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PROCEEDINGS

Building Exotics Excellence:


One City, One Conference
August 29 September 2, 2015
Marriott Rivercenter
San Antonio, Texas, USA
PROCEEDINGS

Building Exotics Excellence: One City, One Conference


AAV Veterinary Reviewers
Greg Burkett, DVM, DABVP (Avian) Vanessa Grunkemeyer, DVM, DABVP (Avian) Christal Pollock, DVM, DABVP (Avian)
Sue Chen, DVM, DABVP (Avian) Michelle Hawkins, VMD, DABVP (Avian) Lauren Powers, DVM, DABVP (Avian),
Michele Curtis-Velasquez, DVM Sharman Hoppes, DVM, DABVP (Avian) DABVP (Exotic Companion Mammal)
Robert Dahlhausen, DVM Jerry LaBonde, DVM, MS Anneliese Strunk, DVM, DABVP (Avian)
Thomas Edling, DVM, MSpVM Angela Lennox, DVM, DABVP (Avian and Exotic Companion Paul Welch, DVM, DABVP (Avian)
Scott Ford, DVM, Dipl ECZM Mammal), Dipl ECZM (Small Mammals) Kenneth Welle, DVM, DABVP (Avian)
Jennifer Graham, DVM, DABVP, Dipl ACZM Steve Metz, DVM Ashley Zehnder, DVM, DABVP (Avian)
Cheryl Greenacre, DVM, DABVP (Avian), Bruce Nixon, DVM
DABVP (Exotic Companion Mammal) Anna Osofsky, DVM

AEMV Veterinary Reviewers


Brendan Carmel, BVSc MVS (Australasian Wildlife), Dan Johnson, DVM, DABVP (Exotic Companion Mammal) Joerg Mayer, DABVP (Exotic Companion Mammal),
GDipComp CMAVA MACVSC (Unusual Pets) Cathy Johnson-Delaney, DVM Dipl ECZM (Small Mammal)
Chris Griffin, DVM, DABVP (Avian) Melissa Kling, DVM Drury Reavill, DVM, DABVP (Avian and Reptile/Amphibian),
Justine Hammond, DVM Angela Lennox, DVM, DABVP (Avian and Exotic Companion Dipl ACVP
Laurel Harris, DVM Mammal), Dipl ECZM (Small Mammals) Jeffrey Rhody, DVM, DABVP (Exotic Companion Mammal)

ARAV Veterinary Reviewers


Jeff Baier, MS, DVM Katie Heinz-Taheny, DVM, PhD, Dipl ACVP Shane Simpson, DVM, BVSc(Hons), GCM(VP), CMAVA
Bruce Bogoslavsky, DVM Karina Mathes, DVM, Dr. med. vet., Cert Spec in Reptiles and Veterinarian
Todd Driggers, DVM Amphibians, Dipl ECZM (Herpetology) Anneliese Strunk, DVM, DABVP (Avian)
Erica Giles, DVM Michael Miller, MS, VMD, DABVP (Reptile & Amphibian) Tim Tristan, DVM
David Hannon, DVM, DABVP (Avian) Paolo Selleri, DMV, PhD, Dipl ECZM (Herpetology & Kim Wojick, DVM
Small Mammal)
Technical Editor
Charlotte Kirk Baer, MS
Introduction

We invite you to enjoy the benefits provided by these Proceedings of ExoticsCon 2015, a combined conference
of the Association of Avian Veterinarians (AAV), Association of Exotic Mammal Veterinarians (AEMV), and the
Association of Reptilian and Amphibian Veterinarians (ARAV). The 2015 combined conference provides access
to leading specialty veterinary researchers and practitioners world-wide sharing their experience and knowledge
in person and through these proceedings, which are furnished to all members of the three associations.

AAV, AEMV and ARAV recognize and thank the following committees and staff for their time and hard work
in assuring a quality program and publication:

ExoticsCon Conference Committee


Cheryl Greenacre, DVM, DABVP (Avian), DABVP (Exotic Companion Mammal), AAV President
Chris Griffin, DVM, DABVP (Avian), AEMV Immediate Past President and Conference Chair
Katie Heinz-Taheny, DVM, PhD, Dipl ACVP, ARAV President-Elect and Conference Chair
Susan Horton, DVM, ARAV Vice President
Micah Kohles, DVM, MPA, AEMV President-Elect
Bruce Nixon, DVM, AAV Immediate Past President and Conference Chair

AAV Veterinary Manuscript Reviewers


Greg Burkett, DVM, DABVP (Avian); Sue Chen, DVM, DABVP (Avian); Michele Curtis-Velasquez, DVM; Rob-
ert Dahlhausen, DVM; Thomas Edling, DVM, MSpVM; Scott Ford, DVM, Dipl ECZM; Jennifer Graham, DVM,
DABVP, Dipl ACZM; Cheryl Greenacre, DVM DABVP (Avian), DABVP (Exotic Companion Mammal); Vanessa
Grunkemeyer, DVM, DABVP (Avian); Michelle Hawkins, VMD, DABVP (Avian); Sharman Hoppes, DVM,
DABVP (Avian); Jerry LaBonde, DVM, MS; Angela Lennox, DVM, DABVP (Avian and Exotic Companion
Mammal), Dipl ECZM (Small Mammals); Steve Metz, DVM; Bruce Nixon, DVM; Anna Osofsky, DVM; Christal
Pollock, DVM, DABVP (Avian); Lauren Powers, DVM, DABVP (Avian), DABVP (Exotic Companion Mammal);
Anneliese Strunk, DVM, DABVP (Avian); Paul Welch, DVM, DABVP (Avian); Kenneth Welle, DVM, DABVP
(Avian); Ashley Zehnder, DVM, DABVP (Avian)

AEMV Veterinary Manuscript Reviewers


Brendan Carmel, BVSc MVS (Australasian Wildlife), GDipComp CMAVA MACVSC (Unusual Pets);
Chris Griffin, DVM, DABVP (Avian); Justine Hammond, DVM; Laurel Harris, DVM; Dan Johnson, DVM,
DABVP (Exotic Companion Mammal); Cathy Johnson-Delaney, DVM; Melissa Kling, DVM; Angela Lennox,
DVM, DABVP (Avian and Exotic Companion Mammal), Dipl ECZM (Small Mammals); Joerg Mayer, DABVP
(Exotic Companion Mammal), Dipl ECZM (Small Mammal); Drury Reavill, DVM, DABVP (Avian and Reptile/
Amphibian), Dipl ACVP; Jeffrey Rhody, DVM, DABVP (Exotic Companion Mammal)

ARAV Veterinary Manuscript Reviewers


Jeff Baier, MS, DVM; Bruce Bogoslavsky, DVM; Todd Driggers, DVM; Erica Giles, DVM; David Hannon,
DVM, DABVP (Avian); Katie Heinz-Taheny, DVM, PhD, Dipl ACVP; Karina Mathes, DVM, Dr. med. vet., Cert
Spec in Reptiles and Amphibians, Dipl ECZM (Herpetology); Michael Miller, MS, VMD, DABVP (Reptile &
Amphibian); Paolo Selleri, DMV, PhD, Dipl ECZM (Herpetology & Small Mammal); Shane Simpson, DVM,
BVSc(Hons), GCM(VP), CMAVA Veterinarian; Anneliese Strunk, DVM, DABVP (Avian); Tim Tristan, DVM;
Kim Wojick, DVM

Technical Editor
Charlotte Kirk Baer, MS

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Conference Office Staff XMi Meetings
Lyn Sholl, CMP, Senior Executive Manager; Jamie Compton, CAE, IOM, Senior Executive Manager; Rachel
Doucet, Executive Manager; Megan Miller, Administrative Associate; Deahna Cring, Executive Assistant

Proceedings Layout and Design BrightLizard, Inc.


Elizabeth Smith

Disclaimer

The material appearing in this publication comes exclusively from the authors and contributors identified in each
manuscript. The techniques and procedures discussed reflect the personal knowledge and experience of the authors
and contributors, and demonstrate their views of the methods that may be used for these medical procedures.
The procedures demonstrated do not incorporate all known techniques, are not exclusive, and other techniques
and technology may also be available. Any questions or requests for additional information concerning any of
the manuscripts should be addressed directly to the authors.

AAV, AEMV and ARAV do not research, review, or otherwise verify any of the information contained in this
publication. Opinions expressed in this publication are those of the authors and contributors and not necessarily
those of AAV, AEMV, or ARAV. AAV, AEMV and ARAV are not responsible for errors or for opinions expressed
in this publication.

AAV, AEMV and ARAV expressly disclaim any warranties or guarantees, expressed or implied, and shall not
be liable for damages of any kind in connection with the material, information, techniques, or procedures set
forth in this publication.

Manuscripts contained in these conference proceedings vary in length and format based on author intentions for
possible future publication. Authors are given the option to publish their complete manuscript herein as the final,
official publication of the manuscript. Authors who wish to retain the right to publish a complete manuscript in
another professional publication at a later date have limited their submission herein to an abstract only.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior
written permission of the publisher.

For permission to reproduce or order copies of this publication, contact the respective association office:
AAV Office, www.aav.org, PO Box 9, Teaneck, New Jersey 07666, USA, e-mail pubs@aav.org.
AEMV Office, www.aemv.org, 618 Church Street, Suite 220, Nashville, Tennessee 37219, USA,
e-mail info@aemv.org.
ARAV Office, www.arav.org, North American Veterinary Community, 5003 SW 41st Boulevard,
Gainesville Florida 32608-4930, USA, telephone 785-865-9401

For information on ExoticsCon educational conferences, visit http://www.exoticscon.org.

For information on membership and other association programs visit the association websites listed above.

Copyright 2015 by:


Association of Avian Veterinarians,
Association of Exotic Mammal Veterinarians, and
Association of Reptilian and Amphibian Veterinarians

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Author Index

Natalie Antinoff, DVM, DABVP (Avian) Vittorio Capello, DVM page 445
page 203, 367, 369 Clinica Veterinaria S.Siro
Gulf Coast Veterinary Specialists Clinica Veterinaria Gran Sasso
Gulf Coast Avian & Exotics Via Lampugnano, 99
1111 W. Loop South, Suite 110 Milano 20151
Houston, TX 77018 Italy

Heather Barron, DVM, DABVP (Avian) Rob Coke, DVM, Dipl ACZM,
page 243 DABVP (Reptile & Amphibian), CVA page 483
Clinic for the Rehabilitation of Wildlife (CROW) San Antonio Zoo
PO Box 150 3903 N St Marys Street
Sanibel, FL 33957 San Antonio, TX 78212

Maryssa Beckman, BS page 79 Kerri Cooper-Bailey, DVM, MS page 659


University of Illinois Furr, Feathers and Scales
3719 Summer Sage Court PO Box 52
Champaign, IL 61820 Pilot, VA 24138

Kyra Berg page 99 Mike Corcoran, DVM, CertAqV page 217, 523
Department of Veterinary Clinical Medicine VCA Wakefield Animal Hospital
University of Illinois 19 Main Street
1008 Hazelwood Drive Wakefild, MA 1880
Urbana, IL 61802
Carolyn Cray, PhD page 355
Josee Bermingham, AHT page 51 University of Miami
Hagen Avicultural Research Institute PO Box 016960 R-46
157 St-Georges Miami, FL 33101
Rigaud, QC J0P1P0
Canada Bob Dahlhausen, DVM, MS page 259
Avian & Exotic Animal Medical Center
Cynthia Bishop, DVM page 379 Veterinary Molecular Diagnostics
Seattle Pacific University 5989 Meijer Drive, Suite 5
3307 Third Avenue West Milford, OH 45150
Seattle, WA 98119
Nicola Di Girolamo, DVM page 467
Joao Brandao, LMV, MS page 341, 343 Clinica per Animali Esotici
Department of Veterinary Clinical Sciences Via Sandro Giovannini 53
Center for Veterinary Health Sciences Roma 00137
Oklahoma State University Italy
Stillwater, OK 74078

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Stephen Divers, BvetMED, DZooMED, Richard Funk, MA, DVM page 469, 491
Dipl ECZM (Zoo Health Management), VCA Mesa Animal Hospital
Dipl ECZM (Herbetology), Dipl ACZM, FRVS 858 N Country Club Drive
page 107, 385, 541, 625 Mesa, AZ 85201
University of Georgia
Dept of Small Animal Med and Surgery Sara Gardhouse, DVM page 357
College of Vet Med, UGA University of California Davis
501 DW Brooks Drive One Shields Avenue
Athens, GA 30606 Davis, CA 95616

Odette Doest, DVM page 493 Bonnie Gatson, DVM page 527
Veterinary Practice Doest College of Veterinary Medicine
Parallelweg 40 University of Florida
Curaao 2015 SW 16th Avenue
Gainsville, FL 32608
Grayson Doss, DVM page 101, 149, 377, 633
University of Wisconsin-Madison Jordan Gentry, DVM page 91
School of Veterinary Medicine Texas A&M University
2015 Linden Drive 4474 TAMU
Madison, WI 53706 College Station, TX 77843-4474

David Eshar, DVM, Amelia Gould page 529


DABVP (Exotic Companion Mammal), University of Illinois
Dipl ECZM (Small Mammal) page 371 College of Veterinary Medicine
The Department of Clinical Sciences Department of Veterinary Clinical Medicine
College of Veterinary Medicine 1212 Briarcliff Drive
Kansas State University Urbana, IL 61801
1800 Denison Avenue
Manhattan, KS 66506 Jennifer Graham, DVM, DABVP (Avian),
DABVP (Exotic Companion Mammal),
Peter Fisher, DVM page 401 Dipl ACZM page 331, 329, 389
Pet Care Veterinary Hospital Cummings School of Veterinary Medicine
5201-A Virginia Beach Boulevard Tufts University
Virginia Beach, VA 23462 200 Westboro Road
North Grafton, MA 01536
Rose Fiskett, VMC, DABVP (Avian),
DABVP (Exotic Companion Mammal) page 173 Cheryl Greenacre, DVM, DABVP (Avian),
PO Box 466 DABVP (Exotic Companion Mammal)
13221 April Circle page 163, 303, 363, 375
Lovettsville, VA 20180 Department of Small Animal Clinical Medicine
College of Veterinary Medicine
Scott Ford, DVM, DABVP (Avian) page 187 University of Tennessee
Avian Specialty Veterinary Services 2407 River Drive, C-247
N48 W14850 Lisbon Road Knoxville, TN 37996
Menomonee Falls, WI 53051

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Vanessa Grunkemeyer, DVM, DABVP (Avian) Jan Hooimeijer, DVM, CPBC page 227
page 639 Consultancy Practice for Birds
North Carolina State University Meppel The Netherlands
College of Veterinary Medicine Galgenkampsweg 4
1060 William Moore Drive Meppel 7942 HD
Raleigh, NC 27607 Netherlands

David Hannon, DVM, DABVP (Avian) Cathy Johnson-Delaney, DVM page 359, 361
page 373, 503, 589 Washington Ferret Rescue & Shelter
Memphis Veterinary Specialists 13813 65th Avenue W #7
4500 Village Gate Drive Edmonds, WA 98026
Arlington, TN 38002
Janet Jones, LVMT, Avian/Exotics, Wildlife/Zoo
Kendal Harr, DVM, MS, Dipl ACVP page 285 page 39
URIKA, LLC Department of Veterinary Medicine
8712 53rd Place W University of Tennessee
Mukilteo, WA 98275 2407 River Drive
Knoxville, TN 37996
Lisa Harrenstien, DVM, Dipl ACZM page 645
Avian and Exotic Veterinary Care Nick Kirk page 29
P O Box 16051 University of Tennessee
Portland, OR 97292 College of Veterinary Medicine
2407 River Drive
Michelle Hawkins, DVM, DABVP (Avian), Knoxville, TN 37966
DABVP (Exotic Companion Mammal) page 163
UC Davis - Veterinary Medicine Petra Koelle, DVM, Dr. med. vet., PD page 481
1 Garrod Drive University of Zurich
Davis, CA 95616 Clinic of Small Animal Medicine
Andreas--Wagner-Strasse 1 A
J. Jill Heatley, MS, DVM, DABVP (Avian), Solalinden D-85640
DACZM page 535 Germany
Texas A&M University
Dept of Small Animal Clinical Sciences Micah Kohles, DVM, MPA page 339
4474 TAMU University of Nebraska-Lincoln
College Station, TX 77843 School of Veterinary Medicine and Biomedical
Sciences
Barbara Heidenreich, BS, Zoology page 619 Oxbow Animal Health
Barbaras Force Free Animal Training P.O. Box 830905
6904 Cherrydale Drive Lincoln, NE 68583
Austin, TX 78745
Jenna Kranz page 89
Adrien-Maxence Hespel, DVM page 25 Schubot Exotic Bird Health Center
Auburn University Veterinary Teaching Hospital College of Veterinary Medicine
1220 Wire Road Texas A&M University
AUCVM DCS 400 Raymond Stotzer Parekway
Auburn, AL 36849 College Station, TX 77843

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Kristian Krause, DVM, DABVP (Feline) Marla Lichtenberger, DVM, DACVECC page 453
page 655 Milwaukee Emergency Center for Animals
Serrano Animal and Bird Hospital 3670 South 108th Street
21771 Lake Forest Drive, # 111 Greenfield, WI 53228
Lake Forest, CA 92630
Marli Linter, DVM page 41, 159
Rhonda LaBelle, LVT page 45 Avian Medical Center
Summertree Animal & Bird Clinic 15952 SW Quarry Road
12300 Inwood Road, Suite 102 Lake Oswego, OR 97035
Dallas, TX 75244
Marcie Logsdon, DVM page 151
Stephanie Lamb, DVM page 115 Washington State University
Arizona Exotic Animal Hospital Veterinary Teaching Hospital
744 N. Center Street Exotics and Wildlife Department
Mesa, AZ 85201 205 Ott Road, Room 1002
PO Box 7060
Isabelle Langlois, DVM, DABVP (Avian) page 15 Pullman, WA 99164-7060
Universit de Montral
Facult de Mdecine Vtrinaire Adolf Maas, DVM page 487
3200, Rue Sicotte ZooVet Consulting, PLLC
Saint-Hyacinthe, QC J2S 2M2 P.O. Box 1007
Canada Bothell, WA 98041

Delphine Laniesse, DVM page 19 Douglas Mader, MS, DVM, DABVP (Canine),
Ontario Veterinary College DABVP (Feline), DABVP (Reptile & Amphibian),
50 Stone Road Dipl ECZM (Herpetology) page 519, 563
Guelph, ON N1G 2W1 Marathon Veterinary Hospital
Canada 5001 Overseas Highway
Marathon, FL 33050
Patricia Latas, DVM page 155
Awe Pono Avian Health Shachar Malka, DVM, DABVP (Avian) page 125
7223 E Camino Valle Verde The Humane Society of New York
Tucson, AZ 85715 306 East 59 Street
New York, NY 10022
Irene Lecona, DVM page 143
University of Minnesota Christoph Mans, DVM, Dipl ACZM
1920 Fitch Avenue page 253, 325
St. Paul, MN 55108 University of Wisconsin
School of Veterinary Medicine
Angela Lennox, DVM, DABVP (Avian), 2015 Linden Drive
DABVP (Exotic Companion Mammal), Madison, WI 53706
Dipl ECZM (Small Mammal)
page 135, 321, 427, 435 Rachel Marschang, PD, Dr. med.vet,
Avian and Exotic Animal Clinic Dipl ECZM (Herpetology)
9330 Waldemar Road page 515, 517, 521, 583
Indianapolis, IN 46268 Laboklin
Steubenstr. 4
Bad Kissingen 97688
Germany

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Karina Mathes, DVM, Cert Spec in Reptiles & Am- Giordano Nardini, DMV, PhD page 489
phibians, Dipl ECZM (Herpetology) page 501 Clinica Veterinaria Modena Sud
Clinic for Pets, Reptiles Piazza dei Tintori, 1
Pet and Feral Birds Spilamberto, 41057
University of Veterinary Medicine Hannover Italy
Buenteweg 9
Hannover 30559 Larry Nemetz, DVM page 297
Germany The BIRD Clinic Veterinary Corporation
200 South Tustin Street, #E
Brynn McCleery, DVM, DABVP (Avian) page 93 Orange, CA 92866
University of Tennessee
College of Veterinary Medicine Bob Ness, DVM page 211
2530 Buffat Mill Road Ness Exotic Wellness Center
Knoxville, TN 37917 1007 Maple Avenue
Lisle, IL 60532
Colin McDermott, VMD page 477
National Aquarium Emily Nielsen, BSB page 475
501 E Pratt Street Auburn University
Baltimore, MD 21202 College of Veterinary Medicine
387 Webster Road, #44
Brandy McKeown, RVT page 69 Auburn, AL 36832
Medical Center for Birds
3805 Main Street Kim Oliver Heckers, PD, Dr. med. Vet
Oakley, CA 94561 page 497, 499
Department of Pathology at Laboklin
Anna McRee, DVM page 133 Laboratory for Clinical Diagnostics
Louisiana State University Steubenstr. 4
Veterinary Clinical Sciences Bad Kissingen 97688
PO Box 1027 Germany
Baker, LA 70704
Geoff Olsen, DVM, DABVP (Avian) page 169
Maureen Murray, DVM, DABVP (Avian) USGS Patuxent Wildlife Research Center
page 275 12302 Beech Forest Road
Wildlife Clinic Laurel, MD 20708
Cummings School of Veterinary Medicine
Tufts University Glenn Olsen, DVM, MS, PhD page 23
200 Westboro Road Medical Center For Birds
North Grafton, MA 01536 3805 Main Street
Oakley, CA 94561
Jill Murray, RVT, RLATG, VTS, AVTCP
(Exotic Companion Animals) Terri Parrott, DVM page 613
page 33, 309 St. Charles Veterinary Hospital
Oklahoma State University 39873 Highway 27
4100 West 19th Avenue, E104 Davenport, FL 33837
Stillwater, OK 74074

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Irene Pepperberg, PhD page 235, 295 Robert Schmidt, DVM, PhD, Dipl ACVP
Department of Psychology page 173, 415, 571
Harvard University Zoo/Exotic Pathology Service
William James Hall 2825 Kovr Drive
33 Kirkland Street West Sacramento, CA 95605
Cambridge, MA 02138
Nico Schoemaker, DVM, PhD, Dipl ECZM (Avian),
Sean Perry, DVM page 531 Dipl (Small Mammal), DABVP (Avian)
Marathon Veterinary Hospital page 3, 273, 365
5001 Overseas Highway Division of Zoological Medicine
Marathon, FL 33050 Department of Clinical Sciences
of Companion Animals
Charly Pignon, DVM, Dipl ECZM (Small Mammal) Faculty of Veterinary Medicine
page 337, 383, 459 Utrecht University
Alfort Naional Veterinary School Yalelaan 108
7 Avenue du Gnral de Gaulle Utrecht 3584 CM
Maisons-Alfort 94700 Netherlands
France
David Scott, DVM page 103
Patrick Redig, DVM, PhD page 5 Carolina Raptor Center
University of Minnesota 6000 Sample Road
1352 Boyd Avenue Huntersville, NC 28078
St Paul, MN 55108
Paolo Selleri, DMV, PhD,
Leslie Reed, DVM page 145 Dipl ECZM (Herpetology),
The Wildlife Rehabilitation Center of Minnesota Dipl ECZM (Small Mammal) page 333
2530 Dale Street N Clinica per Animali Esotici
Roseville, MN 55113 Via Sandro Giovannini 53
Roma 00137
Kelly Rockwell page 537 Italy
University of Illinois
College of Veterinary Medicine Elisabeth Simone-Freilicher, DVM page 349, 505
Department of Veterinary Clinical Medicine Avian and Exotic Medicine Department
1205 E Florida Avenue, Apt 22A Angell Animal Medical Center
Urbana, IL 27606 350 South Huntington Avenue
Boston, MA 02130
David Sanchez-Migallon Guzman, LV, MS,
Dipl ECZM (Avian), Dipl ECAM (Small Mammal), Jeanne Smith, DVM page 109
Dipl ACZM page 13 Avian Health Services
UC Davis 6201 C Enterprise Drive
Department of Veterinary Medicine and Diamond Springs, CA 95619
Epidemiology
School of Veterinary Medicine Brian Speer, DVM, DABVP (Avian),
One Shields Avenue Dipl ECZM (Avian) page 167
Davis, CA 95605 Medical Center for Birds
3805 Main Street
Oakley, CA 94561

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Scott Stahl, DVM, DABVP (Avian page 605 Yvonne van Zeeland, DVM, MVR, PhD,
Stahl Exotic Animal Veterinary Services Dipl ECZM (Avian), Dipl ECZM (Small Mammal)
4105 Rust Road page 67, 81, 119, 273
Fairfax, VA 22030 Division of Zoological Medicine
Department of Clinical Sciences of Companion
Ash Sundaram, DVM page 611 Animals
UC Davis Veterinary Medicine Faculty of Veterinary Medicine
15905 Oakridge Road Utrecht University
Morgan Hill, CA 95037 Yalelaan 108
Utrecht 3584 CM
Michelle Sutherland, BVM&S BSc (Hons) MRCVS Netherlands
MANZCVSc (Avian Health) page 657
Burwood Bird and Animal Hospital Claire Vergneau-Grosset, DVM, IPSAV, Dipl ACZM
128 Highbury Road page 479
Burwood, VIC 3125 University of California - Davis
Australia 2110 Camino Court
Davis, CA 95616
Samantha Swisher, DVM page 345
Avian & Exotic Animal Clinic of Indianapolis Marike Visser, DVM page 7, 83
9330 Waldemar Road Auburn University
Indianapolis, IN 46268 College of Veterinary Medicine
Clinical Pharmacology Laboratory
Lara Sypniewski, DVM, DABVP (Avian) 1500 Wire Road
page 533 214 SRRC
Oklahoma State University Auburn, AL 36849
1 BMVTH
Stillwater, OK 74074 Laetitia Volait, DVM, Dipl ECZM (Small Mammal)
page 381
Thomas Tully, DVM, MS, DABVP (Avian), National Veterinary School of Alfort (Maisons-
Dipl ECZM (Avian) page 17, 123 Alfort)
Louisiana State University 7 Avenue du Gnral de Gaulle,
School of Veterinary Medicine Maisons-Alfort, 94704
Dept. VCS Skip Bertman Drive France
Baton Rouge, LA 70803
Laura Wade, DVM, DABVP (Avian)
Fern Van Sant, DVM page 137 page 127, 165
For the Birds Specialized Care for Avian & Exotic Pets
1136 S de Anza Boulevard, Ste D 10882 Main Street
San Jose, CA 95129 Clarence, NY 14031

Bradley Waffa, MSPH, DVM page 511


Churchland Animal Clinic
6630 High Street W
Portsmouth, VA 23703

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Kenneth Welle, DVM, DABVP (Avian)
page 79, 121
University of Illinois
1008 W. Hazelwood
Urbana, IL 61802

Jim Wellehan, DVM, PhD, Dipl ACZM,


Dipl ACVM (Virology),
Dipl ACVM (Bacteriology/Mycology),
Dipl ECZM (Herpetology) page 95, 97
University of Florida
2015 SW 16th Avenue
Gainesville, FL 32608

Michelle Whitehead, BSc, DVM page 27


University of Illinois, Veterinary Medical Center
1008 West Hazelwood Drive
Urbana, IL 61802

Wen-Ling Wu, DVM, MS page 653


Jurassic Exotic Animal Hospital
No.351, NORTH DIST
Taichung City , 404
Taiwan

Jeanette Wyneken, PhD page 553


Florida Atlantic University
Dept. of Biological Sciences
777 Glades Road
Boca Raton, FL 33431-0991

Shangzhe Xie, BSc/BVMS, MVS


(Conservation Medicine) page 21
University of Adelaide
Roseworthy Campus
Roseworthy, South Australia 5371
Australia

Graham Zoller, DVM, IPSAV (Zoological Medicine)


page 335
Centre Hospitalier Vtrinaire Frgis
43, Avenue Aristide Briand
Arcueil 94110
France

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Table of Contents

Association of Avian Veterinarians

Section 1: AAV Plenary Sessions


Distribution of Nebulized Fluorescein-Labeled Propylene Glycol or Saline in Pigeons (Session #258)........... 3
Falcons, Falconry, and Waterfowl: A Novel Pathway for Influenza Viruses (Session #399).............................. 5
Population Pharmacokinetics of Levetiracetam and Zonisamide in the African Grey Parrot
(Psittacus erithacus) (Session #131)................................................................................................................... 7

Section 2: AAV Hot Topics


Evaluation of the Thermal Antinociceptive Effects and Pharmacokinetics of a Sustained-release
Buprenorphine Formulation in American Kestrels (Falco sparverius) (Session #135).................................... 13
Aspergillus pseudoviridinutans: A Novel Cause of Psittacine Aspergillosis (Session #086)............................ 15
Safety and Efficacy Trials of Copper Oxide Wire Particles and Sericea lespedeza in a Research
Population of Ring-Necked Doves and a Captive Population of Green-Winged Doves (Session #243).......... 17
Rheological Properties of a Sustained-release Formulation of Butorphanol in a Poloxamer 407
Base and Pharmacokinetics in Amazon Parrots (Amazona ventralis) (Session #154/156)............................... 19
Beating the Heat the Australian Way (Session #328)..................................................................................... 21
Testing Bird Hearing: Auditory Brainstem Responses of Diving Birds (Session #171)................................... 23
Radiographic Evaluation of the Thoracic Girdle in Raptors Using a Novel Caudoventral 45
Craniodorsal Radiographic View (Session #224).............................................................................................. 25
Evaluation of Treatment for Severed Blood Feathers in Chickens (Gallus gallus) (Session #163).................. 27
Student Manuscript Winner: Comparison of Various Avian Euthanasia Methods (Session #402)................... 29

Section 3: AAV Technician Track


Bandaging and Wound Management in Exotic Animals (Session #267).......................................................... 33
Monitoring and Caring for Your Avian Anesthesia Patient (Session #358)....................................................... 39
Fecal Cytology (Session #366).......................................................................................................................... 41
Client Handfeeding Education for the Veterinary Technician (Session #335).................................................. 45
Early Parrot Education: A Six-Stage Weaning Process (Session #349)............................................................. 51
The Importance and Efficacy of Foraging Enrichment in Psittacine Birds (Session #254).............................. 67
Avian Hematology: Sample Collection and Cytological Evaluation (Session #398)........................................ 69

xiii
Section 4: AAV Research
Broken Blood Feather Occurrence and Treatment in Pet Birds (Session #148)................................................ 79
Healthy and Feather-Damaging Grey Parrots Display Different Coping Styles (Session #259)...................... 81
Pharmacokinetics of Amitriptyline HCL and Its Metabolites in Normal Healthy African Grey Parrots
(Psittacus erithacus) and Cockatoos (Cacatua species) (Session #130)........................................................... 83
Environmental Stability of Avian Bornavirus: pH and Drying (Session #220)................................................. 89
Experimental Infection of Peach-faced Lovebirds (Agapornis roseicollis) with Avian Bornavirus
Genotypes II and IV (Session #162).................................................................................................................. 91
Cardiac Troponin I as a Biomarker of Myocyte Injury in Turkeys (Session #345)........................................... 93
Phylogenetic Characterization of a Novel Herpesvirus Found in the Liver and Lungs of a Neonatal
Chilean Flamingo with Hepatomegaly (Phoenicopterus chilensis) (Session #297).......................................... 95
The Identification of Novel Herpesviruses and Adenoviruses from Seabirds (Session #320).......................... 97
Effects of Prolonged and Repeated Anesthetic Episodes on Owl Hematology (Session #053)........................ 99
Evaluation of Gastrointestinal Transit Times in Red-tailed Hawks (Buteo jamaicensis) Using
Contrast Fluoroscopy (Session #206).............................................................................................................. 101
A Retrospective Look at Outcomes of Raptors with Ocular Trauma (Session #022)..................................... 103

Section 5: AAV Clinical


Endoscopically Obtained Biopsies of the Proventriculus and the Ventriculus in Pigeons
(Columba livia) (Session #181)....................................................................................................................... 107
Species Specificity of Adherent Lactobacilli Isolated from Psittacine Birds (Session #067).......................... 109
Infundibular Cyst Formation After Incomplete Salpingohysterectomy in a Chicken
(Gallus gallus domesticus) (Session #036)...................................................................................................... 115
Diagnosis and Treatment of Cushings Syndrome in a Senegal Parrot (Session #251)................................... 119
Retricectomy for Resolution of Feather Trauma in an Umbrella Cockatoo (Cacatua alba)
(Session #211).................................................................................................................................................. 121
Hypernatremia in an Umbrella Cockatoo (Cacatua alba) (Session #157)...................................................... 123
Steroid-Induced Remission of Thoracic Round Cell Tumor in a Green-Cheek Conure
(Pyrrhura molinae) (Session #226)................................................................................................................. 125
Acrylic Stabilization for Psittacine Rhinothecal Fractures (The Beak Helmet) (Session #219).................. 127
A Novel Surgical Approach to Avian Femorotibiotarsal Luxation Repair (Session #215)............................. 133
Fatal Baylisascaris procyonis Infection in a Household Psittacine Flock (Session #114 )............................ 135
Surgical Laser Treatment of Squamous Cell Carcinoma (Session #184)........................................................ 137

xiv
Section 6: AAV Wildlife and Conservation
Cardiac Evaluation in the Bald Eagle (Haliaeetus leucocephalus) (Session #068)........................................ 143
Viral Enteritis in Juvenile Black-capped Chickadees (Poecile atricapillus) in a Rehabilitation Setting
(Session #180).................................................................................................................................................. 145
Inflammatory Bowel Disease in a Harpy Eagle (Harpia harpyja) (Session #207)......................................... 149
Conservative Management of Proximal Humeral Fractures in Three Juvenile Raptors (Session #043)......... 151
The Amazing Story of Ruapuke (formerly known as Lisa One), the Kakapo chick! (Session #326)............. 155

Section 7: AAV Poultry


Epidemiology of a Pet Chicken Population (Session #369)............................................................................ 159
Outbreak of Infectious Bronchitis Virus in a Flock of Backyard Chickens (Session #373)............................ 163
Listeriosis Outbreak in a Backyard Chicken Flock (Session #223)................................................................ 165
Surgical Resolution of a Complicated Septic Yolk Coelomitis and Oviductal Impaction in a Pet
Chicken (Gallus gallus domesticus) (Session #270)....................................................................................... 167
Web Sparing Amputation of the Third Digit of a Duck (Session #059).......................................................... 169

Section 8: AAV Master Classes Track 1


Disease Conditions, Clinical Signs and Treatment Modalities of Large Pet Birds (Session #218)................. 173
The Basics of Raptor Care (Session #299)...................................................................................................... 187
Birds With Big Bellies: What Do I Need to Know? (Session #286)............................................................... 203
Laser Therapy in Avian Patients (Session #194)............................................................................................. 211

Section 9: AAV Master Classes Track 2


Physical Examination and Diagnostic Testing of Aquatic Animals (Session #263)........................................ 217
Dealing with Parrot Intelligence and Cognitive Abilities in Daily Practice (Session #170A)......................... 227
Cognition in Grey Parrots: Reasoning by Inference in Studies on Exclusion (Session #170B)...................... 235
Juvenile Raptor Medicine (Session #072)....................................................................................................... 243

Section 10: AAV Master Classes Track 3


Sedation in Pet Birds (Session #285)............................................................................................................... 253
Avian Bornaviral Ganglioneuritis in Clinical Practice (Session #255).......................................................... 259

xv
Critical Thinking and Clinical Reasoning in Exotic Animal Medicine (Session #250).................................. 273
Gastrointestinal Anatomy and Physiology of Birds of Prey (Session #129)................................................... 275
Are Your Numbers Real? How to Design an In-House Quality Control Plan for Your Veterinary
Laboratory (Session #310)............................................................................................................................... 285

Section 11: AAV Master Classes Track 4


Dealing with Parrot Intelligence and Cognitive Abilities in Daily Practice (Session #172)........................... 295
When You Thought it Could Not be Reproductive Disease (Session #337)................................................... 297
Backyard Poultry: Practical Information You Can Use, Presented by Systems (Session #166)..................... 303
Disaster Planning for Pets (Session #204)....................................................................................................... 309

Association of Exotic Mammal Veterinarians

Section 12: AEMV Plenary Sessions


Introducing Alfaxalone into Exotic Companion Mammal Practice (Session #088)........................................ 321
Analgesic Efficacy and Safety of Buprenorphine in Chinchillas (Chinchilla lanigera) (Session #014)......... 325

Section 13: AEMV Monday Sessions


Gerbode Defect in a Rabbit (Oryctolagus cuniculus) (Session #144)............................................................ 329
An Unusual Case of Ascending Pyelonephritis in a Rabbit (Oryctolagus cuniculus) (Session #103)........... 331
Protein to Creatinine Ratio in Pet Rabbits with Suspect or Histologically Confirmed Renal Disease
(Session #278).................................................................................................................................................. 333
Biochemical Predictor of Short-Term Outcome in Rabbits with Urologic Disorders (Session #066)............ 335
Electrophysiologic Testing in Rabbits (Session #262)................................................................................... 337
Effects of Diet on Gastrointestinal Microbial Flora of Healthy Rabbits (Oryctolagus cuniculus)
(Session #360).................................................................................................................................................. 339
Naturally Occurring Idiopathic Hyperthyroidism in Two Pet Rabbits (Session #095)................................... 341
99mTc-Pertechnetate Thyroid Imaging in Euthyroid New Zealand White Rabbits (Session #096)............... 343
Management of Sepsis in a Juvenile Rabbit with Subcutaneous Abscesses (Session #062)........................... 345
A Novel Treatment of Sebaceous Adenitis in a Rabbit (Oryctolagus cuniculus) (Session #339).................. 349

xvi
Section 14: AEMV Tuesday Sessions
Serum Amyloid A (SAA) and C-reactive Protein (CRP) are Major Acute Phase Proteins in Rabbits
(Session #091).................................................................................................................................................. 355
Microbiology and Antimicrobial Susceptibilities of Odontogenic Abscesses in Domestic Rabbits
(Session #124).................................................................................................................................................. 357
Gyrovirus Isolated From Ferrets (Session #071)............................................................................................. 359
Surviving Canine Distemper at a Ferret Shelter (Session #070)..................................................................... 361
Histoplasmosis in a Group of Domestic Ferrets (Mustela putorius furo) (Session #169)............................... 363
Successful Treatment of a Suspected Related Pyothorax in Two Ferrets (Session #257)............................... 365
Diagnosis and Successful Treatment of Myasthenia Gravis in a Ferret (Session #288)................................. 367
Incidence of Sporulated Rods in Ferret and Hedgehog Feces (Session #289)................................................ 369
Clinical Cardiac Assessment of Captive Black-tailed Prairie Dogs (Cynomys ludovicianus)
(Session #256).................................................................................................................................................. 371
Adrenal Disease in a Chinchilla (Session #023).............................................................................................. 373
Dwarf Tapeworm (Hymenolopsis diminuta) Diagnosed in Clinically Ill Chinchillas
(Chinchilla lanigera) (Session #168)............................................................................................................... 375
Urine Analysis in Chinchillas (Chinchilla lanigera) (Session #027).............................................................. 377
Investigating the Cause of Fibrous Osteodystrophy in Satin Cavies (Session #311)...................................... 379
Use of Total Ear Canal Ablation and Lateral Bulla Osteotomy to Treat Otitis Interna in Guinea Pigs
(Session #203).................................................................................................................................................. 381
Use of Tie-in Technique to Repair Tibia Fracture in Rabbits (Session #202)................................................ 383
Thymoma in a Rabbit Complicated by Mycobacteriosis: Unexpected Case Outcome
or Medical Error? (Session #089).................................................................................................................... 385

Section 15: AEMV Master Classes Track 1


The Critical Rabbit (Session #085).................................................................................................................. 389
Urogenital Clinical Presentations and Therapy in the Exotic Companion Mammal (Session #393).............. 401
Diseases of the Urogenital System of Exotic Companion Mammals (Session #153)..................................... 415
Anatomy and Physiology of the Urogenital Tract of Exotic Companion Mammals for Fun and Profit
(Session #138).................................................................................................................................................. 427

xvii
Section 16: AEMV Master Classes Track 2
Alternative Surgical Options for Elective Altering in Exotic Companion Mammals (Session #063)............. 435
Ear Surgery in Pet Rabbits (Session #105)...................................................................................................... 445
From Start to Finish, the Latest: Gastric Stasis and Bloat (Session #321)...................................................... 453
Flexible Gastrointestinal Endoscopy in Ferrets (Session #199)..................................................................... 459

Association of Reptilian and Amphibian Veterinarians

Section 17: ARAV Plenary Sessions


On What Evidence Are Reptile Formularies Based? (Session #290).............................................................. 467
Clinical Challenges in Treating Venomous Reptiles (Session #343)............................................................... 469

Section 18: ARAV Clinical Reviews


Evaluation of the Follicular Cycle in Ball Pythons (Session #225)................................................................. 475
Cloacal Prolapses in Anurans: A Ten-Year Retrospective Review (Session #216)......................................... 477
Prevalence and Risk Factors of Ophthalmic Disease in Leopard Geckos (Session #352)............................. 479
Food Intake in Leopard Geckos (Session #140).............................................................................................. 481
Use of Electroacupuncture in the Management of Stifle Osteoarthritis in a Komodo Dragon
(Varanus komodoensis) (Session #011)........................................................................................................... 483

Section 19: ARAV Diagnostics and Imaging


Hematology and Biochemistry Analyses of Russian Tortoise (Session #099)................................................ 487
Evaluation of a Bench-Top Chemistry Analyzer in Hermanns Tortoises (Session #318).............................. 489
Thyroid Testing in Galapagos Tortoises (Session #123).................................................................................. 491
A Case of Iguana Head Trauma: The Battle Between the Iguana and the Car (Session #340)....................... 493

Section 20: ARAV Cancer and Case Reports


Fibropapillomatosis in Chameleons (Session #346)........................................................................................ 497
Skin Tumors in Chameleons (Session #348)................................................................................................... 499
Squamous Cell Carcinomas, Cholangiosarcoma and Multiple Fibriscesses in a Veiled Chameleon
(Session #127).................................................................................................................................................. 501

xviii
Hyperglycemia Associated with Renal Adenocarcinoma in a Chinese Water Dragon (Session #021)........... 503
Two Cases of Congestive Heart Failure in Lizards (Session #344)................................................................. 505
Management of Quadrate Bone Trauma in a Green Tree Python (Session #101)........................................... 511

Section 21: ARAV Infectious Diseases


Experimental Ferlavirus Infection in Corn Snakes: Pathogenesis and Virus Detection (Session #084)......... 515
Herpesviruses and Mycoplasma in Turtles and Tortoises in Europe (Session #076)...................................... 517
Salmonella in Wild Green Iguanas in the Florida Keys (Session #332).......................................................... 519
Detection of a Mycoplasma in a Carpet Python (Session #141)..................................................................... 521
Protozoan Pulmonary Disease in a Carpet Python (Session #357).................................................................. 523

Section 22: ARAV Therapeutics


Effects of Parenteral Epinephrine and GV-26 Stimulation on Inhalant Anesthesia Recovery
Time in Two Orders of Reptiles (Session #293).............................................................................................. 527
Evaluating the Clinical Effects of Short Duration Ultraviolet B Radiation Exposure in Leopard
Geckos (Session #205)..................................................................................................................................... 529
Clinical Use of Epogen (Epoetin alfa) in Green Sea Turtles and Loggerhead Sea Turtles
(Session #354).................................................................................................................................................. 531
The Use of Cefovecin in the Red-Eared Slider Turtle (Session #212)............................................................ 533
Effect of Profender on Oxyuridae Infestation in Captive Texas Tortoises (Session #045).......................... 535
Evaluation of the Mineral Content of Gut-loaded Crickets Fed a Commercial Cricket Diet
(Session #107).................................................................................................................................................. 537

Section 23: ARAV Master Classes


Clinical Approach to Tortoises and Turtles (Session #081)............................................................................ 541
Reptile Cranial Structures and Functions (Session #330)................................................................................ 553
Clinical Conditions Affecting the Head of Reptiles (Session #331)................................................................ 563
Diseases of the Head of Amphibians and Reptiles (Session #175)................................................................. 571
Reptile Virology: Understanding the Methods and Their Interpretation (Session #142)................................ 583
Non-Steroidal Anti-inflammatory Drugs (NSAIDs) in Reptiles and Amphibians: A Review
(Session #020).................................................................................................................................................. 589
Managing Dystocia in Snakes (Session #353)................................................................................................. 605

xix
Additional Content

Section 24: Hybrid


Conservation of Highly Mutated Cancer Genes in Exotic Species (Session #307)........................................ 611
Standards of Care and Written Protocols in a Multi-Species Practice (Session #213).................................... 613
Training Animals to Accept Oral Medications and Injections without Restraint (Session #029)................... 619
Endoscopy 101: Why and How to Add Endoscopy to Your Exotic Practice (Session #048)......................... 625
Integumentary Wound Healing and Management Techniques for Exotic Pets (Session #274)....................... 639
GnRH Agonists in Avian and Exotic Patients: Opportunities and Challenges (Session #187)....................... 645

Section 25: Posters


Surgery of Complicated Traumatic Colon Prolapse in a Green Iguana (Session #143).................................. 653
Cloacal Carcinoma in a Desert Iguana (Session #161).................................................................................... 655
Oral Fibrosarcoma in a Murray Darling Carpet Python (Session #164)......................................................... 657
Hepatocellular Adenoma in a Paradise Flying Tree Snake (Session #196)..................................................... 659

Section 26: AAV Addendum


House Officer Manuscript Winner: Effects of Manual Restraint and Hooding on Physiologic
Parameters in Red-Tailed Hawks (Session #405)............................................................................................ 663

xx
Section 1

AAV Plenary
Sessions

Cheryl Greenacre, DVM, DABVP (Avian),


DABVP (Exotic Companion Mammal)
AAV President
Moderator
Distribution of Nebulized Fluorescein-Labeled
Propylene Glycol or Saline in Pigeons
Nico Schoemaker, DVM, PhD, Dipl ECZM (Small Mammal), Dipl ECZM (Avian),
DABVP (Avian),
Manda Schottert, DVM,
Sietske Mesu, PhD,
Ineke Westerhof, DVM, PhD, Dipl ECZM (Avian)
Yvonne van Zeeland, DVM, MVR, PhD, Dipl ECZM (Avian), Dipl ECZM (Small Mammal)

Session #258

Affiliation: From the Division of Zoological Medicine, Department of Clinical Sciences of Companion
Animals (Schottert, Schoemaker, Westerhof, van Zeeland) and the Veterinary Pharmacy Division,
Department of Equine Sciences, Faculty of Veterinary Medicine, University of Utrecht, Utrecht, 3584
CM, The Netherlands.

Fungal infections are commonly seen in birds.1,2 Treatment may be initiated with a variety of antifungal drugs
which can be given orally or nebulized. Thus far, research on drug nebulization in birds has been limited and
focused solely on water-soluble vehicles,3-8 while antifungal drugs generally dissolve poorly in water.9 This
study compared the distribution of nebulized fluorescein labeled propylene glycol or saline in 60 healthy racing
pigeons (Columba livia domestica). Following nebulization of the fluorescein labeled saline and propylene glycol
(in concentrations of 5, 20 or 80 mg/ml) for either 0.5 or 4 hours, birds were euthanized. Next, a post-mortem
examination was performed during which the distribution of the fluorescent particles throughout the different
parts of the respiratory tract (nasal cavity, trachea, caudal air sacs, lungs and cranial air sacs) was visualized using
UV-light and photographed. Distribution and staining intensity were subsequently scored by two independent
examiners blinded for the treatment. In addition, lung material was collected and freeze-dried for evaluation
using a fluorescence microscope. At 0.5 hours, limited fluorescent staining was visible in most birds for both
vehicles, with increased staining intensity observed after 4 hours. Fluorescein dissolved in saline was found to
result in a more intense coloring (2.2 0.8) compared to propylene glycol (1.7 0.9). This study has shown
that nebulization with either saline or propylene glycol will result in delivery of particles throughout the entire
respiratory tract of healthy racing pigeons. Further studies are needed to establish therapeutic concentrations of
medications which can be delivered through nebulization.

References

1. Bauck L. Mycoses. In: Ritchie BW, Harrison GJ, Harrison LR, eds. Avian Medicine: Principles and Ap-
plication. Lake Worth, FL: Wingers Publishing;1994:1000-1004.

2. Beernaert LA, Pasmans F, van Waeyenberghe L, et al. Aspergillus infections in birds: a review. Avian Pathol.
2010;39:325-331.

3. Corbanie EA, Matthijs MGR, van Eck JHH, et al. Deposition of differently sized airborne microspheres in
the respiratory tract of chickens. Avian Pathol. 2006;35:475-485.

4. Tell LA, Smiley-Jewell S, Hinds D, et al. An aerosolized fluorescent microsphere technique for evaluating
particle deposition in the avian respiratory tract. Avian Dis. 2006;50:238-244.

ExoticsCon 2015 Main Conference Proceedings 3


5. Beernaert LA, Baert K, Marin P, et al. Designing voriconazole treatment for racing pigeons: balancing
between hepatic enzyme auto induction and toxicity. Med Mycol. 2009;47:276-285.

6. Emery LC, Cox SK, Souza MJ. Pharmacokinetics of nebulized terbinafine in Hispaniolan Amazon parrots
(Amazona ventralis). J Avian Med Surg. 2012;26:161-166.

7. Tell LA, Stephans K, Teague SV, et al. Study of nebulization delivery of aerosolized fluorescent microspheres
to the avian respiratory tract. Avian Dis. 2012;56:381-386.

8. Rundfeldt C,Wyska E,Steckel H,et al. A model for treating avian aspergillosis: serum and lung tissue kinetics
for Japanese quail (Coturnix japonica) following single and multiple aerosol exposures of a nanoparticulate
itraconazole suspension. Med Mycol. 2013;51:800-810.

9. Benson JM, Nahata MC. Clinical use of systemic antifungal agents. Clin Pharm. 1988;7(6):424-438.

4 Building Exotics Excellence: One City, One Conference


Falcons, Falconry, and Waterfowl: A Novel
Pathway for Influenza Viruses
Patrick T Redig, DVM, PhD and
Carol Cardona, DVM, PhD, DACPV

Session #399

Affiliation: The Raptor Center and Department of Veterinary Population Medicine, College of Veterinary
Medicine, University of Minnesota, St. Paul, MN 55107, USA.

The recent occurrences of fatal H5N8 influenza in gyrfalcons used for hunting ducks by practitioners of the sport
of falconry highlights a heretofore unrecognized and unconsidered aspect of the epidemiology of influenza and
the pathways by which pathogenic influenza viruses may be introduced into domestic environments. Falconry,
the use of birds of prey for capturing wild quarry, is a centuries old sport, with origins dating some 4000-5000
years ago in Western China and Mesopotamia. Far from being ancient sport, it is enjoying heightened popularity
on a world-wide basis owing to advances in the ability to propagate falcons in captivity, maintain their health,
and track them in the field with telemetry, all of which have contributed to their utility and abundance. Today,
large falcons such as the arctic gyrfalcon, the globally distributed peregrine falcon, the Asiatic Saker falcon and
hybrids of these produced by artificial insemination (eg, gyrfalcon x peregrine hybrids) are employed. These
large falcons (1200- to 1600-gram birds) are used for hunting waterfowl ranging from teal to gadwalls and wi-
geon to mallards. Another hawk effective for taking mallards especially, is the goshawk. About 4,000 people in
North America are licensed to practice falconry and roughly 1/4 of them are flying these kinds of birds; others
typically fly red-tailed hawks at rabbits. Unlike other exposure pathways to influenza viruses circulating quietly
in wild waterfowl that revolve around indirect exposure to domestic poultry (eg, fecal-contaminated water and
soil), the falcons kill and consume the raw flesh of their quarry. In addition, over the course of a season, the
falconer may collect and freeze ducks which are subsequently fed out to one or several falcons that they may
have in their possession. While the gun-hunter and hunting dogs may be exposed to viruses carried by waterfowl,
the falcon pathway is unique. The recent outbreak in Washington State (December 2014) in which four falcons
died following ingestion of an infected wigeon demonstrates the importance of understanding the details and
ramifications of this type exposure.

Subsequent to this series of events, the introduced H5N8 apparently recombined and reassorted with low patho-
genicity North American H5N2 and H5N1 viruses, yielding two new high pathogenicity viruses. In late February,
2015, evidence of the HP H5N2 appeared in turkey & chicken flocks in Minnesota, Missouri, Iowa, Nebraska,
Wisconsin, and the Dakotas, leading to the death or depopulation of over 40 million birds in an unprecedented
event. Going forward, both the falconry community and the poultry industry will have to adjust to the new reality
that for the first time, there is a highly pathogenic avian influenza virus that will seriously impact their operations.
Decisions as to what those adjustments will be are included in the discussion.

ExoticsCon 2015 Main Conference Proceedings 5


Population Pharmacokinetics of Levetiracetam
and Zonisamide in the African Grey Parrot
(Psittacus erithacus)
Marike Visser, DVM, and
Dawn M Boothe, DVM, Dipl ACVCP, Dipl ACVIM, PhD, MS

Session #131

Affiliation: From Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine,
Auburn University. 1500 Wire Rd, Auburn, AL 36849, USA.

Abstract: Population pharmacokinetics of either levetiracetam (n = 8) and zonisamide (n = 7) were


determined from therapeutic drug monitoring data in epileptic African grey parrots. Mean trough
concentrations were 5.0 3.6 g/ml at 11.3 1.49 mg/kg for levetiracetam (11 1.5 hours) and
10.4 4.0 g/ml at 10.9 1.4 mg/kg for zonisamide (11 1.3 hours). Based on rate constants, disappearance
half-life (hours) was 2.3 0.029 for levetiracetam and 10.9 18 hours for zonisamide. No animal was
controlled. Individual variability necessitates monitoring.

Introduction

Seizures in avian patients occur infrequently, with possible causes including nutritional, trauma, cardiovascular
disease leading the ischemic events, neoplasia, infectious disease, toxins and idiopathic epilepsy.1,2 Treatment of
seizures with antiepileptics includes management of both acute seizures (ie, status epilepticus) as well as chronic
management that prevents or suppresses seizure activity. Common antiepileptics used in veterinary medicine
include bromide, phenobarbital, zonisamide and levetiracetam.3-5 Each has been used anecdotally in birds.1
While reports exist regarding their use for control of seizures in dogs, little information is available for birds.
Yet, half-lives of drugs are generally shorter in birds compared to other species. For example, phenobarbital is
considered the first line anticonvulsant for the treatment of epilepsy in canine patients, with an elimination half-
life that approximates 48 hours.3 However, the half-life of phenobarbital in African grey parrots is significantly
shorter at 1.43-1.66 hours requiring a shorter dosing interval or a larger dose to reach therapeutic levels.6

Zonisamide is among the newer anticonvulsants used as either a sole agent or in addition to phenobarbital for the
treatment of canine patients with refractory epilepsy. Its blocks seizure propagation by inhibiting repetitive firing
of voltage-dependent sodium channels, reducing T-type calcium channel currents, accelerating -amino butyric
acid release from the hippocampus and modulating modulation of the dopaminergic system. This drug also may
protects neurons from free oxygen radical damage. Zonisamide is renally excreted but also metabolized by the
cytochrome P450 3A4 in humans. Zonisamide does not increase hepatic enzymes indicative of liver damage,
cause hepatotoxicosis as does phenobarbital nor induce or inhibit drug metabolizing enzymes7. Current dosing
recommendations in dogs range from 5-10 mg/kg PO q12h.1

Another anticonvulsant which has gained popularity is levetiracetam (Keppra ). This drug has a short half-life
in canines necessitating an 8-hour dosing interval. However, an extended release product may prolong the dos-
ing interval to 12 hr. While the mechanism of action is not yet fully understood, levetiracetam appears to inhibit
presynaptic calcium channels, decreasing seizure propagation. Furthermore, levetiracetam binds to the synaptic
vesicle protein SV2A and may modulate the release of vesicles for exocytosis.5 Levetiracetam also undergoes

ExoticsCon 2015 Main Conference Proceedings 7


metabolism and renal excretion. However, metabolism is extrahepatic with plasma metabolism occurring in situ.
Although it is neither an inducer nor inhibitor of drug metabolizing enzymes, its metabolism may be subject to
induction by phenobarbital. A pharmacokinetic study in Hispaniola Amazon parrots (Amazona ventralis) rec-
ommended a dosing interval of 50 mg/kg PO q8h or 100 mg/kg PO q12h to maintain therapeutic drug levels.8

Therapeutic drug monitoring (TDM) has been utilized in human and veterinary medicine for the monitoring of a
wide variety of pharmacological agents. Measuring of antiepileptics is most important for establishing an effec-
tive therapeutic plasma drug concentration for an individual patient. However, TDM also is useful for identifying
possible toxicities, asses owner compliance, detect the sequela of drug interactions, and help guide alterations
in the dose to provide an individualized approach.9 Utilizing two time points, namely the peak (meaning,
the higher of the two concentrations, collected at 2-4 hours) and the trough (meaning the lower of the two
concentrations, ideally collected just before the next dose), the individual patients half-life can be calculated.

TDM allows the tailoring of any dose to the patient individual therapeutic dose as well as detect sudden changes
in drug concentrations which could be due to alterations in metabolism, excretion or interaction with additional
medications. TDM also allows for the identification of covariates such as gender, breed, weight, and additional
medications within a populations which could alter the efficacy of the drug being monitored. These covariates
can be identified through the use of population pharmacokinetics (PPK), which can utilize sparse data points
to calculate constants such as absorption constant (ka) and elimination (kel) and in turn utilized to calculate
population elimination half-life. In small populations in which very few samples can be collected, PPK can offer
guidelines on which larger studies can be based.10

Utilizing TDM information in African grey parrots for both zonisamide and levetiracetam, the half-life based on
the elimination constant was calculated. The short half-life combined with the lack of response, necessitates the
need for individual therapeutic drug monitoring to determine effect plasma drug concentrations as well as moni-
tor for any changes which could be due to poor drug formulation, disease states or a lack in owner compliance.

Methods

Sample collection and quantification

All TDM samples for levetiracetam (n = 8) and zonisamide (n = 7) submitted for African grey parrots from
2010-2014 were included in the analysis. Most samples included a peak sample (2-4 hours post dose) and a trough
sample (8-12 hours). Additional information included the dose, dosing interval, age of the patient, any additional
medications and whether the patient was controlled on the reported dose (Table 1). Plasma drug concentration
was measured via ARK diagnostic immunoassay (Ark Diagnostics Inc., Fremont, CA) for both levetiracetam
and zonisamide utilizing Siemens Dimension Xpand (Siemens Healthcare, Federal Republic of Germany).

Table Table 1. Dosing,


1. Dosing, age
age and and half-life
half-life rangesranges reported.
reported.

Dose ranges (mg/kg) Age (y) Half-life ranges (h)


Zonisamide (n = 7) 19.8-80 8-19 5.8-66.4
Levetiracetam (n = 8) 5.4-190 2-13 1.6-3.5

8 Building Exotics Excellence: One City, One Conference


Data analysis

Population pharmacokinetics was performed utilizing a Model Phoenix WinNonLin . For zonisamide and
levetiracetam, initial parameters were estimated and the best model selected based on the Akaike Information
Criteria as well as the Bayesian Model. Using the bootstrap technique, the bias and precision of the selected
population pharmacokinetic model were examined, with 1000 bootstrap datasets selected and the elimination
constant (tvKe) calculated. This could then be applied to , allowing for the calculation of a population half-life.

t1/2= 0.693/
where =ln (Cpeak)-ln(Ctrough)/(t2-t1)

Results

None of the patients were reported to be controlled on any reported dose of either levetiracetam or zonisamide.
Mean trough concentrations were 5.0 3.6 g/ml at 11.3 1.49 mg/kg for levetiracetam (11 1.5 hours) and
10.4 4.0 g/ml at 10.9 1.4 mg/kg for zonisamide (11 1.3 hours). Based on rate constants (kel), disappear-
ance half-life (hours) was 2.3 0.029 for levetiracetam and 10.9 18 hours for zonisamide.

Discussion

Based upon the results of therapeutic drug monitoring, we were able to report a population half-life for both
zonisamide and levetiracetam in African grey parrots. As is reported in canines, felines as well as Amazon par-
rots, the half-life of levetiracetam is very short and likely requires three times daily dosing.8 The half-life for
zonisamide may allow for twice daily dosing, however due to the large variation seen, individual therapeutic
drug monitoring to determine the half-life is recommended. Therapeutic drug monitoring can allow the vet-
erinarian to determine the appropriate therapeutic interval for their individual patient and can be utilized to
determine whether changes in therapeutic drug levels may be the cause for break through seizures. This study is
very limited in scope due to the small sample size for both zonisamide and levetiracetam as well as the sparse
data collection points. Additional research regarding the IV and oral pharmacokinetics are warranted in order
to improve seizure management.

References

1. Delk K. Clinical management of seizures in avian patients. J Exot Pet Med. 2012;21:2.

2. Beaufrere H, et al. Diagnosis of presumed acute ischemic stroke and associated seizure management in a
Congo African grey parrot. J Am Vet Med Assoc. 2011;239(1):122-128.

3. Boothe DM, Dewey C, Carpenter DM. Comparison of phenobarbital with bromide as a first-choice anti-
epileptic drug for treatment of epilepsy in dogs. J Am Vet Med Assoc. 2012;240(9):1073-1083.

4. Dewey, CW, et al. Zonisamide therapy for refractory idiopathic epilepsy in dogs. J Am Anim Hosp Assoc.
2004;40(4):285-291.

ExoticsCon 2015 Main Conference Proceedings 9


5. Surges R, Volynski KE, Walker MC. Is levetiracetam different from other antiepileptic drugs? Levetiracetam
and its cellular mechanism of action in epilepsy revisited. Ther Adv Neurol Disord. 2008;1(1):13-24.

6. Powers LV, Papich MG. Pharmacokinetics of orally administered phenobarbital in African grey parrots
(Psittacus erithacus erithacus). J Vet Pharmacol Ther. 2011;34:615-617.

7. Leppik IE. Zonsamide: chemistry, mechanism of action, and pharmacokinetics. Seizure. 2004; 13S:S5-S9.

8. Schnellbacher R, et al. Pharmacokinetics of levetiracetam in healthy Hispaniolan Amazon parrots (Amazona


ventralis) after oral administration of a single dose. J Avian Med Surg. 2014;28(3):193-200.

9. Patsalos P, et al. Antiepileptic drugsbest practice guidelines for therapeutic drug monitoring: A position
paper by the Subcommission on Therapeutic Drug Monitoring, ILAE Commission on Therapeutic Strate-
gies. Epilepsia. 2008;49(7):1239-1276.

10. Ette EI, Williams PJ, Lane JR. Population pharmacokinetics III: Design, analysis, and application of popu-
lation pharmacokinetics studies. Ann Pharmacother. 2004;38:2136-2144.

10 Building Exotics Excellence: One City, One Conference


Section 2

AAV Hot Topics

Cheryl Greenacre, DVM, DABVP (Avian),


DABVP (Exotic Companion Mammal)
AAV President
Moderator
Evaluation of the Thermal Antinociceptive Effects
and Pharmacokinetics of a Sustained-release
Buprenorphine Formulation in American Kestrels
(Falco sparverius)
David Sanchez-Migallon Guzman, LV, MS, Dipl ECZM (Avian), Dipl (Small Mammal),
Dipl ACZM,
Heather Knych, DVM, PhD, Dipl ACVCP;
Glenn Olsen, DVM, PhD,
Susanne M. Ceulemans DVM, MSc,
Hugues Beaufrere, Dr Med Vet, PhD, DABVP (Avian), Dipl ECZM (Avian), Dipl ACZM, and
Joanne Paul-Murphy, DVM, Dipl ACZM, Dipl ACAW

Session #135

Affiliation: From the Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine
(Guzman, Ceulemans, Paul-Murphy), KL Maddy Equine Analytical Chemistry Laboratory (Knych)
University of California-Davis, Davis, CA 95616, USA; USGS Patuxent Wildlife Research Center 12100
Beech Forest Rd. Laurel, MD 20708, USA (Olsen); Health Sciences Center, Ontario Veterinary College,
University of Guelph, Guelph, N1G 2W1, ON, Canada (Beaufrere).

Buprenorphine hydrochloride is recomended for pain management in American kestrels (Falco sparvarius) based
on recent thermal nociception and pharmacokinetic studies.1,2 The current study evaluated a sustained-release
buprenorphine formulation (Bup-SRTM ZooPharm, Fort Collins, CO 80550 USA) in American kestrels (n = 12).
A masked randomized complete crossover study using foot withdrawal threshold to a noxious thermal stimulus
was used to evaluate antinociceptive effects and duration of action of Bup-SR. Baseline thermal withdrawal
threshold data were generated prior to drug administration, followed by foot withdrawal threshold measurements
at 1.5, 6, 12, 24, 48, and 72 hours after intramuscular administration of Bup-SR (1.8 mg/kg) or control vehicle.
Kestrels were assigned an agitation-sedation score and monitored throughout the testing period for adverse effects.
Bup-SR caused a significant dose dependent thermal antinociceptive response in American kestrels for 12-24
hours. The increase in mean withdrawal threshold was suggestive of analgesia. The pharmacokinetic parameters
of Bup-SR (1.8 mg/kg) were compared following IM and SQ administration in American kestrels (n = 12) using
a complete crossover design. Multiple blood samples were collected over 72 hours following administration.
The plasma concentrations were determined by LC-MS, and nave pooling of data was used to generate a mean
plasma concentration at each time point. Mean plasma concentrations were 2.02 and 1.01 ng/mL at 48 hours
following IM and SQ administration respectively.

Disclosure Statement: This study was supported by the American Association of Zoo Veterinarians research fund.

References

1. Gustavsen KA, Guzman DS, Knych HK, et al. Pharmacokinetics of buprenorphine hydrochloride follow-
ing intramuscular and intravenous administration to American kestrels (Falco sparverius). Am J Vet Res.
2014;75:711-715.

ExoticsCon 2015 Main Conference Proceedings 13


2. Ceulemans SM, Guzman DS, Olsen GH, et al. Evaluation of thermal antinociceptive effects after intra-
muscular administration of buprenorphine hydrochloride to American kestrels (Falco sparverius). Am J
Vet Res. 2014;75:705-710.

14 Building Exotics Excellence: One City, One Conference


Aspergillus pseudoviridinutans: A Novel Cause
of Psittacine Aspergillosis
Isabelle Langlois, DVM, DABVP (Avian),
Serge Messier, DVM, MSc, PhD, Dipl ACVM,
Vanessa Barrs, BVSc(hons), PhD, MVetClinStud MANZCVSc (Small Animal),
FANZCVSc (Feline), GradCertEd,
Philippe Dufresne, PhD, McbA, RMCCM

Session #086

Affiliation: From the Department of Clinical Sciences (Langlois) and Pathology and Microbiology
(Messier), Universit de Montral, Faculty of Veterinary Medicine, 3200 Sicotte St, Saint-Hyacinthe, QC
J2S 7C6, Canada, and the Department of Small Animal Medicine, The University of Sydney, Faculty of
Veterinary Science, NSW, Australia, 2006 (Barrs), and Laboratoire de sant publique du Qubec (LSPQ),
20045 chemin Sainte-Marie, Sainte-Anne-de-Bellevue, Qc, H9X 3R5, Canada (Dufresne).

A 15-year-old orange-winged Amazon parrot (Amazona amazonica) was referred for a 6-month history of a slowly
developing swelling involving the right nostril. The bird had recurrent right rhinitis that had been managed with
various topical and systemic antibiotics. Abnormal physical exam findings included blunted choanal papilla and
a mild firm swelling at the dorsolateral aspect of the right nostril with no nasal discharge. Complete blood count
and serum plasma biochemistry were unremarkable. Tomodensitometric examination showed mild deformation
of the right naris and nasal conchae without distinct granuloma. Right nasal flush was performed for cytological
evaluation and culture (bacterial, fungal). Cytological evaluation was within normal limits. Bacterial culture
revealed opportunistic infection with an Enterobacteriacae species. A probable cryptic species in Aspergillus
section Fumigati and Penicillium species were initially identified on fungal culture. Further characterisation of
the fungal isolate by PCR amplification and comparative sequence analysis of the partial -tubulin (benA) and
calmodulin (caM) genes revealed that the Aspergillus isolate was Aspergillus pseudoviridinutans, in the Asper-
gillus viridinutans complex. Successful treatment involved the use of topical clotrimazole used in combination
with systemic antifungals (itraconazole, terbinafine). There has been no recurrence following discontinuation
of treatment. This is the first report of A. pseudoviridinutans infection reported in a bird. Species within the
Aspergillus viridinutans complex are being increasingly recognised as pathogens of animals and humans. These
fungi are typically more resistant to antifungal drugs than Aspergillus fumigatus.

ExoticsCon 2015 Main Conference Proceedings 15


Safety and Efficacy Trials of Copper Oxide Wire
Particles and Sericea lespedeza in a Research
Population of Ring-Necked Doves and a Captive
Population of Green-Winged Doves
Samantha Altemus, BS,
Jenna Terry, BS,
Thomas N Tully, Jr, DVM, MS, DABVP (Avian), Dipl ECZM (Avian),
Deidre Fontenot, DVM,
Joao Brandao, LV, MS,
Victoria Kelly, BS,
James Miller, DVM, PhD

Session #243

Affiliation: Louisiana State University, School of Veterinary Medicine, Department of Pathobiological


Sciences (Altemus, Terry, Kelly, Miller) and Department Veterinary Clinical Sciences (Tully, Brandao),
Skip Bertman Dr, Baton Rouge, LA 70803, USA and Disneys Animals, Science and Environment Dept.
of Animal Health, Disneys Animal Kingdom, Bay Lake, FL 32830, USA (Fontenot).

Abstract: A captive green-winged dove (GWD) (Chalcophaps indica) population regularly tests positive
using fecal examinations for Dispharynx nasuta. This research investigation examined the safety and efficacy
of Sericea lespedeza (SL) and/or copper oxide wire particles (COWP) as biological antiparasitic alternatives to
treat D. nasuta. A 2-stage study was conducted: a safety trial in ring-necked doves (RND) and an efcacy trial in
GWD. The safety trial involved treating 20, equally divided, clinically normal RND (Streptopelia capicola) into
4 groups: 1) 15 mg COWP, 2) 30 mg COWP, 3) 50% diet of ground SL seeds, and 4) a control group. Weekly
fecal samples, pre- and post-treatment (tx) blood samples (complete blood count/plasma chemistry panel, bile
acids/serum copper), and post-treatment liver biopsies were collected from each bird. The 30-mg dose of COWP
and SL were not considered viable treatment options after the safety trial. In a 13-bird efcacy trial, a single
treatment dose of 15 mg COWP was gavaged into the crop of 7 infected GWD. Pre and post treatment blood
samples (CBC/plasma chemistry panel/bile acids/serum copper), physical examinations, weights, and body
condition scores were evaluated in this trial. Daily fecal samples were examined via direct smear to determine
egg count per gram (EPG) of feces to evaluate the effectiveness of COWP. Since shedding was not eliminated
from the treatment group, it can be concluded that there was no clinical signicance between the 15-mg dose of
COWP treatment and control groups in reducing D nasuta infections in the GWD studied.

ExoticsCon 2015 Main Conference Proceedings 17


Rheological Properties of a Sustained-release
Formulation of Butorphanol in a Poloxamer 407
Base and Pharmacokinetics in Amazon Parrots
(Amazona ventralis)
Delphine Laniesse, DVM,
David Sanchez-Migallon Guzman, LV, MS, Dipl ECZM (Avian),
Dipl ECZM (Small Mammal), Dipl ACZM,
Dale Smith, DVM, DVSc,
Heather Knych, DVM, PhD, Dipl ACVCP,
Cornelia Mosley, DVM, Dipl ACVA,
Joanne Paul-Murphy, DVM, Dipl ACZM, Dipl ACAW,
Hugues Beaufrre, DVM, PhD, Dipl ACZM, Dipl ECZM (Avian), DABVP (Avian)

Session #154/156

Affiliation: From the Health Sciences Center, Ontario Veterinary College, University of Guelph, Guelph,
N1G 2W1, ON, Canada (Laniesse, Smith, Mosley, Beaufrere), and Department of Veterinary Medicine
and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616,
USA (Guzman, Knych, Paul-Murphy).

Butorphanol is a kappa-agonist, mu-antagonist opioid drug used routinely for pain management in psittacine
birds. However, the short 1- to 3-hour period of antinociception demonstrated in Amazon parrots limits its clini-
cal application.1,2 Moreover, butorphanol is usually administered parenterally SQ, IM or IV as a continuous
rate infusion, due to its low oral bioavailability.2 Repeated handling is stressful to birds, multiple injections may
induce pain, and IV catheter placement might not be feasible in some situations, hence the need for a sustained-
release kappa-agonist opioid analgesic in psittacine birds. Poloxamer 407 (P407, Sigma-Aldrich) hydrogel has
reverse gelation properties and functions as a sustained release drug carrier.3 The rheological properties of P407
and P407-butorphanol were determined over a range of temperatures. Butorphanol did not significantly alter the
viscosity of the hydrogel, and all formulations were in gel form at avian body temperature (39-41C). Steriliza-
tion of the gel using 0.22-m filter units did not significantly alter its viscosity. Pharmacokinetic parameters of a
dosage of 15 mg/kg butorphanol tartrate in 25% P407 administered SQ were evaluated in 8 Hispaniolan Amazon
parrots. Dosage and P407 concentration were based on the results of a series of pilot studies. Blood samples
were collected before injection, and at 0.08, 0.5, 1, 2, 4, 8 and 12 hours following drug administration. Plasma
butorphanol concentrations were measured using high-performance liquid chromatography-mass spectrometry.
Preliminary results indicate that plasma concentrations of butorphanol considered therapeutic can be reached,
and that the half-life of P407-butorphanol is longer than that of butorphanol tartrate.

References

1. Sladky KK, Krugner-Higby L, Meek-Walker E, Heath TD, Paul-Murphy J. Serum concentrations and
analgesic effects of liposome-encapsulated and standard butorphanol tartrate in parrots. Am J Vet Res.
2006;67(5):775-781.

ExoticsCon 2015 Main Conference Proceedings 19


2. Sanchez-Migallon Guzman D, Flammer K, Paul-Murphy JR, Barker SAJ, Tully TN. Pharmacokinetics
of butorphanol after intravenous, intramuscular, and oral administration in Hispaniolan Amazon parrots
(Amazona ventralis). J Avian Med Surg. 2011;25(3):185-191.

3. Dumortier G, Grossiord JL, Agnely F, Chaumeil JC. A review of poloxamer 407 pharmaceutical and phar-
macological characteristics. Pharm Res. 2006;23(12):2709-2728.

20 Building Exotics Excellence: One City, One Conference


Beating the Heat the Australian Way
Shangzhe Xie, BSc/BVMS, MVS (Conservation Medicine), and
Todd J. McWhorter, BSc, MSc, PhD

Session #328

Affiliation: From the School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy
Campus, Roseworthy, South Australia 5371, Australia.

Abstract: Desert birds have adaptations that allow them to survive in arid environments, but these are
being challenged as temperatures continue to rise. Our research revealed differences amongst Australian
birds belonging to the orders Psittaciformes, Passeriformes and Columbiformes in theirphysiologic and
behavioural adaptations to heat. These results can help us to better predict how individual avian species
will respond to heat and prioritize conservation efforts in the face of climate change.

Australian birds are under increasing threat from the effects of climate change and extreme events like heat
waves. As temperatures continue to rise with climate change, sensitive taxa of birds will be challenged.1

In our first physiologic study, we measured the critica thermal maxima (CTM) of different species of Australian
desert birds using metabolic chambers. The birds belonging to the order Psittaciformes n = 27) in the study had
CTMs between 50-54oC; Passeriformes (n = 81) between 46-50oC; Columbiformes (n = 39) between 58-60oC;
and Caprimulgiformes (n = 23) between 50-52oC.

In another study, Australian desert birds representing the orders Psittaciformes (budgerigars), Passeriformes
(zebra finches) and Columbiformes (diamond doves), were exposed to temperatures of 33oC and 42oC for 2
hours sequentially in a random order 1-2 weeks apart to measure their stress responses. Interestingly, diamond
doves had a higher corticosterone response, even though they have a higher CTM.

Our behavioural observations of birds at the Adelaide Zoo also revealed that columbiforme birds did not modify
their behaviours (eg, spend more time at rest or in shade) as much as psittacine birds and passerine birds. Focal
observations of these birds were performed 15 minutes at a time and recorded using an iPhone app, Animal
Behaviour Pro.

Understanding the different adaptations birds utilize to beat the heat will allow us to better predict how individual
species will respond (both on the individual level, i.e. susceptibility to heat stress, and at the species distribution
and biodiversity level), and help us prioritize conservation efforts.

Acknowledgments: We thank the Holsworth Wildlife Research Endowment and BirdLife Australias Stuart Leslie
Bird Research Award for providing funds for the research project, as well as Erin Turrell and Krista Winter for
their help in the collection and analysis of the data.

ExoticsCon 2015 Main Conference Proceedings 21


References

1. Garnett, ST, Franklin, DC, Ehmke, G, VanDerWal, JJ, Hodgson, L, Pavey, C, Reside, AE, Welbergen, JA,
Butchart, SHM, Perkins, GC, Williams, SE. Climate change adaptation strategies for Australian birds.
National Climate Change Adaptation Research Facility, Gold Coast. 2013;109.

22 Building Exotics Excellence: One City, One Conference


Testing Bird Hearing: Auditory Brainstem Responses
of Diving Birds
Glenn H Olsen, DVM, MS, PhD,
Sara E Crowell, MS, PhD,
Alicia M Wells-Berlin, MS, PhD

Session #171

Affiliation: From the USGS Patuxent Wildlife Research Center, 12100 Beech Forest Rd, Laurel, MD
20708, USA (Olsen, Crowell, Wells-Berlin) and the University of Maryland, College Park, MD 20742,
USA (Crowell).

Hearing has been measured only in about 50 avian species and only in black-footed penguins (Spheniscus de-
mersus)1 and mallards (Anas platyrhynchos)2 among aquatic species. The auditory brainstem response (ABR)
is a scalp-recorded potential using needle electrodes that results from the synchronized neural discharges and is
observed as a series of 4 or more waves within 10 minutes of stimulation.3,4

We tested 10 species of diving birds with 3-10 individuals per species. All birds were sedated with isoflurane by
mask and then intubated prior to testing. Needle electrodes were inserted under the skin and the bird positioned
in sternal recumbancy with the right ear opening 20 cm from the speaker. Stimuli were tone bursts of 5 minutes
duration with 20 minutes interstimulus intervals and ranged from 500 to 5700 Hz and 30-90 dB.

All species had similar U-shaped audiograms with peak sensitivities between 1000-3000 Hz. Northern gannets
(Morus bassanus) and red-throated loons (Gavia stellate) had the highest average thresholds, while lesser scaup
(Aythya affinis) and ruddy ducks (Oxyura jamaicensis) had the lowest thresholds. Indeed, the hearing thresholds
of the 8 duck species tested were more similar to each other than to the 2 non-duck species (northern gannets and
red-throated loons). For the birds whose hearing we tested with ABRs, their peak frequency of vocalizations fell
within the 1000-3000 Hz bandwidth of their most sensitive hearing, except for the common eiders (Somateria
mollisima). Common eider vocalization of 443 Hz did not match the area of most sensitive hearing of 2400 Hz
on the ABRs. This mismatch could be related to the need to hear higher frequency calls of duckling vocalizations
or to some other environmental or behavioral cues.

References

1. Wever EG, Herman PN, Simmons JA, Hertzler DR. Hearing in the blackfooted penguin, Spheniscus de-
merus, as represented by the cochlear potentials. P Natl Acad Sci USA. 1969;63:676-680.

2. Trainer JE. The auditory acuity of certain birds. Doctoral dissertation, Cornell University. In: Fay RR, ed.
Hearing in Vertebrates: A Psychological Databook. Winnetka, IL: Hill-Fay Associates;1988.

3. Hall JW. Handbook of Auditory Evoked Responses. Boston, MA: Allyn & Bacon;1992.

4. Brittan-Powell EF, Dooling RJ, Gleich O. Auditory brainstem responses in adult budgerigars (Melopsittacus
undulates). J Acoust Soc Am. 2002;112(3):999-1008.

ExoticsCon 2015 Main Conference Proceedings 23


Radiographic Evaluation of the Thoracic Girdle in
Raptors Using a Novel Caudoventral 45 Craniodorsal
Radiographic View
Adrien-Maxence Hespel, DVM,
Marike Visser, DVM,
Marie de Swarte, DVM, Dipl ECVDI,
Jamie R. Bellah, DVM, Dipl ACVS

Session #224

Affiliation: From the Departments of Anatomy, Physiology and Pharmacology (Visser) and Clinical
Sciences (Hespel, Bellah), College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA
and the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University
of Tennessee, Knoxville, TN 37901, USA (de Swarte).

Pectoral/thoracic girdle (TG) fractures are a common finding in raptors that have experienced a frontal impact.
The TG is made of the scapula, coracoid and clavicle. A fracture is usually diagnosed by the history of trauma, the
physical exam and x-rays. We hypothesized that by acquiring a novel caudoventral 45 craniodorsal view (H-view)
in addition to the ventro-dorsal view (VD-view) we would improve our examination of the TG. The 24 patients
constituting our study population were raptors presented a to a raptor rehabilitation center for suspected trauma
and inability to fly. After anonymization of all the radiographic images they were reviewed and classified as either
radiographically normal or showing signs of fracture of any bones of the TG. The sensitivity (Se), specificity
(Sp) positive predictive value (Ppv), negative predictive value (Npv) were calculated for each projection and for
their combination. Using a two-tailed Fishers exact test statistical significant differences were found between
Se and Npv of the VD vs. H-view; between the Sp and Ppv of the VD vs. the combination of the two views; and
between the Se, Sp, Ppv and Npv of the H-view vs. the combination of the two views (Table 1). By tilting the
radiographic tube at 45, superimposition of the scapula, clavicle, and coracoid is avoided. A combination of the
VD and H-view was able to significantly improve the Sp, as fractures of the TG was occasionally only visible in
one or the other projections. We therefore recommend using this view in combination with the classic VD-view.

Table
Table1.1.Summary
Summaryof
ofthe
theresults
resultsand
andtheir
theirstatistical
statisticalsignificance.
significance.

Specificity Sensitivity Negative Positive


(xa, yb, zc) (x, z) predictive value predictive value
(x, y, z) (x, y, z)
VD-view 83.35% 85.71% 66.67% 93.33%
H-view 88.24% 100% 77.78% 100%
Combinations of both views 100% 90% 100% 93.33%
a
x: parameters statistically different between the VD and H-view.
b
y: parameters statistically different between the VD-view and combination of both views.
c
z: parameters statistically different between the H-view and combination of both views.

ExoticsCon 2015 Main Conference Proceedings 25


Evaluation of Treatment for Severed Blood Feathers
in Chickens (Gallus gallus)
Michelle C Whitehead, DVM, BSc,
Kenneth R Welle, DVM, DABVP (Avian),
Matthew C Allender, DVM, MS, PhD, Dipl ACZM,
Adam W Stern, DVM, CMI-IV, CFC, Dipl ACVP

Session #163

Affiliation: From the Department of Veterinary Clinical Medicine, College of Veterinary Medicine,
University of Illinois, 1008 West Hazelwood Drive, Urbana, IL 61802, USA (Whitehead, Welle) and
Department of Comparative Biosciences (Allender) and Veterinary Diagnostic Laboratory (Stern), College
of Veterinary Medicine, University of Illinois, 2001 South Lincoln Avenue, Urbana, IL 61802, USA.

Introduction

Pet birds are commonly presented on emergency hemorrhaging from broken blood feathers. We hypothesized that
there would be a significant difference in clotting time and packed cell volume (PCV) in broken blood feathers
managed by manual pressure (MP) and/or feather removal (FR) compared to no treatment.

Materials and Methods

Thirty 2-week-old male color sex-linked chickens (Gallus gallus) were randomly assigned into the three groups:
1) control, 2) manual pressure (MP), and 3) feather removal (FR). Jugular venipuncture was performed for PCV
at 4 timepoints (pre-treatment, 1 hour, 1 day and 7 days) following cutting of the left seventh primary remex.
Postmortem histopathologic evaluation was then performed on the follicular sites.

