What do you see?

Jose Biascoechea, DVM, DABVP (Avian) jose@birdsandexotics.com www.birdsandexotics.com

Reproductive Medicine and Surgery in Birds Sex and the single bird…

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Objectives:

• Primarily psittacines, applicable to most • Female >>> male • Basic husbandry and lifestyle • Brief practical female anatomy • Reproductive diseases • Medical management (GnRH agonists) • Surgical management

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References:

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Passerines “soft bills”

Curl-crested aracari

Small psittacines “hook bills” Old world vs. New world

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Larger psittacines “hook bills” Old world vs. New world

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Birds of Prey, poultry, waterfowl…

�7Dx:Predator trauma Tx: Surgical repair

Be well prepared prior appointment…

Know how to transport them…

Know how to approach and restrain…

Or to not restrain…

Use a gram scale, BCS can be subjective! Weigh in grams, not ounces! 1 oz.~ 30 gms. 3 ounces = 6 canaries Budgie 30g Cockatiel 90g African grey/Amazons 350-450g Large Macaws 900-1200g

Weights…

Anatomy

• Pneumatic bones: humerus, femur, ect.• Communicate with resp. system• CMC vs. carpal bones• Ulna is the larger bone• TBT vs. Tibia• TMT vs. tarsal bones• Sternum (except ratites), coracoids (struts), furcula (wish bone)• Neck vertebra- parrots 9, swan 25• No diaphragm, coelomic cavity• Choanal slit• Only one true sinus, called the IO sinus• Extensive AS system, requires 2 breathing cycles to rid all air • Complete tracheal rings• Breath trough complete keel movements, important during

restraint• Limited lymphatic system• Spleen doesn’t store blood

Anatomy & Physiology

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Kidneys- both mammal & reptile type nephrons (no Loop of Henle) Generally loop diuretics do not work on these nephrons, but sufficient mammalian

type nephrons that diuresis can be accomplished End product of protein metabolism > UA, not urea (prone to visceral & articular

gout) Most female birds have only one functional ovary (the left) Ability birds to store extra Ca in their normally hollow long bones in preparation for

egg-laying Can lay w/o a male!!!

Oropharynx, no defined soft/hard palate, choanal slitNo epiglottis to cover and protect the tracheal opening, more prone to aspiration Crop- altricial birdsStomach: Proventriculus (glandular), ventriculus (grinding)Glucagon is main regulator of glucose, not insulinRetain a "prey' species defense status! This causes birds to disguise signs of illness as long as possible in order to

avoid attack by predatorsTherefore, the most minor signs recognized by an owner, such as decreased

talking or activity, are often life saving when recognized and presented to the veterinarian for treatment prior to more serious debilitation.

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Anatomy & Physiology

Diet…Seeds are:

High in fat low in fiber Missing essential AA: L-lysine, DL Methionine, ect… Low Ca:P ratio Lack essential vitamins

+/- Ideal diet: ~ 70% pellets ~20% VEGGIES and fruits ~10% seeds/nuts

Is not what the owners offer, is what the birds eat!

Balancing Your Parrot’s Lifestyle www.avian-vet.com

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• Nutrition & foraging refers to the make-up of the diet & the time & energy involved in finding, extracting, eating & processing food

• Social interaction includes time spent in a flock setting vocalizing, preening, flying & displaying

• Maintenance activities include all the things that a bird has to do to maintain its physical health, outside of eating, such as sleeping, preening & bathing

• Once these areas have been satisfied, there are additional behaviors & activities that take place on an annual cycle, such as reproduction, molt, or, in some cases, migration

• www.arrotenrichment.com

Environmental Effects on Reproduction

•*Photoperiod* • Photoreceptors retina & pineal gland become sensitized • Stimulates GnRH in release from the hypothalamus

• Most respond to increasing day length, maximum * 12–14 h of light • Rainfall stimulates reproductive activity (zebra finches & cockatiels…) • Presence of a mate, or perceived mate (mirror or human caregiver), is another powerful reproductive stimulus in many avian species

• While birds with physical contact with a mate will have the most stimulation, auditory contact with a male conspecific has also been shown to induce cycling in females of certain species such as budgerigars & ring-necked doves

