# fprc members I need your help!!!!



## Feefo (Feb 8, 2002)

I am at work and I can’t access fprc. Someone brought me a woodpigeon that had been “almost lunch” to a sparrowhawk, a lot of its back has been eaten, organs exposed and pulsing but there is a lot of life in it.

It is warm, clean, washed, rehydrated and has been given painkillers. I am uncertain where to go from here , as it has had the flesh eaten I don’t think there is anything to suture.

I remember that Helen had a feral in a similar condition, the original Almost Lunch.

Can someone do a search for her posts on fprc and copy and paste them into this forum so I can see what she did? The post was a bit before Karen joined, and the words “lunch”, “sparrowhawk” or “hawk” might find it.

Thanks!

Cynthia


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## Pidgey (May 20, 2005)

Cynthia,

I began to try but it only allows you to search a rather small block of the total posts at a time, only a couple hundred at a time out of 65,000 messages. Is there another way to do that?

Pidgey


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## Pidgey (May 20, 2005)

I can tell you this, though, you need to get that area covered with something to keep it from desiccating like a hydroactive dressing (DuoDerm, here) or even a plastic bandage. How large is it?

Pidgey


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## Pidgey (May 20, 2005)

"Oh dear Cynthia - and I was hoping you could take Almost Lunch, (sorry, it was said in jest and the name stuck)! Remember when he first came in with all his back and neck eaten away by a sparrowhawk? Well it has almost healed - he's been off Synulox for a while and is ready for a permanent home as he will never fly again. Too much muscle gone. :-( Laura says she is coming down to Norwich in July and will happily drop him off. See attached piccies.

Helen at Wild-Life-Line"


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## Feefo (Feb 8, 2002)

Thanks Pidgey,

I smeared on Hydrocolloid gel and it is on Synulox. Is there anything before that post from Helen? She would usually give a brief description of how she was treating an injury.

Cynthia


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## Whitefeather (Sep 2, 2002)

Hi Cynthia,
So sorry to hear about the Woodpigeon.

I have searched the fprc posts under 'Almost Lunch' & haven't found Helen's original post only some referring to it.

Any other avenues I might try in an attempt to find it?

Cindy


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## Feefo (Feb 8, 2002)

Hi Cindy,

Searching fprc is hell! THank you (and Pidgey) so much for trying! I am home now and using "sparrowhawk" I managed to find a copy of Helen's post in a reply:



> ... here is today's new patient. At first glance this injured
> pidge doesn't look too bad. Extend his neck and you see that all the
> flesh surrounding the neck, shoulders and spine has gone. His spine
> and shoulder bones are exposed, although that is difficult to see
> ...


:

My own patient is still alive. I had used all my supply of hydrocolloid gel at lunchtime, the vet was shut when I left work so I tried the pharmacy. At first they said they didn't have any. then produced a single Intersite dispenser and then a tray of 1O! I could have hugged the pharmacist. It cost £33.50, but I grabbed it and used a whole tube as soon as I got home, covering first the wound and then covering a a sterile swab which I placed over the wound. 

His horrific injuries are the first problem, the second is the fact that he is a wood pigeon . They can die of stress when handled and I dare not give him an injection of fluids IP as that could also kill him. He goes bananas when I touch him and his struggles cause a bleed. The best I can do is keep him in darkness, cover his head and wrap him in a towel when I handle him.

Poor baby, he is also very young and small.

Cynthia


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## Pidgey (May 20, 2005)

Cynthia,

How extensive is the damage?

Pidgey


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## Feefo (Feb 8, 2002)

The sparrowhawk had started feeding on it, so the flesh of the upper left hand of the back is gone leaving the cavity open. There is still a lot of blood.

I remember Helen metioning a case where a pigeon had a hole in it and she could see the heart beating. That pigeon survived, so I don't want to give up on this one.

He is pooping, can stand and the girl that rescued him says that he had two long drinks...I have settled for gavaging.

I have given him another drop of Metacam for the night.

Cynthia


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## Skyeking (Jan 17, 2003)

Cynthia,

I'm so sorry to hear about this seriously injured wood pigeon.

You said he goes bananas when you touch him, was he ever in shock that you know of? ..

I know you are doing everything you can for this bird to keep him as comfy as possible. I'm glad he is drinking and pooping, hopefully he will eat soon.

I know you are watching this little one each and every minute, as the clock ticks on....

God bless you for all your care and support for this bird and all needy pigeons.


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## Feefo (Feb 8, 2002)

Hi Trees,

Another long involved story coming up!

