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Advice Needed for Sick Dusky Conure (Asper?)

Merlin72

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Hi! I'm having a similar issue with my dusky conure, and I'm wondering if you have an update on how the anti-fungal is going with your budgie?

Merlin is 22 years old (a senior citizen for a conure, and has been totally healthy his whole life), and since August he's been having episodic respiratory symptoms: sneezing lots in a row (clear discharge, no smell), yawning (vet says likely trying to clear his sinuses), wheezing/ "sticky"/wet sounding breathing, occasional open beak breathing. These episodes seem to come on most when he's regurgitating (he'll half-regurgitate food from his crop and then swallow it, doesn't ever fully regurgitate it). His eating, poop, energy levels, and weight have all been completely normal. He's on a mixed seed and pellet diet, which we supplement with fresh fruit/veg. Plumage is great, and his behavior is the same, he's super loving and bonded with me and my partner.

In October he got blood work, crop cytology, and nasal surface swab, all of which showed nothing abnormal. We put him on an antibiotic just in case (enrofloxacin/ Baytril) which didn't seem to make much of a difference. Then we got a full nasal flush, which also showed nothing abnormal. But we put him on a different antibiotic (azithromycin) to see if that would make a difference -- again, no change.

We've seen two different avian vets at this point, and neither of them know what to make of it. I am SO worried it's asper, but the vets both say that if it were, it likely would have progressed more rapidly, but his symptoms have stayed the same for months.

I've also considered whether it's environmental. We've moved around a lot in the last few months to different houses, so his environment has changed, but the symptoms have stayed the same. If it was irritation at dry air, it doesn't make sense to me why this would start in August (the most humid time of year, as we're in New England).. I haven't tried a humidifer yet, but am worried it wouldn't make a difference, as we have been exposing him to steam in the shower and that doesn't seem to help at all (and in fact sometimes seems to make it worse/ bring on symptoms). He's the only bird, so it's not other birds' dust. We don't smoke and are careful about exposing him to things in the air.

Since he's a small bird, I really don't know what to do. The vet said a full CT scan is unlikely to show anything very clearly; he's too small to take a sample using a needle from his sinuses/ lower in his respiratory system.

Do we just wait this out? Do we try an anti-fungal? I'm worried since he's an old bird about putting him on a toxic medicine unnecessarily. Any advice would be much appreciated! Thanks.
 

Hankmacaw

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@Staff @Merlin72 Staff could you move this to it's own thread, so it can get more attention. Merlin I'll be back later to respond to you - just got home from the vet myself and bird.
 

Hankmacaw

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It very well could be asper and I would run a titer test for it, just to rule it out. All fungicides are not toxic. Fluconazole is very friendlynand effective against many fungus and molds, but does not do anything for asper. There are others that are effective against asper but not highly hepatoxic like Lamisil and voraconizole that are somewhat hepatoxic, but not highly so. Other things it could be is a seed stuck in his nasal passages, an environmental irritant. Has your vet ever done a culture and sensitivity on the fluids from his nasal passafes? How is his white blood cell count?

Sorry I was so long getting back to you.
 

Azor

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Hi! I'm having a similar issue with my dusky conure, and I'm wondering if you have an update on how the anti-fungal is going with your budgie?

Merlin is 22 years old (a senior citizen for a conure, and has been totally healthy his whole life), and since August he's been having episodic respiratory symptoms: sneezing lots in a row (clear discharge, no smell), yawning (vet says likely trying to clear his sinuses), wheezing/ "sticky"/wet sounding breathing, occasional open beak breathing. These episodes seem to come on most when he's regurgitating (he'll half-regurgitate food from his crop and then swallow it, doesn't ever fully regurgitate it). His eating, poop, energy levels, and weight have all been completely normal. He's on a mixed seed and pellet diet, which we supplement with fresh fruit/veg. Plumage is great, and his behavior is the same, he's super loving and bonded with me and my partner.

