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how long do i treat sick hatchling once she's better?

Discussion in 'Advanced Tortoise Topics' started by LtDanFan, Nov 7, 2016.

  1. LtDanFan

    LtDanFan New Member

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    i have some questions that i am hoping someone can help to answer. i have a baby leo that i think is sick and I'm not sure how long to continue treatment now that she seems to be improving. jeff was hatched around march/april i think and she was very little when I got her (26g). she initially did great and seemed to thrive but never really gained weight since i got her (only a gram or two I think) while the other babies she shares her tub with gained several grams a week. I made sure to watch them eat every day to make sure no one was getting bullied and there are several piles of greens available at all times plus since she is so small, I held her back after soaking and offered her greens separately from the others to give her a head start. She never gained significant weight or looked any bigger then she started losing weight and her appetite decreased. I noticed her sleeping in the pile of greens quite frequently. She had puffy eyes, and they were closed most of the day, lethargy, and a softening of her shell (or at least i think it was softening- it was never really "hard" to begin with like my other torts).

    i brought temp up in enclosure (no lower than 75 in cold area at night and 85 during the day with hot side about 100 at all times), added full spectrum bulb because previously she was exposed to sunlight all day because of her location but I had to leave the window open and its getting cold here (maybe she got colder than I realized when the weather turned chilly). humidity was always 90-100% on the humid side based on hydrometer in tub and i use coconut bedding that gets re-wet with warm water every few days plus she gets misted a couple times a day. I increased her soaking to twice daily and added daily calcium powder to the greens she was offered. After a week of this, she ate with gusto on friday night for the first time in a long time. Her eyes are less puffy today and she’s been keeping them open more since Friday night. I compare her to my other babies and she looks more normal tonight than she has in a long time.

    When I weighed her tonight after soaking she gained weight (5 grams) since yesterday and this is the first time she’s gained weight. This makes her 1 gram shy of the weight she was when I got her.

    She passed gas and pooped very small on Friday and then pooped twice (again very small) during her soak tonight.

    I don’t want to over supplement her so how long do I need to continue calcium supplementation at this higher level? Her shell is about the same softness as before but I know it will take time to firm up. I know she didn’t get sick overnight so I don’t expect her to recover overnight. I just don’t know how long it will take.

    When will I know that she is out of the woods?

    Is there anything else that I should or can do?

    How will I know if I am over supplementing her calcium?

    How else can I monitor progress or what else do I need to be monitoring on a regular basis other than her eyes, poop and weight?

    I am cautiously optimistic at this point but I know that she still has a ways to go.
    Fredkas likes this.
  2. JoesMum

    JoesMum Well-Known Member 5 Year Member

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    Hello and welcome to TFO. I'll do my best to answer your questions in line.
    Failure to thrive is frequently the first sign of bullying. It can be mental as well as physical and you cannot possibly be watching 24/7 to ensure each tort gets their fair share of basking and food without being moved on.

    Separate this one permanently. It will happen again.

    Even with separate feeding, failure to thrive is a sign of stress and bullying.

    This indicates a problem with temperatures and/or UVB.

    Temperatures must not fall below 80F day or night. Your Leopards must be able to bask at 100F in order to digest food - that's under a proper hot bulb or in full direct sunlight. A proper UVB source (direct sun - not through a window) or from a tube UVB bulb. I don't know what your "full spectrum bulb" is, but unless it is specifically for reptile UVB then it may as well not be there.

    A tiny pinch of Calcium powder should be sprinkled on food 3 times a week - no more as you can overdo it. However, proper UVB is necessary for the dietary calcium to be absorbed.

    Neither do we, but this one needs separating and the others probably do too. How many do you have and what is the enclosure floor area?

    All you can do is keep her separate in a proper enclosure with good UVB and basking. Unfortunately some hatchlings are never destined to succeed (hatchling failure syndrome) and this may be one of them.

