Budgie Statistics
Cockatiel Statistics
Other Small Birds
Nutritional Disorders
Obesity
Thyroid Dysplasia
Renal Disease
Parasitic Diseases
Infectious Disorders
Candidiasis
Avian Gastric Yeast
Mycobacterial Diseases
Chlamydiosis
Mycoplasmosis
Viral Diseases
Reproductive Problems
Egg Binding vs. Dystocia
Other Reproductive Conditions
Egg Yolk Peritonitis
Excessive Egg Laying
Neoplasia
Endocrine Disorders
Gout
Injuries
Regurgitation
Toxicoses
The Cockatiel & Budgie Office Visit
Conclusions
Suggested Reading

Small Parrots in Health and Disease

Budgerigar: Melopsittacus undulatus
Cockatiel: Nymphicus hollandicus

Budgies and cockatiels are the most common pet birds seen in practice. It is important to understand the most commonly encountered diseases and conditions of these popular little birds, in order to be able to properly diagnose and treat them. I think that sometimes veterinarians underestimate the attachment that owners have to these little, personable birds that often become members of the family. We should provide them the same diagnostics and level of care that we would the owner of a macaw or an Amazon parrot. To many budgie and cockatiel owners, their birds are true members of the family and they are willing to have any necessary diagnostics performed, and have any required treatments administered. Do not compromise the quality of care offered to the smaller birds.

The budgerigar, Melopsittacus undulatus, is a fascinating little psittacine with well-deserved popularity due to its small size and big personality. Budgies are also commonly referred to as parakeets, and while they are members of the parakeet group, to prevent confusion, it is probably best to refer to them as budgies. (Other types of parakeets include the Quaker or monk parakeet, the ringneck parakeet and the Alexandrine parakeet, to name a few). The budgie is the best known of all parrots, and has found its way to virtually every country in the world. It may be considered a domesticated parrot, as it has bred prolifically in captivity since the mid 1800s. While sexual maturity usually occurs at approximately six months of age, researchers have shown that young male budgies may produce spermatozoa within 60 days of leaving the nest. This rapid sexual development is a physiological adaptation to an arid environment and enables very young birds to reproduce quickly when conditions are favorable.

When dealing with pet psittacines, most parrots are taken out of the nest as babies to be hand fed to make them tame; however, budgies are usually left with the parents until after they are fledged. Baby budgies tame down very quickly and make devoted, wonderful companions. Anyone who has taken neonate budgies out of the nest in an attempt to hand-feed them quickly discovered that baby budgies are little piranhas! When begging to be fed, they will latch on with those tiny, razor-sharp beaks to fingers, syringes or to anything else they can. It is a most painful experience (literally) to hand feed baby budgies. Anyone who has ever attempted this, usually only tries it once!

Budgie Statistics

Budgies are about seven inches in length and weigh between 26-30 grams. English budgies are slightly larger and weigh proportionally more. The average life span is between six and ten years, and the maximum-recorded life span is 18 years. Budgerigars are native to Australia, and tend to live in large flocks, although they may also be found in small parties. In their native habitat, they feed on seeds procured on or near the ground, and the important food items are seeds of native grasses. Crop contents studied included grass seeds and a few seeds of Portulaca oleracea. Budgies have been described as extremely nomadic in Australia and they can be found inhabiting timber bordering watercourses, sparsely timbered grasslands, dry scrublands and open plains. It is very important to note that wild budgies are very active birds, flying great distances to visit waterholes and seeding grasses. They fly from tree to tree and scurry through the grass searching for seeds. Many problems with captive budgies can be directly attributed to the sedentary lifestyle of the pet caged budgie, when the activity level is compared to that of a wild budgie.

Male budgies can be excellent mimics and can develop huge vocabularies. Hens may whistle and can learn a few words, but they are not nearly as loquacious as males. Budgies are dimorphic upon sexual maturity. Adult males of most colors, except albino and the very pale pastels, develop a blue cere. Hens have a lilac or tan cere that turns brownish upon maturity.

Cockatiel Statistics

Cockatiels are usually taken from the nest when they are two to three weeks of age for hand-feeding. Any of the commercially available hand-feeding formulas are fine to use. Cockatiels are usually 12.5 inches in length, and weight between 75-125 grams. Larger boned show cockatiels may weigh 10-15 grams more. Feel the pectoral muscles; if they bulge away from the center keel bone, then the bird is probably overweight. Sexual maturity may occur as early as six months of age, and up to 12 months of age. The recorded maximum life span is 32 years, but on the average, a cockatiel will live for 15-20 years in captivity, given proper conditions.

Cockatiels are dimorphic once they have molted out the baby feathers. This molt usually occurs at about six months of age. Adult grey males have bright yellow facial feathers and bright orange cheek patches. Adult grey hens have dull facial feathers. With the color mutations, adult males have solid primary remiges and retrices. Hens will have yellow dots on the remiges, stripes of yellow on the retrices. You cannot deduce the sex of an adult pied or pearl-pied by the colors of the facial feathers, as they are brightly colored in both sexes. You must examine the primary remiges and retrices to look for dots and bars on the bird once it has molted. These marks may be very subtle, especially in the lighter color mutations. The pearl markings will be found on both male and female babies, however, upon the first molt, hens will retain the pearl pattern and the males will now have normal, non-pearl feathers. Some color mutations are sex-linked and it is possible to determine the sex of a clutch of babies by their color patterns, if the genetics of the parents are known.

Males are great mimics, and can whistle tunes and talk very well. Hens will vocalize, and can whistle a bit, but most will not talk. It may be possible to make an educated guess about the sex of young cockatiels by listening to them vocalize. Young males will often be whistling, mimicking sounds and chattering, while young hens are not as vocal.

I can't tell you the number of times, during my consultations with avian vets that I have asked the sex of a pet cockatiel, and the vet has not known whether the patient was a male or female. Any vet working on these birds should be able to sex a pet cockatiel that is over six months of age. Why is this important information to know? There are several conditions and problems that are unique to breeding age hens, such as yolk-stroke, internal laying, oviduct infection or dystocia, to name some.