• Nesting material and/or the presence of a nesting box has also been shown to stimulate egg laying and plasma luteinizing hormone secretion in cockatiels and other cavity-nesting species

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Sex & Gender

• Sex- Your assigned gender at birth and/or the gender of your reproductive organs

• Gender- Where you feel that you personally fall on the spectrum between male and female, but some fall in the middle or move throughout the spectrum

• Cisgender- When you identify with the gender you were assigned at birth

• Transgender- When you identify with a gender different than that you were assigned at birth

• Transsexual- When you have had Gender Reassignment Surgery (GRS) to change the sexual organs you were born with to that of a different gender. �19

Sex ? Know ahead of time!

• Boys don’t go to the OB-GYN • Most parrots not sexually dimorphic • DNA sexing blood/feather practical but ~ 99% accurate • Endoscopic, also evaluates reproductive tract • Large part of avian practice is obstetrics

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Endoscopic sexing:

• Left approach ~ 1 ovary • Evaluates most of

reprod tract • Pathology • Biopsy, C/S, cytology • Contraindications:

Fluids, organomegaly

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Eclectus parrot breeding behavior… Polyandry

Rarest of avian mating systems, and occurs when a single female pairs with two or more males during a breeding season Classical: females mate sequentially with single males who then care for the clutch alone Cooperative: female mates with multiple males who care for the clutch cooperatively Classical entails sex-role reversal with all or most parental care given by males, and aggressive competition between females for territories and mates As soon as one clutch is laid, the male assumes incubation duties and the female seeks to lay further clutches with additional males

Surgical Sterilization of Exotic Pets: Risk-Benefit to Procedures (Welle 2018)

Birds • Surgery only when absolutely necessary Reptiles • Surgery when disease is present Ferrets • Deslorelin implants instead of surgery Rabbits • Spay/Neuter before 1 y of age Guinea pigs • Ovariectomy if necessary; castrate if keeping males with other guinea pigs Chinchillas • Spay or castrate only if necessary Rats • Spay or castrate if necessary Sugar gliders • Neuter males

Female reproductive anatomy

• No male needed • 1 Ovary, left side • Infindibulum: engulfs,

fertilization • Magnus: albumen • Isthmus: inner and outer

shell membranes • Uterus: “shell gland” • UV sphincter: sperm-

storage tubules • Vagina • Cloaca “CUP”

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Common reproductive diseases:

Females • Chronic egg laying • Dystocia & egg binding • Ovary “oophoritis”: cysts, neoplasia, infection • Oviduct/Uterus “salphingitis”: egg binding, neoplasia, infection • Coelom: “coelomitis or egg yolk peritonitis” • Cloaca: prolapse, neoplasia

Males • Testes: physiologic enlargement (300x), neoplasia • Phallus: prolapse (waterfowl, others)

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Diagnosis:

• History, History, History • 1st (tech) and 2nd (Dr.) round of questionnaire • Presentation acute vs. chronic • Might have nothing to do with lenght of illness • Observe from distance, dyspnea, tail bobbing • To handle or not to handle

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Diagnosis:

• Ovary: endoscopy, US, CT • Shell gland/uterus: same, rads if shelled • Coelom: rads?, US, CT • Cloaca: same, visual • US: hypoechoic eggs/follicles = not as chronic, hyperechoic = chronic • Rads: widened CH waist, medullary hyperostosis, osteomyelosclerosis,

decreased air sac “spaces”, lack of serosal detail with effusion

• ! approximate normal organ coelomic occupation �27

Diagnosis:

• Might need supportive care prior handling • Warmth, O2, warms fluids, Ca, analgesics, antibiotics, anxiolytics • R/O concurrent or underying disease • CBC: anemia/hemoconcentration, leukocytosis • Chem: Hypercalcemia, phosphatemia, hyperprotenemia/albuminemia,

hyperlipemia/cholesterolemia • iCa+: n - elevated �28

Neuroendocrine Control of Reproduction

• Hypothalamic-Pituitary-Gonadal axis controls reproduction, like other vertebrates

