Since the vet confirmed that Truman's pelvic bone has healed, I have begun more intensive physical therapy with him. This involves several things. First off, I hold him on his back and move his leg up and down. I begin by testing on his good leg to check how far it should normally move. Then I repeat the same on his bad leg. I apply mild be definite pressure as it is this that stretches and exercises the muscles. Other exercises include side to side motions of the leg, step ups, and now also wave trick.
I have been doing progressively more and more step ups with Truman every day. Not only am I encouraging him to step up, but I am also alternating between stepping with the good leg first or the bad leg. Either way, at one point he must hold his entire weight on one leg but by alternating which leg goes first, it effects the muscle groups that are being worked. He seems to prefer to step with his bad leg first so I am trying to force more step ups with the good leg first by putting my finger specifically in front of that leg.
Truman's reward for these exercises is predominantly negative reinforcement. I am forcefully applying the exercise upon him but stop at a random time if he is cooperative. Since it requires little positive behavior on his own part, it is mainly a matter of him not resisting. Since he is used to being handled, this is not too stressful for him and he just needs to endure for a little while and then knows I will stop. I am also providing praise and petting as a mild positive reinforcement upon completion. I do fewer repetitions but repeat frequently throughout the day.
Finally, the first major sign of recovery is that I was able to retrain Truman to wave again. For a month and a half he did not wave because it would force him to put all of his weight on his bad leg which he could not do. But with the good news from the vet, I decided to try to get him to wave now. I realized that it may take longer to train it again this time not because he would have forgotten the trick but because he would need to recover strength in his leg to be able to stand this way.
At first the training progress was slow and he wouldn't even so much as try to lift the foot to wave. Clearly he wasn't doing it on cue. I tried to repeat the wave training method in order to reteach him what I want for him to do. I would reward even if he so much as would lift the foot off the perch. Surprisingly though, he was picking things back up very quickly and within 5 tries he had a sort of wave going and by 10 he was already waving on cue as good as ever. This demonstrates much greater strength in his bad leg than previously anticipated.
The recovery progress had probably already been happening but accustomed to the pain, Truman did not try to use his leg in full. But with my encouragement through positive reinforcement training, Truman is regaining function of his leg much more quickly. With today's progress he is back to 90% of his original state and I would guess that at this rate he should be back to 100% within 2 weeks. This was an exciting breakthrough in Truman's recovery progress. You can expect to see more trick training updates soon. Here is a video of the physical therapy exercise and how I retrained Truman to wave again.
First of all I would like to thank everyone for their support who has been reading my updates about Truman's injury and recovery, all the people who posted responses, comments on youtube, discussions on The Parrot Forum, and endless private messages. Writing posts about this and all of your support is helping me cope with the entire situation. It's just really tough to watch him suffer and really not be able to do anything for him. It's mostly a factor of time and all of this writing and friendly support I am receiving is helping me pass the time in waiting for him to be better.
Before I get into the details about the vet situation, I'd like to share a bit more about how Truman is doing. Today I have noted a slight improvement over previous days this week. I hand fed him 3 times today and still he went to bed not a gram heavier than the previous nights. However, the improvement I am seeing is that by this evening he was actually demonstrating a subtle interest toward food. I noted that he had eaten a few pellets in his tub. He drank a few sips of water when I took him out. I offered him pellets, peas, broccoli, and carrots by hand. He did not really eat any of these but he did take them up in his beak and break them into smaller pieces. Most of this was coming right back out of his beak but at least he is showing some slight interest in food whereas even yesterday he wouldn't so much as look at it. This looks like a turning point and the first step to him returning to a normal feeding regime.
The hand feedings today were all slight. I've learned to make the formula thicker and have been following all sorts of advice I have been receiving. 6cc's is the most that I am getting out of the syringe and I'm lucky if half of that doesn't end up all over the place. Most of my effort goes into Truman not running or flying away from the feeding. As long as I get the stuff into his beak, for the most part he does end up swallowing it. But when I weigh him after a feeding I wonder how he could have gained so little or no weight at all from the food.