Results

Minimal bleeding (estimated <0.03 ml) was observed at the cut feather site regardless of treatment. Clotting
times were significantly longer in control birds than FR and MP birds. The PCV trends were all similar, with the
lowest value at one day post-treatment. However, the control birds had higher PCVs at all timepoints. Twenty
percent of FR birds showed hyperkeratosis, but no other histopathologic changes were observed in any bird.

Discussion

The decreasing trend in PCV appears to correspond with venipuncture sampling rather than treatment approach.
MP treatment revealed the shortest clotting time post-treatment, although it required three minutes of handling. FR
appeared to be least tolerated owing to strong vocalizations (100%) during extraction and increased wing pecking
post extraction (60% FR vs 10% MP vs 10% control). Therapeutic efficacy cannot be definitively determined and
future research with an adjusted model is warranted.

ExoticsCon 2015 Main Conference Proceedings 27


Student Manuscript Winner: Comparison of Various
Avian Euthanasia Methods
Nicholas W Kirk,
Cheryl Greenacre, DVM, DABVP (Avian), DABVP (Exotic Companion Mammal),
Brynn McCleery, DVM, DABVP (Avian)

Session #402

Affiliation: From the College of Veterinary Medicine, University of Tennessee, 2407 River Dr, Knoxville,
TN 37996 USA.

Non-releasable wild birds that were scheduled to be euthanized were anesthetized with isofluorane and then
euthanized by 1 of 6 different methods: 1) IV pentobarbital (PB) (1 ml/kg), 2) IV KCl (2.4-15.38 mEq/kg),
3) decapitation (D), 4) cervical dislocation (CD), 5) exsanguination (E), or 6) thoracic compression (TC).
Cessation of heart rate by Doppler, cardiac electrical activity by ECG, and respiratory rate were determined as
end points of life. This pilot study is based on n = 3 (CD, E, TC), n = 4 (D), n = 5 (KCl), and n = 6 (PB). Mean
cessation of respirations occurred at 0 seconds (D, TC), 17.5 seconds (E), 16 seconds (PB), 28 seconds (KCl), and
1 minute 23 seconds (CD). Mean cessation of Doppler sounds occurred at 22.5 seconds (PB), 59 seconds (KCl),
2 minutes 37 seconds (E), 5 minutes 27 seconds (D), 12 minutes 13.5 seconds (TC), and 24 minutes 3 seconds
(CD). Mean cessation of ECG measured consistent QRS complexes occurred at 52 seconds (E), 63 seconds
(CD), 74.98 seconds (PB), 108.25 seconds (KCl), 280.75 seconds (D), and 242 seconds (TC). TC ceased heart
rate and respiratory rate immediately, but heart beats came back in select cases. The purpose of the study was to
examine and compare these six euthanasia methods. The results showed that there was an array of differences
within and among methods tested.

ExoticsCon 2015 Main Conference Proceedings 29


Section 3

AAV Technician
Track

Jill Murray, RVT, RLATG, VTS, AVTCP


(Exotic Companion Animals)
Moderator
Bandaging and Wound Management in
Exotic Animals
Jill K Murray, RVT, RLATG, VTS, AVTCP (Exotic Companion Animals)

Session #267

Affiliation: From the Center for Veterinary Health Sciences, Oklahoma State University, College of
Veterinary Medicine, Stillwater, OK 74078-2041, USA.

Abstract: Traumatic and post surgical wounds can present many additional challenges in the exotic patient.
Creativity and flexibility while adhering to the basic principles of wound management and bandaging are
vital to a successful outcome when working with exotic animals.

Introduction

The goal of wound management is to take a clean, contaminated and/or unhealthy wound and develop a clean,
healthy granulation tissue bed that can be surgically closed or allowed to heal by second intention. The approach
to wound management is individualized and must encompass many factors including the type and severity of
the wound, degree of contamination, wound location, patient, and client.1

Wound management begins with patient assessment and stabilization. Any life-threatening injuries should be
addressed first. Following which, during stabilization, the wounds should be covered with a temporary protective
bandage to prevent further contamination, control hemostasis, and reduce pain. Once the patient is stabilized, a
comprehensive wound management approach can begin.1

Exotic animals pose many additional challenges in wound management and bandaging. Small patient size,
anatomy, locomotion, external coverings, environment, and physiologic needs challenge the veterinary teams
creativity. Additionally, the high stress level of most exotic patients may result in a negative response to continued
handling and pain, especially when in a debilitated state. These factors must also be considered in the develop-
ment and execution of a treatment and management plan for the exotic animal patient.

Wound Assessment

Wounds may present as surgical incisions, abrasions, penetrating lacerations, burns, degloving/shearing injuries,
crushing injuries and open fractures. Wounds may be classified as clean, clean-contaminated, contaminated or dirty/
infected based on their degree and duration of contamination.1,2 Surgical wounds that are created under aseptic
procedures are clean, whereas surgical wounds that involve contaminated organ systems (i.e. gastrointestinal or
respiratory tract) would be classified as clean-contaminated.2 An older wound will have a higher degree of bacterial
contamination, compared to a fresh or clean wound. Contaminated and dirty or infected wounds have the gross
appearance of debris, are aged (> 6-12 hours) and in the case of surgery may involve traumatic wounds.2 Clean
and clean-contaminated wounds are often managed with primary surgical closure following debridement, while
contaminated and dirty wounds often require medical management before surgical closure may be considered.
Surgical closure may be immediate or delayed depending on contamination and tissue damage. When surgical
closure is not possible, or other factors prevent surgical closure (finances, patients condition, or lack of healthy

ExoticsCon 2015 Main Conference Proceedings 33


tissues) the wound may be allowed to heal by second-intention through epithelialization and contraction of the
surrounding tissues. Second-intention healing will increase wound management time and risks of infection but
with proper and diligent management can be a viable management option.

Wound assessment must also include evaluating the integrity of the surrounding tissue, and supporting skin,
nerves, skeletal structures, and muscle.2 Damage to these vital structures will influence the approach to wound
management. The type of injury and the extent of tissue damage may not be fully apparent until 12-24 hours, or
even days after the inciting injury.2 Devitalized tissue as a result of vascular injury or compromise may not be
immediately apparent, and surgical repair should be delayed until healthy tissue is identified. Open orthopedic
fractures should be stabilized until a clean wound bed can be established to prevent deep tissue and bone infec-
tions following repair. Damaged tendons, nerves and ligaments should be addressed as soon as possible following
patient stabilization to improve chances of functionality and reduce the risks of contracture.2

Ideally, patients with traumatic wounds are immediately assessed and treatment begins shortly after the inciting
injury. All too often, this is not the case as owners may try to manage the wounds at home, the animals may not
show immediate evidence of injury, or in the case of wild animals they do not present until the wound renders them
too weak, allowing for human intervention. Thus, wildlife patients often present with traumatic wounds that are
old and locally infected, increasing their susceptibility to systemic infection. Having been injured and unable to
locate food or shelter for an extended period of time, these animals are often in an advanced state of debilitation.

In the case of companion animals, knowledge of the inciting cause of the wound (ie, bite), circumstances of
injury, and its duration are extremely helpful in the development of a treatment plan. Additionally, pets that are
used to being handled by the owners are less likely to experience the negative impact of management and treat-
ments compared to those with little human interaction.

Therapy

The use of systemic antimicrobials and analgesia should be considered where appropriate. Ideally, antimicrobial
therapy is based on the results of culture and sensitivity. Culture samples should be collected immediately fol-
lowing initial debridement and removal of gross debris. These samples contain a more representative sample of
the bacterial population at the level of the healthy tissue.2 Pending the results of bacterial culture and sensitiv-
ity, a broad-spectrum antibiotic may be selected for therapy. The use of a non-steroidal anti-inflammatory and/
or analgesic medication should also be considered. Pain and stress in exotic animals will negatively affect a
patient which may result in self-induced wound trauma (licking, chewing, scratching), anorexia, and subsequent
gastrointestinal distress that can further complicate patient management.

Most exotic animal patients will require sedation or general anesthesia to facilitate aseptic wound exploration and
treatment, preventing secondary and nosocomial infections. Clipping or plucking the hair or feathers around the
wound allows for better wound assessment, visualization, and reduced contamination1,2; however, shaving and
plucking will decrease the patients natural insulation (a concern in exotic species), and can delay their release
(wildlife). Application of sterile lubricant into the open wound is advised to decrease further contamination with
clipping and plucking.2 Antiseptic cleaners are used to clean the skin surrounding the wound, beginning at the
wound edges and moving circumferentially away from the wound. Resist scrubbing the wound as it is painful
and causes further tissue damage. Antiseptic agents suitable for wound cleansing include dilute chlorhexidine
solution or dilute povidone-iodine solution.2,3 Active lavage to remove gross debris and antiseptic residue should
follow, although caution should be used when cleansing open fracture wounds in avian species due to the presence
of pneumatic bones and their direct connection to the respiratory tract. Lavage pressures of 8-10 psi or greater

34 Building Exotics Excellence: One City, One Conference


are needed to remove bacteria and contaminants from the tissue surface. This may be accomplished through
the use of a syringe with an attached 18g needle for smaller wounds, or a three-way stopcock, syringe and 18g
needle attached to a bag and fluid line set-up containing flush solution.1,3 Sterile saline is preferable to tap water
for lavage and wound cleaning as tap water can further damage cells with its alkaline pH and trace elements.2

Chlorhexidine (2% stock solution) has a broad spectrum of antibacterial activity and works well in the presence
of organic debris (dirty wounds). Chlorhexidine must be diluted to a 0.05% solution to prevent cellular damage.2
This can be done by adding one part chlorhexidine to 40 parts sterile saline or sterile water.1 Povidone-iodine
(10% stock solution) has good antimicrobial, antifungal, antiviral, and antiprotozoal activity, but will breakdown
and lose efficacy with organic debris, and therefore is more effective in clean wounds.2 Povidone-iodine must also
be diluted to 1% to reduce cellular damage by adding one part iodine to nine parts sterile water or sterile saline.

Following wound cleaning, further wound debridement may be indicated to remove dead, diseased, infected,
and damaged tissue. Without appropriate debridement, wound healing is hindered and secondary infection may
ensue. Debridement may be achieved through lavage, sharp debridement (using scalpel blade or scissors), or
mechanical debridement (bandages) techniques. Selection of the method for wound debridement will take into
consideration multiple factors and may not be accomplished immediately (mechanical debridement).

Bandages

Bandages play a vital role in wound management. Exposed wounds are more painful, pruritic, inflamed, and
likely to scar. The ideal bandage will protect the wound from the environment, contamination, and mechanical
forces, will absorb wound exudates, provide support and comfort, and provide an environment that promotes
wound healing.4,5

There are many types of bandages. The selection of a bandage will depend upon the injury, purpose of the ban-
dage, species, age of animal, and circumstances. Bandage needs will change throughout the course of healing,
therefore continued assessment and adjustments will need to occur. Each treatment plan is individualized and
tailored to the patient. When developing a treatment plan, additional considerations must include the potential
for chewing and ingestion of the bandage material, environmental contamination, and patient management. An-
algesia and sedation should be considered as bandage changes can be highly stressful and painful for the patient.4

Bandages consist of three functional layers; the primary, secondary, and tertiary layer.4 Each layer has a specific
function, and the success of the bandage is determined by the collective integrity and function of each layer.

The primary layer is in direct contact with the wound, and should be sterile to reduce the risk of further wound
contamination.4,5 The primary layer can function to protect, debride, absorb exudate, and may contain topical
therapies/medications to promote wound healing. 4

The secondary and tertiary layers provide additional absorption and wound protection. The secondary layer can
function to stabilize the primary layer, absorb exudates, promote hemostasis, and support and protect against addi-
tional trauma.4,5 The tertiary layer secures the primary and secondary layers in place, providing ultimate protection
of the wound from the external environment. The tertiary layer may be porous, occlusive, or semi-occlusive.4,5

Contaminated wounds and those with devitalized tissue may benefit from wet-to-dry bandages or calcium alginate
dressing bandages. Hypertonic agents such as Manuka honey, 50% dextrose or granulated sugar may be incorpo-
rated into bandages when infection is present.4 These should be discontinued when infection is cleared and healthy

ExoticsCon 2015 Main Conference Proceedings 35


granulation tissue has developed. A non-adherent dressing should be used once there is no longer a need for de-
bridement and the goal becomes allowing for the development of healthy granulation tissue and wound closure.4

Wounds that are located in areas of high motion or tension can pose further challenges. Immobilizing bandages
of these areas may be necessary for healing. Traditional immobilization bandages used in small animal practice
are often impractical and not well tolerated in exotic patients. However, modifications of these bandages and
creativity can result in some very effective bandages. Wounds that are located on areas of the body that are dif-
ficult to bandage (head, back) may benefit from a tie-over bandage or adhesive bandage material composing
the tertiary layer.

The frequency of bandage changes will be contingent upon many factors. Initially, daily bandages may be
required, but the frequency will decrease over time as the wound heals and the debridement and exudative
responses of the wound diminish.5 Soiled, odiferous, and slipped bandages should be changed promptly to
prevent additional complications. A soiled bandage increases the risk for wicking environmental bacteria into
the wound, further challenging healing.4 A bandage that has an odour may be an indication of problems de-
veloping. A slipped bandaged may no longer be protecting the wound, may lead to a pressure sore or result in
further trauma. Every bandage change should be done in an aseptic manner to reduce the risk of contamination
and nosocomial infection.4 Wet-to-dry and debridement bandages should be changed daily or every other day,
whereas bandages covering healing wounds with healthy granulation tissues beds may be changed less often.4
Immobilizing bandages should be closely monitored for pressure sores and tendon and ligament contracture.4

Bandage application in exotic small mammals is accomplished in a manner very similar to that of other mam-
malian species. Challenges include their small size and desire to chew. Additionally, short limbs and physical
posture can further complicate care by inhibiting the placement of restrictive devices. Modifications of traditional
bandaging techniques, careful monitoring and creativity are necessary for success.

Avian species pose their own set of unique challenges in bandage application and management. The capabili-
ties and dexterity of their beaks and feet should not be underestimated. The bandages affect on weight bearing,
flight capabilities, and eating must also be considered. In wildlife species, long-term restriction of the wing with
a figure-8-bandage can cause tendon and ligament contracture and subsequently deem a bird non-releasable.
Physical therapy should begin as soon as medically possible to reduce this risk. Additionally, the bird should be
placed in a cage where the perches have been removed or are close to the ground until they have adapted to the
bandage to prevent injuries from falling.6 Changes in weight-bearing ability in ground dwelling and heavy bodied
birds may also be problematic in causing secondary ulcerative pododermatitis. Protection of the contralateral
foot is imperative to reduce this risk.6

The vast differences in locomotion, external coverings, and environmental habitats make reptile wound manage-
ment and bandaging particularly challenging. The humid and warm environmental temperatures needed for most
reptiles are ideal mediums for bacterial and fungal growth. The snakes tubular anatomy and slithering move-
ment make bandage application almost impossible. The shell of chelonians may either help or hinder bandage
application depending on the species (aquatic vs. terrestrial), location and nature of the animal.7

Tissue Healing

Many factors will have an effect on tissue healing: patients age, health, immune status, injury location, degree
of contamination, husbandry and nutrition. Identification and correction of any underlying disease or deficiency
will greatly improve the success of wound management.

36 Building Exotics Excellence: One City, One Conference


Knowledge of tissue healing is important for a successful outcome. As the wound changes and heals the treatment
and bandage needs change. Failure to recognize these changes and make therapeutic adjustments may result in
delays or inhibit wound healing.

The phases of tissue healing in the mammal are defined in five stages: inflammatory, fibroplastic, epithelialization,
contraction and remodeling. Tissue healing in avian species, although thought to be very similar to mammals,
is described as a three-stage process including inflammatory, collagen and maturation phases.8 Tissue healing
in reptilian species is largely dependent on their environmental conditions. Although variability between reptile
species exists, most commonly, healing involves inflammation, fibroplasia, restoration and maturation.7

Conclusion

Appropriate wound management will have a significant impact on healing time and overall outcome. Control
of bacterial colonization through wound cleansing and appropriate bandaging will facilitate wound healing.
Wound management and bandaging in exotic animals can be successful by using established wound management
techniques, combined with species knowledge and creativity.

References

1. Tobias KM, Ayers J. Wound Management in Action: Case Presentations. N Am Vet Comm Clin Brief.
2012;10:61-66.

2. Dernell WS. Initial wound management. Vet Clin Sm Anim. 2006;36:713-738.

3. Ritchie BW, Wooley RE, Kemp DT. Use of potentiated antibiotics in wound management. Vet Clin N Am
Exot Anim Pract. 2004;7(1):169-189.

4. Campbell BG. Dressings, bandages, and splints for wound management in dogs and cats. Vet Clin N Am
Sm Anim Pract. 2006;36:759-791.

5. Swaim SF, Renberg WC, Shike KM. Basics of bandaging, casting and splinting. In: Small Animal Bandag-
ing, Casting & Splinting Techniques. Ames, IA: Wiley-Blackwell; 2011:3-14.

6. Bueno-Padilla I, Arent L, Ponder J. Tips for Raptor Bandaging. Exotic DVM. 2010;12:3:29-47.

7. Mitchell MA, Diaz-Figueroa O. Wound Management in Reptiles. Vet Clin N Am Exot Anim Pract. 2004
January; 7(1):123-140.

8. Ritzman TK. Wound Healing and Management in Psittacine Birds. Vet Clin N Am Exot Anim Pract. 2004
January; 7(1):87-104.

ExoticsCon 2015 Main Conference Proceedings 37


Monitoring and Caring for Your Avian
Anesthesia Patient
Janet Jones, LVMT

Session #358

Affiliation: From the Veterinary Medical Center, University of Tennessee, Knoxville, TN 37996, USA.

Abstract: There may be many circumstances as to why the pet bird may need to be under anesthesia. Some
of the most common reasons may be for physical exam, obtaining diagnostic samples, or for medical and
surgical treatments. The same basic principles of anesthetic management apply to avian patients as well
as small mammal patients with the differences of anatomical and physiological considerations.

Avian Anesthesia Patient

Monitoring the depth of anesthesia for your avian patient can be one of the most challenging tasks during the
procedure. There are many different monitors that should be used during an anesthesia procedure as well as
using your own observations. The challenge is to keep the patient at a surgical level of anesthesia. By checking
the pinch reflex as well as monitoring trends of decreasing or increasing respiratory and cardiac trends, will help
keep your patient at that preferred anesthetic plain.

Perioperative considerations include evaluation of all aspects of husbandry including the source and length of
ownership, diet and dietary preferences, environment, and previous or current illnesses and therapies. A through
physical exam is critical in assessing the birds physical condition, cardiopulmonary status, the severity of illness
and other conditions that may not be known by the owner.

Preoperative diagnostics should include a packed cell volume (PCV), total solids, and blood glucose.

One preanesthetic considerations is fasting the bird. There are different requirements as to fasting birds and the
size of the bird. Fasting is recommended to reduce the chances of regurgitation and aspiration of food. Generally,
the smaller the bird, the shorter the fast time. The fast should be just long enough to empty the crop so palpation
of the crop is always recommended prior to an anesthetic event.

To restrain the bird for physical examination, the handler must always keep a close eye on the bird and watch
for signs of distress in the bird. A towel is generally used and one hand is used to restrain the birds head while
the other hand is used to keep the towel wrapped around the birds body to prevent the wings from flapping.
Another person will be needed to administer any premedications or gas anesthesia. Once the bird is anesthetized,
it should be place on a heated surfaced where the procedure is to be performed and it should not have a righting
reflex or flap its wings. The respiratory rate and effort must be visualized during the whole anesthetic procedure.

Once the bird is laid on the table it is preferred that an intravenous (IV) catheter be placed in either the basilic
vein or medial metatarsal vein. The bird should also be intubated. A non-cuffed, appropriately sized endotracheal
tube is to be used as birds have complete tracheal rings. A heat source must also be placed for most birds as they
become cold. A heated table, a forced warm air heating blanket, or both should be used. Once laid in recumbency,
then the monitoring equipment should be placed on the bird. The most important monitoring equipment is the

ExoticsCon 2015 Main Conference Proceedings 39


Doppler. The crystal can be placed in the mouth on the palatine artery, on the basilic vessel on the wing, or on
the medial metatarsal vessel on the leg. Placement of a cuff can be difficult in birds because of the anatomy in
very small birds. A hand held pulse oximeter should be placed on either the toe or beak of the bird while the
rest of the monitoring equipment is being placed on. The use of a multifunction monitor is very beneficial as
monitoring ECG, end-tidal CO2, and pulse oximetry are desirable. Fluids should be administered IV during the
anesthetic procedure at a rate of 10 ml/kg/h for the first hour and then decreased to 5 ml/kg/h. Emergency drugs
should be readily available and prepared in case of an emergency.

During the anesthetic procedure the respiratory rate and effort must be visually monitored at all times. Birds
will usually go into respiratory distress before they go into cardiac distress. If a decrease in rate or effort is
appreciated, the anesthetic gas should be turned down, usually in 0.25% increments. Avian patients tend to get
cold during an anesthetic procedure and will usually need to be turned down during the procedure. Any change
in heart rate will also need to be addressed during the procedure. Listening to the Doppler is one of the most
valuable monitoring methods. Blood pressure can be monitored during the procedure in the larger bird species.
A pediatric or neonatal cuff is placed on the distal humerus or dorsal metatarsal artery. Normal indirect systolic
Doppler blood pressure in birds is 90-140 mmHg.

Once the anesthetic procedure is completed the gas should be turned off and the patient left on oxygen. Birds
will usually shake their heads when they are ready to be extubated. The endotracheal tube should be examined
upon extubation to look for any signs of blood on the tube. If the patient has been manipulated a lot during the
procedure there can be some trauma in the trachea from the tube. Once the bird is able to stand on its own, the
patient can be placed in the cage preferably with supplemental heat and oxygen. Post-operative analgesics must
also be considered.

References

1. Curro TG. Anesthesia of pet birds. Semin Avian Exot Pet Med. 1998;7(1):10-21.

2. Forbes NA. Avian anesthesia. Vet Quart. 1998;20:S65-S66.

3. Jones MP. Preparation and operative management of the avian patient. Paper presented at: CVC Washington
DC. 2008; Washington, DC.

4. Lierz M, Korbel R. Anesthesia and analgesia in birds. J Exot Pet Med. 2012;21:44-58.

40 Building Exotics Excellence: One City, One Conference


Fecal Cytology
Marli S Lintner, DVM

Session #366

Affiliation: From the Avian Medical Center, 15952 SW Quarry Road, Lake Oswego, OR 97035, USA.

Abstract: The compromised state in which many psittacine patients present to the practitioner severely
limits the ability to use many diagnostic techniques. Any form of restraint, be it for sampling or imaging,
can prove fatal. A fecal sample however, can be collected with no stress to the patient. Typically a fecal
Gram stain is then performed, yet this technique provides only limited information for diagnosis. When
properly utilized, a fecal cytology can offer a wealth of insight on the status and function of the psittacine
digestive tract.

Why Fecal Cytology

For decades the standard fecal examination has revolved around the Gram stain. As the avian digestive tract
contains primarily gram-positive flora, a high percentage of gram-positive organisms on a sample has been con-
sidered normal. Conversely, a large percentage of gram-negative organisms has been considered indicative of
a diseased condition, generally requiring treatment. Numerous erroneous assumptions with this technique need
to be pointed out. Firstly, not all gram-positive bacteria are normal, healthy inhabitants of the avian digestive
tract. For example, Staphylococcus aureus, hemolytic Streptococcus, and numerous Clostridial organisms may
look benign on a Gram stain but can cause serious to fatal disease processes. Secondly, not all gram-negative
organisms are pathogenic. The pet avian patient lives in an environment dominated by gram-negative carrying
inhabitants, so gram-negative bacteria should be expected from exposure alone. In the vast majority of cases this
exposure does not result in disease. Thirdly, and equally important, our sampling sites, and the choana especially,
are grossly contaminated with whatever the birds beak has been in contact with. In no other species, except
when testing for a specific pathogen, would a swab of the oral cavity be used for a diagnostic procedure. The
cloacal culture, also not used in other species, will not differentiate between the organism that is simply passing
through from that which has actually colonized within the system.

Of more importance to diagnosis is the discernment of if the bacteria present are actually causing disease within
the patient. Clinical signs, symptoms, and physical examination are useful. Obvious signs of disease include
an inflamed, mucousy or abscessed choanal, diarrhea or a pasted vent. But, to access the internal aspects of the
psittacine digestive tract, a fecal cytology can aid our diagnostic ability. Due to the unique nature of the psit-
tacine digestive system; its shortness and inability to digest mucous and many cellular structures, many signs of
reaction to irritation may be seen on cytology. Mucous, squamous epithelial cells, columnar cells, and a variety
of white blood cells can be easily observed in the fresh fecal sample. Note that products and excretions from the
urinary, reproductive, and even upper respiratory tract may also be present in the sample.

Sample Collection

Freshness of the fecal sample is critical. Bacteria, yeast, and fungi grow rapidly in feces and elapsed time will
exaggerate resulting amounts. Motility, especially of protozoan, decreases rapidly with time and desiccation of
the sample is seen to destroy cell structures. It is preferable to collect a sample that has actually been observed

ExoticsCon 2015 Main Conference Proceedings 41


passing. Do not attempt to manually collect the sample with a cloacal swab as exfoliation of large amounts of
squamous cells and often red blood cells will result. To prepare a fecal sample a small amount (roughly 4-6 mm)
is placed on a slide. One drop of saline is applied and the sample is gently squashed with a cover slip. Do not
mince, chop or macerate the sample as this damages mucous and urate structures. This should leave a large clear
margin around a fairly thin film of feces giving the practitioner a variety of thicknesses to work with. Grit, nut
shells, or whole seeds will need to be gently manipulated out to allow the cover slip to sit flush.

A good quality microscope, with special attention paid to the 10x and 40x lenses, is essential. The cytological
work will be done without the benefit of staining, so fine focus, brightness control, and condenser contrast will
be critical for visualizing the detail needed. Long term care of the microscope is also important. Be sure to clean
the slide and stage of excess saline before viewing as saline can be corrosive to microscope structures. Clean
slides are also imperative for this procedure as scratches, dust, and water spots will detract from sample analysis.

The Normal Fecal Sample

The normal fecal sample will be primarily composed of plant material. Plant cells, either individually or in large
sheets, will be present in various stages of digestion. Seed material can be seen to have germinal tissue and buds,
leafy vegetables may have stomites, fibers, and plant hairs, and various fruits and vegetables may be brightly
colored such as strawberries, blueberries, and carrots. Pollen appears to pass intact through the digestive tract
and can be mistaken for parasite ova due to its crisp geometry. Processed food items such as pellets, pastas, and
breads lack cell definition and are often seen as globular or grainy background debris. Meat, and especially dairy
products, will leave an excess of oil droplets in the sample. Leavened breads, especially pizza crusts, contain
large amounts of yeast and while killed during baking come through intact in the fecal. This dietary yeast can
be impressive in volume but causes no disease. All of these materials are useful in determining what a patient
is actually ingesting in its diet.

There will be bacteria seen within the sample, it is feces after all. Normal levels vary with the diet. A seed diet
produces the lowest concentrations, while the diet that is more processed and perishable is seen to have an in-
creased level of bacteria. Cooked, frozen and then thawed diets (ie, cook and soak bean mixes) typically have very
high levels of bacteria in a sample. Pelleted formulations tend to range somewhere in between. Normal bacteria
flora is evenly distributed throughout the sample. Species vary, with rods and cocci both being represented, and
can be observed singularly or in pairs but rarely in large clumps or sheets. Partially digested fungal hypha can
be found along with fungal spores. When ingested these dont appear to cause any harm.

The cellular lining of the digestive system varies from a non-stratified squamous within the oral cavity and
esophagus, to a heavily stratified squamous within the gizzard. The intestines are lined with a columnar cell
structure.1 There is a normal exfoliation of these cells and small amounts are routinely seen on fecal examina-
tion. Elevations in squamous cell numbers can be observed following ingestion of wood, nut shells, fibers, or
non-digestible items that wear on the gizzard lining. Psittacine patients stressed about their trip to the vet clinic
frequently pass mildly elevated volumes of columnar cells.

Parasite Analysis

Fecal analysis for parasite ova is a routine veterinary procedure. Psittacine species, primarily due to their man-
agement in captivity and lack of exposure, infrequently present with heavy parasite loads. Ascaris, Capillaria,

42 Building Exotics Excellence: One City, One Conference


and coccidian ova can occasionally be seen.2 Variations in uric acid crystals found in the urine can sometimes
be confused with coccidial oocysts. Some species of parrots, cockatoos especially, are rather adept at catching
insects and consequently these birds may become exposed to tape worms. The avian tapeworm is usually very
small and often an entire egg sac is found microscopically on a fecal smear. The cestode eggs themselves are
typical with a classic 4-6 internal hook structure.

Protozoan infections are much more likely to be observed with a fresh fecal sample. As the sample ages, proto-
zoan typically become slower, flagellar motion wanes, and the organisms round up to become more nondescript.
Without the aid of motility, the cell structure of Hexamita and Giardia is difficult to pick out from background
material. Cysts of Hexamita are the size of a single yeast cell while those of Giardia are 3-4 times larger. These
parasites are typically seen in the smaller psittacine species, and are especially common in parakeets and cockatiels.

External parasites may inadvertently appear in a fecal sample. While contamination of the sample after it was
passed is possible, it appears equally as likely the birds have ingested the mites or lice while preening. This is a
useful diagnostic tool when dealing with species of blood sucking mites that only spend brief periods of time on
the bird. Other insect parts can be seen on fecal examination and some owners may even feed diets that already
contain freeze dried insects. The common seed moth, flies, crickets, cockroaches, and weevils all get eaten and
are nontoxic, but can be rather exciting when viewed on the microscope.

Foreign Objects

The psittacine beak is very adept at tearing apart and destroying. While owners are often adamant their bird
is not ingesting what it has macerated, the fecal examination can be quite revealing. Plastic, rubber, synthetic
fibers, natural fibers, paper, feathers, and hair can all easily be observed. Pigments and dyes from toys will also
brilliantly stain the cells lining the gizzard, often for days or weeks. Grossly in the fecal sample, the presence
of grit, nut shells or whole seed is indicative of a malfunctioning pylorus of the gizzard. Microscopically even
a coarse grain to the sample indicates this sphincter is not doing its job properly. Large foreign bodies that are
ingested generally will not pass through the system, and remain caught in the gizzard. An increase in sloughed
squamous epithelial cells may be an indication of trouble.

Infectious Agents

As noted previously, the bacterial volume in a fecal sample can vary dramatically depending on the perishability
of the diet. Any condition that slows the transit time of the digestive tract will also cause a dramatic increase
in the volume of bacteria seen in the fecal. For example, a bird that has gone without food for eight hours and
hasnt passed a fecal for 4-6 hours will have a much higher bacterial count than normal when a fecal is finally
passed. Signs that the bacteria are actually causing an infection are then not only the relative amount but other
questions to answer include: are the bacteria of all the same morphology? Are they in clumps or sheets? Are
mucous or white blood cells present? Is there an increase in columnar or squamous cells? Essentially, is there
a reaction to the bacteria present? The author uses a scale of 1-4 to record the levels of bacteria, yeast, cells,
mucous, etc. A level of 1+ would correspond to a normal volume of bacteria or cells in the sample. A level of
4+ would be the predominant feature or a standing room only concentration. For example, a patient with a 2+
bacteria level with no mucous and on a cooked, varied diet would be considered normal. However, a 2+ bacteria
level, of predominately the same organism, with a 2+ mucous and columnar cell level, would be indicative of
a disease process.

ExoticsCon 2015 Main Conference Proceedings 43


Yeast infections are a bit more challenging. Determining live growing yeast from dietary dead yeast takes a close
look. Dietary yeast is usually in a single to one bud form. Actively growing yeast will occasionally be budding
to 3 or 4 buds. More aggressive yeast infections will produce forms with pseudo-hyphae. Different species of
yeast can also vary in size and shape. Avian gastric yeast is very large, distinct and difficult to miss. It can vary
in length, vacuole formation and branching.3 The digestive tract does not appear to react as aggressively to yeast
and only mild mucous and cellular responses are seen.

Abnormalities

While cytology can be a very useful aid in diagnosing parasites, foreign bodies, and infections there are numerous
other useful applications as well. Here are five examples. First, an anorexic or starving patient may present with
a scant and biliary fecal. But on cytology, bile staining, mucous, lack of plant material and a dramatic increase
in sloughing of the digestive tract epithelium will be apparent and an infectious agent may also be revealed.
Second, a patient that is dehydrated will have a corresponding increased density of the urate portion of the sample
often well before blood uric acid levels are elevated. Thirdly, discreet blobs of white blood cells and purulent
material, with normal fecal contents, are often seen with reproductive tract infections. A fourth example, melena
from hemorrhage in the digestive tract will produce a very red-brown globular material, usually with little else
seen in the sample. And lastly, trauma to the renal system, including egg binding, may result in trace amounts
of intact red blood cells being passed in the urine portion of the sample.

Conclusion

This technique is very useful, but requires a fair amount of training and practice. Results can be subjective and
need to be interpreted by the practitioner. A good understanding of the normal fecal sample is necessary for proper
comparison and analysis as well as a working understanding of the avian digestive tract as a whole. Numerous
cellular responses and further indications of infection or other detrimental conditions can be observed under a
completely noninvasive technique. This leads the fecal cytology to be a diagnostic tool that is both informative
and a great aid to the practitioner.

References

1. King AS, McLelland J. Birds: Their Structure and Function. East Sussex, UK: Baillire Tindall;1984.

2. Greiner EC. Parasitology. In: Jenkins JR. Avian Medicine and Surgery. Philadelphia, PA: Saun-
ders;1997:332-350.

3. Brown D. Under the Microscope: Microscope Use and Pathogen Identification in Birds and Reptiles. South
Tweed Heads, Australia: ABK Publications;2003.

44 Building Exotics Excellence: One City, One Conference


Client Handfeeding Education for the Veterinary
Technician
Rhonda LaBelle, LVT

Session #335

Affiliation: Summertree Animal & Bird Clinic, 12300 Inwood Road, Suite 102, Dallas, TX 75244, USA.

Abstract: The scope of this presentation is to address the need to educate clients on proper handfeeding
procedures for healthy, neonate psittacine chicks that are at least 14-21 days old. The presentation also
will provide technicians with information and tools to educate their clients.

Introduction

In 1975, the Conference on International Trade in Endangered Species of Wild Flora and Fauna (CITES) greatly
restricted the importation of endangered and non-native species in member countries. CITES was followed by
the Wild Bird Conservation Act of 1992 which banned the importation of the majority of wild-caught parrots into
the United States. Most parrots seen in veterinary practices today are the product of captive breeding practices
where the offspring are hand reared from the nestling stage.

Handfeeding is the process where chicks are fed by humans from a very young age. Handfed parrots imprint
on humans, resulting in young, tame birds that are desirable as pets. Many baby parrots are removed from the
nest (pulled) for handfeeding at 3-5 weeks of age, and require 3-4 feedings per day. The Association of Avian
Veterinarians (AAV) published statements on 8 issues regarding the sale of unweaned birds.1 Two of those
positions are:

The AAV SUPPORTS the conveyance of unweaned birds between qualified parties who possess
the necessary skills of handfeeding in accordance with accepted avicultural industry practices.

The AAV OPPOSES the sale or transfer of unweaned birds to individuals KNOWN not to possess
the necessary level of experience in accordance with accepted avicultural industry practices.

Unfortunately, the myth continues to be perpetuated that owners must be the one to hand feed a bird in order to
have a good relationship with it. As such, many ill-educated and/or unscrupulous breeders sell unweaned parrots
to inexperienced buyers, often with very little instruction on how to handfeed. Injuries and illnesses often seen
in the veterinary clinic as a result of incorrect handfeeding techniques include aspiration pneumonia, septicemia,
crop burns, crop stasis, malnutrition, and poor husbandry among many others.

Equipment

Syringes and/or pipettes

Syringes are the most effective way to feed psittacine chicks. Luer tip oral syringes with O-rings are the best
type to use. If those are not available, standard luer tip syringes can be used. The best syringe sizes to use are

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6 ml, 10/12 ml, and 20 ml. Syringes can be washed, disinfected and re-used multiple times. Some breeders,
citing cleanliness, prefer using pipettes but pipettes must be discarded after one use.

Good quality handfeeding formula

Commercial handfeeding formula is a dry powder that is prepared by mixing with water. A number of great
formulas are readily available in pet stores or through online retailers. Kaytee Exact, Zupreem Embrace,
Lafeber Nutri-start, and Roudybush Formula 3 all are excellent products. Several manufacturers also pro-
duce formulas for psittacine chicks that benefit from a higher fat content (ie, Kaytee Exact Macaw formula).

Digital thermometer

Formula should be between 101-104F at feeding (38-40C). Formula that is too hot will cause crop burns. Formula
that is too cold will chill a chick and possibly induce crop stasis. Many chicks will refuse formula that is too cold.

Disinfectant

After each feeding, syringes should be washed with mild dish soap, and allowed to dry. Syringes should be stored
completely assembled and in the withdrawn position (filled with air), to prevent the O-rings or rubber plunger
from swelling. After cleaning, syringes may be disinfected by soaking for 10 minutes in a bleach solution (1:32)
or Pet Focus, a bird-safe disinfectant and cleaner.

Brooder

Young chicks that are not perching yet will benefit from an enclosure that mimics a nest box. A Rubbermaid
storage container works very well as a makeshift brooder. Multiple holes should be drilled in the lid and along
the upper 1/3 of the container for ventilation. As a general rule, chicks that have body feathers will not need
supplemental heat, and may be kept at room temperature 75-80F (24-27C). Chicks with just pin feathers will
need to be kept at 86-90F (30-32C).2 This may require providing supplemental heat. A heating pad set on
LOW can be sandwiched between two towels and placed under the brooder. Chicks should be watched closely
for signs of overheating (panting) and dehydration (red skin color) from a brooder that is too warm.

Substrate

The substrate in the brooder can be towels, shredded paper or newspaper, or compressed wood pellets. My per-
sonal preference is compressed wood pellets (Bird Country, Critter Country, Kaytee Wood Pellets) on top
of a layer of newspaper. Corn cob litter should not be used as it is prone to growing mold and fungus when wet.

Gram scale

A gram scale is an essential piece of equipment for hand rearing psittacine chicks. Chicks should be weighed
every morning, on an empty crop and that weight recorded in a journal. By tracking the weight, owners can
easily see if their chicks are gaining weight as expected.

Journal

The handfeeder/owner should keep a journal, recording each days empty-crop weight, how much formula is
fed at each feeding, what time each feeding occurred, and any additional observations the owner feels is impor-
tant. Kaytee provides a great downloadable Hand-Feeding Chart that can be printed and distributed to clients
(http://kaytee.com/assets/013/25893.pdf).

46 Building Exotics Excellence: One City, One Conference


Handfeeding

Formula preparation

Handfeeding formula should be prepared in a clean manner, using clean, washed bowls/cups and syringes. For-
mula should be prepared fresh for each feeding following the instructions provided by the manufacturer. The
handfeeding powder is mixed with very warm water until the desired consistency is reached (follow manufacturer
instructions) and then pulled up, into the syringe, before feeding. Filled syringes may be kept in a cup of hot
water (less than 105F/41C) until ready to feed.

Never microwave formula! Microwaving causes hot spots in the formula (areas of superheated liquid) leading
to crop burns.

Handfeeding quantity

Many chicks may be fed 10 to 12% of their body weight. A good rule of thumb for instructing clients is to feed
10% of the empty crop body weight at each feeding. Obtaining a weight first thing in the morning will guide
the owner on how much formula to offer at each feeding. Example: A 100-gram chick will receive no more
than 10 ml of formula. Macaws have a slightly larger crop and can be fed 12-14% of their body weight at each
feeding.3 Overfeeding psittacine chicks can result in aspiration, stretched crops, or obesity (cockatoo chicks). It
is better to feed smaller, more frequent meals than to overfeed a chick.

The crop should be fairly empty when the next feeding is given. This helps the handfeeder confirm that the
contents are passing through the digestive tract. Keeping a journal of how much/what time the chick is fed is an
excellent way for the owner to see any trends that may be developing. A crop that slows down may indicate a
bacterial or yeast infection; formula that is too cold when fed; or any number of potential issues. Instruct owners
to call immediately if they see that the crop has slowed. The weight/feeding journal will help the veterinarian
in their assessment of the chick.

Every chick will gain weight differently, so it is difficult to provide exact percentages. Chicks should gain weight
consistently and continually until they reach the weaning stage. Keeping a journal will help the owner (and the
veterinary team) see if this is happening. Schubot, et al produced several developmental charts outlining expected
growth rates of a number of the macaws, cockatoos, golden conures, and African grey parrots.4 This book is an
excellent clinical reference for psittacine chicks of all species.

Handfeeding techniques

Place the chick on a towel on a flat surface, facing to the handfeeders right. Place your left hand behind the
chicks head, with your thumb and index finger slightly behind the mandible. Holding the syringe in your right
hand, introduce the tip of the syringe into the commissure of the beak on the chicks left side. Wait for the chick
to give a handfeeding response (the action of bobbing up and down) before pushing the plunger on the syringe
to dispense the formula. Feed only as fast as the formula is disappearing down the chicks throat. If formula
wells-up in the mouth, discontinue feeding immediately.

Chicks should be fed from the left side so that the formula is directed toward the esophagus which is located
on the right side of the neck. Applying slight pressure to the commissure of the beak will elicit a handfeeding
response in most chicks. Chicks that do not give a strong response can still be fed, but much more slowly and
carefully. Only small amounts of formula should be placed in the mouth, with the handfeeder closely watching

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to confirm the contents are swallowed before offering more formula. If a chick is not giving a strong response,
check the temperature of the formula and, if needed, re-warm in water at 105F (41C).

It is important to clean the chick of formula residue after each feeding. Experienced handfeeders waste very
little formula and their chicks are quite clean. There is a significant learning curve in mastering the art of hand-
feeding; new owners will need to be instructed to clean the chicks face and feathers of left-over formula. Old
formula on the chick provides a fertile breeding ground for bacteria to multiply, potentially compromising the
health of the chick. Additionally, formula is much easier to remove from feathers when it is fresh as opposed to
the concrete-like consistency it assumes once dry.

Weaning

Weaning is the process where the chick begins losing interest in liquid food, and has more interest in eating solid
foods. Fledging is the time when chicks begin vigorously flapping their wings in preparation for flight. This is,
by far, the most challenging time in the hand rearing process of psittacine chicks.

The first signs of the weaning phase is when an active and alert chick becomes disinterested in formula. The chick
will often beg, eat a small amount of food, and then refuse the remainder of the meal, deciding instead to explore
his environment. At this point, chicks should be reduced from three feedings a day to only two. The first feeding
to be dropped is the mid-day feeding. An abundance of healthy foods including pellets, fresh vegetables, minimal
fruits, nuts, and grains, should be offered to the chick. Chicks introduced to many different foods during this
impressionable time will be less likely to be picky eaters as adults. Up to this point the chick has not needed a
water bowl as his source of hydration has been the formula, so a water bowl should definitely be provided, too.

When the chick shows disinterest in either the morning or evening feeding, the morning feeding should be
discontinued. During this time, the owner is carefully monitoring weight and solid food intake to be certain
the chick IS eating on its own. Solid foods can easily be palpated in the crop if the chick is eating them. The
last feeding to be discontinued is the evening feeding. By this point, the chick is solidly eating on its own and
maintaining a steady weight.

It is important for owners to understand that chicks will lose weight during the weaning process. The crop
decreases in size and the chick slims down in preparation for learning to fly (fledging). Weight loss should be
gradual, and accompanied by decreasing interest in formula. As long as the chick is bright, alert, and active, the
chick can lose 10% of its body weight before the owner needs to be concerned. The importance of keeping a
journal is, again, reinforced.

Fledging

Weaning and fledging go hand-in-hand. Weaning is the process where the chick learns to eat on his own. Fledging
is the process of developing the skills of flight. Both weaning and fledging are important developmental markers
in a psittacine chicks life. As fledging commences, chicks vigorously flap their wings to build up their pectoral
muscles, expend energy, and slim down in preparation for flight.

It is this aviculturists position that all chicks should be granted the opportunity to learn to fly before consideration
is given to restricting flight through wing trimming. The process of fledging benefits chicks physically, socially
and mentally. Chicks that learn to fly develop physical strength and endurance. Mastering take-off, maneuver

48 Building Exotics Excellence: One City, One Conference


and landing skills boost their confidence. And the ability to freely move around provides the psittacine chick
with the opportunity to balance being dependent on their flock (the owner), and express independence through
curiosity, exploration and play.5

Conclusions

The goal of handfeeding, rearing and fledging parrots is to share our home with colorful, intelligent, and en-
tertaining psittacine companions for the remainder of our (and their) life. The eight to sixteen weeks owners
spend caring for their baby parrot is a significant investment of time and energy during a time of formative de-
velopment. The veterinary teams goal should be to help inexperienced owners through this critical stage in the
chicks life, and develop a relationship and bond with owner that encourages them to return year after year for
preventive care exams, and turn to you (not the internet) for information when they have concerns about their
companion parrots health.

References

1. Association of Avian Veterinarians. AAV Position Statement Regarding the Sale of Unweaned Birds. As-
sociation of Avian Veterinarians. Available at http://www.aav.org/?page=unweanedbirds. Accessed July 11,
2015.

2. Clubb SL, Clubb K, Skidmore D, Wolf S, Phillips A. Psittacine neonatal care and hand-feeding. In: Schubot
RM, Clubb KJ, Club SL, eds. Psittacine Aviculture: Perspectives, Techniques and Research. West Palm
Beach, FL: Aviculture Breeding and Research Center;1992:11(1)-11(12).

3. Clubb, SL. Psittacine pediatric husbandry and medicine. In: Altman RB, Clubb SL, Dorrestein GM, Que-
senberry K, eds. Avian Medicine and Surgery. Philadelphia, PA: Saunders;1997;73-95.

4. Schubot RM, Clubb KJ, Clubb SL. Psittacine Aviculture: Perspectives, Techniques and Research. West
Palm Beach, FL: Aviculture Breeding and Research Center;1992.

5. Linden PG, Luescher AU. Behavioral development of psittacine companions: Neonates, neophytes, and
fledglings. In: Luescher AU, ed. Manual of Parrot Behavior. Ames, IA: Blackwell;2006: 93-111.

ExoticsCon 2015 Main Conference Proceedings 49


Early Parrot Education: A Six-Stage Weaning Process
Josee Bermingham, AHT

Session #349

Affiliation: Hagen Avicultural Research Institute, Montreal Canada.

Abstract: Previously undefined weaning and educational stages for hand reared psittacine fledglings
often resulted in compromised health, social skills and lifelong lessons necessary for their journey as a
companion animals. After years of supplying pet retailers in Canada hand fed baby parrots, research and
studying, with consideration to some of the challenges pet owners have had with companion birds over
the years, the Hagen Avicultural Research Team (HARI) has developed the Early Parrot Education and
Weaning Program. During the evolution of the Early Parrot Education program, we have learned that this
is not a concept that begins when the young parrot is sitting in a store or for many, when he arrives at his
new home with a family. Preparations for the young parrots life as a companion bird begins in a small
window of opportunity: during the fledglings fastest growth and mental developmental stages and it is
taught at critical stages of development, both cognitive as well as physical.

Introduction

The Early Parrot Education (EPE) program, a 6-stage weaning process, structuring educational focus in a
timely manner, coincides with the young parrots most opportunistic moment of physical and mental growth.
Physical characteristics such as weight, feather development, crop, commissures, motor skills, cognitive abili-
ties, determine the progression of the stages. Caretakers are encouraged to document their progression as they
mature. Each stage will unravel the structure and the characteristics necessary to implement the essentials such
as educational focus, housing, feeding strategy, primary lessons to prepare the bird with lifelong lessons for his
journey as a companion bird.

While many of the stages are implemented at the breeder facility, retailers and even pet owners will find that
by maintaining the program with domestically raised parrots, the outcome will result in a companion bird that
is well prepared for his life as a companion bird. This alone adds to the quality of life for the young bird. With
established educational lessons already implanted in the fledglings life, new pet owners continue the program
and have more time to enjoy their new family addition. They will have a program that guides them through
proper care and even some of the challenges associated with a parrot companion as he advances through his
normal life stages.

The EPE program begins with acknowledgment of stages based on physical characteristics and not necessarily
age. By identifying and breaking down the stage identification by physical characteristics, the EPE program can
span across the many species of parrots raised as companions. The EPE program utilizes tools to implement
the educational focus or lessons introduced at a timely moment. Tools used in the educational focus include:
nurturing, monitoring, socialization, desensitization, modeling, mentoring, and in later stages, play. Each lesson,
once mastered, becomes a building block toward a more advanced lesson as the fledgling matures.

Avian caretakers, be it the breeder, pet retailer and even the new pet owner, maintain a record of each parrot
chicks achievement or advancement with a chick growth chart, chick weaning chart, and most importantly,
the chicks primary lessons. As these documents become part of the parrots permanent records, caretakers can
maintain the education that benefits the birds lifestyle as a companion pet.

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Primary Lessons

EPE encourages the fledglings caretaker to implement the training with structure and to record the acquired skills
in the primary lessons report card, which becomes part of the fledglings permanent records. Fledglings advance
through their lessons after achievement in prior lessons. Examples of primary education lessons include: prepara-
tions for traveling in a pet transporter, desensitization to interventions such as being groomed or examined by an
avian health practitioner without stress, weaning onto an optimal diet, as well as the achievement of beneficial
exercise and independent play with various levels of foraging and flight harness training.

The Mentors Role in Weaning Education Success

Guidance towards independence, while establishing codes of conduct and respect, will position the parrot chick
within the hierarchy of the human feathered flocks. The aviculturist or human caretaker for the fledgling should
be perceived as a mentor, guide or leader of the flock.

Feeding Strategy and Nutritional Guidance

While one of the steps of weaning a parrot chick includes getting a fledgling to eat on his own, there is an un-
fortunate misconception that chicks wean easier on to a cafeteria style seed, fruit and veggie based diet and that
chicks will knowingly choose balanced nutrition as they mature. This has placed the burden of diet correction
with the pet owner, usually under strong advisement from an avian veterinarian. The logical progression from
hand feeding formula should be the introduction of weaning granules that have the same nutritional formulation
and palatability as the hand-fed formula. This supports the fledgling nutritionally and supports the fledglings
instinct to recognize food readily as he learns to eat on his own.

Weaning stages that introduce assisted spoon feeding of warm soaked granules, complementary offering of dry
granules, as well as implementation of foraging activity through guidance and modeling from older fledglings
and the human caretaker in combination with syringe-fed hand feeding of formula is a winning strategy.

Fledglings must not be lured with food or be food deprived to avoid the association of food with desired behavior.
Nor should assisted feeding be conditional to the fledglings achievement as this would be contrary to nurturing
reinforcement. Food should be available to them unconditionally prior to and throughout the sessions. Much
like a human child off to primary school without a good breakfast, a fledglings inquisitive nature, or its yearn
to learn disappears when hungry. The fledglings focus on his lessons is not present; therefore, nothing will be
learned or achieved.

Set Up

As the parrot chick advances throughout the EPE program, it is vital to acknowledge proper set up or environ-
ment for each stage. Failures in abiding the recommended set up for environments can result in health issues
and possibly negative or undesirable behaviors later in the chicks life.

52 Building Exotics Excellence: One City, One Conference


Seizing the Moment

This inquisitive age characterized by the emergence of feathers at the pre-fledgling age must be seized to intro-
duce the first and consecutive stages of a healthy weaning process. Our role as professional aviculturists must
take a giant leap forward as we take responsibility to actually raise these soon to be fledglings and not merely
ensure they are eating on their own and are of optimal physical health.

With the emergence of hand-fed babies over the past three decades, the aviculturist or nursery caretaker has
focused on nutritional and physical health only. Unfortunately, the lessons that would be considered behavior
related or under the responsibility of the new caretaker come too late in the developmental potential of the
young parrot chick. These lessons should be taught at this very limited, yet inquisitive stage that begins with
the emergence of feathers.

Aviculturists can have an opportunistic approach and active role in laying down the building blocks for a struc-
tured educational and emotional foundation, all while guiding the fledgling with solid nutritional support. The
pre-fledgling age is the opportunistic age for desensitization and establishing the fundamentals of education
that will prepare the chick for its future life as a companion. This can be achieved in a very short time with very
short practices.

With the success of domestic hand-fed parrot babies over the years, the aviculturist or nursery caretaker has focused
on nutritional and physical health only. And, the lessons that would be considered behavior related or under the
responsibility of the new caretaker come too late in the developmental potential of the young parrot chick. These
lessons should be taught at this very limited, yet inquisitive stage that begins with the emergence of feathers.

First and foremost, this inquisitive age characterized by the emergence of feathers at the pre-fledgling age must
include lessons in establishing nutritional skills. Lessons in grooming, playing, and foraging skills will coincide
as the caretaker takes on the role of mentoring with monitoring, modeling, guidance and nurturing techniques.
While this may be perceived as anthropomorphic, parrots do have the ability to be proud of their accomplishments.
Accomplished parrots make better companions. Their life as companions relies on the foundation of weaning
education success established by mentoring through 6 age-relevant stages of weaning.

Stages of Weaning and Education

These crucial stages of the fledglings educational progress can be guided, monitored and recorded on weaning
and training charts featured in the presentation and proceedings. Descriptions of the different stages presented
in this article are merely highlights of various aspects of each stage. Further exploration is recommended to
successfully mentor a fledgling through the stages.

Stage 1: Introductory stage

Nutritional guidance is approached with a different attitude and strategy at this stage of the chicks life, It is
imperative for the chicks long-term digestive health to keep the crop motility in good shape, gradually encour-
age natural crop regression in sync with the pre-fledglings physical alterations. Feedings of hand-fed formula
(spoon or syringe) are usually offered 4 times per day. Nutritious and familiar flavors such as extruded weaning
morsels satisfy his natural tendencies for elementary foraging behavior. The pre-fledged chick will seek the hu-
man caretakers mentoring ability to guide him as he advances throughout the education process. The following
is a list of what takes place during this stage.

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Dramatic changes in physical characteristics (emergence of pin feathers, crop at maximum size, weight
reaching plateau, nails sharp)

Daily weight gain (monitoring is crucial as the growth pattern will indicate the advancements to the next
stage; however, caretakers may be reluctant to weigh and physically examine the chick, but this will be
the foundation for a successful Stage 1)

Cognitive communication recognition

Socialization in the chick pen

Elementary preening skills onto other clutch mates

This age is an opportunistic moment to introduce dry biscuits or granules in nursery chick pen as this is the age
of curiosity, when the fledgling is starting to move around and explore the nest substrate. The fledgling has not
yet developed to the ability to climb or perch. Food must be placed in stable dish in nest substrate. At HARI,
we use recycled newspaper pellet for substrate; we never corncob granules, as these are easily ingested and are
a playground for yeast infection, and we do not use dusty bedding as this causes respiratory illness. At this age,
fledglings should be spending time sleeping, nibbling on dry granules or preening clutch mates. There should be
no toys to distract them from the essentials. The chick pen is partially covered and a cardboard or small animal
plastic den is placed for the chicks retreat.

If possible, chicks are raised with other clutch mates or fledglings of same or different species, assuming there
are no suspected medical concerns of conditions that can be transmitted.

Stage 1. Educational focus: If the chick is transferring from the care of his natural parents, this stage is also an
introduction to the first real look at his new caretaker; therefore, the lesson of trust with this human caretaker
begins! Human Trust: Trust between a bird and human is powerful. One would assume that because the chick is
seeing the human as a source for food, the trust issue is automatic. For the most part, that might be true, but to
further enhance and build on future lessons, the avian caretaker or nursery manager should always reinforce the
relationship with calm actions, soft words of encouragement and gentle mentoring. This chick, as he advances
throughout the education process, will seek the human caretakers mentoring ability to guide him into his final
stages of the Early Parrot Education.

Stage 1. Set up: The chick is out of the dark confines of his nest box and is now placed in a new environment-a
chick pen. To aid in the transition from the nest box and reduce stress, the chick pen, which can be a small animal
pen or a container with high sides, should be covered with a lightweight blanket for most of the time. The chick
pen should also have a good clean substrate that is dust free and absorbent for him to nestle. At HARI, we use a
substrate made of aspen and cat litter made with recycled newspaper as this combination has proven to be dust
free, absorbable, as well as comfortable for the chicks.

Stage 1. Weight monitoring: The caretaker will monitor the chicks daily growth and record weight data on the
Chick Weaning Chart. This daily measurement is crucial to caretaker as the growth pattern will indicate the ad-
vancements to the next stage. It should be said that negative growth patterns will also indicate a possible medical or
nutritional problem. If such is the case, the nursery caretaker can be more proactive in making corrective changes.

Sometimes it is awkward to manage a chick and gram scale, especially when it comes to a heavy bodied species
such as a macaw. However, we want to stress the importance of this routine of daily weighing as it will be part
of this chicks everyday routine in the nursery and hopefully, throughout his life as companion bird.

54 Building Exotics Excellence: One City, One Conference


Stage 1. Health inspection: As the nursery caretaker performs a daily head to toe health check with desensi-
tization methods, the chick will quickly learn that a little light used to check his choanal papillae and a touch
to areas normally considered off limits in older parrots such as under the wing and foot inspection, will be ok.
This mastered lesson will be most valuable throughout the chicks life regardless of who is checking, as this
inspection will give indication of nutrient assimilation and provide an opportunity for general health check by
his future avian caretaker. Parrot owners are encouraged to check these areas of their adult pets or breeders as
these areas that can signify necessary changes in the birds lifestyle.

Stage 1. Pin feather growth, preening, and monitoring with towel desensitization: Pin feathers and towel desen-
sitization go hand in hand. The importance of desensitizing the chick to a towel is to get the bird accustomed
to the future lesson of cradling as this too will become a part of his lessons as he progresses though his primary
education process. It will be expected that sometime during this birds life, he will have to be toweled. Birds that
are not accustomed to towel cradling, are stressed unnecessarily more so in the event of an emergency such as
a broken blood feather or even a simple veterinarian exam. And, stressed birds also show a much higher white
blood cell count, which could be misinterpreted in diagnostic procedure.

Stage 1. Nutritional guidance and feeding strategy: Nutritional guidance will be constant in the EPE and Weaning
Program to benefit the chick as he continues to develop physically as well as serve his cognitive growth. He has
much to learn in the next few weeks and a nutritionally deprived chick will be unable to focus on his upcoming
lessons. In comparison to his wild bird counterpart, its the same course of action when a parent bird brings
food to the nest. The particular food brought to the chick becomes a familiar flavor to him and he will learn by
familiarity that once he leaves the nest, this is the food that is safe and okay to eat. It would without argument, be
detrimental to his survivorship if the parent bird began these lessons after the chick leaves the nest and starts to
an independent search of his own. This is a lesson in nutrition that stays with the chick for his lifetime, knowing
what food is good for him to eat.

Often we see chicks at this age strictly on a 3 or 4 times per day feeding by a syringe. The chicks are winy and
they often display lunging or aggressive behavior when the nursery caretaker appears with a syringe full of hand-
feeding formula. Additionally, they are also often difficult to wean due to prolonged periods of overextended crops
from being fed huge amounts of amounts of formula. Well, those problems could all be avoided if the nutritional
guidance were approached with a different attitude and strategy implemented at this stage of the chicks life.

The crop, once fully extended by volumes of food will soon downsize a bit. Its imperative for the chicks
long term digestive health to keep the crop motility in good shape. This can be achieved with assisted feeding
strategies with softened extruded diet morsels mixed with the hand-feeding formula on a spoon as well as a the
placement of shallow dish with moistened extruded diet in the chick pen. The idea behind this implementation is
not to start forcing the chick to eat on his own, but to play into his natural instincts of picking up and mouthing
objects within his reach, which, at this age, might otherwise be the substrate. It is better to provide nutritious
and familiar flavor to satisfy his natural tendencies for foraging behavior.

Stage 2: Pre-fledgling age

This is a big step as the chick, now deemed a pre-fledgling, is challenged with many new occupations - those
that come naturally as well as those that require a continued guidance by the caretaker. He now will explore his
environment. Physically, the pre-fledgling is up on his hocks more regularly and hes a little more vocal, espe-
cially when he sees his nursery caretaker. He might begin to perch, nibble on a little extruded weaning granules,
and seek companionship with his clutch mates all while he continues to further develop necessary motor skills
and coordination. In this step, the lessons introduced in Stage 1 are still being reinforced by the avian caretaker.

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While the chick remains in the comforts of his chick pen, a few changes to his chick pen are implemented. These
changes will prove useful for his upcoming advancement to his weaning cage-and no, these items are not toys!
The following is a list of what takes place during this stage.

Feeding strategies to encourage natural regression of the crop

Discovery of motor skills

Balance is slowly being acquired

Wing flapping exercise contributes to the development of pectoral muscle mass

Cognitive communication is encouraged

Further desensitization to awaken to other senses

Stage 2. Physical characteristics: The following is a list of physical characteristics observed during Stage 2.

Feathers have emerged on 75-90% of body, head and body feathers as well as wing coverts have emerged,
tail and flight feathers are continuing their growth

Body weight now gradually resting slightly off hocks; feet can now begin to grip perch

Natural downsizing and firming of the crop occurs and is encouraged since the chick will gradually begin
to perch and must not become injured with a large crop; balance and agility will be more challenging
for the chick if the crop is too large

Beak commissures are beginning to harden

Plateau stage on weight chart reached for the larger species

Chicks cannot yet perch with confidence and so weight monitoring must still be done in bin

Nails are very sharp but should not yet be groomed

Chicks are now sleeping approximately 75% of the time; most of their time awake is spent in den, self
preening and preening clutch mates

Curiosity and increasing mastery of gross motor coordination increases foraging through substrate

Stage 2. Educational focus: Occupational lessons introduced in the previous stage, such as warm moistened
towel placement, daily weight recording and general health inspection will continue. The nursery caretaker might
begin a little game session with the towel with a short interval of peek-a-boo. Pre-fledglings are also introduced
to some items that will prove to be more useful in the future steps, such as flight harness and the sound of a
low speed nail salon trimmer. While its not expected for the pre-fledgling to fly, or get his nails groomed, the
desensitization process to these items at this stage will make future lessons a breeze.

Stage 2. Feeding strategy: The nursery manager continues with some syringe feeding at opportune times such
as early in the morning and a good feeding at night. In between those times, soften formulated extruded diet in

56 Building Exotics Excellence: One City, One Conference


a shallow dish of extruded weaning granules are continuously available to the bird. The hand feeder should also
offer the soaked, yet still shaped morsels of extruded diet by spoon. For many seasoned hand feeders, spoon
feeding might sound time consuming and messy, but the value of this feeding strategy does more than encourage
the bird to eat on his own. The textured morsels mixed with the hand-feeding formula help maintain good gut
motility as his crop will start to reduce in size. And, while it might be tempting to offer bits of other foods such
as seed or fruit and vegetable mix, it is imperative that the only food offered to the pre-fledglings be extruded
weaning diet and possibly spray millet to encourage foraging. This measure ensures that the pre-fledgling learns
that extruded food is what he should eat. The introduction of other enrichment foods, such as fruits, vegetables
and treats will come later in the education process. As chicks are beginning to consume more dry extruded diet,
water should now be offered in the cage in a shallow yet stable ceramic dish on the chick pen substrate

Stage 3: Fledgling age

Any nursery caretaker will appreciate that Wow look at you! moment when the chick pen cover is removed
to discover the pre-fledgling is now proudly perched on the side of the chick pen quite comfortably on his own.
This new accomplishment is a sure sign that the pre-fledgling is ready to move on to his new statusa fledgling!
Of the 6 stages of EPE and weaning program, this new stage will involve the most dramatic desensitization
period as a vast array of many new lessons and experiences will be introduced. We do caution that regression
to the previous stage can occur. Lessons include wing flapping (exercise), perhaps with possible flight, daily
bathing, as well as foraging activities, which are introduced in a classroom setting. The following is a list of
what takes place during this stage.

Gregarious nature now awakening

Body conditioning and toning

Introduction to the fledgling cage

Cognitive communication is encouraged-vocal communication, body language & eye contact now has
more significance for mentoring

Self preening education encouraged as mobility and stability increases

Stage 3. Physical characteristics: The following is a list of physical characteristics observed during Stage 3.

Feathers have emerged on approximately 95% of body

Body weight now resting off hocks

To the inexperienced eye chicks may even resemble adult birds

Downsizing and firming of the crop continues

Beak commissures have hardened

Nails should still not be groomed

Mobility is increased and chicks are resting off hocks now, using their beaks and wings to climb with
more agility.

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Stage 3. Set up: The fledgling will now transfer to a weaning cage. A weaning cage is small and will serve the
fledgling with a strong sense of security. And, it will be covered at night, and during resting times in the day.
This cage will offer very little distractions for the curious fledglings as it will contain only rope perches, multiple
dishes with dry extruded weaning granules as well as water are strategically placed near the perches. For a short
time during the fledgling stage, the weaning cage will possibly include a hiding box for an added retreat benefit.
Measures are taken to ensure safety and security-as perches are strategically placed in low position to prevent
overachievers from climbing too high before they have mastered skills in coordination and movement. One might
consider the weaning cage to be sparse as novice caretakers are tempted to offer toys and other items of enter-
tainment to the young bird at this stage. But, remember, the avian caretaker must maintain the fledglings focus!

Fledglings are exposed to other fledglings that have reached more advanced stages of weaning and training
exercises for guidance. They are merely observers at this stage, and will become intrigued with the educational
sessions as the older fledglings engage in this classroom atmosphere.

Stage 3. Educational focus: This is definitely the time to establish the rules of conduct using modeling, mentor-
ing, and gentle handling, but regrettably this is often when mentor caretakers overindulge in cuddling too much
instead of encouraging independence. The following is a list of what can be observed during this stage.

Fledglings become clingers if held too close and preened too close to body of caretakers; they then fear
everything around them

More awake although may still need to nap and retreat to chick pen cavity

Mobility increased, resting off hocks now, using beak and wings to climb with more agility.

Complete misting activity followed by basking session to encourage wing flapping/exercise and self
preening

Clumsy and awkward flight must be supervised and guided

Chicks are learning their place within a flock when misting, basking, foraging

Stronger grip, perching much higher

First basic command is introduced, step up step down out of cage to scale perch

Cognitive communication is encouraged; vocal communication /body language & eye contact now has
more significance for mentoring

Self preening education is encouraged as mobility increases

Gradual supervised socialization with fledglings of other clutches

Personalities are beginning to be revealed

Due to crop regressing, more opportunity to advance the towel cradling exercise

Desensitization to the nail manicure rotary tool or nail file to prepare chicks for slight grooming when
able to perch confidently

Flight harness can be worn more safely as crop has regressed.

58 Building Exotics Excellence: One City, One Conference


Stage 3. Feeding strategy: This is often the age when starvation weaning (intentional or unintentional) occurs.
Weight monitoring and feces monitoring is imperative at this stage. The list below describes what occurs during
this stage.

Feeding a weaning extrusion diet only at this age, additional to assisted spoon-fed feedings or syringe-
fed soaked granules or hand-fed formula, especially in morning and night.

Throughout the continuation of the weaning process; fledglings are encouraged to drink more water as
they are consuming more dry granules

Offering granules soaked in warm water or assisted feedings if necessary (usually 4 times a day but will
not touch commissures or encourage the fledgling to be fed like a chick bopping for large quantities).
Do not want to enlarge the downsizing crop. Eating much more on their own if environment is healthy
and other fledglings or flock mentors eat beside their cage. Still insisting all feeding be principally of-
fered in fledgling cageother than foraging for extruded diet on top of their fledgling cage when being
misted and exercised.

Foraging through exploration, foraging activities still take place inside the fledgling cage

Stage 4: Advance foraging education age

In Stage 4, the recently fledged chick now starts to actively participate in the training sessions; whereas in the
previous Stage 3, he was merely an observer. Comparatively, this would be similar to a preschool child beginning
his first day in kindergarten. The following is a list of what can be observed during this stage.

Weight is beginning to stabilize and is maintained with fewer assisted feedings to provide nurturing and
supplemental consumption

Advanced foraging education by other flock mentors and caregivers

Access to mixed fledgling flight to allow more socialization and exercise during the day and to mimic
foraging activity slightly further away from the nesting cavity

Chicks are actively engaged in primary lesson training and are no longer simply being desensitized

Introducing training sessions that are one on one with mentor (caretaker) although chicks are always
able to view clutch mates during these sessions.

Chicks are now comfortable wearing the flight harness and can have this harness placed and removed easily

Introduced to slight nail grooming

Comfortable with the physical exam as well as towel cradling

Stage 4. Educational focus: It may be favorable to have the flock mentor do most of the education and training
but out of compassion for the fledglings, they must not perceive this mentor as the only caregiver, guide and
disciplinarian since these future companion birds will live most likely away from the breeder. The mentor must
ensure that the fledglings learn to trust being handled and trained by others, and are gradually introduced to this
through social activity and play while at the same time respecting the codes of conduct established with other
trustworthy handlers under supervision. The following is a list of what takes place during this stage.

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Play is the fundamental focus:encourage speech and laughter, vocalization

Occupational activities such as watching television

Desensitization to the travel cage while remaining in view of flock mates

Stage 4. Feeding strategy and nutritional guidance: The fledgling is starting to maintain its weight with occa-
sional assisted feedings, mainly when flocking with other younger birds that are being fed. Droppings are being
monitored to ensure fledglings are eating enough and do not require assistance at every feeding as satiety must
be reached throughout the day to prevent regression. The following is a list of what takes place during this stage.

Foraging activities with the flock and alongside the mentor is encouraged.

Weaning granules are still the recommended diet offered with the occasional spray millet. Enrichment
foods will soon be integrated in the diet in the more advanced stages.

The fledglings weight is monitored, ideally every day. Scale perch training is reinforced, and becomes
a daily ritual.

Stage 5: Fledgling acquiring independence

Weaning independence has been reached as the fledged chick no longer receives assisted feedings to maintain
daily healthy weight. He now enjoys occupational activities such as foraging, preening, play and exercise. Along
with the favorable traits of acquiring more independence comes the inevitable challenges of the newly acquired
self-assurance. He may challenge the flock, mentors and caretakers hierarchy and boundaries, which is why it
becomes imperative that the caretakers nurturing mentorship remains firm yet gentle. The following is a list of
what takes place during this stage.

A glimpse of life outside the fledgling environment and flock: visual environmental enrichment (intro-
duction to outdoors)

Primary lessons and commands learnt in previous stages will be reinforced

Training one on one away from the flock or cage mates

Introduction of fledgling to future caretakers either in person or via internet media with mentors guid-
ance and assurance

Versatile living quarters (day and night cage, activity center, training stand, outdoor flight, transport cage)

Traveling experience is facilitated by the continued one on one guidance and assurance from the mentor
(caretaker) as the fledgling will soon depart to live with its new caretakers

Stage 5. Feeding strategy and nutritional guidance: The fledgling maintains its weight with or without occasional
assisted feedings to continue the nurturing, but is not intended to maintain the weight as the fledgling reaches
satiety on its own. These complimentary feedings are offered in very small quantities mainly when flocking with
other younger birds that are being fed. The following is a list of what takes place during this stage.

60 Building Exotics Excellence: One City, One Conference


The fledglings weight is monitored, ideally every day. Scale perch training is reinforced, and becomes
a daily ritual.

The fledgling is fed 95% weaning granules, 5% millet

Cage paper is changed at every feeding time. Assisted syringe feeding can be given throughout the day
if the droppings monitored reveal green feces.

Stage 5. Educational focus: Nursery caretakers must be creative and intuitive by offering enriching environ-
mental stimuli while providing gratifying and challenging occupational therapy. Such activities may include
foraging activity, stimulating exercise activity, and daily misting. With a little creativity these activities can all
be possible at the exercise activity center. The following is a list of what can be accomplished during this stage.

Environmental enrichment: desensitization and education in hopes that the chick will learn the appreciative
value of sounds and visual enrichment such as water fountains, music, and aquarium, television and radio

The fledgling can be desensitized to sounds that could be instinctively perceived as threatening, and
elicit unwanted behaviors in future; every sound imaginable is downloadable from the internet and a
compilation of these various sounds such as thunder, sirens, loud noises, dog barks, children screams,
fans watching hockey or football games could be used for the desensitization repertoire, but we recom-
mend a trusted caretaker accompany the fledglings while they are exposed to various sounds

Teach the fledgling to really listen to the radio by repeating words you here or singing along, change
the frequency and act intrigued when you hear a new voice or track preferably expose them to different
languages, various beats and sounds for appreciation of this future enrichment and to stimulate vocal-
izing and talking ability

Fledgling is now old enough to shower standing on a shower perch

Monitored supervised flight without a harness indoors before any flight feather grooming is done

The fledgling is desensitized to the sound and touch of the manicure rotary tool; this will gradually lead
to nail grooming using the manicure rotary tool and introduction to this tool can be sheltered under a
towel with the fledgling, where you have his complete attention and anticipation, but remember that the
fledgling has played this game of discovery before when the caretaker brought him several times to this
safe place to introduce food or new devices (just like children hiding under a bed to secretly unravel
something mysterious and new)

Basic step up and out of the fledgling cage and step down onto the perch mounted on the scale is an
integral part of the weaning monitoring process; this exercise should be rewarded with a vocal praise.
Chicks should not have to be lured onto a scale; they are intelligent creatures with the potential to un-
derstand that this is what is expected of them

As the crop has significantly regressed and advanced weaning stages are engaged, the chick will then
be able to be cradled in the towel on an empty crop, after a peek-a-boo play time, and eventually towel
cradling is ultimately achieved when the snugly wrapped towel restrains the birds body almost by itself
while the chick is first laying on his side, then gradually laying on its back. This exercise must be done
on a mattress pad, on the floor. The bird should be less reluctant if made into a playing activity. Nurtur-
ing, guidance, and reassurance are necessary to successfully give confidence to your fledgling

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The fledgling should have developed a relationship of trust with its mentor and other caretakers, as the
framework for a stable foundation should have been laid out. Independence should be been encouraged
and rewarded with praise and nurturing

Steps towards the great outdoors! We romanticize the free flight of parrots in the wild, but it can be
terrifying to a young fledgling born in captivity if not properly introduced to this environment. Learn
to marvel at nature with your fledglings. Before engaging in flight training with the harness outdoors,
make sure your fledgling is comfortable in this environment. Gaze through a window overlooking the
outdoors before stepping out. On a warm day, allow the warm breeze and bird chirps to flow into the
fledgling room. With harness geared up, misting your fledgling outside on a warm sunny and slightly
windy afternoon is a great way to learn to love the wind beneath their wings

Fledglings can also be trained to drink from a water bottle; this is a great idea to add to the transport
cage during discovery and exploration sessions

Familiarize the fledgling to various interventions practiced during a physical exam, with or without
towel restraint

Fledglings can be easily accustomed to the visual inspection of the oral cavity; this exercise is an op-
portunistic moment for aviculturist to monitor the health of the choanal papillae and general health of
the oral cavity of the chicks, starting at a very young age

A flashlight can be used to stimulate the dilatation of the pupil of the eyes

Fledgling should allow palpation of the pectoral muscle and crop

Fledgling should be comfortable with the inspection of his feet for early detection of podo-dermatitis
(bumble foot)

Fledgling should be comfortable to spread its wings, for inspection of growing feathers and stress bars;
this will facilitate feather grooming should this be necessary. We believe fledglings should have the
chance to learn to fly and develop their pectoral muscle before any severe flight feather grooming is done

A stethoscope can be used to listen to the forehead, under the wings and above the hips of the bird. Every
nursery caretaker should be familiar with osculating a chick, to detect any respiratory ruffling from the
air sacs, clicking, muffled or labored breathing sounds which can reveal a past aspiration or respiratory
health concern. Consult with your avian veterinarian to assist you with this proactive and responsible
routine monitoring

Stage 6: Feeding enrichment

This last educational weaning stage is often carried out after the fledgling has left the breeder unless the individual
will be kept for future breeding. The Educational Focus is then carried out by the new caretaker. Instructions
should be clear to ensure that the fledgling maintains all that he has learned. The EPE Primary Lessons acquired
in previous stages have prepared this fledgling both mentally and physically to transition to a new home. The
following is a list of what can be observed during this stage.

62 Building Exotics Excellence: One City, One Conference


The fledgling has acquired weaning independence for several weeks solely on weaning granules and
occasional millet

Feeding enrichment is explored with caution to ensure balanced nutrition and eating habits are maintained

Daily weight monitoring is crucial as regression is highly possible throughout this transition

Monitored time away from the flock or cage mates should be encouraged if the future caretakers do not
have a feathered flock. Audio visual footage of parrots in their natural flock environment can be used to
offer enrichment and mimic the presence of a real flock, so that the natural instinctive communication
skills, foraging and preening behaviors are maintained

Caretakers must be creative and intuitive by offering enriching environmental stimuli while at the same
time providing gratifying and challenging occupational activity

Desensitization to other aspects of companion life such as the first veterinarian exam, visiting a park
while on a harness and travelling to the cottage

Toys can now be introduced in the day cage, after desensitization; short training sessions are recom-
mended on a distinct training stand

Nurturing, guidance and continued mentoring is crucial to reinforce the prior education introduced
throughout the previous stages

Stage 6. Feeding strategy and nutritional guidance: The following is a list of what can be observed during this
stage.

The fledgling has acquired weaning independence for several weeks solely on weaning granules and
occasional millet

Fresh fruits and veggies, hulled seeds and nuts, and healthy table food can be gradually introduced in
small quantities

The introductory foods should never be offered exhaustively or for a prolonged period of time.

Ideally the fledgling maturing towards juvenile age might now be living in a day cage and sleeping in
a separate distinct night cage to prevent territoriality that will develop with the onset of hormones and
monotonous lifestyle and single dwelling. We recommend that the night cage offer exclusively the ex-
truded diet. The introductory enrichment foods should be offered in the late afternoon or at supper time
when enjoying flock foraging with the family caretakers or other birds. The seeds and nuts can also be
reserved for positive reinforcement during training sessions.

At juvenile age the diet consumed can be composed of: 70% extruded diet, 25% healthy seed and nut
mix, 5% millet, fruits and veggies and or healthy table foods

Stage 6. Feeding enrichment: In this final weaning educational stage is where new foods that we consider en-
richment foods are introduced. This last educational weaning stage is often carried out after the fledgling has
left the breeder unless the individual will be kept for future breeding. The Educational Focus is then carried out
by the new caretaker. Instructions should be clear to the new caretaker that the fledgling maintain all that he has
learned to help maintain his journey to companionship.

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Stage 6. Educational focus: As the fledgling leaves the breeder, it is being introduced to new caregivers and
flock mates. With new technologies available, we can explore how we can ease this traumatizing transition for
the fledgling. The following is a list of what can be observed during this stage.

The fledgling has acquired weaning independence for several weeks solely on weaning granules and
occasional millet. Feeding enrichment: fresh fruits and veggies, hulled seeds and nuts, as well as healthy
table food can be gradually introduced in small quantities to allow the fledgling to discover and savor
new textures. Care must be taken, however, to ensure balanced nutrition

Introductory foods should be offered in the late afternoon or at supper time while enjoying flock foraging
with the family caretakers or other birds

The extruded diet, seeds and nuts can be used for positive reinforcement during training sessions or
hidden for foraging; as with all other EPE stages and throughout the parrots life, food should never be
withheld for training purposes

Fledglings should be weighed as frequently as possible since regression is common at this stage

Monitored time away from the flock or cage mates should be encouraged

Nursery caretakers must be creative and intuitive by offering enriching environmental stimuli while at
the same time providing gratifying and challenging occupational activity

Toys can now be introduced into the day cage, after desensitization

Caretaker should continue to be opportunistic with foraging opportunities

Desensitization to other aspects of companion life such as the first veterinarian exam, visiting a park
while on a harness and travelling to the cottage

Nurturing, guidance and continued mentoring is crucial to reinforce the prior education introduced
throughout the previous stages

Awareness of self (fledgling introduced to mirror)

EPE educated fledglings should ideally depart from their primary caretakers with the primary lessons progress
chart. This, along with other documents, will be essential to guide future caretakers and health care professionals
to provide optimal care and recognize the educational foundation provided as a maturing fledgling.

A fledgling suspected of being challenged with a regression in weaning can be further assessed by exploring the
following history and physical characteristics to aid in the medical intervention.

Weaning history: what strategy and monitoring is used? Diet offered: what temperature, quantities, hand-
feeding formulas with or without added morsels are used to encourage natural grinding and reaffirming
of the crop? Are fruits offered or other sugary foods that could lead to bacterial or fungal contamination
and lack of satiety due to less than adequate nutritional density and value?

Weight: how is it monitored, with what precision and how accurate?

64 Building Exotics Excellence: One City, One Conference


Assessment of the physical and physiologic maturity of the individual

Has it been mentored by parental, flock or human caretaker?

Has it been engaged in healthy flock activities (foraging, preening, flight) in absence of a real flock,
does the fledgling have the possibility to see a virtual flock (enrichment footage of birds in the wild)?

Weight, body score and pectoral mass

Condition of the feathers, presence of stress bars could indicate challenges with weaning

Intentional or unintentional starvation weaning practices, crop disorder, less than optimal nutritional
assimilation, inappropriate weaning diet

Assessment of weight loss permitted throughout the weaning stages, no greater than 10 % of the highest
weight recorder at the pre-fledgling age, just prior to the start of the natural crop regression, and great-
est stage of emergence of the feathers.pre fledgling stage. Unfortunately this information is rarely
available as chicks are not often weighed at the pre-fledgling age due to (challenges handling due to the
sharp nails and clumsy plump body)

Condition and maturity of the beak commissures (hardening and sensitivity)

Evaluating a healthy feeding response; a lack of feeding response is common in fledglings despite the
fact they may be very hungry. This is usually the encountered when they have for a few feedings failed
to reach satiety

Recognition of the characteristics that reflect a behavior of hunger or satiety is important. The following is a list
of those characteristics.

Posture can reflect hunger. Swaying movement of the head, ruffled head feathers, beady eyes, rocky
unstable perching, lunging

Saliva in the mouth which is not common in psittacines, can indicate a state of dehydration. Foul sour
crop smell in the oral cavity should be signaled immediately

Dehydration is often one of the unsuspected causes of regression or delayed weaning

Fearful, untrustworthy, weary, screaming, lunging, uncoordinated, shaky motor skills

Evaluation of the droppings (once diet consumed has been clearly and precisely communicated); most
extruded weaning diets do not contain artificial colors and so the feces part of the droppings should be
of the some color as the morsels consumed. Green droppings could indicate hunger. Small dry, stringy
feces can indicate dehydration, foul smelling droppings can be indicative of a bacterial or yeast infection

Observe when drinking or eating. Is there any hesitation or appearance of pain that could highlight a
crop burn? Regrettably some still offer extremely high temperatures to chicks or fledgling temperatures
higher than 103 can cause superficial burns ion the crop or oral cavity. Fledglings will often reject any
assisted feedings and once force fed, may regurgitate if suffering from crop burns. Regurgitate fermented
formula usually is found resting in the lower beak, foul smell

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Dirty feet and tail feathers or feathers around the mouth

Biting, commonly and regrettably misinterpreted as an aggressive behavioral response is often due to
irritable nature of a hungry fledgling

Size of the crop, have it regressed normally or has the natural regression been delayed by assisted feed-
ings of large quantities of syringe-fed hand-feeding formula

References

1. Clubb SL, et al. Psittacine pediatric medicine. In: Shubot, RM, Clubb KJ, and Clubb SL, eds. Psittacine
Aviculture: Perspectives, Techniques and Research. Loxahatchee, FL: Avicultural Breeding and Research
Center;1992.

2. Flammer K, Clubb SL. Neonatology. In: Ritchie BW, Harrison GI, Harrison LR, eds. Avian Medicine:
Principles and Application. Lake Worth, FL: Wingers Publishing Inc;1994:805-840.

66 Building Exotics Excellence: One City, One Conference


The Importance and Efficacy of Foraging Enrichment
in Psittacine Birds
Yvonne van Zeeland, DVM, MVR, PhD, Dipl ECZM (Avian), Dipl ECZM (Small Mammal),
Manon Ravestijn, MSc,
Marjon Mol, MSc,
Nico Schoemaker, DVM, PhD, Dipl ECZM (Small Mammal), Dipl ECZM (Avian),
DABVP (Avian),
Johannes Lumeij, DVM, PhD, Dipl ECZM (Avian)

Session #254

Affiliation: From the Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine,
Utrecht University, Utrecht, 3584 CM, The Netherlands.

