Hello and welcome to Just Answer chat! I'm Dr. Jaime and I'd like to help.
I am very sorry to hear of your loss. If you would like to send the necropsy results to me as a link I could review them and explain them to you. I see that you have many questions and I would like to help clarify them for you.
The tube feeding into the stomach is not a cause of bleeding unless the tube itself caused trauma. 2.5 mL in a 69 gram bird is most certainly appropriate.
The water would also be able to get absorbed through the oral cavity, crop, esophagus and proventriculus.
I am concerned that you were giving Meloxicam- you were not giving this bird 0.5 mL of 0.5 mg/mL solution, right?
Just using the 0.5 mg/mL concentration?
what was the amount he or she was given in mL for the pain/inflammation?
I understand the necropsy report. That is not the issue.
The vet had the syringe marked for the amount to be given to the bird, the discharge report reads as thus"
It is difficult for me to make comments without reviewing the report and dosages of NSAIDS (meloxicam) given.
this is verbatim
Metacam 0.5mg/ml oral, 3 ml. Give 0.06 cc/ml orally every 12 hours for pain and inflamation
I would have used the same dose- 0.06 mL orally twice daily of the 0.5 mg/mL solution in this size conure
the feeding tube was placed into the crop from behind the head, sutured and had a butterfly attachment to keep it in place
So to clarify, you are wondering if the tube could have penetrated the ventriculus or other portion of the gi tract and cause a bleed internally?
And that is routinely how a feeding tube is placed in birds
the medicine was to be mixed with the kaytee formula but it was almost impossible as they did not put a needle in the bad so that I could inject the medicine into the syringe to mix it before I pushed the food into the tubing.
So is it possible that your bird received more than 0.06 mL of the 0.5 mg/mL meloxicam?
When I spoke with the vet and told her this, she told me to push the medicine in first, right after the small water push to be sure the tubing was clear, then push the food in, and then the second small water push
Yes, that is very typical
or to mix it with the food/enteral feeding
and then feed, then flush with water/fluids
no, but since the tube had migrated to the esophagus leading to the stomach, away from the crop
Often we will actually deliver food directly into the ventriculus in the case of upper GI (crop) disease
the entire amt went directly into the stomach, not the crop to be moved slowly to the stomach
yes, I understand that
and the amount that is instilled generally is the same as in crop feeding
I'm sorry, I don't think I understand your question... are you asking if the tube was the cause of death?
when you feed by tube, and you feed to the crop you feed a larger quantity of food that when you feed directly to the stomach
Depending on the species, you can generally feed more food into the crop in doves and pigeons but
in other birds (psitticines)
you can feed similar amounts
I want to know what the amt would be that you would feed to the stomach of a bird this size and if the amt was too large, how would the system handle this
safely, in my experience
the system would allow overflow to go up to the esophagus
and into the preventriculus
how can the stomach, which is much smaller and two parts, handle the larger quantity?
it would reflux upward
into the esophagus and crop (proventriculus)
if the pressure exerted on the syringe was too great
or if the food was too warm
there could be trauma to the GI system
that lead to pathology and/or rupture
I have instilled several times more than the crop capacity
into the ventriculus (stomach)
doing lavages to remove foreign objects
I fed him his food warm, not hot, but warm.
so unless the necropsy report reports a rupture
I think that the amount instilled is unlikely to have caused a bleed
Therein lies another problem
Not microwaved, right? Food continues to cook after microwaving
and I have seen terrible results with microwaving enteral formulas
the vet who did the necropsy was not thorough, is not avian certified and was remiss
no, I only used warm tap water
Did you not submit Squeakie's remains to a pathologist?
I am a little confused.
while he is good to use for minor avian issues, he is not for other things but we do not have a lot of choices here locally.
a friend called ahead and had the necropsy scheduled and told them no, I was hysterical. It killed me
Well, in my experience, I have not seen rupture by instilling a crop sized amount of food directly into the ventriculus.
And I have done several ventricular lavages.
I am sure that you have had a very difficult time and I am very sorry for your loss of Squeakie.
