Avian | Long Beach Animal Hospital - Part 2

Category: Avian

Parrot Fever (Psittacosis)

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Parrot fever has many names, including Chlamydiosis, Psittacosis and Ornithosis. It is called Psittacosis when it occurs in people and psittacine (parrot types) birds, and Ornithosis when it occurs in passerine (pigeons, doves, etc.) birds. Psittacosis is difficult to diagnose, and is a mysterious disease that does not “follow the rules” of typical avian diseases.

Important Regulations

The United States Department of Agriculture regulates the importation of domestic birds in order to protect the domestic poultry industry. These imported birds must be accompanied by a health certificate. Upon admission they are quarantined for 30 days at a special facility and tested for Newcastle disease. During the 30 days they are given food supplemented with medication that will treat Psittacosis. This medicated feed needs to be continued for at least an additional 15 days when the bird is released from quarantine.

State Health Regulations

Psittacosis is a reportable disease. When a positive diagnosis of Psittacosis is made an inspection might occur to determine the cause of the outbreak, number of birds affected, and any human exposure. Depending on the specifics of the situation a quarantine and treatment might be initiated.

Human Health Significance

Humans can get Psittacosis (Chlamydia psittaci) from birds. Cats get Chlamydia psittaci and show evidence of eye problems, but there is no evidence that cats can spread this disease to people. Other species of the Chlamydia bacteria that occur in sheep, goats, and cattle can cause disease in humans, but those diseases are not called Psittacosis.

Exposure is usually due to the inhalation of dried bird droppings that contain the organism, incubation is 6-19 days. Other potential sources of infection are from respiratory secretions and feathers. Symptoms in people range from nothing to severe disease with pneumonia. Typical symptoms include fever, chills, headache, muscle aches and cough. Inflammation of the heart, liver, and nervous system can occur, with even fatal cases reported. With proper treatment most people recover. According to the Centers for Disease Control and Prevention, between 50-100 cases of human Psittacosis are reported each year, with probably many more undiagnosed. Probably due to increased awareness and diagnostic testing, annual incidence of Psittacosis in humans is decreasing.

Cause

Psittacosis is caused by a bacterium called Chlamydia psittaci that is an obligate intracellular parasite. It has been isolated from many birds, especially cockatiels and parakeets. After exposure the incubation period can vary from 3 days to weeks.

Healthy birds can be carriers of Psittacosis, shedding the organism in their droppings intermittently. It is also found in respiratory discharge. Shedding is stimulated in birds by stress like overcrowding, chilling, and shipping. The shed Psittacosis bacteria can remain infectious in the environment for several months.

Symptoms

Birds are masters at hiding any symptoms of illness, especially in Psittacosis. An apparently healthy bird that is singing and eating in the morning can be gravely ill or be found dead by the same afternoon. It is imperative that you tune in to subtle signs of disease in your pet bird, and bring it in for an exam at the first sign of a problem. If you are unsure, it is better to be safe than sorry.

Some birds with Psittacosis do not show any symptoms and can become carriers, shedding the bacterium intermittently, especially when stressed. Others might get a chronic illness or become severely ill and die. Symptoms depend on age at infection, species, virulence of the specific strain of the bacterium, exposure amount, and stress factors.

Typical symptoms, if present, might include a fluffed appearance, poor appetite, weight loss, respiratory disease, and lime green droppings. The droppings might appear to be diarrhea, but in reality they are usually watery urates, the equivalent of bird urine. Some birds have ocular discharge, leading to the term “one eyed cold”. These symptoms occur with many other avian diseases, so it is imperative to follow proper diagnostic parameters when making this diagnosis.

This parrot has a problem as evidenced by its fluffed appearance. It is fluffed because a disease process is preventing it from keeping itself warm, so it is trapping air under its feathers in order to insulate itself. Birds that do this consistently are ill. Psittacosis can cause this, but so can many other bird diseases.

Diagnosis

History

In some cases we have a high degree of suspicion because a bird has been imported into the country illegally. This means it has bypassed the USDA quarantine and treatment facility. These smuggled birds commonly come from Mexico. They can be purchased at swap meets for a low price, so you must be wary of these potential disease carriers.