Other Small Birds

Lovebirds are also commonly kept as pets. They are active little birds that have a great sense of humor. They have very limited mimicking capabilities, however, I had a pet lovebird that would say "hello, hello, hello" in a very deep voice. They can be more difficult to sex, and egg-laying will be one definitive way to ascertain the sex of a hen! While it is possible to make an educated guess based on the laxity of the pelvic bones and the width of the bones, unless the female hormones have causes the pelvic floor muscles to loosen, palpation can be questionable. Males tend to have sharper, pointed pelvic bones, and those of the hen are more rounded and flexible.

Parrotlets are wonderful little birds. They often act like a big parrot in a very small package. They are sexually dimorphic, with males having coloration of the wings and rump, and the hens being primarily one color.

Lineolated parakeets, hanging parrots, Senegal parrots, Meyer's parrots, pleated parrots bee-bee parakeets, grey-cheeked parakeets, Bourke's, Elegant, Turquoisine and Scarlet-Chested are all small psittacines that may end up in the pet trade. Unless something specific should be pointed out about a particular species, I will not have the time or space to cover all the wonderful attributes of these birds. For the most part, the same medical care can be offered to these birds as can be offered to other similar sized species.

Nutritional Disorders

Budgies and cockatiels consume a primarily seed diet in the wild, and they do seem to thrive on a seed-based diet. However, pellets, sprouted seeds, fresh fruits, vegetables, pasta, whole wheat bread and healthy table foods are sound additions to the budgie and cockatiel diet. Birds that eat just seeds should have access to a cuttlebone or mineral block, and should receive supplemental vitamins (but NOT in the drinking water). I recommend Nekton STM as a general vitamin supplement. It should be sprinkled on moist food. Some budgies and cockatiels are extremely resistant to dietary changes.

It should be noted that it could be dangerous to try and convert any bird to a different diet without first ascertaining that it is healthy. Dietary conversion in a sub-clinically ill bird can precipitate a health crisis. Always evaluate a bird's health before to attempting to change the diet of a budgie or cockatiel to make sure that is healthy enough to withstand the stress of changing the diet. This seems to be a common mistake made by enthusiastic, beginning avian practitioners who want to convert a bird to a better diet at the same time that it is being treated for an illness.

Obesity

Budgies, and to a lesser extent, cockatiels, are very prone to obesity and the problems related to being overweight. The obese budgie or cockatiel may develop lipomas, benign fatty tumors. These may be found over the crop area, the chest, or most commonly, the abdomen. In other cases, the bird may develop generalized lipomatosis, which is a layer of fat over the entire surface of the body under the skin. Xanthomas, yellow fatty tumors, may also occur. Surgery may be necessary, especially if the skin over the tumor ulcerates, but often, the tumor will recur, unless changes are made in the diet and activity level.

Obese birds usually have some degree of liver problems. When fat is deposited in the liver, normal liver cells are replaced with fat and over time, if enough normal liver tissue is destroyed, it becomes cirrhotic. Birds with hepatic lipidosis will suffer from some degree of liver dysfunction and may bleed excessively, as the liver is responsible for providing clotting factors in the blood. Hepatic lipidosis is very serious and can be fatal. Prolonged liver damage may result in the liver becoming fibrotic eventually, leading to cirrhosis of the liver. Hepatic lipidosis can have multiple causes, and may have a genetic predisposition. Birds on an all-seed diet with restricted exercise are prime candidates for hepatic lipidosis.

Thyroid dysfunction may result in obesity; however this has been rarely documented in any psittacines, and there are no reports in the literature documenting hypothyroidism in cockatiels. Toxins such as aflatoxins can result in fatty changes in the liver. Steroid administration (from topical ointments) or hormone injections (with methylprogesterone, for example) can cause a bird to gain excessive weight.

Budgies and cockatiels with liver disease may have overgrown toenails and beaks. The best indicator for liver disease in birds is an elevation in the bile acids in plasma or serum. To definitively diagnose liver disease, a liver biopsy should be performed. However, in many cases, a bird with advanced liver disease cannot withstand the stress of a surgical procedure and may have problems with hemostasis, so surgery may not be recommended or possible.

While I do not condone allowing any pet bird free-flight in the home due to the risk of injury or escape, it must be remembered that budgies and cockatiels are naturally very athletic birds, so the largest cage that is practical should be purchased. They should have toys, swings, ladders and playgyms, and owners should encourage their birds to play and exercise frequently to prevent obesity.

Obese birds, and those with lipomas, should be offered a diet lower in fat. Each case should be dealt with individually. As guidelines, I usually recommend decreasing regular seed mix and increasing millet, since millet is lower in fat than the other seeds. Sprouted seed is healthier, and should be offered daily. Harrison's pellets can be a part of a healthy diet (I use these as the basis of the diet for Quaker parakeets with hepatic lipidosis). I also recommend offering pasta and whole wheat bread, plenty of fresh veggies and fruit, and some table foods (without butter, margarine or other added fats). Increasing the activity level of obese birds should be undertaken.

To this day, some budgie books still state that feeding greens, fruit and vegetables will cause diarrhea. Of course, we all know that the consumption of foods with more water in them will cause increased urination, and not diarrhea. Feeding vegetables and some fruits is recommended and bird owners should not be put off by printed misinformation that discourages them from feeding those healthy foods.

Thyroid Dysplasia

Iodine deficiency in the diet may result in thyroid dysplasia in budgies, although this is quite rare today. This occurs in birds that consume an all-seed diet that is deficient in iodine. Birds with thyroid dysplasia present with respiratory signs from the enlarged thyroid glands pressing on the trachea and syrinx. Some develop a characteristic squeak when they breathe. This is treated by prescribing an iodine supplement. Injectable iodine: 20% sodium iodine in saline for injection, 0.01 ml/budgie once, IM. Oral: Make stock solution of 2 ml Lugol's iodine in 30 ml water. Mix one drop of stock solution in 250 ml drinking water. Use daily for treatment, 2-3 times per week for prevention.

