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E. Mitch. Jacksonville University.

The addition of A decrease in photoperiod may induce polyphagia digestive enzymes to the diet may be useful (see and weight gain in pre-migratory birds uroxatral 10 mg lowest price. In some cases buy cheap uroxatral 10 mg, feeding a small quantity creased food intake and weight gains appear to be of grit may improve digestion and aid absorption buy 10mg uroxatral overnight delivery, but mediated by thyroid hormones, prolactin and go- should be supplied only in low quantities to prevent nadotrophins. Cold food, a cold envi- lems are more likely to occur if young birds are ronment or infrequent feeding of large amounts of suddenly introduced to new food items (unhulled food may increase the risk of crop impaction in juve- seeds, particularly). Repeated crop impactions ber of food items at an early age are less likely to may result in an atonic, pendulous crop. Ostriches may eat tion of ventricular musculature has been associated constantly following relocation, leading to foreign with vitamin E and selenium deficiencies and calci- body ingestion and impaction (see Chapter 48). The etiology is Feigned polyphagia, in which a bird hulls seeds and undetermined (see Color 19). Vitamin E and se- foods, particularly highly processed human foods (eg, lenium deficiencies have been suggested as possible cakes, desserts, crackers). When changed to a formulated diet, older, obese budgerigars and cockatiels may lose weight, yet eat Nutritional cases of malabsorption or maldigestion constantly. Obese birds should lose weight slowly to (passing undigested food) include vitamin E and se- prevent hepatopathies associated with overwhelm- lenium deficiencies (sometimes associated with ing fat metabolism. The weight loss can be tempered giardia infection), excess oil in the diet or dehydra- by adding some millet to the diet. A lack of grit has been frequently discussed as a tions and lactulose can be used to suppress progres- cause of maldigestion; however, companion birds on sive hepatopathies in some cases (see Chapter 8). Stud- ies in poultry indicate that the addition of grit in- Polydipsia/Polyuria creases the digestibility of feed by as much as ten percent,14 but similar studies have not been per- Nutritional causes of polydipsia and polyuria include formed in companion birds. Given that obesity is hypovitaminosis A, calcium deficiency, excess pro- more of a problem than maldigestion in companion tein, hypervitaminosis D , excessive dietary salt, dry3 birds, increasing the digestibility of a formulated diet seed diet, formulated diets or a high percentage of that exceeds suggested nutritional requirements is dietary fiber. Charcoal that is used in some grit mixtures may interfere with the absorption of Polyuria alone may occur in birds fed moist foods vitamins A, B2 and K and contribute to deficiencies of such as fruit, vegetables and semi-liquid diets. If offered free choice, some birds may over-con- berries and other fruits can also alter the urine color sume grit, leading to crop, proventricular or ven- (see Color 8). This problem is reported com- monly in North America but appears to be Digestive Disorders uncommon in Australia. The cause for a regional variation in the occurrence of this condition is un- White plaques in the mouth or swelling in the sali- known. Birds showing compulsive grit consumption vary ducts may be associated with hypovitaminosis should be evaluated for hepatopathy, pancreatitis, A (see Colors 8 and 13). Oral paralysis in cockatiels may be related to vita- There is a difference between grit and crushed shell. Crushed shell is almost entirely composed of limestone (calcium car- bonate) and is readily digested by acids in the pro- ventriculus. Crushed shell will provide a source of calcium, and is not effective in aiding in the mechani- cal breakdown of dietary plant material. Heavy met- al toxicity has been associated with feeding crushed shell derived from contaminated sources (oysters raised in polluted waters). The bird was maintained indoors and povitaminosis A leads to squamous metaplasia of had no exposure to sunlight or water for bathing. Horny beak material that is dry and flaky, as well as black discoloration of the epithelial surfaces causing obstruction of respiratory feathers are typical of malnutrition. Dyspnea may be change in diet and daily exposure to direct (unfiltered through caused by calcium or vitamin D deficiency if severe3 