# Tia has possible cancer, going in for surgery on Monday



## QB89Dragon (Apr 12, 2014)

Hi all,
This is my first post on the forums, but would be very grateful for some advice and insights into a strange medical problem with my 5 year old Argentine B&W.

About 3 weeks ago Tia started to loose weight rapidly. Went from a very healthy weight to having no body fat whatsoever, backbone sticking out around the tail and neck, and muscle wastage. This happened over the course of about a week and a half. Both before and during this time, Tia was very active, had a great appetite and did not appear to be in pain.

Tia's recent history:
I've had Tia for 4 and a half years now, she was one year old when I got her. Before I got her she had problems with humidity and lost a thumb last year from it (was surgically amputated to prevent infection). She has hibernated every winter except this last one where she didn't seem to want to hibernate. I also have much better lights, temp controlled heat mat and everything that may have contributed to that.
Due to the Alberta winters being a bit dry, I have taken to giving her a bath every day of lukewarm water (but warm enough for her to enjoy for a bit before leaving the bath) since about January. 
Currently Tia is about 4 foot, head to tail. Weighs in at 2.7kg consistently, there has been little weight change since the start of the year, despite the weight loss given that the weight has been replaced with water. When healthy, last summer she weighed in at a max of 3kg.

Tia's cage and setup:
Tia has a cage with enclosed sides and a wire mesh top. She has an under tank heating mat affixed to a glass cutting board in the cage that is temp controlled and around 100'F on the surface, meaning that Tia is about 90'F body temp while in her hiding place. She has a UVB fluorescent lamp and a basking spot lamp in the cage as well. Bulb is replaced every 6mo. Substrate is exoterra jungle earth, kept moist daily, and her hiding rock is an overturned cat litter box that she prefers - this helps keep humidity up while she's sleeping. 

Tia's diet and husbandry:
Despite having a cage to be in, Tia has a cat flap in the side of her tank and is a 'house tegu', free roaming around a tegu-proof'ed house (my poor carpets!). The house itself is clean, and no cleaning or other potentially toxic substances are used anywhere she might go. Her favourite activities are shitting on my carpet despite litter box training, clawing at things, and chasing patches of sunlight around.
Her diet is a mix of turkey and kale balls, kept frozen, boiled chicken eggs, quail eggs, frozen mice and fresh non-citrus fruit (grapes, melon, strawberries, etc). She seems to have a preference to sweeter fruit, never is a fan of vegetables, and hasn't really switched over from a meat-centered diet to a more vegetarian-ish diet yet.
I give her 1/3 of a teaspoon of repashy calcium plus calcium and vitamin supplement once a week with her food, and her bone density is very good as confirmed with recent x-rays.
I live in a house with two caged ball pythons which I have had for longer than Tia, and are both healthy. She has been outside last summer to a camp ground, a park, etc, usual tegu stuff when it's hot and sunny. But has had little-to-no exposure to other reptiles, or obvious sources of infection or common reptile diseases. I have not been handling other reptiles, nor have I been to reptile trade shows or anything like that in the past 12 months or so.

Tia's symptoms:
Along with the weight loss and muscle wastage, Tia's only other symptom has been swollen belly / abdomen. She seems to have a buildup of fluid there.
Healthy looking feces / urine, and was checked and treated for intestinal parasites a little over a year ago. She is alert, very active and has a healthy appetite.
Until her vet trip yesterday, where her abdomen was palpated, she presented no breathing difficulties.
She developed a large bump on her chest, between the two forearms that feels bony, but was tested with a needle by my vet to try and draw a sample, and it appears to be an abscess - although this hasn't been fully confirmed. It is difficult to know if this is new, or presenting due to the recent weight loss, whereas before it would not have been noticeable.

Trips to the vet:
When the weight loss happened and became noticeable and pronounced, I took her promptly to my local vet that has a history of working with Tia. My first thought would be this could be a Parthenogenic Pregnancy, due to the changes in hibernation over winter, and increased appetite. This still remains undetermined except that a dorsal to ventral x-ray did not show any evidence of eggs, and enzyme markers in a blood test done did not show signs either.
The first step the vet took after the x-ray was to do a full blood panel, which was then compared against a reference done over a year earlier. The blood panel was normal and compared well against her baseline. According to the blood lab's baseline references (which may be inaccurate for Tegus), she had elevated liver and bile enzymes, and slightly high blood glucose. At this point, the vet hypothesized that this may be a rare-albeit-possible case of reptile diabetes, and we this did a urinology test to look for glucose. This came back negative.
Her abdominal fluid was sampled as well, had a normal water potential compared to tissue fluids (if I understood the vet-lingo correctly?), and showed no presence of any WBCs or other cells of any kind.
Her blood tests also confirmed no new WBCs, elevated WBC count or other evidence of infection. Blood tests also ruled out liver or kidney failure.

