Stomach cancer
Cancer can develop in the stomach in dogs, but rarely in cats. There are two major types of cancer that affect the stomach: benign and malignant. The cancer of the stomach usually is malignant and has a high tendency to spread to other parts of the body. If it spreads, the liver and the lymph nodes are commonly affected, however, the tumor can also spread to the lungs. Benign leiomyomas can also affect the stomach, are easily
treated with surgery and have a very good prognosis. Lymphoma (commonly in the feline species), adenocarcinoma and leiomyosarcoma comprise the majority of malignant stomach tumors. Benign tumors have also been reported and include extramedullary plasmacytoma and leiomyoma.

Signs and diagnosis
Breeds that more commonly develop stomach cancer include the Rough Collie, Staffordshire bull terrier, Belgian Shepherd dog and Chow chow and the median age of affected dogs is 9.5 years of age. The primary sign that the pet owner may see at home is vomiting, drooling, decreased activity, decreased appetite, black stools, abdominal pain, and weight loss. Commonly, no additional signs are present upon physical
examination by your companion’s veterinarian.

The diagnosis of a stomach tumor is made upon examination of the inside of the stomach with a flexible video camera called an endoscope. An x-ray following ingestion of barium contrast material is a less sensitive test used to identify a stomach tumor is an x-ray of the stomach following ingestion of barium contrast material. Confirmation of the type of tumor necessitates a biopsy, which may be done at the time of endoscopic  examination of the tumor, but is frequently done after the tumor has been removed. Tests done prior to surgery may include a complete blood count, blood chemistry profile, and urinalysis to check internal organ health. Chest x-rays and abdominal ultrasound are used to identify visible spread of the cancer; however, microscopic spread of cancer to other organs cannot be detected with x-rays and ultrasound.

Treatments
Surgery is recommended to remove the tumor of the stomach. Commonly, this tumor is located in the lower part of the stomach and this portion of the stomach will need to be removed along with a small portion of the small intestine. The remaining portion of the stomach is surgically  reconnected to the small intestine (Bilroth type I procedure). While in the hospital, your companion will receive intravenous fluid therapy, intravenous antibiotic and sometimes anti-vomiting medication. Most patients remain in the hospital for two nights after surgery.

Chemotherapy is usually recommended if the tumor is malignant. This medication will be administered every two to three weeks via intravenous injection by our oncologist for a total of four to five treatments. The treatments are typically done on an outpatient basis and may take a total of 90 minutes to complete each visit. Unlike humans, most dogs do not lose their hair and usually have only mild side effects from the medication, which may include transient loss of appetite and vomiting.

Results
The most common tumor, gastric adenocarcinoma carries a guarded prognosis, as 76% of dogs have metastasis at the time of diagnosis (in 132 cases). Overall survival times are commonly less than 6 months, however in the studies listed below the mean survival was 8.5 months (only 17 dogs had follow-up data). The median survival time following treatment of cats with gastric lymphoma with a Madison-Wisconsin chemotherapy protocol is 10 months. Dogs with a gastric leiomyosarcoma can be potentially cured with surgery alone, but the literature for the most part  indicates similar survival rates as gastric adenocarcinoma. Benign tumors also can be cured with surgical excision.

Learn more about this disease by contacting our Oncology service at your nearest BluePearl veterinary hospital. Here are our hospital locations.

© BluePearl Veterinary Partners 2011

The signs seen with IBD vary with the severity of the disease and the location affected. Animals with IBD involving the small intestine usually present with chronic vomiting, weight loss, diarrhea, loss of appetite, or some combination these problems. Those with large intestinal IBD (chronic colitis) present with diarrhea with or without blood and mucous present, straining to defecate, increased urgency to defecate, and occasionally vomiting.

Diagnosis
IBD cannot be diagnosed on physical examination, history, fecal checks, radiographs or laboratory work. These tests, however, are necessary to help rule out other diseases that may present with similar clinical signs, i.e., parasitic infections, intestinal foreign bodies, liver disease, kidney disease, metabolic diseases, and cancer. Blood studies are also helpful to assess the metabolic status and screen for concurrent problems. Some dogs with severe IBD may have low protein levels in their blood due to loss of proteins through their intestines (protein-losing enteropathy). This finding may severely worsen the long term prognosis for the patient.

