2. Special Edition!
Avian Health Network Newsletter has set aside its usual format this month to present this Special Edition in loving memory to Coco, the victim of PDD. This is her story and what the StopPDD Campaign is really all about finding the cause and treatment for PDD!
Cocos Diary By Gina Haase
Cocos diary is the story of one parrots struggle against PDD and the tender, loving support she received from her caregiver. Although it only covers a short period of Cocos life (November 2003-March 2004), the diary is a touching tribute to the patient, enduring love that exists between parrot and caregiver.
In November 2003, Coco was diagnosed as a likely victim of Proventricular Dilatation Disease (also known as PDD). Shortly after this dreadful discovery, Cocos caregiver, Robert, began keeping a diary detailing their struggle with this tragic disease.
A scientist by profession, Robert describes the diseases progression and his supportive care. He offers his thoughts on the disease and gives advice for bird owners. Throughout the diary, we see glimpses of his deep love for Coco... Coco was a happy, healthy, sweet-natured African Grey parrot who joined Robert and his family of four parrots late December 2002. Extremely talkative and social, little Coco delighted Robert with her clever phrases, whistles and beeps, and they spent many happy moments together.
Roberts other parrots had their own room, but Coco never lived there. Robert sensed that one-year-old Coco was extremely intimidated by the two loud Amazons and two cockatoos, so he kept her in separate living quarters. In retrospect, this turned out to be a very good thing
Coco seemed to enjoy perfect health, but November 2003 brought a distressing change. Coco appeared to be ill on November 17. By the next morning, it was very obvious that her health was deteriorating rapidly. Robert immediately bundled her up for the three-hour journey to the veterinary clinic in Tulsa. When they arrived, Coco had become so dreadfully ill that she was hospitalized immediately.
Coco remained at the clinic for a week while the veterinarians tried to figure out what was wrong. On Thanksgiving Day, Robert began keeping a diary for Coco.
The Fight Begins
At the clinic, Coco was diagnosed as a probable victim of Proventricular Dilatation Disease, or PDD for short. PDD is an insidious, incurable disease that can affect many species of birds, but is most often seen in parrots. Coco was put on Celebrex to help control her symptoms.
Robert wrote in his diary that there have been cases where birds have apparently been cured using Celebrex and he truly hoped that Coco does not have this horrible disease. Her diagnosis remained probable because in most cases its not possible to accurately diagnose PDD in a living bird.
Robert prepared for Cocos homecoming. He decided to house Coco in his office at the University to reduce the chance of accidentally infecting his other birds. A cage, heat lamp, food and other supplies were set up in his office, and he waited for her to be strong enough to come home from the clinic.
On November 29th, Robert settled Coco into her new home. He noted that Coco was very weak, but that she seemed to be holding her own. Celebrex is very bitter, so Coco was gavage-fed to assure that she received her entire dose of medication. Instead of toweling her, Robert gently held Coco in his arms to administer her feeding. Coco did not seem to enjoy eating her easily digestible foods on her own. Robert decided that he would also give her an evening gavage feeding to help her maintain weight.
Searching for Answers
A few days after bringing Coco to his office, Robert discussed Coco and PDD with an associate (a biochemist). The associate pointed out that there seemed to be a few similarities between PDD and human autoimmune diseases. For example, many human autoimmune diseases seem to be triggered to a bacterial or virus attack: antibodies are produced and the immune system mistakes these for enemy proteins and mounts an inappropriate attack against the antibodies.
Multiple sclerosis, Crohns disease, and rheumatoid arthritis are all examples of human autoimmune diseases. Sometimes, the inflammation caused by the inappropriate immune response causes severe damage. Robert noted that this effect may be more like PDD. Celebrex and similar treatments offer some hope because they seem to prevent inflammation until the infection has cleared or the immune response has diminished. But unfortunately, these treatments are not a cure for the disease itself.
Decembers Peaks and Valleys
By the third of December, gavage-feeding seemed to be the only way to get the Celebrex and enzymes into Cocos system. Coco ate on her own and was especially fond of hard corn, sunflower seeds, apples, rice, and above all, egg yolks. He wondered if he could get her to eat egg yolks with Celebrex in them.
December 6 marked the 14th day of Cocos Celebrex treatment. Robert wrote that she was more active and vocal, but he was concerned that she seemed to be eating less on her own. Foods that she did eat werent digested well. Overall, Coco seemed to be in a worse state than before. He decided to increase the amount of food fed by gavage. Robert concluded, We do not want to lose little Coco.
The next day, Robert was pleased to note that Coco seemed to be doing better. She was no longer regurgitating and her crop was emptying at a normal rate. She was more active and even climbed out of her cage and onto a shelf. Robert hoped that improvement would start soon.
Over the next two weeks, Cocos health took a roller coaster ride. On December 11, Coco didnt seem to be improving in spite of the Celebrex treatment and she needed to be constantly gavage-fed. Her health continued to deteriorate until Sunday, December 14. On December 18, Robert was pleased to see that Coco hadnt regurgitated for a week, and there didnt seem to be any undigested food in her droppings. Robert wrote, It is amazing how active she is today. I hope after this near miraculous recovery this week that she suddenly does not worsen and leave us.
