Living with PDD/AG

This article was first published in Parrots Magazine August 2021 Issue 283

What is PDD/AG?

AG/PDD is a progressive neurologic disease with a high case fatality rate once clinical signs are present. Avian Ganglioneuritis better describes the disease since it is not always about the GI system. Birds may exhibit only GI or neurologic signs or a combination of both.

Rossi, Dahlhausen and Orosz. Avian Ganglioneuritis in Clinical Practice. 2018

My precious Ollie was fading away. Literally. And I was powerless to stop it.

Ollie before PDD/AG

Orange-winged Amazon, Ollie, came into my life on August 1st 2010. He was silent, fearful and still, and had various respiratory disorders including aspergillosis. Over the next 10 years he blossomed into the most amazing friend. He had truly wrapped his beautiful wings around my heart.

Our nightmare began in the late summer of 2019 when I was shocked to find undigested food in Ollie’s droppings. Not all the time, just now and again. I put it down to eating unripe strawberries in the aviary. Ollie loved to pick his own strawberries and when he ran out of the red, he started on the green. I removed the strawberry plants but the undigested pieces kept appearing. I called the vet out to see him. The test results for the faecal samples she took came back as normal. His weight was also normal at around 370gms.

Picking strawberries in the aviary

Some months passed and I noticed Ollie who never ate very much seemed to have an increased appetite. One day at the beginning of December he couldn’t wait for breakfast and went into each parrot’s cage to ransack their millet spray. The result was horrifying enough to immediately call the vet again. 

Shocking millet poop

We tried a course of Baytril to discount an infection. The results were a little better, but as soon as the course ended, the bits came back. Another option was that perhaps Ollie’s chronic aspergillosis was flaring up.  Blood tests showed no active asper. Zinc or lead poisoning? Unlikely. Other causes could be atherosclerosis, intestinal papillomas or tumours. There was a limit to the amount of testing we could do for Ollie as he gets highly stressed at being handled.

In March 2020 Ollie began losing weight. An appointment for an X-ray was made. Covid restrictions were already in force, so I couldn’t go inside the building with him. The X-ray showed his proventriculus was large but not grossly extended.

The next logical step would have been to see if Ollie tested positive for ABV but our vet didn’t want to stress Ollie further by taking more blood for a PCR test which is not that accurate. I also found out later that a bird can have PDD without testing positive for ABV (only 2 strains of ABV will cause PDD), just as a bird with ABV doesn’t necessarily go on to develop PDD. In fact, a third of captive birds will likely test positive for ABV and for most it will never be a problem, they will remain perfectly healthy throughout their lives.

It is difficult to test for PDD antemortem, however there is now a test that is said to be 98% accurate. It is the Avian Anti Ganglioside Antibody Test (AGA) which tests for the antibodies created in response to the gangliosides released when the nerve sheath walls are damaged, which is what happens with PDD. It was established by Prof Giacomo Rossi and at the time of writing is only available at his lab, The Faculty of Veterinary Medicine, University of Camerino, Italy, and at Dr. Bob Dahlhausen’s USVMD Labs in Ohio, USA.

Since we had discounted most other likely problems the symptoms were pointing to PDD/AG. I was told there was nothing more that could be done.

Facts

The virus is very unstable in the environment. It loses infectivity within 8 hours. It can’t exist in the environment, so it doesn’t easily go from bird to bird.

J. Miesle M.A., M. Ed. Understanding Avian Ganglioneuritis and Avian Bornavirus (PDD) 2017

Soap and dilute bleach appear to be effective in disinfecting enclosures and items that come in contact with ABV-positive individuals.

Rossi et al

ABV does not appear to be zoonotic; humans and animals do not contract this infection from pet birds.

Exotic Vet Care website. Jan 2019

If there was nothing that could be done medically, then I would try holistically. Through Leslie Moran, I spoke to a homeopathic vet in Austria and she researched a remedy for Ollie. Leslie herself, looked into low fibre foods and supplements for me. Another friend, a Master Reiki practitioner, gave Ollie regular distant reiki sessions. Yet another friend added him to two healing groups. I was nebulizing him every evening with F10 and giving him nightly healing myself. I read up about anti-viral herbs and spoke to someone who had used them for her PDD positive parrot, namely St John’s Wort and Echinacea. As with any sick bird, Ollie was kept as warm as possible with extra heat sources.

