Our Feathered Friends
When I started at the new clinic, I knew that there were going to be some wildlife and exotic species. What I didn't know was that some days, 60% of my patients are not dogs or cats. Who knew?? We are not specialists. This is something that we need to say. We are not reptile specialists, or avian veterinarians. We just happen to be in a location that is the closest veterinary hospital that will see birds, pocket pets and reptiles. There is a lot of learning involved on our part. Did you know that just like mammals, not all birds are created the same??? Our feathered friends are as diverse as our mammalian friends?? When do we learn about Taxonomy? Let's see: Kingdom: Animalia, Phylum: Chordata, Class: Mammalia, Class: Aves, Class: Reptilia - that's dusty, isn't it? Cats and Dogs are at least under the same Order of Carnivora. Not all of the bird species that come in to see us are in the same Order! On our EMR (electronic medical record), did you know we have a list that says Species... then under the Species there are options: Feline, Canine, Avian?? Marsupial?? Rodent?? Ouch... Why is this important? I submitted blood work for a reptile and an avian last week. Sadly, there are no reference ranges for these species. *sigh* Because when we submitted the sample, the computer system read Species: Reptile and Species: Avian *facepalm* Not helpful. Someone needs to explain Taxonomy to our IT personnel! That being said, there are general categories of pet birds that will come in. Similarly, there are categories of pet reptiles and pocket pets. Most of the birds that we see as pets are Psittaciformes (that's the order in case you have forgotten). The phylogeny after this can get more complicated, because the original phylogeny was adjusted as new information was added. So, we end up with Families (i.e. Cacatuidae, Psittacidae, Psittaculidae, Strigopoidae), SuperFamilies (Psittacoidea - true parrots; Cacatuoidea - Cockatoos from mainly Australasia), SubFamilies (Psittacinae - Old World or African parrots; Arinae - New World or South American parrots) - all before we get to the genus-species level!! Ack! Have I confused you? I may have confused myself! Why is this even relevant?? Because the health of the individual bird will be dependent on how far removed they are from their natural counterparts i.e. are they doing what they would normally do in the wild? Consuming the foods as close to what they would be eating? Behaving, interacting or foraging as if they were in the wild? The healthiest captive birds are given the opportunity to eat, behave and just live as if they were in their native environment. Captive parrots are more related to their native counterparts than dogs are to wolves. And people think they need to feed their Pom and Chi like a wolf... But they don't think they need to feed their parrot, like a - parrot? Target Audience: Veterinarians and Vet Students who wish to include feathered friends in their care! This blog post is really for those veterinarians or vet students that are seeing or wish to see our feathered friends. It is also the opinion of a general practitioner that wants to be able to help where no one else is willing. This does not make me a specialist. Every time my reception team comes to me and says, there is this cockatiel that is doing X. I think, oh no... oh no, no no... (insert fancy TikTok video here). But then I also think, yes, I will help this patient, because I know that no one within four hours drive will! Our feathered friends deserve care too. So do the scaly ones! You as the veterinarian and veterinary student, you have skills! You know how to educate yourself, and the basic principles of medicine and working towards a diagnosis are the same. Form and Function in the avian patient may be a little different, and it's likely to be out of your comfort zone if you haven't handled am avian - but you may have a willing technician to help you! Ok, so what do you do? You get the call, you get on Google and see what the natural history is on this species. Temperature, humidity, daylight hours, natural diet and behaviour. It's all biology. All veterinarians have had university level biology!!! This is more than the average person has had! You can do this!! In addition to that, if you have your signalment, you can look up the average weight of what that species should weigh, what is the lifespan of that species, is there sexual dimorphism? Now you already have a little bit of information even before seeing the patient. When our little feathered friend arrives, get a history! Just like you would for your dog and cat patients. In addition to the usual questions of V/D/C/S, you will want to know: what the bird is offered for food AND we want to know what it actually eats. If it's offered a mix, does it just pick out all the peanuts or just eat the millet seed? If they bring a sample, you can usually watch to see what they eat in the clinic. But I will ask "What are their favourite food items, and are they free fed?" "How often do you change the food out completely" and is there opportunity for foraging/feeding toys? Does the bird get any vitamins or