From what I heard this pigeon has been fighting all the way. It was initially spotted bleeding and huddled against a hedge in a field. The person that saw it told a neighbour of her's, who happened to be married to a man that works with the man that "refers" the collared doves that fall on the patio outside my office to me. Because she had heard of my exploits (I scale down the wall outside her husband's window to rescue the doves ) she telephoned her husband and eventually got put through to me. At that stage she hadn't caught it yet but she said it was very energetic it its efforts to escape capture. I had no idea that it would be as badly injured as it was but assumed that it would be suffering from some degree of shock so asked her to put it in a box with a hot water bottle and to prepare rehydrating solution. It was about 3 hours after that that I received it.

Cynthia


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## Pidgey (May 20, 2005)

Sure would be nice if you could keep him on a slight sedative for awhile, huh? You know, one of the things used in avian epilepsy is Diazepam (Valium) for bad seizures. It's a quick in and out medication that can take the edge off. You might ask one of your vets about that possibility for occasions like this. You'd need a formulation that would be easy to measure out really small quantities of the active ingredient though.

An old friend of mine had a daughter who got a duck that had a large wound in the front of the chest that you could see the heart beating through. She swears up and down that they put sulfur powder on it until it healed and the vet told them to! I haven't researched that but it sure sounds... awful. Even worse, they named it "Yucky Duck". Now that's adding insult to injury but Helen's name "Almost Lunch" ranks right up there, huh?

Best of luck with this one, Cynthia!

Pidgey


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## Feefo (Feb 8, 2002)

LOL, I could do with "mother's little helper" myself at the moment but it is seldom prescribed for humans in the UK. But I will see if the vet is inclined to part with pigeon sized dosages. Valium is particularly useful to have to hand for pigeon-poisoning incidents

Cynthia


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## Maggie-NC (Jun 22, 2005)

Cynthia, my good wishes go out to you on this. I've never had a bird come in that badly injured (and hope I never do!). 

I am interested in the valium for poisoned birds. I have not heard of this. Since we periodically get in some that may have been poisoned it would be helpful to have more info. Just when you get a chance.

Maggie


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## pdpbison (Mar 15, 2005)

Hi Cynthia, 


Yes...covering their Head sometimes is a resort I can recommend.

I usually have the Toe-end of a Cotton child's sock, maybe three inches worth, which I use when I have to.

Might be worth a try that way..and, it can be slit in little ways at it's hem for a twist-tie even to help keep it on.


Good gosh...I sure wish you well with this one...!


Phil
Las Vegas


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## Reti (Jul 20, 2003)

Cynthia, the injuries sound horrific and too bad it is a woodpigeon.
He is in the best hands he could possibly be.
Good luck with is one, I so hope and pray he makes it.

I asked my vet about the valium, seens like we don't use it in the clinic, they prefer phenobarbital for seizures.

Reti


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## Pidgey (May 20, 2005)

Phenobarbital is better for recurrent epileptic seizures but in humans you have to do occasional bloodwork to monitor toxicity and it's one of those things that you better be very consistent and exact with dosing because if you miss or go off of it all of a sudden, it can be very much not good.

That's the beauty of Valium--it doesn't have to build to a blood plasma level and you don't need to worry about suddenly not getting your dose. However, it's not very good for consistent epilepsy, either.

Pidgey


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## Reti (Jul 20, 2003)

That's the beauty of Valium--it doesn't have to build to a blood plasma level and you don't need to worry about suddenly not getting your dose. However, it's not very good for consistent epilepsy, either.

Pidgey[/QUOTE]

I prefer Valium over Phenobarbital for seizures, the toxicity is much lower with valium. BUT, the withdrawal from the benzodiazepines (valium is one of them) is much more dangerous than the withdrawal from phenobarbital. Seizures is one of the withdrawal syptoms.
So, using either one has to be closely monitored.
Now, as you mentioned, valium is used for acute seizures, but phenobarbital is used for leng term control.
Then I wonder, for long term control could we use on birds other antiepileptics like Phenytoin?

Reti


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## Feefo (Feb 8, 2002)

*Update*

I did a lot of research on poisoning a year or so back, I will try to find the conclusions. But Reti is the one that has had first hand experience and (with the help of her vet) managed to save Victoria's life, fortunately I have never had to deal with a poisoned pigeon.

Maggie, this is by far the worst injury that I have had to deal with . The girl that brought her said "But of course you deal with injuries like this all the time." I had to admit that not only had I not dealt with such an injury but that I am also extremely squeamish (she wasn't and was looking with interest at the wound!) and feel on the verge of fainting when dealing with a particularly horrible wound. 

The pigeon, happily unaware of the terrible state of its back, made it through the night. She has not eaten so I gave her Poly Aid by tube. She is still active, moving away from the heat lamp. I tried to take a photo a few minutes ago, but she took that as an opportunity to consider escaping, so I am leaving well alone. Pity, as I find that I see a lot more in an enlarged digital photo than I do with my strongest glasses on.