In October he got blood work, crop cytology, and nasal surface swab, all of which showed nothing abnormal. We put him on an antibiotic just in case (enrofloxacin/ Baytril) which didn't seem to make much of a difference. Then we got a full nasal flush, which also showed nothing abnormal. But we put him on a different antibiotic (azithromycin) to see if that would make a difference -- again, no change.

We've seen two different avian vets at this point, and neither of them know what to make of it. I am SO worried it's asper, but the vets both say that if it were, it likely would have progressed more rapidly, but his symptoms have stayed the same for months.

I've also considered whether it's environmental. We've moved around a lot in the last few months to different houses, so his environment has changed, but the symptoms have stayed the same. If it was irritation at dry air, it doesn't make sense to me why this would start in August (the most humid time of year, as we're in New England).. I haven't tried a humidifer yet, but am worried it wouldn't make a difference, as we have been exposing him to steam in the shower and that doesn't seem to help at all (and in fact sometimes seems to make it worse/ bring on symptoms). He's the only bird, so it's not other birds' dust. We don't smoke and are careful about exposing him to things in the air.

Since he's a small bird, I really don't know what to do. The vet said a full CT scan is unlikely to show anything very clearly; he's too small to take a sample using a needle from his sinuses/ lower in his respiratory system.

Do we just wait this out? Do we try an anti-fungal? I'm worried since he's an old bird about putting him on a toxic medicine unnecessarily. Any advice would be much appreciated! Thanks.
Hi, my budgies blood test is abnormal. She has monocytosis (high level of monocytes) and to many basofils. She used to have a low red blood cell count (very strange) but it is normal now.
What spices of conure is Merlin? Maybe it is age related? I think CT is a good "try". If the test haven't shown anything abnormal it could be something that disrupts the sinus, maybe Merlin has something enlarged that causes him to not being able to clear his sinus? Obstructions usually have a correlated inflammation and would show up on blood work (not always tho). Asper often do show sign of it in the blood work depending of what kind of infection (that is why my budgie is geting treatment).


I have noticed that this problem comes when its time for bed. Like clockwork! Is Merlins problem also "time specific"?
 
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Merlin72

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Thank you so much @Hankmacaw and @Azor for your replies and thoughts.

Sorry for my ignorance, but would a titer test be different from the blood work they did back in October? I haven't actually seen what they tested his blood for, all I know is the vet told me the results were "normal", except for a slightly elevated white blood cell count.

They did a culture from the nasal flush, and said the only organism that grew was a normal bacteria. Is that the same as a "culture and sensitivity"?

Both vets we've seen have said that definitively ruling out asper is hard because of Merlin's size, but I don't know why that would be -- maybe they can't draw enough blood at once to test? I will ask again about how we might be able to rule out asper by doing a titer test.

Merlin's nares aren't swollen and the lack of sign of infection in the sinuses makes me think it unlikely he's had an object stuck in there for months? But some other internal obstruction/ growth is definitely possible... although then it's hard to see why his symptoms are only episodic, and why he isn't wheezing and struggling to breath all the time. On any given day, he'll have periods where he's super active (chewing up his toys, preening, exploring), and then he'll have short, periodic episodes where he's sneezing a lot, wheezing, and staying very still. But once those pass, he's back to being very active. I know birds hide their sickness, but it does legitimately seem like it's something that bothers him in fits and starts, and not all the time.

I'm a bit concerned about the cost and risk of doing a CT scan given that he's an old guy. Wouldn't it require full sedation? I'd definitely appreciate any thoughts you have on the risks/ benefits of doing the scan vs just keep trying a bunch of different medications and seeing what sticks.

Merlin's problem isn't time specific, although I would say we usually notice his wheezing/ sneezing fits more in the morning/ afternoon, and less in the evening/ around bed time. In terms of an environmental irritant, initially when this started in August I thought it might be a pollen allergy, since the ragweed season was so bad this year. And then I thought it might be dust? But the persistence of his symptoms across seasons and locations makes that seem more unlikely (we've spent multiple weeks in Rhode Island, Massachusetts, Pennsylvania, Vermont, and DC since August). The only other environmental thought I have would be smoke damage, as we do cook a lot and I can think of times we've burned things and the smoke alarms have gone off. But we don't use Teflon, and he's always in a different room when we're cooking things on the stove (but on the same floor/ smoke could filter in through a closed door?). It feels like far too infrequent and indirect exposure to cause long-term damage, but maybe that's wrong.