mineral supplements? the habitat (caged, free roam in the house), type of cage and size of cage for the bird size; do they live with another of its species? Are there more birds in the house? How much handling does the bird get? toys (mirrors can cause reproductive behavioural issues - so we want to know these things), anything with lead/zinc that they could consume? photoperiod (day-night cycle) and access to any UV light, any outside time with direct sunlight? Reproduction: especially important if they know they have a female bird. Has it previously laid? When was the last clutch? This is not a complete list, but a good start! Now, we need to be the detective and take all that history and pull out the important things that are deficient. Typically it will be diet. I would say 90% of the time the bird isn't eating a well-balanced diet. Common Pet Bird Problems: Diet: A poor diet or eating too much seed and not enough well-balanced foods can lead to: obesity -> fatty liver disease hypovitaminosis A -> nasal or ocular discharge, poor digestion cardiovascular disease -> atherosclerosis or hardening of the arteries from diets too high in fat Egg-binding - a common emergencies in the female avian, so check that coelom for distension. This may be a combination of problems in the history. It could be due to poor hydration (low humidity) + lack of calcium + excessive stimulation to lay +/- diet Feather-picking: This could be ectoparasites, endoparasites, nutritional deficiency, pain due to any number of issues - arthritis or other, and/or behavioural. Sometimes you have to treat the behaviour, in order to give you time to determine the underlying cause because you don't want them to get worse! There are these awesome felt e-collars that protect the bird from causing more damage to itself. Choosing the size of e-collar is the tricky part. This is not an exhaustive list... again, just somewhere to start! The Work-Up: Ok, our patient has arrived. Here is a little caveat. If you have a really sick exotics patient, you may just want to do a quick assessment, put them in an incubator with the appropriate temperature and humidity, and watch to see what they do. They may be stressed from the car ride over and you do not want to rush into an exam in case they are too stressed from the trip. I often have the pet come in and sit for 30 to 60 minutes. This gives me time to look through the history and get a distance evaluation. Are they stable enough for me to handle them or are they going to get too stressed and arrest from just the handling for an exam? Your patient has survived the initial transport to the hospital. You will want to first mention to the owners that handling causes stress and some exotics patient can enter cardiac arrest. I ask owners if they are ok with me giving a mild sedative/anxiolytic to help with this. Especially the ones with respiratory issues - just like your dog and cat patients that come in dyspneic, you given them an anxiolytic before doing anything else, right? The one thing that I have learnt, not just with time, but I learnt in school, lucky for me, is to not be afraid to use anxiolytic injectable medication to help facilitate the physical exam, radiographs and blood collection. This is not just a promotion of fear-free handling. It makes it safer for your exotics patients when they are handled, as they are not scared. Often we will include some pain medication in there. Think about pain and shock and what that does to the cardiovascular system. Some of these pets are not used to being handled. If they are very sick, the stress of handling for an examination can contribute to worsening of disease, sometimes leading to cardiopulmonary arrest. You have access to specialists, so use them! There are exotic formularies available. I always use reversible sedatives. As time progresses, you will have a protocol that you feel comfortable with. If you have a tiny patient, you will want to dilute your sedative medications. I draw up the smallest volume into an insulin syringe, and then dilute this with saline. Insulin syringes are just easier to get a small volume as accurate as possible, as well as not wasting your controlled drugs. It really doesn't make sense if you have drawn up a large volume relative to a tiny Budgie. But again, this is my preference. I'll give the mild sedative, and put them back in the incubator to relax. Then I come up with a plan. We want some diagnostics. What are we going to be able to realistically get for this patient? How big is it? Cockatiel or Cockatoo? Or a smaller Budgie? A lot of the differentials of the health of your avian patient can be divulged from the history alone. However, you may wish to get some imaging and blood work while the patient is in hospital and under sedation. Radiographs and a chemistry/CBC would be a good place to go to next. Even if everything comes back normal! Now you have a baseline for that patient. Some of these parrot species live 50 to 80 years! If you have offered diagnostics and the owner declines, at least you know you have tried. Someone once told me that you are only 33% responsible for the outcome of the pet's health. The