Cynthia


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## Skyeking (Jan 17, 2003)

Hi Cynthia,

My best to you and this injured pigeon.

I know how you feel, I remember my Sebastian having his skin torn open and exposing some organs, I got a teeny bit squeemish myself. With him it was just a matter of stitches though, no skin missing.

Please do continue to update us, and sure hoping he eats on his own soon.


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## jazaroo (Jan 1, 2006)

Hi Cynthia,

I am going to make a suggestion that might seem a little unorthodox at first.

You may want to consider covering the whole wound with plain granulated table sugar, using a lot to completely cover and form a thickened barrier. The sugar will absorb moisture from the birds body and form an artificial scab, or you could also mist the sugar with a spray bottle to moisten from the top. It will also act as a barrier to infection and prevent infection. It will also allow the body to close itself underneath and heal. 

There is a lot of information on the net using sugar this way. do a Google search for SUGAR WOUNDS for more information. I have used sugar this way to help heal a family member and friend who had wounds that were not healing well with proper medical treatment, sugar does work.


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## Feefo (Feb 8, 2002)

Hi Jazaroo,

Thanks for the suggestion. I think that the Intrasite Hydrogel has a similar effect, but it also prevents dissecation which will be one of the main dangers with this sort of tissue damage:




> > *Description*
> >
> > Intrasite, is a colourless transparent aqueous gel, which contains 2.3% of a modified carboxymethylcellulose (CMC) polymer together with propylene glycol (20%) as a humectant and preservative. When placed in contact with a wound, the dressing absorbs excess exudate and produces a moist environment at the surface of the wound, without causing tissue maceration.
> >
> > ...


Cynthia


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## Victor (Dec 18, 2004)

Cynthia, I have read and re-read your thread and posts on this poor little victim.

I am just in awe that you made it a mission to try and allow this wonderful bird the right to live and breathe. 

I bet you have been through much since yesterday.

You are a living angel.


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## jazaroo (Jan 1, 2006)

Cynthia,

Yes, it seems that the Intrasite Hydro gel is a very good product to close/cover the wound. My real concern was preventing infection in such a large wound. If you read some of the information on treating with sugar, bacteria cannot survive in its presence. I do not understand how or why it works, there is detailed information in some of the search returns on this, but it does. The bonus is it is innocuous.

One of the people I mentioned was a friend who badly burned on the calf. It was treated and seen by her doctor a few times and really was not improving, red and oozing looking like it was infecting. I told her the same thing, this may seem a little unorthodox, try sugar. She rinsed the wound applied sugar and rewound it with gauze. To change dressing she just rinsed in warm water to remove the old sugar and reapplied. Within a few days the the burn stopped oozing and closed and an almost clear membrane formed and was soon replaced by new skin. Today there is hardly a trace to show the injury. 

Just a little more information and I do know the bird is in the very best of hands and I will say a little prayer for its recovery.


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## Feefo (Feb 8, 2002)

Teresa, did you stitch Sebastian? I am not sure that I would have the courage to do that unless it was a life and death situation and I couldn't get to a vet!

Victor, you are very kind but I doubt that any of us would give up on a pigeon that fights so much to live! 

Jazaroo, I will certainly try sugar on myself next time I have a wound! For the past year I appear to have managed to cut or burn myself on a weekly basis (accidentally!)

Cynthia


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## kittypaws (Sep 18, 2005)

*Good Luck*

With the little one Cynthia - he is lucky that he was found by someone who knows your penchant for creatures of the feathered kind.... 

Tania


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## Skyeking (Jan 17, 2003)

cyro51 said:


> Teresa, did you stitch Sebastian? I am not sure that I would have the courage to do that unless it was a life and death situation and I couldn't get to a vet!
> Cynthia



Oh, not me...My rehabber friend did the stitches, and I held him.


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## Feefo (Feb 8, 2002)

*Wood Pigeon Woes*

I don't know whether Intrasite has anti bacterial properties like sugar does so I decided to flush the area with metronidazole when I change the dressings, but this pigeon isn't helping herself!

Most of the time she gives the impression of being paralysed, she lies so quiet and still. I was keeping her in a cat carrier because it was small, ventilated but protected and could be adapted to a heat lamp. But this morning I found she had managed to "do a G2" and had got her head in the square door grid...the head was drooping so I thought she was dead and yanked her out cursing my stupidity and cradled her in my arms but found she was amazingly still alive.

I moved her into a plastic pet tank and clipped the heat lamp to the top. Unfortunately that is see through and I found her battering herself against the side in her attempts to escape, causing her wounds to bleed again. Now I have had to cover the sides of the tank with towels.

Despite everything I think her wounds are looking better, although like Helen's "Almost Lunch" the spine is visible (I took a photo yesterday) . I am using a whole 15 mg container of Intrasite each day.

