Vomiting medication + gas/bloating

[soleaux]

Thank you so much everyone for the comfort and support. I don’t know what to do anymore. I hope Dr Echols will have an idea or direction, weeks ago I wanted to fly out of state to see either him or Dr. Orosz but now it’s too late and she’s too weak.

@Hankmacaw Oh Hank, bless his soul. He sounds like he was quite the troublemaker but I’m glad it wasn’t hard on him. CaEDTA is apparently hard on the kidneys but can be mitigated with fluid I hear.

How hard should a nauseated, lethargic bird be breathing? Basil seems to be breathing harder than normal in certain positions, I stay at home and watch her all day but at this point I’m not even sure if it’s been like this all along or if I’m going crazy from exhaustion and heartbreak. I don’t think this is normal or good but it seems to only happen in certain positions.

Here’s a video of her breathing when it’s harder.
IMG_3089.MOV - Google Drive

But certain positions she also breaths like this:

IMG_3092.MOV - Google Drive

Am I overreacting? I’m so afraid to rush her off to the vet, the car ride is so stressful but I don’t want to wait if it is an issue But even if I’m able to go today, none of the clinics have weekend emergency care and the one clinic that does has really scary reviews.

Her poop also changed a week ago from stringy to squiggly

 

[Hankmacaw]

Basil should not be breathing as hard as he is in that first video.

I'm sorry, I don't remember, but have you ever had rays taken of Basil? They are invaluable in a difficult case like Basil's. He should be in an O2 unit - that's pretty obvious.

 

[enigma731]

@Hankmacaw I believe they have done xrays including a contrast study and were trying to arrange for a CT.

I don't know that I see heavy breathing so much as difficulty balancing due to generalized weakness.

 

[soleaux]

Yeah, we have done two regular xrays and also two contrast studies (one with barium and the other iohexol). Last round was done about a month ago, revealed enlarged proventriculus, enteritis, gas, and pooling of dye at her cloaca. Even though she definitely has some sort of GI lesion we didn’t see them in the dye studies.

I don’t know if it’s breathing or balance like Enigma suggests.. those videos were taken 5 seconds apart after she changed positions. When she isn’t sleepy, her breathing seems fine, here’s one just from a minute ago.
IMG_3097.MOV - Google Drive

I really wish we had better after hour care/emergency services, usually I would not hesitate to go to my primary vet but I’m scared to take her to the EC place because this place has mixed up euthanasias more than once.

 

[enigma731]

I don't think there's a solid right answer, but I'd probably keep her at home if I was in your position.

 

[parrotluv]

Hope Basil starts to feel better soon.

 

[soleaux]

I agree.. am trying to keep her environment as consistent as possible.

My vet consulted with Dr Echols today, I’m very lucky they’re friends and can talk on such short notice.. he had a lot to say about the xrays, but here is the advice he gave us.

“The findings are all non-specific however seem to focus on intestinal disease which includes pancreatic and hepatic disease. Since most chemistry values were unusually low (likely related to blood loss), it would be good to repeat these values now that the blood volume has returned. Second, I would add amylase to the chemistry panel. The only means to get a more definitive diagnosis would be exploratory surgery which is likely not needed if Basil continues to improve.

My main concern is pancreatic disease and/or lower intestinal disease. The top differentials include primary pancreatic disease (non-specific inflammation, viral/bacterial infection, neoplasia, insufficiency, other), coelomic inflammation/coelomitis and segmental to diffuse intestinal disease (infectious, neoplastic, other).

Therapeutically, I recommend the following:
1. Add Digestive Enzyme
Digestive Enzyme (USANA)
For pancreatic disease, GI plant based FB’s, etc
Crush ½ tablet and sprinkle over slightly moistened (misted with water) food. Use once to twice daily as needed.
2. Continue with the Carafate 25 mg/kg PO TID until producing normal droppings and consistently gaining or maintaining weight.
3. Add VetOmega- give 0.33 cc/kg PO SID lifelong.
4. Consider a metronidazole trial- watch for reaction.
5. Take Basil off omeprazole
6. Consider Amphotericin B trial”

I don’t know how we’ll get metronidazole in her, she had the most horrible and violent reaction to it when we tried last time. I am hoping and praying with everything I have that this is curable or manageable, that it isn’t malignant neoplasia/tumors. I hope this works

 

[Hankmacaw]

I don't know what the "For pancreatic disease, GI plant based FB’s, etc" is - do you? The only thing I can find on the internet ifor Vet Omega s VetOmega 950 which is Omega three and some other things. I'm scared to death of Amphotericin B, so am very curious of what the "trial" would consist of.

Jasper takes metronidazole every other day and doesn't have any problems with it and it has helped her appetite quite a lot.

It all sounds interesting and Dr. Echols is really good. Did Dr. Echols give any indication that tumors were showing in the xrays you have done?

