Atherosclerosis: The Hidden Killer

Atherosclerosis is a common disease in companion parrots – one we must all take seriously. If you have ever heard of an older parrot who died suddenly, without apparent cause, there is a good chance that this progressive disease was a primary factor in the demise.

What is Atherosclerosis?

Atherosclerosis is one type of arteriosclerosis.  The word atherosclerosis derives from the Greek words athero, which means “gruel or porridge,” and sclerosis, which means “hardness.” This is a fairly descriptive term for the disease itself, in which cholesterol is deposited onto the sides of arteries, creating hard plaques. Once build-up is great enough, plaques can dislodge; these cause blockages, which lead to heart attack.

It is primarily a disease of inflammation. The more inflammation, the greater the risk of atherosclerosis.Blue and Gold by Engin Akyurt

Birds are more susceptible to atherosclerosis than any mammal, with the exception of humans. “The reported incidence rates in avian species range widely from 1.9% to 91.9%.”(Powers, 2015)

A Confusion of Information

While much is known about atherosclerosis in humans, this information cannot be readily transferred with reliability to birds. Reading through scientific papers about the disease causes consternation and befuddlement. Undeniable conclusions are lacking, although more recent research does point to strong correlations.

Much of the research has been done on bird species other than parrots, such as quail, waterfowl, and chickens. Diagnosis on parrot species who have succumbed to this illness has been conducted on a very mixed population, particularly those kept previously in zoos, who have been maintained under a variety of conditions and fed a mix of diets.

Moreover, the studies that are being done on risk factors that exist for parrots are being performed on the known risk factors for humans and other mammals. There may, however, be other risk factors specific to avian species that may take longer to uncover, such as individual species’ genetics.

Thus, I will warn you that what I write today may well be something I will edit extensively in another five years.  The danger is significant and real for our parrots, so an examination now of what we know is important. However, I have every expectation that some of what you read below may be proved wrong in the future, while additional details will in turn come to light.

Which Parrots Are At Risk?

While we have a very good understanding of risk factors in mammals, this is not so with parrots. But, a few things we do know.

Speciesparrot-2005767__340

It is currently agreed that Amazon parrots, African Grey parrots, quaker parakeets, and cockatiels appear to be at greatest risk. While the disease has been seen in cockatoos and macaws, they are not believed to be quite as susceptible. Many avian species, though not all, have been found to develop atherosclerosis in captivity.

Age

Increased age is a significant risk factor. However, while more common in older parrots, Nemeth states that atherosclerosis has been found in birds aged 1 to 42 years. (Nemeth at al, 2016) It is most common in companion parrots over the age of 10.

Gender

Female parrots have been proven statistically to be at greater risk. Female birds in reproductive mode generally have elevated levels of cholesterol, triglycerides and lipoproteins, as well as calcium, creating greater susceptibility.

Diet and Nutrition

“The inclusion of cholesterol in the diet of birds that consume non-animal protein, even as low as 0.25% of the diet, dramatically increases plasma and serum cholesterol levels.” (Petzinger and Bauer, 2013).

Petzinger also mentions a 2003 paper by Bavelaar and Beynen that found that African grey parrots fed a high-fat diet containing palm kernel oil (saturated fatty acids) had increased cholesterol levels.cockatiel-1213758__340

Petzinger also reports on the findings of yet another study from 2012. In this research, a total of 47 cockatiels who were supplemented with fish oil had lower plasma cholesterol than cockatiels fed flaxseed oil. The conclusion? “Thus, dietary fish oil (and possibly dried algae products) may be more beneficial than oils high in A-linolenic acid on reducing risk factors and prevalence of atherosclerosis in avian species.” (Petzinger and Bauer, 2013)

Another nutrient capable of lowering cholesterol levels in birds is pectin. Pectin is the soluble fiber contained in fruit and some vegetables.

The overall amount of food eaten may also contribute to the development of atherosclerosis. Overeating and obesity are proven risk factors for mammals. This correlation has been studied in birds with varying conclusions.

Physical Inactivity

Every research paper I read reported a presumed link between inactivity and the development of atherosclerosis. However, I could find no evidence that any link between exercise and this illness had actually been researched in avian species.Conure2

Since such a strong link exists between the two in mammals, including humans, it would be foolish to ignore it here and the papers I read did include recommendations for exercise in companion parrots.

Inflammation

The literature on human health names inflammation in the body as a primary cause for the development of atherosclerosis. In fact, inflammation is currently being discussed in what is being called “a unifying theory of disease.” (Harvard Health, 2006) In other words, inflammation is now considered as a significant factor in the development of many chronic human illnesses.