At this point my hypothesis to-date were as follows:
- Parthenogenic pregnancy (not likely given x-ray and blood enzyme levels)
- Diet related from too many sweet fruits and an overabundance of sugar in the diet (not likely, and evidence suggests otherwise, e.g. urine sample)
- Heat damage to organs from warm baths every day since January this year, and/or fluctuating heat mat temps (vet thinks this is unlikely and would present as a visible burn on the skin before organs start being damaged)

To help confirm or disprove my hypothesis, I've cut fruit out of the diet, and stopped the daily baths, and have confirmed her temps as posted above.

My vet's hypothesis to-date were:
- Liver or kidney failure (blood tests disproved this)
- Heart failure leading to build up of fluid in abdomen and loss of blood to extremities (haven't proven or disproven this yet)
- Tumor or cancer (haven't proven or disproven this yet, as blood tests can only see certain markers for certain types of cancer)

So at this point we were a bit stuck for ideas, so I went to a specialist reptile vet in Calgary yesterday. No further evidence arose from the exam there, but a few new suggestions came.
The specialist's ideas were:
- Heart failure possible
- Cancer or tumour likely
- Ovarian cyst or necrotised ovaries (unlikely but could be reproductive related)

The second vet did another blood test so we can see how this has changed over two weeks.
She initially suggested ultrasound to try and get an idea of what it might be, but retracted that suggestion on the grounds of whatever it is is very likely to lead to surgery anyway, so they want to perform exploratory surgery on monday.

Unfortunately this has lead to the kicker here. If they find something during surgery that is treatable, they will treat it, if they find something that isn't treatable, they'll let her pass on the table while under anaesthetic. If it is a heart problem, the surgery and anaesthetic will likely kill her anyway. So it's a tough spot to be in unfortunately when I think she is fairly early on in her life, and otherwise should be healthy right now.

If it is multiple tumours the vet wants to let her go on the table, however I have heard of lizards at zoos and in other special cases undergoing a regime of chemo drugs successfully. I don't think this has been considered by my vet, and I'd wonder what you guys think for a tegu?

Hopefully you guys can offer some suggestions or ideas / experience here. I really care about keeping Tia around so I'm hoping there's some info that can be had on this so that there's better news on Monday when the surgery happens!


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## Monkey Girl (Apr 12, 2014)

First, I like to say I'm so sorry to learn of your girl's health issues. I hope things turn out. I'm not much help since I just purchase a yearling tegu and I am a newbie. 

But your thread breaks my heart, your little gu has an excellent mom, you are doing everything (and then some) for your little girl. What a dilemma you must be in, I'm sorry I'm of no assistance. :-(. 

I live in Edmonton as well, and this winter was especially brutal, cold and dry. Bathing your Tia daily makes sense during the winter months. 

Wow, her illness is a mystery and you have done everything possible for her. My heart goes out to you for such a difficult decision you must make for Monday. Which vet will you be using, the one in Caalgary or Edmonton?

Please keep us posted. I will be thinking of both of you.


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## QB89Dragon (Apr 12, 2014)

Monkey Girl said:


> First, I like to say I'm so sorry to learn of your girl's health issues. I hope things turn out. I'm not much help since I just purchase a yearling tegu and I am a newbie.
> 
> But your thread breaks my heart, your little gu has an excellent mom, you are doing everything (and then some) for your little girl. What a dilemma you must be in, I'm sorry I'm of no assistance. :-(.
> 
> ...



Thanks for your kind words. Yeah, it was a dry winter - my two pythons don't like it much either! Tia really seemed to like the baths every day, it was her 'treat' for using a litter box actually.

In Edmonton I'm going to Westside Animal Clinic, and in Calgary I'm going to Calgary Avian & Exotic Pet Clinic. I'm going to be in Calgary for the surgery as they need a specialized artificial respirator to be able to do the surgery.


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## Aardbark (Apr 14, 2014)

I dont really have any advice that can help you, but I wanted to send you my sympathies and my hopes that Tia get well and healthy. You sound like a great owner and Tia a wonderful tegu. I personally would not be able to let her pass on the operating table like that. Your vet may be thinking about how much money multiple surgerys would cost, and thus not suggesting it.

