Happy New Year!
I know I'm such an emo. I really need some guidance. I think these three questions might be easy. The first two are to know if the advice is even safe.
I apologize if this is a repeater. We have a new development and no search function.
Ginger, 12 years with a heart murmur. "Heart murmur is benign". Clover is a tiny 57 gram parrot that's not a spring chicken either at 11 years old. But from my understanding, and I'm not a vet, that it's not safe to keep putting dogs and parrots, especially Ginger and Clover with those two important factors each, under general repeatedly.
Dog vets: Ginger keeps having the sebaceous cysts. We were basically told to ignore them until they become a problem by becoming impacted or becoming enlarged. They became quite large. So under general, they carved them out and sutured her.
But new ones are back. One has already ruptured. But right now they're small, though many in number. I understand they run deep. Again the vets at our practice gave us the same advice, only now allow them to rupture twice. I also called around and got the same advice elswhere and dermatologist who don't do any surgery. Then I hit upon one dermatologist who actually does surgery. They said, sure. If the dog is calm and tolerates it, upon an exam, we can do a local block and remove the cysts while small.
I don't want to set vets against vets, but isn't that more safe than putting Ginger under general, with her two potential danger issues, under general each time we get a new crop of cysts and they they too become problems? The one that ruptured is already a problem, it lies under her harness. I don't like putting pressure on her neck, and it also rubs what she lies on.
Avian vet: Then Clover, with her occassional mutiliating (skin perferations) and plucking. New vet threw a lot of meds at her at once. If one worked, I dunno how we would eve be able to tell which one was the lucky one. But it didn't work and I don't think I should have gone along with everything at once. Her crop swelled up after the high dose of Meloxicam and it was an ordeal.
Anyways, then the vet starts getting excited talking about Lupron. For once, I don't let emotion take over and I tell her I'll have to touch base with her after some considering. This was even after one dosage of Lupron. I didn't know it needed a series. She didn't say. Nothing happened, if it was supposed to, I understand from what she told me, that the series was required for result. So a while after that initial dose, she began again with the series. I asked for pricing to plan how to pay for it. Then my head is whirling because she starts talking about a surgical procedure to implant a Lupron implant. Putting my tiny bird under general and inserting it. Not just once, but annually. Much more expensive than the injections. I'd like to know why surgery all of a sudden. Then she's telling me how the injections don't usually show any results anyways and the surgery is the only real way you'd know if it works. Obviously, I'm worried about her limited quantities of blood should anything go wrong, the sedation, and everything else involved for a non-life threatening, occassional problem.
Out of curiosity, I ask another avian vet at a different practice. He tells me, not in so many words, that it's pretty crazy and I should try less invasive, safer things first, like biopsying the site to see if there's a sudden flare up of an infection when she does her mutilation/plucking bit.
Isn't that much safer than putting my tiny bird under general for an implant?
Now for more in depth advice required please. Sigh. Ginger again. (She was a puppy mill dog who came with health issues so it's not all in my head. How many dogs have DI??!)
I swear, all of a sudden, Ginger's bottom insisors are worn down or broken but they're tiny and jagged, the gums there get angry, and the top (PERFECTLY still there) insisors bite into her bottom naked gums there and she bleeds. She'll happily still chew away on cookies (I've never given bones and other teeth breaking things for this reason minus when I tried duck feet) with blood covering whatever she's eating. Her famous stomach was runny so I gave her white rice. You should have seen it turn pink!
I don't know what to do about this. We went to a service dog consult and they diagnosed stage 1 periodontis disease at 12. Since I'm neurotic, I brush her teeth daily with a soft brush and gentle strokes. (I've been doing it for 12 years so it's not just a gum injury due to that.) So anyways, understandable at 12 years of age, right? Well the vet dentist advocated putting her under general for a full cleaning... Lord knows what kind of advice I'll get between them (they're the resident vet dentists) and my general care vets. I don't know what to do.
Hmmm. Those are pretty complex problems. I won't hold still for a thourough scaling of my teeth and myself wish I culd be put under but I can see your concern. Has she ever had any heart problems under a general even with a nurmur? You can see the problems that might arise if they all tried to do a thorough cleaning without sedation.
Is Clover a codkatiel by any chance? Just asking. What exactly woudl the Lupron be for? Is it a cancer drug or what?
Are you near a university vet school? Soemtimes you can get terrific consults and really up to the minute care at their clinis.
Oh Michelle, what a post!
Okay, first lets talk Ginger...