Nevertheless, inflammation as a process “remains a mystery.” (Anft, 2016) However, scientists are beginning to agree that lifestyle choices like diet and exercise may increase (or reduce)  inflammation.parrot eating cracker

Common foods that cause inflammation, which are often fed to parrots, are fried foods and those containing refined carbohydrates (white flours and sugars).

Co-Infection with Psittacosis

The disease Psittacosis, also known as Parrot Fever, is more accurately referred to as Chlamydia psittaci. This disease is still relatively common among companion parrots, especially those who have come from large collections. While researchers disagree about whether there is a conclusive correlation between infection with Chlamydia and atherosclerosis, some studies appear to agree on this.

Signs and Symptoms

Sadly, the most common sign of atherosclerosis is sudden death. In the late stages, there may be symptoms such as weakness, lethargy, neurological  signs (including seizure-like activity), trouble breathing and exercise intolerance. However, these may be less observable due to parrots spending long hours in cages. It is easier to identify exercise intolerance, for example, in parrots who fly.

At this point in time, diagnosis is extremely difficult. Most people will never imagine that their parrots are ill until they lose them unexpectedly, well before their time. With better imaging techniques, as well as a better understanding of identifying factors in serum chemistries, this may change in the future.

What Can We Do?

Atherosclerosis in companion parrots is still not well-understood. Direct and specific correlations from the human health field may only be suggestive. Thus, we do not have well-defined risk factors that would allow us to target flawless measures for prevention.

FoodSkewerMoreComplexSuggested lifestyle changes reported in the literature include “increasing physical activity by providing more opportunities for locomotion and foraging behaviors and decreasing the stress level  in their captive environment. Limiting dietary excess and obesity also seem to be a reasonable strategy, but species-specific dietary needs should be considered.”(Beaufrere, 2013)

“Birds should be provided ample opportunities for exercise and activities such as foraging, and even flight, if considered safe for the bird. Excessive energy content in the food should be avoided, such as excess carbohydrates and fats. Birds should receive regular preventative veterinary care with periodic bloodwork monitoring.” (Powers, 2015)

Diets that contain relatively high levels of Omega-3 fatty acids reduce the prevalence of the disease. (Petzinger and Bauer, 2013) Nordic NaturalsNewer research indicates that fish oil may be more effective in this than alpha-linolenic acid, the type of omega-3 found in plants, such as in flax seed oil. Supplementation with fish oil may be an excellent addition to the diets of many companion parrots, but this should not be undertaken without the advice of your veterinarian.

Pectin in the diet has also decreased the occurrence of atherosclerosis. (Petzinger and Bauer, 2013) Pectin is the soluble fiber found in fruit. Too much pectin can result in a decrease in the absorption of nutrients from the intestine, however. Thus, fruit should be fed in moderation for most species.

Reducing the overall amount of food, i.e. not over-feeding, can also decrease the prevalence of atherosclerosis. This  information too, however, could be harmful if implemented to the extreme. Hunger and malnutrition do nothing to improve overall health. It is best to consult with your veterinarian about the quantity of foods to offer.

Suggested Action Steps:

After as thorough a review as I could muster with the research I was able to access, I think the following steps are prudent:

  • Identify an avian vet who specializes in birds and schedule annual visits.
  • If your veterinarian tells you your bird is fat, take this seriously and formulate a plan for gradual weight reduction.
  • Discuss with your veterinarian supplementation with fish oil. (The correct dose is important and should be obtained from your vet.) Nordic Naturals is an excellent choice.
  • If you have a female parrot, do everything you can to minimize triggers for the increased production of reproductive hormones. (You should do this for males too.)
    • Discourage a pair bond
    • Avoid cuddling and other highly affectionate interactions
    • Prevent cavity seeking (getting into closets, boxes, etc.)
    • Feed a low-fat, low-carbohydrate diet013
  • Do not feed foods high in saturated fat (fatty meats, butter, margarine, cheese, coconut oil, palm oil, fried food, or snack foods).
  • Do not feed pasta, white rice, or any foods that contain white flour or sugar and other sweeteners.
  • If your bird eats a seed mix as a dietary staple, convert him to a pelleted diet with supplementation of fresh foods.
  • Avoid overfeeding. Remember the size of the creature you are feeding.
  • Encourage foraging and try to incorporate some physical activity into this.
  • Encourage exercise.
    • Determine whether you and your bird might be a candidate for flight in the home.
    • If not, work to discover ways to encourage as much movement as possible.Green And Red Healthy Food
  • Do feed foods high in pectin, in moderation (apples, pears, plums, peaches, apricots, cherries, strawberries, guava, carrots and peas). Apples are especially high.
  • Do feed foods high in omega-3 fatty acids or that are otherwise known to reduce cholesterol (oats, barley and other grains, walnuts, flax seeds, chia seeds, hemp seeds, edamame, almonds, beans, tofu, salmon)
  • Do feed foods that fight inflammation (green leafy vegetables, blueberries, salmon, broccoli, cauliflower, kale, peppers, grapes, celery, ginger, tumeric)