• GNRH initiate cascade

• Transported > anterior pituitary gland, stimulates LH release

• GnRH’s ability to stimulate FSH is unclear in avian species

• Some use “luteinizing hormone-releasing hormone” rather than GnRH for birds

• Most vertebrates, including birds, possess multiple forms of GnRH (GnRH I-III)

• Their ability to stimulate LH & possibly FSH, release is variable depending on species, sex & reproductive status

• In addition, multiple types of GnRH receptors have been identified, mammalian/non-mammalian

• Incongruities between avian & mammalian GnRH peptides & their receptors may explain the reduced efficacy of synthetic GnRH-agonists in avian species �29

Leuprolide acetate (Lupron®)

• Synthetic, long acting GnRH

• Excessive egg laying & to diminish undesired reproductive behavior

• Used extensively in many species, few controlled trials about efficacy

• Reversibly prevent egg laying in cockatiels after a single IM injection

• Treated cockatiels had 12–19 d delay in egg laying vs. control group

• Single IM injection (800 µg/kg) to nonbreeding adult Hispaniolan Amazon parrots reduced plasma sex hormone levels < 21d

• Management ovarian neoplasia in cockatiels along with periodic coelomocentesis

• Unknown efficacy in most avian species, wide dose ranges (100 - >1200 µg/kg)

• Recommended range for most psittacines is 400-1000 µg/kg q2-3 w

• May not be financially feasible for all clients, as long-term treatment is usually required

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Suprelorin F, Virbac

• Controlled-release implant designed for use in dogs for reversible suppression of testosterone production, “contraception” for 6-12 m, depending on implant size

• 4.7-mg & 9.4-mg implant, less $ than repeated Lupron

• 4.7-mg available as an FDA Indexed Minor Use/Minor Species product for management of ACD in ferrets

• Primarily to decrease reproductive behaviors and egg laying in avian species

• Used successfully for long-term management of non-resectable ovarian neoplasia in cockatiels

• Sertoli cell tumors in budgerigars

• Chemopreventative effects in domestic chickens against development of ovarian neoplasia �31

Suprelorin: Data

• Several published case reports & retrospective studies describing the use of Deslorelin in psittacines

• Only prospective controlled studies to date on Deslorelin in birds are in chickens, quail & pigeons

• Chickens, 4.7-mg reduced egg production ~180d, 9.4-mg implant inhibited egg production for 319d

• Japanese quail, 4.7-mg reversibly decreased egg production in 6 /10 birds for 70d

• Pigeons, 4.7-mg reduced egg production for 5–7w & reduced serum LH concentrations for 84d vs. control birds �32

Suprelorin: Facts!

• Effective dosing proven challenging across several species, even those of similar weight & taxonomy

• Despite much higher doses given to Japanese quail vs. dogs, efficacy/duration were less

• A single 4.7-mg implant had a longer effect in chickens than in quail, both are Galliformes

• Substantial interspecies/individual variation

• Extrapolation of these results to other avian species, should be done with caution

• Dosing interval is challenging

• Return to reproductive behavior and/or egg laying ~ best indicators for reimplantation

• Hormone levels were highly variable & did not accurately reflect reproductive status

• In addition to behavioral/environmental modifications, repeated implantation of a 4.7- mg implant consecutively over a period of 6–9 m led to a successful resolution of chronic egg laying

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Suprelorin: Implantation

• ELDU

• Deep sedation or general anesthesia

• SC in the mid-scapular region, others

• Use apteria, sterile preparation

• A small amount of tissue adhesive

• IME most common side effect of placement is treatment failure�34

Egg binding: • Failure of an egg to pass through the oviduct at a normal rate (~48 h)

Dystocia: • Mechanical obstruction of an egg in the caudal reproductive tract • Can occur at the level of the caudal oviduct/uterus, the vagina or the

vaginal-cloacal junction. • Obstruction can result in cloacal impaction &/or prolapse �35

Laying an egg is a big deal for a kiwi, so usually don’t lay more than 1-2

Dystocia (Medical management)

• Supportive care: heat support, fluid therapy, Ca+ and analgesics

• +/- Oxytocin as the avian equivalent, mesotocin, does not stimulate uterine contraction

• Arginine vasotocin (AVT) controls oviposition in avian species

• The exact mechanism of AVT-induced uterine contraction is unknown, but it likely stimulates local production of prostaglandins including E1