I don't think I would describe a heart murmur as benign. Most murmurs in older dogs are pathological, meaning there's something wrong with the valves of the heart that is causing the murmur. They can be mild and not causing overt disease or they can be causing problems. I suspect when they said benign they meant that it wasn't causing a problem or she had very mild changes to her heart.
Murmurs may progress over time. Some stay the same and never cause a problem but some can progress into heart failure. You never know what path it'll take, you just have to watch and wait over time.
Yes, dogs with murmurs and some form of heart disease are more at risk under anesthesia. As are older animals in general. However, a murmur on it's own doesn't mean anesthesia and surgery won't be tolerated. When was the last time she had an ultrasound on her heart? Or even if she has? If she needs surgery and you're concerned how much her heart will be impacted - get an ultrasound or repeat ultrasound first to see exactly what is going on in the heart and whether the ultrasonographer (usually a veterinary specialist) feels she'll be able to tolerate anesthesia. That might put your mind at rest or flag up any concerns that might be brewing. There's also lots of different anesthesia protocols available to us know so we can tailor everything to the individual needs of each animal. Anesthesia is also much safer over than it was in the past.
That being said, you always try to minimize the amout of time any animal gets put under. Just like you do in humans. Sometimes it's unavoidable but the least amount of time put under anesthesia, the better.
Sebaceous cysts are irritating. They're totally benign but, like you found out, can grow quite large and can burst. Draining them alone doesn't always work because they just fill right back up again. Some dogs are just more prone to them than others. Surgery is the best way to make them go away and not return. Though, that doesn't mean they can't come back elsewhere. Like you've also found out.
Local blocks versus general anesthetic - the short answer is that it depends on the animal and depends on the procedure. The skin is a very sensitive organ and the sensation goes pretty deep. You need to get the block deep enough into the deep tissues if you're making a full thickness cut into the skin, which is how most cysts are removed. You also need to be fairly comfortable with that type of anesthesia. Giving the local anesthetic hurts and it can sting until it kicks in. And the animal must be calm enough to sit there for the procedure. You also do have to be a little careful with the amount of local anesthetics you give because dogs and cats (and other animals) are more sensitive to them than humans are. But, if you can meet all those requirements then yes, the local block and surgery is safer than general. But, there's a lot of buts if that makes sense. Some of these cuts are pretty precise and if the animal moves you could make situations worse. If you've found a vet willing to give it a try with local, then definately try. I don't think I'd personally feel comfortable doing it unless a lot of criteria were met - small cysts that wouldn't need a lot of time or work to remove, a patient good dog, etc.
Her teeth sound a little odd. You said they all of a sudden broke or became worn? Are they worn to the gums? You said there are sharp points? Just because the bottom teeth are broken or gone, doesn't mean the top should damage the bottom gums, especially enough to make them bleed. That sounds a little fishy to me and I would let someone have a look, though it sounds like you already did. It almost sounds to me like the remaining bottom teeth should be removed so the gum can heal. That way when the top teeth hit the gums, it shouldn't bleed. Dogs lose their teeth all the time and never have bleeding issues with the opposite teeth. To be honest, I would consider the dental before the cyst removal if it's causing her to bleed. Again, if you're worried about the heart - you can always ultrasound first.
Hope that helps for Miss Ginger.
This post was modified from its original form on 05 Jan, 18:46
Now, I certainly don't claim to be an expert on birds.
Lupron is a hormone regulator that can effect both male and female hormones and, therefore, can be used in both males and females for certain reproductive and hormonal problems. In humans it's used to treat prostate cancer, endometriosis, early puberty and other problems. Basically, the drug will reduce either testosterone in men and estrogen in females. Helping conditions that are under the control of those hormones.
In birds, it can help unwanted egg laying and some agression, regurgitation and feather plucking. For the latter 3 (aggression, regurgitation and feather plucking) only if they are under hormonal control. If there's another underlying issue, the Lupron probably won't make a difference. It does need to be given as a course of shots but the length of time is dependent on if there's an improvement, how much of an improvement, and toleration.
I've used the depot implant in dogs and ferrets, never in birds. I suspect it's something like giving a bird a microchip and I would certainly shy away from that in small birds. I mean, there's not a lot of fat or muscle in little birds to place these implants. I agree with the 2nd opinion vet who said it seemed a bit extreme to jump to implants, especially for an occasional problem. I'm also not entirely sure why the implants would work better than the shots. It's the same medication so should have the same impact on the hormones.