parrot-2960562__340Atherosclerosis is a scary prospect, given what we now know about the susceptibility of our companion parrots. However, I suspect that we have in our hands the tools for prevention, just as people do. Granted, risk factors outside of our control exist, such as age and gender. However, we do have enough information to take action and keep our parrots as healthy as absolutely possible.

Thank you for reading my blog. I am Pamela Clark, an IAABC Certified Parrot Behavior Consultant. My passion is helping people with parrots by offering behavior consultations and publishing information you can trust. To access free resources, schedule a consultation, or subscribe to my newsletter (which is a different publication from this blog), please visit me at http://www.pamelaclarkonline.com. Until next time!

References:

Anft, M. 2016. “Understanding Inflammation.” Johns Hopkins Health Review. Volume 3, Issue 1. https://www.johnshopkinshealthreview.com/issues/spring-summer-2016/articles/understanding-inflammation

Beaufrere, H.  Dr. Med Vet, PhD, Dip. ECZM, Dip. ABVP. 2013. “Avian Atherosclerosis: Parrots and Beyond. Topics in Medicine and Surgery.http://dx.doi.org/10.1053/j.jepm.2013.10.015https://www.sciencedirect.com/science/article/abs/pii/S1557506313001754?via%3Dihub

Bavelaar F. J. & Beynen, A.C. (2004) “Atherosclerosis in Parrots: A Review. Veterinary Quarterly, 26:2, 50-60. https://doi.org/10.1080/01652176.2004.9695168

Nemeth, N.M. , Gonzaliz-Astudillo, V., Oesterle, P.T. Howerth. E. W.  “A 5-Year Retrospective Review of Avian Diseases Diagnosed at the Department of Pathology, University of Georgia”. Journal of Comparative Pathology. Volume 155, Issues 2–3, August–October 2016, Pages 105-120. https://doi.org/10.1016/j.jcpa.2016.05.006

Harvard Health Publishing. April 2006. Harvard Medical School. “Inflammation: A Unifying Theory of Disease. https://www.health.harvard.edu/newsletter_article/Inflammation_A_unifying_theory_of_disease

Petzinger, C. PhD, Bauer, J, DVM, PhD, Dip. ACVN. 2013. Journal of Exotic Pet Medicine. Volume 22, Issue 4, October 2013, Pages 358-365. “Dietary Considerations for Atherosclerosis in Common Companion Avian Species. https://doi.org/10.1053/j.jepm.2013.10.013

Petzinger,C BS, Heatley, J DVM, MS, DABVP, DACZM, Cornejo,J BS, Brightsmith, D. PhD; Bauer, J DVM, PhD, DACVN. Journal of the American Veterinary Medical Association. March 1, 2010, Vol. 236, No. 5, Pages 523-528. https://doi.org/10.2460/javma.236.5.523

Powers, L. DVM, DABVP. 2015. “The Silent Killer: Atherosclerosis in Pet Birds.” CVC in Washington, D.C. Proceedings.  Published on DVM 360. http://veterinarycalendar.dvm360.com/silent-killer-atherosclerosis-pet-birds-proceedings.

Suspicions and Fears about Avian Veterinary Care

Recently, I received a message from someone asking how she could teach her parrot to climb again after a bout of egg binding. Clearly, a medical problem remained, yet the owner was reluctant to take the bird back to the vet as he had asked. She also posted on Facebook asking for advice.

It would be easy here to lapse into judgment, but that would serve no forward-thinking purpose. The bird’s owner clearly does love her, is trying to get help, and the advice she got on Facebook mirrored my own – get the bird back to the vet. We can hope she did.

Distrust and Suspicion of Veterinarians

I choose to discuss this here because her behavior is not uncommon. images (18)I worked as a technician for avian veterinarians for close to 20 years before retiring this past January. The suspicion, distrust, and fear behind such behavior are actually very typical of a certain percentage of pet owners. This is a problem that deserves examination.

