Waiting to see the vet in an hour

I am crying for you guys and with you guys!! Can the vet do an x Ray? This seems like it could be an intestinal blockage..... Cairo o want you better!
 
Still praying hard for Cairo. Also want to reassure you on a certain point. I know how badly you must want to take him with you so that you can watch over him, but you're doing the right thing by leaving him with your partner. If things should go critical, there is a known vet familiar with his situation right there. While we would all want to be there for our fids, right now it's more important that he is within reach of the care he would need if at all necessary.

Given that he's still vomiting and not taking in enough fluids/food, however, your partner should probably preemptively take him back in. He was already dehydrated, so he can't afford to lose anymore.

Come on, Cairo! We're all pulling for you! Stay strong! Fight this thing!
 
My heart squeezing for long few seconds every time I saw a post that he is still vomiting. **SOB***

HANG IN THERE BUDDY.. YOU CAN DO IT!!!!!!! Keep some foods in you PLEASE!!!!
 
Okay, deep breath...

First of all, he's so weak because he's terribly dehydrated, and that's why he's in danger of dying...As someone else already mentioned, I would have your partner take him back to the Vet so they can give him "Sub-Q" Fluids, or "Sub-Cutaneous" Fluids, which means "under the skin". This doesn't require an IV/finding a vein at all, they simply fill a large syringe with fluids, such as Lactated Ringers Solution in this case, and they inject it right underneath the skin on his back. The fluid accumulates under the skin and forms a visible lump that slowly gets absorbed into his bloodstream over about an hour or so. It's the quickest way to get a large amount of fluids into a bird who is so dehydrated and who's blood-pressure is so low that they can't find a vein. It takes all of a minute to do, it doesn't hurt them at all, and it's also something that is actually easy for most people, even inexperienced people, to do at home once a day...Although there shouldn't be an issue with your partner bringing him in for this once a day or so to keep him going...The other great thing about a Sub-Q Fluid injection is that it's not being put directly into his GI Tract, so he won't vomit it back-up...That's what is making him so sick right now and putting him in-danger of flat-lining, the fact that he's so dehydrated that his blood-pressure is tanking. I'd call the Vet ASAP and tell them he's still vomiting everything up and is severely dehydrated, and ask them if they can give him a Sub-Q Fluid injection ASAP and see how he does with it. I'll post more below, but that is the most important thing you can do right now for him, get fluids into his body to keep his BP up and do it in a way that he won't vomit back out again...
 
I am so sorry that you & Cairo are going through this. I am praying hard for him. Keeping you all in my thoughts and hoping for good news soon.
 
Now if I have this right, Cairo was totally fine all day long and had been totally fine, right up until the point that you gave him all of the new toys/treats, correct? And his first symptom was excessive vomiting..How long after he started playing with the new toys/treats did he first vomit? Are his droppings at all runny/loose or do they have any bubbles in them?

****Did the Vet do a regular X-Ray? Did the blood-work they ordered include a heavy-metal panel? He needs to have a regular X-Ray done ASAP, like immediately if any of the new toys he was chewing-on contained any metal at all.

Are any of the new toys he played with for the very first time that night before he started vomiting made of metal, or do they contain any metal parts?

***I'm going to go ahead and assume that this is heavy-metal poisoning until they take an X-Ray and confirm that it isn't. The reason I'm saying this is because he was completely fine with no issues at all, then he played with new toys (I'm assuming there is metal in/on some of them somewhere), and then he started vomiting constantly, and is still vomiting now a day later with no signs of it letting-up, even with the anti-emetic medication...It's likely not anything like a bacterial or fungal GI Infection, simply based on how quickly it started, the fact that it started right after playing with new toys he never had played with before, and the fact that it's not getting any better at all, he's still vomiting up anything he puts in his stomach. These are all indications that there is something in his stomach or upper GI-Tract somewhere that shouldn't be there, and he's probably not going to stop vomiting until it's gone...If any of the new toys he was playing with are metal or contain metal parts, it's a possibility that he ingested some of the metal, even just a tiny a bit of metal-plating on a toy like a bell can cause metal-poisoning in a bird. If they ran a Heavy-Metal panel as a part of the blood-work he did, it may or may not show-up depending on what type of metal it is, or because they took the blood so quickly after he ingested it. However, a regular X-Ray will immediately show if there is anything at all inside of his stomach or his GI Tract that shouldn't be there, and if it's metal they'll know immediately. He needs an X-Ray ASAP...

