Ask An Expert: Dr. Brian Speer, DVM

Answered by Dr. Brian Speer, DVM:

An important consideration when treating uvitis in any patient is that the hypothetical cause of the inflammation needs also to be treated. In your bird's case it seems that antibacterial therapy is being forwarded as your attempt at primary treatment, with steroids and anti-inflammatory treatments being used to help address the actual inflammation that is believed to be present. Although the drug meloxicam has comparatively few adverse effects known in birds, there are several known potential problems with the use of steroids in birds - including but not limited to immunosuppression with possible secondary infections, abnormal fat metabolic disorders, increases in urinary output, and loss of appetite. These problems are somewhat dependent on dose delivered, the specific steroid being used, the frequency and duration of treatment, and the size and species of bird. In mammals, since they typical patient is much larger than your bird would be, these adverse effects are encountered much less frequently than in birds, and many veterinarians that are most familiar with mammalian practice may be inclined to use steoids more frequently than would a focused avian practitioner. The probable increase in urinary output that you describe, combined with loss of appetite make me concerned that there may be a problem with the steroids in your bird's treatment regime, and I would recommend that these drugs not be used anymore, pending consultation with your veterinarian. The one thing that does not necessaril fit with this possibility though, is that these observed changes in urinary output and appetite seem to have developed over a week or so after the likely discontinuance of steroid treatments. At this point in time, it may be prudent to have some blood testing performed to assess the general systemic health status of your bird (kidney, liver function in particular), have the details of the primary diagnosis of uveitis re-evaluated, and then begin to chart a different course of potential treatment. If your veterinarian is not clear on diagnosis or treatment options for your bird, I would recommend that you ask that they either consider referring you to a colleague who may be better positioned to help, or consult with a specialist about diagnosis, treatment and management options.

Response 2: It is hard to guide you further, in the absence of being able to physically and hands-on evaluate your bird, unfortunately. Dilation of the pupil could be related to a functional blindness being present, or the development of some iris adhesions to the lens or cornea of the eye (synechiae). It is good that the abnormal droppings have returned to normalcy. Blepharospasm (squinting of the eye) may be related to pain or discomfort, but not necessarily always. In the absence of having a more detailed understanding of exactly what is going on, it would be challenging, if not impossible, to recommend specific diagnostic maneuvers that necessarily will help clarify things for you, unfortunately. Some of the basic blood testing is always a fair approach in launching a diagnostic workup in most ill birds, and these would include a baseline CBC and a good biochemistry profile. Was there any possibility of referral or obtaining a more advanced opthalmic examination performed?

Answered by Dr. Brian Speer, DVM:

It would be technically impossible to provide you with a definite "yes" or "no" answer about your concerns here, unfortunately. The best answer to your question would be best arrived at with a proper veterinary examination and with the aid of some baseline laboratory screening. At this age, it is not uncommon for subclinical obesity to begin to show subtle signs, which can include alterations in urinary output in some individuals. On the flip side, there can be some variations in urinary output seen in some individuals due to season, hormonal cyclicity and diet being consumed. A veterinarian who is given the opportunity to actually see your bird and examine it should be best positioned to help you with your concerns.

Answered by Dr. Brian Speer, DVM:

I am attaching some links to Jerry Jenning's website at Emerald Forest Bird Gardens for a series of leads that should help you with several of your husbandry concerns.

Home page: http://www.emeraldforestbirds.com/
Preparation of food: http://www.emeraldforestbirds.com/Food.html
Care sheet: http://www.emeraldforestbirds.com/CareSheet.htm
Information sheet for this species: http://www.emeraldforestbirds.com/keelbill2.htm

Answered by Dr. Brian Speer, DVM:

Suzanne - it would be inappropriate for a healthcare professional to hypothesize what may be wrong with your bird and recommend treatment. There may very well be a number of issues present here, necessitating examination and diagnosis. Blepharospasm (holding the eyelids closed) should be presumed to be associated with pain in your bird. Although it may be somewhat traumatic to obtain this diagnosis, your potential options for treatment or lack of need for treatment then should be quite clearly delineated. I'd strongly recommend a proper veterinary evaluation for your bird as soon as you can arrange it.