Truman seems to have two phases. Every time I come in from some absence, I always find him very mellow and squatting low on one leg. He definitely doesn't seem to be eating or playing much while I'm gone. However, as soon as he sees me, he gets up and becomes more active. He seems to be pretty active in my presence but very mellow in my absence. This is probably a good thing when it comes to letting his leg heal.
Throughout this week since Truman's Metacam crash I have been in regular contact with the Center for Avian & Exotic Medicine. Unfortunately the office manager that can authorize billing changes was unavailable throughout the week. However, I had several conversations with the nurses and one of the vets about Truman's progress. Unfortunately the results of those conversations were inconclusive but that is because for a while Truman was neither improving nor getting worse. The conclusion we have basically been reaching every time was to wait and see which direction his recovery takes. This was by no means anyone's fault, it was just that there was no point in changing his medications or stressing him by traveling to the vet again if things were not getting worse.
Finally the office manager returned today from a trip pertaining to animal rescue. She was unavailable when I called in the morning but she called me back herself a little later. Actually this is one of the things that I really appreciate from this facility. Whenever the person being reached is unable to talk, they always call back. In a world where we find ourselves talking to machines or someone abroad, this is always a welcome courtesy. The office manager called me back and we ended up talking for half an hour. The conversation began with Truman's current condition and progress and eventually led to the medication overdose and billing.
It turns out that Truman's prescription was mixed up with a rabbit's medication. They were both set to receive metacam but in slightly varying dosages and durations. Someone screwed up and misplaced the two. I joked that the poor rabbit must have only received a bird sized dose! Luckily Truman's overdose was not so tremendous but then again if they gave me a dosage suitable for a horse, bells would have been going off. The main reason I think this mix up went unnoticed was because the number of days was close (5 vs 7) and the dosages are both quite small despite the actual variation.
There is no doubt that the follow up tests and medications were good practice to verify that the overdose had not caused any substantial damage. My main concern was that I received a hefty bill that predominantly pertained to care Truman was receiving specifically in response to the medication mismatch. I felt that it was unjustified to have to pay for the damage control. I had no objection to the care he received in response to the overdose. In fact I am actually quite relieved that the vet had the competence to realize the concerns that such an overdose might raise and dealt with them appropriately.
I was very happy that the office manager was very aware of the situation and cooperative. In the course of the week I had prepared a bombardment of arguments to use but did not have to because she was being very respectful and supportive. This is good because having to try to fight for justice only leads to harder feelings. As I've stated in my original post, overall I am actually quite happy with the Center for Avian & Exotic Medicine, so I am relieved that this situation was professionally dealt with and I can continue Truman's vet care with this clinic.
Ideally the extra tests/medications should not have been charged in the first place which would have averted all the frustration, but unfortunately the office manager was out all week and the other staff could not have authorized such an amendment. It is not even that I do not want to pay for Truman's care, but rather that I felt cheated having to pay for tests to see if the mistake had caused damage. The absolute most important thing is that the overdose did not do any harm. The whole billing thing we have all the time in the world to sort out, so I'm not worried. The office manager offered to refund any fees associated with the medication issue. She made a full refund for that recent visit. I explained to her that it's not necessary to refund for Truman's new pain medication because I would have bought that for him even if the whole metacam dosage went according to plan. Yet I received a refund for the entire amount billed for the recent visit.
We also discussed whether or not I should be taking Truman outside. We reached a consensus that if done the right way, that in fact getting some air and sunlight would be beneficial to him. I have been preparing to start taking him outside for nearly two weeks now. Check back soon to find out what I had in store for him. It's something big and this next article you won't want to miss!
Before giving an overall judgment of this vet clinic, I'd prefer to wait until the completion of Truman's treatment. However, I would like to mention again that the staff are very pleasant and professional, the facilities spotless, and there exists a genuine concern for the animals' well being. I wish pet stores and companies I deal with overall could live up to these standards.
In the past few days I have been experimenting extensively with foods to see what he'll eat. Counting on him to eat his pellets himself has been futile. He may nibble on them a little bit but he hardly gets any meaningful amount into his crop though. Normally if I stick a pellet in his beak, he'll at least chew and swallow it but not now. He just spits his pellets right back out. The first time I tried to feed him oatmeal he would not eat it. Later I learned that if I force the oatmeal into his beak, then he'll swallow it but only then. He has made very little independent effort to eat food since Sunday.
