Heather Sparks

BA (Hons) CertECC DipVN RVN | Lincolnshire, UK

hlsrvn@outlook.com

Heather completed her veterinary nursing qualification in 2016. Since then, she has completed multiple courses including canine behaviour and nutrition and, in 2019, completed the Vets Now Emergency and Critical Care qualification. She is now set to study surgical nursing under Schedule 3.

ABSTRACT

Kittens, cats, puppies and dogs are often rehomed by staff in the veterinary profession when they are signed over, or lost and unclaimed. We cannot help but want to take them into our own care and make them part of our immediate family.

However, what happens when presented with a companion psittacine? This article has been created to provide an insight into owning a companion bird and the nursing considerations needed for the successful rehabilitation of a compromised Amazon parrot.

Key words orange-winged Amazon parrot, psittacine, avian, nebulise, training, rehabilitation  

WHAT IS HE?

The Amazon parrot is deemed the archetypal green parrot, with the orange-winged (Amazona amazonica) (Figure 1) falling in that category, alongside other examples of Amazons, e.g. the yellow-headed Amazon (Amazona oratrix), blue-fronted Amazon (Amazona aestiva) and red-lored Amazon (Amazona autumnalis). The orange-winged has a life expectancy of 35–40 years (Harcourt-Brown & Chitty, 2005). Some studies suggest 39 is the maximum (Young et al., 2011) while the age of 60 years has been reported by Levine and Practice (2003). Generally, the larger the body mass, the longer the expected life-span (Munshi-South & Wilkinson, 2006).

IS THE BIRD MALE OR FEMALE?

Genetically based sexing is the most reliable method of sexing the Amazona species. This can be done via blood samples, feather pulp samples or saliva samples (Harcourt-Brown & Chitty, 2005). Unfortunately, these invasive methods are not well tolerated and are likely to cause an increase in stress and a reduction in trust. Specialised equipment is used for the genetic testing and is therefore expensive to process, with a turnaround time of several weeks (Volodin et al., 2015).

It is an important step to establish the sex in order to rule out other potential conditions. Females are at risk of developing egg binding disorders due to hypocalcaemia as a result of poor nutrition. Males may develop testicular neoplasia resulting in weight loss and liver changes (Harcourt-Brown & Chitty, 2005). Blood tests revealed this parrot, named Peridot, was male.

History and assessment

SIGNALMENT AND PRESENTATION

According to the history acquired at the initial consultation, Peridot is a male orange-winged Amazon parrot, approximately 20 years old and weighing 350 grams. It was unknown if he was parent-reared or hand-reared and the length of previous owner’s ownership was not obtained. He arrived at the practice for a routine appointment, having fallen from his perch for the second time in the space of a few weeks, and was ‘unable to right himself’. His diet for the previous year consisted of out-of-date seed and occasional fruit. It was recorded that his mobility had decreased and he appeared ‘depressed’.

Physical examination by the veterinary surgeon (VS) revealed poor muscle mass in the legs and chest. The keel was easily palpable. His feather quality showed tatty feather edges and stress lines, which could indicate internal disease, lack of preening and/or poor nutrition (Figure 2) (Harcourt-Brown & Chitty, 2005). He displayed increased abdominal effort during inspiration and signs of chronic respiratory infection, which may have led to permanent damage. Prognosis was guarded. Radiographs or computerised tomography (CT) were discussed. However, factors contributed to halting the procedures, including his instability and likelihood of death in his current condition, and the client’s financial restrictions. 

DIAGNOSTIC TESTS

Even in the healthiest of avian species, obtaining a sufficiently large blood sample for testing can be challenging (Hawkins et al., 2006).

As can be observed from Table 1, the heparinised plasma sample acquired was not sufficient to calculate sodium, potassium or ionised calcium levels. Biochemistry and haematology blood profiles were produced and these showed elevated levels of aspartate aminotransferase (AST). Alone, this could indicate muscle cell damage. In the event of creatine kinase (CK) levels being elevated alongside AST, the likelihood is muscle damage rather than liver damage.

