When Lior was sick, I spent a lot of time on the forum reading about cases with similar symptoms, so I will share what happened with her as well in case it helps someone in the future. I've posted about parts of it, but not the entire story.
On October 14, Lior (my 3 1/2 year old Fiery-shouldered conure) started showing signs of severe dyspnea (labored breathing). While her appetite was normal, she was fluffed up, hunched over, and breathing very rapidly with tail bobbing. I immediately took her to the vet, where they put her in oxygen until the vet could examine her. He noticed on visual examination that her abdomen* was distended, and felt her abdomen to confirm that there was fluid in there. He also showed me how to feel for fluid in case it was necessary in the future. 18 ccs of clear greenish fluid were removed via needle aspirate that day (nearly 1/3 her body weight). X-rays were done, but only showed a vague mass in the right side. We scheduled her to come back in for barium contrast x-rays the next day. A sample of the fluid was sent out for cytology.
(*Using the term abdomen for simplicity, though a bird's body cavity is more properly called the coelom.)
Normally an endoscopy would be the next choice for diagnosis, but this was not a safe procedure in a bird that had either a large cyst or free fluid in the coelom, as endoscopy involves puncturing an air sac.
She was put on strong antibiotics (Chloramphenicol) for two weeks. Her barium study the next day (after removal of another 5 cc of fluid) showed that a mass and/or fluid in the right side was causing displacement of her lower intestines - they were being shoved to the side by whatever was in there. Because Lior was a female bird in breeding condition, the presumptive diagnosis was reproductive, but there was one question - why was the apparent mass on the right side? Parrots have one active ovary and oviduct on the left side (They're born with two, but only one develops), so presenting with these issues on the right side was atypical.
The vet felt it was likely that fluid would build up again, so we were advised to watch her closely and bring her back in whenever her breathing became labored again. I also monitored her weight at home on a daily basis. She went in for three more taps (10 cc, 10 cc, 4cc) during the following two weeks.We were hopeful after the 4 cc tap that she was improving.
In the meantime, the cytology results came back and showed nothing conclusive. There were inflammatory cells, but nothing that showed an infectious etiology, and no neoplastic cells.
On October 31, however, she was back up to 13 cc of fluid, and she received her first injection of Lupron, in the hopes that it would reduce the build up of fluid. At this point, given her hormonal behavior, the vet still thought we were dealing with a reproductive issue. Cystic ovarian disease is not uncommon in female birds in breeding condition, though it's seen more frequently in cockatiels and budgies, and Lior didn't have any past history of egg laying or reproductive difficulty.
Two more taps followed (11 cc, 13 cc), and she got another dose of Lupron on November 13. (14 cc removed that evening.) Vet felt that we should see results within another week. If not, we would talk about the ultrasound that I mentioned early on. If we went that route, they would refer us to UPenn, since their ultrasound docs have a lot of bird experience. (The vet who does ultrasound at the office I use mostly does small mammals.)
Another 5 taps followed, totalling 72 ccs. By that point, Lior had had 170 cc of fluid removed overall, which was almost 3x her body weight.
During the last weekend in November, Lior started to have balance and coordination issues, and had polyuria. She was weak and tired. A friend suggested giving her electrolytes to perk her up and replace some of the fluid she was losing. I used Avitech's "Electrovites", which I had on hand. I lowered all of the perches in her cage and provided more platforms. The electrolytes worked well and she regained her energy rapidly. At her next appointment we did more bloodwork to check her kidney function.(13 ccs fluid removed at that appointment.) She was also back on antibiotics. My vet called UPenn to set up the referral for an ultrasound, and I made the appointment for December 6th.
Throughout all of this, Lior was happy and active, except on the days of her taps, when her breathing would become labored. The good still outweighed the bad, but the time between taps was decreasing.. at this point, she had to go in every other day. Lior wasn't a bird that got stressed about going to the vet - she liked trips in the car, and always stepped up eagerly to go in her carrier - but timing the taps, and watching her difficulty breathing on those days was extremely hard.
