M. Scott Echols, DVM, ABVP-Avian
Brian L. Speer, DVM, DABVP-Avian
When presented with an individual patient requiring emergency treatment, an attending clinician is required to take an accurate history, perform a physical examination, collect necessary diagnostic tests, and begin appropriate therapy in a timely manner. With the avian flock, the conceptual approach to emergency medicine is the same, but the individual steps are handled quite differently (Fig. 1). This article clarifies how to recognize, approach, and provide emergency care to a unique patient, the avian flock. The authors believe that at present time, the non-domestic bird flock is the least completely addressed patient in avian medicine. The reader is asked to understand the basic concepts behind flock health management rather than treating a pathogen alone. Although specific pathogen management protocols are important in flock medicine, they consistently fail to serve the overall needs of the entire flock unless incorporated into a complete and comprehensive therapeutic approach.
The American Heritage Dictionary defines aviculture as "the raising and keeping of birds" and a flock as "a group of animals, birds, or fish considered collectively." The authors more specifically define a flock as a population of two or more birds. An aviary is a structure or location that holds a flock. The authors further define an aviary to include all of the physical buildings, displays, pens, pastures, and so forth that hold the collective flock and the owner in its definition. Most commonly, we think of aviculturists as people who raise and propagate birds. Flock medical principles apply not only to the aviculturist's aviary, but also to the pet stores selling birds, the conservationists working to propagate or even to reintroduce captive-bred endangered species, and the zoos displaying captive avian species. Although probably less appreciated, avicultural medical management also applies to the household with two or more feathered family members! The bulk of this article is oriented toward managing facilities with numerous birds, but it is particularly important for the reader to understand that the same principles discussed here apply toward smaller avian collections.
When a lovebird is depressed, on the bottom of the cage, tachypneic and fluffed, an attending clinician can easily state that this bird requires emergency care. Flock-related emergencies are not always as easily defined but still involve a condition (or conditions) of serious nature and that requires immediate action. Immediate actions in flock terms may be taken from hours to several days or weeks. As a general statement, flock emergencies are serious conditions that affect, or may affect, the flock and not just an individual bird. Flock emergencies may manifest in one of several categories, such as sudden increase in mortality rates, poor traffic flow, financial loss markedly decreased production, environmentally related issues such as inclement weather, as well as true or perceived outbreaks of infectious disease. Oftentimes, these are interrelated areas that require an accurate history, physical examination, and appropriate diagnostics before the most effective treatment can be instituted to best serve the needs of the aviary.
Throughout this article the reader is asked to interpret disease as "any deviation from or interruption of the normal structure or function of any part, organ or system (or combination thereof) of the body." This definition also applies to a flock, which serves as the body and is not limited to infectious causes. Flock-related diseases disrupt the overall homeostasis of the flock and include, but are not limited to, diseased production; financial loss; poor traffic flow; and compromised nutrition, aviary design, and environment; and infectious disease.
The mechanics of collecting a thorough medical history and performing a good physical examination of a flock are probably the two most challenging but very important components to understand. An accurate history should include questions that pertain to the overall homeostasis of the flock and the sick or dead bird(s) if present. With every bird presented, whether apparently healthy, clinically ill, or deceased, inquire: Do you have any other birds? If the answer is yes, an attending veterinarian has the opportunity to offer flock medical services. Again, the flock is defined as any population of two or more birds. Your avicultural client may have two pet birds and is seeking to obtain another, a pair of Cockatiels in the house and a single duck in the backyard, or 150 mixed psittacine species in a large outdoor building.
Once a client has been identified as an avicultural client, additional historical questions help clarify the degree of relative risk or potential impact of the presenting complaint(s). Consider the following questions: How many other birds do you have? When were the last physical evaluations of these birds performed? What degrees of direct or indirect exposure have the birds had? Do you have a conceptually closed aviary (see discussion later in test)? These types of inquiries apply to the owner who presents with a sick, deceased, or clinically healthy bird and are intended to provide information about the flock. Continue with inquiries related to history of infectious and non-infectious conditions, and any present concerns of possible specific disease processes that may exist within the aviary. These questions may help build or support a flock differential diagnosis list.
