ground.

◦ Location
- Nashville, TN.


Current Problem - Gular Edema is the issue that I (and 3 vets) have been trying to diagnose for months now. The swelling especially seems to flare up after feeding and when he is introduced to stressors. The Edema HAS reduced over the last 2 weeks, though his tongue has worsened.

Recently, his tongue has started to weaken over the course of a month. Initially, he was missing high on his feeders; It gradually progressed to shooting his tongue only about an 2 inches out of his mouth. Now, he takes at least 15 minutes in between catching prey from his cup to reset his tongue and swallow his feeder. This is my biggest concern. It looks to me that his tongue is sitting against his airway after swallowing which causes him open mouth gape occasionally after feeding.

Also, his feces have been smellier than usual with a bubble or two present. In addition, small crystals have formed around his nostrils. Salt? Uric acid?

I’ve seen 3 different vets on multiple occasions. The first 2 had little experience with chameleons. The third was a referral after vet #2 needed help with diagnosis. I've been sticking with vet #3 who drew some fluid from his swelling and determined that it is a transudate fluid.

The 3 vets have prescribed (in this order): .1 MLs of Furosemide (to reduce swelling) .15 MLs of Baytril by mouth for 7 days, Meloxicam, (to see if the swelling was inflammation due to injury), 1 Baytril injection, and Pedialite. All of these meds were prescribed to see if anything would change. No change was seen using any prescription so far. He hasn't been on any of these meds for the last 2 months.

That brings us to this week. Dr #3 did a blood panel on Mingo. Unfortunately, he didn't have a blood panel standard for a panther chameleon, so he's not sure what to focus on. He's contacting colleagues to find one. In the meantime, any help from vets on this thread would be amazing! Do the symptoms and blood panel seem to be speaking to you in any way? Hypovitaminosis A? Kidney failure?

I recently started giving him 5 MLs of a vitamin B complex mixed with water daily for the last 3 days. That seemed to help his tongue slightly! Planning to continue this. Please ask clarifying question if needed! Thank you guys.

PS: Isn't he absolutely gorgeous?! Just had to throw that in there...
 

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It's strange that he is displaying symptoms of lacking vitamin A(tongue issues). Unless the swelling is causing it directly. Also, could it be a malnutrition? Possibly an imbalanced gutload? Carrots don't have vitamin A. They have beta carotene, which we don't even know if chameleon can process like we do. If this is the case, it would seem your chameleon is missing a lot of vitamin A from the diet. Though I do see the worry in adding it and I am no doctor. It seems too extreme, especially in a panther, to be caused from hypervitaminosis when you're not even supplementing it. Just throwing ideas out there for you. I am absolutely not a doctor and just giving you some food for thought. Would like to hear some other's thoughts more experienced in the medical field. @JacksJill worked for an exotic vet I believe, maybe she can add something to this.

Anyway, would like to follow along and see how this goes for you. Good luck.

Edit: I notice your gutload is almost all sugary fruit, banana is rarely/if ever used for example. Sugar is also said to cause edema in humans, though I'm not sure how that would translate to reptiles.
 
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I'm far from a vet but a couple of things stand out to me right off. I don't mean to sound harsh so please don't take it that way if any thing comes off looking that way. @Matt Vanilla Gorilla, see anything I missing?

◦ Your Chameleon - Male Ambilobe Panther, 9 month old. 6 inches N/V; 125 grams. Still growing. I bought Mingo 6 months ago from Kammurflage Kreations. I’ve had a stellar experience with them! They have been incredibly helpful!

◦ Handling - About once a week.

◦ Feeding - 6 Crickets and 1-2 Dubia Roaches daily--6 days a week. Gut loading using Repashy Bug Burger, Oranges, Melon, Zucchini, Grapefruit, Carrots, Apples and Bananas. I always have Bug Burger, one veggie and one fruit in the cricket enclosure at a time. (In the last few weeks I have stopped using carrots due to their high vitamin A content.)

Slow him down to every 2 to 3 days on feeding, at his age you are over feeding him. How often are you offering the citrus? I'll make a note on the repashy down below.

◦ Supplements - Repashy CalciumPlus. Initially, I dusted at every feeding for the first 3 months. When the Edema formed, I stopped supplementing entirely for 6 weeks to see if I was over-supplementing (per the breeder’s advice). Now using a Low-D formula calcium powder.
again see notes below on repashy

◦ Watering - 1 nozzle Mist King system set to shower 10 minute at 8:30; 3 minutes and 10:30, 12:30, 2:30 and 4:30.