    Please read the following to get the most up to date care for Leopards

    How to raise a healthy Leopard Tort
    http://www.tortoiseforum.org/threads/how-to-raise-a-healthy-sulcata-or-leopard-version-2-0.79895/

    For those who have a young Sulcata (applies to Leopards)
    http://www.tortoiseforum.org/threads/for-those-who-have-a-young-sulcata.76744/

    Beginner Mistakes
    http://www.tortoiseforum.org/threads/beginner-mistakes.45180/
    Tidgy's Dad likes this.
  3. LtDanFan

    LtDanFan New Member

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    thank you for for your response. i appreciate your time.

    i guess i should have been more clear. i was trying to summarize and didn't want the post to be too long. i got her first (end of spring) and she was alone until the two others came along (about 2 weeks ago) and the problems started well before she shared her tub. i had wondered about her lack of growth but i couldn't ignore it once i had 2 live comparisons in front of me. I'm not sure when the weight loss started as there was a period of time that i was unable to weigh her weekly as i had been doing initially and more recently. i realized it when i weighed the new babies because i weighed jeff at the same time. she has actually gotten better since i got the other babies (probably due to the more intensive care she's gotten).
    according to what I've read, hatchlings and young torts can do well in groups as long as the sight line is arranged so that they don't have to see the others all the time.
    I'm pretty well educated in animal behavior, although i will admit there are people that know more about certain things than i do but i just do not think that bullying is a feature of jeff's issue given that it started long before the addition of her tub-mates and has actually improved since they've come along. i realize the potential exists but i just don't see it as a cause in this specific case. my entire house is full of animals that defy the "expected" behavior.
    it is my understanding the leopards are less territorial and less aggressive than other species but if this is incorrect, I'm willing to try keeping her alone. i have another tub that is about 30 quarts or so and i can get that set that up in a few days time.

    they (3 of them) are currently in a 55quart (low and long like the ones they make to slide under a bed for storage) rubbermaid container with 2 water dishes on opposite ends, 3 hides (one of them humid) throughout, two piles of greens on opposite sides (but both in proximity to the central heat source so the torts stay warm while eating. i don't know the measurements offhand so i'd have to dig out a tape measure but its about 4ft by 2ft i think. basking area is around 100F at all times. ill add another ceramic bulb to keep the cold temps up. are you saying that basking area should be warmer than 100F? i thought 75 was ok for winter temps in at night on the cold side. over the summer she was in a similar set up but outside on a protected porch with sunlight exposure during the day and inside at night.
    the window she was by was open to allow unfiltered sunlight in (i'm aware that a closed window will block UVA/UVB radiation) but i had to close it when the weather turned cold. it took a couple of days to receive the reptisun bulb so there were a few days she may have gone without. I'm sure it didn't help but i can't see that it was the whole problem given that she has been soft all the time. perhaps its just the temp having been low that was the issue.

    the bulb I'm using for lighting is a reptisun UVA/UVB bulb made for reptiles.

    she had a cuttlebone in the tub at all times and initially i grated it onto the greens a couple times a week but then decided to let her regulate her own intake based on need. apparently that didn't happen as expected so I'm back to supplementing her.

    I'm pretty sure that i have addressed the issue and the fact that she seems to be responding is a good sign but i am well aware of the phenomenon of critically ill animals showing dramatic improvement just prior to dying, so i know her situation is still precarious. i was hoping for a more concrete time frame or more specifics about recovery from illness in tortoises as in when can i reasonably feel that she is truly "over" this issue (or at what point i would say she is not over it and i need to do something different vs she will never be over it and i should euthanize her to save her the suffering), but perhaps its not out there.
    so, i guess ill just continue the baby food soaks twice daily and keep up with the calcium until she either grows or dies. perhaps its worth a phone call to a colleague at the local exotics practice for some input.

    thank you for the links, always helpful to have that info handy as a reference.
  4. Yvonne G

    Yvonne G Old Timer TFO Admin 5 Year Member Platinum Supporter

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    You don't need the baby food soaks if the tortoise is eating. Baby food soaks are a vehicle to get nutrition into a tortoise that isn't eating. Have you tried offering a bit of soaked Mazuri Tortoise Diet?
  5. LtDanFan