Previous studies have indicated the importance of foraging opportunities in the prevention or reduction of feather
damaging behavior in parrots.1,2 The importance of foraging as a behavioral need was further demonstrated by
the finding that parrots will choose to work for their food rather than obtain it freely (ie, contrafreeloading).3-6
However, compared to the situation in the wild, in which birds often spend more than 5-8 hours per day on locat-
ing, manipulating and consuming their food,7 the foraging opportunities in captivity are often limited.8 Although
a variety of foraging enrichments and foraging techniques have been employed in captivity,8-10 it was thus far
not known how effective these enrichments are in stimulating foraging behavior and lengthening foraging times.

The present study focused on determining the efficacy of eleven different types of commercially available for-
aging enrichments and foraging techniques in 12 grey parrots. Results showed marked differences between the
techniques and devices in their efficacy to lengthen foraging times. Although most techniques and devices were
able to induce 2- to 3- fold increases in foraging times compared to baseline (i.e., when eating out of a food bowl,
which resulted in foraging times of approximately 30-45 minutes), none of them were able to lengthen foraging
times to a level comparable with the wild situation. Findings of this study indicate the necessity for development
of new techniques and devices to stimulate the foraging behavior of captive parrots.

A full version of the paper concerning the efficacy of foraging enrichment has been published in Applied Animal
Behaviour Science (Van Zeeland YRA, Ravestijn M, Mol M, et al. Efficacy of foraging enrichments to increase
foraging time in grey parrots (Psittacus erithacus erithacus). Appl Anim Behav Sci. 2013;149:87-102)

References

1. Lumeij JT, Hommers CJ. Foraging enrichment as treatment for pterotillomania. Appl Anim Behav Sci.
2008;111:71-85.

2. Meehan CL, Millam JR, Mench JA. Foraging opportunity and increased physical complexity botch prevent
and reduce psychogenic feather picking by young Amazon parrots. Appl Anim Behav Sci. 2003;80:71-85.

3. Coulton L, Waran N, Young R. Effects of foraging enrichment on the behaviour of parrots. Anim Welfare.
1997;6:357-363.

ExoticsCon 2015 Main Conference Proceedings 67


4. Joseph L. Contrafreeloading and its benefits to avian behavior. Proc Annu Conf Assoc Avian Vet. 2010:
399-401.

5. Rozek JC, Millam JR. Preference and motivation for different diet forms and their effect on motivation for
a foraging enrichment in captive orange-winged amazon parrots (Amazona amazonica). Appl Anim Behav
Sci. 2011;129:153-161.

6. Van Zeeland YRA. The feather damaging grey parrot: An analysis of its behaviour and needs. PhD The-
sis, Utrecht University, 2013. Available at: http://dspace.library.uu.nl/handle/1874/276159. Accessed
March 9, 2015.

7. Snyder NF, Wiley JW, Kepler CB. The parrots of Luquillo: Natural history and conservation of the Puerto
Rican parrot. Camarillo, Western Foundation of Vertebrate Zoology, 1987.

8. Rozek JC, Danner LM, Stucky PA, et al: Over-sized pellets naturalize foraging time of captive orange-
winged Amazon parrots (Amazona amazonica). Appl Anim Behav Sci. 2010;125:80-87.

9. Bauck L. Psittacine diets and behavioral enrichment. Sem Avian Exot Pet Med. 1998;7:135-140.

10. Echols MS. Foraging and enrichment webinar. Available at: http://lafeber.com/vet/foraging-and-enrichment-
webinar/. Accessed March 9, 2015.

68 Building Exotics Excellence: One City, One Conference


Avian Hematology: Sample Collection and
Cytological Evaluation
Brandy McKeown, RVT

Session #398

Affiliation: From the Medical Center for Birds, 3805 Main Street, Oakley, CA 94581, USA.

Abstract: Hematology is an important diagnostic tool in veterinary medicine. Its use aids in determination
of the presence or absence of systemic health and host humeral immune system status, as well as patterning
ongoing disease processes. Veterinary technicians, with appropriate training and knowledge, can perform
hematological exams and play a vital role in the diagnostic process. This presentation will review and
demonstrate the following: sample collection/preparation, performing an estimated white cell count,
differential count and a review of cell forms and their functions.

Introduction

Hematology is viewed as a foundational diagnostic tool in medicine.Veterinarians usethe hemogram to help


assess the systemic health and immunologic condition of their patients. Many disease conditions, including
some infections, some neoplasms and others are associated with hematologic abnormalities, and these changes
are often used, when observed, to pattern differential diagnoses. Hematological exams are used not only for
diagnostic purposes with patients presented for diagnosis and treatment, but are commonly used as a preventa-
tive health, or monitoring measure for those individuals that appear outwardly healthy. Quality control measures
throughout the process of sample collection, preparation and evaluation, and data reporting are important. When
pre-analytic, analytic and post-analytic errors are recognized and minimized, clinical interpretation, will be most
optimally facilitated.

Venipuncture and Sample Collection

Low stress handling

When performing venipuncture, it is important to have a secure hold on the patient while concurrently trying
to minimize exposing the patient to stress. Stress can lead to elevated blood pressure, increased hematoma risk
as well as result in a greater potential for altered hematology and biochemistry results. Examples of artifactual
changes include elevated white blood cell counts, shifts in differential cell counts, and elevations in some bio-
chemical parameters (LDH, CPK, AST). In addition to these mechanical concerns, learned fear to the stimuli
associated with forceful or inappropriate restraint techniques can become increasingly problematic in regards to
the mechanics of future healthcare delivery. With this in mind, use a towel of appropriate size for your patient
and take the time to effectively shape the restraint experience. Avoid the older-school capture and restraint
techniques which although effective for a single laboratory sampling, often set the stage for longer term adverse
learned experiences. Some patients, with the utilization of positive reinforcement and behavior modification,
can be examined and have laboratory sample collection without physical restraint. The use of conscious seda-
tion or even general anesthesia can be used to facilitate venipuncture, but these methods should not be used as
substitutes for low-stress handling methods.

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Jugular venipuncture

Although jugular venipuncture can be performed on the right or left side, the right jugular vein of most birds
is typically larger, and hence, is the preferred vein for sampling. Take caution to not restrict sternal movement,
and pay close attention for open-mouthed breathing patterns or other suggestions of stress, respiratory distress
or hyperthermia.Place the birds head between your index and middle fingers, just under the lower mandible
and cranial portion of neck making sure that the right side of the bird is exposed to you since the right jugular
is typically more prominent than the left.Gently extend stretch the neck by slightly rotating it over your middle
finger, by using your index finger.Apply a small amount of 70% isopropyl alcohol to the neck area and part the
feathers along the cervical apteryla.Place your thumb (on the hand that is holding your patient) on the caudal
portion of the neck to hold off, raise and position the right jugular vein.You may need to roll the trachea out of
the jugular groove area to better expose the vein. The cervical air sac may on occasion fill up with air and block
your view as well. If this occurs, you can simply reposition the birds head or roll the jugular vein slightly. At
this point, the vein should be adequately exposed to you and you should see it very clearly.It is important that
you see this vein clearly, because most bird skin is comparatively thin, and the vein should be able to be clearly
visualized prior to venipuncture. Do not simply stick or probe with your needle blindly! With obese parrots,
you can palpate and visualize the jugular vein similar to the way you may identify it in canine or feline patients,
but you may want to tackle this after some prior experience under your belt. Amazons are commonly obese and
can present as challenges for jugular venipuncture. These obese birds are more stress susceptible, vulnerable to
hyperthermia, potentially prone to clotting problems, and can have a harder time breathing adequately.

For most companion bird species, use a 25- to 27-g needle with a syringe bevel down and parallel to the vein to
get just under skin, then lance down just slightly. Pull back gently but quickly on the plunger, being cautious
not to collapse the vein but not taking too long, as blood can clot quickly. Jugular venipuncture it is not easily
performed in Columbiformes (pigeons and doves), due to the presence of a large cutaneous venous plexus, which
obstructs clear view of the vein.

Cutaneous ulnar vein (basilic)

This vein is commonly used on some of the larger species of birds and usually requires two people: a restrainer
and the person performing the blood draw.For this procedure, a towel is often used to facilitate restraint. The
towel should be wrapped around the one wing, leaving the other exposed for venipuncture. The restrainer should
use their other hand for holding the legs and feet out of the field and in a comfortable position for the patient.
The venipuncturist pulls out the exposed wing by gently grasping the carpal joint, resting the elbow on the third,
fourth and fifth fingers of their other hand. The index finger is then used to hold off and raise the vein where it
crosses over the ventral medial aspect of the elbow and should be easily visible.Apply isopropyl alcohol, and
move feathers to the side for optimal exposure of the vein. Gently insert your needle with similar technique
described for jugular venipuncture. Pull back on the plunger gently, and you should get a flash of blood. Be very
cautious, as this vein collapses very easily and can form hematomas easily.1

Medial metatarsal vein

This venipuncture site also tends to require two people.The holder will restrain the bird in a towel as above. The
towel should be around the back of the bird while wrapped up and over wings to restrict their movement.Bunch
and grasp the towel around one foot while the person who is to draw the blood pulls out the other leg and holds
the vein off close to the inguinal area.Rotate the body of the bird approximately 45 degrees toward the vein
you are accessing, to allow more exposure and ease of technique by the phlebotomist. The medial metatarsal
vein runs up the medial portion of the tarsometatarsal region, wraps forward across the hock joint towards the
tibiotarsus.5 You can see where this vein rises up when held off, and when wetted with alcohol. The hock joint

70 Building Exotics Excellence: One City, One Conference


is supported beneath with the third, fourth and fifth fingers of one hand, and the index finger of the same hand
is used to hold the vein off similar to the technique that is used for the cutaneous ulna vein. To hit this vein,
insert the needle, bevel down, and insert it under a scale and lance down slightly. It is important to note that this
vein is like the cutaneous ulna, and can also develop hematomas or collapse easily.

Other sites for blood sampling

Although once popular, the use of the toenail clip method for obtaining samples is no longer a recommended
technique. Concerns about the pain that is induced by this technique, and sample artifact problems are the pri-
mary cited reasons. In pigeons, the occipital venous sinus can be used for obtaining venous blood samples. This
technique has some risk of potential brainstem injury, and is used in birds greater than 400 grams, frequently
that have been anesthetized.1

Slide Preparation and Staining: Creating a Good Smear

It is important that regardless of however you prepare your slides, that they be prepared first.Clots can form in
less than three minutes with non-heparinized blood. Following preparation of your smears from whole blood,
fill your microhematocrit tubes, and then the remainder of your sample vials.EDTA is sometimes used as an
anticoagulant, but problems are reported in a number of bird species with unexplained progressive hemolysis.
This problem has been described in crowned cranes, corvid species, ostriches, kookaburras, hornbills and some
penguins. With EDTA samples, it is recommended that the blood smears be evaluated within three hours. In
general, if an anticoagulant is to be used, heparin is most commonly chosen for these reasons. There are two
common methods for blood film preparation. In conventional feline and canine hematology, a drop of blood
is applied to one side of a glass slide, and the end of another slide is gently placed next to the drop of blood,
then the slide is pushed down and glided over the first slide, creating a fairly uniform smear. Another method
that is commonly used is the coverslip method. This method provides you with two smears from one drop of
blood.Taking one cover slip, apply one small drop of blood to a corner.Then take another cover slip and gently
rest it on top of the drop of blood.The blood film will spread out and begin to feather at its edges. At that point
in time, quickly glide the two coverslips apart.This coverslip smear technique provides you with two smears,
both with feathered edges.You usually want to do this twice to create four total smears.The coverslip method
conserves blood and provides the hematologist more slides to choose from. Conserving how much blood is
used is particularly important with small patients. One percent of body weight is the general rule of thumb for
maximum blood volume collection in most birds. The thickness of the films should be thin enough to read print
beneath a uniform monolayer.

Red Blood Cells, White Blood Cells and Their Function

Red blood cells (erythrocytes)

Avian red blood cells are nucleated. A normal mature erythrocyte will have a nucleus that stains moderately
basophilic, that is usually oval in shape. The nucleus is typically a little less than half the size of the entire red
bloodcell.The cytoplasm of the erythrocyte is a light pink color, with a slight dark pink wall. Immature eryth-
rocytes (reticulocytes), will show a degree of polychromasia with more basophilic cytoplasm. The nucleus is
larger than that of the mature erythrocyte, with a slightly more rounded nucleus and more pronounced basophilic
stippling. Reticulocytes can be preferentially identified using supravital staining with new methylene blue, bril-
liant cresyl blue, Romanowsky or Wrights stains.2 These preferentially stained reticulocytes will have a distinct

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ring of aggregated reticulum surrounding the cell nucleus Reticulocytes are larger and rounder than a mature
erythrocyte. It is normal to see up to eight percent immature erythrocytes (reticulocytes) in a healthy bird hemo-
gram. In circumstances where you are seeing at least 11-15% reticulocytes, you may be seeing some sort of a
response to blood loss (regenerative). A rubricyte will be very round with an extremely large nucleus. Rubricytes
have a less dense nuclear chromatin large basophilic nuclear stippling with purple to black chromatin and very
little dark blue cytoplasm. Some rubricytes may almost appear similar to a lymphocyte, but lymphocytes have
a grey tinted cytoplasm.Rubricytes are usually seen only in markedly regenerative responses, since they are a
very young stage of development and typically remain in the bone marrow.

White blood cells (leukocytes)

Granulocytes: Granulocytes include the heterophil, the eosinophil and the basophil. All cells are polymorpho-
nuclear, meaning an irregular shaped nucleus. Granulocytes contain cytoplasmic granules which have varying
staining characteristics and shapes.

Heterophils: Heterophils are in general similar to the neutrophils of mammals. Heterophils are highly motile and
phagocytic. Their primary function is for bacterial killing by chemotaxis, ingestion, and lysis. Avian heterophils
lack proteinase for liquification of necrotic tissue, which is why birds tend to form granulomas. The heterophil
is usually the most common white blood cell (with exceptions in certain disease processes and a few species that
are lymphocytic, such as the canary). Overall, there is little interspecies variation in appearance of most hetero-
phils. Theyare round shaped or sometimes lobulated cells, with a slightly larger size than red blood cells. The
nucleus is usually bilobed. Cytoplasm is colorless to faintly pink-staining. Cytoplasmic granules (chromatin) are
rice-shaped pink or magenta staining. Heterophil granules in most species are fusiform or spindle shaped. These
granules are unstable when exposed to aqueous solution and may disrupt, leaving small, spherical, red-staining
granules. Inadequate fixation can result in degranulation of heterophils and basophils. Immature heterophils have
fewer granules, which are more rounded and strongly basophilic. Toxic changes that are described in heterophils
include cytoplasmic basophilia, vacuolization, and degranulation. Toxic heterophilsare commonly graded on
a loose scale of 1+ - 4+. These scaled toxic changes have progressive and irregular shaped granules in their
cytoplasm. In more severe toxic changes, there can be granules seen that are fusing together and even having
what appears to be vacuoles inside. The walls of the nucleus may be less distinguishable in the more severely
toxic heterophils you may see. Immature heterophils tend to be larger than their mature counterparts, with less
definition between nuclear chromatin and cytoplasmic granules colors, and have fewer visible cytoplasmic
granules than mature heterophils.

Eosinophils: The function of the avian eosinophil is unknown. Eosinophils tend to be seen more often in this
authors practice in response to acute inflammatory processes, such as some forms of skin disease, and some acute
pulmonary disease processes.1 Eosinophils have blue cytoplasm with an irregular lobulated nucleus containing
large purple chromatin within. In most species, the cytoplasmic granules are spherical and stain a clear bright
red to slight purple. A basophilic nature of eosinophil granules is characteristic of most psittacine birds. Duck
eosinophil granules are rod-shaped.

Basophils: Basophils seem to be seen more often in this authors practice in response to some chronic inflam-
matory processes, such as in birds recovering from smoke inhalation, or in canaries with tracheal or air sac mite
infestations.1 Basophils are motile cells involved in inflammatory reactions. These cells are generally smaller
cells, with spherical basophilic granules and a light blue staining nucleus. Inadequate fixation can result in de-
granulation of heterophils and basophils. Basophil granules are comparatively large in size.

Mononuclear cells, lymphocytes:Lymphocytes range in size from large, medium and small. All lymphocytes are
round shaped cells, with cytoplasm that is clear or pale blue of varying amounts and homogenous in appearance.

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Their cytoplasm may have some azurophilic or basophilic staining granules. The nucleus of the lymphocyte
is round and centrally or slightly eccentrically located. In reactive lymphocytes, the cytoplasm may have dark
blue basophilic stippling and cell size will be larger than what is seen with a normal lymphocyte.Reactive lym-
phocytes tend to be seen withinflammatory disease processes. In this authors practice, lymphocytic reactivity
is rated on a 1+ - 4+ scale.1

Mononuclear cells, monocytes: Monocytes are larger than lymphocytes, and are round to slightly irregular in
outline. Their cytoplasm is grayish blue, opaque, has a reticular or finely granular appearance and contains vacu-
oles which may produce the appearance of two zones; light and dark staining. The nucleus of the monocyte is
eccentric round, elongated or indented, which is pale staining, kidney-shaped. Monocytes have a short time in
circulation, passing into tissues and become macrophages. The monocyte can sometimes be mistaken for large
lymphocytes. A significant difference between the monocyte and large lymphocyte is that monocytes have large
nucleus that tends to be irregular shaped, allowing for more cytoplasm to be seen.Comparatively, the cytoplasm
in lymphocytes has a more granulated appearance. The main functions of the monocyte are believed to be
phagocytic for microbes, necrotic-cells and cell debris, and to concentrate antibody to present to lymphocytes.
A relative or absolute monocytosis can be seen in many forms of chronic inflammatory disease.1

Thrombocytes

The thrombocyte is a nucleated oval-shaped cell, smaller than most red blood cells. They are larger; more
rounded, and have strongly staining nuclei. The cytoplasm stains colorless to faint blue, and may have
1-2 small basophilic inclusions within it. Typically, there will be 1-2 thrombocytes seen per oil-immersion field.
An activated thrombocyte may have pseudopodial formation, increased degrees of vacuolization, and aggrega-
tion. Thrombocytes have a phagocytic function, and tend to increase with bacterial infections.

Hemoparasites

There are quite a few hemoparasites described in avian species. In commonly kept pet species in the United
States, Hemoproteus, Plasmodium and Leukocytozoon often are noted. Gametocytes of Haemoproteus are
seen in the cytoplasm of the red blood cell. These organisms arch around the nucleus. Most birds infected with
Haemoproteus are asymptomatic, with exception of rock doves and quail. Clinical signs that may be exhibited
include hemolytic anemia, anorexia, and depressed mentation. Leukocytozoon is most often seen in waterfowl,
turkeys and young raptors. Gametocytes living in the host red blood cell dramatically displace the nucleus, often
distorting the shape of the cell. Some clinical signs of infection with Leukocytozoon can include anorexia, depres-
sion, hemoglobinuria, dehydration, and hemolytic anemia. Plasmodium is the causative organism of malaria.
Frequently identified host species include passerine species, Sphensiformes, some Galliformes, Falconiformes
and Anseriformes. A unique quality of Plasmodium infection is its ability to have gametocytes present in the
erythrocyte, thrombocyte, and leukocytes. It is important to note that even though the gametocytes are in the
cytoplasm and look similar to Haemoproteus, they will displace the nucleus. Clinical signs associated with infec-
tion of Plasmodium include hemoglobinuria and acute death. Associated hemogram abnormalities may include
lymphocytosis, hemolytic anemia and leukocytosis.

White Blood Cell Count

The total white blood cell count (WBC) is determined with three common methods: absolute, indirect and
estimated. The direct method of absolute cell count determination uses Natt & Herrick Solution (includes new

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methlene blue). The direct count is performed by filling a hemocytometer, and on high dry (400 magnification)
by counting all leukocytes in the cells in 9 squares, then adding 10% and multiplying by 100. The eosinophil
Unopette (brand 5877) method is an indirect counting method, as it only stains heterophils and eosinophils.
With this method, the hemocytometer is charged similarly, and at 100 magnifications (low dry), the stained cells
in 9 squares are counted. Ten percent is added, and this number is multiplied by 16. Then, the differential cell
count is performed to obtain the percentage of individual white blood cells, and the total white blood cell count
is calculated from these figures. The estimated white blood cell count is performed on a thin monolayer flood
film, and its accuracy is largely dependent on the thickness and overall quality of the film that is being read. Us-
ing the 40X lens, count the total number of white blood cells presents in five fields. Take care before beginning
the count that you are counting from a representative location on the smear, were the cells are not too sparse or
not too clumped. Add these 5 fields up and divide by 5. Multiply this number by 2,000 for the estimated white
blood cell count.

Differential White Cell Count and Red Blood Cell Morphology

This portion of your estimated CBC relies on your cell identification skills.Use a cell counter or worksheet with
the cell names on it, and manually count every heterophil, eosinophil, basophil, lymphocyte, and, monocyte that
you see, until you reach a total of a minimum of one hundred cells.It is also important to observe and note the
thrombocytes that are seen. Usually, you will see 1-4 thrombocytes on a field in a fairly normal hemogram. You
may see clots that have formed at some locations. If these are seen, they should be noted. Next, take time to ob-
serve and record your findings regarding polychromasia and anisocytosis. Typically, a 1-8% polychromatophilic
red blood cell percentage is seen in a normal avian hemogram. In cases where there is a depressed hematocrit
or anemia (PCV < 35%), you may see suggestion of a regenerative response, demonstrated by a high polychro-
matophilic red blood cell percentage of at least 10-15% or even greater. The presence of round erythrocytes
with oval nuclei in polychromatic cells is suggestive of an asynchronous maturation of the cell nucleus and the
cytoplasm, probably owing to accelerated erythropoiesis as would be seen in a regenerative anemia. Pay care-
ful attention to the morphology of the erythrocytes, noting poikilocytosis. For polychromasia, anisocytosis and
poikilocytosis, these changes are empirically rated by slight (normal), moderate, or high.Regenerative changes
of the erythrocyte can be represented by a percentage of the RBCs that you see during your differential count,
or by using the + rating system, in which a plus symbol after the number recorded suggests that the approximate
percentage is roughly ten times that number(eg, 2+ regenerative RBCs = 20%).

Artifacts Estimates and Errors

Attention should be paid to stain artifacts and poor stain color if seen. Stains should be kept in closed-lid contain-
ers and should be changed often, depending on use as they can accumulate bacteria growth.2 Avoid fingerprints,
glue, or other random materials mixing with your stain. Only stain one slide at a time, this will ensure an extra
slide is available if accidents occur. Make your notes objectively and factually, reporting only what is seen as
opposed to your interpretations of what you see. Most importantly, understand these are estimates and are not
exact. In this authors practice the estimated white cell count may be performed multiple times on a few slides
for the same patient and blood draw in order to challenge the data that is generated for accuracy and potential
interpretive meaning. This process, when indicated, helps give a more accurate picture of the patient before you.
Lastly, watch for trends, ask questions and feel comfortable with acknowledging that you may not recognize
an odd cell on a slide. These steps will ensure that you will continue to grow, change, and learn and reduce the
possibility of misinterpretation of what you are seeing.

74 Building Exotics Excellence: One City, One Conference


References

1. Campbell TW, Ellis CK. Hematology. Avian and Exotic Animal Hematology and Cytology. 3rd ed. Somerset,
NJ: Wiley Blackwell; 2007.

2. Campbell TW. Avian Hematology and Cytology. 2nd ed. Ames, IA: Iowa State University Press; 1995.

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Section 4

AAV Research

Julia Whittington, DVM


Moderator
Broken Blood Feather Occurrence and Treatment
in Pet Birds
Maryssa Beckman, BS, and
Kenneth Welle, DVM, DABVP (Avian)

Session #148

Affiliation: From the University of Illinois College of Veterinary Medicine, Urbana, IL 61802, USA.

Broken blood feathers are a very common presenting complaint in avian patients. Traditionally, the therapy for
this condition has been to pluck the feather from the follicle. Despite its frequent listing as an emergency, our
hypothesis is that the risk of this condition is overestimated. We further hypothesize that the removal of these
feathers may be an unnecessary source of pain and trauma. The current study consists of a survey of avian
veterinarians to determine the frequency of severe hemorrhage and whether outcomes vary between methods
of treatment. The survey consists of 8 questions relating to incidence, treatment, complications, and outcomes
of birds with broken blood feathers. While results are still coming in, the current results reflect 66 responses,
representing over 600 collective years of experience. Contrary to our hypothesis, broken blood feathers may
present a serious risk of life-threatening hemorrhage with 15% of respondents having encountered these cases.
Most veterinarians surveyed treat this condition by removing the whole feather (80%). The remaining veterinar-
ians treated the condition with direct pressure at the end of the broken feather. The most common complications
noted for both methods, were that the follicle continues to hemorrhage after removing the feather (47.06% of
cases) or restarts after stopping (68.63% of cases). Overall, complications were low, occurring in less than 20%
of cases. Clipped wings also were not found to be protective against feather damage. Further studies are planned
to investigate alternative treatment options.

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Healthy and Feather-Damaging Grey Parrots Display
Different Coping Styles
Yvonne van Zeeland, DVM, MVR, PhD, Dipl ECZM (Avian), Dipl ECZM (Small Mammal),
Marleen van der Aa, DVM,
Claudia Vinke, PhD,
Johannes Lumeij, DVM, PhD, Dipl ECZM (Avian),
Nico Schoemaker, DVM, PhD, Dipl ECZM (Small Mammal), Dipl ECZM (Avian),
DABVP (Avian)

Session #259

Affiliation: From the Department of Clinical Sciences of Companion Animals (van Zeeland, van der Aa,
Lumeij, Schoemaker) and the Department of Animals in Science and Society (Vinke), Faculty of Veterinary
Medicine, Utrecht University, Utrecht, 3584 CM, The Netherlands.

In various animal species, a correlation is present between the response to stressing stimuli (coping style)
during behavior tests and the susceptibility to develop behavioral disorders.1-4 To investigate whether this
correlation also is present in parrots, 22 grey parrots (Psittacus erithacus) with and without feather damaging
behavior (FDB) were subjected to a manual restraint test (MRT), novel object test (NOT) and open field test
(OFT). During these tests, which were performed with 1-week intervals in between, the parrots behavioral and
neurophysiologic responses were recorded and subsequently analyzed. Birds with and without FDB differed
significantly with regard to their behavioral response in all of the tests. Of the 3 tests, OFT resulted in the highest
correlation between presence of FDB and the type of response displayed, with FDB birds showing higher open
field activity, indicative of a proactive coping style. This proactive response of FDB birds was also found in NOT.
Differences were less obvious in MRT, which only showed differences in vocalizations (duration, frequency and
latency time) and a tendency towards increased corticosterone response. These results indicate that FDB parrots
display a proactive coping style, similar to feather pecking laying hens.5-7 The study thereby provides further
insight into the etiology of FDB, and suggests a potential role for behavior tests to establish whether a parrot is
at risk for developing FDB. Further (prospective) studies with larger groups of parrots are, however, necessary
to confirm these findings and determine whether and which behavior tests have (the highest) predictive value.

References

1. Wechsler B. Coping and coping strategies: a behavioural view. Appl Anim Behav Sci. 1995;43:123134.

2. Koolhaas JM, Korte SM, De Boer SF, et al. Coping styles in animals: current status in behavior and stress-
physiology. Neurosci Biobehav Rev. 1999;23:925935.

3. Koolhaas JM, De Boer SF, Coppens CM, Buwalda B. Neuroendocrinology of coping styles: towards un-
derstanding the biology of individual variation. Front Neuroendocrinol. 2010;31:307321.

4. Korte SM, Prins J, Vinkers CH, Olivier B. On the origin of allostasis and stress-induced pathology in farm
animals: celebrating Darwins legacy. Vet J. 2009;182:378383.

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5. Jones RB, Blokhuis HJ, Beuving G. Open-field and tonic immobility responses in domestic chicks of two
genetic lines differing in their propensity to feather peck. Br Poult Sci. 1995;36:525530.

6. Albentosa MJ, Glen E, Leeb C, et al. An evaluation of response to novelty as a predictor of pecking tendency
in laying hens. Appl Anim Behav Sci. 2003;82:313328.

7. Rodenburg TB, Buitenhuis AJ, Ask B, et al. Genetic and phenotypic correlations between feather pecking
and open-field response in laying hens at two different ages. Behav Genet. 2004;34:407415.

82 Building Exotics Excellence: One City, One Conference


Pharmacokinetics of Amitriptyline HCL and
Its Metabolites in Normal Healthy African Grey
Parrots (Psittacus erithacus) and Cockatoos
(Cacatua species)
Marike Visser, DVM,
Michelle M Ragsdale, DVM, CVPP, CCRP, CVMA,
Dawn M Boothe, DVM, PhD, Dipl ACVIM, Dipl ACVCP

Session #130

Affiliation: From the Department of Anatomy, Physiology and Pharmacology (Visser, Boothe) Auburn
University College of Veterinary Medicine, Auburn University, 1500 Wire Rd, 214 SRRC, Auburn, AL
36849, USA, and The Pain Vet, 6202 Pebble Canyon Ct, Katy, TX 77450, USA (Ragsdale).

Abstract: Amitriptyline is a tricyclic antidepressant used clinically to treat feather destructive behavior
inpsittacine birds. The recommended therapeutic range is 1-5mg/kg PO q12-24h, which has been
extrapolated from human medicine and based on anecdotal reports. The purpose of this study was to
describe the individual and population pharmacokinetic parameters of amitriptyline following a single
oral dose at 1.5 mg/kg, 4.5 mg/kg and 9 mg/kg, in healthy African Greys (Psittacus erithacus, n = 3) and
cockatoos (Cacatua species, n = 3). Two birds received an initial 1.5 mg/kg oral dose and blood samples
collected for 24 hours at fixed time intervals and serum concentrations of amitriptyline and its metabolites
were determined by polarized immunofluorescence. After determining the initial parameters and a
14-day wash out period, African grey parrots (n = 2) and a cockatoo (n = 1) received a single oral dose at
4.5 mg/kg and cockatoos (n = 3) and an African grey parrot (n = 1) received a single oral dose at 9 mg/kg.
Concentrations reached the minimum therapeutic range reported in humans (60 ng/ml) in 4 of 10 studies
(4.5 and 9.0 mg/kg). Concentrations were considered toxic in one cockatoo, with regurgitation, ataxia and
dullness noted with the administration at 9 mg/kg dose. Concentrations were non-detectable in 2 studies
(1.5 and 4.5 mg/kg). Serum concentrations were detectable but below the human therapeutic range in
3 birds (1.5 mg/kg, 9 mg/kg). Drug concentrations were continuing to increase at the end of the study
(24 hours) for 1 bird. The elimination half-life varied from 1.6-91.2 hours. The current recommended
dose of 1-2 mg/kg q12h does not appear to be sufficient to achieve serum concentrations within the
human therapeutic range and does not yield predictable concentrations. This study suggests doses of up
to 9 mg/kg may be necessary in some birds, although this dose is likely to achieve toxic concentrations
some bird. Additionally, the elimination half-life is sufficiently variable that dosing intervals are not
predictable. Therapeutic drug monitoring combined with response to therapy is indicated to determine
individual therapeutic ranges.

Introduction

The tricyclic antidepressants (TCAs) are among the used drugs in companion animal behavioral medicine and
chronic pain management.1,2 TCAs are CNS stimulants, and as a group act by increasing concentrations of
serotonin (5-HT) and/or norepinephrine in the CNS by blocking reuptake. In addition, long term therapy ap-
parently alters the postsynaptic monoamine oxidase receptor sensitivity.3 TCAs used in veterinary medicine
include both clomipramine and amitriptyline, and have been used for a myriad of conditions. Amitriptyline
hydrochloride has been used for treatment of canine separation anxiety,2 neuropathic pain in a falcon4 as well as
psychogenic feather picking in companion birds. Clinically, the reported dosages for amitriptyline in companion
birds have been extrapolated from anecdotal canine reports, human pharmacokinetics and clinician experience.5

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Pharmacokinetics of oral and IV amitriptyline in greyhounds showed extremely poor oral bioavailability (6%),
suggesting that the current recommended oral dose does not reach the human plasma therapeutic range of
60-220 ng/ml.6 However, a study examining oral and transdermal amitriptyline in cats indicated that therapeutic
levels could be reached via oral administration, but not transdermal.7 The disposition of the TCA drugs occurs
by mechanisms that can be expected to vary markedly among species, rendering those species for which doses
have been extrapolated more susceptible to adverse reactions. These include variable oral absorption, high protein
binding, large volume of distribution, long elimination half-life and hepatic metabolism.

Amitriptyline has been used clinically in pet birds to control feather picking, as well as more severe automutilative
behaviors. The current recommended dose for use of amitriptyline in companion birds is 1-5 mg/kg q12-24h, but
does not contain any pharmacokinetic data to determine whether therapeutic levels are reached.8 Due to the recent
reports concerning poor bioavailability, as well as the potential clinical use in the management of chronic pain
and feather picking, the validity of the current therapeutic dose recommendations require scrutiny. The purpose
of this pilot study reported here was to determine the pharmacokinetics of amitriptyline following single dose
oral administration in order to establish whether therapeutic intervals in cockatoos and African grey parrots are
feasible with the current dosing range.

Materials and Methods

Data collection

A total of 10 studies were performed in 6 birds: 3 cockatoos (one Umbrella cockatoo [Cacatua alba], 1 Gof-
fins cockatoo [Cacatua goffini], and 1 sulphur-crested cockatoo [Cacatua galerita]), and 3 African grey parrots
(Psittacus erithacus). Each bird was a member of the parrot research colony at the Schubot Exotic Bird Health
Center, Texas A&M University. Each bird received up to two of the following doses: 1.5 mg/kg, 4.5 mg/kg, or
9.0 mg/kg. One cockatoo and 2 African grey parrots initially received 1.5 mg/kg, based on a volume of distribu-
tion in humans of 15 L/kg and a target plasma concentration of 100 ng/ml, which lies in the middle of the target
range for humans (60-220 ng/ml).3 This dose also falls within the current recommended guidelines for treatment
of feather destruction behaviors in psittacinces.5

Samples were analyzed within 24 hours of collection to assure that concentrations were detectable and not toxic.
Based on sub therapeutic concentrations at 1.5mg/kg, the dose was modified such that 1 cockatoo and 3 African
grey parrots received 4.5 mg/kg and 3 cockatoos and 1 African grey received 9.0 mg/kg. All birds were not studied
at all doses because of ethical concerns related to animal stress. A minimum 14-day washout period was observed
between doses if a bird received more than one dose. All doses were given orally as a solution of amitriptyline
(Elavil, AstraZeneca, Wilmington, DE) which was prepared by diluting the commercial intravenous solution
with 5% dextrose in a 1:9 ratio. The intravenous solution was used for formulation of the dose rather than a
suspension of ground tablets to better ensure even distribution of the active ingredients throughout the diluted
oral solution. Oral solutions for each dose were prepared immediately prior to dosing, and birds were not fasted
prior to drug administration. Each dose was deposited into the crop via a rubber feeding tube (14 French, Sov-
ereign feeding tube and urethral catheter, Sherwood Medical, St. Louis, MO), and the tube was flushed with 3
cc of water before withdrawal from the crop. Blood samples for drug assay were collected from the jugular and/
or basilar (wing) vein via venipuncture before and approximately 1, 2.5, 5, 7.5, 10, 17 and 24 hours following
drug administration. Serum was harvested within 4 hours of sample collection, and stored at 4oC until assayed.
Each bird was observed for evidence of drug loss or adverse drug effects for a 5-hour period after dosing, and
intermittently for the remainder of the 24-hour blood collection period. Newspapers were placed under each
cage to detect any drug that might be lost via regurgitation.

84 Building Exotics Excellence: One City, One Conference


Determination of serum amitriptyline

Amitriptyline concentration was quantitated in serum by a fluorescence polarization immunoassay (TDxFLx


Tricyclic Antidepressant Assay, Abbott Laboratories, IL), which was validated for psittacine plasma. The coef-
ficients of variation for the assay controls ranged from 2.9-8.5%. The quantitation limit of the assay was 20 ng/
ml. The assay detects 4 primary TCAs, and a number of related compounds. The assay does not discriminate
between the parent compound and its major metabolite in humans, which has up to 30% cross reactivity. Con-
centrations about 300 ng/ml are considered as toxic with this assay.

Data analysis

For each bird, amitriptyline concentrations at each time were subjected to non-compartmental analysis (Phoenix
St. Louis, MO), providing the elimination half-life (t1/2), area under the curve (AUC), mean residual time
(MRT) and maximum concentration (Cmax) and time to maximum concentration (Tmax) (Table 1). Because the
drug was not administered intravenously, neither volume of distribution nor clearance could be determined; thus,
the elimination curve may not reflect elimination.

Table
Table 1. Individual
1. Individual pharmacokinetic
pharmacokinetic parameters.
parameters.

ID (dose) t1/2 (h) Tmax (h) Cmax (ng/ml) AUC ( min*ng/ml) MRT (h)
AG3 (1.5 mg/kg) 91.0 5.0 39 166662 132.0
AG1 (4.5 mg/kg) 1.6 2.5 82 23985 4.2
AG3 (9.0 mg/kg) 15.0 5.5 390 263135 18.5
C3 (4.5 mg/kg) 7.0 2.5 56 10162 11.0
C2 (9.0 mg/kg) - 10.0 60 - -
C3 (9.0 mg/kg) - 24.5 31 - -
C1 (9.0 mg/kg) 7.6 1.5 90 8557 11.7

Results

Most birds tolerated the oral administration of amitriptyline well, with the exception of 1 bird, which vomited
following administration of 9 mg/kg. Peak serum amitriptyline concentrations approximated 390 ng/ml in this
bird, a concentration exceeding the toxic range established for humans using this assay (300 ng/ml). This same
bird had received 1.5 mg/kg (1/6 the dose) which generated peak serum concentrations of 39 ng/ml and no
adverse effects (Table 1). Concentrations of 390 ng/ml were unexpected and exemplifies the marked variability
achieved in drug concentrations among birds. Adverse reactions noted in this bird and potentially attributable to
amitriptyline included regurgitation, both shortly after drug administration and at 15 hours post-administration;
ataxia (wobbling on the perch); and delayed responses to stimuli such as persons approaching the cage.

As a result of sub therapeutic or non-detectable concentrations, doses received by the birds were variable
(Table 1). Three of 6 birds received more than 1 dose. In 2 of the 10 total studies, performed (at 1.5, 4.5 and
4.5 mg/kg), concentrations were not detectable. Serum drug concentration versus time curves best fit a 2-com-
partment model in those trials (n = 7) for which concentrations were sufficiently detectable to allow modeling.
This included all cockatoos (n = 3) dosed at 4.5mg/kg (n = 1) and 9.0mg/kg (n = 2) and 1 African grey parrot at
4.5 mg/kg. Because results were so variable among birds even at the same dose, means were not calculated for
pharmacokinetic parameters. The variability is best appreciated by comparing individual birds (Table 1). In all

ExoticsCon 2015 Main Conference Proceedings 85


but 1 of the 7 studies for which concentrations were detectable, serum amitriptyline concentrations were below
the targeted range of 100 ng/ml and below the minimum therapeutic range (60 ng/ml) for humans in 3 of 7 stud-
ies (Table 1). The time to Tmax was markedly variable, ranging from 1 to 9 hours; for the latter, concentrations
may have continued to increase after the last sample was collected in this bird. The disappearance half-life was
also variable, ranging from 1.5 to approximately 91 hours.

Discussion

The calculated dose of 1.5 mg/kg failed to generate concentrations that might be considered effective based
on human therapeutic ranges. Indeed, concentrations were sub therapeutic in all birds studied at 4.5 mg/kg.
The final trials studied at a dose of 9.0 mg/kg continued to yield sub therapeutic concentrations in 3 of 4 birds.
Although above therapeutic in a fourth bird, the concentrations were sufficiently high to potentially cause ad-
verse reactions. Although variability was expected in data among birds and variability has been documented in
humans, the magnitude of variability was not. Three birds were studied twice, allowing for some comparison
of maximum drug concentrations for different doses (ie, dose-concentration relationship). One bird (AG1) was
studied at 1.5 mg/kg (45 ng/ml) and 4.5 mg/kg (83 ng/ml), resulting in a reasonable dose-response relationship.
A second African grey parrot (AG3) was studied at 1.5 mg/kg (39 ng/ml) and 9 mg/kg (390 ng/ml), resulting
in a much higher than anticipated concentration at 9 mg/kg. This may reflect saturation of drug metabolizing
enzymes. One cockatoo (C3) was studied twice, at 4.5 mg/kg (52 ng/ml) and 9.0 ng/ml (31 ng/ml), revealing
a very poor dose-response relationship. Concentrations were continuing to increase in this bird at the last sam-
pling time of 24 hours.

Clearly, the disposition of TCAs is quite variable in this study among psittacine birds, both among species
within the same genus as well as between genera. Differences among African grey parrots appeared to be more
pronounced than those among cockatoos in this study. Differences in rates of absorption may account for some
of the variability in maximum concentrations which occurred in this study, as is suggested by the marked dif-
ferences in Tmax. In addition, concentrations in one bird peaked twice, suggesting delayed absorption; however,
bioavailability and volume of distribution differences are also likely to contribute to variability in maximum
concentrations. Birds were not fasted prior to drug administration in an effort to mimic clinical use of the drug,
so it is possible that food interfered with absorption. Differences in dose formulation for each animal were not
likely because the oral solution was made with an intravenous preparation to assure dissolution and to facilitate
equal distribution of the drug throughout the compounded preparation. In addition, care was taken to mix each
preparation well prior to administration. It is likely that differences in maximum concentration among the trials
would have been greater had tablets rather than the IV solution been used to prepare the products. The magnitude
of the differences in pharmacokinetic parameters between species and within species at different doses suggests
that further studies need to be performed, including a focus on bioavailability.

The disappearance of amitriptyline in the birds of this study is much faster than that reported for human patients
(21 hours).3 This may suggest that time to efficacy may not be as long in birds as in humans. It may also indicate
a need to dose animals twice daily, a dosing interval that may prove too inconvenient for some bird owners.
Because one animal appeared to be absorbing drug at 24 hours, further studies are needed to fully characterize
the rate of absorption and what impact a slow rate of absorption might have on dosing intervals.

This study did not address the efficacy of amitriptyline for use in feather-picking pet birds, nor did it attempt to
address a multiple-dosing regimen, which is needed to maximize effects of behavior-modifying drugs. However,
this data does suggest that the current recommended dose of 1-5 mg/kg for medicating pet birds is too low to
achieve a serum concentration within the human therapeutic range in selected African grey parrots and cocka-

86 Building Exotics Excellence: One City, One Conference


too species. In this study, the highest concentration detected when birds were given a dose of 1.5 mg/kg was
44.61 ng/ml, which is below the human therapeutic range. These data would suggest that to reach 100 ng/ml,
cockatoos might require 9.0 mg/kg, while African grey parrots require approximately 4.5 mg/kg. This study sug-
gests that genus and/or species differences might affect the pharmacokinetics of amitriptyline to the point that
therapeutic failure may occur either due to failure to achieve effective concentrations or the attainment of toxic
drug concentrations. Therapeutic drug monitoring by a qualified laboratory may be crucial to therapeutic safety
and efficacy. Finally, the results of this study also emphasize the hazards of tacit acceptance of pharmacokinetic
and efficacy trials carried out in one species for use in a different species.

References

1. Huang K-L, et al. Prolonged analgesic effect of amitriptyline base on thermal hyperalgesia in an animal
model of neuropathic pain. Eur J Pharmacol. 2013;702(1-3):20-24.

2. Jochle W. Abnormal behavior and adaptation problems and their pharmacological control in dogs and cats.
Tierarztliche Praxis Ausgabe Kleintiere Heimtiere.1998;26(6):410-421.

3. Kukes VG, et al. Experimental and clinical pharmacokinetics of amitriptyline: Comparative analysis. B
Exp Biol Med. 2009;147(4):434-437.

4. Shaver SL, et al. A multimodal approach to management of suspected neuropathic pain in a prairie falcon
(Falco mexicanus). J Avian Med Surg. 2009;23(3):209-213.

5. Eugenio C. Amitriptyline HCl: Clinical study for the treatment of feather picking. Proc Annu Conf Assoc
Avian Vet. 2003;133-135.

6. Norkus C, Rankin D, KuKanich B. Pharmacokinetics of intravenous and oral amitriptyline and its active
metabolite nortryptyline in greyhound dogs. Vet Anaesth Analg. 2015;1-10.

7. Mealey K, et al. Systemic absorption of amitriptyline and buspirone after oral and transdermal administra-
tion to healthy cats. J Vet Intern Med. 2004;18(1):43-46.

8. van Zeeland YRA, et al. Feather damaging behavior in parrots: A review with consideration of comparative
aspects. Appl Anim Behav Sci. 2009;121:75-95.

ExoticsCon 2015 Main Conference Proceedings 87


Environmental Stability of Avian Bornavirus:
pH and Drying
Jenna B Kranz, BS,
Paulina Escandon, MS,
Jeffrey MB Musser, DVM, PhD, DABVP (Dairy)

Session #220

Affiliation: From the Schubot Exotic Bird Health Center (Kranz, Escandon, Musser) and the Department
of Veterinary Pathobiology (Escandon, Musser), College of Veterinary Medicine, Texas A&M University,
College Station, TX 77843, USA.

Environmental stability of avian Bornavirus (ABV) was examined. ABV was relatively stable between pH 6
to 11. ABV rapidly lost infectivity when dried; infectivity was reduced relative to control by 36, 87, 99.97, and
100% after drying for 8 hours and 1, 2 and 4 days, respectively.

Avian Bornavirus (ABV) is the etiologic agent of proventricular dilatation disease, a fatal neurologic and gas-
trointestinal disease in psittacines and other birds.1,2 ABV is shed in the droppings.3 The precise mechanism
of transmission has not been elucidated, but transmission is considered to be by the fecal-oral route, with the
respiratory route also being suggested.3 Chemotherapeutics have not been shown to be efficacious in treatment
or prophylaxis. Hygiene and cleanliness is essential to reduce viral exposure,3 thus knowledge of environmental
stability would be useful. The purpose of this study was to measure the reduction in infectivity of ABV under
various conditions, thereby gaining an insight into likely control measures. ABV, isolated and propagated from
brains of Patagonia conure (Cyanoliseus patagonus), was subjected to a range of pH environments and desicca-
tion. ABV rapidly lost infectivity when dried at 25C and 21% relative humidity: infectivity was reduced relative
to control by 36, 87, 99.97, and 100% after drying for 8 hours and 1, 2 and 4 days, respectively. When ABV was
added to pH adjusted saline and allowed to stand for 5 minutes, the virus was relatively stable between pH 6 to
11, with no loss of infectivity at pH 8 and 9. However in strongly acid or alkaline environments, infectivity was
reduced by 84 and 89% at pH 3 and 12, respectively, and was effectively eliminated at pH 2. The sensitivity of
ABV to desiccation suggests that virus could lose viability soon after being shed into the environment.

References

1. Honkavuori KS, Shivaprasad HL, Williams BL, et al. Novel Borna virus in psittacine birds with proven-
tricular dilatation disease. Emerg Infect Dis. 2008;4:1883-1886.

2. Gray P, Hoppes S, Suchodolski P, et al. Use of avian Bornavirus isolates to induce proventricular dilatation
disease in conures. Emerg Infect Dis. 2010;16:473-479.

3. Hoppes SM, Tizard I, Shivaprasad HL. Avian Bornavirus and proventricular dilatation disease: diagnostics,
pathology, prevalence, and control. Vet Clin N Am Exot Anim Pract. 2013;16:339-355.

ExoticsCon 2015 Main Conference Proceedings 89


Experimental Infection of Peach-faced Lovebirds
(Agapornis roseicollis) with Avian Bornavirus
Genotypes II and IV
Jordan Gentry, DVM,
J Jill Heatley, DVM, MS, DABVP (Avian), Dipl ACZM,
Ian Tizard, BVMS, BSc, PhD

Session #162

Affiliation: From Schubot Exotic Bird Health Center, Department of Pathobiology, College of Veterinary
Medicine, Texas A&M University, 4474 TAMU, College Station, TX 77843, USA.

Differences in infectivity between different genotypes of avian Bornavirus (ABV) have not been demonstrated
in a live bird model. Peach-faced lovebirds were inoculated with ABV genotype-II or ABV genotype-IV via both
intranasal and intramuscular routes.1 Birds were tested weekly for viral shedding by PCR of cloacal swabs for
28 weeks. Blood and urine were collected for serologic and PCR testing.2 Birds were humanely euthanized and
necropsy performed. Tissues were collected for viral PCR and histology.3 Gastrointestinal and cloacal lumen
contents were swabbed at multiple sites for viral PCR. No clinical disease was induced in any birds. No persis-
tent viral shedding was observed. Gross and microscopic examination revealed no evidence of ABV infection.
PCR for viral RNA and genetic sequencing confirmed the presence of ABV-2 in the brains of ABV-2 inoculated
birds.4 ABV was not identified in the brains of ABV-4 infected birds. Birds in both groups seroconverted. Birds
urine in both groups was PCR positive for viral RNA. This is the first report of difference in infectivity between
ABV genotypes in experimentally infected psittacine birds.

References

1. Gancz AY, Kistler AL, et al. Experimental induction of proventricular dilatation disease in cockatiels (Nym-
phigus hollandicus) inoculated with brain homogenates containing avian bornavirus 4. J Virol. 2009;6:100.

2. Heatley JJ, Villalobos AR. Avian bornavirus in the urine of infected birds. Vet Med Res Rep. 2012;3:19-23.

3. Delnatte P, M Mak, et al. Detection of avian bornavirus in multiple tissues of infected psittacine birds using
real-time reverse transcription polymerase chain reaction. J Vet Diagn Invest. 2014;26(2):266-71.

4. Guo J, S Payne, et al. Avian bornaviruses: Diagnosis, isolation, and genotyping. Curr Protoc Microbiol.
2014;34:15l.1.1-15l.1.33.

ExoticsCon 2015 Main Conference Proceedings 91


Cardiac Troponin I as a Biomarker of Myocyte
Injury in Turkeys
Brynn McCleery, DVM, DABVP (Avian),
Sara Johns, DVM,
Sophie Jesty, DVM, Dipl ACVIM,
Michael Jones, DVM, DABVP (Avian)

Session #345

Affiliation: From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine,
University of Tennessee, 2407 River Drive, Knoxville, TN 37996, USA.

Cardiac troponin I (cTnI) is one of the most sensitive and specific biomarkers for cardiovascular disease in
human and veterinary medicine; however, clinical application has not been evaluated in birds.1 Baseline cTnI
levels were measured for 8 black Spanish poults using a point-of-care assay (i-STAT cTnI, Abbott Point of
Care Inc, Princeton, NJ, USA) and a high-sensitivity assay (hsTnI; Abbott ARCHITECT STAT High Sensitive
Troponin-I, Abbott Diagnostics, Lake Forest, Illinois, USA). Poults randomly assigned to the treatment group
(n = 4) received doxorubicin, a known toxin to turkey myocytes, dosed at 2 mg/kg IV 3 times per week for
2 weeks. The control group (n = 4) received an equivalent volume of sterile saline IV.2 Troponin measurements
were repeated at 24h (i-STAT only) and at the end of the study.

There were no significant mean differences in i-STAT cTnI or hsTnI values between group or between time
periods. Results of this pilot study suggest that i-STAT cTnI and hsTnI may not be clinically useful in turkeys
with myocyte injury.

References

1. Reagan WJ. Troponin as a biomarker of cardiac toxicity: Past, present, and future. Toxicol Pathol.
2010;38:1134-1137.

2. Czarnecki CM. Doxorubicin (adriamycin)-induced cardiotoxicity in turkey poults: An animal model. Comp
Biochem Physiol. 1986;83:53-60.

ExoticsCon 2015 Main Conference Proceedings 93


Phylogenetic Characterization of a Novel
Herpesvirus Found in the Liver and Lungs of a
Neonatal Chilean Flamingo with Hepatomegaly
(Phoenicopterus chilensis)
Christopher C Coverdill,
Julie Barnes,
Michael M Garner,
Kevin L Hinton,
James FX Wellehan Jr

Session #297

Affiliation: From the College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA
(Coverdill, Barnes, Hinton, Wellehan), and Northwest ZooPath, 654 West Main, Monroe, WA 98272,
USA (Garner).

A novel herpesvirus was detected in a 17-day-old Chilean flamingo with pneumonia, hepatopathy and severe
anemia. Necropsy identified a pale, enlarged liver, mildly increased fluid in the lungs, and red foci in the spleen.
Histologic exam revealed marked hepatic necrosis with syncytia, splenic necrosis and interstitial pneumonia
with eosinophilic intranuclear inclusions within hepatocytes and in unidentified cells of the lung. Transmission
electron microscopy identified virions consistent with a herpesvirus in the nucleus and cytoplasm of degenera-
tive hepatocytes. Nested consensus PCR, sequencing, and phylogenetic analysis identified a novel herpesvirus
within the genus Iltovirus in the subfamily Alphaherpesvirinae.

ExoticsCon 2015 Main Conference Proceedings 95


The Identification of Novel Herpesviruses and
Adenoviruses from Seabirds
Jordyn Sthay, BS,
Galaxia Corts-Hinojosa, MV, MSc, PhD,
Antonia Gardner, DVM,
Linda L Archer, BS, and
James FX Wellehan Jr, DVM, PhD, Dipl ACZM, Dipl ACVM, Dipl ECZM

Session #320

Affiliation: University of Florida, Department of Small Animal Clinical Sciences, College of Veterinary
Medicine, Gainesville, FL 32610, USA (Sthay, Corts-Hinojosa, Archer, Wellehan) and South Florida
Wildlife Center, 3200 SW 4th Ave, Fort Lauderdale, FL 33315, USA (Gardner).

Herpesviruses and adenoviruses are significant avian pathogens that often cause persistent or latent infections.
They have high host fidelity and there is evidence they have typically coevolved with their hosts. Little is un-
derstood of seabird viruses. Human impacts on our oceans are significant, and environmental degradation is
expected to exacerbate the effects of viral pathogens. We surveyed diverse seabird species for these viruses,
resulting in identification of novel herpesviruses and adenoviruses. Larid Herpesvirus 1, in the genus Iltovirus,
was identified from ring-billed gulls (Larus delawarensis). While a herpesvirus has previously been identified
in common loons (Gavia immer),1 we have identified a second novel loon herpesvirus, Gaviid Herpesvirus 2. A
novel herpesvirus of northern gannets (Morus bassanus), Sulid Herpesvirus 1, and a novel herpesvirus of Hum-
boldt penguins (Spheniscus humboldti), Spheniscid herpesvirus 1, were also identified. Novel viruses in the genus
Aviadenovirus were identified, including ring-billed gull aviadenovirus 1, brown pelican aviadenovirus 1, wood
duck aviadenovirus 1, and three from northern gannets. One novel virus in the genus Atadenovirus was identified
from a brown pelican (Pelicanus occidentalis), brown pelican atadenovirus 1. In the genus Siadenovirus, two
northern gannet siadenoviruses were identified. A member of the genus Ichtadenovirus found in a ring-billed
gull may have been infecting fish prey and likely represented a pass-through. Although further data is needed,
similar herpesviruses and adenoviruses are known to recrudesce and cause clinical disease in persistently or
latently infected poultry. The potential clinical significance of these viruses will be discussed.

Acknowledgments: This project was supported by the California Department of Fish and Games Oil Spill Re-
sponse Trust Fund through the Oiled Wildlife Care Network at the Wildlife Health Center, School of Veterinary
Medicine, University of California, Davis.

References

1. Quesada RJ, Heard DJ, Aitken-Palmer C, Hall N, Conley K, Childress AL, Wellehan JFX. Detection and
phylogenetic characterization of a novel herpesvirus from the trachea of two stranded common loons. J
Wildl Dis. 2011;47(1):233-239.

ExoticsCon 2015 Main Conference Proceedings 97


Effects of Prolonged and Repeated Anesthetic
Episodes on Owl Hematology
Kyra Berg,
Kelly Wiggen,
Megan Watson, DVM, MS,
Julia K Whittington, DVM

Session #053

Affiliation: From the Department of Veterinary Clinical Medicine, University of Illinois, College of
Veterinary Medicine, 1008 Hazelwood Drive, Urbana, IL 61821, USA.

Captive raptor management involves minimizing stress during secure restraint. Often this is in the form of
volatile inhalant anesthetic restraint, like isoflurane. Physiologic stress responses in avian species manifest as a
mild leukocytosis with lymphopenia, and in other species, isoflurane has been documented to stimulate a physi-
ologic stress response. In this study, owls underwent isoflurane anesthesia for various durations and frequencies
to determine the effect of inhalant anesthetic restraint on the hemogram.

Clinical management of free-living raptors is complicated by the need to minimize stress and provide secure
restraint to avoid potential injury to both patient and handler. Isoflurane is a volatile inhalant anesthetic agent
commonly used in veterinary medicine to facilitate medical and surgical treatments, and is the most common
form of anesthesia utilized in care of raptors. Volatile inhalant anesthetic agents are known to stimulate physi-
ologic stress responses from prolonged and serial administrations.1,2 The purpose of this study was to evaluate
the hematological effects as an indicator of this stress response of prolonged and serial administrations of iso-
flurane in healthy native North American owls presented to the University of Illinois Wildlife Medical Clinic.

Prolonged administration of isoflurane demonstrated decreased packed cell volume (PCV), total protein (TP),
and lymphocyte counts over time, with return to normal following anesthetic recovery. Serial administration of
isoflurane demonstrated a decreased heterophil count that resolved by the third day of anesthetic administration.
Lymphopenia is consistent with a physiologic stress response in birds, while the heteropenia is not. It is unde-
termined how the heteropenia affects immune function in these patients. Our results suggest that owls requiring
isoflurane administration may suffer immune compromise, potentially increasing risk for opportunistic infec-
tions. Additionally, hematology results not accurately reflect the status of the patient if collected in association
with volatile inhalant anesthetics.

Acknowledgments: The authors thank the National Wildlife Rehabilitators Association for financial support of
this project.

References

1. Elena G, Amerio N, Ferrero P, Bay ML, Valenti J, Colucci D, Puig NR. Effects of repetitive sevoflurane
anesthesia on immune response, select biochemical parameters and organ histology in mice. Lab Anim
2003;37:193-203.

2. Mitsuhata H, Shimizu R, Yokoyama M. Suppressive effects of volatile anesthetics on cytokine release in


human peripheral blood mononuclear cells. Int J Immunopharm. 1995;17:529-534.

ExoticsCon 2015 Main Conference Proceedings 99


Evaluation of Gastrointestinal Transit Times in
Red-tailed Hawks (Buteo jamaicensis) Using
Contrast Fluoroscopy
Grayson Allen Doss, DVM,
Jackie M Williams, DVM, MS, Dipl ACVR,
Christoph Mans, Dr med vet, Dipl ACZM

Session #206

Affiliation: From the University of Wisconsin-Madison School of Veterinary Medicine, Madison, WI


53706, USA.

Red-tailed hawks (Buteo jamaicensis) are one of the most abundant raptorial bird species in North America.
The goals of this research were to establish normal gastrointestinal transit times in the red-tailed hawk and to
investigate if use of a falconers hood affected GI transit. In a randomized, blinded, complete crossover design,
hooded and non-hooded adult hawks (n = 7) were gavage-fed a commercial barium suspension (25 ml/kg, 30%
w/v) into the crop. Fluoroscopic still images were obtained at 5, 15, 30, 45, 60, 90, 120, 180, 240, and 300-minute
time points. In non-hooded birds, gastrointestinal transit time ranged from 30-180 minutes (median: 90 minutes,
interquartile range (IQR): 60-90 minutes). Time to complete crop emptying ranged from 30-180 minutes (median:
90 minutes, IQR: 30-120 minutes). Contrast material was present in the stomach in all birds within 5 minutes of
administration, and in the small intestines within 5-15 minutes (median: 5 minutes). Gastric emptying of contrast
material was not complete in 4/7 animals by 300 minutes after administration.

Hooding of red-tailed hawks resulted in a significant (P = 0.047) delay of complete crop emptying (hooded bird
crop emptying median: 180 minutes, range: 90-180 minutes, IQR: 120-180 minutes). GI transit times were 1.33-
2 times longer (median 1.5) in 6/7 hooded birds, but no statistically significant effect of hooding on GI transit
parameters, other than on crop emptying, could be detected in this study.

ExoticsCon 2015 Main Conference Proceedings 101


A Retrospective Look at Outcomes of Raptors
with Ocular Trauma
David E Scott, DVM

Session #022

Affiliation: From the Carolina Raptor Center, 6000 Sample Road, Huntersville, NC 28078, USA.

Ocular trauma, particularly of the posterior chamber, is very common in birds of prey admitted to rehabilitation
centers. The prognosis for these cases is variable and depends on many factors. Identification of risk factors is
crucial to the management and triage of these cases.

This retrospective study will attempt to identify statistically significant risk factors that affect prognosis. A sum-
mary of the individual cases and the findings will be presented.

Ocular trauma is very common in birds of prey admitted to rehabilitation centers.1-3 Abnormal exam findings
often seen include large amounts of floating debris and blood in the posterior chamber, as well as retinal detach-
ment. While damage to the anterior chamber is quite rare, damage to the posterior chamber is very common.4,5
Because the posterior chamber is not visible to the casual observer, a thorough ophthalmologic exam including
visualization of the fundus is critical.6 There are many variables that affect the clinical course so the outcome
and prognosis can be difficult to predict.

This study was a retrospective look at cases admitted with clinical signs that could be attributed to a traumatic
injury to the eyes. Each bird was assigned a 4-point severity score based on the extent of the damage visualized
in each posterior chamber. This score and several other factors including the species and nocturnal/diurnal life
style were examined in order to discover any correlation to release-ability.

Several interesting conclusions were reached. Of the birds deemed releasable (ie, those that did not die or
were euthanized before 24 hours), 51% were eventually rereleased. The outcome was highly dependent on the
severity of the initial injury. The average admission scores for released and non-releasable birds was 4.87 and
3.08, respectively (P < 0.0001). While not surprising, this was an important finding as these cases can be easily
categorized and can therefore be triaged accordingly based on the expected outcome. In addition, the species
correlated well with recovery and diurnal birds showed a much larger average improvement between pre and
post-scores (diurnal +2.03, nocturnal +0.8, P < 0.0001).

In summary, this study shows that even relatively severe cases (especially in diurnal birds) can recover, so efforts
should be made to treat and rehabilitate these cases.

References

1. Murphy CJ, et al. Ocular lesions in free-living raptors. J Am Vet Med Assoc. 1982;181(11):1302-1304.

2. Seruca C, et al. Ocular consequences of blunt trauma in two species of nocturnal raptors (Athene noctua
and Otus scops). Vet Ophthalmol. 2012;15(4):236-244.

ExoticsCon 2015 Main Conference Proceedings 103


3. Williams DL, et al. Chronic ocular lesions in tawny owls (Strix aluco) injured by road traffic. Vet Rec.
2006;159(5):148-153.

4. Buyukmihci NC. Lesions in the ocular posterior segment of raptors. J Am Vet Med Assoc. 1985; 187(11):1121-
1124.

5. Gumpenberger M, Kolm G. Ultrasonographic and computed tomographic examinations of the avian eye:
Physiologic appearance, pathologic findings, and comparative biometric measurement. Vet Radiol Ultra-
sound. 2006;47(5):492-502.

6. Labelle AL, et al. Clinical utility of a complete diagnostic protocol for the ocular evaluation of free-living
raptors. Vet Ophthalmol. 2012;15(1):5-17.

104 Building Exotics Excellence: One City, One Conference


Section 5

AAV Clinical

Paul Welch, DVM, DABVP (Avian)


Moderator
Endoscopically Obtained Biopsies of
the Proventriculus and the Ventriculus in
Pigeons (Columba livia)
Izidora Sladakovic, BVSc (Hons I), MVS,
Stephen Divers, BVetMed, DZooMed, Dipl ECZM (Zoo Health Management),
Dipl ECZM (Herpetology), Dipl ACZM, FRCVS,
Angela Ellis, DVM, PhD, Dipl ACVP

Session #181

Affiliation: From the Zoological Medicine Service, Department of Small Animal Medicine and Surgery
(Sladakovic, Divers) and the Department of Pathology (Ellis), College of Veterinary Medicine, University
of Georgia, 501 D. W. Brooks Drive, Athens GA 30602, USA.

(Ellis current address: Antech Diagnostics, 1111 Marcus Ave. Suite M28, Bldg 5B, Lake Success, NY
11042, USA.)

There are numerous case reports describing the clinical progression of a proventricular or ventricular disorder in
birds, with a definitive diagnosis often established only at necropsy or via a coeliotomy.1-6 Endoscopy-guided
biopsy of the proventriculus in an umbrella cockatoo (Cacatua alba) allowed for an ante-mortem diagnosis
and successful treatment of proventricular nematodiasis.7 There are no studies evaluating the ease, efficacy and
safety of gastroscopy, and endoscopic biopsies of the proventriculus and ventriculus in birds. The objective
of this study wasto evaluate the usefulness and safety of gastroscopy and endoscopically-obtained biopsies
from the proventriculus and the ventriculus in pigeons (Columba livia).Ease of visualization, ease of sample
collection, diagnostic quality of the biopsy and safety of the procedure were evaluated. Fifteen pigeons were
anesthetized and upper gastrointestinal tract was endoscopically evaluated using a 2.7-mm 30o telescope housed
in a 4.8-mm operating sheath. Saline infusion was used for lumen dilation and to enhance mucosal visualiza-
tion. Mucosal biopsies were taken of the proventriculus and ventriculus using 5-Fr biopsy forceps. Following
a monitoring period of three to six days, the pigeons were euthanized and necropsied. The procedure was safe
using a modified biopsy technique in the proventriculus and standard biopsy technique in the ventriculus. There
were no adverse effects associated with the procedure detected during the post-procedure monitoring period or
at necropsy. Diagnostic quality of the samples is due to be evaluated pending histologic analysis; the findings
will be presented at the conference.

References

1. Anjos BL, Diefenbach A, Rissi DR, Lovato M, Flores T, Pereira LQ, Kommers GD. Anaplastic ventricular
adenocarcinoma in a blue and gold macaw (Ara ararauna). Braz J Vet Pathol. 2012;5:7880.

2. Campbell TW, Turner O. Carcinoma of the ventriculus with metastasis to the lungs in a sulphur-crested
cockatoo (Cacatua galerita). J Avian Med Surg. 1999;13:265-268.

3. Gibbons PM, Busch MD, Tell LA, Graham JE, Lowenstine LJ. Internal papillomatosis with intrahepatic
cholangiocarcinoma and gastrointestinal adenocarcinoma in a peach-fronted conure (Aratinga aurea). Avian
Dis. 2002;46:10621069.

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4. Leach MW, Paul-Murphy J, Lowenstine LJ. Three Cases of Gastric Neoplasia in Psittacines. Avian Dis.
1989;33:204210.

5. De Voe R, Degernes L, Karli K. Dysplastic koilin causing proventricular obstruction in an eclectus parrot
(Eclectus roratus). J Avian Med Surg. 2003;17:2732.

6. Yonemaru K, Sakai H, Asaoka Y, Yanai T, Fukushi H, Watanabe K, Hirai K, Masegi T. Proventricular ad-
enocarcinoma in a Humboldt penguin (Spheniscus humboldti) and a great horned owl (Bubo virginianus);
identification of origin by mucin histochemistry. Avian Pathol. 2004;33:77-81.

7. Mejia-Fava J, Divers SJ, Jimnez DA, Ambrose DL, Rech R, Gottdenker NL, Mayer J. Diagnosis and
treatment of proventricular nematodiasis in an umbrella cockatoo (Cacatua alba). J Am Vet Med Assoc.
2013;242:11221126.

108 Building Exotics Excellence: One City, One Conference


Species Specificity of Adherent Lactobacilli
Isolated from Psittacine Birds
Jeanne Smith, DVM, and
Sheikh A Selim, DVM, MPVM, PhD

Session #067

Affiliation: From Avian Health Products, 6201C Enterprise Drive, Diamond Springs, CA 95619, USA
(Smith) and PHL Associates, Inc, 24711 County Road 100A, Davis, CA 95616, USA (Selim).

Abstract: Adherent lactobacilli were isolated from crop epithelial cells of a cockatiel (Nymphicus
hollandicus), a budgerigar (Melopsittacus undulates), and a green-cheeked conure (Pyrrhura molinae
molinae). A minimum of 1.5 x 106 live organisms/ml drinking water was administered to the same
species of origin and birds from species of varying levels of relatedness. Colonization was determined
by recovering the test lactobacillus from feces after discontinuing dosing. The conure isolate colonized
birds from the same genus as the bird of origin, but not in birds from the same family or subfamily. The
cockatiel isolate colonized in a red-tailed black cockatoo (Calyptorhynchus banksii), considered to be in
a different subfamily, but not in other birds in the family Cacatuidae. The budgerigar isolate colonized
in the budgerigar only, not in birds from the same family or subfamily.

Introduction

Lactobacilli species have formed the cornerstone for probiotic and beneficial bacterial products based on research
in mammals and birds. Research in poultry showed that only birds had lactobacilli strains that adhered to chicken
(Gallus gallus) gastrointestinal endothelial cells, mammals did not. Mammalian lactobacilli do not colonize the
gastrointestinal tract of the bird species studied. Adherent lactobacilli isolated from chickens , Carolina wood
duck (Aix sponsa), pigeon (unreported species), quail (unreported species), and pheasant (unreported species) all
adhered to chicken crop endothelial cells in vitro but colonization in vivo was reported to be species specific.1,2
The species in those studies were from different orders or related at the family level at best. In mammalian re-
search, probiotic strains of lactobacilli are also described as species specific, but the species studied (rats, mice,
pigs, dogs, and humans) are widely divergent.3

There has been very little research on adherence or colonization of lactobacilli in psittacine birds. One study
administered a chicken origin lactobacillus-based probiotic to neonates of several psittacine species, but viable
lactobacilli were not found in the inoculum and the test lactobacillus was not recovered from cloaca cultures.4
Although research in poultry has not revealed a minimum dose of live lactobacillus required to result in colo-
nization or to provide beneficial effects, significant benefits have generally been seen when chicks are dosed
with 106-109 live organisms per bird or in a similar range per liter of drinking water or gram of food. Another
study administered two formulations of a chicken origin lactobacillus to cockatiel neonates. Live organisms
were recovered from the inoculum, the dose of live organisms was calculated to be 6 x 106 for one formulation
and 2.5 x 106 for the other based on manufacturer claims. Crop swabs yielded greater numbers of lactobacilli
in the treated birds, but adherence or colonization of the gastrointestinal tract with the test lactobacillus was not
evaluated.5 The authors administered an adherent lactobacillus isolated from cockatiels to neonate cockatiels at
a dose rate of 5 x 105 live organisms per chick every 3 days. Crop epithelial cell adherence was demonstrated
and there was a statistically significant reduction in gram negative bacteria found in crop contents.6

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The purpose of this study was to determine if adherent lactobacilli isolated from psittacine birds can colonize
other species of psittacine birds related at the family, subfamily, and genus level.

Materials and Methods

Bacteria

Parent-raised young adult or juvenile birds were anesthetized with isoflurane and given intracoelomic injections
of euthanasia solution. A cockatiel, budgerigar, and green-cheeked conure were used due to availability of a bird
meeting the above criteria being euthanized for diagnostic purposes. The crops were removed aseptically and
washed with sterile saline three times. The supernatant from the third washing was retained. The crops were
macerated and the macerate and the third wash supernatant were cultured on Rogosa agar under microaerophilic
conditions. Adherent lactobacilli were identified by recovering significantly higher numbers from the macerate
than the wash solution. The bacteria were speciated, grown in selective liquid media, and lyophilized. Numbers
of live organisms were determined by titration of reconstituted bacteria within one month of the start of each
trial. A Lactobacillus salivarius was isolated from the cockatiel and from the budgerigar. A Lactobacillus reuteri
was isolated from the green-cheeked conure.

Birds

All birds except the Pyrrhura conures were individual pet birds. Their feces were cultured on blood agar plates
under microaerophilic conditions prior to administration of lactobacilli. Any lactobacilli present were identified
as a different species from the test lactobacillus prior to inclusion in the study. The Pyrrhura species were breed-
ing birds from the same facility the L reuteri was obtained. These birds were treated with enrofloxacin at a rate
of 50 mg/120 ml drinking water for 10 days. Feces were cultured and birds were included in the study if their
feces yielded no bacterial growth. The cockatiel origin L salivarius was administered to a cockatiel, a red-tailed
black cockatoo (Calyptorhynchus banksii), a black palm cockatoo (Probosciger aterrimus), a Goffins cockatoo
(Cacatua goffini), a budgerigar, a Solomon Island eclectus (Roratus solomonenesis), an orange-winged Amazon
parrot (Amazona amazonica), and a sun conure(Aratinga solstitialis). The budgerigar origin L salivarius was
given to two budgerigars, a Solomon Island eclectus, an orange-winged Amazon parrot, a sun conure, and a
cockatiel. The green-cheeked conure origin L reuteri was given to a green-cheeked conure, a fiery-shouldered
conure (P egrefia egregia), a maroon-bellied conure (P frontalis frontalis), a pearly conure (P perlata lepida), a
black-capped conure (P rupicola sandiae), a rose-crowned conure (P rhodocephala), a sun conure, an orange-
winged Amazon parrot, a Solomon Island eclectus, a budgerigar, and a cockatiel.

Treatment and Sampling

Birds were housed individually and fed dry pellets or seed mix only. The inoculum was reconstituted the first
day of treatment and administered at a rate of 1.5 x 106 to 4 x 107 live organisms per ml non-chlorinated drink-
ing water. Treated water was made fresh daily for 10 days. Previous stability testing of the inoculum showed
insignificant loss of titer over 10 days of refrigeration. Feces were collected from each bird on the last day of
treatment and weekly for up to 4 weeks thereafter. The feces were cultured on blood agar plates under micro-
aerophilic conditions (candle jar) and any bacterial growth morphologically similar to the test lactobacillus was
speciated. In some cases sampling was discontinued if a bird had negative samples (no test lactobacillus isolated)
the previous two samplings.

110 Building Exotics Excellence: One City, One Conference


Results

Table 1 shows the results of administration of the cockatiel origin lactobacillus. The bird species are listed in
descending order of relatedness to the cockatiel. In the on-treatment sampling, the test lactobacillus was recovered
from the feces of all the birds except the Goffins cockatoo and the orange-winged Amazon parrot. After ending
treatment, the test lactobacillus was isolated from the feces of the cockatiel and the red-tailed black cockatoo
weekly for 4 weeks.

Table 2 shows the results of administration of the budgerigar origin lactobacillus. The bird species are listed in
descending order of relatedness to the budgerigar. During treatment, the test lactobacillus was recovered from
the budgerigars, the Solomon Island eclectus, and the sun conure, but not the orange-winged Amazon parrot
or the cockatiel. The test lactobacillus was recovered from the Solomon Island eclectus one week after ending
treatment but not at later samplings. The budgerigars remained positive for the 4 weeks post treatment.

Table 3 shows the results of administration of the green-cheeked conure origin lactobacillus. The bird species
are listed in descending order of relatedness to the green-cheeked conure. The test lactobacillus was recovered
from feces from all the birds tested while on the treatment. The green-cheeked conure and the fiery-shouldered
conure remained positive for the 4 weeks post-treatment. The maroon-bellied, pearly, and rose-crowned conures
tested positive at one week post-treatment and at 4 weeks post-treatment. The sun conure, orange-winged Amazon
parrot, and the Solomon Island eclectus remained positive at the one week post-treatment sampling only. The
cockatiel tested negative after treatment ended.

Table 1.Table 1. Recovery


Recovery of cockatiel
of cockatiel origin adherent
origin adherent L. salivarius
L. salivarius from feces.
from feces.

During 1 wk 2 wk 3 wk 4 wk
Species Relationa CFU/cc water
txb post tx post tx post tx post tx
Cockatiel S 1.5 x 106 + + + + +
Red-tailed black cockatoo F 4.5 x 106 + + + + +
Black palm cockatoo F 4.5 x 106 + - -
Goffins cockatoo F 4.5 x 106 - -
Budgerigar O 1.5 x 106 + - - - -
Solomon Island eclectus O 1.5 x 106 + - - - -
Orange-winged Amazon O 1.5 x 106 - - - - -
Sun conure O 1.5 x 106 + - - - -
a
S=same species, F=same family, O=same order.
b
tx=treatment.

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Table 2.Table 2. Recovery
Recovery of budgerigar
of budgerigar origin adherent
origin adherent L. salivarius
L. salivarius from feces.
from feces.

During 1 wk 2 wk 3 wk 4 wk
Species Relationa CFU/cc water
txb post tx post tx post tx post tx
Budgerigar S 4 x 107 + + + + +
Budgerigar S 4 x 107 + + + + +
Solomon Island eclectus SF 4 x 107 + + - -
Orange-winged Amazon SF 4 x 107 - -
Sun conure F 4 x 107 + - -
7
Cockatiel O 4 x 10 - -
Budgerigar S 4 x 107 + + + + +
Budgerigar S 4 x 107 + + + + +
a
S=same species, SF=same subfamily, F=same family, O=same order.
b
tx=treatment.

Table 3.Table 3. Recovery


Recovery of green-cheeked
of green-cheeked conureadherent
conure origin L. reuteriL.from
origin adherent reuteri from feces.
feces.

During 1 wk 2 wk 3 wk 4 wk
Species Relationa CFU/cc water
txb post tx post tx post tx post tx
Green-cheeked conure S 1.2 x 107 + + + + +
Fiery-shouldered conure G 1.2 x 107 + + + + +
7
Maroon-bellied conure G 1.3 x 10 + + - - +
Pearly conure G 1.3 x 107 + + - - +
Black-capped conure G 1.3 x 107 + + - - +
Rose-crowned conure G 1.3 x 107 + + - - +
Sun conure SF 1.2 x 107 + - - - -
Sun conure SF 1.2 x 107 + - -
Orange-winged Amazon F 1.2 x 107 + + - -
Solomon Island eclectus F 1.2 x 107 + + - -
Cockatiel O 1.2 x 107 + - - -
a
S=same species, G=same genus, SF=same subfamily, F=same family, O=same order.
b
tx=treatment.

Discussion

Recovery of the test lactobacilli from feces while it was still being administered indicates the bacterias ability
to survive the environment of the gastrointestinal tract. One of the requirements for an effective probiotic is
this ability to survive passage.7 In this study, the lactobacilli were recovered in most of the birds. The cockatiel
origin lactobacillus was not recovered from the Goffins cockatoo or the orange-winged Amazon parrot, and the
budgerigar origin lactobacillus was not recovered from the orange-winged Amazon parrot or the cockatiel. This
would not seem to be affected by relatedness as the bacteria survived in other members of less related species.

Recovery of the test lactobacilli from feces after treatment was discontinued is an indicator of the bacterias abil-
ity to colonize the gastrointestinal tract. Colonization can be achieved either by adherence to the gastrointestinal
endothelial cells, adherence to material in close association with the endothelial cells, or by rapid reproduc-

112 Building Exotics Excellence: One City, One Conference


tion that allows the bacteria to replace itself before it is swept out of the gastrointestinal tract.2,3 Because birds
must be sacrificed to determine adherence, we decided that colonization would be an acceptable measure of the
bacterias adaptation to a bird species. The cockatiel origin lactobacillus successfully colonized the red-tailed
black cockatoo but not the black palm cockatoo or other members of the family Cacatuidae. The taxonomy of
the cockatiel is controversial. It is the only species in its genus and has been classified as the only member of its
subfamily; however, DNA sequencing suggests that the cockatiel and the Calyptorhinchus cockatoos should be
reclassified within the same subfamily.7 If that is the case, the cockatiel origin lactobacillus was able to colonize
birds in the same subfamily. The budgerigar is also the only species in its genus. It belongs to the same subfam-
ily (Psittacinae) as the Solomon Island eclectus and the orange-winged Amazon parrot. The budgerigar origin
lactobacillus only colonized the budgerigars, not members of the same subfamily. The Pyrrhura conures belong
to the same subfamily (Arinae) as the sun conure, but the green-cheeked conure origin lactobacillus colonized all
of the Pyrrhura conures. The pearly, rose-crowned, maroon-bellied, and black-capped conures tested negative
for the test lactobacillus at 2 weeks post treatment and 3 weeks post treatment. This failure to recover the test
lactobacillus those 2 weeks may have been due to the habits of those four birds. They all dipped their pellets
into their water bowls until their water was pellet sludge. Their water was changed twice daily, but this may
have affected the fecal cultures. The pellets typically have Bacillus species and the fecal cultures of these four
birds consistently yielded high numbers of Bacillus species. The lactobacillus, being more fastidious, may not
have grown on media in competition with the Bacillus. The test lactobacillus reappeared among the Bacillus at
4 weeks post-treatment.

The ability to adhere, or at least colonize, has been found to be necessary to obtain many of the benefits of lacto-
bacillus treatment in poultry.2,3 Previously, this ability has been described as species specific. This study identi-
fied a cockatiel origin adherent lactobacillus capable of colonizing a red-tailed black cockatoo, a bird possibly
from the same subfamily; and a green-cheeked conure origin adherent lactobacillus capable of colonizing birds
within the same genus. Research in poultry has shown that not all adherent lactobacilli are created equal. They
vary in their reproductive rates, ability to adhere (even in the same species of origin), production of metabolites,
and conference of beneficial effects.2,3,8 This study was limited in terms of bird numbers and bird species. More
research is needed to determine if other lactobacilli can be found with a broader ability to colonize our many
companion bird species.

References

1. Fuller R. Ecological studies on the lactobacillus flora associated with the crop epithelium of the fowl. J
Applied Bact. 1973;36:131-139.

2. Fuller R. Epithelial attachment and other factors controlling the colonization of the intestine of the gnoto-
biotic chicken by lactobacilli. J of Applied Bact. 1978;45:389-395.

3. Gomez-Gil B, Roque A, Turnbull JF, Inglis V. A review on the use of microorganisms as probiotics. Rev
Latinoamericana de Microbiologica. 1998;40:166-172.

4. Joyner KL, Swanson JL. The use of a lactobacillus product in a psittacine hand-feeding diet: its effects on
normal aerobic microflora, early weight gain, and health. Proc Annu Conf Assoc Avian Vet. 1988;127-137.

5. Tully TN, Shane SM, Kearney MT. Evaluation of two Lactobacillus acidophilus formulations as dietary
supplements in neonatal cockatiels (Nymphicus hollandicus). J Avian Med Surg. 1998;12:25-29.

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6. Smith JM, Selim SA. Performance of neonate cockatiels given cockatiel derived lactobacillus. Proc Annu
Conf Assoc Avian Vet. 2003;157-159.

7. Christidis L, Boles W. Systematics and Taxonomy of Australian Birds. Collingwood, Australia: Csiro Pub-
lishing;2008:150.

8. Garriga M, Pascual M, Monfort JM, Hugas M. Selection of lactobacilli for chicken probiotic adjuncts. J
Appl Micro. 1998;84:125-132.

114 Building Exotics Excellence: One City, One Conference


Infundibular Cyst Formation After Incomplete
Salpingohysterectomy in a Chicken (Gallus
gallus domesticus)
Stephanie Lamb, DVM, DABVP (Avian)

Session #036

Affiliation: From Arizona Exotic Animal Hospital, 744 N Center St Suite #101, Mesa, AZ 85201, USA.

Abstract: A 9-month-old Dutch bantam hen (Gallus gallus domesticus) presented with ascites 3 months
after having a salpingohysterectomy and proventriculotomy procedure performed. Evaluation of the patient
revealed a transudate fluid was present. This fluid was removed by coelomocentesis but continued to return
requiring repeat aspirations. An exploratory surgery was performed and it was found that a portion of the
infundibulum had been left behind during the previous surgery. This segment of the reproductive tract
had a large cyst developing on it. The patient had the remainder if the infundibulum removed. A persistent
right oviduct was removed as well. Post-operatively the patient did well and the ascites did not return.

