Ask An Expert: Dr. Brian Speer, DVM

Answered by Dr. Brian Speer, DVM:

In many psittacines of this size or larger, the juvenile moult is first completed (in my experience) in the 6-10 month age group or so. It is possible that your bird still may get there. One of the spin-off problems that occurs with some of the types of wing trims that are performed in young birds, is that the stage is set for falling, recurring trauma and a secondary inhibition of pinfeather re-growth. If this is a persistent observation in this bird after another few months, I would certainly recommend a physical examination.

Answered by Dr. Brian Speer, DVM:

Sunny - alone, those color changes in the nails to not necessarily concern me too much. This could be secondary to the primary process that is causing the drdy and cracking issues on the feet (I do not really see this in the photos), mechanical trauma issues caused by the bird, or the topical medications you have been applying to the feet and nails. If the skin lesions are progressive, I'd suggest you ask your veterinarian to consider further investigation, but otherwise, would not necessarily recommend a "jump" to treatment or detailed diagnostic investigation (yet)

Answered by Dr. Brian Speer, DVM:

Cindi - it is probably a bit unethical for me to be making specific medical recommendations for your bird in this type of a forum, with the amount and number of veterinarians that have had specific hand's-on evaluation of him, whereas I have not. Always remember, however, that it is fair to ask your attending veterinarian to consult with another colleague, or to provide radiographs and medical records so that you can have them independently reviewed. This is something that we do at our practice on a daily basis for many bird owners and colleagues around the globe. But, we still are limited in that we cannot see, hear and actually handle the bird, and as such, can only consult from the side about what may or may not be present, what may or may not be significant, and what may or may not be appropriate to consider and/or do. The laboratory "abnormalities" you have mentioned are actually within acceptable normal limits, in my eyes, and those changes are likely insignificant. What I do not see, however is the recorded physical examination and the remainder of what WAS evaluated and deemed to be normal. Remember that choanal culture isolates do not necessarily have to equivocate to actual infectants in many ill birds, and it may be unfair to assume that these isolates are responsible for what you are assuming to be a granuloma in the area of your bird's syrinx. Many actual syringeal infections require specific endoscopic visualization for diagnosis and confirmation of their etiology - a procedure that I suspect may have been discussed with you. Overall, however, most syringeal granulomas that we see in parrots here typically are minimally evident on radiography, and one would have to wonder if this noted soft tissue density is actually outside the syrinx and pressing on that location, causing similar clinical signs too. There are, unfortunately, a number of tumors that are described in parrots in this location, producing significant vocal changes and clinical disease - but not necessarily a "granuloma" per-se. I would forward that many granulomatous disease processes can be treated successfully, depending on what their identified cause turns up to be, the manner of treatment, and their specific location in the patient at hand. At the risk of being inappropriate in this forum, you can find our practice website and contact phone numbers if you search Medical Center for Birds, should you be interested in a more detailed consultation here. The striking things here in my mind here remains: 1) the need for a bit more accurate diagnosis, 2) hopefully resulting in more accurate treatment options, 3) and a need to investigate the most optimal means with which to address the comfort of your bird, regardless of what the nature of the diagnosis turns up to be.(as well as along the path of obtaining this information)

Answered by Dr. Brian Speer, DVM:

Dear Cindi - Your bird is certainly ill and in need of an accurate medical diagnosis and treatment regime.

First up, I would suggest that you ask your current attending veterinarian if they would be willing to refer you to a qualified colleague, hopefully a certified specialist, for further evaluation, diagnosis and treatment. At 28 years of age, there are a vary very large number of problems that could be potentially of concern here. In general, regurgitation of mucus and weight loss would be suggestive of an upper gastrointestinal issue that may require far more than simple blood tests and aerobic cultures in order to diagnose. It is not uncommon to need radiographic imaging, and even dynamic fluoroscopic imaging, plus or minus endoscopy in order to establish a diagnosis. Possibilities of some chronic infectious disease issues, some forms of cancer, gastric foreign bodies or combinations of these all remain distinct possibilities here. The presence of an elevated blood level of Aspergillus galactomannan, alone is far from a clear diagnosis of the disease, Aspergillosis, and the described clinical signs here tend to make me suspicious that at-best, Aspergillosis if present is far from the only disease process present.

Answered by Dr. Brian Speer, DVM:

Dear Eb - In short, it should be doubted if there is a nutritional need that is driving this feather damaging behavior of this pair. Other "purposes" for this behavior should be considered, including but not limited to a displacement activity to perceived stressors. Sometimes, such a behavior may be related to the perceived "stress" of an unhatched clutch and the removal of those eggs, and limited other activities with which to let it off with. One consideration, presuming this to be at least in part involved here, would be to enrich the nesting and flight site with materials that can be chewed, frayed and functionally mulched that may have equal if not greater value to the birds over chewing their own moulted feathers.

Answered by Dr. Brian Speer, DVM:

Unfortunately, there is nothing specific that I can recommend beyond allowing your bird to rest in a warm environment, and to continue to offer free-choice food and water. You are right - a good physical examination and diagnosis is important to obtain, sooner than later. Aspergillosis, of course, is one of many, many, many potential problems that could be present. Although I would not necessarily fix my mindset on one disease such as this; I certainly would strongly recommend getting that examination performed!

Answered by Dr. Brian Speer, DVM:

From your video and your message, it is apparent that your bird, Yako, certainly is ill and that you are very concerned and have been trying hard to get the help he needs. My general thoughts here are that there is either a primary central nervous system issue resulting in impaired function, a secondary central nervous system problem being caused by another, or pain. Unfortunately, I am not able to see the laboratory data attachment that you have sent.

Immediately before and after the more obvious clinical signs, your bird is much more comparatively responsive and functional - suggesting that this may not be a seizure, but rather something else. There are many degenerative disorders of the brain that in principle could cause these types of signs - although most will produce persistent signs, and not a situation such as this where clinical signs come and go, or seem to be precipitated by drinking behaviors. It sounds like you have been working with your veterinarian to rule down a number of problems and rule up the probability of others. Athlerosclerosis is a fairly common and serious disease problem in grey parrots, and this can certainly have a potential role here, if it is present. This diagnosis may be suggested by radiographic findings, but it is confirmed with more involved imaging studies. Some afflicted birds will show improvement when treated with vasodilating drugs - and you may want to ask your doctor about this possibility, if it has not been considered already at present time. If there are consistent signs noted when your bird drinks water, I would also have to bring up the possibility that the process of swallowing could be painful, which could in part have a generating role in the clinical signs. Again, I would suggest that you speak with your doctor, and inquire about the possibility of pain having a role here in your bird's clinical signs, and if there is or may be a need for pain relief.

These are some general thoughts that you are welcome to pass on to your attending veterinarian, and I wish you the best in your efforts to help Yako!

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?