Metabolic Bone Disease and Gout
Two different conditions that could mimic each other.

A Case of MBD
This Veiled recovers with Dr. Alfonso's help.

Subcutaneous Filarial Worms
Dr. Alfonso takes this Ambanja Panther to surgery. (Photos)

Battle Wounds
So you want to house those Veileds together, huh?

Respiratory Infections from Improper Husbandry
A common problem for chameleons kept in poor conditions.

Cats and Chams
Cats are predators by nature and should never be trusted.

Oral Abscess
If you notice one eye is closed a lot this could be the reason.

Temporal Gland Infection
Dr. Alfonso takes this Jackson's to surgery. (Photos)

Mandibular Abscess
Dr. Alfonso takes this Chamaeleo johnstoni to surgery. (Photos)

Tongue Amputation
This Oustaleti's tongue was amputated at the level of the hyoid bone.

Parasites
A brief overview of reptile parasites.

Failure to Acclimate
This WC F. pardalis just can't take captivity.

A Sad Day at Work
Poor husbandry is a death sentence for this once beautiful Parsonii.

Two different conditions that could mimic each other.

MBD is actually the name given to a group of metabolic disorders that affect Calcium storage in bones. The most common of these diseases is one known scientifically as "Nutritional Secondary Hyperparathyroidism" but we'll use it here as a synonym to MBD. MBD is caused mostly by a deficiency in blood calcium which makes the body remove calcium from the bones. In the long run these causes weak bones that are prone to fractures and bend easily. The chameleons will take a bow legged appearance and are not able to fully lift the body from the branches. Lack of calcium is mostly due to improper diet being by improper gut loading of insects or by improper supplementation.

MBD can also occur even in the presence of adequate calcium levels if the body can't absorb the calcium. The body uses Vitamin D3 to absorb calcium from the intestines. Vit D3 is produced in the body by exposure to UV light but mostly UVB. That's why calcium supplement come without D3 for "outdoors" or with D3 for "indoors". The recent Mercury vapor bulbs seem to produce adequate levels of UVB and are a good addition to any cage setup if it is destined to be indoors. However nothing beats the good old Sun.

Treatment is not 100% successful and the animal always retain the bone deformities caused by the condition. The target is to increase availability and absorption of calcium into the chameleons body to promote storing the calcium back into the bones. In successful recoveries, the chameleons can live a somewhat normal life provided that the nutritional requirements are met.

Moving on to gout. Gout is a condition caused by excessive levels of protein in the diet. Most precisely it is excessive levels of uric acid in the blood which is a byproduct of protein metabolism). Uric acid will find its way into organs and joints mainly, and forms crystals that impede their normal functioning. It is most easily diagnosed in the joints, where the condition is called "articular gout", than it is in organs ("visceral gout"). In joints it will cause mild to severe swellings and reduced mobility of the joint. The chameleons may appear painful when walking and might even react overly aggressive when the affected joint is touched. Chameleons are usually noticed refusing food or eating very little while at the same time drinking a lot of water. If left unattended, the condition progresses to an almost arthritic stage where the animal is unable to move and then death. Gout is not uncommon in chameleons that are fed pinky mice on a constant basis or crickets that have been gut loaded solely with high protein foods like cat or dog food.

Treatment is successful when action is taken quickly. Advanced cases require surgery to remove the crystals from the joint and be able to provide mobility. Mild cases might still require surgery but some have been able to be managed medically by providing adequate amounts of water and medications that help dissolve the crystals.

These 2 conditions should not be taken lightly and should be treated as soon as possible since both are life threatening. MBD seems to be more common in young, growing animals because they need more calcium while Gout appears to affect mostly adult animals that get too much protein (although it can affect any age group).

Ivan Alfonso, DVM

Metabolic Bone Disease (MBD) is well documented in the literature, but it is still probably the most commonly seen problem in captive reptiles.

A 1 year old male Veiled chameleon was presented with the complaint of swollen limbs and not being able to hold on to his branches. Upon examination, the male exhibited muscle tremors, flaccid tail, swollen and severely bowed limbs, "rubber jaw", and a very depressed attitude. He was laying on the bottom of the plastic tub he was brought in.