◦ Fecal Description - Stool is firm with white urate. Had a smear and float done: negative for bacterial infection and parasites. It has been smellier than usual for the last week and a half.

◦ History - About 4 months ago, Mingo’s urates were slightly yellow for about a week. He’s had previous health issues that I know of.


Cage Info:

◦ Cage Type - 18x18x36 all screen enclosure. Pictures below.

Strongly consider moving him to a 24 x 24 x 48. He's is definitely big enough for his adult cage at this point.

◦ Lighting - Up until 2 months ago, this was my lighting setup: 50 watt zoo-med basking bulb; 12” zoo-med t5 HO 5.0 UVB bulb. in April, I changed to a 75 watt basking bulb, and swapped UVB bulb to a 26watt zoo-med 5.0 CFL bulb. Lighting is on a 12 hour timer (7am-7pm).

Go back to linear uvb and the correct length for the cage. Pangea has some pretty good prices on the zoo med t5ho hoods if you want to stay zoo med. Unless Mingo is sitting directly under that cfl bulb he is not getting uvb exposure at all.

◦ Temperature - Cage floor sits about 75, with the basking spot at 94 (the basking spot was 85 before the recent bulb change). Lowest overnight temp is 70. Measured using dial thermometers.
Do you have an infrared thermometer at all? Those dial thermo/ hrygro are not very accurate. Accurite makes a pretty cheap digital thermo/ hygro that is fairly accurate for around $9 at Lowes. Infrared thermometers are pretty cheap on Amazon. I paid around $13 for the one I have I believe.

◦ Humidity - Humidity ranges from 30% to 55% after mistings. Measured using a dial hydrometer.

See above ^

◦ Plants - 1 live Golden Pothos and 1 Croton Nervia at the bottom of his enclosure. He doesn’t have much contact (if any at all) with this plant.

◦ Placement - Mingo’s enclosure is located in a spare bedroom that doesn’t receive much foot traffic. The air vent is across the room, about 10’ away. The top of the enclosure is 6 feet from the ground.

◦ Location
- Nashville, TN.

I sent you a pm on the repashy.
 
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Interpreting blood work is above my pay grade but I did find some comments by ferretinmyshoes a very good veterinarian that has been on the forum in the past. Blood work has to be interpreted as a whole because one system affects another but her break down of individual indicators may help you. Remember these comments are based on another chams blood work but I selected the relevant parts.

"High glucose often causes concern for diabetes in mammalian species, but not so in reptiles. There is an intestinal adenocarcinoma in bearded dragons that can cause extremely elevated blood glucose levels (like in the 600+ range). But otherwise sometimes stress can cause it to elevate at the time of the blood draw and we don't really worry about it much."

"The way to look at calcium and phosphorus is in ratio with each other: calcium should be at least twice as high as the phosphorus levels. If this ratio is inverted then it is suggestive of MBD or kidney failure. If the uric acid(UA) levels are also high this is extremely suggestive of advanced kidney failure. However it is not always so straightforward - my 6 year old male that just passed had a 1:1 ratio of calcium to phosphorus, which isn't good but isn't terrible, and his uric acid levels as normal. But on necropsy his kidneys were in advanced stages of failure microscopically."

Here is the thread it came from for reference. https://www.chameleonforums.com/threads/blood-test-results.124707/

I would bet that the B vitamins are causing the stool odor. They have a very strong odor and being water soluble pass very quickly thru the system. The time line is right for that also.
 
Grapefruit is not a safe food to feed if you ever need to medicate your chameleon. Also, too much citrus is not good either. Many, many medications are not compatible with grapefruit! You need to feed the bugs leafy greens low in oxalic acid (dandelions being a great example). You need to add usable (to the chameleon) vitamin A suplimentation. Retinal palmitate (you can get gell caps from a human pharmacy) is a great vitamin A to use! The how to use it is in the link below.

I also agree with @dshuld @jamest0o0 and @JacksJill on the feedback they gave you.

https://www.chameleonforums.com/thr...nced-keepers-please-share-your-wisdom.152159/
 
It's strange that he is displaying symptoms of lacking vitamin A(tongue issues). Unless the swelling is causing it directly. Also, could it be a malnutrition? Possibly an imbalanced gutload? Carrots don't have vitamin A. They have beta carotene, which we don't even know if chameleon can process like we do. If this is the case, it would seem your chameleon is missing a lot of vitamin A from the diet. Though I do see the worry in adding it and I am no doctor. It seems too extreme, especially in a panther, to be caused from hypervitaminosis when you're not even supplementing it. Just throwing ideas out there for you. I am absolutely not a doctor and just giving you some food for thought. Would like to hear some other's thoughts more experienced in the medical field. @JacksJill worked for an exotic vet I believe, maybe she can add something to this.