Intestinal and stomach biopsies are ultimately necessary for a diagnosis. These can be obtained either endoscopically or surgically. The ultimate recommendation of endoscopic or surgical biopsies is made on history, clinical signs, laboratory findings, and diagnostic imaging studies. The pathologist’s evaluation of biopsy samples will confirm the presence of IBD, specify the type of cellular infiltrate involved, stage the severity of the disease, and help to establish a treatment plan and prognosis for your pet.

Types of IBD
Lymphoplasmacytic enteritis
This is the most common form of IBD seen. This disease is due to an excessive accumulation of two types of white blood cells, lymphocytes and plasma cells, in the lining of the gastrointestinal tract. Excessive protein loss from the blood stream into the intestines is seen in very severe cases and is termed a protein-losing enteropathy. If inflammation is persistent and untreated, fibrosis (scar tissue) can result causing irreversible tissue damage. Lymphangiectasia (see below) may develop secondary to severe IBD. When lymphangiectasia is present, the prognosis is a great deal poorer as compared to those without this change.

Prognosis depends on the severity of the inflammation, presence of fibrosis, your pet’s body condition, and response to therapy. In cats, severe lymphocytic-plasmacytic enteritis may be a premalignant lesion, meaning that cancer (specifically lymphoma) may develop at a later date.

Eosinophilic enteritis
This appears to be an allergic reaction to a dietary protein. A strict elimination diet in conjunction with medical therapy is often needed to resolve the signs. Prognosis is variable since some animals are unusually sensitive to many foods and are difficult to control.

Antibiotic responsive diarrhea
This occurs when there is an overgrowth of one or more bacterial species in the small intestine. The bacteria may be present because of anatomic defects, underlying intestinal disease, overuse of medications (frequently antibiotics), or for other unidentified reasons. Prognosis is often good.

Lymphangiectasia
Though primary lymphangiectasia is not an inflammatory disease, the clinical signs may be much the same. This is an obstructive disorder involving the lymphatic system of the intestinal tract. The underlying cause is rarely found. Secondary lymphangiectasia may develop in severe IBD. In either case, the prognosis is generally very poor. Small to medium breeds of dogs may initially respond fairly well to dietary and medical therapy; however, large breeds of dogs often do poorly despite dietary and medical therapy. Prognosis is often extremely poor.

Other
Any disease that produces inflammation, infiltration, congestion, or bleeding in the gastrointestinal tract can produce signs similar to IBD. Examples would include fungal disease, infiltrative cancers, advanced heart failure, and chronic nonsteroidal or steroidal drug therapy. Low grade intestinal lymphoma is commonly encountered in cats and rarely in dogs. This is a slow progressing disease with clinical signs that mimic those of inflammatory bowel disease. Unfortunately, surgical intestinal biopsies, rather than endoscopic biopsies, are typically required to confirm diagnosis of intestinal lymphoma.

Treatment
Dietary
The goal of dietary management is to reduce the antigenic stimulation of the gastrointestinal tract’s immune system and to meet your pet’s nutritional requirements in an easily digestible form. This may be done with homemade diets (using recipes we provide you) or one of several commercially available diets. Diet therapy is often critical in achieving control of these diseases. In some patients, a limited ingredient diet with unique protein sources may be required.

Medications
The goal of drug therapy is to “settle down” the immune response by suppressing the inflammation caused by the infiltration of cells into the gastrointestinal tract. Several types of anti-inflammatory drugs are used as the initial medications depending on the type of inflammation present. In patients with more severe disease, a combination of immunosuppressive mediations may be prescribed.

Corticosteroids (Prednisone, Prednisolone, Budesonide)
Prednisolone and prednisone are the primary anti-inflammatory drugs used because of their degree of effectiveness as well as their low cost and wide availability. Depending on the cause of the disease, most pets will show improvement in gastrointestinal signs within 1-2 weeks of starting appropriate therapy. The primary side effects seen are dose related and include increases in thirst, urination, appetite and anxiety. These can result in weight gain, agitation, restless and mood changes. These changes will resolve as the dose of the corticosteroid is reduced over the course of therapy. Prednisolone is preferred in cats because many cats cannot adequately convert prednisone to prednisolone, the active anti-inflammatory ingredient.

