Urgent - Picking at feet

[Kentuckienne]

Katie, I'm so sorry that I'm only seeing this today. But I'm fairly certain I know exactly what's happening with Jasper. The same thing happened to Maya. Here is the link to the thread where I discussed the situation, and the solution that has kept the issue at bay for over a year now, in massive detail: http://www.parrotforums.com/eclectus/61889-okay-let-s-talk-abv-pdd-toe-tapping.html

In short, it is most likely a form of PDD. Not necessarily the form that enlarges the proventriculus (the one that killed my poor Bixby), but rather the form that attacks the peripheral nervous system. This form usually attacks when the immune system is somewhat compromised (which would explain Jasper's on again, off again toe-tapping and wing-flipping) and causes symptoms such as a tingling in the feet which prompts a gnawing to the point of abrasions and even bleeding lesions, and toe-tapping and wing-flipping.

Know this, Katie. This form of PDD, caught early enough, can be managed. Typically, an anti-inflammatory is prescribed in conjunction with nerve pain relief meds. Anti-inflammatories are also good, given the abrading of the feet. Cuts off infection if it has started, prevents it if it hasn't. The lessening of Jasper's gnawing is likely due to the fact that your vet did prescribe anti-inflammatories and pain meds. Takes a few days to really get things under control, though.

Anyhow, read that thread. It'll give you an idea of what to expect over the coming weeks. And you can also show it to your vets to help with their brainstorming session. Honestly, I'm 85-90% sure this is what is going on with Jasper. If they implement a similar plan for him as Maya's vet did for her, I'm confident he'll recover.

And Katie, you've done nothing wrong. He was likely born with it. PDD is mostly (if not always) transmitted vertically (parent to child).

As always, you can reach out to me by pm if you want to discuss this more in depth. I've got your back, my friend.

Anansi, it's indescribably great to have someone like you on this board. It doesn't seem as if any of the vets involved were going to come up with a clue ...

 

[Kentuckienne]

I personally am allergic to nickel. If anything with nickel on it touches my skin, the skin will blister and develop what looks - and itches - just like poison ivy. I have to coat all my costume jewelry pieces with clean nail polish where they might touch skin. It takes only a few hours for the itching to start, and it clears up quickly. Maybe remove everything from the cage that you aren't SURE is stainless steel, and see if that changes anything.

 

[katie_fleming]

Laylatoo I'm so sorry to hear what you're going through as well Glad the results were negative but still doesn't help you figure things out.

So firstly, Jasper is like his old self again. This is the first day like I feel like I have him back. He's initiated play, talking for the first time since Thursday, he's eating dinner like a little pig, my heart is just breaking.

I also just heard from my vet. So thankful she was willing to call and talk about things.

I told her that he can still reach his feet with the cone and that I had taken it off. She said the wounds were fairly superficial yesterday so she doesn't feel like the next cone option is necessary yet. She said if it gets worse tomorrow then we could do it, but it sounds pretty drastic. Like he won't be able to move.

She said she read through all of these threads and the one Anansi sent. I'm so appreciative she did this. I told her he had xrays done in 2015 when another vet had suspected PDD but they were normal. She told me about another test that they can do (which I was told about before but said no to) where they board him for 24 hours and take fecal samples every 12 hours.

She said they secrete it in their poop but not always so it's hard to catch. But if the sample reads positive then they definitely have it. HOWEVER if the sample reads negative, they can still have it but it's just not showing. I remember thinking, so what's the point the first time I heard this....because if it's negative it can still be positive, so the test unless it comes back positive is inconclusive.

What are your thoughts?

She also said she was trying to link the incident from 2 weeks ago (the abscess in his mouth) with this because they were close together. She said he went through an incredible amount of stress with the sedation then anesthesia and abscess removal, etc. She wondered if it had awakened something that was suppressed. I forget what she called it. Immune-suppression, something.....which triggered the PDD.

