Friday, February 29, 2008

Coping with Loss

Little note from me:
I thought it is important to touch on this sensitive subject.
Dr. Jeff Feinman wrote the article in his site.
Special thanks to Dr. Jeff who gave me the permission to post this in my blog.
You can find the original article by clicking this link.

Coping With the Loss of a Pet

Author: Dr. Jeff Feinman

Grieving

Our pets live relatively short lives. For many of us who love our pets, their death can affect some of us even more than the death of a relative or friend. The death of a pet leaves few people totally untouched.

A pet may come to symbolize many things to each of us. It may represent a child, perhaps a child yet to be conceived or the innocent child in us all. It may reflect the ideal mate or parent, ever faithful, patient and welcoming, loving us unconditionally. It is a playmate and a sibling. It is a reflection of ourselves, embodying negative and positive qualities we recognize or lack in ourselves. The same pet may be all of these, alternating between roles on any given day or for each member of the family.

When a pet dies, we expect that our pain will be acknowledged, even if it is not shared, by our relatives, friends and colleagues. Though the bond between you and your pet is as valuable as any of your human relationships, the importance of its loss may not be appreciated by other people. The process of grieving for a pet is no different than mourning the death of a human being. The difference lies in the value that is placed on your pet by your family and by society as a whole.

Your grief may be compounded by lack of response from a friend or family member. Realize that you do not need anyone else's approval to mourn the loss of your pet, nor must you justify your feelings to anyone. Do not fault anyone who cannot appreciate the depth of your grief for a pet. The joy found in the companionship of a pet is a blessing not given to everyone.

Seek validation for your pain from people who will understand you. Speak with your veterinarian, a veterinary technician, groomer or another pet owner. Ask for a referral to pet grief support groups or veterinary bereavement counselors in your area. The death of a pet can revive painful memories and unresolved conflicts from the past that amplify your current emotional upheaval. Seek comfort in the support of professional counselors or clergy.

This is an opportunity for emotional growth. Your life was and will continue to be brighter because of the time that you shared with your pet. This is the best testament to the value of your pet's existence.

Five Stages of Mourning

The stages of mourning are universal and are experienced by people from all walks of life. Mourning occurs in response to an individual's own terminal illness or to the death of a valued being, human or animal. There are five stages of normal grief.

In our bereavement, we spend different lengths of time working through each step and express each stage more or less intensely. The five stages do not necessarily occur in order. We often move between stages before achieving a more peaceful acceptance of death. Many of us are not afforded the luxury of time required to achieve this final stage of grief. The death of your pet might inspire you to evaluate your own feelings of mortality. Throughout each stage, a common thread of hope emerges. As long as there is life, there is hope. As long as there is hope, there is life.

Denial and Isolation: The first reaction to learning of terminal illness or death of a cherished pet is to deny the reality of the situation. It is a normal reaction to rationalize overwhelming emotions. It is a defense mechanism that buffers the immediate shock. We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain.
Anger: As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family. Anger may be directed at our dying or deceased pet. Rationally, we know the animal is not to be blamed. Emotionally, however, we may resent it for causing us pain or for leaving us. We feel guilty for being angry, and this makes us more angry.

The veterinarian who diagnosed the illness and was unable to cure the disease, or who performed euthanasia of the pet, might become a convenient target. Health professionals deal with death and dying every day. That does not make them immune to the suffering of their patients or to those who grieve for them.

Do not hesitate to ask your veterinarian to give you extra time or to explain just once more the details of your pet's illness. Arrange a special appointment or ask that he telephone you at the end of his day. Ask for clear answers to your questions regarding medical diagnosis and treatment. Discuss the cost of treatment. Discuss burial arrangements. Understand the options available to you. Take your time. Both you and your veterinarian will find that honest and open communication now are an invaluable long-term investment.
Bargaining: The normal reaction to feelings of helplessness and vulnerability is often a need to regain control. If only we had sought medical attention sooner. If we got a second opinion from another doctor. If we changed our pet's diet, maybe it will get well. Secretly, we may make a deal with God or our higher power in an attempt to postpone the inevitable. This is a weaker line of defense to protect us from the painful reality.
Depression: Two types of depression are associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate. We worry about the cost of treatment and burial. We worry that, in our grief, we have spent less time with others that depend on us. This phase may be eased by simple clarification and reassurance. We may need a bit of helpful cooperation and a few kind words. The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our pet farewell. Sometimes all we really need is a hug.
Acceptance: Reaching this stage of mourning is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression.

Pets that are terminally ill or aging appear to go through a final period of withdrawal. This is by no means a suggestion that they are aware of their own mortality, only that physical decline may be sufficient to produce a similar response. Their behavior implies that it is natural to reach a stage at which social interaction is limited. The dignity and grace shown by our dying pets may well be their last gift to us.

Explaining Pet Loss to Your Child

It is natural to want to protect our children from painful experiences. Most adults, however, are surprised to find how well most children adjust to the death of a pet if they are prepared with honest, simple explanations. From a young age, children begin to understand the concept of death, even though they may be unaware of it at a conscious level.

When a pet is dying, it may be more difficult for a child to resolve the grief experienced if the child is not told the truth. Adults should avoid using terms like "put to sleep" when discussing euthanasia of a family pet. A child could misinterpret this common phrase, indicating the adult's denial of death, and develop a terror of bedtime. Suggesting to a child that "God has taken" the pet might create conflict in the child, who could become angry at the higher power for cruelty toward a pet and the child.

Children are capable of understanding, each in their own way, that life must end for all living things. Support their grief by acknowledging their pain. The death of a pet can be an opportunity for a child to learn that adult caretakers can be relied upon to extend comfort and reassurance. It is an important opportunity to encourage a child to express his or her feelings.

Two- and Three-Year- Olds: Children who are two or three years old typically have no understanding of death. They often consider it a form of sleep. They should be told that their pet has died and will not return. Common reactions to this include temporary loss of speech and generalized distress. The two- or three-year-old should be reassured that the pet's failure to return is unrelated to anything the child may have said or done. Typically, a child in this age range will readily accept another pet in place of the dead one.

Four-, Five-, and Six-Year-Olds: Children in this age range have some understanding of death but in a way that relates to a continued existence. The pet may be considered to be living underground while continuing to eat, breathe, and play. Alternatively, it may be considered asleep. A return to life may be expected if the child views death as temporary. These children often feel that any anger they had for the pet may be responsible for its death. This view should be refuted because they may also translate this belief to the death of family members in the past. Some children also see death as contagious and begin to fear that their own death (or that of others) is imminent. They should be reassured that their death is not likely. Manifestations of grief often take the form of disturbances in bladder and bowel control, eating, and sleeping. This is best managed by parent-child discussions that allow the child to express feelings and concerns. Several brief discussions are generally more productive than one or two prolonged sessions.

Seven-, Eight-, and Nine-Year-Olds: The irreversibility of death becomes real to these children. They usually do not personalize death, thinking it cannot happen to themselves. However, some children may develop concerns about death of their parents. They may become very curious about death and its implications. Parents should be ready to respond frankly and honestly to questions that may arise. Several manifestations of grief may occur in these children, including the development of school problems, learning problems, antisocial behavior, hypochondriacal concerns, or aggression. Additionally, withdrawal, over-attentiveness, or clinging behavior may be seen. Based on grief reactions to loss of parents or siblings, it is likely that the symptoms may not occur immediately but several weeks or months later.

Adolescents: Although this age group also reacts similarly to adults, many adolescents may exhibit various forms of denial. This usually takes the form of a lack of emotional display. Consequently, these young people may be experiencing sincere grief without any outward manifestations.

Reasons for Euthanasia

We are never quite prepared for the death of a pet. Whether death is swift and unexpected or whether it comes at the end of a slow decline, we are never fully aware of what a pet has brought to our lives until our companion is gone.

Our involvement with the final outcome may be passive. We may simply not pursue medical or surgical treatment in an aging pet. Perhaps its ailment has no cure and the best we can do is alleviate some of its suffering so that it may live the remainder of its days in relative comfort. An illness or accident may take it suddenly.

Everyone secretly hopes for a pet's peaceful passing, hoping to find it lying in its favorite spot in the morning. The impact of a pet's death is significantly increased when, as responsible and loving caretakers, we decide to have the pet euthanized.