With my intervention, luckily his weight has remained fairly stable in the 305-315g range. He is no longer losing any more but it's been a tough fight to get enough food into him to keep him in this weight range. Normally he drinks a lot of water and in the week prior he drank profusely. However, since the medication change he barely drinks a few sips of water a day. And I know exactly how much he drinks because I do not leave water for him in his tub. The last time I did, he knocked it over and the whole tub was flooded. Since then, I just offer him water in a dish every few hours.
Surprisingly, Truman exhibits some interest towards vegetables. I don't know if he's just playing with them as a chew toy or actually ingesting them but I do see them fairly torn up when I offer them to him. While he rejected apple sauce (human baby food) and Lafeber's, he still has a taste for nuts. I've been giving him an entire walnut (partially cracked) and several almonds every day. He's too "tired" to eat his pellets but he can work at those nuts for hours on end.
I believe that I've noticed some improvement with his bad leg. He seems to stand on both legs a bit more of the time rather than on just one alone. He has a stronger grip and I can feel more weight in the bad leg when he is standing on my hand. However, I'm not certain if perhaps this is merely because his good leg is tired so he's just balancing out the pain between the two. When I leave him alone, he squats very low, almost on his belly. He leans over on one leg and a wing. It almost looks as though he is nesting. He used to sit up higher before the medication switch so I'm not sure if this is in any way indicative of his condition or if he has just learned over time the most comfortable way to sit.
For the last few days Truman has been very flighty. He has had at least 5 flights yesterday and about as many today. A week ago I could trust him not to fly but now he takes every opportunity to fly away when I'm not looking. Just yesterday I had Kili and Truman out. I was trying to have Kili fly a recall. She wouldn't come but suddenly I felt something land on my hand as Truman flew from behind me and came to me instead. Behaviorally, Truman has shown some significant improvement in recent days but his appetite seems to have taken more of a dip. I find it strange how he can be so energetic on so little food.
I finally got in contact with Truman's breeder and she gave me recommendations about hand feeding him. I would not have a chance to get to a bird store that would sell hand feeding formula so I had it overnighted to me instead. That cost a good buck but considering how much I've put out on vet care already, this was not so extreme. I wanted to have it on hand as soon as possible in case Truman is eating poorly. If Truman's weight continues dropping, I will have to bring him back to the vet, but with my continuing efforts we have been able to avoid this for now.
The breeder instructed me to mix the formula in a cup with 2 parts water for every 1 part powder. She also suggested throwing a bit of peanut butter and Lafeber's into the mix. I have not had a chance to grab the peanut butter yet but I did add the Lafeber's for some extra nutrition. She explained to me the importance of exact temperature control so I ordered a thermometer along with syringes in that overnight package.
To make the formula, I begin by boiling water and then letting it cool for a little while. Then I pour the water into a mug and mix the powder in until it gets a muckier consistency. I keep mixing with a spoon and begin monitoring the temperature. I wait until the temperature begins dropping below 115 degrees Fahrenheit and then proceed to prepare to feed. By the time it reaches 110F, I suck it up into the syringe and offer it to Truman. Earlier today he had a really big hand fed meal but in the evening he ate much less. Most of it he shook off and it ended up on the floor and on me.
Likewise he's been annoying about taking his medication as well. He used to take it pretty eagerly but now he closes his beak, resists, and then shakes it off or spits it out. Not only does he not eat on his own but he sure makes it difficult to get stuff into him as well. Luckily (for the most part), what I can sneak into his beak, he will consume.
Here is a video of how I prepare the formula, give medication, and then handfeed the baby formula to Truman. Please do not use this video as a reference for hand feeding baby parrots and don't ask me how to. I know next to nothing about hand feeding and this is just the second time I did it on an already weened parrot.
Truman had been taking metacam for the five days since I brought him home. While he did not seem heeled by any means, he was in better spirits and a bit more active. He has been limping and his leg barely improved in a week's course. He gained a little bit of strength back in the leg but no improvement beyond that. In a midweek follow up the nurse said that this was about the progress excepted in this amount of time.