After collecting a basic history and establishing that a flock is involved, define the potential severity of the problem. Obviously, the more information available, the better the flock-related questions that can be asked. The next and last set of generic questions support the degree of relative concern for a true flock emergency. Are any other birds having problems? If so, what are their signs and over what time period? Which species and which age group are involved (if known)? Have any new birds been added within the past 1 to 3 months? If new birds have been added, from what source, when did they arrive and where were they placed within the aviary? Has anything recently changed within the aviary or the environment (this may include changes in diet, medications, outdoor pesticide use, new carpet, and so forth)?
At this point, the battery of basic questions and examination findings of the birds presented (if already performed) will, it is hoped, lead you into additional inquiries. One of the more simple but challenging aspects of flock medical management is to keep in mind that not all flock emergencies are the result of infectious disease. If only concerned about pathogens and their resultant infectious disease issues, an attending clinician may miss obvious or subclinical nutritional disease, inappropriate traffic flow, and other factors that may be the underlying cause to the disease outbreak. Perhaps one of the key deficits that occur in handling flock medical emergencies is that traditionally, flock managerial recommendations have been made based solely on information obtained from individual birds that are presented.
If not already completed, focus attention to the bird(s) presented — whether dead or alive. Sometimes, flock-related questions come well after you have examined or necropsied an individual bird. One of the most valuable flock diagnostic tests is the list of detailed diagnoses established in individual ill birds and necropsies. This list is only available for use and reference if the attending veterinarian maintains a designated flock file with a current and updated problem file. Consider yourself an avicultural veterinarian whenever working with a client owning two or more birds, and maintain designated flock files for these clients as you may be called upon to serve their flock medically or epidemiologically.
As mentioned above, establish if the aviary is conceptually open or closed. A conceptually closed aviary is one that has effective control over human, animal, and fomite traffic flow into and within an aviary.[2,12,14] In a closed aviary, the birds must earn their way into an aviary by passing a predetermined set of criteria. Movements of people and potential fomites are similarly controlled. The details of the earning process differ between aviculturists and the species involved, but will always include a physical evaluation, screening labwork, and a set time frame for a quarantine period. This concept is foundational because if an aviary is open, meaning no control of the above-listed factors, infectious disease becomes a much more random and unpredictable event. Open aviaries are prone to both chronic and acute types of infectious disease, in addition to non-infectious diseases, and are usually best managed with crisis intervention protocols only.
The pet store serves as a special aviary in that it is comparatively much more potentially open, and control of infectious agent movement becomes more challenging. Most pet stores cannot afford the space or time to have each bird entering into the store physically examined, tested, and quarantined, owing to the nature of the business. If a pet store is both breeding birds and buying birds wholesale, it is advised that the breeding population and progeny be treated as a closed aviary. Aviculturists who frequently move birds around (as when showing birds) also are at increased relative risk of breaking closed aviary rules.
Assuming a sick lovebird has been presented from a flock potentially at-risk, consider recommending evaluation of both patients: the individual bird and the aviary. Use those findings plus their relevant histories to help set a plan. Just as the lovebird deserves a thorough physical examination, so, most likely, does the aviary from which it came.
Several aspects of the initial aviary physical examination do not require an actual site visitation. In fact, visiting the aviary before obtaining some basic information may not be cost or time efficient for you or your avicultural client. There are five basic components to the aviary examination: the mission statement, the aviary map, the traffic flow map, the financial records, and finally, the production records.[1,2] Once you have evaluated these five basic components, you can better direct a focused on-site aviary visitation as may be needed.
A mission statement is simply a written declaration of who the client is, what the client is trying to accomplish and how, and in what time frame the client wishes to achieve the stated goals. The mission statement is most appropriately included in the client's avicultural flock medical record. All aviculturists should be encouraged to have a mission statement that is current and periodically updated as situations and goals change. When addressing a flock emergency, clearly understanding the actual mission to be served is essential for properly delivering medical care.
It is generally agreed that most aviculturists wish to raise and sell birds, but how they desire to do it varies tremendously. The mission statement should govern how avian veterinarians can help manage an aviary, particularly during emergencies! Understandably, most multi-avian pet owners do not have a mission statement, but it is still important to understand and document how clients feel about their collection and how they wish to have an avian veterinarian approach their aviary.