This video shows her with dyspnea on a Sunday when I had to take her in for an emergency fluid tap, since she clearly could not wait until her scheduled appointment on Monday.
(My goal in scheduling her appointments was to get her in when under 14-15 cc had built up, since that was around the tipping point when she would start showing signs of respiratory distress again. Fluid taps are invasive and have the potential to cause severe infection, as a needle is inserted directly into the abdominal cavity, so overscheduling them unnecessarily comes with risks.)
This one was taken the same day, after 17 cc of fluid were removed! Much better.
Ultrasound day was long. One machine was broken, so there was a big wait for the one working machine. Lior had a brief exam by the avian vet there, who shared that one more sign of fluid retention in a bird is extra wear or redness on the soles of their feet.
The first ultrasound wasn't as clear as it could be, since there was fluid in her abdomen, but it showed a large, multicystic mass approx 1.5 cm in size, which appeared to be adhered to the right body wall and extended towards the back. It was difficult to tell where it orginated. Possible suggestions were the pancreas and the body wall. What we were draining all along was not free fluid in the coelom, but rather the fluid from the largest cyst on the mass. The cyst was causing significant displacement of her organs and was pressing upwards on her heart. I was offered the option of having the fluid drained, and having a second ultrasound done. Obviously I stayed to have this done! At this point, things did not sound positive, and losing her started to feel like a very real possibility.
The second ultrasound was clear enough that they were able to do a fine needle aspirate of the center of the mass, so that we could figure out whether the mass was cancerous or benign. Either way, the vet said, Lior would need surgery to remove the mass. The second ultrasound showed that there were significant adhesions to the body wall caused by scar tissue, but it was now even less obvious where the mass originated. The only organ in that area of the body is the pancreas, so a pancreatic mass was suggested. I was told we should have the results back by Tuesday, and we were on our way (6 hours later)...
The findings, as summarized on part of the extensive and extremely useful PDF that UPenn sends out after an appointment:
"Conclusion: Cystic right-sided coelomic mass of unknown origin and fibrinous peritoneal/coelomic changes. DDx can include pancreatic neoplasia, coelomic neoplasia, oviduct/reproductive enlargement with cystic changes (although located on right side and normally is on the left), carcinoma, vs. infectious or traumatic process.
OVERALL ASSESSMENT
-Lior has a large mass located in her coelom (belly), as seen on the radiographs performed by your primary care veterinarian and on ultrasound today. Ultrasound further revealed that the mass is made of numerous small fluid-filled structures called cysts, some of which are very large. The largest of these was tapped with a needle and fluid was drawn off during the ultrasound.
-This allowed better visualization of the mass, which was adhered to the body wall on the right side. A fine needle aspirate was taken of the mass and submitted for cytology (evaluation the cells of which it is made).
-This mass is very likely the cause of the recurring fluid that your primary care veterinarian is removing from her coelom every 2-3 days. Unfortunately, while cytology may provide a diagnosis, it is possible we will not know exactly what it is made of unless a biopsy is taken. Based on the mass's ultrasonographic appearance and location, potential origins include the body wall and the pancreas.
-We suspect that this mass is the cause of the fluid build up in her coelom and that it will need to be surgically removed."
Lior had another tap the next day to make her comfortable for the weekend, with our next fluid tap appointment scheduled for Monday night. Shortly before I left work that evening, I missed a call from UPenn. I emailed Dr. Wyre and told her that she could give me the results via email. I was waiting at a stoplight on my way to Lior's appointment when I checked my phone and saw that Dr. Wyre had sent the results.. Lior had cancer. The origin was still unknown, and it was thought to be either carcinoma or liposarcoma.
Lior's primary vet and I discussed her options - he said that the only two remaining were surgery or euthanasia before her quality of life declined. If surgery was successful, we would discuss chemotherapy afterwards in the event that the cancer had spread beyond the mass. We both wanted to give her a chance while we still could.