owner takes 33% and then the pet takes 33%. It's not all that equally weighted, but it just means that you cannot take 100% of the responsibility of the outcome. Another mentor said to me, you cannot care more about the patient than the owner does. I know, it can be hard to go home knowing that you were not able to do everything that you knew you could for that patient. It's a tough gig and hard to live with sometimes, but you will get burnt out of this profession if you hold on to every case that you wish you could have done more. I digress, as I so often do!! OK, our work-up! My staff like to do the radiographs first, as they wish to take advantage of the hands-free radiology while the bird is the sleepiest. The sedative protocol I use works well when they are not stimulated, but they tend to wake up when stimulated. They will go back to sleep easily though so do not get frustrated if you feel like your sedation isn't working. You just will not be able to predict it like in your cat and dog patients. I learnt to do lateral and VD rads for birds using Micropore/clear medical tape while they were sedated. I also personally like to have the wings superimposed on the lateral view, but will stagger the pelvic limbs. This will be different if you are doing a check for fractures (we learnt to do a drop wing radiograph for these. Essentially the Cr-Cd view, but I won't go into details here). Once the x-rays are taken, we will collect the blood sample. Make sure you know what the laboratory needs for your blood sample. You may wish to contact your lab beforehand to ensure you have collected the blood in the correct manner. Ours likes two slides for a CBC with a hematocrit tube and a green top (I think the microtainers are 'mint top') with a gel separator for the chemistry and bile acids. No purple top tubes as the EDTA does something to the nucleated red blood cells for avian and reptilian blood. What that something is, I cannot recall, but it's something to do with the fragility of the cells. Either way, it is important to check with your lab before you collect the blood. As a rule of thumb, you can draw 1% of the body weight of your patient without disrupting the hemodynamics too much. That is 1 ml for every 100 grams of body weight. (It's actually 10% of the blood volume so it is a bit of a guestimation). See LaFeber's website for more information on how to collect from birds. As noted, sick patients also may not handle the blood draw as well as your stable patients. They may be dehydrated and cannot handle you taking more of their blood volume. Even if your mind wants to do the basic workup. You have to weigh those pros and cons. I like to draw from the jugular vein, but I like to hold the head and draw with the needle directed towards the heart (it's the opposite direction that most people use for cats and dogs). Again, everyone will have their personal preference, and mine comes from working with the exotics interns over the few years I was in veterinary school. One thing that I always have to remember, which I thought I would mention here is that you need to draw slowly, don't get too excited when you hit the vein and attempt to draw quickly. The needle is a small diameter and the vein is not as resilient as a mammalian vein. If you draw the plunger back too quickly you create too much suction and don't get the blood in the syringe. We can get some tiny patients in. The average Budgie patient is around 30 grams, that is 0.3 mL of blood. When you're used to drawing 3 mL from your dog and cat patients, this tiny amount seems like it isn't going to go a long way. There are pediatric microtainers that we can use for our small patients. However, when you look at what the minimum draw volume is for the gel separator heparinized tube, you need 400 uL (that's 0.4 mL). That is not all that helpful for a patient who is tiny! Depending on the length of your micro hematocrit tubes, you may be using 50-75 uL (0.05-0.075 mL) of your blood for the PCV, as well as a couple of drops for the slides. For Cockatiel patients and larger, you can safely draw enough blood to get your CBC and chemistry. You have done your work up, you got your x-rays and your blood sample. Use an external radiologist or avian specialist to help you read them! What you do next will depend on how stable the patient is. Does the bird need supportive care (fluid resuscitation, gavage feeding, injectable pain medications?) or is it stable that it can go home and be monitored at home while you wait for the results? That is where the art of veterinary medicine comes in, for all of our cases regardless of species. Just as with our cat and dog patients, we have to use some clinical judgement while we wait for our diagnostics to be run. This also comes from experience. There is nothing wrong with offering hospitalization (as long as you have the staff to support the pet overnight). If your feathered friend is fluffed up at the bottom of the cage and not responding to supportive care, you may have to have a heart-to-heart with the pet parent. Sometimes being realistic about the outcome is more valuable than getting all of the answers first.