Unsure if I should do that test or not. Because unless it's positive, it could still be positive or negative, which doesn't help us.

 

[Anansi]

Sorry to point this out Katie, but even a positive result isn't necessarily a confirmation in and of itself. Thing is, there are multiple strains of Avian Borne Virus. (7 or 9, I believe.) but only 2 of those strains are known to lead to PDD. So the number of birds with ABV is far out of proportion to the number of birds who have, or will eventually contract, PDD. Further complicating this fact is that the test that detects ABV cannot distinguish between the different strains.

Add to this the fact that even having the ABV strain that can lead to PDD doesn't necessarily mean your bird will develop PDD. Partially because some birds appear to be carriers, and partially because there is a theorized catalyst that also must be a part of the mix before the ABV can progress to PDD.

Then there's the fact that the ABV test can only catch the presence of ABV when the virus is actively shedding. This causes many a false-negative.

This brings us to your question of why even bother with that test. Point of fact is that the test is a tool. While it's not as conclusive as one might hope, getting a positive result in addition to your bird showing other symptoms would allow one to reasonably conclude that the detected ABV has indeed progressed to early PDD. At this point, much can be done to both preserve the bird's quality of life and extend the bird's life expectancy... even in a case like Bixby's. Unfortunately, I didn't find out in time. All that I know I learned mostly in the aftermath of his passing.

Keep in mind though, Katie, that if I'm right about the type of PDD Jasper might have, his prognosis is far brighter than Bixby's was... and more akin to Maya's. What does this mean for you going forward? Well, I'm a little more careful than I was about keeping Maya's environs healthy and clean. And I'm more observant for any early signs of foot gnawing, wing-flipping or toe-tapping. At the first appearance of any of these symptoms, I know just what to do to minimize the duration and intensity of the flare-up.

As for your question about the feasibility of the x-ray, that would really only come into play if he has the form of PDD that Bixby did. The x-ray would pick up the enlarged proventriculus, as well as any undigested food particles traveling through it at the time.

Personally, I would have him x-rayed. Not because it's likely. As I said, I truly believe he has the peripheral nervous system manifestation. But rather, because in the less likely event that he does also have the version that affects the proventriculus, the earlier you know the better his prognosis.

Just realized I didn't quite answer your question about the ABV test and whether you should do it. Given Jasper's current situation, I would concentrate on the nerve pain meds and anti-inflammatories. Positive results yielded here would speak volumes for a diagnosis. Testing would be secondary, depending on the money you would have to work with at that point. X-ray would be second place in priority, and the ABV test would be 3rd... and completely irrelevant if the x-ray yielded a positive result.

Oh! And as for how long it took Maya, I started medicating her on May 14th, I believe, and she finally stopped completely with the foot gnawing by the 31st. The cessation was gradual and came in increments.

And Kentuckienne? Thank you. I see stuff like this as Bixby's contribution even more so than my own.

 

[katie_fleming]

Thank you so much for all of that information. I'm really grateful for you taking your time once again to help with Jasper. Means a lot.

I forget exactly what the vet said on the phone but she said she can change his current meds as if we're assuming it's PDD which would help better. Do you happen to have the names of the ones Maya is on? Maybe she was saying it's the nerve pain meds as opposed to what he's on now. I forget....so much information

So if I proceed with the xray and it still shows it as normal, I guess the ABV would be next. Did Maya test positive on the ABV test?

Did you get a cone for Maya or have any way of getting her to stop picking? The cone wasn't successful for Jasper, he could still reach his feet.

He didn't have toe tapping all day (just one or two times) but this evening it started again. It's very mild.

Edit: Not sure if this is worth mentioning but while Jasper has had toe tapping and wing flipping before he never had picking. Did Maya exhibit the same thing? He also went *ages* without any. This is so devastating that now he is picking. Since Maya had her first episode how many times has it happened during the year? I need to re-read your thread again, everything is a blur right now.