Budesonide is a newer corticosteroid medication having largely local effects on the lining of the intestine with minimal absorption into the body. Budesonide may not be effective in dogs or cats with severe inflammatory bowel disease. Side effects are much less than those seen with other corticosteroid medications. Some patients, however, have side-effects similar to those of prednisone or prednisolone. Budesonide is expensive and the dosing of small pets requires recompounding of the medication.

Metronidazole, Tetracycline, Doxycycline, Tylosin, Azithromycin
These are all antibiotics with or without weak anti-inflammatory effects. These drugs may be used alone or in conjunction with other more potent anti-inflammatory drugs. These antibiotics may modulate or alter bacterial populations within the intestine, and may allow a lower dose of the other anti-inflammatory medications to be used. They may be used alone in animals suspected to have antibiotic responsive diarrhea.

Cyclophosphamide (Cytoxan)
Cytoxan is used in pets that have serious side effects to the corticosteroids, are not fully responsive to corticosteroids, or require additional immunosuppressive medication because of the severity of disease. Side effects of Cytoxan include bone marrow suppression (loss of ability to produce red and white blood cells and platelets) and sterile hemorrhagic cystitis (bloody urine). Because this is a potent drug, it is very important to monitor the CBC (complete blood count) in pets being treated with Cytoxan on a regular basis (every 4-6 weeks).

Azathioprine (Imuran)
This drug is also reserved for dogs that are not responsive to or having problems with corticosteroids. Although side effects are less than those with cyclophosphamide, this drug can also cause severe bone marrow suppression. As with cyclophosphamide therapy, there may be a recommendation that a CBC be monitored on a regular basis (every 4-6 weeks). Azathioprine is very toxic in cats, therefore its use in cats is not recommended.

Chlorambucil (Leukeran)
This drug is used in cats that either are not responsive to corticosteroids or as a sole anti-inflammatory drug in diabetic cats. Chlorambucil is generally used in conjunction with corticosteroids in cats with severe inflammatory bowel disease or those with low-grade small cell intestinal lymphoma. Although side effects are minimal, this drug can cause severe bone marrow suppression. As with cyclophosphamide therapy, there may be a recommendation that a CBC be monitored on a regular basis (every 4-6 weeks).

Conclusion
Some pets may require either long term dietary management or low dose medical therapy throughout their lives. Though IBD cannot be cured, the goal of treatment is to control the clinical signs without the need for medications. If reoccurrence of signs is seen, medical therapy may need to be re-instituted. Please contact us before restarting any medication with your pet.

Learn more about this disease by contacting our Internal Medicine service at your nearest BluePearl veterinary hospital. Here are our hospital locations.

© BluePearl Veterinary Partners 2011

Calcium oxalate stones are most commonly found in male dogs and cats and form due to a condition of the kidney that promotes oxalate excretion into the urine. Certain breeds such as Schnauzers are more prone to have this problem. Oxalate stones may also form if the pet has a tumor of the parathyroid gland or another type of cancer.

Ammonium biurate stones form if a pet has a liver disease such as a congenital disease called a portosystemic shunt (vascular abnormality). In such cases the liver is unable to clear the blood of uric acid, thus stones form. Surgical  correction of the shunt usually prevents the stones from recurring. Dalmatians lack an enzyme called uricase in their liver and kidney cells that results in the accumulation of high levels of uric acid in the blood, which causes the formation of urate stones in the kidneys and bladder.

Signs and diagnosis
Clinical signs of bladder stones may include straining to urinate, passage of blood-tinged urine, frequent urination, and having urinary accidents in the house. If a stone has passed into the urethra (the tube that extends from the bladder to the outside) the pet may not be able to produce any urine or only pass small dribbles of urine. This sign should not be ignored as your pet could die from urinary obstruction. Your veterinarian will make radiographs (x-rays) of the abdomen to identify stones that may be within the kidneys, bladder, and urethra. Some stones are visible on plain x-rays, yet others cannot be seen. In such cases, a dye (contrast) study or ultrasound of the abdomen may be recommended. Blood testing including a complete blood cell count and chemistry profile are used to check the health of the internal organs prior to surgery. Fasting and posteating bile acids testing may be performed if a portosystemic shunt is suspected. Urine testing which also includes culturing the urine for bacteria and antibiotic sensitivity is very important.

