# Resistant canker?



## eternal (Feb 13, 2010)

I have new pigeon, he has canker (he also has salmonellosis and some respiratory infection). 

He's on metronidazole for 10 days and the canker in his mouth (palate) isn't gone.
He was on 100mg per kg 1 times per day regime and 50mg per kg 2 times per day also.

What now?? 
How long does it take for canker to clear completely??

I also found other dosage, 200mg per kg QID??


----------



## pdpbison (Mar 15, 2005)

What other meds hase he been on?


Seems like some of the things which we assume to be Canker, have a Bacterial component or are Bacterial...or a Bacterial condition is combine with the Canker Lsion inflamitory-debris condition somehow.

Metronidazole and Enroflaxyn together will sometimes clear the throat debris issue, where Metronidazole alone may not.


----------



## Dobato (Jul 3, 2008)

Eternal, most times a second antiprotozoal is either substituted or added, the best for resistant canker for pigeons would be Ronidazole (12.5mg/kg q24h), if not the Spartrix (Carnidazole), one 10mg pill a day along with 50mg/kg q12h of the Metronidazole. If neither of these is a possibility, then you could try switching him to Tinidazole (Fasigyn), as not too long ago a caregiver in Greece ran into a case of canker that was not clearing, I suggested he switch to Tinidazole and it did finally clear. Is the Metronidazole you have liquid?....if not pick up some liquid as well and give the Tinidazole orally (same dosing as Metronidazole, 50mg/kg q12h) and with a small brush paint any oral canker lesions with the liquid Metronidazole.

Karyn


----------



## eternal (Feb 13, 2010)

Ok, I'm going to buy Ronidazole. 

He has two small wounds on his head, one is near the left ear and the other one is on the top of the skull. They look kind of lumpy. I put him on Thiamphenicol, it's better version of Chloramphenicol. I tried to remove the crust, it's not easy and there is still some crust left really deep on the skull, and I'm afraid to touch that. Should I just leave it be or should I remove everything and treat the wound??


----------



## Pidgey (May 20, 2005)

eternal said:


> I also found other dosage, 200mg per kg QID??


"QID" or "QD"?

If it's out of the formulary file that I sent you, it's probably "QD", which simply means "Quaque Die" or "once per day". "QID" means "Quater In Die", or four (4) times per day, which I've never seen for Metronidazole at 200 milligrams per dose. I think you're getting close to toxicity there.

Anyhow, sometimes the mass of leukocytic debris (dead white blood cells and whatnot) that make up the yellow, cheesy deposits takes awhile to actually break up even after the trichomonads are all dead and gone. I've actually got one (a squeaker) that had the good sense to end up in my yard when he got too far gone to fly that has exactly the same problem. I performed a swab test onto a "wet mount" microscope slide and found more trichomonads wiggling around than I've ever seen before at one time. I went high dose (250 mg/kg, PO, QD) and am also giving Ronidazole at 10 mg/kg, PO, QD (Metronidazole in the morning; Ronidazole in the evening).

His is a largish mass on one side of the jaw that has invaded into the left jaw structure and goodness knows what all--there's a distinctive swelling (hard mass) on that side extending part way down the neck. On the inside, it's looks like a cheesy mess over there. Naturally, he can't swallow well due to the inflexibility of the throat from essentially the level of his glottis down about two centimeters. I'm tubing him and he's doing just fine (I get wing-flipped several times per day). I expect it's going to take many days for that bunch of crap to finally dissolve and go down the piping. There is, of course, some fear that the jaw on that side won't hold its structure and he'll go "scissorbeak" really badly.

Pidgey


----------



## Dobato (Jul 3, 2008)

eternal said:


> Ok, I'm going to buy Ronidazole.
> 
> He has two small wounds on his head, one is near the left ear and the other one is on the top of the skull. They look kind of lumpy. I put him on Thiamphenicol, it's better version of Chloramphenicol. I tried to remove the crust, it's not easy and there is still some crust left really deep on the skull, and I'm afraid to touch that. Should I just leave it be or should I remove everything and treat the wound??


