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Discussion Starter #1
Hi, everyone,

My 25+ y.o. cockatiel suddenly got very sick almost three months ago. He's much better now, but he's periodically had almost random symptoms, and I'd really love some input. We're a little stuck because he's too small to do bloodwork (normally 76 g, but has only been 68-70 g for the last month). Here's the rundown, as brief as I can make it.

It started 2.5 months ago with:
-he lost 20% body weight in 2 days (from 76 to 60 g)
-had undigested millet in his poop
-was VERY sick until the vet tube-fed him for a few days
-2 gram stains showed nothing
-xray showed slight liver enlargement, but nothing definite
-got antibiotics for 3-4 weeks

2 weeks ago:
-he regurgitated seeds over 12 hours, something I've NEVER seen him do, ever.
-gram stain & xray normal
-he may have ingested some cardboard; I took it away
-vet gave him 1 antibiotic shot

Last 3 days:
-a little blood in his poop; not clear if it's in urine, urates, or stool
-gram stain showed "lots of yeast AND gram-negative rod bacteria"
-started him on antibiotic (enrofloxacin) and anti-yeast (diflucan + nystatin)
-oh, and an ulcer aid, just in case (sucralfate)

Ongoing:
-with more than a few pinches of millet, he starts passing a few undigested millets. Maybe he's not hulling them? But it seems weird that he suddenly stopped hulling when he got sick.
-occasional blood in his poop yesterday/today
-he's slowly gained weight since 2.5 months ago, but he's still 10% below normal

Otherwise, he's acting totally normal, appetite, active, singing, and droppings looks great. Mostly seed diet, some pellets, daily greens. He finally started eating whole-grain bread (I was so excited) -- about 3 days before the blood in the poop, so I think that caused/exacerbated the yeast infection. Removed bread immediately. Decidedly NOT hand-fed and a picky eater. Daily lactulose & vetriliquid DMG for liver.

Is it possible the yeast/bacteria was there for months and just now showed up on the gram stain? Is it normal for yeast (or bacteria) to cause blood in the droppings? Can the antibiotic and antiyeast and antiulcer counteract each other? Does any of this sound like kidney or liver disease? With bloodwork impossible, what else can we do?

Tips for gaining weight, especially since he can't seem to process the volume of millet he used to? He's got Young Again digestive aid/probiotic sprinkled on his seeds - any ideas on more effective ways to get that into him?

Sorry this post is so long, but there are so many factors. I honestly don't know if any of these things is related. Also, the avian vet I settled on (out of 3 avian vets) is caring but very stressed as they are the only avian vet at a large 24/7 hospital, so it always feels like I'm imposing when I ask too many questions. I'm hoping you guys might have some helpful thoughts or experiences.
 

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It sounds like AGY. It is a type of yeast, formerly known as megabacteria.

It can cause bleeding in the GI tract, undigested seed in droppings, vomiting, extreme sudden weight loss, lethargy, etc.

I'm currently treating Allie for the same thing.

Her symptoms were much more subtle. We found secondary infections of the GI tract to begin with (gram negative bacteria in gram stain) so we began treating with Enrofloxacin and Flagyl. After 2 weeks, the gram stain came back clear..so we discontinued the meds. A week later she stopped eating so we hospitalized her, and her gram stain was still normal.

Then she was eating well on her own, but continuing to lose weight. We were pretty much out of options..bloodwork was normal, gram stains were fine..so as shot in the dark I decided to do an AGY and Giardia test. These both are parasites.

While we were waiting for the test to come back, Allie lost more weight and had black droppings (digested blood). Back to the vets..a gram stain revealed the secondary infections came back. And while receiving supportive care that day, the AGY test came back and it was positive.

So we started her on Clavamox (similar to Flagyl, but more broad spectrum), Orbifloxacin (similar to Enrofloxacin), Amphotericin (AGY treatment), and Pepcid (to decrease chances of the Ampho causing GI upset).

We're about half way through treatment. She's doing okay, but the Ampho is a rough drug. We were initially going to the vet every 4 days for sub q fluids because we needed to keep her hydrated to prevent the Ampho from causing kidney damage. Now we go once a week for a check up and more fluids.

Allie's age is unknown..she usually weighs 89 g. At the worst point she was 65 g, and 18 days into treatment we're 76 g. But, I am feeding her formula with a crop needle otherwise she would not be gaining.

We also have her in a small cage with a heat lamp over it and perches placed low so she can conserve energy.
 

