That calcium carbonate had better be ok - it's the same one I bought.
I hate to do this to you, but you should read this = maybe print it out and bring it to the vet with you to discuss and decide which tests to run. Personally I would run an asper titer test and culture a sample for fungal growth. If he comes back negative on both of those, I would have aa protein electrophoresis performed (on blood) which will tell your Dr. if certain protein are high that indicate asper.
DIAGNOSIS
Diagnostic testing includes blood work (complete blood count, biochemistry), fungal culture, serology, imaging, endoscopy, and histopathology.1
FIGURE 1. Ventrodorsal radiograph of an eclectus diagnosed with aspergillosis. Soft tissue opacities can be appreciated in the cervical region of the coelom.
Blood work may reveal moderate to severe leukocytosis with heterophilia (25,000–100,000 cells/mcL) with a reactive left shift.1,2,4 Repeated blood work can be used to evaluate disease progression and treatment success. Chronic inflammation may reveal nonregenerative anemia.3,4 Elevated liver values (aspartate aminotransferase and lactate dehydrogenase), elevated creatine kinase, hypoglycemia, hypoalbuminemia, and hyperglobulinemia (beta and gamma) are characteristic. Increased uric acid or electrolyte abnormalities can be seen as well. Protein electrophoresis can be used to obtain an overview of inflammatory changes.1,2 A decreased albumin:globulin ratio (<0.5) should raise suspicion for aspergillosis.1
Cytology and fungal culture can be useful for detecting fungal spores. To reduce sample contamination, an aseptic technique must be used. Cytology may show septate, 5- to 10-mcm-thick hyphae with straight parallel sides, ball-shaped terminal ends, and 45° branching.2 Culture of samples taken from granulomas or the respiratory tract can help confirm aspergillosis.1
Signs of ocular aspergillosis typically include discharge, dull/cloudy cornea, blepharospasm, photophobia, swelling, and/or conjunctival yellow exudate.2,4
FIGURE 2. CT scan of the eclectus parrot shown in Figure 1 diagnosed with aspergillosis. Note the detailed view of the lesion compared with the radiograph in this image.
Serologic assays can be used to monitor treatment response and fungal exposure. An active
Aspergillus infection can be better diagnosed with paired-titer serology than with a single titer because of the ubiquitous nature of the fungus.1,2
Noninvasive imaging—radiography, computed tomography (CT), and magnetic resonance imaging (MRI)—can help determine the location and distribution of potential lesions; however, images from these technologies cannot confirm the disease. Lateral and dorsoventral radiography is helpful for evaluating the lungs and air sacs (lower respiratory tract).2 A late-stage infection can have radiographic evidence of multiple soft tissue densities (granulomas;
FIGURE 1). Asymmetry, the thickness of air sac walls, hyperinflammation, consolidation, and soft tissue density in the lungs/air sacs can be observed.1,2 Radiographic evidence is not ideal for detecting short-term improvement.3 CT and MRI can be useful for viewing exact lesion locations (
FIGURE 2); however, such testing is associated with a higher financial burden and often requires anesthesia or heavy sedation.
FIGURE 3. (A) Endoscopic photo of an aspergillosis granuloma in a wild red-tailed hawk. (B) Close-up view of the same granuloma.
Endoscopy, while invasive, provides the substantial benefit of enabling acquisition of representative samples (biopsy and/or culture) from lesions (
FIGURE 3). It also helps visualize granulomas and air sac plaques.1,2 Granulomas can be localized in the nares, trachea, lungs, and/or air sacs.1 In addition, endoscopy allows direct treatment of granulomas by endoscopic removal and application of antifungal agents via the treatment channel of the endoscope.1,2
On pathology, lesions typically involve the respiratory system; chronic lesions usually involve the entire respiratory system, but acute cases can have lesions in the lungs and air sacs. Birds with aspergillosis typically have white or yellow plaques or nodules/granulomas and a mold-like lesion, or a general cloudiness, in the air sacs.2,4 Aspergillosis can disseminate into other body systems, but this is rare. Invasive forms have been reported to be localized to the trachea or syrinx (
FIGURE 4).2
Initial supportive treatments typically include stabilization, stress reduction, and collection of adequate samples to confirm the diagnosis.
FIGURE 4. Necropsy photo of aspergillosis lesions in the coelomic cavity (liver, air sacs, heart lesions) of the hawk in Figure 3.
Histopathology with periodic acid-Schiff or Gridley staining can demonstrate the fungal structure inside granulomas, and immunohistochemistry can help identify specific fungal species. Histopathology can be used to diagnose granulomatous air vasculitis and/or pleuritis, a thickened air sac with inflammatory cells and germinating conidia in macrophages, heterophilic and lymphohistiocytic lung lesions, and/or pneumonia with edema and hemorrhage.2
Other tests, such as
acute-phase proteins (1), specific antigen detection, serologic assays, and
Aspergillus toxin identification, are available but require further research of their diagnostic value.2
(1) "Protein electrophoresis"
Yes, Dr. Driggers is my veterinarian and has been for almost 22 years now - we sort of learned together, since he had only been out of school for 2-3 years then) He learned a lot faster than I did. Although, he told me that Hank had made him a much better vet, because nothing was simple and straight forward with Hank. He always made the Dr. work for his money. I wish that everyone could have a vet like Dr. Driggers (who was mentored by Dr; Orosz who is a great vet).I never hesitate questioning him and he never takes offense at my questions - although his explanation often go over my headJasper was on Metacam daily for 15 years and she's fine and dandy.
Jasper was on Metacam daily for 15 years and her blood chemistry has always been fine any effects from it.
Keep in there plugging away
@Fuzzy