I have started feeding her Kaytee Exact because I don't want her crop to stop functioning, but can only give 10ml at a time because in typical woodpigeon fashion she contracts her crop so the food spills back into the mouth with the danger of aspiration.

Her poops have become forest green.

She is on Metacam for the pain, I don't like prolonged use of it but the avian vet said that Hawkeye could have it for a week so I will do the same for this one.

Cynthia


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## pigeonpoo (Sep 16, 2005)

*Diazapam*

Cynthia,

I am in the UK and have Diazapam. If you need it just let me know.

Pigeonpoo


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## Feefo (Feb 8, 2002)

Here is a photo of the little one just after she had her dressings changed tonight:


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## Feefo (Feb 8, 2002)

Thanks 'Poo! Does anyone know the dose for pigeons?

Cynthia


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## kittypaws (Sep 18, 2005)

*Cynthia*

What a dear little bird. I know you will do the very best for her/him.

Good luck 

Tania


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## Feefo (Feb 8, 2002)

Sadly I don't think she will make it, she seems to be going downhill fast.

Poor little thing, she isn't a wood pigeon but a stock dove. That is why she is so small and has such dark eyes.

Cynthia


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## Whitefeather (Sep 2, 2002)

cyro51 said:


> Sadly I don't think she will make it, she seems to be going downhill fast.
> 
> Poor little thing, she isn't a wood pigeon but a stock dove. That is why she is so small and has such dark eyes.
> 
> Cynthia


I am so sorry to hear this Cynthia.
You & that sweet baby are in my thoughts. 

Cindy


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## TAWhatley (Mar 6, 2001)

I'm so sorry the bird is doing so poorly Cynthia. I'll still be hoping for yet one more little miracle to save the bird.

Terry


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## Skyeking (Jan 17, 2003)

I'm so sorry to hear that sweet little bird is doing poorly, you are in my thoughts and prayers tonight.


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## Reti (Jul 20, 2003)

I will pray for a little miracle. I so hope he makes it.

Reti


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## Pidgey (May 20, 2005)

An infection in the spine is probably the worst and most likely scenario. Desiccation of the spinal cord would be horribly difficult to prevent, too. I don't know if it's possible but I know you're doing your best and I'm wishing you all possible luck.

Pidgey


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## Feefo (Feb 8, 2002)

She didn't make it. 

I don't think the spine was the problem, it was visible through the flesh but not exposed and under a thick coating of gel all the time.

I think that she did further damage when she started battering against the tank, she was okay until then and immediately after was worse.

Poor baby, I don't think stock doves as nearly as hardy as woodpigeons and feral pigeons. They are so shy that I have never had a close look at one, I am not at all certain that they adapt to captivity.

Thanks for your support everyone.

Cynthia


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## TAWhatley (Mar 6, 2001)

I'm very sorry Cynthia. You certainly did all you could for this little one.

Terry


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## Victor (Dec 18, 2004)

She was in the best hands in her time of need. You did everything and beyond that you could. I am sorry you lost her.My heartfelt condolances to you .


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## pdpbison (Mar 15, 2005)

Hi Cynthia,




I am so sorry...

You sure gave this one really good try...
She had comforts and warmth with you too.

Little Dove...


Phil
Las Vegas


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## Reti (Jul 20, 2003)

I am so sorry Cynthia.

Reti


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## pigeonmama (Jan 9, 2005)

Cynthia,
We don't always meet with success in our attempts with our little ones. In the end, all we can hope for is what's best for the bird. In this little bird's case, you succeeded, you gave her safety, comfort, food and water, meds. It was up to her to decide to live or die, and she chose. You did so much for her, and if she had survived, she would most likely not have been able to be set free.Sounds like this little bird would not have responded well, or been happy with aviary life. She now is free to fly where ever she chooses. You did wonderfully well with your attempts.
Daryl


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## Pidgey (May 20, 2005)

It sounds to me that even as bad as Pierpont was, she was in a lot better shape than your little stock dove. I can't imagine how horrible it must have been, being eaten alive like that. I had always thought that they either passed out or predator killed them first. I'm so sorry for the dove and for you, Cynthia.

Pidgey


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## Skyeking (Jan 17, 2003)

Cynthia,

I'm so sorry to hear the little one passed. You did your best, as always, my heartfelt sympathy and BIG hug goes out to you.


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## jazaroo (Jan 1, 2006)

Cynthia, I am so very sorry to hear this news. God bless you, you did your very best.


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## Whitefeather (Sep 2, 2002)

God Bless you, sweet dove.

Cindy


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## Maggie-NC (Jun 22, 2005)

Cynthia, I am very sorry.

