Urgent Care :: 20 year old RES stopped basking, change in behavior

[angelaaa]

I have 2 RES, one of them is named Muddy who is about ~23 years old. For the last 20 years, my RES have been doing well, until I noticed Muddy stopped basking for a month up to now. Muddy used to love basking almost to the point where I was worried she was over-basking. For all their life, we've only put around 2 inches high water which I know isn't the right proper setup, but we've been afraid to increase the water since they've been living this way all their life. Typically their head/neck extends out of the water, but Muddy's head has been submerged under the water a lot now to the point where I noticed algae on her head which never happened before. She also seems less active.
Muddy has always ate normally 1x/week on Reptomin pellets and always had a big appetite. On 7/11, she ate less than half and ate very slowly which was concerning. We took her to the vet on 7/13, the vet wanted to trial the antibiotic ceftazidime injections 0.25ml every 3 days. (Syringes are pre-filled and kept frozen and then thawed before administering). We did the 2nd dose on 7/16. But today 7/19, Muddy did not eat at all, which is very worrisome because this has never happened before. We were told the antibiotic shouldn't affect her appetite. So now I am very worried and don't know what's wrong. When we were at the vet, the vet was saying the bloodwork and x-ray could be done, but they can't tell a lot of answers, so he wanted to try the antibiotic. The vet only said that bloodwork shows kidney failure? And x-ray would show the lungs and if there are eggs. He said CT scan would be the most telling but it is $5k, ugh.

Some background info: we have a heat lamp and UVB lamp, no swollen eyes, no nasal discharge, Muddy had a big bowel movement on 7/13 during the drive to the vet. Muddy is 1.27kg, ~5.5 inches in length. We do not notice any weight loss, but I'm sure there will be since she did not eat today.

I would love some advice on what to do, and if there are any insight to what might be wrong with my Muddy? I will continue the antibiotics for now (wonder if I should stop at any given point if there's no improvement?) but it worries me that she didn't eat at all for the first time in like 23 years. I feel like taking her to another vet for a second opinion.

[steve]

I think a blood test could tell what kind of possible infections there may be. If I recall, lack of appetite is possible from those injections and is another layer of stress. How is the other turtle doing and are they kept together?

[angelaaa]

i apologize for the late reply. I ended up taking my turtle to UC Davis Vet to get bloodwork, x-ray, and a CT scan since we did not see an improvement. After tests and procedures, we suspected visceral gout as the diagnosis due to elevated levels of uric acid and crystal-like deposits near the gallbladder, and a small mineral spot near the right kidney, and a dense liver. The vet suggested a biopsy requiring surgery and a feeding tube. I am not sure if there's any posts of RES with gout and tube feeding. I did see one post dated many years ago concerning for fluid buildup, which I also think Muddy is showing signs up (very protruded areas between the neck and arms). My family and I are leaning against the biopsy and tube feeding as we know Muddy is at an old age and I do not want to put her under more stress. She already had a breathing complication waking up from sedation from the CT where they needed to place an endotracheal tube and use an Ambu bag for breathing support. Since coming back from the vet visits on 7/29 and 8/4, I don't know why Muddy has detoriated. Her bites of food are very weak, majority of time she misses the food when she bites and her head continues to be submerged in the water (we only have 2-3 inches high water). She has refused to eat food now and her last good intake was on 8/10 of ~10 Reportmin pellets. She reacts when I touch her, but she looks like she could be in discomfort or what I'm deeply afraid of is that she is in pain. She stopped basking...there was only two attempted times she basked which was before the Davis vet visits. I'm not sure if the procedures/tests and sedation worsened her condition because she is an old turtle. I don't know if anyone has any insight but deep down I know that this disease is progressive and Muddy may likely have kidney failure due to the possible fluid retention. There's a daily oral medication called Allopurinol that can be given but I am hesitant on stressing Muddy out by prying her mouth open every day to give this medication. I am now concerned that Muddy has refused to eat and her condition seems to be worsening. Ever since I can remember, Muddy has always been in my life and has literally grew up with me. I want my pets to live a dignified life and I know I would need to make a very tough decision soon. Any words of advice or insight would be helpful. Thank you.

[steve]

There's nothing for me to contribute but I'm sorry you and Muddy are going through this. You're doing everything you can. Usually when I feel my turtles might be sick, I clean the tank and let them bask outside under the Sun (more than usual).