Euthanasia is the induction of painless death. In veterinary practice, it is accomplished by intravenous injection of a concentrated dose of anesthetic. The animal may feel slight discomfort when the needle tip passes through the skin, but this is no greater than for any other injection. The euthanasia solution takes only seconds to induce a total loss of consciousness. This is soon followed by respiratory depression and cardiac arrest.

Doctors of veterinary medicine do not exercise this option lightly. Their medical training and professional lives are dedicated to diagnosis and treatment of disease. Veterinarians are keenly aware of the balance between extending an animal's life and its suffering. Euthanasia is the ultimate tool to mercifully end a pet's suffering.

To request euthanasia of a pet is probably the most difficult decision a pet owner can make. All the stages of mourning may flood together, alternating rapidly. We may resent the position of power. We may feel angry at our pet for forcing us to make the decision. We may postpone the decision, bargaining with ourselves that if we wait another day, the decision will not be necessary. Guilt sits heavily on the one who must decide. The fundamental guideline is to do what is best for your pet, even if you suffer in doing this. Remember that as much as your pet has the right to a painless death, you have the right to live a happy life.

Each of us mourns differently, some more privately than others, and some recover more quickly. Some pet owners find great comfort in acquiring a new pet soon after the loss of another. Others, however, become angry at the suggestion of another pet. They may feel that they are being disloyal to the memory of the preceding pet. Do not rush into selecting a replacement pet. Take the time to work through your grief.

To help you to prepare for the decision to euthanize your pet, consider the following questions. They are intended as a guide; only you can decide what is the best solution for you and your pet. Take your time. Speak with your veterinarian. Which choice will bring you the least cause for regret after the pet is gone?

Consider the following:

What is the current quality of my pet's life?
Is my pet still eating well? Playful? Affectionate toward me?
Is my pet interested in the activity surrounding it?
Does my pet seem tired and withdrawn most of the time?
Is my pet in pain?
Is there anything I can do to make my pet more comfortable?
Are any other treatment options available?
If a behavioral problem has led me to this decision, have I sought the expertise of a veterinary behavior consultant?
Do I still love my pet the way I used to, or am I angry and resentful of the restrictions its condition has placed on my lifestyle?
Does my pet sense that I am withdrawing from it?
What is the quality of my life and how will this change?
Will I want to be present during the euthanasia?
Will I say goodbye to my pet before the euthanasia because it is too painful for me to assist?
Will I want to wait in the reception area until it is over?
Do I want to be alone or should I ask a friend to be present?
Do I want any special burial arrangements made?
Can my veterinarian store the body so that I can delay burial arrangements until later?
Do I want to adopt another pet?
Do I need time to recover from this loss before even considering another pet?

Please note: The information provided here is meant to supplement that provided by your veterinarian. Nothing can replace a complete history and physical examination performed by your veterinarian. - Dr. J

The article was originally posted on April 4, 2009 1:17 PM. However, the date posted on the thread will be 2/29/08 11:17 PM. The reason for this discrepancy is due to Google blog system that only allow me to classify articles based on time it was written. So, in order to keep the blog tidy and the articles to be classified under the right subject, I have to change the posted date listed to February. As you can see, February folder deals with care and health problems.

Health Section I- Conclusions

With all the “common” diseases I presented (with “miscellaneous” chapter keep expanding), it is not uncommon that the facts tend to overwhelm beginners. This also affects me when I was a first timer. I thought there are too many things to tackle and too many diseases to watch out for.

But, you should not be discouraged. Keep on reading and learning facts about your marvelous chameleon pet.
I have compiled a few general tips for you:

Happiness of your chameleon begins from a proper care and a good husbandry. Problematic elements in the husbandry produce discomforts. And, prolonged discomforts will eventually stress your chameleon. Stress is your worst enemy in keeping your chameleon healthy. It weakens their immune systems. And, if ignored, it will eventually lead to mortality. Notice that almost 90% of the diseases I presented in the health chapters can be tracked back to improper cares. Therefore, please educate yourself in the correct husbandry and care for your chameleons to ensure a healthy long life for them.
Provide the best for your chameleon’s sake. Research, research, and research. The most horrible thing you can do is playing a role of vet when your chameleon needs the real one. If you do not have any access to an exotic vet nearby, you might want to find one soon before your chameleon gets sick.
It is important for you to spend quality times with your chameleon daily. Be aware that “quality” time does not mean handling and bugging your chameleon (no pun intended). But, rather observing them in the captivity. Develop an acute sense of your chameleon “normal” routines. Once you develop that sense, you will be able to spot any ‘weird’ behavior(s) exhibited by your chameleon. Approach that with calm manner and do not over react. Check your husbandry, temperature, and humidity. See if there is a fluctuation and anomaly that need to be corrected. Assess if the behavioral change are hormonal issues (sexual maturity), psychology issues (such as seeing another chameleon or its own reflection in the room), supplemental and diet issues, and/or the actual health issues. I bet you have heard from someone or read an article to this extend “chameleon is a fragile animal. They often die out of nowhere.” That statement is truly a faulty idea. Chameleon does not die out of nowhere. Chameleon is not as fragile as we thought. As a matter of fact, they are tough creatures. They are so tough that they often do not develop any obvious symptoms until the disease is in advanced stage. Therefore, the owner’s task is to develop a “motherly” instinct in detecting the early symptoms.
Symptoms are often a sign to an underlying problem that needs to be corrected soon. The most infamous sign of a sick chameleon is closing eyes or sleeping during the day. Unfortunately, it only tells you that there is something wrong. Closing eyes can pretty much means anything from too much UVB to hypovitaminosis A. Therefore, it is imperative to consult to your trusted vet. Your good assessment combined with your vet expertise can usually tackle a lot of the health problems.

Be aware that one illness might mask another illness. Such as gout can mask a more serious organ failure. Therefore, I cannot stress the importance of consulting with your trusted vet more than this.

Here is a good case study of this situation:

The owners of the chameleon (named “Scooter”) are very knowledgeable in chameleon husbandry. They provided a correct setup and the chameleon has been growing wonderfully.

Until winter 2007, it suddenly stopped eating for a week. And, soon, it developed a new symptom: its hind legs and tail begun to lose strength and completely paralyzed in no time. The owners went to the vet that same day. X-rays were taken. And, the vet suspected that it maybe the case of an impaction. The vet gave Scooter a shot of calcium, some de-worming treatment, and a bottle of calcium to give daily.

The owners also give a very small dose of mineral oil to scooter with his daily force-feeding of water and calcium to help to pass the impaction. After a full 2-3 weeks of no eating or movement from his back legs, he finally released the impaction.

The owners made another appointment for that day to have scooter checked up on. They brought a stool sample from that day for the vet to look at. And, the stool contained a numerous population of coccidia.

It has been known that coccidia in chameleons can also cause impactions. The vet gave the owners 2 weeks worth of medication to kill off the coccidia. Scooter, soon, regained his health and has been climbing happily.

If your chameleon seems to die out of nowhere, you might be interested in doing a necropsy to find out what exactly kill yours. You can definitely do it on your own if you are knowledgeable enough. Or, you can have your vet do it for you. Necropsy is a very valuable learning experience.
Sometimes no matter how good a keeper you are, the stress of captivity and the seriousness of the illness can overwhelmed your chameleon. If it succumbs to its illness, regardless of everything that you have done, do not be discouraged. Learn from the experience to not repeat the same mistake.

Hope that helps!

Health Section H- Miscellaneous Problem (in progress)

WARNING: This health chapter is written in hope to educate new chameleon owners to recognize early symptoms of sickness. Many of the pictures shown in health chapter are an advanced case of the disease. If your chameleon exhibit symptoms like these, it is HIGHLY advised for you to bring your chameleon to an exotic veterinarian as soon as possible. This article should NOT be used as a substitute for a vet visit. Please be a responsible pet owner. The author cannot be held responsible for any abuse or form of misused of the post. The identity of the sick chameleon's owner(s) is kept hidden to respect their privacy.

A. ROSTRAL RUBBING/ ROSTRAL ABRASION

Case Study:
The chameleon in the picture is a melleri. He was used to be cared under someone else and put in a large outdoor cage. The rubbing has started since. Under a new owner care (Suzanne Boom), he was introduced in a free-range habitat. She dedicated a whole room for her chameleon(s). The chameleon finally seems content and does not exhibit the behavior anymore.

FACTS:

Rostral Rubbing is a serious condition for chameleons in captivity that needed to be addressed soon. This is often caused by psychological problems than any other. It mostly stems from the chameleon inability to cope in captivity, small restricting cage, and/or possible elements in the enclosure that causes it to react in a strong behavior to get out from the environment.