Spiraling Downward
On Christmas Day (December 25), Coco began a harrowing journey into illness. Coco weighed a mere 268 grams: 92 grams down from her normal average weight of 360 grams. The next day, Coco became violently ill, dropped weight, and appeared to be near death. Robert examined her droppings under a microscope, and discovered large amounts of
megabacteria (also referred to as avian gastric yeast). These large organisms live in the digestive tract of some birds, and have the potential to cause symptoms similar to those of PDD.
Robert quickly placed Coco in a large carrier, brought her home from his office, and placed her, carrier and all, into his bathtub with a heating pad beneath for extra warmth. He then adapted a dramatically different feeding routine: heavy gavage feedings with acidic foods four to five times a day, and hoped for the best.
A Happy Beginning to the New Year
Roberts intensive care routine paid off and he saw the last megabacteria on January 2. Coco retreated from the brink of death. Her weight and strength increased and she no longer sat listless on the floor of her cage. Coco returned to her home in Roberts office. He noted that she had made remarkable improvements: vocalizing, eating on her own, and helping him mix up her food. Roberts new problem was getting Coco to eat on her own: she had become very used to her gavage feedings.
January 28 was the 34th day of heavy gavage feedings with acidic foods. Due to inclement weather, Coco was back in Roberts bathroom. Robert had been gradually reducing the amount of gavage feedings to three times a day one day; two times a day the next. Coco talked and played normally. Much to Roberts chagrin, sweet little Coco had learned to imitate flushing toilets and other undesirable sounds!
Robert recalled that about one-third of the diagnoses for PDD are wrong, and many birds treated with Celebrex are healthy several years later. Perhaps Coco has some hope for long-term survival.
Treatment or Cure?
Throughout February, Coco enjoyed a marked improvement in health. Coco weighed 348 grams on February 9, about 10 grams less than her normal average weight. Coco ate all of her favorite foods on her own and only received two gavage feedings a day. There were no undigested seeds in her droppings. February 9 was also milestone day 45 of Cocos modified acidic foods treatment.
Robert pondered the question, Is this treatment a cure or not? and hoped that it was. Robert also noted that he disagreed with the euthanization advice that some vets frequently give in regards to PDD victims and thought that Cocos story was an excellent example of management and survival.
On February 17, Coco weighed 356 grams and was eating on her own. Robert planned to reduce her gavage feedings to once a day and wondered when (and if) he should discontinue Celebrex.
March and the Megabacteria
Battle By March 1, Coco once again was behaving like a normal, healthy parrot. Coco beeped and whistled, played with her toys, and devoured her favorite foods. She was maintaining a near-normal weight of 350 grams. Coco still received her daily dose of Celebrex and was down to one small gavage feeding a day. Robert noted that corn no longer passed through undigested and planned to reduce her gavage feedings to once every 36 hours.
A week later, Robert reported that Coco had developed dark droppings and rapidly dropped weight when she was gavage-fed less than once a day. This effect was immediately reversed when the acidic foods were fed to Coco. Robert examined her droppings under a microscope and discovered large amounts of megabacteria. He ordered a product called Megabac-S to combat the megabacteria and waited for it to arrive.
Coco began the ten-day Megabac-S treatment on Friday, March 12. Robert discontinued the acidic foods and reduced her Celebrex dose. After a few days of the new treatment, Coco relapsed into illness. However, this illness was different: there were no dark droppings and no regurgitation. Coco became severely dehydrated and wouldnt eat on her own. Offering more water didnt improve her dehydration. Robert resumed feeding her acidic foods and her illness retreated.
Tuesday, March 23 was the last day of the Megabac-S treatment. Coco behaved normally and ate her favorite foods. Two days after the Megabac-S treatment finished, Coco seemed remarkably better. Robert knew that PDD is often accompanied by the problem of megabacteria. The question was whether Coco simply had a massive megabacteria infection, or whether she also had PDD. Robert hoped that the PDD diagnosis was wrong but noted that Cocos vet thought that she most likely had both.
Robert reflected on Cocos bout with the strange illness during the Megabac-S treatment. He wondered if it was caused by the sudden discontinuation of the acidic food, the massive destruction of megabacteria, or the Megabac-S itself. Or was a reaction to the reduced amount of Celebrex?
Cocos Final Journey
Ten days after her megabacteria treatment, Coco was behaving normally and eating well. Shed been gaining weight and had no undigested seeds in her droppings. Over the weekend, Coco talked and played like a normal healthy parrot, and even decided to take a short flight. On Monday, March 29, Robert spent a long time playing with little Coco. She talked, beeped like his microwave and acted like her normal, sweet self.
Coco finally lost the war against PDD on March 30. After two weeks of seemingly improving health, Coco lay on the bottom of her cage, near death. Robert fed her a small meal and resigned himself to the probability that Coco would not survive past the day. Before he left for work, Robert wrote, Our individual lives are transitory, both for us and for all living creatures.
When Robert returned from work, Coco was still on the bottom of her cage. Barely alive, she tried to raise her head to greet him. Robert went back outside to shut the garage door, and wondered if he should try to feed her. In that short time, Coco took her last breath and was released from the clutch of this dreadful, insidious disease.
Roberts final entry in his diary was, My yellow clivia was blooming near her cage, fitting for the departure of such an incredibly sweet bird.
- Read Roberts complete diary under our "Living with PDD" section.
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