Parrot Physical Exam

From The Proceedings of the International Aviculturists Society, January 1996, Orlando, FL

There is absolutely no substitute for a good physical exam to determine the health status of any species. It is usually possible to assess an avian patient but it does require a thorough exam. Cursory exams have limited worth. The across the room exam will allow evaluation of feather quality, posture, character of respiration and some behavioral traits but it is a trap to assume that valid conclusions can be drawn from such an exam. The evolutionary process that have adapted bird to their successful niches as flock animals in challenging ecosystems have instilled in the individual a tendency to look good at all costs. Birds are very unlikely to show signs of subclinical illness. Failure to appear vigorous would likely result in a parrot ending up as someones lunch. Failure of an individual to appear healthy could ultimately affect the wellbeing of the whole flock. Anyone attempting to ascertain the health status of a parrot must understand their drive to appear healthy and alert.

This paper will describe a thorough exam that can be done by anyone capable of safely restraining a bird. It does require two people. A third can be useful for taking notes and passing equipment. This physical exam is intended for people familiar with parrots and able to safely capture and restrain them. This exam is a routine home, or aviary management tool for people interested in knowing more about their birds health. It is not intended to replace a professional veterinary exam. Birds that are already showing signs of illness should be seen by a qualified veterinarian as soon as possible. Any process of restraint should be viewed as a potential stress for any psittacine. At all times during the exam the bird must be monitored for any signs of decompensation or intolerance of the procedure. Care should be taken to prepare all tools and equipment before hand. Handling time should be minimized and the bird should be observed closely after the exam and the recovery time (time until normal behavior resumes) noted.

First the bird should be safely caught and restrained. We prefer to capture and hold the bird in a towel. Darkness is useful since parrots don’t dark adapt very well. If it is possible, capture the bird on a flat surface with the towel in a dark quiet environment. A psittacine of any size can be safely restrained by gently encircling their neck with the thumb and first finger. The secret is in a gentle extension or lengthening of the birds neck. The towel can be used to gather up the wings and stabilize the bird. Ideally the "one bird / one towel" rule should be employed to avoid spread of disease. It seems less stressful to insulate them from direct contact with our hands by using a towel. Pet parrots seem to transfer their dislike of restraint to the towel instead of the handler. Gloves seem to leave a lasting impression about the threat of a human hand. If removal of birds from the aviary is the first step, it should be done with great attention to the birds physical and psychological safety. Once captured it can then be gathered up in a towel.

Start at the top of the head. Examine the quality of the skin and feathers. The skin of a parrot is generally smooth and translucent. Some flaking is normal but excessive flaking can be an indication of environmental dryness or poor diet. It is helpful to know before hand the normal feather pattern for your patient. The bald patch on the head of some cockatiels and cockatoos is a great spot to check skin quality and health. Solitary birds may have problems preening the shaft off new head feathers. If they resist human help preening, a good time to "do their do" is while they are restrained. Look for abnormalities of the feather as well as the shaft. The shaft (rachis) should be smooth. The rachis should be thin at the tip and thicker at the base. The feather shaft should be clear and free of discolorations and deformities. The vane or feather should be smooth. Interlocking barbules result in the smooth appearance of the feather. The feather should be free of stress bars. Color should be appropriate for the species. If the bird is a solitary animal changes on the head are significant. If the bird lives with other bird changes on the top of the head could represent preening damage from other birds.

Proceed to the birds face. The eyes, nares, ears and mouth deserve a very close look and can provide an inordinate amount of information about nutritional status and environmental conditions. The birds eyes should be bright and clear. The conjunctiva are the membranes surrounding the eyeball. There is a nictitans or third eyelid that moves from the inside corner to clean and lubricate the cornea. These membranes should only be visible by gently lifting the eyelid. A very careful look can show inclusions in the cornea or densities of the lens. Eye lids should be uniform and smooth. Inflammation of one or both eyes or the conjunctiva is a common sign of systemic disease. It is less common for the problem to be trauma. The sinuses surrounding the eyes should be checked for swelling. It is not uncommon for some species of birds that have significant sinus inflammation or infection to develop bloody tears while restrained or while their mouths are opened for examination. Although this can be very disconcerting,it does resolve spontaneously. African Greys with extreme sinus inflammation or infection are the most likely to do this although I have seen it most species for the same reasons.