WC chameleon generally exhibits this kind of stress more so than a CB one. But, bear in mind that a CB chameleon can also exhibit this behavior. Melleri and other giant chameleon species often are more affected to this symptom compared with veiled and panther.

Therefore, it is crucial for you to put your chameleon in an appropriate size cage. The rule of the proper size to avoid rostral rubbing in adult chameleon is usually “the bigger the better.”

If ignored, your chameleon might develop a serious infection or abscess in the immediate future.

Prevention:

Avoid putting your chameleon in a small and constricting cage because you need to save space. You should know in advance that having a chameleon would require you to sacrifice your time and your space. If you cannot provide those, you should not consider having a chameleon as a pet.
Chameleons will almost always prefer to be outside than inside. Be aware letting your chameleon to have access view to outside environment can tempt him to try to escape. Some will try and soon give up since the screen will block them. But, others might be headstrong and insist on escaping. Hence, the rostral rubbing begin. I am not saying that you should limit the access of outside view for your chameleon, I am just telling you to be aware of the possibility of inflicting stress to your chameleon.

Symptoms to watch out for:

Blister and/or scarification tissue on your chameleon’s nose
Eagerness to get out of the enclosure.
Infections

Treatment:

Get him a bigger enclosure. Limit the access of outside view for a while.
Topical ointment such as Silvadene cream, Neosporin, or Zymox can be used to avoid infection.

B. MISSING TOENAILS

FACTS:
It is a condition where reptiles (in this case chameleons) slough their toenails.
According to Geraldine Diethelm, in the article “Digit Abnormalities,” There are 4 causes that can lead to this condition (Mader, Reptile Medicine and Surgery: 2nd ed, pp 774-5):

Trauma. Such as cuts and abrasions. If the injury is not treated, an infection then might developed that can lead to loss of toes.
Dysecdysis (retained shed) around the digits can lead to this condition also by cutting off the blood circulation.
NHSP (Nutritional Secondary Hyperparathyroidism) can cause swelling around the digits and limbs.
Microorganisms that cause infections such as salmonella, Escherichia coli, mycobacterium spp that are found in joint cultures and interdigital lesions.

This certainly cannot be ignored as chameleons are arboreal and depend on their appendages and nails to climb.

Prevention:

Although most of chameleons will do fine in the standard aluminum screen cage, some of them (especially the one that loves climbing on the screen) can accidentally get their toenails caught in the screen. The injury can often lead to missing toenails. If possible, use a bigger screen size (1/8”) than the usual (1/16”) mesh. Some companies give you the option. When you purchase a custom cage, ask if they have bigger size screen mesh.
If you have already purchased the usual screen cage, you can also line the inside with a plastic chicken wire.
Maintain proper humidity for your chameleon.

Symptoms to watch out for:

Blister and/or swelling on your chameleon’s toes
Infections
Loss of toes (duh! ^_^)

Treatment:

Fix your husbandry
Clean the wounds
Topical ointment such as Silvadene cream, Neosporin, or Zymox can be used to avoid infection.
If the cause are microbial, go to the vet to get the appropriate anti microbial therapy.

Health Section G -Burns

BURNS

Case Study:
The chameleon is suspected to stay under the light for too long due to chill shock (read under prevention sub chapter to understand the meaning of term).
The owner fortunately is educated in chameleon care. Thus, he recognized the early symptoms and immediately went to a leading herp vet in the area. Neosporin (to prevent infections) was used in tandem with drugs administered by the vet.

The chameleon is slowly recuperating and currently is very healthy and active. Kevin still applied Neosporin (antibiotic ointment once in a while). His case is presented to educate people on how important to educate yourself constantly about chameleon keeping. He request me to relay this message to all of the viewer of this blog:

“I only request that the readers know, even though I did a lot of research on this and seen a good vet, that this was my unique experience. The information provided surely can help, but it should not replace a trip to a good herp vet.” Kevin

He also graciously provided us the progression picture of his chameleon:

FACTS:

Thermal burn is a common serious condition for chameleons in captivity. This is often caused by improper husbandry method such as putting heat lamp inside the enclosure or too close to the top of the cage allowing your chameleon access to get real close to the heat source. Unlike us, reptiles do not have suitable skin sensation to quickly get away from extreme heat.

Due to this, it is crucial for you to minimize the chance of your chameleon getting too close to the heat bulb. Also, avoid having the bulb “touching” the mesh in the topside. Baby chameleons often climb upside down during the adaptation stage to a new enclosure. You will want to avoid your chameleon from touching the hot surface of the bulb. Maintaining a correct ambient temperature and basking temperature is essential to avoid this risk. Furthermore, during the season when ambient temperature of the room is too cold, it is advisable for you to be alert to your chameleon’s behavior. Often when it is too cold, your chameleon will try to heat himself by coming real close to the light bulb.

The burned area might appear first as blisters or pale skin, which will turn to grey or black over period of time. Soon, the burned tissue will be necrotic. The danger of infection becomes imminent if it not treated properly. Consult with your veterinarian to assess what kind of treatment and changes you need to do while your chameleon in the healing process.

Unfortunately, the scar will be permanent. Loss mass due to necrotic tissue will not grow back. Necrotic tissues will eventually fall off. The skin will grow and cover the burned area. However, it will take quite a while for your chameleon to do this.

Prevention:

Avoid putting light bulb inside of the cage and/or directly on top of the enclosure where your chameleon skin can have physical contact with the bulb.
Monitor the basking temperature routinely, especially during extreme weather.
Do not use high wattage bulb when it is not necessary.
Understand during extreme temperature drop, your chameleon might seek to get closer to the heat bulb and not realized the danger of burn (chill shock).

Symptoms to watch out for:

Black, gray, blister, and/or necrotic tissue on your chameleon skin
Infections

Treatment:
When you go to the vet, most likely your vet will clean the wound and use sterile dressing.
Your vet might prescribe some topical ointment such as Silvadene cream
If infection occurs, some antibiotics will be needed.
Deep burns will need more aggressive treatment (i.e.: culture, sensitivity, and/or debridement) done by your vet.
Let the scab fall of on its own. Do not try to peel it off!
chameleon with thermal burn case recovers very slow. Therefore, persistence and patience of the owner are needed.

B. UVB BURN

Case Study:
The chameleon above is a case study presented by my friend, Dave Weldon. Recently, he had a chance to work with a UVB Burn related case. He is an expert in UVB related issues with chameleon.

Lighting used on the cage: Zilla™ Desert 50 bulb (Fortunately, the company had issued a recall of the product). They also put some advisory notice and an imperative instruction for you to properly install the light.
Please discontinue the use, if you have this series as your chameleon UVB source!

FACTS:

UVB Burn is exactly what it sounds. It is a condition where your chameleon is over exposed to a dangerous level of ultraviolet radiations. UVB burn can happened to all creatures on earth. Fortunately for us, humans, we can easily escape from scorching UVB ray by going indoors or wearing sunscreen, but the same cannot be said to your chameleon that stuck inside of the cage 24/7.

UVB Burn is a serious health hazard that can kill your chameleon in a short amount of time. Many beginners are usually more worried whether they are providing enough UVB for their chameleon that they often think the more UVB exposure the better.
This kind of thinking is quite dangerous. UVB is very beneficial for your chameleon. But, an over exposure of UV radiation can quickly deteriorate your chameleon’s health.

Here is an excellent site where you can educate yourself about your reptile’s UVB need.

As I do not consider myself knowledgeable enough as far as UVB requirements, I have decided to ask someone with a better understanding about this matter.
So, here goes (red is my question, lavender is Dave Weldon’s answer):

Q: How do I know I am providing enough UVB for my chameleon?
A: There are several ways to look at the question. You can assume that you are providing enough UVB if you are using one of the recommended UVB light sources at the proper distance and your chameleon takes advantage of it by basking many hours a day. You can improve the odds by measuring the UVB energy using a Solarmeter 6.2 UVB meter at the basking spot to insure that you actually have 5 to 15 uW/cm2. Another way to answer the question is by evaluating the health of your chameleon. A skeletal x-ray can show if the bone density is acceptable or not. A blood test can also shed some light on circulating calcium levels. However it is possible that the levels are being maintained by pulling calcium from bone. This is essentially how MBD occurs. The bottom line is to avoid experimentation and use the best UVB source with a proven track record with chameleon keepers. Use it the way that other experienced keepers recommend.