Friday was the last day I gave the medication to Truman. Over the weekend his state began a steady decline. On Saturday he seemed pretty neutral but by Sunday was slowly losing weight. I could still tell that he was eating but yet he was putting out less than he was taking in. By Monday morning his weight was very low and I began contemplating taking him to the vet. However, he did eat a little bit of pellets which was encouraging but not nearly the amount he would eat in a normal meal. I began to suspect that the quick withdrawal of the medication was making Truman feel bad again and not eat.
Thus I called the vets office to find out if this is expected upon termination of the medication. As we were talking about extending Truman's medication, there appeared to be some confusion about dosages. I was being told about lowering Truman's dosage from .1 to .05mL but I had been giving Truman 0.5mL throughout the week. At first it seemed as though I had been measuring the wrong dosage but upon further examination of the medication label, I was able to validate that in fact I was giving him the amount that was recommended to me. It turned out that the medication dosage was wrong and that Truman had been overdosing on metacam for an entire week!
The vet offered a courtesy visit to bring Truman in to check his condition. I was already contemplating whether to bring him to the vet or not so I obliged. The overdose was confirmed so they wanted to run some blood work on him to make sure it was not endangering the kidneys. Luckily it was not. Furthermore the tests showed that he was getting sufficient calcium from his diet for his fracture to heel although no significant progress has been made with that.
I am happy that the office is thoroughly working with Truman but not at all thrilled about this dosage mix up. And it's not even so much the fact that he got a larger dose, because it appears that it did not harm him (and actually he probably didn't overdose as badly as it seems cause he'd spit half the medication out and shake it all over, some landing on the floor and the rest on me), but rather that this ended up costing me big time. So while they didn't charge me for the visit, I still had to shell out a good $250 for this time alone.
The blood work to check that the overdose did not harm his systems ended up costing $112 and would not have happened if someone didn't screw up the dosage recommendations in the first place. Furthermore I had to buy a $45 medication that is supposed to help suppress the effects of the overdose. So while the other stuff I paid for might have been incurred either way, I ended up paying nearly twice as much as a vet visit just to get the whole overdose situation cleared up. While I can forgive the dosage mistake as it had not done any damage, I'm not happy to be paying an extensive bill for amending that mistake.
After the blood work, Truman needed to have a fluids injection as he hadn't been eating sufficiently. After bringing him back from the fluids injection, I took Truman out of his carrier to see how he was doing. He was bleeding profusely from the leg they did the injection to. I had to call a nurse back in to help. They don't use quick stop or anything else to stop this sort of bleeding except wiping it down and applying pressure. She applied a lot of peroxide and worked on stopping the bleeding. She told me that Truman is more sensitive and bleeds more than other birds for these kinds of procedures. Eventually the bleeding was stopped but his leg remained bruised.
On the subway ride back home, I took a peak into Truman's carrier (which I was keeping covered with a towel) and my heart nearly stopped when I saw him laying down on the bottom of the carrier with his eyes shut. He appeared dead! But then I saw an eye open and then the other. Regardless it seemed like he was on his last breath and no longer to hold up the weight of his head. I was having a panic attack and wondering if I should get off the train and catch another one back to the vet's office. I decided that I had just been there and they had given him any injections they'd give him and that they wouldn't be able to do much anyway. I figured the best thing would be to get him home to rest. As the train neared home, I spotted Truman standing up and holding his head higher. As time passed he stood better and better. I have a feeling he was just woozy from the blood loss and injections and resting his head down was the easiest way for him to balance during the turbulent train ride.
After getting him home, I immediately put Truman back in his tub and offered him pellets. He actually ate some which was a tremendous relief to me. I offered him water to drink and then even more pellets. After consuming an almond and some more water, Truman had brought his weight back up to at least his normal low weight so I was much relieved. He has had a difficult and exhausting day so I covered him to go to sleep a little earlier than usual. I just hope this new series of medications makes him better soon.