I really hope things go well for Tia.


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## QB89Dragon (Apr 15, 2014)

Just giving you guys a quick update.

I'm sad to have to say that unfortunately Tia didn't make it.

It has been an extremely difficult few days - a rollercoaster journey as it were, both for me as well as her vets and staff at both her clinics. However the story of her remarkable surgery follows, as well as all the highs and lows we've gone through.

Tia went in on Monday morning to start the exploratory surgery. All her blood work had come back over the weekend, showing no indication of any issues.
They got antibiotics into her a few hours prior to the surgery as well as doing all the prep work, and then put her under a full general anaesthetic, calculated for her weight minus an estimate of the fluid volume inside her.
When they opened her up, they were absolutely shocked to find as much fluid as they did, over a litre came out - this was over a third of her body weight.







After removing the fluid from her body, they began to explore for any cancer or other identifiable problems. For the first bit there they were worried that they couldn't find anything. They reported back to me, waiting in the other room, that the lack of any identifiable issue may mean it is a heart problem, or possibly liver failure which can onset in reptiles suddenly even when they have good blood stats on liver enzymes.
However a few minutes later the vet tech came back with a camera, having taken a photograph of one of her ovaries which was greatly enlarged with ovarian cysts. It turns out both ovaries were highly abnormal and enlarged, they had also fused to other tissues and organs making their removal very difficult. As well they found a white plaque like material around her liver and other organs in the lower chest cavity, at first this was suggested to be malignant cells, but later decided it was likely mineralization of some kind.
The vet proceded to remove the ovaries, using many metal clips to seal off the various blood vessels that had grown to support such an enlarged organ. However the blood loss got quite bad, and her system was in shock from the removal of fluid. Her heart stopped at one point during the surgery and had to be restarted with epinephrine.
Two and a half tense hours later, the ovaries had been removed, and they had stitched Tia up. Her heart rate was at a normal 46 beats per minute and we thought we had come through the worst of it, everyone's fingers were crossed at this point!
According to the vet, it was amazing that Tia was alive, let alone active, when she came in. The fluid in her body was putting huge pressure on her organs, particularly the lungs, as in the last few days her breathing became difficult.
It was at this point I got to see her as she was recovering. She had been under anaesthetic, as well as artificial ventilation with a breathing device.






Her body size was tiny, and it was clear how much damage was done in terms of muscle and body fat lost.
As her anaesthetic was switched off, the vet began to try and replenish lost blood volume and keep her stats up. They gave her injections of blood plasma, glucose, atropine and electrolytes over the course of the next 3 hours. However it was clear that things had taken a turn for the worse as her heart rate wasn't stable, going up and down repeatedly, but each time getting worse. Her heart stopped another 3 times over the course of it, and needed epinephrine each time to get it going again. It was clear that her body couldn't take it.
Her blood loss from the surgery had reduced her blood's oxygen carrying capacity, which her liver needed to metabolize the anaesthetic, and her heart needed to keep pumping blood. She was breathing pure oxygen at this point and it wasn't enough. Also it seemed that removing the fluid had put her cells under stress from the sudden change in water potential that they had gradually adapted to given the extreme water stress created by the surrounding fluid. Her last blood test showed she was dehydrated, despite drinking a lot of water daily. Unfortunately there was little we could do about either of these two things, there aren't Tegu blood banks unfortunately!
The sign we were all hoping for was that she would take a breath or two, and gradually recover from there. Reptiles have a reflex where they begin to breath again as CO2 builds up, and they also have an incredible ability to respire anaerobically for extended periods of time, so to try and trigger this mechanism, she was taken off her breathing equipment by the vet.
At this point it was 7pm, and the vet clinic had to close for the night. They had arranged staff to be on standby at the emergency 24 hour clinic where she could be overnight, but without her breathing on her own, the chances of making the journey by car and surviving would be slim, and even if she did, the chances of her making it through the night were also slim.
So by about 7pm, we knew she had only maybe a 5% chance, and the vet said we had three options, desperately try and keep her on ventilation, make it to the emergency clinic, and see if they can keep her going overnight, but the chances of that working were slim, and the cost huge. She was already at the max for all they could give her, plasma, glucose, electrolytes, pain meds and significantly, heart drugs to keep her heart going.
The other option was to put her down with barbiturates, or to let her lay peacefully in an incubator in case she does take a breath and slowly work its way up miraculously from there. We decided to go with the latter as there may be a chance that way. So we all went for the night exhausted from the ordeal, but sadly in the morning when we came in, it hadn't worked and Tia had passed away with the signs showing that she had truly gone.