It could also be a blockage somewhere throughout his GI Tract, they sometimes will ingest a part of a toy, not necessarily metal but anything, even something made of some kind of fabric, and this can get stuck in their Crop, or anywhere below in their GI Tract, and cause a GI Obstruction. In most cases this too will show-up on a regular x-ray, and sometimes they can simply use an Endoscope to do a flush and then collect whatever it is that is causing the blockage. Without seeing the toys he was chewing on it's hard to say what it might be, but just the way this presented so acutely is indicative that he ate something he shouldn't have...

If it is metal-intoxication, they have to do something called "Chelation", where they feed him a substance that will bind to the metal and then it will be carried out of his GI Tract normally, and the substance that they feed him actually absorbs the metal and keeps it from seeping into his bloodstream and poisoning him more...If it's not metal poisoning, it could still be something from the new toys that he swallowed, as someone mentioned some of those foraging balls have little tiny magnets that hold the pieces together, or it could be anything really, and it will most-likely show-up on the X-Ray. If he continues to just vomit and vomit and vomit every time he eats or drinks anything, that is a pretty good indicator that he has something in his tummy that shouldn't be there...
 
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Cairo is doing slightly better. We skyped this evening. I called to him like I normally do when I get home, and he flew out to find me.

My partner offered him a variety of foods - chop, watermelon, banana water, formula, and I think something else. Cairo ate the watermelon and some watered chop. He seems to be keeping the food down now. However, his droppings are very watery. My partner said, after the watermelon, Cairo just passed the watermelon straight away, turning his droppings pink. We've been wondering if Cairo has an allergy/intolerance to watermelon, but if it's what he can eat, then maybe we'll have to risk that trade off.

As soon as the vet opens again on Monday at noon, my partner will call in to arrange a timing.

...

As for the cause, we talked it over with the vet. I literally ran through his entire history with her to find a cause (like 'two days ago he smelt a bit sour but he smells normal now' to 'he used to get lost for weeks with his previous family, could he have picked up a disease'). Our vet says it could be possible he could have picked something up that's only now just surfacing (she mentioned that the free-flying community here has parrots that have picked up wild diseases and transmitted it within the group unknowingly, and Cairo was originally part of that community).

She has tentatively suggested that it might be the package of foraging toys. She had an incident where a dog got exposed to airline fumigation (like the disinfectant they gas stuff and people with) and the dog got an asthma attack from it. So Cairo was in the room when we opened the package - it was very dusty as well, and he tried to fly into the package, which likely stirred up the dust.

Then again, while his droppings looked normal when his vomiting first started, they did have a bubble or two, but I was chalking that up to the fact that it falls quite some distance before it hits the newspaper. Our vet says the first sign he was ill wasn't the vomiting - it was that he stopped wanting to eat his chop that morning (we received the package in the evening). So she did also ask if we used any sprays around him or if he got a hold of anything he shouldn't eat.

As for the toys.. There is an acrylic toy with magnets, but he didn't play with that. We got him some metal toys, but he never touched those either. I'll have my partner ask if they do x-rays as well for heavy-metal poisoning. That was one of my thoughts as well.

Let me get my partner to snap a photo of his blood work results. Right now, Cairo has kept his food down for the past couple of hours. But he's still limiting his sounds to his discomfort noise. And he only preened once for a few seconds - not his typical long sessions. So I still want him checked-up by the vet to see if we can't help him further.
 
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I think I've attached the photo of his blood work here.
 

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His blood work looks fine, but there was no special testing run, like a heavy metal panel...This is good though. No sign of infection though, which again points to something other than a typical "illness", but rather like he has eaten something he shouldn't have, he was poisoned by something, exposed to something like a gas, etc.