• Commercially available prostaglandin E2 creams (Prepidil® Gel, dinoprostone) can be utilized topically on the vent of an affected bird to help with egg expulsion

• These medications are expensive, hard to find and have variable efficacy�36

Ovocentesis

• Medical management fails, or bird is decompensating Plan A: Cloacal ovocentesis

• Aspiration of the egg contents with a 16-18 ga needle with the patient under GA

• Manipulate egg such that the shell is visible through the cloaca with the assistance of a speculum

“Plan B”: percutaneous ovocentesis can be performed by aspirating the contents of the egg through the coelomic wall

• Remaining shell fragments are manually removed if visible, or should pass on their own within several days

• If they do not, surgical removal is often indicated

• Broad-spectrum antibiotics & analgesics due to the risk of salpingitis�37

For pictorial purposes, not this easy

Surgical Management

• Common reproductive tract surgical procedures done in practice

• Salpingohysterectomy, also endoscopically

• Phallic prolapse correction +/- amputation

• Salpingotomy, Cesarian Section & Reproductive Tract Sparing, not as common

• None are simple outright

• Primarily because they are typically called when significant pathology present

• Rarely done for prophylactic reasons�38

Salpingohysterectomy(SPH) “Spay”

• Removal of the uterus and oviduct

• Dystocia, ruptured/diseased oviduct, prolapsed oviduct & chronic egg laying

• A “high-risk procedure”, not recommended as routine preventative therapy

• Ovary is not commonly removed in birds d/t concerns for fatal hemorrhage from the multiple, short ovarian vessels in close proximity to aorta

• Presumed hormonal feedback loop exists from the uterus to the ovary, thus intracoelomic ovulation following SPH is not common in psittacines

• However, continued ovulation and subsequent egg-yolk peritonitis has been noted in several galliform and anseriform species �39

• Midventral, vertical horizontal, inverted “L”

• Left lateral celiotomy, most common, best visualization of the oviduct

• RLL with left pelvic limb extended cranially or caudally

• +/- microsurgical instruments

• Radiosurgery bipolar, +/- monopolar

• Retractors, Lone Star!�40

• Vessels to be ligated

• Gelfoam handy • Uterine ligation

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• Dissect skin and coelomic wall musculature, +/- transect last 2 ribs

• Identified oviduct in the left dorsal aspect of the coelom and gently elevate from CdVC

• Transect non-vascular oviductal ventral ligament to facilitate straightening of the entire oviduct

• Elevated the infundibulum to expose the dorsal ligament of the oviduct

• Often a small vessel is present traveling from the ovary to the infundibulum, coagulate or occlude with a hemostatic clip

• A branch of the Ov. artery is present along the length of the dorsal ligament and should be ligated during transection of this ligament �42

• As dissection approaches the cloaca, identify and avoid the ureter (small, white tubular structure originating from the kidney)

• The uterus is then ligated and removed at its junction with the cloaca with hemostatic clips or appropriate-size monofilament suture

• Closure is achieved in 2 layers: coelomic wall musculature and skin

• Taper needle�43

• Mango spayed + Deslorelin Implants prn, ocassional meloxicam • Monitoring… Weight and ventral coelom for “yellowing” • Tango Deslorelin implants q 6-12m • Prevention? 10:14, more foraging, less human stimulation, GnRH implant,

keep trim • Prognosis ? Good with monitoring, can ectopically ovulate

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“Mango & Tango”

Coelomitis of Reproductive origin “EYP” = chronic

• D/T salpingitis, metritis, oophoritis, ovarian cysts, cystic hyperplasia of the oviduct, oviduct rupture, ectopic eggs, septicemia, neoplasia & granulomatous disease

• Nonspecific CS including lethargy, anorexia, depression, dyspnea, “swollen” • CBC: leukocytosis with associated heterophilia • Chem: Hypercalcemia (or hypocalcemia for chronic egg layers or malnourished

birds), hyperglobulinemia & hypercholesterolemia • Rads: shelled egg within coelom or loss of serosal detail “free fluid” • US: neoplasia, unshelled eggs, ectopic ova, cystic ova, free fluid & collapsed eggs • US guided sampling any soft tissue pathology • Coelomocentesis free fluid should be performed when indicated, cytology & C/S