In case helpful, here are some links to videos of his "episodes":
Like I said, thank you so much for any advice or brainstorming you can offer! Although I've had Merlin for 22 years, since he hasn't been sick before I don't have a lot of experience with bird illnesses :(
 

Hankmacaw

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You should get copies of all of your tests results for your records, for if he ever has to go to different vets.

Aspergillosis is either chronic or acute. If you bird had acute asper he would have died long ago, but the chronic form is sneaky and can hang around for months and months before it really breaks out

An asper titer is a blood serum test, while the PCR test is done on whole blood. Yes the asper tests are separate from the CBC (complete blood count) and Chem Panel ( blood chemistry panel ) your vets probably did before. Asper generally has quite a high WBC associated with it - but there are exceptions.

Don't be afraid of sedation/anesthesia. There are newer ones in use today and the vets are much better at using them. You only ever hear about the horror stories, not the ones with no issues. My two sickly birds were probably anestethized a total of 100 times over 23 years, They always seemed perkier when they came out from under it. My Dr. owns his own CT scanner and charges $500 for a scan. So no more expensive than , say three tests.

You know your bird better than anyone. If it were my bird, and after all that you have gone through with throwing things at the wall, I would either have asper confirmed or eliminated.
 

Merlin72

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OK this is super helpful. I will go to our primary vet and see what she says re: asper titer/ blood serum test, and also the CT scan. Really good to know re: sedation. I wonder what the deal is with them saying it would be too hard to get a definitive answer on chronic asper....I'll ask.

We had the primary vet send the test records directly to the new vet (the primary vet didn't have appointments available quickly enough), but not directly to us. But yeah, I should probably ask for my own copies!

Thank you so much!!
 

Hankmacaw

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Like I said chronic asper is very sneaky and like my vet says, it can present in 100 different ways in 1.000 places. My Hank had chronic asper when I got him in 1997 and it finally took an endoscopy to get a final diagnosis. Asper colonies were found on his liver, testes and kidneys (none in the respiratory system). An xray would not have shown these colonies would never have been found on an xray unless they were very, very large.

You may want to read this to educate yourself a bit on endoscopies, in case it becomes a possibility in your bird's diagnosis.

 

Azor

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Thank you so much @Hankmacaw and @Azor for your replies and thoughts.

Sorry for my ignorance, but would a titer test be different from the blood work they did back in October? I haven't actually seen what they tested his blood for, all I know is the vet told me the results were "normal", except for a slightly elevated white blood cell count.

They did a culture from the nasal flush, and said the only organism that grew was a normal bacteria. Is that the same as a "culture and sensitivity"?

Both vets we've seen have said that definitively ruling out asper is hard because of Merlin's size, but I don't know why that would be -- maybe they can't draw enough blood at once to test? I will ask again about how we might be able to rule out asper by doing a titer test.

Merlin's nares aren't swollen and the lack of sign of infection in the sinuses makes me think it unlikely he's had an object stuck in there for months? But some other internal obstruction/ growth is definitely possible... although then it's hard to see why his symptoms are only episodic, and why he isn't wheezing and struggling to breath all the time. On any given day, he'll have periods where he's super active (chewing up his toys, preening, exploring), and then he'll have short, periodic episodes where he's sneezing a lot, wheezing, and staying very still. But once those pass, he's back to being very active. I know birds hide their sickness, but it does legitimately seem like it's something that bothers him in fits and starts, and not all the time.

I'm a bit concerned about the cost and risk of doing a CT scan given that he's an old guy. Wouldn't it require full sedation? I'd definitely appreciate any thoughts you have on the risks/ benefits of doing the scan vs just keep trying a bunch of different medications and seeing what sticks.