This little bird would roll over on his back and stick his tongue out and wiggle, he really bought me. I am the outreach director for a non profit and never buy birds unless it is to rescue them and I ended up buying him from petco of all places, I fell in love with him at first sight
You do not feel that he was ever overdosed nor could have had anything other than facial trauma as the other bird was in his enclosure?
Oh- how adorable!
I also work for an avian rescue- happy Avian awareness day- Jan. 5th!
he was special. When I went to get him, he was saying, "give me a kiss, give me a kiss" and he would bird cuss me, just bob his head and fuss...I adored him.
I really wish that I could tell you the cause of death, but without seeing the necropsy results (or the actual remains) I am left with speculation.
I am doing a radio interview on Jan 26 for our rescue, we are Parrot Guardian here in NC.
I know a bird that says that too. It is very heartwrenching.
I wish so much that I had the body sent to Raleigh for further testing..
I work with MAARS in MN.
my friend, and partner in the non profit, had good intentions, she was thinking about me having the body back.
I like Drury Reavil and also NW Zoopath; however if you would like me to review the report I can give you my thoughts.
If you have access to his remains you could always submit his organs for histopathology
with a boarded pathologist
to look for signs of trauma vs. inflammation, etc.
Slides can be made and reviewed microscopically to determine this.
I do think that the tube slipped into the esophagus and caused trauma that killed him. He changed significantly on Thursday afternoon, and started passing tarry stools shortly thereafter. He died the next morning. When called the vet said to just watch him. I should have taken him in. I regret that. I really do not think that the tubing was necessary. I have learned a lot. He was talking and using the beak, and his tongue. He could easily have been fed with the syringe by mouth. She had planned to keep him on the tube for four weeks.
(Avian awareness day=National Bird Day; sorry brain freeze)
The tarry stools signify an upper GI bleed
(coffee ground blood = digested blood)
Well, it is possible that he could have been gavage fed, but not syringe fed- I have seen more birds develop pneumonia than anything from syringe only feeding
and in a bird, what is considered the upper gi?
It is possible the tube migrated/or he could have fallen and that could have been all that it took to puncture something;
He was wasting away as well
however the ventriculus is a very muscular organ and not easily traumatized
I cannot tell you how many birds I have seen with screws, nails, etc. etc. etc. inside their gizzard that they have ground down over time!
see, that is my thought as well, something happened. All injury was head and it was healing well, and it was five days after the fact
So a tiny red rubber feeding tube is not very likely to cause trauma
but it is possible
I don't think that it went that far. It was lodged in the esophagus.
...nor was he ever overdosed with an NSAID
now, even the esophagus is unlikely to be a problem
unless the tube punctured that and severed a major vessel
or even the liver
or spleen (very VERY unlikely)
but the necropsy report reveals none of that?
I think that in the process of migrating into there there may have been a problem....the liver, if the food being pushed in was not being properly digested or made ready to digest, could that not cause damage to the liver
and also then keep him from the nourishment he needed?
If the food was not being properly digested he may have had an underlying problem that was just worsened or exasperated by stress/trauma.
birds in pain also lose weight FAST
The food you were feeding was Exact?
This is a very highly digestable food.
and not likely a problem for the liver to help metabolize
With the process of the food being the break down beginning in the stomach with the digestive juices, then the grinding process, if too much was forced into the stomach and this was bypassed, could this have caused the trauma to the liver, etc, and caused the bleed?
and if he was well hydrated he would be able to move the food easily
He was most likely in pain unless the metacam was helping.
for pain and inflammation
he had water available, he was to drink on his own
and he only had minor wounds to beak and face
and if he was drinking on his own he probably didn't hurt too bad on his face/beak
But as we both know it is not approved for use in avians and I was concerned with that when I picked him up
He was only 2?
He could have had a virus- most commonly seen in younger birds.
And it is just coincidental; or like some dogs
was predisposed to bleeding tendicies
due to his immune system
well, I don't know how much he was drinking. I am trying to remember if he drank a lot, he wanted to ge on my shoulder all the time. I hope that I did not hurt him by allowing that.
a petco bird isn't likely to have the best immune system or breeding pedigree, IMO
He was very healthy, and not exposed to anything
and is very VERY likely to be exposed to disease
well, that is the odd thing, they give their birds all their shots and test them for everything before they sell them, which surprised me.
conures also have a disease called conure bleeding syndrome
oh, really? I have others, what is this disease?