I got to say goodbye to her there, which was extremely hard to do. She will be cremated privately and the ashes returned to me to keep safe.

She was an extremely nice tegu, with an amazing personality and temperament. She was scared of being at the vet on her trip on Friday after having so many tests done, she was trying to climb onto my chest when the vet came in the room as me holding her would calm her down. It was very touching, Tia even needed the vet to hold her for her to relax when the anaesthetic was being administered. I'm sure it was heartbreaking for everyone there, and everyone who knew her, that such a wonderful animal has passed on. She was irreplaceable to us and had shown all of the best qualities that a tegu has to offer as more than just a pet, but a companion and a member of the family even.

It was also a remarkable case for that vet clinic and to see a reptile come in like that, as well as change so suddenly from being outwardly healthy. The vet had a number of theories and ideas that I can share here so that hopefully the body of medical knowledge that's out there can grow.
The vet believes that this has been going on for years in her ovaries, and there was no indication it was cancer, nor was there any necrosis of the ovaries (a common problem in captive reptiles).
It is likely that fluctuating hormone levels has effectively turned on and off her ovaries, and that the cause of this may be due to temperature fluctuations or improper temperatures either during summer or winter.
This caused eggs to turn into cysts inside the ovaries. There were multiple ones that they found during the surgery, both large and small. This could have happened years ago, and she remained healthy despite this for some time, but the theory behind why her condition changed so suddenly is that one of these cysts burst and began releasing fluid into her body cavity.
It also seems worth mentioning that she had a small quantity of blood in the urine about this time a year ago, she was taken to the vet then, but no signs of infection or other problems presented. However this *may* be an early warning sign to look out for, especially if you know your tegu may have been kept at an improper temperature, or missed hibernating for a few winters. Another thing to learn from this is that fluid in the abdomen creates this dangerous water potential that can cause stress on the system following surgery - acting quickly to correct the issue may save your 'gu.

So a huge thanks to both my vets who have absolutely gone way above the call of duty and have done everything that we could have done to give Tia the best chance of recovery, as well as minimizing any pain or suffering she may have gone through. I'm heartbroken to have lost her.

R.I.P Tia
(2007-2014)


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## marydd (Apr 15, 2014)

Heart breaking. You are one amazing tegu owner. She was a lucky girl.


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## Aardbark (Apr 16, 2014)

Awwwww  

Im so sorry for you. The loss of such an amazing friend, not a pet, but a family member. I cant think of any good words to say to try to help comfort you. My heart goes out to you and Tia. Be strong and remember the love that you shared.


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## magnetx (Apr 16, 2014)

RIP TIA!!!! sorry for your loss


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## Roadkill (Apr 16, 2014)

Sorry for your loss.
And sorry if the following questions bother you in your mourning.
I've done a number of surgeries on tegus (as a researcher, not a veterinarian) and I'm very intrigued by some of the details you've given and wonder if you know a few things. The plaque you say was around the liver, do you know if this was anterior/caudal/or both of the post-hepatic septum? Do you have any idea of the state of the abdominal fat bodies in Tia? Do you know if the fluid build-up was in the thoracic cavity? the abdominal cavity? both? (that is frankly an amazing amount of fluid, but I have seen the odd reptile present with similar disturbing volumes - from what you've said I'd surmise both cavities as the lungs are in the thoracic cavity and the ovaries are in the abdomenal). When you say large eggs were present, any idea of the size?

Not that it would have made much difference in this case, but while all vertebrate animals have the respiratory response of engaging ventilatory activity when CO2 levels reach a certain threshold, there is some that theorize part of how reptiles can suppress their metabolism is by over-riding this reflex and building up CO2; this along with the fact that I've seen numerous tegus not spontaneously breathe post-surgery and in one of my earlier subjects I had thought much the same, "it'll restart on its own", the tegu didn't, and whether from a lack of O2 or complications during the surgery, this one particular tegu has had permanent brain damage the rest of its life (it's still alive, but has zero drive to feed itself, you have to put food in its mouth) - long story short, when it comes to tegus/reptiles, I don't recommend taking them off the artificial respirator until you see signs of spontaneous breathing/arousal. Especially with the common practice of many vets using ketamine as part of the anaesthetic regimine (I abhor the use of ketamine, I find it really knocks the reptiles down too deep, but I understand why some prefer its use).