Treatment
If there is a strong index of suspicion that struvite stones are present, based on previous test results, a prescription diet and antibiotics may be recommended. Stone size is monitored with biweekly sequential radiographs (x-rays). The stones should dissolve within two months after initiating therapy.

In some cases, surgery will be recommended to remove the stones. An incision is made on the lower part of abdomen to expose the bladder. An incision is made into the bladder, stones are removed and the bladder is flushed multiple times to ensure that all stones are successfully removed. Alternatively, hydropulsion, a nonsurgical form of stone removal, which involves filling the bladder with saline and manually  squeezing the bladder to expel the stones, can be used in female dogs and cats with small bladder stones. After surgery or hydropulsion,  radiographs (x-ray) or ultrasound examinations are performed to ensure that all stones have been successfully removed. Laparoscopy is a minimally invasive surgery (and less painful than traditional surgery), which involves making a very small incision in the lower abdomen can also be used to remove stones. This method of treatment also allows the surgeon to fully examine the bladder for other problems and
confirm that all stones have been removed.

If the bile acids test, ultrasound, and/or other special tests support that your companion has a portosystemic shunt (vascular abnormality) that is causing the stones to form, an exploratory surgery to identify the shunt will be recommended. A band is placed around the shunt vessel, which will gradually constrict the abnormal vessel over a period of six weeks.

Stones are analyzed by a lab to determine the stone type. With this information, treatment (medication with or without a special diet) will be recommended to help prevent stone recurrence. Dalmatians usually require a special diet and medication (allopurinol) to prevent stones from developing again. The most important treatment to prevent stone recurrence is to increase the water consumption.

Results
The prognosis following stone removal is good, provided that preventive measures are taken to help prevent stone recurrence. Oxalate stones may recur in spite of medical therapy in some breeds. For this reason, radiographs or ultrasound of the bladder should be used to evaluate stone recurrence every few months at your regular veterinarian’s hospital. If the recurrent stones are very small, nonsurgical hydropulsion can be used to remove them.

Learn more about this disease by contacting our Surgery service at your nearest BluePearl veterinary hospital. Here are our hospital locations.

© BluePearl Veterinary Partners 2011

Reasons for abdominal exploratory
An abdominal exploratory is a surgery in which an incision is made into the abdomen to examine the internal organs. Reason to perform such a surgery is to remove tumors, remove foreign objects from the stomach or intestine and to collect biopsies from internal organs.

Signs and diagnosis
Ongoing weight loss, vomiting, and diarrhea are the primary indicators of chronic bowel disease or of other internal organ disease. Blood work is done initially to rule out a variety of diseases such as kidney failure, liver disease and inflammation of the pancreas. Abdominal ultrasound is very helpful to determine if the patient has tumors in the internal organs or thickening of the bowel. Commonly, samples of internal organs are needed to arrive at a diagnosis. These biopsies are sent to a lab where a pathologist examines the tissue under the microscope to make a diagnosis. Common diseases that are diagnosed by the pathologist include inflammatory bowel disease and a diffuse type of cancer called lymphoma. If inflammatory bowel disease is present, the pathologist will further help define the subtype of inflammatory bowel disease.

Surgery
An incision will be made into the abdomen to allow the surgeon to examine the internal organs. If a disease is found that can be treated with  surgery such as a tumor or a gastrointestinal foreign body it will be performed. A biopsy of the intestine involves removing a 4 mm circular piece of the intestine and then sewing the hole closed. Commonly liver biopsies are also taken. In some cases the pancreas is biopsied if pancreatitis is suspected. While in our hospital, your companion will continue to receive intravenous fluids, electrolytes and in some cases plasma or an artificial plasma product called Hetastarch. Your companion will be carefully monitored in the intensive care and will be given narcotics to ensure a pain-free recovery. Most patients that have abdominal surgery leave our hospital within 24 to 72 hours.

Learn more about this disease by contacting our Surgery service at your nearest BluePearl veterinary hospital. Here are our hospital locations.