We were able to get her scheduled for that Thursday, when both he and the other surgical doctor would be in the office. They would both scrub in and be involved to give Lior the best chance possible. but it was considered very risky nonetheless. She was in poor body condition from being ill, and since they didn't know where the mass originated, it was diffiuclt to assess the risk accurately before they went in. Any abdominal cavity surgery in a bird is high risk.. a mass involving an organ significantly moreso. Dr. K told me that if what they found was inoperable, they would call to ask my permission to euthanize her while under anesthesia.
I dropped Lior off on Thursday morning. Sadly, I received a call only 10 minutes after she went under anesthesia.. she hadn't even made it to surgery. The stress on her organs was too great, and anesthesia was too much for her to survive. They asked for permission to perform a necropsy which, of course, I okayed.
Dr. B called me later to give me the results, telling me that he had approached the necropsy as though he were performing the surgery itself, rather than like a traditional necropsy. What he found indicated that she was unlikely to have survived surgery if she had made it that far. The mass was in the oviduct, which had, at some point, shifted to the wrong side of the body, possibly from being dragged by the weight of the cyst, and become adhered to the right body wall. This was why the x-ray and ultrasound results were so puzzling.. it was, in fact, reproductive in origin, but the organ had been forced out of its usual position in the body. He said that while they would normally be able to isolate certain blood vessels during surgery, they wouldn't have been able to do so in Lior because they had grown through the mass like a spiderweb, making the risk of hemorrhage during surgery highly likely.
I asked that a sample of the mass be sent out for histopathology so that we could figure out what type of cancer it was. I debated having samples sent out of other organs so that we would know for sure whether it had metastasized (spread elsewhere), but decided not to, as I have other birds that require vet funds as well. I figured that getting answers on the type of cancer would provide at least some guidance as to whether it was likely to have spread.
The results came back a week later, and it was confirmed to be a carcinoma of reproductive origin. The vet felt that it was likely that cancerous cells had already seeded throughout the body cavity, and that we might have been looking at cancer elsewhere in as little as a month after surgery, had she survived.
I don't really know how to conclude this... It all happened so quickly and seemingly randomly that it's still difficult to fathom. Maybe just with Lior, eating some strawberries only two days before she passed away.
On October 14, Lior (my 3 1/2 year old Fiery-shouldered conure) started showing signs of severe dyspnea (labored breathing). While her appetite was normal, she was fluffed up, hunched over, and breathing very rapidly with tail bobbing. I immediately took her to the vet, where they put her in oxygen until the vet could examine her. He noticed on visual examination that her abdomen* was distended, and felt her abdomen to confirm that there was fluid in there. He also showed me how to feel for fluid in case it was necessary in the future. 18 ccs of clear greenish fluid were removed via needle aspirate that day (nearly 1/3 her body weight). X-rays were done, but only showed a vague mass in the right side. We scheduled her to come back in for barium contrast x-rays the next day. A sample of the fluid was sent out for cytology.
(*Using the term abdomen for simplicity, though a bird's body cavity is more properly called the coelom.)
Normally an endoscopy would be the next choice for diagnosis, but this was not a safe procedure in a bird that had either a large cyst or free fluid in the coelom, as endoscopy involves puncturing an air sac.
She was put on strong antibiotics (Chloramphenicol) for two weeks. Her barium study the next day (after removal of another 5 cc of fluid) showed that a mass and/or fluid in the right side was causing displacement of her lower intestines - they were being shoved to the side by whatever was in there. Because Lior was a female bird in breeding condition, the presumptive diagnosis was reproductive, but there was one question - why was the apparent mass on the right side? Parrots have one active ovary and oviduct on the left side (They're born with two, but only one develops), so presenting with these issues on the right side was atypical.
The vet felt it was likely that fluid would build up again, so we were advised to watch her closely and bring her back in whenever her breathing became labored again. I also monitored her weight at home on a daily basis. She went in for three more taps (10 cc, 10 cc, 4cc) during the following two weeks.We were hopeful after the 4 cc tap that she was improving.
In the meantime, the cytology results came back and showed nothing conclusive. There were inflammatory cells, but nothing that showed an infectious etiology, and no neoplastic cells.