glass) sunlight. This can occur if a ciency causes the formation of ragged feathers, while tube is accidentally placed in the trachea when at- a deficiency in growing cockatiels has been associ- tempting crop feeding or if a bird (particularly a weak 46 ated with a lack of contour feathers. The association between diet and feather pigment Plumage Abnormalities has long been recognized by canary breeders. Caro- tene and xanthophyll pigments, which originate from Dark, horizontal lines (stress marks) on feathers plant material, are found in fat globules in the feath- have been associated with nutritional deficiencies ers and give rise to yellow, orange and red colors (see (particularly methionine) and indicate that a release Chapter 24). Birds lacking a dietary source of carote- of corticosteroid hormone occurred while the feather noids may develop muted feather or skin colors, was developing. Stress lines are common in neonates while dietary supplementation of carotenoids in that have had a disrupted feeding schedule or in birds with suitable genetic backgrounds will result in raptors that are molting while in a training period increased depth of color. Molting abnormalities, retained feather sheaths and dry flaking beaks have also been Prolonged feeding of bacon rind and bone marrow associated with overall nutritional deficiencies (Fig- has been associated with an oily feather and stool ure 31. Raptors Feather picking may be initiated by dry, flaky, fed laboratory rats and mice (reduced carotenes) may pruritic skin, which in turn can be caused by nutri- lose the yellow coloration of their cere, feet and legs tional deficiencies, particularly deficiencies of vita- that is characteristic in free-ranging birds. Porphyrins are less sensitive to dietary influ- possible cause of self mutilation (Figure 31. The black feathers in this Amazon parrot resolved with a change in diet Melanin occurs in granules in the skin and feathers (seeds to formulated diet) and correction of chronic active hepatitis. This pigment is derived from tyrosine in an enzy- occurs, melanin granules in the middle of the feather, matic reaction requiring copper. Consequently, defi- if present, would absorb all wave lengths of light, ciencies of tyrosine (or other related amino acids) or giving the visual effect of black (Figure 31. In deficiency, timing of the deficiency in relation to most cases, their occurrence depends on a scattering feather development and the initial color of the af- of light caused by the structure of the keratin in the fected feathers. While lysine deficiency in chickens, spongy layer of the feather rami rather than on the turkeys and quail produces achromatosis, there was presence of pigments.

In her anger and disgust she also announced that she was placing a "Voodoo curse" upon him order uroxatral 10mg without prescription. Russell and his girl friend had been born on an island in the West Indies where Voodoo was prac- ticed by the ignorant and superstitious discount 10 mg uroxatral. Yet generic uroxatral 10 mg otc, when in the heat of anger, his girl friend "cursed" him, he felt vaguely uncomfortable but did not think too much about it. However, he remembered and wondered when a short time later he felt a strange small hard "bump" on the in- side of his lip. Smith," who promptly assured him that the bump inside his mouth was the feared "Afri- can Bug," which would slowly eat away all his vitality and strength. Russell" who had first called upon me had been a very impressive individual, slightly too-large lip and all. He stood about six feet four, a large man with the physique of an athlete and the bearing and manner that bespoke of an inner dignity and gave him a magnetic personality. The bump which had caused all the trouble was merely a small bit of scar tissue from his operation. He gave a sigh of relief, and it seemed as if there was an almost immediate change in his posture and ex- pression. The truth had not only set him free of fear and restored his confidence— but had actually reversed the "aging process. Russell as I did, both "be- fore" and "after," you would never again entertain any doubts about the power of belief, or that an idea accepted as true from any source, can be every bit as powerful as hypnosis. It is no exaggeration to say that every human being is hypnotized to some extent, either by ideas he has uncriti- cally accepted from others, or ideas he has repeated to himself or convinced himself are true. These negative ideas have exactly the same