Well, IME, we have had more birds come in sick to our organization from mass breeders (several sources, all exposed to each other) than private homes
here's a good link: http://www.avianweb.com/conurebleedingsyndrome.html
I wish I could share him with you. He was so wonderful. I currently have 12 parrots, two of them fostered
Likely caused by a virus
I am so sorry for your loss.
I am sure he was such a delight to have in your life.
and no bird is even close to him. I did buy two greencheeks to replace him but they are not squeakie
12! What a great flock! Lucky birdies.
I have MS and he was my best buddy
You will never replace him; but you will always have his memory.
I know it sounds cliche, but all of the animals that have affected me are still here; in my thoughts, heart, and pictures.
And the STORIES!
Again, if you'd like me to review the necropsy report I'm happy to, but there are many possibilities here.
thank you....the last two I took in, and will be the last two that will be part of my flock, were African Greys, one of which harmed Squeakie. The male is 40 and has never had a human. He has been very abused, has one wing and I am his first person in his entire life. He was wild caught and he has come a long way. I can hold him like a baby in my arms now and he kisses me. When the last lady had him came to sign him over, she cried. He just chose me. He will always have a home. He is funny, has a very dry sense of huimor. The greys are so smart, communicate with us and we love them.
I also have a wild caught grey that I share my home with.
The wild caught are different aren't they
She is amazing. It baffles me that they survived us.
Yes, very much so.
the other grey is so different and was hatched here
She has even been exposed to some very serious disease and had resistance.
She doesn't pluck, is very smart and has a very special sense of humor.
yes, my old fellow has only one wing and the lost wing was crushed and left that way for a long time. Scott McDonald did several of his six surgeries. He has been in 13 rescues before he came to me.
Back to your original Squeakie- if there is anything else I can do please let me know. Consider submitting any remains to a board certified avian pathologist; you often can do this directly.
And if you work with an organization it is likely they will be able to help you submit paperwork.
ok, as to that. We buried him.
and it was last July
Would there be anything of any use there?
Possibly; tissue can tell us some things; you could have his remains tested for viruses, etc.
And if it is infectious (i.e. ABV)
you could know for the remainder of your flock.
But it is possible that this is traumatic only
or it is also possible, sadly, that you will not get a final diagnosis.
If he had died in the winter, I would think maybe, but he was in the ground in the summer. I made him a burial shroud, and put him in his tent with his picture and then put that in a plastic container with a poem.
That happens sometimes.
Oh, that is very sweet.
I have buried some of my own animals in the winter; after thawing the ground.
He was beautiful. My husband made a great grave for him
It is so hard to lose them.
more than I could have ever imagined. I cleaned his cage and he was out on the outside and I missed it.
I'm so sorry.
You have a flock of 12 though!
He got on the side of the old Greys cage and he bit him and I saw it. It is an awful memory and I feel so gulty
Accidents are terrible and those of us who love multiple animals all at once
are often the victims of such tragedies
and beat ourselves up over it!
yes, and I love them all...I have a Nanday, three suns, two quakers, an indian ringneck, a cockatiel and the two fancy greencheeks as well as the two greys.
He was lucky to have such a kind and loving guardian
and you are very cautious now; and probably a little paranoid.
It is so unlikely that this accident was the cause of his death.
I'm a little jealous!
I am, and the Greys were sort of new, I had gotten them in Mar and learned a hard lesson
But there are almost 80 birds at the rescue now; so I can get a flock fix any time.
but please don't beat yourself up.
It was an accident.
haha....I think that all totaled we have about 150.
And you do so much for the birds! They are lucky to have you.
We had over 200 at one point!
well, I so appreciate your time. wow, 200. I think that the hardest part is cage cleaning
I wish I could give you an answer but without records/reports I only have speculations.
I hope that this has helped you some.
I totally clean every day, they all have a large cage and it is hard
yes it has
And bird-bird injuries!
