Unexplained Regurgitation

[3 Beebs]

Hello everyone! Been a long time reader, this is my first time posting because I really don't know what to do. It's fairly long so bare with me.

Background info:
- Cockatiel
- 3 years old
- Female
- Eats pellets and some veggies (very fussy eater)
- Currently a little overweight

Bradie had a mild crop infection last year, the only symptom she had was regurgitation. She was put on some antibiotics and this cleared up. Fast forward to a couple months ago, and she starts regurgitating again, only at night, and not directed at anyone or anything (fairly untamed and cranky bird). Now this is regurgitation and not vomiting, neck pumping etc but nothing ever comes up.
So I went to our Avian vet a few weeks ago, did crop wash/swab and fecal smear, found a little bacteria in her poo so was given some more antibiotics, the vet said it is unlikely related to the regurgitation. Mentioned that her feathers look dull and her crop is "flabby".

Went back a week later, bacteria was gone, regurgitation still happening, so x rays were suggested. They did the x rays and kept her overnight as well for observation. Second vet joins to figure this out. At this point a hormonal cause is definitely ruled out. Nothing obvious was found, couple faint spots here and there but still no clear answer. Was prescribed an anti fungal just to rule out the basics.

* At this point it is discovered that an old injury on her wing tip has now developed into a Xanthoma (yay), which they want to remove by amputating the wing tip, I don't want to even think about this at the moment.

Following week we do blood tests, Bradie is crowned "Most difficult patient vet has treated" due to her hatred of hands and handling (understandable at this point) and needs anaesthesia to take the blood. Biochemistry panel comes back fairly normal, vet says she's "surprisingly healthy for a bird that looks sick", no indication of heavy metal poisoning or liver issues which is what I had my money on. Complete blood count came back with the indication of inflammation. This can either be related to the Xanthoma or what ever is causing the regurgitation.

A third vet has now joined the team and they all had another detailed look at the x rays, they said something about some spots in the lower digestive tract that could be adhesions that are fairly close together, these could be causing irritation leading to the regurgitation, but still not sure.

Now this has cost $800 so far, and they are now suggesting a barium contrast study next week after trying some anti-inflammatories for 7 days. This will cost another $300-$500. As someone who only earns about $400 a week this is taking a strain on my wallet. As well as this the vet is an hour and a half drive away, so petrol is costing a fortune also. I'm not sure if they'll let me go on a payment plan.

My thing is, if she's not getting any worse and not in obvious pain, would it be okay to just leave it and see what happens? All I know is it's causing her a lot of stress going there all the time as well, which isn't fun for either of us.

My first course of action was to just try and improve her diet and get her exercising to lose some weight, but the vets are all "lets try this and this and this" because they HAVE NO IDEA what is causing it.

Has anyone else experienced this completely unexplained regurgitation, or found a cause for such a thing?


Thanks guys,
Amy and the Beebs; Bradie, Billie and Benny

 

[Lady Jane]

Are these vets avian certified? I would have the crop swab repeated to check for yeast again. If this was my bird I would definitely give her a rest from all the testing unless she was sick and you say she appears to be better. Is he eating a healthy diet? Birdie bread is a good way to do that. I purchase Mammas on amazon and add healthy ingredients. My two adore it. How old is she?

 

[CrazyBirdChick]

I would also wonder if it's a certified avian vet. That seems like some extreme testing for regurgitation. I thought regurgitation was normal from time to time?

And the xanthoma....I think a wing amputation sounds pretty extreme for that too. Unless it's bothering her so much that she's picking it?

I'm no expert on bird illness so don't take my post literally. It just strikes me as odd, especially that the vet doesn't seem experienced with bitey birds and had to put her to sleep for a blood test.

 

[sunnysmom]

@enigma731 ?

 

[enigma731]

If cost were no issue, I would (and did in my bird with weird GI symptoms) do the barium study. But I'm also of the opinion that if a bird is clinically stable, it can be a good approach to wait and see if other symptoms develop. Do you know specifically why the vet feels she "looks sick"?

 

[parrotluv]

A few suggestions,
Apple cider vinegar in drinking water
Probiotics daily
Harrison brand Flora

 

[iamwhoiam]

I would probably do the barium study although if regurgitation is not serious and she is not losing weight you could wait. Had the study done with one of my birds who vomited frequently (definitely vomiting and not regurgitation) and had severe weight loss and nothing abnormal was evidenced by the study. She was on a roller coaster where she would be totally normal for weeks and months and then start vomiting and losing weight again. Much more severe condition than what you describe with your bird. Never got a definitive diagnosis and she probably had every test you can imagine. Hope they can figure out what is going on with your 'tiel.
See what happens with the anti-inflammatories. Also consider giving vetri-DMG to your bird. Discuss this with your vet. It's great for boosting the immune system and supporting bodily functions and systems. https://www.amazon.com/VetriScience-Laboratories-0900590-030-Vetri-DMG-Liquid/dp/B00008DFDO

 

[3 Beebs]

She doesn't eat as healthily as I want, but she's getting better. These vets are at the Avian and exotics university vet so the best in our area, I did watch her try to take the blood but Bradie was squirming so much it looked like she was either going to have a heart attack or hurt herself on the needle, giving her medicine is a massive challenge too so I can understand why she needed to do it. I don't think I have any photos but her feathers have definitely changed, they've gone very dark and dull, her eyes are a bit dull too, she was an active and noisy little bird but we barely hear a sound from her anymore, that's what she meant by "looks sick".

