How to diagnose avian diseases (Proceedings)
Veterinarians should be aware of signs that a bird is becoming severely stressed while being examined.
Signs that a bird is becoming severely stressed during a physical examination:
1. Weakness2. Closing of eyes
3. Lack of movement
4. Abnormal vocalization
If any of these signs occur the patient should be placed immediately in a critical care unit. A veterinarian should always remember that if in doubt regarding severe stress always put the bird in the critical care unit and wait. Owners, especially in emergency situations want their companion animal treated as soon as possible. With avian patients, if they are treated and are not able to withstand the stress of the examination and procedures, death will quickly ensue. An explanation of judicious evaluation and examination is a must for owners bringing in patients that are critically ill or injured. In the majority of cases if the bird does not survive minimal treatment and supportive care while waiting for adequate recovery allowing for more intensive measures, death would have arrived sooner with a more aggressive approach.
The protocol for evaluation and treatment we use consists of
2. External physical examination
3. "Hands on" physical examination
4. Formulating differential diagnoses list
5. Diagnostic testing to confirm top differential diagnosis
6. Treatment – also treatment while waiting for diagnostic test results
We use students to obtain the initial history of the case and view the avian patient. This allows stimulus of the owner's memory prior to the veterinarian entering the room. The veterinarian also has the luxury of discussing the history with the student before meeting the client. The combination of revisiting questions that may be significant to the presentation, covering any deficiencies of the evaluation, and an owner's stimulated memory often expose important information that was not obtained in the initial exchange.
The observation physical examination is next. This examination can be very useful when trying to determine abnormal posturing, neurological signs, respiratory condition and behavior related problems. The veterinarian must always remember that the animal is in a strange location, in an abnormal environment (e.g. travel cage, pet carrier), and has been transported over some distance. All of the above are reasons for the bird to be highly aware of its surroundings appearing alert. More than one client has apologized for the apparent "miracle" recovery their bird has made by just driving it in the carrier to the veterinarian's office. Always take the owners initial concern for fact. Birds that appear to have a spontaneous recovery will often return to their depressed state once the owner has left and the patient placed in a hospital cage. Owners must be informed on an avian patient's ability to mask clinical disease signs when located in a threatening environment such as a veterinarian's office. Optimally the observation physical should take place without the bird being able to see "strangers." A 2 way mirror or small observation window is the best technique to properly evaluate the bird from a distance.
Once it has been determined that the patient can be held for a complete physical examination the bird must be captured with as little stress as possible. One consideration must be determined prior to capture – if any diagnostic samples need to be collected that may be affected by stress it is strongly recommended to collect those samples before the complete examination takes place. This is especially true for blood collection in which the sample is submitted for a complete blood count. Small birds are best captured by observing their location in a cage and placing a hand in the door of the enclosure. Have the owner or veterinary technician turn off the light and slowly grab the bird before it has time to accommodate to the darkness. This works easily and always impresses the owner. For parrot species the darkness technique does not always work and a slow movement with a toweled hand behind the patient's neck with the bird observing the towel is very effective. The added benefit is the bird does not become afraid of the towel, an important consideration for future visits. These techniques are recommended for pet birds in the veterinary hospital, but parrot species in aviaries are captured using gloves, nets, and towels.
Birds have an excellent memory. Birds also do not like what they cannot control and they cannot control the physical examination process. We have found that most owners are happy for the veterinarian to leave the room and then bring the bird back after the examination is complete. We like to accommodate the owner's request but feel if it is often best to bring the bird "in the back." We explain the possible psychological connection the bird may have with the owner as they watch the procedure or that it may involve a needle collecting blood. There has been one owner faint who insisted being in the room during blood collection of an avian patient. Examine the bird from the symmetry of the beak to the health of the uropygial gland. Any abnormalities are recorded on the physical examination form. If diagnostic samples need to be collected, the recommendation for these tests is made to the owner.
Diagnostic testing is recommended based on the initial presentation, history, and physical examination findings. The testing is done to confirm a diagnosis with full explanation to the owner. As owners have the final approval if a test is submitted, an education on why the test is recommended and the how results may be interpreted is provided. With avian patients I feel that we do not have the luxury to perform tests for the sake of performing tests because of the limitations of sample collection and stress to the patient. Therefore it is imperative that veterinarians understand how to interpret avian diagnostic testing and when those tests may have significance to the case being examined. Time and again inappropriate diagnostic testing will confuse a case diagnosis rather than help confirm the illness.
Physical examinations and subsequent diagnostic testing is the foundation of avian veterinary medicine. Understanding of the proper protocol for each will elevates one's practice and gain confidence from the bird owning public.