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Pictures Undigested food in poop - update

ncGreyBirdLady

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Dartman

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Well, I'm sorry he's still not doing as well as he looks:( Either way he still seems to be a happy boy and just being good with your lot in life and looking forward to the next days adventures can help a lot with a good mom doing her best to do whatever it takes to keep him as healthy as possible.
Nerd bird had bad feathers, was really underweight, and like that, but he was very happy and soldiered on with me for 31 years together, and he never really changed, just did Nerd things and hung out with us.
 

Karen

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I'm so sorry. It does sound very stressful. I am hoping he keeps eating for you and the meds and supplements get sorted out . Sending good thoughts your way for you and Ollie.
 

Hankmacaw

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@Fuzzy I'm so very sorry. Asper is enough to deal with without the ABV. Is his thoracic air sac the only place that the asper appears. If it is a granuloma and accessible, it can be removed by endoscopy (not nearly as traumatic as surgery). Has your vet discussed removing it with you? Jasper and Hank both had granulomas removed by this method and it improved their recovery a lot.

My very best thoughts go out to your baby.

" 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."

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FIGURE 3. (A) Endoscopic photo of an aspergillosis granuloma in a wild red-tailed hawk. (B) Close-up view of the same granuloma.

 

Fuzzy

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@Fuzzy I'm so sorry he's going through this. My thoughts are with you all.
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Thanks, Carol :hug8:

@Fuzzy I'm so very sorry. Asper is enough to deal with without the ABV. Is his thoracic air sac the only place that the asper appears. If it is a granuloma and accessible, it can be removed by endoscopy (not nearly as traumatic as surgery). Has your vet discussed removing it with you? Jasper and Hank both had granulomas removed by this method and it improved their recovery a lot.

My very best thoughts go out to your baby.

" 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."

View attachment 330683
FIGURE 3. (A) Endoscopic photo of an aspergillosis granuloma in a wild red-tailed hawk. (B) Close-up view of the same granuloma.


Golly, I didn't know granulomas looked like that!! Ollie had an endoscopy 10 years ago by an avian vet when we lived on the mainland. Back then he said it would be too dangerous to try to remove since if it got pierced in the process the spores would go everywhere spelling death for Ollie. The vet on Monday inferred that the granuloma could have spread... ie. he could have more granulomas now. 10 years ago he just had the one in the thoracic air sac - about the size of half the size of the original vet's little finger nail. Ollie went on anti-fungal meds after it was discovered.
 

enigma731

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I sort of wonder if the asper is causing his GI issues. Not that he couldn't have ABV too but if he's already got one chronic illness, I'd first be looking into whether that could be the cause of all the symptoms. What do you think @Hankmacaw ?
 

Hankmacaw

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Asper can present in 100s of ways and from my experiene with Hank and Jasper (not to the extent of Hank) the Asper made him nauseous for weeks. He was on Metoclopramide, off and on for weeks. Additionally, he was hand fed at least two times a day and sometimes several times a day. Aspergillosis is also noted for allowing opportunistic infections to take hold. He had so many bacterial infections that I can't even remember most of them. It took four years to clear him of active Asper, reduce the opportunistic infections, and get his immune system back to a reasonable level. It happened after a long time, but it was a nightmare and expensive.

I have always felt strongly that a bird must have the fuel to fight any illness, so keeping his weight up was a primary focus. I wish that I had had Prozyme then. because it is such a help in making food usable to them. Prozyme predigests food so it is readily available to be absorbed by the bird. https://smile.amazon.com/Prozyme-Or...&psc=1&qid=1584022180&sprefix=prozyme,aps,205 .
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I have a feeling that Ollie's Asper should be addressed aggressively and it will help with his ABV (digestion of food). Be prepared to give him a fungicide, not for days or weeks, but for months. Be prepared that some of his organs may have been damaged (milk thistle for his liver and celebrex for swelling and pain, DMG to boost his immune system).Then, of course the Asper fungicides. There are a lot more available than therer were twenty years ago.

If you want, I can outline some of those Asper meds now available.
 

enigma731

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Does he actually have an ABV diagnosis?
 

sunnysmom

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:sadhug2::sadhug2::sadhug2:
 

Hankmacaw

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@Fuzzy Does he have an ABV diagnosis as the result of a test?

@enigma731 I don't believe he has had a test run - but maybe Fuzzy will come on and tell us for sure.
 