Renal Disease

Cockatiels and budgies should probably not receive a 100% pelleted diet. I have seen too many cockatiels and budgies that have been on a pelleted diet for years develop renal disease. However, pellet manufactures have assured us that they have rectified the problems related to renal disease in these birds. But, as before, birds on pellets are essentially on long-term nutritional studies. For this reason, I recommend not feeding more than 50% pellets, some seed, and a good portion of the diet should be table foods, fruits, veggies, pasta, whole wheat bread, and other nutritious items.

Renal disease may be difficult to diagnose in the early stages. Birds are usually lethargic, weak and anorexic. GI signs are also seen in adult birds with advanced or severe renal disease. Birds may develop visceral or articular gout from any severe renal dysfunction that results in chronic, moderate or severe hyperuricemia. Lameness may often be the first sign noted in psittacine birds with neurological deficits resulting from renal neoplasia, particularly in budgerigars. Neurologic deficits and lameness are attributable to direct compression, invasion or impingement of the branches of the lumbosacral plexus that passes through the kidneys.

Plasma uric acid values above the established reference range may support a tentative diagnosis of renal dysfunction. However, hyperuricemia is neither uniquely specific nor sensitive for renal disease. In general, uric acid levels elevate only when renal function falls below 30%. Uric acid synthesis occurs in both the liver and renal tubules. Uric acid excretion occurs independently of the rate of tubular water reabsorption. While we often rely on uric acid levels as the best means of assessing renal function, it is not sensitive enough to rely on solely. Urinalysis should be performed in all suspected cases of renal disease, as if it is performed and evaluated correctly, it can be of significant value. Dipstick values are of limited help, as most sticks will read positive for blood (probably from having the urine mixed in the cloaca with fecal matter). However, the sediment may be very helpful, as WBCs, RBCs or casts present in the urine can help in diagnosis. Radiographic evaluation of the kidneys, for renal size, density and mineralization may help support a diagnosis. Renomegaly or other signs of renal disease are indications for renal biopsy. Endoscopic biopsy, as well as visualization of adjacent organs, can be a great source of medical information. The recommended site for biopsy should be either the middle or caudal renal divisions, to avoid the cranial renal artery. Remember that polyomavirus can cause polyuria.

Hypovitaminosis A can cause renal disease, so if the history suggests a possibility of this condition, supplementation with vitamin A or beta-carotene should be administered.

Treatment for renal diseases should include providing parenteral fluids, if warranted, with hyaluronidase to facilitate absorption (Wydase, Wyeth-Ayerst Labs, 75 U/L of fluids, estimated daily fluid requirement for most birds is 40-60 ml/kg/day). If the disease has an infectious component, appropriate antimicrobials should be administered. Omega-3 fatty acids have been proposed as a desirable adjunct to therapy (6 cc flax seed oil or safflower oil mixed with 24 cc corn oil, dosed at 0.11 ml PO q24 hr. per cockatiel).

Avocado, chocolate, caffeine, alcohol, milk products containing lactose, garlic and onions should not be fed, due to potential toxicosis problems.

Parasitic Diseases

Budgies with a crusty cere, feet and vent are usually infested with the Knemidokoptes mite. Most budgies with this condition are young (usually less than one year of age). These mites do not cause pruritis and cause a honeycomb type appearance to the skin and cere, upon close examination. Scrapings of the lesions or examination of the crusts in oil under the microscope will show the mites. The treatment of choice is ivermectin based upon careful dose calculation. Dosage: 0.2 mg/kg PO, repeat in 10-14 day intervals until signs decrease. I will often also apply a small amount of the diluted ivermectin topically directly to the lesions. This can also be given injectably, but I have had fine success treating these birds orally. Although they do not appear to be very contagious, it is recommended that all birds kept in the same cage also be treated with ivermectin, either orally or topically. As with demodectic mange in dogs, this mite appears to be related to the immune status of the bird, and often the offspring of infested birds will develop Knemidokoptes, as well. Treatment should be repeated at 10-14 day intervals until the bird is clinically normal. Long-term infestation may result in permanently deformed beaks, which will require periodic shaping with a grinding tool and emery board. Mites do not live off the bird, so treating the cage is not necessary, but is recommended as a precautionary measure. Mites that occur in older birds usually indicate some underlying medical problem, such as hepatic lipidosis, diabetes mellitus or even tumors. Mites occasionally occur in other species of birds, rarely cockatiels.

Red mites, Dermanyssus sp., can occur in all psittacines, including the small ones. These mites are very contagious between birds of different species, and they suck blood. They are visible to the naked eye as tiny specks of red pepper. Diagnosis can be attempted at home by covering the cage with a white sheet at night and then examining it in the morning for the presence of little specks of red or black. Red mites remain off the bird and climb on the host to take a blood meal at night. They can make the infested birds very nervous and irritated as they interfere with normal sleep patterns. They sometimes bite people when birds are absent. In addition to treating the birds with red mites, the entire cage and bird area must be thoroughly disinfected to prevent reinfestation. Treatment with oral ivermectin and topical 5% carbaryl, repeated weekly, is usually effective. I saw one case involving a military macaw that had a severe infestation with red mites, and the poor baby bird had multiple feather cysts caused by the damage from the mites. The main thing to remember is that the mites will NOT be visible on the bird during examination during the day, so it is easy to miss them.

I once performed an aviary evaluation for a flock with serious decreased production. We were performing physical examinations and CBCs on all the birds (including Golden conures, rare Amazons and cockatoos). We did not finish before dusk, so we took a break to eat dinner, and then went back outside to finish the tests and exams. The first bird that we caught after dark was literally crawling with red mites!!! No wonder production was down; the poor birds were unable to get a good night's sleep, with their boxes infested with mites! None of the birds had serious anemia from the mites, but many did have elevated eosinophils counts (found in the differential portion of the white blood cell count), which could indicate a parasite problem.

Feather mites can occur on budgies, and two species have been described to infest budgies. These mites, however, are not commonly encountered. Feather and quill mites can be found (rarely) on cockatiel feathers (usually primary and secondary remiges). Many budgie and cockatiel owners believe that they must use some sort of protection against mites, which can be hung on the outside of the cage, but these are ineffective and potentially dangerous, as the fumes can cause liver damage and perhaps cancer if inhaled for a long period of time. Mite protectors usually have mothballs (paradichlorobenzene) as the active ingredient. If a bird does not have mites, a mite protector is not necessary to prevent infestation. I have seen scarlet-chested parakeets with active mite infestations and unusual stress-bars on the feathers as a result.

