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Merlin - possible pancreatic issues

GreenThing

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Symptoms

- Shocked to weigh him after a few months (he was around 30g) and find that he was 45g
- Slight puffiness around his crop not going down
- Labored movement visible in his abdomen, like a pulse (but no tail bobbing)
- Increased appetite in my LEAST food motivated bird, to the point that he was coming over to investigate/try anything I was eating
- Raising his wings like he is too hot in our AC-cooled house
- A little polyuric, but he's also molting right now (are my birds ever not molting?)

Went to my new vet, who had treated Margo. Merlin has always been high strung and was not easy to handle. They managed to take blood but accidentally lost some (a genuine accident but hard for me to even talk about). Only had enough for one test.

The vet went through a few theories:

- Fiber impaction.
I am going to go over every inch of their cage cover tomorrow, but just seems so unlikely. I have always been paranoid about this and don't use any fiber toys or even rope perches. I was also going to rotate their toys this weekend because nothing had been chewed in a while.

- Thyroid issues.
Floated as a possibility but described as very difficult to test.

- Pancreatic issues.
His gram stain showed an unusually high level of undigested starch crystals. I'd never heard of this before. She suspects that his food is not properly digesting and he is over-eating to compensate, thus the swelling being an over-full crop. She said he had some fat deposits in his belly but not enough to account for 44 grams of weight-- he wasn't obese. Maybe it's the food. She thinks this could also be why he is too hot (body working hard and struggling to digest food).

The one blood panel they were able to do did not point to anything conclusive, although I'm struggling to remember the details. She also mentioned that he bled very easily, and it worried her. Merlin was in a panic the whole time, more than Percy or Margo. He was so weak and disoriented when we got home.

She gave me Lactulose with milk thistle to give orally twice a day and prozyme powder for his food. I don't know how I am going to handle giving him medicine right now. I trained Percy to go into my hand-- Merlin has always been much harder.

I am absolutely blindsided and not dealing with this well. Wanted to post in case anyone had experiences with a similar diagnosis. Merlin has always been okay. When Percy died I just thought Merlin would keep being okay.
 

Pixiebeak

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Lipoma are common in budgie. My Clear has a big one...but vet should have been able to tell.. ok re read , she does think has some but doesn't affect digestion

A scary one would be PPD

I'm sure sorry you are going through this
 

GreenThing

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thank you <3

I worked so hard never to handle them and to always let them do things of their own agency, but I think I'm going to need to put in some work desensitizing Merlin to being handled. The vet implied that if this diagnosis is correct, he will need the supplement to his digestive system for his whole life. She's honest about how many things it could be-- she didn't mention PPD, I'm not sure how "undigested food" and "undigested starch crystals" compare, but PPD doesn't sound impossible... I did take a risk putting him in with a rescue budgie, even though I waited and did all the available tests first.

I wondered lipoma at first, too, because the slight lumpiness seemed a little sudden, but I interpreted what she said as he had more fat (normal fat) in his belly.

I was hoping so much that she was going to say he'd just stealthily gained too much weight, and I had been working midnight shifts (giving them frankly too much sleep/not enough daylight for a few weeks), so I thought maybe that influenced his behavior.
 

GreenThing

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The syringe I was given to give the 0.02 meds is absolute crap and after giving it today Merlin was sneezing repeatedly. I'm worried he aspirated.

Every day, twice a day, I'm chipping away at the trust he has had in me since he was a baby, and I don't even know if it's helping.
 

GreenThing

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Vet emailed me to say Merlin has a slightly raised white blood cell count-- that plus my description of his behavior and the occasional sneeze made her want to add antibiotics. I would have brought this up regardless because he's still acting so uncomfortable after eating (plus slightly labored breathing), so I'm glad she followed up.

He's doing great with lactulose + milk thistle on his oats, and the upside of only getting a few oat groats is that he's excited about his greens (Percy was always up for some greens, Merlin not always). As small an amount of seed as I was giving him, I think without his big buddy it was just too high an amount for him.

Clearly seeds wouldn't have caused infection (still don't know what's going on there, still worried Margo had something, even after 40 days of quarantine and blood and fecal and psittacosis tests), but it was a wake up call to adjust his diet.
 

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Some infections can cause free fluid in the abdomen. But most fluid is a gram per milliliter. And I don't think it's possible for your little one to have 15 ml free fluid in abdomen...

Raising wings can be pain not over heating

Is he showing fat over keel at this increased weight? Or is it all in the lump/swelling/ crop?