effect upon our behavior as the negative ideas implanted into the mind of a hypnotized subject by a professional hypnotist. He strains and struggles until the muscles of his arm and shoulder stand out like cords. And although normally he can hoist a 400 pound weight overhead, he now actually cannot lift the pencil. On the one hand they "try" to lift their hand, or the pencil, by voluntary effort, and actually con- tract the proper lifting muscles. But on the other hand, the idea "you cannot do it" causes contrary muscles to contract quite apart from their will. The negative idea causes them to defeat themselves—they cannot express, or bring into play their actual available strength. The gripping strength of a third athlete has been tested on a dynometer and has been found to be 100 pounds. Again, strangely enough, hypnosis has not added any- thing to his actual strength. What the hypnotic suggestion did do was to overcome a negative idea which had pre- viously prevented him from expressing his full strength. In other words, the athlete in his normal waking state had imposed a limitation upon his strength by the negative be- lief that he could only grip 100 pounds. The hypnotist merely removed this mental block, and allowed him to express his true strength. Barber has said, it is awfully easy to assume that the hypnotist himself must have some magical power when you see rather miraculous things happen during a hypnotic session. The timid, shy, retiring Caspar Milquetoast becomes outgoing, poised, and makes a stirring speech. Another individual who is not especially good in adding figures with a pencil and paper when awake, multiplies two three-digit figures in his head. All this happens apparently merely because the hypnotist tells them that they can and instructs them to go ahead and do it. The power, the basic ability, to do these things was inherent in the subjects all the time—even before they met the hypnotist. The subjects, however, were unable to use this power because they themselves did not know it was there. Without realizing it, they had hypnotized themselves into believing they could not do these things. And it would be truer to say that the hypnotist had "dehypnotized" them than to say he had hypnotized them. Within you, whoever you may be, regardless of how big a failure you may think yourself to be, is the ability and the power to do whatever you need to do to be happy and successful. This power becomes available to you just as soon as you can change your be- liefs. In one sense of the word every person on the face of the earth is inferior to some other person or persons. I know this, but it does not induce feelings of inferiority within me and blight my life —simply because I do not compare myself unfavorably with them, and feel that I am no good merely because I cannot do certain things as skillfully or as well as they. I also know that in certain areas, every person I meet, from the newsboy on the corner to the president of the bank, is superior to me in certain respects. But neither can any of these people repair a scarred face, or do any number of other things as well as I. Feelings of inferiority originate not so much from "facts" or experiences, but our conclusions regarding facts, and our evaluation of experiences. For example, the fact is that I am an inferior weight-lifter and an inferior dancer.

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Amyloidosis in domestic ducks has been 116 resistant to heat and drying and remains viable for associated with crowding and social stress uroxatral 10 mg without prescription. The vegetative form produces though there is no treatment for amyloidosis purchase uroxatral 10mg with visa, main- the toxin and requires dead organic matter and an tenance of environments with minimal stress and anaerobic environment purchase 10 mg uroxatral. The presence of carcasses of low exposure to infectious diseases should decrease 73 invertebrates and vertebrates, rotting vegetation, its occurrence. High temperature and ver- Capture myopathy has been reported in Lesser Snow tebrate carcasses also promote maggot infestations. Geese and Ross’s Geese that were captured with Birds that eat maggots may consume the toxin at the same time. Some birds (18 hours post-capture) were stiff and unable to The botulism toxin affects peripheral nerves and fly but could walk. Others were unwilling to walk and results in paralysis of voluntary muscles and an appeared depressed. Once paralysis of leg mus- were pallor