Update Sisi (aspergillosis)

[Tvdv96]

Hello everyone,

It's been a while, had quite a bust time and have been very busy with Sisi and Ravi (American kestrel) who's also fallen ill, but luckily Ravi is finally getting better. So things are finally calming down a bit, I'm glad to be back on this amazing forum and thought I would give an update on how Sisi is doing.

Sisi has been on medication for aspergillosis quite some months now and she also had a lot of vet visits. She also has been on antibiotics 2 times in the meantime because of secondary infections. Thankfully she's a bit more vocal now and she still eats and drinks. But unfortunately she still isn't better, she's still short of breath sometimes and hasn't touched a toy since she became ill . I've gone to the vet again yesterday, he still isn't satisfied with how Sisi is recovering.. he thinks she has some scarred tissue which also causes a bit shortness of breath, but he still hears some muffled sounds in her air sacs. We discussed if it doesn't get better with Sisi to do an endoscopy or a CT-scan to look what's exactly going on.

Hope you are all doing well

Greetings from me and Sisi

 

[zoo mom]

So sorry Sisi is sick. @Hankmacaw do you have any advice that might help.

 

[ParrotNuts]

So sorry about Sisi........ I hope she gets better soon

 

[Hankmacaw]

@Tvdv96 I am so very sorry that Sisi has Asper. It was the bane of my existence for 24 years with my beloved Hank and Jasper. Jasper finally died from Asper in Sept. of 2020 - her poor body just could not fight it any longer. We did keep her alive for 21 years after the first of several onsets. It sounds as if your vet is handling it well. I have a couple of questions. Which fungal medication is Sisi on? Is she being nebulized?

I recommend that she have an endoscopy sooner rather than later. While inside her the Dr. can remove any colonies of Asper that he can get to and he can lavage her airsacs with Amphotericin B - it is the only fungicide that actually kills the Asper microbes and not merely interfere with it's reproduction. Amphotericin is highly toxic to the liver, but much less so when applied by this method. Is or has she been on Itraconoazole? One of the most successful methods of fighting Asper recently is to give Itraconazole for 4-5 days then switch to vorconazole or lamisil.

Jasper also had other severe health issues, such as severe atherosclerosis. African Greys are susceptible To atherosclerosis - does Sisi have atherosclerosis?

My total empathy is with you - It is a hard battle and I hope you win it.

 

[Greylady1966]

I'm wishing Sisi the best. As @Hankmacaw said, it's a hard battle and I hope you win to.

 

[Hankmacaw]

PS - put Sisi on Milk Thistle right now to combat the liver toxicity in ALL fungicides.

 

[Tvdv96]

So sorry about Sisi........ I hope she gets better soon

Thank you so much

@Tvdv96 I am so very sorry that Sisi has Asper. It was the bane of my existence for 24 years with my beloved Hank and Jasper. Jasper finally died from Asper in Sept. of 2020 - her poor body just could not fight it any longer. We did keep her alive for 21 years after the first of several onsets. It sounds as if your vet is handling it well. I have a couple of questions. Which fungal medication is Sisi on? Is she being nebulized?

I recommend that she have an endoscopy sooner rather than later. While inside her the Dr. can remove any colonies of Asper that he can get to and he can lavage her airsacs with Amphotericin B - it is the only fungicide that actually kills the Asper microbes and not merely interfere with it's reproduction. Amphotericin is highly toxic to the liver, but much less so when applied by this method. Is or has she been on Itraconoazole? One of the most successful methods of fighting Asper recently is to give Itraconazole for 4-5 days then switch to vorconazole or lamisil.

Jasper also had other severe health issues, such as severe atherosclerosis. African Greys are susceptible To atherosclerosis - does Sisi have atherosclerosis?

My total empathy is with you - It is a hard battle and I hope you win it.

I'm so sorry for your loss, you have taken such great care of them and thank you so much for this information!

Sisi is getting Fungitraxx which I believe is Itraconazole. She is getting this orally and she hasn't been nebulized. The medication options here in the Netherlands are a bit limited, but I do believe that Amphotericin B is available here.

The vet has been putting of the endoscopy because of the risks, but I read some information about Asper and believe it would indeed be better to do an endoscopy, especially since we are struggling for a while now. I will definitely talk about this with my vet!

I don't know how atherosclerosis can be tested, but the vet did some blood work some time ago and this looked good fortunately, only a slightly elevated liver level.

Thank you so much!

 

[Tvdv96]

I'm wishing Sisi the best. As @Hankmacaw said, it's a hard battle and I hope you win to.

Thank you so much!

PS - put Sisi on Milk Thistle right now to combat the liver toxicity in ALL fungicides.

I will definitely do that, are there any particular good brands?

 

[Hankmacaw]

The only means of diagnosing atherosclerosis (I believe) today is by xrays and your vet's experience. My vet is a whiz at it after 25 years of taking care of my two sickly birds.

