Dr. C was a new graduate working in a private practice dedicated to the care of exotic pets including avian and pocket pet species. A 20-year-old male Amazon parrot was presented to Dr. C for a routine beak and nail trim. The bird was wrapped in a towel to facilitate handling for the procedure as is customary for the practice. Dr. C proceeded with the nail trim with no issue. During the beak trim, the parrot struggled and briefly got the third digit of the right limb caught in the towel. When the limb was freed, it was noted that the distal phalanx was missing from the digit.
Upon further examination, it was noted that there was no bleeding from the wound. Ischemic injury was suspected. Due to the nature of the wound, surgical amputation to the next interphalangeal joint was recommended. The client consented and surgery was completed by a second veterinarian within the practice. At recheck, the surgical wound appeared to be healing although slower than anticipated. The client was advised that sutures would need to remain in place for an additional week with foot bandaged for protection.
The client did not return for 4 months and upon examination, the toe was noted to have exposed bone with non-healing wound with no evidence of bleeding at or near the wound. The patient was referred for full toe amputation at secondary care center and the client alleged that Dr. C had been negligent in treating the injury. The client demanded compensation for the ongoing medical care related to the injury, Dr. C reported the claim to their insurance carrier.
While the insurance carrier was conducting a claim review, patient was seen at a third facility for additional toe injuries leading to amputation. During treatment, a CT confirmed suspected diagnosis of atherosclerosis. Based on Dr. C's thorough record keeping and the diagnosis at the third facility, the insurance carrier determined that Dr. C had met the standard of care and informed the client that compensation would not be provided, as the injuries could not have been prevented and Dr. C had treated and handled patient appropriately.
A Closer Look at Ischemic Injury
Ischemic extremity injuries may be a sign of cardiovascular
disease, specifically atherosclerosis in birds.
This disease process is more common in aged pet bird populations. Atherosclerosis causes decreased lumen volume
due to a buildup of cholesterol plaques within the affected arteries leading to
decreased circulation. The disease may be associated with inappropriate diet
and an increased plasma cholesterol level.
Clinical signs are often not present but may include exercise
intolerance, fainting and sudden death.
Handling Avian Patients
It is essential to use appropriate handling techniques for avian patients. Staff and veterinarians alike need training in appropriate restraint for necessary procedures to minimize risk to patients and humans. The Association of Avian Veterinarians has a restraint toolkit which provides useful resources for those working with feathered patients.
Resources:
1. www.aav.org
2. Sharman M. Hoppes, 2021, Geriatric Diseases of Pet Birds
Merck Veterinary Manual https://www.merckvetmanual.com/exotic-and-laboratory-animals/pet-birds/geriatric-diseases-of-pet-birds
3. Avian cardiology, Strunk, Anneliese et al. Veterinary
Clinics: Exotic Animal Practice, Volume 6, Issue 1, 1 - 28