Maggie


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## mr squeaks (Apr 14, 2005)

I'm so sorry, Cynthia. We try our best and sometimes, the final decision is out of our hands. I know you did your best. I'm sure the little dove knew that.

A BIG HUG from me too!


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## kittypaws (Sep 18, 2005)

*I too Cynthia,*

am sorry to hear that the little one didn't make it. She had a lot to do didn't she to survive? Thank you for making her last few days more comfortable than had she'd been left where she was found.

Tania


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## Feefo (Feb 8, 2002)

Thank you all for your support and kind thoughts.

This little stock dove must have had more loving thoughts sent her way than any stock dove ever had before.

I am grateful that at the very least I was able to give her pain relief.

Cynthia


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## Nooti (Mar 14, 2002)

Just found thread Cynthia.
Sorry the bird didn't make it. I read the first two pages with bated breath hoping you managed to pull it off.
In future cases BR gel is a lot cheaper and lot more efficient and I will be using this on Stringfellow. Had to order some as they didn't have it in today. If you can't get hold of any from your vet let me know. I can get some.


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## Feefo (Feb 8, 2002)

Hi Helen,

I wish you had been around then, I could have sent you the photo for advice on how bad it was. 

I think I have the photo I took on day 2, perhaps if I send it to you you can tell me what the real damage was? Then at least I can learn from the experience.

I haven't been able to find BR, I remember Ali saying she had the same trouble a couple of years ago..

I was hoping that you could also get me some Hartman's...I stopped using that for a while and I lost a couple of rescues. As soon as I started using it again I had no more deaths! But now I have run out.

Cynthia


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## Nooti (Mar 14, 2002)

Sorry Cynthia
This thread didn't show on my computer as you having replied so I missed it. Just looked here on the offchance. I'll get on to that tomorrow for you. I have just bought a tube of BR gel then found some in my drug cabinet so you can have the new tube. I'll get some Hartmann's too. That's vital. Will your vet not let you buy any? Or is he the type that needs to see the patient before prescribing?


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## Feefo (Feb 8, 2002)

Hi Helen,

The vet that I try to see at the surgery when I can is actually lovely about pigeons, he has refered some to me and he usually only charges me for medicines but the surgery prices are exhorbitant (£58 for 100 ml of Baytril 2.5% solution) and those are the ones he has to stick to! He encourages me to find medicines cheaper elsewhere and will sign a repeat prescription but I haven’t found a good source for Hartmann’s yet.

I haven’t discussed the Hartmann’s with him partly because I have only just run out and partly because there was some controversy about using it IP. I wanted to gen up on the formula for rehydration and how to administer it into the inguinal flap (?) so that if he questioned me I could persuade him that I will use it responsibly .

Cynthia


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## Nooti (Mar 14, 2002)

Yeah, I remember you saying something about him saying not to inject IP. Sadly it's the quickest and best method as you know. Ove the hundreds I've injected IP I've only lost one - a woodpigeon and that would have died anyway whatever exam and treatment it had. It was just a lunatic - as they are. 
You'll not be far off IP in the inguinal flap anyway!  
I'll pick some Hartmann's up tomorrow.


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## Nooti (Mar 14, 2002)

I found the following when researching myself for you - thought it excellent info and worth bringing here. It makes a long post and I've had to split it into two.

Avian Emaciation:

Unraveling the Mysteries of Recovery
Wildlife rehabilitators are routinely faced with animals, usually birds, who have faced prolonged periods of time without food and have lost a substantial amount of weight. Experience has shown that simply feeding these animals their normal diet is counter-productive and often results in fatality. This article sets guidelines for determining when an animal is emaciated, describes various complications of starvation, and delineates a protocol for recovery based on experience with hundreds of birds of prey.


Introduction

There is perhaps nothing more frustrating to a wildlife rehabilitator than trying to do battle with something you cannot see, and watching an animal starve to death in the midst of plenty. 

Lesson number one is to resist the urge to feed them! A bird that has lost, say 30% of its body weight might use its last available calories to break down any food offered, and might very well die before the resulting energy is available on the cellular level. If the calories to digest that food are not available, the food will sit in the crop or stomach and rot, resulting in a proliferation of bacteria, toxemia, and death.

Starvation is, in essence, the prolonged absence of nutrition, and is sometimes found in medical texts under 'inanition' or 'anorexia.' The result is emaciation. One of the many difficult aspects of dealing with emaciation is that it NEVER presents alone: it is either the result of some underlying physical problem, or results in debilitating physical problems (e.g., suppressed immune system, parasite infection, anemia, dehydration, or kidney damage), or BOTH. At times, it is almost a relief to detect an obvious cause of starvation, because those cases where all of the physical systems seem otherwise normal can be a real challenge. 

Physical Signs of Emaciation

How can you tell if a bird is starving? There are some subjective and some objective measures.

