How to keep avian patients alive (Proceedings)

It is a clinical challenge when veterinarians have to treat avian patients. It is the thoughtful use of therapeutic procedures on a debilitated patient that is often correlated to the successful outcome of a case presentation.

Physical Examination

When a veterinarian enters the exam room ready to question the owner regarding their beloved companion bird, care and expertise is expected. It is not only important to get a good history and understand the techniques needed to provide a professional service but also to inform and educate the owner regarding information on a pet they may have little expertise and knowledge regarding husbandry and health. It is important for veterinarians to gain continuing educational support to add specific avian medical information to the technician's basic veterinary knowledge already learned through professional training and expertise. When establishing or expanding a species group within a practice, veterinary and referral support is important when faced with "in house" questions about a patient's condition or care. When treating and collecting diagnostic samples from avian patients proper equipment must be used. This is a small but important investment for a practice to make in order to provide the quality of service that clients have come to expect. A basic history following an avian line of questioning not only provides information focused on the presenting problem, but also allows one to review deficiencies of husbandry or nutritional care. Any problems noted with owner care or nutritional offerings should be discussed with the owner in an educational manner. As mentioned previously it is not unusual for new avian animal owners to be totally unaware of the proper measures to care for and feed their feathered friends.

When taking the history of an avian case we try to follow the same protocol for each patient. We have separate history forms printed out for each exotic animal species, including birds. We believe if you do not ask the question client usually will not you that particular information. It is very important to ask the right questions about the bird being examined. Initial background information, other than the basic data required for the registration form, includes length of time owned, previous owner, vaccination history, placement of cage was or flight, how often is the bird handled character of the feces and when was the last molt.

Husbandry issues are a common source of illness and trauma to companion avian species. Questions should be asked about the cage location, substrate, size of cage, cage material, cleaning, disinfect and perches/toys. As questions are asked during the interview, a more detailed explanation may be needed if it is determined that there is a potential problem area. The other major component of questioning centers on the nutrition provided and ingested by the bird. Type of food being offered and the daily amount being offered are the first questions asked in this section. A more important question for the owner is not what the bird is being fed, but what it is eating. Water source, water container and how often the water is changed are included in the nutritional section.

Finally quarantine procedures and new bird acquisitions should be covered during the case review. These questions will coincide with a review of the bird population at the owner's house and if the patient was housed alone or in a group. After questioning, the owner needs to review any past medical problems and give the veterinarian a specific historic description of the current medical problem(s).

Equipment

For the examination the bird should be observed without the stress of holding and then, if possible, a complete "hands on" physical examination. To properly examine the avian patient and collect diagnostic samples for testing a few avian specific equipment items are recommended. One of the advantages of expanding into a pet avian practice is the minimal investment that is needed to treat most of the disease problems associated with these animals. Grooming, which includes nail trims, beak care and wing feather trims can be a large part of an avian practice. A hand-held motorized grinding tool is used on larger birds for nail trims and beak grooms (Dremel, Inc., Racine, WI). We use a battery operated hot-wire cautery unit to trim small bird's nails, <150 grams (MDS, Inc., Brandon, FL). The cautery unit appears less stressful on the smaller birds than the motorized grinding tool.

Special avian surgical equipment includes small cuff-less endotracheal tubes (Bivona, Inc., Gary, IN), radiosurgical equipment (Ellman International, Inc., Hewlett, NY) and respiratory monitors (Medical Engineering & Development, Inc., Jackson, MI). Small ophthalmic surgical instruments are easier to use on avian patients than those manufactured for dogs and cats. A special avian microsurgical pack can be purchased through Sontec Intruments, Inc., Englewood, CO.

Specific avian equipment is very useful, but usually not a large investment. Equipment such as incubators, digital gram scales (a must), acrylic perches for scales, examination boards, feeding needles, beak specula and avian specific Elizabethan collars are available through a number of companies that regularly exhibit at larger veterinary conferences (Veterinary Specialty Products, Inc., Boca Raton, FL), (Henry Schien, Inc., Port Washington, NY) and Lyon Electric Company, Inc., Chula Vista, CA).

There are critical care feeding supplements that are specifically made for avian patients and must be in stock when treating pet birds. The feeding supplements are manufactured for the debilitated patient as well as the newly hatched chick that needs a full complement nutritional supplement. There are more critical care feeding products, available, but the products listed have provided excellent success and are available through the Lafeber Company, Cornell. IL.

Veterinary Specialty Products (VSP, P.O. Box 812005, Boca Raton, FL 33481, (561) 362-7340 is not a product but offers both established and new avian products. All avian veterinarians should receive this company's catalog. Veterinary Specialty Products carry avian specific restraint collars in all sizes, endotracheal tubes, popular textbooks, avian surgical drapes, restraint boards, feeding tubes, digital gram scales, perches and leg band cutters.

Ellman International, Inc. (800) 835-5355 has been a friend of avian medicine with their patented radiosurgery technology. Ellman's basic Surgitron® has given veterinarians a low cost alternative to laser technology for many years and still offers advantages than can match a laser unit at a fraction of the cost. Recently with the development of the dual frequency unit, a solid state digital unit with a multiple application hand piece, this company's status was solidified within the avian/veterinary community. Ellman International also manufactures beak repair epoxy and a very reliable effective tissue glue marketed as Tissu - Glu®.