Merlin's problem isn't time specific, although I would say we usually notice his wheezing/ sneezing fits more in the morning/ afternoon, and less in the evening/ around bed time. In terms of an environmental irritant, initially when this started in August I thought it might be a pollen allergy, since the ragweed season was so bad this year. And then I thought it might be dust? But the persistence of his symptoms across seasons and locations makes that seem more unlikely (we've spent multiple weeks in Rhode Island, Massachusetts, Pennsylvania, Vermont, and DC since August). The only other environmental thought I have would be smoke damage, as we do cook a lot and I can think of times we've burned things and the smoke alarms have gone off. But we don't use Teflon, and he's always in a different room when we're cooking things on the stove (but on the same floor/ smoke could filter in through a closed door?). It feels like far too infrequent and indirect exposure to cause long-term damage, but maybe that's wrong.

In case helpful, here are some links to videos of his "episodes":
Like I said, thank you so much for any advice or brainstorming you can offer! Although I've had Merlin for 22 years, since he hasn't been sick before I don't have a lot of experience with bird illnesses :(
Wow, I looked at all the videos. This is exactly the same but ofc in another much bigger bird.

I have noticed that it starts after I shut down lights and I have began to speculate of why this happens..
Like when ppl sneezing when looking at a strong light, I can't find such specific information in the literature.

Do the episodes last some minutes (max 10-15)? If you do find out the cause please tell me. I do think they should be able to take more blood from your Merlin then from a budgie. I do believe that it is possitive to search for antibodies in the blood. I don't remember how much blood they have to take. From what I can remember this should be possible.

I would class him a medium sized bird but I'm no expert on sizing up birds. I have read extremely much about budgies and avian medicine.
I started reading all this chapters and have a bunch written down. I recommend you read a little if you want.

It's devided in to chapters so it's easy to read. http://avianmedicine.net/wp/publication_cat/clinical-avian-medicine/
 

Merlin72

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@Azor @Hankmacaw - Our primary vet got back to us and suggested doing another nasal flush, but this time a cytology (instead of the culture and sensitivity that the other vet did, and which didn't show anything abnormal).

I don't know how a cytology is different from a culture and sensitivity. Do you know? What do you think of this suggestion?

I've asked about the asper titer and haven't heard back yet.

Many thanks again for all your help.
 

Hankmacaw

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Cytology is the examination of cells within a sample. It is done by a pathologist using slides and a microscope. The samples on the slides (from you bird) are stained and different stains tell the pathologist different things along with the size shape and number of discrete types of cells in the sample.

I would not do both tests as the cytology will tell you with more sensitivity what is in the sample. Yes, do the cytology - IMO.
 

Merlin72

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So helpful to know re: the cytology. When you say you would not do both tests, do you mean you wouldn't do both a culture and sensitivity AND the cytology, or do you mean you wouldn't do both the asper titer AND the cytology?
 

Hankmacaw

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Not the asper titer and cytology. If your Dr. wants to do the cytology let him. They are both about the same cost.
 

Azor

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@Azor @Hankmacaw - Our primary vet got back to us and suggested doing another nasal flush, but this time a cytology (instead of the culture and sensitivity that the other vet did, and which didn't show anything abnormal).

I don't know how a cytology is different from a culture and sensitivity. Do you know? What do you think of this suggestion?

I've asked about the asper titer and haven't heard back yet.

Many thanks again for all your help.

Cytopathology is frequently called "cytology", which translates "the study of cells".
Basically you look at extracted cells under a microscope. We use this within human medicin to diagnose cancer but can be used to diagnose a variety of things.


Avian Medicine: Princilpes and Application: <--- here is a good written representation of the procedure.

The tests are different tools of diagnosis, more tools the better IMO.
Bean working hard the last couple of days due to the situation here in Sweden over 12h/day. Sorry i haven't been able to answer your question earlier!

