At DoveLewis, an astounding variety of species are walked, wheeled and carried through our doors on a daily basis. In addition to dogs and cats, we regularly treat a cornucopia of exotic pets and wildlife, including (but not limited to) psittacines, rats, ferrets, raptors, turtles, rabbits, chickens, guinea pigs, hamsters, snakes and fish. Unfortunately, pet birds are almost universally prey species and are quite adept at hiding signs of illness. Subsequently, by the time many of our avian patients are presented to the hospital, they are unstable and in need of immediate medical attention. Avian medicine is not part of the core curriculum in many veterinary schools, and without pursing an elective or externship in exotics medicine, it would be easy to start a veterinary career with minimal experience in avian medicine. This article is intended to present a basic overview of avian emergency medicine so you’ll be more confident and prepared for treatment the next time a client walks into your clinic with a lovebird, chicken or barred owl.
Just as with dogs and cats, there are many different types of emergency presentations that you might see during an avian veterinary visit. With pet birds (typically psittacines), the most common presentations involve respiratory distress, trauma, and lethargy/inappetence or “ADR.” Wild birds of all species and backyard poultry (typically chickens) are most commonly brought to the hospital for traumatic causes, though we also frequently see infectious etiologies.
Triage and Visual Exam
Proper triage is essential for any patient, and a visual exam can be as informative as a physical one for your avian patient. The first thing to determine is the bird’s stability. Conditions that require immediate treatment are respiratory distress, hemorrhage, neurologic signs or seizure activity, and any bird that is sitting on the bottom of its cage, appearing dull or lethargic, and not perching (with the exception of fledglings). These birds should be brought directly back into the treatment area and emergency care, such as oxygen, initiation of hemostasis and anti-epileptics, should be instituted immediately. Heat, nutritional support and antibiotics should also be considered. Respiratory distress in birds is usually manifested by tail bobbing, fluffed feathers, open-beaked breathing and dull or distressed mentation. Birds lack diaphragms, and tail bobbing occurs secondary to an increased abdominal component to their respirations. Seizure activity may be secondary to hypocalcemia, hypo- or hyperglycemia, and toxins such as lead or inhaled aerosols.
When a pet bird is presented to the hospital, taking a thorough history is also essential. Many bird owners are well versed in their pet’s nutritional requirements and housing needs, and are very knowledgeable about how to properly care for their pets. However, misinformation abounds, and medical conditions related to husbandry and welfare are all too common. Many emergency presentations can be traced back to inappropriate housing, diet or environment. A number of basic history questions are transcendent between small animal and avian medicine, but some examples of additional avian-specific questions to ask the owner or caregiver include:
- Has your bird ever seen a veterinarian before?
- Do you know the age of your bird?
- Where did you acquire your bird? How long ago?
- Do you know the sex of your bird? (Some birds, such as budgerigars, cockatiels and eclectus parrots have sexually dimorphic traits, but most psittacine species can only be sexed by egg-laying behavior or by DNA sexing.)
- What bird food does your bird eat? What treats do you offer your bird in addition to its regular diet, and how often? Has your bird eaten any avocado recently? (Persin, a compound found in avocado, is highly toxic to many birds and can cause acute weakness, bruising, edema, dyspnea and death within 24 to 72 hours.)
- Is your bird housed with any other birds? Have any new birds been introduced to the household recently? If so, are they displaying the same clinical signs?
- Do you use any scented sprays, scented oils, aerosols or other cleaning products near your bird’s cage? (Birds can be very sensitive to cleaning products and aerosols and may become very ill if they inhale or ingest them.)
- Do you cook with Teflon-coated pans? (Polytetrafluoroethylene, or PTFE, can be released from overheated Teflon cookware and can cause toxicosis and death.)
- Does your bird have unsupervised time outside its cage? If so, does it regularly chew on anything? Is there any known or suspected lead paint in the household?