Introduction

Complications can arise associated with any surgical procedure that is performed on a patient. When it comes
to salpingohysterectomies in avian species complications that have been reported include hemorrhage, potential
for ligating the ureter, patient post-operative manipulation of sutures, and continued follicular development with
yolk release and egg yolk coelomitis.1-3 In one study of endoscopic salpingohysterectomies in pigeons (Columba
livia), complications occurred in 29% of patients and included inadequate radiosurgery, mild hemorrhage, fo-
cal coagulative necrosis of the left kidney, and small hematoma formation on the kidney surface.4 In this same
study, one female had a segment of the magnum left behind.4 The patient in this report underwent an elective
salpingohysterectomy in the hopes of preventing reproductive related disorders but ultimately suffered from an
iatrogenic reproductive problem. A cyst developed in the infundibulum after an incomplete salpingohysterectomy
procedure. To the authors knowledge, a complication of this sort has not been previously reported.

Although this complication has not been documented previously, cystic hyperplasia of the oviduct is a naturally
occurring disease reported in avian patients and it can have a similar presentation to what was observed in the
patient of this report.5,6 The pathophysiology that has been postulated to cause cystic hyperplasia of the oviduct
to occur includes improper formation of the left oviduct, originating from a persistent right oviduct, or secondary
to endocrine abnormalities.5 Signs associated with cystic changes to the oviduct include abdominal distension,
ascites, depression, and dyspnea.5,6 Diagnostics that are often needed to look for this disease include blood
work, radiographs, and ultrasonography. Aspiration of cysts may reveal a mucoid fluid.5,6 Definitive diagnosis
may require laparotomy.5 Treatment can involve supportive care but salpingohysterectomy may ultimately be
needed to cure the problem.5,6

The patient in this report presented with the similar signs of abdominal distension, ascites and dyspnea.

Diagnostics to try and determine the cause for the patients issue were the same as those that are required for
cystic hyperplasia of the oviduct and ultimately a laparotomy was used to gain a definitive diagnosis. The cause
for the cystic development of the infundibulum in this patient is likely different from that which has been postu-

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lated for cystic hyperplasia however. During the first attempt at salpingohysterectomy, no cystic structures were
reported to be present. It wasnt until after this procedure that the cyst developed. It likely developed from the
fact that the tissue was not completely removed and a blood supply was still present feeding into the structure.
Proper blood drainage may have been impaired as a result of the surgery, thus causing an increased hydrostatic
pressure and edema production at the segment of the infundibulum that remained. Had the vasculature been
properly clamped the cyst may not have had the opportunity to develop. Another interesting difference between
what was found in this patient and reports of cystic hyperplasia is the difference in the type of fluid produced.
This patient had a pure transudate fluid develop while cystic hyperplasia is associated with a more mucoid fluid.

This case represents an important consideration for the private practitioner while performing a salpingohyster-
ectomy. It is important to remove the oviduct completely from the coelom in order to prevent a post-operative
iatrogenic complication such as this one.

Clinical Report

In November of 2013, a 6-month-old female Dutch bantam hen (Gallus gallus domesticus) presented to the
clinic for possible ingestion of metallic objects. Radiographs were taken and revealed the patient had ingested
several large linear wires and numerous small particulate metallic objects. Surgical removal was elected for the
patient in order to remove the material from the ventriculus. At the time of the surgery it was requested that the
bird be spayed as well in order to prevent future reproductive related problems. No reproductive related issues
were present in the bird and it had been routinely laying normal eggs. The patient was considered to be a pet
and was not intended to have its eggs used for human consumption.

The patient was taken to surgery on the day of presentation. Entry was made into the coelomic cavity through
a ventral midline incision that had a perpendicular extension at its cranial most border toward the left side of
the body just below the keel. A proventriculotomy was performed first and the foreign objects were extracted. A
salpingohysterectomy was performed next in the same anesthetic episode. The patient recovered uneventfully
and was placed on post-operative pipercillin (100 mg/kg IM q12h for 10 days; Zosyn, Pfizer Inc, Philadelphia,
PA, USA), meloxicam (0.75 mg/kg IM q12h for 1 day; Metacam, Boehringer-Ingelheim, St. Joseph, MO, USA)
, torbutrol (1.3 mg/kg IM q12h for 7 days; Torbugesic, Pfizer Inc, Philadelphia, PA, USA), sucralfate (20 mg/kg
PO q12h for 7days; Carafate, Aptalis Pharma US Inc, Bridgewater, NJ, USA) and lactated ringers solution (25
ml/kg SC q 12h for 5days; Lactated Ringers Injection, USP, Hospira Inc, Lake Forest, IL, USA). It was elected
to not test the patient for lead or zinc toxicity and instead presume toxicity was present. The patient was started
on CaEDTA (35 mg/kg SC q12h for 5 days; CaEDTA, Diamondback Drugs, Scottsdale, AZ, USA).

The patient returned 7 days after the initial surgery and had blood drawn to test for lead and zinc. It was doing
well from the initial surgery. The zinc level came back within normal limits (1.9 ppm; reference range, <2 ppm)7
but the lead level was high (0.84 ppm; reference range, <0.2 ppm).7 CaEDTA was reinstated at the previous
dosage but repeated for two five day rounds with a two day break between. Blood lead levels were checked
again at the end of this treatment time and found to be within the normal range (0.12 ppm; reference range, <0.2
ppm).7 Therapy was discontinued.

Three months after the initial presentation to the hospital the patient returned for heavy breathing and a firm,
distended abdomen. On physical examination there was a slight increase in respiratory effort and a pop sound
when its lungs were ausculted. The abdomen was distended making palpation of coelomic contents difficult. The
vent was slightly loose appearing and the comb and wattles were bright red in coloration. The initial work up
consisted of radiographs which revealed a loss of detail in the caudal coelom and minimal gas in the abdominal

116 Building Exotics Excellence: One City, One Conference


air sacs. One metallic object was still present within the ventriculus. An ultrasound was performed next and it
was found that there was a large amount of fluid in the coelom and the ovary appeared to have follicles present
on it. A coelomocentesis was performed next and a total of 60 ml of fluid was withdrawn. The fluid was analyzed
and revealed that the total protein was 0 g/ dl and the specific gravity was 1.007. Cytologic analysis revealed
no inflammatory cells, red blood cells or microorganisms. A complete blood count and chemistry panel with
bile acids was evaluated. Results were within normal limits. A barium contrast series was performed to assess
organ location and help with developing a list of rule outs. A fecal sample was analyzed and results were normal.
Further diagnostics of a repeat lead level were discussed but declined.

After analyzing the data the concern about a reproductive cause for the coelomic fluid was highest on the list of
differentials. Due to the patient having been spayed previously there was concern about internal ovulation as a
cause for the fluid although the fact that the fluid was a transudate did not seem to fit with this. A persistent right
oviduct that was producing hormones was also considered as the right side of the reproductive tract had not
been thoroughly explored during the original surgery. The patient was started on a series of leuprolide acetate
(1000mcg/kg IM; Lupron Depot, Professional Arts Pharmacy, Baltimore, MD, USA) injections to see if that
would reduce the ascites from reoccurring. Meloxicam (0.5 mg/kg PO q12h; Metacam, Boehringer-Ingelheim,
St. Joseph, MO, USA) was also started to reduce inflammation. Enrofloxacin (10 mg/kg PO q12h for 14 days;
Baytril, Bayer, Kiel, Schleswig-Holstein, Germany) was given for the chances of infection as a cause for the
patients signs. A single dose of lactated ringers solution (25 ml/kg SC; Lactated Ringers Injection, USP, Hospira
Inc, Lake Forest, IL, USA) was administered after coelomocentesis.

The patient came back two weeks later for reassessment and a second leuprolide acetate injection. The patient
again had a tense abdomen and an increased respiratory effort when stressed. On repeat coelomic ultrasound
there were no active follicles seen at the ovary although fluid had returned. There was 96 ml of a transudate fluid
removed. The enrofloxacin was discontinued but leuprolide acetate and meloxicam were continued.

Two weeks later the patient returned again. The abdomen was again distended and 84ml of transudate fluid was
removed. Repeat cytology of the fluid revealed no changes from the initial evaluation. A third leuprolide acetate
shot was administered. It had appeared to be effective in reducing the follicles at the ovary but fluid was continu-
ing to accumulate. At this time it was determined that further work-up would be needed. An exploratory surgery
was deemed as the next best diagnostic step. Other differentials that were considered aside from reproductive
causes for a transudate fluid included liver disease, hypoproteinemia from gastrointestinal loss or renal disease,
or cardiac disease. Since previous diagnostics did not reveal any changes that would be consistent with these
other disorders it was still postulated that reproductive disease was the most likely reason for the current issues.

The patient returned to the hospital once weekly for the next month to have fluid removed from the coelom. The
surgery was postponed for personal reasons until it was a better time for the owner to have it performed. During
these follow up visits anywhere from as little as 24 ml to as much as 132 ml was removed.

Three months after the initial presentation for ascites the patient was taken back to surgery. The patient was
premedicated with midazolam (1 mg/kg IM; Midazolam Injection USP, Akorn Inc, Lake Forest, IL, USA) and
torbutrol (1 mg/kg IM; Torbugesic, Pfizer Inc, Philadelphia, PA, USA) and induced with and maintained on
sevoflurane (2-6% inhalation; Sevoflo, Abbott Laboratories, North Chicago, IL, USA) with intubation. A ventral
midline incision was made and extended perpendicularly at its cranial border to the left to make an inverted L inci-
sion. The coelomic cavity was explored and a large cystic structure was present in a segment of the infundibulum
that had been left in the body from the previous spay. A vessel was found leading into the cyst. Hemoclips were
applied and the vessel was transected. The cyst was then followed to its base near the ovary and it was found that
the dorsal oviductal artery was present feeding into the cyst. Hemoclips were placed at this site and the vessel

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was transected, freeing the infundibular cyst from the body cavity. The vaginal stump portion of the uterus was
inspected and found to be present at the junction with the cloaca. This area was left as it was. The right side of
the reproductive tract was explored and a persistent right oviduct was present. The base of this was ligated and
it was removed from the body. A large follicle was present on the oviduct. The follicle was twisted at its base
until it able to be removed. A small amount of free yolk was present in the coelomic cavity from internal ovula-
tion. This was cleaned out with the use of cotton tipped applicators. The coelomic cavity was closed routinely
and recovery was uneventful. The patient was started on meloxicam (0.3 mg/kg PO q12h for 7 days; Metacam,
Boehringer-Ingelheim, St. Joseph, MO, USA) and pipercillin (100 mg/kg IM q12h for 10 days; Zosyn, Pfizer
Inc, Philadelphia, PA, USA) and was discharged from the hospital. The patient returned 2 weeks later for suture
removal and was reported to be doing very. At the time of this publication the patient was still doing well and
had no reoccurrence of signs.

References

1. DVM 360. Spaying reptiles and birds (Proceedings). Available at: http://veterinarycalendar.dvm360.com/
spaying-reptiles-and-birds-proceedings. Accessed April 2, 2015.

2. Bennett RA, Harrison GJ. Soft tissue surgery. In: Ritchie BW, Harrison GJ, Harrison LR, eds. Avian Medi-
cine: Principles and Applications. Lake Worth, FL: Wingers Publishing Inc;1994:1096-1136.

3. Bowles HL. Evaluating and treating the reproductive system. In: Harrison GJ, Lighfoot TL, eds. Clinical
Avian Medicine: Volume II. Palm Beach, FL: Spix Publishing Inc;2006:519-539.

4. Hernandez-Divers SJ, Stahl SJ, Wilson GH, et al. Endoscopic orchidectomy and salpingohysterectomy
of pigeons (Columba livia): An avian model for minimally invasive endosurgery. J Avian Med Surg.
2007;21:22-37.

5. Bowles HL. Diagnosis and management of female avian reproductive diseases. Proc Annu Conf Assoc
Avian Vet. 2001;349-357.

6. Romagnano A. Avian Obstetrics. Semin Avian Exot Pet Med. 1996;5:180-188.

7. Dumonceaux G, Harrison GJ. Toxins. In: Ritchie BW, Harrison GJ, Harrison LR, eds. Avian Medicine:
Principles and Applications. Lake Worth, FL: Wingers Publishing Inc;1994:1030-1052.

118 Building Exotics Excellence: One City, One Conference


Diagnosis and Treatment of Cushings Syndrome
in a Senegal Parrot
Yvonne van Zeeland, DVM, MVR, PhD, Dipl ECZM (Avian), Dipl ECZM (Small Mammal),
Peter Bastiaansen, DVM,
Hans Kooistra, DVM, PhD, Dipl ECVIM (Companion Animals),
Nico Schoemaker, DVM, PhD, Dipl ECZM (Small Mammal), Dipl (Avian), DABVP (Avian)

Session #251

Affiliation: From the Department of Clinical Sciences of Companion Animals, Faculty of Veterinary
Medicine, Utrecht University, Utrecht, 3584 CM, The Netherlands (van Zeeland, Kooistra, Schoemaker),
and Dierenkliniek De Baronie, Beeksestraat 60B, Prinsenbeek, 4841 GD, The Netherlands.

A 12-year-old female Senegal parrot (Poicephalus senegalus) was presented with a history of increased appetite,
rapid weight gain and polyuria/polydipsia. Physical examination revealed obesity, abdominal distension and
excessive subcutaneous fat deposits. On radiographs and CT, an obvious hepatomegaly was present, whereas a
complete hematologic and biochemical profile revealed an increased activity of liver enzymes and increases in
bile acids. Additional work-up included an ACTH-stimulation test and dexamethasone suppression test. Results
of the ACTH-stimulation test1 were found to be inconclusive. Subsequently, a dexamethasone suppression
test was performed by giving 0.5 g/kg dexamethasone intravenously and collecting blood for corticosterone
measurements at t = 0 and t = 90 minutes.2 Whereas other Senegal parrots, used as control, showed an obvious
decrease in corticosterone levels at t = 90 minutes, corticosterone levels in our Senegal parrot were unaffected.
These findings led to the presumptive diagnosis of Cushings syndrome. Treated was subsequently initiated
with trilostane (Vetoryl, Dechra Ltd, Staffordshire, UK; 1 mg/kg q24h orally), which resulted in a decrease of
clinical signs.

Cushings syndrome or hyperadrenocorticism is a disease which affects the function of the adrenal glands
resulting in an increase of plasma cortisol (mammals) or corticosterone (birds).1,3 Although the disease has been
described previously in birds, the diagnosis has thus far only been made during post-mortem examinations.4,5
This is the first report describing the diagnosis and treatment of Cushings syndrome in a live bird. Results clearly
demonstrate the value of both the dexamethasone suppression test and trilostane in the work-up and therapeutic
intervention for avian Cushings patients.

References

1. De Matos R. Adrenal steroid metabolism in birds: Anatomy, physiology, and clinical considerations. Vet
Clin N Am Exotic Anim Pract. 2008;11:35-57.

2. Westerhof I, van den Brom W, Mol J. Sensitivity of the hypothalamus-pituitary-adrenal system of pigeons
(Columbia livia domestica) to suppression by dexamethasone, cortisol, and prednisolone. Avian Dis.
1994;38:435-445.

3. Galac S, Reusch C, Kooistra H. Adrenals. In: Rijnberk A, Kooistra H, eds. Clinical Endocrinology of Dogs
and Cats: an Illustrated Text. Hannover, Germany: Schltersche Verlagsgesellschaft; 2010:93-154.

ExoticsCon 2015 Main Conference Proceedings 119


4. Cornelissen H, Verhofstad A. Hyperadrenocorticism caused by an adrenal carcinoma in a parrot. Vet Quart.
1998;20:S111.

5. Starkey S, Morrisey J, Stewart J. Pituitary-dependent hyperadrenocorticism in a cockatoo. J Am Vet Med


Assoc. 2008;232:394-98.

120 Building Exotics Excellence: One City, One Conference


Retricectomy for Resolution of Feather Trauma in an
Umbrella Cockatoo (Cacatua alba)
Kenneth R Welle, DVM, DABVP (Avian)

Session #211

Affiliation: From the University of Illinois College of Veterinary Medicine, 1008 W Hazelwood Drive,
Urbana, IL 61802, USA.

Feather trauma is a common problem among pet birds. This can result in chronically painful wings and tails
that cannot regrow a normal row of feathers because each new feather is unprotected by a fully formed adjacent
feather. The follicles may become damaged and poorly functional over time. A 6-month-old, intact male umbrella
cockatoo (Cacatua alba) was presented to the University of Illinois Veterinary Teaching Hospital Zoological
Medicine Service for feather damage that occurred shortly after receiving a wing trim by the owner. Over the
next 18 months, various medical, behavioral, and husbandry methods failed to allow normal regrowth of the
tail feathers. The bird presented 17 times over the 18 month period for problems associated with broken blood
feathers in the tail. Feather imping was ruled out because of the lack of hollow adult shafts to serve as a base.
Diagnostic tests including circovirus testing, feather biopsies, radiographs, hematology, and chemistries failed
to elucidate a medical cause of the problem. Because of the chronic pain associated with the frequent retrix
damage, the decision was made to perform a complete retricectomy. All of the retrical follicles, along with the
pygostyle were surgically removed. The surgical technique will be described. Healing was uneventful and the
bird has been clinically normal with no further blood feather injury for 19 months at the time of this abstract.

ExoticsCon 2015 Main Conference Proceedings 121


Hypernatremia in an Umbrella Cockatoo
(Cacatua alba)
Max Rinaldi, DVM,
Joao Brandao, LV, MS,
Javier Nevarez, DVM, PhD, Dipl ACZM, Dipl ECZM (Herpetology),
Thomas N Tully, Jr, DVM, MS, DABVP (Avian), Dipl ECZM (Avian)

Session #157

Affiliation: From the Louisiana State University School of Veterinary Medicine, Dept. Veterinary Clinical
Sciences, Skip Bertman Dr, Baton Rouge, LA 70803, USA.

An approximately 30-year-old male umbrella cockatoo presented 4 days after being found with its head in the
jaws of a raccoon. The bird was presented depressed with a severely swollen right eye, and numerous puncture
wounds around the right eye and cere. The bird was placed in the intensive care unit and stabilized with fluid
therapy, antibiotic and pain medication. Blood was not collected due to the birds health status and enucleation
procedure to remove the right eye. Following the enucleation procedure, in which blood loss was minimal,
a complete blood count and plasma chemistry panel were submitted. Abnormal results of the CBC included
heterophila and reactive monocytosis while the plasma chemistry panel revealed hypernatremia 184 mmol/L
(ref 152-164 mmol/L), hyperchloremia 149 mmol/L (ref 104-126 mmol/L), hypoalbuminemia, elevated CK
and AST. Post-operative treatment included intravenous 0.9% NaCl, hetastarch, human albumin, and mannitol.
Plasma sodium continued to remain above 180 mmol/L therefore neurogenic diabetes insipidus was suspected.
Desmopression was then administered to the patient. Day 3 exhibited no change in hypernatremia status, crsytal-
loid fluid therapy was changed to lactated ringers and demopression, hetastarch, and albumin was continued.
At the end of the third day the crystalloid fluid therapy was changed to 0.45% saline + 2.5% dextrose. By day
4 the patient had improved but the hypernatremia never resolved. Although there was an apparent continuing
improvement in mentation the patient was found dead on day 5. The knowledge and understanding of treatment
protocol regarding electrolyte imbalances and hypoalbuminemia in critical avian case presentations is a key to
stabilizing the patient.

ExoticsCon 2015 Main Conference Proceedings 123


Steroid-Induced Remission of Thoracic Round Cell
Tumor in a Green-Cheek Conure (Pyrrhura molinae)
Shachar Malka, Bsc, DVM, DABVP (Avian)

Session #226

Affiliation: From the Avian and Exotic Animal Service, The Humane Society of New York, New York,
NY 11022, USA.

A 13-year-old male green-cheek conure was presented for voice change and progressive dyspnea. Diagnostic tests
included CBC and biochemistry profile without significant alterations. These tests were repeated throughout the
following months and remained within normal limits. Chlamydia antibody titer (EBA) was negative. Radiography
followed by intracoelomic endoscopy confirmed the diagnosis of a thoracic mass. He was initially treated with
oral azithromycin that was later replaced by oral vibramycin and orbifloxacin without significant improvement.
In the absence of specific diagnosis and lack of response to the antibiotic therapy, an inflammatory or neoplastic
processes were considered. Oral prednisolone was added to his treatment protocol for its anti-inflammatory and
anti neoplastic properties, and the bird showed remarkable improvement. Prednisolone was used for 5 months and
was tapered off. While treated with prednisolone, antibiotics and gastrointestinal protectant (omeprazole) were
administered in conjunction, in order to prevent possible steroid induced side effects. The bird was in complete
remission for an additional 5 months. However the disease relapsed and the bird exhibited rapidly progressive
dyspnea and voice change again. The bird died 13 months after the initial presentation. A complete necropsy
revealed a large thoracic anaplastic round cell tumor severely compressing and infiltrating the lungs.

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Acrylic Stabilization for Psittacine Rhinothecal
Fractures (The Beak Helmet)
Laura Wade, DVM, DABVP (Avian)

Session #219

Affiliation: From Specialized Care for Avian & Exotic Pets, 10882 Main St, Clarence, NY 14031, USA.

Abstract: Traumatic fractures of the psittacine beak can be severely painful, debilitating and many times,
life-threatening. Due to the very thin rhinothecal bony support and strong muscles of rhinokinesis, fractures
of the upper mandible are challenging to stabilize. Placement of a visible light-cured dental acrylic support
splint directly to the beak can stabilize the fractures to allow for healing. This presentation demonstrates
the successful use of a beak helmet in a Senegal parrot (Poicephalus senegalus) and eclectus parrot
(Eclectus roratus).

Introduction

Rhinothecal (maxillary rhamphothecal) fractures

Parrots are frequently presented for evaluation of injuries of the maxillary rostrum which may be superficial
keratin defects or more serious dermal or bony wounds. Blunt force trauma, such as flying into hard surfaces
is common and shear fractures may occur. Bite wounds from other parrots are also seen and typically involve
crush fractures. Other injuries, such as entrapment trauma (cage, toy, other) and partial to complete amputation
is possible.

Due to the highly vascular nature of the beak, significant bleeding and pain are often associated with fractures
and avulsions. Depending on the extent of damage, these injuries usually severely affect the birds ability to eat,
climb and preen. The rostral diverticulum of the infraorbital sinus extends into the upper mandible, and infec-
tious organisms may be introduced into the respiratory system.

More detailed description of psittacine skull anatomy, deformities and surgical procedures serve as excellent
ancillary references.1-4 In addition, use of dental composites to correct developmental deformities may be found.5
Because of the delicate anatomy of the psittacine beak, repair of fractures using pins and screws is not usually
feasible, especially in smaller patients. However, dental acrylics and tissue glues can be adhered directly to the
keratin surrounding the fracture.6

Acrylic photopolymerization

The use of light-cured resins is common in human dentistry where photoinitiation of polymerization is caused
by either visible or ultraviolet (UV) light. Most commonly, special lamps that produce visible wavelengths in
the blue spectrum (400-500 nm) are used. Activated by tungsten halogen or fluorescent light, the soft, moldable
putty is rapidly cured into hard acrylic.7,8 Although safer than UV wavelengths, care should be taken when using
visible light lamps to protect the eyes of the operator, assistant and patient.9

Successful retention of the acrylic splint lies in the creation of a clean, dry keratin keratin surface, proper etching
of the keratin and use of a bonding agent to ensure a tight grip to the keratin (caution should be used with the

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etching jelly as it contains phosphoric acid: avoid contact with the skin, eyes or mouth). Keratin must be tightly
adhered to the underlying dermis/bone in regions where the splint is applied. Applying the acrylic to several
parts of the beak ensures more even distribution of pressure forces.

Clinical Reports

A Senegal parrot and an eclectus parrot with traumatic maxillary/rhinothecal fractures were successfully treated
with application of a temporary acrylic splints as described in the Beak Helmet Procedure section. Pertinent
case information is provided below.

Senegal parrot

A 120-g, 7-year-old male Senegal parrot (Poicephalus senegalus) presented after being bitten by a cockatoo with
a very unstable lateral proximal rhinothecal (maxillary) fracture. Bite wounds punctured into the sinus bilater-
ally near the cere. The bird was painful and had bled significantly and was admitted to the hospital. Midazolam
(5 mg/kg IM; Hospira Inc, Lake Forest, IL, USA), meloxicam (0.5 mg/kg IM; Loxicom, Norbrook Labs Ltd,
Down, Ireland), butorphanol (2 mg/kg IM; Torbugesic, Pfizer Inc, New York, NY, USA) and Plasmalyte A
(50 ml/kg SQ; Abbott Laboratories, North Chicago, IL, USA) were administered. Once sedated, a technician
held the bird upright in a towel, and the beak and wounds were gently cleaned with chlorhexidine 2% (Vet One/
MWI, Biose ID, USA) and 0.9% sodium chloride (Hospira Inc, Lake Forest, IL, USA). An acrylic support splint
was applied to the culmen, lateral (supra-tomial) and proximal transverse (sub-cere) aspects of the rhinotheca
to stabilize the fractures. The inner occlusal ledge was not included in the splint. A small Elizabethan collar was
placed to keep the bird from scratching at the beak. It was started on meloxicam (0.5 mg/kg PO BID; Metacam,
Boehringer Ingelheim, St. Joseph, MO, USA), compounded enrofloxacin 15 mg/kg PO BID and itraconazole
(10 mg/kg PO qd; Sporanox, Janssen Pharmaceuticals, Titusville, NJ, USA).

The next day, the splint was intact and the bird started eating soft foods. Mild bloody discharge was noted from
the sinus wounds. The following day, the bird seemed comfortable, was eating and sinus bleeding had stopped.
The patient was discharged the next day with meloxicam for 10 days, enrofloxacin for 14 days and itraconazole
for 30 days.

A progress call one week later reported the bird was eating seeds and pellets. One month later, the owner called
to say the helmet had fallen off, but the bird was doing well. A follow-up appointment was recommended.

Eight months later, the bird presented for follow-up. The bird maintained weight and was exhibiting normal
behavior, appetite, and stools. There was no sneezing, respiratory compromise or apparent irritation. The maxilla
had narrowed on both sides and had some keratin build up along the mid-culmen. All fractures were healed and
filled in with bone and keratin. The rhinothecal tip was 2-3 mm long and straight but the gnathotheca appeared
normal. Using a rotary tool with an aluminum oxide grinding stone, the excess keratin was removed and the tip
was filed to a more normal shape.

Two years later the bird is doing well.

Eclectus parrot

A 502-g, 8-year-old male eclectus parrot (Eclectus roratus) presented with an unknown trauma to the upper beak
and was unable to eat. A bilateral fracture of the lateral mid-rhinotheca (maxilla) was noted and was moderately
unstable. Midazolam (Hospira) 5 mg/kg IM, meloxicam (Norbrook) 0.5 mg/kg IM, butorphanol (Pfizer)1 mg/kg

128 Building Exotics Excellence: One City, One Conference


IM, enrofloxacin (15 mg/kg SQ; Baytril, Bayer Healthcare LLC, Shawnee Mission, KS, USA) and Plasmalyte
A (Abbott) 40 ml/kg SQ were administered. Once sedated, a technician held the bird upright in a towel, and the
wounds were gently cleaned with chlorhexidine 2% (Vet One) and 0.9% sodium chloride (Hospira). An acrylic
support splint was applied to the culmen, lateral (supra-tomial) and proximal transverse aspects of the rhinotheca
to stabilize the fractures. The inner occlusal ledge was included in the splint.

Later that day, the bird was discharged with compounded enrofloxacin 15 mg/kg PO BID x 14 days and meloxi-
cam (Boehringer) 0.5 mg/kg PO BID x 10 days. A call the next day reported the bird was doing well and eating
but wouldnt stay in the smaller smooth-sided cage. A recall 10 days later indicated the bird continued to do well.

At the 3-week recheck the bird was bright and doing well. It was eating well and there was no reports of bleed-
ing or sneezing. Stools were mildly loose while on medication. The splint was in good position with the fracture
aposed nicely and keratin looking normal.

Three months later, the bird was doing well, eating normally (cracking seeds). Although the splint was still intact,
it had moved down with the normal keratin growth and was starting to separate at the proximal aspect. Using
a high speed dental drill, the acrylic was sectioned in several places and the helmet was removed. There was a
slight keratin ridge but the fracture appeared healed and new keratin was intact. There was some overgrowth of
the rhinothecal tomium which was trimmed with an aluminum oxide grinding stone.

One year later, the bird is doing well with normal cosmetic beak appearance and function.

Beak Helmet Procedure

Materials

1. Curing lamp for polymeric dental materials. Heliolux DLX visible fiberoptic light (Ivoclar Vivadent,
Schaan, Liechtenstein)

2. Aluminum Jelly (Duro/Loctite Corp, Hartford, CT, USA)

3. Light-curing bonding agent. Bond 1 primer/adhesive (Pentron Clinical, Orange, CA, USA)

4. Light-activated urethane dimethacrylate. Triad VLC reline material (Dentsply Intl, York, PA, USA)

5. Hand-held rotary tool (Dremel mini-mite/Robert Bosch Tool Corp, Mt. Prospect, IL, USA) with
grinding stones, engraving bits

6. Protective eyewear

7. Cotton swabs, sterile saline (0.9% sodium chloride), chlorhexidine 2% scrub, 70% isopropyl alcohol

Sedation protocol

1. Meloxicam 0.5 mg/kg IM

2. Butorphanol 1-2 mg/kg IM

3. Midazolam 0.5 mg/kg IM

ExoticsCon 2015 Main Conference Proceedings 129


Splint application procedure

1. Clean surface of keratin


a. Chlorhexidene scrub-soaked cotton swabs to remove organic material
b. Flush with sterile saline
c. Wipe with alcohol-soaked cotton swab (avoid contact with fracture)

2. Etch the keratin


a. Apply chemical etching gel (aluminum jelly), rinse with saline
b. For additional purchase, mechanically etch (Dremel)

3. Air dry

4. Apply bonding agent (Bond 1), light cure 5-10 sec

5. Mold and apply acrylic (Triad), light cure 10 sec (Fig 1)

Go home instructions

1. Feed soft foods first 1-2 weeks

2. Remove hard plastic, wood and metal toys for first 4 weeks
a. Avoid biting metal first 1-2 weeks after splint removal

3. Limit use of beak on metal bars if possible


a. Smaller birds house in glass aquarium to avoid climbing

4. Avoid/restrict flight to reduce risk of hitting beak

5. Avoid biting on medication syringes

6. Pain control (meloxicam 0.3-0.5 mg/kg PO BID x 7-10 days)

7. Additional pain control (tramadol?)

8. Antimicrobials?
a. Consider prophylactic antimicrobials that penetrate bone
b. Consider prophylactic antifungals for open sinus cavities, especially high-risk species,
individuals

9. Expect bony healing in 4-6 weeks with intact splint


a. Remove splint if still present at 12 weeks

130 Building Exotics Excellence: One City, One Conference


Figure1.1.Authors
Figure Authorsline
linedrawing
drawingofofacrylic
acrylicsplint
splintapplied
appliedto
to the
the rhinotheca
rhinotheca to
to stabilize
stabilize aa lateral
lateral maxillary
fracture as viewed from the right side (identical mirror image on the left side).
maxillary fracture as viewed from the right side (identical mirror image on the left side).

Discussion

The goals of the splint are to restrict movement of the fracture fragments to allow for bony union and to provide
comfortable use of the beak for proper nutrition. The acrylic should be placed above and below the fracture
and should be connected by three points (Fig 1). In essence, the helmet triad follows the natural anatomy of the
pressure-bearing keratin and culmen. By distributing any pressure to the arms of the helmet, the function of
the beak is restored and pain is reduced. The acrylic arms should be thick enough to provide adequate support
and can be built-up during the application. No attempt to cover the fracture with acrylic should be made, as blood
and fluid is expected to drain for several days. Owners can gently flush wounds with saline if needed.

As these injuries are considerably painful, use of opiods and NSAIDs are very helpful. A combination of an opiod,
NSAID and a benzodiazepine produced heavy sedation to allow for wound cleaning and splint application with
manual towel restraint. Although general anesthesia could be used, the birds would have had to be intubated,
and this extra handling could have caused further disruption of the fractures. The birds in this report did very
well post-splinting with NSAIDs only, but an opiod, such as tramadol could be added for pain management.

The Senegals fracture was considerably more unstable and the bird was hospitalized for several days for close
observation and supportive care. The eclectus had sustained less blood loss and was less painful and was hos-
pitalized briefly. Both birds quickly adjusted to the presence of the splint and were eating within several hours
of stabilization.

Because of the risk of infection, both birds were prescribed antibiotics to reduce bacterial growth in the open frac-
ture sites. The Senegal was also prescribed an antifungal to reduce the risk of Aspergillus sp. growth in the sinus.

Although the eclectus had much more climbing activity than the Senegal, the helmet stayed on much longer than
anticipated. One difference in the construction of the splints is that the eclectus had a portion of acrylic cover-
ing the inner occlusal ledge, which may have formed a cradle for the beak tip. In order to prevent early splint
dislodging, all attempts should be made to reduce the birds access to hard objects and surfaces. It is important
to ensure there is no acrylic right at the lateral tomial occlusal surface to keep the bird from leveraging the splint.
Also, tapering the acrylic to this point will help reduce the purchase the bird might make with the splint.

ExoticsCon 2015 Main Conference Proceedings 131


Depending on the nature of the fracture, return to normal appearance varies. Damage to the thin dermal fibro-
vascular stroma/periosteum can cause permanent beak defects. If the germinative layer or bone is damaged,
keratin may not grow back. The eclectus maintains a normal rhinothecal appearance but the Senegal has a mild
deformity that needs periodic shaping.

References

1. Wade L. The parrot beak. 2011. Available at: http://www.birdchannel.com/bird-diet-and-health/bird-care/


the-bird-beak.aspx. Accessed April 22, 2015.

2. Speer B. Beak deformities: form, function, and treatment methods. Proc Annu Conf Assoc Avian Vet.
2014;213-219.

3. Speer B, Echols MS. Surgical procedures of the psittacine skull. Proc Annu Conf Assoc Avian Vet. 2013;
99-109.

4. Clipsham R. Rhamphorthotics and surgical corrections of maxillofacial defects. Sem Av Exo Pet Med.
1994;3(2):92-99.

5. Tully TN, Stevens A, Diaz-Figaroa O, et al. Use of a dental composite to correct beak deviation in psittacine
species. Proc Eur Assoc Avian Vet. 2003;203-205.

6. Altman RB. Acrylic beak repair. Proc Assoc Avian Vet Aust Comm. 1996;137-139.

7. Fouassier JP, ed. Radiation curing in polymer science and technology, practical aspects and application.
Essex, England:Elsevier Sci Publ;1993.

8. Dental composite light curing system. US Patent 6602074 B1. Available at: http://www.google.com/patents/
US6602074. Accessed April 22, 2015.

9. Szmanska J. Work-related vision hazards in the dental office. Ann Agric Environ Med. 2000;7:1-4.

132 Building Exotics Excellence: One City, One Conference


A Novel Surgical Approach to Avian
Femorotibiotarsal Luxation Repair
Anna Elizabeth McRee, DVM,
Thomas N Tully, Jr, DVM, MS, DABVP (Avian), Dipl ECZM (Avian),
Javier G Nevarez, DVM, PhD, Dipl ACZM, Dipl ECZM (Herpetology),
Julia Sumner, BVSc (Hons), Dipl ACVS (Small Animal)

Session #215

Affiliation: From the Department of Veterinary Clinical Sciences, Louisiana State University School of
Veterinary Medicine, Skip Bertman Drive, Baton Rouge, LA 70803, USA.

Abstract: A juvenile umbrella cockatoo (Cacatua alba) presented for acute non-weight bearing lameness.
Right medial femorotibiotarsal subluxation was diagnosed radiographically. Femorotibiotarsal joint
stabilization was performed using a lateral extracapsular suture modified from the technique described
by DeAngelis and Hohn. The bird regained function of the joint up to 4 months post-operatively, which
allowed enough time for the joint to arthrodese at an anatomic perching angle.

Clinical Report

A 3-month-old male umbrella cockatoo (Cacatua alba) presented for acute non-weight bearing lameness of the
right leg. Right medial femorotibiotarsal subluxation was diagnosed radiographically and surgical management
was elected. Femorotibiotarsal joint stabilization was performed using a lateral extracapsular suture modified
from the technique described by DeAngelis and Hohn. A 1.5 x 10 mm self-tapping screw was placed in the lateral
femoral condyle, and then a 20-g hypodermic needle was drilled through the proximal aspect of the tibiotarsus.
A single strand suture was placed through the hole in the tibiotarsus, run under the soft tissue structures of the
knee, and anchored around the screw in the lateral femoral condyle (1 Prolene, Ethicon, US). A horizontal mat-
tress suture was placed around the lateral joint capsule for imbrication (2-0 Prolene, Ethicon, US). With physical
therapy initiated 4 days post-operatively, the bird regained function of the joint and remained functional 4 months
after surgery, which allowed enough time for the joint to arthrodese at an anatomic perching angle.

References

1. DeAngelis M, Hohn RB. Evaluation of surgical correction of canine patellar luxation in 142 cases.
J Am Vet Med Assoc. 1970;156:587-593.

2. Azmanis PN, Wernick MB, Hatt JM. Avian luxations: occurrence, diagnosis and treatment. Vet Quart.
2014;34:11-21.

3. Baumel JJ. Arthrologia. In: Baumel JJ, ed. Nomina Anatomica Avium. London, England: Academic Press;
1979;157-169.

4. Bowles HL, Zantop DW. A novel surgical technique for luxation repair of the femorotibial joint in a monk
parakeet (Mytopsitta monachus). J Avian Med Surg. 2002;16:34-38.

ExoticsCon 2015 Main Conference Proceedings 133


5. Powers LV. Stifle luxations in birds. Proc Annu Assoc Avian Vet. 2014;67-71.

6. Fuss FK, Gasser CR. Cruciate ligaments of the avian knee: insight into a complex system. J Morphol.
1992;214:139-151.

7. Villaverde S, Benito de la Vibora J, Gonzalez R, et al. Management of the femorotibial luxation by splint-
ing, intramedullary pins, external skeletal fixator and tension bands: A pilot study in domestic pigeons
(Columbia livia domestica). Proc Int Conf Avian Herp Exot Mammal Med. 2013;196-2002.

8. Bennett RA. Management of joint luxations in birds. Paper presented at: Western Vet Conf. 2013.

9. Orosz SE, Ensley PK, Haynes CJ. Anatomy of and surgical approaches to the leg: femur. In: Avian Surgical
Anatomy: Thoracic and Pelvic Limbs. Philadelphia, PA: Saunders; 1992:59-77;102-106.

10. Helmer P, Redig PT. Surgical resolution of orthopedic disorders. In: Harrison GJ, Lightfoot TL, eds. Clini-
cal Avian Medicine. Vol II. Palm Beach, FL: Spix Publishing; 2006:768-771.

11. Bonin G, Lauer SK, Sanchez-Migallon Guzman D, et al. Radiographic evaluation of perching-joint angles
in cockatiels (Nymphicus hollandicus), Hispaniolan Amazon parrots (Amazona ventralis), and barred owls
(Strix varia). J Avian Med Surg. 2009;23:91-100.

12. Chinnadurai SK, Spodnick G, Degernes L, et al. Use of an extracapsular stabilization technique to repair
cruciate ligament ruptures in two avian species. J Avian Med Surg. 2009;23:307-313.

13. Rosenthal K, Hillyer E, Mathiessen D. Stifle luxation repair in a Moluccan cockatoo and a barn owl. J As-
soc Avian Vet. 1994;8:173-178.

14. Azmanis PN, Voss K, Montavon P, et al. Management of experimental stifle joint luxation with combination
of collateral ligament prosthesis and hinged linear external skeletal fixator (HLESF) in domestic pigeons
(Columbia livia domestica). Proc Annu Assoc Avian Vet. 2010;281-282.

15. Harris MC, Diaz-Fiueroa O, Lauer SK, et al. Complications associated with conjoined intramedullary pin
placement for femorotibial joint luxation in a Solomon Island eclectus parrot (Eclectus roratus solomonen-
sis). J Avian Med Surg. 2007;21:299-306.

134 Building Exotics Excellence: One City, One Conference


Fatal Baylisascaris procyonis Infection in a
Household Psittacine Flock
AM Lennox,
C Hanika Holland,
MM Popielarczyk,
KR Kazacos

Session #114

Affiliation: From the Avian and Exotic Animal Clinic of Indianapolis, Indianapolis, IN 46268, USA
(Lennox), Indiana Animal Disease Diagnostic Laboratory, West Lafayette, IN 47907, USA (Holland),
Indiana Animal Disease Diagnostic Laboratory, West Lafayette, IN 47907, USA (Popielarczyk),
Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA (Kazacos).
Present Address (Popielarczyk): Antech Diagnostics, c/o Clifton Park, NY 12065, USA.

Six indoor-housed pet psittacines were presented for sudden onset of neurologic disease. Species included a
yellow-headed Amazon parrot, two blue-crowned conures, one sun conure and one half-moon conure. Supportive
care was ineffective and all birds succumbed and were submitted for necropsy and histopathology. The first bird
to die was submitted for necropsy, and there were no abnormal gross findings except for agonal aspiration of
crop contents. Histopathologic findings indicated larva migrans (verminous encephalitis). Morphologic features
of numerous large ascarid larvae were consistent with Baylisascaris species.

The 6 carcasses were submitted for larval recovery and enumeration. An average of 87 larvae (range 17-150)
were recovered from the brains, and 173 larvae (range 47-285) were recovered from the body (carcass and
viscera). Larvae were recovered from the eyes of 5 birds and spinal cords of 3 birds. Samples of food that was
kept in a garage in covered trashcans were evaluated grossly for the presence of feces. Representative samples
were evaluated for parasite eggs by centrifugal sedimentation-flotation using Sheathers sugar at specific grav-
ity 1.25-1.27. Pieces of semi-dried raccoon feces were present in the food, and numerous infective B. procyonis
eggs containing motile larvae were recovered from samples examined. These cases demonstrate an exception-
ally high naturally occurring worm burden, and demonstrate the importance of biosecurity, even in birds housed
exclusively indoors.

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Surgical Laser Treatment of Squamous
Cell Carcinoma
Fern Van Sant, DVM, and
Munir Kureshi DVM

Session #184

Affiliation: From For the Birds, 1136 S De Anza Blvd, San Jose , CA 95129, USA (Van Sant) and Cupertino
Animal Hospital, 10026 Peninsula Ave, Cupertino, CA 95014, USA (Kureshi).

Abstract: Squamous cell carcinoma (SCC) is a commonly reported neoplasia in companion psittacines.
Many conventional treatments including surgery, cryosurgery, chemotherapy and radiation therapy fail
to cure the disease. Four cases of confirmed SCC resolved after treatment with a CO2 surgical laser.

Introduction

Squamous cell carcinoma (SCC) is a commonly reported neoplastic condition of the skin and gastrointestinal tract
of companion psittacines.1 Many conventional therapies such as surgical excision, radiation or chemotherapy
fail to stop local recurrence.2-4 SCC is usually slow to metastasize, but very likely to recur locally from incom-
plete margins. A multi-institutional survey done between 2012 and 2014 identified 85 confirmed cases mostly
in cockatiels, amazon parrots and small conures. Despite surgical excision or surgical excision in combination
with radiation or chemotherapy 71.7%(61/85) had progressive disease and died or were euthanized.5

Clinical Report

This talk describes 4 cases of SCC in 4 companion birds. The SCC in these patients was at 3 different sites,
1 lingual, 1 oral pharynx and 2 uropygial gland. All lesions were confirmed by histopathology. The lesions were
completely resolved in 3 birds with multiple surgical laser ablations and currently managed in the third. In all
cases the surgical equipment used was a Luxar Nova Pulse CO2 laser. The laser was used in conjunction with a
5mm Storz Video Otoscope with a 5fr diameter working channel. Images were recorded on a Vet Video Camera
ll NTSC.

All patients were anesthetized for the procedures using isoflurane/O2. Anesthesia was delivered by mask or
endo-tracheal tube. Procedures generally took less than 20 minutes including induction of anesthesia. All patients
received preoperative workups and appropriate preoperative/postoperative medical management. All received
supplemental Vitamin A. Video and digital images of the original lesions, surgical laser procedures and final
outcome will be shown during the presentation.

Case 1

A 25-year-old female double yellow headed amazon parrot (Amazona oratrix) was surrendered to a rescue orga-
nization after the diagnosis of advanced SCC of the tongue in 2011. The large necrotic mass occupied the entire
oral pharynx. Rendering the bird unable to eat. Conversations with clinicians at University of California Davis
School of Veterinary Medicines Companion Avian and Exotic Pet Service offered a poor prognosis with the

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few therapeutic options available. We opted for a de-bulking surgery as a palliative measure. CO2 laser ablation
was used on the extensive lesion on the right side of the tongue. Each of the 5 laser procedures over 9 months
(10/2011,12/2011, 2/2012, 5/2012,7/2012) shrunk the active lesion and rapidly restored function and offered
dramatic pain relief. After 12 months a small ulceration was noted on the tongue tip but histopathologic exam
was negative for SCC and the lesion resolved following biopsy. The bird has been free of SCC for almost 3 years.

Case 2

An approximately 15-year-old female cockatiel (Nymphicus hollandicus) presented with a large ulcerated mass
that covered most of her caudal dorsal skin. The lesion was debrided and biopsied. Uropygial SCC was con-
firmed. Laser surgical ablation was performed twice, first in 4/2014 and again in 8/2014. The second procedure
addressed a finger like projection growing from the tail base caudal to the original lesion. This lesion was also
confirmed by biopsy as SCC. A third surgery w/ conventional techniques was done in 2/2015 to address a small
growth at the tailbase as the laser was unavailable. She is currently lesion free.

Case 3

A 20-year-old female cockatiel (Nymphicus hollandicus) presented with a crusty ulcerated lesion on the right
side of her uropygial gland. The first biopsy was inconclusive but the second confirmed SCC. Laser ablation
was preformed twice over 3 months (3/2014 and 5/2014). The lesion completely resolved and the site has been
free of recurrence for over a year.

Case 4

A 10-year-old female gray cockatiel presented in early 2012 to Medical Center for Birds (MCFB) for dysphagia,
hyper-salivation and an ulcerative stomatitis. A mass was identified, removed and biopsied. SCC was confirmed.
Secondary infection was cultured and treated w/ antibiotics. A second debulking surgery was done at the MCFB
in 3/2013. In 1/2014 the cockatiel presented for difficulty breathing and eating. At that time a new mass was
noted with a tendency for caseous exudate to collect in the left lingual fossa. The bird was moved to a sanctuary
and presented for care at For the Birds in 1/2014. A series of 3 laser surgeries were done 2/2014-5/2014. The
buccal lesions resolved with surgical laser ablation but it appeared that the lesion had spread to the glottis and
laryngeal mound. As laser of the glottis seemed ill-advised, palliative medical management to address inflam-
mation and a pseudomonas infection was started. To our amazement the lesions on the glottis resolved and no
lesions have recurred since.

Conclusion

Given the all-too-common occurrence of SCC in companion psittacines and the high rate of failure of conventional
therapies, ablation with CO2 laser should be considered as a safe and possibly more effective therapy. The CO2
laser removes tissue with a highly focused infrared beam. The rapid absorption of laser energy instantly ablates
the soft tissue target area, sealing capillaries, small blood vessels and nerve endings providing good hemostasis
and minimizing pain for the patient.

The many benefits of laser ablation for SCC include minimal procedure time, minimal pain, good hemostasis
and most importantly a better chance of eliminating the lesion permanently.

138 Building Exotics Excellence: One City, One Conference


References

1. Reavill D, Tumors of pet birds. Vet Clin N Am Exot Anim Pract. 2004;7:537560.

2. Manucy TK, Bennett RA, Greenacre CB, et al. Squamous cell carcinoma of the mandibular beak in a Buf-
fons macaw (Ara ambigua). J Avian Med Surg. 1998;12(3):158-166.

3. McLaughlin A, Reavill D, Maas A. Management of recurrent cutaneous squamous cell carcinoma in a


cockatiel (Nymphicus hollandicus). Proc Annu Conf Assoc Avian Vet. 2014;341-346.

4. Heatley JJ, Bellah J, Brawner W, Reavill D. Radiation therapy of squamous cell carcinoma in a golden
eagle. Proc Annu Conf Assoc Avian Vet. 2007;327-328.

5. ZehnderA, Swift L, Sundarum A et al. Multi-institutional survey of Squamous cell carcinoma in birds. Proc
Annu Conf Assoc Avian Vet. 2014;3.

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Section 6

AAV Wildlife and


Conservation

David Scott, DVM


Moderator
Cardiac Evaluation in the Bald Eagle
(Haliaeetus leucocephalus)
Irene G Lecona, DVM,
Kristin Barncord, DVM,
Christopher Stauthammer, DVM, Dipl ACVIM (Cardiology)

Session #068

Affiliation: From the Raptor Center, College of Veterinary Medicine, University of Minnesota, 1920 Fitch
Ave, St. Paul, MN 55108, USA (Lecona); Department of Cardiology, College of Veterinary Medicine,
University of Minnesota, 1365 Gortner Ave, St. Paul, MN 55108, USA (Barncord, Stauthammer).

Abstract: The use of cardiovascular imaging modalities in birds is complicated by rapid heart rate,
unique anatomical considerations (air sac, large keel) and restraint techniques. There are few studies of
cardiovascular imaging modalities in eagles. To evaluate normal cardiac morphometric and functional
parameters in bald eagles, radiography, electrocardiography (ECG) and transesophageal echocardiography
(TEE) were utilized on birds presented for rehabilitation with no clinical evidence of cardiac abnormalities.
Study data will be presented and efficacy of modalities discussed.

Introduction

The objective of this study was to evaluate cardiac morphology and function utilizing radiography, electrocar-
diography and transesophageal echocardiography in six healthy bald eagles, as part of a comprehensive study
carried out to compare cardiac morphometric and functional parameters in eagles with no clinical evidence of
cardiac abnormalities and eagles with lead intoxication.

Methods

Preliminary data was collected to establish reference values for cardiac size on radiographs. Ventrodorsal views
were examined and used to measure cardiac silhouette on 27 healthy eagles. The heart width (57.89 4.34 mm),
coracoid width (14.502.15 mm), sternum width (66.78 3.12 mm) and thoracic width (102.19 7.56 mm)
were measured. The sternal width was the most accurate predictor of cardiac width.

Electrocardiography was performed on hooded birds under manual restraint, as isoflurane anesthesia has been
noted to alter ECG parameters in bald eagles. Using 7-MHz pediatric multiplane TEE, five consistent imaging
planes of the heart were viewed from three positions of the probe. M-mode echocardiography was performed
from caudal transverse view of left ventricle and cranial longitudinal view of the aorta. M-mode images were
used for measuring internal diameter of left ventricle during diastole (1.67 0.23 mm) and systole (1.20 0.21
mm) as well as calculating left ventricular fractional shortening (28.1 2.49%). Tissue Doppler was performed
of left ventricular free wall and interventricular septum from caudal transverse and longitudinal planes. Color
and spectral Doppler evaluation was performed on all four cardiac valves from the two defined longitudinal
imaging planes. Image analysis and measurements were performed and evaluated by a veterinary cardiologist.

Acknowledgments: We would like to thank the Morris Animal Foundation for financial support of this study.

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References

1. Aguilar RF, Smith VE, Ogburn P, Redig PT. Arrhythmias associated with isoflurane anesthesia in bald
eagles (Haliaeetus leucocephalus). J Zoo Wildl Med. 1995;508-516.

2. American Veterinary Medical Association. AVMA Guidelines for the Euthanasia of Animals 2013 ed. Scha-
umburg, IL: American Veterinary Medical Association;2013.

3. Arent L. Raptors in Captivity: Guidelines for Care and Management. Surrey, BC: Hancock House;2006.

4. Beaufrre H, Pariaut R, Nevarez JG, Tully TN. Feasibility of transesophageal echocardiography in birds
without cardiac disease. J Am Vet Med Assoc. 2010;236(5): 540-547.

5. Beaufrre H, Pariaut R, Rodriguez D, Tully TN. Avian vascular imaging: a review. J Avian Med Surg.
2010;24(3):174-184.

6. Beaufrre H, Pariaut R, Rodriguez D, Nevarez JG, Tully TN. Comparison of transcoelomic, contrast trans-
coelomic, and transesophageal echocardiography in anesthetized red-tailed hawks (Buteo jamaicensis). Am
J Vet Res. 2012;73(10):1560-1568.

7. Hassanpour H, Moghaddam AKZ, Bashi MC. The normal electrocardiogram of conscious golden eagles
(Aquila chrysaetos). J Zoo Wildl Med. 2010;41(3):426-431.

8. Joyner PH, Jones MP, Ward D, Gompf RE, Zagaya N, Sleeman JM. Induction and recovery characteristics
and cardiopulmonary effects of sevoflurane and isoflurane in bald eagles. Am J Vet Res. 2008;69(1):13-22.

9. Lumeij JT, Shaik MA, Ali M. Radiographic reference limits for cardiac width in peregrine falcons (Falco
peregrinus). J Am Vet Med Assoc. 2011;238(11): 1459-1463.

10. Straub J, Forbes NA, Thielebein J, Krautwald-Junghanns ME. Pulsed-wave Doppler echocardiography in
birds of prey. Vet Rec. 2003;153(24):742-746.

144 Building Exotics Excellence: One City, One Conference


Viral Enteritis in Juvenile Black-capped Chickadees
(Poecile atricapillus) in a Rehabilitation Setting
Leslie A Reed, DVM,
Renee Schott, DVM,
Anibal G Armien, DVM, MSc, PhD,
Sunil K Mor, DVM, MS,
Sagar M Goyal, DVM, PhD

Session #180

Affiliation: From the Wildlife Rehabilitation Center of Minnesota, 2530 Dale St N, Roseville, MN 55113,
USA (Reed, Schott) and the Department of Veterinary Population Medicine, 1365 Gortner Avenue,
University of Minnesota, St. Paul, MN 55108, USA.

Abstract: A group of 31 juvenile black-capped chickadees (Poecile atricapillus) housed at a wildlife


rehabilitation center all developed sudden lethargy followed by acute death. Prior to death, several birds
demonstrated undigested food and one showed frank blood in their droppings. Necropsies on four of the
birds revealed loss of body condition, dehydration, and evidence of enteritis including gas-distended
intestines and the presence of yellow, watery fluid. Viral particles consistent with viruses of the family
Reoviridae were seen when intestinal contents were examined by negative contrast electron microscopy.
Reoviruses are common in mammalian hosts and also in domestic and wild avian species, but have not been
identified in black-capped chickadees prior to this study. Reoviruses can be pathogenic or non-pathogenic
in avian species, with 85-90% of the strains being non-pathogenic.1 The pathogenic strains have been
associated with clinical signs of enteritis in ducks and pigeons,2 chickens,3 turkeys,4 grey parrots, and
quail.5 Clinical signs also include arthritis and lameness in chickens6 and turkeys,7 respiratory infections
in chickens,3 and neurological symptoms in a wild crow.8 Preliminary molecular analysis revealed that the
reovirus recovered from the intestines of the chickadees was closely related to turkey enteric and arthritis
reoviruses. Further studies should be conducted on identification and characterization of reoviruses in
wild bird species.

Introduction

In a wildlife rehabilitation setting, it can be challenging to control disease outbreak, especially when working
with hundreds of different species of animals, many of whom harbor different infectious organisms. During
the months of May through September at the Wildlife Rehabilitation Center of Minnesota, one of the operat-
ing nurseries is the songbird or avian nursery. This nursery contains hundreds of young birds at all stages of
life, from hatchlings to fully flighted juveniles. Birds are housed together with conspecifics of the same age.
Hatchlings are kept in individual makeshift nests in an incubator, young fledglings in plastic baskets, and older
fledglings and flighted juveniles in wooden dowel cages. The birds are cared for and hand fed daily by hundreds
of volunteers and interns.

Some species, such as the black-capped chickadee (Poecile atricapillus) appear to be more sensitive than others
to pathogens and more prone to developing nosocomial infections. During the summer of 2011, a large die-off
of suspected orphaned juvenile black-capped chickadees prompted further investigation into the cause of death.
Viral particles consistent with the family Reoviridae were detected in the submitted birds. Although reoviruses
have been identified in many other avian species, this was the first finding of a reovirus in a chickadee species.
The reovirus amino acid identity was 97-99% with turkey enteric reoviruses. This discovery may suggest a

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relationship between reovirus transmission from wild birds to domestic poultry.The purpose of submitting the
deceased birds for necropsy was to determine the cause of death in order to take proper action to prevent future
infections and casualties of juvenile chickadees at the Wildlife Rehabilitation Center of Minnesota, and to further
educate other rehabilitation centers that may be experiencing a similar issue.

Reoviruses are common in many species of mammals and birds, wild and domestic. Reoviruses belong to the
family Orthoreovirus, family Reoviridae. Composed of a double-stranded RNA genome, the virus is nonen-
veloped, icosahedral, and 70-80 nm in size.9 Eighty-five to ninety percent of avian reoviruses are considered
non-pathogenic.1 Clinical signs associated with pathogenic strains include malabsorption, runting-stunting
syndrome, inclusion body hepatitis, ulcerative enteritis and respiratory infections.9 The viruses also cause mus-
culoskeletal conditions such as lameness, arthritis, and brittle bone disease/femoral head necrosis in chickens.6
Two types of reovirus affecting domestic turkeys are turkey enteric reoviruses and turkey arthritis reoviruses.9

Case Report

In 2011, 36 juvenile black-capped chickadees were admitted to the Wildlife Rehabilitation Center of Minnesota
between the dates of May 23 and August 10. All birds were thought to have been orphaned. 31 were found acutely
dead in the cage within one week of each other. Several cases had a short history of undigested droppings, and
one case had frank blood in the droppings soon before death. All cases died before treatment could be initiated.
Four of the deceased chickadees were sent to the Veterinary Diagnostic Laboratory at the University of Minnesota
for necropsy. The other specimens were too autolyzed, or were not saved, for submission. All 4 chickadees were
found to be emaciated, dehydrated and had gas-dilated intestines which contained watery yellowish fluid. The
cause of death was thought to be acute catarrhal enteritis. No significant lesions were found upon histological
examination. No pathogenic bacteria or parasites were isolated from any of the 4 chickadees. Negative contrast
electron microscopy revealed viral particles consistent with those of the family Reoviridae. The reovirus was
confirmed with reverse-transcriptase PCR.

Phylogenetic analysis was performed which revealed the virus detected in the chickadees to have 97.1-98.3%
and 89.4-97.8% nucleotide identity, as well as 99.6-100% and 97.3-100% amino acid identity, with turkey enteric
reovirus from apparently healthy and reovirus infected turkey poults in Minnesota, respectively. The nucleotide
and amino acid identity were also compared to other strains of avian reovirus such as chicken, duck, goose,
psittacine birds, and Tvarminne and were found to have the closest relationship to turkey enteric reovirus. This
suggests a possible relationship between the transmission to domestic turkeys, and the evolution and creation of
new variants of reovirus in the environment. For example, turkey arthritis reovirus was recently discovered (2013)
in commercial turkeys with lameness and arthritis. This is thought to be a re-emerging disease, first discovered
in the 1980s.9 The source of the newly identified turkey arthritis reovirus is unknown; however, the chickadee
reovirus had 90.4-100% nucleotide and 97.7-100% amino acid identity with turkey arthritis reoviruses.

Since this discovery, further measures have been taken at the Wildlife Rehabilitation Center of Minnesota to
increase biosecurity with hopes of decreasing disease transmission when working with juvenile black-capped
chickadees. All juveniles are now housed in a room separate from other juvenile bird species, and are only cared
for by a finite number of people. Siblings are always kept together, and singletons only combined after they are
determined to be healthy. Hands are sanitized frequently when working with the birds, and always in between
groups of birds. Isolating the birds in this manner has proven over the last three years to greatly increase survival
and subsequent release rate. In comparison to a 1% release rate in 2011, the rate increased to 36.6% in 2012,
18.5% in 2013, and 38% in 2014.The variation in 2013 may have been due to any number of factors, including
more of the birds already being sick or injured upon admission than previous or following years, or personnel
not following proper protocol when caring for the birds, leading to a poorer prognosis.

146 Building Exotics Excellence: One City, One Conference


This study showed an important potential connection between reovirus transmission from wild birds to domestic
poultry. Further epidemiologic studies need to be completed in wild avians to determine the relationship between
these viruses.

References

1. Jones RC. Avian reovirus infections. Rev Sci Tech. 2000;19:614-625.

2. Kaschula VR.Anew virus disease of the muscovey duck (Cairina moschuta) present in Natal. J. S Afr Vet
Med Assoc. 1950;21:18-26.

3. Bagust TJ, Westbury HA. Isolation of reoviruses associated with disease of chickens in Victoria. Aust Vet
J. 1975;51:406-407.

4. Jindal, ND, Patnayak P, Chander Y, et al. Detection and molecular characterization of enteric viruses from
poult enteritis syndrome in turkeys. Poult Sci. 2010;89:217-226.

5. Meulemans GD, Dekegel G, Charlier R, et al. Isolation of orthoreoviruses from psittacine birds. J Comp
Pathol. 1983;93:127-134.

6. Vertommen M, Jhh Van E, Kouwenhoven B, et al. Infectious stunting and leg weakness in broilers. I. Pa-
thology and biochemical changes in blood plasma. Avian Pathol. 1980;9:133-152.

7. Levisohn S, Gur-Lavie A, Weisman, J. Infectious synovitis in turkeys: Isolation of tenosynovitis virus-like


agent. Avian Pathol. 1980;9:1-4.

8. Dander E, Huhtamo E, Farkas SL, et al. Complete genome analysis identifies Tvarminne avian virus as a
candidate new species within the genus Orthoreovirus. J Gen Virol. 2014. In press.

9. Mor SK, Armien AG, Reed L, et al. Detection and molecular characterization of a reovirus in black-capped
chickadees (Poecile atricapillus) from Minnesota, USA. J Wildl Dis. 2014;50(4):928-932.

ExoticsCon 2015 Main Conference Proceedings 147


Inflammatory Bowel Disease in a Harpy Eagle
(Harpia harpyja)
Grayson Allen Doss, DVM,
Christoph Mans, Dr med vet, Dipl ACZM,
Laura Johnson, DVM,
Marie E Pinkerton, DVM, Dipl ACVP,
Kurt K Sladky, MS, DVM, Dipl ACZM, Dipl ECZM (Herpetology)

Session #207

Affiliation: From the University of Wisconsin-Madison School of Veterinary Medicine, Madison, WI


53706, USA (Doss, Mans, Sladky, Pinkerton), and Tender Care Animal Hospital, LLC, Prairie du Chien,
WI 53821, USA (Johnson).

A 14-year-old, male, harpy eagle (Harpia harpyja) was presented for a several week history of lethargy, decreased
appetite, and weight loss. The eagle was initially treated with a course of fenbendazole for a Capillaria infection.
Plasma biochemistry and complete blood count prior to presentation were unremarkable. On presentation, the
harpy eagle was pancytopenic, but other initial diagnostics were unremarkable. The bird continued to decline and
chronically vomited all forms of force-fed nutrition. Additional diagnostics, including gastroscopy and gastric
biopsies, GI contrast fluoroscopy, infectious disease testing, and exploratory laparoscopy were unremarkable.
Full-thickness surgical biopsy of the duodenum revealed a mild lymphoplasmacytic inflammation extending into
the muscularis mucosa, consistent with inflammatory bowel disease. The eagle responded to treatment with oral
prednisolone at a dosage of 2 mg/kg/day. Tapering off the prednisolone did not result in recurrence of clinical
signs and the animal made a complete recovery.

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Conservative Management of Proximal Humeral
Fractures in Three Juvenile Raptors
Marcie Logsdon, DVM

Session #043

Affiliation: From the Exotics and Wildlife Department, Veterinary Teaching Hospital, Washington State
University, PO Box 647060 Pullman, WA 99164-7060, USA.

Abstract: Three immature raptors ranging in age from nestling to fully fledged presented with humeral
fractures deemed too proximal for effective surgical intervention. All three of the birds were treated with
conservative management consisting of figure-of-eight bandages and cage rest. Two of the three birds
made a full recovery and were released. These cases demonstrate the potential for healing by avian species
even in situations where surgical stabilization is not an option.

Introduction

Humeral fractures in the proximal metaphyseal region in avian patients pose special challenges for surgical sta-
bilization due to the lack of adequate medullary space for intramedullary pins, the lack of space in the proximal
fragment for placement of cross-pins,1 and the large overlying muscle mass. A tension band and modified cross-
pinning technique have both been described as surgical options but require a high level of surgical skill.1 The
general consensus is that conservative management is a less-desirable option for patients such as wild birds that
must return to full performance. This clinical report describes 3 juvenile raptors that all presented with proximal
humeral fractures and were treated conservatively with external coaptation and pain management. Two of the
three birds regained full flight capabilities, demonstrating that conservative management is still a viable option
when surgical intervention is not feasible and there is a high demand for performance.

Clinical Report

Case #1

A nestling Swainsons hawk (Buteo swainsoni) was seen for injuries presumably related to falling from its nest.
It presented with minor abrasions to the head and a right wing droop. Initial intake weight was 530 g and the
patient was in good body condition with a body condition score (BCS) of 3/5. A fracture was palpable in the
right shoulder region. Radiographs revealed a short, oblique fracture in the proximal right humeral metaphysis.
There was some overriding of the fracture ends with cranioventral displacement of the distal fracture fragment.
The patient was placed in a figure-of-eight bandage with a body wrap and started on enrofloxacin (15 mg/kg
PO q24h; Bayer Corp, New Haven, CT, USA) and meloxicam (0.3 mg/kg PO q24h; Metacam, 1.5 mg/ml sus-
pension, Boehringer Ingelheim Vetmedica, Inc, St. Joseph, MO, USA) for 7 days. Four days after intake, while
performing physical therapy under general anesthesia to prevent muscle contracture, a marked fibrous callus
was already noted. By day 6 the callus was deemed stable enough to remove the bandage. This decision was
supported by the fact that the patient was not old enough to be heavily using its wings. The patient was moved
to a partitioned outdoor enclosure that housed an adult Swainsons hawk in order to decrease the potential
for imprinting on humans. At this time physical therapy was discontinued. Approximately 1 week later it was

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allowed access to the entire enclosure. Initially, it did not appear able to fully extend its right wing and was unable
to fly. This state persisted apparently without improvement for approximately 3 weeks. Over the course of the
fourth week, noticeable improvements were seen and the patient began flying between perches in the enclosure.
Initial evaluation on a creance line showed some asymmetry in wing extension.

The patient continued to be creanced 2-3 times weekly and over the next 2.5 weeks it showed marked improve-
ment. By the end of its conditioning regiment the patient could fly 100-125 up to 12 times on a creance line.
Both wings extended symmetrically and exhibited full range of motion and the patient was capable of turning in
either direction. It was then allowed to overwinter relatively undisturbed in a flight enclosure. Prior to release the
following spring it was live prey tested and conditioned. At that time its overall body condition had improved,
it was flying 125 15-20 times per creance session and it passed its pre-release exam.

Case #2

A recently fledged great horned owl (Bubo virginianus) was found down unable to fly. Weight was 814 g with
a body condition score of 1.5/5. Its PCV was 27% with a total protein of 3.5 g/dl. Unrelated injuries included a
focal area of corneal edema in the left eye. With treatment, this lesion resolved without incident. Radiographs
revealed a transverse fracture of the left proximal humeral metaphysis with moderate proximal, dorsal, and
caudal displacement of the distal fragment. The wing was stabilized using a figure-of-eight bandage with body
wrap. The patient was treated for dehydration and malnutrition. Pain management consisted of meloxicam
(0.2 mg/kg PO q24h; Metacam, 1.5 mg/ml suspension, Boehringer Ingelheim Vetmedica, Inc, St. Joseph, MO,
USA) for seven days. On day 8 the fracture was stable on palpation and the bandage was removed. Approxi-
mately 1 week later it was moved out into a larger enclosure with 2 other great horned owls: a young orphan
and a resident adult that annually served as a foster dad. At that time it had a marked left wing droop. For ap-
proximately 2-3 weeks it did not noticeably improve; the wing droop remained static and the owl did not appear
able to fly. After 4 weeks in the enclosure (6 weeks post-initial presentation) it was seen flying short distances
between perches. Over the next 2.5 weeks it was conditioned on a creance line in a manner similar to the first
case, live-prey tested, and evaluated for release. Although there was still a slight wing asymmetry noticeable
while flying (its affected wing appeared slightly flatter), it was able to fly silently, maneuver well, and was
deemed releasable. Repeat radiographs showed bony remodeling and fusion of the fracture ends.A radiographi-
cally evidentmalunion was present but did not affect the scapulohumeral joint. The soft tissues surrounding the
fracture site were within normal limits and the left clavicular air sacwas well aerated.

Case #3

An immature (4- to 5-month-old) red-tailed hawk (Buteo jamaicensis) presented after having been observed in
an agricultural field dragging its left wing for several days. On presentation its fracture was estimated to be ap-
proximately 1 week old. It was in poor condition, weighing 638 g with a body condition score of 1.5/5. Its PCV
was 29% with a total protein of 1.6g/dl. Radiographs revealed a transverse fracture of the left proximal humeral
metaphysis with moderate proximal, medial, and dorsal displacement of the distal fragment. It was placed in a
figure-of-eight bandage with a body wrap and treated for emaciation, dehydration, and external parasites. Pain
management consisted of tramadol (20 mg/kg PO q12h; tramadol hydrochloride tablets, Cardinal Health, Zanes-
ville, OH, USA) for 6 days and concurrent meloxicam (0.5 mg/kg PO q24h; Metacam, 1.5 mg/ml suspension,
Boehringer Ingelheim Vetmedica, Inc, St. Joseph, MO, USA) for 3 days. While the patient was in a bandage
physical therapy was performed under general anesthesia 2-3 times weekly to prevent muscle and ligament con-
traction. After 10 days of physical therapy and cage rest the bandage was removed. The patient was kept confined
in a small indoor enclosure for one additional week before being moved outside to a flight enclosure. At that
point in time its wing droop and inability to fly were almost identical in appearance to the previous two cases.
It was managed in the flight enclosure for 41 days without any signs of improvement. Its wing droop remained
severe enough that the tips of its primary feathers were beginning to show wear and it would occasionally get
the injured wing stuck between its legs. Due to its lack of improvement and concerns about quality of life the
decision was made to euthanize.

Conclusion

These cases demonstrate several important considerations for conservatively treating proximal humeral fractures
in raptors. First, two birds recovered fully over time, with a relatively small investment of labor and resources.
Second, in both these cases daily observations did not detect improvement as well as weekly or bi-weekly
assessments. These cases went through a period of apparent stagnation for approximately 3 weeks during recov-
ery before improvement was noted. Once apparent improvement began, advances were rapid and marked. This
pattern suggests that clinicians and wildlife rehabilitators should exercise patience when using these techniques.
Third, while there were certainly other non-investigated factors that could have affected outcomesuch as poten-
tial tendon or ligament damagein these three cases the age of the patient seemed to play a role in determining
outcome: the nestling Swainsons hawk made a complete recovery, the recently fledged great horned owl made a
functional recovery despite a minor malalignment of the fracture ends, and the fully-fledged, passage red-tailed
hawk did not regain its flight ability. These cases suggest that conservative management may be a viable option
for full recovery, especially for young birds.

References

1. Helmer P, Redig P. Surgical resolution of orthopedic disorders. In: Harrison GJ, Lightfoot TL, eds. Clinical
Avian Medicine, Vol 2. Palm Beach, FL: Spix Publishing;2006:765.

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The Amazing Story of Ruapuke (formerly known
as Lisa One), the Kakapo chick!
Patricia J Latas, DVM

Session #326

Affiliation: From the Tucson Wildlife Center, PO Box 18320, Tucson, AZ 85731, USA andAwe Pono
Avian Health, Tucson, AZ 85731, USA.

This is the amazing story of Ruapuke (formerly known as Lisa One), the miracle kakapo chick!

Off the coast of far south New Zealand lies a small island that is home to the one of the worlds most precious
treasures. Whenua Hou is the last refuge of almost all of the 125 remaining kakapo in the world. There are no
kakapo in captivity. There are none in zoos. There are none in aviary breeding situations. There are only these
last few wild survivors from the time when New Zealand was the land of birds. Before the arrival of humans,
kakapo were the most ubiquitous ground bird in New Zealand. They were officially declared extinct in the
1980s. A tiny, relictual population was rediscovered and eventually removed to a predator-free offshore refuge.

The story of Lisa-1 begins with the majestic rimu tree. In mid 2013, the rimu trees on Whenua Hou were pre-
dicted to produce a good crop of fruit. The rimu mast triggers the breeding season for female kakapo; somehow
the males also are attuned to this event. The fruiting cycle is very complicated, and sadly has been altered by
climatic changes in the remnant forests of mature rimu trees. Good rimu means there will be kakapo chicks.

The nocturnal, flightless kakapo are unique parrots, the most astonishing feature being their reproductive be-
havior. They are lekking species in which males cluster in loose groups and perform a display that is enticing to
females. The males select high ridges in their territory, and meticulously sculpt bowl-shaped depressions in the
ground. These bowls essentially function as the deep resonating body of a stand-up bass.

The perfect booming bowl ensures excellent acoustics for low-frequency sound transmission. The male pumps
his thoracic air sacs huge with air, then, the concert begins.

The boom that is produced sounds like a combination of bass drum and blowing across the top of a whiskey
jug. It penetrates the austral nights, and attracts the lady kakapo from far and wide. Several males compete with
booming, and the females stroll around the bowls, assessing the various tunes.

When a female is nearby, the male switches to a ching song, higher pitched and designed to pinpoint his loca-
tion. Almost every year, Lisa the kakapo is first female out, and nearly always selects experienced male Blades.
After a 45-minute mating session, Lisa rushed to her nest, and produced two eggs. The secure nest site was
already set up with cameras and live humans to observe.

Lisa was captured on Stewart Island (Rakiura) in 1982. She is an experienced mother and always anxious to
raise chicks. Of her 2014 eggs, one was infertile, and one held a tiny, precious, viable embryo.

The hatching of any parrot egg is a risky enterprise. Females need to be in top condition. Males need to be attrac-
tive and fertile. The males and females must find each other in a timely fashion. The eggs have to be fertilized.
The embryos have to struggle to exist, and survive. The chick has to emerge from the egg, and then survive to
the first feeding. All this in about 30 days!

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For the kakapo, the entire situation is even less likely. With less than 125 birds in the entire world, less than that
are on this one island. Far less than that are mature, reproductively active adults. Fewer still are fertile. The tiny
percentage that are left are genetically divergent enough to produce viable offspring. These are huge odds against
the production of viable, healthy chicks, and against the recovery of one of the worlds rarest birds.

This treasured egg was incubated faithfully by Lisa, until in an unfortunate accident she crushed the nearly full-
term egg. Because all nesting females are under close observation by dedicated staff and volunteers, the egg
was immediately rushedin the dead of night down steep muddy trailsto the kakapo headquarters incubator,
and Lisa was given a dummy egg to replace it. The embryo was only a few days from hatching. Kakapo rangers
patched it up with autoclave tape and glueand it hatched! Lisa-1 the miracle chick entered the world.

Kakapo are initially named according to the order in which they are hatched. Hence the original name, Lisa-1.
Six kakapo chicks were produced in 2014: Lisa 1, Heather 1, Heather 2, Rakiura 2, Rakiura 3 and Huhana 1.
They received their true names many months later: Rurapuke, Tohu (gift), Mahli, Taeatanga, Te Awa (the river),
and Moorehouse (an important kakapo researcher).

Each hatchling represents more than 1% of the worlds population of kakapo, equivalent to 70,000,000 human
beings. Even if all 6 youngsters survive the first few years and live to a full reproductive adulthood, that will
not make up for the death losses since the last breeding season in 2011. At one point there were 133 kakapo. In
2014 there were 124 plus 6 chicks. Each chick is valuable, each breeding season is so dangerous and fraught
with anxiety.

Ruapuke was gifted his name with a Maori blessing during Waitangi Day celebrations. The name, which means
two hills, comes from Ruapuke Island, which is northeast of Whenua Hou. In the early 1800s, Ruapuke Island
was a stronghold for the Ngai Tahu chief Tuhawaiki (bloody Jack), and supported the largest Maori population
in southern New Zealand. It also was the place where the Treaty of Waitangi was signed, 175 years ago.

Rurapuke is the miracle chick, hatched from glue and tape, the living hope of a rare and amazing species.

156 Building Exotics Excellence: One City, One Conference


Section 7

AAV Poultry

Anna Osofsky, DVM


Moderator
Epidemiology of a Pet Chicken Population
Marli S Lintner, DVM

Session #369

Affiliation: From the Avian Medical Center, 15952 SW Quarry Road, Lake Oswego, OR 97035, USA.

Abstract: Ten years into the pet poultry craze in Portland an initially healthy chicken population has
steadily succumbed to a large variety of illnesses, contagious diseases and parasites. Factors include
introducing birds from around the world, sharing birds, vaccination issues, wild bird and insect vectors,
global warming trends... and more.

Introduction

Pet poultry has always had a place in Portland city culture, but it has only been the last 10 years or so that it has
blossomed from quirky pet status to its current popularity. As in many cities, regulations in Portland allow an
owner to have three hens but roosters are strictly prohibited. Even with this small flock size, the number of hens
within city limits has grown large enough to actually support a small cottage industry. Stores that specialize in
chickens and chicken supplies are seen selling everything from feed to coops, nest boxes to medical products,
treats to designer wear, and are becoming increasingly common. Poultry clubs and events, including the famed
Portland Coop Crawl, continue to attract new membership. Throughout this insurgence of pet chickens there has
also been a parallel insurgence of various contagious diseases and parasites. Some were expected as a natural
course, but others were a surprise. Of even more surprise were those diseases that were expected and have yet
to show. While Portland cannot represent all cities with poultry populations, it is hoped that these trends will
prove educational to the pet poultry practitioners.

Epidemiology

Around 2005 poultry began to be seen as a unique pet and a statement of creative sustainability (fresh eggs). It
was also quickly observed that chickens have wonderful personalities and make entertaining additions to the
backyard. Building fancy chicken coops became not just an urban past time but a friendly neighborhood com-
petition. Chicken clubs formed and fresh eggs were shared. At that time the supply of chickens was essentially
limited to the large local feed stores. Wilco, FarmGro, and Coastal supplied vaccinated day old chicks in the five
most common varieties. Barred Plymouth Rocks, Rhode Island Reds, Buff Orpingtons, Black Australorps and
Sex Linked chicks dominated the scene. Chicks were virtually disease free and we saw little to no external or
internal parasites (including coccidia). We also had no cases of Salmonellosis. As poultry became more popular
and our poultry case load grew, (to almost a third of our avian only practice) trends quickly became apparent.
The most common presentation initially seen was trauma from predator attack. From the owners dog, to the
neighbors dog, to the stray dog, to coyote, fox, raccoon, bobcat, martin, weasel, rat, bear, skunk, hawk, eagle,
owl, it seems virtually everything eats chickens! Many of these predators have very characteristic methods of
operation. Dogs usually chew large patches of skin off the rump, raccoons go for the back of the neck and face,
coyotes take the whole bird, and raptors leave a pile of feathers in open areas. Many changes and adaptations to
coop design and safe runs have been implemented since, but predators continue to be a threat.

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Our second most common presentation was obesity. Owners love to feed their chickens! Diets supplemented
with extra grains, table food treats and the latest online suggestions resulted in morbid obesity. This obesity then
contributed to fatty liver disease and liver fracture, acute heat stroke episodes and increased egg yolk peritonitis
and reproductive issues. It can be very difficult to assess weight as palpation of the keel is not a good indicator
due to the fact that massive amounts of fat will first fill the coelomic cavity. We instruct owners to frequently pick
up their hens to gain awareness for how hollow and light they should feel. A chicken should never feel heavy
and solid. Weighing is too inaccurate a measure as crop fullness and egg laying cycles will fluctuate results.

It wasnt until the third or fourth year that we began seeing our first infectious agents. Coccidia arrived from an
outlying mixed-flock farm. Acute bloody diarrhea was the primary symptom and medication was able to control
this small outbreak. Unfortunately though, more birds had already been sold and coccidiosis would become a
fairly common occurrence from then on out. (This desire to want something different than your neighbor would
be the source of many new diseases over the years.) There now appear to be other factors currently involved in
the spread of coccidiosis in which wild birds are the leading suspects. The other infectious agent, a viral disease
called Mareks, can present in three very distinct forms. It was the neurological form we observed first. Owners
reporting lameness in their hens would arrive with the characteristic leg weakness and decreased nerve sensa-
tion. Oddly the cases remained sporadically located with no evidence of bird to bird transmission. There was an
increase in cases seen after warm weather, causing insect vectors to be suspected. No cases were confirmed in
birds that had been previously vaccinated.

Next spring poultry shipments from the Midwest to two of our new urban chicken specialty stores brought in
viral laryngotracheitis and viral encephalomyelitis.1 The encephalomyelitis ran its course fairly quickly as the
neurological symptoms were distressing enough for most owners to opt for euthanasia. The tracheitis virus has a
low mortality rate and ended up in some small commercial flocks. It re-appears yearly and seems to be here to stay.

With all the earthworms that chickens eat in Portland, and it being the vector for gape worm (syngamous trachea), I
am always surprised by how infrequently I see this parasite. It is quite common in the local robins, but the chickens
seem to thankfully avoid it. Our first real internal parasite issue was Acanthocephalids, the very small aggressive
thorny-headed worm of the small intestine. The first case was found during a necropsy in which the worms had
caused enough trauma to the duodenal loop that it had ruptured. It is believed that the pill bug is the intermediary
host in my area. Our second internal parasite issue, the cecal worm, resulted from close contact between poultry
and wild birds. A very small and very contagious parasite, hens often presented with diarrhea, weight loss, and
secondary infections. Roundworms of various species, and possibly contracted from various species, cause much
less pathology. But when passed in the droppings the large worms are very distressing to owners.

We have seen a variety of external parasites make their way further north, possibly due to changing weather pat-
terns. This past summer the chicken mite, Dermanyssus gallinae, arrived from Northern California. This is a very
aggressive blood sucking mite that had thwarted my diagnosis due to its habit of only infesting the birds at night.
During the day, when patients were brought to the clinic, we saw tired and pale birds but without an apparent
cause. This is the only external parasite we have dealt with that will also bite humans. Long term treatment of
the birds, at least once a week for four weeks, has proven successful. Concerns about online recommendations
to treat with topical canine products such as fipronil or imidacloprid have been unadvised as no egg withdrawal
times appear to exist. As summer turned to fall lice infestations began to also become more common. Lice proved
much easier to diagnose and treat than their mite counterparts and we instructed owners to check for nits and
nests at the base of the feather follicles along the ventral abdominal wall. Lice spread rapidly through town, too
fast for human distribution, and it is believed that wild birds were the transmission mode. On questioning, most
owners had bird houses, bird baths, or bird feeders in the yard with direct access to their chickens.

160 Building Exotics Excellence: One City, One Conference


Six to eight years into the chicken craze new issues with Mereks disease were brought to light. Firstly, many
of our hens were now greater than five years of age and appeared to be losing their vaccination protection. The
cases dramatically switched from the neurological to the visceral tumor presentation.1 Next, a very vocal group
of poultry enthusiasts persuaded the local feed stores to sell unvaccinated chicks. The rationale being if vaccines
could cause autism they did not want to feed eggs to their children from vaccinated hens. It worked, and for two
seasons most of the distributors sold unvaccinated chicks. Cases of Mareks, frequently presenting with egg yolk
retention due to tumors blocking the oviduct, continued to rise.

At this stage many owners were becoming discouraged and began giving away their hens. This of course would
result in diseases continuing to spread throughout town. But the worst was yet to come. The next spring a new
fly, as of yet unidentified, began causing horrible cases of fly strike. Laying eggs in the fecal material invariably
caught in the plumage below the vent, the maggots would then eat into the visceral body wall and/or the cloaca.
Damage was often extensive with compromised cloacal tissue and viscera exposed. Most birds were euthanized.

This past year, our first case of confirmed lymphoid leucosis was diagnosed.1 Similar to Mareks, lymphoid
leucosis is a virus causing disseminated tumor presentation. Our cases were most likely to involve the gastroin-
testinal tract and were consistently fatal. In this disease, unfortunately there is no vaccine available. Once again,
as in Mareks, this virus did not seem to spread readily from hen to hen, but showed up randomly all over town.
An insect vector is also suspected to be the cause of transmission.