Personally, I would hedge more on the side of caution rather than lets take these extreme steps and see if it works. I would certainly try a course of injections first to see if it'll help. The skin biospies to rule out infection. Heck, I'm not even sure you need a biopsy - maybe just an impression smear or trial course of antibiotics when she starts feather plucking.
Lupron is still pretty new in general and there are more and more uses found for the drug. It's been a wonder in ferrets, where some people are leaning more to yearly implants than spays and neuters. I've also used a similar product in an older female dog that had been spayed but was still showing signs of heats. After some testing we found that a small piece of her ovary had been left by mistake and she was still getting all those hormones. But she was old and fat and it would have been next to impossible to find that tiny remnant (they only have to be a speck of a tissue to cause problems) and the owners weren't keen on surgery either. So we tried the implant and it kept the heats at bay. But a dog is much different to a tiny bird.
They're going to be expensive too because if you think about it, it's a years worth of medication in one administration. Plus, more so with birds who need to be put under to implant it.
I just don't know if it's worth all the expense and stress for, like you said, an occasional problem that you're not even sure it's hormonal and not some other cause.
I would be hesitant to do the implant and I think I'd try the injections and other steps first.
Hope that helps with Miss Clover.
First I have to apologize for my really confusing post. I have a cold and it was really bad the day I wrote the intitial post and now reading it back over, I was rambling, repetative and unclear. I'll clear some things up now.
She's always had a heart murmur, even since she was a pup and it's always, thankfully, never caused problems or worsened but it's still a factor when considering anesethia for her. She has had an ultrasound a few years ago and we'd repeat it if anything changes or she needs to be put under.
Ginger's really calm and stays very still for procedures. She's also very stoic when it comes to pain. Of course I can't really say how she feels when she gets things done but she doesn't even flinch or show any stress signals. I've been told that Adequin injections can sting and be painful but you wouldn't even know by watching Ginger get them. I don't know how the sensation compares to a deep local block. I've also had some moles removed from myself with a local block and again, I don't know what that would feel like for her but the injection of the block was the most aversive part of the procedure for me but judging from my own personal experience with it, if it's anything like that for her, it wasn't that bad and if it's safer, then I'd prefer that for her.
The front bottom insisors are either worn or broken. I think you're right that any remaining bits of tooth need to be removed. Her top insisors press into the bottom gums and where I see this happening is where I see blood. I wonder if that's because the bottom gums are inflamed and swollen from the tooth fragments and if those teeth were gone, the top teeth wouldn't injure the gums anymore.
I think it's time to change vets again for Clover. I just don't get a very good feeling about our current one with these dramatic and invasive treatments. It's been much more than just this implant. It was a lot of other things as well. Thanks so much for the advice on less invasive tacts than even a skin biopsy. It would be nice to not have to put her through the stress of removing skin if a smear or course of the antibiotics will suffice. That will be our next step when the plucking and mutilation next rears it's ugly head and then a series of Lupron if the former doesn't work. Since I found what may be a good new vet to take over her care and a game plan for the plucking/mutilation, of course Clover's let up on doing it for now so we'll just have to wait for next time.
It's not fun. With a house full of pets, it feels like there's always something and it usually lies with Ginger. Then I rescued another puppy mill dog and she has her own problems but nothing like Ginger. At least yet.
No apologies needed!
As long as the heart murmur is stable and she's had general anesthetics before and done well, then you should be okay should she need it again in the future. Taking a wart off a human is a little different than taking off a cyst in a dog. Usually with humans, they'll use local and scrape it off or burn/freeze it off with liquid nitrogen. It's all very superficial. Usually for dogs, we have to cut into the skin and usually full thickness (deeper) than they do for humans. But if your vet thinks they can get good analgesia (pain control) with a local block and is happy to do the procedure, then it's worth a try. Like I said, it all depends on how big the offending lump is and the dog. Also, the nature of the lump. It's worth a shot to avoid general anesthetics.
Glad to hear her heart murmur is currently stable. That's great!!
How's it going with the neurologist and all that? Made any progress or got an answers? I can't remember, did you end up doing the MRI?
It also sounds like you've got a good game plan for Clover. And I'm glad it seems like you've found a good avian vet that you can trust. Someone who'll work with you and get plans in motion rather than going for the most dramatic things first.
And isn't it always the case... You can be guaranteed that whenever you bring your pet to the vet for a specific problem, they're always better. Maybe it's the adrenaline of, I'm better and I don't need to go to the doctors.