The nares or nose holes should be carefully examined. Tremendous species variability exists and the examiner should expect a Yellow Naped Amazon to be very different from a Mollucan Cockatoo. In general both nares should be the same shape and color. The skin around them should be smooth and pink. The openings should be clear of plugs and debris. The operculum is the keratinized plate within the nares . It should be free of debris and smooth. There should be no staining of the skin or feathers by exudate. If the nares are occluded by dry crusty plugs it may indicate infection or conditions that are too dry and dusty. The beak below the nares should be smooth. Fissures or other defects of the beak below the nares usually means there has been chronic sinus drainage from the nares. It is not uncommon for chronic sinus infections to result in some increase in the rate of growth on one side of the beak. This can result in malocclusion and a tendency for the beak to curve.

The beak should be smooth and shiny in neotropical birds and smooth and dusty in most old world birds. Dry flaky changes beneath the cere are abnormal. The mandible and maxilla should meet and be bilaterally symmetrical. Some flaking of the beak near the tip is normal. Healthy parrots in healthy environments will keep the steadily growing beak in perfect trim.

A thorough exam of the ears is often overlooked. Although disease of the ear canals is relatively uncommon a wealth of information can be gleaned from a good look. The skin around the ears can be carefully parted or moistened with warm water. The tissue lining the canal can gently be rolled outwards. The healthy ear canal should be smooth, pale pink and dry. The ear canals house some of the few exocrine glands in the psittacine. The glands are usually quiet and not inflamed. Birds with active inflammatory or infectious processes of the sinuses often have impressive inflammatory changes in their ear canals. The glands can become very cystic and inflamed. Improving dry, dusty environmental conditions or treating the secondary infections that result from these conditions will resolve these changes. Ear canals are best viewed with an otoscope, but a pin light will suffice. There are great species difference in both conformation on ear canals and patterns of inflammation. Many amazons have tiny ear canals. Most cockatoos have large ones.

The oral cavity deserves a good look. I prefer to open the mouth with two strands of gauze. The gauze is looped around the mandible and the maxilla and the mouth carefully opened. This is about the only way to view the papilla, the choanal slit, oropharynx, the glottis and the tongue. Spike like sensory papillae are well developed in most species and line the margins of the choanal slit, the back of the oropharynx and the laryngeal mound. The mucosal surface is lined with salivary glands. The mucosal surface should be smooth and free of plaques or exudate. The oropharynx should be fairly dry and free of inflammation. The base of the tongue should be free of swellings or accumulated debris. Changes in the oropharynx that result in blunting of the papilla or excessive mucus production are usually associated with inadequate vitamin A. The tiny opening at the bottom of the choanal slit is the infundibular cleft or the common opening of the eustachian tubes.

Once the head has been examined the rest of the exam will proceed fairly quickly.

The neck area should be carefully palpated for lumps or abnormalities. The feathers over the crop can be parted and the crop visualized. Any food in the crop will be felt. The crop should not contain a lot of fluid or gas. Peristaltic activity can be seen as waves of muscle activity. These are most obvious in juvenile birds.

The pectoral muscle mass should then be examined. The muscle mass should be symmetrical and species appropriate. Birds that fly will have more developed muscles.

Sedentary birds or bird with limited room to move may have flabby poorly developed muscles. Parrots predisposed to obesity may develop cleavage or the "Dolly Parton" look. The feathers should be parted and the skin over the keel examined. Any evidence of feather picking should be noted. The feathers over the chest should be well formed and of good color. Any tendency of the feathers to age poorly or show pigment changes should be noted. If a stethoscope is available, the heart should be ausculted. Heart rates are variable by species and degree of excitement. Heart rhythms are regular and unusual patterns are significant. Like most technical skills, the use of the stethoscope requires repeated use and practice.

The abdominal space should then be palpated. The liver margins should not extend into the abdominal space. Any distention of the abdomen with fluid, fat or masses is significant. In small birds the abdominal space is small and more of a potential space than an actual space. Any increase in the distance between keel and pelvis may bear watching. Pelvic bones should be palpated for position and flexibility.