Avian Influenza made its debut in the spring of 2015. As the H5N8 cases mounted north of Portland we anticipated
the waterfowl migration heading towards us with nothing short of dread. Portland has numerous rivers, lakes
and marshes heavily populated with waterfowl creating a ripe environment for the spread of the disease. Federal
authorities arrived, web sites were activated, and information dispersed. But, how do you protect hundreds of
small flocks scattered over a huge geographical area from a highly contagious virus spread by defecating geese
flying overhead? Biosecurity measures, which we are trained to understand, are often lost or distorted on the
general public. So our message was simple: Avoid walking in parks and near ponds and golf courses where mi-
gratory waterfowl may be present. Clean or change your shoes whenever entering your coop. Remove wild bird
feeders from poultry areas. Contact the authorities with any unexplained poultry deaths. Somehow we managed
to avoid any outbreaks in Portland. The only cases that spring in the state involved mixed flocks with ponds and
wild waterfowl on the premises.

Conclusion

Biosecurity measures, disease prevention, and disease control are all well outlined for the commercial poultry
industry.2 Keeping hens caged and confined in itself will avoid exposure to most predators and diseases. While
we may not ascribe to the battery life of a caged hen, there are still many practices and procedures that can be
gleaned for the small at home flock. So how does the veterinarian instigate biosecurity to the multitudes of three
hen households where vectors such as wild birds, rodents, and insects can come and go at will? What we cur-
rently recommend is to first and foremost start with healthy, clean, vaccinated chicks or pullets. Buy an entire
flock from one distributor, and avoid sharing and mixing birds. Plan to build a coop safe from predators and
rodents. Keep wild birds as far away as possible. Keep biting flies and mosquitoes under control. And as the
veterinarian, never underestimate the misguided and erroneous information available to well-intentioned chicken
owners. The internet, changing trends and at home remedy suggestions can greatly influence the shifting target
that is pet poultry health.

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References

1. Lintner MS. Obesity in the pet chicken. Proc Annu Conf Assoc Avian Vet. 2008;69.

2. Alexander DJ, Andersen AA, Arends JJ, Arp LH, et al. Diseases of Poultry. 10th ed. Ames, IA: Iowa State
University Press;1997.

162 Building Exotics Excellence: One City, One Conference


Outbreak of Infectious Bronchitis Virus in a Flock
of Backyard Chickens
Cheryl B Greenacre, DVM, DABVP (Avian), DABVP (Exotic Companion Mammal), and
Michelle G Hawkins, VMD, DABVP (Avian)

Session #373

Affiliation: Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University
of Tennessee, Knoxville, TN 37996, USA and Department of Medicine and Epidemiology, School of
Veterinary Medicine, University of CA, Davis, Davis, CA 95616, USA (Hawkins).

Six days prior to presentation, a group of 17 2-year-old barred rock adult hens and 3 adult roosters (1 2-year-old
bird and 2 1-year-old birds) were purchased from a man who had said they were raised on his farm. Two days prior
to presentation the chickens exhibited varying degrees of rales, mild coughing, periorbital swelling and edema
of the head. A mild serous nasal discharge also was present and some of the hens had laid eggs with abnormal
shells. At presentation approximately half the birds had died and the owner brought 3 birds for euthanasia and
testing. While under isoflurane anesthesia, but prior to euthanasia with pentobarbital IV, a choanal swab was taken
and blood was collected from the right jugular vein. Samples were submitted to the Poultry Disease Research
Center in Athens, Georgia. The birds were found to be negative for avian influenza, infectious laryngotracheitits,
infectious coryza, and mycoplasmosis, but were positive for infectious bronchitis virus (IBV).

IBV, which is caused by a coronavirus, affects only chickens and has a worldwide distribution. This disease is
highly contagious and easily spreads via airborne particulate matter, fomites and venereal transmission.1 Younger,
immunosuppressed chickens show more severe clinical signs than older immunocompetent chickens. Clinical
signs include upper respiratory signs including sneezing, gasping, rales, and nasal discharge. Young are affected
worse than adults, showing gasping and labored breathing. In an affected flock of chicks, all birds will typically
develop clinical signs within 36-48 hours and the clinical disease will typically last approximately 4 days (longer
if secondary infections develop). Older chickens show a 5-10% drop in egg production for about 10-14 days. The
reproductive tract can also be affected by this virus resulting in irregular and roughened eggshells with watery
albumin and decreased egg production. Also, newer strains of the disease may affect the kidneys. Tests include
virus neutralization, hemagglutination inhibition or ELISA. The best method to control is to disinfect, repopu-
late and vaccinate. There is no treatment, but antibiotics can be given to prevent secondary bacterial infection,
especially with infectious coryza. The virus is easily destroyed by disinfectants, sunlight and heat. Increasing
the environmental brooder temperature by 5 degrees Fahrenheit helps chicks to recover. Continuous emergence
of new IBV genotypes and lack of cross protection among different IBV genotypes have been an important
challenge for vaccination programs. Although live attenuated IBV vaccines induce a potent immune response,
the risk of reversion to virulence, neutralization by maternal antibodies, and recombination/mutation events are
important concerns for their usage. Inactivated vaccines induce a weaker immune response and often require
multiple dosing and/or the use of adjuvants. Recent advances in recombinant DNA technology has resulted in
experimental IBV vaccines that show promise in antibody and T-cells responses, which are comparable to live
attenuated vaccines. Although most recombinant IBV vaccines are not yet available commercially, it is expected
these types of vaccines will be more effective at inducing a cross protection against multiple IBV genotypes.2

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References

1. Gallardo RA, Hoerr FJ, Berry WD, van Santen VL, Toro H. Infectious bronchitis virus in testicles and
venereal transmission. Avian Dis. 2011;55(2):255-258.

2. Bande F, Arshad SS, Hair Bejo M, Moeini H, Omar AR. Progress and challenges toward the devel-
opment of vaccines against avian infectious bronchitis. J Immunol Res. 2015;424860. Epub 2015.
doi.org/10.1155/2015/424860.

164 Building Exotics Excellence: One City, One Conference


Listeriosis Outbreak in a Backyard Chicken Flock
Laura Wade, DVM, DABVP (Avian), and
Jarra Jagne DVM, Dipl ACPV

Session #223

Affiliation: From Specialized Care for Avian & Exotic Pets, 10882 Main St, Clarence, NY 14031, USA
(Wade) and Cornell University Animal Health and Diagnostic Center, College of Veterinary Medicine,
PO Box 5786, Ithaca, NY 14852, USA (Jagne).

Listeriosis has previously been reported to be rare and sporadic in poultry. In 2013, a case of listeriosis was
described in an urban flock in Washington State.1 In 2014, 2 back-yard layer flocks experienced listeriosis out-
breaks in New York State.2 One of the New York flocks is described in this presentation.

A mixed flock of chickens was experiencing illness including weight loss and mortality. Several birds showed
neurologic signs including torticollis and leg paralysis. Three affected birds submitted for pathology were found
to have septicemia from Listeria monocytogenes. Post-mortem examination identified pericarditis, severe myo-
carditis, coelomitis and hepatic necrosis. Samples of frozen heart and liver sections of formalin-fixed tissue
were positive for L monocytogenes (serotype 4b) by real time PCR. Veterinarians working with chickens should
consider Listeriosis and its potential zoonotic implications.3,4

References

1. Crespo R, Garner M, Hopkins S, Shah, D. Outbreak of Listeria monocytogenes in an urban poultry flock.
BMC Vet Res. 2013;9:204. Available at http://www.biomedcentral.com/1746-6148/9/204. Accessed
May 13, 2015.

2. Jagne J, Buckles E, Fernandez J, Miller A, Daverio H. Listeria monocytogenes infection in backyard layer
flocks-more than a sporadic disease? Proc Annu Conf Am Assoc Avian Pathol, Am Vet Med Assoc. 2015
(in press).

3. Dhama K, Verma A, Rajagunalan S, et al. Listeria monocytogenes infection in poultry and its public health
importance with special reference to food borne zoonoses. Pak J Biol Sci. 2013;16:301-308.Available at:
http://scialert.net/qredirect.php?doi=pjbs.2013.301.308&linkid=pdf. Accessed May 13, 2015.

4. Abdul-Aziz T. Overview of Listeriosis in poultry. The Merck Veterinary Manual. Available at:
http://www.merckvetmanual.com/mvm/poultry/listeriosis/overview_of_listeriosis_in_poultry.html.
Accessed May 13, 2015.

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Surgical Resolution of a Complicated Septic Yolk
Coelomitis and Oviductal Impaction in a Pet Chicken
(Gallus gallus domesticus)
Nathaniel Kane, DVM,
Brian Speer, DVM, DABVP (Avian), Dipl ECZM (Avian)

Session #270

Affiliation: From The Medical Center for Birds, 3805 Main Street, Oakley, CA 94561, USA.

Septic yolk coelomitis with oviductal impaction is a condition well documented in chickens.1-4 Surgical interven-
tion with regard to this condition has been described in avian species along with whole blood transfusions when
the need arises.5-7 A 3-year-old female Sebright chicken was presented with a 3-week history of progressive
lethargy. Relevant physical examination findings included a moderately-distended coelom with palpable ascites.
A tentative diagnosis of oviductal impaction and suspected septic yolk coelomitis was reached after utilizing
CBC, biochemistry, screening and contrast radiographs, contrast fluoroscopy, and ultrasound imaging, and this
diagnosis was ultimately corroborated at the time of surgery. Initial surgical intervention was focused on sal-
pingohysterectomy and debridement of inspissated yolk material free within the coelom, but was complicated
by near-fatal hemorrhage from the cranial ovarian artery. Repeated homologous transfusions were required fol-
lowing the immediate blood loss event. Escherichia coli was isolated from oviductal and intestinal peritoneal
swabs at aerobic culture. A second surgical procedure two months later was successful in partial ovariectomy
and the complete removal of the remainders of the oviductal stump and infundibulum. Seventeen months after
initial presentation and nineteen months after the final surgical procedure, the bird remains asymptomatic and
outwardly healthy based on physical examination, screening laboratory database (CBC, plasma biochemistry),
and radiographic assessment. Long-term husbandry goals are focused on antecedent arrangement (caloric re-
striction, promotion of foraging behaviors) without the apparent need for GnRH agonist or other treatments.

References

1. Davis MF, Ebako GM, Morishita TY. A golden comet hen (Gallus gallus forma domestica) with an impacted
oviduct and associated colibacillosis. J Avian Med Surg. 2003;17(2):91-95.

2. Landman WJM, Heuvelink A, van Eck JHH. Reproduction of the Escherichia coli peritonitis syndrome in
laying hens. Avian Pathol. 2013;42(2):157-62.

3. Srinivasan P, Balasubamaniam BA, Gopala Krishna Murthy TR, Balachandran P. Prevalence and pathology
of oviduct impaction in commercial white leghorn layer chicken in namakkal region of India. Vet World.
2014;7(8):553-558.

4. Landman WJM, Cornelissen RA. Escherichia coli salpingitis and peritonitis in layer chickens: an overview.
TijdschrDiergeneeskd. 2006;131(22):814-22.

5. Echols S. Soft tissue surgery. In: Backyard Poultry Medicine and Surgery: A Guide for Veterinary Practi-
tioners. Eds. Greenacre CB, Morishita TY. Wiley-Blackwell. 2015; Chapter 16.

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6. Finnegan MV, Daniel GB, Ramsay EC. Evaluation of whole blood transfusions in domestic pigeons (Co-
lumba livia). J Avian Med Surg. 1997;11(1):7-14.

7. Morrisey JM. Practical hematology and transfusion medicine in birds. Proc Western Vet Conf. 2013.

168 Building Exotics Excellence: One City, One Conference


Web Sparing Amputation of the Third Digit of a Duck
Geoff Olsen, DVM

Session #059

Affiliation: From The Medical Center For Birds, Oakley, CA 94561, USA.

An 18-month-old female Cayuga duck (Anas platyrhynchos domesticus) presented for bilateral bumblefoot le-
sions with minimal lameness. A soft swelling was identified at the dorsal aspect of the third phalange and another
over the first interphalangeal joint of the same digit. An aspirate of the lesions yielded a non-hemolytic Staphy-
lococcus species within the left interphalangeal joint, and radiographically there was no evidence of osteolysis
present. A marked leucocytosis of 94,000 was identified. An initial course of trimethoprim sulfamethoxazole
and pressure-relieving bandages resulted in only minimal improvement. Over the next 8 weeks, despite repeated
bandage changes and medical management, the patients lameness progressed to become non-weight bearing.
Repeat radiographs revealed luxation and osteolysis of digits 2 and 3 on the left foot. The leucocytosis had in-
creased to 180,000 est WBC. Amputation of digit 3 was performed to attempt to resolve patient discomfort and
allow placement of amikacin-impregnated PMMA beads. The phalanges were removed, using a dorsal incision,
resulting in minimal damage to the interdigital web. There has been minimal contraction of the interdigital web
and the duck has demonstrated no lameness 9 months post surgery.

This caseis important, as septic arthritis and pododermatitis arecommon conditions in waterfowl1,2 and aquatic
bird species, and digital amputation is complicated by the presence of the interdigital web. Medical management
is not always adequate to resolve these lesions. This novel procedure resolved patient pain and discomfort and
the interdigital web continues to retain normal form and function 9 months after surgery.

References

1. Blair J. Bumblefoot: a comparison of clinical presentation and treatment of pododermatitis in rabbits, ro-
dents, and birds. Vet Clin N Am Exot Anim Pract. 2013;16(3):715-35.

2. Backues K. Anseriformes. In: Miller RE, Fowler ME, eds. Zoo and Wild Animal Medicine vol 8. St. Louis,
MO: Elsevier Saunders;2015:116-126.

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Section 8

AAV Master Classes


Track 1
Disease Conditions, Clinical Signs and Treatment
Modalities of Large Pet Birds
Rose Ann M Fiskett, VMD, DABVP (Exotic Companion Mammal),
Drury R Reavill, DVM, DABVP (Avian), DABVP (Reptile and Amphibian), Dipl ACVP,
Robert E Schmidt, DVM, PhD, Dipl ACVP

Session #218

Affiliation: From Zoo/Exotic Pathology Service, 6020 Rutland Drive #14 Carmichael, CA 95608 USA.

Abstract: Disease conditions and clinical signs of several large companion birds are presented, including
African grey parrots, Amazon parrots, cockatoos, and macaws. Infectious diseases, neoplasia, and metabolic
and nutritional disorders common to each species are reviewed. In some cases treatment modalities are
discussed.

This paper is modified from the Association of Avian Veterinarians 2006 proceedings. It is a review of the
more common diseases identified in large bird species kept as pets and correlates pathological changes
and clinical presentation of specific disease processes. In addition, the diagnostic tests and treatment
regimens, along with expected outcomes, are reviewed.

African Grey Parrots

Infectious diseases

Adenovirus infection is recognized as sporadic outbreaks of African species (African grey [Psittacus erithacus]
and Senegal [Poicephalus senegalus] parrots). There is a variable species susceptibility to adenoviral infections
and the infection can look like a Pachecos outbreak in a collection. Lesions include extensive necrosis of the
liver, spleen, pancreas, and intestines with viral intranuclear inclusions. The virus is spread by horizontal trans-
mission; the incubation period is unknown. Clinical signs include depression, dyspnea, hemorrhagic diarrhea
and death usually within 4-6 days of symptoms onset. Infections may be subclinical or mild; symptoms usually
develop in conjunction with other viral or bacterial infectious agents and immunosuppression. The diagnosis is
generally obtained at necropsy and histologic examination. As the viral inclusions may appear similar to those
of polyomavirus and herpesvirus, confirmation can be considered with viral probes. Live bird testing is difficult
and generally requires electron microscopic examination of feces or pharyngeal secretions for the virus.

Circovirus infection in African grey parrots is characterized by significant immunosuppression. The infection is
associated with pneumonia, enteritis, and death. Feather lesions commonly seen in other species with this infection
are uncommon. A severe leukopenia and non-regenerative anemia is a common finding on the complete blood
count (CBC). Virus is shed in the feces, crop secretions, and feather dust. The minimum incubation period is
reported as 21-25 days with a maximum period of years.1 Several tests are available to detect this virus in exposed
psittacine birds including a hemagglutination assay used to detect serum antibody levels to study the prevalence
of PBFDV in wild Australian parrots and viral PCR. PCR technology can detect the virus in blood and can be
used for environmental screening. In a review of case submissions, the African grey parrot is the most common
large pet parrot diagnosed with circovirus infections, followed by lovebirds and eclectus parrots (Eclectus rora-
tus) (Drury R Reavill, oral communication, March 2004). A certain percentage of birds may mount a sufficient
immune response and clear the virus. Attempts to produce a safe and effective vaccination have proven futile.

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Cutaneous papillomas are virally induced warty lesions that occur on the skin of the face and feet. One report
describes multiple cutaneous papillomas on the face of an adult male Timneh parrot (Psittacus erithacus tim-
neh).2 Proliferative skin lesions were found over the head, affecting the palpebrae, the cutaneous areas at the
angles of the upper and lower beaks, and the skin contiguous with the lower beak. Lesions tested positive by
immunostaining with papilloma virus group-specific antibodies. No treatment was described and the lesions
progressed. In a recent report, cloacal and cutaneous papillomas of African grey parrots were associated with
a newly recognized alphaherpesvirus (proposed psittacid herpesvirus 2).3 Both cases of cutaneous papillomas
identified by one author (Reavill) were around the eye and beak on African grey parrots.

Proventricular dilatation disease (PDD) in African grey parrots presents most commonly as a central nervous
system disease. At least one known cause is a novel negative-strand RNA virus (avian Bornavirus). The histo-
logic lesions are a severe lymphoplasmacytic ganglioneuritis, frequently accompanied by an encephalomyelitis.
Diagnosis is by clinical signs and RT-PCR. Treatment includes supportive care, easy to digest foods and selective
COX-2 inhibitor Celebrex and/or other anti-inflammatory medications.

Salmonella typhimurium infection can result in high mortality of young birds, lories, and African grey parrots.4
It is considered a primary pathogen; some serotypes can penetrate the mucosal barrier. Noninvasive serotypes
may result in the carrier state. Transmission is by ingestion of contaminated food or water or by direct contact of
aerosolized fecal or feather dust. Feces of chronically infected carrier birds are one of the most common sources
of infection. The disease course in birds is dependent on the number of organisms, their serotype, and the age,
species, and condition of the host. It ranges from a peracute, acute, chronic, to subclinical infection. Clinical
signs include depression, lethargy, anorexia, weight loss, diarrhea, pasty vents, lameness, abscess formation,
convulsions, poor hatching or excessive fledgling mortality, dehydration and crop stasis, meningitis, osteoar-
thritis, and sudden death. The classic gross lesions are hepatomegaly, splenomegaly, pneumonia, and a catarrhal
to hemorrhagic enteritis. Diagnosis is made by fecal or affected organ culture. Antemortem diagnosis by fecal
cultures is difficult because of the intermittent shedding. Therapy is based on antimicrobial sensitivity and the
condition of the bird. Treatment periods can be long (3-8 weeks) and may not eliminate the organism. Control
of this highly contagious disease is dependent on strict isolation, vector control, and appropriate disinfection.
Infections do pose a public health risk.

Fungal pneumonia caused by Aspergillus species or other fungal organisms (such as Absidia, Mucor, Rhizopus,
Penicillium species, etc.) is a common finding in young African grey parrots infected with circovirus. Fungal
pneumonia and granulomas can suggest immunosuppression as well as support exposure to an overwhelming
number of fungal spores in any of our pet birds.4 Environmental evaluation is necessary to identify a potential
source of fungal spore formation (eg, wood shavings, corncob bedding, and seed hulls). Review of the recent
medical history may identify use of immunosuppressive drugs, chronic antibacterial therapy, environmental
stressors, neoplastic conditions, severe malnutrition, or underlying infectious disease agents.

The clinical presentation of dyspnea, weight loss, exercise intolerance and chronic debilitation are all suggestive
but not definitive for infection. Addition clinical signs include mucopurulent to mucoid nasal discharge, loss
of voice, depression, vomiting, PU/PD, weight loss, CNS signs, and, as the disease progresses, dyspnea. Initial
blood evaluation may have an elevated white count with degenerative heterophils and reactive lymphocytes.
Chronic disease usually progresses to a monocytosis and non regenerative anemia. A decrease in serum albumin
and an increase in globulin are also characteristic of this disease.

Antemortem diagnosis of a fungal respiratory infection can be challenging. In some cases, the disease involves
only the upper airway, in others the lungs and air sacs. Diagnostic tools including radiographs, endoscopy and
biopsy, cytology, hematology and culture, still may not yield an appropriate diagnosis. Newer ancillary testing

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used in human medicine (PCR and ELISA antigen detection) may not be useful as most birds will isolate the
infection in a granuloma, will not have detectible circulating levels in the blood, or may not be infected with
that specific type of fungus. Serology may be an effective diagnostic tool in certain species of birds where the
secondary antibodies used were species specific.

Radiographic examination may reveal mycotic lesions in the lungs and air sacs. Bronchopneumonia, nodular
airsacculitis with focal densities, asymmetry and hyperinflation or consolidation may be visualized. Intraluminal
lesions in the trachea, syrinx and bronchi are not usually visualized on radiographs. Computed tomography may
be useful to identify these lesions and lesions in the skull.

Endoscopic examination of the trachea and airsacs may be the best way to identify fungal plaques and collect
samples for cytology, histology and culture. Sensitivities to the currently available antifungal medications should
be considered as resistant strains of A fumigatus have been reported. This is not a common procedure with com-
mercial labs and many will need to send the cultures to a research or university facility for the specified drug testing.

Initial treatment of fungal respiratory infections is usually Amphotericin B. It can be administered intravenously,
intratracheally, in sinus flushes and as a nebulizing agent. Use of the drug requires careful monitoring of renal
function as it is nephrotoxic. A dose of 1.5 mg/kg IV q8h for 3-5 days in combination with terbinafine, fluco-
nazole or intraconazole (caution in African grey parrots) orally and in conjunction with nebulization therapy
with either clotrimazole or terbinafine is recommended. 5 When using Amphotericin B intratracheally it must
be diluted with water as it is inactivated in saline. Use caution when flushing sinus infections as severe sinusitis
and death have been reported. Newer drugs such as Voriconazole (13-18 mg/kg PO BID) have also anecdotally
shown promise with treating a variety of fungal infections in birds.

Itraconazole is used most widely as an oral therapy for Aspergillosis. While the normal dosage range in most
species is 5-10 mg/kg BID for 5 days, then SID for duration of treatment, there are reports in the literature that
African grey parrots may require a lower dose of 2.5-5.0 mg/kg PO q24h for safe treatment. Fluconazole is best
used in central nervous system infections and infections in the eye. Clotrimazole and enilconazole are used when
topical application can be achieved through inhalation or nebulization. Miconazole can be used in the ophthalmic
form for fungal keratoconjunctivitis every 4 hours. Terbinafine at 10-15 mg/kg PO q12-24h in combination with
intraconazole is a safe and effective treatment. Terbinafine has is well absorbed orally, has minimal side effects
and can effectively penetrate granulomas.5

Nebulization therapy can be a useful adjunct therapy to systemic treatment. Drugs used include Amphotericin
B, Clortrimazole, Terbinafine and a disinfectant F10 (diluted 1:250). Usual treatment course is every 12 hours
for 3-12 weeks.5

Surgical debridement of tracheal, air sac and sinus lesions may be necessary to facilitate a long term cure. Recent
advances in endoscopic laser surgery offers a much better therapeutic prognosis.

Even with aggressive therapy of a respiratory fungal infection, unless the underlying cause is identified and cor-
rected, and the patient is given excellent supportive care, the prognosis is guarded at best.

Metabolic and nutritional disorders

Atherosclerosis is a proliferative lesion of the tunica media and tunica intima of elastic and muscular arteries.
Atherosclerotic plaques cause abnormal vascular flow and loss of endothelial integrity, with decreased vessel
elasticity and variable degrees of vessel narrowing. These changes in vessel walls can initiate thrombosis. In
birds, lesions are primarily in the aorta and brachiocephalic arteries. In psittacine birds, atherosclerosis can be a

ExoticsCon 2015 Main Conference Proceedings 175


primary cause of death, which may occur without premonitory clinical signs. Birds may develop dyspnea, muscle
wasting, progressive paresis of the legs, and seizure-like activity. Radiographically, an increased prominence of
the brachiocephalic arteries, aorta, and in cases with chronic pulmonary congestion from left cardiac dysfunc-
tion, a diffuse increased opacity of the lungs can be recognized. Diagnosis ante mortem may include alteration
of blood lipid levels, radiodense and enlarged and/or tortuous great vessels on radiographs, direct visualization
(exploratory or endoscopy) of affected vessels, and disrupted blood flow noted on micro CT angiography or MRI
time of flight studies. Specific therapy has not been described; however, addressing potential risk factors such as
elevated plasma cholesterol level, poor diet, social stress, and inactivity may help. There are anecdotal reports
of the use of statin drugs but controlled studies regarding safety and efficacy have not been done. Based on
a submission review (Drury R Reavill, oral communication, March 2004), atherosclerosis is most common in
African grey parrots, lovebirds, Amazon parrots (Amazona species), and cockatiels. The average age range is
10-15 years.6

Hypocalcemia syndrome in African grey parrots has been characterized by decreased levels of blood calcium
associated with tetany or seizures.6 Clinical presentation includes generalized weakness, inability to perch, slow
blink reflex, seizures and death. The exact etiology of this condition is unknown but may be related to nutritionally
poor diets which includes low calcium and magnesium and potentially high phosphorous foods. Glucocorticoid
therapy will also decrease the total calcium concentration as will hypoalbuminemia, hypovitaminosis D3, hy-
poparathyroidism, or renal hypoparathyroidism. Diagnosis is based on clinical presentation, nutritional history
and serum calcium levels. Total calcium is representative of the active ionized calcium, protein bound calcium,
and calcium chelated with anions. In African grey parrots, a significant correlation has been found between total
calcium and albumin concentration in the plasma. Interpret calcium along with albumin concentrations; bound
calcium is biologically inactive. Caution should be used with the administration of isoflurane. Treatment is de-
pendent on correction of any underlying nutritional deficits, usually by switching to a high quality pelleted diet,
calcium supplementation during the transition, and exposure to natural sunlight or UV light indoors.

Some birds, especially African grey parrots, develop massive keratin rhinoliths that distort the nares and nasal
sinus. These are commonly due to hypovitaminosis A and secondary infections. Pet birds that are on a primary
seed or cereal grain diet or have intestinal mucosal lesions that interfere with conversion of carotenoids to vitamin
A may develop vitamin A deficiency. Vitamin A deficiency results in epithelial squamous metaplasia, which is
manifested as hyperkeratosis of the oral cavity, conjunctiva, nasal lacrimal duct, urinary tract, upper alimentary
tract, and respiratory tract. In large parrots, the epithelial changes will appear when vitamin A concentrations in
the liver decrease below 50 IU/g.7 Keratinizing epithelium will block the ducts of submucosal mucus glands,
causing the glands to enlarge with secondary infections that produce large keratin granulomas within the nasal
or oral cavity. The squamous metaplasia also alters the mucosal defenses, predisposing the bird to fungal and
bacterial infections, primarily of the respiratory tract.

Diagnosis is made by clinical presentation and treatment consists of surgical removal and curettage with flush-
ing, post op eye drops in the wound, and correction of underlying nutritional deficiencies.

Neoplasia

Malignant melanomas are typically located on the face and beak of African grey parrots.

Gross lesions appear as brown-black masses with irregular borders that infiltrate into the surrounding tissues.
These can look similar to cutaneous hemangiomas and hemangiosarcomas. One author (Reavill) has seen 2 cases
of malignant melanomas developing on the head in African grey parrots and one on the beak of a budgerigar
(Melopsittacus undulatus). All tumors recurred after surgical removal.

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African grey parrots uncommonly develop lipomas, gastric carcinomas, fibrosarcomas, bile duct carcinomas, or
xanthomas compared to other psittacine birds.

Parasites

Sarcocystis is a protozoal infection that results in high morbidity and mortality of Australian, Asian, and African
origin psittacine birds and occasionally exotic columbiformes (pigeons and doves). In a review of cases (Drury
R Reavill, oral communication, March 2004), lories and lorikeets are the most common species affected by sar-
cocystis, followed by African grey parrots, cockatoos, and eclectus parrots. American or Neotropical (Mexico,
South, and Central America) psittacine birds are relatively resistant to the disease as adults. Transmission is by
the definitive host, opossums, and by mechanical vectors such as cockroaches. The normal intermediate hosts are
cowbirds and grackles. Death occurs rapidly due to early parasite schizogony (asexual reproduction) in the lung,
which leads to fatal respiratory collapse. For birds presenting with acute respiratory distress, signs suggestive of
small airway disease (ie, respiratory distress with an expiratory wheeze), and from areas with known sarcocystis
infections, aggressive supportive care and terbutaline therapy may be of benefit. Terbutaline is a Beta agonist
and will cause bronchodilation and decrease pulmonary vascular resistance. The primary cause of respiratory
distress seen with Sarcocystis is vascular endothelial damage and increase in pulmonary vascular resistance.8
The drug pyrimethamine may also be of benefit in some cases with early diagnosis or high suspicion. Severe
pulmonary congestion and hemorrhage may be the only lesion recognized on gross examination. Control of the
opossum and cockroach population is important.

Other conditions

Automutilation of the sternum in psittacine birds (split sternum) generally occurs over the cranial portion of
the sternum, along the point of the keel, and may appear as an open wound of the skin and muscle. Continued
self-trauma can lead to tissue necrosis and infection, which can extend into the deeper muscles and bone of the
keel. A mixed bacterial population (Streptococcus species, Staphylococcus aureus, E coli, Pseudomonas species,
and Klebsiella species) and occasionally fungi can be isolated from these wounds. The pruritis typical of these
lesions may be due to the secondary infections. Improper wing trims in heavy-bodied birds (African grey parrots
and Amazon parrots) resulting in a traumatic landing on the sternum is suspected to be one cause. In flighted
birds the reason for self-mutilation is unknown.

Choanal atresia is described in African grey parrots. A persistent membrane or bony plate at the palate of the
nasal cavity results in a closed choanal slit. This blocks the normal drainage of nasal secretions into the oral
cavity. Young birds present with a chronic nasal or ocular discharge and in some cases, the infraorbital sinuses
will be distended with clear secretions. Surgical correction is recommended.

Constricted toe syndrome can be caused by fibers, scabs, or necrotic tissue and may result in avascular necrosis
of the distal toe. In juvenile and nestling macaws (Ara species), African grey parrots, eclectus parrots, cockatoos,
and conures, the development of digital necrosis occurs without an identifiable constricting foreign material.
Proposed causes include low humidity, egg-related strictures, ergot-like intoxication, or digit fractures. This
deformity consists of an annular ring of constriction that eventually causes swelling and necrosis of the distal
segment of the toe. If identified early, some resolve with increased environmental humidity, hot moist compresses,
massage therapy, and surgical correction. Fibrous annular rings are incised and accumulated serum and tissue
debris gently debrided. The toe should be soaked in a warm, dilute, povidone-iodine solution and an antibiotic
ointment applied. DMSO may reduce inflammation. If the distal segment is severely swollen or necrotic it should
be surgically removed. Toe constrictions can often be prevented by keeping susceptible species on non-desiccating
surfaces and increasing brooder humidity.9

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Feather damaging behavior occurs quite commonly in African grey parrots. On histologic examination, there
may be no lesions or perivascular dermatitis. Perivascular dermatitis is suspected to indicate an allergic skin
disease, although confirmation can be difficult. Gross changes possibly associated with allergic skin disease
include feather loss, reddening of the skin, and occasionally surface exudates. Some of the gross lesions may
be secondary to self-trauma. As yet, there are still an insufficient number of cases with follow-up information
to better define this disease. A diagnosis of idiopathic self-mutilation is made when no organic cause can be
identified and the feather follicles and skin have no histologic lesions.10 This aberrant behavior is the commonly
believed cause for many feather-picking birds. It is attributed to boredom, loss of a mate (human or feathered),
dietary changes, environmental maladaptation, exposure to cigarette smoke, or intolerance to new stimuli. This
condition looks like perivascular dermatitis with missing and frayed feathers, reddened skin, ulcers, and pruritis.

Amazon Parrots

Infectious diseases

Mycobacteria infection in many species including birds, generally results in a chronic wasting disease. From
case submissions (Drury R Reavill, oral communication, March 2004), Amazon parrots, brotogerids, Pionus,
and finches/canaries are most commonly infected.

Birds are most commonly infected with Mycobacterium avium, M intracellulare and M genevense. M avium
and M intracellulare share many characteristics and are frequently grouped as M. avium-intracellulare (MAI)
complex.11 Infection is usually oral through ingestion of the organism. The usual age of presentation is
3-10 years. Clinically with the intestinal form muscle wasting and emaciation is the usual presentation, along
with eventual decrease in appetite. Poor feather quality, lethargy, weakness and pallor can also be seen. Acute
or chronic lameness can be suggestive of bone involvement. Liver enlargement can cause air sac compression
and increased respiratory effort. Lesions can also occur in the sinuses and syrinx. Skin lesions such as diffuse
non-pruritic thickening and tubercles have been reported. Lesions in and around the eye have also been reported.
It is important to note, that, unlike humans, it is not a respiratory disease.

Diagnosis of mycobacteriosis can be difficult. Clinical presentation, severe leukocytosis, organomegaly, and
cytologic or histologic presence of acid fast bacteria suggest a high index of suspicion. While the leukogram
indicates a severe response, the serum chemistries are usually unremarkable except liver enzymes which may be
mildly elevated if the liver is involved. Serum protein electrophoresis may aid in the diagnosis early in the course
of the disease. Radiographic examination may reveal hepatosplenomegaly and gas dilated loops of bowel. Boney
lesions may be seen as either lysis or sclerotic lesions. Laparoscopic examination and biopsy is extremely useful
in obtaining a diagnosis. Fecal acid fast examination is usually not rewarding. While advances have been made
is serology, these tests are species specific and generally not useful in private practice. While culture is the gold
standard, it takes weeks to months and many times the organisms dont grow. DNA PCR has a rapid response
time for detecting the organism in fecal samples and is the most reliable diagnostic method. Intradermal skin
testing has not been useful in avian species.

There is controversy regarding the treatment of avian mycobacteriosis. Many veterinarians recommend eutha-
nasia. Surgical excision of discrete tubercles may be curative. There are many drugs with anti-mycobacterial
activity such as azithromycin, clarithromycin, ciprofloxacin, hifalutin, rifampicin, amikacin, clofazimine and
ethambutol. Multi-drug therapy is recommended and for at least four months or longer. Vaccination has histori-
cally not proved efficacious.

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Mycobacterium is very stable in the environment. It can survive for months to years in the environment and
birds infected with M avium shed tremendous amounts of the organism into the environment. Any infected birds
must be permanently isolated from other birds as they may continue to infect the environment. Prevention of
infection through intelligent cage design and sanitation is essential in larger collections.

Of concern is the HIV-positive owner of an infected bird. Studies show that while infection with M avium in
these patients is on the rise, the source is thought to be environmental, based on DNA probe examination.11

Chlamydia psittaci is an energy dependent obligate intracellular parasite that is a zoonotic disease agent. Amazon
parrots typically present with the classic disease. The clinical signs include sinusitis, dyspnea, conjunctivitis,
polyuria, diarrhea, lethargy, anorexia, yellow to dark green droppings, poor feathering, and chronic weight loss.
Rarely central nervous system signs such as opisthotonos, tremors, and convulsive movements can develop. He-
matology, radiography, serum biochemistries, DNA PCR probes, antigen capture tests, antibody tests, cytology,
and culture are all procedures that can provide a clinical diagnosis. No antemortem test will certify a bird is free
of Chlamydia. Postmortem findings can include hepatomegaly, splenomegaly, and cloudy air sacs. Histologic
lesions include a histiocytic, lymphoplasmacytic hepatitis, splenitis, pneumonia, airsacculitis and nephritis.
Aerosol inhalation and ingestion are the primary routes of transmission. The incubation period of Chlamydia
psittaci ranges from 5 days to several weeks.

Treatment of chlamydia can be difficult. Because of the intracellular nature of the organism, long term treatment
is recommended. Good client communication and compliance with treatment protocols is essential for success-
ful treatment. Doxycycline is the drug of choice and must be administered so that the patient is treated with the
therapeutically effective dose for the full 45 day treatment regimen. Oral forms of the drug can be administered or
the injectable form (Vibravenous European formulation) can also be used for the treatment of individual birds.

This disease has zoonotic potential, presenting as a flu-like disease in humans. It can progress to severe pneu-
monia and death, especially in immunocompromised people. Current research is trying to improve diagnostic
tests and possible develop a vaccine for this disease.

Psittacid herpesviruses [PsHV] are a heterogeneous group of avian herpesviruses.7 Genotypes 1 through 4 and
their corresponding serotypes are most commonly associated with an acute fatal disease (Pachecos disease) seen
in many species of parrots. Further research over time may change the classification of this viral group. There
is variable species susceptibility to this viral infection. Amazon parrots, cockatoos, cockatiels, and macaws are
the most common species diagnosed with a herpesvirus infection (consistent with Pachecos disease) identified
in a recent survey (Drury R Reavill, oral communication, March 2004). Susceptible birds usually die with no
or few clinical signs (depression, anorexia, fluffed, intermittent diarrhea hemorrhagic, polyuria/polydipsia,
convulsions, and biliverdin staining of feces and urates). Ingestion, inhalation, and conjunctival exposure have
experimentally been shown to result in infection and disease. The incubation period ranges from 3-14 days.
Survivors in an outbreak should be considered latently infected. Carrier birds shed the virus in the feces and
pharyngeal secretions. PsHVs are maintained in nature in birds that are persistently infected with the virus.
Amazon parrots and certain species of conures and macaws have been shown to continuously shed virus in oral
secretions and feces. Diagnosis is by DNA-PCR swabs of the oral and cloacal mucosa. Treatment can be tried
with acyclovir; a vaccine was available at one time.

Extra-hepatic lesions occur with a fair degree of frequency in PsHV disease. The herpesvirus outbreaks that
primarily target the respiratory tract (Amazon tracheitis-like virus) have been recognized in Amazon parrots,
brown-throated conures (Aratinga pertinax), Bourkes parakeets (Neopsephotus bourkii), whiskered lorikeets
(Oreopsittacus arfaki), and rosellas (Platycercus species). The tracheal mucosa and lungs appear edematous
and congested. The Amazon tracheitis virus is believed to be a variant of the infectious laryngotracheitis virus.

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Amazona (neotropical) pox enjoys a wide host range of South American psittacine birds. The disease may present
in either the dry (cutaneous) or wet (diphtheroid) forms. The cutaneous form involves the nonfeathered areas of
skin where papules or raised scab-like lesions develop around the eyes, beak, nares, tibiotarsus, and feet. The
lesions will eventually desquamate, usually without leaving a scar. The wet form affects the mucous membranes
and generally results in a high mortality rate. The lesion is a depigmented, raised plaque covered by a diphtheritic
membrane on conjunctiva, oral membranes, trachea, and bronchi. Transmission is by fomites, arthropod vectors,
and direct contact. The diagnosis is usually based on the histopathology of the affected tissues and identification
of hyperplastic and hypertrophic epithelial cells with large eosinophilic intracytoplasmic inclusions. A vaccine
is available for some species.

Hepatic lipidosis (fatty liver syndrome) is the excessive accumulation of lipid within hepatocytes that can result
in hepatic dysfunction. In a recent survey (Drury R Reavill, oral communication, March 2004), fatty liver syn-
drome was most common in cockatoos, cockatiels, Amazons, macaws, eclectus parrots, African grey parrots,
budgerigars, lories, and Quaker parrots (Mysiopsitta monachus). The etiology of the lesion in young birds appears
to be diets rich in fats. In adult birds, protein malnutrition, high-fat diets, and obesity appear to be contributing
factors. Fatty liver syndrome is also generally associated with renal lesions, heart disease such as atherosclerosis,
lung lesions, and non-specific gastroenteritis.

Neoplasia

Cholangiocarcinoma (bile duct carcinoma) is an aggressive locally invasive liver tumor that can metastasize.
Recent reports have suggested a relationship between papillomatosis and bile duct carcinoma. One author
(Reavill) has seen this tumor in Amazon parrots with an average age at presentation of 12 years (the youngest
was 3 years of age and the oldest was 17 years of age). A smaller number of macaws and rarely budgerigars,
cockatoos, conures, lovebirds, grey cheek parrots (Brotogeris pyrrhopterus), parrotlets (Forpus species), and
Quaker parrots are recognized in a recent review (Drury R Reavill, oral communication, March 2004). Birds
generally present acutely with non-specific clinical signs (cloacal prolapse, weight loss, anorexia, acute trembling,
coma, and seizures) or are found dead. On gross examination, the liver is either enlarged or has multiple white
to tan, semi-firm nodules. Metastases are unusual but have been found in the lung and pancreas. Antemortem
diagnosis is difficult; chemotherapy may be tried.12

Lipomas are benign lumps of fat that are most common in Amazon parrots, budgerigars, Quaker parrots, rose-
breasted cockatoos (galahs) (Cacatua roseicapilla), and cockatiels. These soft, pale yellow, encapsulated, lobulated
masses in the subcutis are most frequently found over the sternum, abdomen, and inner thighs. If traumatized,
they may become inflamed and necrotic. Obese birds can develop fat pads in the typical locations for lipomas,
so it is possible that some masses are hyperplastic adipose tissue and not lipomas. There is a possible relation-
ship with abnormal thyroid gland function and the development of multiple lipomas. Therapy includes caloric
reduction, diet change, and surgical removal when there is rapid tumor growth, increased vascularity of the
tumor, or ulceration of the overlying skin. Recurrence is common.

Multicentric lymphosarcoma (malignant lymphoma) is the most common lymphoid neoplasia in psittacine birds
and passerine birds. One study reports an age range from 5 months to 30 years, with an average of 8 years at the
time of diagnosis.12 Clinical signs associated with lymphosarcoma include periorbital or cutaneous swelling,
depression, anorexia, weight loss, paresis, lameness, abdominal swelling, diarrhea, blindness, scant droppings,
dyspnea, polydipsia, regurgitation, feather loss, and folliculitis. Anemia (PCV<35%) is common in birds. A
leukemic blood profile is uncommon in psittacine birds with lymphoid neoplasia. This disease can present with
both diffuse and nodular involvement. Organs and tissues that are typically infiltrated include the liver, spleen,
kidneys, skin, bone, gastrointestinal tract, thyroid gland, oviduct, lungs, sinus, thymus, testes, brain, mesentery,

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trachea, fat, periorbital muscles, and pancreas. The liver, spleen, and kidneys are most frequently affected and
generally appear enlarged and pale. Other diseases that may grossly resemble visceral lymphosarcoma include
amyloidosis, fatty liver syndrome, atoxoplasmosis (in mynahs and canaries), hepatitis, systemic mycobacteriosis,
and other forms of neoplasia. Some patterns of presentation noted include African grey parrots with periorbital
masses, Amazon parrots with choanal masses, and umbrella cockatoos (Cacatua alba) with multiple nodular
cutaneous masses. Diagnosis is made by aspiration cytology or biopsy of the affected tissue and, if indicated,
bone marrow evaluation. In both the literature and in one authors experience (Reavill), cutaneous presentations
have a more pleomorphic cell population containing large lymphoblasts, small well-differentiated lymphocytes,
and scattered plasma cells. Treatment has included prednisolone, orthovoltage X-ray, vincristine sulfate, chlo-
rambucil, cyclophosphamide, doxorubicin, and L-asparaginase; however, few birds have responded favorably.12

Other conditions

Amazon foot skin necrosis occurs in Amazon parrots of all ages (primarily yellow-naped Amazon parrots [Ama-
zona ochrocephala]). Clinical lesions appear as irregular patterns of erythema or brown to black discoloration
on the unfeathered skin of legs and feet. The birds act very pruritic and will attack the area of the lesions. Auto-
mutilation is common. Etiology is unknown; one paper implicated exposure to crack cocaine smoke as causing
similar lesions in African grey parrots. Treatment consists of preventing further mutilation while permitting the
lesions to heal. Some birds have recurring episodes.

Additional syndromes

These conditions have been commonly identified in this species but more detailed description is provided under
the species in parentheses following the condition: fungal pneumonia (African grey parrots), automutilation of
sternum (African grey parrots), xanthoma (Quaker parrots), Sertoli cell tumors (budgerigars), papillomatosis
(macaws), atherosclerosis (African grey parrots), and chronic liver disease (cockatiels)

Cockatoos

Infectious diseases

Circovirus infection usually causes beak lesions. In the skin lesions include necrosis and ballooning degenera-
tion of epithelial cells in the epidermal collar and epidermis, basal and intermediate zones of the developing
feather shaft with feather sheath hyperkeratosis resulting in retention of the feather shaft. In the pulp there is
heterophilic inflammation with basophilic intracytoplasmic and occasionally intranuclear inclusions. Beak le-
sions are histologically similar. In peracute cases lesions may only be found in the bursa of Fabricius or thymus.
Secondary bacterial and fungal infections are common.

Diagnosis is by DNA-PCR of whole blood. Birds with normal feathers should be retested in 90 days as many
will clear the virus.

Cutaneous herpesvirus lesions can resemble dermal papillomas. These are warty or plaque-like areas of skin
thickening and horny layer proliferation occurring on the foot, toes, legs of macaws (Ara species), and cocka-
toos. Nodules are proliferative and may be solitary or multiple, especially in cockatoos. The lesion in macaws
is typically a roughening of the skin and/or a flat, raised plaque. De-pigmentation of the diseased tissue is com-
mon. Electron microscopy of the lesions occasionally demonstrates viral particles suggestive of a cytomegalic
herpesvirus. Mode of transmission is unknown, but is assumed to be by direct contact; however, the virus does
not appear to be highly contagious. Treatment attempts include grinding the lesions and acyclovir cream.

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Feather damaging and mutilation

(See also discussion under African grey parrots.)

Feather damaging occurs in captivity and this behavior has multiple precipitating factors. Damage occurs to
the feathers and skin the bird can reach; companion birds may also be picked around the head and neck. Head
feathers are normal, although crested birds may chew on their crests. After a period of time, the picking becomes
an obsessive behavior and continues long after the inciting cause is gone. Follicular damage and atrophy results
in cessation of feather growth; chronic damage results in abnormal feather development and molt and many
advance to self-mutilation. The mutilation can lead to a chronic pruritic ulcerative dermatitis. Internal lesions
or infections may be precipitating factors. Pruritis in humans has been associated with hepatopathy; many birds
seem to have signs associated with chronic undiagnosed liver disease.

Behavioral feather damaging is a diagnosis of elimination. A thorough physical examination, complete blood
count (CBC), serum chemistries, feather pulp culture and cytology, skin lesion culture and cytology, radiographs,
endoscopic and direct microscopic examination, and biopsies of affected feathers (preferably blood feathers,
including the surrounding skin) may yield a reason for the feather destruction.

Management of the feather picking bird is complex. Identification and correction of underlying medical issues
may alleviate the behavior. Nutritional aberrations must be identified and corrected. Identification of any psy-
chological and environmental factors is more difficult; a site visit may be necessary. Several central nervous
system drug regimens have been suggested. Successful therapy results in a decrease of destructive behavior, not
necessarily its cessation. If all else fails, give em a JOB!

Additional syndromes

These conditions have been commonly identified in this species but more detailed description is provided under
the species in parentheses following the condition: constricted toe syndrome (African grey parrots), hepatic
lipidosis (Amazon parrots), lipoma (Amazon parrots), polyomavirus (macaws), proventricular dilatation disease
(macaws), and sarcocystis infection (African grey parrots).

Macaws

Infectious diseases

Papillomatosis is characterized by proliferative, grey-white growths on mucous membranes. Recent research


links these tumors to a viral infection with PsHV genotypes 1, 2, and 3 (psittacid herpesvirus).13 In psittacine
birds, association between papillomatosis and bile duct and pancreatic duct tumors is suggested. Reported sites
of occurrence include the oropharynx, choanal cleft, conjunctiva, larynx, esophagus, crop, proventriculus,
ventriculus, nasal mucosa, nasolacrimal duct, bile ducts, pancreatic ducts, and cloaca. Papillomatosis primarily
affects New World psittacine birds especially macaws (the most common), Amazon parrots, and hawk-headed
parrots (Deroptyus accipitrinus accipitrinus). Regression and recurrence is cyclic. Noted clinical signs include
bleeding from the vent, lethargy, weight loss, cloacal prolapse, and agitation. Anemia is a frequent finding.
Cloacal papilloma should be differentiated from cloacal carcinoma, which is infiltrative, aggressive, and typi-
cally has areas of necrosis and hemorrhage. Surgical removal of large masses may relieve some clinical signs
although recurrence is common.

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Polyomavirus causes organ necrosis and basophilic karyomegaly in many tissues. This virus is capable of causing
disease in all psittacine species, however; nestling and juvenile birds are the most susceptible to disease. Infec-
tion results in nonspecific signs of illness including anorexia, crop stasis, depression, spontaneous cutaneous
and feather hemorrhage, paresis, ataxia, and sporadic death. The virus is excreted in feather dander and drop-
pings. Horizontal transmission is the major method of infection. Adults may also be affected. Infection persists
in the kidneys of carrier birds and virus is excreted intermittently during times of stress. The virus is infective in
contaminated environments. Assays using DNA-PCR probe technology can be used to diagnosis exposed birds
and the environment. Use of the vaccine (if still available commercially) is controversial.

Proventricular dilatation disease (PDD) is defined by lymphoplasmacytic inflammatory infiltrates within the
peripheral and/or central nervous system. The clinical signs may vary between psittacine species but generally
include depression, weight loss, constant or intermittent regurgitation, passage of undigested seed in the feces,
ataxia, abnormal head movements, seizures, and proprioceptive or motor deficits. There is variable distention or
dilation of the gastrointestinal tract, most commonly noted in the proventriculus. A viral etiology, avian Bornavirus,
is associated with PDD; research is ongoing regarding the mode of transmission, incubation, and disease develop-
ment. Diagnosis is with western blot (detectable tiers with clinical disease) and fecal DNA-PCR. Additionally,
lesions seen radiographically (severely enlarged proventriculus) or abnormal ventricular contractions identified
on fluoroscopy. Control of the infection is by limiting traffic thru the aviary, excellent hygiene and disinfection
using phenol, formaldehyde or hypochlorite solutions. One author (Reavill) identifies PDD most commonly in
macaws (the youngest at 4 months), African grey parrots, conures, cockatoos, and eclectus parrots.

Nutritional and metabolic disorders

Vitamin D3 toxicity usually results from unnecessary supplementation. The blue and gold (Ara ararauna) and
hyacinth macaws are prone to the development of hypervitaminosis D3. Increased vitamin D3 supplementation
may result in crop stasis, increased serum uric acid levels and the presence of articular gout, and regurgitation
after feeding. Widespread soft tissue calcification can occur.

Lateral beak deviation (scissors beak) is most often diagnosed in macaws. The cause is unknown and may include
low or unbalanced calcium in the diet, viral diseases, trauma, improper handfeeding techniques, and alterations
in the mandibular occlusal surface. If recognized early, the problem may be corrected by trimming the lower
beak, reshaping the occlusal surface of the rhamphotheca, and therapeutic massage. If that is not successful, a
ramp built from dental acrylic over a stainless steel mesh can be attached to the lower beak to apply pressure to
correct the upper beak. Careful monitoring is necessary so as not to overcorrect the beak.

Macaw thyroid hyperplasia (hyperplastic goiter) has been recognized in macaws and particularly blue and gold
macaws. The cause of the condition was not determined with certainty in most cases. Possible causes include
iodine deficiency, goitrogenic substances, and hereditary biosynthetic defects. Clinical signs in affected birds
were either nonspecific or related to the other disease conditions present.7

Unknown etiology

Chronic obstructive pulmonary disease (macaw pulmonary hypersensitivity) is generally associated with poly-
cythemia and appears to be most common in the blue and gold macaw. Early diagnosis is difficult due to the
reserve capacity of avian lungs and relative inactivity of captive macaws. The lung lesions are generally advanced
when polycythemia occurs. Signs may include dyspnea, tachypnea, and radiographic changes in the lungs. The
hematocrit is often > 60%. A leukocytosis may be present if there is a secondary infection. The prominent le-
sion is atrial smooth muscle hypertrophy and some atrial loss due to fusion and epithelial bridging. Occasional

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proliferation of parabronchial lymphoid tissue and lymphoid nodule formation has been identified. Many of
these macaws have been kept in aviaries with poor ventilation or exposed to the feather dander of cockatoos,
cockatiels, or African grey parrots. Therapy is generally symptomatic that includes placing the bird in better
ventilated areas, treating for secondary infections, and possibly the use of anti-inflammatory drugs.

Additional syndromes

These conditions have been commonly identified in this species but more detailed description is provided under
the species in parentheses following the condition: constricted toe syndrome (African grey parrots), cholangio-
carcinoma (Amazon parrots), lymphosarcoma (Amazon parrots), hepatic lipidosis (Amazon parrots), fungal
pneumonia (African grey parrots), cutaneous herpes (cockatoos), and herpesvirus (Amazon parrots).

References

1. Ritchie BW. Avian Viruses Function and Control. Lake Worth, FL: Wingers;1995.

2. Jacobson ER, Mladinich CR, Clubb S, Sundberg JP, et al. Papilloma-like virus infection in an African gray
parrot. J Am Vet Med Assoc. 1983;183(11):1307-1308.

3. Styles DK, Tomaszewski EK, Phalen DN. A novel psittacid herpesvirus found in African grey parrots (Psit-
tacus erithacus erithacus). Avian Pathol. 2005;34(2):150-154.

4. Reavill DR. Fungal and bacterial diseases. In: Rosskopf WJ Jr, Woerpel RW, eds. Diseases of Cage and
Aviary Birds. 3rd ed. Baltimore, MD: Williams & Wilkins;1996:586-612.

5. Dahlhausen RD. Implications of mycosis in clinical disorders. In: Harrison GJ, Lightfoot T, eds. Clinical
Avian Medicine. vol II. Palm Beach, FL: Spix Publishing;2005:691-704.

6. Beaufrre H, Ammersbach M, Reavill DR, Garner MM, Heatley JJ, Wakamatsu N, Nevarez JG, Tully
TN. Prevalence of and risk factors associated with atherosclerosis in psittacine birds. J Am Vet Med Assoc.
2013:242(12);1696-1704.

7. Rosskopf WJ Jr, Woerpel RW. Pet avian conditions and syndromes. Rosskopf WJ Jr, Woerpel RW, eds.
Diseases of Cage and Aviary Birds. 3rd ed. Baltimore, MD: Williams & Wilkins;1996:260-282.

8. Schmidt RE, Reavill DR, Phalen D, eds. Pathology of Pet and Aviary Birds. 2015. In press.

9. Lichtenberger M, Reavill D, Bloss J. Atypical sarcocystis in a cockatoo. Proc Annu Conf Assoc Avian Vet.
2005.

10. Ritchie BW, Harrison GJ, Harrison LR, eds. Avian Medicine: Principles and Application. Lake Worth, FL:
Wingers;1994.

11. Reavill DR. Avian Dermatology: Practitioners Symposium. Chicago, IL: American Board of Veterinary
Practitioners;1997.

12. Tell LA, Woods L, Cromie RL. Mycobacteriosis in birds. Rev Sci Tech. 2001;20(1):180-203.

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13. Reavill DR. Tumors of pet birds. Vet Clin N Am Exot Oncol. 2004:7(3):537-560.

14. Styles DK, Tomaszewski EK, Jaeger LA, Phalen DN. Psittacid herpesviruses associated with mucosal
papillomas in neotropical parrots. Virology. 2004;325(1):24-35.

ExoticsCon 2015 Main Conference Proceedings 185


The Basics of Raptor Care
Scott Ford, DVM, DABVP (Avian)

Session #299

Affiliation: From Avian Specialty Veterinary Services and Brook-Falls Veterinary Hospital and Exotic
Care, N48 W14850 Lisbon Rd, Menomonee Falls, WI 53051, USA.

Abstract: This class covers top concerns encountered during consultations including species considerations,
examination, triage, initial supportive care, bandaging, and diagnostics. The presentation will also discuss
recognition and treatment of commonly encountered injuries and illnesses. This information should help
prepare practitioners with limited raptor experience for seeing the occasional raptor patient.

Introduction

This master class covers the basics of intake, diagnostics, and stabilization of birds of prey. Space precludes
discussion of many additional important topics so participants are encouraged to check the references at the end
of this manuscript and to attend the live discussion. In the United States, veterinarians may receive wild birds
of prey without special permit (50CFR 21.12(d)). They are permitted to care for them as long as is necessary
for stabilization of health, after which they must be quickly transferred to a licensed wildlife rehabilitator. If
you intend to receive wildlife, you should establish a working relationship with a local wildlife rehabilitator in
advance. Each rehabilitator has specific expertise and facilities that will be suited to particular types of birds or
types of injuries. You may find that you need to work with multiple rehabilitators to serve all the needs that arise.
Further, some wildlife facilities have internal protocols dictating whether they will treat birds that are non-native
or that sustain injuries that render them non-releasable. It is best to determine all of these particulars in advance
and establish clear guidelines for yourself and your staff to avoid delays in care later. It is also recommended
to obtain copies of participating rehabilitators permits in the event wildlife or law-enforcement agents ever
question the presence of wildlife at your clinic.

Taxonomy

Bird of prey refers to birds that capture and kill their prey primarily with their feet. The word raptor is from
Latin meaning plunderer or to seize/take by force. Diurnal birds of prey (hawks, eagles, falcons, etc.) are
all assembled under the order Falconiformes. Primarily nocturnal (or crepuscular) species (owls) are assembled
under the order Strigiformes.

Accipitriformes

This group was once a family within Falconiformes but is now more widely recognized as a separate order. It
includes hawks, buzzards, eagles, harriers, kites, osprey, secretary birds, and Old World vultures. They are the
most ubiquitous raptors seen throughout the world. They are subdivided into common categories of soaring
hawks (Buteos), woodland hawks (Accipiters), sea eagles, booted eagles, kites, and a few other small groups
such as parabuteos and osprey.

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Buteos have broad wings with rounded tips and emarginated primaries (eg, slots in the wingtips)excellent
for soaring on thermals which is their most frequently seen flight modality. There is a range of sizes and most
have light undersides to the body and wings, with variable amounts of streaking, and darker feathers above.
The tarsi are mostly unfeathered but rough-legged hawks (Buteo lagopus) are an exception. Buteos are robust
and generally calmer than Accipiters. Red-tailed hawks (B. jamaicensis) are the most familiar example in North
America. The adults are unmistakable with their large build and red tail feathers. However, it takes 2-3 years
to acquire the red tail. Other common examples include broad-winged hawks (B. platypterus), red-shouldered
hawk (B. lineatus), ferruginous hawk (B. regalis), and Swainsons hawk (B. swainsoni). European species, such
as the augur buzzard (B. augur) and common buzzard (B. buteo), may also be seen in the care of falconers or
zoo collections in the US. Generically, these hawks are probably the most amenable to captivity and relatively
easy to handle, train, or keep temporarily in a clinic situation. Their primary prey is rodents and small mammals.

The Harris hawk is classified in its own genus, Parabuteo. Although very similar to other hawks, it differs in
having a more social lifestyle, often hunting cooperatively in family units.1 It also demonstrates a lower ten-
dency to soar, staying close to the ground most of the time. Harris hawks are extremely common falconry birds
in the USA and are acquired almost exclusively through captive breeding, most being human-imprinted. Many
are also commonly exposed to pets in the home setting. Because of this and because of their naturally social
nature, captive Harris hawks tend to be easy to keep in a clinical setting and may require minimal restraint for
examination and procedures.

Accipiters have shorter wings and longer tails than buteos of similar size. They are best adapted for active flight
through woodlands and semi-open habitat and they have a characteristic smooth flap-flap-flap-glide flight style
when on hunting flights. Common native North American examples include northern goshawks (Accipiter
gentilis), Coopers hawks (A. cooperii), and sharp-shinned hawks (A. striatus). Finnish goshawks, which are a
local race of northern goshawk, are prized by many falconers for their larger size. Accipiters, in general, tend to
be more active and more prone to stress in captivity. They can tend to have explosive escape or attack reactions
to capture and restraint. For this reason, extra care should be taken to provide quiet, darkened caging, to secure
them well during restraint, take greater care to prevent feather damage, and get them into a rehabilitators care
(or the home setting in the case of falconers) as soon as possible. Accipiters have a reputation of being more
prone to aspergillosis during times of stressprophylactic use of an antifungal (eg, itraconazole 5 mg/kg PO
q12-24h) is advised during transport or initial treatment.

Sea eagles are most famously represented by the bald eagle (Haliaeetus leucocephalus). The equally known coun-
terpart in Europe and Asia is the white-tailed sea eagle (H. albicilla). Neither of these species is used for falconry
in the US but they are seen in the UK as part of falconry collections. African fish eagles (H. vocifer), Stellars sea
eagles (H. pelagicus), and white-bellied sea eagles (H. leucogaster) are not uncommon in zoological collections.
Adults are characterized by primarily dark brown plumage except for white markings on the tail, head, and in
some species, the wings. These white markings do not appear until sexual maturity at 5-6 years of age. Second-
year bald eagles exhibit tremendous amounts of white mottling on their body plumage. Sea eagles are the largest
living specimens of raptors if one excludes vultures. They require extra caution in handling, mainly because of
the great amount of personal injury that is possible. However, when sick or injured, they are usually no more
difficult to handle than large hawks if approached calmly. Once the eyes are covered, most become completely
tractable. Bald eagles have an anecdotal reputation of being prone to aspergillosis and so prophylactic use of an
antifungal is advised during transport or initial care. Prey base is primarily fish and a variety of carrion but they
show an amazing degree of foraging flexibility and are known to eat birds, mammals, and aquatic crustaceans.

Booted eagles differ from sea eagles in many regards but the most obvious difference is the presence of leg feath-
ering down to the toes. The hallux talon tends to be much larger than comparably sized sea eagles and the head

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and beak are generally smaller. The most common example is the golden eagle (Aquila chrysaetos). Adults have
overall primarily brown plumage with golden nape and head feathers, grey beak with yellow cere, and yellow
feet. Juveniles have variable amounts of white to the base of their tail and remiges during their first 5-6 years. In
the hand, birds of any age can have faint splotches of lighter color in the remiges and rectrices. Golden eagles
are kept by specially permitted falconers in the United States, typically acquired from federal agents through
depredation programs. Because of how these birds are captured, it is common for falconers to receive them with
injuries to their tarsi from leg-hold trapping. Prey typically consists of mammals and can include rather large
prey such as young goats or sheep.

Despite similar prey base and habitat choice, and some similarities in appearance, the osprey (Pandion haliaetus)
is categorized independently from sea eagles. The wings and legs are slimmer and longer than bald eagles. They
have white underbody, wings, and neck, brown plumage above, and a characteristic brown eye stripe and brown
carpal patches, as seen from below. In the hand, the feet exhibit a curious ability to transition from zygodactyl
to anisodactyl by swiveling toe #4 (outermost front toe) forward or back. The talons are also unique in that they
are rounded, in cross-section, vs. grooved as seen in all other birds of prey. Ospreys eat primarily aquatic prey
such as fish and amphibians but have been observed attacking snakes. They prefer to nest atop dead trees or
towers vs. the usual live-topped trees that eagles prefer when the option is available.

Falconiformes

The most obvious difference of falcons from hawks is that the wings are thin and pointed. They are high-perfor-
mance aerial hunters taking predominantly avian prey with the exception of smaller falcons, such as the kestrel,
which may take insects and small rodents. Many species of falcons exhibit malar stripes, large, dark eyes and
cap, a notched maxilla, and osseous tubercles in the nares. Some species, such as the kestrels, also exhibit sexual
dichromatism. In the case of American kestrels (Falco sparverius), this is seen as red mantle feathers and black
stripes of the tails of females as compared to a blue-grey back and less tail barring in males. Commonly seen
representatives of this group in North America include American kestrels, peregrine falcons (F. peregrinus), prairie
falcons (F. mexicanus), merlins (F. columbarius), and gyrfalcons (F. rusticolus). Species from other continents
that are common in falconry collections in the USA include Lanner (F. biarmicus) and saker falcons (F. cherrug).
There are at least 19 natural subspecies of peregrine falcon worldwide and identification can be difficult, even
for the experienced. Commonly seen subspecies are the Peales (F. p. pealei), anatum (F. p. anatum), Barbary
(F. p. peligrinoides), Cassini (F. p. cassini), and tundra (F. p. tundrius) peregrines. Falcons are also extensively
hybridized through artificial breeding techniques further complicating their identification. Clinicians should not
be reluctant to ask a falconer species, subspecies, or hybrid of his/her falcon. The natural origin of a species may
have ramifications on a birds resistance to particular infectious agents (eg, one breeder suggested that Fijian per-
egrines may be more prone to falcon herpesvirus carried by North American feral pigeons pers. comm. Dewey
Savell, Oakley, CA, 2007). Falconry birds tend to be amenable to remaining hooded or in darkened enclosures
for periods of time with minimal stress. Free-living falcons are considerable more stressed during initial stages
of captivity and may be more prone to self-injury or fungal respiratory disease. Prophylaxis with an antifungal
is recommended during courses of antimicrobials or repeated stressful therapies.

Vultures

Vultures are subdivided into Old and New World species. There has been much debate for many years regard-
ing their proper classification as raptors or as members of other taxa. As of 2014, they have been divided such
that Old World vultures are all considered condors and assigned to their own order, the Cathartiformes, while
New World vultures remain as the Cathartidae family within Falconiformes. In general, vultures and condors are
scavengers. They lack the strong feet and long talons typical of raptors. They tend to have similar wing structure

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to Buteos and eaglesbroad for effortless thermal and dynamic soaring. In flight they generally carry a more
pronounced dihedral, or v, in their wing posture as compared to hawks and eagles, and frequently rock their
wings in windy conditions. They have a tendency to urinate on their legs which is thought to promote evapora-
tive cooling and help sanitize the skin after traversing through rotten carcasses. Unlike other raptors, vultures
and condors disgorge food from their crops to feed their young. They also tend to regurgitate food in a passive
fashion when stressed, which may help lighten them for escape and provide a distraction for predators. A recent
study found that feces from vultures contain fewer and more benign species of bacteria than their mouths, which
supports the general attitude that vultures are helpful janitors of the environment.2 However, other studies
have shown that Old World vultures may act as reservoirs for certain pathogens.3

Strigiformes

Owls differ from Falconiformes in many clinically important ways. They possess large, forward-facing eyes, acute
hearing, and are active flyers while hunting. Depending upon species, there is a variable degree of fringing and
softness to their feathers to discourage noise production. Not all owls are nocturnalsome are active in broad
daylight as seen particularly in high-latitude species such as snowy (Bubo scandiacus) and short-eared owls (Asio
flammeus). Commonly admitted representatives in North America include barn owls (Tyto alba), great-horned
owls (Bubo virginianus), barred owls (Strix varia), great grey owls (Strix nebulosa), western/eastern screech
owls (Megascops kennicottii/M. asio), snowy owls, northern saw-whet owls (Aegolius acadicus), burrowing
owls (Speotyto cunicularia), and northern pygmy owls (Glaucidium gnoma). In addition, many zoos or falcon-
ers may possess Eurasian eagle-owls (Bubo bubo). Owls are diverse in their prey base, some species showing
tremendous adaptability. Most common items include small mammals but many also prey on nestling song birds,
ducklings, reptiles, amphibians, and aquatic crustaceans. Owls are generally stoic, particularly when injured or
ill, and may seem calm. However, their primary means of predator avoidance is camouflage and remaining still. It
is best to assume that an owl is stressed and discourage staff from petting or cuddling owls. They do not respond
as dramatically as diurnal birds of prey to coverage of the head to calm them. However it is still recommended.
Light towels or linens work well in this regard since standard falconry hoods will not fit them. The feet tend to
have shorter toes and legs, making restraint slightly more challenging than with other raptors. The toes can also
be more difficult to open and they have very fast reactions to close them. For nocturnal and crepuscular owls, it
is probably more critical to consider in-flight noise production as part of a pre-release assessment. Asymmetries
in the wings or damage to feathers may increase their noisiness in flight and interfere with their ability to hunt.
This may be less of a factor for mostly diurnal species such as burrowing and short-eared owls.

Housing, Capture, and Restraint in a Clinical Setting

Precautions

Because of their extremely acute senses and fast, often violent, reactions, personnel must make a conscious effort
to move slowly and calmly when working with birds of prey. Talking should be discouraged and voices kept
low. Sedation and/or anesthesia are recommended for all but extremely brief procedures in wild raptors. Light
leather gloves are recommended for handling most raptors of 1 kg or less. For larger birds of prey, heavy leather
welding gloves or gauntlets are recommended. A leather welding jacket can also provide upper body protection
during restraint. During restraint, both the head and feet of raptors must be controlled to prevent injury to per-
sonnel or themselves. Covering the eyes will have a dramatic calming effect on most diurnal birds of prey. Two
people are recommended when capturing or handling large birds of prey. It must be clearly understood that the
restrainer will be completely responsible for restraint and should not be distracted by anything else. The examiner
will act as an assistant during capture and securing the bird. Any time parts of the bird are transferred from one

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persons control to another, there must be clear communication (eg, Do you have the leg? Yes, I have the
leg ok, Im letting go of the leg). The restrainer should monitor the birds stress and comfort at all times.
If the bird pants, water can be applied with a spray bottle to the feet and face to facilitate evaporative cooling.

Temporary housing

Falconry birds are usually best kept in the carrier that the falconer provides. It is common practice for falconers to
utilize a giant hood which is basically a large, lightweight carrier with no windows, small ventilation holes, and
a large door that facilitates retrieving their bird on the fist. Falconers may also provide block, bow, or ring perches
with weighted pedestals for their bird to rest on while in clinical care. Falconers are usually very reluctant to leave
their bird at a veterinary clinic without direct supervision. This is based on a lack of confidence in veterinarians
to know how to handle falconry birds. In most cases, the home environment will provide less stress and a greater
degree of monitoring than can be provided in a veterinary clinic. Falconers tend to be practical and not prone to
squeamishness or reluctance of administering injections or wound cleansings. However, extremely sick birds
requiring regular IV or subcutaneous fluids should be hospitalized or receive brief appointments for treatments.

For temporary housing of wild raptors, the emphasis should be on quiet, warmth, and limited vision. Typical
small animal treatment cages or pet carriers can be easily modified to be adequate for stays of a few days. Bars,
fencing, and wires can damage feathers if the bird tends to latch on to them and hang. The bars can be masked
off with cardboard or draped, in the case of kennel doors, with a towel to block visual input and prevent wire
contact with feathers. A tail guard, made with thin cardboard or plastic sheet, can be wrapped around the rectrices
and taped with painters masking tape to the upper and lower tail coverts. Ambient noises common in veterinary
clinics, such as barking and voices, are also unsettling. Wild birds are best kept in isolation wards or other quiet
areas of the hospital. The enclosure should have a soft floor (eg, towels without any loose threads or holes) and,
ideally, a perch. Toweling will absorb the shock of jumping about and will absorb ambient sounds, which tend
to be amplified within metal-walled animal enclosures typically used in clinics.

Capture and restraint

Equipment necessary for safe capture and handling includes protective gear for personnel (leather gloves, leather
jacket for large raptors, safety glasses), an appropriately sized blanket or towel, a head covering (eg, a small
towel; hoods are best for diurnal raptors), and foot coverings. Raptors have greatest strength in closing their toes.
Foot wraps can be used to keep the foot closed and prevent self-inflicted trauma and injury to personnel. Foot
coverings are made commercially and consist of leather or canvas bags that fit snugly over the feet and have
Velcro closures. Alternatively, the toes can be wrapped around a wad of cotton gauze pads and covered using
self-adherent bandaging material (Vetrap, 3M, St. Paul, MN, USA).

As described above, fear and stress should be assumed to be present, even if it is not obvious. For this reason, it is
recommended to use sedation (midazolam 1-2 mg/kg IM or IN) or general anesthesia for examinations, physical
therapy, radiography, or any procedures longer than a couple of minutes. Further, to shorten any procedures, it
behooves the clinician to prepare all equipment and supplies in advance and review, with their assistant, what
will happen to ensure that it goes quickly and smoothly.

Capture is accomplished differently for falconry and non-falconry raptors. Falconry raptors are most familiar with
casting, which is the process of securing the feet or enveloping with a towel while perched on the falconers
fist. The falconer may advise you on what method they prefer to use with their bird. In some cases, one simply
reaches up slowly from under the tail and behind the legs, grasps them, and lifts the bird off the fist. Then the
wings and body are secured with the other hand. In other cases, a towel is brought swiftly and smoothly from
behind, over the head, and the bird is bundled as it is scooped off of the fist.

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Wild raptors are best captured using a towel large enough to block the entire front of the enclosure. The towel is
slowly advanced towards and over the bird at the back of the enclosure. In the case of large birds of prey, such
as eagles, a heavy blanket is recommended. Once the blanket or towel is over the bird, it is brought down tight
to the floor and wrapped snugly around the bird. If the bird is held snugly it has less ability to grasp with its feet.

Once snugly bundled and pulled free of the enclosure, the legs are the first thing to be carefully restrained
through the towel or blanket. The feet are then exposed one at a time, extricated from the blanket, and placed
in the restrainers grasp. The head is then exposed and should be immediately hooded or covered with a smaller
covering. The blanket or towel is then slid out from behind the patient to prevent overheating. Foot coverings
can also be applied to prevent human- or self-injury from talons.

Hooding is most easily done while the birds head is still covered with the towel or blanket. The tip of the beak is
exposed with the blanket pinched back over the eyes. The hood is held by the top-knot and slowly slid over the
head as the blanket is retracted. Performed this way, the bird will remain calm and never see what is happening.
If the head is uncovered, do not try to reach in and grab it. Raptors respond powerfully to open, reaching hands.
Instead, lead in with your elbow, place it on top of their head, and press the head down onto their breast or against
the restrainers body. Once pinned, keep gentle pressure on and slide your forearm down until your fingers can
wrap around the back of the head. Remember that birds have complete tracheal rings and so you can hold with
fingers around the base of their head and throat without choking them. Cover the eyes with your fingers as you
advance the hood. The pointed straps on a hood close it and the knotted ones open it.

Large birds of prey are typically held vertically against the front of the restrainers body (Fig 1). The legs can be
held individually (best with very large raptors) or together with the index finger separating the legs. Separating
the legs slightly can prevent self-injury with the talons if the feet are not wrapped. The opposite hand is held just
under the head or against the upper breast to prevent biting. Since birds do not possess a diaphragm and instead
depend on great traverses of their caudal sternum for ventilation, it is best to leave the lower breast unrestrained
at all times. Forearms are used to prevent the wings from spreading. Smaller raptors can be cradled in one arm
with the feet held in the opposite hand. When restraining large raptors on a table, one wing can be tucked up
against the restrainers front while one hand holds the feet and the other is placed across the upper chest to pull
the opposite wing tight to the body. In this manner, the head, feet, and wings are all contained safely while not
impinging on breathing or cooling.

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Figure 1. Methods of restraint for large raptors.

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Health Evaluation

Health evaluation is used here as a holistic term inclusively considering the result of physical examination,
imaging, laboratory diagnostics, and review of history and husbandry.

Admission and history

When taking in injured wildlife, it is critical to record contact information for the person who retrieved the bird,
the details of when and where it was found, and whether any care was already administered. These details help
determine cause of injuries and potential location for return of the bird to the wild or, in the case of nestlings,
restoring them back to their natal territory to reunite with parents. Knowing proximity to anthropogenic hazards
such as power lines, roads, or hunting areas can help determine cause of injuries. Some staff training is required
to collect these details, but an admission form simplifies the process and ensures that a review of the details is
not forgotten.

Exam

Pre-Exam: Often there is haste to get a bird out of its carrier and swing right into an examination, which com-
pletely misses the chance to see how it stands and reacts without alteration by drugs and increased stress. The
bird should be observed in its carrier to see if it can stand, whether it reacts to your presence, and whether it is
holding wings, head, or feet in odd positions. The mutes (droppings) should be checked for presence of feces,
urates, and urine, which can help in assessing hydration, GI function, and sometimes (in the case of biliverdin-
uria) hint at processes such as hemolysis (eg, from plumbism or internal bleeding).

Head: As with other birds, the physical exam should be performed systematically from beak to tail. When remov-
ing the hood for examination, it is best to dim ambient light and keep noise to a minimum. The head should be
restrained prior to removing the hood. The oral opening of raptors is soft from the commissures to about half the
length of the beak. By inserting a finger or thumb at the commissure, you can safely open the beak for inspec-
tion. The ears should be checked for bruising or bleeding, which can occur with head trauma. Direct pupillary
light reflexes should be present but consensual light reflexes are not reliable. Direct ophthalmoscopy is helpful
for identifying intraocular bleeding and lens trauma. Indirect ophthalmoscopy is usually necessary to fully ap-
preciate retinal trauma. Rocuronium bromide has been identified as safe and effective in a variety of raptors and
Amazon parrots for achieving mydriasis.47

Crop: The crop is not present in Strigiformes. In birds that do have a crop, it should be empty, smooth, and
scarcely palpable. Foul gas eructation or presence of food in a severely debilitated bird can raise suspicions of
gastric stasis (see below).

Wings and legs: Aside from starving due to hunting inexperience in young raptors, most admissions are due to
traumatic injuries. Wings should be very carefully and systematically checked for subtle injuries. First, the wing
or leg should be palpated for swelling or obvious injury before being extended. In unanesthetized birds, the
examiner should also note any hyperesthetic responses (eg, unusual jerking, writhing, or vocalizing in response
to touching the limb) which may indicate pain. Second, the limb is extended gently to assess passive range of
motion. In the case of the wing, the quality of the feathers is assessed and the symmetry of spread is noted. The
examiner takes note of any crepitus, pain, or deficit in extension. If a deficit is unclear a comparison with the
contralateral limb is recommended. Third, range of motion (ROM) is assessed. A goniometer is a simple tool for
performing joint angle measurements. Consistent technique is important to ensure comparability of the results
over time. For example, the wing should be extended straight outward (90 to the spine), keeping it in the same

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plane as the shoulders. Similarly, when each component, such as the shoulder, is extended, it should be kept
in that same plane. With legs, it is most natural to evaluate them in a sagittal plane. Consistent landmarks are
also critical for repeatability. Figure 2 demonstrates ROM tests and joint measurement. The maximum angle is
the point at which resistance is felt or discomfort expressed. The measurement should be conducted 2-3 times,
with a relaxation phase in between. Next, each joint is individually manipulated to detect crepitus. Finally, the
reciprocal apparatus of the wings and legs is assessed by applying gentle force to manipulate opposing joints. In
the case of the wings, the carpus is depressed caudally while the elbow is depressed cranially. These combined
forces should cause the elbow and carpus to pivot open and spread the wing utilizing the tendons primarily.
Feather damage, failure to spread evenly, and any new feather growth should be noted.

Figure 2. Goniometry. The wing should be extended in the same plane as the scapulae (shoulders). The
most commonly measured angles are the shoulder and elbow.

Deficits in passive extension of the wings may indicate synostosis of the radius and ulna, joint disease or trauma,
contracture of the propatagium, impingement of tendons from bone callus, or adhesions between damaged mus-
cles or ligaments. Deficits of the reciprocal apparatus while still having normal passive ROM, suggests tendon
injuries specifically. Deficits or excesses in shoulder ROM suggest orthopedic injury to one of the elements of
the pectoral girdle, especially the coracoid.

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The feet should be opened and inspected. There is a tendon locking mechanism present in raptor feet. It is
formed by fine interdigitations between the flexor tendons and their sheaths in the plantar aspects of the toes.
The mechanism can be safely overcome and the foot opened. The leg should be extended fully when opening the
foot to decrease the birds mechanical advantage. The last joint (P3-P4) of toe #3 provides the point of greatest
mechanical advantage for opening the foot. This joint and toe#1 are simultaneously opened with firm traction.
If the bird is tensing the muscles of the leg, there will be a grinding or ratcheting sound heard but this does not
appear to cause any damage or discomfort. The plantar skin of the feet should be clean and rough (impressively
so in fish-eating raptors). The talons should be very sharp and smooth. Smoothing of the skin or blunting of the
talons indicates protracted time on the ground. Foot lesions should be measured and noted. There are grading
systems for pododermatitis (bumblefoot) lesions. The author uses a system of 0-5 (Table 1).

Table
Table1.1.Bumblefoot
Bumblefootgrades;
grades; this
this is
is the bumblefootgrading
the bumblefoot gradingsystem
systemused
usedbyby
thethe author.
author.

Grade Description
Normal, clean, spiculated skin on the plantar surfaces. Normal smooth scales on dorsal
0/5
surfaces.

1/5 Loss of spiculation, mild smoothing, no wounds or pinkness.

2/5 Smoothing of skin with pink, soft areas or cracks/wounds that do not perforate the dermis

3/5 Scabs or wounds that perforate the dermis, mild swelling.

Significant localized swelling, thick scabs with core of necrotic or scar tissue. No
4/5
radiographic evidence of osteomyelitis.
Deep core of necrotic or scar tissue, regional swelling, radiographic evidence of
5/5
osteomyelitis.

Body: The breast should exhibit thick pectoral muscles on each side with the keel palpable down the center. There
should be moderate convexity to the muscle around the keel. If the keel is extremely prominent, this indicates
loss of pectoral muscle mass from starvation or disuse. Pectoral muscle mass can be scored on a scale of 1-5 or
1-10. In communication with colleagues, the denominator of the score should be stated since there are multiple
scales in use. While useful, such a score should not be termed a body condition score since it does not take the
abdomen or other areas into consideration. The abdomen should be concave with easily palpable pubic bones
just cranial to the vent. The vent should be clean, pink, and slightly moist when gently everted. In cases where
spinal trauma is suspected, a visual inspection of the spine is useful. The spine is wetted with chlorhexidine
solution or isopropyl alcohol to move the feathers aside and moisten the skin. The dorsal vertebral processes are
visible. Sometimes spinal trauma will result in visible bruises.

Feathers: The overall condition of the feathers should be noted. Damaged or soiled feathers, particularly those
of the wingtips or tail, suggest protracted debilitation. Lice are frequently found on ill or injured raptors and
become larger and more numerous with chronicity. These lice do not present a threat of infestation to humans.
However, immediate treatment with topical carbaryl or pyrethrin is recommended.

Neurologic assessment: Rapid tracking of the head side to side is indicative of central or peripheral vestibular
lesions. Head trauma, intoxication (lead or organophosphates), and avian influenza or West Nile virus infection

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are top considerations in wild birds of prey. Inability to stand or use the feet or legs should raise suspicions of
spinal trauma, which can be difficult to detect on radiographs (see below). In such cases, deep pain should be
assessed in the toes and tone of the tail and vent assessed. Lack of deep pain in the toes and/or flaccid paralysis of
these areas carry a poor prognosis. It is worth noting that it is not unusual to elicit a withdraw reflex in birds while
performing the deep pain response test or manipulating the legs, even though the spinal cord may be severed. A
proper deep pain response is movement of the head, vocalization, or upper body struggling. Proprioception can
be assessed by holding the upper body and allowing the feet to brush up against the edge of a table or lowering
the bird to meet the floor with its feet.

Triage and euthanasia

Policy: Unfortunately there are limits to what may be humanely or ethically treated. A written policy is recom-
mended for yourself and the rehabilitator with whom you work. The policy should be open enough to allow
some case-by-case flexibility. However, many situations can be defined, in advance, as requiring euthanasia. In
the USA, 50CFR21.31(e)(4)(iii) requires:

You must euthanize any bird that cannot feed itself, perch upright, or ambulate without inflicting additional
injuries to itself where medical and/or rehabilitative care will not reverse such conditions. You must euthanize
any bird that is completely blind, and any bird that has sustained injuries that would require amputation of a leg,
a foot, or a wing at the elbow or above (humero-ulnar joint) rather than performing such surgery8

Exceptions can be arranged with regional permit agencies, but these are uncommonly granted. Other situations
are more open to interpretation and may depend upon the expertise and facilities available at hand. As an ex-
ample, a pelican with complex fracture of its forewing will require an orthopedic surgeon, a rehabilitator familiar
with pelicans, and a facility that can serve the unique needs of housing pelicans. If even just one of these items
is not immediately available, it should probably be euthanized. Finally, some conditions fall into grey areas
and have low chances of success. A case in point is open fractures. If received fresh and clean, the prognosis is
fair. Exposed, devitalized bone, particularly if heavily contaminated or in conjunction with severe maceration
of muscle and skin, carries a very poor prognosis. But there are many degrees in between. Some species will
also deal with protracted care in captivity better than others. It is difficult for a veterinarian who uncommonly
attends wildlife to know these details but the rehabilitator can provide input.