    LtDanFan New Member

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    i have offered her mazuri frequently. she seems interested in it but doesn't eat more than a bite or will just smell it and turn to something else. she prefers the repcal when i offer both side by side and I've tried using 1 small pellet to get her interested in mazuri but she doesn't seem to get excited by it. the first night she ate well she turned away from mazuri to her greens and i think she prefers greens so i guess i can't be too upset with her. and ill keep trying, maybe one day she'll eat it.
    she is eating for now so ill go back to regular water soaks. she's just so ineffectual about it that i wonder how much she really is consuming. a lot of the time she takes a couple of tiny bites and stops or reaches out but misses the leaves and just chomps at the air. I've never seen my other torts do this.
    is there a point at which I'm soaking her too much? she's spending 30-45 minutes twice a day in the water.
    she keeps gaining weight, I've been weighing her daily for the last few days. i am just trying to get a day to day objective measurement of how she is doing. she's way to tiny to draw blood and check that way and I'm sure that radiographs would be just as ineffectual except for showing what i suspect will be metabolic bone disease, which i am suspicious of based on her soft plastron.
    i guess ill just keep going and she will either make it or not. I've read others talk about the "100g" mark so that will be my benchmark. she's 27 grams after her morning soak today so i guess I'm nearly a third of the way there. here's to hoping.
    thank you for your input and help in saving my little baby.
  6. cmac3

    cmac3 Well-Known Member

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    You may have posted it but I just skimmed the post. What type enclosure do you have open or closed and how big is it?
  7. Tom

    Tom The Dog Trainer 5 Year Member

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  8. LtDanFan

    LtDanFan New Member

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    she is in a rubbermaid tub about 4ft x 2 ft. (i think. id have to dig out a tape measure to be sure but I'm 5ft tall and on my side its nearly as long as i am). it takes up nearly the whole top of my dresser which is actually a wall unit meant to hold those decorative fabric drawers turned on its side so its pretty big. right now its half covered to allow for the ceramic heat emitter and light bulb and avoid melting the cover. i mist several times a day, keep the coconut bedding wet and have moss in the hides which i wet at least two times daily. there are 2 water dishes at each end of the enclosure. I'm working on getting an entirely closed set up for inside but the hydrometer measures humidity at about 90% most of the time on the humid side (it sits on the surface).
    My outside setup is entirely closed up (and that's where she spent the summer up until about 3 weeks ago when temps dropped) but temperatures fluctuate too much for me to be sure that she's warm enough all the time even with heat support during the day.
    the empty tub i have that i can move her into actually slides into my snake rack where the temp is set to be no lower than 85F at all times. if i move her, i can slip her in there at night to keep her warm and pull her out during the day to clamp the light and ceramic heat emitter to the side of the tub but that may make humidity more challenging as it will be covered at night but open during the day. same coconut bedding, though so maybe that will hold enough humidity during the day if i keep it wet.

    the bulb is an exoterra (oops, thought that was reptisun bulb, sorry) Solar Glo 125W all in one UVA/UVB, visual light and heat. it sits about 6 inches (15.24cm) above the substrate. and is angled to cover the entire enclosure (minus the hides and sight breaks).
    i added under tank (tub) heat using a mat and a rheostat to prevent overheating and the temp overnight was 77 on the cold end with the temp still around 90 on the hot end, so i have another CHE and lamp fixture on order to bring up overall temps over 80 and always have the snake rack at night thing as an option (as above).

    i got her from a private breeder. I have obtained other reptiles from him in the past that are healthy and doing very well so i had confidence in his capabilities and methods. i would call her start "semi-humid", meaning i know the breeder soaked her daily and provided water dishes (i asked) in the enclosure but I'm not sure he kept her in a completely humid environment as all the pictures i saw before i purchased her were staged on paper towels so i could see the options. i know he fed (or i guess at least offered it to her since i'm not sure she likes it) mazuri as he sent a bag of it with her as well so i would have something until my order came in. i can ask for details but i don't think it matters now, where we are is where we are, my questions are not of "why" or necessarily "how" but "how long" and "what does it look like when...."

    I'm sure the hatchling failure syndrome (i have read that thread several times but ill revisit it again for any hints of what else i can be doing) or random "I'm not meant to live" syndrome is at play, the question is when will know that she is out of the woods or when should i pull the plug and euthanize her because she's hit the point of no return. as long as she's improving (or at least no worse) I'm inclined to give her a chance but i want to know if she's not better by X time period, her prognosis is poor so i can prevent her suffering any more than she has thus far. I've read all that information multiple times over and my question is not "what is wrong with her?" rather "when will i be able to say that she is better?"
    I agree that HFS is a terrible term (interestingly, we have the terms fading kitten or fading puppy syndrome to describe poor doing canine and feline neonates but the similarities and differences between those and HFS is a topic for its own thread....) as there are lots of reasons hatchlings die and some are avoidable and some are not but in the absence of specific information such as CBC results, biochemical profiles, etc, we cannot classify them all separately as clinical signs tend to overlap between all the "syndromes" that can cause baby mortality. the question is when can i say she is "over" it?
    if she were as big as even a neonatal dog or cat i would have the ability to collect some biochemical information necessary to answer my questions and provide objective measures of prognosis, improvement or decline. but because that is not possible I'm left with subjective measurements (aside from fecal production, weight gain, and general appearance compared to normal) with which to make decisions and that's what I'm struggling with.