Giardia and ascarids (roundworms) frequently occur in budgies and cockatiels. I have seen these parasites in all species of parrots, small and large alike. (Don't forget, I practice in Florida, the land of bugs and parasites!) It is important to realize that birds need not be kept in walk-in aviaries (with access to the ground), nor do they have to be housed in sub-standard conditions to harbor these parasites. While you may reside in an area of the country where intestinal parasites are not a common problem, do not forget that many times, cockatiels and budgies are bred elsewhere and shipped all around the country. Cockatiels are bred outdoors in great quantities in Florida and shipped nationwide. Sometimes a band number will give the practitioner an idea of the state of origin, as often bands are imprinted with a two letter state identification. Make sure that your veterinarian IS writing the band numbers down on each and every patient. Scarlet-chested parakeets in my practice have been diagnosed as carrying heavy loads of ascarids, as well as feather and quill mites.

This author has found that ivermectin is not the most effective dewormer for ascarids. Pyrantel pamoate is a better and more efficacious choice. The dose is 4.5 mg/kg PO, repeated every 10-14 days. Of course, it is impossible, I think, to overdose a bird with this drug, and the only way you could possibly hurt a bird with it is to aspirate it.

However, do not choose fenbendazole, as it has been known to cause idiopathic hepatopathies, resulting in death, especially in cockatiels. Trichomonads occasionally occur in budgies and cockatiels, as well, and this parasite is most often diagnosed from a swab taken from the oral cavity or crop. They tend to be found intracellularly in psittacines, making diagnosis elusive. The most effective treatment that this author has found for trichomonads and other protozoal parasites is ronidazole.

I recommend that birds be periodically dewormed, at least once or twice, during routine first examination, with pyrantel pamoate, even if fecal parasite examinations are negative. This is because the gastrointestinal tract transit time is so fast in birds that worm eggs do not concentrate in the fecals (as they do in dogs and cats), and it is not only possible, but likely, to miss ascarids on a fecal exam. I have performed countless second opinions on small birds with GI problems that have had negative tests for worms, yet, when I dewormed them, they passed roundworms! A very interesting paper was published a few years ago about this very problem, out of the University of Georgia. If a bird passes roundworms, it should be periodically dewormed for the rest of its life, as pathologists have found that larvae may encyst in the tissues and be released during times of stress, resulting in additional worms infesting the intestines.

Dosages:

Pyrantel pamoate: 4.5 mg/kg PO q7-10 days

 

Praziquantel: 9 mg/kg IM (for cestodes)

Note: fenbendazole can cause fatal hepatopathies, especially in cockatiels, and should not be used in pet birds routinely, also causes feather abnormalities resembling PBFD if administered when bird is molting.

Cestodes may not be a big problem in the smaller birds, but are occasionally diagnosed. Unlike ascarids, with a direct life-cycle, tapeworms require an intermediate host, and it is thought that the intermediate host is the grain beetle and/or cockroach, but not the ubiquitous grain moths often found in stored bird seed.

Giardia, a one-celled protozoan intestinal parasite is often difficult to diagnose in birds. Wet mounts of fresh droppings may sometimes show the protozoa. However, other tests may be necessary to diagnose Giardia. An ELISA (enzyme-linked immunoassay) test on the droppings may be performed. While the ELISA is very accurate, false negatives may occur if Giardia is not present in the sample submitted for examination. Fecal trichrome staining is another diagnostic tool. One lab has had great success in diagnosing Giardia (and other parasites) by having the vet collect feces over several days, which increases the chance that the organism will be shed. The droppings are placed in a special fixative that they will supply, which prevents damage to the fragile trophozoites, and then the droppings are examined with six different stains.

The lab performing these tests is:
Parasitology Research Lab, LLC
P. O. Box 35079
Denver, CO, USA 80239
Phone: 303-576-6800 FAX: 303-307-8333

The cost is very reasonable and well worth the extra effort to send the samples there, as protozoal infestations are often under-diagnosed.

Treatment of Giardia can be problematic, and most available drugs only kill Giardia in a low percentage of birds. Metronidazole works in about 40-60% of cases. However, it has poor palatability, as well. Ronidazole is the most effective medication that I have found to date. Ronidazole dose: 6-10 mg/kg PO q24h x 6-10 days or 10% powder: 100-200 mg/L drinking water x 7 days. This, as well as other out-of-country drugs, can be purchased from Global Pigeon Supplies (phone: 912-356-1320). Fenbendazole may work well, however, due to potential hepatic toxicosis, this should be avoided. One way to prevent reinfestation is by having a bird use a water bottle in place of the more common water bowl. This should be a standard recommendation for all pet birds, as in addition to preventing reinfestation with protozoa and ascarids, water bottles also prevent the exponential growth of bacteria that occurs hourly in water bowls

In my practice, a high percentage of budgies and especially cockatiels that are feather-pickers are harboring Giardia or Hexamita, another one-celled flagellated protozoal organism that inhabits the intestines of birds. The pattern of plucking is usually under the wings, along the humerus, (leaving the remiges), the insides of the thighs and perhaps the chest or lower abdomen. Primarily, the coverts and contours are removed, but not primary remiges or retrices. It is easy to miss this organism since it is only shed sporadically and the trophozoites quickly disintegrate. Through my consulting with Antech, I see many vets performing feather picker profiles on cockatiels, when in all likelihood, these birds are suffering from giardiasis or other flagellated protozoa. If you can't confirm a diagnosis, consider treating with a course of ronidazole anyway, and convert the bird to a water bottle to prevent re-infestation. This should always be discussed with your avian veterinarian.

Recently, I have diagnosed cases of cryptosporidiosis in feather picking birds and I have also seen this organism cause serious gastrointestinal problems.

Infectious Disorders

While budgies and cockatiels are very hardy little birds, bacterial infections are commonly encountered. Most occur in birds that have a water bowl or cup and not a water bottle. Even the most diligent owner cannot prevent fecal and food contamination of water in an open vessel, which will rapidly grow bacteria. Budgies and cockatiels are very smart little birds and most will rapidly adapt to using a water bottle. For bathing, a bowl of tepid water can be offered periodically.