Anyway, would like to follow along and see how this goes for you. Good luck.

Edit: I notice your gutload is almost all sugary fruit, banana is rarely/if ever used for example. Sugar is also said to cause edema in humans, though I'm not sure how that would translate to reptiles.


Thanks for the helpful thoughts, James! Yes, I found it weird that he seems to be exhibiting signs over HYPO and HYPER vitaminosis simultaneously: edema and tongue issues... Have you ever known hypovitaminosis A to cause edema? Thanks for the advice on gutload!
 
Last edited:
I'm far from a vet but a couple of things stand out to me right off. I don't mean to sound harsh so please don't take it that way if any thing comes off looking that way. @Matt Vanilla Gorilla, see anything I missing?

◦ Your Chameleon - Male Ambilobe Panther, 9 month old. 6 inches N/V; 125 grams. Still growing. I bought Mingo 6 months ago from Kammurflage Kreations. I’ve had a stellar experience with them! They have been incredibly helpful!

◦ Handling - About once a week.

◦ Feeding - 6 Crickets and 1-2 Dubia Roaches daily--6 days a week. Gut loading using Repashy Bug Burger, Oranges, Melon, Zucchini, Grapefruit, Carrots, Apples and Bananas. I always have Bug Burger, one veggie and one fruit in the cricket enclosure at a time. (In the last few weeks I have stopped using carrots due to their high vitamin A content.)

Slow him down to every 2 to 3 days on feeding, at his age you are over feeding him. How often are you offering the citrus? I'll make a note on the repashy down below.

◦ Supplements - Repashy CalciumPlus. Initially, I dusted at every feeding for the first 3 months. When the Edema formed, I stopped supplementing entirely for 6 weeks to see if I was over-supplementing (per the breeder’s advice). Now using a Low-D formula calcium powder.
again see notes below on repashy

◦ Watering - 1 nozzle Mist King system set to shower 10 minute at 8:30; 3 minutes and 10:30, 12:30, 2:30 and 4:30.

◦ Fecal Description - Stool is firm with white urate. Had a smear and float done: negative for bacterial infection and parasites. It has been smellier than usual for the last week and a half.

◦ History - About 4 months ago, Mingo’s urates were slightly yellow for about a week. He’s had previous health issues that I know of.


Cage Info:

◦ Cage Type - 18x18x36 all screen enclosure. Pictures below.

Strongly consider moving him to a 24 x 24 x 48. He's is definitely big enough for his adult cage at this point.

◦ Lighting - Up until 2 months ago, this was my lighting setup: 50 watt zoo-med basking bulb; 12” zoo-med t5 HO 5.0 UVB bulb. in April, I changed to a 75 watt basking bulb, and swapped UVB bulb to a 26watt zoo-med 5.0 CFL bulb. Lighting is on a 12 hour timer (7am-7pm).

Go back to linear uvb and the correct length for the cage. Pangea has some pretty good prices on the zoo med t5ho hoods if you want to stay zoo med. Unless Mingo is sitting directly under that cfl bulb he is not getting uvb exposure at all.

◦ Temperature - Cage floor sits about 75, with the basking spot at 94 (the basking spot was 85 before the recent bulb change). Lowest overnight temp is 70. Measured using dial thermometers.
Do you have an infrared thermometer at all? Those dial thermo/ hrygro are not very accurate. Accurite makes a pretty cheap digital thermo/ hygro that is fairly accurate for around $9 at Lowes. Infrared thermometers are pretty cheap on Amazon. I paid around $13 for the one I have I believe.

◦ Humidity - Humidity ranges from 30% to 55% after mistings. Measured using a dial hydrometer.

See above ^

◦ Plants - 1 live Golden Pothos and 1 Croton Nervia at the bottom of his enclosure. He doesn’t have much contact (if any at all) with this plant.

◦ Placement - Mingo’s enclosure is located in a spare bedroom that doesn’t receive much foot traffic. The air vent is across the room, about 10’ away. The top of the enclosure is 6 feet from the ground.

◦ Location
- Nashville, TN.

I sent you a pm on the repashy.