 

[plumsmum2005]

Katie, I'm so sorry that I'm only seeing this today. But I'm fairly certain I know exactly what's happening with Jasper. The same thing happened to Maya. Here is the link to the thread where I discussed the situation, and the solution that has kept the issue at bay for over a year now, in massive detail: http://www.parrotforums.com/eclectus/61889-okay-let-s-talk-abv-pdd-toe-tapping.html

In short, it is most likely a form of PDD. Not necessarily the form that enlarges the proventriculus (the one that killed my poor Bixby), but rather the form that attacks the peripheral nervous system. This form usually attacks when the immune system is somewhat compromised (which would explain Jasper's on again, off again toe-tapping and wing-flipping) and causes symptoms such as a tingling in the feet which prompts a gnawing to the point of abrasions and even bleeding lesions, and toe-tapping and wing-flipping.

Know this, Katie. This form of PDD, caught early enough, can be managed. Typically, an anti-inflammatory is prescribed in conjunction with nerve pain relief meds. Anti-inflammatories are also good, given the abrading of the feet. Cuts off infection if it has started, prevents it if it hasn't. The lessening of Jasper's gnawing is likely due to the fact that your vet did prescribe anti-inflammatories and pain meds. Takes a few days to really get things under control, though.

Anyhow, read that thread. It'll give you an idea of what to expect over the coming weeks. And you can also show it to your vets to help with their brainstorming session. Honestly, I'm 85-90% sure this is what is going on with Jasper. If they implement a similar plan for him as Maya's vet did for her, I'm confident he'll recover.

And Katie, you've done nothing wrong. He was likely born with it. PDD is mostly (if not always) transmitted vertically (parent to child).

As always, you can reach out to me by pm if you want to discuss this more in depth. I've got your back, my friend.

Anansi, it's indescribably great to have someone like you on this board. It doesn't seem as if any of the vets involved were going to come up with a clue ...

This seems particularly harsh on a profession that IMHO is extremely busy and will do forums and ours in particular no good if we have any professional readers out there and go CAV bashing just to gain a bit of kudos.

 

[katie_fleming]

Hey giys, another update.

I decided to do xrays so I'm waiting at the vet now for Jasper to be finished. The vet said it wasn't a test for PDD but I want to see if his proventriculos (sp?) Is enlarged or not and compare to his xray from 2 years ago.
She is going to switch one of his meds.

I feel so awful for Jasper couldn't help but be in tears when I let them take him to the back. He has gone through so much since Friday and 2 weeks ago with the abscess. Awful. He was shaking when he realized where he was. Just awful.

He was so sweet this morning giving me some kisses and talking a little bit. Kills me seeing him going through this.

He only picked at his feet a bit this morning but more of a scratch than anything (I think).

Will update with the xray results shortly.

 

[plumsmum2005]

Oh Katie I am so sorry, sending you supportive hugs.

Spend a few minutes with Jasper out of his cage making friends before leaving and checking he is OK to leave. Ask to do this of the nurses, I always do and Plum is OK with every visit to the AV as a consequence, had his fair share! I always go to collect him from his pod and put him in his cage or backpack.

 

[Anansi]

Thank you so much for all of that information. I'm really grateful for you taking your time once again to help with Jasper. Means a lot.

Not a problem, Katie. I've been where you are, so anything I can do to help.

I forget exactly what the vet said on the phone but she said she can change his current meds as if we're assuming it's PDD which would help better. Do you happen to have the names of the ones Maya is on? Maybe she was saying it's the nerve pain meds as opposed to what he's on now. I forget....so much information

The antibiotic is Enrofloxacin, the nerve pain medication is Gabapentin, and the anti-inflammatory is Celebrex. The antibiotic medication was a two week course, and the nerve and anti-inflammatory meds were for 30 days. He'd also prescribed a topical cream to ease the irritation in her feet, as they were badly abraded. Definitely worse than Jasper's right now. The name of the cream escapes me, but I'll look it up once I get home.