Fuzzy

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Thank you for continuing to rack your brains. I very much appreciate it. Ollie hasn't had a test for ABV. The vet suggested bloods and X-rays whilst Ollie is anesthetized for the bloods. He doesn't want to take more blood for the ABV test as well as it is a lot of blood to take - he takes it out of the wing which is a slow process. He is hoping to see what the proventriculus looks like - if it is normal or distended. He is willing to consult my London avian vet for his opinion about the X-rays as this vet isn't an avian vet.
He said that it might indeed be fungal, but that anti-fungals are hard on the digestive system so not willing to give them if fungal isn't the problem - I guess he will be able to tell from bloods? I asked for Celebrex, but he was only willing to give me a week's supply of Metacam to see how Ollie was with it. Again not willing to give me Metoclopramide as no testing of it has been done on birds (although I had some in London for Chico once). Not willing to mix meds.

I could ring my London vet and see if he would do a phone consultation, but also I don't want to alienate this vet as he is the best on the island for birds. My hope is that if I get Ollie back to him for bloods and X-rays he will be willing to consult with the London vet. But of course Ollie now has an aversion to the travel cage... which I am working on daily. He'll get in it at night, but not during the day now because of our vet visit on Monday. I am hoping it will take maybe a week to show him nothing bad is going to happen when he goes in the cage. But half of me is terrified of Ollie receiving an anaesthetic from this vet... I am sure it will be ok, but I keep thinking that he isn't an avian vet.

I feel so helpless here.
 

Hankmacaw

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@Fuzzy - please don't feel helpless. I will support you as much as I am able and I'm sure that enigma's advice will be valuable too.

I read back through this entire thread ( a good thing to do) and found that you are using most of the supplements I was going to recommend.

After reading the thread again, I'm even more convinced that the major problem that Ollie has is associated with his chronic aspergillosis. Granulomas are encased microbes that are not spreading, but they can and do become active again. Hank's fourth round with asper was caused by a granuloma becoming active.

Meloxicam is fine for pain and inflamation - hope you can keep it up. Celebrex and Onsior have both had positive positive records for ABV.

Fungal medications can cause nausea, but there are things that can help immensely. Metroclopromide has been used for many years with birds and numerous medications commonly used with birds have never been researched on birds. If your Dr. won't (he sounds exceptionally conservative) give you the metroclopromide for nausea you can buy some Calcium Carbonate - the same thing that is in Tums without the sugar - and give him that before each meal for nausea.

There are many more fungal medications today than when Hank had asper. This is my and my vet's (Dr. Driggers) favorite method of treatment.

"In his practice, Dahlhausen uses itraconazole initially for five to six days along with Lamisil and then continues with just the Lamisil for the rest of the treatment period."Lamisil is a very safe drug, so it's great for long-term therapy," Dahlhausen said."
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You really, really need to get those blood tests done. Both you and your vet are operating blind without them. Be darned sure you ask for an Asper Titer test - insist on it.

I wish the best for you and Ollie, but you need knowledge that only the test results can give you.

Treatment takes months not weeks. And the more supportive care the better. Ollie is a very ill bird and he needs all of his supplements, every day. Did you get prozyme?
 

JoJo&Loki

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I’m so sorry you are going through this.
Thoughts and prayers for Ollie (and you!)
 

Fuzzy

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Thank you so much for more brilliant info, @Hankmacaw. It gives me hope that it might not be ABG. Thank you for telling me he needs an Aspergillus Titer test - I was wondering what sort of test would reveal Asper activity. He's been on two anti-fungal meds in the past... definitely the Lamisil. I'd have to look up the other. Your vet is Dr Driggers? I attended a live webinar he gave re ABV/ABG about a year ago - he was so good. I thought back then, I am so lucky none of my birds have it....!

The calcium carbonate sounds very good. Would this be ok?:

It is hard to get Ollie to take meds etc. as at the moment, as he keeps changing his mind about what he wants to eat/drink. I have wasted so many doses of Metacam. First day I successfully injected a grape and he ate all of it, then has refused grapes consistently since then. Could I sprinkle the calcium carbonate over his sprouts?

Yes, I got the Prozyme and am using it. Thank you. And I won't be so afraid to use the Metacam.

I will try to get Ollie to the vet for a blood test etc asap. Hopefully next week.
 

Fuzzy

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I've just this minute made an appointment for Ollie to have bloods and X-rays next Wednesday. I have to take him in at 8.30am and leave him there. I feel sick. :sad2: My thinking is that I will put him in the travel cage the night before since he is still good about going into the cage at night. I have asked for the Asper Titer test... and will tell them again that morning.
 

Hankmacaw

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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
 

Hankmacaw

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I feel sick.
Don't feel sick - maybe you are going to have enough information to finally help Ollie and get him as well as he can be. Having had asper for that long he probably won't come out of it free and clear, but he will at least have a much more pleasant life. Hank was a very happy bird when he finally shook the asper.
 
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