Toe bites are the pits!
haha....my cockatiel is the best at cuticle bites
I'm glad. Well best wishes for your radio interview and have a great NBD on Jan. 5th!
he has never loved being messed with and I have had him 15 years.
If you ever need assistance in the future, please preface your question with Dr. Jaime-
he feels his life has been invaded
and I'd be happy to help.
thank you and the same to you
Loverbirds are the worse, IMHO.
IF for any reason you think of anything that may fit this situation, that may help, please let me know
LOL bet he is a funny guy!
I most certainly will, I will have an archive.
*lovebirds (but loverbirds is appropriate, don't you think, lol)
My issue right now is that I want part of what they charged back as a matter of principal to donate to the rescue.
my greencheeks are really loverbirds
Ah, wouldn't that be ideal. Maybe just ask them for money and they will donate?
they get it on all the time, leaving no need to have them sexed
Without trying to threaten?
I donate all my time to the rescue; most vets are happy to help where they can...
they won't. Their business mgr has changed the reason they have no liability over and over. He is sickening
He wants me to turn them into the state board.
Without a solid pathology report, unfortunately I don't know that you'll be able to get anythign
but if they feel like they did something wrong, maybe they will donate? Or maybe they will donate just because they love birds too!
he knows that because there was not a total necropsy done I would not win, but what bothers me is that by doing so, I will put a black mark on the vets record. Win lose or draw, he would be throwing her under the bus
My career was as a stock broker and any complaint on my U4 was something i would never want
Well, that is your call, but do you want to drag your name/their name and possibly the organizations name through the mud? That is a hard question.
and she would not want a complaint on her record, regardless of the outcome.
That is true.
But you have to be sure... and without being sure I wouldn't go there.
And it's hard without a complete report... by a pathologist...
and any other person who may have a complaint against her, if they see that there has been a complant will file one much quicker.
Very true. You have thought about this a lot.
Honestly, it sounds like the vet did a great job medically
the question is "what happened?"
was it trauma?
was it a virus?
was it the elusive conure bleeding syndrome?
and the necropsy report is inconclusive?
yes, and he knows that. In a civil suit, we would be on a more level playing field because while I may not be able to prove that it was their fault they cannot prove it was not..
As far as lawsuits go I cannot comment, but the medical treatment from what you have told me is quite appropriate.
all he says in the report is that the tube was found in the esophagus leading to the stomach, and that the intestines were filled with a black tarry substance consistent with blood. He felt that the blood may be due to the head injury. His report is stupid. He did not even see he tube at first, so he is really not a good source.
Well that is something I'd have a pathologist review, at the very least
to state if that is a good report or not
tarry blood is digested blood
I cannot see how that would relate to the head injury
unless he was injured bodily at the same time as well (i.e. bitten, shaken, liver trauma, etc.)
Well, my problem with the treatment is that she said that his frontal bones were crushed and they were not. Nor were any of the bones broken that she said were. She planned to leave the tube in for four weeks and he would not have survived that. And she did not take the bloody stools seriously nor the fact that he was stumbling and acting odd the evening before he died. To me, she was negligent
Digested blood implies upper gi bleed, ulcers, etc.
It is VERY hard to say if there is a skull fracture on X-rays of a tiny bird; MRI/CT is required generally for these fractures to be CONFIRMED (but could be suspected on palpation)
If you think that you should consider pursuing a complaint
The board will review the treatment, records and post-mortem findings
and there was no injury to anything except his head, his beak torn away slightly on the right side and the sinus cavity pierced, nostril destroyed. No head trauma as in brain, no broken bones. The bleeding was minimal, only with beak manipulation for diagnosis.
so i see how she could have thought that the head trauma was
related to the black tarry stool
when there is a sinus bleed
the blood often drains from the choanae
and gets swallowed
= digested black tarry blood
well, it is late here
and I need to go to bed
But that would be a lot of bleeding over many days
and this was five days after the injury
If you have further questions at any point come back and click reply
and it was healed
otherwise if you are satisfied, click accept at any time.
Unless a bone shard dislodged or trauma recurred...
it all has been horrible.
so hard to say.
none of that.
It certainly sounds like it.
You are welcome. I'll check back tomorrow if you have further questions.