    to answer the "treatment" question- no medications. I consider everything that i am doing beyond "normal" maintenance to be a "treatment" as a matter of course. my other torts are getting soaked once daily, a normal ration of mixed greens, grass from my lawn nd dandelions also from my yard as well as mazuri and that stuff my friend gave me (until i run out) and the cuttlebone in the tub (i can see the chunks they have taken out of it, very cute). so her treatment has been the baby food soaks, the extra calcium (I'm sure she is at a deficit- how can she not be with a soft plastron), multiple soakings, multiple offerings of greens while segregated from the others etc. at this time, i do not see an indication for antibiotics (otherwise i would have started something) and while i considered a course of fenbendazole to cover the bases, given that she is a captive bred baby I'm sure that parasites are low on the list of what is causing her issues. however, i have access to both liquid that can be squirted down her throat (at the risk of aspiration, i know) or powder that can be sprinkled onto her greens (at the risk of her not eating it) so if some can tell me there is a significant benefit to risk ratio in a CBB, ill pick that up from work tomorrow.

    thanks again for all your help and advice, despite my questions and tendency to challenge "traditional" knowledge, i appreciate the input of people with more experience than myself in these matters.

    if anyone has had a baby that was in a similar state and survived, i'd be very interested in hearing form you. perhaps you can help with the "when did you know it was ok" question. that's the type of information I'm looking for most of all. i just don't want her to suffer or to find her dead if she's too far gone to make it. ill euthanize her to save us both the suffering if that's the case but i'd rather just get her through this if there's hope she will.

    for now she seems to be hanging in there. no poo tonight during her last baby food soak (the container was already open and i didn't want to waste it and didn't think it would hurt her) but the cranial and caudal portions of her plastron feel subjectively firmer than i remember (maybe just wishful thinking because the central position is just as soft as before??. how long would it take to detect a difference once UVB and calcium supplementation is added or increased?) but she weighs 23g after soaking tonight and that's less than after soaking last night. she didn't eat as well last night as she did the night before but ate some this morning and I'm about to feed her now.
  9. Shaif

    Shaif Well-Known Member

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    I'm sorry you are going through this. I have the same problem. I've tried every bit of advice I can find, and my baby continues to decline. He has a few decent days followed by several bad ones.
    I hope you end up ok. It's amazing, isn't it, when you see actual healthy babies. The difference is heartbreaking.
  10. Yvonne G

    Yvonne G Old Timer TFO Admin 5 Year Member Platinum Supporter

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    I think your Exo Terra Solar Glo Bulb is way too close to the substrate. It should be no closer than 12" from the top of the tortoise's carapace.
  11. LtDanFan

    LtDanFan New Member

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    ok, ill move it up. that's not hard to do as i can angle the fixture.
  12. Tom

    Tom The Dog Trainer 5 Year Member

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    I would not use any wormers. That is not a likely cause of your issue, and it might be more than your baby can handle at this point.

    My rule of thumb is if they reach 100 grams, you are generally out of the woods. Some stall for weeks or months and then manage to pull through. Some seem fine for weeks and months, and then die fairly suddenly. There is no way that I have found to predict it. All that can be done is for you to offer the best conditions possible and hope for the best. When they are this little, vet treatments and general "fussing" seems to make things worse. Either they are going to pull out of it and make it or they aren't. Time will tell.

    If the tortoise is active and eating, let it ride. Wait and see. If the tortoise gets lethargic, stops eating, and the plastron gets soft and bruised looking, then the baby is not likely to make it. It is at that point that I would consider euthanasia.
  13. Tom

    Tom The Dog Trainer 5 Year Member

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    The type of bulb you are using is called a Mercury Vapor Bulb. They need to be pointing straight down and not at an angle. The distance from the substrate for any basking bulb should be determined by a thermometer.