Q: What are the prevention methods of UVB Burn?
A: This question really falls in line with the previous Q. Aside from just using the recommended Reptisun 5.0 linear tube positioned at the proper distance; using a Solarmeter 6.2 UVB meter will insure that levels are proper. Getting UVB burns is usually only caused by using an improperly designed UVB source or a UVB source that is not designed for individual use. For example a UVB source designed for Zoo applications rather than our typical chameleon enclosure would likely cause serious overexposure and likely cause UVB burns if a chameleon were able to gain access to close proximity of that source.

Q: Help. My vet is available only next week. My chameleon has a bad case of UVB burn. What should I do in the mean time?
A: Find another vet :-). Actually chameleon having a UVB burn is a rare occurrence. The more often case is burn caused by heat; in effect, basking lamp overexposure can be treated with Silvadene cream to minimize the chances of bacteria problems. It may take many weeks for the skin to slough-off, scab-over, and otherwise heal. Scaring will be permanent.

Prevention:

Provide your chameleon with a foolproof and recommended UVB bulb.
If you have the extra cash, purchase the Solarmeter to get an accurate reading of the UVB radiation emission by your bulb.

Symptoms to watch out for:

Scab and reddish or dark burn on your chameleon skin
Lethargic, Sleeping during the day.
Closing one eyes or both

Thursday, February 28, 2008

Health Section F -Gout and False Gout

GOUT & GULAR EDEMA

FACTS:

Gout is a common serious condition for chameleons in captivity. It is caused by excessive level of uric acid in the blood (hyperuricemia). Gout is a very complex disease that has many forms. To understand better about it, let us study of what happened to protein inside of chameleon’s body by reading at this simplified diagram:

(Area 1: Protein → amino acids) → (Area 2: Broken by liver into Purin and pyrimidine → Purin is degraded into uric acid) → (Area 3: Cleared by kidney from the blood).

Gout is divided into 2 types:

Happened in the area of number 1 is Primary Gout = this type derived from excessive intake of protein and/or failure in amino acid metabolism.
Happened in the area of number 3 is Secondary Gout =this type derived from renal failure. The crystal urate, then, turned into crystallized deposits (tophi) that find their way into your chameleon organs (visceral gout), around the joints (peri articular gout), and joints (articular gout).

Prevention:

Avoid feeding your chameleon with high protein diet. Your chameleon is a low protein (insects) eater. Therefore, feeding him with high protein (mammals and other vertebrates, i.e.: pinky mice and anoles) feeder EXCESSIVELY can raise the risk of him getting gout.
Avoid feeding your feeder (such as roaches) with high protein gut load (cat food, dog food, and fish flakes). These gut load are fine for your roaches but NOT for your chameleon. If you need your roaches to establish a colony, you may feed them dog food. But avoid feeding the roaches to your chameleon while they are in the dog food regiment. I recommend taking out the roaches that are about to become your chameleon's food and put them on the vegetable gutload diet for at least 24 hours, to ensure there is no more traces of dog food in the roaches' guts.
Monitor the hydration status of your chameleon closely. Dehydration is also a common cause of renal disease that leads to gout.

Symptoms to watch out for:

Swelling joints and reduced mobility (articular gout).
Your chameleon looked painful when climbing or walking (due to this, gout is often misdiagnosed as arthritis).
Over aggressiveness from your chameleon when his joints are touched.
Anorexic and excessive drinking behavior.

Treatment:

Go to the vet ASAP.
Depending on the severity of the case, your chameleon might have to undergo a surgery to remove the excessive tophi.
Prescription medications to dissolve crystals.
Increased misting and water supplies for your sick chameleon.

Please be aware that this disease is very complex. And this chapter has covered nothing but the surface. Gout is an extremely serious condition that needed attention fast. So, consult to your qualified vet.

Sources:
Kenneth Lopez, D.V.M article
Ivan Alfonso, D.V.M article

B. Gular Edema

Dave Weldon's chameleon Case Study:

"The panther appeared to have gular edema. The vet verified through blood tests that it wasn't kidney failure but a poor Ca:Ph ratio of 1:2 instead of 2:1 likely brought on by diet (not enough calcium or too much phosphorus). He prescribed 0.1cc a day of Mylanta for a couple of weeks. The Mylanta binds-up excess phosphorus and lets it be excreted. Another blood test was done and the ratio was back to 2:1 where it should be."

(Please realize that this case study is presented to educate people the importance of consulting to the vet BEFORE registering a treatment. Without consultations, trying to cure gular edema is the same as walking on top of a thin bridge blindfolded. There are too many complex elements in dealing with this disease. Each chameleon is unique and there is NO such thing as one standard treatment for all Gular Edema cases).

BE AWARE that the solution presented in this case study might NOT be the solution for your chameleon. Therefore, I STRESSED it again to CONSULT your VET.

FACTS:

This is the area where everything is a bit murky and undefined. I will try my best to explain what I know from my research about this. If any of you out there can help me in providing more information about this, please send me a message.

According to Adcham.com glossary, Gular Edema is basically a buildup of fluid in throat and neck. As far as I know, Gular Edema is a clinical sign of body unbalance and the symptom of organ failure in correcting the imbalance.

Due to my difficulty in finding thorough facts about this, I decided to ask Dr. Matthew Wheelock about Gular Edema. This is his reply:

Edema usually occurs when there are less proteins flowing in the blood stream. The proteins do other things, but in this case it causes an osmotic level that usually keep fluids within the blood vessels. When the blood is carrying less protein than the "stuff" in the tissues around it, it will cause the interstitial space (in the tissues) to fill with fluid causing edema.

Since edema is usually gravity dependent, this is why feet and hands/ or legs tend to get edematous first. (This is where it gets iffy...) In the chameleon, I imagine that cervical or gular edema is also due to gravity. I imagine that a chameleon that normally hangs on a branch in the down position would cause edema to be in the front end. Since they don't have a diaphragm, I imagine that the neck might be more prone than the front legs. (Just a hypothesis.)

So, why edema in the first place? Usually there are three reasons for low albumin/total proteins:

Loss
Destruction
Not creating them

In this case it is usually 3. Hypervitaminosis usually causes mineralization in the major organs. The one specific to this conversation is the liver. The liver not only filters excess items (some vitamins and minerals), it is where most of the total proteins in the blood is made.
So destruction of the liver = edema. In chameleons, this usually manifests in gular edema.

With the above being true, any liver problem, or destruction, or loss of total blood proteins would cause this problem, not necessarily just hypervitaminosis A.

Prevention:

Provide adequate supplements (not too much and not too less)
Monitor the hydration status of your chameleon closely.

Symptoms to watch out for:

Swelling joints
Swelling Throat and neck region

Treatment:
Go to the vet ASAP. So, he/she can diagnose the exact cause of this disease.

Health Section E -Parasites

PIN WORM

-photo courtesy of Dave Weldon-

PARASITES

Cage Type: 28X18X50 (in.) an Aluminum Screen cage.
Lighting: Zoomed basking spot lamp 75 watt & Reptisun tube 5.0 (UVA and UVB bulb)
Temperature: >60F degrees at night and between 70-80 in the day. 87-89 degree basking area.
Humidity: 40-60%.
Misting session: 4 times a day
Length of misting session: 5 minutes.
Plants: Hibiscus, Ficus, 2 Pothos.

The first time I checked the fecal was a week after I purchased my chameleon. The fecal test yielded a negative result for parasites (October 2007).

On mid January 2008, I got a chance to have a free fecal float test. Therefore, I submitted the fecal sample. It was also yielded a negative result for parasites.
On last weeks of January 2008, Paul threw a hunger strike. He refused to eat silkworms and hornworms that I had for him and only wanted to eat bugs. I went to a local reptile store to purchase crickets. Unfortunately, this is where I suspect my chameleon got infected. This is the only thing “foreign” from my usual care (I rear my own insects feeder except for crickets).

Columbus relished the crickets until I notice he stopped eating them on February 5, 2008. I went back on my silkworm batch and he started eating the worms diet again. On Thursday February 7, 2008, I notice a considerable change in his grip. He usually gripped my hands strongly when I moved him for his usual sun-basking regime. I put Paul’s stool in a zip lock bag and called the animal hospital for a fecal float.

After couple of minutes, I saw one intestinal nematode crawl out of the fecal and died. I immediately schedule the vet visit for that day. And, my chameleon was tested positive for nematodes and coccidia. The vet gave me a Panacur and an Albon to administer.

