*** WARNING: GRAPHIC PICTURES BELOW ***
It all started with an itchy bird in November. Then she started feather chewing on her back. Then it was skin picking in her armpits. The first day we saw blood on her beak we started looking for a better (i.e. avian-certified) vet and got a real diagnosis.
On December 1st, our first visit to the new vet, she was prescribed Ketohex (a topical spray 2x daily for the potentially-infected wounds in armpits) and Metacam for pain relief (0.1 mL of 1.5 mg/mL suspension by mouth every morning and evening).
On December 6th the culture tests came back. Her picking resulted in dual Staphylococcus and Enterobacter infections. Due to a failure of the pharmacy to notify us of the filled prescription, she wasn't started on additional medication until December 9th. At that point we started her on Ciprofloxacn, an antibiotic (0.5 mg/mL in her drinking water) and Ketoxonazole, an anti-fungal since birds are often susceptible to to fungal infections while on antibiotics (0.2 mg/mL in her drinking water).
On December 10th we found out that Rhubarb tested positive to Avian BornaVirus (ABV), which may have contributed to her initial tingling/itches. Thankfully she had NO gastrointestinal symptoms.
On December 11th we ran out of Metacam and by the evening of the 13th she started to pick her back VERY aggressively:
Our vet kindly came in and saw her on the 14th, even though his office is closed on Sundays. He refilled our metacam prescription and fitted her for a collar so she could heal without picking. After the initial angry bird tantrum was thrown, she was happy to accept scritches as usual:
She kept getting better, with a healthy appetite and stabilized weight (and even a little gain) until the 26th (a Friday). Then she started to drink a bit more water and had somewhat watery droppings. For those who aren't familiar with reading bird droppings, they consist of three parts: Feces (brown/green little "log"), uric acid (white paste) and a small amount of clear liquid urine. Uric acid is how birds and reptiles conserve water while clearing out nitrogenous waste from the breakdown of protein in their food and recycling of protein in their bodies. Anyway, enough poopology...
She kept getting more and more sedentary while her poop kept getting more watery (polyuria) and she kept drinking more water (polydipsia). Why is it that she always seems to get worse over a weekend?! We kept her warm and provided diluted organic coconut water (1 part coco water to 3 parts pure water) to replenish her electrolytes. She was drinking as much in a few hours as she normally would during an entire day. She seemed to be doing a bit better at first, but by the evening of the 28th she was suddenly much worse off with droppings that looked like this:
(Huge amounts of urine with very little uric acid. Thankfully she didn't have diarrhea, which is defined as loose/watery feces.)
We already had a vet appointment for the morning of the 29th. That morning when I got her up she was heavily favoring her left foot, and basically refused to move unless she absolutely had to do so. We took her to the vet and during his examination, he removed some of the smaller scabs (from her wing/elbow joints) to see if the infection had resolved underneath. A white goo came out of the wound:
He examined it closely and told us this was URIC ACID accumulating around her wing joint. She was having a sudden case of very severe gout. He drew some blood for tests and told us to stop ALL remaining medications immediately. He proscribed oral allopurinol (a medicine that reduces production of uric acid and increases secretion of it) starting that night. We took her home, gave her the first dose of allopurinol and fed her crushed Harrison's pellets mixed into her seeds with a bit of water since she was having a hard time breaking down the whole pellets. The temperature in the room was turned up to 80F (27C) and she seemed to be doing better, even putting up a little fight when it came time for receiving medicine.
Yesterday morning (the 30th) she was doing a bit better with more uric acid and less urine in her droppings as well as less water drinking. Then we got the call from the vet. Her blood uric acid was 103 dg/mL, indicating a massive loss of kidney function. Normal for a bird like her is 2-10 dg/mL. She also had blood sugar levels that bordered on diabetes. Bird blood sugar can be elevated to a reading of 500 during times of stress without serious negative consequences long term. According to our vet, above 600 is considered diabetic in a cockatoo. Rhubarb had a blood sugar of 580. We asked if hospitalization would be wise so she could be monitored full time. He agreed and so our little girly bird is now in the avian ICU:
(When I asked if we could have a picture of her in the incubator he took us right back to see her, even though I'd only meant for someone to take a picture for us. We have an AWESOME vet!)
As the temperature climbed she looked more comfortable, even managing a little face puff right before we left:
They're going to be putting in an intraosseous IV so they be be sure she's staying hydrated and if she has any more watery poop they will be testing for urine glucose to confirm (or disprove) the possibility of diabetes which can also cause polyuria/polydipsia.
This has been a rough way to end the year. ABV alone is a life changer. Loss of kidney function with diabetes on top of that makes her possible outcome grim at best. And if she has diabetes and manages to pull through we will be looking at constantly monitoring her blood glucose and giving insulin daily. Does anyone have experience with diabetes in birds?
I know I didn't ask much by way of questions, but I wanted to put info out so that if someone else has a bird with a similar problem while taking Metacam/antibiotics/antifungals they can react sooner then I did. I keep kicking myself for letting it go an extra two days just because I already had an appointment booked for the 29th. I should have called when I first noticed some watery droppings. Don't make my mistake!
It all started with an itchy bird in November. Then she started feather chewing on her back. Then it was skin picking in her armpits. The first day we saw blood on her beak we started looking for a better (i.e. avian-certified) vet and got a real diagnosis.
On December 1st, our first visit to the new vet, she was prescribed Ketohex (a topical spray 2x daily for the potentially-infected wounds in armpits) and Metacam for pain relief (0.1 mL of 1.5 mg/mL suspension by mouth every morning and evening).
