# Missy has liver disease



## RowdyTiel (Jan 24, 2013)

[For the sake of organization, I'm creating this new thread. Here is the link to the previous one: http://talkcockatiels.com/showthread.php?t=125209]

Missy was just diagnosed with liver disease (also has inflammation) today.  She's currently on Baytril and Denamarin* from the vet (milk thistle may replace denamarin after this is gone - vitamin b supplement was suggested too), and we were told to come back in 60 days to check to see if there have been any changes.
I may see if I can get her to try a more raw diet as well.

Has anyone else here ever had a bird*with*liver disease? Is there some way to find out how advanced it is?
Do birds usually recover from it or is it more like something that can only be managed?

(I'm asking the vet some of these questions in an email as well, since I forgot to ask on the phone.)
At the moment, I'm taking a crash course researching binge on liver disease in birds.*

I can't stand knowing my baby's not well. I'm hoping this is something that can at least be managed; I don't know if I could handle losing Missy sooner than expected (....like, if she reached 20yrs :x. ), especially after losing Mav so young.


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## CaliTiels (Oct 18, 2012)

Oh, I'm sorry Hope. Aside from my own tiels, Missy is one of my favorites. I wish I knew more about cockatiel health, but I hope she gets better soon


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## Brandon2k14 (Nov 26, 2014)

Oh no  please no shes such a beautiful girl I hope u dont lose her I love her soo much shes also one of my favourites.I seriously hope she gets better ill say a prayer for her.Missy please get better .How old is Missy? I know what its like to lose a pet well I think of my pets as part of the family of course and the pain never goes away .I hope u dont lose her.Rocko and Loki also hope u get better .


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## littletiel (May 15, 2011)

I am so sorry! I hope she recovers well with all your love.


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## tielbob (Mar 25, 2013)

So sorry! I hope she gets better soon.


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## JoJo's Mom (Oct 20, 2012)

I am so sorry to hear this. I too will say prayers that she can heal from this. Healing thoughts being sent your way.


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## bjknight93 (Nov 13, 2011)

I'm assuming they did a chem panel on Missy's blood sample to diagnose liver disease. As far as I know, that would be the only way to diagnose it, and to know how advanced it is..they typically measure liver enzymes and another value I can't quite remember. There is a certain range these enzymes should measure between, and if they're higher than the upper value then the liver isn't functioning normally and the bird has liver disease. Depending on how high the value was out of range should tell you bad it is. 

The liver can repair itself, so unless it is completely "fried" then it will heal with time, a diet change, and supplements to help the liver function. 

What does Missy's current diet typically consist of? As long as it is balanced, then it shouldn't give her any liver problems. Too much seed can cause fatty liver disease and too much pellets can cause liver disease as a result of excess protein in the diet. 

In the past, I have used *alcohol-free* milk thistle and *alcohol-free* dandelion extract together. I believe the dosage was 1 drop of each per 3 oz water. I would need to look back in my forum threads for a definite answer. I have also used Avitech's Herbal Bird Rx product, Liver Detox, which is the two extracts combined. They have dosage instructions on the bottle for their product. You can get this from Avitech's website, Amazon, or MSBS. 

I've had liver values tested after starting these products, and they really work. They help the liver function until it has healed itself.


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## Janalee (Jul 25, 2012)

*liver disease*

I am so sorry to hear that! I lost my cockatiel Meshach to cancer. The vet said it affected her liver. spleen and ovaries. So it wasn't exactly just liver disease. But one of the things I used was milk thistle (without alcohol). Sadly, with cancer, it just postponed the inevitable. But hopefully in Missy's case you will be able to cure and heal her liver. Best wishes to both of you!


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## bjknight93 (Nov 13, 2011)

Lactulose is another thing that some have recommended using, however I found it unnecessary...and I prefer more natural methods to support the body. But that is something you can look into as well if you feel like you need to. Also, my dosing in the above post was correct. 1 drop of each extract to 3 oz of water.


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## TamaMoo (Jan 12, 2014)

No advice, still, but Joey and I are still sending her hugs and scritches, and sending you hugs too. I can only imagine your level of worry, and am keeping my fingers crossed you get good answers soon.


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## enigma731 (Aug 12, 2011)

One thing you'll want to do is ask for copies of Missy's lab work. That way you'll know what the specific liver values were. You should start keeping a record of these over time if you have her tested more than once, because sometimes vets don't keep good track, especially if a bird is being seen by more than one different practice.