As a technician, I became aware that there is a generalized distrust of veterinarians and their motives among many who live with animals. Some entertain suspicions that the veterinarian is just recommending services in order to make money. They don’t understand the diagnostics and procedures being recommended, so fear they are being taken advantage of. They are frightened of the expense that might be incurred and feel no ability to take control of this if they do take their pet in.

We Distrust What We Don’t Understand

I think it’s normal to suspect what we don’t understand. I hesitate to take my car to a mechanic. I don’t know anything about cars or what routine maintenance and repairs cost, so I wind up being afraid that I will be taken advantage of. I feel that I have no way to protect myself, so I hesitate due to my suspicion and distrust, as well as fear of the potential expense.

Demystifying Avian Veterinary Care

We need to demystify avian veterinary care, so that all bird owners can have a trusting relationship with a qualified avian vet that includes honest two-way communication. Hopefully, this blog post can serve as a beginning towards that goal.

Photo by Hush Naidoo on UnsplashFor those of you who don’t have a trusting relationship with a veterinarian, please read the blog post that I wrote earlier in the year – The Avian Veterinarian: Tips for Choosing One You Can Trust. If you already have a veterinarian you trust, you may not need the information below. However, if your thoughts lurk in the dark places between “I could never afford care for my parrot!” and “My vet always wants to do too much testing!” …then the information below may help.

 Allow me to share what I know to be true about veterinarians,  medical testing and procedures, and how to best take control of your situation when you do seek medical care for your bird.

Veterinary Fees and Motivations

First, I can set to rest any fears you may entertain about being taken advantage of financially. No one becomes a veterinarian to make money. Most that I know live modestly with spouses who provide a second income.

download (5)Even if it were the most lucrative profession on the planet, most would not pursue it.  If you don’t have either diarrhea or vomit on your shoes at least once during the day, you have had to defend yourself against physical harm from the chihuahua whose fear, distrust and suspicion exceeds his owner’s.

Being a veterinarian is difficult and being an avian vet is even harder. Even if a veterinarian’s true passion is avian medicine, he often still has to see dogs, cats, and other animals in order to make a living. Relatively few places in the United States have a large enough population of bird owners to sustain an avian-only practice.

Aside from the daily physical unpleasantness and danger from animals who resist their medical care, the schedule is grueling. Often there is no emergency service available for after-hours care, so avian vets wind up seeing patients on weekends and evenings if clients need them.

To suspect a veterinarian of recommending services photo-1535241556859-780cb9f395f2simply to make money reflects a profound lack of understanding about the nature of the profession. People become veterinarians because they love animals and want to help them (and perhaps because healing animals is more appealing than healing humans).  None of them are getting rich doing it.

Why is Avian Veterinary Care So Expensive?

Avian veterinary care can seem quite expensive, however. Partly, this is just a matter of perception. Clients with medical insurance of their own are used to having liability only for a co-pay and meeting a deductible. This leaves them out of touch with what the real costs are for medical care.

First, care is expensive because veterinarians receive exactly the same amount of training and incur the same amount of debt as human medical doctors. For avian vets, additional training is required not only for themselves, but their staff. Birds are different from any other pet we see and a great deal of study regarding new advances is required to keep up to date.

photo-1516665813681-197673df81eeNext, avian veterinary care is expensive because appointment times must be longer. Most dog and cat owners don’t need a lot of help with diet and husbandry.  Bird owners, however, frequently do need help with diet, husbandry, and behavior issues. Since these things can impact health and the human-animal bond, we must spend the time to address them.

Further, very ill birds may need to be hospitalized in order to perform diagnostics and initiate treatment. This too increases expense. Sick birds can be quite fragile.  The ancient physician’s oath, the guiding principle that permeates every branch of medicine, is “First Do No Harm.” 

Avian medicine is more expensive because we can’t use the same procedures and medications for birds as we do for mammals. We can usually take a radiograph of a dog without sedation. To x-ray a bird requires either conscious sedation or anesthesia. This requires additional staff, equipment, and medications, all of which translate into increased costs.

Last, medications for birds can be more expensive because they often must be photo-1522827585129-4ba47bae3e06compounded. You can’t pill a parrot.  It’s necessary to create a liquid from a tablet or capsule so that it can be administered orally. This takes expertise, time and additional supplies.