The author prefers to euthanize birds while under isoflurane general anesthesia.9 After masking down, a dilute
pentobarbital-based euthanasia agent is administered via IV or IO injection. Some agents appear to require
higher dosages than those suggested for dogs or cats of comparable mass. Rehabilitators will often request input
on how to euthanize birds when they cannot get them to a veterinarian. Carbon dioxide suffocation tends to be
the simplest, most humane, most accessible, and safest method for most rehabilitators. A darkened plastic stor-
age container in a ventilated area can be modified with a hole in the side for injection of carbon dioxide from a
commercially rented tank. Raptors as large as eagles can be euthanized with this method. After filling the con-
tainer, which may require 3-5 minutes for large birds, the flow is stopped and the container left undisturbed for
15-20 minutes to ensure complete asphyxiation. Death should be confirmed by auscultation before disposal.

50CFR21.31 describes that contact with federal permit agents is required prior to euthanizing listed endangered
or threatened migratory bird species (except when such persons cannot be contacted and prompt euthanasia is
warranted by humane consideration for the welfare of the bird).8 Most raptor species can be disposed of through
cremation services. You are not permitted to donate bodies or parts to any non-permitted persons. Bald and golden
eagles must be transferred to the National Eagle Repository in Commerce City, CO. Sometimes there may be
special requests regarding transfer or disposal of species of special concern. Check with a local rehabilitator or
your regions federal or state wildlife permit agents.

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Initial Care

Initial priorities for raptor stabilization include pain management, fluid resuscitation, temporary stabilization of
wounds and fractures, and re-initiation of alimentation (aka, refeeding).

Analgesia

An early and multi-modal approach is recommended. Butorphanol at 1-4 mg/kg IM as often as every 2 hours has
been described as effective.10 Because this much handling is detrimental to rest and healing, the author typically
compromises with a dose of 1-2 mg/kg q6-12h IM in combination with other drugs. Accepted meloxicam dosages
have slowly increased in the past 10 years although little has been done to determine long-term toxic effects.
1 mg/kg IM q12h hours has become typical of dosages used in raptors with no apparent side-effects.11 There is
a lower bioavailability when administered orally in pigeons and so doses as high as 2 mg/kg PO are described
in some non-raptor species. Despite lack of demonstrable nephrotoxicity seen in the 60 avian species that have
been documented to receive meloxicam, caution is still recommended in cases of hypovolemia. In those cases,
it should be administered after initiation of fluid resuscitation. Based upon a pharmacokinetics study of tramadol
and using human analgesic concentrations, 5 mg/kg PO q12h is recommended for bald eagles.12

In addition to pharmaceuticals, application of cold or heat can have an analgesic effect. Cold compresses, for a
maximum of 10 minutes, twice daily, can be used for injuries sustained within 48 hours. Heat is more appropri-
ate for older injuries and is applied similarly. A cold compress can be made from crushed ice wrapped in a towel
or bags of freezer-stored rice. Cold or warm packs should be focused on the injured region and care should be
taken not to induce hypo- or hyperthermia or burns. Warm packs should not exceed 110F (43C).

Fluid resuscitation and re-alimentation

Fluid support should be the priority. Digestion of protein requires a great deal of energy and fluid secretion.
Also, a raptors metabolism is most adept at releasing ATP from protein rather than carbohydrates.13-15 Finally,
it is not unusual for a raptor to have been starving for several days prior to admission meaning that they will be
significantly dehydrated and their digestive tract may not function efficiently. Food of any type should usually
be withheld for the initial 12-24 hours to allow for fluid resuscitation. Providing food too soon to a raptor in this
condition can lead to life-threatening consequences such as gastrointestinal stasis, putrefaction of GI contents,
and metabolic acidosis.

Assessing Hydration: Indicators of dehydration include tackiness of the mucus membranes of the oral cavity and
cloaca, coolness of the extremities, a sunken or almond-shaped or dull appearance to the eyes, and prolonged
tenting of the skin on the dorsum of the foot.14,16 In addition, urates may be chalky or gritty and there can be
presence of uroliths in the cloaca (as determined with a thermometer as a probe). It is safe to assume that most
birds of prey are at least 5% dehydrated. Those with more severe indicators are probably 10% or more dehydrated.

Treatment Planning: Fluid support should replenish deficit gradually while providing daily maintenance require-
ments (~5% of the body mass) and ongoing losses from stress or disease.14 Replacement of half of the deficit
is recommended in the initial 12-24 hours, the remainder over the following 2 days. In combination with main-
tenance requirements and assuming a moderate to severe fluid deficit of 10% (halve these numbers if patient
shows only mild dehydration), a fluid resuscitation plan can be created as follows:

DOSE: 5% of body weight in grams (eg, 3500 gram bald eagles dose would be 175 mls). This dose is
best administered via a combination of oral (gavage) and parenteral (IV/IO) routes. The dose includes
any fluids provided in gavage feedings.

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DAY 1: Administer DOSE every 8 hours. No food for initial 12-24 hours. If patient is alert and respon-
sive, shows no signs of crop stasis, and produces mutes (droppings), gavage feeding of small amounts
of a carnivore critical care diet may be considered.

DAY 2: Administer DOSE every 12 hours. If patient is alert and responsive, shows no signs of crop
stasis, and produces mutes, gavage feed gradually increasing amounts of a carnivore critical care diet.
If mutes demonstrate digested material, a small amount of soft meat (no integument or bones) may be
fed in the last half of the day in conjunction with gavage feeding.

DAY 3: Administer DOSE every 12 hours. If patient is stable and demonstrates good GI function, soft
meat is increased in conjunction with gavage feeding.

DAY 4+: Continue to decrease fluids administration and increase volumes of soft meat while carefully
assessing digestive function and attitude. When the bird is self-feeding and gaining weight, it may be
transitioned to chunked whole prey (with integument and bones).

Route selection: In most mild to moderate cases of dehydration, a combination of gavage and subcutaneous
routes is sufficient. Initially, most of the volume (75%) should be delivered parenterally since the GI tract may
not be efficient at absorption. This is gradually shifted to mostly orally as the GI tract is found to be more and
more functional. Patients who are in shock or severely hypovolemic may benefit from initial large boluses (10
ml/kg slowly) of fluids delivered IV or IO. Common access sites include the basilic vein, the medial metatarsal
vein, the jugular vein, or the distal ulna for IO access.

Fluid selection: Isotonic crystalloid fluids (eg, Normosol-R, Lactated Ringers Solution) are commonly used in
raptors for parenteral administration but can be used orally as well. Commercially available non-flavored elec-
trolyte solutions are acceptable for gavage (Pedialyte, Abbott, Chicago, IL, USA). 6% Hetastarch (10-15 mls/kg
IV or IO) in conjunction with crystalloids (reduce dose by 50%) can be utilized in cases of severely depressed
total serum solids (eg, <2 mg/dl).

Gavage feeding: Clear fluids are recommended for at least the first dose to promote and assess movement of the
GI tract while also allowing time for the process of fluid resuscitation to begin. In cases of severe dehydration,
initial doses of oral fluids are poorly assimilated resulting in very loose, clear mutes. The first substances requiring
digestion should be easy to digest and assimilate since enzyme systems may not have functioned for a protracted
period of time and blunting of intestinal villi, important for absorption, has likely occurred. An elemental diet
(Emeraid Carnivore, Lafeber Company, Cornell, IL, USA) may offer advantages in this regard since it should
require little or no digestion. Volumes should be kept cautiously small initially and gradually increased.

How to gavage feed: Ball-tipped gavage needles of different sizes are appropriate for small raptors up to about
1000 grams. For larger birds, a catheter-tipped syringe and an 18 French red rubber catheter are recommended.
The tube can be marked with tape or a marker to estimate the distance to the bottom of the crop. In birds lacking
a crop, or if you intend to fill the stomach first, the mark should approximate the distance to the tip of the keel.
The needle or tube is attached to the syringe and pre-lubricated with a water-soluble jelly (KY, Reckitt Benck-
iser, Slough, Berkshire, UK). The bird should be held upright on the restrainers front such that the bird is well
below the chest level of the veterinarian. The head is restrained as discussed earlier for oral examination (thumb
in the corner of the mouth). The neck must be extended upwards fully to allow good filling of the crop without
reflux. The tube is slid past the glottis and down the esophagus, typically from the birds left to right although
in birds of prey, the exact direction of passage is not critical as they have extremely expandable throats. When
the established mark is at the oral commissure, the position of the tube is verified. This is done by feeling the

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neck and crop but also direct visualization of the glottis at the base of the tongue. The fluid dose is then intro-
duced smoothly and slowly, watching the gullet for any reflux. Usually this is due to not having the tube deeply
enough or allowing the neck to relax too much. If reflux occurs, pull the neck straight and lift the tube slightly
to encourage drainage into the crop. If fluids rise to the point of covering the glottis then withdraw your tube
and tip the head sideways and down (while keeping the neck stretched) to allow fluids to drain from the throat.
If performing gavage in conjunction with feeding, it should be performed prior to offering food. After feeding,
to avoid reflux, care should be taken not to apply pressure to the crop after gavage feeding.

Ingluvial stasis (aka sour crop): This can occur when food is present in the GI tract but the patient is too
dehydrated to digest it. Other causes include obstruction or infectious disease (eg, trichomoniasis or candidia-
sis) of the GI tract. The crop will fail to empty, there may be an acrid, putrid odor from the mouth, and the bird
may regurgitate fetid ingesta. Droppings will exhibit scant or absent feces. A resulting bacterial overgrowth can
ultimately cause crop edema and endotoxemic shock.17 Treatment for ingluvial stasis includes removal of food,
either orally or by ingluviotomy, followed by oral antibiotics, such as trimethoprim sulfadimethoxazole at 48
mg/kg PO every 12 hours or clindamycin at 50 to 100 mg/kg PO every 12 hours until clinical signs resolve.
Some authors also lavage or gavage diluted antiseptics (eg, chlorhexidine) into the upper gastrointestinal tract
after removal of fermented crop contents. Radiographic images and other diagnostic tests are recommended to
identify and address the underlying cause of ingluvial stasis. Food should slowly be reintroduced in conjunction
with fluid therapy.

Temporary bandaging

Temporary stabilization of fractures or coverage of wounds is required until a patient is stable enough for sur-
gery.18 Wounds should be flushed with a dilute antiseptic solution (Nolvasan (chlorhexidine diacetate), Zoetis
Animal Health, Florham Park, NJ, USA) and physiologic saline and covered with a non-adherent dressing. If
bones are exposed, the site should be flushed and the bones manipulated back under the surrounding tissue.
Temporary sutures may be applied if there is a tendency for exteriorization to recur. A coating of sterile water
soluble jelly may also be beneficial to prevent drying inside of a bandage. The figure-8 dressing is a common
wrap for covering wounds and stabilizing fractures of the wing. It should include a band around the chest, high
under the axilla, to prevent motion of the humerus or shoulder if fractures of these sites are involved. Care must
be taken to avoid over-tightening of the figure-8 dressing and it should be removed, PT performed, and replaced
every 2 days to prevent contracture of the propatagialis and compression of the humeroulnar or carpal joints.

Radiographic Positioning

For optimum results and ease in consultation with other veterinarians, radiographic views should be carefully
positioned and include at least two orthogonal views of each region. For the body, VD and lateral views are recom-
mended. The wings should be extended dorsally and the legs extended ventrocaudally. Overlap of the coracoids
and coxofemoral joints indicates optimum positioning. For wings, VD and AP views are recommended. The AP
view can be achieved by vertical restraint of the patient while extending the wing across the vertical x-ray beam.
The elbow should be lowered as close the plate as possible and the wing straightened to the point of joint/muscle
resistance and held so that the propatagium is perpendicular to the beam. Where shoulder injury is suspected,
it may be appropriate to obtain two VD views of the pectoral girdle: One with the wings held neutral and one
with the shoulder extended maximally. This sometimes helps enhance luxations or fractures of the coracoid or
clavicle. AP and lateral views of the legs are typically visible when whole body VD and lateral views are taken.
However, foot images are sometimes required and for these it is helpful to have dorsal-plantar and lateral views.
A birds thoracic and lumbar spine should normally be very straight on a well-positioned VD, but spinal details

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are difficult to evaluate in birds due to the complexity of intervertebral joints. The edge of a piece of paper can
help evaluate subtle skews in alignment of the spine. Marks can be made on the paper at the vertebral joints to
assess regularity in spacing of the vertebrae.

References

1. Jones MP. Behavioral aspects of captive birds of prey. Vet Clin N Am Exot Anim Pract. 2001;4:613-632.

2. Roggenbuck M, Brholm Schnell I, Blom N, et al. The microbiome of New World vultures. Nat Commun.
2014;5:5498. Available at: http://www.nature.com/doifinder/10.1038/ncomms6498.

3. Vela A, Casas-Diaz E, Fernndez-Garayzba JF. Estimation of cultivable bacterial diversity in the cloacae
and pharynx in Eurasian griffon vultures (Gyps fulvus). Microb Ecol. 2015;69:597-607.

4. Petritz OA, Guzman DS, Gustavsen KA, et al. Evaluation of the mydriatic effects of topical administration
of rocuronium bromide in Hispaniolan Amazon parrots (Amazona ventralis). Proc Annu Conf Assoc Avian
Vet. 2014;13-14.

5. Barsotti G, Briganti A, Spratte JR, et al. Safety and efficacy of bilateral topical application of rocuronium
bromide for mydriasis in European destrels (Falco tinnunculus). J Avian Med Surg. 2012;26:1-5.

6. Barsotti G, Briganti A, Spratte JR, et al. Bilateral mydriasis in common buzzards (Buteo buteo) and little
owls (Athene noctua) induced by concurrent topical administration of rocuronium bromide. Vet Ophthalmol.
2010;13:35-40.

7. Barsotti G, Briganti A, Spratte JR, et al. Mydriatic effect of topically applied rocuronium bromide in tawny
owls (Strix aluco): Comparison between two protocols. Vet Ophthalmol. 2010;13:9-13.

8. Anon. Code of Federal Regulations: Rehabilitation Permits. USA; 2010. Available at: http://cfr.regstoday.
com/50cfr21.aspx#50_CFR_21p31.

9. Leary S, Underwood W, Lilly E, et al. AVMA Guidelines for the euthanasia of animals: 2013 ed. Schaum-
burg, IL: American Vet Med Assoc;2013.

10. Hawkins M, Avian DA, Barron HW, et al. Avian analgesia: Considerations for companion and wild birds.
Proc Annu Conf Assoc Avian Vet. 2014;129-136.

11. McKinney P. Raptor Medicine: The MiddleEast Experience. In: AAVAC-UPAV. Yandina, QLD, Australia;
2014. Available at: http://www.vin.com/members/cms/project/defaultadv1.aspx?id=6500008&pid=11396
&catid=&.

12. Souza MJ, Martin-Jimenez T, Jones MP, et al. Pharmacokinetics of intravenous and oral tramadol in the
bald eagle (Haliaeetus leucocephalus). J Avian Med Surg. 2009;23:247-252.

13. Ford S, Chitty J, Jones M. Raptor medicine master class (gastrointestinal, integument, respiratory). Proc
Annu Conf Assoc Avian Vet. 2009;143-162.

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14. Ford S, Chitty J, Jones M. Raptor medicine master class (bumblefoot, nutrition, stabilization). Proc Annu
Conf Assoc Avian Vet. 2008;173-192.

15. Ford S. Raptor gastroenterology. J Exot Pet Med. 2010;19:140-50. Available at: http://dx.doi.org/10.1053/j.
jepm.2010.05.004.

16. Ford S. Avian care and handling at the Alaska Raptor Center. Alaska Raptor Center, Sitka, AK; 2003.

17. Samour JH. Management of raptors. In: Harrison G, Lightfoot T, eds. Clinical Avian Medicine (vol II).
Palm Beach, FL: Spix Publishing;2006:915-56.

18. Graham JE, Heatley JJ. Emergency care of raptors. Vet Clin N Am Exot Anim Pract. 2007;10:395-418.

202 Building Exotics Excellence: One City, One Conference


Birds With Big Bellies: What Do I Need to Know?
Natalie Antinoff, DVM, DABVP (Avian)

Session #286

Affiliation: From Gulf Coast Veterinary Specialists, 1111 W Loop South, Houston, TX 77027, USA.

Abstract: Coelomic distension in birds is a challenging problem that requires rapid recognition and
appropriate management. If distension becomes severe, it may compromise the inflation of the air sacs,
leading to respiratory distress. Etiologies include reproductive disorders, gastrointestinal disorders,
hypoproteinemia, hepatic disease, cardiac disease, and neoplasia. Radiography and ultrasound are extremely
valuable tools for both diagnosis and treatment. If fluid is present, coelomocentesis should be performed
early in the course of treatment, sometimes prior to undertaking any diagnostics.

Introduction

Coelomic distension in birds can be a challenging situation, even for an experienced practitioner. Many birds
with coelomic distension will present with clinical signs of respiratory disease due to an inability of the air sacs
to completely expand (similar to pleural effusion in small mammals). In an emergency setting, it is essential
that the clinician is aware of common etiologies and recognizes when intervention is appropriate, and when
diagnostics and therapeutics should be limited. In appropriate cases, coelomocentesis is a life-saving procedure
that can be performed by any veterinarian; yet when improperly performed this procedure can lead to further
compromise and even death in these patients. This presentation will address many of the etiologies for coelomic
distension, as well as appropriate intervention and care for each individual situation.

Coelomic Distention

Coelomic distention in birds can arise due to any number of etiologies. In patients with gastrointestinal disease,
it may be due to fluid accumulation/ascites from hypoproteinemia. In reproductively active birds, it may be the
result of egg-related peritonitis. Cardiac disease in birds may lead to effusion rather than pulmonary edema.
Hepatic disease can lead to fluid accumulation from either hypoproteinemia or from hepatomegaly.

Regardless of underlying cause, there are several precautions when dealing with a bird with coelomic distention.
Remember that since birds lack a diaphragm, they rely on expansion of the keel for respiration. In addition, birds
breathe using air sacs, which line the entire body and extend down to the pelvic region. Whether fluid or a mass
is the cause of the coelomic distention, it acts as a space-occupying lesion that restricts the ability of the air sacs
to expand, thereby compromising respiration.

DO NOT place these birds in dorsal recumbency. Perform the physical examination and as much of the diagnostic
profile as possible while restraining the patient in an upright, normal anatomic position. Use oxygen as necessary,
and provide frequent breaks from restraint to avoid respiratory compromise. If coelomic distension is suspected
(and in almost every dyspneic bird), the first step in the physical examination should be gentle coelomic palpa-
tion to assess for the degree of distension, fluid, or mass; the second step should be auscultation. Those may be
the only 2 steps possible in distressed birds.

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If the distension is fluid, coelomic centesis (abdominocentesis) can provide rapid relief. Avian coelomic centesis
can be comparable to thoracocentesis in a mammal with severe pleural effusion as the fluid is removed, the
respiration almost immediately eases, regardless of underlying cause. However, because of the lateral location of
the air sacs in birds, centesis should only be performed in the central third of the coelomic region. Lateral puncture
can lead to leakage of the fluid directly into the air sac compartment, and can result in drowning of the patient.
Hypothetically, divide the patient into thirds along the longitudinal plane, with the lateral thirds being the air
sacs and the central third representing the actual coelomic cavity. Whenever possible, use ultrasound to direct the
centesis to decrease patient risk. If ultrasound is not available, palpate the most distended or most dependent area
along the central third. Use a 25-ga butterfly needle or a small catheter to withdraw fluid. In almost all situations
in avian patient, it is appropriate to remove as much of the fluid as possible to relieve respiratory compromise.
If frank blood is aspirated, stop immediately, as this may indicate penetration of a vital organ. Evaluate PCV to
determine the safety of further centesis. Collect fluid for cytologic analysis and bacterial culture and sensitivity.
Check total protein of the fluid immediately if hypoproteinemia is a concern.

The Peritoneal Cavities

It is important to understand that although we think of the coelomic cavity as one large singular space, it is actu-
ally comprised of several compartments, separated by peritoneal membranes. These membranes all have names
related to their anatomic location (provided for your reference below); however, when evaluating the location of
fluid accumulation, it is most important to understand the clinical relationships of these peritoneal membranes.

The intestinal peritoneal cavity is most closely comparable to the coelomic cavity of mammals. It is an elongated
cavity which extends from the liver to the vent along the midline/center of the coelomic region, and contains
the intestines and gonads. Clinical relevance: Effusions originating from any of these origins will accumulate in
the intestinal peritoneal cavity, and as this cavity distends, the lateral air sacs will be unable to inflate. In very
severe cases the liver can be cranially displaced.

There are 4 hepatic peritoneal cavities, which surround the liver. These are actually only potential spaces un-
less fluid is present, which can become contained within these cavities. The cavities are the right and left dorsal
hepatic peritoneal cavities and the right and left ventral hepatic peritoneal cavities. The membranes that define
these cavities are called the right and left hepatic ligaments (as the name implies, these attach the liver to the
medial aspect of the air sacs on either side) and the left and right sheets of the posthepatic septum, which are also
branches of the dorsal and ventral mesentary. The left dorsal hepatic peritoneal cavity communicates with the
intestinal peritoneal cavity. (Simplification: The posthepatic septum divides the peritoneal cavity into the intestinal
peritoneal cavity and the right and left hepatic cavities, which are then subdivided into dorsal and ventral by the
hepatic peritoneal membranes.) Clinical relevance: Effusions coming directly from hepatic neoplasms or cysts
may be contained within these hepatic peritoneal cavities, especially in the cranial cavities. In these cases, the
coelom may not be as distended, as the fluid is localized around the liver, but still can cause significant respira-
tory compromise. Centesis of this region can also be more challenging and may require the use of ultrasound.

There are also pericardial and pleural cavities. The lungs do not surround the heart in birds; rather, it is sur-
rounded by the liver. Because there is no diaphragm, the pericardium becomes continuous with the coelomic
peritoneal partitions. Clinical relevance: cardiac disease and right heart failure may manifest as accumulation
of fluid in any of these compartments.

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Therapy

Treatment should be directed at the underlying etiology. If coelomic fluid is present, cytologic analysis and
culture and sensitivity of the coelomic fluid should be performed. Removal of as much of the coelomic fluid as
possible is one of the most important aspects of stabilizing the critical patient with coeloic distension. However,
sometimes fluid is in pockets and it is not always possible to remove all fluid present. Ultrasound is very ben-
eficial in identifying larger pockets of fluid for centesis; however, remember to remain in the central third of the
coleomic region (rather than lateral) when perfoming centesis. The clinician is always advised to determine the
risks vs benefits of centesis when smaller amounts of fluid are present.

For hypoproteinemia from GI loss, or hepatic disease, in addition to treating the primary problem, hetastarch
can be administered intravenously to aid in restoring protein levels and plasma oncotic pressure. Differentials
for gastrointestinal loss can be any severe diarrhea, or any enteritis; consider bacterial etiologies such as myco-
bacteriosis, salmonellosis, E. coli enteritis, clostridial enteritis, or any other bacterial infection; fungal etiolo-
gies such as avian gastric yeast or severe candidiasis; viral etiologies such as proventricular dilation disease, or
neoplastic processes such as lymphoma.

Treat bacterial overgrowth with appropriate antimicrobials, initially targeted based on the gram stain, and modi-
fied based on culture and sensitivity when available. For maldigestion or malabsorption, clinical signs will be
similar to those of companion animals, and weight loss will be present. Zinc toxicity can be associated with
pancreatic insufficiency, so consider evaluation of blood zinc levels. Complete workup will include radiographs
and barium GI series.

Cardiac disease is another potential cause of coelomic fluid accumulation. Diagnosis of cardiac disease can be
challenging in birds, but when the etiology is truly cardiac, there is usually a murmur or arrhythmia. Normal
heart rates vary by species but may be over 400 beats per minute in smaller birds, which makes auscultation of
murmurs nearly impossible. However, arrhythmias can be detected regardless of heart rate. Clinical evaluation
for cardiac disease should include radiographs to evaluate heart size, and electrocardiogram if an arrhythmia
is present. Cardiac ultrasound can be performed in most birds, but may be challenging in some species due to
small coelomic window Birds rarely develop pulmonary edema, with effusion being more common clinically.
Since there is no diaphragm, rather than pleural effusion, the fluid is free in the coelomic cavity. Fluid may also
be present in the hepatoperitoneal cavity. Treatment is similar to that of companion animals. Furosemide can be
used in heart failure; however, since most of the nephrons in avian kidneys lack a loop of Henle, they may have
less efficacy than in mammals, or may require higher doses. Commonly used drugs such as enalapril, benazepril,
digoxin, and newer drugs like pimobendan, amlodipine, and sildenafil can all be used if indicated.

Perhaps the most common causes for fluid accumulation are reproductive in origin. Egg binding and/or egg-
related peritonitis can lead to congestion of the oviduct, as well as fibrin accumulation. Release of yolk material
into the coelomic cavity may occur, either as a sequela to egg retention, or as a result of ectopic ovulation. Al-
though the yolk is initially sterile, its presence can set up an inflammatory response within the coelomic cavity.
In addition, even mild cases of salpingitis can lead to coelomitis and bacterial invasion. Diagnosis is made based
on clinical signs, ultrasound, and aspirate of coelomic contents. Fluid analysis will reveal yolk material with or
without inflammatory cells and bacteria. Treatment is aimed at controlling infection, stabilizing the patient, and
minimizing inflammation. Steroids should be avoided in most cases, but NSAIDs may be beneficial. Surgery
is often required. Bacterial culture and sensitivity should always be performed.

Cystic ovarian disease is another reproductive cause of fluid accumulation. Ultrasonographically, it may be pos-
sible to see multiple cystic structures of varying size on the left in the craniodorsal region of the abdomen, or a

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single large cystic structure may be apparent. Birds only have a left ovary, so most reproductive structures will
appear on the left unless there is severe displacement. Treatment for cystic ovarian disease is limited. The ovaries
are generally not removed at surgery due to their vascular supply. However, the individual cysts can sometimes
be bluntly dissected off the ovary and removed. Extreme caution must be used to avoid rupture of the cyst and
release of the fluid into the coelomic cavity. Medically, Leuprolide acetate is effective in managing many cases
of cystic ovarian disease; however, this is a recurrent disease.

Reproductive neoplasia can also lead to fluid accumulation. The masses can usually be seen ultrasonographically
as irregular, soft tissue structures associated with the reproductive tract. Aspiration of the fluid or the mass may
reveal neoplastic cells or a modified transudate. Some uterine masses can be surgically removed, but there is
currently no treatment for ovarian masses.

Reproductive Disorders

Reproductive disorders are serious, complicated problems faced by the avian veterinarian, and are perhaps one of
the more common emergency presentations in avian patients. Many are chronic, but others can be immediately
life-threatening. The etiology of reproductive disorders is often multi-factorial. In wild birds, many natural factors
such as light/dark cycles, availability of nest sites, or suitable food sources influence reproductive behaviors and
capability. In captivity, birds lack the environmental cues that stimulate egg production and subsequent cessa-
tion of the laying cycle. The act of nesting and raising a clutch is one cue for cessation of egg laying; if a nest is
destroyed by predation or storm, this then may serve as a stimulus for production of a second clutch. Nutrition
in captive birds is frequently deficient in nutrients including calcium and vitamins A & D. In addition, many pet
birds are overweight, which may also contribute to difficulty in egg-laying. In captivity, variation of light/dark
cycles often depends on family work schedules, leading to sporadic changes that interfere with natural cues.
Once eggs are laid, many owners remove the eggs, which may then stimulate production of a second clutch, and
a repetitive cycle may ensue, leading to depletion of calcium and nutritional complications even in the presence
of an adequate diet.

Egg retention

Egg retention is a common clinical presentation in pet birds. By definition, egg-binding is the delay in passage
of an egg through the oviduct, when compared to the normal rate for that bird. Most commonly kept pet spe-
cies have well defined laying intervals, and normal variation is within 24 hours of the defined interval for that
species. Dystocia is defined as obstruction of the oviduct by a developing egg.1 This may occur anywhere in
the oviduct, and a shell may or may not be present. Sequela may include prolapse of the oviduct or cloaca from
straining, rupture of the oviduct and subsequent peritonitis, respiratory compromise, paresis or paralysis from
pressure on the obdurator nerve, or obstruction of the cloaca.

Clinical signs

Clinical signs in the egg-bound bird are variable, and may be mild or extremely severe. Lethargy, fluffed feath-
ers, straining, polyuria, voluminous droppings, wide-based stance, and paresis or paralysis of the legs all may
occur. These birds often become anorexic, which then further debilitates them.

Diagnosis

Diagnosis is based on appropriate history, physical examination, and radiographs. Palpation of the abdomen
often reveals a firm or soft egg, which is often located on the left side, but may displace the oviduct and can be

206 Building Exotics Excellence: One City, One Conference


palpated in any location within the abdomen. In some deep-chested species such as the Amazon parrot, palpation
may be less reliable. Radiographs are essential. Even when there is no doubt about the presence of an egg, it is
vital to obtain radiographs to detect the degree of calcification (overcalcification is as significant a problem as
undercalcification); the size and position of the egg; fracture of the egg shell; and the presence of multiple eggs.
Polyostotic hyperostosis, or osteomyelosclerosis, a normal physiologic increase in calcium deposition in the long
bones prior to egg laying, may also be detected radiographically, as can fractures or poor overall bone quality.

Treatment

Treatment is aimed first at stabilizing the patient, then at extraction of the egg. Warmed fluids can be administered
subcutaneously or intravenously (or intraosseously). A warm dark humidified incubator should be provided.
Calcium and vitamin D are often beneficial. The dose for calcium is 50-100 mg/kg/day. (Calcium gluconate
injectable is 100mg/ml but is only 9% bioavailable; Calcium gluconate or calcium glubionate oral solution is
usually 23 mg/ml but about 60% bioavailable and is the recommended treatment if the patient can take oral
medications.) Antibiotics and gavage feedings can be administered as necessary. If a bird has been anorexic, and
is debilitated but not in distress, supportive care, gavage feeding and fluids are recommended for 12-24 hours
prior to any intervention. The bird must be able to pass feces if this approach is to be taken. Many birds will
respond to supportive care alone.

Medical therapies

Medical therapies that have been used to promote oviposition include oxytocin (0.01-0.1 ml IM once; can be
repeated), prostaglandins, and arginine vasotocin (0.01-1.0 mg/kg). Arginine vasotocin is the naturally released
hormone in birds, and is believed to cause the release of prostaglandins. However, this hormone is not commer-
cially available, and oxytocin, the mammalian compound, is more commonly used. These are only indicated if
the hen is not obstructed. Prostoglandins are suggested as superior because they can increase uterine contraction
and relax the vaginal sphincter.1 Adequate calcium must be present to enable uterine contraction.

The use of luprolide acetate or deslorelin, although beneficial for many birds in the treatment of both cystic
ovarian disease and chronic egg laying (see below), is unlikely to be effective in management of egg retention.
Once ovulation has occurred, these hormones will not alter the course of dystocia or egg-binding. However, even
in the case of egg retention, Leuprolide acetate may be used to attempt to prevent subsequent egg production.

Surgical therapies

If medical management fails after 12-24 hours, then the least invasive surgical procedure possible to facilitate
passage of the egg should be attempted. Each step should be attempted prior to a more aggressive approach; as
the more invasive the approach, the greater the likelihood of oviductal damage and tearing, bacterial invasion,
subsequent infection, or scar tissue formation and future reproductive complications. For each step mentioned
subsequently, the bird should be anesthetized with isoflurane or sevoflurane.

Manual expression: Very gentle manual pressure is used to direct the egg caudally and may lead to oviposition.
It is essential to direct the egg caudally and take great care not to press cranially and compromise the patients
respirations. Mild eversion of the oviduct may occur with this procedure but is almost always resolved without
treatment once the egg is expelled. If the egg is adherent to the oviduct, or not visible when applying pressure,
this technique should be avoided.

Cloacal ovocentesis: Using a vaginal speculum or well-lubricated cotton applicators, a focal light source, and
an assistant, gently dilate the cloaca and manipulate the tissues to visualize the egg and oviductal opening. This

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requires patience and persistence. Aim toward the birds left dorsal region, and continually manipulating the
speculum to gain visualization. Stabilize the egg to prevent rotation or retraction into the body cavity, and again
use extreme caution to avoid compromising the respiratory system. Once a small segment of egg shell is visible,
insert an 18-g needle with attached syringe into the egg (Suggested syringe sizes: cockatiel, 6-12 cc; Amazon/
African grey parrot, 12-20 cc; macaw, 20 cc). Aspirate the contents of the egg, and using steady digital pressure,
gently implode. Once imploded, the fragments can be gently removed using a small pair of curved hemostats.
Gentle lavage or infusion of antibiotic may be useful. If the egg is not visible, this method is not recommended.

Percutaneous ovocentesis: If the egg cannot be visualized cloacally, then percutaneous ovocentesis can be at-
tempted. The egg is stabilized within the coelomic cavity, a small area is prepped, and an 18-ga needle with
syringe attached is inserted through the body wall into the egg. (Insertion of the needle should be on the left
side of the body to avoid intestines.) While continuing to hold the egg, the contents are aspirated and the egg is
imploded. Once collapsed, the fragments in most cases will pass. If the egg is adherent to the oviduct, it may
not pass following this procedure. It is not possible to determine this if the egg is not visible cloacally. With this
procedure there is a much greater risk of peritonitis and oviduct or uterine tear.

Salpingohysterectomy or salpingotomy: When all other techniques have failed, true surgical intervention is re-
quired. A left L-shaped or curvilinear incision is ideal, but other approaches may be necessary based on position
of the egg. Caution must be taken to avoid incising intestinal loops when making the approach. The oviduct is
usually readily apparent but may be surrounded by adhesions or yolk peritonitis. The oviduct is dissected distally
to the cloaca and ligated. Then advance proximally to the infundibulum (fallopian tube), being careful not to
destroy the branch of the ovarian artery supplying the infundibulum. Ligate proximal to the infundibulum, leaving
the ovary intact in the bird. The oviduct is removed, and 2- or 3- layer standard closure is performed. If the bird
is of valuable breeding stock, a salpingotomy can be performed to remove the abnormal egg and preserve the
oviduct; however this is not recommended for pet birds due to the high potential for subsequent complications.
Postoperatively, supportive care should be continued and analgesics added as necessary.

Cystic ovarian disease

A small population of birds, when reproductively active, develop a great deal of fluid distention of the abdomen.
This usually occurs prior to egg laying, but may be present through the reproductive cycle. In many of these
birds, the amount of fluid present causes respiratory compromise. Ultrasonographically, the presence of one or
several fluid-filled cysts is considered diagnostic for cystic ovarian disease (in contrast to generalized fluid within
the coelomic cavity). Aspiration of this fluid usually reveals a modified transudate.

Treatment for cystic ovarian disease is limited. The ovaries are generally not removed at surgery due to their
vascular supply. However, the individual cysts can sometimes be bluntly dissected off the ovary and removed.
Extreme caution must be used to avoid rupture of the cyst and release of the fluid into the coelomic cavity.
Medically, Leuprolide acetate or deslorelin can be effective in managing many cases of cystic ovarian disease;
however, this is a recurrent disease.

Egg-related peritonitis

Release of yolk material into the coelomic cavity may occur, either as a sequela to egg retention, or as a result of
ectopic ovulation. Although the yolk is initially sterile, its presence can set up an inflammatory response within
the coelomic cavity. In addition, even mild cases of salpingitis can lead to coelomitis and bacterial invasion.
Clinical signs vary in severity but generally include lethargy, coelomic distension, malaise, inappetence, and
chronic weight loss. Diagnosis is made based on clinical signs, ultrasound, and aspirate of coelomic contents.

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Fluid analysis will reveal yolk material with or without inflammatory cells and bacteria. Treatment is aimed
at controlling infection, stabilizing the patient, and minimizing inflammation. Steroids should be avoided, but
NSAIDs may be beneficial. Surgery is often required. Bacterial culture and sensitivity should always be performed.

References

1. King AS, McLelland J. Birds: Their Structure and Function. East Sussex, England: Balliere Tindall;1984.

2. Joyner KL. Theriogenology. In: Ritchie BW, Harrison GJ, Harrison, LR eds. Avian Medicine: Principles
and Application. Lake Worth, FL: Wingers;1994:748-804.

3. Bennett RA, Harrison GJ. Soft tissue surgery. In: Ritchie BW, Harrison GJ, Harrison, LR eds. Avian Medi-
cine: Principles and Application. Lake Worth, FL: Wingers;1994:1096-1136.

4. Bowles HL. Evaluating and treating the reproductive system. In: Harrison GJ, Lightfoot TL, eds. Clinical
Avian Medicine. Palm Beach, FL: Spix Publishing Inc;2006:519-539.

5. Petritz OA, Guzman D, Paul-Murphy J, et al. Evaluation of the efficacy and safety of single administra-
tion of 4.7 mg deslorelin acetate implants on egg production and plasma sex hormones in Japanese quail
(Coturnix coturnix japonica). Am J Vet Res. 2013;74:316-323.

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Laser Therapy in Avian Patients
Robert D Ness, DVM

Session #194

Affiliation: From the Ness Exotic Wellness Center, 1007 Maple Ave, Lisle, IL 60532, USA.

Abstract: Laser therapy, also known as photobiomodulation, utilizes a specific wavelength of light to
penetrate tissues and elicit a biochemical and biological response. Laser therapy reduces pain, reduces
inflammation and accelerates healing. Effective treatment depends on delivering an appropriate dose of
laser energy into the affected tissue. In the authors experience, avian patients with acute inflammatory
or traumatic conditions typically respond with a single or few treatments sessions at relatively low target
doses. Chronic or deep tissue conditions require a higher target dose and more frequent treatment sessions,
with some necessitating ongoing maintenance therapy.

Key words: laser therapy, photobiomodulation, avian, class IV laser

Science of Laser Therapy

Laser therapy is the result of electromagnetic energy interacting chemically and biologically with tissue caus-
ing photo-bio-modulation. The term laser is an acronym for Light Amplification by Stimulated Emission of
Radiation. Current literature is replacing the term laser therapy with photobiomodulation (PBM).1 Photo-
biomodulation is present all around us as photosynthesis occurring in plants and Vitamin D formation within our
skin cells. Lasers allow light therapy to be targeted specifically and quickly. Lasers produce a single wavelength
beam of light, which is collimated as it is generated. Laser light has the inherent property of being coherent, or
in phase, which means it is a uniform, orderly light beam. Class IV therapy lasers use a simple beam of light
to penetrate deeply into tissues to produce positive tissue changes.2 Patients with any degree of pain, inflam-
mation, or requiring tissue healing are potential candidates for class IV laser therapy. Laser therapy should be
incorporated into routine pain control protocols for all patients. Avian patients with a wide variety of acute or
chronic conditions show clinical improvement with the use of class IV laser therapy. Some acute conditions may
only need a single treatment, while others may require several sessions over days to weeks. Chronic conditions
involving chronic pain or inflammation also benefit, but treatment extends over a longer time period and may
require on-going treatment to maintain effect.

Mechanism of Laser Therapy

Laser therapy reduces pain, reduces inflammation and accelerates healing.3 Patient perception of pain is reduced
by an increased release of tissue endorphins. Nerve cells are affected, nociceptors are suppressed, stimulation
thresholds are increased, and neuronal impulses are reduced. Inflammation is reduced by decreased release of
prostaglandins and inflammatory mediators, by increased macrophage activity and leukocyte phagocytosis, and
by reducing edema through dilation of lymphatic vessels.4 Healing is accelerated by increased blood flow from
vasodilation, by increased angiogenesis and capillary production, by increased release of stimulating cytokines,
and by stimulation of fibroblast activity and collagen production. Electrical, pressure and temperature gradients
are created as coherent laser light is polarized by the mixed density of tissue.

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Target Dosing

Success in treating conditions depends on delivering an appropriate dose of laser energy into the affected tissue.
Insufficient dosing results in treatment failure. Overdosing wastes time and practice resources, however it is not
detrimental to the patient. Target doses are expressed in J/cm2. One joule (J) is the energy delivered with one Watt
of power in one second. Established target doses are 3-4 J/cm2 for superficial conditions (conditions in tissue
that we can see) and 8-10 J/cm2 in deep conditions (conditions beneath the skin).5 Power and time are inversely
proportional in calculating the total energy (joules) delivered. Treatment time can be reduced by increasing
power. Likewise, treatment time increases if the power (Watts) is reduced. When treating superficial conditions
with a lower target dose, power usually remains relatively low since achieving a target dose of 3-4 J/cm2 does
not take long. Many superficial conditions affect sensitive tissue and a lower power setting is more comfortable
for the patient. When treating deep tissue conditions, power is increased to reduce the time required to achieve
a target dose of 8-10 J/cm2. Some laser treatment protocols, such as wound or abdominal disorders, require an
estimation of the treatment area when calculating the target dose of a laser treatment. A simple technique for
estimating the patients surface treatment area is by comparing the size of the area to be treated relative to a
3 x 5 inch index card, which has an approximate area of 100 cm2.6

Considerations in Avian Laser Therapy

Many conditions commonly encountered in avian practice may improve considerably with laser therapy. Special
considerations should be addressed when using therapeutic lasers on birds due to the inherent power of the class
IV laser in opposition to the relatively thin dermis of birds. Therefore, adjustments are made in the laser settings
to facilitate the lower optimal therapeutic dosing, typically by reducing the total energy administered by approxi-
mately 50% of a comparably sized mammal. The adjustments can be made by modifying the frequency, watts
or time. Regarding frequency, the typical continuous wave setting is adjusted to a pulsed wave, which delivers
50% of the energy directly to the patient. Similarly, a lower amount of total energy, in Joules, is accomplished
by decreasing the treatment time or decreasing the strength of the laser by lowering the wattage. Continuous
movement of the treatment wand is also important in accomplishing an effective laser session. A steady move-
ment over the entire affected area in a grid pattern allows appropriate distribution of therapeutic energy, while
avoiding discomfort from overheating of the birds skin or feathers.

Laser Therapy for Acute and Superficial Conditions

Superficial acute conditions include lesions that are easily observed and recently developed, which require the
lower target dose of 3-4 J/cm2 with just one to a few treatments. Superficial skin lesions and mild soft tissue
trauma as experienced in wing tip trauma from night fright, acute bite wounds, acute pododermatitis, early stages
of feather trauma, and post-operative surgical incisions are classic examples that respond well to the integra-
tion of laser therapy in the wound management protocols. Other situations that can respond to the lower target
dosing include beak trauma and uropygial gland impaction or abrasion. Some of these conditions may require
a single laser session lasting less than a minute in order to achieve a successful outcome in conjunction with
traditional wound care protocols.

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Laser Therapy for Chronic and Deep Conditions

Avian conditions requiring higher target dosages of 8-10 J/cm2 are the deep or chronic disorders. Deep acute
conditions that require a few treatment sessions include fractures, sprains and acute coelomic distension. In ad-
dition, less obvious conditions that benefit from the anti-inflammatory effects of laser therapy include ingluvitis
and respiratory disease. Many chronic conditions that plague the avian practice can benefit from the higher tar-
get dosages with multiple laser sessions include chronic feather picking, self-mutilation, advanced bumblefoot,
arthritic gout and osteoarthritis, in addition to the usual therapeutic protocols. Often these conditions are more
successfully treated with several sessions at relatively lower target dosages compared to other species.

Safety Precautions and Contraindications

As with any form of medical therapy, there are certain safety precautions and contraindications that must be
observed. Due to the near infrared wavelength of the Class IV lasers, protective eyewear must be worn which
are calibrated to the proper laser frequency in order to prevent significant retinal damage. Everyone in the room,
including the patient, must have their eyes protected when the laser is in use, since there is risk of retinal dam-
age from direct exposure to the beam as well as reflective scatter of the laser light. The birds eyes are protected
simply by covering the eyes with a dark cloth or towel. Overheating of the skin and feathers is a potential risk
from improper operator technique by not keeping the probe in motion during the laser session. Contraindications
to laser therapy include treatment over cancerous sites or reproductive organs and active hemorrhaging. Precau-
tions and careful consideration should be used when utilizing laser therapy with concurrent use of photosensitive
medications, such as tetracycline or griseofulvin.

Summary

Photobiomodulation provides a wide range of beneficial effects by reducing pain, reducing inflammation and
healing of damaged tissues. Laser therapy is recently becoming routine in many veterinary practices, as well as
in sports medicine, orthopedics and physical therapy centers on the human side of medicine. Likewise, avian
medicine should embrace this therapy to expedite the healing process of our patients while reducing their pain
and inflammation.

References

1. Anders JJ, Lanzafame RJ, Arany PR. Low-level light/laser therapy versus photobiomodulation therapy.
Photomed Laser Surg. 2015;33:183-184. doi: 10.1089/pho.2015.98 48.

2. Hamblin MR, Demidova TN. Mechanisms of low level light therapy. Proc Int Soc Optics Photonics.
2006;6140. doi:10.1117/12.646294.

3. Peplow PV, Chung TY, Baxter GD. Application of low level laser technologies for pain relief and wound
healing: overview of scientific bases.Phys Ther.2010;15(4):253-285.

4. Karu TI. Molecular mechanism of the therapeutic effect of low-intensity laser radiation. Laser Life Sci.
1988;2(1):53-74.

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5. Bjordal JM. Low Level Laser Therapy (LLLT) and World Association for Laser Therapy (WALT) dosage
recommendations. PhotomedLaserSurg. 2012 Feb;30(2):61-2.

6. Pryor, BA. Class IV Laser Therapy. Intervention and case reports confirm positive therapeutic outcomes in
multiple clinical indications. LiteCure, LLC. 2009. http://www.udel.edu/PT/PT%20Clinical%20Services/
journalclub/caserounds/11-12/September/PryorLaserPromotional.pdf. Accessed July 13, 2015.

214 Building Exotics Excellence: One City, One Conference


Section 9

AAV Master Classes


Track 2
Physical Examination and Diagnostic
Testing of Aquatic Animals
Mike Corcoran, DVM, CertAqV

Session #263

Affiliation: From the VCA Wakefield Animal Hospital, 19 Main St, Wakefield, MA 01880, USA.

Abstract: Doing a physical examination on a fish or other aquatic animal has many similarities to other
animals. A systematic approach should be used consistently to ensure that a thorough physical examination
is performed. The approach can be head to toe, by organ system, or whatever else works best for the
individual practitioner to ensure consistency. Learning normal from abnormal is important, just as in any
other animals. Generally, aquatic animals are bilaterally symmetric. Any asymmetry should be reason
for further investigation. A basic knowledge of anatomy and physiology of the animals being examined
is important for interpretation of any abnormalities.

With aquatic animals, the differences in physical examination are the need to sedate the animal more
often for handling and the presence of gills rather than lungs. Sedation and examination of gills will be
covered in this section to highlight the important points. Also covered will be important aspects of different
portions of anatomy with regard to examination.

The Fish Patient

The physical examination should ideally start with observation of the fish in the pond or aquarium. Look for
any abnormal movement when swimming, erratic behavior, abnormal buoyancy or body position in the water.
Observe to see if the fish is flashing (extending a portion of the body out of the water) or rubbing against rocks
or substrate.

The oral cavity is easily visualized in most fish, especially with sedation. Ulcerative lesions, rostral abrasions,
swelling or redness should be reason for further investigation. In most fish, the oral cavity should provide clear
visualization to the inside of the operculum and the gills. If there is foreign material or a mass that prevents
visualization deep into the oral cavity then this could affect respiration. Many fish do have teeth, and evaluation
of the teeth can provide important clues to health. For example, pufferfish have teeth that continuously erupt, and
elongation of the teeth can interfere with normal prehension of food leading to nutritional deficiencies.

The eyes of fish also provide important clues to the health of the animal. Most ophthalmic abnormalities seen in
other animals can be detected in fish. Corneal ulcers (as well as loss of slime coat on the body) can be detected
with fluorescein stains.1 Uveitis or exophthalmos can be indicators of systemic bacterial or viral infections.
The eyes are also one of the most common sites for presentation of neoplasia in the fish based on the authors
experience, though this is likely due to the ease of observation by the owner. Air bubbles will often be detected
in the anterior chamber of the eye in cases of gas supersaturation.

Gills are observed by manually opening the operculum. This will often require sedation. It should also be noted
that some species of fish have very sharp edges to the operculum and the clinician could sustain an injury if not
appropriately cautious. In general the gills should be pink to red (similar to mammalian gums), but there can be
wide variation between species. The gills should also appear to flow freely. The author thinks of the appearance

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of long grass in the wind. Pale areas, especially if not symmetric, should be investigated as should any apparent
thickening of the gills. While examining the gills grossly, a gill biopsy sample should be obtained (discussed
later in the section).

Fins should have clear edges without any frayed areas. They are a common site for bacterial or fungal infec-
tions. Frayed areas could be due to trauma with or without secondary infection. Hair-like lesions, thickened
areas or discolored spots should be investigated. Leading rays should stand erect and feel firm unless swimming
or maneuvering.

Scales should be easily distinguished and should generally be flush to the body. The condition of skin and
scales also provides valuable information with regard to fish health. Sepsis will often cause flushing of the
scales and prominent vascularization, especially on the ventrum. Scales sticking out from the surface of the
skin (pineconing) is an indication of ascites, coelomic masses or thickened skin. Abrasions, missing scales,
dull coloration or increased thickness of the slime coat can be indications of either trauma or external parasites.
Some external parasites can be easily visualized on physical examination. Look caudal to fins or any other
areas that would provide refuge from the water flow of a forward swimming fish. While examining the skin and
scales, a skin scraping should be taken from almost all fish as part of a standard examination. This is slightly
different from a skin scrape on other animals and will be discussed later in the section.

The vent should also be observed for any swelling, redness or other abnormalities. Look for feces or portions
of internal parasites extending from the vent. Often a fecal sample can be obtained easily once a fish is sedated.

Procedures

Skin scraping is an effective way to evaluate the health of the slime coat and look for external parasites. Plastic
cover slips work best for the scraping. Angle the cover slip, drag from front to rear along the lateral line, ventrum
and behind the pectoral fins. Place the cover slip on a microscope slide using sterile saline solution of a drop of
water from the fishs enclosure. Look at the slide within 5-10 minutes for the best chance at finding parasites.

Gill biopsies allow for evaluation of the health of the gills and checking for external parasites that affect the
gills. Iris scissors or small suture scissors work best. With the scissors, cut a small (1-3mm) area from the tip of
the gill. Place the gill biopsy on a slide with sterile saline or water from the enclosure and cover with a cover
slip. Evaluate the slide within 10 minutes. The gill should have thin lamellae and minimal thickening from other
cells. There should be no gas bubbles within the blood vessels.

For both gill biopsies and skin scrapings, the textbooks listed in the references contain photos of normal and
abnormal samples for comparison.

Blood samples can be obtained for chemistries, complete blood count or disease testing. The most common sites
are the ventral tail vein and the heart. The ventral tail vein can be accessed from a ventral or lateral approach.
The ventral approach is recommended for show fish as phlebotomy sites can lose scales or have color changes
that affect appearance. These changes are less noticeable on the ventral surface.

Aspirates of fluids or solid masses and incisional or excisional biopsies of masses can be obtained similar to
procedures used in any other animals.

Radiographs and ultrasound imaging are both useful diagnostic tools for fish and other aquatic animals. Radio-
graphs can be taken on a sedated fish briefly out of the water or with the fish in a small container of water. Con-

218 Building Exotics Excellence: One City, One Conference


trast can be given orally for better evaluation of the GI tract or IV to evaluate vascular structures or the urinary
system. Ultrasound can be done directly in the water without the need for any transducer gel. If the ultrasound
unit does not have a battery supply it is wise to wrap the transducer in an equine palpation sleeve for safety.
Transducer gel can be used inside the sleeve.

Endoscopy can be useful in many species of fish. Anesthesia is required for most endoscopic procedures.

Anesthesia and Medication

Sedation and anesthesia are commonly needed for procedures or even physical examination in fish. Medica-
tions can be injected, given orally or administered through the water. Based on the authors experience, the most
common, easily administered and safest anesthesia medication for general use is MS-222 (Tricaine S, Western
Chemical, Ferndale WA, www.wchemical.com). Dosing ranges from 50-150 mg/L in water. It should be com-
bined with an equal weight of sodium bicarbonate due to the pH unless the water already has a high hardness.
Once the fish is submersed in the solution, stage 2 anesthesia is obtained in 5-15 minutes. Reversal is normally
in a similar time frame once removed from the solution. Tolerance between species varies, so when working
with a new species or a debilitated fish it is best to start at a lower dose and gradually increase as needed. There
have also been recent studies looking at the safety and efficacy of propofol and alfaxalone as immersion agents
for fish, but further research is needed for them to be recommended for valuable fish.

Medications can be given by injection, per os or as a medicated bath. Sites for IM injections include pectoral
muscles and the paravertebral muscles adjacent to the dorsal fin. Oral medications can be administered by oral
feeding tube or with medicated food in a gel diet. Medicated baths are made by placing medication into the pond
or aquarium for a prolonged immersion or into a medicated tank for a short bath depending on the need. More
information can be obtained in references listed with this article.

In addition to antibiotics, anti-parasitics and other medications, dont forget pain medication. Just like any other
animals, fish can feel pain and will heal better when pain control is addressed.

The Importance of Water Quality Testing in Aquatic Animal Health

Proper water quality is essential for maintaining healthy aquatic animals. This is true of fish, coral, invertebrates,
turtles and amphibians. In most cases these animals live in the same water where they eat, drink and eliminate
waste. Animals in captivity have the added challenge of living in a far smaller volume of water than their
counterparts in the wild. Its very important that their caretakers understand how to test the water and respond
to any abnormal parameters. This article explains why its important to test several different water quality val-
ues and how they affect each other. The reader shouldnt need to relearn past chemistry class notes to get an
adequate understanding.

All systems should regularly be tested for pH, temperature, ammonia, nitrites, nitrates and alkalinity. Additional
tests may be important depending on different species being held or special circumstances.

Testing methods

A wide range of water testing kits are available ranging from a few dollars to thousands of dollars in cost. In
general, you get what you pay for with water quality testing kits. At the less expensive end of the spectrum are

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dip strip type kits. A plastic strip is dipped into the water and pads on the strip change color to indicate levels.
Few of these are adequate as more than a basic screening tool even for a casual hobbyist. The next step up is
what is called colorimetric kits. Drops of chemicals are added to a small volume of water in a test tube and a
color change is used to determine test results. For the average hobbyist these are usually adequate and can be
obtained for about $30 in a kit that will give 50-100 tests. The important factor with these kits is watching the
expiration date on the chemicals. These kits are available from American Pharmaceuticals, Red Sea, Sea Chem,
Instant Ocean and other manufacturers.

For the professional level aquarist and the veterinarian its far more appropriate to get more expensive and ac-
curate kits. There are some colorimetric kits that have greater accuracy. Manufacturers like Hach and LaMotte
offer kits with improved accuracy at a reasonable price. The same companies offer digital monitoring devices
that should be utilized for some species that require special care or filtration.

The big three: Nitrogen cycle

The foundation of water quality is what is called the nitrogen cycle (Fig 1). This is monitored by testing ammo-
nia, nitrites and nitrates. Waste produced by aquatic animals is not put nicely in the yard to await scooping; it is
deposited into the water in which they feed and swim. The nitrogen cycle is a natural mechanism for removing
this waste. Organic material (feces, uneaten food, dead fish, etc.) decomposes to form ammonia. In the water,
bacteria convert the ammonia to nitrites, then other bacteria converts the nitrites into nitrates. The nitrates are
removed from the water by plants, water changes or they are broken down by other bacteria into nitrogen which
is then released into the air as a gas. All three of the compounds can be harmful to living animals, so having the
bacteria of the nitrogen cycle well established in an aquarium is important for good water quality and aquatic
animal health.

If any of these parameters are above the normal range, it means that there is too much waste being produced
relative to the level of bacteria in the biologic filter. Steps must be taken to identify and correct the underlying
problem. The most common causes are having too many animals in a system, overfeeding or improperly prepar-
ing the tank prior to placing animals in the system. Properly preparing a tank for animals requires special steps
to cycle the biological filtration over several weeks prior to animals being placed into the tank.

There are also some animals that produce more ammonia than others and usually require better filtration. Lionfish,
octopi, sharks, rays, reptiles and amphibians are good examples. If biological filtration parameters are elevated
on a system with these animals, it may be due to inadequate filtration. Certain medications and chemicals can
also kill the bacteria in a biological filter, along with drastic changes in pH or temperature.

220 Building Exotics Excellence: One City, One Conference


Organic
waste

Ammonia

Nitrites

Nitrates

Nitrogen

Figure 1. Nitrogen cycle.

Temperature, pH, and alkalinity

Temperature, pH and alkalinity are important to observe closely because they are important on their own, and
because they affect the nitrogen cycle.

The normal values for these parameters will depend on what species of animals are being kept. Knowing the
normal values for specific animals is an important part of maintaining good health. Listing normal values for all
animals kept as pets are beyond the scope of this article, but it is important to evaluate a number of sources and
check the reliability of information. In addition to knowing the normal values, an understanding of the effect
on the biological filtration and the animal is valuable in avoiding problems in a system.

Temperature: Temperature is important for most animals kept in aquariums because most are poikilothermic or
endothermic. Each species has its own specific temperature. Temperatures that are too cold or too high for the
animal being kept will at the least cause stress, and at the worst could be fatal. As the temperature of the water
rises, the amount of oxygen that can be dissolved in the water decreases (Fig 2). This becomes very important
for systems that contain tropical fish as an example. A warm water system requires good water circulation and
disruption of the waters surface to make sure that air is continually dissolved in the water. If the water becomes
too stagnant because of a power failure, the fish in the system could suffocate.

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Dissolved
Oxygen

Water
temperature
(pH, salinity)

Figure 2. Water temperature and dissolved oxygen relationship.

pH: Some animals require a very specific tight maintenance of pH while others are more tolerant of fluctuations.
Even animals that are tolerant of a wider range of pH do better with less fluctuation. Depending on the animal,
it may be better to maintain a steady pH that is out of the normal range for that species than deal with fluctua-
tions by using chemicals to try to maintain the normal range and having wide fluctuations in the process. Rapid
shifts in pH can be harmful or fatal to most animals.

The pH also affects the nitrogen cycle. With increasing pH, ammonia also changes to a form that is more toxic to
the animals in the system. Most water testing kits measure total ammonia. Measuring total ammonia and pH, the
amount of ionized ammonia (ammonium) versus the more toxic unionized form (ammonia) can be determined
to help assess the risk to the inhabitants of the system. If necessary, pH can be shifted to aid in the treatment of
animals affected by adverse water quality.

Alkalinity: Alkalinity is a measure of elements in the water that help to act as a pH buffer. This is one of the
most often overlooked parameters outside of professional aquariums, but one of the most important to maintain.
The tests measure bicarbonate and carbonate, which act to help keep the pH in balance. If alkalinity is low, the
system is in danger of experiencing rapid changes that can lead to the deaths of the animals in the system (Old
tank syndrome). In addition to rapid serious changes, low alkalinity can allow shifts in pH daily that will lead
to chronic stress for the animals in the system. Low alkalinity can usually be corrected by adding a source of
calcium carbonate, such as crushed oyster shells or coral. If dangerously low, it can be corrected in the short
term by adding baking soda (sodium bicarbonate), but this should be done very carefully under the guidance of
someone very experienced with water quality maintenance.

Additional tests

Salinity: This is a measure of the salt content in a system. For marine aquariums, this should be considered part
of the standard regular testing. When water from a salt water tank evaporates, the salt stays behind. Replac-
ing the evaporated water should correct for this. Water changes also need to be done with water of the correct
salinity to avoid fluctuations. The range needed depends on the species of fish or coral in the tank. Measuring
salinity can be done with a refractometer or a hydrometer. A refractometer needs to be calibrated with distilled
water frequently to ensure accuracy. Failure to frequently calibrate is the most common cause of errors with
refractometers. Hydrometers are calibrated to a specific temperature of water, and this often does not match the
aquarium water temperature. The calibration can be changed at the time of purchase by an experienced aquarist.
Aquariums of different temperatures will require different hydrometers to match the calibration.

222 Building Exotics Excellence: One City, One Conference


Dissolved oxygen: For systems that have salt water fish, large volumes of water, poor circulation or high pH fresh
water fish, monitoring dissolved oxygen can be important. This test measures the amount of oxygen that is in
the water available for the fish to breathe. Systems with high salinity, high temperature or high pH are especially
vulnerable to problems with lower oxygen levels that could stress the fish in the system. Low dissolved oxygen
can be corrected by agitation of the waters surface or by the addition of air stones to the aquarium or pond.

Supersaturation: In contrast to low oxygen levels, supersaturation of gasses can occur in systems that have a
filtration system leak or rapid pressure changes to the water in the filtration system. Supersaturation of gasses
can lead to illness in fish similar to decompression sickness in human scuba divers.

Total hardness: Total hardness is a measure of different elements in the water, usually calcium and magnesium.
Many species of fish require specific hardness. Research into the animals that will be kept should tell if this is
an important parameter to monitor. Low Total hardness can be corrected by the addition of limestone or various
calcium salts.

Calcium, magnesium and other trace elements: Keeping some animals (particularly corals) may require moni-
toring various trace elements and keeping them in specific ranges for optimal growth. Specifics of these tests
are advanced and beyond the scope of this article other than to recommend some research into requirements for
coral prior to incorporating them into a reef system. See the related article on the website for more information
on coral water quality.

Copper: If evaluating disease (or keeping) sharks, rays or other copper sensitive fish, then it may be wise to
monitor copper levels. A very sensitive kit is required for copper levels in aquariums or ponds. The kit should
be capable of accurate readings between 0.05 and 0.2ppm. Copper should also be monitored closely when there
is a concern for metal toxicity or using copper as a therapeutic treatment for parasites.

Phosphates: A common concern for hobbyists is excessive algae in an aquarium. Often this is secondary to high
phosphate levels providing good nutrients for algae.

Common Medical Conditions in Fish (the very condensed version)

Common medical conditions in fish include water-quality related and non-water-quality related. These condi-
tions have been summarized in various publications.1-8

Water-quality related

Ammonia toxicity: (aka new tank syndrome): This condition is also known as new tank syndrome due to its preva-
lence with new hobbyists who fail to establish a proper biological filter in an aquarium. It can also occur with
improper maintenance, overfeeding, overstocking or death of the bacteria in the biological filter from excessive
cleaning or addition of antibiotic medication. It can present as a chronic stressor leading to immunosuppression
and opportunistic infections, or as an acute toxicity resulting in sudden death of multiple fish.

For acute toxicity, lowering the temperature of the water and performing a 50% water change can be a life-
saving procedure. The pH can also be adjusted downwards, but more slowly. Activated carbon can help remove
the excessive ammonia. Correction of the underlying problem and re-establishing a proper biological filter is
necessary for long term health.

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pH crash: This condition is also known as old tank syndrome. If poor alkalinity is maintained, the pH of the system
can fall very rapidly, resulting in severe stress and often high mortality. This is typically a chronic water quality
problem that has an acute presentation when it reaches a critical point. Buffers need to be added to the system
to raise the pH to a safe level for any surviving fish and ensure stability of the pH. This is one of the only situa-
tions where a water change can be extremely harmful, so it should be ruled out prior to a massive water change.

Nitrite toxicity: This condition is also known as brown blood disease. Elevated nitrite levels in the aquarium
can result in the conversion of hemoglobin to methemoglobin, resulting in poor oxygen carrying capacity and
suffocation. Gills can appear brown on gross examination, but toxic levels of methemoglobin can occur without
this change.

Hypoxia: Low oxygen concentration should be considered with sudden stress, particularly in salt water aquari-
ums with a pump failure or ponds with excessive algae. In outdoor ponds, the fish will often be stressed or there
will be mortality in the morning and they may improve during the day. Algae produce oxygen by photosynthesis
during the day, but utilize oxygen for energy in periods of darkness, resulting in low oxygen concentration.

Fish may also be seen near the water surface gulping (piping) and may congregate near waterfalls or other areas
of surface agitation.

Supersaturation: This condition is also known as gas bubble disease and is similar to decompression sickness
(the bends) in scuba divers. Leaks in pipes or cavitation in pumps can dissolve excessive amounts of gas in the
water. When exposed to this excessive dissolved gas, the gas may come out of saturation in the fish and form gas.
Gas bubbles may be seen in the anterior chamber of the eye, under the skin or may be detected on a gill biopsy.
Agitating the water and adding air stones can help remove the excess dissolved gasses. Thorough inspection of
the filtration system should be initiated. Some investigation has been started into improvised dive chambers
for individual fish affected.

Non-water-quality related

Ectoparasites: Many different ectoparasites affect fish. This is one of the most common disease conditions di-
agnosed that is not a water quality concern (though often related to water quality). Diagnosis is generally easy
with physical examination, skin scrape in gill cytology. Treatment varies with the parasite and the animal, but
is frequently accomplished by water-based medications.

Endoparasites: These parasites also are common in fish (as in other animals). Frequently a fecal sample can be
obtained with close observation of a fish being sedated. In some species of fish, the parasite may be visualized
extending from the vent on physical examination. Care must be taken distinguishing internal parasites from nor-
mal water inhabitants when examining a stool sample. Treatment usually requires oral or injectable medication.

Reproductive disease: This can be very common in koi and some other species of fish. Just like other species, it
can be related to husbandry, infection, neoplasia, stress, etc. Depending on the cause, medical or surgical treat-
ment options can be pursued.

Neoplasia: Need I say more? Fish get cancer, too. One of the more common encountered is peri-ocular neoplasia
in goldfish. These masses are easily debulked and there can be an extended time regrowth of the mass and an
improvement in the quality of life for the fish.

Ascites: This condition is also known as dropsy or pineconing. Dropsy is a general laymans term for bloating,
pineconing refers to the appearance of a fish that has the distal ends of the scales extending outward from the
body. The workup for ascites is very similar to other animals, as are the differential diagnoses.

224 Building Exotics Excellence: One City, One Conference


Obesity: Obesity is one of the most common diseases of fish (and most other pets!). Although obesity is almost
never the presenting complaint, it can be an underlying cause of other conditions and needs to be addressed for
overall health. The overfeeding that leads to obesity is also a common cause of water quality concerns.

Buoyancy disorders: Swim bladder disease and buoyancy disorders are common in many species of fish. Dif-
ferent conditions can result in either negative or positive buoyancy. The approach to these cases, differential
diagnoses, diagnostic and treatment options could easily occupy more than a master class on their own, so further
discussion is unrealistic for this paper.

Viral, bacterial and fungal diseases: Many viral diseases are well documented in fish, and again beyond the
scope of this paper, but the veterinarian should be aware of the possibility of viral diseases of significance in
practice. Frequently bacterial infections are opportunistic and gram negative. External fungal infections are
common as opportunistic concerns as well.

Nutritional disease: In addition to obesity, vitamin deficiencies, improper food storage, etc. For many species,
full nutritional requirements are not yet known.

Trauma: Trauma can occur from cage mate aggression, predators (outdoor ponds), breeding behavior, falling
aquarium decorations, etc.

Burns: Burns can occur from submerged heaters and other electrical equipment.

References

1. Noga EJ. Fish Disease: Diagnosis and Treatment. 2nd ed. Ames, IA:Blackwell Publishing;2010.

2. Roberts HE. Fundamentals or Ornamental Fish Medicine. Ames, IA:Blackwell Publishing; 2010.

3. Saint-Erne N. Advanced Koi Care for Veterinarians and Professional Koi Keepers. Phoenix AZ: Erne
Enterprises;2002.

4. Williams DL. The Fish Eye. In: Ophthalmology of Exotic Pets. West Sussex UK:Wiley Black-
well;2012:211-227

5. Carpenter JW. Fish In: Exotic Animal Formulary. 4th ed. St. Louis, MO:Elsevier Press;2013.

6. Braitwaite V. Do Fish Feel Pain? Oxford, UK:Oxford University Press;2010.

7. Minter LJ, Bailey KM, Harms CA, et al. The efficacy of alfaxalone for immersion anesthesia in koi carp
(Cyprinus carpio). Vet Anaesth Analg. 2014;41(4):398-405.

8. Kanani HG, Ahadizadeh S. Use of propofol as an anesthetic and its efficacy on some hematological values
of ornamental fish Carassius auratus. Springerplus. 2013;2:76.

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Dealing with Parrot Intelligence and Cognitive
Abilities in Daily Practice
Jan Hooimeijer, DVM CPBC

Session #170A

Affiliation: Consultancy Practice for Birds, Galgenkampsweg 4 7942 HD Meppel, The Netherlands.

Abstract: It is important to acknowledge and to deal with the intelligence and cognitive abilities of parrots
to prevent behavior problems. Ignoring the negative effects of human body language and human attitude is
another reason for behavior problems. A 5-step protocol is presented as a tool to show respect for parrots
as intelligent prey animals, to reward desired behavior, to reduce the stress of handling and create mutual
trust. Definitions concerning normal behavior, unwanted behavior, desired behavior, enforced behavior,
and displacement behavior are described as tools to understand parrot behavior. Using displacement
behavior is described as a method to deal with parrots showing behavior problems. Wing clipping can
make it possible to offer parrots more freedom as companion birds, become part of the family flock inside,
and benefit outside from the social interaction, exercise, sun, and fresh air. The disadvantages of having
a parrot on the shoulder are discussed.

Reprinted from Annual Conference of the Association of Avian Veterinarians, New Orleans, 2014.

Introduction

In general, there is still a lack of awareness that parrots are non-domesticated prey animals being kept in captivity
as highly intelligent animals with remarkable cognitive abilities. Without understanding normal behavior and
underestimating the high intelligence and cognitive abilities of parrots, a wide variety of behavioral problems
are apt to occur, depending upon the individual parrot, species, and circumstances surrounding the bird.

Behavior

Behavior in nature is based on innate behavior and founded on learning, experience, intelligence and cognitive
abilities. Behavior is driven by the urge to survive as an individual and as a species.

Dealing with parrots in captivity, we need to understand that the behavior of parrots is determined by different
factors, including heredity. To understand behavior, we have to understand and learn about the principles of ethol-
ogy. Looking through the eyes of parrots, we have to consider that our body language and attitude determines
the body language and behavior of parrots.

Parrots are built and behave as prey animals

Parrots are prey animals in nature. The fear of being killed as a prey animal determines a major part of normal
behavior in nature. Fear of getting killed as prey animals can also be expected as normal behavior within captivity.

A typical anatomic feature of parrots as prey animals is the position of their eyes. The eyes of parrots are posi-
tioned at the side of their head, enabling parrots to observe the whole environment.

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The eyes of predators are positioned in a way that enables the animals to watch straightforward using binocular
vision. The eyes of humans are positioned in the same way as predators like dogs, cats, owls, and birds of prey.
When a parrot looks at a human who is talking and smiling at the parrot and showing their teeth, the parrot may
be intimidated by a perceived predator.

Dealing with parrots without understanding the consequences of the specific characteristics of parrots as prey
animals may contribute to a parrots insecure/defensive behavior.

Parrots are intelligent birds with amazing cognitive abilities

Learning more about the intelligence and cognitive abilities of parrots, we can conclude that parrots do under-
stand our meaning, posture, and attitude. Parrots learn by observing other birds, other animals, and humans as
part of their environment. Parrots draw their conclusions and behave accordingly. Dealing with parrots is like
dealing with children that are eager to show and demonstrate what they have learned. The Model/Rival tech-
nique, described by Pepperberg, is acknowledging the intelligence and observational learning skills of parrots.

Allowing myself as author some anthropomorphism: From the viewpoint of parrots, it must be frustrating to
experience not to be appreciated for their intelligence and talents but to be considered as just beautiful, funny,
and cute.

Definitions that are used within the Consultancy Practice for Birds to define different categories
of behavior.

Normal behavior: Normal behavior is species/individual specific behaviour that is not meant to manipulate the
caretaker. Examples are eating, drinking, grooming, playing, sitting in the cage, sitting on the hand. It is the
experience of the author that the outcome of rewarding normal behavior is that the bird will develop behavior
to manipulate the caretaker to get attention. That behavior can be considered undesired behavior.

Unwanted/undesired behavior: Unwanted/undesired behaviour is behavior that is meant to manipulate the behavior
of the caretaker. This may include screaming, talking, biting, feather picking. Showing fear, frustration, anger,
concerns, and laughter will be considered as a response and thereby as a reward. Showing to have a problem
will make the bird become insecure and reason to develop unwanted behavior.

The outcome of rewarding unwanted behavior is obvious.

Wanted/desired behavior: The definition, used within the Clinic for Birds, for wanted behavior is behavior that
is created/manipulated by the caretaker. It is behavior that the caretaker would like to see repeated in the future.
Wanted behavior is not behavior that is the result of a command or a request. Wanted behavior is also not the
behavior the bird is showing to get a treat.

Rewarding wanted behavior, including rewarding their intelligence, is showing respect for the bird and will
create self-esteem and mutual respect and prevent unwanted behavior.1

Enforced behavior: Enforced behavior is the result of a command, any kind of force or behavior motivated by
a treat or food. Enforced behavior is also behavior out of fear for punishment.

Displacement behavior: Tinbergen,2,3 as one of the founders of ethology, has described displacement behavior
in gulls showing territorial behavior. Instead of a fight-or-flight response, the gulls started to preen themselves,
started to pull at grass as if they were collecting materials to improve the nest, and showed looking-away behavior.

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In a conflict situation in nature as well as in captivity, parrots have the choice between a fight response or a flight
response. Displacement behavior can be considered as the ultimate alternative behavior when a fight-or-flight
response is not the best choice or even impossible. Displacement behavior seems to be completely out of order
but is having the effect that the other parrot or the human caretaker becomes distracted and a new situation is
created. Typical examples of displacement behavior are nail biting, itchy behavior, grooming behavior, flapping
the wings, shaking the tail, shaking the head, looking at the sky with one eye, and being funny. Grooming and
preening have been associated with normal behavior that birds perform when the birds are comfortable. These
can also be displacement behavior that the bird shows in a conflict situation.4 When we are responding to this
behavior in a way that we are rewarding displacement behavior, we can expect that this behavior that is normal
behavior in a conflict situation becomes unwanted behavior.

Dealing with parrots, we can expect to see displacement behavior in different conflict situations. The most com-
mon conflict situation is when parrots as prey animals are approached by humans in an intimidating manner.
Caretakers and veterinarians do not realize that humans show the typical characteristics of a raptor with their
eyes in the front of their face, just like dogs, cats, owls and other birds of prey.1 We can also observe displace-
ment behavior of parrots that are inside or upside their cage showing territorial behavior.

Under those circumstances, it is important to know how an avian species analyzes and combines its perceptual
experiences to understand what is happening in the surrounding world.5

There are reasons to hypothesize that parrots utilize extensive information processing, that is at least to some
degree, they do not simply react mindlessly to environmental stimuli, but actually process the stimuli and choose
to react in a certain ways.6

When displacement behavior is not recognized or not understood and caretakers are responding to displacement
behavior in a way that is considered as rewarding, displacement behavior can easily result in abnormal repetitive
behavior without the primary trigger that was causing the conflict situation.in the beginning.7 It can be one of the
explanations when we are dealing with complex behavioral problems like feather destructive behavior. It can be
assumed that the type of displacement behavior has a genetic component and that the type of displacement may
differ between species accordingly. It can also help explain why some species are more prone to feather destruc-
tive behavior.8 It can be postulated that the way displacement behavior is expressed will also be influenced by
environmental factors and observational learning ability of the parrots. Because of that, it has been argued that
hand feeding baby parrots is contraindicated because birds needs to learn by observing normal behavior of their
parents, including normal displacement behavior in conflict situations.9

How to deal with displacement behavior

First of all, it is important to recognize and acknowledge displacement behavior and to consider that the parrot is
showing to be in a conflict situation. Any direct response to the bird at that moment can be considered a reward
and can create maladaptive behavior. By showing displacement behavior as caretaker and veterinarian, we are
interrupting the conflict situation.

5-step behavioral protocol dealing with and manipulating a parrot

The most important aspect of dealing with parrots is the attitude of the person or persons caring for the parrot. A
basic protocol for veterinarians and caregivers of parrots can be summarized in 5 steps. This protocol can also
be used with any parrot showing any behavior problem.

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Step 1: Convince the parrot that you have no negative intentions by showing a posture and nonintimidating body
language, acknowledging the fact that parrots are prey animals. Make the bird observe without being the center
of attention. Show that you are comfortable, that you dont have a problem with anything, and be happy in your
situation. In a way, be a positive role model. Show that without any interaction with the parrot; dont even look
at the bird. Be sure you will have all the attention of the bird when you are doing your stuff. Be silly, playing
with a toy, throwing a little ball against the ceiling, or whatever. Parrots feel comfortable with people who are
comfortable with parrots and with themselves. Your interaction around the parrot will tell him all about you. It
means that people often have to act and play a role around the parrot. What we create by doing so is wanted/
desired behavior.

Step 2: Reward the behavior that has been manipulated by our attitude performing step 1. You have created a
reason to tell the parrot that its the most beautiful creature on this planet and how precious the bird is to you.

Step 3: Establish yourself as the best teacher the parrot can wish for. Show respect for his intelligence by sharing,
in detail, what there is to see around it, ie, birds in the trees, toys on the table, colors, shapes, sizes, objects.
You can also describe the color of the tail or beak. Parrots truly enjoy observing and learning. Reward the bird
for his intelligence in a nonintimidating way.

Step 4: Allow the bird to touch your pen, toy, paper, or towel and praise the bird enthusiastically. Only let them
touch items when you say it is okay. When they reach out for anything, just take it away without a word and
present it later after telling that now its okay to touch or even bite into the item. Then, they are, in general, very
gentle touching with their tongue. Ask the bird to participate in the learning process by offering it new, small,
unthreatening objects. Tell the bird that it may to touch and feel the objects and allow it to investigate. Praise
each positive move. You also can present your hand and tell the bird that it may step up and praise the bird for
doing so. (This is the opposite of giving a command or making the bird step up to get a treat.)

Step 5: Show the parrot that accepting new situations is okay because there are reasons to trust you under the
circumstances that you have created. When the parrot shows fear, do not reassure the bird. Reassuring the bird
can easily create more fear and insecurity. It is the authors experience that after steps 14, mutual respect and
trust have been established. When the parrot fears a place or object like the towel, be understanding and start
over with step 1 of the protocol. Soon it will learn that there is no reason for fear. Then, tell it how smart and
wonderful it is. This will help to stimulate the self-esteem all parrots need to develop normal parrot behavior.
The goal is to create a situation in which a parrot can accept novel situations. It can be an examination, taking
blood, grooming, wing clipping, gently towelling, and so on.1,10

Dealing with behavior problems of parrots

Dealing with behavior problems is looking for a diagnosis.9 It is important to consider the circumstances and to
understand the reason for the behavior and its consequences. In general, unwanted behavior of parrots in captiv-
ity can be considered as behavior that started as normal behavior under unnatural circumstances. Dealing with
unwanted behavior, we have to consider that unwanted behavior will become more and more a problem when
the consequence of that behavior is experienced by the parrot as a reward. Any response whether positive,
negative, emotional, and even subconscious to the (unwanted) behavior can be considered a reward for the
(undesired) behavior.

Preventing unwanted behavior

Prevention of unwanted behavior requires understanding the background of unwanted behavior, looking at the
circumstances, the consequences, the natural behavior, and body language of parrots as social, intelligent prey

230 Building Exotics Excellence: One City, One Conference


animals. Prevention of unwanted behavior involves ensuring their health and welfare by making sure that they
benefit from certified organic pelleted food, sunlight, fresh air, and exercise. Prevention of unwanted behavior
is encouraged by creating an enriched environment in which the parrot is allowed to express its intelligence
and skills; providing toys and food in a way that it is stimulating parrots to express normal foraging behavior.
Preventing unwanted behavior is enabled with social interactions with other birds, other animals and humans.
Taking a bird outside for a walk, a bike ride, a picnic, or a family visit will prevent unwanted behavior. Pre-
venting unwanted behavior also includes understanding that the cage of a bird can be considered by the birds
as their nesting site. In nature, birds spend their time during the day and night at the same location when they
are breeding as part of their reproductive cycle. At their nesting site, the bird will be insecure with interlopers
and express the need to defend that position and show territorial behavior. To prevent unwanted behavior, the
advice is to create a more natural day-night routine in which the bird gets 10-12 hours of sleep in a special small
sleeping cage located in another room of the house, away from the location the bird spends the daylight hours.
Birds in nature do not sleep at night where they spend their daytime hours, foraging or drinking. Preventing
unwanted behavior is about understanding that birds prefer to sit in a high position when the birds is insecure.
For that reason, sitting on the owners shoulder is not encouraged.

Redirecting unwanted behavior, displacement behavior.

We have to consider that every response to unwanted behavior can be perceived as a reward.

Instead of responding to the behavior of the parrot and instead of ignoring the behavior, the advice is to act in a
way that there is no problem with the demonstration of displacement behavior.

Part of the displacement is looking away and demonstrating behavior showing to have no problem. The result
of demonstrating displacement behavior is that insecurity and aggression disappears.

Over the years, the author has observed this behavior both as a birdwatcher in nature and as an avian veterinar-
ian dealing with parrots in captivity. In a situation of unwanted behavior, step 1 of the 5-step behaviour protocol
can be considered as showing displacement behavior, creating wanted behavior that can be rewarded in
step 2. Using this protocol in this order, unwanted behavior is not rewarded. Having the bird watch us when we
are not looking at the bird, acknowledging and rewarding their intelligence and rewarding the behavior with touch-
ing, feeling and even biting a specific object can all be done within 30 seconds. Using this protocol, unwanted
behavior is redirected into wanted behavior and the bird is rewarded for that.

Wing Clipping

In the wild, flying is essential for the survival of parrots, with the typical exception of the kakapo (Strigops
habroptilus). Flying enables parrots to find food, water, and a safe place to sleep. Flying is a way to escape from
predators; flying in flocks also offers protection from predators. For parrots in captivity that are kept as com-
panion birds, flying is no longer essential for their survival. Within the Consultation Practice for Birds, clipping

can be recommended for safety reasons but is mainly recommended because it makes it possible to provide the
parrot more freedom and social interactions both inside the house and during the daily outside activities with
the caretaker; the bird has a wider range to become more a part of the family (flock). In the experience of the
author, wing clipping done with a parrot-friendly attitude helps prevent behavior problems and prevents parrots
from ending up in parrot rescue facilities.

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Hand-Rearing of Baby Parrots

Basically, the necessity for hand-rearing baby parrots in the past was the result of management failures concern-
ing housing, nutrition, and care complemented with a lack of knowledge about the natural breeding behavior
of parrots. Over the years, hand-rearing baby parrots became a commercial activity because females produced
more eggs.

The Dutch Parrot Foundation, supported by the Clinic for Birds has been successfully campaigning in the Neth-
erlands against the hand-rearing of baby parrots and the trade in unweaned baby parrots.

The result is that after July 1, 2014, it is not allowed to separate a baby parrot from the parents until the baby
parrot is able to eat completely on its own. The new legislation is putting parrots on the existing list with dogs,
cats, rabbits, chimpanzees, and other species for which separating youngsters from the parents was already
regulated for many years.

The new regulation is based on the data that has become available during the past 15 years showing the negative
consequences of separating baby parrots from their parents. A range of behavioral problems and welfare issues
have been recognized as consequences of separating youngsters from the parents. As described in other animals,
separating youngsters before or during the first imprinting phase can lead to irreversible behavior problems.

Data are showing that, as described in other animals, separating youngsters before or during the important first
imprinting phase can lead to irreversible behavioral problems. Some of the behavioral problems can occur after
months or even after years, especially when the birds become hormonally active. Insecure behavior, biting be-
havior, feather picking, and self mutilating can become serious consequences of separating a baby parrot from
its parents.11,12

Conclusions

We have to learn from parrots what they already know by looking through the eyes of parrots.

Parrots are some of the most charismatic, intelligent, and social animals on the planet, having a very high life
expectance when we are doing a good job. Consider and acknowledge parrots as prey animals. By adjusting our
body language, we show respect for parrots instead of showing an intimidating posture, creating insecure and
defensive behavior. By showing respect for their social skills and intelligence, we show respect for parrots. The
natural learning process is by observing the behavior and skills of their parents, other members of the flock, and
humans. Never outwardly show you have a problem because that will make the bird insecure and create behavior
problems. Parrots sense when we have a problem, and insecure behavior becomes obvious.