    I generally recommend against under tank heaters and mats for little ones. I've seen too many issues with them. I find the over head CHEs set on a thermostat to be a safer and more reliable way to mange ambient and night temps.
  14. LtDanFan

    LtDanFan New Member

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    I'm so sorry to hear about your baby's situation. I am wishing for the best for all 4 of us :)
    unfortunately, waxing and waning is common among critically ill animals and that makes things very difficult indeed.
  15. LtDanFan

    LtDanFan New Member

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    that's what i was thinking. I'm glad you agree.

    fair enough. i didn't think there was anything that would predict outcome (it never hurts to ask as others have much more experience than i do in this area) but i appreciate all the help in offering jeff the best conditions possible so that i know i did all i could for her. its just so frustrating having to wait to know if everything that I'm doing is going to help. but such is life, i suppose. here's hoping i can get her to 100 grams and be prepared for the other thing you mentioned.

    plastron is currently soft but not discolored and i see no liquid underneath it. i check it obsessively, so it that changes ill know and can make that decision for her. thank you for that information, thats exactly what I'm looking for.

    i agree and all the time i say "just because we can do something doesn't mean we should". its the uncertainty that I'm struggling with. I'm just used to having so much more information to make decisions about when to intervene and when to stop intervening and when to just do nothing so I'm probably being more neurotic about it than necessary. thank you for your patience.
    i wish there were more survival stories so that we could synthesize more information about what actually works and what does not and anything that can be used to predict outcome. of course I'm sure that before we do that we have to define failure to thrive in tortoises and determine more accurately what contributes to it besides husbandry. but that's a project for another time......

    thank you for that information. at one time i knew all about bulbs and the difference between them, pros, cons, etc but unfortunately, that stuff doesn't stick around once i've made my decision. i don't have room in my head to keep everything i read, lol.

    i respect your opinion and i appreciate the advice but in the spirit of open discourse, i feel obligated to express a dissenting opinion. i am happy to hear your stories however as i do keep an open mind and will reconsider should i feel that the risk (based on actual occurrences) outweighs the benefit. While i do not recommend under tank heat for everyone i think its all about your set up and i have personally found UTH no more or less effective and no less dangerous than other forms of artificial heat. i once was involved in the care of a tortoise (an adult of considerable size and several decades of age) that was severely burned and eventually died because his CHE fell into the enclosure and he and his enclosure caught on fire. for me, its all about informed and intelligent choice, your set up and the risks you are wiling to take. I wouldn't dream of using a hot rock in my snakes' enclosures but my colleague regularly uses them. she also feeds live which i refuse to do. perhaps i have seen more bitten and burned snakes than she has or maybe she feels that she mitigates the risk so she can reap the benefits, i don't know.

    i truly appreciate your time, as well as that of everyone else who has chimed in to help or offer support. ill do my best to see y'all updated.
  16. Diamond

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    So sorry to hear about your sick baby. I bought my first hatchling in Feb. and had to euthanize him in July. He was 8 months old and was doing just what you are describing, biting at the air when the food was right there. Would seem like he was going to turn around and then would not eat for days. I was at the vet frequently for antibiotic shots . He would perk up 2 days later and eat for a few days and then decline again. This went on for 2 months. He grew very slowly and at 8 months was only 26 grams, his shell became soft and started to become concave, so the vet and I decided he was suffering and I opted for euthanasia. I kept asking the vet the same questions you are asking, but he said there really is no way to know if he would survive, but since he seemed like he was trying to get well I just kept caring for him like you are with soaking twice a day, keeping him warm and doing the best I could for him. It was a sad day when I had to let him go. I now have a new baby Russian who was 20 grams when I got her and she is now 43 grams and is about 11 weeks old. She is alert, bright eyed and eats like crazy. I did not have a well baby to compare my 1st one too, but I learned on this forum that if they are started wrong it could have an impact. I know my new baby was kept in a warm humid environment and I'm pretty sure my 1st one was not since I was told not to worry about humidity if I was soaking daily! My new baby gets both and I am amazed at the difference in her health and size.