© BluePearl Veterinary Partners 2011

In New World species, the Sarcocystis oocyst usually forms benign, microscopic cysts in the muscles, and clinical illness in these birds (i.e.  conures, Amazons, and macaws) seldom occurs. In Old World Species (i.e. cockatoos, Eclectus, African Greys) the cysts infect the lung, kidneys and the nervous system. Bleeding from the lungs can cause a severe anemia and death in a short period of time. In birds where the nervous system is affected, ataxia, weakness and possibly seizures can occur.

Clinical Signs of Sarcocystosis
Pulmonary (lung) Sarcocystosis is most common, and affected birds may show severe dyspnea (labored breathing), weakness, and excessive water consumption. Neurologic signs (weakness, loss of balance) will occur when the nervous system is affected, seen particularly in cockatoos and African Gray parrots.

Diagnosis is difficult because there is no single specific diagnostic test available. A combination of tests may give an indication of infection with Sarcocystosis. Affected birds do not shed sporocysts in their stool, although if the infection is severe enough that an overwhelming number of oocysts are ingested, a few may pass through the digestive tract and be visible in the feces. Anemia is a prevalent sign on blood work in many birds, but other disease processes can also cause anemia. Often the diagnosis is based on clinical signs, anemia, the species of bird affected, and location – Florida being one of the primary areas where this disease occurs.

Treatment
Therapy includes a combination of drugs with antiprotozoal activity in combination with supportive care. Pyrimethamine, a drug used for treating toxoplasmosis and other systemic protozoal infections, is often used in conjunction with trimethoprim-sulfadiazone in an attempt to control the organism. A newer medication used in horses with a similar disease may be useful. Treatment is often needed for a period of weeks to months.

Learn more about this disease by contacting our Avian service at your nearest BluePearl veterinary hospital. Here are our hospital locations.

© BluePearl Veterinary Partners 2011

Mycobacterium sppare ubiquitous environmental saprophytes. Even though Mycobacterium spp have zoonotic potential, infections in birds and humans are considered to originate from the same environmental sources.Mycobacterium spp can infect and cause disease in any organ system but are most commonly associated with the liver, gastrointestinal tract or respiratory tract. Suggestive clinical changes include cachexia, depression, weakness, granulomas, diarrhea, regurgitation, hematochezia, and dyspnea.

Mycobacteriosis should be on the rule-out list in any bird with heterophilia, particularly with a sustained count above 30,000. Radiographs can be used to document granuloma formation in affected tissues or organomegaly. Endoscopy is helpful for further evaluation of abnormal organs and for collection of samples for cytology, histology and culture. A tentative diagnosis of mycobacteriosis can be made by demonstrating acid-fast, rodshaped organisms in feces, tissue aspirates or impression smears of suspect patients. The clinician should be aware that there are numerous Mycobacterium sp. that are commonly found in soil, some foods and organic debris. Many of these strains are not considered to be pathogenic to vertebrates; however, pathogenic and nonpathogenic strains cannot be distinguished by acid-fast staining. A confirmed diagnosis requires isolation of the organism, however, Mycobacterium spp are difficult to isolate and results may take from 4 to 6 weeks. DNA probe-based testing has been used to detect mycobacterial nucleic acid in samples from birds and humans. While these tests can be used to document and speciate mycobacterial nucleic acid recovered from tissues or secretions of affected birds, their prognostic value as screening assays in clinically
normal companion birds remains undetermined.

With the zoonotic potential of this organism, instigation of therapy should be carefully considered. Clients should discuss health issues with their attending physician before deciding to proceed with treatment for positive birds. Treatment is labor intensive, may require months to years and may not effect a cure. Easily accessible granulomas should be excised. Suggested treatment regimes involve a combination of drugs including isoniazid, ethambutol, rifabutin and azithromycin. Infections in humans are currently considered environmentally derived, but birds with mycobacteriosis should not be housed in direct or indirect contact with children, the elderly or those with immunosuppressive disorders.

Foreign Bodies
Birds may consume any number of foreign materials that can serve as mechanical barriers to passage of ingesta, cause mucosal damage resulting in secondary bacterial or fungal infections or provide a source for toxin absorption. Sharp foreign bodies can cause penetrating wounds resulting in fatal peritonitis. Birds may consume lead and zinc from multiple environmental sources resulting in heavy metal toxicosis. Consumption of other metals (such as copper, mercury, etc) may also cause toxicosis but are uncommonly reported in companion birds.