Does it seem like air? If you gentle touch eil finger fo you feel crackle ? Or fluid? Does it move ? Or solid? Is it warmer than other places on his body?
 

GreenThing

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Some infections can cause free fluid in the abdomen. But most fluid is a gram per milliliter. And I don't think it's possible for your little one to have 15 ml free fluid in abdomen...

Raising wings can be pain not over heating

Is he showing fat over keel at this increased weight? Or is it all in the lump/swelling/ crop?

Does it seem like air? If you gentle touch eil finger fo you feel crackle ? Or fluid? Does it move ? Or solid? Is it warmer than other places on his body?
The only times I was holding him were to give meds for a few days, and at those times he didn't have a lump in the crop area. When the vet felt him, he did, and she said to her it felt like a crop full of food. She went with lactulose because of that + the undigested starch crystals in his gram stain. She thinks he was over-eating because something wasn't sending him the message he was full, or his crop wasn't emptying normally. I mentioned the pain, too-- I thought it looked more like discomfort wing-raising, not cooling down wing-raising. His feet feel unusually warm, usually they only get hot when he's excited, and I can feel the change.

I would say no significant fat over his keel (she didn't think the weight was fat, or not ALL fat, either)-- tonight after lots of pellets there was a noticeable bulge on the right side. In her email she mentioned thyroid issues, too--

Okay then it makes sense to try a round of antibiotics in case something is hidden in his respiratory tract if the symptoms are still there after the crop is empty. It is odd that he seems out of sorts after eating. For that, I'm inclined to watch for that through this treatment period and see if perhaps it's due to the previous crop stretching which could take time to settle down. Budgies not eating enough iodine (more an issue with birds getting a lot of seeds) can get an enlarged thyroid inside the chest (ours is on the front of our neck, theirs is right above the heart next to the esophagus) and that can put pressure on the thyroid gland and the respiratory tract if big enough. The pellets should give enough iodine to avoid this so if it was starting up if he was overdoing the seeds it will start to reduce and help as well.
 

GreenThing

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After a second round of blood tests, the vet wrote me today to say:
Overall the new set of testing didn't show anything really concrete. We do feel comfortable that the digestion issue is not happening because an ongoing inflammatory condition in the pancreas. The values that would otherwise show inflammation there are normal. It is possible that the inflammation occurred in the past, healed with damage which is why the starch crystals are not being digested, but usually there is some residual chronic inflammation in this organ causing some degree of increase even later on. So that's good, but keeps us looking.

The values that would show liver *inflammation*, kidney issues, low calcium/ electrolytes are all okay.
the main other discrepancy is an elevation of bloodfats.

The increase in bloodfats can hint towards fatty liver disease, before the damage occurs to raise the inflammatory marker increase which can happen more later in the course of issues. So I don't think there's evidence of failing yet. But another hint towards the liver being the origin of this issue.
As I told her, I will never forgive myself if he has developed fatty liver from his diet. On one hand, that would be good news because it is a potentially solvable health problem (vs. some other liver problem), but on the other, I am flabbergasted and questioning everything I've been doing.

Only piece of the puzzle not fitting is why his crop area, specifically, is swollen. She's having me collect stool from him to test this weekend.
 

Pixiebeak

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It sounds like you and your veterinarian are being very diligent and checking every angle. It's wonderful that you veterinarian is so good at communicating and explaining with you.

I sure hope the issue is discovered. How is overall? Any improvement?
 

GreenThing

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It sounds like you and your veterinarian are being very diligent and checking every angle. It's wonderful that you veterinarian is so good at communicating and explaining with you.

I sure hope the issue is discovered. How is overall? Any improvement?
Not worse and not better. :( Same amount of labored movement in the abdomen, same weight, same appearance of discomfort. But he's continuing to eat, grow and molt new feathers, and fly around-- biggest change is that he's acting shy and isn't constantly flying to me and seeking attention. That's possibly because I had to restrain him, but I think it's much more likely because he doesn't feel good-- he's like that when he's molting, too. He gets standoffish and wants personal space from me and birds.

While I was shocked at the idea that the tiny, twice-daily scoop of seeds they get (pellets all the time and greens regularly) could have resulted in fatty liver, thinking about it realistically (and the tiny cumulative changes since Percy died), it's absolutely possible. Both Margo and Merlin have been eating greens and pellets much more readily now that I've cut seeds to almost none. Merlin gets six oat groats with his lactulose and I pick off individual millet seeds if I need a treat, now.