    I'm not sure if any of this helps you, but just keep doing what you are doing and if it ends up that you need to euthanize your baby, you will know when the time is right. Also, my baby had 2 vitamin A injections. He did well with the 1st, but quickly declined after the second, so I question if that that may have been the determining factor in him getting worse. Unfortunately I will never know.

    Good luck and I hope your baby gets better.
  17. Shaif

    Shaif Well-Known Member

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    I feel like there are many of us going through the same situation. I check the forums daily. So many similar cases.
    If it is of any comfort, humans who die of renal failure are not in pain. The level of toxins slowly builds up in the blood, and the patient becomes lethargic, confused, but not uncomfortable.
  18. LtDanFan

    LtDanFan New Member

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    wanted to share an update on jeff today to keep everyone that is interested posted on how she is doing. she didn't eat much last night but apparently ate well during the day when i wasn't watch because this afternoon she passed a large amount of stool (for her size and compared to recent fecal production) during her warm water soak and she woke up right away and became active in the water which i haven't seen in a while. she was 23g prior to soaking and 25g after soaking despite defecating. i have come to suspect that the gram or 2 difference between weigh ins more likely reflects degree of dehydration based on this. so my goal is to continue soaking twice daily (weighing before and after) to make sure that i don't need to add a third soak in there somewhere. if she is in renal failure, she will be producing a lot of urine (assuming she is in a polyuric phase) and she may not be keeping up with her losses on her own. so until her weight stabilizes and does not change so much between pre and post soaking ill make sure to keep an eye on her water availability and soak her accordingly.
    Today she ate with the same gusto as friday night (which was the best I've seen her eat in weeks) after her afternoon soaking and subjectively her carapace feels firmer than it did a few days ago. abdominal scutes are still soft but those cranial and caudal to it are firming up (subjectively) and give less than the abdominal scutes when i press gently. maybe that's me wishful thinking but i don't have any other way to assess that. No liquid visible underneath so far and no bruising or discoloration.

    as a side note- i was thinking about the formation of liquid under the plastron being reported to be noted prior to death in torts that are ill and suspect of suffering from renal failure and i wonder if that is an indication that they are anuric and their kidneys have shut down completely, hence they are retaining fluid and are essentially in end stage renal failure. hmmm, just a thought.

    anyway, today seems to be a good day and I'm still cautiously optimistic about jeff's outcome. i realize that i could lose her at any time and it will be devastating but as long as she continues to have more good days than bad i'll keep going.

    i know you meant to make me feel better and thank you, i really appreciate it, but i disagree as i have seen many patients with end stage renal failure. I don't know your experience but having studied the physiology of disease and consequences of organs dysfunction, physiologically there is more going on than just "toxins just building up and people becoming confused ".
    Animals and people in renal failure are absolutely suffering (but i agree that the degree does vary between stages and individuals), especially at the latter stages of the disease. perhaps not in the same way as other diseases and not with pain that can be localized but the build up of uremic toxins causes excess gastric acid formation leading to GI ulceration, ulceration in the mouth (bacteria feed on the nitrogenous waste and proliferate causing damage to sensitive mucosal tissue) as well as stimulation of the emetic center causing nausea. Anemia causes weakness and they are likely experiencing insatiable thirst due to the dehydration of body tissues secondary to excess renal losses. When the kidneys shut down completely, they can no longer rid the body of excess fluid and that fluid will build up in the peripheral tissue causing edema and in the lungs causing pulmonary edema which will cause a feeling of suffocation.
    Granted not all animals will experience the end stages of disease as we can mitigate some things (providing soakings and allowing free drinking for example) and in some cases provide supportive care while the kidneys recover from injury (they do so very slowly, however) but overall I would not wish this on anyone. While i cannot say that this all happens in tortoises (there is a frustrating lack of research on disease processes in non-mammal species and diagnostic information in these cases for various reasons), we know it happens in mammals and given a lack of evidence to the contrary i would suspect that the process has similar consequences in reptiles possibly even some that are not recognized in mammals.
    In mammals we can give antacids to reduce excess gastric acid production and anti nausea medications to reduce the effect of uremic toxins on the emetic center of the brain. We can give medications to increase bone marrow production of red blood cells to address anemia, we can give fluids under the skin or place a feeding tube to provide water and nutrition in the absence of voluntary intake but we do not do these things in tortoises for various valid reasons and so I have to consider that all these things are contributing to a poor quality of life overall.
    cmac3 likes this.
  19. Shaif