Physical Exam

The physical exam may or may not reveal significant abnormalities. An exam of a bird gives us limited information compared to dogs and cats. This is because of the unique anatomy and physiology of a bird. Several examples will elucidate this point.

  • A birds body temperature can go well over 107 degrees F and still be normal
  • They do not have external lymph nodes that can be felt during an exam
  • Their heart rate can easily be up to 500 beats per minute, making it almost impossible to detect murmurs and arrythmias
  • They do not have a diaphragm, the muscle of breathing that separates the abdomen from the chest
  • They use air sacs as a major part of their respiratory physiology, as opposed to dogs and cats using only lungs.
  • Their keel bone extends far down over their abdomen, making it impossible to accurately palpate abdominal organs.

Diagnostic Tests

Since a physical exam on birds yields significantly less information compared to a dog or cat, we need to rely more on diagnostic tests.

Taking a blood sample from the small veins of a bird is a refined art. One of our nurses is taking one from the leg vein of a cockatoo.

A blood panel might be perfectly normal, or it might show significant problems. This is a blood panel from a bird positive for Psittacosis on the ELISA test. The arrows point to the significant abnormalities. The white blood cells (WBC count) are elevated, it is anemic (HCT is low), and its liver test (AST) is high. These findings give us an indication that this bird might have Psittacosis, but they can also occur with other avian diseases though.

Another diagnostic test helpful in Psittacosis is radiology because it allows us to visualize internal organs. This radiograph is also from the above bird. It has an enlarged spleen (S), the circular structure in the middle of its coelomic cavity.

If you would like to learn more about reading a bird radiograph click here.

Culture

Culture is used to detect the Chlamydia organism itself, and is one of the most accurate methods of making an accurate diagnosis. It is time consuming, requires special techniques and laboratories, and since shedding of the bacteria can be intermittent, samples need to be collected for several days. Also, it can take up to several weeks before the result is available, which defeats the purpose of the test for many ill birds. Unfortunately, the laboratories that perform this culture are not readily available to us.

Psittacosis tests

Psittacosis tests have been developed to aid us in our diagnosis. No test is perfect or applies to every situation and species. In some cases we will perform several of these tests to increase accuracy:

  • Antibody Tests- These tests check for antibodies made by the immune system when it is exposed to the Chlamydia organism. Birds that are stressed, in poor nutritional state, or have other diseases, might not produce antibodies at all. Also, it is possible for these tests to be negative early in the course of the disease when the immune system has not had enough time to produce antibodies.
    • EBA- Elementary Body Agglutination checks the antibody called IgM (immunoglobulin M), which is found early in the course of the disease. As a result, it is used as a screening tool for healthy birds or if a bird is suspected to be early in the course of the disease. A positive result does not easily differentiate a bird that actively has the disease from a bird that has been exposed in the past and is currently not ill. It only requires a small amount of blood in relation to other blood tests. IFA- Immunofluorescent Antibody checks for IgG (immunoglobulin G) that builds up in the bloodstream later in the course of the disease. It gives a better long term perspective as a result.
  • Antigen Tests- These tests check for the shedding of the Chlamydia organism in the feces. Viable Chlamydia are not needed for a positive diagnosis since they test for antigen or DNA of Chlamydia.
    • ELISA-Enzyme-Linked Immunosorbent Assay is used on ill birds. It was originally developed to detect human Chlamydia. Like the culture, samples should be taken over several days to increase the chance of finding the problem in intermittent shedders. It is an easy test to administer and can be performed as an outpatient basis with immediate results. False negatives and false positives can occur. a bird with a negative on this test still could have Psittacosis. A bird with a positive on this test might have Psittacosis.PCR- Polymerase Chain reaction is another antigen test. It has great promise and might become the test of choice in the future.

Autopsy (Necropsy)

Unfortunately, Psittacosis is sometimes accurately diagnosed only at necropsy.

This dark red organ is the enlarged spleen of a bird that died of Psittacosis.