Using the 5-step behavior protocol is creating a relationship based on mutual trust and respect.

It is vital to reward wanted behavior. It is vital to reward the intelligence and acknowledge the cognitive abilities
in parrots. It is vital not to reward normal behavior. It is vital not to reward unwanted behavior. It is important
to recognize displacement behavior and to use displacement behavior when we are in a conflict situation.

Taking care of the health, welfare, well-being, and conservation of parrots in the world is our primary respon-
sibility as avian veterinarians. Parrots are honest and show whether you are doing a good job just as children show
whether their teacher is doing a good job. In that way, parrots have become my best teachers because they correct
me when Im wrong. Im grateful for the parrots in my life because they force me to be a better avian veterinarian.

232 Building Exotics Excellence: One City, One Conference


If Not Us, Who? If Not Now, When?

Acknowledgments: I would like to thank Harrisons Bird Foods, The Netherlands for sponsoring the parrot
events in the Netherlands. Finally, I thank the staff of the Consultancy Practice for Birds for their support and
understanding. Without them, nothing could have been accomplished over the years.

This paper is based on Hooimeijer J. Welfare and behavior in parrots. Proceedings AAV 2013 Jacksonville
pp 289-297.

References

1. Hooimeijer J. Dealing with behavior problems of parrots. Proc DVG Meeting, Munich, Germany. March 2008.

2. Tinbergen N. Spieden en speuren in de vrije natuur. Amsterdam, The Netherlands; Uitgeverij Ploegsma; 1959.

3. Tinbergen N., Curious Naturalists. London Country Life 1958

4. Sprijt BM, van Hooff JARAM, Gispen WH. Ethology and neurobiology of grooming behavior. Physiol
Tev. 1992;72:825.

5. Zucca P. Mind of the avian patient: cognition and welfare. Proc of the 9th European AAV Conference,
Zurich. 2007; 357-365.

6. Pepperberg IM. The African grey: how cognitive processing might affect allospecific vocal learning. In:
Balda RP, Pepperberg IM, Kamil AC, eds. Animal Cognition in Nature; 1998.

7. Garner JP. Perseveration and stereotype-systems-level insights from clinical psychology. In: Rushen J.
Mason G. eds. Stereotypic Animal Behavior; Fundamentals and Applications to Welfare. Wallingford,
England, UK: CABI; 2006:121-152.

8. Seibert LM. Feather-picking disorder in pet birds. In: Luescher AU, ed Manual of Parrot Behavior. Oxford,
England: Blackwell Publishing; 2006:255-265.

9. Orosz S. Diagnostic workup of suspected behavioral problems. In: Luescher AU, ed. Manual of Parrot
Behavior. Oxford, England: Blackwell Publishing; 2006:233-245.

10. Hooimeijer J. A practical behavioural protocol for dealing with parrots. Proc Assoc Avian Vet, 2003:177- 181.

11. Engebretson M. The welfare and suitability of parrots as companion animals: a review. Anim Welf.
2006;15:263-276.

12. Schmidt R. The influence of the breeding method on the behaviour of adult African grey parrots. Inauguural
Dissertation zur Erlangung der Doktorwurde der Vetsuisse-Falkultat der Universitat Bern. 2004.

For additional references, contact info@vogeladvies.nl

ExoticsCon 2015 Main Conference Proceedings 233


Cognition in Grey Parrots: Reasoning by Inference
in Studies on Exclusion
Irene M. Pepperberg, PhD,
Adrienne Koepke,
Paige Livingston,
Monique Girard,
Leigh Ann Hartsfield

Session #170B

Affiliation: Department of Psychology, Harvard University, William James Hall, 33 Kirkland St, Cambridge,
MA 02138, USA.

Abstract: Grey parrots (Psittacus erithacus) abilities for visual inferential reasoning by exclusion were
tested in 2 experiments. The first replicated the grey parrot study performed in an Austrian Zoo, which
in turn replicated that of Premack and Premack with apes. Here parrots watched an experimenter hide
2 equally desirable foods under 2 separate, opaque cups, surreptitiously remove and then, in view of
the birds, pocket/eat 1 of the foods, leaving birds to find the still baited cup. The experiment contained
controls for various alternative explanations for the birds behavior, but birds might still have avoided a
cup from which something had been removed rather than specifically tracking the eaten food. Thus, in
the second experiment, some trials were run with 1 food slightly more preferred than the other, during
which 2 items of each type were hidden and only 1 of the items were removed from 1 cup. Sessions also
included Experiment 1-type trials to see if birds tracked when and when not to use exclusion. Thus birds
would be rewarded for attending closely to all the experimental aspects needed to infer how to receive
their preferred treat. Three of 4 birds succeeded fully.

Reprinted from Annual Conference of the Association of Avian Veterinarians, New Orleans, 2014.

Introduction

For over 35 years, I have used a modeling technique (the model/rival or M/R procedure) to train grey parrots to
use an allospecific code (English speech) referentially, and then employed the code to test their cognitive abili-
ties.1 Some studies, however, have been performed without the use of a vocal response, and 1 such study is the
basis of the current talk. This study also used 2 companion animals in addition to my laboratory-based subjects.
I specifically decided to present this study at the Association of Avian Veterinarians conference in order to dem-
onstrate the intelligence of the typical grey parrot to show the inherent competence of these creatures, that
extensive training is not prerequisite for such behavior, and to engender respect for these birds by their owners.

Several recent studies of comparative avian cognitive competence have focused on reasoning by exclusion; that
is, the ability to base a decision on the exclusion of potential alternatives. As is true for most cognitive abilities,
exclusion likely involves several levels of competence, and many experiments conflate the different levels.2 For
example, at the simplest level, exclusion merely involves avoidance. A subject, given A and B, with significant
experience or training in picking A when told take a but for whom B is novel, is asked to take b. The subject
generally picks B, not necessarily because of any inferential reasoning that b is related to B, but because it
does know not to choose A in the absence of a that is, to avoid choosing A in the absence of the appropriate
cue. However, in all these studies, full understanding of the relationship between b and B strong inference

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by exclusion is slower to develop. In most cases, if the subject, soon after choosing B, is then given B, C,
and D, where C and D are novel, and is again asked to take b, the level of correct response is not always above
chance,3-5 and a correct response could be a consequence of choosing the least novel item. Likewise, if B and C
both novel have recently both been chosen by exclusion in separate trials, and are then pitted against each
other in additional trials, subjects also respond mostly at chance.6 Furthermore, extension of the targeted term b
to anything other than the exact novel object B (ie, to other B-like items) that is, generalization usually takes
considerably longer to develop.7

Recently, the concept of exclusion has been extensively tested in the nonlinguistic arena in birds, involving tasks
such as searching for food under 1 of 2 hiding sites after being shown that the other is empty; a few of these have
involved parrots (keas, Nestor notabilis;8 grey parrots, Psittacus erithacus9,10). In many cases, the results were
exquisitely dependent upon the details of the experimental design and possibly upon the history of the subjects.
For example, grey parrots could respond to auditory clues as to whether a closed container was full or empty, but
only when the container was shaken horizontally, not vertically.10 Notably, some subjects in exclusion studies
seemed to have initial difficulties in tracking hidden objects (eg, being distracted by local enhancement in which
they attend to the last site touched by the experimentor) and, in other cases, subjects could responding in a way
that did not require a full understanding of exclusion (ie, simply avoiding the place where they saw something
disappear). Quite likely, differing results may also occur because of individual differences in the subjects involved
(usually a small number), somewhat different experiences in living/rearing conditions for the various species, or
somewhat different task constraints. We examined some of these possibilities.

Given that grey parrots seem to have some sensitivity to exclusion in the linguistic sense11 and that at least 1
grey parrot exhibited an understanding of physical exclusion in a study that tightly controlled for issues such as
avoidance and simple associational learning,9 we decided to repeat the latter study in our laboratory with grey
parrots that have had considerable experience with tracking hidden objects12,13 and symbolic representation1,14
to see if they would also pass the tests (Experiment 1), and, if so, then expand the testing to learn more about
what they understand about the concept of exclusion (Experiment 2). We also tested 2 grey parrots that were
pet birds but lived with humans who had formerly been trainers in our laboratory and who could be relied upon
to carry out trials the same way as in the laboratory. The pet birds had never been formally tested for tracking
hidden objects but were given daily foraging tasks, involving the discovery of treats hidden in various ways.
Given that these 4 birds were reared in, and now live in, completely different conditions from the zoo-based grey
parrots previously tested,9 that 2 are pets and 2 live in a laboratory, our findings in Experiment 1 would examine
the extent to which reasoning by exclusion is widespread among grey parrots. Experiment 2 was designed to test
exactly what grey parrots remembered and understood about the conditions of the task.

Experiment 1

Here we repeated the Austrian study,9 which required grey parrots to exhibit a fairly advanced level of inferential
reasoning by exclusion; we also repeated part of another study1 to test for local enhancement. We adapted the
procedures as described below. As in the very first paper to study exclusion in nonhumans, specifically apes,2
we hid 2 equally desirable items under 2 opaque cups; subsequently, the parrots were allowed to witness an
experimenter eat 1 of the items that had been removed secretly (invisible condition) or removed in full view
(visible condition), or watched an experimenter simply handle an object identical to 1 that was hidden (associa-
tion control). They were then allowed to choose 1 cup. Our predictions were that, like one of the grey parrots in
the Austrian study,9 our birds would successfully reason by exclusion.

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Subjects

The 4 birds tested were Griffin (male, 16 yr old, Pepperberg lab); Arthur (male, 13 yr old, Pepperberg lab);
Pepper (female, 15 yr old, Hartsfield home); Franco (male, 10 yr old, a rescue, then in Hartsfield home for
3 yr). The Pepperberg birds had had considerable laboratory training and testing in various areas, including that
involving the use of referential speech; the Hartsfield birds had had no formal laboratory training or testing, but
had exposure to training, not testing, in referential speech.

Materials

The apparatus consisted of same-sized plastic cups of differing colors, placed on a tray, equidistant from each
other and from the parrots beak. The use of differently colored cups, a departure from the Austrian study,9 was
intentional: distinguishing identical cups relies on spatial memory (ie, for left vs right position), which was not
what the experiment was intended to test.2 Rewards consisted of equally desirable small treats (bits of differ-
ently colored jelly beans) not available outside of sessions; birds had shown no preference for particular colors
or flavors of the beans used in previous experiments, and the colors of the beans and cups differed so that the
birds could not associate cups and beans.

Procedure

We conducted several controls before initiating formal testing. We first conducted controls (this time using nuts,
a somewhat healthier treat than the jelly beans) to see if humans might be cuing the birds to choose the appropri-
ate cup via head, eye, or body position, although earlier studies had already demonstrated that grey parrots do not
use human cues in choice experiments unless the cues are deliberate and obvious.1 Specifically, parrots did not
previously respond to human gaze direction when objects on a tray were closely spaced (< 5 cm) and the human
head was about 30 cm away from the tray, which was also the case here. We next tested for olfactory cuing, using
the jelly beans. In both sets of controls, a treat was placed under 1 cup on the tray while out of sight from the bird;
the tray with both cups was then presented to the bird with the experimenter looking directly between the two cups;
the bird was then allowed to choose. Placement of the treat and cup color was randomized from trial to trial, using
random.org. All 4 birds were completely random in their choices; we thus initiated formal testing.

Tests consisted of both visible and invisible hiding conditions. Although we performed statistics on the tasks inde-
pendently, trials were intermixed so that birds never knew what type of session they would receive. The order
of conditions was randomized. Both sessions began with the placement of a bird in his/her respective position.
Out of sight from the bird, the experimenter placed 2 beans in front of the 2 cups. She then turned to the bird and
placed the tray in front of the bird. Right-left placement of the differently colored cups and beans were random-
ized amongst the trials, again using random.org. In both conditions, the experimenter initially called the bird by
name, telling the bird to Look or Pay attention as she covered both beans simultaneously. Sometimes, if the
birds attention seemed to be wandering, she simultaneously uncovered and then recovered the beans. Sessions
of 2 or 3 trials for each bird, sometimes separated by several days, were conducted per condition until 30 trials
total were completed for each condition for each bird.

In the visible condition, in full view of the subjects, the experimenter lifted 1 cup, manipulated the bean, returned the
cup, lifted the other cup, manipulated the bean, and returned the cup. The control manipulation (for local enhance-
ment) consisted of taking the bean, showing it to the bird, putting it back on the tray, covering it, and showing an
empty hand after returning the cup. The test manipulation consisted of taking the bean, showing it to the bird and
eating it or putting it in her pocket before returning the cup. The right-left order of manipulations was randomized
as was placement of the beans, and no bean type was removed more than 3 times in a row (random.org). Afterward,
the bird was allowed to make a choice. The bird received the reward for a correct choice, and was shown the empty
space under the cup if an error was made.

ExoticsCon 2015 Main Conference Proceedings 237


The invisible condition was identical to the visible condition with the exception that after covering the beans with
the cups, the experimenter turned away with the tray, removed a bean out of sight of the bird, turned back, and, in
obvious sight of the bird, then either put the bean in her pocket and showed the bird an empty hand or ate the bean.
Invisible trials effectively controlled for local enhancement that is, picking, in error, the cup that had been handled
in that the cups and tray were out of sight while the treat was removed, but we decided to run separate tests on the
Brandeis birds as an additional control. For Griffin and Arthur, we thus intermixed 30 visible trials in which we did
not handle both cups equally, but rather only handled the cup from which the bean was removed. Had Griffin and/or
Arthur shown an effect of local enhancement, we would also have tested Pepper and Franco (see below).

Intermixed with formal testing trials, association control trials were performed to test if birds had developed the
rule, always choose the cup with the food type not having been shown. Here, the experimenter visibly placed the
2 different beans on the tray, covered them with the cups, and then took in full view of the subject 1 jelly bean
(of the same type as one of the beans being hidden) out of her pocket, showed it to the bird and put it back in her pocket
or ate it. Afterward, the bird was allowed to choose. Thirty trials were intermixed with visible and invisible trials.

To ensure that we were not overinterpreting the birds actions, we checked for interobserver reliability. In the lab, a
second individual independently viewed all trials and noted the birds choices. Observations were compared. A
small percentage of trials (10%) were videotaped for additional reliability checks in the absence of data sheets
by someone (IMP) who had not watched the trials. In the Hartsfield home, where an independent observer was
not always available, 24 trials (12 for each bird for each experiment) were videotaped, digitized, and sent to the
lab for identical interobserver reliability tests.

Results

Data for each bird was processed separately, because we wished to see if they differed with respect to age, sex,
and rearing conditions.

All 4 birds succeeded on the visible task. Statistics were binomial tests, chance of . Griffins score was 24/30
(p < 0.01), Arthurs was 21/30 (p = 0.02), Peppers was 23/30 (p < 0.01), and Francos was 21/30 (p = 0.02). Learn-
ing was not involved as birds made no more mistakes on the first versus the last half of the tests: Using Fishers
exact test, two-tailed, for Griffin, p = 1.0, for Arthur, p = 1.0, for Pepper, p = 1.0, and for Franco, p = 0.43. All birds
were correct on their very first trials. Griffin was correct on all his first 5 trials, Pepper and Franco on 4 of first 5 trials,
and Arthur on 3 of his first 5 trials.

All 4 birds also succeeded on the invisible tasks. We again used binomial tests, chance of . Griffins score was
26/30 (p < 0.01), Arthurs was 24/30 (p < 0.01), Peppers was 20/30 (p = 0.05), and Francos was 25/30 (p < 0.01).
Arthur and Franco were correct on all 5 of their first 5 trials; Griffin and Pepper were correct on 4 of their first
5 trials, Griffin missing only the first trial, Pepper the fourth. Pepper was also correct on the very first trial, but because
she made 10 errors, we checked to see if her performance differed between the first and last 15 trials (ie, if learning
was involved), but found no difference: 10/15 correct for each half.

On the association tests, birds demonstrated that seeing a trainer simply handle a particular treat did not cause
them to choose that treat. All birds chose at chance, that is, chose, for example, orange at the about same rate
when either orange or purple were displayed, and vice versa (Fisher exact test, two-tailed).

On tests for local enhancement, Griffin was slightly less accurate, with a correct score of 21/30, but still statistically
significant (p = 0.02, binomial test, chance of ); Arthur was slightly more accurate, with a score of 23/30

238 Building Exotics Excellence: One City, One Conference


(p < 0.01, binomial, chance ). Griffin made essentially the same number of errors in the first half as the second
(5 vs 4) but did err on his first 3 trials. Arthur also divided his errors essentially equally (3 vs 4) but was correct on
his first trial and 4 of his first 5 trials. We thus felt justified in not testing the Hartsfield birds on this particular task.

Notably, birds never dithered and made all choices deliberately. No disagreement occurred on any trial between
on-site observers as to which cup a bird had chosen in the lab. For the videotaped trials, the independent observer
agreed with the original scorers on 100% of the trials.

Discussion

All of our birds succeeded on all tasks, in contrast to the Austrian study,9 in which only 3 birds of 8 succeeded
on the visible task and only 1 succeeded on the invisible task. The major difference in our study was that we
used 2 differently colored cups so that the birds did not have to remember a spatial cue (left-right), but could use
cup color instead. Color per se was not a cue, however, as it was randomized on every trial, and did not lessen
the need to respond based on inferential reasoning. Although the data did indeed suggest that grey parrots can
reason by exclusion, we were still concerned, however, that birds might simply be avoiding the cup from which
a reward had been removed. Thus, we performed Experiment 2.

Experiment 2

Here, we wanted to determine exactly what the birds knew about what was under each cup. Although Experi-
ment 1 (association control trials) ensured that birds were not simply going to the cup that represented the food
that had not been handled, might birds conceivably have focused on the lack of removal of an object in these
controls, not on a specific object? Would a bird be willing to return to a cup from which a favored reward was
partially removed, in contrast to a cup that held something to which they were indifferent? Success on these so-
called favorite trials would show that the birds were truly focusing on what was under each cup, and, when
intermixed with additional Experiment 1 trials, provide another control that their visible and invisible trials were
indeed based on inference. Our main goal, however, was to test whether the birds knew when to use and when
not to use inference by exclusion to solve the problem.

Subjects

The same 4 birds were used.

Materials

The same cups were used, but now we needed to use 2 foods differing somewhat in desirability. Both Brandeis
and Hartsfield birds consistently choose jelly beans over their standard chow when given a choice outside of
testing. Thus beans and chow were contrasted. The number of correct trials would be the number in which the
bird chose the favored food.

Procedure

The Favorite trials, both invisible and visible, were interspersed with standard visible and invisible trials
from Experiment 1, to test if birds could switch between types of trials; the one exception was Arthur, whose
standard trials were all invisible. The reason was that Arthur still had several invisible standard trials to perform

ExoticsCon 2015 Main Conference Proceedings 239


for Experiment 1; for the other birds, these trials were in addition to those of Experiment 1. Griffin and Arthur
began with a visible Favorite trial, but Pepper and Franco with an invisible Favorite trial, to see if order affected
behavior and if the latter pair could succeed on the most challenging problem immediately. The contrast was
feasible, given that both sets of birds had performed at comparable levels in Experiment 1.

In all Favorite trials, birds saw 2 beans placed under 1 cup and 2 pieces of chow under another. As in Experiment
1, the experimenter removed either 1 piece of chow or a bean, invisibly or visibly, and then birds were allowed
to choose; 17 trials were visible and 13 invisible. (NB: We intended to perform 15 trials in each condition, but
the student forming the test schedule interchanged two trials.) Would birds attend to both the identity and the
number of treats and their placement? In all cases, the birds could get at least 1 bean if they realized that 1 or
both beans had been left under the cups. These trials thus were an additional control for the possibility that the
birds had learned to avoid the cup containing what the experimenter had recently eaten, but only when they
remembered that multiple items had been stored.

Results

Again, each birds results were considered independently.

All 4 birds succeeded on the trials, but some differences were apparent. On Favorite trials, Griffin succeeded on
13/17 visible trials (p = 0.02) and 12/13 invisible trials (p < 0.01). He succeeded on his first trial in each task. On
visible Favorite trials, he made more errors on the first than on the second half of his trials but recovered accuracy
quite rapidly: The difference between halves was not statistically significant (Fishers Exact test, two-tailed). For
intermixed Experiment 1-type trials, he was correct on 8/10 (p = 0.05). On Favorite trials, Arthur succeeded on
14/17 visible trials (p < 0.01) and 12/13 invisible trials (p < 0.01), he didnt differ in number of errors in first versus
second half trials. He also succeeded on his first trial in each task. For Experiment 1 trials, he was correct on 8/10
invisible trials (p = 0.05). On Favorite trials, Pepper succeeded in 14/17 visible trials (p < 0.01) and 10/13 invis-
ible trials (p = 0.05). No differences existed in her first versus second half trials. She was correct on her very first
invisible trial and on 5/5 of her first visible trials. For intermixed Experiment 1-type trials, she was correct on 9/10
(p = 0.01), erring on 1 visible trial. On Favorite trials, Franco similarly succeeded on 13/17 visible trials (p = 0.02)
and 12/13 invisible trials (p < 0.01). In each task, he failed on his first trial but succeeded on his next 4 of 5 trials.
He made a few more mistakes in his first than in his second half of trials, but, as with Griffin, differences were not
statistically significant; thus he also recovered quickly. Again, like Griffin, he made only a single error on invisible
trials. Unlike the other birds, however, in intermixed Experiment 1-type trials, he was correct on only 6/10 (p =
0.38), erring on 2 visible and 2 invisible trials, and thus his score was below statistical significance.

Discussion

All 4 birds succeeded on the Favorite trials, visible or invisible, demonstrating that they did not simply avoid a cup
from which something had been removed. Three birds (Griffin, Arthur, Pepper) also appeared to be able to switch
between experimental conditions, that is, to understand something about when to use or to ignore exclusion. Even
if we choose to eliminate Arthur because all his standard trials were invisible (a task on which he was slightly more
accurate than visible trials, though not at a statistically significant level, p = 0.55, Fisher Exact Test, two-tailed), 2 of
3 birds understood when to ignore versus use exclusion.

240 Building Exotics Excellence: One City, One Conference


Francos failure to switch between tasks may, however, have a particularly interesting explanation. Quite possibly,
his failures were not failures per se, but actually involved exploratory or boredom behavior. We note that such
an issue is not uncommon in intelligent birds. Evidence exists that keas17 and large-billed crows18 will, after
succeeding on various tasks, often later employ other, less successful or simply different methods, possibly from
boredom or maybe to find other possible solutions (exploratory behavior); we also have observed what appeared
to be boredom in our studies with grey parrots.19,20

The take-home message is that grey parrots are capable of solving fairly complex, inferential tasks, and that con-
siderable training and testing in a laboratory situation is not a prerequisite for these abilities. We do note, however,
that the companion (pet) parrots used in this study live in an exceptionally enriched environment, with many
foraging toys and chew toys, almost constant human companionship, and some training (although no testing) in
use of referential speech. We suggest that an enriched environment will enable not only grey parrots, but likely all
companion birds, to develop to their full potential.

This paper is based on: Pepperberg, IM, Koepke, A, Livingston, P, Girard, M, & Hartsfield, LA. Reasoning by in-
ference: Further studies on exclusion in Grey parrots (Psittacus erithacus). J Comp Psychol., 2013;127:272-281.

References

1. Pepperberg IM. The Alex Studies. Cambridge, MA: Harvard; 1999.

2. Hill A, Collier-Baker E, Suddendorf T. Inferential reasoning by exclusion in great apes, lesser apes, and
spider monkeys. J Comp Psych. 2011;125:91-103.

3. Dixon, L.S. (1977). The nature of control by spoken words over visual stimulus selection. J Exp Anal Behav.
1977:27:433-442.

4. Kastak D, Schusterman RJ. Transfer of visual identity matching-to-sample in two California sea lions
(Zalophus californianus). Anim Learn Behav. 1994;22:427-435.

5. Aust U, Range F, Steurer M, Huber L. Inferential reasoning by exclusion in pigeons, dogs, and humans.
Anim Cog. 2008;11:587-597.

6. Griebel U, Oller DK. Vocabulary learning in a Yorkshire terrier: Slow mapping of spoken words. PLoS
ONE. 2012;7:e30182. doi:10.1371/journal.pone.0030182.

7. Schusterman RJ, Krieger K. California sea lions are capable of semantic comprehension. Psychol Rec.
1984;34:323.

8. Schloegl C, Dierks A, Gajdon GK, et al. What you see is what you get? Exclusion performances in ravens
and keas. PLoS One. 2009;4:e6368.

9. Mikolasch S, Kotrschal K, Schloegl C.African grey parrots (Psittacus erithacus) use inference by exclusion to
find hidden food. Biol Lett. 2011;7:875-877.

10. Schloegl C, Schmidt J, Boeckle M, et al. Grey parrots use inferential reasoning based on acoustic cues
alone. Proc Roy Soc B: Biol Sci. 2012;279:4135-4142.

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11. Pepperberg IM, Wilcox SE. Evidence for a form of mutual exclusivity during label acquisition by Grey
parrots (Psittacus erithacus)? J Comp Psychol. 2000;114:219-231.

12. Pepperberg IM, Willner MR, Gravitz LB. Development of Piagetian object permanence in a Grey parrot
(Psittacus erithacus). J Comp Psychol. 1997;111:63-75.

13. Pron F, John M, Sapowicz S, Bovet D, Pepperberg IM. A study of sharing and reciprocity in Grey parrots
(Psittacus erithacus). Anim Cog. 2013;16:197-210.

14. Pepperberg IM, Wilkes SR. Lack of referential vocal learning from LCD video by Grey parrots (Psittacus
erithacus). Interact Stud. 2004;5:75-97.

15. Mikolasch S, Kotrschal K, Schloegl C. Is caching the key to exclusion in corvids? The case of carrion crows
(Corvus corone corone). Anim Cog. 2012;15:73-82.

16. Premack D, Premack AJ. Levels of causal understanding in chimpanzees and children. Cognition.
1994;50:347-362.

17. Gajdon GK, Amann L, Huber L. Keas rely on social information in a tool use task but abandon it in favor
of overt exploration. Interact Stud. 2011;12:304-323.

18. Izawa IE, Watanabe S. Observational learning in the large-billed crow (Corvus macrorhynchos): effect of
demonstrator-observer dominance relationship. Interact Stud. 2011;12:281-303.

19. Pepperberg IM, Carey S. Grey Parrot number acquisition: the inference of cardinal value from ordinal
position on the numeral list. Cognition. 2012;125:219-232.

20. Pepperberg IM, Gordon JD. Numerical comprehension by a Grey Parrot (Psittacus erithacus), including a
zero-like concept. J Comp Psychol. 2005;119:197-209.

242 Building Exotics Excellence: One City, One Conference


Juvenile Raptor Medicine
Heather Wilson Barron, DVM, DABVP (Avian), and
Michelle Hawkins, VMD, DABVP (Avian)

Session #072

Affiliation: From the Clinic for the Rehabilitation of Wildlife, 3883 Sanibel-Captiva Rd, Sanibel, FL 33957,
USA (Barron) and the Department of Medicine and Epidemiology, School of Veterinary Medicine, 2108
Tupper Hall, University of CA, Davis, Davis, CA 95616, USA (Hawkins).

Abstract: This 2-hour master class reviews juvenile raptor medicine and rehabilitation. Scope covers
everything from egg incubation to release; including renesting, behavioral considerations, nutrition,
frequent diseases, emergent care, and varying release practices. Critical care of juveniles, with a specific
focus on fluid therapy, blood and plasma transfusions, treatment of metabolic derangements, and intensive
supportive measures are included. Management practices span information useful to the private falconry
practitioner, wildlife hospital, or zoologic collection.

Adapted in part from Raptor Medicine, Rehabilitation and Management Different Approaches for the
Best Release Proc N Am Vet Conf. 2015.

Renesting and Hand Raising

Many juvenile raptors admitted as orphans to veterinarians are actually abducted away from healthy parents.
Eggs may also be submitted, for example after a nest has fallen from a tree that has been recently trimmed.
Many eggs brought to the California Raptor Center are Northern Harriers that are found in agricultural fields,
but great horned owls and barn owls are also often presented. The primary goal is to return the egg or chick to
its natural environment, but if the original nest has been destroyed or is in harms way like on a farm thats
not an option. If thats the case, rehabilitators often attempt to place the egg or chick in the nest of another bird
of the same species. But it is important not to jeopardize one bird to save another, so first it must be determined if
the nest can accommodate an extra mouth to feed. If it cannot, the egg or chick will be placed in the nursery. Its
important that eggs are placed in an incubator as soon as theyre found. To stay viable, eggs must be incubated
at approximately 99.8 degrees Fahrenheit until hatched and rotated regularly.

Good Samaritans should be instructed that if a bird nest has fallen out of a tree, but the young or eggs inside the
nest appear healthy, to replace the nest as high in the tree as can be reached. If this is not possible, have them
consider placing the nest in nearby bushes or even nailing it to the side of the tree in an area where the young
will have some shade and shelter from the elements. If the nest itself is missing or damaged, an artificial nest
can be created. With nestling raptors, both parents are generally caretakers. However, both may be away from
the nest, depending on the species of raptor, for the purposes of hunting to feed the nestlings. Nestling rap-
tors are altricial and lack remiges or flight feathers. They are not yet able to perch and should be placed back
into the nest if possible. If adults are still caring for clutch mates, a fallen neonate can be put back no matter
how long it has been out of nest. However, with some species, you may need to be aware of the potential for
siblicide. A nestling raptor is often out of a nest because it has been pushed out by a stronger sibling. When
young birds leave the nest, they are fledglings and have feathers covering their bodies. They leave the nest
for short periods of time to hop along the branches (known as branching) and often fall out of trees. Advise
concerned members of the public that they may watch from a distance to see if the bird can get out of harms

ExoticsCon 2015 Main Conference Proceedings 243


way by itself and if the adult birds continue to care for the young bird. Usually adults will come down to feed
the fledglings, who will fly on their own in a few days. Young should be reunited with their parents or fostered
to the same species in order to have the best chance of survival as adults in the wild.

One of the most important reasons to try to immediately return eggs and hatchlings to their natural environ-
ment is to avoid having birds imprint on humans or other species. Young raptors undergo important periods
of filial and sexual imprinting and parents often provide varying levels of support for young long past fledging.
Some birds are more susceptible to human imprinting than others. Gray owls, for example, are more likely to
imprint than barn or screech owls. Imprinting can occur from both sound or sight, and it is irreversible. Birds
that imprint on humans cant survive in the wild, and should not be released. Many nursery caretakers use pup-
pets and wear masks when feeding and handling the hatchlings to minimize this human interaction. Imprinted
birds dont have the instinct to breed and cant instinctually care for hatchlings, but they can play a surrogate
role in captivity by teaching young birds how to feed while allowing them to imprint on their own species. Ap-
proximately 7-10 days after hatching, the ambient temperature is lowered from 98 degrees to the mid-to-upper
80s. After feathering, the bird can be cared for at room temperature. After a few weeks, many species of birds
can be moved outside and placed with other birds of their own kind so they can naturally imprint and begin to
learn behavior skills. Avoidance of imprinting on humans ensures the greatest probability for long term survival.

Juvenile Raptor Nutrition

Working with avian wildlife can present a number of challenges and chief among these is providing adequate
nutrition. The first step in surmounting this difficulty is in correctly identifying the species and having adequate
knowledge of the wild-type diet the animal would normally consume. A replacement diet can often be devised
that will meet the immediate energy needs of the patient. Providing inappropriate food items may result in an-
orexia, gastrointestinal, or metabolic disturbances. Furthermore, young wild raptors often present in a state of
severe cachexia, which puts them at additional risk for metabolic imbalances with refeeding syndrome.

Determining nutritional needs always starts with a thorough assessment of the patients condition. Birds that
are cold and dehydrated may have more emergent considerations than caloric needs. Electrolyte imbalances
and circulatory volume must be restored in order for the gastrointestinal system to be able to properly process
food. Interestingly, in the authors experience, hypoglycemia is usually not a concern in raptors unless they are
bacteremic or very near death. One study demonstrated that buzzards (Buteo buteo) subjected to a prolonged
fast maintained blood glucose levels within normal limits until near the end of a 13-day fast when a progressive
hyperglycemia was documented.1 So providing high sugar supplements to young raptors on intake may be con-
traindicated in the absence of documented hypoglycemia. Further, owls are considered glucose intolerant, in part
because of low hepatic glucokinase activity and an inadequate suppression of gluconeogenesis in the presence
of exogenous glucose, apparently because they evolved with large excesses of amino acids and limited glucose
in their normal diet.2 Critically ill birds are often in a hypermetabolic state and may become acidemic or suffer
other metabolic derangements even more quickly than an otherwise health bird that is simply denied sustenance.
Be advised that in one study with seabirds, 4 handheld blood glucose monitors underestimated blood glucose
levels by 33% in comparison with laboratory values.3 So low blood glucose values determined by handheld
glucometers in birds should possibly be viewed with some skepticism.

Many raptors presented for medical care are injured and are frequently suffering from distributive (ie, pain,
septic) or hypovolemic (ie, hemorrhagic) shock. Feeding a bird suffering from ileus due to shock or electrolyte
imbalances may result in enterotoxemia as the food decomposes in the gut. Enteral feeding may need to be
delayed for 612 hours in smaller/younger raptors or 1224 hours in larger/older birds to allow for rehydration,

244 Building Exotics Excellence: One City, One Conference


warming, and initial stabilization of the patient. An elemental diet, composed of easily digestible amino acids,
is going to be more easily assimilated by the digestive tracts of most debilitated patients.

As the patient becomes more stabilized, the species of bird as well as the presenting medical complaint may be
taken into consideration when planning the next phase of nutritional support. Enteral feeding at this point may
progress to critical care diets with more complex protein, fiber, or fat content as appropriate. Initially it may be
desired to feed smaller volumes more frequently to prevent regurgitation and possible aspiration in the severely
debilitated bird. However, the stress of handling wild birds encourages the necessity of feeding larger volumes
less frequently as soon as the patient appears ready. Gavage feeding should always be the last treatment ad-
ministered and then the patient is returned immediately to the cage to decrease stress-associated regurgitation.

Transition to whole, solid foods should be gradual. Small pieces of food items may be offered and consumption
may be encouraged by offering via forceps or force-feeding. At this point, daily gross intake should be estimated
to make sure an adequate amount of food is offered. Typically large raptors, like eagles, will eat 8%10% of
their own body weight a day in prey items; medium raptors, like red-tailed hawks 15%20%; and small raptors,
like kestrels, up to 30%. A general rule for debilitated raptors is to feed approximately 250 kcal/kg/day to meet
the hypermetabolic needs associated with injury, stress, and illness.4 Slicing open the prey items so that organs
are exposed will often encourage eating in wild birds that are used to eating freshly killed prey. Removal of
integument and large bones is recommended early in the transition to solid food. Raptors, especially piscivorous
raptors, fed whole prey items that are frozen then thawed may be supplemented with a daily vitamin supplement,
which should include an appropriate amount of vitamin B1 (thiamine). Thiaminases are enzymes found in the
raw flesh and viscera of certain fish and shellfish. When ingested these enzymes split thiamine, an important
compound in energy metabolism, and render it inactive. When feeding young raptors or eyas, start with rodent,
chick, or fish (as appropriate for the species) supplemented with vitamin/calcium powder. Remove skin, scales,
tail, teeth, and pulverize the bones for hatchlings. Deficiencies may develop in just a few days if given only or-
gan meat; metabolic bone disease is a common condition in juveniles that are fed inappropriately. Initially feed
every 2 hours throughout the day and then gradually reduce to twice a day. Newborn hatchlings are commonly
fed five times a day. Most species will stop eating when they are full. If examining a young raptor species with
a crop, a bulge in that region will be noticeable.

Properly monitoring the patient as the feeding regimen progresses is the key to success. Monitor body weight
first thing every morning before any food or treatments are given. Note attitude and appetite in the chart. A subtle
change in appetite or regurgitation in a patient that has been previously progressing well is often the first sign
of complications. Young raptors will begin to cast (regurgitate indigestible prey parts) around the time that pin
feathers are emerging. Note casts and droppings and remember that owls usually cast after every meal whereas
hawks generally have more than one meal per pellet. Monitor body condition score and avoid overconditioning
as too much weight may inhibit proper weaning and flight conditioning.

Ulcerative Pododermatitis

The etiology of ulcerative pododermatitis (or bumblefoot) is multi-factorial, but conditions leading to poor cir-
culation or decreased epidermal health are often the core issue. Predisposing factors to consider include obesity,
inactivity, malnutrition, cold ambient temperature, trauma, poor perching, wet or dirty substrate, etc. Therefore,
treatment necessarily involves identifying the underlying problem and correcting it. Keep in mind the species of
bird and the prognosis for full return of foot function when diagnosing the disease and formulating a treatment
plan. Raptors often develop pododermatitis in the hospital and it can happen very quickly, particularly in juveniles
that hock sit for a large part of the day. Therefore, the plantar surface of the feet and hocks should be examined

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daily in all hospitalized birds, particularly the ones that are bearing weight abnormally or the heavy-bodied ones.
Preventative measures are key in rehabilitation facilities and this disease is more easily prevented than treated.
Because pressure necrosis is often a contributing factor, redistributing the way the bird bears weight may help
in restoring impaired circulation. A variety of materials have been recommended over the years in designing
creative bandaging; corn pads and polyethylene foam (pool noodles) work well in some cases.

Fluid Therapy

It is reasonable to assume most birds presented on emergency are going to need some type of fluid therapy, either
for shock or dehydration. If there are any clinically obvious signs of dehydration, such as sunken appearance to
the eyes, tenting facial skin, increased capillary refill time (often taken at the basilic vein), or in downy neonates
red, wrinkled skin, then greater than 7% dehydration may be assumed and parenteral fluids are ideal. Less than
5% dehydration is usually assessed via bloodwork and may respond more readily to oral fluids if the GI tract
is functional. In one study involving water deprivation in pigeons, serum osmolality and total solids were the
most useful values in monitoring hydration status. After 24-48 hours of water deprivation, neither the PCV nor
the electrolyte concentrations changed significantly.5 Assume at least 10% dehydration in nestlings that have a
history of being out of the nest for 24 hours or more.

Rehydration and diuresis are important considerations in critical care of the avian patient. During dehydration,
the degree of urine concentration is much less in birds than in mammals. To compensate for this, the renal output
in birds may decrease by up to 25-50%, depending on the degree of dehydration. This leads to a build-up of
metabolic waste products and may also affect the dynamics of drugs used in therapy. In a study in which pigeons
were water deprived for 3 days, plasma urea nitrogen proved to be a more reliable indicator of prerenal azotemia
than uric acid concentrations.6 Ideally, in addition to assessing hydration, electrolyte, and acid-base status of
the patient, the nutritional and cardiopulmonary status should also be assessed prior to initiating fluid therapy.

Catheters

Placing intravenous (IV) or intraosseous (IO) catheters is a simple, quick procedure that every clinician should
be able to perform in birds. Most patients presented on emergency will probably warrant having venous access.
For wild birds, where the patient would be expected to return to eventual flight or hunting performance, IV cath-
eters are usually preferred. If unable to place an IV, an IO catheter in the ulna or tibiotarsus may become a life
saving necessity. These are extremely stable, effective, and easily placed, but carry some risks. There are several
different considerations that may dictate which choice is used. As in small animal medicine, it is recommended
that peripheral catheters be maintained for no more than 3 days.

Complications associated with IO catheterization include penetration of both cortices, failure to properly enter
the medullary cavity, arthritis, osteomyelitis, and extravasation of fluids with associated pain. Extravasation
has been observed even with proper catheter placement after 12 days of use. Intraosseous catheterization is
contraindicated in patients with metabolic bone disease, fractures, or other boney derangements. Administra-
tion of alkaline or hypertonic solutions may cause pain and transient microscopic changes in the bone marrow.
These solutions should be diluted prior to administration and the catheter flushed with heparinized saline after
any drug injection.

Crystalloid fluids

Use of crystalloid fluids in birds has been based primarily on data extrapolated from other species as there have
been few studies to evaluate different fluid types in birds. If bloodwork has yet to be acquired, a safe empiric

246 Building Exotics Excellence: One City, One Conference


fluid choice in most juvenile raptors is Lactated Ringers Solution (LRS), which may be given IV, IO, SQ, or
PO. LRS may help correct metabolic acidosis when lactate is metabolized in the liver to liberate bicarbonate.
It is best to warm the fluids (100-103oF) so that they more closely approximate normal avian body temperature
(104-110oF). Generally this can be done by placing the capped syringe of fluids in a warm water bath, or by
microwaving the bag of fluids or by having a fluid warmer that is kept stocked with fluids. When maintaining
intravenous or intraosseous catheters, it is important to minimize the amount of flush used so that the patient
is not over-heparinized (recommend a flush solution of heparinized saline 10 units/ml). Fluids may be bolused
IV or IO in 10-25 ml/kg increments over 5-7 minutes. For emergency stabilization in acute shock, rapid fluid
administration has been safely given at a rate of 1-2x blood volume/hour with evaluation of air sac and lung
sounds every 15 minutes. Although many people prefer to make up fluid deficits over 24-48 hours, it may be
safe to replace the interstitial fluid deficit more rapidly in birds. Raptors may have a daily fluid requirement that
ranges from 50-150 ml/kg/day (depending on size and age). This amount should be added to the fluid deficit to
calculate total fluid volume requirements. Only about 25% of a crystalloid solution remains in the vasculature
30 minutes after administration due to fluid shifts into the interstitial space.

For severe hemorrhage, whole blood transfusion (volume for volume) should be provided. If this is not available,
it has been recommended to provide crystalloid fluids at 3 the volume of blood loss. However, this recom-
mendation is based on mammals where the interstitial space is 2 the vascular volume, whereas in birds, the
interstitial space is 4 plasma volume. Replacement fluid volumes may need to be greater than 3 blood loss.

Hypertonic fluids

Hypertonic fluids (eg, 7.5% NaCl) are used to expand intravascular volume during resuscitation following acute
severe hemorrhage. The major benefit of hypertonic saline is intravascular volume expansion at one-fourth the
volume of isotonic solutions. The mammalian dosage (4ml/kg) given over 10 minutes has been used effectively
used in birds. However, due to osmotic diuresis and rapid redistribution of sodium cations, the intravascular effect
is transient (<30 minutes) and additional fluid therapy with a crystalloid or colloid must be used. Hypertonic fluids
are contraindicated in dehydration, hypernatremia, and head trauma with intracranial hemorrhage. The sustained
use of hypertonic saline is not recommended because hypernatremia and hyperchloremic acidemia, increased
bleeding, and exacerbation of underlying cardiac and pulmonary disease due to fluid overload may occur.

Colloidal fluids

Colloids, such as plasma, dextrans and hetastarch, should be used in patients in shock, those suffering acute
blood loss, and in cases of severe hypoalbuminemia. Small patient size and species diversity often preclude the
use of natural colloids, such as homologous or heterologous plasma. The indications for the use of synthetic
colloids (eg, hetastarch 6%, Hextend and hemoglobin-based oxygen carriers) are the same as hypertonic saline
although the benefits last longer. They do not provide albumin, thrombocytes, or coagulation factors. All are
cleared through the kidneys so they are used with caution in patients with cardiac or renal impairment. The use
of synthetic colloids in humans and dogs has been associated with coagulopathies, but this has not yet been
reported in birds. Hetastarch may be given at a bolus dose of 10-15 ml/kg IV or IO (bolus over 10-15 minutes)
q8h up to 4 treatments. Colloidal therapy should be used in conjunction with crystalloid therapy.

Blood and Plasma Transfusions

Trauma or disease resulting in hemorrhage is a common emergency presentation in wild raptors of any age.
Total blood volume in birds is estimated to be approximately 10% of BW (ie, a 1000-gram bird would have a

ExoticsCon 2015 Main Conference Proceedings 247


100 ml blood volume). Interestingly, birds are less susceptible to shock from blood loss than are mammals. An
otherwise healthy bird can lose up to 30% of its blood volume with no apparent ill effects. In one study, the
removal of 60% of the blood volume in healthy pigeons did not cause significant clinical affects and resulted
in a return to normal PCV by day 7 without treatment.7 This is due to a birds ability to quickly mobilize large
numbers of RBCs from the bone marrow and also probably from an ability to rapidly replace vascular fluid
loss from the extravascular space.

Whether to transfuse an avian patient with acute blood loss should be given careful consideration. Pigeons
suffering from acute blood loss had a better response to IV fluids than to heterologous or homologous blood
transfusions. The same study showed a single iron dextran given IM (10 mg/kg) to pigeons was associated with
a significant increase in packed cell volume within 48 hours.7 In another study in chickens, birds were divided
into 4 groups: untreated controls, and treated with intravenous hetastarch, with a hemoglobin-based oxygen car-
rier, or by autotransfusion. No significant differences were found in mortality, respiratory rate, heart rate, PCV,
or hemoglobin values among the 4 groups at the end of resuscitation.8 However, in similar a study in mallard
ducks, while there was no statistical difference in mortality rate among 3 fluid resuscitation groups with cyrstal-
loids, hetastarch, or hemoglobin-based oxygen-carrying solution (HBOCS), a trend of decreased mortality rate
was observed in the HBOCS group.9

If the PCV from acute hemorrhage is less than 20% or in more chronic cases less than 15% (normal PCV for most
adult birds is in the 35-55% range; keep in mind that normal PCV and RBC counts tend to be lower in young and
female birds but published reference ranges for younger age groups is scant) and the patient is demonstrating
clinical signs of anemia, a whole blood transfusion may be beneficial. Also, if the patient is hypoproteinemic
and has an anemia of less than 20%, a whole blood transfusion may be beneficial for the plasma proteins as
well as the RBCs. Whole blood and plasma transfusions should ideally be from same species. However, if a
homologous donor is not available, a single heterologous transfusion from a donor of the same genus (ie, Buteo
to Buteo) may be of some benefit. The half-life of whole blood heterologous transfusions may range from 12
hours to 4.5 days (depending on whether the donor is within the same genus) whereas a homologous transfusion
may have a half-life of 6-11 days.10

There is no information on blood grouping in wild birds. In chickens, at least 28 different blood group antigens
have been found. A rough cross match (major and minor) can be performed mixing donor and recipient red cells
and serum on a glass slide. An absence of gross agglutination or hemolysis suggests compatibility. The recom-
mended anticoagulant is sodium citrate, although acid citrate dextrose (ACD), citrate phosphate dextrose (CPD),
or heparin can also be used. The recommended ratio is 0.1 ml of citrate per 0.9 ml of blood or 2 IU of heparin per
ml of blood. The amount transfused is 10-20% of the patients blood volume (1-2% BW) and can be given IV
or IO. This amount would be expected to increase the PCV by 2-5%. Donor blood should be used immediately;
there are no reports on the affects of any time of storage for whole blood in raptors. Long term storage of avian
blood is not recommended as mammalian storage media appears to be inadequate to support avian erythrocyte
metabolism. An 18 mm blood filter should be used. The patient should be evaluated every 15 minutes for the
first hour for signs of a transfusion reaction, such as panting due to increased body temperature. Anaphylactic
reactions following a single transfusion are rare, but the patient can be premedicated with diphenhydramine.
Transfusion reactions have been reported in birds given multiple heterologous transfusions.

Supportive care for anemic patients should include B vitamins and iron. Young raptors often present in poor
body condition with hypoproteinemia from a failure to hunt proficiently in the first year of life. Anecdotally,
plasma transfusions are thought to be helpful if the total protein (TP) is less than 1.5 g/dl by refractometer or in
cases of suspected rodenticide toxicosis. Although, based on data from the companion animal literature, plasma
transfusions are unlikely to produce significant change in albumin concentrations. If a homologous donor is
unavailable, hetastarch may be just as beneficial (see section above under Colloids).

248 Building Exotics Excellence: One City, One Conference


Release

In anticipation of release, young raptors need the opportunity to learn to hunt while still receiving food support.
In the normal course of events, their parents would serve this function. However, even under those ideal circum-
stances, survival rates for the first year are poor and range from 25-40% depending on the species and the study.

For captive raised juveniles, different methods of release have been tried with varying success. The instinct to hunt
in raptors is strong, but it does take juveniles a while to get the hang of it. Therefore, a hard release generally
has the poorest success rate. Allowing raptors to learn to capture prey in the captive setting, known as mouse
school, appears to have some success in improving survival. Finally, a soft or hacking release has been
documented through radiotelemetry and visual monitoring to have a high success rate. 11 Hack boxes allow the
bird to adapt to the wild and acquire natural instincts with minimal danger. Most birds are ready to be released
between 30 to 90 days of life, but this varies by species. Hack boxes allow birds to learn to fly and adapt to the
wild without completely cutting them off from their caretakers. Food is placed on the boxes for several weeks as
the bird learns to hunt. Over time, the birds will acquire their survival instincts and will no longer be dependent
on the food left at the hack boxes. In general, birds should be placed in the hack box at least one week before they
begin to fly. A bird that already knows how to fly would likely not return to the box, which is why its important
to start early. Food is placed on the box every day, giving the bird an opportunity to learn to hunt without being
completely cut off from its food source. Eventually, the bird will be able to sustain entirely on its own hunting.
This technique is used for a variety of birds at the California Raptor Center, but not with barn owls, which are
released locally. Barn owls can feed on their own after just 15 days and are ready for release without the need
for a hack box after just 28 days. The timing of release is important. Diurnal birds should be released early in
the morning and nocturnal species released at dusk. In colder climates, migrating species should be released in
the fall to give them time to become proficient hunters and to become conditioned for a long flight. Otherwise,
waiting until spring for release is advised.

References

1. Garcia-Rodriguez T, Ferrer M, Carrillo JC, et al. Metabolic responses of Buteo buteo to fasting and refeed-
ing. Comp Biochem Physiol A Physiol. 2003;87(2):381-386.

2. Myers MR, Klasing KC. Low glucokinase activity and high rates of gluconeogenesis contribute to hyper-
glycemia in barn owls (Tyto alba) after a glucose challenge. J Nutr. 1999;129:1896-1904.

3. Lieske CL, Ziccardi MH, Mazet JA, et al. Evaluation of 4 handheld blood glucose monitors for use in
seabird rehabilitation. J Avian Med Surg. 2002;16(4):277-285.

4. Redig PT, Arent L, Lopes H, Cruz L. Rehabilitation. In: Bird DM, Bildstein KL, eds. Raptor Research and
Management Techniques. Surrey, B.C. Canada: Hancock House; 2007:411-422.

5. Martin HD, Kollias GV. Evaluation of water deprivation and fluid therapy in pigeons. J Zoo Wildl Med.
1989;20(2):173-177.

6. Lumeij JT. Plasma urea, creatnine and uric acid concentrations in response to dehyration in the racing
pigeon. Avian Pathol. 1987;16:377-382.

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7. Finnegan VM, Daniel GB, Ramsey EC. Evaluation of whole blood transfusions in domestic pigeons (Co-
lumba livia). J Avian Med Surg. 1997;11(1):7-14.

8. Wernick MB, Steinmetz HW, Martin-Jurado O, et al. Comparison of fluid types for resuscitation in acute
hemorrhagic shock and evaluation of gastric luminal and transcutaneous PCO2 in leghorn chickens. J Avian
Med Surg. 2013;27(2):109-119.

9. Lichtenberger M, Orcutt C, Cray C, et al. Comparison of fluid types for resuscitation after acute blood loss
in mallard ducks (Anas platyrhynchos). J Vet Emerg Crit Care. 2009;19(5):467-472.

10. Degernes LA, Harrison LD, Smith DW, et al. Autologous, homologous, and heterologous red blood cell
transfusions in conures of the genus Aratinga. J Avian Med Surg. 1999;13:10-14.

11. Morzenti, A. Captive Raptor Management: Common Raptors of the United States. 2nd ed. Madison, WI:
Wildlife Publications;1998.

250 Building Exotics Excellence: One City, One Conference


Section 10

AAV Master Classes


Track 3
Sedation in Pet Birds
Christoph Mans, Dr med, vet, Dipl ACZM

Session #285

Affiliation: From the School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden
Drive, Madison, WI 53706, USA.

Abstract: Sedation of pet birds has become an increasingly popular technique in order to facilitate common
clinical procedures such as physical examination, blood collection or radiography. Sedation provides
immobilization, reduces vocalization, and attenuates the stress-response caused by manual restraint.
Midazolam and midazolam-butorphanol are the most commonly used drugs for sedation in pet birds,
and provide dose-dependent sedation with no significant side effects, if used at the published dosages.
Midazolam has amnestic and anxiolytic properties in birds, which provide additional benefits, besides it
sedative properties. The intranasal route of administration is a non-invasive alternative to intramuscular
administration, and has been shown to be safe and effective technique to rapidly and reliably induce sedation
in pet birds. Reversal with flumazenil should be performed in most cases of midazolam or midazolam-
butorphanol induced sedation, in order to achieve rapid and complete recovery.

Introduction

Sedation of dogs and cats in veterinary practice is daily routine for a variety of procedures, such as radiographs
and ultrasonography, or other non-painful, but potentially stressful procedures. However, historically for avian
patients, either manual restraint of conscious birds or general anesthesia is typically performed, in order to
complete most clinical procedures. General anesthesia predisposes birds to cardiovascular and respiratory
depression, and may cause aspiration of gastric or crop contents and hypothermia. In contrast, manual restraint
in conscious birds is simple to perform, but can have negative consequences, including stress to the bird and/or
handler, negative conditioning to the clinic environment (eg, the person restraining or the towel used for restraint),
hyperthermia, and the predisposition of trauma to the handler and/or bird. Several recent studies demonstrated
that manual restraint of birds causes increased body temperature and respiratory rate.1,2 In sick, old, or very
stressed bird, acute collapse and death secondary to manually restraint have been reported. Therefore, sedation
techniques provide a useful alternative for reducing physiologic stress in birds undergoing non-painful clinical
procedures. Further sedation in birds, provides easier restraint and increases the safety of many clinical proce-
dures (eg, blood collection, radiography, ultrasonography) and allows for a more complete examination, which
would otherwise only be achieved under general anesthesia. Using safe and effective sedative protocols in pet
birds, provides substantial benefits to the patients as well as the veterinarian and staff, and should be considered
for a variety of clinical procedures.

Route of Drug Administration

Historically sedative drugs have been most commonly administered by intramuscular injection in birds. Recently
the intranasal administration of sedative drugs in birds has gained increased attention. Intranasal administration
of midazolam in Hispaniolan Amazon parrots, ring-necked parakeets, budgerigars and canary finches resulted
in rapid onset of dose-dependent degree sedation, which is completely reversible with intranasal flumazenil.2-5
Intranasal drug administration offers an alternative, non-invasive technique for drug administration in birds

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(Table 1). It is characterized by its ease of administration, high bioavailability, rapid onset of action, and reduced
pain compared to intramuscular administration. Elevation of muscle enzymes in biochemistry panels secondary
to intramuscular drug administration is avoided, if intranasal administration is used instead. In addition, clients
perceive the intranasal route as non-invasive, compared to intramuscular injection, which leads to better client
compliance in cases in which sedation is recommended. The time of onset to sedation is rapid, typically within
3-5 minutes.2-5 However, limitations of intranasal administration include incomplete drug delivery, due to sneez-
ing during administration, physiologically narrowed nostrils (eg, cockatoos) or upper respiratory disease (eg,
blocked or stenotic nostrils). In some cases in larger birds (eg, macaws) the drug volume can also be limiting the
effectiveness and produce excessive sneezing, therefore leading to incomplete drug delivery. Higher concentrated
drugs (eg, midazolam 50 mg/ml, Zoopharm, Windsor, CO) are available, but intramuscular administration might
be more feasible in these cases.

Table
Table 1. Comparison
1. Comparison of intramuscular
of intramuscular and and intranasal
intranasal drugdrug administration
administration in birds.
in pet pet birds.

Intramuscular administration Intranasal administration


Pro Reliable drug delivery Non-invasive and not painful
Faster administration Higher client acceptance
Reduced risk of needles stick injury
No changes in the biochemical panel
Contra Invasive Risk of incomplete drug delivery
Potentially painful Difficult to administer larger volumes
Possible post-injection hemorrhage May cause sneezing
Changes in the biochemical panel More difficult in birds with feathered nares

Drugs Used for Sedation

Midazolam

Midazolam is currently the most commonly used drug for sedation of pet birds and has a wide margin of safety.
Midazolam has sedative, muscle relaxing, anxiolytic, amnestic and appetite stimulating properties in birds.2,6,7
The injectable form of midazolam (midazolam hydrochloride (5 mg/ml); Hospira Inc, Lake Forest, IL) or a
more concentrated form (50 mg/ml, Zoopharm, Windsor, CO) can be administered intranasally and intramus-
cular, without side effects.2-4 Dosages commonly used in pet birds range from 0.5-3 mg/kg.8 At the University
of Wisconsin, we routinely use 2 mg/kg of midazolam in pet birds, if administered intranasally and as the sole
sedative agent. In smaller birds such as finches or budgerigars (Melopsittacus undulatus) we routinely use
4-6 mg/kg of midazolam if administered alone.

Diazepam

Diazepam is of similar efficacy as midazolam in birds following intranasal administration, but has a longer on-
set time and duration of action.4,5,9 While less commonly used for intranasal administration in birds, diazepam
represents a suitable alternative, in cases in which midazolam might not be available. The intramuscular admin-
istration of diazepam should be avoided, due to delayed absorption and muscle irritation.5 Dosages commonly
used in pet birds range from 0.2-2 mg/kg, if used as a sole sedative agent. Dosages as high as 10-15 mg/kg have
been administered to finches and budgerigars, without significant side effects.4,5,9

254 Building Exotics Excellence: One City, One Conference


Butorphanol

Butorphanol is the currently the most commonly used opioid analgesic in birds. Besides its analgesic effects,
butorphanol has sedative effects, which are potentiated by benzodiazepines (ie, midazolam, diazepam). The
combined administration of midazolam and butorphanol is recommended in birds for which midazolam alone
provides only an insufficient level of sedation or which require deeper sedation for certain clinical procedures
such as radiographic positioning. Butorphanol can be given in combination with midazolam, drawn into a single
syringe and can be given parenterally as well as intranasally. No side effects of intranasal administration of bu-
torphanol at a dose range of 1-3 mg/kg are seen in psittacine birds.8 At the University of Wisconsin we routinely
use butorphanol 1-2 mg/kg combined with 2 mg/kg of midazolam in pet birds administered intranasally or by
intramuscular injection.

Reversal of Sedation

Reversal of sedation in pet birds will depend on the patient and the purpose of sedation. Sedation performed in
order to facilitate physical examination and diagnostic sample collection should always be reversed, in order to
have the patient return to normal behavior and food intake as soon as possible. It is important not to discharge
sedated patients, as owners do not tend to appreciate to have a partially sedated bird, which might be imbalanced,
sleepy and refuses to eat.

Birds that underwent sedation for e-collar or bandage placement or that were sedated for control of seizures,
should not be reversed. In these cases, birds should be carefully monitored and reversal considered, if the level
of sedation is perceived too deep or the duration of sedation is prolonged, and might interfere with physiological
behavior, particular food intake.

Flumazenil

Flumazenil is a benzodiazepine antagonist, and is used to reverse the sedative effects of midazolam and diazepam
in birds.2,3,8,9 The injectable form of flumazenil (flumazenil hydrochloride (0.1 mg/ml), Abaxis Pharmaceutical
Products, Schaumburg, IL) can be administered intranasally, intramuscularly or intravenously, without side ef-
fects. The recommended dosages range from 0.01-0.1 mg/kg. Alternatively a flumazenil to midazolam ratio of
13:1 has been recommended, but it has been shown that lower doses of flumazenil achieve complete recovery
from midazolam induced sedation in birds.2 The author prefers to administer 0.05 mg/kg initially. If reversal
is deemed unsatisfactory, then the same amount of flumazenil can be administered repeatedly. Recovery from
sedation is usually complete within 10-15 minutes. Reversal with flumazenil is recommended in all birds, which
are intended to be discharged from the hospital soon after, in order to avoid injuries from falling of perches and
to avoid negative client perception, of having a behavioral abnormal acting bird. Therefore it is important to
ensure that complete reversal has occurred, prior to discharge from the hospital, by assessing complete recovery
of the sensory and motor function (eg, approaching the bird, rotating finger/perch).

Syringes Used for Intranasal Drug Administration

Insulin syringes (0.5 ml) or 1-ml tuberculin syringes are recommended for use in most birds.5 These syringes
allow for an accurate delivery of sedative drugs, even in small birds. The needles should be removed prior to
intranasal delivery in order to avoid injury. The dead space in the hub of tuberculin syringes should be considered,
then used for small volumes, and therefore insulin syringes without a hub are generally preferred.

ExoticsCon 2015 Main Conference Proceedings 255


Step-By-Step Procedure

1. Educate the bird owner about what to expect in regards to sedation of their bird. Sedation with benzo-
diazepines and butorphanol at the published dosages is safe in pet birds, but birds will appear sleepy,
which owners are not used to. Inform them that in some cases regurgitation might occur, particularly in
macaws.

2. Manually restrain the bird using a towel and immobilize the head.

3. Administer the sedative drugs into the nostrils over 5-10 seconds. Split the total dose between both
nostrils. If intramuscular administration is performed, administer the sedative drugs by injection in the
pectoral muscle using a 25- to 28-g needle.

4. Release the bird from manual restraint and allow 7-10 minutes for reaching maximum effect of sedation.
Do not allow the bird to perch high, instead place it on the floor or in its carrier.

5. Manually restrain the sedated bird. Monitor respiration throughout the restraint period, as well as heart
rate. Perform necessary clinical procedures (eg, physical examination, blood collection, radiographs).

6. If reversal is indicated, administer flumazenil intranasally. Split total volume between nostrils. Alterna-
tively flumazenil can be administered by intramuscular or intravenous injection.

7. Release the bird on the floor or in its carrier and monitor recovery. Do not allow perching high, in order
to avoid trauma from falling, until the bird has completely recovered. Most birds will recover within
10-15 minutes. Assess recovery before discharging the bird. Administer a second dose of flumazenil if
recovery is incomplete.

Useful Tips

1. Each bird requires an individual assessment prior to choosing a suitable sedative drug protocol. Birds,
which have no previous experiences with manual restraint, may require less sedation compared to birds,
which had previous negative experiences, and become readily stressed or fearful in a veterinary clinic
environment.

2. Macaws usually require a combination of midazolam and butorphanol in order to achieve a sufficiently
deep level of sedation, suitable to perform a variety of clinical procedures.

3. Even though a bird might not appear sufficiently deep sedated while under manual restraint for a clini-
cal procedure, is might become more sedated, once stimulation is discontinued, making it unsuitable to
be discharged from the hospital. Therefore every bird, which is intended to be discharged shortly after
completion of the procedures performed under sedation, should receive flumazenil.

4. Cockatoos often do not recover completely after the initial dose of flumazenil. A second dose of fluma-
zenil is often necessary.

256 Building Exotics Excellence: One City, One Conference


Conclusions

Sedation of pet birds offers a practical alternative to manual restraint of conscious birds and to general anesthesia
for a large variety of clinical procedures. Sedation decreases the risks of complications by attenuating the side
effects of manual restraints and avoids the potentially fatal side effects of general anesthesia (eg, cardiovascular
and respiratory depression, aspiration of crop content). The intranasal route of administration is an alternative
non-invasive technique, which has been proven highly effective in birds and usually increases the client compli-
ance agreeing on sedation for their bird. Intranasal or intramuscular sedation, using midazolam, with or without
butorphanol, is a simple, safe, effective, reversible, and readily available option for sedation of avian patients
in daily clinical practice.

References

1. Greenacre CB, Lusby AL. Physiologic responses of Amazon parrots (Amazona species) to manual restraint.
J Avian Med Surg. 2004;18:19-22.

2. Mans C, Guzman DSM, Lahner LL, et al. Sedation and physiologic response to manual restraint after
intranasal administration of midazolam in Hispaniolan Amazon parrots (Amazona ventralis). J Avian Med
Surg. 2012;26:130-139.

3. Vesal N, Eskandari MH. Sedative effects of midazolam and xylazine with or without ketamine and detomidine
alone following intranasal administration in Ring-necked Parakeets. J Am Vet Med Assoc. 2006;228:383-
388.

4. Sadegh AB. Comparison of intranasal administration of xylazine, diazepam, and midazolam in budgerigars
(Melopsittacus undulatus): clinical evaluation. J Zoo Wildl Med. 2013;44:241-244.

5. Vesal N, Zare P. Clinical evaluation of intranasal benzodiazepines, alpha-agonists and their antagonists in
canaries. Vet Anaesth Analg. 2006;33:143-148.

6. Gilbert DB, Patterson TA, Rose SP. Midazolam induces amnesia in a simple, one-trial, maze-learning task
in young chicks. Pharmacol Biochem Behav. 1989;34:439-442.

7. Farkas L, Crowe SF. The role of the benzodiazepine-GABA system in the memory processes of the day-old
chick. Pharmacol Biochem Behav. 2000;65:223-231.

8. Mans C, Braun J, Feeny M. Intranasal sediation with midazolam or midazolam-butorphanol in psittacine


birds: A retrospective evaluation of 114 cases (2010-2012). Proc 1st Int Conf Avian, Herpetol Exot Mam-
mal Med. 2013;292.

9. Prather JF. Rapid and reliable sedation induced by diazepam and antagonized by flumazenil in zebra finches
(Taeniopygia guttata). J Avian Med Surg 2012;26:76-84.

ExoticsCon 2015 Main Conference Proceedings 257


Avian Bornaviral Ganglioneuritis in Clinical Practice
Robert D Dahlhausen, DVM, MS,
Susan E Orosz, PhD, DVM, DABVP (Avian), Dipl ECZM (Avian)

Session #255

Affiliation: Avian & Exotic Animal Medical Center and Veterinary Molecular Diagnostics, Inc,
5989 Meijer Dr, Suite 5, Milford, OH 45150, USA (Dahlhausen) and Bird and Exotic Pet Wellness Center,
5166 Monroe St, Suite 350, Toledo, OH 43623, USA (Orosz).

Abstract: Avian Bornavirus (ABV) has been shown to be a causative agent of proventricular dilatation
disease in birds. The avian Bornaviradae represent a genetically diverse group of viruses that are widely
distributed in captive and wild populations around the world. They are widely distributed in tissues of
affected birds and generally produce a non-suppurative ganglioneuritis in the gastro-intestinal tract and
central nervous system. Diseased birds may or may not demonstrate ABV ribonucleic acid on ante-mortem
tests or test positive on serological assays. Alternatively, clinically normal individuals may test positive on
molecular and serological assays. The route of transmission in natural infections has not been thoroughly
ascertained. Management of affected birds is beneficial and currently centered at reducing neurological
inflammation, managing secondary complications, and providing nutritional support.

Introduction

Neuropathic gastric dilatation of psittacine birds was initially reported as a wasting disease in macaws imported
into North America and Europe from Bolivia in the late 1970s.1-8 Originally limited to macaw species (Ara
species), the disease was later identified in other parrot species as well. One of the first reports was by Ridgeway
and Gallerstein in 1983 followed by the report of impaction, dilatation, and degeneration of the proventriculus in
16 large psittacine birds by Clark in 1984.1,6 Originally called macaw wasting disease, the disease has also been
referred to as macaw fading syndrome, myenteric ganglioneuritis, infiltrative splachnic neuropathy, neuropathic
gastric dilatation, and proventricular dilatation disease (PDD). The disease may be more appropriately termed
avian myenteric ganglioneuritis, non-suppurative ganglioneuritis, or avian auto-immune ganglioneuritis.9 These
articulate the disease process better and remove the focus on the proventriculus.

PDD has been described in over 80 species of psittacine and non-psittacine birds worldwide, both captive and
in the wild.10,11 African grey parrots (Psittacus erithacus), macaws (Ara species), Amazon parrots (Amazona
species), and cockatoos (Cacatua species) are the most common psittacine species affected.10 The disease is
minimally represented in Quaker parrots (Myiopsitta monachus) and lovebird species (Agapornis).9 Lesions
suggestive of PDD have also been described in canaries (Serinus canaria), the greenfinch (Carduelis chloris),
long-wattled umbrella bird (Cephalopterus penduliger), a bearded barbet (Lybius dubius), Canada geese (Branta
canadensis), toucans (Rhamphastidae), honey creepers (Drepanidinae), roseate spoonbill (Platalea ajaja) and a
peregrine falcon (Falco peregrines).12-15 PDD is a progressive neurologic disease with a high case fatality rate
once clinical signs are present.16 The disease presents a serious threat to captive propagation and conservation
efforts for endangered psittacines such as the Spixs macaw (Cyanopsitta spixii).

ExoticsCon 2015 Main Conference Proceedings 259


Proventricular Dilatation Disease

Clinical signs

Clinical signs are variable and depend upon the host species involved, severity of disease, distribution of lesions
and affected organ system involved. They vary from case to case. They may present in the central, peripheral,
and/or autonomic nervous system. Although neurogenic in nature, signs are generally classified as gastrointes-
tinal (GI) or central nervous system in character. Birds may exhibit only gastrointestinal or neurologic signs or
a combination of both. GI tract signs reflect pathology of the terminal ganglia of the vagus nerve (cranial nerve
X). The vagus, also referred to as the pneumogastric nerve, is the autonomic nervous systems parasympathetic
control of the heart and digestive tract. It regulates homeostatic function of the proximal GI tract, pancreatic
endocrine and exocrine function, hepatic glucose production, and heart rate. Gastrointestinal signs reflect varying
degrees of dysfunction and neurogenic atrophy including delayed crop emptying and impaired GI tract transit,
regurgitation, anorexia, dilatation and sometimes impaction of the upper GI tract. Pyloric motility is disturbed
with severe alteration of gastric emptying and stasis.

Affected birds have impaired ability to digest and absorb dietary nutrients leading to loss of body weight, passage
of undigested food material in the feces and diarrhea. The vagus nerve is also a major constituent of the inflam-
matory reflex, a neural reflex that controls innate immune responses and inflammation during GI tract pathogen
invasion and tissue injury.17-19 Impairment of this reflex and reduced vagal stimulation of gastric acids impairs
the natural resistance to bacterial overgrowth and leads to alterations in the intestinal microbiome. Overgrowth
of pathogenic organisms such as Clostridial species and fungal organisms often occur in affected birds. This
classic form of the disease is most often observed in new world psittacines.

Central nervous system lesions commonly involve the cerebrum or cerebellum. Cerebral perivascular cuffing
and glial cell injury can cause seizures in affected birds. Optic lobe lesions lead to a cortical blindness which
may be reversed with effective treatment. Disruption of the Perkinje, glial, and granule cell layers of the cerebel-
lum produce disorders in fine movement and equilibrium evidenced as ataxia, proprioceptive deficits, intention
tremors, incoordination, dysarthria (vocalization abnormalities), motor deficits and reduced cognitive ability.
Old world psittacines often exhibit these central nervous system signs although concurrent, non-clinical lesions
in the GI tract are usually present.

Inflammation and myelin degeneration of the dorsal nerve roots, white matter, and associated ganglia have been
identified at all levels of the spinal cord in PDD affected birds.20 Thoracolumbar lesions were the most common
and severe. The dorsal root ganglia contain cell bodies of sensory neurons that bring information from the pe-
riphery to the spinal cord. PDD associated peripheral neuritis has been implicated as a cause of feather picking
and self-mutilation in affected birds.20

Myocarditis as a component of PDD has been previously reported.21 Lesions are more frequent and severe
in the right side of the heart which may reflect the higher density of nervous tissues in this area. Additionally,
parasympathetic innervation of the heart is partially controlled by the right vagus branch which innervates the
sinoatrial node. Dilatation of the right ventricle of the heart of affected birds has previously been described. Ar-
rhythmias and alterations in blood pressure may also be observed in affected birds. Cardiac lesions can result in
acute death in otherwise clinically normal birds.

A survey of pet birds with clinical signs of PDD found 66% of birds exhibited central nervous system signs,
22% GI tract signs, 9% feather picking and mutilation, and 9% acute death.22

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Pathology

Characteristic histological lesions of PDD involve lymphocytic, plasmacytic inflammatory infiltrates of nervous
tissues, axonal swelling, myelin degeneration, and perivascular mononuclear cell infiltrates of blood vessels and
connective tissue surrounding affected nerves.20 Lesions often present in ganglia of the GI tract (ganglioneuri-
tis), central nervous system (encephalitis, myelitis), peripheral nerves including the sciatic, brachial, and vagal
nerves (neuritis), and retina (retinitis). Abnormalities may be observed at all levels of the spinal cord but are
especially severe in the thoracolumbar portion. They include vacuolation and spongiosus of the white matter,
axonal swelling with myelin degeneration, perivascular infiltrates in the grey and white matter and associated
ganglia and dorsal nerve roots, and gliosis. Lesions may also be observed in the heart which demonstrates focal
to diffuse areas of myocardial necrosis associated with infiltration of mononuclear cells. The intracardiac nerve
plexus of the right side of the heart is often more severely affected.20 Lymphocytes may be scattered diffusely
throughout the adrenal medulla or localized in clusters adjacent to cortical tissue.

The disease process of PDD involves inflammation of the nerve ganglia which exposes normally sequestered
ganglioside proteins to the host immune system. Studies by Rossi et al have shown that the release of G 50
proteins from nerve ganglia produce pathologic lesions similar to that noted in the autoimmune neuropathy
of Guillian Barr syndrome.24-27 Disease occurs when the host immune response is directed to these exposed
proteins causing corresponding neurologic dysfunction.

Diagnosis

PDD should be considered in the differential diagnosis of any bird exhibiting neurological and/or gastrointestinal
signs. A presumptive diagnosis can be made based upon the history, clinical signs, and radiographic evaluation
of the digestive tract. Definitive diagnosis can be confirmed by demonstrating the characteristic histopathologic
lesions in tissues from affected birds.

Plain and contrast radiography, and fluoroscopic evaluation of gastrointestinal motility, have been used for
tentative ante mortem diagnosis. Radiology and ultrasonography often reveal various degrees of enlargement,
thinning and/or impaction of the ingluvies, proventriculus, ventriculus, and proximal duodenum. The proven-
triculus is often severely dilated, filling the left side of the coelomic cavity. It often appears as a J shape causing
the ventriculus to be displaced to the right and ventrally.28 Dilatation and thinning of the wall of these organs
may lead to impaction and rupture. Contrast studies often demonstrate prolonged transit times throughout the
gastrointestinal tract.29

Clinical pathologic findings in PDD are inconsistent and generally reflect the state of malnourishment, dehydra-
tion, and secondary infections that may occur with this disease. Serum chemistry profiles and complete blood
counts are often normal although a relative and absolute heterophilia, hypoproteinemia, anemia, gram-negative
and Clostridial bacterial enteritis have been reported.28 Gastrointestinal stasis predisposes to overgrowth of the
digestive tract with yeast and gram-negative bacteria.

Ante-mortem diagnosis of PDD can be confirmed by identification of the characteristic myenteric ganglioneuritis
in biopsy samples of the crop, ventriculus, and adrenal gland.10 Crop biopsy specimens should include a visible
blood vessel/nerve complex. While reported to be an effective method of ante mortem diagnosis with an accuracy
of 76%, it has been reported that only about 76% of PDD affected birds have crop lesions.10,30 In practicality,
crop biopsies are reported to be indicative of PDD in only about 30 to 35% of cases.10,31

Post-mortem examination often reveals emaciation and the presence of a distended, impacted proventriculus
and ventriculus. Thinning of the wall of these organs occurs and rupture of these organs may be present. Histo-

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logical examination of a wide range of tissues should be conducted on birds suspected of succumbing to PDD.
Tissues submitted should include the ingluvies, proventriculus, ventriculus, duodenum, adrenal gland, heart,
spleen, and brain.

Differential diagnoses

Tumors or papillomas of the crop, proventriculus, ventriculus, and intestines, ingestion of foreign bodies, mega-
bacteriosis, and parasitism can cause gastrointestinal signs identical to those seen in PDD.10 Emptying of the
proventriculus and ventriculus appears to be inhibited as long as the intestinal tract is distended. Inflammatory
disease and neoplastic diseases of the ventriculus and proventriculus also can cause gastrointestinal stasis. Heavy
metal poisoning is commonly associated with central nervous system signs but can cause gastrointestinal stasis
as well. Internal papillomatosis may result in a chronic wasting disease that resembles PDD. PDD should be
considered as a differential in any bird with CNS disease. Traumatic injuries, heavy metal poisoning, neopla-
sia, viral, bacterial and fungal infections of the CNS, nutritional deficiencies and hydrocephalus are additional
diseases that can appear similar.10

Avian Bornavirus

An infectious etiology for PDD has long been suspected based on its apparent spread through aviary collections.
Transmission electron microscopy studies in the 1990s provided the first evidence of a viral etiology demonstrat-
ing inclusion bodies and enveloped virus-like particles in the myenteric plexus, celiac ganglia and fresh feces
from affected birds.32 Attempts to isolate an infectious agent were unsuccessful at the time.

In 2008, two independent research groups identified a novel virus in tissues from PDD-affected birds and named
it avian Bornavirus (ABV).33,34 It was proposed as the causative agent of PDD. Subsequent studies have con-
firmed the association between ABV infection and PDD.38-42 Disease development was reproduced by parenteral
inoculation of psittacine birds, such as cockatiels (Nymphicus hollandicus) or Patagonian conures (Cyanoliseus
patagonus), with genotypes ABV-2 and ABV-4. However, ABV has also been found in healthy birds which may
remain apparently disease free for years.35-39

Bornaviruses are enveloped, non-segmented single-stranded negative sense RNA viruses. They are members of
the family Bornaviridae in the order Mononegavirales. Other families within the order include the Filoviridae
(West Nile virus), Rhabdoviridae (rabies virus), and the Paramyxoviridae. Currently 15 ABV genotypes have
been identified. The recent reclassification of avian bornaviruses is psittaciform Bornavirus 1 (PaBV- 1,2 ,3 4,7),
passeriform Bornavirus 1 (CnBV-1,2,3, canary) and (MuBV-1, munia finch), waterbird Bornavirus 1 (ABBV-1,
aquatic bird Bornavirus 1), passeriform Bornavirus 2 (EsBV-1,estrildid finch Bornavirus 1), and tentative, unclas-
sified bornaviruses of avian Bornavirus MALL (ABV-MALL), parrot Bornavirus (5 PaBV-5), parrot Bornavirus
6 (PaBV-6), and parrot Bornavirus (8 PaBV-8).43 PaBV 2 and 4 are the predominate genotypes in psittacine birds.

The genetic variability of ABV is much greater than that observed in Borna disease virus. There is a 91-100%
shared nucleotide identity within a genotype and only 68-85% between genotypes. Different genotypes seem
to cause different disease in different species and individuals but the relationship between genotype, species
of bird, and observed clinical disease is obscure at this time. Infection with one genotype does not appear to
be protective against another. Simultaneous infection with two genotypes can occur and may result in severely
worse clinical disease.

262 Building Exotics Excellence: One City, One Conference


ABV is widely distributed in the body of infected birds.44 It reproduces in a non-cytopathic manner in the host
nucleus and persists due to mechanisms that evade the host immune system.45 As a result, ABV infections are
considered chronic and life-long. It is there for unlikely that anti-viral or vaccine therapy will effectively elimi-
nate the viral infected state.

Infection rate

ABV is widely distributed in both captive and wild avian populations. Approximately 15- 40% of normal healthy
birds are positive for the presence of ABV. Lierz detected ABV RNA in 27 (45.8%) of 59 healthy appearing pet
birds.46 Thirty five of 77 (45%) healthy birds from an aviary with a past history of PDD were found positive
for ABV-specific serum antibodies.47 A survey of laboratory samples submitted for other testing revealed ap-
proximately 34% (271/791) avian samples tested positive from across the USA.48

Almost all collections of psittacine birds will contain individuals infected with ABV. A large-scale survey revealed
that ABV infection is widespread among captive psittacines in Europe, with 23% of 1,442 birds considered
infected.36 Similarly, a high infection rate was observed in captive canaries in Germany,49 as well as in certain
populations of wild waterfowl in North America.49,50

While a significant percentage of the avian population is infected with ABV, the frequency of clinical Borna
viral disease is much lower. The majority of ABV positive birds do not exhibit clinical disease. When it does
occur, disease presents on a continuum of intensity with many birds exhibiting only mild disease. The clinically
wasted bird represents the more severe form of untreated, chronic disease.

Transmission

The epidemiology of BDV is currently not well understood. ABV is shed in the urine and feces of infected
birds. The urofaecal-oral route is assumed to be important for horizontal transmission but other routes cannot
be excluded. Transmission via the respiratory tract and vertically through the egg have also been discussed but
supporting experimental evidence is lacking at this time. Piepenbring et al. did report successful ABV trans-
mission to one cockatiel placed in contact with a group of cockatiels that were experimentally infected with
ABV-4.38 Most other studies indicate that horizontal transmission of ABV by direct contact is inefficient in im-
munocompetent fully fledged birds.51 Cockatiels (Nymphicus hollandicus) were infected with ABV-4 by oral
and intranasal application. Clinical signs of disease were not observed in any of the birds during the 174 day
observation period. At the end of the study, pathohistological and immunohistochemical examination revealed
neither lesions typical for PDD nor ABV specific antigen in any of the birds.52 Kistler et al reported a dramatic
PDD outbreak during which 13 unweaned chicks of various psittacine species died.54 These observations suggest
that ABV transmission may be much more efficient in unweaned nestlings with immaturely developed immune
systems compared to older individuals.

Experimental studies have shown that ABV infections can be induced experimentally when the virus is injected
intramuscularly, intravenously, and intracranially in birds. Gancz et al. (2009) were the first to demonstrate that
PDD could be transmitted to healthy birds by the use of infected-brain tissue. They inoculated cockatiels by
multiple routes with a brain homogenate from either an ABV4-positive bird or from a PDD-/ABV-control bird.
The birds inoculated with healthy control bird homogenate remained healthy, whereas all three birds inoculated
with brain homogenate from ABV-infected birds developed both gross and microscopic lesions typical of PDD.39
Gray et al. isolated ABV in cultured DEF. After six passages, these infected cells were injected intramuscularly
into two Patagonian conures (Cyanoliseus patagonis). Clinical signs of PDD developed within 66 days post-
infection in both challenged birds. The presence of typical PDD was demonstrated on necropsy and histopathology.

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RT-PCR demonstrated the presence of the inoculated strain in the brains of the challenged birds.40 Piepenbring
et al. inoculated 18 cockatiels by both the intracerebral and intravenous routes with an isolate of ABV4 cultured
for six passages in a quail cell line (CEC-32). All challenged birds became persistently infected but the clinical
disease patterns that developed varied among individuals. Five birds developed clinical signs of PDD, while
on necropsy 7 of the 18 had a dilated proventriculus. All infected birds did, however, show mononuclear cell
infiltrates characteristic of PDD in a wide range of organs.38 Strong suggestive evidence for vertical transmission
of ABV from the hen to the egg has been reported in psittacines and canaries. Several studies found eggs from
infected hens to be ABV-positive by PCR assays.51,55-57 Final proof of vertical transmission provided by the
detection of productive infection in embryos or chicks reared under isolated conditions is lacking at this time.

The incubation period of PDD is unknown. Clinical observations suggest that this could be as short as several
weeks to as long as many years.8,28 In general, transmission is believed to require long term, close contact among
birds. Unlike other RNA viruses that are more stable (West Nile virus), endonuclease enzymes in the environ-
ment tend to rapidly degrade the avian Bornavirus. Soap and dilute bleach appear to be effective in disinfecting
enclosures and items that come in contact with ABV-positive individuals.