Good luck with all you've got on your plate. Tell us about the new little rescue. Is she yours or a foster?
I've got some pretty great news. One of the vets said Ginger's growth is a wart and so she removed it today with Ginger awake, just laying there. She was so good that they also removed a skin tag from her cheek that she has a tendency to scratch and make bleed so it was a nuisance. Turned out that the wart was indeed a sebaceous cyst but the good news is that we've found our new primary vet who is ammendable to keeping an open mind about things.
So I also had her look at Ginger's bottom incisors. She said she couldn't be 100% sure but she thinks that the teeth aren't actually that worn down. She thinks that the gums are just that puffed up. Bad news is that she has to be put under for this proceedure so they can be lazored down. But her teeth will likely not have to be removed, which I'm happy about! Her gums are really inflamed and unhappy so we need to get it done soon. We brush every day so it's just one of those things. She doesn't think it's cancerous because it's a whole area, not anything that looks like a uniform tumor. I'm trying to stay positive and not worry about all the bad things that it could possibly be so we'll lazor them down and hope they don't come back up again.
Then Clover. She mutilated and plucked again and we saw the other vet. I think we really liked him! He did a scrape and found bacteria and yeast. But he (and I) think it's most likely secondary, as in getting into the wound rather than being there first and being the reason she's digging into herself. But it's possible it's primary and the cause so I'm just going to observe her on the antibiotics and yeast meds.
I realized, Clover shows hesitancy before hopping from a distance (like from perch to perch) or before launching herself into flight. So this got me thinking. Maybe there's some early arthritis or some undetected injury that's causing her pain and thus, causing the self inflicted harm. So I'm also observing her on Gabapentin. But the next order of business will be X-rays and I'm okay with that. She'll have to be heavily sedated but not put under general, so I feel okay about that too. I don't think being un-sedated and in restraints would be a good idea for a prolonged series of X-rays. She's just so neurotic and being a prey animals and everything, I think it would be more stress than it's worth.
If that shows nothing, then we'll look at a series of Lupron and if that's promising, then possibly an implant. Then we'll have just about exhausted every medical reason for mutilation and plucking.
Daisy came with us (Clover's sister) and we had her annual done with this vet. Wow. I've never seen her so calm at a vet appointment before. She wasn't biting at all. I couldn't even believe it. I think we might be switching to him. He was confident, calm, expedient but gentle. Very competent, or so it seemed. I also liked that he took blood from the jugular rather than quicking a nail and leaving that boo boo open to picking and dirt.
Ginger got her MRI two years ago and there's only a slight progression in her back issue and leg issue. We've found Duralactin and I'm surprised at how well it works! I have no idea what hyper immunized cows are and what the milk protein would do but I'm not the only one who's seen a difference in her. I'm also considering swim therapy for keeping up muscle tone.
Or did you mean for her Diabetes Insipidis? We never got a MRI of her head so I dunno if it's due to a tumor or what. We're tackling one problem at a time and eventually, we'll see a specialist for this and see if an alternate treatment for this condition effects her ability to stay cooler. In the meantime, the cold weather and short hair is sufficing for now.
Angel was my long time foster and I've adopted her last October after fostering her for a year. I still haven't signed the contract but she's stuck with me! She was a breeder at a mill that was shut down and comes with those typical issues. She's come a long, long way. It took a long time but she's almost "normal" with me. I let her come around in her own time. She LOVES Ginger. She's lazy, has pretty much no prey drive, is highly food motivated, and fits in really well. She's an adorable small mini poodle (10 lbs), white with an apricot stripe down her back. Has allergies (like Ginger), has a collapsible trachea, and those seem to be all her health issues so far. I think she may have Canine Compulsive Disorder because ANY time she gets excited, whether good (play, walks, going outside) or bad (vet visit, people she doesn't like, strange experiences), she barks. She also rubs against things repetitively and licks my face repetitively. When really stressed (mostly vet stuff), she circles and works in her other strange behaviors in patterns. Clomicalm and behavior modification are doing wonders for her and she keeps improving.
She's incredibly smart and learns things so fast. I'll probably do agility or treiball with her. I'm thinking I'll do treiball with Ginger, since it's low impact, and agility with Angel since I can't do that with Ginger but Angel can. Then maybe some other dog sports.
She's loving life! I'll have to post some pics of her. She's too cute for her own good. People can't seem to control themselves around her.
Was Ginger's MRI really 2 years ago now? Holy crap! Time does fly.