Even though budgies and cockatiels are very small birds, it is, of course, possible to run complete blood counts and blood chemistry panels on them. The complete blood count is probably the most important single test that can be run on a bird, as it helps to determine if a bird has a bacterial, fungal or viral infection, and it shows if a bird is anemic, dehydrated or suffering from a myriad of problems.

Due to small blood volume, it is safe to take 1 cc per 100 grams body weight in a healthy bird. So, for a 28 gram budgie, you may safely take 0.28 ml. To maximize test information, fill a hematocrit tube, make a good blood slide, and put the rest into a green top tube (Microtainer) with separating gel, and spin it for the chemistries. This way, the lab can run a PCV, estimated white blood cell count with differential, and desired chemistries, maximizing the amount of information that can be run on a small sample. While there is some controversy about the validity of an estimated WBC, in small patients, it can be advantageous. Venipuncture can be accomplished using the right jugular vein or perhaps the medial metatarsal vein (using a small gauge needle to cannulate the vein, without a plunger that will collapse the vein). Avoid nail clipping for procuring blood and also avoid using the basilar or ulnar wing vein, due to large hematomas formation and the risk of fracturing the wing.

Bacterial culture of the conjunctiva, respiratory tract, choanal slit, crop, cloaca or lesion may help diagnose bacterial problems. Fungal cultures may be helpful. A Gram's stain may help screen birds for potential problems, however, it is only useful as a screening test, and not as a true diagnostic test in most cases. Usually, a healthy bird will have predominately Gram-positive cocci and rods. Gram-negative rods are not normally found in high percentages in most birds. An abnormal Gram's stain should be followed up by appropriate culturing. Candida may be picked up on Gram's stain, as well, but some foods add brewer's yeast to the diet, which may show up on the Gram's stain. If yeast is causing problems, it may be budding or have pseudohyphae. When in doubt, ask for a fungal culture, which will differentiate between brewer's yeast and potentially pathogenic Candida. And it is not necessary to have owners stop feeding bread if a bird has a yeast infection, as yeast involved in bread making is killed during the baking process.

Spirochetes, rarely found on a choanal Gram's stain, are most commonly found in lovebirds. Research needs to be performed in this area, but this author feels that spirochetes found in ill birds should be treated. Trimethoprim/sulfamethoxazole (Bactrim, Roche, 48 mg/ml., dosed at 100 mg/kg PO q 12 hr. x 10 days) has proven clinically effective in this author's practice.

Candidiasis

Yeast infections with Candida can occur, especially in birds that suffer from hypovitaminosis A. Many bacterial and yeast infections in budgies and cockatiels occur as a result of owners allowing birds to eat out of their mouths, or if they allow a bird to have contact with human saliva. Our mouths contain many microbes that can cause disease in birds, and contact with the human mouth should be strictly prohibited. I never use Nystatin alone anymore to treat candidiasis. Instead, I use a combination of fluconizole, 100 mg. crushed and added to 20 ml. of Nystatin, 100,000 U/ml. Dose at 0.5 ml. per 1000 gm. bw PO q 12 hr., and may be doubled in severe cases. This works very well for baby cockatiels with candidiasis, and 5 days of treatment is usually all that is needed. For prevention of candidiasis, when baby birds are on antibiotic therapy, this mixture works very well. It should be shaken prior to administration and should be stable at room temperature for six months.

Avian Gastric Yeast

Avian gastric yeast (AGY), formerly called megabacteriosis is a controversial disease in budgies. These large, Gram-positive organisms, now thought to be one species of Actinomyces fungus, can be found in the proventriculus (and sometimes the crop or other portions of the GI tract) of both healthy and ill birds. The organism is found both on the surface of the koilin layer and within the koilin, down to the level of the mucosa of the ventriculus. AGY has been reported to be found in the liver of a severely infected bird. It can be difficult to diagnose in live birds. While occasionally AGY will be found on a fecal Gram's stain, regurgitated or vomited material, or fluid from a crop wash or proventricular wash is more likely to prove diagnostic. Some researchers believe that AGY are normal inhabitants of the GI tract and others feel that this organism is responsible for causing disease in budgies. Signs in budgies include chronic weight loss, dysphagia, vomiting/regurgitating, diarrhea and death. This can also occur in other birds, including cockatiels. This is usually treated with oral amphotericin B dosed at 100 mg/kg PO q 12 hr. x 10 days or 1 g/L drinking water x 10 days. Other drugs are being investigated, including fluconazole.

Mycobacterial Diseases

The bacteria responsible for causing tuberculosis, Mycobacterium is most commonly diagnosed in grey-cheeked parakeet (even domestically raised ones), and may cause disease in budgies and cockatiels, as well. I have also diagnosed avian TB in hanging parrots, among the small psittacines. The acid-fast stain of fecal material or from a granuloma (if present) may be useful for presumptive diagnosis. The organism may also be grown on culture, but it must be sent to the National Lab in Ames, Iowa. A newer DNA PCR test for TB is available, and this may prove to be helpful in diagnosis in the future. Often, birds with TB will have an elevated white blood cell count.

Chlamydiosis

Chlamydophila sp. is responsible for causing chlamydiosis (and I am told that we will not need to change the name to chlamydophilosis, which none of us can pronounce) also called psittacosis. This organism may cause respiratory disease in budgies and cockatiels, and is contagious to other birds through infected droppings, and infected secretions. It may also affect the liver and GI tract. Budgies and cockatiels can be carriers of chlamydiosis, and may not show clinical signs. Chlamydiosis is fairly common in budgies and cockatiels, and it should be noted that testing is not always accurate in the live bird. DNA PCR testing is helpful in procuring a diagnosis and the white blood cell count may be mildly elevated, or it may remain normal. Chlamydophila is very host-adapted to cockatiels and diagnosis is very problematic in the live bird. Current testing recommendations include performing the EBA titer in cockatiels, in addition to a choanal/cloacal swab for a DNA PCR. A DNA PCR of the blood should never be used alone as a diagnostic test for chlamydiosis.