Thanks for your thoroughness! I'll slow the feeding down. I fasted him for a few days about a month ago to see if that might help
(breeder's suggestion) but no dice. I only give the citrus about one every 4 or 5 weeks to feeders. I'll look into investing in a infrared thermometer.
Have been putting some money aside for the enclosure update; thanks for the reminder.
Awesome info on Repashy. I'm out of Bug Burger, so it will be good to try something new. Thanks!
 
Interpreting blood work is above my pay grade but I did find some comments by ferretinmyshoes a very good veterinarian that has been on the forum in the past. Blood work has to be interpreted as a whole because one system affects another but her break down of individual indicators may help you. Remember these comments are based on another chams blood work but I selected the relevant parts.

"High glucose often causes concern for diabetes in mammalian species, but not so in reptiles. There is an intestinal adenocarcinoma in bearded dragons that can cause extremely elevated blood glucose levels (like in the 600+ range). But otherwise sometimes stress can cause it to elevate at the time of the blood draw and we don't really worry about it much."

"The way to look at calcium and phosphorus is in ratio with each other: calcium should be at least twice as high as the phosphorus levels. If this ratio is inverted then it is suggestive of MBD or kidney failure. If the uric acid(UA) levels are also high this is extremely suggestive of advanced kidney failure. However it is not always so straightforward - my 6 year old male that just passed had a 1:1 ratio of calcium to phosphorus, which isn't good but isn't terrible, and his uric acid levels as normal. But on necropsy his kidneys were in advanced stages of failure microscopically."

Here is the thread it came from for reference. https://www.chameleonforums.com/threads/blood-test-results.124707/

I would bet that the B vitamins are causing the stool odor. They have a very strong odor and being water soluble pass very quickly thru the system. The time line is right for that also.

Awesome resource on explaining the blood panel! Good find. And good clue about the Vitamin B--I hadn't thought to link those two.
 
Grapefruit is not a safe food to feed if you ever need to medicate your chameleon. Also, too much citrus is not good either. Many, many medications are not compatible with grapefruit! You need to feed the bugs leafy greens low in oxalic acid (dandelions being a great example). You need to add usable (to the chameleon) vitamin A suplimentation. Retinal palmitate (you can get gell caps from a human pharmacy) is a great vitamin A to use! The how to use it is in the link below.

I also agree with @dshuld @jamest0o0 and @JacksJill on the feedback they gave you.

https://www.chameleonforums.com/thr...nced-keepers-please-share-your-wisdom.152159/

Awesome info! Haven't given feeders grapefruit in months but I'll make sure not to while he's on any medication. Been feeding dandelion greens to them for the last few weeks actually. Glad to hear that it might help. I got a human-grade Vitamin A supplement a few weeks ago but I wanted to wait to see the blood work results. I guess it's time to start giving it to him... And yes, I accidentally chose the right one (retinal palmitate)!

I saw some suggestions on the thread you sent but no concrete regiment. I'm thinking one drop on a feeder for three days, then more dose a week later. Monthly after that. Just a shot in the dark though. Any thoughts?
 
Thanks for your thoroughness! I'll slow the feeding down. I fasted him for a few days about a month ago to see if that might help
(breeder's suggestion) but no dice. I only give the citrus about one every 4 or 5 weeks to feeders. I'll look into investing in a infrared thermometer.
Have been putting some money aside for the enclosure update; thanks for the reminder.
Awesome info on Repashy. I'm out of Bug Burger, so it will be good to try something new. Thanks!

I have nothing more to say! ;) i personally feed my panther with 4-5 crickets every 2-3 day sometime less. I have one melleri female with chronic oedema and this is clearly linked to a hypovitaminose A and/or overfeeding she always on a restrictive diet for her good!

Good luck with him.. personally I think baytril or any kind of antibiotic can just be another problem and not a solution here.. I don't understand why the antibiotic "guessing" :/
 
Thanks for your thoroughness! I'll slow the feeding down. I fasted him for a few days about a month ago to see if that might help
(breeder's suggestion) but no dice. I only give the citrus about one every 4 or 5 weeks to feeders. I'll look into investing in a infrared thermometer.
Have been putting some money aside for the enclosure update; thanks for the reminder.
Awesome info on Repashy. I'm out of Bug Burger, so it will be good to try something new. Thanks!

You're welcome. As ferretinmyshoes mentioned in one of the linked threads, it may take several months for this to reverse. Which in the case of Mingo I believe will be the case. I can definitely understand the stashing money for the larger cage too lol. I have a lighting experiment I've been putting on hold for a while due to work being slow for my wife.