of the skeletal muscles and pulmonary cles has occurred, ducks may attempt to swim using and hepatic congestion. By comparison, birds with lead poison- lysis and fragmentation of skeletal muscle fibers. Many affected waterfowl (75 to Viral Duck Virus Enteritis 30 90%) can be saved by being provided fluids, a cool Bacterial Pasteurellosis 2 environment and antitoxin. Salmonellosis 1 Fungal Aspergillosis 99 Disease prevention requires control of fluctuating Candidiasis 62 water levels during hot summer months and a Parasitism Haemoproteus 1 prompt removal of animal protein to decrease the Capillariasis 6 source of toxin production and maggot infestations. A Echinuriasis 1 single waterfowl carcass can produce several thou- sand toxic maggots. A duck can become intoxicated Amidostomiasis 2 by eating only two to four maggots. In the United States and Canada, Toxicity Botulism 28 most outbreaks occur from July to September, al- Talon 6 though cases are seen in south Florida on a year Noninfectious Amyloidosis 122 round basis. Lead shot has been banned in many states for 110 cm in a Trumpeter Swan) to the cranial aspect of hunting, but is still used in skeet shooting. The bird is tilted, head down, at a the United States, annual waterfowl losses from lead 45° angle on the table. Lead water are pumped into the ventriculus using a 140 poisoning in Trumpeter Swans occurred when ml gastric lavage syringe. Water pressure and grav- drought conditions caused water levels to drop, al- ity will force most of the food, grit and lead pellets out lowing birds to reach previously unattainable shot. A Clinical signs of lead intoxication include weight loss, colonoscope can be used to visualize and remove weakness and depression, bright green diarrhea, remaining lead particles (see Chapter 37). Normal serum levels Gastric lavage and endoscopy can be used to remove of zinc are 1. Abnormal levels seen in an affected group to 12 hours, masked down with isoflurane and in- of ducks were 12. Zearalenone was found to interfere with sperm Exposure to a penny for two months in the ventricu- production in ganders but not with egg production in lus is sufficient to cause toxicity. Clinical signs of T intoxication include vomi-2 chelation therapy (see Chapter 37). Geese force-fed 60 to 90 grams of contaminated grain developed head and leg Mycotoxicity tremors and died within 19 hours. Diag- Ergotism is caused by toxic alkaloids formed by the nosis in field cases is difficult, because some toxins fungus Claviceps purpurea, which parasitizes and have subtle or nonspecific effects. Clinical changes forms sclerotia in place of the seed in certain cereal may be delayed and animals may have changed food grains. Heavy mortality was seen in two- to four- by the time symptoms occur, making it difficult to month-old Muscovy Ducks fed wheat containing find the source of the toxin. The birds died 48 hours after more than one toxin, and analytical procedures for developing lethargy and diarrhea. Necrosis and gangrene of the extremi- toxicosis, fusariotoxicosis and ergotism have been ties, which occur in mammals, have not been re- described in free-ranging waterfowl. Aflatoxin Algae blooms usually occur in eutrophic waters in has been associated with liver cirrhosis in older warm, sunny weather. Nodular hypoplasia or hepatoma may occur in shallow water so that the liberated toxin will not be chronic cases. Algae often concentrate on the downwind at one to two weeks of age, showing signs of inappe- shore of lakes. Some of the common genera of blue- tence, depressed growth, cyanosis of the feet and legs green algae implicated in animal intoxication include (caused by subcutaneous hemorrhages), ataxia, con- Nodularia, Rivularia, Aphanizomenom, Oscillaria, vulsions and opisthotonos. An Anabaena bloom on Storm Lake in slightly swollen kidneys, and petechiae on the kid- Iowa was associated with the deaths of 5,000 to 7,000 neys and pancreas. In birds over three weeks of age, Franklin’s Gulls, 560 ducks, 400 coots and 200 pheas- the liver is firm and slightly shrunken and has a ants. Death occurred two to ten minutes after inges- reticulated pattern; ascites and hydropericardium tion of a minimal lethal dose. Immunosuppression with chronic aflatoxicosis may Clinical signs may be peracute prostration and be a problem with waterfowl as it is with some other death, restlessness, blinking of the eyes, repeated species. The significance of aflatoxicosis in free-rang- swallowing, salivation and regurgitation.