On December 6th the culture tests came back. Her picking resulted in dual Staphylococcus and Enterobacter infections. Due to a failure of the pharmacy to notify us of the filled prescription, she wasn't started on additional medication until December 9th. At that point we started her on Ciprofloxacn, an antibiotic (0.5 mg/mL in her drinking water) and Ketoxonazole, an anti-fungal since birds are often susceptible to to fungal infections while on antibiotics (0.2 mg/mL in her drinking water).
On December 10th we found out that Rhubarb tested positive to Avian BornaVirus (ABV), which may have contributed to her initial tingling/itches. Thankfully she had NO gastrointestinal symptoms.
On December 11th we ran out of Metacam and by the evening of the 13th she started to pick her back VERY aggressively:
Our vet kindly came in and saw her on the 14th, even though his office is closed on Sundays. He refilled our metacam prescription and fitted her for a collar so she could heal without picking. After the initial angry bird tantrum was thrown, she was happy to accept scritches as usual:
She kept getting better, with a healthy appetite and stabilized weight (and even a little gain) until the 26th (a Friday). Then she started to drink a bit more water and had somewhat watery droppings. For those who aren't familiar with reading bird droppings, they consist of three parts: Feces (brown/green little "log"), uric acid (white paste) and a small amount of clear liquid urine. Uric acid is how birds and reptiles conserve water while clearing out nitrogenous waste from the breakdown of protein in their food and recycling of protein in their bodies. Anyway, enough poopology...
She kept getting more and more sedentary while her poop kept getting more watery (polyuria) and she kept drinking more water (polydipsia). Why is it that she always seems to get worse over a weekend?! We kept her warm and provided diluted organic coconut water (1 part coco water to 3 parts pure water) to replenish her electrolytes. She was drinking as much in a few hours as she normally would during an entire day. She seemed to be doing a bit better at first, but by the evening of the 28th she was suddenly much worse off with droppings that looked like this:
(Huge amounts of urine with very little uric acid. Thankfully she didn't have diarrhea, which is defined as loose/watery feces.)
We already had a vet appointment for the morning of the 29th. That morning when I got her up she was heavily favoring her left foot, and basically refused to move unless she absolutely had to do so. We took her to the vet and during his examination, he removed some of the smaller scabs (from her wing/elbow joints) to see if the infection had resolved underneath. A white goo came out of the wound:
He examined it closely and told us this was URIC ACID accumulating around her wing joint. She was having a sudden case of very severe gout. He drew some blood for tests and told us to stop ALL remaining medications immediately. He proscribed oral allopurinol (a medicine that reduces production of uric acid and increases secretion of it) starting that night. We took her home, gave her the first dose of allopurinol and fed her crushed Harrison's pellets mixed into her seeds with a bit of water since she was having a hard time breaking down the whole pellets. The temperature in the room was turned up to 80F (27C) and she seemed to be doing better, even putting up a little fight when it came time for receiving medicine.
Yesterday morning (the 30th) she was doing a bit better with more uric acid and less urine in her droppings as well as less water drinking. Then we got the call from the vet. Her blood uric acid was 103 dg/mL, indicating a massive loss of kidney function. Normal for a bird like her is 2-10 dg/mL. She also had blood sugar levels that bordered on diabetes. Bird blood sugar can be elevated to a reading of 500 during times of stress without serious negative consequences long term. According to our vet, above 600 is considered diabetic in a cockatoo. Rhubarb had a blood sugar of 580. We asked if hospitalization would be wise so she could be monitored full time. He agreed and so our little girly bird is now in the avian ICU:
(When I asked if we could have a picture of her in the incubator he took us right back to see her, even though I'd only meant for someone to take a picture for us. We have an AWESOME vet!)
As the temperature climbed she looked more comfortable, even managing a little face puff right before we left:
They're going to be putting in an intraosseous IV so they be be sure she's staying hydrated and if she has any more watery poop they will be testing for urine glucose to confirm (or disprove) the possibility of diabetes which can also cause polyuria/polydipsia.
This has been a rough way to end the year. ABV alone is a life changer. Loss of kidney function with diabetes on top of that makes her possible outcome grim at best. And if she has diabetes and manages to pull through we will be looking at constantly monitoring her blood glucose and giving insulin daily. Does anyone have experience with diabetes in birds?
I know I didn't ask much by way of questions, but I wanted to put info out so that if someone else has a bird with a similar problem while taking Metacam/antibiotics/antifungals they can react sooner then I did. I keep kicking myself for letting it go an extra two days just because I already had an appointment booked for the 29th. I should have called when I first noticed some watery droppings. Don't make my mistake!
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to you! Your vet sounds like he knows what is best. I know the diagnosis is not good and keeping her comfortable is the goal. Don't beat yourself up, you doing what is best for her. 
It wasn't my idea about the Metacam. The vet said he's seen it in a few avian cases over the years. I have to apologize because I don't want people to think that Metacam CAUSED the kidney problems. There was probably some kind of subclinical renal dysfunction that was exacerbated by Metacam clearance. And there's many things that can cause low-normal kidney function including developmental stress (getting too cool or not turning enough while in the egg), toxic metal exposure, or even avian bornavirus (which we now know she has). She started with the Metacam before we knew she had ABV and there was no indication of compromised kidney function at the time. This is a RARE scenario that most likely came out of preexisting and undetected low kidney function. 