Answered by Dr. Brian Speer, DVM:

At least in the United States, coccidiosis is comparatively uncommonly diagnosed in the Budgerigar. In other parts of the globe, however, this can be seen more often, however. Australia is one example where this diagnosis may be more common. Baycox is the brand name of the drug Toltrazuril, which is active on the intracellular phase of infection, usually requiring a very short two day treatment period. Passage of undigested seed in the droppings is an uncommon clinical sign that would be linked to Coccidiosis. The broad spectrum antibiotic, Baytril (Enrofloxacin) has no activity against this parasite (coccidia). In general, I would suggest that you ask your veterinarian to repeat a physical examination on your young budgie, and to consider screening for intestinal parasites, Gastric Yeast (Macrorhabdus) and other more likely explanations for the clinical signs you see.

Answered by Dr. Brian Speer, DVM:

Laura - there are must be environmental, behavioral and nutritional stimuli that are responsible for supporting your birds reproductive drive during those times of year. Realistically, these need to be carefully evaluated and corrected, using ethically and ornicologically sound principles. The wood chewing behavior, realistically, is probably associated with nest building behaviors, I would anticipate. Although the calcium carbonate present in Tums is a good source of Calcium, unless a large number of other variables are addressed (dietary fat content modification, etc), this will at best be a short term solution - kind of consistent with your experiences, to-date. Furthermore, I would not anticipate that the antibiotic, Ciprofloxacin, should have much of any merit in treatment of most birds with the clinical signs as you describe - uterine bacterial infections are generally far less common in parrots as compared to the metabolic issues that should be present. I would strongly recommend that you consult with your attending veterinarian and make sure that you are approaching this issue in the most balanced manner possible.

Pasted below are some excerpts from a prior conference proceedings for veterinarians that I have published in the past:

Chronic egg-laying in the pet bird poses a significant threat to the health and behavioral well being of many pet birds. When a hen lays repeated clutches or larger than normal clutch size without regard to the presence of a normal mate or confined breeding season, a myriad of secondary problems can follow. Ultimately, functional exhaustion of the reproductive tract poses risk of metabolic and physiological drain on the bird, particularly on calcium and energy stores. All of these ultimately predispose the hen to egg binding, dystocia, yolk coelomitis, oviductal impaction, oviductal torsion, cloacal prolapse and osteoporosis. Although chronic egg laying is seen in many companion bird species, it is most commonly described in the smaller species, including budgerigars, cockatiels, lovebirds and finches. Medical intervention has traditionally focused combinations of environmental management, counter-hormonal therapies and surgery. In general avian medical practice, counter-hormonal therapies, including leuprolide acetate (lupron), seem to be the more common treatments recommended for chronic egg laying, and salpingohysterectomy, and environmental/behavioral recommendations seem to be less commonly implemented. The purpose of this paper and presentation is to outline the function of the female reproductive tract, the etiopathogenesis of chronic egg-laying, and to critically review and ethically prioritize potential medical interventions to resolve or address the problem.

Unlike many of the more common pet domestic mammal species, avian reproductive function is predominately initiated by extrinsic or environmental stimuli, as opposed to intrinsic cyclicity. Once the hypothalamic-pituitary-gonadal axis is triggered, a predictable cascade of events and consequences can occur. These events include endocrine, physiologic, behavioral and anatomic changes and activities in birds. Even what has been described as signs of reproductive behavior (paper shredding, nest building, hiding under papers, and/or seeking dark places), in reality, are predominately controlled by activity of the pituitary-gonadal axis, and are not necessarily involved with the triggering of its activity. In this sense, nest-seeking behaviors are merely the result of an already activated pituitary-gonadal axis, and are predictive of more direct reproductive activity in birds. In an ideal clinical preventative setting, by effectively controlling the triggers of the pituitary-gonadal axis should be most preventative, if not curative. In clinical settings with more advanced reproductively linked disorders, after the immediate clinical problem has been successfully addressed, efforts on a preventative level still are an essential part of complete medical care.