Ollie sunbathes whilst Kobe plays beneath him – they were never far from each other

Ollie’s food choices were changing. He seemed to be choosing the more easily digested cooked foods. He used to do anything for cashews but would no longer touch them, which was sensible as he was either vomiting them or the pieces were showing up in his poop. I was making cooked mash which consisted of lower fibre grains and legumes, squash, spinach and anti-inflammatory turmeric and ginger. Most of his foods were sprinkled with digestive enzymes and probiotics. He was getting anti-inflammatory flax oil, alcohol-free herbal tinctures of Milk Thistle for his liver, St John’s Wort and Echinacea. DMG for his immune system plus the homeopathic remedies.

Tempting Ollie to eat wherever he chose to sit

Ollie had always been very active but had started to sleep a lot. At this point he was still able to fly. His smell was different. He used to smell of fruity cookies, but not so fruity now. He was a little more short-tempered. He used to love targeting, turning circles on cue, etc, but had lost interest. His feathers were very slightly unkempt when he used to look so perfect. The feathers over his crop seemed to bulge and then go down. Gassy? Yeast?

His weight and mood fluctuated. Then at the beginning of May there were more bits in his poops and he was not so well. His weight started to fall and he was vomiting. I had started adding extra nutrition to his food with Emeraid Omnivore Intensive Care which is specifically for birds with digestive issues.

More undigested pieces in his droppings

At the end of May I found the Avian Ganglioneuritis (PDD) Diagnosis Support Group on Facebook (see link at the end under “references”) which was a wealth of information and help. They had a link to an excellent video by Dr Bob Dahlhausen, a US Avian Diplomat Vet and greatly respected researcher (first video at the end of the article). For those without an avian vet the video is gold dust. Dr Dahlhausen gives the names of recommended drugs and dosages per bodyweight. I was able to pass this info to my vet and at the beginning of June we started Ollie on the NSAID, Celebrex, and Gabapentin to address nerve pain and seizures. I had to make them up myself. I chose to mix them with children’s apple and pear juice since that was more palatable to Ollie than the sugar syrup I first used.

Constantly looking for easy to digest foods that could also disguise his meds, I experimented with Organix baby porridge which is iron and dairy free unlike adult instant porridge. He seemed to like it.

By the end of August, he was down to 333gms and two weeks later just 316gms. I was now adding both Emeraid and Harrison’s Recovery Formula to his baby porridge. The porridge had become his main source of calories. As well as the formulas, his meds and all the other supplements were added to his porridge multiple times a day.

Weighing Ollie using the baby porridge as a reinforcer

Our vet visited Ollie on September 9th. We talked about euthanasia as I wanted to be prepared for everything. I was relieved he said it could certainly be done in the home rather than at the surgery. He also described how when being euthanised, unlike a dog or cat which goes to sleep peacefully, a bird becomes active, and not to be alarmed at it. It was how birds shut down. On a happier note, he had the great idea of adding oil to his porridge to increase the calories and also suggested trying CBD oil. Interestingly Dr Todd Driggers in the US also suggests trying CBD oil as a way to help with the pain. So, I began to add a few drops of flax oil to each feed, plus one drop of 4% CBD oil per day. Ollie’s weight started to rise again. Instead of isolating, he began to join in with the rest of the flock.

Ollie and Kobe on their Atom – picture taken a month before Ollie died

His friend, Kobe, the Blue-headed Pionus was never far from his side. I was initially concerned that Kobe might catch the virus, however it is thought that horizontal transmission, from bird to bird, especially to an adult with a healthy immune system, is unlikely, but of course not impossible. It might be more likely if there was close contact between the birds over many years. Kobe had only become close to Ollie since November 2019 after 9 years of rejecting Ollie’s offers of friendship. It would have been stressful for both to separate them. Stress is a major player in this disease.