 

[soleaux]

I think he just means that the USANA probiotics will help with those things, but I have no idea what “plant based FBs” stands for. My vet said she ordered both it and the VetOmega.

You nebulized Amph B for asper treatment for Hank and Jasper, right? I assume he suspects some sort of fungal infection.. How did your guys react to it?

Basil had the most scary vomiting reaction to metronidazole, it took her 40 min to empty herself the next morning and she was shaking her head so fast it blurred. Have seen a lot of birds throw up but that was something else.

He didn’t really, it was more of an analysis of what they showed. Here’s what he said:

“Radiograph review: 2 plain VD (mildly rotated), 1 plain lateral (mildly rotated), 1 contrast VD (mildly rotated) and 1 contrast lateral all dated 9-28-2018- The proventriculus is mild-moderately distended with normal overall shape. Because of the proventricular distension, the proventriculus extends more dorsal and caudal than normal contributing to a sharp 90 degree bend between the proventriculus and ventriculus. Other than the more dorsal orientation of the orad ventriculus, the ventriculus appears to be of normal shape and size. The isthmus appears to be normally contracted. The hepatic/intestinal silhouette moderately extends beyond the coracoid-coxofemoral line on the left and right side (even accounting for the patient rotation). There is subjectively poor radiodensity along the proximal coracoids and humerii and along the entire notarium, synsacrum and caudal vertebrae. This is very subjective as we are at the limit of resolution and the background appears pixelated and variable. Both caudal thoracic air sac spaces are decreased in size and the abdominal air sacs are almost completely compressed. As viewed on lateral films, the cardiac outflow tract is prominent. There is no other readily visible support of cardiac disease. The barium present in the intestines show clearly to poorly defined boarders. This is non-diagnostic, however suggests filling deficits and/or thickened intestinal mucosa (also sometimes called a brush boarder effect).

Radiograph review (Texas A&M): labeled Oct 19, 2018: 2 DV (bird in the box) views with iohexal contrast and VD (minimally rotated) and lateral (minimally rotated): In addition to the comments above, there is strong support for dilated gas filled intestinal loops intermittently present through the lower coelom.

Lab interpretation: 9-29-18: heterophilic (78%) leukocytosis (34K), severe anemia (26%), low total protein (0.4 g/dl), low calcium (6.9 mg/dl), low cholesterol (18 mg/dl), low AST (47 IU/L), low bile acids (7.9 umol/L), relatively high phosporous (5.7 mg/dl) to calcium.”

 

[iamwhoiam]

Dr. Echols was very thorough in his review. Hoping that his recommendations will help Basil.
My bird did not do well on Flagyl either.

 

[Hankmacaw]

I did nebulize Jasper with Amph B and it seemed to hurry up the effectiveness of the nebulization. Dr. Driggers would only allow three days of nebulization with Amph B - which was fine with me. We then switched to something which I can't remember the name of. Hank's liver was far too gone to get Ampn B anywhere near him.

Did you notice that Basil has four of eight airsacs that aren't functioning properly? That could have an awful lot to do with his trouble breathing. Jasper's cruddy airsacs are 100% of her problems with breathing.

I should have said that Jasper gets along fine with Metrodizanole, while Hank would puke it up immediately. I seems to be specific from bird to bird - B&Gs are supposedly the most sensitive to it.

I've got all of my fingers and toes crossed that Basil starts getting better soon.

 

[iamwhoiam]

Any updates?

 

[webchirp]

I am so sorry things are still scary. Many, many hugs and prayers

 

[soleaux]

Thanks everyone

Any updates?

On Monday we had another CBC and chem panel taken for a baseline for the new treatment. She hasn’t improved but is holding steady with her anemia. Her amylase, which Dr Echols wanted to look at for pancreatitis, was normal.

Basil is taking the metronidazole okay. I gavage it and the other meds/supplements so maybe not tasting it helps her keep it down. She’s more alert than last week, from either the new medication or reduced nausea now that she’s off sporanox.. can’t tell which. Her appetite is still pretty bad though.

We are getting Amph B compounded, it’s oral but apparently topical? And doesn’t get absorbed into the body.

I’ve had formula well up in the back of her throat twice when gavaging. With how much she’s gavaged I guess that’s bound to happen. I pulled out right away, it didn’t overflow her mouth and she hasn’t shown any outward signs of aspiration or respiratory distress (that heavy breathing stopped) but I’m still paranoid about aspiration or aspiration pneumonia — she’s already on antibiotics, but I can’t help but worry. We’re going to recheck her blood in a week or two to see if treatment has helped.

 

[iamwhoiam]

Based on what you posted there does seem to be some improvement: keeping the food down, more alert, amylase normal, no more heavy breathing, etc. That is all good. I hope that she will continue to gain strength, eat more on her own, and recover. Hope the results from the next set of blood tests are positive. She is a fighter and you are doing everything you can for her.