There are critical care feeding supplements that are specifically made for avian patients and must be in stock when a debilitated bird presents. The feeding supplements are manufactured for the critical patient as well as the newly hatched chick. There are more than critical care feeding products available but the products listed have provided excellent success and are available through the Lafeber Company, Cornell, IL. Kaytee Products Incorporated (P.O. Box 230, 521 Clay St., Chilton, Wisconsin 53014) is a feed company that specializes in avian/exotic animal feed and products.

Lyon Electric Company, Inc. (1690 Brandywine Ave., Chula Vista, CA 91911, (619) 216-3400, is a company that for many years developed a reputation in the poultry and game bird industry through the sales of low cost incubators. Recently they have used their expertise and developed quality intensive care units. There is the low cost animal intensive care unit and the advanced Pro-Care 27 Intensive Care Unit. The Pro-Care 27 ICU incorporates an oxygen supply, humidity sensor, nebulizer port and solid state digital technology. All veterinary hospitals must have an intensive care unit for their avian/exotic patients.

Grooming, which includes nail trims, beak care, and feather trimming of the wings, can be a very important part of an avian practice. A hand-held motorized grinding tool is used on larger birds for nail trims and beak grooming (Dremel Inc., Racine, WI). We use a battery operated hot-wire cautery unit to trim small bird's nails < 150 grams (MDS Inc., Brandon, FL). We feel the cautery technique is less stressful on the smaller birds than motorized grinding and less bloody than using human nail clips. Feather trimming of the wings can be accomplished with any form of scissors but we have found small serrated edged bandage scissors work best. For chemical cautery of the nails after trimming, hemostatic powder or silver nitrate tipped sticks are recommended. We prefer the silver nitrate tipped sticks which need blood to activate. The user must be careful upon activation of the silver nitrate because it will stain the part of the hand that comes into contact with the cautery agent black.

The Bair Hugger® (Arizant Healthcare Inc., 10393 W. 70th St. Eden Prairie, MN 55344, (800) 733-7775) is a product that uses convective heat to help maintain a patient's body temperature. This product has been very effective in maintaining an avian patient's body temperature under surgical conditions. The ability to control the temperature using the Bair-Hugger® temperature management unit (Model 505 most popular in veterinary medicine) makes this product somewhat unique when compared to the conventional conductive and radiant heat sources commonly used on avian patients. This is a significant development in surgical patient care and can be used on other companion animals that need body temperature support.

Treatment

The initial phase of evaluating a patient's health is through a rapid external physical examination. If the patient appears to be severely debilitated or getting worse the bird should be "put down" and placed in a critical care unit. Any antibiotic, chelation agent or fluid therapy should be initiated prior to the patient's placement into the incubator.

If it is determined the patient can withstand the stress of handling and treatment then fluid therapy may be initiated. Normosol or Lactated Ringers Solution can be administered through the following routes: subcutaneous, intravenous, intraosseous, orally and through the cloaca. Anatomic sites commonly used for IO catheter placement include the distal ulna (larger birds), proximal ulna, proximal tibiotarsal bone and lateral femur (young and small birds). Placement of the IO catheter begins with proper site preparation, similar to epithelial preparation for an IV catheter. A 22-gauge, 1½" spinal needle is the catheter of choice in most psittacine cases although any size needle may be used, provided that a stylet is inserted into the needle prior to placement of the IO catheter into the medullary cavity of the bone.1 When the IO catheter is placed in the distal ulna, the distal wing tip is flexed and the needle is inserted at a 45 to 60° angle, and this angle is reduced once the catheter enters the cortex.2 The needle should be advanced to the hub, stylet removed and the catheter flushed with heperized saline. The catheter is capped with a PRN and managed as an IV catheter. Intraosseous catheters require more maintenance than an IV catheter and should be flushed 6 to 8 times a day to maintain patency. Subcutaneous fluid therapy is not an effective method of rapid restoration of circulatory fluid volume. Adding hyaluronidase (Wydase, Wyeth-Ayerst Pharmaceuticals, Philadelphia, PA) to lactated Ringer's solution (LRS) for SC fluid administration has been recommended as a method to increase the absorption rate of the fluid into the circulatory system.1

Environmental Support

When treating the avian patient, environmental support has a significant impact on the success of many cases.1 Environmental support can be classified as temperature/humidity control (in most cases heat), oxygen supplementation/administration and nebulization.1 There are many avian intensive care units (ICUs) on the market, but the veterinarian should carefully examine the clinic's needs before purchasing this piece of equipment.1 When comparing avian intensive care units, cheaper is not always better.1 Important features that improve a unit's performance are digital temperature and humidity control, ease of cleaning /disinfecting and durability.1

References

1.Tully TN. Psittacine therapeutics. Vet Clinic North America: Exotic Animal Prac. 3;1:59-90.

2.Lamberski N, Daniel G. The efficacy of intraosseous catheters in birds. In: Proceedings of the Assoc of Avian Veterinarians. Chicago, IL, 1991, 17-19.

3.Griffin C, Snelling LR. Use of hyaluronidase in avian subcutaneous fluids. In: Proceedings of the Assoc of Avian Veterinarians, St. Paul, MN, 1998, 239-240.

4.Clubb LS, Wolf S, Phillips A: Psittacine pediatric medicine. In: Schubot RM, Clubb KJ, Clubb SL (eds): Psittacine Aviculture Perspectives, Techniques and Research. Loxahatchee, FL, Aviculture Breeding and Research Center, 1992, 16.1 – 16.27.