Subjective

Breast musculature should be rounded and, with most species, reach the top of the keel bone. Although you can always palpate the keel (leading edge of the breast bone) in a bird that is flying and within its normal weight range, these muscles will feel full and well-developed; in a bird that is starving, these muscles waste away to varying degrees, leaving the keel very prominent. A 'knife-edge' or 'razor' keel is, like it sounds, when you can actually pinch the keel, feeling bone with the pads of your fingers. Other bone, like the lumbar area of the lower back, will also be palpably prominent. 

One of the primary signs of prolonged inanition is a lime-green dropping: when the gastro-intestinal tract is empty, there is nothing to mix with the bile that is produced automatically (whether the bird is eating or not) by the gall bladder, and the droppings come out lime-green. Often the droppings are primarily urates; sometimes even foamy in appearance. 

And even notice the 'feel' of the bird in your hand compared with your normal experience. 
Objective 

Compare the weight upon intake to normals. Obviously, even this objective measure has an element of subjectivity to it; given the often large size/weight ranges for most species, especially gender size variances, you don't always know to which normal range to compare the bird. An excellent resource book (and essentially the only resource beyond your own records of species' weights in your area) is Body Weights of 686 Species of North American Birds by John B. Dunning, Jr., now available through the International Wildlife Rehabilitation Council. For example, say you receive a bird as much as 30% down in weight. This has an impact on treatment, as will be discussed, but a note of warning on the use of these printed averages; although the referenced book is an excellent resource, it must be used with a grain of caution. It is a compilation of many different surveys, which are referenced in the back of the book, and which also vary by geographic location and time of year. Record-keeping of intake and release weights is critical. 
Categories of Emaciation

Treatment protocols vary by the degree of starvation. Category I birds are between 90%-100% of normal; the keel may be slightly prominent but not severe. Perhaps there has been a storm; perhaps the bird has been trapped in someone's garage; perhaps it has been sitting in a daze in a ditch for a couple of days, but in essence it is not in a critical state of starvation. Category II birds are 75%-95% of normal and you will be seeing some complications of prolonged malnutrition, as well as of the underlying injury or disease process, such as anemia. Category III birds are 50%-75% of normal weight and are an extreme challenge to save. By the time you see this degree of wasting in a wild animal, you are seeing a lot of changes inside; some things are no longer functioning well and may never recover. This does not mean that you give up on these birds. 

Complications of Starvation

Whether or not there is an underlying injury or disease process, starvation almost always presents along with severe dehydration, anemia, and both ecto- and endo-parasites. Obviously, treatment of the dehydration is imperative and can be addressed in multiple ways. On intake, the author frequently administers subcutaneous fluids in the inguinal flap; IV fluids are difficult to administer, even into the jugular, when veins are collapsed and blood pressure low, but can often be used after SQ fluids have added volume to the system. Oral electrolyte solutions are also used unless there is blood in the mouth or any sign of respiratory compromise, but may or may not be well-absorbed. (The author had at least one case where oral fluids essentially ran right through the system unchanged.) Replacement volume calculations can be found in IWRC's Basic Wildlife Rehabilitation 1AB, a Skills Seminar manual.

Ectoparasites are always treated, by the author, with the application of a pyrethrins-based powder, because these mites and lice can present a risk to other birds in the center. Endoparasites are treated at the discretion of the rehabilitator and veterinarian based on severity of infestation and degree of debilitation.

Anemia will probably respond to general supportive treatment but can also be addressed with iron dextran injections weekly and/or a tonic such as Beecham's Pet-Tinicä orally. Iron should not be administered in the presence of an infection, however, as bacteria find iron exceptionally beneficial and can multiply faster than antibiotics can take care of them1. Get any infection under control before using iron supplements to treat anemia. Severe anemia can be assisted by blood transfusions and the author has used an education bird as a donor, as well as a bird under rehabilitation. The Raptor Center at the University of Minnesota typically transfuses any bird that presents with a PCV of less than 20.

Emaciation Protocol

Successful treatment for emaciation involves rehydration, the calculation of the calories necessary for a slow and steady weight gain, and the various means of supplying those calories. Each of these steps involves choices.

Hydration

Typically, the author gives nothing but electrolyte fluids during the first eight hours. If, however, the eight hours would stretch into more overnight, she adds an amino acid solution to an oral hydration formula, in order to provide some nutrition. Such solutions contain very few calories, however, and neither do electrolyte solutions. The bird may gain some weight from rehydration, may lose a little since little or no calories are being provided in the first few hours, or may roughly balance out. Do not attempt to provide calories by way of a high percentage glucose solution: 

a) their addition makes a solution hypertonic and may actually complicate dehydration

To calculate the amount of fluids necessary to compensate for the deficit and provide the normal daily maintenance levels, see the Fluid Therapy section of the IWRC Basic Wildlife Rehabilitation 1AB Manual3. To rehydrate a bird is a prolonged process and must be continued for the first few days, or as long as any signs of fluid deficit are present, even after emaciation treatment feedings have started.