The Xanthoma is an issue because it bleeds a lot, one tiny bump and it's off again, that's why they suggested it, they're worried she'll bleed to death. I'm keeping her in a plastic tub hospital cage at the moment so she can't fall and hurt it again like she does in her cage, I'm going to try and see if we can shrink it by losing weight and just getting her on a better diet. The injury this arose from has been an issue since I go her, during night frights etc she'd always knock that wing tip, breaking blood feathers every time, at one point the head vet had to remove 5 blood feathers from there, she's continued to knock it and the feathers never get a chance to grow back so she's pretty much got a little unprotected stump which then grew into the Xanthoma.

I know regurgitation isn't usually an issue, my Ringneck Billie is in love with her swing and will "lovingly" regurgitate on that occasionally. But Bradie's is every day and night, and a lot more violent than the normal bonding way, that's why we're concerned.

I'll try the anti inflammatories and see how we go, I'll make the decision next week depending on if there's any change.

Thanks guys,
Amy and the Beebs; Bradie, Billie and Benny

 

[enigma731]

You might also ask about trying her on Reglan, which has really helped my tiel who has stress related vomiting on a semi-regular basis.

 

[Lady Jane]

So these vets are learning? If so that is something to think about.

 

[3 Beebs]

no, they bring in students to learn, but the university has the best specialist centres in the state. One of the vets working with us has been a bird only vet for 5 years, but a vet for longer.

I've made the mistake of taking a bird to a non-avian specialist before and it cost the birds life. I was told to come to this vet originally but didn't want to make the trip, you can imagine how I felt after that.

 

[JLcribber]

My thing is, if she's not getting any worse and not in obvious pain, would it be okay to just leave it and see what happens? All I know is it's causing her a lot of stress going there all the time as well, which isn't fun for either of us.

Thats how I would proceed at this point. It could just be a learned behaviour for all they know. I have known of birds with regurgitating "habits".

Exercise and diet are great therapy to cure many ills.

 

[Lady Jane]

Anyway it's a teaching environment. I know from working at Johns Hopkins Hospital. In order to teach, sick patients are needed. Guess I am cynical from past experiences with humans. I have no idea how it would be in the avian world.

 

[JLcribber]

When a bird is overweight that means they are eating too much (and sedentary). Now that the bird is fat, there is pressure on all the organs. The bird still over eats. Settles down for the night and ends up regurgitating some of it back up. You might want to examine your "food management".

Does she eat like a pig?

 

[3 Beebs]

@Lady Jane I've only seen students there twice in the 10+ visits i've had, this particular university is where 95% of vets in our state come from and being one of the few avian/exotics vets they would have to take one some students occasionally, in saying that i'm pretty sure there's only 5 places to study vet science in the country lol

@JLcribber she definitely did until I started portion control when this all started. So she's stopped stuffing her face in one sitting and now eats smaller amounts throughout the day.

 

[enigma731]

Anyway it's a teaching environment. I know from working at Johns Hopkins Hospital. In order to teach, sick patients are needed. Guess I am cynical from past experiences with humans. I have no idea how it would be in the avian world.

As someone who both recently was a trainee and who now mentors trainees in the human medical environment, I'd like to say that the opposite side of this is that in having a teaching mindset/talking to trainees, you often end up thinking outside the box in helpful ways. Plus the fact that students can bring a really helpful fresh perspective. That's one of the reasons teaching hospitals tend to be the best in the country in terms of innovation.

While I don't know that I'd agree with the way they're stating she's their "most difficult patient," the diagnostics seem appropriate to me and very similar to the course I went through with my stress puker. With birds, it's always a tradeoff between the invasiveness/cost of the diagnostics and the possibility that the bird could deteriorate from an unknown condition. Some vets tend to be much more diagnostic-heavy than others, just as an orientation. There's not a clear answer to either approach, it's more a matter of you asking yourself what level of risk you're willing to accept. If you think she seems stable and feel that the diagnostics are doing more harm than good, then waiting to see how things progress may be an answer. On the other hand, with signs of inflammation in her GI and ongoing symptoms, it's possible that she could have a tipping point where she goes rapidly downhill. I'm not telling you which one is right, I have been where you are and made varying decisions depending on the circumstances.

Do you think you could get/post a video of the regurgitation here? That might help us with some other ideas. I definitely think it's worth pursuing behavioral/environmental modification in addition to any vet follow-up you may do.

 

[3 Beebs]

Yeah i'll try and get a video the next time she does it

 

[3 Beebs]

 

[enigma731]

Does she always do it while she's eating?

 

[JLcribber]

What I see is a "learned behaviour". She swallows some food to the crop. Then gurges it up and swallows down the throat. She acts just fine. It may have been a symptom of the original infection (not necessarily though) but it's just something she's doing. JMO