This air sac is cloudy, an indication of an infection. Psittacosis could be a cause of this.

Treatment

Birds that are suspected of having Psittacosis are immediately isolated. Protective clothing should be worn at all times when treating these suspects. Routine surgical masks might not be adequate to prevent exposure.

Birds that are weak, losing weight, or not eating need supportive care. This consists of fluids and supplemental feeding. We will frequently hospitalize them until they regain their strength. The mainstay of treatment is with the tetracyclines.

There are several different methods to get this medication into a birds system in order to achieve adequate blood levels.

  • Medicated Feed- Medicated foods can be purchased or made up that contain 1% chlortetracycline (CTC). These need to be fed for 45 days. Acceptance is variable, so monitoring of food consumption is imperative. Calcium should not be greater than >7% in this diet because it can interfere with the tetracycline.
  • Oral Doxycycline- This is the drug of choice for oral treatment. It is also used for 45 days, and is given to birds that are cooperative.
  • Injectable Doxycycline- This drug, also know as Vibravenous, is given once every 5-7 days. Treatment is given for at least 6 weeks. Irritation can occur at the injection site, so it must be given under the direction of a veterinarian.

Prevention

Do not purchase a bird that seems ill or you suspect has been brought into this country illegally. New birds should be examined, tested, and quarantined for at least 45 days. During this 45 days these new birds can be treated also.

People with compromised immune systems should not be exposed to birds that might have Psittacosis. Gloves, masks, and protective clothing should be used when cleaning cages and working around birds suspected of this disease.

Clean cages and feeding bowls frequently, and set up housing so droppings, food, and feathers do not contaminate other cages.

Chlamydia psittaci is susceptible to routine disinfectants. Common ones include Lysol, bleach, 70% isopropyl alcohol, and Roccal.

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Prolapsed Cloaca

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Introduction

A cloacal prolapse is a serious problem requiring immediate veterinary care. Trauma to the internal organs that are prolapsed through the opening can seriously affect the bird. It is seen in cockatoos and the smaller breed birds like budgies and cockatiels. It requires immediate replacement of the prolapsed organs.

Cause

Straining due to parasites, abdominal masses or tumors, chronic egg laying, abnormal eggs and poor nutrition are all predisposing factors. Determining the exact cause can be
difficult.

Symptoms

Birds that have this problem might exhibit depression, straining, lack of droppings, fluffed appearance, and poor appetite. Sometimes the only symptom you notice at home is blood in the droppings. These symptoms occur in other diseases, so the diagnostic approach has to be thorough.

Diagnosis

In many prolapsed birds there is a history of recent egg laying. During the physical exam internal organs (intestines or reproductive usually) are apparent at the cloaca. When diagnostic tests are used their main indication is to find the underlying cause to the problem in order to prevent recurrence. These tests include fecal exams for parasites, x-rays for abdominal masses pushing on the abdominal contents, and blood panels to determine general health and organ function.

Treatment

Birds with prolapsed cloaca’s require emergency care. Many are hypothermic and require immediate warming. Others can be dehydrated so warm fluids are also administered. Antibiotics are usually administered to prevent infection in the affected organs.

Once a bird is stabilized the prolapse is replaced back into the abdomen. The sooner the better because internal organs that are exposed to the environment are easily traumatized and infected. Amputation could be needed on infected tissue or tissue that has inadequate blood supply.

In some cases we anesthetize the bird to allow muscle relaxation and subsequent easier replacement of the affected organs. This patient is in a special anesthetic chamber allowing us to safely administer the anesthetic.


This prolapse has been present for several hours. The coloration tells us it is healthy enough to allow replacement back into the abdomen. It will be gently cleansed and flushed with sterile saline. It is an internal organ and requires delicate handling.


The area is lubricated copiously with K-Y jelly and the prolapse is gently manipulated back into the abdomen using Q-tips. This process takes several minutes because the organ is swollen and predisposed to tearing.


After it is replaced special sutures (at the arrows) are used to prevent it from coming out again. They are put in tight enough to keep the organs inside but loose enough to allow droppings to pass. These sutures will be kept in for at least several days to allow the prolapsed tissue to heal.