Vertical transmission, from the hen’s ovum to the egg, is considered to be the primary mode of transmission. Similarly, reproductive stimulation can easily activate the virus. Dr Todd Driggers says it is vitally important not to encourage sexual stimulation in our parrots for this very reason. I believe this is what activated the virus in Ollie. That summer of 2019 I have never seen him so highly sexed.

Two weeks after the vet’s visit, Ollie began losing weight again. He was eating cooked brown rice with flax oil, hardboiled egg, cooked vegetables, and of course the porridge mixed with the two formulas, meds and supplements. On October 14th he dropped below 300gms. The stress on my part was intense. I felt helpless watching him decline whilst still holding out hope that if I fed him enough, he’d put weight back on. At the same time, I had to gauge that I wasn’t over filling his crop, the walls of which were getting very thin due to the PDD. It was also getting slower at emptying and to add fresh food on top of food already in there was asking for an overgrowth of bacteria or yeast.

Some days it was a battle to get him to eat, other days he was constantly hungry.  By this time, he was going off the porridge, but had started to eat gulps of plain Harrison’s Recovery Formula. I switched to adding his meds and supplements to the Harrison’s. Emeraid Omnivore is even easier to digest, so I began adding that to the Harrison’s too.

Ollie gulping formula

Towards the end of October, he didn’t look so well. His crop was bulging and his eyes puffy. He ate and slept.  His weight was around 255gms. He was so thin. I adjusted his meds to suit his lower weight. Ollie was getting weaker and losing the ability to fly. I carried him where he wanted to go on a perch since he was not that keen on hands.

Trying to encourage Ollie to eat

On December 3rd when I took the cage covers off in the morning, he was on the cage floor. He’d obviously fallen in the night and couldn’t climb up again. I felt terrible. That day I bought some long untreated pinewood slats to make a raised false cage bottom. I covered it with nontoxic upholstery foam which I happened to have pre-cut as a spare for my elderly and arthritic Panama Amazon, Chico, for whom I’d made a similar raised cage bottom some years before. Covered that in towels, then newspaper. He was now safe if he fell again.

Padded and raised bottom of Ollie’s cage – there was also a heated dog pad under the towels

I trusted I would know when the time would be right to euthanize him. It wasn’t right yet. He still loved to sit with Kobe on the hanging toys, or sunbathe in the weak winter sun on top of a box I had put in front of a glass door. We continued like this for another fortnight as his weight gradually decreased to 214gms.

Ollie sunbathing in front of the glass door

On the night of December 19th, after a fall, my beloved Ollie lost his fight for life. It was too late to call the vet. He died lying on my chest. As our vet had described, he suddenly became active, flailing, and I knew his brain was shutting down. Then something amazing happened. A few minutes after his last breath, I “heard” the words, “I am ok”. A chink of comfort amid the absolute despair.

I hope one day there might be some means of more effectively addressing this horrific disease. Ollie has gone, but he will be forever in our hearts.

References

Rossi, Dahlhausen and Orosz. Avian Ganglioneuritis in Clinical Practice. 2018

J. Miesle M.A., M. Ed. Understanding Avian Ganglioneuritis and Avian Bornavirus (PDD) 2017

Todd Driggers DVM Avian Bornaviral Ganglioneuritis. Update 2019

Avian Ganglioneuritis (PDD) Diagnosis Support Group on Facebook: https://www.facebook.com/groups/AvianPDD

Unmissable video presentations:

Lafeber webinar: Avian Bornavirus: Avian Bornavirus? Avian Ganglioneuritis? Your Questions Answered! with Dr Susan Orosz and Dr Bob Dahlhausen, March 11, 2022:

Lafeber webinar: Avian Bornavirus Part 1 – Common Signs & Treatments with Dr Susan Orosz, Jul 30, 2021:

Lafeber webinar: Avian Bornavirus Part 2 – A Review & More with Dr. Susan Orosz & Dr. Bob Dahlhausen, Oct 23, 2021:

Dr Bob Dahlhausen’s video presentation to vets, Sep 27, 2015 (the sound fades in and out but it is packed full of information including meds and dosages per bodyweight):