    Shaif Well-Known Member

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    I'm so so glad your Jeff is rebounding. I hope with all my heart that you and have a wonderful outcome.
    And your research on renal failure is absolutely correct. Except that metabolic encephalopathy is among the first symptoms of End Stage Renal Diease (ESRD). For example, patients who have missed their dialysis treatments present with confusion and lethargy, but not pain. The painful ailments you mention are from chronic illness and gastroparesis caused by the anorexia from encephalopathy.
    Please do not think for a second that I am challenging you. Your response and information is sound. And you bring up an excellent point-- when is it too much? I wish we had the answers. And I also wish we never had to ask for them.
    I do have some experience in this field. I am a physician and am married to a nephrologist (kidney specialist). All of my family are physicians also, and we have seen many losses to ESRD. It's really not a bad way to go.

    I appreciate your info and your research. I pray for you and Jeff as well as my Zeus.

    Let's be success stories!
  20. LtDanFan

    LtDanFan New Member

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    i do not think you are challenging me at all, i enjoy friendly evidence based debate and I'm fascinated by the differences between human and veterinary medicine. i also have experience in this field, i am a veterinarian and a third year critical care resident (critialist in my world, intensivist in yours). while i cannot speak to renal failure in people, and clearly you and your wife are more qualified in this regard than i, i am very familiar with the ins and outs in animals admittedly mammals more than reptiles despite having read Mader's Reptile Medicine on multiple occasions. we do not recognize metabolic encephalopathy as a feature of renal failure (regardless of stage) in dogs and cats as often as apparently is done in people. in fact, most cases of metabolic encephalopathy are secondary to hepatic failure (or portosystemic shunting), not renal failure. I've seen acute renal failure be fatal in a matter of days and the reason that people elect to euthanize (or the reason the patients code) is more often related to pulmonary edema (secondary to anuria or oliguria and fluid intolerance) and not encephalopathy. same with end stage disease. most often people euthanize due to poor quality of life or the patient literally starves to death because they are anorexic but they show now obvious signs of encephalopathy. One could argue that is because pets do not vocalize the way they feel and a lot of what goes on with them from minute to minute is unknown unless it can be measured on a chemistry analyzer, perhaps encephalopathy is more of a feature of renal failure than we recognize but these animals are not clinically encephalopathic that we can appreciate. daily people ask me why their pet was "fine yesterday" when they clearly have a chronic issue and the only way i can explain it is that they do not vocalize how they "feel" so the nuances of their illnesses are lost on us. unfortunately, unless the owner is extremely vigilant and/or routine blood work and urinalysis is performed, most cases of renal failure in dogs and cats are diagnosed in the latter stages of the disease and encephalopathy is not a common feature of renal failure in dogs and cats (although it is theoretical for sure). as far as the human side of things, i defer to those that know more than i do about less furry two-legged mammals, lol.
    furthermore, dialysis is not a common treatment for animals as it is cost prohibitive (upwards of 10-20K initially) for a significant portion of pet owners and is most commonly employed in cases of acute renal injury or toxic exposure, not for chronic disease. The veterinary nephrologists may do it for chronic disease more than i am aware, but most of the referrals i make for dialysis are AKI cases. I'm sure this makes a difference in how people vs animals feel. unfortunately, however renal failure is a common diagnosis among elderly cats, being one of the top 4 or 5 conditions we see on a regular basis. during my ER rotations, i diagnose it at least once or twice weekly and many more patients than that were diagnosed historically.
    After years of seeing patients that can only be compared to prunes and skeletons, i think that renal failure is a pretty miserable way to go but that's just based on my subset of patients, i can't speak for others in other conditions, and I'm extrapolating from my experience as a vet which I'm sure is different than your experience as a human clinician. although, i will admit that there are much worse ways to go.
    hopefully jeff won't have to worry about that because she will pull through. and in the absence of being able to draw blood to measure kidney values, i can't even say she is in renal failure at all. looking back she was a poor-doer from the beginning, so any number of things could be contributing to her illness. I'm just hoping to get her to the magical 100g so i can stop obsessing about her, lol.

    i am fascinated by the differences between human and veterinary medicine and while physiology is physiology, not all physiology is created equal.
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