I'm so glad to hear she's doing so well. I always think about you and Ginger and the rest of your clan. And it sounds like you might have finally found a primary and an avian vet that you can really get behind and trust. That makes all the difference in the world. I can already tell the difference with tone of your posts when you talk about them. You seem much happier and much more confident with both of them. It's wonderful to see. Because the trust between the owner and the vet has to be strong, stronger even than the trust between a person and their own doctor. It means the world and I'm happy that you seem to have finally found that and that things seem to be falling into place.
There's nothing about the DI that will show up on an MRI, I was thinking about the one for her back/hips but I thought it was way more recent than 2 years ago. Crazy.
Let me know how Clover does on Gabapentin. I've had very variable results with that pain medication in dogs, at least. I'm not totally crazy about it but keeping an open mind. I've heard good things about Duralactin and I used it a lot more in England than I do here. It was just coming out in the UK when I was working there. The milk caesin proteins from the milk have been shown to block the inflammatory processes for some reason. No one really 100% understands it but it's a nice, safe, non-medicine product that really seems to work. Glad it's working for you and even happier it's working for Ginger and giving her some relief. It's not that well know here, in the USA, so I often forget about it.
Angel sounds like, well... an angel! I can't wait to see pictures of her. And it sounds like she's found a wonderful foster failure home.
Thanks for the updates!
I remember when Ginger was on Gabapentin, it was so-so but more than anything, pretty much put her to sleep. With Clover, I think it's helping because she doesn't seem to hesitate before launching herself or jumping anymore. I'm getting over my sleep problems and a lot still gets by me so I could be wrong but I think it's made a difference, but can't swear on it.
But we got near the end of her medication (for the fungi and bacteria) course and she dug into her wing again. I'm not sure at all that it's an infection that's causing the mutilation. So like I said, next step whole body X-ray and then next step if that fails is a series of Lupron. If that works, I'm pretty sure our new lovely doc (I love him! lol) can implant it without having to put her under anesethia. From what I understand, it's about the size of a dog's microchip? I could be wrong. But if it is, they can deal with it! Lord knows they've done more painful things to each other and themselves. Ok... We'll probably do pain meds.
But all this has to wait because Daisy decided it was her turn to freak me out. All of a sudden, she's not her fiesty self. And she has patches of missing feathers. And she has an "egg bum". Looks like she's ready to pass an egg. But she's been like that for a month. I didn't feel any egg when I palpated but I'm not a vet! I dunno if I woud even recognize it if I did.
He didn't feel an egg when he palpated. He said to give it time. Then her CBC came back with a high cholesterol value! Like really high. I can't remember which one it was in particular.
Then a couple of weeks later, her egg bum was bigger so we went back to see him. She got a Lupron injection, an X-ray, and a more comprehensive cholesterol screening.
X-ray showed nothing but a follicle on her overies that he didn't if was know was normal or not. Turned out it was, she laid an egg a couple of days ago and probably has another one on the way if it was a follicle such a short time ago? Then the blood work came back and it didn't show alarminginly high cholesterol. It showed slightly elevated VLDL and tryglcerides (I'm not sure, are these the same thing?). He said to give red palm oil. Sunshine Factor, though I'll probably buy not that brand. It's all the same, just more money for a tiny bottle.
The thing is, her diet isn't high in cholesterol. In fact, she's on a low fat, low protein diet and I don't give her junk food so I'm guessing it's also low cholesterol.
I've started giving her oatmeal for breakfast every day. I'll have to research other cholesterol lowering foods. I'm not huge on supplements but maybe even I'll look at those.
Oh, and he said that there's no indication that there's cancer or a tumor causing the egg bum. That it's probably just inflammation/fluid retention. So that's a relief.
And that the bare patches were most likely from her plucking due to discomfort.
I don't really understand where this elevated VLDL comes from. High cholesterol of any kind has never shown up in her annual CBCs before. And I don't see how her diet could be causing it. I think the fattiest thing she eats is flaxseeds I give for the omegas and nuts for occassional treats and foraging.
I'll post pictures of Angel in the family thread. She's SOOOOOO cute! She has a pony tail thing going on right now. Lol.
Her swelling is going down. She's lost a few grams and is back to normal weight, although I can still see a bit of an egg bum left. Some of her bare patches have pin feathers. Looks like everything was hormone related.... Her bile acids were also elevated, though slightly. I'll have to get her cholesterol rechecked sooner or later to make sure it's normal again.