So if I proceed with the xray and it still shows it as normal, I guess the ABV would be next. Did Maya test positive on the ABV test?

Did you get a cone for Maya or have any way of getting her to stop picking? The cone wasn't successful for Jasper, he could still reach his feet.

He didn't have toe tapping all day (just one or two times) but this evening it started again. It's very mild.

I didn't give Maya the ABV test at that point, opting rather to go for the x-ray. (Bixby tested negative, btw. The full diagnosis came from the necropsy.) Everything looked good. However, given how closely Maya's symptoms matched up with the symptoms for Peripheral nervous system variant of PDD, I've accepted that she does have it. Giving her the test now would either confirm what I pretty much already "know", or give a negative result... which wouldn't mean much of anything given the proliferation of false negatives associated with that test. Nothing to be gained, really.

No, I never got a cone for Maya. The medication got it all under control after around 2 weeks. Btw, Jasper was wearing more a collar than a cone. A cone would prevent him from reaching his feet. Hopefully the nerve meds would render a cone unnecessary.

And the slowing of Jasper's tapping is a good sign. The effect of the meds is gradual, but undeniable.

Edit: Not sure if this is worth mentioning but while Jasper has had toe tapping and wing flipping before he never had picking. Did Maya exhibit the same thing? He also went *ages* without any. This is so devastating that now he is picking. Since Maya had her first episode how many times has it happened during the year? I need to re-read your thread again, everything is a blur right now.

For Maya the toe-tapping came first, and was followed closely by the foot gnawing. But the incident I described in my thread was the first time it had ever happened. Her flare-up was just an extreme one right off the bat.

A bit of good news, here. Since that one episode, Maya has not had an episode since. It's been a year and four months, now.

 

[Anansi]

This seems particularly harsh on a profession that IMHO is extremely busy and will do forums and ours in particular no good if we have any professional readers out there and go CAV bashing just to gain a bit of kudos.

Ah, K. I believe you have mistaken the spirit of her intent, here. I didn't take it as a bashing so much as acknowledgement of what I'd pointed out in my thread about PDD... that there is still so very much that the veterinary field at large does not yet know about it.

Bixby's veterinarian was an excellent one, yet even he didn't see what was happening until it was far too late. My current vet just happens to be one of those who has had a lot of experience dealing with PDD in all of its forms, and as such has a bit of an advantage in that area. And it's my good luck that he is so willing to answer all of my questions and help guide my research.

 

[katie_fleming]

Thanks for your replies Anansi. The emerg vet gave me a topical anti-bacterial cream for him. He literally runs away and up my arm, etc when I try to put it on him so I never really get a good amount on his feet but I'm doing my best.

Ok, so now for the update about today. This is the first chance I've had to sit down at my computer. I'll try and write this quickly:

• The vet used Barium this time, the previous one from 2 years ago did not
• She said his xray showed a slightly enlarged proventriculus
• She said they measure their keel (sp) and divide it by 2, and that's the size the proventriculus should be. His is she said "slightly bigger"
• I asked to see his xray from 2 years ago and now side-by-side, and it was difficult to even see anything b/c the first vet didn't use Barium, and it looks like things were a bit shifted last time

I took a picture with my phone of the computer screen. I am waiting for the actual file of the xray (they charge for the DVD and I paid for it the first time but this time she said she would email it to me but it wouldn't be good enough if I wanted to use it for a second opinion). The zoom % on both screens was not the same as far as I could tell. It was a +/- button but I did not see what they were both set to so I don't believe they were at the equal zoom anyway.


But here is the picture I took on my cell phone. Left side: today, right side: 2 years ago. Until I get the file and can put it side-by-side myself in Photoshop I feel very uncomfortable even posting this because the comparison is bad but here we go anyway:

She said while the proventriculus is not super enlarged, "like 3 times the size" it was still bigger.