Most non-domestic avian species are breed opportunistically, and are reproductively active only when favorable environmental conditions exist. These are typically birds adapted to tropical or desert climates, and, if the climate allows, these birds may breed. In the absence of supportive environmental conditions, reproduction does not occur. In a given year, the proportion of birds in a wild population that actually breed can be low, and some species breed only every other year or every few years. Parrots are mainly monogamous and, in the case of larger species at least, pair for life. The bond between pairs is constantly reinforced by a variety of behaviors, such as allopreening and feeding. This strategy is perhaps adaptive, because of the high proportion of learned (as compared to instinctive) behavior exhibited in parrots: pairs that know each other well and have experience of one another breed more successfully.

Environmental cues that can stimulate reproductive activity and ultimately lead to oviposition in avian species include photoperiod, temperature, rainfall, available food supply, the presence of nesting material, and/or the presence of a mate (real or perceived). The perceived photoperiod by birds is understood by many as a very important environmental cue for reproductive activity in most avian species. Its role in parrot species is not as well studied as it is in many other taxonomic groups of birds. Rainfall is known to stimulate reproductive behavior in many tropical and desert-dwelling species of birds. Rainfall and temperature often directly affect the available food supply, which is another critical factor affecting reproductive activity. The presence of nesting sites and appropriate nesting materials is a powerful reproductive cue for many parrot species. Abnormal “mates” can include an owner or other human, some items within the cage, and toys. Another bird housed in the same cage, the same room, or even simply within hearing distance may strongly stimulate reproductive drive. In some species, there is a genetic predisposition for chronic egg-laying and lack of normal reproductive hormonal balance. Pet chickens and waterfowl are common species representations of the genetic predisposition for chronic egg laying. Pair-bond enriching behaviors such as include regurgitative feeding, copulatory behaviors, nest site inspection and mutual preening are acknowledged as triggering cues for reproductive activity.

Medical intervention generally is guided along the ethical guidelines of “Least intrusive, most effective”. A hierarchy of treatment options that progressively move up this scale, as-indicated in specific cases is vastly important. Many of the more intrusive treatment options, when not preceded by some of the more foundational and less-invasive recommendations for excessive egg laying should be realistically predisposed to a higher degree of failure. Degrees of intrusiveness of a recommended treatment can be tested by the amount of induced stress, physical pain, and cost. In addition, treatments that require repeated administrations should be challenged for their compatibility with this hierarchy in-toto. Degrees of effectiveness can be tested by their short term and long term effect at directly achieving their goal, as well as their effect at preventing recurrence in the future. Reduction of the probability of potential side effects and their adverse consequences on the health and welfare of the bird is also a very important test of effectiveness of a treatment.

Prevention
Many young parrots sold as pets are “mentored” and taught by their new owners only one form of social interactive skills (pair bond enrichment behaviors), as opposed to the typical array of social skills that would have been taught by the parents of their wild counterparts. Deficits in normal social interaction skills, foraging activities, learned inappropriate pair bonding behaviors, inappropriate diets, the provision of nesting environments and other factors are common. The first and foremost component of healthcare and prevention of excessive egg laying comes from the identification of existing risk factors at routine examination, client education, appropriate recommendations, and careful follow up on recommended actions with owners. Recommendations for enrichment of normal lifestyles, positive reinforcement training for guiding flock interactive behaviors, dietary recommendations, foraging training, and cage environment improvements all are essential foundational preventative maneuvers. In essence, enrichment of these types of behaviors is a key aspect of the routine annual examination.

Environmental and Behavioral Interventions
In the presence of excessive egg-laying in companion birds, a series of recommendations and training / enrichments should be outlined for bird owners. Specific recommendations are guided by signalment, history and physical examination findings. Although many of the needed recommendations require the “removal” of reproductively associated stimuli and behaviors, more ethical recommendations should also concurrently package and emphasize the training of normal behaviors to replace what is removed. The stress that can be generated by environmental and behavioral deprivation, although it can add to short-term “effectiveness”, should be viewed as less ethical than a behavior-change strategy that is based on differential reinforcement of alternative behaviors. Environmental and behavioral deprivation can easily result in an increase in behavioral problems, ultimately adversely affecting the health and welfare of these patients. In most circumstances and when applied correctly, environmental and behavioral interventions should be viewed as most ethical, least intrusive and most effective treatments for uncomplicated chronic egg laying.