Calculation of Calories

Different types of animals have different metabolic rates and different caloric requirements. The formula for determining the caloric needs of a bird in your care is as follows:

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## Nooti (Mar 14, 2002)

Animal Factor x (weight in kg) .75 x basal rate factor = Kcal/24 hrs. 

The animal factor is a multiplier based on the metabolic rate of different types of animals; as you would assume, these vary from a reptilian low of 10 to a small bird high of 129. Birds are typically divided into two classifications: passerines (or those weighing 100 gms or less) with an animal factor of 129, and non-passerines (those weighing over 100 gms) with an animal factor of 78.3

This formula is an inverse exponential function of the body weight: i.e., the daily caloric requirement is negatively related to body weight (but not in a straight line) or, as we have all noticed, a kestrel needs to eat far more in relation to its body weight than does an eagle!

The basal metabolic rate (BMR) is defined as the number of calories necessary for an animal at rest, in a thermo-neutral environment to maintain its body weight. The basal rate factor depends on the age and condition of the bird and is a multiplier of the basal metabolic rate. That is, a healthy adult bird, in order to maintain its body weight in normal activity, needs 2x the BMR; a sick adult needs 3x, in order to maintain body weight AND provide energy for healing; a healthy, growing juvenile needs 4x; and a sick juvenile, 5x.

The IWRC Basic Wildlife Rehabilitation 1AB manual explains this at length and provides examples of these calculations, as well as charts that can be used in the absence of a calculator with a yx key or a square root key.

Whether your bird is a sick adult or juvenile, it is important to start it out on the low end of the scale: providing no more than 1.5-2 x the BMR in the first day of feeding, and gradually working up over several days to the appropriate basal factor of 3, 4 or 5.

What to Feed, How Often, and How Much

Two of the primary decisions to be made are what to use to provide these calories and how to balance the benefit of numerous small feedings against the stress of handling.

Category I and II birds can usually be started (after the initial period of rehydration and often the addition of small amounts of an amino acid solution to second/third fluids and the first few feedings) on Ultracalä , Isocalä Osmolyteä or Ensureä , all of which are easily digested and absorbed, nutritionally complete, isotonic human tube-feeding formulas. They are approximately 1.0 or 1.1 kcal/ml. The author prefers Ultracalä because of the addition of fiber, which has helped to control some of the diarrhea which tends to accompany the use of Isocalä . Category III animals will probably need an elemental diet: a diet made up primarily of the building blocks of nutrition and which takes little or no energy to break down. Some examples are Vivonexä or Tolerexä , human elemental tube-feeding formulas; they are, however, hypertonic, so since they are usually used while the bird is still being rehydrated, care needs to be taken to offset the hypertonicity with extra fluids. In the absence of these products (which are very expensive), the author has used higher quantities of amino acid solutions in conjunction with Ultracalä .

Using Ultracalä as an example, the quantity to feed is easily determined by taking the result of our kcal formula and dividing by 1.1 kcal/ml. That is, a 300 gm starving (and 10% dehydrated) barn owl which received only fluids and then fluids with amino acids in its first 8 hours, would then need in its next 24 hours, 47.6 kcals (1.5 x basal) or 43 mls of Ultracalä . To calculate how much to tube in each feeding, the rehabilitator must factor in both the volume of Ultracalä and the volume of hydration solution (25 ml) needed for a total oral volume of some 68 ml that must be ingested. A rough rule-of-thumb for figuring out stomach capacity of an animal is 55 ml/kg of body weight: for a 300 gm barn owl, that would mean its maximum capacity would be some 16 ml. In order to minimize the risk of aspiration in an already debilitated bird, the author recommends stepping that number down to approximately 12-15 ml/feeding. Thus, dividing the 68 ml of volume needed during this 24 hours by 15, results in 5 (rounded); resulting in a suggested 5 feedings of 13.7 ml each - 8.7 ml of Ultracalä and 5 ml of fluids. If volume is a problem or the bird regurgitates, fluids can be given SQ instead of orally.

Obviously, the daily calorie requirements will go up as the bird is moved up the scale to its necessary 3, 4 or 5x basal and as it gains weight. This can pose a problem; the author tries to ensure that the system of a debilitated bird is clear of food for at least part of each day, usually overnight. This means that an ever-expanding amount of calories and volume needs to be ingested over a period of some 14-16 hours.