Prevention

There are factors involved with this problem that we have no control over. Factors we can control are good nutrition, a clean environment, spaying birds that are predisposed to egg binding or are excessive egg layers, minimizing obesity and stimulating exercise.

Careful daily observation of your pets daily habits will help you recognize the early symptoms of this disease. No matter what the problem, any time your pet bird shows any symptoms of a disease, no matter how subtle, it is considered significant and requires immediate veterinary care. This is because birds are masters at hiding illness, and we are all too often presented with sick birds in advanced stages of disease. Our ability to return these birds to normal health is diminished because proper care has not been given early on in the disease process where it is most beneficial.

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Budgie Growth Removal

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This little guy had a growth near his cloaca that weighed almost as much as he did. We removed it because it was getting larger and interfering with bowel movements.

Birds this size have little blood, so bleeding control (hemostasis) is critical. We removed it using the laser, taking advantage of its tremendous bleeding control, the lack of post operative inflammation, and the pain control it brings by cauterizing instead of cutting nerves.

The lack of bleeding during the surgery when using the laser means the surgery goes faster, and anytime there is less anesthetic time needed to complete a surgery this is a major advantage in a pet this size.

Graphic photos on this page.

Anesthesia

Birds tend to be more sensitive to anesthesia than most mammals, so special precautions are taken to minimize the risk. We always perform pre-anesthetic diagnostic tests prior to surgery to make sure there are no internal problems.

Surgery-Monitor

We use special monitoring equipment during the surgery

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Lisa is just starting the anesthetic process. This bird will also have hot water bottles, and a hot water blanket to lay on, to keep it warm during the surgery. Small animals lose body heat rapidly during anesthesia and surgery, so we want to stay ahead of the curve and prevent it from happening. 

This is a sterile procedure, and we treat it like any other surgery using aseptic technique. You can see our laser unit in the background. 

Surgery

The growth is large for a bird this size, and has probably been there for months. It is starting to interfere with bowel movements at this point. Luckily it was benign.

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Our patient anesthetized, and just before starting our final prep

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Once our patient is draped, and under the proper plane of anesthesia, we start the laser surgery

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Half way through and there is no bleeding at all

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No suture are needed, and healing will be complete in a few days, with no pain or post operative swelling

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Macaw Cataract Surgery

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With the significant help of our favorite veterinary ophthalmologist, the late Dr. Paul Jackson, along with our favorite human ophthalmologist, Dr Art Giebel, we removed a cataract from a Macaw.

This page has graphic surgical pictures.


Anesthesia

Birds tend to be more sensitive to anesthesia than most mammals, so special precautions are taken to minimize the risk. We always perform pre-anesthetic diagnostic tests prior to surgery to make sure there are no internal problems.

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We use general anesthesia because this is delicate surgery and there can be no movement of our patient

Surgery-Monitor

We use special monitoring equipment during the surgery in all our recent surgeries

Equipment

In addition to the substantial surgical expertise of our surgeons, this surgery is not possible without special equipment, especially a dual surgical microscope.

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Our patient is anesthetized and ready for surgery

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Dr. Paul and Dr. Art work together as a team during the surgery

Surgery

A microscopic incision is literally made into the eye near the cornea. The cataract is emulsified just like in people. A new lens is not put in, unlike in people.

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Our surgery team, from left to right-

Art Giebel, MD

Carl Palazzolo, DVM

Paul Jackson, DVM

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Our patient ready to go home

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A healed eye

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Fractured Bird Leg

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Due to the fact that birds have small, and sometimes hollow bones, it is not unusual for them to break them due to trauma. Falling off a perch, being injured by another animal, or even being stepped on by its owner are some of the more common causes of a fracture. Sometimes there are underlying problems causing the bones to be weak and susceptible to fracture during normal activity. The tibiotarsal (shin bone) is the one most commonly fractured.

This page shows a tape splint on a simple fracture.  This splint is light and stable, perfect for a small bird like a budgie (parakeet) or a cockatiel. At the end of this page you will see fractures that need surgery, with a link to seeing the full surgical repair of a fractured femur (thigh bone) in a rabbit at our hospital.