I have used this brand of Milk thistle for years and my Dr. oked it. https://smile.amazon.com/Thistle-Ex...83&sprefix=liquid+milk+thistle,aps,228&sr=8-2

 

[redindiaink]

She is getting this orally and she hasn't been nebulized.

Is nebulizing the medication an option? It's what we did with Bug (YNA) when we treated him for aspergillosis.

 

[Hankmacaw]

There are a number of medications that can be nebulized. Depends on the medication.

I forgot this somehow, but I did know it and it leaked out of my brain. I'm so sorry.

"In general itraconazole, is well-tolerated; however, caution should be used when considering the use of this drug in African or timneh gray parrots, because they are more sensitive to itraconazole present in the form of distinct anorexia and depression.6,11 Remarkably, PK studies explaining this higher sensitivity in African or timneh gray parrots are still lacking"

https://core.ac.uk/download/pdf/154952249.pdf

Talk to your Dr. about changing the medication to Voraconazole or Terbinifine

I recommend that you read the entire article ^. Especially the portion about delivery by nebulization near the end.

 

[Tvdv96]

Is nebulizing the medication an option? It's what we did with Bug (YNA) when we treated him for aspergillosis.

There are a number of medications that can be nebulized. Depends on the medication.

I forgot this somehow, but I did know it and it leaked out of my brain. I'm so sorry.

"In general itraconazole, is well-tolerated; however, caution should be used when considering the use of this drug in African or timneh gray parrots, because they are more sensitive to itraconazole present in the form of distinct anorexia and depression.6,11 Remarkably, PK studies explaining this higher sensitivity in African or timneh gray parrots are still lacking"

https://core.ac.uk/download/pdf/154952249.pdf

Talk to your Dr. about changing the medication to Voraconazole or Terbinifine

I recommend that you read the entire article ^. Especially the portion about delivery by nebulization near the end.

Thank you so much for the information, I will definitely read the article!
I will also discuss it with my vet to give Sisi some different medication which can be nebulized. I think this also will be a bit more pleasant for her, because I'm really struggling to giver her, her medication orally right now. She hates the medication and is starting to clench her beak now, which is understandable after such a long time! So I think nebulizing would be a more pleasant option for her

 

[Tvdv96]

Today I had a consultation over the phone about Sisi with my vet. He agreed that we need to examine Sisi further and that an endoscopy is needed. He gave me a referral to a specialist, so I'm going to call them tomorrow to make an appointment.
Hope we can make an appointment soon, you can just see that Sisi is just not herself

 

[Greylady1966]

I hope you can get in soon, hopefully they won't be too busy. Thinking of you and Sisi..

 

[Hankmacaw]

After my brain woke up and I remembered the warnings about Itraconazole and African greys, I wondered if some of her not seeming as well was due to the Itraconazole. Perhaps she will prove to be at least feeling better when off it for awhile.

I can't encourage the endoscopy enough. Hank's ,my male GW's, life was saved due to his fist endoscopy. He had chronic Asper and none of it was affecting his lungs and respiratory system - the Asper colonies were all on his internal organs - liver, kidneys, testes and on the pericardium of his heart. Dr. was able to lavage all of those sites with Amphotericin B (lavage is ok with AGs too I believe) and it turned the corner for him.

Please keep us updated.

 

[sunnysmom]

Sending good thoughts and prayers to Sisi.

 

[Tvdv96]

I hope you can get in soon, hopefully they won't be too busy. Thinking of you and Sisi..

Thank you so much! I hope that as well

After my brain woke up and I remembered the warnings about Itraconazole and African greys, I wondered if some of her not seeming as well was due to the Itraconazole. Perhaps she will prove to be at least feeling better when off it for awhile.

I can't encourage the endoscopy enough. Hank's ,my male GW's, life was saved due to his fist endoscopy. He had chronic Asper and none of it was affecting his lungs and respiratory system - the Asper colonies were all on his internal organs - liver, kidneys, testes and on the pericardium of his heart. Dr. was able to lavage all of those sites with Amphotericin B (lavage is ok with AGs too I believe) and it turned the corner for him.

Please keep us updated.

I actually hadn't thought of that yet, I hope she indeed gets a bit more like herself when she gets other medication!

I didn't know the organs could be affected as well. I think the endoscopy will be a good step indeed, especially since she got medication for so long but she doesn't seem much better. The vet also listened to her lungs the last time, they seem to sound clear, but he does hear something around her air sacs.

I will definitely keep you all updated, thank you so much for all the good thoughts and help

Sending good thoughts and prayers to Sisi.

Thank you so much

 

[Tvdv96]

I called the specialist this morning, and Sisi and I have an appointment for Thursday the 17th of June. So luckily quite soon . I'm a bit nervous but also glad that we're going to examine Sisi further now.

 

[Greylady1966]

I'm glad it's not a long wait for you. The sooner the better. Is the specialist far from you.

 

[Tvdv96]

I'm glad it's not a long wait for you. The sooner the better. Is the specialist far from you.

It's about a two and a half hours ride, Sisi luckily likes to go on car rides