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## RowdyTiel (Jan 24, 2013)

Thank you everyone for the thoughts and well wishes. <3

*@Brandon2k14*, She's about 9 1/2 years old now.



bjknight93 said:


> I'm assuming they did a chem panel on Missy's blood sample to diagnose liver disease. As far as I know, that would be the only way to diagnose it, and to know how advanced it is..they typically measure liver enzymes and another value I can't quite remember. There is a certain range these enzymes should measure between, and if they're higher than the upper value then the liver isn't functioning normally and the bird has liver disease. Depending on how high the value was out of range should tell you bad it is.
> 
> The liver can repair itself, so unless it is completely "fried" then it will heal with time, a diet change, and supplements to help the liver function.
> 
> ...





bjknight93 said:


> Lactulose is another thing that some have recommended using, however I found it unnecessary...and I prefer more natural methods to support the body. But that is something you can look into as well if you feel like you need to. Also, my dosing in the above post was correct. 1 drop of each extract to 3 oz of water.


I emailed the vet last night so hopefully I'll get a response tomorrow morning with answers to a few of my questions. 

The receipt says:


> 1 Exotic/Avian/Farm Exam...$49
> 1 Avian Comp Profile w/ RST BI...$176.28
> 1 Bun & Creatnine...$30.90 (I got half off that because of a "Good Clients" discount? This test was done because he first believed it to be kidney infection, I think?)


Her diet usually consists of seed, sprouts, veggies (she'll only eat spinach, bok choy and nibble on grated carrot so far - I'll be starting to make mash as well, so hopefully she'll try that), and pellets. While she eats her pellets like a champ and loves them, I'm fairly certain that she eats more seed than pellets.

One of the questions in my email to the vet was if it was advisable to use the milk thistle (another parrot owner linked me to one of the alcohol free ones on Amazon) in conjunction with what she's on right now? I'm willing to try anything that might help her! And the more holistic the better.

*@enigma*, Yes, Dr. Kilbane mentioned I might want to have a copy for my records as well. So I'll be, hopefully, picking a copy up on Monday after I get off from work or see if the office can email me a digital copy.


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## enigma731 (Aug 12, 2011)

Sometimes liver enzymes can also be high due to infection. So you might ask the vet whether it's possible in Missy's case, since it doesn't seem like her diet should have caused problems.


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## RowdyTiel (Jan 24, 2013)

enigma731 said:


> Sometimes liver enzymes can also be high due to infection. So you might ask the vet whether it's possible in Missy's case, since it doesn't seem like her diet should have caused problems.


Thank you, I'll be sure to ask!

- - - - -
In continuation with previous updates, here was this morning's droppings. They're finally solid and she's pooping frequently again, rather than just 6-7 droppings a day.


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## RowdyTiel (Jan 24, 2013)

I got my copy of the results today. It's all greek to me, so if anyone could help me out in deciphering it, that would be wonderful! I'm seeing a lot of "LOW" and "HIGH" on the bar graph on much of these, though...
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*Avian Comprehensive Chemistry:*
_Test................Results.........Adult ReferenceRange_
Total Protein 2.4 ...............3.0-5.5 g/dL
Abumin 0.9 ...............1.9-3.2 g/dL
Result Verified
Globulin 1.5 ................2-4 g/dL
SGOT (AST) 173 ...............20-350 IU/L
Phosphorus 1.7 ................3.0-5.5 mg/dL
Glucose 336 ...............180-350 mg/dL
Calcium 7.3 ................7.6-12 mg/dL
Sodium 148 ................140-160 mEq/L
Potassium 6.3 .................3.0-4.5 mEq/L
Chloride 114 ................90-110 mEq/L
Cholesterol 235
CPK 150 .................50-400 IU/L
Uric Acid 4.3 ..................2.0-10.0 mg/dL
Hemolysis 1+ No significant interference.


*Bile Acids, Resting (Avian/Exo*
Bile Acids, Pre Meal 89.2 ...............20-80 umol/L
AVIAN BILE ACIDS
The avian bile acids interpretation is based on diagnostic testing performed here at Antech and a literature review. An avian bile acids value below 80 uM/L appears to be within the normal range for most psittacine species. An avian bile acids value between 80-100 uM/L is suspicious for hepatic disease in most psittacine species. An avian bile acids value between 100-120 uM/L is highly suspicious for hepatic disease in most psittacine species. A bile acids value above 120 uM/L is indicative of hepatic disease in all psittacine species so far investigated. Both hemolysis and lipemia will falsely elevate bile acids and preclude interpretation of the value. Bile acids have not been investigated in all avian species. Therefore, results must be interpreted with regards to other diagnostic tests and the history and signs of the patient.


*Bun/Creatinine*
BUN 5
Creatinine 0.2
Hemolysis 1+. No significant analyte interference.
Icterus 1+. AST may be increased by 20%. See online reports for specific comments regarding this interference. No other significant analyte interference.