Btw, he is a handsome boy for sure.
 
Another thought I hadn't really looked at yesterday, your calcium to phosphorus ratio is off a bit too. It should be around 2:1 and it shows he has roughly 3.6:1.

If he were mine here is what I would do until your vet develops a plan of attack for you. Take him off repashy products entirely. Grab a bottle of reptivite w/o d3, sticky tongue farms indoor and outdoor, bee pollen, liquid vitamin A capsules (@Matt Vanilla Gorilla mentioned earlier). Reptilesupplyco.com has decent prices on all of it minus the vitamin A capsules. Schedule would be something like:

Food

Sunday 1 reptivite and bee pollen
Monday no food
Tue stf outdoor and bee pollen
Wed off
Thur stf outdoor and bee pollen
Friday off
Sat- off/ small treat/ snack- think hornworm 1 or two to help get some extra moisture in to help flush kidneys.
Sun 2 stf indoor and bee pollen

Water
8 to 10 min am

1 to 2 min mid day

3 to 5 min pm

If you have a cold mist humidifier; hook it up so that it "fogs" his cage at night. Run it for 6 to 8 hours, set for the hours before lights come on more then right after lights off and skip the mid day misting. Bump pm water to 5 to 7 minutes.

Getting busy at work so give me a bit and I'll try to elaborate a little more.
 
http://www.anapsid.org/hypercal.html

I shared this with @JacksJill privately and is also worth a read since it relates to what you have going on. After reading something she shared with me I found this. Between what she shared with me and this, I'm even more convinced the source of your edema problem will come back to the repashy. With giving him repashy daily, even the lo d version, at this stage in his life is overloading his systems. I know on ccusa it is suggested to think of the lo d as more of a multivitamin then a daily supplement. they suggest to give it one time a week as your multivitamin.

How ever, as I shared with you and @JacksJill privately, after reading the thread in C.A.D. and noticing it developing in my own younger chams, I stopped using it any more then once a month. I've reached out to the guy I got Odin from who uses nothing but human grade supplements to see if he uses a particular brand of prenatal vitamins. He buys calcium, calcium w/ d3 and prenatal vitamins and crushes them to make his own powders. He also uses bee pollen with each dusting on top of those too. May be a cheaper/ faster solution to get Mingo off the repashy regimen sooner rather then waiting on the supplements to come in I mentioned earlier.
 
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Another thought I hadn't really looked at yesterday, your calcium to phosphorus ratio is off a bit too. It should be around 2:1 and it shows he has roughly 3.6:1.

If he were mine here is what I would do until your vet develops a plan of attack for you. Take him off repashy products entirely. Grab a bottle of reptivite w/o d3, sticky tongue farms indoor and outdoor, bee pollen, liquid vitamin A capsules (@Matt Vanilla Gorilla mentioned earlier). Reptilesupplyco.com has decent prices on all of it minus the vitamin A capsules. Schedule would be something like:

Food

Sunday 1 reptivite and bee pollen
Monday no food
Tue stf outdoor and bee pollen
Wed off
Thur stf outdoor and bee pollen
Friday off
Sat- off/ small treat/ snack- think hornworm 1 or two to help get some extra moisture in to help flush kidneys.
Sun 2 stf indoor and bee pollen

Water
8 to 10 min am

1 to 2 min mid day

3 to 5 min pm

If you have a cold mist humidifier; hook it up so that it "fogs" his cage at night. Run it for 6 to 8 hours, set for the hours before lights come on more then right after lights off and skip the mid day misting. Bump pm water to 5 to 7 minutes.

Getting busy at work so give me a bit and I'll try to elaborate a little more.

To elaborate a little more on this, the liquid Vit A would be given as 1 drop once a month. I got mine from CVS because I couldn't find any in Wal-Mart in my area. Hydration is going to be a very big key along with stopping the repashy or going to once a month with it though, I would not use it for the next couple of months at least until he levels out. The cool mist humidifier will help with night time "hydration". If you haven't checked it out, podcast #89 I think it was, on "naturalistic hydration" it explains what Bill and a few others have been researching on this subject.

As a side note, one post in the thread I pm'd you, the guy I got Odin from showed a female that had a sever case like yours that he had received. The person he purchased her from was also using repashy. He stated he was able to clear it in a week with bee pollen, plain calcium and lots of water. Though I trust his knowledge of chams very much, take the time frame with a grain of salt as always.
 
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