Urgent Ivan is very sick and vets don't know what's wrong! He needs our help!

[parrotluv]

Hope the vet prescribes some pain/anti inflammatory meds to make him comfortable till you can get to the bottom of all this. Hope he feels better soon

 

[greys4u]

 

[melissasparrots]

I'd check for heavy metal poisoning. Polyuria plus itchy bird makes me think of zinc poisoning.

 

[twrigles05]

My vet says that Asper presents in 100s of different ways. My Hank had a very low titer value, but had Asper colonies on his liver and testes. It spread to other organs including his lungs and airsacs later, but it took a long time to diagnose Asper because of how it presented in Hank. It was chronic, as opposed to acute Asper.

His swollen crop is worrisome - unless he just ate an elephant, it is very swollen. Did the vet have anything to say about that extreme swelling? There seems to be very little redness, indicating irritation, but it could very well be irritated on the inside. How about a laparoscopy and histology on a tissue sample?

Thank you. What is Asper? Is that Aspergilliosis? Is there a treatment for it?

His crop has started swelling in the last week, which is after our most recent vet visit. It's been like this ever since starting him on celebrex. Maybe the celebrex is causing his crop to swell? I will schedule another vet appointment for next week.

 

[twrigles05]

Everyone -- I just want to say THANK YOU so much for all of your contributions here. I have learned a lot today and am scheduling a vet visit tomorrow morning to get Ivan tested for heavy metal toxicity as this is something I had never considered before. I will also bring up aspergilliosis and avian gastric yeast as well.

I will keep you all updated.

Thank you!

 

[Begone]

I will keep you all updated.

Yes please do that and good luck!

 

[Macawnutz]

Thank you. What is Asper? Is that Aspergilliosis? Is there a treatment for it?

His crop has started swelling in the last week, which is after our most recent vet visit. It's been like this ever since starting him on celebrex. Maybe the celebrex is causing his crop to swell? I will schedule another vet appointment for next week.

Yes, Aspergilliosis.

Gastric yeast is sometimes difficult to test for. It will often not show up in tests in a positive bird. Repeat testing is needed or collection of stool samples over a few days can help. Often it is misdiagnosed and instead labeled as PDD however your symptoms sound nothing like PDD or AGY to me. Should we be looking for a more experienced vet for you? Where are you located and who do you use?

 

[Hankmacaw]

Yes, there are much more effective and less toxic treatments for Aspergillosis now than a few years ago. @Macawnutz and I have both used voriconazole for Asper with great success and none of the toxicity to the liver. It is fairly new as a medication for Asper. Other treatments are Amphotericin B, very toxic to the liver and must be used with care, although it is the only medication that actually kills the Asper fungus. It can be used for nebulization without any harm for a short period of time. Itraconazole is probably the next most effective, but again there is danger of organ damage if used too long. Both of my birds were on Itraconazole for too ilong and both suffered liver damage - it was a case of damage the liver or they would have died. Lamisil is less toxic and less effective, but is used on many birds that aren't critical.
Good article about the basics of Asper;
Aspergillosis in Birds | VCA Animal Hospital



Aspergillosis

Aspergillosis, penguin
Courtesy of Dr. Gerry Dorrestein.

Tracheitis due to aspergillosis can occur in immunocompromised birds. Aspergillusgranulomas often form in the syrinx of psittacine birds and raptors and are particularly challenging to treat. Changes in vocalization may occur before dyspnea is observed, and often these birds will stretch out their necks while breathing. Lower respiratory disease, including airsacculitis, often involves invasion by Aspergillus spp. Granulomas of the air sacs or the coelomic cavity are also common, usually in the caudal thoracic or abdominal air sacs. These lesions may require surgical resection.

Diagnosis:
Diagnosis can be challenging but should be pursued because treatment is longterm and costly. Aspergillosis should be considered in any pet bird presenting with signs of upper or lower respiratory disease, wasting disease, or marked leukocytosis/monocytosis. A leukocytosis/monocytosis combined with clinical signs and radiographic findings can provide a strong presumptive diagnosis in suspect cases. Often birds with chronic disease will be anemic. A radiograph may reveal airsacculitis, granulomas, or severe pulmonary disease. A CT scan or MRI is more likely to reveal more subtle or diffuse disease. Serologic testing is of limited use; antibody and antigen titers, including galactomannan antigen testing, often result in false-negative or false-positive results. A false-negative often occurs because of immunosuppression, so consultation with the laboratory regarding interpretation is important. PCR testing to detect specific Aspergillus DNA is a much more sensitive method to confirm infection and is more suitable for immunocompromised birds because detection of antibodies is not involved. Plasma protein electrophoresis showing increased β-globulin levels is consistent with aspergillosis. Definitive diagnosis may require direct visualization of lesions either by surgery or endoscopy and confirmation by biopsy, cytology, and/or fungal culture of lesions. Low fungal viability may yield a negative culture despite confirmation by cytologic results.

Treatment:
Treatment varies depending on the site of infection. An acute tracheal infection with obstruction by an aspergilloma is an emergency that may require placing an air sac tube. After tube placement, syringeal or tracheal plaques are removed with a rigid endoscope. Amphotericin B can then be instilled intratracheally at 1 mg/kg through the glottis, and treatment with systemic antifungals and nebulization should be started. Amphotericin B is the only fungicidal agent available and can be used in nebulization, as a nasal flush, intratracheally, and in IV administration. For nebulization, a concentration of 0.25–1 mg/mL of sterile water can be used. Nasal and sinus flushes are generally more dilute at 0.05 mg/mL of sterile water. Amphotericin should not be diluted with saline, because this decreases its potency.