There's still the possibility it's hepatic disease with a totally different cause or something else altogether. Very grateful for this vet, for sure.
 

GreenThing

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After a prolonged period of "not worse, not better" Merlin took a sudden turn for the worse around Sunday night. Not his breathing or eating or droppings, but his behavior-- he was acting weak, not flying out of or inside his cage, refusing to step up even for millet, and screaming territorially at Margo if she so much as moved. The pieces started clicking when he screamed at a toy and then didn't seem able to eat millet from my hand-- he was losing his sight.

Wednesday morning I took off the cover, and he was just sitting there, staring around, making twitching head movements (at the time, I thought this was neurological). My new vet was out and they were full of emergency cases, so I called the vet who cared for Percy... only to learn that the vet had passed away and the practice was permanently closed. Had a bit of a cry and a crisis, because I couldn't get any reliable referrals, then picked another practice based just on their reviews and the fact that they could take an emergency case right away.

Told vet 3 we has been focusing on liver issues, got her all the bloodwork and notes from vet 2, and she immediately recommended another full blood panel and X-Ray, with the reasoning that we needed to clearly rule on whether liver was the problem or not. She was also immediately wary of his STILL distended crop.

Merlin survived anesthesia (I heard him go down and come back out because he screamed and screamed the whole time he was there), but she only got one view. She said his levels (I think she did full chemistry and red blood cell count) were all healthy and his body condition, to her, felt much too healthy for him to be at a risk of fatty liver. She zeroed in on fungal infection. She thinks he has had a fungal infection of the crop this whole time, and that it has potentially inflamed/spread to his brain. She thinks it is also possible that he had a stroke at some point. She gave me Nystatin and Voriconozole as well as a Harrison's probiotic I'd never heard of, and told me to go ahead and keep giving the prozyme powder and lactulose, since they can't hurt. She said she felt there was a 70% chance he will survive, and a much lower chance that he might regain his eyesight. This feels optimistic, to me.

I definitely swore when she said "fungal infection", because "Did we adequately rule out a fungal infection?" had been kicking around in my head all month, as I daily saw that his crop was still distended. It is worth noting that vet 2 emailed me saying that she had "seen no signs of a fungal infection", and thinks it is more likely that he has a brain tumor. Neither vet thought he would survive a crop swab or crop wash, so (aside from gram stain) I think both were going by process of elimination. I asked vet 3 why vet 2 didn't suspect fungal infection-- vet 3 said she was just going by her experience with budgies-- that swollen crop was likely either impaction or infection (and he'd already been treated with and did not respond to antibiotics).

Merlin is eating and became much calmer when housed alone in the carrying cage. Now that I know he is blind, his behavior makes so much more sense. Just like when he was a baby, and I'd hide my hand behind his toy, he quite enjoys headrubs when he can't see that they are coming from human fingers. Sadly, this has also made restraining him for medication much worse. I am so afraid he will have a heart attack, because he can't register the slightly lessened threat of being grabbed by a person, so he screams and fights like he is going to die.

I saw a video from him a few months ago on my phone, when he was running around on my chest, chirping away. I am trying not to think about everything that has been lost in these few months and just appreciate the small things, just like he is doing. He genuinely seems stimulated by figuring out his environment, and he gave a few chirps when preening in the sun, this morning. A few times I told him I'm here and gently touched his beak-- he'd give an angry chirp, then pause, then softly nibble my finger. I tried to towel to keep this positive association with the feeling of my hand, but he's so much harder to get ahold of that way.

I think vet 2 might not be wrong about a possible brain tumor-- his behavior changes (not wanting to fly to me or sit on my shoulder) in November might have been related to slowly losing his sight this entire time. I guess I will know in seven days, if the antifungal medication seems to be working.
 

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I can't offer any new ideas but I wanted to say I'm sorry you and Merlin are going thru this.
And send hugs :sadhug2: :sadhug2:
You are doing a great job caring for him when it is so hard to figure things out.
 

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I'm so impressed with your care and dedication. Hoping for improvement with this new treatment.
Birds can get crop impaction or partial impacts from fibers , threads , fabrics ..I don't know if that fits with symptoms or not . Like I'm not sure if would cause crop inflation.

It unfortunately, just can be difficult to determine health issues, even with everyone giving it their best . Sometimes it's just tough , I've followed cases all the way to conclusions with extensive testing and histopathology and still no clear answers.
 