The reason his droppings are so runny right now is because he's had no fluids at all and then he ate watermelon, which is nothing but water...So that's pretty normal. And if all he will eat is watermelon then let him eat watermelon as long as he's keeping it down, because he desperately needs the fluids...

I would insist upon getting an x-ray done, regardless of anything else. One x-ray will show his entire body, and will rule-out or confirm a ton of things, including whether or not he has eaten metal (metal glows on a regular x-ray, no special films or anything needed, they'll see it immediately as it usually appears as little glowing flecks in the stomach), it will show any blockages, it will show an enlarged liver or kidneys, enlarged spleen, it will show any free-fluid or free-gas somewhere, etc. It will show all of his air-sacs, it will show any masses anywhere like his GI Tract, his lungs, etc. it will show is Crop and if anything is perhaps stuck in there, etc. So the things that need to be ruled out here since it's not likely an infection are foreign-bodies, heavy-metal, masses, GI obstruction, etc...all of which will be evident on a regular x-ray.
 
I think I've attached the photo of his blood work here.

I assume the hand-written commentary are normal value ranges. Interestingly, the CK is quite low. Some sources reference "CK" as similar to "CPK" though others suggest CK (Creatinine Kinase) is not applicable to birds.

"CPK : Creatinine phosphokinase: located in the muscle cells; most elevations are related to muscle injury, e.g., rough handling, trauma, injections, muscle wasting or Central Nervous System disease (creatinine kinase is not applicable in birds)
Abnormal counts indicate muscle damage; this test is used in conjunction with AST to differentiate between liver and muscle damage."


I wouldn't get too bogged-down in the minutiae of lab results, better to have the doc explain the global significance.

Glad to hear Cairo is doing better! I know this trip is sheer torture for you, hopefully each day sees progress.
 
I'm so glad Cairo is keeping things down a bit better, now. I'm really hoping that trend continues.

I very much agree with Ellen's suggestions regarding the x-rays as well as the possibility of metal poisoning due to the rapid onset of his symptoms. Not saying that's definitely what it is, but because of the danger of that possibility it's probably better to rule it out quickly.

Stay strong!
 
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They've hospitalised him.

He woke up with an appetite - rejected formula, but ate 7g of banana and 16g of chop mixed with rice. Then vomited it all up.

My partner took him in the moment the vet opened. And they decided to hospitalise him. My partner called me during client work to get a green light on the cost. I broke down in front of my colleague, telling him I'll pay whatever cost just to get him healthy again.

As for the subcutaneous fluids, they said it would stress him too much. And for the x-ray, they don't have a machine in-house. The vet doesn't think there's anything blocking because he's passing waste just fine. But they aim to get him better by Wednesday (not perfect health, but better). So if he isn't better by tomorrow or Wednesday, I'm going to push the issue of the x-ray. My partner said he'll visit the clinic again tomorrow, so I expect an update.

I got this bill (attached). Just been trying to keep myself together so I can deliver my reports on time, so I haven't tried to decipher it yet.

Out of all the vets in Singapore, I trust this one the most. She actually cares about birds, she actually wants to do blood tests, she cares about treating birds like the intelligent beings they are. So while I disagree about not doing the x-ray today, I can't trust another local second opinion.

My partner said Cairo started screaming when they brought him to the back for treatment. He sees it as a good sign that Cairo at least is responsive to the world around him.

As for the cause, this evening, we just got another shipment of parrot toys - this time all wood. It's from a different vendor, but this batch was mildewy. I've asked my partner to tell the vet that we should consider that he might have gotten exposed to mold, even though they're different shipments, different times, different vendors. At least we can try from there

My boss won't let me go home, which I can understand from his perspective. And any rate, Cairo is hospitalised until at least Wednesday. I'll pay out of my savings for it, but at least I know he's getting care from people who have the means and know-how.

So yep, that's how I ended up, crying in a Manila shopping mall.

I know Cairo doesn't understand, but I hope forgives me for not being there. My partner said he was particularly cuddly today, which is concerning because he isn't a cuddly bird. He said Cairo did preen a little, which is better than before.
 

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Oh Poor Cairo.
I know how stressed out you must be - sending all the love and prayers your way.
Hopefully he’ll be better by Wednesday and back home in no time!