Myself, I would not dig at the dried wounds, I would rub a bit of the of the Rivanol ointment you have on the crust/scabs to help heal and soften them up a bit and they'll slough off when ready.

Karyn


----------



## eternal (Feb 13, 2010)

It's QD, thank you, I didn't see that. Ok, I'm going to give Metronidazole at 250mg/kg and I'm going to buy Ronidazole tomorrow. 
And for how long can he take these meds?


----------



## Pidgey (May 20, 2005)

eternal said:


> And for how long can he take these meds?


Not sure, actually... but they can be safely given for weeks. However, there might not really be a need to do it. I'll retest that one that I've been giving meds for the last three days and see if there are any trichomonads left. I'm pretty sure there won't be, to the tune of 99%. However, I'll do the test for peace of mind and let you know. Might be late tonight, though.

Pidgey


----------



## Jaye (Mar 13, 2008)

I dunno if Ronidazole combined w/ Metronidazole is the greatest combo, actually.

I have had good success w/ Spartrix combined w/ Metronidazole...and Spartrix combined w/ Ronidazole.

FYI - my avian vet says of the three...Metronidazole is actually the third choice, because some canker can be resistant to it. I had a similar situation happen recently....poor pigeon was about a day from death's door when I snagged him. He initially bounced back well on Metro, but after 3 days...all of the sudden he started going downhill again...pretty dramatically. That's when I added the Spartix. Had to keep the regimen up for 2+ weeks and I kept him around another week to make sure there was no backlash. He is back out there in the Feral world and doing fine, now.

Personally, I would suggest Spartix in combo with one or the other "-zoles".


----------



## pdpbison (Mar 15, 2005)

Throat debris can take several days to well over a week to clear out...it can vary rom one instance to another.


----------



## Pidgey (May 20, 2005)

Well, I checked this morning and there are no living trichomonads that can be found by way of crop and esophageal swabs at this point. I've never seen resistant canker here before. Because of what I saw in the scope from the first swab (too much bacteria), I also treated with Trimethoprim/Sulfa because my bird is still a squeaker (Trimethoprim/Sulfa is easy on them). 

Also, when I dosed the Metronidazole, I suspended the crushed-pill powder in concentrated lemon juice mixed half-and-half with water. The acid helps the medicine to absorb, even if it has to go through the walls of the esophagus (one of my vets called that "an old chicken trick"). And I dribbled a tiny bit just inside the beak to kill the offending trichomonads at the initial site. You always have to worry that an oral medication isn't going to actually get absorbed due to the GI shutting down, so that's why I did some of the things that I did.

Anyhow, the debris is starting to break up and the swelling is going down a bit. I've been feeding him plenty of Kaytee, so he's gaining weight, getting quite an attitude and generally lazing around in his cage as if he owns the joint. The looks that he gives us now are basically of disdain towards one's subjects (kinda' like a lot of cats give). His one wing begins ticking when we inadvertently annoy him (doesn't seem to take much... ). I'm hoping that he can start swallowing seeds on his own shortly.

Pidgey


----------



## pdpbison (Mar 15, 2005)

Hi Pidgey,



Good mentions...


Similarly, I also 'swab' any visible debris in the Throat, if by using a Q-Tip to do so, and this definitely aids in dissolving or eliminating the placque/debris material it contacts.

I had not heard of using Lemon Juice before...sounds like a nice thing to do, even it if might burn a little as far as open lesion sites!

But, I think the dissolved Meds also burn a little under those conditions, so, oh well...either way, gotta do it.



Phil
Lv


----------



## Pidgey (May 20, 2005)

The vet had actually said to use orange juice but I didn't have any. I haven't seen any flinching or "guarding behavior" to indicate that he felt that "acid burn" kind of pain like I'm accustomed to when drinking such stuff while suffering a sore throat, but who knows...