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GreenThing

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I'm so impressed with your care and dedication. Hoping for improvement with this new treatment.
Birds can get crop impaction or partial impacts from fibers , threads , fabrics ..I don't know if that fits with symptoms or not . Like I'm not sure if would cause crop inflation.

It unfortunately, just can be difficult to determine health issues, even with everyone giving it their best . Sometimes it's just tough , I've followed cases all the way to conclusions with extensive testing and histopathology and still no clear answers.
Thank you :heart:

I have always been super careful about fibers (I inspected their cage cover just in case)-- no rope perches or fibrous toys, and Merlin's chewing habits have been the same since he was a baby, so I felt comfortable ruling that out.

I think you're right-- I hope that if nothing else his experience is helpful to both avian vets, who see so few budgies compared to other birds.

I am trying to be cautious and remember every night that he could be gone in the morning

[AN INTERLUDE LITERALLY WHILE I AM WRITING THIS, IN WHICH HE GETS ACCIDENTALLY STUCK IN A LITTLE FOOD BOWL BRACKET WHILE EXPLORING, AND SCREAMS AND SCREAMS WHILE I PUSH HIM POOH BEAR LIKE BACK DOWN THE WAY HE CAME]

Okayyyyy taped that up glad that happened while I was here.

What I was GOING TO SAY is that he seems to be feeling better and looking a little more like his sleek torpedo self. This could all be my hopeful bias. At the very least he seems feisty and feeling (comparatively) good. I don't know about greys and the really big brain birds, but budgies, like dogs, are blessedly absent any existential dread or sorrow. He is clearly not thinking, "Oh no, my sight is gone, I cannot see the beauty of life, what if it never returns?" He is living some equivalent of, "Hm. Whole world dark all time now. Ok. How get food when world dark? This food? *BITES* Nope."
 

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Thank you :heart:

I have always been super careful about fibers (I inspected their cage cover just in case)-- no rope perches or fibrous toys, and Merlin's chewing habits have been the same since he was a baby, so I felt comfortable ruling that out.

I think you're right-- I hope that if nothing else his experience is helpful to both avian vets, who see so few budgies compared to other birds.

I am trying to be cautious and remember every night that he could be gone in the morning

[AN INTERLUDE LITERALLY WHILE I AM WRITING THIS, IN WHICH HE GETS ACCIDENTALLY STUCK IN A LITTLE FOOD BOWL BRACKET WHILE EXPLORING, AND SCREAMS AND SCREAMS WHILE I PUSH HIM POOH BEAR LIKE BACK DOWN THE WAY HE CAME]

Okayyyyy taped that up glad that happened while I was here.

What I was GOING TO SAY is that he seems to be feeling better and looking a little more like his sleek torpedo self. This could all be my hopeful bias. At the very least he seems feisty and feeling (comparatively) good. I don't know about greys and the really big brain birds, but budgies, like dogs, are blessedly absent any existential dread or sorrow. He is clearly not thinking, "Oh no, my sight is gone, I cannot see the beauty of life, what if it never returns?" He is living some equivalent of, "Hm. Whole world dark all time now. Ok. How get food when world dark? This food? *BITES* Nope."
I love you guys ! I'm so invested in your journey. :heart:
I'm hoping that yay the meds are working!!
 

AW2023

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I'm so sorry you are experiencing this. Merlin is really lucky to have you advocating for him!
 

Icey

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You're doing such a wonderful job and it's so refreshing to see people like you who are bound and determined to get to the cause of Merlin's illness.
Sending good thoughts he can bounce back.
:hug8:
 

GreenThing

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Merlin did great at the vet today, and was so happy to be going home that he was chirping and singing at the reception desk. Fluffy singing when we got home. Incomprehensibly, he wanted head scratches the whole drive home, too (this bird would not let Percy OR Margo preen him, no matter how itchy he got).

Vet said to all appearances the antifungals are working. He will probably be healthy but blind (for as long as that health lasts). I am trying not to fixate on "what ifs" or be too down on myself for not knowing more than the vet. Again.

Margo will be going in next week for another round of tests with this new vet. I want to think that the rescue bird from the awful overcrowding situation is the one who tipped the scale, but I know it is just as possible that the stress of Percy dying + new budgie + whatever other invisible thing was going on in his little body + picking at one little spot of dropping on the grate could have done it, too.

Very difficult to accept that he was being eaten alive by awful toxin-releasing fungus while I kept treating the wrong problem for all of these months, but it is good to see him comfortable and happy.
 

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So happy he is improving!
 

Icey

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Aww some good news finally. Now relax and breathe, after scritches, of course. ;)
 
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