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Coelomitis of Reproductive origin “EYP” = chronic

Therapy: • +/- O2, supportive care • Dyspnea, assess for free fluid & therapeutic coelomocentesis • Long-acting GnRH agonist • If neoplasia, granulomatous disease, or cystic disease… • Coelioscopy or exploratory/biopsy

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Salphingitis, Metritis, Oophooritis

• Infectious: E. coli, Salmonella spp, P.multocida, Streptococcus spp & Mycoplasma gallisepticum

• Non infectious: egg binding, dystocia, foreign material or neoplasia

• CS: nonspecific to coelomic distension or cloacal discharge

• CBC/Biochemistry leukocytosis/heterophilia with/out toxic changes, increasing the suspicion for an underlying infectious etiology

• Rads/US may be useful when evaluating for secondary disease processes (egg binding, dystocia)

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Salphingitis, Metritis, Oophooritis

• Infectious tx based on C/S for an appropiate period of time

• Long-acting GnRH agonists to reduce ovarian activity, thus minimizing inflammation to the reproductive tract mucosa associated with egg development.

• If noninfectious etiology recommendations based on the underlying cause with emphasis to simultaneously address any required husbandry changes

• Refractory cases > SPH

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Ectopic ovulation (Infundibulum fails to catch the ova) &

Oviductal rupture

• CS: nonspecific, if coelomitis, can present with coelomic distension and may be depressed, weak & dyspneic

• Depending egg maturity rads may show a shelled egg within the coelom, often hard to discern if it is truly ectopic

• US may reveal that an egg is outside the oviduct & is recommended for radiolucent ova that have ovulated within the coelom

• Monitor 12-48 h for oviposition or progression/development of CS • Tx. depends on underlying cause �49

Distended coelom budgerigar d/t internal ovulation post coelomocentesis

Reproductive cloacal prolapse

• Prolapse of the oviduct, uterus, vagina and/or cloaca can occur • Secondary: dystocia, normal egg laying, physiological hyperplasia, other

diseases affecting these tissues, general debilitation and malnutrition • Keep moist and clean • 50% Dextrose • Moistened shrunken tissues are gently replaced with a lubricated swab

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Reproductive cloacal prolapse

• Recurrence is common and re-replacement should be attempted • If necessary, stay sutures can be placed laterally on either side of

the vent to help prevent recurrence • No purse string! • Atraumatic needles • Is fails > SPH • Cloacal reduction procedures (plasty, body pexy, rib pexy)

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Boys will be boys… Phallic prolapse on those who have one!

• Waterfowl, ostriches, Vasa parrots, others • If caught early, lubricate, NSAIDs, +/- antibiotics,

topical lidocaine/marcaine, suture vent, GNRH tx. • If can’t reduce or reprolapses >

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The big “C”

• Enlarged radiographically not equal to neoplasia • Sertoli cell tumors, seminomas, Leydig (interstitial) cell tumors, adenocarcinoma,

leiomyosarcoma, lymphosarcoma, others • CS: nonspecific (lethargy, decreased appetite & behavior changes), to serious

complications, including leg paresis or paralysis • Brown cere in budgerigars, typically occurs with hormone-secreting testicular

neoplasms, normal in some females • Dx: Biopsy for definite Tx: • Chemo • Neuter, risky • GNRH if hormonally induced �53

• Follow the bible; Balancing Your Parrot’s Lifestyle • Upon presentation most have been sick for a while, do

supportive care first • Observe closely prior restraint, then add midazolam • Practice medical spays or neuters trough the use of

GNRH agonists • Not all big testes on rads are neoplastic • Give your clients handouts or refer to websites

otherwise your appointments will take forever�54

Tips!

Conclusion

•Reproductive medicine is a large part of an avian practice •Prevention is the key •10:14, foraging, minimize human stimulus & enhance positive reinforcement, control weight & use of long acting GNRH implants

•Stabilize prior to handling or diagnosis •Know your anatomy •Attend CE wet labs to enhance skills •Thank the internet for some great images •Publish what you see, it is easier than you think

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Thanks!