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Intravascular use of iodinated ceed to angiography with the hope to at least partially contrast material can be seen with angiography buy cheap uroxatral 10 mg, which embolize the lesion purchase uroxatral 10 mg mastercard. Angiographic embolization of requires intra-arterial injection of contrast material cheap uroxatral 10 mg with amex. Iodinated contrast mate- utilized in the procedure, resulting in a patient dose of rial is a crucial component in computed tomography for 7 mL kg−1. Because of the heart failure, the infant was delineating anatomic structures and enhancing infection fluid restricted prior to and after the procedure. However, the injection of intravascular iodi- Within 24h after the procedure, the baby’s serum nated contrast can result in a number of complications creatinine rose from 0. The child expe- Nephrotoxicity of radio contrast material and acute rienced no further renal compromise. Kiessling with an increasing incidence due to more common use all contribute to a prerenal reduction of renal per- of radio contrast studies over the years. The route of administration is return to normal renal function within an average time relevant. Clearly, most common cause of hospital-acquired acute renal patients receiving angiographic/interventional pro- failure after surgery and hypotension [17]. Aiming for the lowest general population without any known risk factors [4, contrast dose possible to achieve the desired result is 37]. Preexisting been rigorously established, but the following num- renal dysfunction appears to be a primary risk factor. There launches into a prolonged vasoconstrictive period with is also an even safer alternative to angiography, namely a subsequent decrease in renal blood flow. Hydration is a crucial preventative kidneys as well as atheroemboli-induced renal vasocon- strategy that is also the most efficacious in the preven- striction as important pathophysiologic factors [36]. The nephrogram is a vis- ible sign of contrast material that has entered the renal 6–12 h before contrast bolus and continuing up to 12 h cortical glomerular apparatus following intravascular following contrast administration [11]. Interestingly, injection, but cannot be filtered out into the collecting recent data discusses the superiority of sodium bicar- system due to the acute renal failure that has ensued. These Asymptomatic (nonoliguric) transient rise in cre- authors contend that the bicarbonate ion is inhibitory atinine mentioned earlier is a common early clinical toward free radical formation due to its increasing pH presentation suggestive of a benign course. The antioxidant drug N-acetylcysteine (adult dose of 600mg administered twice the day before and 20. These benefits have are several simple principles for the clinician to con- been particularly noted in high-risk patients with renal sider and some obvious questions to ponder: insufficiency [47, 52]. Nevertheless, the results of clini- › Is the study that utilizes contrast material really cal studies have shown significant variation as recently needed for the child’s care? Patients conflicting evidence (some experimental trials show- at risk could be observed more closely and timely ing efficacy while others show no statistical advan- intervention be initiated, potentially ameliorating the tage), none of the aforementioned agents can clearly disease course; also, avoidance of additional renal insults be recommended. Without a doubt, more experimental data are required before these agents can be definitively added 20. Certainly continued ing contrast agent could limit renal exposure to its toxic hydration and optimization of the extracellular volume effects. Identify and discontinue any nephrotoxic drugs at a few days regardless of treatment regimen, particu- least 48–72 h prior to contrast administration. Asif A, Epstein M (2004) Prevention of radiocontrast sidered safe with virtually no recognizable or repro- induced nephropathy. N Engl J Med 332:647–655 stage renal disease), the administration of gadolinium 7. A possible mech- Using a dopamine type 1A receptor agonist in high risk anism to explain the etiology is the dissociation of the patients to ameliorate contrast associated nephropathy. Fishbane S (2008) N-Acetylcysteine in the prevention of children recover with no long-term renal sequelae. Grobner T (2006) Gadolinium—a specific trigger for the - High-dose of contrast material (exceeding 5 mL kg−1) development of nephrogenic systemic fibrosis? Pediatr Nephrol 22:2089–2095 - Administration of N-acetylcysteine twice a day admin- 21. Am J Kidney Dis Nephrogenic systemic fibrosis: a review of 6 cases related 24:713–727 to gadolinium injection. Tommaso C (1994) Contrast induced nephrotoxicity in patients systemic fibrosis: suspected etiological role of gadolin- undergoing cardiac catheterization. Margulies K, Schirger J, Burnett J Jr (1992) Radiocontrast Pract 93:29–34 induced nephropathy: current status and future prospects. Rev Cardiovasc Med 4:3–9 nephropathy after coronary angioplasty in chronic renal 39. Kidney Int 41:1408–1415 rial induced renal failure in patients with diabetes, renal 61. They elect to monitor the child closely with neurologic monitoring and attention to any symptoms of 21. The patient was discharged after an Case Vignette uneventful stay of 48 h following admission. In the emergency room, lithium blood Poisonings, intoxications, and medication overdoses are level returns at 5mmol L−1. The emergency room phy- the leading causes for admission of pediatric patients sician reviews available written references and con- to the intensive care unit. In some circumstances, altering of the acid– Alcohols Slurred speech, base status or augmentation of urine output may reduce desinhibition, ataxia, the morbidity and mortality of a toxin. In even rarer cir- hypothermia, confusion, cumstances, extracorporeal removal of the toxin may be memory loss helpful.

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