Typical changes associated with alimentary tract foreign bodies include anorexia, regurgitation, weight loss progressing to cachexia, passage of scant feces, diarrhea, constipation, hematochezia and melena. Heavy metal toxicosis has been linked to CNS signs, depression, anorexia, cachexia, weakness, regurgitation, diarrhea, PU/PD, hematuria, hematochezia, pruritus, chronic or recurring bacterial or fungal infections and
feathering abnormalities.

The history should provide information on how the bird is housed, its access to unsupervised roaming of the home, the type of metal used in the enclosure, any available toys and the bird’s “chewing” habits. Data from a CBC and chemistry profile will help determine if systemic changes have occurred. Depending on the type of foreign body, clinical pathology data may be normal or reflect changes suggestive of tissue damage and secondary bacterial or fungal infections.

Radiographs are indicated in any bird with chronic weight loss, vomiting or diarrhea. Radiographs may help determine the location, shape and number of radiodense foreign bodies. Contrast studies can be used to image filling defects caused by radiolucentforeign bodies. Birds should be fully hydrated before administration of barium to prevent contrast material from forming concretions. The recommended dose range for barium sulfate is 0.025 to 0.05 ml/g of body weight. The higher dose is recommended when one is attempting to document radiolucent foreign bodies. A typical contrast series includes radiographs taken at 0.5, 1, 2 and 4 hours. Additional radiographs at 8, 12 and 24 hours may be indicated in cases involving slowed gastric emptying. Organic iodine should be considered in patients in which a foreign body may have perforated the gastrointestinal tract. It should be noted that patients with heavy metal toxicosis may not have radiographically detectable foreign bodies in their alimentary tract. Conversely, birds can consume inert metals (i.e., stainless steel) that are radiographically discernible but are not associated with toxicosis.

Radiographs may indicate a mechanical obstruction of the gastrointestinal tract that may be caused by intraluminal or extraluminal masses. Laparoscopy, gastroscopy or colonoscopy may be used to further evaluate suspected foreign bodies or to collect samples from the crop, esophagus, proventriculus, ventriculus and colon.

Blood levels of lead and zinc are necessary to confirm heavy metal toxicosis in birds with suspicious radiographic changes. Whole blood is the sample for choice for determining lead concentrations and plasma is necessary for determining zinc concentrations. Lead toxicosis should be suspected in birds with whole blood levels greater than 0.6 ppm and zinc toxicosis should be suspected in birds with plasma levels greater than 2.0 ppm. The tubes used for heavy metal analysis should be of suitable plastic with a stopper that does not leach heavy metals. Sample contamination should be considered in any case of suspected toxicosis where the lead or zinc levels are more than 5 time the high end of normal. The basophilic stippling and cytoplasmic vacuolization of red blood cells that is reported in mammals with lead toxicosis are not consistently recognized in avian patients.

Foreign bodies should be removed as soon as possible after ingestion to facilitate their rather simple removal from the crop or proventriculus; removal from the ventriculus or intestines is more problematic. Smooth, non-penetrating foreign bodies in the crop, proventriculus or ventriculus can usually be removed by endoscopy or flushing. For flushing, the patient should be placed under isoflurane anesthesia and intubated. The choanal slit should be packed with an appropriately sized gauze pad. A red rubber feeding tube is passed per os down the thoracic esophagus and into the crop. The tube is then directed into the thoracic esophagus through its opening located at the right, lateral, dorsal corner of the thoracic inlet. With minimal practice, tubes can be readily passed into the proventriculus in birds weighing more than 150 gms. With the bird in either dorsal or ventral recumbency and the head tilted 30 degrees down, begin flushing the proventriculus with warm sterile saline. Place a sterile collection device under the birds head to collect the wash fluids. In our experience, flushing with up to a liter of fluid may be necessary to completely evacuate the proventriculus and ventriculus. By collecting the flush, one can count the number of foreign bodies that have been removed and compare them to radiographic findings. Since initiating flushing procedures, we have only had to use laparoscopy for surgical removal of foreign bodies located in the intestines, with sharp edges, or that had penetrated the gastrointestinal tract.