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## TheTeguGurl (Apr 17, 2014)

Wow reading this bring tears to my eyes. I am so sorry for your loss of your tia. May she rest in peace. Never hae i seen or heard someone go far and beyond as you to help your tegu. ! Thank you for doing all that you could for her. she knows that you loved her with everything. She will be waiting for you at rainbow bridge.


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## glk832 (Apr 17, 2014)

Man smh.. God Bless you..


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## Monkey Girl (Apr 21, 2014)

I am so sorry for your loss. 

I hope you take comfort in knowing you went above and beyond for Tia. You have set the bar for the quality of care and love you provided to your sweet Tia. You truly are an amazing person who proved your love and commitment through every possible way to help your little girl. It's more then obvious she was a very important member of your family, how lucky she was to have been part of your family. 

My sincere condolences


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## Martin Van Der Hoek (Apr 21, 2014)

QB89Dragon said:


> Hi all,
> This is my first post on the forums, but would be very grateful for some advice and insights into a strange medical problem with my 5 year old Argentine B&W.
> 
> About 3 weeks ago Tia started to loose weight rapidly. Went from a very healthy weight to having no body fat whatsoever, backbone sticking out around the tail and neck, and muscle wastage. This happened over the course of about a week and a half. Both before and during this time, Tia was very active, had a great appetite and did not appear to be in pain.
> ...


Very sorry for your loss


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## hanniebann (Apr 21, 2014)

So many tears. You did everything you could. I'm sorry for your loss.


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## QB89Dragon (May 10, 2014)

Roadkill said:


> Sorry for your loss.
> And sorry if the following questions bother you in your mourning.
> I've done a number of surgeries on tegus (as a researcher, not a veterinarian) and I'm very intrigued by some of the details you've given and wonder if you know a few things. The plaque you say was around the liver, do you know if this was anterior/caudal/or both of the post-hepatic septum? Do you have any idea of the state of the abdominal fat bodies in Tia? Do you know if the fluid build-up was in the thoracic cavity? the abdominal cavity? both? (that is frankly an amazing amount of fluid, but I have seen the odd reptile present with similar disturbing volumes - from what you've said I'd surmise both cavities as the lungs are in the thoracic cavity and the ovaries are in the abdomenal). When you say large eggs were present, any idea of the size?
> 
> Not that it would have made much difference in this case, but while all vertebrate animals have the respiratory response of engaging ventilatory activity when CO2 levels reach a certain threshold, there is some that theorize part of how reptiles can suppress their metabolism is by over-riding this reflex and building up CO2; this along with the fact that I've seen numerous tegus not spontaneously breathe post-surgery and in one of my earlier subjects I had thought much the same, "it'll restart on its own", the tegu didn't, and whether from a lack of O2 or complications during the surgery, this one particular tegu has had permanent brain damage the rest of its life (it's still alive, but has zero drive to feed itself, you have to put food in its mouth) - long story short, when it comes to tegus/reptiles, I don't recommend taking them off the artificial respirator until you see signs of spontaneous breathing/arousal. Especially with the common practice of many vets using ketamine as part of the anaesthetic regimine (I abhor the use of ketamine, I find it really knocks the reptiles down too deep, but I understand why some prefer its use).



Hey there. Thanks for your sympathies and sorry for the delay in responding to your post.
I got ahold of the vet and passed on your questions.
This is her response. Hopefully it can help!



> There were caseous plugs of material that were free floating in the coelomic cavity and these likely represented proteinaceous egg material, the same material that appeared to be plaques. My surgical notes are not specific enough to be able to accurately answer the question regarding the question regarding the liver, but I will say caudal - the majority of the adhesions were associated with the right ovary. There were no ‘eggs’ per se – there were egg follicles on both the ovaries and these were in varying stages of formation / necrosis. It was the right side where at least one follicle had ruptured. Hope this helps.


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## Roadkill (May 10, 2014)

Thank you for the response, it was interesting nonetheless.


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## Josh (May 15, 2014)

RIP Tia. Very sorry for your loss. Thank you personally for educating us all on her condition and all that you went through to help her. This tegu community will benefit hugely from your experience and from the knowledge of what happened to Tia.


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## chitodadon (May 16, 2014)

My condolences


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