I gave him a piece of corn to work on swallowing over lunch and he finally hurked it back up--I don't think he can manage seeds yet even though he's trying. You can see what looks to become a largish cavity on that side of his esophagus if that debris were to come loose in a big chunk. Obviously, it's going to have to in order for him to be able to swallow stuff on his own and it's just a matter of time. It's pretty easy to feel his jawbone on the good side and the swelling on the bad side completely envelopes it--that's the only thing worrying me at this point.

Pidgey


----------



## Jaye (Mar 13, 2008)

Just to chime in ~ gotta be careful when swabbing the throat ~ and I wouldn't at all recommend a novice trying it. The growth can break off and that can actually make the whole situation far worse...

I like the juice trick.....never had heard of that one before....


----------



## Pidgey (May 20, 2005)

Jaye said:


> Just to chime in ~ gotta be careful when swabbing the throat ~ and I wouldn't at all recommend a novice trying it. The growth can break off and that can actually make the whole situation far worse...
> 
> I like the juice trick.....never had heard of that one before....


Many medications tend to absorb within percentage brackets. A known percentage might not absorb; might get destroyed by stomach acid; might get rendered inert; etc. ... all leading to a "PDC", or "Plasma Drug Concentration":

http://books.google.com/books?id=GVtdtOsIsAUC&pg=PA4&lpg=PA4&dq=definition+PDC+Plasma+Drug+Concentration&source=bl&ots=7Xu5fV8DO6&sig=PVvk5bMcyfQcC9Tk67Tj7JXK1GQ&hl=en&ei=zJvATMHHDYW0lQeSop2-Cg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBMQ6AEwAA#v=onepage&q&f=false

Don't know why the citric acids are supposed to help carry the stuff across the membrane, just going on the vet's word at this point. I suppose there might be a reference in that book cited above, but don't have the time at the moment to go looking.

Pidgey


----------



## pdpbison (Mar 15, 2005)

I mix a tiny cocktail of meds in Water, and add a few drops of 'DSMO' for the Swabbing solution...this seems to carry the meds into the Tissues.


I swab onto the boarders of the Lesions, and, I swab the outer Skin area also.


----------



## Pidgey (May 20, 2005)

I'm seeing some good tissue granulation in the throat at this point but the poor guy sure salivates a lot--he drools a bit. Of course, that other stuff is trapped between that area inside the throat and the outer skin--can't help but wonder if it might abscess out in time through the outer skin, never had one like this before. Can't really remember many surviving here on the board when they've had bad swelling underneath the jaw, but that might speak more for my failing memory than the reality of it.

Anyhow, eternal, we sometimes hold these discussions on people's threads to pass on what we've seen and done before as some kind of way of helping inform you (a person with a particular case) of what we know (and what we sometimes don't know).

Pidgey


----------



## pdpbison (Mar 15, 2005)

Pidgey said:


> I'm seeing some good tissue granulation in the throat at this point but the poor guy sure salivates a lot--he drools a bit. Of course, that other stuff is trapped between that area inside the throat and the outer skin--can't help but wonder if it might abscess out in time through the outer skin, never had one like this before. Can't really remember many surviving here on the board when they've had bad swelling underneath the jaw, but that might speak more for my failing memory than the reality of it.
> 
> Anyhow, eternal, we sometimes hold these discussions on people's threads to pass on what we've seen and done before as some kind of way of helping inform you (a person with a particular case) of what we know (and what we sometimes don't know).
> 
> Pidgey




I had one a couple years ago who was a younger adult feral, who had really heavy swelling and inflamitory debris blockage in his upper Throat.

He was very thin, really a mess.

Anyway, lots of mucous once we got going with the meds being delicately Tubed-in, thin chows Tubed-in and so on.


Anyway, a few days into this, I notice a wet spot on his neck, and over days it became an open greyish white hole about 1/4 inch wide, communicated to his Esophagus, and would leak Water when he drank.