*CBC (Avian and Exotics)*
WBC Estimate 2.9 ...............4.0-10.0 1000/uL
WBC count estimated from smear.
HCT 49 ................42-55 %
Verified by Microhematocrit Method
RBC Morphology Normal
Blood Parasite None Seen
Heterophils 28 ................40-70 %
Absolute Heterophil Count 812...............2000-7000 /mL
Bands 0
Absolute Bands 0
Lymphocytes 62 ...............18-50 %
Absolute Lymphocytes 1798
Monocytes 10 ...............0-3 %
Absolute Monocytes 290
Eosinophils 0 .................0-2 %
Absolute Esoniphils 0
Basophils 0
Absolute Basophils 0
Thromboycte Adequate
Comment
Blood smear reviewed by technologist.


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## enigma731 (Aug 12, 2011)

So...that looks basically normal except for a mild elevation in the bile acids. Can you have your regular vet review the labwork?

ETA: To be clear, I don't actually know what normal values are in birds, but I have a pretty good amount of experience in reading lab reports like this. Based on the ranges given, it looks like there's a mild elevation in the bile acids and some fluctuation in electrolytes (sodium, potassium), but the electrolyte thing is not hugely unusual for a bird that's stressed at the vet.


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## RowdyTiel (Jan 24, 2013)

He won't be back until the end of this week (the vet that saw Missy faxed the results to my regular vet's office), but I'll shoot him an email and see what he thinks!


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## enigma731 (Aug 12, 2011)

Either way, I definitely don't see anything in those lab results that makes me think this can't be treated.  In fact, there's pretty good evidence of infection there, so it may be that just treating that will normalize everything else.


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## RowdyTiel (Jan 24, 2013)

Missy finished off the last of the denamarin this morning and finished the baytril on Saturday. She's been so good for me about all of this. <3 Her droppings are looking solid again for the most part and I haven't noticed any abnormalities thus far. 

I'll be ordering some milk thistle hopefully within the next couple of days; (how is it so hard to find something alcohol free at the stores?? Even the health food stores!).


@engima, Also, thank you for your input on the results! When should I go back and have her re-tested?? Dr. Kilbane said two months? Is that normal to wait that long?


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## enigma731 (Aug 12, 2011)

I think that timeframe is probably fine since there was nothing to suggest really severe organ failure and you've seen improvement already. Her liver will need some time to heal, even if it's just from the infection. But as always, check with your vet if you feel unsure.


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## Francesca (Apr 30, 2015)

Don't have any advice, but wanted to send good thoughts your way. Hugs!


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## littletiel (May 15, 2011)

Good thoughts and hugs from me too!


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## vidchick (Jul 1, 2015)

I really hope Missy is going to be ok, sending loads of good vibes 

I so know what you're going through, I recently lost my beloved Pip to liver disease, and I did the binge googling, too. I lost weeks of nights on the computer. He was diagnosed too late, so I couldn't save him, but Missy should have a good chance and it seems you are doing all the right things with diet.

Pip wouldn't ever touch fruit or veg so I had to make sneaky bird cakes where I blended fruit and veg and then made into cakes, which he would eat. I learnt a lot of very hard lessons this year.

Anyway, please keep us updated how Missy is doing


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## RowdyTiel (Jan 24, 2013)

enigma731 said:


> I think that timeframe is probably fine since there was nothing to suggest really severe organ failure and you've seen improvement already. Her liver will need some time to heal, even if it's just from the infection. But as always, check with your vet if you feel unsure.


Got it, that makes sense.  I haven't gotten the chance to call the vet's office due to work, but I'll hopefully be able to get ahold of them either on Monday or Wednesday to double check!



@*vidchick*, I am so so sorry about your little one.  It's so terribly hard when they leave you. My thoughts are with you. <3 


- - - - - - - - -
Thank you everyone for the well wishes to Missy! She's eating well and little by little starting to try more and more veggies. I make a fresh chop for her every morning with sprouts and then another fresh batch in the evening.

Her droppings have been solid for the most part, but this morning I noticed a couple of abnormal ones again. :/ Watery, yellow-ish, strange looking urates, and lots of bubbles.


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## RowdyTiel (Jan 24, 2013)

Dropping from a few hours ago. She had just done a bit of flying, so I'm assuming that's why this one watery, considering her others have been solid for the most part.
The feces' color is from the pellets she ate this morning.

But the urates look weird to me.


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## Brandon2k14 (Nov 26, 2014)

I hope Missy gets better soon im sure with a owner like you shes a strong girl.Also I wanted to know how did u teach her the wings trick I saw your video missy is great at it she opens her wings fully.And Rocko and Loki are sending hugs.