Best of luck!
 

Merlin72

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Hi! Just an update that the culture and cytology of the nasal flush sample came back completely normal. The vet says this means the issue is likely NOT in the nasal cavity or front of the sinus. But they are also running an asper PCR and the vet says it could be another week or so until they have results from that.

If the asper result comes back negative (which is my hope, of course!!), I am not sure what our next step should be. @Hankmacaw do you have any suggestions? We've already done two courses of different antibiotics over the last few months, with no effect on his symptoms. If it isn't asper and it isn't a bacteria, any ideas what it might be or what we should do next?
 

Azor

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Hi! Just an update that the culture and cytology of the nasal flush sample came back completely normal. The vet says this means the issue is likely NOT in the nasal cavity or front of the sinus. But they are also running an asper PCR and the vet says it could be another week or so until they have results from that.

If the asper result comes back negative (which is my hope, of course!!), I am not sure what our next step should be. @Hankmacaw do you have any suggestions? We've already done two courses of different antibiotics over the last few months, with no effect on his symptoms. If it isn't asper and it isn't a bacteria, any ideas what it might be or what we should do next?
What i have noticed working is vitamin-A and I don't know why. If i feed her carotenoids for some days her symptoms go away, also after vit-A injection she was symptom free for some time. im going back to the vet now on Monday. I'm starting to suspect some sort chronic of hypervitaminos-a (why IDK...).
 

Hankmacaw

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You might ask your vet about a Protein Electrophoresis test. My vet has resorted to this test a couple of times when he wasn't getting answers from some of the other tests.

" Electrophoresis: Electrophoresis has received much attention recently as a valuable diagnostic tool in avian medicine. A serum sample is placed on a special “plate” and an electrical charge is applied. The various components of the serum migrate across the plate and are separated by their response to the charge. Once separated electrophoretically, each of the components can be evaluated and quantitated. Most frequently, electrophoretic methods are used in birds to determine the percentage of five major protein fractions in serum: pre-albumin/albumin, alpha-1 globulins, alpha-2 globulins, betaglobulins, and gammaglobulins—in serum protein. In healthy birds, albumin is the largest protein fraction, constituting up to 40% of total serum protein in some species. An inflammatory process will result in a decrease in albumin concentrations and an increase in total protein due to elevations in the alpha-, beta-, and gammaglobulin fractions. The end result of these changes is a decrease in the albumin/globulin (A/G) ratio. Other conditions that result in a decrease in the A/G ratio include egg yolk peritonitis and chronic infectious diseases, such as aspergillosis, chlamydiosis, and tuberculosis. Frequently, the total protein concentration will be within normal range while the A/G ratio is decreased. This occurrence indicates that the A/G ratio is of greater clinical importance than total protein concentration. A decrease in albumin level can develop due to reduced albumin synthesis in chronic liver disease or chronic infection. Albumin loss also occurs with renal disease, parasitism, gastrointestinal disease, and overhydration. Albumin increases occur with dehydration. 8 An increase in alpha- and betaglobulins can result from acute nephritis (inflammation of the kidney), severe active hepatitis, systemic mycotic (fungal) infections, and nephrotic (kidney) syndrome. An increase in gammaglobulins, which are composed primarily of immunoglobulins (antibodies), will occur with antigenic stimulation, such as in cases of acute or chronic inflammation, infection, chronic active hepatitis, vaccinations, and immune-mediated disorders."
 

Merlin72

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Hi! I just wanted to let you all know that Merlin's asper PCR test results finally came back -- NEGATIVE. What a relief. While were waiting for the asper results, the vet put him on two antibiotics at once, one oral and one as nasal drops, and in the past 10 days his symptoms have basically totally gone away!! No more sticky breathing or sneezing fits. So I think we can say the mystery has been solved and this was a very stubborn bacterial infection somewhere in his respiratory system. Don't know why the other two courses of anti-biotics didn't work, but I'm not complaining!

@Hankmacaw and @Azor - Thank you both so much for all your advice!
 
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