Does the vet have any theories on what might have happened to him? Since he’s hospitlized, they’ll be able to moniter him and hopefully find the root to the problem.
 
I'm glad they got an IV in and he can get meds and fluids that way! You are so strong, abd stuck an amazing dedication to your ekkie! I too want him well as soon as possible I'm hanging in your every post. I hope they find the answer to the rapid persistent vomiting!! I have so much empathy for you both.
 
So yep, that's how I ended up, crying in a Manila shopping mall.

I know Cairo doesn't understand, but I hope forgives me for not being there. My partner said he was particularly cuddly today, which is concerning because he isn't a cuddly bird. He said Cairo did preen a little, which is better than before.

I wish you had someone there with you, to give you a hug and to comfort you.

Cairo doesn't have you, but he isn't alone. He has someone to cuddle with and someone who loves him during this difficult time. Of course he would prefer you, but it's important to remind yourself he's being cared for AND loved on.

Something to think about later: remember how your boss treats you during this time, and evaluate if that's someone you want to work for when everything has calmed down. Business / clients ARE important, and you have a job to do, but you also have a family that's in crisis. In a calm, non-crisis moment, evaluate how you were made to feel during this time. That's my advice as a lifelong member of the workforce with babies both human and non ;)
 
Laura I don't think they got an IV in him, they won't even do Sub-Q fluids, which makes no sense at all, especially since they are taking blood. If they can draw blood, they can give Sub-Q fluids...

I can only give you my professional and personal advice, and that is that Cairo is very sick if he's still vomiting everything up after days...Eating mold most-likely would not do this at all, as his GI Tract would take care of it...Now breathing-in mold is a whole other story, but there would have to be a lot of spores in the air for that to happen...

I'm not necessarily saying " GI blockage" that would stop his bowels from passing droppings, I'm saying a Crop blockage or something foreign in his stomach/GI Tract, such as metal, which would be poisoning him slowly, or just something that he swallowed that shouldn't be there...

The only thing I don't like about what this Vet is doing, and I really don't like it and have a horrible feeling about it, is the waiting and the "if he's not better by tomorrow or the next day, then we'll do an X-Ray", because as anyone here can tell you (and most-all experienced CAV's will tell you) birds do not hang-on for long. That's what is killing me with this right now. Birds become horribly stressed and die just from the stress, and now he's in a hospital, and they're still not taking an X-Ray or even giving him fluids at all...The stress of the dehydration on his body could kill him...Birds just are not animals that you can ever "wait and see" with, especially one that has been vomiting for 3-4 days now, and they still have no idea what is causing it...He needs an x-ray now...OR if they're going to take blood, they need to at the very least run a heavy-metal panel to check his Zinc levels, and then do an X-Ray...but waiting until tomorrow, certainly until Wednesday to take an x-ray is not good and is very scary at this point...

I'm sending positive energy to you and Cairo and your partner, but I would be pushing HARD for an x-ray today along with getting his Zinc level taken...
 
By the way, I'm very sorry that your boss is being so harsh about this situation, it makes me wonder if he would be acting the same way and forbidding you to take time-off and not go on this business trip if Cairo was your human-child...I've had a boss like this, where he was more concerned about the fact that HE was losing money if I wasn't there than the fact that I was going through radiation and cold-laser treatments (I actually had to come back in to work right after leaving the hospital after treatments and work until at the earliest 8:00 p.m., while he took out another salesperson he was buddies with to go drinking at around 4:00...it was lovely). I left that job after 7 years on a medical-leave, and that General Sales Manager was fired about 6 months later because the owners finally got enough complaints about him and had enough valuable salespeople, finance, and sales managers quite because of him. So what goes around comes around, however, what I can say to you with conviction just from my own experience is that some things are just more important, and the regret that you feel when you don't get to see someone you love dearly when they are sick or even dying never, ever goes away...It's just not worth it in the grand-scheme of life, even though it seems catastrophic in the short-term. I missed 3 grandparents dying within 4 months of each other because they all happened between November and February, the busy holiday months when "we need all-hands on deck"...And the more valuable you are, or the more money you make a company or more-so a sales-manager that is above you and who's paycheck relies upon you being there selling, the worse they treat you, which makes no sense at all, but it's just how it goes with people like that.