- What toys does your bird play with? Are they made specifically for birds?
- Where in the household is your bird’s cage kept? What is the temperature and air quality of the room?
- What is the substrate in the bottom of the cage? How often is the substrate changed and the cage cleaned? What products are used in the cleaning?
If your avian patient appears stable, take some time to examine it in its enclosure before starting your physical exam. Are there any missing or broken feathers, or do the feathers look disheveled? A healthy bird will spend a large amount of time preening, but an unhealthy bird may have a rumpled look to it. The tail feathers may even be broken or stained with fecal material if the bird has been spending a lot of time on the bottom of its cage. Is the bird holding both wings in a normal position, or is one wing drooped? Is it placing weight equally on both feet? Is there a head tilt? Are there any droppings in the cage, and if so what do they look like? Normal droppings are comprised of urine (clear), urates (white) and feces (brown to green). A dark color can indicate digested blood, and frank blood in the droppings is not normal. It is also important to remember that birds can have a stress polyuria, which is different from diarrhea: Birds normally reflux fluid into their colon where it can be resorbed, but this reabsorption can be bypassed in a stressful situation and the increased water output can be confused for diarrhea. Finally, if the urates are bright or lime green, this could indicate an acute hepatopathy and can be a sign of psittacosis.
When physically examining the avian patient, a thorough, systematic approach is essential. Many components of the avian physical exam can be adapted from a mammalian physical exam, though there are some important differences. When assessing the hydration of an avian patient, gently pinching the skin around the eyelids can be used to evaluate skin turgor, and the cloacal mucosa is commonly used to evaluate mucous membranes. Examination of the oral cavity can be performed by gently opening the beak with a pair of tape stirrups. Evaluate the choanal papillae: Are they visible with sharp points, or are they blunted or absent – a sign of vitamin A deficiency and inappropriate diet. Are there any plaques inside the oral cavity? If so, take a sample with a sterile swab. If the bird is showing signs of upper respiratory disease, a partially obstructive foreign body may occasionally be visualized.
Palpate the neck and crop for any foreign bodies or abnormalities. The crop is present on the right side of the base of the neck and typically contains some ingested food material. In chronically ill birds, it may be empty or it may feel full and fluid-dilated, a sign of crop stasis or overgrowth/infection. If the crop feels full or abnormal, a swab may be taken for additional diagnostics such as a wet mount, gram stain or culture.
When auscultating an avian patient, the heart, lungs and air sacs should all be evaluated. The heart and air sacs are best auscultated ventrally, and the lungs are best auscultated dorsally. Listen for any murmurs, arrhythmias or abnormal respiratory sounds. Palpate the keel: In a bird with an ideal body condition, the ventral edge of the keel should be palpable but not prominent. A sharp, easily palpable keel represents poor body condition and could be indicative of chronic disease or inappropriate husbandry, and an over-conditioned bird with a keel that is difficult to palpate may have metabolic disease, hepatic disease, or lipomas that are interfering with normal function. The coelom should feel slightly concave and soft when palpated. A full, round, turgid coelom could indicate intracoelomic fluid, which should be confirmed with ultrasonographic evaluation. An egg may be palpable in reproductively active females, and intracoelomic masses may also be palpable. Next, evaluate the cloaca: Is it swollen and edematous? Is it prolapsed? Are there dried feces or dried blood present? Finally, conduct a thorough orthopedic and musculoskeletal exam. Examine both wings and both legs for symmetrical musculature and evidence of orthopedic injury. Evaluate whether both feet are gripping with equal strength. Look thoroughly for any wounds, broken blood feathers, or evidence of self-mutilation or feather plucking.
Starting with a foundational knowledge gathered from the physical exam, and taking a thorough history, is essential to treating avian patients. Check out the Part Two of this article to learn more about emergency procedures and treatment.
Special thanks are given to Dr. Katherine Quesenberry and Dr. Scott Ford for their time and contributions to this article.
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