It was concluded that reduced muscle mass and poor diet contributed to Peridot’s condition.

Treatment plan, rehabilitation and nursing considerations

HOSPITALISATION

Peridot spent a total of four days at the clinic, separated from cats and dogs in a secluded exotic ward. It was important to remove the threat of predators while hospitalised to reduce his stress further and improve his recovery.

His quiet environment was isolated from traffic and human contact, other than the times where scheduled checks from nurses and veterinary surgeons were required and when medications were due. Fluid therapy was introduced in 10ml boluses of warmed lactated Ringers, spiked with a vitamin and mineral supplement solution, administered subcutaneously via the inguinal fold. A seven-day course of enrofloxacin was introduced to combat the respiratory disease and the nostrils were flushed daily, with the aid of a 0.91mm diameter irrigating cannula, to improve the respiratory effort. This was well tolerated and did not require an anaesthetic to perform.

NUTRITION AND CROP FEEDING

In healthy psittacines, 1% of the body weight can be given as food (10ml/kg). This can be increased to 3% of the patient body (30ml/kg) if necessary (Edis, 2017). A plan was made to begin crop feeding. Hagen’s Hari Tropican Hand Feeding Formula was used, beginning with 10ml initially (30ml/kg), and increasing this by 5ml each day.  

Utilising the basic energy requirements (BER) calculation is advised when planning an accurate feeding regime.

BER (Kcal/day) = 78 x (body weight in kg) 0.75

(Froehlich & Forbes, 2015).

Improvement was observed in his appetite, demeanour and beha
viour but he still had a poor prognosis.

DIET

Amazona amazonicas come under the feeding group of frugivores. In the wild, their diet consists purely of fruits (Harcourt-Brown & Chitty, 2005). In captivity, pellet or complete mixes should make up 60–80% of their daily diet, with the remaining 20–40% consisting of various treats, nuts and seeds, including sprouting seeds, fresh fruits and vegetables (Amazon Parrot Feeding Guide, 2021).

Lack of basic nutritional knowledge combined with some owners’ reluctance to invest in more expensive but superior complete mixes may have contributed to an increase in psittacines being seen in veterinary clinics (Brightsmith, 2012). As Peridot improved in the short time he was hospitalised, food needed to be provided and be accessible. Due to the rarity of recovery and nursing a psittacine patient, the practice team contributed by providing nuts, vegetables and fruit – fresh and on a daily basis. Hand feeding was a reliable way to encourage eating and it appeared Peridot enjoyed the company and one-on-one time. Therefore, everyone was involved, the interaction was positive and the results were rewarding.

Personal research in veterinary texts helped to identify the everyday foods that contained the essential nutrients needed for Peridot’s rehabilitation. Table 2 shows examples of fruits and vegetables high in vitamin A and protein. Reliable internet sites can be accessed. However, designing an up-to-date and basic guide may be more useful to owners and this is something that can be done by the veterinary nurse.  

As well as these foods, multivitamin powder and liquid supplements were added to food and water. ZuPreem® fruit/veggie/nut dry pellet blends were purchased and provided daily (Figure 3). Treats were also offered, including avian-friendly fruit jelly cups, popcorn, and fresh mixed nuts, i.e. whole almonds, walnuts (in shells), cashews, pine nuts, monkey nuts (in shells) and brazil nuts. Figure 4 provides a visual representation of the proportions of foods that should be part of the parrot’s daily intake. 

HYPOVITAMINOSIS A

Vitamin A is an important fat-soluble vitamin that can be stored in the body for long periods. Should vitamin A feature less in the diet, the stores are then used up, leading to vitamin A deficiency. It is identified as one of the most common conditions diagnosed in the veterinary clinic and it is a condition that can be easily avoided.