Due to potential legal problems, every cockatiel owner should be advised about the zoonotic potential of chlamydiosis. I give every cockatiel owner a hand-out (purchased from the AAV publications office). If an owner declines testing, be sure to note that in the chart.

Of course, all psittacines are susceptible to this primitive bacterial organism. Appropriate testing should be performed when indicated.

Mycoplasmosis

Another disease that may present with similar clinical signs is mycoplasmosis. Both Chlamydophila and Mycoplasma may be treated with doxycycline or enrofloxacin. Enrofloxacin dosage: 7.5-20 mg/kg q12 hrs. PO. Please note that the package insert for BaytrilTM states that one injection only should be given, then the pet should be switched to oral dosing. Enrofloxacin is often a good first choice, as it will also treat any secondary invaders, such as Pseudomonas, at the beginning of therapy, and then the bird can be switched to doxycycline for a total of a minimum of 45 days treatment. Thorough environmental cleaning must be performed to prevent reinfection as the organism is stable in the environment for long periods of time. Environmental swabs from windowsills, doorjambs, blinds and floors can prove useful. For flock treatment: water-soluble doxycycline is available from Global Pigeon Supplies, phone: 912-356-1320.

Viral Diseases

Budgies are often implicated in outbreaks of polyomavirus infection. This virus can cause budgie fledgling disease. French moult, a slow, debilitating disease of budgies may be caused by polyomavirus or psittacine beak and feather disease virus (PBFD). A vaccine against polyomavirus is available to protect non-budgerigar psittacines, and a vaccine for budgies is under investigation. Cockatiels may also suffer from polyoma viral infections. Budgies and cockatiels may also be affected by other types of viruses, including Proventricular Dilatation Disease, PDD. Unfortunately, I am seeing more and more cases of PDD in breeder cockatiels (diagnosed by crop biopsy including a large blood vessel), so I expect to see more of it in pet cockatiels shortly.

Unfortunately, lovebirds may harbor and develop PBFD, Psittacine Beak and Feather Disease, also called avian circovirus 1 and avian circovirus 2 (with 2 being diagnosed as a variant found in lories). While most breeders of the larger psittacines have long ago tested and culled out any PBFD positive breeders, lovebird breeders have not, for the most part, done so, due to the high cost of testing. So, PBFD occasionally still occurs in lovebirds, with signs similar to those seen in larger parrots (loose feathers, alopecia, abnormal feathers, overgrown beak and nails and secondary infections). This can then spread to other young birds of other species.

Reproductive Problems

Budgies are determinate layers, meaning that a hen will lay a predetermined number of eggs per cycle, usually four, six or rarely eight. This is in contrast to cockatiels, which are indeterminate layers. A cockatiel hen will continue to lay eggs to replace those lost from her clutch. So, if an owner takes the eggs away from a hen as she lays them, she may lay so many eggs (the record in my practice is 27!) that she becomes depleted of her nutrients, which can be life-threatening. However, the budgie will usually cease laying once her clutch is complete, even if the eggs are taken away from her. This is why so many more cockatiels end up with egg-related problems when compared to budgies.

Hypocalcemia can be treated with vitamin D3 injection, injectable calcium (Calphosan: calcium gluconate 50 mg/ml and calcium lactate 50 mg/ml, IM, 5-10 mg/kg q12 hr PRN. Make sure bird is well-hydrated when giving injectable calcium. I usually dilute 50:50 with sterile saline for IM injections). NeocalgluconTM in the drinking water can be administered in the drinking water, 1 ml per ounce (30 ml) drinking water. I often recommend crushing up TumsTM as an inexpensive calcium supplement.

Male budgies of many colors, excluding some of the pale colors, will develop a blue cere as they mature. The hen will develop a tan or brown cere upon maturity. Some hens will develop brown hypertrophy of the cere, a thickening of the cere that is considered normal, however, for cosmetic reasons, an avian veterinarian can carefully peel off the excessive growth. If the cere color of a mature male budgie changes from blue to brown, this is often an indication of a feminizing tumor of the testicle.

The normal incubation period for a cockatiel is 21 days, beginning counting on the day the last egg of the clutch is laid or when the hen begins sitting tightly on the eggs. The normal incubation period for a budgie egg is 18 days. Psittacines usually oviposit every other day.

Egg Binding vs. Dystocia

Occasionally, a hen may have difficulties in laying an egg. There are actually two terms used, depending on the situation. Egg binding is the failure of an egg to pass through the oviduct at a normal rate. This may or may not be associated with dystocia, which involves the mechanical obstruction of oviposition or cloacal function because of the egg's presence in the distal oviduct.

Dystocia should be expected to be a more advanced clinical presentation than egg binding alone. Egg binding or dystocia may have many causes, including hypocalcemia resulting in a soft-shelled egg, genetic predisposition, a damaged or small pelvis, a malformed egg, poor muscle tone and body condition of the hen or tumors. Smooth muscle functional deficits of the oviduct, mechanical tears or damage to the oviduct, excessive egg laying and subsequent fatigue of the oviduct, nutritional deficiencies or excesses (vitamin E1, selenium, calcium), and concurrent stressors such as hypo- or hyperthermia may also be causes of egg binding or dystocia. Supplying the hen with heat and humidity may help her pass the egg, however, dystocia can rapidly become an emergency, requiring immediate veterinary care. Applying mineral oil or water-soluble jelly to the vent is not likely to be effective, unless the egg is clearly visible just inside the vent.

Diagnosis is made on clinical signs, physical examination, and supportive diagnostic tests. Many egg-bound hens are dehydrated, so the first treatment that should be performed is usually the administration of fluids. Radiographs may be helpful in confirming dystocia. An injection of calcium may help the hen by allowing the oviduct to contract more strongly. An injection of vitamin D helps calcium absorption. If fluids, the vitamin injection and the injectable calcium, in addition to heat and humidity don't facilitate passage of the egg, ovocentesis can be accomplished through transabdominal or cloacal access, which will relieve the pressure of the egg mechanically obstruction of the cloacal emptying. It usually takes 12-48 hours for the shell pieces to pass. If warranted, a prostaglandin gel (PrepodilTM gel) may be applied inside the vent, as long as the egg can physically pass. The prostaglandin gel works along the natural pathways, which utilize arginine vasotocin, which has been shown to induce oviposition in domestic avian species, likely through the effect of the release of prostaglandins from the oviduct tissues. Is a much better drug to use in place of oxytocin, which is the drug that was classically used to cause contractions of the oviduct (and is used in mammals). Extreme care must be taken by any female personnel dealing with this gel, as it can cause serious problems with the female reproductive tract. I no longer use oxytocin in any avian species, as not only is it not usually effective, but it can be very detrimental to a debilitated bird.