So, she said the enlarged proventriculus was not necessarily indicative that it is PDD. She said it could be a few things:

• PDD
• Infection of the proventriculus
• Metal toxicity

She said since he had his abscess 2 weeks prior to when this happened, she wondered if (and remember, they had to stop the procedure halfway through due to Jasper's heart rate fluctuating too much, so she wasn't able to empty the entire abscess) if the infection could have spread. I guess since the proventriculus is part of the digestive system the infection could have spread there.



On Monday when she did a crop wash/tested poop (sorry forget the name) she said she found a bit of yeast but had to use 5 different settings on the microscope to find it and there wasn't that many.



(Big breath. I've been crying and man today is just awful.)


So she prescribed him the following: (1 month)

• Antibiotic (different than the one he was on for 2 weeks)
• Anti fungal
• Nerve pain medication (assuming it could be PDD)
• Anti-inflammatory (assuming it could be PDD)

I really questioned her about whether or not she thought based on his history, results today, etc, if it was more likely to be infection or PDD and she said both were on par.

I really struggled to make a decision about doing the ABV test since it's so inconclusive. I waited until my parents were both home to talk to them about everything, I simply couldn't make a decision on my own. I even talked to the vet a second time for quite awhile about everything. She was excellent at explaining everything but I know she simply doesn't know. It could be too many things I guess.

She said she feels comfortable waiting a month while he's on this cocktail (man it's so many meds to give him I'm just overwhelmed and feeling such defeat) to see what he's like after. She said we can do bloodwork at that time to see what his WBC is doing. She also said we could do another xray but there's a few possible scenarios that are problematic:

• Proventriculus doesn't shrink: If it is an infection, perhaps it's being resistant to the meds she prescribed; or; PDD; or metal toxicity
• Proventriculus shrinks: Infection could be gone; still can't rule out PDD

I feel like I'm forgetting something but it's after midnight and I'm just done right now. Jasper was such a trooper today and really is the sweetest bird. Breaks my heart. He's still wing flipping a lot and a bit more toe tapping tonight (seems to only pop up later in the evening now; mild). He's still picking a bit at his feet but no new wounds since Sunday and looks more like he's scratching at the pre-existing ones.


Thank you to whoever in advance actually has read this entire post, there's so much in here. If I think of something else I forgot I will add it tomorrow.



Time to try and sleep now. Going on day 4 of not going to work but luckily can work from home right now but not Friday. Using sick time for when I'm at the vet and trying my best. Worried to death.

 

[katie_fleming]

Posting a follow-up. These are his xrays from 2 years ago (no barium). Once I get the file from my vet from today then I hope to have a more accurate side-by-side comparison, especially since the one (above) on the left I'd zoomed in like crazy. Really annoyed the first vet didn't use barium....

 

[plumsmum2005]

Katie you are doing so well in very difficult circumstances. You will get through this, you have so much love for Jasper and show such diligence with his care. I am hoping you managed to get some sleep. My thoughts are with you.

 

[Anansi]

Hi, Katie. First, sending you the biggest virtual bear hugs, my friend. Take some solace in the fact that you are doing everything within your power to help Jasper. And I cannot stress enough that PDD, when caught early on, can definitely be managed. One vet told me of a macaw who had been under his care for PDD for around 12 years. The mac is strong and healthy and only needs to have his situation managed during flare-ups when his immune system is compromised.

So if Jasper does have PDD, please don't despair. A slightly enlarged proventriculus means it was caught early. That said, however, I must applaud your veterinarian's caution and determination to cover all bases. Her approach is a sound one, and she has made sure not to close her mind off to the other possibilities such as metal toxicity or infection.

We're all behind you, Katie. You've got a whole community here wishing the best for you and Jasper.

 

[katie_fleming]

I really appreciate all the support. I've had so many meltdowns. Jasper is my everything.