Flushing the nares and sinus with unmedicated sterile water or saline before medicating may allow samples to be obtained for cytologic examination and culture. Several flushes of unmedicated warm isotonic saline or sterile water should be done before a final infusion of the medicated mixture. Care must be exercised to maintain the bird’s head in a downward position to avoid the potential for aspiration of the infected debris into the lower respiratory tract.

Itraconazole (5–10 mg/kg, PO, once to twice daily) is the most commonly used azole for systemic infection. African grey parrots are more sensitive to adverse effects of itraconazole, especially regurgitation and anorexia, and should be dosed at 5 mg/kg/day, PO. Terbinafine (10–15 mg/kg, PO, bid) can be used in lieu of or in conjunction with itraconazole. Clotrimazole can be used for nebulization in conjunction with systemic therapy (10 mg/mL, nebulized 15–30 min 2–4 times/day). Voriconazole(12–18 mg/kg, PO, bid) is being used for resistant strains of Aspergillus.

If fungal granulomas are identified and the lesions are accessible, debulking endosurgically or treating the lesions topically with amphotericin B may improve the outcome. Birds undergoing treatment should be monitored closely for adverse effects of many antifungal drugs, which can include depression, anorexia, and liver dysfunction. Hepatic enzyme, bile acids, and uric acid concentrations should be monitored every 4 wk during treatment. Treatment success may be difficult to determine, but serial CBCs and radiographs may be helpful. Treatment with oral drugs should be continued for 2–4 wk after clinical signs have resolved. Birds with aspergillosis often have underlying disease problems and may be immunocompromised, which may affect treatment and recovery. Thickened and scarred air sacs that develop during and persist after infection can provide an ideal environment for disease recurrence.

From the Merck manual

 

[zoo mom]

So sorry your bird is ill. Hoping you get answers and an effective treatment soon.

 

[finchly]

Please keep us updated. I am so sorry your baby is sick. You are doing a great job trying to drill down to the cause of his illness.

 

[twrigles05]

Thank you everyone. I scheduled a new appointment for this Wednesday with a new vet (Anneliese Strunk, DVM, Diplomate ABVP (Avian)) at the Avian and Exotic Animal Hospital in Bothell, Washington. This will be the fourth vet that will see Ivan. I am definitely going to bring all of his previous medical records & x-rays, and I will mention aspergilliosis and heavy metal toxicity.

I'll post in here after Wednesday with his results. I will keep checking this thread in case anyone else has other ideas in the meantime. Thank you!

 

[Hankmacaw]

Well, Dr. Strunk has all of the qualifications. I hope the appointment reveals what is wrong with that boy.

 

[enigma731]

Dr. Strunk was my vet until I moved out of Seattle and she's awesome. She's very good at comprehensive diagnostics and will definitely do the kind of workup you need to get an answer.

 

[StarrySkies]

Dr. Strunk is my vet. She's good at what she does, even Sunny wasn't too angry about going there.

 

[iamwhoiam]

Hope things go well with the new vet.

 

[enigma731]

BTW, Dr. Strunk is the most experienced, but all the vets in that practice are great with birds, and they are on call 24/7. You can be seen as an emergency during business hours for only $50 extra, so don't hesitate to do that if you feel like he needs to be seen before Wednesday. That practice is amazing and I miss them (although I'm super fortunate to have a pretty awesome clinic here in Atlanta too).

 

[jmfleish]

Sorry I haven't been on for several days. Heavy metal poisoning, especially zinc, can be ingested slowly and can stay in the body forever and slowly do mild damage. I have to admit, some of the signs do sound like HMP. There is a specific blood test they do for that and it will read in parts per million (ppm). Vets disagree on what is high. I went through this with my Ducorps' Cockatoo Reggie. 2.0ppm is what is considered high normal in most birds and 2.5ppm is consider high normal for Cockatoos. Reggie was tested at 3.9ppm. His symptoms were not as similar to your Ivan, he was shaking one of his legs and was picking blood feathers. We chelated with several different meds and his levels would come down but ultimately go back up and the vets finally decided that he just had a normally high level after a period of about 9 months and three chelations. They also felt that if he truly had zinc toxicity then he would have died from it. This all happened when he was about 7. I had him retested when he was about 14 just because I was curious and he had come down to 2.9ppm, still high but not the 3.9ppm that he was at, so clearly he did have something going on at the time. One of my vets that I have now still feels that numbers that low are not worrisome. He feels that treatment for zinc toxicity are worrisome when they get up into the 8ppm-12ppm range. Like I said, vets disagree on this! When Reggie was first diagnosed, the vet treating him was going to do a skin scraping to see if there was a bacterial problem and refused to do it when she saw his zinc level. I'm not sure why that mattered, but clearly, there's a difference of opinion when it comes to zinc toxicity.

The other very interesting thing about zinc toxicity is that it settles in the organs and the bones and that's probably why it's so hard to get rid of. The meds given slowly do remove it from the body but it's my understanding that it takes a while to get rid of it. The meds are hard on the body too. I never saw Reggie get sick on the medication but I really felt like we weren't getting anywhere and I had no idea where he would have gotten the zinc from. Hind sight is 20/20 but I wish I would have kept chelating now that I know he probably really did have too much zinc in his system. He's now basically completely naked except for his head and he's got issues with his uric acid levels which I feel is part of the years he had the problems with the zinc in his system.

 

[iamwhoiam]

How is Ivan doing?

 

[Alien J]

 

[95talongirl]

poor little birdie!

I sincerely hope you can find some answers to this mystery and he feels better soon!