This case is presented in this blog to educate people of the importance of noticing early symptoms of abnormality in your chameleon behaviors, having a regular fecal test (at least once a year), maintaining cleanliness of the enclosure, and being careful of where you buy your feeders.

FACTS:

Parasitosis is a common health problem encounter in captivity both for veteran keepers and beginners. It often exists in WC chameleon than the CB one. However, be aware that this is not exclusive to wild caught chameleons. This is one of those problem that can happen to your chameleon at any time. You can certainly reduce the risk by maintaining sanitary habit and preventing cross contamination. But, it will not prevent your chameleon from getting it at all. Therefore, it is always important to be alert at all time for symptoms and have a fecal test done once or twice a year.

Parasitism is a health problem that can be hazardous overtime. Most parasites live “harmoniously” inside your chameleon’s body as long as your chameleon’s immune system is active enough to suppress the parasites reproduction rate. A new owner should realize the need to deworm their WC chameleons and quarantine it from other chameleon to avoid cross contamination.

There are basically three common types of parasites that are troublesome to your chameleon (be aware that beside these three there are another types):
A. Protozoan type (i.e.: Coccidia): This usually found in your chameleon’s digestive track and live under control of your chameleon’s immune system. As soon as there is a shift in the chameleon’s ability to suppress them, there will be huge outbreak that can severely affect your chameleon. Coccidia can be fatal to baby and juvenile chameleons. It has also known to cause impaction in chameleons.

B. Nematodes (Subcutaneous and Intestinal. i.e.: Roundworms, Pinworms)
The subcutaneous is basically the parasites that have “wandered” off under your chameleon’s skin. An outline of the worm under your chameleon skin might become visible. When you see it, you can bet that inside his body, there are intestinal parasites as well. Sub cutaneous nematode is rare to be found in US based Captive Breed chameleon. This type of parasites, often carried by mosquitoes, are plenty in Madagascar, Africa.

Most case you will find in CB chameleons are pinworms and roundworms, and the common “culprits” are improper cage cleaning, cross contamination from other animals (such as reptilians, another chameleon, and feeder –crickets, etc-)

C. Hemoparasites
This type can be found floating in your chameleon’s blood stream. A simple fecal float test will not detect this type of parasites. A blood sample has to be taken to make sure.

Since the treatment for Parasites (i.e.: Panacur) requires a precise dosage, you need an exotic vet consultation on the best way to safely kill the parasites without harming the chameleon itself. Although very rare, coccidia and nematodes such as round worm and pin worm are transmittable to human, mammal, and fellow reptilians.
I am aware that most parasites are host specifics, but I always uphold the importance of cleanliness and sanitary ritual when handling your chameleon (especially the one infected with parasites).

Prevention:

Maintain sanitary ritual vigorously. Clean your chameleon cage once a week. Do not leave poops and urates overnight. Wash your hand before and after cleaning the cage or handling your chameleon.
Avoid purchasing crickets from dirty pet stores. If possible, ask the store staff how they keep their feeders. Go and investigate, especially if they are willing to show you where they keep them. A hesitation is usually not a good sign. If they have nothing to hide, they won’t mind showing you their feeder’s room. An abnormal dirty and improper feeder room are signs telling you to run. If your chameleon contracts parasites out of nowhere and you have always keep your feeder in clean condition, you should consider changing your feeder supplier (this is the lesson that I learned the hard way).
Avoid swapping “furniture” (feeder cup, dripper system, vines, and plants) that is used for different chameleons. A used cage is a way to safe money. HOWEVER, be a smart owner. Assume the worst when you purchased a second hand cage. Wash the whole cage with a solution of bleach (water: bleach ratio = 10:1) and rinse it well. You should also blast the cage with hot steam (be careful of burning risk), sun dried the cage for several hours before using the cage for your chameleon.
Avoid feeding your chameleon a wild caught insect. Not only they might carry parasites, they also can have pesticide and other volatile chemical trace.
Be aware that introducing your chameleon to another chameleon (for breeding purpose) can contain a risk of infecting your healthy chameleon. Only approve to breeding agreement with somebody you trust.

Symptoms to watch out for:

Anorexic, sudden burst of appetite not followed with growth
Thin belly or beer belly
Lethargic or Restlessness.
Feces or vomit contains visible parasites (for certain parasite only. Most are invisible to the naked eye), smelly, runny, and/or bloody stool.
Sunken eyes.
Visible worm like outline under your chameleon’s skin.

Picture of the visible parasite infested stool:

TREATMENT:
Early detection plays an important factor. The sooner you treat it, the better the chance your chameleon will survive. This is the area where an exotic vet visit is a must. There is no other way. Experimenting treatment for this type of disease is extremely hazardous for your chameleon’s health.

Most common therapy for nematodes are Panacur. Currently, in US, there is no cure for Coccidia. Albon does not kill coccidia. It only halts the reproduction cycle. Other countries (i.e: Canada) has already found a medicine (Appertex and Ponazuril) that actually obliterate Coccidia.

Side Notes: Be aware that Albon may cause a nasty side effect to your chameleon (not true in all cases). Many chameleon keepers, including me, reported that their chameleons completely stop eating altogether after Albon therapy. I had to quit the therapy and force feed Paul for a while.
After the experience, a friend of mine and his vet recommend the usage of Ponazuril as an alternative.
Ponazuril worked wonder and, during the therapy, Paul exhibited no side effect.

Meanwhile, the sick chameleon’s cage and furniture should be quarantined from other chameleons in your house to avoid cross contamination. Sanitary becomes extremely important. Use paper towel at the bottom of the cage. If the paper towel has made a contact with the feces, you should take it out of the cage immediately.

Coccidia in particular is a parasite that you do not want to get. It is a nasty creature that are extremely hard to get rid off. I suggest you wear nitrile gloves when you handle your sick chameleon. And, then wash your hand with soap before and after handling. The cage will need to be cleaned in extreme manner.
Bleach does not kill coccidia. Only hot boiling water (a steamer is said to work great to disinfect the cage) and ammonia will. Please AVOID mixing BLEACH with AMMONIA. The fumes will kill you instead. The live plants you used in the cage are pretty much rendered useless. You might be better off by throwing away your plants and never introduce them anymore inside your reptile cage to avoid reinfestation.

Tuesday, February 26, 2008

Health Section D -Respiratory Infection

RESPIRATORY INFECTION

Chameleon with Respiratory Infection often produces excess mucus as apparent in the picture.

FACTS:

Respiratory Infection is a common health problem encountered in captivity. In the simplest explanation, RI is basically an infection in the chameleon’s respiratory track.
When the infection occurs in the lung (Pneumonia), it is known as LRI (Lower Respiratory Infection). On the other hand, when the infection occurs in nasal sinuses and mouth, it is known as URI (Upper Respiratory Infection). This disease can be caused by several numbers of reasons but mostly stem from improper caring (low temperatures) and husbandry issues (cage is too wet or too dry).

RI should be treated aggressively to prevent fatality. A chameleon owner has to be alert if his/her chameleon starts to show the symptoms of RI. It is very imperative for you to go to the vet as soon as you suspected that your chameleon might contract this disease. The longer you wait, the more likely your chameleon will die.

The best way, as usual, is by prevention. This is where your thermometer and hygrometer play important roles to keep your chameleon happy. Here are some prevention methods that you can take:

Avoid having too low temperature in your chameleon’s cage. Play around with different wattages bulbs to see which work better to maintain the recommended temperature for your chameleon (please see the veiled and panther chameleon care 101A).
Avoid creating a constantly wet cage condition with no air ventilation. Allow a complete drying time in between misting. Too much stagnant humidity, as well as not enough humidity, can lead to the case of RI (refer to care 101C).
Avoid using enclosure that promotes poor ventilation such as an aquarium. In order for a cage to have proper ventilation, it needs to have at least 2 screen sides. An all screen cages is a very good enclosure for your chameleon.
Practice good hygiene habits when caring for anything that related to you and your chameleon. A dirty stagnant water source and insect cultures can increase the risk of RI.

Symptoms to watch out for:

The presence of increased mucus in the chameleon’s mouth.
Weird noise accompanied with breathing (popping, crackling, purring, or cat-like sounds). Try to keep your ear closed to your chameleon and listen carefully for these sounds.
Labored breathing by gasping and opening its mouth even in the low temperature range. In the morning, chameleon does yawn like human. Such activity is normal.
Lungs often overly inflated.
Some swellings the forehead (between eyes) and even eyes (looked puffy) can occur.
Snoring during sleeping.