Absorption of toxins may be reduced and passage through the intestinal tract may be hastened by tubing with magnesium sulfate, peanut oil or corn oil. In cases of documented lead toxicosis, the alimentary tract should be flushed to remove any radiographically detectable, as well as undetectable, metal and the patient should be given a systemic chelating agent to reduce blood lead levels. Affected patients usually respond rapidly to chelation therapy with a cessation of clinical signs often within 6 to 12 hours of initiating therapy. Chelation therapy is neither  indicated or necessary in most cases of zinc toxicosis. When the source of zinc is removed, the kidneys of a well hydrated patient will rapidly excrete zinc returning blood levels to a normal level.

Surgery is necessary to remove foreign bodies that are sharp, have penetrated the mucosa or that are partially or completely occluding the intestines. A left lateral celiotomy is used to gain access to the proventriculus and ventriculus. The patient is placed in right lateral recumbency and the left leg is retracted caudally. A skin incision is made that extends from the cranial aspect of the pubis to the dorsal uncinate process of the fifth or sixth rib. The skin incision will allow the left leg to be retracted caudally and slightly dorsally. A radiosurgical incision is made starting in the external abdominal oblique muscle caudal to the last rib. The incision is extended caudally to the cranial extent of the pubis. The last several ribs may need to be transected and removed to gain proper exposure of the ventriculus and proventriculus. The ventral suspensory ligament is bluntly dissected allowing the proventriculus to be retracted caudally. Stay sutures placed in the ventriculus will help in safely manipulating the proventriculus. The coleomic cavity should be packed with moistened gauze. Foreign bodies in the proventriculus or ventriculus are best removed from an incision made in the isthmus, the area between the proventriculus and ventriculus. The sharp incision is made starting at the caudal extent of the isthmus and progressing orad into the proventriculus. An endoscope placed through the incision may be helpful in identifying and removing foreign bodies located in the caudal ventriculus. The incision is closed using a simple continuous appositional suture pattern that is then over-sewn with a continuous inverting pattern. Placement of a duodenal feeding tube may be necessary if severe damage has occurred to the proventriculus or ventriculus.

Removal of intestinal foreign bodies may require a simple incision or removal of damaged bowel with a side-to-side anastomosis. In many cases, the intestinal tract has sustained severe damage before a causative foreign body is detected and the prognosis for recovery is poor.

Learn more about this disease by contacting our Avian service at your nearest BluePearl veterinary hospital. Here are our hospital locations.

© BluePearl Veterinary Partners 2011

Originally, canaries and budgerigars were recognized as being infected with this organism. Other species that have been commonly documented to be infected include lovebirds, cockatiels, and parrotlets.

Signs of Illness
The most common presentation is a chronic condition, where the birds often appear healthy and look as though they are eating as well or better than normal. They display the “masking” syndrome of appearing to eat, to avoid detection of weakness. Regurgitation is common. You may not see your bird vomit, but the appearance of sticky feathers on top of the head is the usual indication that it has been regurgitating. There may be diarrhea, increased urine, and for those birds that eat seed, you may see them passing undigested seed in the stool. These birds gradually lose weight, and by the time you notice that they are acting ill, they are often extremely emaciated.

There are several indications on blood work that your veterinarian can use to tentatively diagnose this disease. Also, the organism may be seen on a fecal examination, which is a done from the droppings. On larger birds, barium contrast study X-rays may also give an indication of stomach ulceration and other changes in the intestinal tract.

Birds that are affected with other diseases, particularly circovirus, are predisposed to disease from Megabacteria due to their compromised immune system.

Other diseases that may cause these same symptoms include Trichomonas (a protozoan parasite) Candidiasis (another type of milder yeast infection), Proventricular Dilatation Disease (a wasting disease caused by a virus) and toxicity from metals such as lead and zinc.

Treatment of an individual pet bird involves the use of an antifungal mediation. Despite appropriate treatment, affected birds often do not survive a clinical infection. If you have multiple birds housed together or breeding birds, your veterinarian can help you devise a plan to control or eliminate this disease.

Learn more about this disease by contacting our Avian service at your nearest BluePearl veterinary hospital. Here are our hospital locations.