These are just a few reasons why avian medical care can seem very expensive.  I hope this explanation will allow you to set aside any suspicions you may have about your veterinarian trying to increase your invoice with unnecessary services. You can instead assume that your veterinarian is well-intentioned.  He wants the best for you and your bird. That fact is bankable.

Finding Comfort in a Foreign Land

For most people, spending time in a veterinarian’s office is about as much fun as spending time in a human doctor’s office. The physical surroundings are strange and too sterile. The vocabulary is foreign and you can wind up feeling stupid because you aren’t familiar with the terms used. Often the staff seems to be in a hurry, which makes asking questions uncomfortable. download (4)It’s easy to doubt the need for something that you don’t understand.

If this has been your experience, it can help to understand more about the standard testing that may be recommended, as well as the procedures that are used to address certain situations. Better familiarity may help you to feel like you have more control of the situation and are better able to communicate with less confusion.

Why are Laboratory Tests Necessary?

A physical exam reveals much valuable information: malnutrition and vitamin A deficiencies, respiratory illness and sinus or eye infections, feather abnormalities, problems with bones and joints, and external parasites.

However, there is even more that this examination will not tell you. This is why your veterinarian will at some point recommend doing some laboratory tests. Unfortunately, there is no one test that will reveal all necessary information to diagnose a problem. It is often necessary to perform a few different tests, each of which provides a piece to the diagnostic puzzle.

Below is a brief description of each, provided so that the next time you go to the vet you will understand more of what is said. Please save this post so that you can refer to it before your next vet appointment. These are the tests most commonly recommended.

Complete Blood Count (CBC)

This blood test looks at red blood cells, white blood cells and platelets (which cause blood clotting). download (8)The test reveals signs of anemia, infection, blood protein levels, inflammation, and the presence of blood parasites. When a bird is sick, the white blood cell (WBC) count will show the level of infection present. If this is very high, the test may need to be repeated after the first round of antibiotics to see if this therapy needs to be continued.

Your veterinarian may recommend this test even if your bird is healthy. Every bird is different. By doing a CBC when your bird is well, your vet then knows exactly what is normal for him. This information will help in the future if he does fall ill.

Serum Chemistry Panel

This blood test is often performed along with the CBC. It evaluates individual organ function and is invaluable for diagnosing liver and kidney disease, as well as diabetes. It provides electrolyte values, calcium levels, and cholesterol levels. This test is especially important for older birds, sick birds and those who have been eating a poor diet.

Fecal Direct Smear and Fecal Flotation

download (9)These tests are usually performed together and may be referred to as a “fecal analysis.”  They reveal the presence of intestinal parasites and any bacterial or yeast overgrowth. The direct smear can be invaluable in diagnosing avian gastric yeast (known previously as megabacteria). Your vet may recommend this when your bird is sick, but also as an initial screening test when you bring a new bird into your home.

Gram stain and/or Culture and Sensitivity

These tests are usually done for the same purpose – that of determining the type of organisms (bacteria and/or yeast) present in both the respiratory and gastrointestinal tracts. These tests also are valuable for routine screening on well birds, as well as to provide diagnostic assistance when the bird is ill.

Some vets seem to prefer Gram stains, while others find more value in doing a culture and sensitivity.  The Gram stain quantifies the number of organisms present and distinguishes between two different classifications of bacteria. It can also reveal the presence of a yeast overgrowth in the gastrointestinal tract or spirochetes in the oral cavity.

The culture and sensitivity also identifies organisms present, but in addition tests for which antibiotics will be most effective in treating them. This is very helpful in minimizing any guesswork when it comes to choosing a medication.

Cytology

If your bird has a lump or mass, a wound that isn’t healing, or some type of skin irritation, your veterinarian will likely recommend a cytology.  The sample obtained is stained with dye and then examined under the microscope to determine what type of organism is causing the problem.  Only in this way can your veterinarian know which type of medication is needed. In the case of a mass, he will be able to tell if this is malignant.

Radiographs (X-rays)

Radiographs can reveal pneumonia, fungal infections, foreign bodies, and bone fractures or abnormalities.  download (10)They are often recommended as a second stage in the diagnostic process, unless physical signs dictate their immediate need.

I once had a Red-lored Amazon who displayed signs of respiratory illness. We performed a CBC and chemistry panel.  The latter was normal and the WBC count was just slightly elevated, but we treated her with antibiotics anyway.