Other Reproductive Conditions

Occasionally, a hernia may be associated with egg binding. With a hernia, the muscles usually tear, resulting in a saggy abdomen, and in some cases, other internal organs can fall into this pouch. Surgery is usually necessary to correct the hernia. Prolapse of the oviduct is seen usually subsequent to dystocia. Treatment includes removal of the egg (if still present), cleaning the exposed tissues, repairing lacerations and gently replacing the exposed tissues. Prognosis is generally good and a return to normal breeding function will occur if damage was not severe. Occasionally, prolapsed tissue must be amputated. Usually, a biofeedback mechanism is in place that will prevent future egg laying if a portion of the oviduct is removed.

Oviductal torsion (also called uterine torsion) may be difficult to differentiate from egg binding and requires surgery. Usually, severe vascular compromise requires salpingohysterectomy with loss of future breeding. Oophoritis is most commonly associated with pathogens such as Salmonella. Ovarian cysts occur frequently in cockatiels. Ultrasound will delineate fluid-filled cysts that may be aspirated or surgically removed. Ovarian neoplasia is most commonly diagnosed in the budgie.

Lymphomatosis, adenocarcinoma, leiomyosarcoma, leiomyoma, adenoma and granulosa cell tumors have been reported. Complete surgical removal is almost impossible due to the close proximity of the ovary to the caudal vena cava. Oviduct impaction, oviductal (uterine) rupture and ectopic eggs may occur.

Egg Yolk Peritonitis

Egg yolk peritonitis is used to describe peritonitis associated with the presence of egg yolk material. Internal laying, ectopic ovulation and septic and non-septic yolk related peritonitis all occur. Not all hens with egg yolk peritonitis develop ascites (fluid in the body cavity). Yolk or fat globules may be seen in abdominal fluid or blood (in peripheral blood smears or above the buffy coat in spun hematocrit tubes. Treatment with aspirin, 5 mg/kg PO q 8 hr. or hyaluronidase (WydaseTM) 5 U/kg, diluted with an equal or greater quantity of isotonic sodium chloride, IV q 12 hr. for 1-3 days may prove beneficial. In some cases, surgery and coelomic flushing may be necessary. Yolk stroke may also be treated with hyaluronidase at the same dose.

Excessive Egg Laying

Excessive egg-laying occurs most commonly in cockatiels. In addition to attempting reducing the photoperiod to 8-10 hours of light per day, leaving the eggs under the hen, improving nutrition, removing the hen's preferred nest sites, removing toys the hen has a sexual affinity for and changing the cage or cage location, medical therapy may be attempted. If the owner knows when the hen is acting broody, and can bring her in during that phase (often accompanied by increased water consumption, loose stools, holding droppings, etc.) injections of HCG (Human chorionic gonadotropin (Pregnyl, Organon) may be attempted to abort the cycle, at 500-1000 IU/kg IM q 3-6 wks. Leuprolide acetate (Lupron, Tap) dosed at 0.375 mg/cockatiel IM may reduce ovarian activity, although this drug is very expensive. In the long run, salpingohysterectomy may be the best choice as a permanent solution for the pet cockatiel that is not intended for breeding.

Neoplasia

Budgies often suffer from a myriad of tumors as they age. Budgies that develop a limp or weakness of one leg often have a tumor pressing on the sciatic nerve, causing the leg problem. The tumor may be of the kidney, gonad or adrenal gland. Other tumors may occur in almost any organ. Cockatiels can also develop malignancies as they age. Fibromas and fibrosarcomas are the most commonly seen in my practice and most often develop on the wing.

Endocrine Disorders

Hypothyroidism, although not well-described, may occur in budgies. Diabetes mellitus, also quite rare, occurs in budgies, as well. Tumors of the adrenal or pituitary gland have occurred. Cockatiels, especially, fat, female and four or older, may develop diabetes mellitus. In birds, diabetes is due to an overproduction of glucagon, as opposed to a lack of insulin in mammals. Treatment may be attempted with insulin, but is often unrewarding. Birds metabolize insulin very quickly, so it is not a question of tight control, but reducing blood glucose levels for a period of time. Insulin NPH (Humulin N, Eli Lilly and Co., Indianapolis, IN, USA), may be attempted initially, at 0.5-3 units/kg (suggested initial dose for a budgie is 0.0002 U, larger psittacines, 0.01-0.1 U). Better control may be obtained using glipizide (Glucatrol, Pfizer Pharmaceuticals, Inc, NY, NY, USA, 1.25 mg/kg PO q24 hr.) Dietary modification is helpful. Try using Harrison's pellets as a base for the diet.

Gout

Gout is quite common in budgies. It may be a result of kidney disease or it may be primary in origin. If urates are deposited in the joints, this is called articular gout. This is a very painful condition and treatment is usually unrewarding. Visceral gout, where urates are deposited on the surface of organs, such as the heart and liver, is usually diagnosed at necropsy. Gout also occurs in cockatiels, and is usually secondary to renal disease. Treatment with allopurinol (Zyloprim, Burroughs Wellcome) may be attempted. For budgies and cockatiels, crush 100 mg. tablet in 10 ml. sterile water, and give 1.0 ml. per 30 ml. drinking water, mixed fresh several times per day. Maintain adequate hydration, and consider using SQ fluids with 75 IU of hyaluronidase per liter of fluids. In severe cases, decrease dosage of allopurinol by 25% and gradually increase over several days. Add colchicine (Colchicine, ColBenemid, Merck) at 0.04 mg/kg q 24 hr PO or IV, gradually increased to q 12 hr in severe cases of gout.