At this point I don't know what to think. My vet is saying it could still be one of many things and not necessarily PDD. I want to get a second opinion. I am waiting to hear back from the emergency vet that I took him to.

I asked for a copy of my vet's notes. Here's more info. Shows how uncertain she is based on all the possibilities. Just wanted to share to see if anyone had any extra input for me.

I'm still trying to be optimistic that it isn't PDD but I don't know what to think anymore. I can't lose Jasper

I am happy to report that he looks like he's feeling much better. I brought him to the park yesterday in his carrier and he was quite happy. Talking again, eating well, even initiated playing with me a couple of days ago. I think the meds make him a bit drowsy but otherwise he's still on the mend but each day is better than the last.

It takes awhile to give him meds twice a day, 4 in the morning, 3 in the evening. He takes them well, I'm so glad I trained him years ago. He shakes his head sometimes but I give a little less at a time now and it seems better.

I am determined to figure out what this is.

I went into Photoshop and put his first xray over the second xray. I re-positioned his body so they'd match better so if you switch between the layers in Photoshop (or just switch between the photos, back and forth) does it really look that much bigger???? It's a damn shame the first vet didn't use Barium. Maybe I'm just seeing what I want to see. But I definitely want a second opinion and I definitely want a higher res version of his xray (they make you pay of course but I want it)

They really need to be downloaded so you can go back and forth easily.

 

[plumsmum2005]

Be brave, you are! You will get through this, take one day as it comes.

Very pleasing news to hear Jasper is looking/feeling brighter.

Brilliant news he takes his meds, he is such a sweet boy.

Keep the faith, don't lose hope. Sending you hugs and prayers.

 

[katie_fleming]

I've shown two other medical professionals his xrays and both said they can barely see any difference between the two. I am definitely sending these to other vets as soon as I get the high res file.

Anansi will PM you

 

[katie_fleming]

Hey guys, just wanted to post a quick update about Jasper since its been a few days.

Firstly, I continue to see daily improvements which is great. Last night was the first time I did training with him since before all of this happened. He was so excited to do his puzzle and let me put his harness on no problem. Had to change up his treats since he's getting far too many with meds twice a day.

He's talking, playing, and seems almost be his old self again. However, his wing flipping persists. I'd rate it as moderate right now but it seems to be better/worse at certain times of the day? Hard to say for sure since I'm at work through the day. He has mild toe tapping. It's pretty non-existent for a bit but then seems to pop up. Very mild however. I'm wondering if I should stop his pellets for a couple weeks and see if that does anything. He's on Roudybush, the ones his breeder recommended. Only 1 tbsp a day.

His feet are healing slowly. He seems to pick a little bit now and then but I think it's from them being itchy as they heal. He really doesn't like me putting ointment on them so I do my best but he simply won't let me get every spot.

I'm still waiting for my vet to send high-res versions of his xrays. Sent another reminder this morning. They make you pay for the CD (kind of dumb when you've just spent $300 to have an xray done) but I said I'd just pay over the phone and they can email the file. Hoping I get it soon. The ~200px one they sent is far too small.

Even though my bank account is absolutely shot right now I did an order yesterday of some new toys for him. Hopefully they'll be a nice distraction and help lift his spirits even more while he's on all of these meds and recovering.

That's about it for now I still haven't been able to get back in touch with the emergency vet but will try calling again later. Hopefully I can get those xrays soon. Thanks everyone for keeping Jasper in your thoughts

 

[LordTriggs]

good to hear he's improving and returning to his old self

I'm not an Ekkie owner but the consensus I hear constantly is not to feed pellets and instead only feed fresh fruit and veg

 

[coopedup]

Katie, There is a direct correlation between wing flipping and toe tapping and pellets with Wrangler. Might not be with Jasper, but it's worth a try giving them up and seeing if they make any difference. To replace them try a small apple on a skewer in his cage. Gives him something to forage/eat/play with during the day. Glad to hear he's improving!