The cloacal margins should be examined closely. The vent should not have any staining of the surrounding feathers. The vent should be free of any fecal debris. The cloaca should have good tone and even margins. Many birds with inadequate nutrition or in very dry environments may show hyperkeratosis or a chapped appearance. The lining or mucosa can be examined by gently puckering the cloaca to see the lining. Any swelling, discoloration or masses are significant. Mucosal tissue that protrudes out of the cloaca is abnormal. With gentle experienced hands if problems are noted, a lubricated sterile swab can be inserted to evert the mucosa. If papillomas are a concern, apple cider vinegar can be lightly sprayed on the mucosa to identify the masses.

Before proceeding to the legs and wings, the back should be carefully palpated. It is awkward to do a good visual exam of the birds back while its in a towel but it is relatively easy to run your hands up the back checking the preen gland, skin and feathers. The uropygial gland or preen gland is a bilobed gland located at the base of the tail. It is well developed in the African Grey and absent in the Amazon. Secretions aid in feather maintenance and weatherproofing. Vitamin D3 precursors are secreted in the oil. Exposure to ultraviolet light triggers the chemical change to active VitD. Subsequent preening results in ingestion of the active vitamin. Plugging or failure of the gland to empty is most commonly associated with poor nutrition. Neoplasms of the gland are not uncommon in budgies. If your patient is a cockatoo your hands should come away from the back and under the wings covered with powder. This powder is produced by specialized down feathers. It aids in grooming and waterproofing. Birds that produce inadequate amounts of powder often have a greasy or unkept appearance.

The wings should be examined by extending them one at a time. The skin and feathers should be checked for quality and color. Any loss of color or normal structure should be investigated. The tendency of some birds to barber their wings should not be considered normal and should be investigated. The carpus and elbow joints should be examined for flexibility.

Careful examination of the feet and legs will conclude your exam. Careful attention should be paid to the skin of the legs and feet. The scales of the lizard skin on the legs and feet should be uniform both on the dorsum and plantar surfaces. Excessive scaling or loss of the discrete scaling pattern can be indicative of poor nutrition or other environmental factors. Plantar erosions or ulcerations can result from inadequate perching surfaces or obesity. Many large birds will develop erosions of the hock or ankle. These usually resolve with changes in diet and perches. It is normal but inconvient for parrots to have sharp nails. Nail trims should to be done with the needs of the bird in mind. Birds in captivity, especially those with clipped wings need to be able to securely grip a perch. Overgrown nails can also reflect environmental or nutritional need. Nails that are allowed to overgrow can start to pierce the foot on narrow perches. Erosions and ulcerations of the foot need immediate attention. Perforating wounds can introduce bacteria directly into joint spaces and can result in serious systemic infections.

Once the physical exam is completed and the bird released, it should be observed for its ability to recover. Birds with some degree of debilitation will take longer to recover. This may be seen as an inability of the bird to catch its breath. Most healthy birds will recover in under 5 minutes.

The results of a physical exam should only be one part of a health assessment. It is a good rule of thumb to gather and evaluate some laboratory parameters. This need not be extensive or costly. A great deal of ball-park information can be obtained from a PCV/TP. A packed cell volume (PCV) is a measure of the birds red-blood cell count. A couple of drops of blood are collected in a tiny capillary tube. This is then spun in a centrifuge to pack the red cells and separate them from the serum. Where as mammals can have a broad range of normal measurements psittacines in good health usually have PCVs of 45-55%. It makes sense that flighted birds would have an adaptive need for more red cells to carry the oxygen that powers their flight. Readings below 40% should be investigated. The total protein or total solids are read off the top of the spun tube. A refractometer is used for this measurement. It is very easy to collect a couple of tubes during the physical exam. These can then be spun down and read by your veterinarian.

Direct fecal exams and gram stains are two other quick and inexpensive procedures that can round out your assessment. A wet mount or direct fecal is a great screen for protozoan parasites and yeast. A gram stain is not a reliable stand alone test but can provide a great deal of information. Most parrots should have fecal bacteria that are mostly gram positive rods and cocci. Most healthy fecal samples have large numbers of beneficial bacteria. Good information about a birds general health and its diet and environment can be obtained from a gram stain. Many aviculturists with access to a microscope have learned to prepare and read gram stains and direct fecals.

As with any protocol for health evaluation the results will vary with the experience of the examiner and the amount of information available. Working directly with someone experienced in these techniques makes the process easier.


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