TREATMENT:
Early detection plays an important factor. Since the cure process requires aggressive antibiotic treatments (such as Baytril or Fortaz), DIY treatment should be HIGHLY discouraged. An exotic vet’s expertise is definitely needed in this case. The vet will be able to pint point the cause (fungal, bacterial, secondary to nutritional or environment). Treatment can last to a month and need to be followed by an after care for another month to prevent the disease from coming back.

Be aware that Baytril is a strong antibiotic and might prove to be too harsh for your chameleon's body. To avoid kidney and organ failure, I recommend to watch out for your chameleon's hydration status.

Meanwhile, the enclosures should be corrected (if this is the case). The temperature should be kept to an optimum range for your sick chameleon. Maintaining the POTZ (Preferred Optimal Temperature Zone) will rev up your chameleon's metabolism allowing him to fight the infection more effectively. Furthermore, humidity should also be reduced or added depending on the case.
GENERALLY (not always the case), adding humidity would be a proper choice as the extra humidity will allow the excess phlegm to move loosely.

Health Section C- Impaction

IMPACTION

I used the color "red" to highlight the underlying problem
Cage Type: 10 gal aquarium.
Lighting: ZooMed reptisun 5.0 flourescent uvb bulb and a ZooMed 60 watt basking bulb (at night: 65-70 F) and (at day: 75-80 F). (Basking area: 85-90 F)
Humidity/ Misting session/ Length of misting session: 50 to 70%/ twice a day + Constant Humidifier/ (N/A)
Plants: Fake plants and fake vines.
Diet: 7-10 quarter inch Crickets as staple feeders. Zoomed calcium is used every other feeding. Feeders are gut loaded with Flukers orange cubes, Flukers high calcium cricket feed, many veggies and fruits such as oranges, apples, carrots, lettuce and other greens, grapefruit, grapes, and bee pollen granules.
Substrate: Yes. Wood Barks.

Picture of the impacted chameleon's husbandry:

After series of forum conversations, sadly, this was another example of improper husbandry. The owner told me that he bought the chameleon from a reputable reptile store at a reptile expo. The store sold him the barks and recommended him to put the barks in the enclosure. The owner set up the enclosure per advice of the store. The chameleon stayed in the condition for 1 month without a problem. Some sleeping during the day occurred once in a while.

One day, the chameleon started to be acting weird and was shaking his head around and then would stretch his neck out almost like a wolf howling. Since he grabbed a couple more crickets right after that, the owner left the premise thinking that the chameleon was fine. When he came home, the owner found his veiled chameleon dead (see the picture above). The chameleon vomited a big roll of cricket parts.

Unfortunately, the chameleon discussed has been buried before a necropsy can be done.
However, the possible situation is that the chameleon tried to hunt the crickets hiding under the bark and accidentally ingested the substrate or a cricket that was too large (unlikely, since the owner claim that he never gave the baby chameleon crickets bigger than 1/4 inch).

The bark then most likely lodged and blocked the chameleon's air passage or other internal organs. This is another textbook example of why substrate is not recommended for chameleons enclosure.

With the owner's permission, the case is presented in this blog to educate people of the necessity of proper husbandry methods and the importance of extensive researches about chameleons care. It is the customer responsibility to familiarize themselves to the basic care.

FACTS:

Impaction is another common health problem encounter in captivity. It is extremely fatal if not treated as soon as possible. In the simplest explanation, impaction is basically a blockage in Chameleon’s digestive system or any other internal organs mostly caused by large foreign objects and/or feeders. Another common name for digestive system impaction is “constipation”. Impaction can severely block the vent of your chameleon, making it impossible to defecate or even to breathe. The body then has no choice but to reabsorb the feces. The toxic wastes in the feces will later cause severe breakdowns in organ functions. An untreated impaction can lead to fatality. A chameleon owner has to be alert if his/her chameleon starts to show the symptoms of impaction. A light impaction can be treated at home. But, once the treatment does not show any improvement, a visit to the vet is a must. The longer you wait, the more likely your chameleon will die.

In certain unfortunate case where choking is involved (such as the one discussed above), the emergency is immediate and the chameleon impacted has to be brought to a vet ASAP.

The best way, as usual, to cure an impaction is by prevention. Use your common sense in this matter. Here are some prevention methods that you can take:

A lot of people love the idea of using substrates in their chameleon’s enclosure mainly due to aesthetic and humidity reasons. However, substrates are more of a nuisance than anything. Free roam crickets often love to hide inside the substrate layer. This rises the possibility of your chameleon accidentally ingest the substrate while hunting for foods. The risk even becomes higher to those of you who own a veiled chameleon. Some veiled chameleons love to ingest dirt for unknown reasons. Having substrates in the enclosure is a recipe to disaster. The substrate can block your chameleon's air passage and digestive system. Even further, substrate are often become a breeding ground for bacteria that can be problematic to your chameleon’s health.
Avoid feeding your chameleon with feeders that are larger than the width of his forehead (exception apply to soft bodied insects such as hornworms, silkworms, etc). Another thing to avoid is feeding your chameleon too many insects.
Avoid having plastic decorations and foreign objects in the cage that can be easily swallowed by your chameleon (such as plastic grapes attached to your fake plants, gravels that are small enough for your chameleon to eat, potting soils that contain wood bark and wood chips).

Symptoms to watch out for:

No fecal activity for several days (more than 4 days) regardless being fed. Baby chameleons should defecate daily. Some Juveniles and adult might skip a day or two. Always look for the presence of feces in the enclosure.
The chameleon often tries to defecate but nothing comes out.
In some cases, the chameleon looked bloated.
In advance cases, the impacted condition often can pinch your chameleon’s nerves causing a paralysis (usually the back leg).
The chameleon refuses to eat.
The chameleon exhibit symptoms like choking.

Comparison Pictures: N/A

TREATMENT:
If impaction detected early, the treatment is quite simple. Misting more often and prolonging the time per session is recommended. The extra humidity will help him in this area. It is imperative to mist him with warm water. You can put hot water (NOT BOILING) inside your spray bottle so that when you mist him, warm water will come out of the nozzle. This warm misting therapy will induce your chameleon reaction to defecate.

If your chameleon is old enough (5 months or older), a "shower" method can be used to help your impacted chameleon. DO NOT SHOWER BABY CHAMELEONS. The water droplets can clog its nostril and cause it to drown.
Please refer to Health Care: Dehydration chapter for “how to shower your chameleon.”
Lots of misting and shower will be beneficial to help your chameleon overcome this.

Mineral oil/ cod liver oil can be administered orally about once a week to help “lubricate” your chameleon intestine.

If the treatment does not prove to be effective by several days (2 days), a vet visit is in order. If the treatment works, you will see a bigger than usual feces successfully expelled from your chameleon’s body.

When choking is involved, you need to go to the vet right away. It is considered an emergency case.

Sunday, February 24, 2008

Health Section B- Metabolic Bone Disorder

METABOLIC BONE DISORDER

I used the color "red" to highlight the underlying problem
Cage Type: 38 gal mesh cage (Reptarium). Before, he was placed in 10 gal aquarium.
Lighting: 75-Watt compact UVB, and 100-Watt Full Spectrum basking spot Temperature, ceramic heat lamp: (at night: no lower than 65) and (at day: 75 F). (Basking area: 95 F)
Humidity/ Misting session/ Length of misting session: N/A
Plants: Fake plants and fake vines.
Diet: Crickets and Meal worms as staple feeders. No supplements used. Feeders are gut loaded with Flukers gut load and orange slices.
Substrate: Yes. A carpet.

Picture of the chameleon's husbandry:

After series of forum conversations, sadly, it was another example of improper husbandry due to a lack of research. The owner told me that he bought the chameleon from a local breeder a month ago. It already had a slight curvy/bowed legs; during that time, the owner did not know what an MBD legs looked like. He/She thought that the bowed leg was normal for a chameleon. To make things worse, the breeder did not bother to alert the new customer of what was going on with the chameleon the customer purchased. Therefore, the owner failed to see the progressive MBD development over time. The chameleon also received a poor steady diet of non supplemented cricket and MEAL WORMS. The gut loads were used solely without addition of fresh fruit and vegetables.