Environmental stimuli may need to be altered, and every recommendation should be carefully balanced with an enrichment or differential reinforcement plan for alternative behaviors. The photoperiod may need to be altered and reduced for some species. Nest sites, toys, and other items to which the bird has a sexual affinity should be removed from the enclosure. Access to a nesting environment (shredded papers, a box, or other dark cavities) should be prohibited. In the event that a pet bird is showing nesting behavior and laying eggs in a designated site within the cage environment, removal of eggs from the nest should be avoided for the normal incubation period for each species to discourage the hen from laying another clutch. Any perceived or actual mate should be removed from the cage or room environment. In some situations, and with some species such as the Cockatiel, visual and auditory separation from a “mate” may be necessary. A “one-person bird,” with only a single household member who exclusively handles and cares for the bird should be potentially viewed as an established “mate relationship”, which may serve as a trigger for reproductively driven behaviors and activities. Stimulatory petting by the owner, such as rubbing the pelvis, dorsum, and cloacal regions should be stopped. “Flock” interactive behaviors should be encouraged in preference to one person or “mate” interactions in the home. The cage location and internal set up (perches, toys, etc) should be changed and rotated periodically to provide a “new or changing” environment that is less stable and less reproductively stimulating. Inappropriate nutrition that is identified should be corrected to improve the hen’s dietary plane to decrease the severity of metabolic drain. Dietary alteration with a reduction of caloric intake appears to significantly reduce or stop egg production with many companion parrot species, as well as enable training and behavior-change strategies.

Medical Therapy
Medical therapies for chronic egg-laying tend to focus on drug therapies to reduce or stop egg production. Pharmacologic options have included medroxyprogesterone acetate, levonorgestrel, human chorionic gonadotropin, Norethidrone/mestranol, testosterone, and leuprolide acetate (Lupron). With the exception of leuprolide, most of these drug or hormonal therapies have variable effectiveness and significant adverse side effects. Although leuprolide acetate appears to be a safe alternative, this product is expensive, requires repeated use, and does not alone correct the causative cascade of reproductive activity in the female bird.

Surgical intervention
Surgical salpingohysterectomy or endoscopic salpingohysterectomy may be indicated in specific patients that are plagued with chronic egg laying problems. Ethically, this option should be pursued only if environmental, behavioral and/or medical therapy has not been successful, the relative risk to the overall health and welfare of the bird is gauged to be significant, and if there is no intent to breed the particular hen. Surgical treatments carry the greatest cost at their outlay, require advanced training in avian soft tissue surgery or endosurgery, and also carry the greatest immediate risk of procedural complications and death. Salpingohysterectomized birds still retain their ovary, and hence may still be predisposed to estrogenic behaviors, hyperestrogenism, cystic ovarian disease, internal ovulation and egg yolk coelomitis.

CONCLUSIONS
Chronic egg laying issues in companion birds can be successfully addressed, most effectively, least intrusively by applying an ethical hierarchy to treatment recommendations. Behavioral and environmental changes are essential and often are effective when applied in a first-line approach. Medical treatment options and surgery are more intrusive, and still require behavioral and environmental changes in order to be effective. Ethical guidelines for treatment of chronic egg laying in companion birds are essential components of the standard of care.

Answered by Dr. Brian Speer, DVM:

In an older cockatiel, there can be a variety of problems that can develop in the uropygeal gland (preen gland) area. There are a small handful of tumors, cystic problems, and some types of infections that can be seen. I would recommend that you re-visit your veterinarian, and ask for either:1) Referral to a specialist for evaluation and diagnosis, 2) a discussion of options that may allow for diagnosis. These may include the use of fine needle aspiration, surgical biopsy, or other methods. Although it is probably not fair to expect a veterinarian to visually assess the structure and factually tell you exactly what is going on, it is fair to ask how this answer can be obtained, should it be needed. "Lancing" and draining a preen gland, alone, may be a bit inappropriate for some of the types of problems that I have listed above.

Answered by Dr. Brian Speer, DVM:

I suspect that what you are seeing is a normal apteryal area on your bird. Most birds do not have a solid set of feathers everywhere on their body, and the central sternal area and that over the crop are non-feathered skin, or apteryal regions. When the feathers become wet, this makes them more visible.