On October 31, however, she was back up to 13 cc of fluid, and she received her first injection of Lupron, in the hopes that it would reduce the build up of fluid. At this point, given her hormonal behavior, the vet still thought we were dealing with a reproductive issue. Cystic ovarian disease is not uncommon in female birds in breeding condition, though it's seen more frequently in cockatiels and budgies, and Lior didn't have any past history of egg laying or reproductive difficulty.
Two more taps followed (11 cc, 13 cc), and she got another dose of Lupron on November 13. (14 cc removed that evening.) Vet felt that we should see results within another week. If not, we would talk about the ultrasound that I mentioned early on. If we went that route, they would refer us to UPenn, since their ultrasound docs have a lot of bird experience. (The vet who does ultrasound at the office I use mostly does small mammals.)
Another 5 taps followed, totalling 72 ccs. By that point, Lior had had 170 cc of fluid removed overall, which was almost 3x her body weight.
During the last weekend in November, Lior started to have balance and coordination issues, and had polyuria. She was weak and tired. A friend suggested giving her electrolytes to perk her up and replace some of the fluid she was losing. I used Avitech's "Electrovites", which I had on hand. I lowered all of the perches in her cage and provided more platforms. The electrolytes worked well and she regained her energy rapidly. At her next appointment we did more bloodwork to check her kidney function.(13 ccs fluid removed at that appointment.) She was also back on antibiotics. My vet called UPenn to set up the referral for an ultrasound, and I made the appointment for December 6th.
Throughout all of this, Lior was happy and active, except on the days of her taps, when her breathing would become labored. The good still outweighed the bad, but the time between taps was decreasing.. at this point, she had to go in every other day. Lior wasn't a bird that got stressed about going to the vet - she liked trips in the car, and always stepped up eagerly to go in her carrier - but timing the taps, and watching her difficulty breathing on those days was extremely hard.
This video shows her with dyspnea on a Sunday when I had to take her in for an emergency fluid tap, since she clearly could not wait until her scheduled appointment on Monday.
(My goal in scheduling her appointments was to get her in when under 14-15 cc had built up, since that was around the tipping point when she would start showing signs of respiratory distress again. Fluid taps are invasive and have the potential to cause severe infection, as a needle is inserted directly into the abdominal cavity, so overscheduling them unnecessarily comes with risks.)
This one was taken the same day, after 17 cc of fluid were removed! Much better.
Ultrasound day was long. One machine was broken, so there was a big wait for the one working machine. Lior had a brief exam by the avian vet there, who shared that one more sign of fluid retention in a bird is extra wear or redness on the soles of their feet.
The first ultrasound wasn't as clear as it could be, since there was fluid in her abdomen, but it showed a large, multicystic mass approx 1.5 cm in size, which appeared to be adhered to the right body wall and extended towards the back. It was difficult to tell where it orginated. Possible suggestions were the pancreas and the body wall. What we were draining all along was not free fluid in the coelom, but rather the fluid from the largest cyst on the mass. The cyst was causing significant displacement of her organs and was pressing upwards on her heart. I was offered the option of having the fluid drained, and having a second ultrasound done. Obviously I stayed to have this done! At this point, things did not sound positive, and losing her started to feel like a very real possibility.
The second ultrasound was clear enough that they were able to do a fine needle aspirate of the center of the mass, so that we could figure out whether the mass was cancerous or benign. Either way, the vet said, Lior would need surgery to remove the mass. The second ultrasound showed that there were significant adhesions to the body wall caused by scar tissue, but it was now even less obvious where the mass originated. The only organ in that area of the body is the pancreas, so a pancreatic mass was suggested. I was told we should have the results back by Tuesday, and we were on our way (6 hours later)...
The findings, as summarized on part of the extensive and extremely useful PDF that UPenn sends out after an appointment:
"Conclusion: Cystic right-sided coelomic mass of unknown origin and fibrinous peritoneal/coelomic changes. DDx can include pancreatic neoplasia, coelomic neoplasia, oviduct/reproductive enlargement with cystic changes (although located on right side and normally is on the left), carcinoma, vs. infectious or traumatic process.