History taking revealed a diet of mealworms that were not gut loaded and were dusted with vitamins once a week. The chameleon was kept in a screened cage of adequate size, but with exposure to light only through a glass window. The fact that this animal had no exposure to UVB and no significant calcium source led to the condition it was exhibiting. Prognosis was poor due to the severe debilitation of the patient.

The owner declined hospitalization and wanted to pursue treatment on an out-patient basis. Calcium gluconate injections were given intraperitoneally (into the abdomen) twice daily since those were the only times the owner could come in. This process continued for approximately 3 days until the muscle tremors were controlled and the patient started eating. All through this process the chameleon never stopped drinking and had a very good hydration status.

Oral therapy with calcium glubionate was started twice daily for 1 month. After 30 days of oral therapy, the male Veiled chameleon looked much improved and appeared to be completely recovered. All four limbs remained bowed, but the bones felt strong. Oral calcium therapy was continued for 1 more month.

The owner called to report the chameleon was doing great and eating very well. the owner now keeps this male C. calyptratus under a mercury vapor lamp for UVB exposure and gutloads a bigger variety of feeder insects before offering them as food.

This is a successfully treated case that continues to do well because of improved husbandry and nutrition.

Ivan Alfonso, DVM

It was a Wednesday in October 2000 and I was ready to take my half day off when a client called the clinic saying that he was bringing his 6-month-old female Veiled chameleon for a checkup. He said she had a bite wound made by the male. When he came in, he brought the female who had a severely necrotic left hind foot and an equally necrotic tip of tail. When I asked the owner for some history, he told me that this happened a couple of days ago when the male approached the female and she rejected him. The male then proceeded to attack her, biting her leg and tail as she tried to get away. He had kept them housed together since buying them in a pet shop 5 months prior.

The female appeared very alert and was in good health despite the lesions. I advised the owner that surgery should be performed to amputate the useless foot and tip of tail and prevent further infection. He agreed, and within 20 minutes I was operating on the chameleon. Anesthesia was performed by masking the patient and keeping her on 5% isoflurane. A tourniquet was placed on the tail and the leg to control bleeding during surgery. The dead tissue at the tip of the tail was amputated and the wound was cauterized.

The leg was amputated at the level of the knee (stifle), lightly cauterized and the skin was closed with surgical glue. The patient came out of anesthesia almost immediately. Baytril (enrofloxacin) was used as antibiotic of choice for post-operative care. I took her home with me and placed her in a heavily-planted screened cage with a 75-watt heat lamp. She got settled and proceeded to eat 6 large crickets and drank a good amount of water. She went home to her owner the next day and he reports that this chameleon is doing great with no complications. He is now housing his chameleons in separate cages.

The lesson of this case is to avoid caging chameleons together. It is true that some species have low intraspecific aggression, but they should still be maintained separately. Veiled chameleons (Chamaeleo calyptratus) are typically aggressive and are likely to attack other chameleons if kept in small cages. Nobody likes losing their prized chameleons to injuries, so invest in enough cages to keep them individually.

Ivan Alfonso, DVM

As we all know by now, chameleons need humidity to thrive in captivity. But chameleons also need good ventilation to prevent the air from becoming too humid and causing respiratory problems from bacterial and fungal infections. A cage with several screen sides or a full screen cage provides good ventilation and the addition of live plants, a source of moving water, and misting at least once daily should provide good humidity levels. The following case is one of bad husbandry as a result of bad advice.

A small, approximately 3 month old female Veiled chameleons was presented to the clinic with the complaints of open mouth breathing, bubbling at the mouth, and a thick foamy saliva. Upon examination, the little Veiled chameleon was severely dehydrated and exhibited pale yellow colors. The owner claimed the patient ate 2 crickets that morning. The chameleon was showing labored, open-mouth breathing with an occasional bubble or two while exhaling.