On Wednesday morning (August 4th, 2010), Truman and I had a bit of a disagreement. I took him out of his cage for his customary morning poop. For ten minutes he sat around on his perch and didn't do anything. Then he suddenly flew off and landed on my windows shades and released an all nighter. This was much similar to a previous episode of this. Thus I ended up spending all morning cleaning poop out of my blinds again and by the time I finished I was in a rush to get to work. Every time I went to try to get Truman he'd fly off and things turned into a nasty chase. The more he flew away, the more effort I exhibited to get him which in turn made him flee reflexively.
The chase terminated in a exhaustion and a crash. Truman no longer tried to get away. I picked him up, comforted him briefly and put him away in his cage. For the remainder of the day Truman appeared lethargic and was closing one eye much of the time. He did not eat a thing in the morning nor in the evening. I began to worry that he became sick either from too much stress getting chased in the morning or possibly from my bird store visit several days prior. I decided to let him sleep on it and see if he improves over night. By the following morning when he did not touch his food, I decided immediately to take him to the vet.
Instead of going to my local vet, I took him to a specialized avian vet in Manhattan and over an hour away. They had a nurse take a look at him almost immediately to determine that he is in stable enough condition to allow the doctor to finish a previous animal before examining Truman. After a brief wait we entered and I explained the scenario. I told about how I suspected his drastic behavior change to be either illness from bird store, stress from chase, or possibly injury. Truman stood the entire exam on a single foot and limped when trying to move around. The previous day he did not exhibit so much difficulty in the foot so I was not as concerned that it was injury. However, by this time it was much more apparent. The vet determined that Truman had hurt his leg and that if anything, the pain was coming from higher up.
I was in a difficult position with a wedding I had to attend over the weekend and no ability to provide him special care and attention. So I decided to have Truman taken care of by the office until Sunday. I came back to visit Truman Thursday night, Friday morning, Saturday morning, and then picked him up on Sunday night. After an xray it turned out that Truman had a fractured pelvic bone on his left leg. The vet explained that there is really nothing they can do about it but that the good news is that it should heal on its own. The first day they fed Truman soft food and injected him with liquids but by the next day he was already eating pellets on his own. I had brought a bag of his normal pellets with me when I dropped him off and left those so he'd have a familiar food.
On the second day of Truman's stay, I came to visit bringing an almond for him to munch on. He devoured it right down and was looking much more alive than he was the previous days. He was finally a bit more alert looking and making some of his customary sounds. I continued visiting him and noting small signs of improvement. Today I picked him up and brought him home. The office provided me with medication to give to Truman for the next 5 days. It is an anti inflammatory and pain killer which should aid the healing process.
I had to set up a special living area for Truman for the next few weeks. Truman can't go back into his cage for a while because he needs to avoid climbing in order that his hip can heal. So I set up a large plastic bin with a low perch and steep sides. This way he cannot climb up the sides and has little room to walk around. Truman needs a good few weeks of rest so that he can improve. I also made a special lid with a wire mesh for the top. It is as much my fear of Kili getting into Truman's tub as it is for Truman to get out. There is no way Kili/Truman can climb in but they are both flighted and I won't be taking any chances. I leave his tub uncovered when I am home but will cover it when I am not.
So five days and $600+ since Truman's injury, things are starting to return to normal. Truman won't be able to fly around or do tricks for a few weeks but I am glad that his injury should be recoverable. I will be feeding him calcium rich foods like spinach, broccoli, almonds, and yogurt if he accepts in addition to his pellets. If not, he can have lots of almonds. He normally has one a day as it is and the extra fat shouldn't be an issue considering he's under weight now as it is. Surprisingly I've learned that almonds are a great non-dairy source of calcium.
I have learned a few lessons in this whole process. Obviously I learned that you can't take things too far with a bird and it's important to keep a low stress environment so they can think with their head rather than get out of control in an enclosed space. It is my fault for pushing Truman too far and assuming he was as tame as Kili. However, I also learned that good vet care is available (albeit at some distance and expensive cost) and should be used when necessary. I am really happy with the Center for Avian & Exotic Medicine in all regards including their level of expertise, specialization, quality facilities, and friendly staff.