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Discussion Starter #3
Thanks for the input. I'm definitely worried about AGY. But I'm getting some conflicting info from online and the vet -- does AGY show up on a gram stain, or does it require a special test? My vet is not great at suggesting more things to do unless I've researched it and know what to ask. Blood is starting to show up in every dropping today, which has me very worried.

You said Ampho is rough. In what ways, besides Allie needing sub q fluids? Is this one these things where the cure could be worse than the disease?

Best wishes to you and Allie!
 

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There is a specific test for AGY. It won't show up on a gram stain. The AGY test is done by getting a fecal sample...the lab then does a DNA or PCR test to determine if AGY is in the stool. The bacteria is shed intermittently, though so even if the result was negative then it doesn't completely rule the disease.

The Amphotericin is known for causing GI irritation. That is why treatment is so rough. It is a 30 day long treatment, medicating twice a day. Because the drug can ***age kidneys the bird must be kept hydrated, hence the sub q fluids.

My biggest issue with this medicine is that some days Allie doesn't eat very well. And I'm ***uming that is because of the irritation she's feeling. The other side effect of the Ampho is that it has caused excessive mucous to be secreted in the GI tract. So if you open Allie's beak you can literally see mucous bubbles coming out.

I'm using a crop needle (long stainless steel tube that goes into the mouth, down the esophagus, and into the crop) to deliver meds and to give formula feeds. Sometimes as I'm giving formula an abundance of mucous comes into the mouth and I have to discontinue momentarily to let her swallow all the mucous. Otherwise she wouldn't be able to breath. She is just maintaining weight or gaining so slowly, that I feel if I was not formula feeding then she'd still be losing weight.
 

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BTW it's an internet myth that the yeast in bread can cause yeast problems in birds. The common yeast that causes illness is Candida albicans. AGY (avian gastric yeast) is Macrorhabdus ornithogaster. Bread yeast is Saccharomyces cerevisiae aka brewers yeast. It's benign in its action, a completely different species than the problem yeasts, and also completely dead in the bread because the heat of baking kills it. There might have been something in the bread that was hard on his system (wheat allergy? gluten?) but it's unlikely that the yeast caused problems.
 

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Discussion Starter #6
New developments: he p***ed three weird droppings today that were mostly yellow and a little bubbly. With the first two, it may have been mostly urine/urates mixed up. But in the third one, the stool itself looked yellowish. I was gone most of yesterday and he didn't eat much -- could that have something to do with it? He just now p***ed a very normal poop.

Nailed my vet down and asked a bunch of questions just now: my vet had NOT HEARD OF Avian Gastric Yeast. Once I called it megabacteria, he kind of knew what it was. But he didn't seem to know that it's now thought to be yeast, that it responds better to antifungals, that there's a separate test, or that it's treated with amphotericin and not diflucan/nystatin. He did say ampho is very dangerous and that the gram stains check for megabacteria (none of his gram stains showed any). He also says that it doesn't matter what yeast was seen as it's all treated the same way and that a bacterial culture may not be helpful since the enroflaxocin treats the gram-negative rods that showed up. He's calling the lab to find out about AGY testing.

This is what sucks about having moved to a small town in a sparsely populated state. This vet is very well-intentioned and caring, but I just don't feel the level of avian knowledge here compares to where I used to live. I'm going to see if my previous avian vet will do a phone consult.

tielfan: I wasn't sure if bread could really cause yeast, given all you mentioned. But I'm guessing if there was yeast there already, the bread turning to sugar certainly fed it.
 

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The bubbly poops is gas produced because of gastrointestinal irritation/inflammation. Allie had that too, and has had them occasionally during treatment as well.

Do you think you could call the other vets in your area and ask them if they have any experience treating AGY? If the other vets have experience I would switch my bird's care to them.

Yes, amphotericin is a very rough drug, but it is also might be the only thing that can save your bird.

If you decide to stick with your current vet, I would ask that he consulted another avian veterinarian on the phone to guide his method of treatment and so he will have someone to support him throughout him the process too.

However, if your vet refuses to test/treat your bird properly (testing for AGY and prescribing amphotericin instead of the diflucan/nystatin) then I would definitely switch vets. I would not sit and watch my bird die when the condition is treatable.
 

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Discussion Starter #8
The latest: After 3 days of blood in most droppings, I’ve seen no blood, or almost none, in about 24 hours. I’m cautiously happy. He had about 3 in a row again today that were yellowish (the stool, not the urates). Today and yesterday, the 3 parts were kind of cloudy and mixed together, with little or no stool. But he went for a while without eating both days – maybe it’s that, or a side effect of a drug? Also occurred to me that maybe those were more pellet-y poops than seed poops?