History taking revealed a very poor setup. the enclosure was a 10 gallon aquarium with a screened top. Lighting was provided by a regular incandescent heat bulb and a fluorescent light with UVB output. Several branches were available for climbing. Water was provided by a dripping system. Substrate was a gravel bottom with some sand on top. The gravel was present to aid in draining the water provided for drinking. No natural plants were present and the diet was mostly small crickets and mealworms.

By picturing the enclosure setup we find a lot of mistakes, but the main 2 are the aquarium used as a cage and the stagnant water on the gravel substrate. The heat lamp was turning the aquarium into a small incubator, or oven, and helped in evaporating the water in the bottom of the tank. The humidity rose to very high levels directly proportional to the temperature. These factors are excellent for causing a severe respiratory infection, which was what the little Veiled had. After talking to the owner, she agreed to only antibiotic therapy since she couldn't afford a microbiology culture and didn't want to euthanize her pet. The owner was advised to keep the chameleon in a well-ventilated area and use the antibiotic as indicated. Sadly enough, a call next morning from the owner revealed the patient died overnight. The owner informed me, however, that if she ever purchased a chameleon again, she would buy a screen cage first and follow proper husbandry for these animals.

This case shows us that if we forget the BASICS we may not be able to keep a chameleon healthy in captivity. I often use an analogy I made up to describe these kinds of husbandry problems:

"Keeping a chameleon in an aquarium is like keeping a goldfish in a toilet bowl; it might live for a while but sooner or later disaster will strike".

Ivan Alfonso, DVM

A female Chamaeleo calyptratus, approximately 8 months old, was presented to the clinic with the complaint of being attacked by a cat. I asked the owner as to how this happened, and the response was that this Veiled chameleon was in a free-range setting in a bedroom. The chameleon had access to every corner of the room via plastic vines but would sleep in a ficus tree that was placed inside a 10 gallon aquarium. Apparently, the door to the bedroom was left open and the family house cat got in a tried to help itself to a tasty morsel.

Upon physical exam, the female had 4 puncture wounds, 2 on each side of the body. Both hind legs were paralyzed and a very weak grip was felt in the front legs. the chameleon was still alert but clearly in pain and having difficulty breathing. Radiographs showed a collapsed left lung and some fluid density in the abdomen suggestive of internal hemorrhage.

Euthanasia was advised since the extensive damage caused by the cat warranted a poor prognosis. the owner declined euthanasia and decided to take the chameleon home. He called the next day to report the chameleon had died.

Although free-roam settings seem appropriate for large species of chameleons, they may not be the best option in a household shared with other domestic animals that would consider a chameleon a meal.

Ivan Alfonso, DVM

This is one of the most challenging cases I've had and it so happens to be one of my own animals.

I obtained a WC male C. hoehnelii in March 2001. He seemed surprisingly healthy and had a good appetite. His fecal sample showed some hookworms and he was treated for those. No musculoskeletal abnormalities were noticed and his oral cavity seemed in good shape.

Around early August 2001, I noticed that he started to close his right eye, but kept his left eye open and his appetite was decreasing. I checked his mouth and found what looked like an abscess on the right side of the upper lip. I took a sample of the debris and submitted it for culture and sensitivity. I debrided and cleaned the area and started broad-spectrum antibiotic therapy. Results returned about 3 days later and showed a significant growth of Pseudomonas that was sensitive to Baytril and sulfa drugs among other medicines. I continued systemic antibiotic therapy with Baytril and applied Silvadene cream to the affected area of the oral cavity.

The little male showed improvement after 14 days of therapy and gained back almost all his lost weight. Both eyes were open and the abscess site looked great. Two weeks went by and I started to notice that my C. hoehnelii was rubbing the right side of his mouth against some branches. When I checked his mouth again, the previous abscess was now a foul smelling, rotten area in the bone. I felt devastated but immediately rushed him to the clinic. When I started to debride the area, a piece of the maxilla (jaw bone) broke off. The bone looked devitalized and very friable. I sent the piece of maxilla for histopathology and started Clindamaycin (another antibiotic drug) therapy in the meantime.