Signs of vitamin A deficiency include poor feather condition and altered colouration (these visual clues are often seen initially by the owner), metaplasia of the epithelial membrane and increased susceptibility to respiratory disease and infection. Hypovitaminosis A has a detrimental effect on many areas including the kidney, liver, keratin production, the reproductive system and increase in chronic infections. Vitamin A is needed in relatively large volumes (5000.00 IU/kg) for basic maintenance.

Other vitamin deficiencies include vitamin D which results in thinning egg shell and production, increased embryotic death and hypocalcaemia. However, this is more relevant to females as a lack of vitamin E causes poor reproductivity. Riboflavin B2 is a water soluble vitamin found in nuts and, if lacking in the diet, contributes to poor feather quality, ataxia and diarrhoea (Froehlich & Forbes, 2015; Harcourt- Brown & Chitty, 2005).

Peridot’s progression

On the fourth and final day of hospitalisation Peridot continued to improve. His respiratory effort decreased and there was minimal nasal discharge noted. He started to develop preening behaviours and was more active. There was a marked improvement in his appetite but his weight continued to decline. His increase in activity may account for this mild weight loss. It was discovered that the owner had made the decision to relinquish ownership of Peridot and, after considerable discussion, I decided to take him on.

A ‘transfer of ownership’ contract was drawn up to include both parties’ and the animal’s details (the contract must be signed by both parties for validation).

Due to his stabilisation and signs of continuous improvement, the decision was made to move him into the home. A medication and feeding plan was established and his original cage and belongings were donated and cleaned with bird-friendly disinfectant before he was placed back inside. This was done to remove any bacteria or viruses that may have contributed to the respiratory infection Peridot had developed. He was placed in a busy area of the home to encourage positive social interaction during the day. However, it was also suitable for rest periods (Baker, 2012). Hospitalised or recovering parrots should be allowed 12–14 hours of continuous rest, with limited noise, lighting and visits (other than the times for feeding or medication) (Froehlich & Forbes, 2015).

Amazons are highly active birds, therefore placing perches at varying levels is advised. However, the cage set-up was adjusted to accommodate his ataxia, with perches placed in the lower third of the cage, along with a cushioned base and a parrot-friendly hammock. Shortly after his arrival, he settled and fed himself continuously, consuming multiple fruits, vegetables (Figure 5) and nuts, including high-potency nutritional pellets. Syringe feeding with the hand-rearing formula continued during social hours. His weight did fluctuate as his activity increased but did show an upward trend overall.

THE HUMAN-AVIAN BOND AND ENRICHMENT

After settling in to his new environment it was soon discovered that Peridot had a strong urge for human avian bonding. He presented his head and neck multiple times and enjoyed human contact. Aengus and Millam (1999) defines tameness as ‘the general absence of aggression toward humans and tolerance to handling’.

Categories highlighted in the study by Anderson (2014) include affection and physical contact. It states that this socialisation is important to young captive-reared parrots having good experiences during veterinary procedures and when performing basic husbandry. Principally, as with new puppy owners, encouraging psittacine owners to routinely check feet, ears and eyes while the bird is young improves the success of examinations when visiting the veterinary clinic.

Amazons are highly intelligent birds and require a large amount of enrichment to avoid boredom and, in severe cases, self-mutilation. Peridot particularly enjoys unravelling plaited ropes. Toys can be used to hide food and encourage wild foraging behaviour. However, due to his conditions, having food easily accessible was necessary.

TRAINING

During his time at the clinic, Peridot was restrained regularly and, understandably, responded aggressively towards towels and gloves, even from a distance. Positive reinforcement for a desired behaviour helped reduce his aggressive emotional response to these items. A highly regarded treat, toy or praise should be offered after every correct response to encourage repetition, decrease fear and improve bonding (Baker, 2012). Whistle or clicker training aids are useful communication tools due to their unique sounds (Martin, 2007).

Daily training with a chopstick was use
d initially: each time he touched the stick with his beak, a click followed and then a highly valued reward was offered by hand. Popcorn was the treat of choice. He then advanced to touch gloved hands, although this is still a work in progress.