She initially improved, then worsened again. We took radiographs as a next step, which revealed a large inoperable thyroid tumor that was pressing on her trachea, making it hard for her to breathe.  This one additional test changed our treatment course completely.  It was clear that euthanasia was the best course to prevent further suffering.

These are only a few of the tests commonly recommended. I hope that you will openly discuss with your vet the advantages and disadvantages of anything he thinks needs to be done. Remember that he is on your side and wants the best for you and your bird.

Staging Diagnostics

I have heard many clients express frustration about having paid for initial diagnostics only to have additional testing recommended. While it may be easy to be suspicious in such a case, there is a good reason for this. SickAmazonMost veterinarians will stage diagnostics – they recommend certain steps initially in hopes that these will provide the needed answers. (Most vets are respectful of both clients’ pocketbooks and  patients’ stress levels.) If a diagnosis can’t be determined after these tests, others might be necessary.

If you encounter this situation, please remember that your vet isn’t just trying to get more money out of you. Further, it doesn’t mean that he doesn’t know what he’s doing. This is a standard way to proceed in both veterinary and human medicine.

The Severely Ill Bird

It is also imperative at times to hospitalize a very sick bird in order to stage both diagnostics and treatment. Since companion birds have retained the ability to hide illness, your bird may be sicker than you have realized by the time you do get him to the vet. If this is the case, don’t be surprised if your veterinarian recommends keeping him at the clinic for a day or longer. Again, this isn’t because he is trying to jack up your invoice.

In the case of respiratory illness, your vet may even delay the physical exam until your parrot has been stabilized a bit. He may first just let him rest for a short time in a warm incubator, even providing a little oxygen. He might then administer subcutaneous fluids, putting his patient quickly back to recover from that. After another hour, he might attempt to collect a lab sample. After another rest, he might give an antibiotic injection. It is best to proceed slowly in such cases, so that the needed treatment doesn’t make the bird worse. Again, this very necessary process will translate into increased cost.

Preparing for Expense

You must assume that your bird will require medical care, just as do you and your other pets. If you plan ahead for this, you can take most of the fear out of the experience. Several options exist.

  • Put a small sum aside each month into a separate savings account ear-marked just for avian veterinary care.
  • Consider pet insurance. Unfortunately, the only company in the United States currently offering coverage for birds is Nationwide Bird & Exotic Pet Insurance (formerly known as VPI or Veterinary Pet Insurance).
  • Pet Assure offers a discount card, which may reduce fees at some clinics within their network.
  • Apply for CareCredit. This company offers help financing health care expenses. It is easy to apply for and can be used for your own health care also. Not every veterinarian accepts CareCredit, so check first before making an appointment.
  • If your veterinarian doesn’t offer to go over a treatment plan, which outlines the costs of the day’s services, request one. This process can seem a bit daunting and the most suspicious of us may imagine that this is an arm-twisting exercise. However, nothing could be further from the truth. A treatment plan is an invitation to have a conversation. It’s your chance to ask questions about what has been recommended and to frankly discuss any financial limitations you may have.

Conclusion

Your bird is going to need both routine veterinary care, as well as treatment for injuries and illness. photo-1521866337281-e7207a7159c9Birds always seem to get themselves into trouble in one way or another.

We can act on our love for them by planning for this, both by securing the financial means to pay and learning more about veterinary procedures and processes. Both will allow you to enter into a true partnership with your veterinarian. Remember, he has dedicated his life to you and your birds.

Thank you for reading my blog. I am Pamela Clark, an IAABC Certified Parrot Behavior Consultant and licensed veterinary technician. My passion is helping people with parrots. To access many free resources or subscribe to my newsletter, please visit me at http://www.pamelaclarkonline.com. Until next time!

References

Association of Avian Veterinarians. 2018. “Bird Health Exam.” https://www.aav.org/page/healthexam

Magnuson, M. 2018. “Ask the Vet: Why is Veterinary Care So Expensive?” The Project Pawsitive Foundation: http://www.projectpawsitive.com/2018/01/17/veterinary-care-expensive

Rupley, A. DVM, ABVP Avian. 1997. Manual of Avian Practice. Philadelphia: W. B. Saunders Company.

Sakas, P DVM, MS. 2002. “Understanding Avian Laboratory Tests.” Material was adapted from Essentials of Avian Medicine: A Practitioner’s Guide,  2nd Edition by Peter S. Sakas DVM, MS. AAHA Press. https://nilesanimalhospital.com/files/2012/05/Understanding-Avian-Laboratory-Tests.pdf

Credits: Featured image is by Benny Kirubakaran on Unsplash.