During the 3 days I waited for results, the chameleon responded to the antibiotics and ate a few times on his own. The results from histopathology showed necrotic bone tissue with concurrent osteomyelitis (infection in the bone) caused by Pseudomonas sp.

Apparently the Pseudomonas that caused the abscess spread to the bone before I treated it. I decided to euthanize my chameleon since the condition could only become worse, but he beat me to it by dying that afternoon before I could go home and get him.

It is very difficult to see signs of illness in chameleons until they are very obvious. It is unknown to me what the cause of this infection was, but it taught me to do full physical exams on all my animals at least twice a week to try and diagnose any problems at an early stage.

Ivan Alfonso, DVM

A female CB F. oustaleti was presented with the complaint of having a damaged tongue. The owner reported that the female tried to catch a cricket from a far away distance and the tongue went flaccid. The chameleon bit her tongue several times while attemting to retract it and close her mouth. The owner moistened the tongue and tried to place it back inside the chameleon's mouth the best he could. The chameleon's husbandry was very good and she was kept in a screened cage.

Upon physical examination it was noticed that the chameleon swallowed her tongue and was having slight difficulty breathing due to this. Part of the tongue was obstructing the trachea making it hard for the chameleon to breathe.

Surgery was recommended to amputate the tongue. The owner agreed and the patient was taken to the surgical roon to be anesthesized. 5% isoflurane was used for anesthesia. Once the patient was under anesthesia, the tongue was extracted from the esophagus. The tip revealed ulcerated lesions and the area attached to the hyoid bone showed several bite marks. These vital areas of the tongue were moderately discolored and necrotic. Absorbable suture material was used to tie off the tongue at the level of the hyoid bone and it was amputated. Bleeding was minimal and the patient recovered from anesthesia very fast.

Systemic antibiotics were used to prevent secondary infections. The owner was advised to either hand feed or bowl feed the chameleon since she did not have a tongue any more and would not be able to hunt her food. Prognosis was guarded since it was up to the Oustalet's to learn how to drink and eat without a tongue. A few days passed and the female struggled to adapt but eventually did and is now doing fine. The owner was very happy with the results and trained the chameleon to eat from a bowl and to drink in a vertical position to prevent choking.

Trauma is usually the most common cause for tongue damage. It is very important to furnish the cage properly to prevent the chameleon's tongue from getting entangled in any of the cage's accessories. If you know your chameleon is a voracious eater, make sure you place the insects at a normal distance from him/her to prevent any overextension of the tongue that could lead to damage of the tissues.

Ivan Alfonso, DVM

Kraken was my favorite Blue Bar Ambilobe Panther Chameleon. He was purchased as an adult in March 29, 2002. He had some old scars and a partially broken rostral process. He seemed in overall good health. His weight was 140 grams when purchased. A fecal exam revealed only hookworms and he got dewormed for those. He ate and drank well for the following few weeks and gained a lot of weight (160 grams). He bred to one of our Ambilobe females and continued to do great for us. Around the middle of June, Kraken started to reduce its food intake but continued to drink normally and acting his usual self. This was followed by constant weight loss and slight dehydration. Bloodwork revealed no abnormalities and fecal exams were negative. The dehydration was corrected by providing SQ fluids which helped a lot. Even after a slight period of improvement, Kraken continued to worsen and got to a weight of 110 grams. His eyes started to look sunken and his appetite was almost gone. Again one last run of medical intervention was attempted (IV fluids, bloodwork, steroids, Emeraid) but with no significant success. Given the fact that the animal looked miserable and was in for a long and possibly painful "wasting away" process, euthanasia was elected. He was put to sleep on August 8, 2002 at my house and he will be greatly missed.

No medical reason was found to explain Kraken's condition. It was certainly not an infection of any kind and not any kind of injury. The most logical explanation is a failure to acclimate to captive conditions due mainly to the old age the animal was purchased. A very good friend of mine refers to this as the "honeymoon" period where the animals do great for several months before slowly wasting away due to long term stress. It is a pity that Kraken can't continue to be with us but there is a lesson to be learned from every experience and there is certainly a good one to be learned from this case.

Ivan Alfonso, DVM

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