Category I and II animals can, by day 3 or 4, have Nutri-Calâ added to their diet; it is a low-volume, high calorie supplement which provides 6 kcal/ml. Because it is fat-based (34.5%), it takes a certain amount of energy to assimilate and the bird needs to be able to provide this. Nutri-Calâ should be used very judiciously and with caution on a Category III animal. If a Category III bird is moved slowly up the scale to 3 or 4x basal, it may be able to assimilate Nutri-Calâ by the time many small meals have exhausted its volume capacity.

When to Add Solids

Two of the most critical elements to monitor in emaciation treatment are blood values: PCV and serum protein. Blood should be drawn on Day 1 (and adjusted heuristically for the false elevation of these values caused by dehydration) and monitored again approximately every other day. PCV provides a reading of anemia; the author has seen birds come in with values less than 10%; from the hematocrit tube (and even better from a blood smear), the rehabilitator can judge whether any anemia is regenerative (amount of immature red blood cells) and whether or not the bird is battling an infection (prominent buffy coat or white cell count). Serum protein, or the amount of circulating protein expressed in grams per deciliter, is a measure representing a fairly complicated interaction between protein synthesis and catabolic rate, or in other words, measures how able the bird is to convert available protein to usable energy. In a bird that has not eaten, serum protein is typically very low. Readings lower than 2 gms/dl indicate an inability to perform that conversion well, and birds with low serum protein should not be fed solid food.

Unfortunately for those of us who might like clear guidelines, the author has also had several birds come in with serum protein at adequate levels who were still unable to process food. Some came in with packed, sour crops; some ate food provided by the author but were unable to process it. With birds with crops such conditions must be handled by removing the rotted food from the crop. If the food which is not being moved along consists of a tube mix, sometimes it can be sucked out through a tube and syringe. It is, however, always better to err on the conservative side and provide solid food in small amounts, even to birds with adequate blood readings and normal droppings, until you are sure they can handle it.
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## Nooti (Mar 14, 2002)

Assuming the bird's serum protein has reached 2 g/dl, the author starts factoring 'solid' food into the tube-feeding mix at an initial rate of 10% of the day's caloric requirements. That is, say our 300 gm barn owl is now up to 350 gm, and his serum protein has reached 2.1 gm/dl; he is at 4x basal (adult bird, recovering from an injury, and trying to gain weight) and so needs 142.5 kcal/day. We want to provide 10% or 14.25 kcal from solids. The author has used Science Dietâ dry cat food (or dog food) soaked in water or electrolyte solution and then blended, to provide this solid portion. The caloric content varied based on how promptly the mixture was put through the blender after it was softened. The most effective mixture provided 1.6 kcal/cc to add to the Ultracalä . Hill's has now developed a new product called a/dä , specifically for cats and dogs that are unable to eat solid food. Hill's representatives have indicated that they think it is an adequate diet for sick raptors as well, and it provides 1.6kcal/cc. It is a semi-solid food, too solid for tube-feeding as is, but when mixed with Ultracalä provides a good intermediate step. The amount of calories derived from solids (i.e., food that is closer to a natural diet and that is correspondingly more demanding to digest) can be stepped up each day if the bird shows no adverse reactions.

Summary

Treatment of emaciation can be a frustrating experience. Once you have a protocol which seems to work, there is a fine line between sticking with success and being willing to experiment when something better presents itself. Like most areas of wildlife rehabilitation, emaciation demands a blend of science, intuition, observation skills, and a willingness to 'fly by the seat of your pants.'

For example, if any bird (thin or not) presents with lime-green droppings and a serum protein of 2.2, the author would initiate her emaciation protocol, starting at 1.5x basal requirements on the first day after the 8 hour rehydration period. How quickly the bird progresses through the steps depends on the recover of blood values, general attitude, weight gain, the condition of the droppings, and indications of what else might be wrong. Poisoning suspects should be given lots of fluids anyway to assist in flushing the system. Birds with broken bones might be switched as fast as possible to solid foods (Ultracalä has a calciumhosphorous ratio of 1:1) or the tube mix supplemented with calcium or bone meal (Ca of 2:1). Borderline cases of diurnals might be started on 'solid' solids because it can be removed, if necessary, from their crop. Solid food that is not being digested cannot be retrieved from the stomachs of those birds without a crop, so a tube mixture with a/dä as the solids (which could be removed, perhaps, by tube if necessary) would be used instead.

It is the author's experience that a starving bird usually shows some dramatic signs of improvement over the first couple of days, probably as the result of warmth and rehydration. By the third day, however, the underlying condition may reassert itself and some birds regress at this point, usually vomiting and often dying. If they make it through the third day, the odds seem to go up for their recovery. If at any step of the process, such as when going from 3x basal to 4, or from 10% solids to 25%, there is an adverse reaction (vomiting or deteriorating blood values), back off and start up again more slowly.


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