Avian Bornavirus Diagnostics

Polymerase chain reaction

The diagnosis of PDD has traditionally been based on the identification of histological lesions in biopsy or
necropsy tissues. With the discovery of the association of ABV with PDD, diagnostic testing has focused on
reverse transcription polymerase chain reaction (RT-PCR) for the detection of ABV ribonucleic acid (RNA) in
affected birds. Ante mortem detection of viral infection in the naturally or experimentally infected bird is how-
ever challenging. Urine, feces, and cloacal swabs are samples reportedly most likely to contain virus; however,
a whole blood sample in combination with choanal/cloacal swabs may provide greater sensitivity. Fecal swabs
are less desirable as RNAases and other degrading or inhibiting agents may rapidly degrade the viral RNA in
these samples. Cloacal sampling, however, likely underestimates the prevalence of ABV infection. Intermittent
urofecal shedding of ABV is described in both experimentally and naturally-infected parrots which can lead to
a false negative test result.38,58,59 One research study recommended the use of feather calami for ABV RNA
testing.60 The consensus of opinion among most other researchers at the 2014 ABV Research Forum was that
this was not an appropriate sample for accurate ABV testing.9 It should be noted that there is no consistent or
standardized method of testing among laboratories offering this service. Reported rates of ABV positive tests
among several university and commercial laboratories range from 3-33%. With only about 68-85% sequence
identity among the known ABV genotypes, some assays may not be able to detect all ABV genotypes. Primers
have been designed to target the nucleocapsid (N) gene, matrix (M) gene, phosphoprotein (P) gene, and poly-
merase (L) gene. Assays designed for detection of the M and immunodominant N gene sequences appear to have
a similar high sensitivity.35 Those for the L and P genes are generally less accurate. Both gel-based RT-PCR
and real-time RT-PCR have been successfully used to detect ABV RNA. Real-time PCR assays appear to be the
more sensitive of the two techniques.

Serology

Serologic assays have been used to detect ABV exposed or infected birds. The indirect fluorescent antibody
(IFA) assay is preferred by many investigators, particularly in Europe. Researchers in the USA tend to use the
Western Blot assay.61,62 Both appear to be appear to be sensitive and specific assays. They cannot however dif-
ferentiate between diseased birds and healthy carriers. Not all birds shedding viral RNA are antibody positive.47

264 Building Exotics Excellence: One City, One Conference


The discrepancy between viral shedding, presence of antibodies, and clinical disease is now well recognized in
parrots infected with ABV.38,62,63 Viral shedding and presence of antibodies coincided in only one-fifth of the
samples in a large study of captive psittacines.36 In another study of free-ranging psittacines, 50% of ABV RNA
positive birds did not show antibodies against ABV by IFA.11 Many apparently healthy birds may however be
seronegative while, at the same time, shedding ABV in their feces.

In a large-scale study conducted in captive psittacine birds in Europe, 17% of the birds had detectable antibod-
ies.36 Widespread persistent asymptomatic infection with less common clinical disease is a consistent feature of
Bornavirus infections, and may be attributed to the lack of cytopathic effect of bornaviruses and their ability to
escape recognition by the innate immune system.

Serologic testing for antiganglioside antibodies appears to more accurately detect clinically affected birds. Anti-
ganglioside autoantibodies are utilized as markers of immune-mediated disease and are triggered by a variety of
pathogens. High antiganglioside antibody levels were detected in 15.5% of 650 avian serum samples and 98%
of symptomatic and histologically positive PDD birds.65 Further studies to help determine the sensitivity and
specificity of antiganglioside autoantibodies in the diagnosis of PDD are needed.

Proventricular Dilatation Disease Pathogenesis

Infection studies with ABV have satisfied Kochs postulates and shown that it is a cause of PDD in birds. Some
researchers are of the opinion that it is the sole cause of PDD in birds.66 While ABV is a causative agent of PDD,
the relationship of ABV in the pathogenesis of this disease remains unclear. Although the virus is non-cytopathic
it can induce inflammation and a selective loss of glial cells and neurons. This cell loss appears secondary to T
cell cytotoxicity. The presence of CD8+ T cells parallels the onset of neurologic dysfunction. Rossi et al have
demonstrated immunocomplex deposition around affected nerve ganglia associated with high positive expression
of complement fractions by immunofluorescence in birds with clinical PDD.65 They suggest that PDD is induced
by an autoimmune mechanism similar to the pathogenesis of Guillain Barr Syndrome where gangliosides act
as major antigens. To confirm this theory, they challenged 6 cockatiels (Nymphicus hollandicus) intraperitone-
ally (IP) or orally with purified avian gangliosides. One month post infection, 100% of IP inoculated and 33%
of orally challenged parrots developed neurological and GI tract signs compatible with PDD. Four of the birds
demonstrated the classic lymphoplasmacytic ganglioneuritis in crop biopsies and all showed histopathologic
changes compatible with PDD.67 These findings warrant further investigation into the mechanisms of autoim-
mune reactions against nerve ganglioside proteins and their possible involvement in the pathogensis of PDD.

Treatment

PDD has historically been a fatal disease of psittacine birds with mortality approaching near 100%. Even with
appropriate supportive care, most birds succumb to progressive debilitation, starvation, secondary infections,
or CNS disturbances. The ganglioneuritis and encephalomyelitis associated with PDD is inflammatory in na-
ture, the chronicity of which, contributes to the progressive, debilitating nature of the disease. The rationale
for a therapeutic approach was that diminishing this reaction was expected to lead to clinical improvement and
possible resolution of clinical signs in affected birds. In 2002, we demonstrated the resolution of clinical PDD
by Cyclooxygenase 2 (COX-2) inhition.68 Since this time, clinicians have recognized the early signs of avian
ganglioneuritis and the variable ways it can presents in a clinical setting. The use of preferential and selective
COX-2 inhibitors has improved and extended the quality of life of affected birds.

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Gastrointestinal prokinetic agents such as Cisipride (Propulsid, Janssen Pharmaceutica Inc. Titusville, NJ, USA)
and metoclopramide (Reglan, Schwarz Pharma, Seymour, IN, USA) are helpful in improving transit in birds
with GI tract involvement, especially early in the course of therapy. Appropriate antibacterial and antifungal
therapy should be instituted to control overgrowth of intestinal anerobes, yeasts, and Macrorhadus also in these
individuals. GI tract disease results in an altered intestinal microbiome. Probiotics and prebiotics (Sivoy, Rome,
Italy) may prove helpful in restoring a normal intestinal environment. Omega fatty acids are also helpful in
reducing inflammation and clinically beneficial in affected birds.70 Semi-elemental diets such as Emeraid Om-
nivore and Carnivore (Lafeber Emeraid LLC, Cornell, IL, USA) require minimal digestion and provide a readily
absorbable source of essential nutrients and omega fatty acids. The liver often is exposed to bacterial showers
from the abnormal intestinal environment in affected birds. Herbal supplements like Milk Thistle (Milk Thistle,
Lowalcohol, Gaia herbs, Brevard, NC, USA) and ginger (Ginger Root, CertifiedOrganic, Gaia herbs, Brevard,
NC, USA) are helpful in reducing inflammation, preserving hepatic function, and improving GI tract transit.

Gabapentin (Neurontin, Pfizer, New York, NY, USA) is increasingly being used in birds to help treat self-mutilation
and to control neurogenic pain. It is a useful adjunct in managing birds with avian ganglioneuritis. Clinical signs
in affected birds tend to increase with the onset of breeding activity. Reduction of the stress of elevated hormonal
activity through the use Leuprolide acetate (Lupron Depot, AbbVie, Chicago, IL, USA) or Deslorelin implants
(Suprelorin, Virbac Animal Health, Fort Worth, TX, USA) is very beneficial.

Mammalian Borna disease virus shows a high degree of sensitivity to Ribivirin (Virazole, Valeant Pharma-
ceuticals International, Bridgewater, NJ, USA), a ribonucleic analog that stops viral RNA synthesis. To date,
the use of this and other antiviral agents in the treatment of avian bornaviral disease has not been rewarding or
adequately researched.

Immunomodulation therapy through the use of Mycobacterium bovis extracts to redirected trafficking of acti-
vated antigen-specific CD4+T cells to local inflammatory sites has been shown to modulate the initiation and
progression of a Th1-mediated peripheral and CNS autoimmune disease. This researched group found significant
improvement in clinically diseased birds when this approach was combined with selective anti-COX-2 therapy.69

With patience, perseverance, prolonged therapy, reduced stress, and attention to correction of secondary problems,
quality and longevity of life in many ABV clinically affected birds can be significantly improved. Implementa-
tion of appropriate therapeutic plans, early in the course of clinical disease, are most productive. Therapies may
be minimally effective in severely affected individuals.

Formulary

Celecoxib (Celebrex, Pfizer Inc, Mission, KS, USA). Initially 30-40 mg/kg divided BID PO. Long term 15-30
mg/kg BID PO. For central nervous system involvement 60-80 mg/kg divided BID PO.

Robenacoxib (Onsior, Novartis Animal Health,North Ryde, NSW). 2-10 mg/kg IM weekly, and subsequently
monthly.69

Meloxicam (Metacam, Boehringer Ingelheim Vetmedica Inc, St. Joseph, MO, USA). A preferential COX-2
inhibitor, not selective). 0.5 mg/kg IM; PO once daily. Oral form is formulated for canine species and may have
reduced bioavailability in avian species; one clinical trial has shown its use exacerbates signs of clinical disease
in ABV infected cocaktiels (Nymphicus hollandicus).71

Gabapentin (Pfizer). 10-25mg/kg BID PO up to 50 mg/kg BID PO in self -mutilating birds (Cathy Johnson-
Delaney, written communication, 2015)

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43. Kuhn JH, Drrwald R, Bo Y, Thomas Briese T, et.al. Taxonomic reorganization of the family Bornaviridae.
Arch Virol. 2015;160:621-632.

44. Rinder M, Ackermann A, Kempf H, et al. Broad tissue and cell tropism of avian bornavirus in parrots with
proventricular dilatation disease. J Virol. 2009;83:5401-5407.

45. Reuter A, Ackermann A,Kothlow S, Rinder M, et.al. Avian bornaviruses escape recognition by the innate
immune system. 2010. Viruses 2010;2:927-938.

46. Lierz M. Avian Borna virus research at the free University of Berlin. Paper presented at: Research Forum
of the 10th European Association of Avian Veterinarians Conference; March 17, 2009; Antwerp, Belgium.

47. Herzog S, Enderlein D, Heffels-Redmann U, Piepenbring A, et.al. Indirect immunofluorescence assay


for intra vitam diagnostic of avian Borna virus infection in psittacine birds. J Clin Microbiol. 2010;48(6):
2282-2284.

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48. Dahlhausen RD, and Orosz SE. Avian Borna virus infection rates in domestic psittacine birds. Proc Annu
Conf Assoc Avian Vet. 2010;13-15.

49. Rubbenstroth D, Rinder M, Stein M, Hoper D, Kaspers B, et al. Avian bornaviruses are widely distributed
in canary birds (Serinus canaria f. domestica). Vet. Microbiol. 2013;165:287-295.

50. Payne S, Covaleda L, Jianhua G, Swafford S, et.al. Detection and characterization of a distinct bornavirus
lineage from healthy Canada geese (Branta canadensis). J Virol. 2011;85(22):12053-12056.

51. Rubbenstroth D, Brosinski K, Rinder M, Olbert M, et.al. No contact transmission of avian bornavirus in
experimentally infected cockatiels (Nymphicus hollandicus) and domestic canaries (Serinus canaria forma
domestica). Vet Microbiol. 2014;172:146-156.

52. Heckmann J, Enderlein D, Piepenbring A, Herzog, S, et al. Investigation on different routes of transmission
of avian Bornavirus in cockatiels (Nymphicus hollandicus). Paper presented at: International Conference
on Avian, Herpetological, and Exotic Mammal Medicine; April 18, 2015; Paris, France.

53. Lierz M, Piepenbring A, Herden C, Oberhuser K, et.al. Vertical transmission of avian bornavirus in psit-
tacines. Emerg Infect Dis. 2011;17(12):2390-2391.

54. Kistler AL, Smith JM, Greninger AL, Derisi JL, et.al. Analysis of naturally occurring avian bornavirus
infection and transmission during an outbreak of proventricular dilatation disease among captive psittacine
birds. J. Virol. 2010;84:2176-2179.

55. Kerski A, de Kloet AH, de Kloet SR.Vertical transmission of avian Bornavirus in Psittaciformes: avian
Bornavirus RNA and anti-avian bornavirus antibodies in eggs embryos, and hatchlings obtained from
infected sun conures (Aratinga solstitialis). Avian Dis. 2012;56:471-478.

56. Lierz M, Piepenbring A, Herden C, Oberhauser K, et.al. Vertical transmission of avian Bornavirus in psit-
tacines. Emerg Infect Dis. 2011;17:2390-2391.

57. Monaco E, Hoppes S, Guo J, Tizard I. The detection of avian bornavirus within psittacine eggs. J Avian
Med Surg. 2012;26:144-148.

58. Raghav R, Taylor M, Delay J, Ojkic D, et al. Avian Bornavirus is present in many tissues of psittacine birds
with histopathologic evidence of proventricular dilatation disease. J Vet Diagn Invest. 2010;22:495-508.

59. Heatley JJ, Villalobos AR. Avian Bornavirus in the urine of infected birds. Vet Med Res Rep. 2012;3:19-23.

60. de Kloet AH, Kerski A, de Kloet SR. Diagnosis of avian Bornavirus infection in psittaciformes by serum
antibody detection and reverse transcription polymerase chain reaction assay using feather calami. J Vet
Diagn Invest. 2011;23(3):421-429.

61. Lierz M, Piepenbring A, Heffels-Redmann U, Sibylle Herzog S, et.al. Experimental infection of cockatiels
with different avian Bornavirus genotype. Proc Annu Conf Assoc Avian Vet. 2012;9-10.

62. Villanueva I, Gray P, Mirhosseini N, Payne S. The diagnosis of proventricular dilatation disease: Use of a
Western blot assay to detect antibodies against avian Borna virus. Vet Microbiol. 2010;143:196-201.

270 Building Exotics Excellence: One City, One Conference


63. Heffels-Redmann U, Enderlein D, Herzog S, Piepenbring A, et.al. Follow-up investigations on different
courses of natural avian Bornavirus infections in psittacines. Avian Dis. 2012;56:153-159.

64. Rossi G, Ceccherelli R, Crosta L, et al. Anti-ganglioside specific auto-antibodies in ganglia of PDD-affected
parrots. Proc Annu Conf Eur Assoc Avian Vet Conf, 1st Sci ECZM. 2011;177-178.

65. Pesaro S, Crosta L, Bertoni P, Ceccherelli R, Rossi G. Anti-ganglioside antibodies production as a theory
of PDD pathogenesis. Proc Annu Conf Eur Assoc Avian Vet. 2009;89.

66. Payne SL, Delnatte P, Guo J, Heatley J, et.al. Birds and bornaviruses. Anim Health Res Rev. 2012;13(2):
145-156.

67. Rossi G, Crosta L, Ceccherelli R, Pesaro S. New evidence in PDD pathogenesis: can ganglioside sensitiza-
tion satisfy Kochs postulates? Proc Annu Conf Eur Assoc Avian Vet. 2009;155.

68. Dahlhausen B, Aldred S, Colaizzi E. Resolution of clinical proventricular dilatation disease by Cyclooxy-
genase 2 inhibition. Proc Annu Conf Assoc Avian Vet. 2002;9-12.

69. Rossi G, DVM, Crosta L, Ceccherelli R, DVM, PhD, Stefano Pesaro S. PDD: Our point of view after 7
years of research. Proc Annu Conf Assoc Avian Vet. 2009;79.

70. Clubb SL. Clinical management of psittacine birds affected with proventricular dilatation disease. Proc
Annu Conf Assoc Avian Vet. 2006;85-90.

71. Hoppes S, Heatley J, DVM, Guo J, PhD, Turner D, et.al. Meloxicam treatment in cockatiels (Nymphicus
hollandicus) infected with avian Bornavirus. J Exot Pet Med. 2013;22:275-279.

ExoticsCon 2015 Main Conference Proceedings 271


Critical Thinking and Clinical Reasoning in
Exotic Animal Medicine
Yvonne van Zeeland, DVM, MVR, PhD, Dipl ECZM (Avian, Small Mammal), and
Nico Schoemaker, DVM, PhD, Dipl ECZM (Small Mammal), Dipl ECZM (Avian),
DABVP (Avian)

Session #250

Affiliation: From the Division of Zoological Medicine, Department of Clinical Sciences of Companion
Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, 3584 CM, The Netherlands.

During this interactive Masterclass, a selection of clinical cases involving a variety of exotic animal species
will be offered to the participants. These cases will range from common and routine disorders, to patients with
more complex and unusual diseases. The participants will be given the opportunity to choose which cases they
would like to see discussed. Participants will be asked and encouraged to critically think about the work-up of the
presented case, whereby they will be asked to consider all relevant aspects and motivate each of the steps they
take in the process towards establishing a definite or presumptive diagnosis and treatment plan. With the vary-
ing backgrounds of the participants (ie, number of years in practice, level of experience with exotics or number
and type of continuing education hours followed, but also where in which country , and when training was
received), fun and interesting discussions are likely to arise, whereby challenging questions may be raised that
require sound clinical reasoning and critical thinking in order for an informed decision to be made concerning
the diagnosis and/or treatment of the exotic animal patient.

The theoretical principles of critical thinking and clinical reasoning can be found in the text of the proceedings of
the preconference day titled Basic Diagnostic and Therapeutic Decision Making: A Guide to Apply Evidence
Based Veterinary Medicine in Your Practice.

ExoticsCon 2015 Main Conference Proceedings 273


Gastrointestinal Anatomy and Physiology of
Birds of Prey
Maureen Murray, DVM, DABVP (Avian)

Session #129

Affiliation: From the Wildlife Clinic at Cummings School of Veterinary Medicine at Tufts University, 200
Westboro Rd, North Grafton, MA 01536, USA.

Abstract: Raptor gastrointestinal anatomy and physiology differ substantially from non-carnivorous birds.
An understanding of raptor gastroenterology is crucial to maintaining the health of raptors in a wildlife
rehabilitation or captive setting. Clinicians treating birds of prey should be aware of how to evaluate proper
gastrointestinal function and how to determine proper nutritional needs for different species.

Adapted from: Murray M. Raptor gastroenterology. Vet Clin Exot Anim. 2014;17:211-234.

Introduction

The term raptor encompasses a variety of avian species with different natural histories, anatomic features, and
diets. Most commonly raptor is used to refer to hawks, falcons, and owls. While these birds share certain similari-
ties, they are taxonomically distinct groups. Based on genetic analyses showing that birds in the family Falconi-
dae are not closely related to other birds previously included in the order Falconiformes, in 2010 the American
Ornithologists Union (AOU) recognized the new order, Accipitriformes, which contains three families.1 Owls
are in the order Strigiformes, which contains two families. Current classification based on the AOU Checklist
of North and Middle American Birds2 is given in Table 1.

An understanding of the similarities and differences among these groups, along with knowledge of species
natural histories are crucial components to providing appropriate care of these birds in a captive or wildlife
rehabilitation setting.

Table
Table 1. 1. Current
Current American
American Ornithologists
Ornithologists Union
Union classificationofofraptors.
classification raptors.

Order Family Birds Included Examples


Falconiformes Falconidae Falcons, caracaras Peregrine falcon (Falco peregrinus),
American kestrel (Falco sparverius)
Accipitriformes Accipitridae Hawks, eagles, kites Red-tailed hawk (Buteo jamaicensis),
Bald eagle (Haliaeetus leucocephalus),
Coopers hawk (Accipiter cooperii)
Pandionidae Osprey Osprey (Pandion haliaetus)
Cathartidae New World vultures Turkey vulture (Cathartes aura),
California condor (Gymnogyps
californianus)
Strigiformes Strigidae Typical owls Great horned owl (Bubo virginianus,
Eastern screech-owl (Megascops asio)
Tytonidae Barn owls Barn owl (Tyto alba)

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Anatomy and Physiology

Beak and tongue

Raptors have strong, curved beaks, the color of which varies among species. In birds of the genus Falco the beak
is distinguished by a notch along the cutting edge, or tomia, of the upper bill, referred to as the tomial tooth or
tomial notch. This structure is believed to allow falcons to quickly sever the spinal cord of their prey.3

Food is manipulated with the beak and tongue, which like in most other birds (except parrots) lacks intrinsic
muscles.4 The tongue in raptors is minimally protrusible, and the rostral portion is firm and rough.4 In eagles
and vultures, the rostral portion of the tongue may be curved into a trough-like shape.4

Esophagus and crop

The crop, or ingluvies, is an enlargement of the cervical esophagus that functions to store food,5 allowing a bird
to ingest a large amount to be digested at a later time. Spindle-shaped crops are present in the Falconiformes
and Accipitriformes.6 The crop is particularly well developed in vultures.7 The Strigiformes do not have crops,6
but food can be stored throughout the length of the esophagus.5

Proventriculus and ventriculus (gizzard)

Carnivorous and piscivorous birds possess an undifferentiated type of stomach, which differs significantly from the
highly differentiated type seen in herbivores and granivores.5 As in other birds, the raptor stomach is comprised
of the proventriculus (pars glandularis) and the ventriculus or gizzard (pars muscularis), with the proventriculus
being the site of gastric juice secretion.5,8 However, given the soft consistency of their diets, the raptor gizzard
is not required to perform the degree of mechanical digestion that occurs in birds consuming diets of a harder
nature.5,8 In contrast to the thick-walled gizzards of granivores, the carnivore/piscivore gizzard is thin-walled,
relatively poorly muscled, and lacks the opposing pairs of thick and thin muscles that are responsible for the
contractions that grind the food in many other avian species.5,6,8

The proventriculus and gizzard of raptors serve as expandable storage organs to accommodate large prey items
and as the site of chemical digestion.5,8 Externally there may be little obvious distinction between the proven-
triculus and gizzard.5,8 The proventriculus is lined by mucosal ridges (plicae proventricularis), which are ab-
sent in non-carnivores and serve to increase the storage capacity of the proventriculus.5 Gastric juice from the
proventriculus maintains a low pH in the gizzard, which is the site of gastric proteolysis.4 The cuticle, or koilin
layer, which is produced by mucosal glands of the gizzard, functions primarily to protect the mucosa from the
gastric juice produced by the proventriculus.5,8

Gastric digestion and pellet egestion

The digestive process in raptors differs substantially from that in birds more commonly seen by veterinarians,
such as psittacines. The sequence of muscular contractions in the stomachs of raptors is much simpler than the
contraction sequence in species with paired thick and thin muscles in the gizzard due to the decreased need for
mechanical grinding of food.4 In addition, indigestible components of the prey are retained in the gizzard, com-
pacted into a pellet, and egested. The egestion of pellets, also referred to as castings in falconry terms, prevents
indigestible material from passing through the entire gastrointestinal tract.6 Egestion is a process unique to birds,
as it does not share the characteristics of emesis or regurgitation in mammals.9

276 Building Exotics Excellence: One City, One Conference


Pellet composition

The composition of the pellet varies among groups of raptors; the pellets of some contain both hair and bones
(eg, owls), while others contain predominantly hair (eg, hawks).6 Table 2 details the composition of pellets by
taxonomic group.

A study that compared gastric digestion among seven species of raptors found that the stomachs of birds in the
families Falconidae and Accipitridae are significantly more acidic (pH 1.6) than the stomachs of birds in the
family Strigidae (pH 2.35).14 The more acidic gastric environment of the hawks, eagles, and falcons in the study
is likely the reason for the more complete digestion and bone corrosion in these birds compared to owls.14

Table
Table 2. Pellet 2. Pellet composition
composition by taxonomic
by taxonomic group. group.

Order Family Pellet composition


Falconiformes Falconidae Predominantly hair6
Accipitriformes Accipitridae Predominantly hair6
Pandionidae Scales and bones10
Cathartidae Hair, vegetable matter, minimal to no bone11-13
Strigiformes Strigidae Hair and bone6
Tytonidae Hair and bone6

Pellet appearance and frequency of egestion

The appearance of the pellet varies with the diet. Raptors fed white laboratory mice will produce tan-colored
pellets, while the pellet produced from a meal obtained in wild is usually darker due to the color of the fur or
feathers of the prey. Fresh pellets may be covered with mucus and occasionally some bile staining can be seen
on the surface of a pellet. There should be no odor to the pellet.

It is important to monitor pellet egestion in raptors, as failure to produce a pellet can indicate dysfunction of GI
tract. The frequency of pellet egestion varies with taxonomic group. While multiple factors appear to influence
the meal to pellet interval (MPI),15-20 following are some general guidelines.

Owls: Generally egest one pellet per meal. The stimulus appears to be the presence of the pellet in the gizzard.19
Studies have shown that larger meals result in a longer MPI.17,19,20 However, MPI also increased in barred owls
(Strix varia) fed a submaintenance compared to maintenance amount of food, indicating a potential ability to
increase digestive time and thoroughness in response to nutritional needs.17

Hawks and falcons: Have been noted to egest one pellet per 2-3 meals but also multiple pellets per one meal if
meal size was large.15,18,19 Some studies have found that hawks egest at dawn in response to photoperiod.15,19
Although in another study captive hawks fed late in the day did not cast at dawn, they did have shorter MPIs
than hawks fed at dawn, supporting a potential role of photoperiod.16 This response to photoperiod is suggested
to be an adaptation to diurnal hunting, allowing the stomach to be empty during the time of day the bird is seek-
ing prey.16 Variation in pellet composition, size, and frequency based on the parts of the prey that are eaten has
been noted.15,18

Ospreys: Pellets are small and rarely seen, which indicates that the majority of their dietary items pass through
the entire gastrointestinal tract.10

Vultures: Pellets are produced at unknown intervals.11-13 In a rehabilitation setting, pellets may be difficult to
discern if the bird exhibits regurgitation as a stress response when observed or handled.19

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Small intestine

The avian small intestine (SI) is shorter than in mammals.8,21 There is less variation in the structure and function
of the SI among birds than there is in the stomach,7 although carnivorous birds have a shorter SI than granivo-
rous birds, as the digestion of meat occurs more rapidly.5,7,8 There are relative differences in SI length among
raptors. Piscivores have longer SIs than birds that eat avian or mammalian prey; vultures also have longer SIs
relative to species that eat live prey; and birds that hunt other birds on the wing have shorter SIs than those that
hunt by soaring or pouncing, which is likely an adaptation to decrease weight and increase agility in the air.22
This difference in SI length affects digestive efficiencya longer SI allows higher efficiency.22 This subject is
discussed further under the section Nutrition.

As in other birds, the SI is the principal site of chemical digestion and nutrient absorption.4,21 The villi in car-
nivores are better developed than in noncarnivorous birds, which compensates for the shorter length of the SI.7
The SI consists of the duodenum, jejunum, and ileum, though there is little histologic differentiation among
these regions, which are mainly demarcated by anatomic position.5,7,8

Ceca

Birds have paired ceca that originate from the rectum at the junction of the rectum and the ileum.7,21 Avian ceca
are classified into four types: intestinal, glandular, lymphoid, and vestigial.23 The Accipitriformes and Falconi-
formes have very small ceca of the lymphoid type.24 Although small or vestigial ceca are generally characteristic
of carnivorous birds, owls are an exception to this generality as they have large ceca.7,21 Owls possess glandular
ceca that contain goblet cells and secretory glands.5,7,21

The function of the ceca in owls is not well understood, though it has been hypothesized that they play a role
in water balance.25,26 In a study in which cecectomy was performed in great horned owls, no change in food
metabolizability or in body weight were noted compared to control owls.25 Although the cecectomized owls
did show an initial increase in water consumption, by 21 days postoperatively water consumption had returned
to normal.25 However, a separate study that also performed cecectomy in great horned owls and then subjected
them to heat stress found that the owls lost body mass and became dehydrated, indicating that the ceca likely do
function to maintain water balance under certain environmental conditions.26 In other raptors, water balance is
entirely maintained by the kidneys and the rectum.27

Cecal contents are evacuated with less frequency than rectal feces.8 Cecal droppings can be distinguished from
rectal feces in that they are of a softer consistency, usually very dark in color,8,21 and may be voluminous. Cecal
droppings can be observed in owls periodically and should not be mistaken for diarrhea.

Rectum

The rectum in birds is short and extends from the ileocecal junction to the cloaca.21 American kestrels, how-
ever, have a relatively long rectum, which is thought to be particularly important in maintaining water balance
in this species.28 Histologically the rectum is similar to the SI but has shorter vili.21 The rectum opens into the
coprodeum in the cloaca.

Nearly continuous antiperistalsis occurs in the rectum, which is interrupted when defecation occurs.21 This anti-
peristalsis moves urine and feces from the cloaca into the rectum, where water and sodium chloride are resorbed
prior to excretion.29 In owls rectal antiperistalsis moves contents into the ceca.21

278 Building Exotics Excellence: One City, One Conference


Appearance of the feces

Thorough examination of the droppings (referred to as mutes in falconry terms) is essential to evaluating the
gastrointestinal tract. The appearance of the feces can vary based on the diet, but the feces should be formed and
are generally dark brown in color and surrounded by white urates and a small amount of clear urine. The feces
may be tan colored in birds fed day-old chicks.3,30 Watery feces can occur in birds that are not fed appropri-
ate casting material.31 Anorexia is a common cause of green feces due to the passage of bile. Some birds may
intermittently have green feces unrelated to anorexia or underlying pathology.31

Liver and pancreas

While in many avian species the right lobe of the liver is larger than the left,4 in raptors this size difference is less
pronounced. Birds of prey possess gall bladders, which are located in the right lobe of the liver.4 Carnivorous
species have particularly well developed gall bladders.5 The avian pancreas has three lobes: dorsal, ventral, and
splenic.4 Pancreatic secretions are similar to mammals; amylase, lipase, and trypsin are produced.4,5 In carnivores,
the pancreas is relatively small, which is thought to be due to the high digestibility of the diet.8,27

Nutrition

Proper nutrition is crucial to gastrointestinal and overall health. It is essential to know the appropriate diet for a
given species. Many falcons and birds in the genus Accipiter require avian prey. Ospreys are strictly fish-eaters.
Although the diet of some species, such as barred owls and red-tailed hawks, is comprised predominantly of
small- to medium-sized mammals, these birds also consume avian and amphibian prey. Some small raptors, such
as American kestrels and eastern screech-owls, regularly consume insects.

Digestive efficiency

Specialist feeders, such as birds in the genus Accipiter and falcons, have shorter SI lengths relative to other rap-
tors.5,7,8 Due to this decrease in SI length, these birds have decreased digestive efficiency compared to generalist
feeders with longer SIs.22 A study that compared the efficiency of digestion in a specialist feeder, the peregrine
falcon, and a generalist, the common buzzard (Buteo buteo), found that when the two birds were fed the same
diets, the peregrine falcon absorbed 7% less of the diet than the common buzzard.22 Moreover, the peregrine
falcon lost body mass when fed a mammalian prey item but gained body mass when fed an equivalent amount of
an avian prey item.22 While the common buzzard gained body mass on both diets, it gained more when feeding
on the avian diet.22 These results suggest that some prey items may be more efficiently assimilated, possibly due
to a difference in fat content, which would compensate for decreased digestive efficiency in specialist feeders.22
These results also stress the importance of feeding the appropriate diet for a given species.

Diet

Most raptors in a rehabilitation setting will readily eat dead prey if offered appropriate food items. Ospreys are
a notable exception and may require hand feeding during the length of the rehabilitation process.

The best diet to offer raptors in captivity is one that resembles the natural diet as closely as possible within the
limitations of what food items are readily available and of high quality.31-33 Food items should be obtained from a
known and reputable source to prevent the possibility of disease transmission via the food and to ensure adequate
nutrition of the prey items as well as humane handling of the animals.33 Regular feeding of road kill should be

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avoided due to the potential presence of pathogens and toxins. Pigeons should not be fed to raptors, as several
infectious diseases, including Trichomonas gallinae and herpesvirus, can be transmitted via this route.3,31,34,35

To ensure the diet is nutritionally balanced, it is crucial that whole prey items, including all internal organs, be
offered to the bird.28,34 It is also imperative that the food item be of appropriate size for the raptor to ensure the
bird is able to consume the entire item.33

Because frozen/thawed items often lose some of their moisture content, soaking the items in water prior to feed-
ing is often recommended.3,31,33 Frozen/thawed fish are commonly fed to ospreys and bald eagles and must be
supplemented with thiamine (30 mg/kg of fish as fed PO q24-48h).30,31,36 All raptors should have a fresh water
source available at all times.

Allometric scaling, or determination of the daily minimum energy cost (MEC) can be used to determine the
daily caloric needs for raptors in a rehabilitation setting.37 The result of the equation 78 x (body weight)kg0.75
represents the minimum kilocalories (kcals) a bird of prey requires at rest. Using a simplistic but not grossly
inaccurate assumption that 1 g of prey item as fed equals 1 kcal, the result of this equation can be assumed to be
the minimum amount of food (in grams) a raptor requires daily without taking into account potential increased
needs for weight gain, activity, or healing. Although different vertebrate food items vary in their caloric con-
tent,38 the assumption of 1:1 ratio can provide a reasonable, straightforward starting point for determining an
amount to feed; however, birds should be weighed frequently and the amount fed adjusted as needed based on
an individual birds need for weight maintenance or gain.

Common food items

Laboratory-raised or other captive-raised mice and/or rats, day old chicks, and commercially available Coturnix
quail are common food items used for raptors in a rehabilitation setting. In general the nutritional composition of
whole vertebrate prey is complete and fairly constant across types of prey items, differing mainly in the amount
of fat present, which determines the caloric density.28 The protein quality of vertebrate food items is excellent,
as is the vitamin and mineral content and digestibility.28,39-41 Laboratory-raised mice and rats tend to be higher
in fat and lower in protein than free-living rodents but overall they provide adequate nutrition to mammal-eating
raptors.33,41,42 Day-old chicks should be fed with the yolk sac intact33,39 and, if fed to growing birds, calcium
supplementation may be required.39

Glucose metabolism

Glucose metabolism in birds of prey is different from mammals and from granivorous birds given that their diet
is high in protein and lipid and low in carbohydrate.43,44 Studies indicate that birds have lower insulin and higher
glucagon levels compared to mammals43,45 and that carnivorous birds have lower insulin levels compared to
chickens.43 It appears that glucagon rather than insulin is the main hormone regulating glucose metabolism in
birds.45,46 Studies in barn owls and black vultures (Coragyps atratus) have found that in both fasting and fed states
these species exhibit a high rate of gluconeogenesis using amino acids to maintain blood glucose (BG)43,44,47
and that BG is resistant to prolonged fasting because of this high rate of gluconeogenesis.44,47

Chronic malnutrition

Due to the metabolic differences described above, it is difficult to draw exact comparisons between the patho-
physiology of refeeding syndrome as it is understood in humans or other mammals to physiologic derangements
that may occur in chronically malnourished raptors. However, nutritional support for emaciated raptors in the
rehabilitation setting should be approached carefully. Severe anemia and hypoproteinemia are hematological

280 Building Exotics Excellence: One City, One Conference


changes that may identify a chronically malnourished raptor.3,30,33 Protocols for treating falconry birds in low
condition (i.e., at a critically low body weight) have been described3,30,31,48 and are likely applicable to the
free-living raptor. As there are currently no documented cases describing the pathophysiology of a refeeding-
like syndrome in free-living raptors, a practical approach to chronically malnourished birds, should focus on
providing warmth, assuring adequate hydration, incremental introduction of high quality nutrition suitable for
strict carnivores (high protein, high fat, minimal carbohydrates), and addressing underlying medical problems
such as chronic injuries and parasite burdens.

References

1. Chesser RG, Banks RC, Barker FK, et al. Fifty-first supplement to the American Ornithologists Union
Check-List of North and Middle American Birds. Auk 2010;127:726-744.

2. American Ornithologists Union. AOU checklist of North and Middle American birds. Available at: http://
checklist.aou.org/taxa. Accessed April 20, 2015.

3. Redig PT, Cruz-Martinez L. Raptors. In: Tully TN, Dorrestein GM, Jones AK, eds. Handbook of Avian
Medicine. 2nd ed. New York, NY: Saunders Elsevier;2009:209-242.

4. King AS, McLelland J. Digestive system. In: Birds: Their Structure and Function. 2nd ed. London, UK:
Bailliere Tindall;1984:84-109.

5. McLelland J. Digestive system. In: King AS, McLelland J, eds. Form and Function in Birds, vol 1. London,
UK: Academic Press;1979:69-181.

6. Duke GE. Gastrointestinal physiology and nutrition in wild birds. Proc Nutr Soc. 1997;56:1049-56.

7. Klasing KC. Anatomy and physiology of the digestive system. In: Comparative Avian Nutrition. New York,
NY: CABI Publishing;1998:9-35.

8. Denbow DM. Gastrointestinal anatomy and physiology. In: Whittow, GC, ed. Sturkies Avian Physiology.
5th ed. San Diego, CA: Academic Press;2000:299-325.

9. Duke GE, Evanson OA, Redig PT, et al. Mechanism of pellet egestion in great-horned owls (Bubo virgin-
ianus). Am J Physiol 1976;231:1824-1829.

10. Poole AF. Diet and foraging ecology. In: Ospreys: A Natural and Unnatural History. Cambridge, UK:
Cambridge University Press;1989:67-84.

11. Kirk DA, Mossman MJ. Turkey vulture (Cathartes aura). In: Poole A, Gill F, eds. The Birds of North
America, No 339. Philadelphia, PA: The Birds of North America, Inc;1998:1-32.

12. Snyder NF, Schmitt NJ. California condor (Gymnogyps californianus). In: Poole A, Gill F, eds. The Birds
of North America, No 610. Philadelphia, PA: The Birds of North America, Inc; 2002:1-36.

13. Buckley, NJ. Black vulture (Coragyps atratus). In: Poole A, Gill F, eds. The Birds of North America, No.
411. Philadelphia, PA: The Birds of North America, Inc;1999:1-24.

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14. Duke GE, Jegers AA, Loff G, et al. Gastric digestion in some raptors. Comp Biochem Physiol. 1975;50A:
649-656.

15. Balgooyen TG. Pellet regurgitation by captive sparrow hawks (Falco sparverius). Condor. 1971;73:
382-385.

16. Fuller MR, Duke GE, Eskedahl. Regulation of pellet egestion: the influence of feeding time and soundproof
conditions on meal to pellet intervals of red-tailed hawks. Comp Biochem Physiol. 1979;62A:433-438.

17. Duke GE, Fuller MR, Huberty BJ. The influence of hunger on meal to pellet intervals in barred owls. Comp
Biochem Physiol. 1980;66A:203-207.

18. Duke GE, Tereick AL, Reynhout JK, et al. Variability among individual American kestrels (Falco sparverius)
in parts of day-old chicks eaten, pellet size, and pellet egestion frequency. J Raptor Res. 1996;30:213-218.

19. Duke GE, Evanson OA, Jegers A. Meal to pellet intervals in 14 species of captive raptors. Comp Biochem
Physiol. 1976;53A:1-6.

20. Kostuch TE, Duke GE. Gastric motility in great horned owls (Bubo virginianus). Comp Biochem Physiol.
1975;51A:201-205.

21. Duke GE. Alimentary canal: anatomy, regulation of feeding, and motility. In: Sturkie PD, ed. Avian Physi-
ology. 4th ed. New York, NY: Springer-Verlag;1986:269-288.

22. Barton NW, Houston DC. A comparison of digestive efficiency in birds of prey. Ibis. 1993;135:363-371.

23. Clench MH, Mathias JR. The avian cecum: A review. Wilson Bull. 1995;107:93-121.

24. Clench MH. The avian cecum: update and motility review. J Exp Zool. 1999;283:441-447.

25. Duke GE, Bird JE, Daniels KA et al. Food metabolizability and water balance in intact and cecectomized
great-horned owls. Comp Biochem Physiol. 1981;68A:237-240.

26. Chaplin SB. Effect of cecectomy on water and nutrient absorption of birds. J Exp Zool Suppl. 1989;3:81-86.

27. Klasing KC. Digestion of food. In: Comparative Avian Nutrition. New York, NY: CABI Publish-
ing;1998:36-70.

28. Klasing KC. Nutritional strategies and adaptations. In: Comparative Avian Nutrition. New York, NY: CABI
Publishing;1998:71-124.

29. Johnson OW. Urinary organs. In: King AS, McLelland J, eds. Form and Function in Birds, vol 1. London,
UK: Academic Press;1979:183-235.

30. Joseph V. Raptor medicine: An approach to wild, falconry, and educational birds of prey. Vet Clin Exot
Anim. 2006;9:321-345.

31. Cooper JE. Nutritional diseases, including poisoning, in captive birds. In: Birds of Prey: Health and Disease.
3rd ed. Oxford, UK: Blackwell Science Ltd;2002:143-162.

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32. Heidenreich M. Feeding. In: Birds of Prey: Medicine and Management. Oxford, UK: Blackwell Science
Ltd;1997:24-34.

33. Chitty J. Raptors: Nutrition. In: Chitty J, Lierz M, eds. BSAVA Manual of Raptors, Pigeons, and Passerine
Birds. 2nd ed. Gloucester, UK: British Small Animal Veterinary Association;2008:190-201.

34. Forbes NA. Raptors: Parasitic diseases. In: Chitty J, Lierz M, eds. BSAVA Manual of Raptors, Pigeons, and
Passerine Birds. 2nd ed. Gloucester, UK: British Small Animal Veterinary Association;2008:202-211.

35. Stanford M. Raptors: Infectious diseases. In: Chitty J, Lierz M, eds. BSAVA Manual of Raptors, Pigeons,
and Passerine Birds. 2nd ed. Gloucester, UK: British Small Animal Veterinary Association;2008:212-222.

36. Carpenter JW. Nutritional/mineral support used in birds. In: Exotic Animal Formulary. 4th ed. St. Louis,
MO: Elsevier Saunders;2013:302-308.

37. Pokras MA, Karas M, Kirkwood JK et al. An introduction to allometric scaling and its uses in raptor medi-
cine. In: Redig PT, Cooper JE, Remple D, et al, eds. Raptor Biomedicine. Minneapolis, MN: University of
Minnesota Press;1993:211-224.

38. Dierenfeld ES, Alcorn HL, Jacobsen KL. Nutrient composition of whole vertebrate prey (excluding fish) fed
in zoos. Nat Agric Libr Z7994,Z65, 20p. Available at: https://archive.org/details/CAT11124570. Accessed
July 15, 2015.

39. Bird DM, Ho SK. Nutritive values of whole-animal diets for captive birds of prey. Raptor Res. 1976;10:
45-49.

40. Tabaka CS, Ullrey DE, Sikarskie JG, et al. Diet, cast composition, and energy and nutrient intake of red-
tailed hawks (Buteo jamaicensis), great horned owls (Bubo virginianus, and turkey vultures (Cathartes
aura). J Zoo Wildl Med. 1996;27:187-196.

41. Douglas TC, Pennino M, Dierenfeld ES. Vitamins E and A, and proximate composition of whole mice and
rats used as feed. Comp Biochem Physiol. 1994;107A:419-424.

42. Crissey SD, Slifka KA, Lintzenich BA. Whole body cholesterol, fat, and fatty acid concentrations of mice
(Mus domesticus) used as a food source. J Zoo Wildl Med. 1999;30:222-227.

43. Myers MR, Klasing KC. Low glucokinase activity and high rates of gluconeogenesis contribute to hyper-
glycemia in barn owls (Tyto alba) after a glucose challenge. J Nutr. 1999;129:1896-1904.

44. Migliorini RH, Linder C, Moura JL, et al. Gluconeogenesis in a carnivorous bird (black vulture). Am J
Physiol. 1973;225:1389-1392.

45. Braun EJ, Sweazea KL. Glucose regulation in birds. Comp Biochem Physiol. 2008;151B:1-9.

46. Hazelwood RL. Pancreas. In: Whittow GC, ed. Sturkies Avian Physiology. 5th ed. San Diego: Academic
Press;2000:539-555.

47. Veiga JA, Roselino ES, Migliorini RH. Fasting, adrenalectomy, and gluconeogenesis in the chicken and a
carnivorous bird. Am J Physiol. 1978;234:R115-121.

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48. Redig PT. Nursing avian patients. In: Beynon PH, ed. BSAVA Manual of Raptors, Pigeons, and Waterfowl.
Gloucestershire: British Small Animal Veterinary Association Limited;1996:42-46.

49. Smith EE. Haematologic parameters on various species of strigiformes and falconiformes. J Wildl Dis.
1978;14:447-450.

284 Building Exotics Excellence: One City, One Conference


Are Your Numbers Real? How to Design an In-House
Quality Control Plan for Your Veterinary Laboratory
Kendal E Harr, DVM, MS, Dipl AVCP (Clinical)

Session #310

Affiliation: URIKA, LLC, 8712 53rd Pl W, Mukilteo, WA 98275 USA.

Abstract: With the increase in numbers of analyses being performed in veterinary clinics, analytical
results would benefit from high-quality, well-validated in-clinic assays with a good quality assurance
program. Veterinarians do not receive training during their veterinary medical education to enable them
to easily manage analytical equipment. Moving forward during a busy day to construct and effectively
manage an in-house laboratory requires a step by step management plan built on quality assurance and
control as the foundation.

Introduction

In the past 15 years, there has been a large move to perform more analysis of veterinary samples in-clinic.
Indeed, in a 2008 VIN survey, >85% of clinics had some form of in-clinic laboratory.1there are little published
data regarding in-clinic quality assurance and control practices.\\n\\nOBJECTIVES: The purpose of this study
was the identification of the common equipment used in hematologic, biochemical, urinalysis, and other testing,
and assessment of quality control and assurance programs currently being performed in-clinic.\\n\\nMETHODS:
All members of the Veterinary Information Network (VIN This has been driven by marketing campaigns by the
large retailers of laboratory equipment that state all of the positive factors. There is the potential for improved
turn-around time especially in after-hours clinics where they are most needed. Decreased transport and handling
of samples, which can add artefact and error, would also result in significant improvement in accurate and pre-
cise results. Additionally, certain analysis such as coagulation factors and urinalysis are temperature and time
dependent. These and other similar analyses would benefit from high-quality, well-validated in-clinic assays
with a good quality assurance program. The hope in the clinics is that the purchase of laboratory equipment also
increases revenue to the clinic by keeping laboratory work in the clinic revenue stream.

What these marketing campaigns frequently do not address is quality control of laboratory samples which is
legally mandated for the same equipment in human medicine. This has been overlooked in large part as the added
cost is perceived to be a deterrent for purchase of equipment. Veterinarians do not receive training during their
veterinary medical education which would enable them to manage the equipment that they purchase. Indeed, few
clinical pathology courses teach quality assurance to veterinary students at all. Veterinarians are therefore poorly
prepared to be a discerning consumer when sales representatives from the major companies come to sell their
wares. They are dependent on quality assurance (QA) and quality control (QC) education from manufacturers,
which is important, but should be just one facet of the quality assurance knowledgebase in the facility if there is
to be an in-house laboratory. They also are taken unaware when sales representatives try to sell them different
products which include reagent contracts and lack any mention of an appropriate quality assurance program. The
appropriate costs of a well-managed laboratory are frequently grossly underestimated. Practitioners have been
caught in reagent purchase requirements which are very costly as they are not familiar with actual usage and
expiry of these products. This can result in the use of expired reagent which is obviously against all guidelines
and results in imprecise, inaccurate and poor quality results.2

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So how do we move forward during our busy day to construct and effectively manage an in-house laboratory?
The answer, step by step, one builds the foundation. QA is the overall system for assuring the quality of laboratory
test results. QA includes monitoring and assessment of all laboratory systems and procedures, with the objec-
tive of identifying problems, making corrections, and continuously improving the quality of testing service such
that pre-analytical, analytical, and post analytical error are minimized. Internal and in-clinic QC validation and
reference interval generation are part of the instrument/method validation and verification process (see American
Society of Veterinary Clinical Pathology (ASVCP) Point of Care (POC), General QA guidelines, and reference
intervals: http://www.asvcp.org/pubs/qas/index.cfm).35veterinarians ideally should demonstrate a commitment
to self-monitoring and regulation of laboratory performance from within the profession. In response to member
concerns about quality management in veterinary laboratories, the American Society for Veterinary Clinical
Pathology (ASVCP QA ensures that ongoing instrument performance is stable and that the errors inherent to
the instrument/methods do not exceed levels that would invalidate the interpretation of test results. Important
QA tools include regular training and assessment of personnel, regular QC procedures and participation in an
external quality assurance (proficiency testing) program.6

Management Plan

Actually sitting down and constructing a management plan, though it seems like more time and work, typically
results in significant cost savings due to adequately managed reagent and time savings as a direct result of bet-
ter trained personnel, better communication, written plans and SOPs. This is of course in addition to decreased
error in sample measurement.

The concept of quality requirements is the foundation for quality planning. Quality requirements can help guide
interpretation of laboratory test results because they provide perspective about variability of results within an
acceptable interval and potential significance of abnormal findings. A hierarchy of quality requirements has
been proposed, and the most stringent quality requirements are based on clinical outcomes and clinical decision
thresholds.

Quality laboratory medicine requires continual maintenance through a quality assurance program. A recent study
by Rishniw and others suggested that performance of in-clinic biochemical analyzers was significantly worse
than that of reference laboratories, and that individual in-clinic analyzers of most common makes periodically
and unpredictably failed quality assurance. Additionally, certain analytes tended to be problematic with most
analyzers. In all cases, the clinicians participating in that study were unaware of the accuracy and precision of
their own in-clinic analyzers, and did not routinely undertake quality control measures to examine and validate
performance.7 Subsequently, recommendations for quality assurance in veterinary practice were developed, and
have been recently published.6,8,9

In the VIN survey, practitioners obviously desired quality results, however when it comes down to specifics,
there appears to be a lack of knowledge how to implement the level of quality control necessary to obtain them.
This is an outline of where to begin.

A. Create standards or management policies for your business and criteria for the standards.
1. Use federal, state regulations, ASVCP guidelines and client contractual obligations as
a starting point.
2. Review best practices through AAHA, ASVCP, and American Association of Veterinary
Laboratory Diagnosticians (AAVLD) and determine how you can strive to achieve them.

286 Building Exotics Excellence: One City, One Conference


Align your criteria with accreditation standards, even if you do not pursue accreditation.
These will become the basis of your policies and procedures.

B. Create a quality program/management description.


1. This document should include:
a. a mission statement,
b. company reporting structure
c. annual program evaluation process
d. goals
2. Business practices and specific policies relevant to the quality programs scope.

C. Create policies and standard operating procedures (SOPs) according to manufacturers recommendations
and current ASVCP guidelines.

D. Establish a plan for in-clinic and external quality assessment of equipment according to ASVCP
guidelines.
1. In-clinic quality assessment includes controls analyzed according to a schedule that is
appropriate for the equipment. Actual frequency and controls required varies greatly
between specific instruments from daily to internal QC performed by manufacturer
technicians. Ask your manufacturer about available QC packages. If they say that they
dont have any, buy another instrument.
2. According to the ASVCP Point of Care guidelines external quality assessment should
be performed at least biannually.

E. Work with various leaders (eg, department chairs, clinical pathologists, head technologists, business
managers, etc) to develop workflows and standard operating procedures that support your quality pro-
gram and meet high principles for running your business.

F. Train staff and hold refreshers to ensure workflows are understood, implemented and meeting the needs
of your business.
1. Use written policies and SOPs as training tools. Have staff sign off on these so they
may be referred to if there are any misunderstandings at a later date.

G. Establish a quality committee that include employees from multiple departments/areas. Consider external
participants, such as clients or referral veterinarians, who can provide subjective feedback. This com-
mittee and regular meetings assures that any issues are quickly addressed
1. Meet on a quarterly basis to review quality reports, trends and improvement activities.
2. The data the committee reviews should include quality metrics, sales/revenue reports,
satisfaction survey results and other screening tools relevant to your business.

H. Implement corrective action plans when results are unsatisfactory and performance needs improvement.
Hold management accountable for developing action plans and achieving results. Continue monitoring
to ensure that your company is providing the best possible products and services.

Following ASVCP Point of Care Guidelines,10 will provide the framework for a perfect score on AAHA man-
agement inspections. Tables 1 and 2 provide outlines for the guidelines.

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Table 1. General
Table recommendations
1. General andand
recommendations chemistry testing
chemistry in the
testing veterinary
in the in-clinic
veterinary laboratory.
in-clinic laboratory.

Guideline item Compliant? Additional comment(s) by auditor


Yes
2.2 Written quality plan or manual exists
No
Yes
2.2 Document control policy in place
No
2.2 POCT committee or working group formed and
Yes
meets regularly(academic veterinary medical centers
No
and large multi-specialty hospitals)
2.4 POCT operators properly trained, and training Yes
documented in written records No
2.4 Periodic competency audits of POC operators
Yes
carried out by appropriate supervisor and
No
documented in written records
2.5 Manufacturers recommendations for POCT
instrument/test kit use and maintenance followed by Yes
all operators; manufacturers user manuals available No
to all operators
2.5, 2.7 Instrument performance study carried out
Yes
after instrument purchase and installation; results
No
documented
2.5 Annual (or as needed, following major service or
Yes
software upgrade) instrument performance
No
reevaluations carried out; results documented
2.5 Instrument log maintained that documents QC,
Yes
maintenance, upgrades, and trouble-
No
shooting/resolution of QC failures
2.6.2.1 At least one level of assayed quality control Yes
materials used routinely with all POCT instruments No
2.6.2.2.1-3 Specify frequency of running controls
N/A
and method of control data interpretation
2.6.2.4 Recommended sequence followed when Yes
quality control material lot number changes No
2.6.3 Participating in external quality assessment Yes
(EQA, or proficiency testing) program No
2.7.2 Following instrument performance studies,
observed total error (TEobs) for each analyte Yes
compared to ASVCP-recommended TEa for that No
analyte
2.8 For all testing, reference intervals used to
interpret patient data established or
Yes
transferred/validated per ASVCP recommendations
No
(also see compliance checklist for ASVCP reference
interval guideline)
2.9 For all testing, system to verify accuracy of Yes
reported patient results is in place No
2.9 For all testing, any annotations to patient results
Yes
are initialed and dated; corrected results are clearly
No
identified as such
2.9 For all testing, patient medical records archived Yes
(and backed up, if electronic) as required by law No

288 Building Exotics Excellence: One City, One Conference


Table
Table2. 2.
Additional recommendations
Additional specific
recommendations to to
specific hematology testing.
hematology testing.

Guideline item Compliant? Additional comment(s) by auditor


3.3.2 Blood smear review performed by qualified Yes
personnel for all CBCs (ASVCP recommendation) No
3.3.2 Blood smear review performed by qualified
Yes
personnel for all CBCs from sick patients and for CBCs
No
having unexpected or suspicious results (acceptable)
3.3.2 Medical repeat and review criteria are in place and Yes
used routinely No
Yes
3.4.1 Clotted samples are rejected
No
3.4.1 Blood smears made by qualified personnel ASAP Yes
following blood collection No

Reference Intervals

Reference intervals are a cornerstone of modern day diagnosis which are taken for granted and poorly understood.
Asking the correct questions can change understanding and use of your laboratory report. Are your reference
intervals (RI) correct for your patient? Are they method, species, and population specific? Where did they come
from and were they generated according to current ASVCP guidelines? Is partitioning required to improve acu-
ity of diagnosis? You need to ask your laboratory for this information if it is not apparent to you on your record.
According to current guidelines, if there is any deviation from normal generation in statistical or population
analysis, this must be directly annotated on the report. If RI generation has been in accordance with guidelines,
this should be available to the clinician in a written report (RI study summary document). This information may
include, but is not limited to: Reference population demographics and number of reference subjects sampled,
subject preparation and time or season of collection, if relevant, sample type and handling, confidence intervals
around the reference limits. If you are unaware of the specifics of the reference intervals you are currently us-
ing, please ask! The numbers that you use likely on a daily basis for diagnosis are typed in by a technician from
data generated by one or a handful of hopefully qualified quality assurance specialists (aka, human beings who
make mistakes).

When was the last time that the reference interval was reviewed and revalidated? Current recommendations are
revision every 3-5 years. Even at reputable institutions this can be problematic. Recently at UC Davis, it was
realized that bovine hematology reference intervals that were used and essentially disregarded by clinicians as
most results were out of bounds were last evaluated in the 1950s.11 Amazing what written archives sitting on
a slightly older emeritus professors shelf found by an exuberant veterinary student can elucidate; not likely to
happen in the digital age.

In Clinic Equipment

In a 2007 VIN survey, only approximately 25% of 371 practitioners had developed/validated the reference in-
tervals they were currently using, meaning that the majority of respondents were not in compliance with current
ASVCP recommendations.4

Validation of existing reference intervals, potentially supplied to you by your manufacturer should be verified
for your population and for your individual instrument. In order to do this, ASVCP guidelines recommend:

ExoticsCon 2015 Main Conference Proceedings 289


Several issues should be scrutinized when external RI are considered for transference.

1.1 The appropriateness of the reference population with respect to age, sex, breed, geography, physiology, etc.

1.2 Differences in pre-analytical techniques, such as patient preparation and collection method.

1.3 Differences in test methodology

1.4 Differences in instrument accuracy and imprecision (analytical quality).

1.5 Differences in laboratory quality by the laboratory donating the RI and the laboratory adopting them.

If significant differences are detected in the above areas, transference may not be appropriate. Many RI studies
are not well documented and often lack the detailed information necessary to determine the appropriateness of
transference.

The following validation procedure is relatively quick and straightforward. Evaluate 20 samples from normal
animals representative of the clinics own patient population against the candidate RI. If there are any outliers
that are suspected to be diseased, they should be eliminated and additional samples collected. If 2 of the 20
values fall outside the candidate RI, it is considered transferable. If > 2 of the original 20 values fall outside the
candidate RI, transference is rejected for that analyte. This is basically a binomial test and will not determine
whether the transferred RI is too wide for the receiving laboratory. If all 20 samples fall within the candidate
RI, it may be inappropriately wide for the adopting laboratory. When this occurs, another 20 samples should be
evaluated. The probability that all 20 results will be within the candidate RI is about 0.36, and with 40 samples
the probability falls to about 0.13. If all 40 samples fall within the candidate RI, then it is likely too wide and de
novo RI should be determined (Table 3).

290 Building Exotics Excellence: One City, One Conference


4
Table
Table3.3.Procedural
Proceduralsteps
stepsfor
fordedenovo
novodetermination
determinationofofRIRIfor
fornew
newmethods
methodsorornew populations.4
newpopulations.

Step Procedure
1 Perform literature search for information about analytes to be measured (preliminary investigation).
2 Define reference population and establish selection, inclusion and exclusion criteria (Section 1 and
Table 1).
3 Develop questionnaire to be completed by examining clinician, owner/caretaker or both in order to
determine if reference individual fits the selection or partitioning criteria (Section 2).
4 Determine number of reference individuals available or the number required to establish reference
intervals with desired level of certainty (as reflected by 90% CI around the reference limits) (Section
3).
5 Select reference individuals, preferably by direct methods (Section 4).
6 Collect and handle reference samples in standardized manner (Section 5).
7 Analyze reference samples using well-controlled methods (Section 6 and 7).
8 Prepare histogram (Section 8).
9 Identify outliers (Section 9). This may require prior transformation to appropriately apply outlier
detection methods and may need to be repeated after initial outliers are eliminated.
10 Determine distribution of reference data (Gaussian or non-Gaussian) (Section 10). If using parametric
methods, transform data if it is not Gaussian and retest distribution. Transformation may improve the
performance of the robust method. Nonparametric methods do not require any particular distribution.
11 Calculate upper and lower reference limits using an appropriate statistical method based on
distribution of data and number of samples (Section 11 and Table 2). Calculate confidence intervals
for the upper and lower reference limits.
12 Determine the need for partitioning only if there are sufficient numbers of reference samples or there
is evidence for clinical importance (Section 12).
13 Document all previous steps for a comprehensive reference interval summary report (Section 13 and
Table 3).
Source: American Society of Veterinary Clinical Pathology Quality Assurance and Laboratory Standards
Committee Guidelines for the Determination of Reference Intervals in Veterinary Species and Other Related
Topics, p 27 (references to sections and tables are to said guideline). Available at:
http://www.asvcp.org/pubs/pdf/RI%20Guidelines%20For%20ASVCP%20website.pdf. Accessed July 15,
2015.

References

1. Bell R, Harr K, Rishniw M, Pion P. Survey of point-of-care instrumentation, analysis, and quality assurance
in veterinary practice. Vet Clin Pathol. 2014;43(2):185-192.

2. Vap LM, Harr KE, Arnold JE, et al. ASVCP quality assurance guidelines: Control of preanalytical and ana-
lytical factors for hematology for mammalian and nonmammalian species, hemostasis, and crossmatching
in veterinary laboratories. Vet Clin Pathol. 2012;41:8-17. doi:10.1111/j.1939-165X.2012.00413.x.

3. Flatland B, Freeman KP, Friedrichs KR, et al. ASVCP quality assurance guidelines: Control of gen-
eral analytical factors in veterinary laboratories. Vet Clin Pathol. 2010;39:264-277. doi:10.1111/j.1939-
165X.2010.00251.x.

4. Friedrichs KR, Harr KE, Freeman KP, et al. ASVCP reference interval guidelines: determination of de novo
reference intervals in veterinary species and other related topics. Vet Clin Pathol. 2012;41(4):441-453.
doi:10.1111/vcp.12006.

5. Harr KE, Flatland B, Nabity M, Freeman KP. ASVCP guidelines: Allowable total error guidelines for bio-
chemistry. Vet Clin Pathol. 2013;42:424-436. doi:10.1111/vcp.12101.

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6. Flatland B, Freeman KP, Vap LM, Harr KE. ASVCP guidelines: quality assurance for point-of-care testing
in veterinary medicine. Vet Clin Pathol. 2013;42(4):405-423. doi:10.1111/vcp.12099.

7. Rishniw M, Pion PD, Maher T. The quality of veterinary in-clinic and reference laboratory biochemical
testing. Vet Clin Pathol. 2012;41:92-109. doi:10.1111/j.1939-165X.2011.00386.x.

8. Gunn-Christie RG, Flatland B, Friedrichs KR, et al. ASVCP quality assurance guidelines: control of pre-
analytical, analytical, and postanalytical factors for urinalysis, cytology, and clinical chemistry in veterinary
laboratories. Vet Clin Pathol. 2012;41:18-26.

9. Vap LM, Harr KE, Arnold JE, et al. ASVCP quality assurance guidelines: control of preanalytical and ana-
lytical factors for hematology for mammalian and nonmammalian species, hemostasis, and crossmatching.
Vet Clin Pathol. 2012;41:8-17.

10. American Society of Veterinary Clinical Pathology. ASVCP Point of Care Guidelines. Available at: http://
www.asvcp.org/pubs/qas/newQas/PDF/ASVCP%20POCT%20QA%20Guideline%20May%202013.FI-
NAL.pdf or http://www.asvcp.org/pubs/qas/index.cfm. Accessed May 15, 2015.

11. George JW, Snipes J, Lane VM. Comparison of bovine hematology reference intervals from 1957 to 2006.
Vet Clin Pathol. 2010;39(2):138-148. doi:10.1111/j.1939-165X.2009.00208.x.

292 Building Exotics Excellence: One City, One Conference


Section 11

AAV Master Classes


Track 4
Dealing with Parrot Intelligence and
Cognitive Abilities in Daily Practice
Irene M Pepperberg, PhD

Session #172

Affiliation: Department of Physiology, Harvard University, Cambridge, MA 02138, USA.

For almost 40 years, I have examined cognitive and communicative abilities of grey parrots. I discuss work of
the last decadea briefer version of some of the material presented in Session #0502-000170but now with
an emphasis on how understanding the intelligence of these birds impacts the ways in which they need to be
treated by owners and veterinarians.

I will discuss results of studies on numerical competence, optical illusions, delayed gratification (the marshmal-
low test given to 4-year-old children), inference by exclusion, Piagetian liquid conservation, and probabilistic
reasoning.

ExoticsCon 2015 Main Conference Proceedings 295


When You Thought it Could Not be Reproductive
Disease
Larry Nemetz, DVM

Session #337

Affiliation: From The BIRD Clinic Veterinary Corporation, 200 S Tustin St #E, Orange, CA 92866, USA.

Abstract: Reproductive disease in avian medicine is often underdiagnosed and therefore not treated. The
reason, perhaps, is that the avian patient with reproductive pathology presents with symptoms of other
organ systems: respiratory, neurologic (peripheral/central), gastrointestinal, urinary, hepatic, cardiovascular,
musculoskeletal, endocrine, or dermal that misdirects the practitioner away from the true primary etiology.
The diagnosis of reproductive pathology requires an understanding of how this organ system can influence
clinical symptoms, biochemical values, and radiographic interpretation of other organ systems. This
masterclass describes the interrelationship of the reproductive system of the avian patient and the other
organ systems both anatomically and physiologically. Second, clinical cases will be used to illustrate how
a preliminary diagnosis was incorrect, but with this new knowledge of the avian reproductive system, a
definitive diagnosis and successful long term therapy could be accomplished.

Introduction

The avian reproductive system poses unique problems in diagnosing its pathology. The organs of concern, the
ovary, oviduct(s), testes, and ductus efferens are internal, non-palpable, and have no specific chemical analytes
that indicate pathology. The gonads anatomically are located ventral to the cranial end of the kidney and adjacent
to the adrenal glands. In addition, they are in close proximity to the lungs, aorta, caudal vena cava, common iliac
vein, lumbosacral nerve plexus, and autonomic nerves supplying the intestinal tract. This close relationship can
directly or indirectly affect these other structures. The avian gonads also exert their effects through hormone
secretions. The ovarian hormones influence bone metabolism, hepatic metabolism, oviductal size and function, and
behavioral characteristics while testicular hormones can influence bone metabolism and behavioral characteristics.

With multiple interrelationships between the gonads and other organ systems, a correct diagnosis first begins
with the knowledge that these relationships exist. Second, a clinician needs a good history, including the hous-
ing of the patient, other birds in the house, the social structure, the diet, and history of any seasonal patterns
or oviposition. Third, a physical examination, biochemical analysis including a complete blood count (CBC),
plasma biochemical panel assay with plasma triglycerides, ionized calcium levels, and protein electrophoresis
are warranted. Plasma triglyceride levels have been associated with ovarian activity,1 but often are not included
in biochemical assays from commercial veterinary laboratories. Fourth, well positioned whole body ventrodorsal
and lateral radiographs allow evaluation of anatomic changes related to the gonads and adjacent organs.

How does this data help a clinician diagnose reproductive pathology as the primary etiology of the present-
ing clinical signs? In this authors opinion, the most important biochemical analytes are plasma triglyceride
(> 170 mg/dl), cholesterol (> 250 mg/dl), calcium (> 12 mg/dl), and uric acid (> 5.5 mg/dl). Any or all of these
values can be normal or abnormal with gonadal pathology, so they are not specific indicators, but can indicate
the possibility of gonadal pathology. Hypertriglyceridemia (> 300 mg/dl) has been demonstrated to have a high
correlation with ovarian activity.1 Cholesterol values are useful in relation to triglyceride levels to differentiate
dietary influences versus ovarian activity. Hypercalcemia has been associated with ovarian activity,2 but normal

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calcium values do not rule out ovarian activity or reproductive pathology. This author believes uric acid values
are influenced by gonadal pathology, but further research is needed in regards to this relationship. Laboratory
reference normals were established without this information taken into consideration. Current upper limits of
uric acid in most avian species are too high, leading to many missed (reproductive) diagnoses. Radiographs are
a means to actually interpret the presence, size, and shape of the gonads as well as other findings suggestive of
gonadal activity or pathology. Proper interpretation in all species requires high detail images and excellent radio-
graphic positioning to prevent oblique angles leading to misinterpretations. The ventrodorsal image involves the
keel bone superimposed over the vertebral column, the wings and legs extended, and the line between the two
humeral heads and the two femoral heads positioned perpendicular to the keel. Extension of the legs extends the
coelomic cavity and removes cranial-caudal rotation of its contents. The right lateral image involves aligning the
dorsal acetabular rims parallel to the synsacrum and superimposing the coracoid bones. This lateral view is more
difficult to acquire correctly, with the consequence of poor gonadal interpretation. Rotation of the synsacrum
influences the position/image of the kidneys, adrenals, and gonads. Rotation of the shoulders can lead to misin-
terpretation in changes of the caudal pulmonary serosa, heart, and syrinx. The change in opacity of the caudal
pulmonary serosa is of use if a ruptured ovarian follicle or cyst is suspected. An oblique right lateral image with
non-superimposed caudal pulmonary serosa can appear radiodense, indicating fluid where fluid does not exist.

The basics of diagnosing avian reproductive disease has been described, but it is best explained in the context of
real clinical cases to determine if gonadal pathology was the true etiology of the presenting clinical symptoms.
Background is provided on each of the cases below and important aspects of each case will be discussed during
the presentation.

Case 1

Case 1 was a 110-g, female Meyers parrot (Poicephalus meyeri) with a hatch date of April 01, 1995. The bird
was the authors pet. On January 04, 2013 the bird was presented for a routine yearly physical examination and
biochemical evaluation. All previous yearly evaluations were normal biochemically and radiographically. The
blood results were: WBC 17,000, heterophils 40%, lymphocytes 57%, basophils 1%, eosinophils 2%, uric acid
9.2 mg/dl (2.5-10.5 mg/dl), triglycerides 108 mg/dl (25-170 mg/dl). Radiographic evaluation demonstrated
hyperostosis of the long bones suggestive of ovarian activity.

This case will be used to demonstrate the importance of radiographic positioning in the diagnosis of reproductive
disease versus other possible pathology.

Case 2

Case 2 was a 910-g, female military macaw (Ara militaris) with a hatch date of August 06, 1996. This was its
first visit to a veterinarian. On August 01, 2005 the bird was presented for sleeping more than usual for 4 days.
The bird usually laid one egg per year, but had not laid an egg since early 2004. On examination there was mild
left leg paresis, but no palpable pathology. A CBC was normal. Monitoring was recommended. Two days later,
the bird was favoring her left leg more, not vocalizing, but eating well. Radiographs were recommended.

On November 15, 2006 the bird presented again for losing balance, listless, sleeping all day, not grooming, but
eating well. It weighed 897 g. Mild feather destructive behavior was observed bilaterally in the ventral propatagial
region and inner distal femoral region. There was a 6% anemia below normal. Radiographs were recommended.

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On December 23, 2014 the bird presented for coughing one day along with progressive feather destructive
behavior of the cervical and top of propatagial regions. It weighed 900 g. Physical examination confirmed the
primary complaint and feather destructive behavior bilaterally along the trunk in the axillary region. Radiographs
and a CBC were recommended.

Case 3

Case 3 was an 947-g female umbrella cockatoo (Cacatua alba) with a hatch date of August 21, 2000. It was
a referral case. In August 2013 it presented for a distended coelom and projectile droppings for greater than
1-month duration. The history from referring records included feather destructive behavior since 10 months of
age. In 2002, it weighed 734 g, in 2003 its weight was 849 g, in 2006 its weight was 542 g after a prolapsed
cloaca, which was surgically replaced, in 2009 it weighed 880 g, in 2010 it weighed 707 g, in 2013 it weighed
948 g, and oviposition had never occurred. Odiferous droppings in 2010 responded to antibiotics. On examination
there was extreme pectoral muscle atrophy, no active feather follicles on the entire trunk region, and a distended
coelom that was firm to the touch. Radiographs were recommended.

Case 4

Case 4 was a 258-g male alexandrine parakeet (Psittacula eupatria) with a hatch date of March 10, 1995. This
bird was the authors pet. On May 18, 2010 it presented for feather destructive behavior of both legs and dorsal
synsacrum, increased aggression and vocalization. A CBC and biochemical panel where normal, but uric acid
was 12.1 mg/dl (4-14 mg/dl). Full body radiographs were evaluated.

Case 5

Case 5 was a 135-g female red-winged parrot (Aprosmictus erythropterus) with a hatch date of January 30, 1991.
On November 10, 2011 it presented for feather destructive behavior at the synsacrum region over the ovarian
region. Oviposition has never occurred. Its history included being on pellets (Roudybush) for 19 years. Plasma
chemistries to date had all been normal. It tested Bornavirus (+) on September 14, 2009. A biochemical panel
was normal except triglycerides 203 mg/dl (<170 mg/dl). Estradiol level was evaluated 23.68 pg/ml. Full body
radiographs were evaluated.

Case 6

Case 6 was a 139-g male Indian ring-necked parakeet (Psittacula krameri) with a hatch date of February 14, 2010.
On May 10, 2013 it presented for a right foot injury suspected by a mate attack 5 days earlier. On examination
there was a soft tissue injury to digit 4 phalanges 2 and 3, and an abrasion to the ventral tibiotarsometatarsal
(TMT) region. Therapy included topical cleaning/disinfection, oral broad spectrum antibiotics, and isolation from
the female mate. The patient represented May 21, 2013 for bleeding from the right foot from self-mutilation.
On examination there was an injury to the right foot in addition to toe tapping behavior. Full body radiographs
were evaluated.

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Case 7

Case 7 was a 455-g female Congo African grey parrot (Psittacus erithacus) with a hatch date of March 10, 1994.
As a second opinion on May 17, 2013 it presented for left foot injury of 3 weeks duration with persistent and
worsening leg twitching starting 2 days after the injury. The owner believed the bird was attacked by other pet
parrot. The bird was on an antibiotic, antifungal, and NSAID, but no diagnostic testing was performed. Its his-
tory included first oviposition in March 2013 and second oviposition 2 days before the interspecies incident. On
examination there was a depression in left digit 2, phalanges 1-2.

The area did not appear to be painful. Radiographs indicated a healed fracture of digit 2 phalanx 2. Periosteal
reaction coincides with history and timing of the traumatic event. Biochemical panel and CBC results included
WBC 12,000/l, heterophils 80%, lymphocytes 20%, ionized Ca 1.3 mmol/L, cholesterol 316 mg/dl, and
triglycerides 89 mg/dl.

Case 8

Case 8 was a 194-g female blue headed Pionus (Pionus menstruus) with a hatch date of July 07, 1998. As a second
opinion on April 13, 2012 it presented with a 2-year history of episodes of anorexia, difficulty breathing, and oral
plaques on buccal and lingual mucosa. Histopathology included focally extensive ulcerative necroheterophilic
inflammation with bacterial rods and mucosal hyperplasia, dysplasia, and hyperkeratosis. Repeated cultures
were done with multiple bacterial organisms, multiple antibiotic (clavamox, baytril, amikacin), antifungal (itra-
conazole, terbinafine) regimens and vitamin A injections. All biochemical values were within reference ranges,
but there was no radiographic evaluation. Its history included the fact that the owner also maintains a Goffins
cockatoo and a caique in a very small house. On examination there were oral multifocal hyperkeratotic plaques
with increased oral mucous production, which was confirmed. Diagnostics included oral biopsies (3 sites), which
reconfirmed focally extensive hyperplastic mucosal epithelium with inflammatory exudates and intraexudate
bacteria. Radiographs demonstrated increased radiodensity in the caudal 50% of lung field on lateral view with
a soft tissue mass (5 x 3 mm) caudal to the lung field, cranial to the gonadal region.

Case 9

Case 9 was a 605-g female double yellow-headed Amazon (Amazona oratrix) with a hatch date of August 30, 1988.
On Feb 16, 2010 it presented for yearly examination and radiographic evaluation due to an 11% weight gain over
the previous 4 years. Chronic lipemia had been present since 2005, but the owner was working on diet management
and conversion from seed to pelleted diet. Plasma demonstrated marked lipemia, but blood chemistries were not
evaluated. Radiographs demonstrated hyperostosis of all non-pneumatic long bones, cranially displaced ventriculus
and poor overall coelomic detail. The diagnosis was chronic ovarian activity. A full biochemical evaluation was
recommended, but the owner did not return until August 18, 2011 with a primary complaint of the bird becoming
aggressive toward his wife and more vocal. A CBC count and biochemical evaluation was performed.

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References

1. Nemetz L. Chronic hypertriglyceridemia as a marker for ovarian pathology. Proc Annu Conf Assoc Avian
Vet. 2010;49-52.

2. Kenny AD. Parathyroid and Ultimobranchial Glands. In: Sturkie PD, ed. Avian Physiology. 4th ed. New
York, NY: Springer-Verlag;1986:466-478.

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Backyard Poultry: Practical Information You Can Use,
Presented by Systems
Cheryl B Greenacre, DVM, DABVP (Avian), DABVP (Exotic Companion Mammal)

Session #166

Affiliation: College of Veterinary Medicine, Department of Small Animal Clinical Sciences, 2407 River
Drive, C-247, University of Tennessee, Knoxville, TN 37996, USA.

Abstract: Many different diseases, pathogens, and parasites are observed in backyard poultry. An overview
of the most common problems are provided and discussed regarding the respiratory, musculoskeletal,
intestinal, and dermatologic systems.

Introduction

There are important diseases, pathogens, and parasites that can affect backyard poultry. An overview of the
most common problems are provided and discussed regarding the respiratory, musculoskeletal, intestinal, and
dermatologic systems.

Respiratory

Mycoplasmosis most common

There are three different species of Mycoplasma that can infect chickens. Mycoplasma gallisepticum causes
respiratory disease in chickens, but an infectious sinusitis in turkeys. Mycoplasma meleagridis causes an air
sacculitis and skeletal deformities in turkeys. Mycoplasma synoviae causes air sacculitis and synovitis /lameness
in chickens. Mycoplasma gallisepticum (MG) is seen in backyard flocks and is of concern because it can easily
spread to nearby commercial flocks and cause economic devastation for that commercial flock. Most commer-
cial flocks are MG free. To participate in the National Poultry Improvement Plan (NPIP) a flock needs to be
MG free. Transmission is through fomites. Clinical signs of MG in chickens includes an upper respiratory disease
with swelling of the infraorbital diverticulum of the infraorbital sinus with caseated pus. The best prevention
is to depopulate and repopulate with clean stock. Treatment can be attempted with antibiotics (spectinomycin,
lincomycin, erythromycin, or tylosin), but birds remain carriers for life.

Infectious bronchitis virus

Infectious bronchitis virus, caused by a coronavirus, affects only chickens and has a worldwide distribution.
Younger, immunosuppressed chickens show worse clinical signs than older immunocompetant chickens. Clinical
signs include upper respiratory signs including sneezing, gasping, rales, and nasal discharge. Young are affected
worse than adults showing gasping and labored breathing. In an affected flock of chicks, all birds will typically
develop clinical sings within 36-48 hours and the clinical disease will typically last approximately 4 days (longer
if secondary infections develop). Older chickens show a 5-10% drop in egg production for about 10-14 days.
The reproductive tract can also be affected by this virus resulting in irregular and roughened eggshells with
watery albumin and decreased egg production. Also newer strains may affect the kidneys. Tests include virus

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neutralization, hemagglutination inhibition or ELISA. The best method to control is to disinfect, repopulate and
use live vaccine. This disease is highly contagious that easily spreads via airborne particulate matter and via
fomites. There is no treatment, but antibiotics can be given to prevent secondary bacterial infection, especially
with infectious coryza. The virus is easily destroyed by disinfectants, sunlight and heat. Increasing the environ-
mental brooder temperature by 5 degrees Fahrenheit helps chicks to recover. There is a vaccine available, but it
is not used in backyard flocks since there are numerous serotypes.

Infectious coryza

Infectious coryza affects mainly chickens (it can affect pheasants and guinea fowl as well). The causative agent
is Haemophilus paragallinarium, a gram-negative rod. The incubation period is 1-3 days and the course of the
disease is approximately 4-12 weeks. Clinical signs include upper respiratory signs and swelling of the face with
foul smelling (hallmark) and sticky nasal and ocular discharge, dyspnea and rales. Clinical signs also include
decreased egg production. Birds that recover are lifetime carriers. Transmission is through direct or indirect
contact. Mortality is about 20-50%. Treatment consists of giving antibiotics such as sulfa drugs, erythromycin
or tetracycline, but since affected birds are lifetime carriers, the only way to control the infection is through
depopulation and leaving the premises vacant for at least 30, preferably 60 days after cleaning and disinfecting
before repopulating. Avoid mixing flocks or mixing different ages and sources of birds. There is a vaccine avail-
able, but it is seldom used in backyard flocks.

Infectious laryngotracheitis (ILT)

Infectious laryngotracheitis affects only chickens (and pheasants). The causative agent is a Herpesvirus. Chickens
older than 14 weeks are more affected than younger chickens, so the disease is usually seen in mature chickens.
There is a mild form in the US that is associated with decreased egg production, conjunctivitis, nasal discharge,
swollen infraorbital sinus and in more severe cases moist rales. Shaking of the head and flinging necrohemor-
rhagic material from the trachea is a hallmark of this disease including an inspiratory dyspnea and death. At
gross necropsy a mucoid to necrohemorrhagic tracheitis is present. Diagnosis is confirmed via virus isolation,
ELISA, or indirect fluorescent antibody test. Prevention is through the use of a live vaccine. The disease can be
spread by fomites. Properly dispose of dead birds to prevent spread (incinerate). Antibiotics can be used, but it
is better to depopulate and then vaccinate new birds.

Avian influenza need to know about this one

Avian influenza affects many species. The causative agent is an orthomyxovirus. It is also known as fowl
plague. The clinical signs are variable since there are mild and highly pathogenic forms, but include anorexia,
decreased egg production and respiratory disease with the mild form to respiratory distress, facial swelling, diar-
rhea and neurological signs with the highly pathogenic form. Usually the mild form of the disease is associated
with high morbidity and low mortality. Basically coughing, sneezing and sudden death are the typical signs of
this disease. This a highly contagious disease associated with high mortality of both domestic and wild birds.
There is no treatment. Testing usually involves virus isolation. This is a reportable disease. A killed vaccine is
available, but not used in backyard flocks. Depopulation is usually the recommended action during an outbreak
and the disease should be reported to the state veterinarian.

Newcastles disease need to know about this one

Newcastles disease affects many species of birds. The causative agent is a Paramyxovirus. There are 4 dif-
ferent forms that vary in severity. The least pathogenic form is the lentogenic form which causes a mild upper
respiratory disease and usually only affects the young. The mesogenic form also causes a mild upper respiratory

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disease, decreased egg laying, and has a low mortality. The neurologic/velogenic form causes a sudden onset of
upper respiratory disease followed by neurological signs with approximately a 50 to 90% mortality. The worst
form, which is a foreign animal disease for the US, is the exotic Newcastles disease (END) or also known
as the viscerotrpic velogenic form that is associated with neurologic signs and high mortality. In the US there
is a vaccine for the first three forms listed here, but in the US we do not vaccinate against END, we test and
eradicate since it is a foreign animal disease. There is a serology test available at Californias San Bernardino
County Laboratory for PMV 1,2 and 3. A paramyxovirus; many different kinds of Newcastle disease; mostly
mild disease in poultry and they are vaccinated at one day of age; causes mild conjunctivitis in people; test at
US Quarantine stations. Exotic Newcastles disease (aka VVND or viscerotropic-velogenic Newcastles disease)
is a foreign animal disease and millions are spent to eradicate all exposed birds when there is an outbreak in the
US (last one was in California, 2002/2003 affecting 3.5 million birds)

Musculoskeletal

Mareks Disease most common

Mareks disease affects only chickens. The causative agent is a Herpesvirus. Clinical signs are generally seen in
birds that are 12-20 weeks of age, but can be seen as young as 3-4 weeks of age. This highly contagious disease
is associated with a high morbidity and low mortality. The incubation period is typically 4-12 weeks, clinical
signs are seen in 10-12 weeks chickens. Transmission is mainly via virus shed in skin and feathers. The virus can
persist in the environment indefinitely (feathers and dander in poultry houses and yards). Clinical signs of the
paralytic form include an asymmetrical paralysis since the virus affects the sciatic (technically the ischiadic)
nerve and presents as a bird that cannot stand because one leg is pointed forward while the other leg is pointed
backward. A clinical sign of the ocular form is gray eye where the color of the iris gradually changes from
brown to gray and the pupil becomes irregularly shaped. There is no treatment. Prevention is by administering
a polyvalent vaccine in the egg or after hatching at 1 day of age. Understand that no vaccine is100% protective
and that vaccine administration may not be 100% at the hatchery since it is typically a spray on vaccine as the
chicks go by on the conveyor belt. Mareks disease must be differentiated from lymphoid leucosis based on age
of clinical signs, and gross and histopathological lesions (ischiadic nerve enlargement).

Lymphoid leukosis

Technically lymphoid leukosis is an infectious disease, but is basically a neoplasia and presents as such. Affects
only chickens. Clinical signs usually occur in older chickens at approximately 24-40 weeks of age. The clinical
signs are non-specific and include anorexia, weakness, pale comb and distended abdomen. At gross necropsy
grey to white tumors are observed in the liver and other organs. The clinical signs are sometimes difficult to dif-
ferentiate from those of Mareks disease, but lymphoid leukosis does not occur before 14 weeks of age, whereas
Mareks disease usually occurs at 10-12 weeks of age. The best prevention is to test and cull positive breeder birds.

Pododermatitis

Ulcerative pododermatitis tends to occur if the chicken is overweight, on a roughened surface, or if one leg and
foot bears more of the body weight than the other, or a combination o