Current vet got some suggestions from his lab. Bird got an iron injection today to help with the blood loss (probably why he didn’t eat much today – stress), and we’re doing a cytology on his feces to see if red blood cells are present (in case it’s not blood).

I had a phone consult today with my previous vet! :D Made me feel much better. He’s dealt with AGY and said it would definitely have shown up on one of the 4-5 gram stains we’ve done b/c AGY rods are HUGE. (This tracks with info I've found online, that there are several fecal tests possible for AGY, including gram stains, and that PCR tests are often done when AGY doesn't show up on those tests but is still suspected.) He also said that he treats AGY with diflucan/nystatin first and goes to ampho only if the first treatment didn’t work. He wasn’t too surprised that the current vet still knows it as megabacteria. Suggested that Bird may have had crop yeast for a while that didn’t show up on fecal gram stains until it spread, probably after Bird’s bread buffet last week :\ Also said ANY GI inflammation/irritation can cause bloody droppings, which is what I originally had thought from these boards! Honestly, I started freaking out this week b/c current vet seemed to think this was highly unusual. At any rate, I’m starting to think AGY is less likely now.

Meanwhile, he approved of the current course of meds and supplements. He said he’d feel okay doing bloodwork at 70 g, and that a good avian vet and avian lab should be to handle a CBC on 0.5 cc’s of blood. Of course, he had plenty of history with healthy Bird. Current vet has only seen Bird sick. Maybe the vets I talked to here don’t use good avian labs and would need to take more blood? At any rate, I’m going to see if we can get Bird over these infections first. Then I’ll consult other local avian vets about bloodwork. Oy, I really hated to move away from my previous vet.

BJ, I am listening to what you're saying, too. I'll call a couple of local vets about AGY next week, too. Of course, most are closed for the weekend/holiday now. Which is why I keep ending up with the current vet.
 

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Allie didn't have AGY rods show up on her gram stains, and we did lots of them. I would really push for the AGY test. I'm not convinced your bird does not have it, and quite honestly, you don't have much time to waste. Once the bleeding continues for so long in the GI tract it can cause permanent damage. This is your bird, and these are your decisions, but I'm feeling uneasy about the current situation.
 

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I have been reading this thread for the last couple of days and have felt a great deal of concern and sadness for your little bird. I am going to say something which could well be controversial but I am wondering whether it is the best thing for your bird to keep putting it through so much at such a wonderful age. It has been ill for some time now and anything to do with the gastric area can be very uncomfortable. Would it not be best to say goodbye to your little pet and have it euthanized, quietly and lovingly with you present. You have obviously been a good mum or he would not have lived for so long, perhaps this would be the best gift you could give him.
 

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If you wait too long you may not have a choice. If the GI bleeding goes on for too long it causes permanent damage so you may be forced to euthanize.

I really think you're at a point where you need to change your treatment plan or discuss your bird's quality of life with your vet. The nystatin and diflucan are obviously not improving your bird's condition.

I helplessly watched Allie lose over 25% of her body weight as we struggled to diagnose her. And euthanasia was always in the back of my mind.

Allie did not have clear-cut symptoms, but your bird DOES! If you want your bird to have any chance of living, then the disease needs to be treated now. In fact, at this point if I were you, I wouldn't even do an AGY test. I would just treat it because I don't think your bird has time to wait on test results.

It's time for you to get heavy on some decision making. Your bird is going to go one way or another, and this is a point where something needs to be done.

You guys are in my thoughts.
 

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Discussion Starter #12
Thanks for your concern, guys. Through all this, he's behaving very normally and happily, maintaining weight, and doesn't seem to be in any discomfort. Pretty sure he's not faking it, either. Trust me, I'm keeping a close watch. So his quality of life is good. Also, after 3 days of blood showing up, no blood for 3 days.

I did try calling two local vets yesterday who may have experience with AGY, but neither was in office. They should be calling me back tomorrow morning. If not, I will call them again. Current vet has no experience with AGY and is the only one in the city available on weekends, so this is the soonest I can get more information on a possible treatment change.
 

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Discussion Starter #13
Oh, his droppings started improving (blood decreasing) about 30 hours after the diflucan/nystatin treatment began, too. So I do think that is helping.
 

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I think I've given you all the advice I can. It is up to you what you do with it. I'll still watch this thread and send positive thoughts to you, but I won't be posting on this forum anymore. Private message me if you need me.
 
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