Diagnosis

Most birds that have broken legs will not bear weight on the affected leg. Most fractures can be palpated by one of our doctors, although a bone can be fractured without any obvious evidence during examination. Taking a radiograph is one of the best methods to determine if a fracture is present.

Do you see the fracture in this view?

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The fracture is more apparent in this side view. This emphasizes the importance of taking two views. This fracture is classified as a mid shaft transverse fracture of the tibiotarsal bone.

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Splinting

Most tibiotarsal bones heal well when splinted with special tape. We usually keep the splint on for one month, although this varies. On occasion we need to perform surgery for proper stabilization. This is more common when there is a fracture of the femur (thigh bone).

The first step in splinting this cockatiel fracture is to remove all the feathers over the fracture site. Plucking them allows them to grow back faster compared to cutting them. You can see the bruising that is apparent on this birds leg directly over the fracture. Birds routinely show bruising of many colors, which is sometimes misinterpreted as gangrene by inexperienced people.

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The first layer of tape is applied directly to the skin. We use a type of tape that will cause minimal irritation to the sensitive skin during the healing process and when we remove it after the bone has healed.

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These tape strips are molded over the leg to provide the beginning stages of stability. Several pieces are used to cover above and below the fracture

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The next layer of tape is waterproof and much stronger. Several strips are used to provide the necessary stability.

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When all the layers of tape are applied a hemostat is used to gently mold all the layers tight up against the bone. Now the fracture site is stable and the bone can begin the healing process.

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One our doctor feels the bones are lined up properly and the fracture site is stable, the excess tape is trimmed.

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The splint is trimmed for easier mobility. With the fracture stable this bird will feel substantially better, and start bearing weight very soon. It needs to remain quiet and not climb or play excessively during the healing process. The foot should be checked daily for swelling and the splint should be kept clean and dry (of course it is OK to sign the splint). Weekly rechecks by one of our doctors will ensure the splint is secure and the foot is not swelling.

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This budgie also had a broken tibiotarsal bone that was repaired with a tape splint

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He was grateful we took away his pain and started playing with us right away

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For comparison purposes this is a cast put on a wiggly 6 year old boy named Mike. As you can see, one of his fans is signing the cast while he enjoys some R & R. Your bird needs the same kind of attention during its healing process. Make sure it gets plenty of rest and good nutrition, and remove perches initially so it can not climb around the cage. Putting something soft in the bottom of the cage is also needed.

Surgical Fractures

Some tibiotarsal fractures will not heal with a tape splint.

These are typical of  bird fractures that require surgery

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This is not a bird tibiotarsal fracture. It gives you an idea of how we might use pins on a bird

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We would like to use plates on birds fractures like other animals. Bird bones are too thin, and the plate is too heavy, to use in a bird.

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This is a rabbit femur fracture

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The appearance of the fracture after repair

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Click here if you want to see the full surgical repair of this rabbit fracture

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How to Read a Radiograph (X-Ray)

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This is a fun section designed to test your diagnostic abilities. Periodically we will show new x-rays (the proper word is radiograph) for you to test your skills, so remember to come back and see what new rads (that is the slang word we sometimes use) are posted on our site.

Before we get started, lets get some basics out of the way. There are five radiographic densities:

Soft tissue– internal organs like the liver and kidneys with a whitish color

Fat– the fat around the internal organs, also with a whitish color. Without this fat you would not be able to differentiate the different internal organs like the liver or kidneys, since they are soft tissue, and have the same radiographic density.

Air– this is black, and is what you see for the lungs in a chest radiograph

Bone– which is brighter than soft tissue or fat

Metal– Vivid, very bright, and hard to miss

Look at each x-ray closely (sometimes very closely) and see if you can figure out what is wrong. We have a couple of clues to help you make an interpretation:

  • Use symmetry when you can. Compare both sides, legs, or whatever else that might be useful.
  • Pull your face away from the screen and scan the whole x-ray before you jump into the details.
  • After you have scanned the whole radiograph look very closely for subtle changes.