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## enigma731 (Aug 12, 2011)

I agree that the urates look off there. I would consider getting a recheck sooner since it's possible there was a kidney infection, which may have recurred.


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## RowdyTiel (Jan 24, 2013)

Brandon2k14 said:


> I hope Missy gets better soon im sure with a owner like you shes a strong girl.Also I wanted to know how did u teach her the wings trick I saw your video missy is great at it she opens her wings fully.And Rocko and Loki are sending hugs.


Thanks, Brandon!

I taught her that trick through clicker training by capturing her stretching her wings. She caught on SUPER fast and started doing small random wing lifts *clicked and rewarded*, and then I started waiting and withheld the click asking for more; which eventually led to full wings out, and now holding them open for longer than just a moment.



enigma731 said:


> I agree that the urates look off there. I would consider getting a recheck sooner since it's possible there was a kidney infection, which may have recurred.


My regular vet is back so I'll try to give him a call tomorrow. Ugh, it's so frustrating!  I just want my baby to get better.
Should I just be looking at getting another blood test? (also is it possible to just have specific levels tested rather than everything?) Or would it be advisable to have a gram stain done as well?


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## enigma731 (Aug 12, 2011)

I would let the vet decide which tests are best, because I'm honestly not sure in this case.

And I know, it's so frustrating when they're sick.


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## RowdyTiel (Jan 24, 2013)

I emailed my vet and the vet that she saw. I'll be trying to call tomorrow before work to see if I can get her in sometime this week.


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## Brandon2k14 (Nov 26, 2014)

RowdyTiel said:


> Thanks, Brandon!
> 
> I taught her that trick through clicker training by capturing her stretching her wings. She caught on SUPER fast and started doing small random wing lifts *clicked and rewarded*, and then I started waiting and withheld the click asking for more; which eventually led to full wings out, and now holding them open for longer than just a moment.
> 
> ...


Thanks I should have thought of capturing it using the clicker.


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## RowdyTiel (Jan 24, 2013)

I received an email response from Dr. Kilbane (the vet she saw), and he wants to keep her on Denamarin for life and that he's not that concerned with the urates. (But if I feel like I should bring her in again, they can fit me in.) I'd read somewhere that stringy urates mean there's a bacterial infection? Yet he's not concerned about it?

I'm probably over-reacting but I feel like since liver disease can be so common in cockatiels, that maybe this vet is blinded by that fact and not considering other things/possibilities?

I'm still waiting for Dr. Butler's response (regular vet).


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## TamaMoo (Jan 12, 2014)

I hope Dr. Butler can ease your concerns. Although other doctors are good in a pinch, the one who knows her best is the one I'd feel most comfortable with.


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## RowdyTiel (Jan 24, 2013)

TamaMoo said:


> I hope Dr. Butler can ease your concerns. Although other doctors are good in a pinch, the one who knows her best is the one I'd feel most comfortable with.


I just got a response from Dr. Butler. :/ He says, "The stool looks good to me."
Does this look "good" to anyone else? https://farm1.staticflickr.com/273/20315994852_f2d2d55d3b_h.jpg

But his suggestion was to rely on Dr. Kilbane's recommendations since he was the one who did the initial work.


I'm just...ugh I'm stressing because she's had several symptoms suggesting a possible bacterial infection [bubbles in droppings, stringy urates], but the vet thinks the urates look fine? 
How do vets usually test for a bacterial infection? I might just have to ask for it to be done, at least for my own peace of mind.


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## RowdyTiel (Jan 24, 2013)

I haven't had Missy on denamarin since she had the last of her first prescription. I have however been adding more and more fresh veggies and sprouts to her diet and is moving along steadily! She nearly empties her plate every time now of her veggie mash and sprouts. Going to be introducing the sprouted legumes mix soon too. I'll eventually get to the 5% of fruits to add to the mash diet and see how she takes to those as well.

We used up all of the last veggie mix so I made a new batch tonight! This batch consists of carrots, yu choy, watercress, parsley, celery, napa cabbage, spinach, kale, and a bit of cucumber.

She's also been getting a bit of milk thistle everyday.

So far, good droppings and she's keeping a steady weight. Hopefully we'll hear some better news when we go back to have her levels re-checked next month.


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## sunnysmom (Sep 23, 2011)

I hope Missy continues to improve! Good job with her.


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## dianne (Nov 27, 2013)

It's so great you are able to make these dietary changes for her. I am sure that is doing her a lot of good. It's inspiring. I want to be better about more veggies for my tiels.

Hope all continues to be well with her.


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