Please note, animals are able to associate this unique sound positively, provided it is used in a positive way. The reverse can occur and the parrot may become anxious in anticipation of something negative occurring, so it is important to use these aids correctly and with caution. 

Nebulisation

Upper and lower respiratory infections and disease are common conditions in the Amazon parrot (Levine & Practice, 2003). Peridot presented with nasal discharge, dyspnoea, sneezing and increased respiratory effort. Therefore, the nebuliser was used to provide relief four times a day for the period of thirty minutes.

The nebuliser is designed to administer medications into the upper respiratory tract and lower airways (Downing & Gibson, 2018). Medications, such as bronchodilators and antibiotics, can be delivered via this method (Froehlich & Forbes, 2015). Small particles, appearing as a partially opaque fog, are inhaled. Ideally, NaCl 0.9% should be used for the dilution of the medications or if nebulising solely to moisten the respiratory tract and encourage the removal of mucus caused by the infection.

The use of the nebuliser encouraged a bathing behaviour. Peridot exhibited a desire to preen his feathers, including using his water bowl as a bath. Amazon parrots – especially the orange-winged – display bathing behaviour when encouraged via simulated rainfall on a weekly basis and it is shown to improve the animals’ welfare (Murphy et al., 2011). 

Discussion

There was a sudden requirement to design and adapt the veterinary environment for the hospitalisation of this Amazon parrot. Although it is relatively rare to be presented with this particular species in a regular day-to-day clinic, it is less uncommon in specialised, exotics practices. Therefore it may be beneficial to work, volunteer or experience life in an exotics practice and adjust the ideas gathered to suit your exotics ward.

The development of in-house guides for psittacine owners, or those wanting to become responsible for a psittacine, is a reliable way to provide knowledge, basic husbandry and to recognise signs of ill health. It avoids owners researching online and finding potentially inaccurate advice.  

Radiography will help establish the condition of the lung and air sacs, however, it has been advised to look into performing a CT scan over a radiograph. This does require anaesthesia which, at the time, was likely to be fatal. 

Conclusion

Feather quality appeared to be a relevant indicator of progress during the rehabilitation process. Although rehabilitation is still ongoing, at the time of this report, Peridot is improving and his progress is very encouraging.

Do make sure there is a good variety of foods that are high in vitamin A and protein, as lack of these essential nutrients causes a wide range of visual and internal issues. Do not keep complete diet mixes past their expiration date. Change the food regularly.

Respiratory disorders and disease cause many avian patients to be seen in the veterinary clinic and, unfortunately, some owners decline offers of treatment due to financial implications.

Do maintain a biosecurity protocol with safe disinfectants and clean on a regular basis. If there are other birds in close proximity, ensure they remain separate from each other to avoid the spread of diseases. Conditions that could easily be avoided with correct biosecurity and basic nutritional knowledge are left unaddressed. 

It will never be 100% confirmed to what permanent damage Peridot has succumbed. However, regular checking of the biochemistry and haematology profiles will monitor his requirements. By doing so, it is possible for him to enjoy another 20 years of mutually rewarding life with his new family.

Do continue positive training to improve bonding, handling and trust. Do not restrict toys and enrichment when you are not available to be the entertainment.

It has been four months since Peridot was rehomed with changes put in place. His weight is still fluctuating but remains stable. Haematology and biochemistry tests have been repeated. There has been a marked improvement in the AST result and there was sufficient sample to record in potassium, calcium and sodium. The clicker training helped the veterinary surgeon extract a blood sample easily and with minimal fuss. Since the article was originally written, it was discovered that the previous owners were regular smokers and this could be a contributing factor to the respiratory condition. However, until radiography or CT is performed safely, maintaining his weight and wellbeing is being considered first.

References

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Anderson, P. (2014). Social dimensions of the human–avian bond: Parrots and their persons. Anthrozoös, 27(3), 371–387. https://doi.org/10.2752/1753037 14X13903827488006 

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