Injuries

Budgies and cockatiels, being the inquisitive little birds that they are, may get underfoot, and may be injured by being stepped on, closed in a door, etc. Fractures of the wing or leg frequently occur, and can be usually simply treated by using a tape splint. Bird bones heal quite rapidly, so splints won't need to be kept on as long as one would for a dog or cat (usually 2-3 wks is sufficient, based on radiographic improvement).

Budgies and cockatiels may get a concussion from flying into a window or mirror, or injuries may occur by an encounter with a ceiling fan. This is clinically called "shredded tweet." Treatment with steroids should only be used judiciously immediately after injury, if warranted.

Regurgitation

A budgie may regurgitate to a favorite toy, mirror or its favorite person. This is a normal behavior. This must be differentiated from regurgitation resulting from disease. Cockatiels may also regurgitate to a favorite person or toy, but not as commonly as in budgies. Regurgitation occurs from the crop, vomiting occurs from the proventriculus.

Toxicoses

Lead or zinc toxicosis may occur from birds chewing on galvanized welds on hardware cloth cages (the welds contain up to 1% lead and zinc). Sources of heavy metals are published in many sources, as are treatments. Plastic toys may also contain zinc. Other toxicoses may occur from paradichlorobenzene in mite protectors, non-stick cookware fumes, insecticides, and other sources that affect other species.

The Cockatiel and Budgie Office Visit
(this is for avian veterinarians, but may prove helpful to owners)

  1. Use a magnifying loupe when performing a physical examination or you will miss subtle lesions.
  2. Make sure you have an accurate scale to weigh your patients in grams, not ounces.
  3. Become competent in capture, restraint and common techniques.
  4. If the bird is flighted (ask owner the last time the bird was clipped) prior to trying to capture it. Always keep at least two closed doors between a flighted bird and the outside world.
  5. Do not use a toenail trim for a blood sample. Use venipuncture sites. Anesthesia is not necessary if proper restraint is used. The right jugular vein is larger than the left and is easily accessed. Since I perform most of my work in front of the clients, I do not usually choose the jugular vein, as most clients don't like to see it! If I perform venipuncture in the back room, I usually choose the jugular for efficiency and speed. Do not routinely use the wing veins, as it is possible to fracture the wing, and this site usually leaves a huge hematoma. My preferred site is the medial metatarsal vein, located on the medial side of the hock. Pluck the feathers (if you perform the venipuncture in the area that is scaly, hemostasis will be difficult to accomplish). The key to successful venipuncture at this site is to use an insulin syringe, 1 cc, with a 27-gauge needle, WITHOUT the plunger. Hold off the vein by occluding the stifle area, clean with isopropyl alcohol, and cannulate the vein, bevel up. The syringe will fill by capillary action and because of the back pressure of the vessel. Bird blood doesn't clot as quickly as canine or feline blood, so you have usually a few minutes to procure the amount of blood necessary for tests. Withdraw the needle and have your technician apply digital pressure to the venipuncture site for a minute or so. I use the medial metatarsal vein for birds as small as budgies and lovebirds, and for birds up to the size of macaws. It's my favorite vein!
  6. Grooming is a vitally important skill to learn properly. More bad will is generated by clinics that have improperly groomed birds than you probably realize! Clip primary wing feathers, beginning with the last one at the wing tip, using rounded point scissors. Clip each feather individually, identifying the shaft to ensure that it isn't a blood feather. Clip each feather at the base, where it is a dry quill. Make sure that you don't cut the coverts. Clip 6 or 7 feathers on each wing, and then test fly the bird to ensure that it doesn't get any lift or that it can fly horizontally for any distance. Cockatiels are strong flyers and may need up to 8 feathers clipped on each wing. Budgies usually require 5 to 7 primaries cut on each wing. The older, or more commonly used clip leaves primary wing feathers cut in half. This type of trip produces sharp cut ends of the feathers that tend to poke the bird in the side when the wings are folded. This may predispose a bird to feather picking, and many birds begin chewing on the stiff shafts in an attempt soften them. Clip or grind toenails, then file them to smooth them off. Only trim beaks that are overgrown or have excess growth protruding out from the beak (that hasn't normally flaked off).
  7. Provide the AAV Certificate of Veterinary Examination, or some other written report of your examination. I also provide all clients with copies of all tests for their files (I practice in Florida, and if there is a hurricane, with power outages, I feel that clients should have records for shelters, etc.) AAV and Winger's Publishing offer excellent client education materials that I provide for clients, as well. Write down the band number (if present) and keep this in your permanent records. Record which leg is banded, color and type of band, and any numbers or letters stamped into it.

Conclusions

Budgies and cockatiels are wonderful little birds with great ability to mimic speech. They can be loving companions. Veterinary care is important for them, and just because they are small birds, their preventative medical care should not be neglected. Avian veterinarians are able to provide the same quality of care for a budgie as for a macaw. Always offer the budgie and cockatiel owner the same diagnostic plan that you would for the owner of a larger bird. With proper care and diet, the budgie and cockatiel can live a long, healthy life.

Budgerigars and cockatiels are wonderful little birds that can make great companions. Given an appropriate diet, exercise and medical care, they can live long, healthy lives. They are prone to obesity and related problems. Common infectious diseases found in other species of psittacines are also found in budgerigars and cockatiels. Reproductive problems occur more commonly in cockatiels, which are indeterminate layers.

Suggested Reading

Moore RP, Snowden, KF, et al. Diagnosis, treatment and prevention of megabacteriosis in the budgerigar (Melopsittacus undulatus). Proc Annu Conf Assoc Avian Vet. 2001;161-163.
Pollock CG, Pledger T, et al. Diabetes mellitus in avian species. Proc Annu Conf Avian Vet. 2001:151-155.
Bowles HL, Update of management of avian reproductive disease with leuprolide acetate. Proc Annu Conf Assoc Avian Vet. 2001;7-10.
Echols MS. Management of specific avian renal disease. Proc Annu Conf Avian Vet. 1999:101-108.

Cadeusus
Copyright 2006 Margaret A. Wissman, D.V.M., D.A.B.V.P.
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