© BluePearl Veterinary Partners 2011

Your veterinarian may need to perform several diagnostic tests, including a complete blood count, blood chemistries, radiographs (X-rays) and even echocardiology (ultrasound of the heart). Often a significant elevation in the thickness of the blood, revealed by the PCV (or hematocrit) is present. Also, changes on the X-rays may help your veterinarian to diagnose this disease. Even if macaw asthma is diagnosed, secondary bacterial or fungal (Aspergillosis) infection may occur and require treatment.

Various allergens have been implicated in causing macaw asthma. The most common association has been with bird species (primarily cockatoos and African Greys) that produce aerosolized powder down. Some macaws can co-habit a household area with no resultant problem. However, ideally these bird species should be housed separately. If this can not be accomplished, the prophylactic use of a quality air filter (such as a HEPA filter) positioned near the cage of the powder-down producing species is recommended for the pulmonary health of the macaw as well as the owners themselves. Many other environmental allergens may be involved, but no consistent agents have been isolated.

The best initial treatment for severe disease is oxygenation. Depending on your bird’s condition, your veterinarian may recommend  hospitalization and additional treatment. Long-term management includes removal of the inciting particulate matter – whether that is dust from other birds, or other material, with increased ventilation/HEPA filters. Your veterinarian may recommend drawing blood to thin it, allowing better circulation, and/or the use of bronchodilators.

Repeat crisis situations (episodes of severe respiratory distress) may occur and necessitate re-hospitalization and phlebotomy. Unfortunately, some birds cannot be saved. Change of environment and increased ventilation will reduce the speed of disease progression. Some permanent lung damage is present, and exercise intolerance may persist and worsen over time due to interstitial fibrosis (scarring of the lungs).

Learn more about this disease by contacting our Avian service at your nearest BluePearl veterinary hospital. Here are our hospital locations.

© BluePearl Veterinary Partners 2011

The underlying cause of iron storage disease is not well understood. A genetic predisposition is suspected in some species. Physiological mechanisms that developed to compensate for a low available dietary iron may contribute to iron storage disease. Although the dietary iron requirements of most birds remain unknown, many diets contain high iron concentrations. Current recommendations are for a diet that contains less than 100-ppm iron and low Vitamin C level (< 100 mg/kg), as Vitamin C increases the body’s absorption of iron.

Treatment for iron storage disease may include phlebotomy, (removal of blood in order to reduce the body iron stores), chelation therapy to bind the iron and allow the bird to excrete it, and diet alteration.

Research is continuing into the cause, prevention and treatment of iron storage disease; check with your veterinarian for the most recent information.

Learn more about this disease by contacting our Avian service at your nearest BluePearl veterinary hospital. Here are our hospital locations.

© BluePearl Veterinary Partners 2011

Prolonged begging for food causes straining and dilation of the vent. Misplaced sexual attraction to their human surrogate mate will also cause vent straining and movement. Retention of stool in the vent for prolonged periods stretches and dilates the cloaca. The vent lips are often grossly stretched and appear flaccid. Behavioral modification is often difficult for owners to accomplish, since it involves altering the tight bond that they have with their bird. Behaviors that increase this inappropriate bonding in affected cockatoos include stroking the bird, especially on the back (i.e. petting), feeding the bird warm foods by hand or mouth and cuddling the bird close to the body.

Cloacopexy is a surgical procedure than can be used to hold the prolapse in a reduced position against the body wall without compromising the vent. However, if the bird still perceives the owner as either its parent or its mate, it will continue to strain and the problem may recur despite surgical correction. Surgical correction can be repeated if necessary. If the cloacal lips have been overly stretched, surgery to reduce the opening may be considered. This too may recur over time and need to be repeated. Some veterinarians have found that a total change of environment and human companionship (i.e. finding the bird a new home, either temporarily or permanently) is necessary to correct this problem.

Cockatoos that are independent of humans do not exhibit cloacal prolapse. If an owner is serious about trying to change their bird’s behavioral patterns, behavioral modification will be necessary. Some success has been noted when Clomipramine is added to the behavior therapy. Websites that address behavioral issues in captive parrots include those listed below.
www.avianstudios.com
www.goodbirdinc.com
www.parrotenrichment.com
www.parrots.org/index.php/referencelibrary/behaviourandenviroenrich/

Learn more about this disease by contacting our Avian service at your nearest BluePearl veterinary hospital. Here are our hospital locations.

© BluePearl Veterinary Partners 2011