The owner, after the chameleon stopped eating, force-fed it with 1 cc Flukes Aid twice a day. It no longer pooped daily and also fell once in a while from the tree. During we first conversed, the owner did not realize that his/her chameleon got a severe MBD. Unfortunately, regardless of the vet visit and active treatment, the chameleon passed away.

With the owner's permission, the case is presented in this blog to educate people of the necessity of proper husbandry methods, the importance of extensive researches about chameleons care before purchasing one, and the significance of buying chameleons from a REPUTABLE breeder or STORE. Remember, a big retail chain store or somebody you know does not always necessarily practice an honorable business when it comes to selling chameleon. A lot of people are poorly educated in chameleon's care. Therefore, it's easy to sell sick chameleon to those poor victims. It is the customer responsibility to educate themselves to avoid getting swindled.

FACTS:

Metabolic Bone Disorder (MBD), aside from dehydration, is another most common death of chameleons in captivity. It is extremely fatal if not treated as soon as possible. If treated early, the chameleon can survive and live a quite normal life. Unfortunately, the condition of the limbs is irreversible. The best way to cure MBD is to prevent it from happening at all.

MBD is a degenerative disease caused by poor ratio of Calcium and Phosphorus in the chameleon’s body. The chameleon’s bone structure is destroyed progressively, until the bone no longer able to support the chameleon’s body. Many numbers of causes can lead to MBD. But, the most common thing comes from poor nutrition, poor or lack of supplementing, and the absence of UVB light in the husbandry. Unfortunately, captive breed chameleons often get this debilitating sickness due to the owner’s lack of knowledge in the proper caring facts.

Please refer to the LIGHTING paragraph in chameleon care 101A and the FEEDING facts in chameleon care 101D for proper chameleon caring.

------------------------------------------------------------------------------------------------
Dr Matthew Wheelock has written an excellent article about MBD and Supplementation:

An Overview of Calcium Supplementation
By: Matthew Wheelock, D.V.M

Calcium supplementation is a topic that continues to plague the community of chameleon owners, breeders, and enthusiasts. How much do we give? How often do we give it? Do we give it with or without vitamin D3? Do we have to give it in addition to a multivitamin? and on, and on.... There doesn't seem to be any real consensus. If you ask different successful breeders and enthusiasts, you may get significantly varying opinions on how to supplement. Additionally, what works for one chameleon owner could be certain death for another owner's chameleon.

WELL, WHY IS THAT?!!!

In the following article I will "attempt" to explain a number of variables in the metabolism of calcium that may help a keeper determine their own supplementation protocol. Please Note- There is no way to completely cover this subject in one article. At best, this is a starting point for understanding calcium and supplementation thereof. This article will discuss 1) general facts and terminology, 2) how calcium is absorbed and how D3 is synthesized/acquired, 3) what nutritional secondary hyperparathyroidism and renal secondary hyperparathyroidism have to do with this, and 4) the potential for hypercalcemia and the possible risks/consequences for over supplementation.

1) General Facts and Terminology

Roughly 2% of a chameleon's weight is made up of calcium. Bone is the most commonly recognized source. However, about 1% of body calcium is found outside the bone and is a very active player in various and important body systems. Heart function, nerve conduction, muscle contraction are only a few systems dependent on stable levels of calcium.

In reptiles-	Calcium to phosphorus ratio- should be 2:1 (Actual reference ranges will/may vary from species to species, though the ratio will be roughly the same.) Calcium in the blood serum has two forms: ionized and unionized.
Ionized-	This is the biologically active form. It is circulating and available for use.
Unionized-	This is a form that is already bound to other complexes (primarily proteins (albumin) in the blood.) Total serum calcium is roughly 50% ionized and 50% unionized.

It is important to note that many factors may be involved in getting a correct reading of these levels. For instance, if albumin is low, there may be a lower unionized ratio of calcium, and a higher ionized form. If pH is high, it will decrease the ionized form. Vitamin D3 is essential for one form of calcium absorption while estrogen helps to maintain calcium levels. We also know that stress and old age lower calcium absorption. The point is that a myriad of dueling chemical systems make it hard to establish normals for chameleons in general, let alone, subspecies and regional differentiations.

Add to this the fact that we don't know how much calcium will be absorbed by a particular chameleon. Some species absorb what's needed and excrete the rest without ever absorbing the unneeded portion. Some chameleons absorb extra calcium and excrete what is not needed by way of the gall bladder and urinary systems. Some chameleons excrete calcium solely by way of the urinary system.

External stimuli affect absorption too. Sudden increases in dietary fat lower calcium absorption. Dietary fiber, plant phylates and oxalates also affect absorption�

Summary- Lots of factors affect the metabolism of calcium. Since each chameleon is unique in this respect, the owner will have to tailor a specific supplementation protocol to fit that particular chameleons needs.

2) How Calcium is absorbed and how Vitamin D3 is synthesized / acquired

In order to understand the main concepts of supplementing calcium, it is important to discuss Vitamin D3 in its relation to UVB lighting.

How is Vitamin D3 synthesized / acquired?
There are 2 primary methods for obtaining vitamin D3-
a) synthesizing it from exposure to ultraviolet B radiation
b) consuming a vertebrate that synthesized the hormone through exposure of the sun.

The production of vitamin D3 occurs as a result of the photosynthetic conversion of 7-dehydrocholesterol to pre-vitamin D3 (UVB represents the range of light considered important for synthesis of D3.) Pre-vitamin D3 is converted to vitamin D3 via a temperature dependent process. At this point the hormone is transported to the liver where it is hydroxylated to 25-hydroxyvitamin D3. The kidneys serve as the site for the final conversion of the hormone to its active form 1,25-hydroxyvitamin D3 (Calcitriol).

Why is Vitamin D3 important and how does it relate to calcium?
Vitamin D3 is an essential hormone that plays many different important physiological roles. Its role in calcium metabolism is probably its most recognized function.

Vitamin D3 stimulates intestinal absorption of both calcium and phosphorus, thus causing a rise in blood serum calcium and phosphorus concentrations. Without vitamin D3, ingested calcium would not be accessible to the body.

That pesky parathyroid
The parathyroid is an endocrine organ that regulates the production of parathyroid hormone (PTH). PTH is important to this discussion because it maintains serum calcium within normal limits by affecting bone resorption, renal calcium excretion, and metabolism of vitamin D3.

What do we need to know about the parathyroid?
If circulating serum calcium levels are low, the parathyroid turns on production of PTH and in turn, vitamin D3 is secreted by the kidney. PTH stimulates osteoclastic activity (break down of bone) to put the calcium and phosphorus in the blood. Vitamin D3 stimulates the intestinal absorption of BOTH calcium and phosphorus, thus raising both serum concentrations.

PTH also stimulates the kidneys to increase excretion of phosphorus without loosing the calcium. This is important because D3 increases phosphorus absorption in the gut and PTH causes the breakdown of bone, also increasing phosphorus levels.

3) What do nutritional secondary hyperparathyroidism and renal secondary hyperparathyroidism have to do with this?

Most owners call all calcium deficiencies Metabolic Bone Disease (MBD). This is actually an incomplete term as there are many ways bone disease can be affected by metabolic pathways. The ones that concern us are nutritional secondary hyperparathyroidism and renal secondary hyperparathyroidism.

Nutritional secondary hyperparathyroidism (NSHP)-
NSHP is when there is an excessive production of parathyroid hormone (PTH) due to low serum calcium. Either there was 1) no available calcium in the diet, or 2) no available vitamin D3 to stimulate intestinal absorption. Regardless, no dietary calcium is absorbed into the bloodstream. Since no calcium is readily available for intestinal absorption, calcium is resorbed from the bones.

Consequences are weakening of the bones with secondary breaks and abscesses. Since calcium is also required all over the body, weakness, tremors, anorexia are also problems.

Renal secondary hyperparathyroidism (RSHP)-
RSHP is a consequence of renal disease and lost kidney function.

Remember-	the kidney (among other things) was supposed to 1) synthesize D3 and 2) respond to PTH and excrete excess phosphorus.
Problem-	No D3' No absorption of calcium No D3' the parathyroid continues to stay on to stimulate production of D3. Increasing levels of PTH continue to 1) break down bone and 2) intestinally absorb calcium and phosphorus, but now can't get rid of the phosphorus because of decreased kidney function.

Consequences- if mild, metabolic bone degeneration and continued destruction of the kidneys. Hyperphosphatemia and hypercalcemia unchecked will both cause death.