Those who can do and produce are not necessarily meant to be teachers or managers of others. That's for sure.
 
Sending you and Cairo feathered hugs, I understand how difficult it is to have a sick bird and be absent because of work.

I too am concerned with the "watchful waiting" strategy. Cairo exhibits persistent symptoms of illness, and lack of fluids/nourishment in a parrot is problematic.
 
This morning I emailed my CAV just to see if he had any suggestions about Cairo's case. I basically just summed-up the situation and told him that Cairo was seemingly fine (though he refused his Chop the morning before the vomiting started), no other symptoms at all, and that you had gotten a shipment of new toys and wood to chew on, and after playing with/chewing on them for a while he started to vomit, and has continued to pretty-much vomit up everything he's gotten in him, and isn't eating much at all except for some watermelon that he kept down yesterday, but this morning he again vomited everything up again. I copied your blood-work results photo to him, and told him that he was admitted to the animal hospital this morning, and that your vet's plan was to "wait and see if he's better by Wednesday, and if not then they will possibly do an x-ray", and that they will not give Sub-Q fluids due to the stress of doing it, but that they may be doing more blood-work...Usually he gets back to me within a day or so, but he replied to my email about 45 minutes after I sent it. I forgot to tell him that you don't live in the US, so that's why he commented about taking him elsewhere or finding another Avian Vet to take him to, but here's his email response:

HI ellen. I was going to call you today about scheduling Bowie for a re-check of his toe anyway so give me a call about then when you get a chance. I'm sure he's fine though or I would have heard about it or seen him already.

I would put this Eclectus in the Guarded-to-Grave category and would suggest finding another doctor to send his records to and get the proper diagnostics completed as soon as possible today. Continuous vomiting for days is not something seen in birds much at all and is one of the issues that sets my alarm bells off. He has to be very dehydrated and my worry is always acute kidney failure when they are losing fluids like this and not taking any fluids in even for a day. When it's for multiple days you have to worry about the kidneys. The blood work results on that computer slip are all normal but need to be repeated often because of the dehydration and his Uric Acid and his Phosphorous need to be checked often as I'm sure they are different right now then they were whenever they ran this blood work.

What you're describing has a differential including bacterial or fungal infection (WBC's are normal so that's not it, and the vomiting was acute so that's a rule-out for me immediately), poisoning or toxicity due to the bird getting into something like a pesticide, chemical, cleaner, etc., foreign body obstruction in the Crop or intestinal tract, lead or zinc poisoning, allergy (acute so rule-out for me), severe kidney disease, viral infection, GI Cancer, or some kind of sudden trauma. Most of these can be ruled-out due to the acute-onset of the vomiting and others because of the continuation of the vomiting over two or three days. This bird is very sick and I myself don't agree with worrying first about stress, though some doctors do put stress in birds above everything else. The problem with that here is that the bird is going to go into kidney failure or collapse due to blood pressure.

The unboxing of new toys can be easily assumed as the cause because of the sudden vomiting right after the bird played with them and that's why I'm not in agreement with not doing rads right now. And if the bird is too dehydrated to place an IV catheter then I would be putting in a IO catheter immediately to give fluids through, but if they are too hesitant to give fluids under the skin then they aren't going to want to put an IO catheter in for sure. I suggest that they find another doctor that can do rads right away and in the meantime it's all supportive-care like fluids and anti-nausea meds. If you let me know where he lives I can make a recommendation. I hope this turns around for him. It's a sick bird.

Call me later about Bowie!
Dr. N

EDIT: I forgot, I called him right after he sent me this email, and he asked me if your Vet had run a "serum biochemical panel" yet? This is a blood-test that confirms/rules-out poisoning/toxicity with many different things, such as metals, plants, etc. I told him I had no idea what blood-work, if any, was run except for the basic tests I sent him...He said they looked fine, but if his Uric Acid, Phosphorous, or his CPK levels are repeated and are off even a little, it's an indication of kidney damage/failure due to the dehydration.
 
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