OVERALL ASSESSMENT
-Lior has a large mass located in her coelom (belly), as seen on the radiographs performed by your primary care veterinarian and on ultrasound today. Ultrasound further revealed that the mass is made of numerous small fluid-filled structures called cysts, some of which are very large. The largest of these was tapped with a needle and fluid was drawn off during the ultrasound.
-This allowed better visualization of the mass, which was adhered to the body wall on the right side. A fine needle aspirate was taken of the mass and submitted for cytology (evaluation the cells of which it is made).
-This mass is very likely the cause of the recurring fluid that your primary care veterinarian is removing from her coelom every 2-3 days. Unfortunately, while cytology may provide a diagnosis, it is possible we will not know exactly what it is made of unless a biopsy is taken. Based on the mass's ultrasonographic appearance and location, potential origins include the body wall and the pancreas.
-We suspect that this mass is the cause of the fluid build up in her coelom and that it will need to be surgically removed."
Lior had another tap the next day to make her comfortable for the weekend, with our next fluid tap appointment scheduled for Monday night. Shortly before I left work that evening, I missed a call from UPenn. I emailed Dr. Wyre and told her that she could give me the results via email. I was waiting at a stoplight on my way to Lior's appointment when I checked my phone and saw that Dr. Wyre had sent the results.. Lior had cancer. The origin was still unknown, and it was thought to be either carcinoma or liposarcoma.
Lior's primary vet and I discussed her options - he said that the only two remaining were surgery or euthanasia before her quality of life declined. If surgery was successful, we would discuss chemotherapy afterwards in the event that the cancer had spread beyond the mass. We both wanted to give her a chance while we still could.
We were able to get her scheduled for that Thursday, when both he and the other surgical doctor would be in the office. They would both scrub in and be involved to give Lior the best chance possible. but it was considered very risky nonetheless. She was in poor body condition from being ill, and since they didn't know where the mass originated, it was diffiuclt to assess the risk accurately before they went in. Any abdominal cavity surgery in a bird is high risk.. a mass involving an organ significantly moreso. Dr. K told me that if what they found was inoperable, they would call to ask my permission to euthanize her while under anesthesia.
I dropped Lior off on Thursday morning. Sadly, I received a call only 10 minutes after she went under anesthesia.. she hadn't even made it to surgery. The stress on her organs was too great, and anesthesia was too much for her to survive. They asked for permission to perform a necropsy which, of course, I okayed.
Dr. B called me later to give me the results, telling me that he had approached the necropsy as though he were performing the surgery itself, rather than like a traditional necropsy. What he found indicated that she was unlikely to have survived surgery if she had made it that far. The mass was in the oviduct, which had, at some point, shifted to the wrong side of the body, possibly from being dragged by the weight of the cyst, and become adhered to the right body wall. This was why the x-ray and ultrasound results were so puzzling.. it was, in fact, reproductive in origin, but the organ had been forced out of its usual position in the body. He said that while they would normally be able to isolate certain blood vessels during surgery, they wouldn't have been able to do so in Lior because they had grown through the mass like a spiderweb, making the risk of hemorrhage during surgery highly likely.
I asked that a sample of the mass be sent out for histopathology so that we could figure out what type of cancer it was. I debated having samples sent out of other organs so that we would know for sure whether it had metastasized (spread elsewhere), but decided not to, as I have other birds that require vet funds as well. I figured that getting answers on the type of cancer would provide at least some guidance as to whether it was likely to have spread.
The results came back a week later, and it was confirmed to be a carcinoma of reproductive origin. The vet felt that it was likely that cancerous cells had already seeded throughout the body cavity, and that we might have been looking at cancer elsewhere in as little as a month after surgery, had she survived.
I don't really know how to conclude this... It all happened so quickly and seemingly randomly that it's still difficult to fathom. Maybe just with Lior, eating some strawberries only two days before she passed away.
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Sad 
I have lost some pets and humans to it 