I did not fuss with it, and, it lasted maybe a week, then, got smaller and healed up as the rest of the issue also cleared out and healed, and, after that all was well, he was fine, ate well, everything good...gained is weight back, got his muscle mass back.

I let him have a month or two in free rove free fly in here, and released him.


Often these Throat debris ones will have lots of Mucous once the meds start working.


----------



## eternal (Feb 13, 2010)

Debris is still there, right above the tongue, and I noticed that he has large hole right above the tongue, in his palate and even some seeds are getting stuck. 
He is on aminonitrotiazole, I wasn't able to find carnidazole and ronidazole, metronidazole is definitely ineffective. I worry about his kidneys and liver, these meds are really nephrotoxic and hepatotoxic


----------



## pdpbison (Mar 15, 2005)

Hi eternal,



Well, keep him well hydrated, and slightly acidify his drinking Water with Apple Cider Vinegar, say, Three Tablespoons to a Gallon.


Are you swabbing the effected areas with a solution of the Medicine and DMSO and a little Vinegar or Lemon Juice?


Phil
Las Vegas


----------



## eternal (Feb 13, 2010)

I only found DMSO in gel form, but in combination with heparin and dexapantenol. Is it ok?


----------



## pdpbison (Mar 15, 2005)

eternal said:


> I only found DMSO in gel form, but in combination with heparin and dexapantenol. Is it ok?




Hi eternal,



I do not know how those would interact with the intended Medicines of the Solution.


Maybe just use a little Lemon Juice, Water, and the Antiprotozoal Medicine as ingredients for the swabbing Solution.


I imagine you could find plain 'DMSO' on e-bay or other internet sources and simply get some throug the Mail if you wanted.



As far as this individual Pigeon - what meds all tolled are they on?


And, are they eating, or being Tube Fed, or?


Phil
Las Vegas


----------



## eternal (Feb 13, 2010)

Huge piece of canker fell out today. Here are the pictures. 
http://img258.imageshack.us/gal.php?g=041120101786.jpg

I just pulled it gently with tweezers because it was already loose, I know I shouldn't remove any canker because the bird can bleed out, but in this case the canker was practically hanging. Why is this yellow debris formed anyway?

Now he has a hole in his palate. 

He was eating normally but it seems like he started to eat less these days. I have to monitor him more closely.


----------



## Pidgey (May 20, 2005)

eternal said:


> Huge piece of canker fell out today. Here are the pictures.
> http://img258.imageshack.us/gal.php?g=041120101786.jpg
> 
> I just pulled it gently with tweezers because it was already loose, I know I shouldn't remove any canker because the bird can bleed out, but in this case the canker was practically hanging. Why is this yellow debris formed anyway?
> ...


It basically works this way: some invading agent (bacterial, viral, protozoal) causes an immune response, where the body sends in massive amounts of immune cells. An analogy would be if some terrorists invaded a few homes in a neighborhood and the government sent it a massive amount of troops to obliterate them at any cost. If the troops weren't absolutely perfect shots, then a bunch of stray bullets could end up damaging the surrounding houses and killing the folks that live in those houses.

In short, that's exactly how you need to think of what's going on. Interestingly enough, it's the body's immune system that does most of the damage instead of the actual trichomonads--many pigeons live with exactly the same bugs in their upper GI tracts with no appreciable effect. That's precisely BECAUSE their immune systems take a more relaxed attitude towards those bugs. Always remember that the bulk of the people who died during the flu epidemic in 1917-18 was the younger and stronger individuals rather than the older folks. You can research that and use "cytokine storm" as search words, it's the same principle.

One of the interesting effects of Metronidazole is that it can moderate the cell-mediated immune response, mostly in the lower intestines but other areas as well. You have to wonder if its effects in these cases is more due to its anti-protozoal activity or, rather, to its immune response moderation effect.

Pidgey


----------