4) How do diet and supplementation tie into all of this information?

Under ideal conditions, reptiles would get:

a) Adequate natural light

b) A variety of food sources like their natural habitat. All nutrients and calories needed for growth, maintenance and reproduction.

If these conditions were met there would be no need for UV lighting and supplementation�

That is not how it is however; so, the ultimate question is how much and of what? Hopefully, by now, it is apparent why it is not that simple.

UVB lighting- UVB either comes from the sun or appropriate lighting. Optimal situations would provide natural sunlight. (Remember, glass filters UVB). However, since this may not always be an option, artificial sources of UVB may be used.

If sufficient UVB lighting is offered, this is a big step in naturally preventing MBD in a reptile housed inside. With the tubes and bulbs offered now a days, natural synthesis of vitamin D3 is the safest way of regulating calcium absorption. This assumes 1) there is adequate calcium in the diet, and 2) the bulb used is close enough for the animal to utilize and does not have significant burn out that causes less than optimal exposure to UVB.

Some experts might suggest under these circumstances, that supplements might not be necessary.

Food items- Variety is more readily available these days, but still does not simulate the variety in the wild. Additionally, some of the staple feeders used are not adequate in the calcium:phosphorus ratios. (Remember- should be 2:1) Crickets, mealworms and superworms are actually the opposite ratio. Pheonix worms and butter worms are good in ratio, but too high in fat.

This ratio in staple insects may be overcome by appropriate gut loading with appropriate legumes and greens and various formulated feeds. (Certain diets high in calcium may cause gut impaction in crickets.) If not, it may be necessary to supplement.

Supplementation- The jury is still out on the amount needed and the interaction between all the minerals and supplements. Do keep this in mind though: Chameleons use calcium according to their metabolic rate. Thus lowland species tend to require more calcium than montane species because they are maintained at warmer temperatures and have higher metabolic rates. Faster growing chameleons need more calcium than slow growers. Females with larger egg mass require more calcium than barren females or low producers. As a general rule, as calories intake increases, so should calcium intake.

Calcium with D3- If you have adequate UVB (by bulb or unfiltered natural lighting), calcium with D3 may not be necessary.

Unfiltered natural lighting- Animals that are outside in the sun more than 45 minutes a day should not be supplemented D3. The body will already be maximally generating its own D3. If D3 is consistently given dietarily, the pituitary will not be able to regulate calcitriol (active D3) that quickly and spikes of hypercalcemia will most probably occur. Over time, hypervitaminosis D and hypercalcemia will cause clinical signs of soft tissue calcification, depression, anorexia, excessive drinking, urination, and weight loss.

UVB lighting- There is probably some argument for supplementing D3 occassionally with animals only provided UVB lighting. Due to the narrow scope of some UVB bulb, evidence of varying burn-out times on UVB bulbs, and tendencies of the reptiles to not bask close enough to the bulbs, supplementation could be helpful. With occasional supplementation of D3 and artificial lighting, the body will most likely be able to regulate D3 production preventing hypervitaminosis D while decreasing the chance of hypocalcemia.

How much is "occasional supplementation?" This is still being debated. For those interested- The half-life of calcitriol is @48-72 hours in mammals, maybe longer in reptiles. Supplementing mild amounts of D3 no more than 1-2 a week may allow the body to regulate natural production and prevent danger of an overdose. This timeframe for clearance of D3 however may be longer�

So, how good do you feel about your UVB bulb? If your bulb is no good, or your reptiles refuse to bask close enough for it to be effective, maybe vitamin D3 is for you. If your UVB is good, and your reptile uses it appropriately, maybe vitamin D3 may still be for you in small amounts, or not needed at all.

Calcium without D3- If the UVB is working, the ideally the body will take only what is needs. However, excess dietary calcium by itself may inhibit the absorption of other trace minerals. Too much is still not good.

Multivitamins- This is probably a better source of complete supplementation overall BUT-if you are giving insects that have an inverse ratio of Ca:P, this may not be enough. Additionally, we still do not know the exact requirements for even the best researched reptiles as of yet. So, be careful, like calcium and vitamin D3, overdosing multivitamins can also cause toxic reactions

Wrap Up- There is no easy answer. Try to understand how your individual reptile's body systems work. Try to factor in varying restrictions that your reptile will encounter (environmental, metabolic, financial, availability, others.) Then, shoot for a happy medium to "hopefully" get your chameleon enough but not too much of what he or she needs.

Some other helpful definitions:
Hypocalcemia- (low serum calcium)

Caused by-

-nutritional deficiency- prey or food with an inadequate calcium level.
-impaired absorption- calcium absorption may be impaired by phylates (like soy ingredients), oxalates (like spinach), high fat pet foods, acidic foods.
-nutritional imbalance- inappropriate calcium to phosphorus ratio in the food eaten.
-renal compromise- kidneys are not working.
-inadequate lighting- lack of UVB to convert D3 to active form.

Clinical signs-

-muscle tremors, spontaneous bone fractures, inadequately calcified eggs.

Hypercalcemia- (high serum calcium)

Caused by-	-primary hyperparathyroidism- parathyroid tumor causing excess secretion of PTH. -oversupplementation- supplements. -nutritional imbalance- foods rich in calcium (rare). -bone resorption- bone infection or cancer.
Clinical signs-	-Maximal calcium tolerances are likely 3-5 times corresponding minimums. Higher intake may lead to conditioned deficiencies of trace minerals combined with high- fat diet, formation of calcium soaps in the digestive tract.

Hyperphosphatemia- (high serum phosphorus)

Caused by-	-renal disease -hypervitaminosis D -excessive dietary phosphorus
Clinical signs-	-calcification of the heart and kidney, bone resorption, and secondary nutritional hyperparathyroidism.

Hypervitaminosis D- (high serum calcitriol)

Caused by-	-excessive supplementation
Clinical signs-	-soft tissue calcification, depression, anorexia, polyuria/polydypsia (excessive drinking / urination), and weight loss.

Sources

I highly encourage everyone to do their own research. This is merely a summary of facts. Most of the sections above are paraphrased from available sources. I happily give credit where credit is due:

Dr. Donoghue- Chameleon News, On-line E-zine. May 2002.
Dr. Mader- Reptile Medicine and Surgery. 1996.
Drs. Feldman and Nelson- Canine and Feline Endocrinology and Reproduction, 3rd edition. 2004.
Drs. Duncan, Prasse, and Mahaffey- Veterinary Laboratory Medicine- Clinical Pathology, 3rd edition. 1994

North American Veterinary Conference Proceedings 2007

Speakers-

Dr. Mader
Dr. Mitchell- LSU
Dr. Fleming- Disneys Animal Programs
Dr. Pare- Toronto Zoo

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Symptoms to watch for (hypocalcemia caused MBD):

Chameleon trembles excessively when climbing.
Chameleon often falls from the tree
Chameleon stays at the bottom of enclosure.
Bone fractures/ abnormal looking limbs (bowed legs).
Spinal deformity.
Rubbery jaws and bendable casque.
Chameleon is unable to lift its body with its legs.
Lethargic, loss of appetite, paralysis.

Comparison Pictures:

-"Straight Casque" photo courtesy of Justin Carl-

TREATMENT:
Unfortunately in the case of MBD, often chameleon's owners start to recognize symptoms when the disease is already at mild to advanced stages. Therefore, there is no other way except for a vet intervention. Most vet will administer a liquid calcium injection in hope to correct the lack of calcium balance. Meanwhile, I highly suggest you to correct your enclosure and feeding regiments. There are things that you can do, IN ADDITION, to hasten the recovery process (BESIDE administering the vet's prescribed medicine -PLEASE consult this treatment suggestion to your vet, before you actually start doing it):

Lots of sunlight basking. When the weather permits, expose your chameleon to sunlight. Let him bask as much as possible. Have half of the cage covered in the shadow in case he wants to escape from the scorching sunlight. 10 am to 2 pm is the best time.
Phoenix worm, provided that your chameleon loves them, is an excellent feeder with the best Calcium : Phosphor ratio. Feeding your chameleon this insects can definitely help. Don't forget to prick your worms before feeding time to ensure that your chameleon's stomach can digest them fully.
You might benefit from using a 10.0 reptiSUN TUBE, instead of 5.0, for your recovering chameleon. Remember to follow the appropriate distance rule listed by the company to avoid adding a complication to your chameleon (such as Conjunctivitis or UVB burn)!