First we will show a bunch of fun radiographs of the more unusual pets we see at our hospital. After that we will do some radiograph reading lessons, teaching you about the normal anatomy of dogs and cats. After that is a little test to see how you did. We will stick to abdominal radiographs for the test to make it easier. Good luck, and have fun!

Exotic Animal Radiographs

These first few rads are for a little fun, and to get your eyeballs warmed up for later.

Pregnant Guinea Pig

Iguana bladder stones. Click here to see the surgery to remove a bladder stone in an Iggie. 

Female rabbit with mummified fetuses that are several months old

California Desert Tortoise (CDT) with eggs

Two white bladder stones in a Guinea Pig

 

Normal hawk from our Wildlife Care Program

Calcium sludge in the bladder of a rabbit. This is called hypercalciuria, and you can read our detailed page on it

Did you also see the microchip and the calcium in the kidney?

Chinchilla incisor and molar teeth

 Snake with eggs

Rabbit with a fluid filled uterus

Do you see the two pellets in this hawk’s wing?

Did you also see the fracture in this wing? How should this be handled? You can see what we did in our Wildlife  Care Page

Normal X-Rays of dogs and cats

This is a radiograph of the abdomen of a normal cat that is laying on its right side. The head is towards the left. Use the diagram below to identify the organs.

The stomach has food in it, and the large intestine contains feces. All five radiographic densities are present in this abdominal radiograph. Do you see all of them? 

Air- is in the lungs along with gas in the intestines

S.T. -soft tissue is the liver and kidney

Fat- this is abdominal fat

Bone- lumbar vertebrae

Metal- the R marker to indicate this cat is laying on its right side is made of metal

Here is another normal cat abdominal radiograph, this time with an empty stomach

Here is another one, this time with the spleen and metallic sutures from a spay.

You can easily see the liver (L), stomach (S) kidneys (K) , the small intestines (SI), the large intestine (LI), the urinary bladder (UB), and the Spleen (Sp). The arrow points to stainless steel sutures in the muscle layer from a spay operation.

Abnormal X-Rays

This dog is having a difficult time urinating. Can you tell what is wrong?

Look towards the right side of this abdominal radiograph

Does labeling the organs help in your diagnosis?

The bladder is huge, because this dog is having a difficult time urinating. It is probably due to nerve dysfunction, since the spinal cord has changes called spondylosis. The circle points this out on one of the vertebrae

You can learn more about this problem, called spondylosis, from our arthritis page

This is a dog abdominal radiograph. Notice anything unusual?

Again, look towards the right side

You can see the circle around the numerous stones (called calculi) in the urinary bladder

Did you also notice the stones in the kidney and pelvic urethra?

Our web page on bladder stones has lots of good information

This cat is labeled for you. Anything fishy?

Look towards the left side of the radiograph this time

Did you see the pellet in the neck? Look again at the radiograph above, its plain as day.

Now that you are an expert at reading radiographs give the following one a try. It is from a cat that is straining to urinate and has blood in its urine. The answer is below, along with a picture with arrows pointing to the abnormalities.

This cat has 2 stones in its urinary bladder (click here to learn more about them and see a surgery of how they are removed). The stones are radiopaque, which means they show up easily on the radiograph. Some bladder stones are radiolucent, and can only be seen by injecting dye or air into the urinary bladder.

The arrows point to the bladder stones, along with the faint metallic sutures from a spay

Pretty easy so far, huh? Don’t get too confident just yet, our next few are a little harder. Look over the next few abnormal radiographs and send us an e-mail with your answer. If you aren’t sure and just need some clues e-mail us also and we will help you. Good Luck!

Abnormal X-Rays

Now that you are experts at reading x-rays, you can put your newfound skills to work. Email us at vet@lbah.com for the answers.

  1. What do you think about this cat radiograph?

2. This radiograph is an abdomen view from a very sick dog. It is 13 years old and losing weight

 

3. This is from an elderly dog that is losing weight

3. This dog is limping on its rear leg

 

 

 

 

 

 

 

 

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