Mission statements should be simple and to the point. For example, "I, Panama Jack, owner of Amazons-R-Us, wish to sell a low number of high-quality birds at a higher than average price to the pet bird market," or "I, Val U. Smith, owner of Birds by the Bucket, operate a high-volume aviary selling low-cost Amazon parrots to the wholesale market." These mission statements differ greatly. Although both owners are raising and selling Amazon parrots, their goals alone set them apart. Given a disease outbreak, Mr. Jack may want to identify and eradicate the problem while saving all of the birds if possible. On the other hand, Ms. Smith may only want to eliminate or isolate the exposed birds and move on with production.
Aviary maps depict the basic physical anatomy or layout of an aviary. The map can be a simple line drawing of a house up to a multi-building avian complex. The drawing should include cages, feeding areas, footbaths, walls, doors, and other details. Maps should demonstrate location of individual birds and breeding pairs or colonies and give approximate spatial relationship to surrounding structures. With more intensive and regular aviary management, in-depth detail can be added to the map. For the flock emergency, a simple aviary map can be drawn in minutes (Fig. 2).
Aviary maps are for identification of disease locations. By mapping the location of infectious and non-infectious diseases, avian veterinarians and aviculturists can quickly determine if the problem is disseminated, regional, or localized. By assessing the distribution of the disease within the aviary, avian veterinarians and their avicultural clients can formulate a concise diagnostic and therapeutic approach.
For example, Panama Jack has several sick Amazon parrots and has provided his aviary map showing that only birds in bedroom #1 are apparently affected. Regardless of the disease, an avicultural veterinarian can initially focus diagnostic and treatment efforts on bedroom #1, rather than testing and treating all of the birds. By viewing the same map, an attending veterinarian can advise where to move visibly unaffected birds and can set up appropriate barriers and direct traffic flow (discussed below) in an effort to prevent dissemination of a pathogen or other disease process. Mapping locations of sick birds also gives you information on potential mode of transmission and virulence of infectious disease processes when present.
As the third component to the flock physical examination, traffic flow maps are fairly easy to make and evaluate. Clients are asked to draw daily movements on a copy of the aviary map. Traffic flow maps should clearly demonstrate how the birds are fed, cleaned, and treated (if appropriate) and in what order. Ideally, traffic flow maps should reveal concise, orderly movements throughout the aviary. Traffic flow maps with lines going everywhere that frequently cross over, suggest inappropriate and inefficient movements, which often serve to help disseminate pathogens (Fig. 3). With some species, poor or excessive traffic flow can also be disruptive to the birds.
In emergency situations, evaluating traffic flow is key in allowing all parties to understand how potential pathogens and non-infectious disease processes are being or have been introduced into and within the aviary. With infectious-disease-related flock emergencies, it is easy to blame the problem on an agent, rather than understanding the actual pathogenesis that allows that organism to disseminate. In reality, most epidemic proportion losses to infectious disease outbreaks in aviaries are usually the result of diseased traffic flow! A common situation involves placing susceptible birds, such as weaning babies, in or near areas of high traffic flow. An infectious pathogen introduced into an environment with poorly controlled traffic flow almost predictably results in a clinically diseased aviary.
Finances are sometimes difficult to discuss with clients. This is especially true when the client does not know the status of his or her avicultural financial situation. It is important that avicultural clients at least know their basic credits and debits. Veterinary expenses, of course, are included as part of the debits and should also be a part of a financial plan. The specific details of the client's finances should be left to a trained accountant, but as attending veterinarians, we need to understand clearly how our services and fees can monetarily affect a client. If it has not already been approached and an emergency develops, avian veterinarians should discuss finances with the avicultural client before establishing a diagnostic and therapeutic plan.
Individually, diagnosing and treating multiple birds can be very expensive and potentially devastating to an aviculturist. For example, a pet-store client brings you a dead bird that you subsequently determine has an infectious disease. If you proceed to test, quarantine, and treat all of the store birds, assuming you charge appropriately for your services, you may easily become a significant component of your client's financial loss. As an attending veterinarian, you may have saved the individual birds, but the true patient, the aviary, is now financially diseased! Although many private aviculturists tend to absorb their losses and subsidize their aviary, inappropriate avian veterinary costs can place significant financial strain on a business and potentially weaken the doctor-client relationship.
Many avicultural clients maintain records of their birds' production such as clutches/year, eggs/clutch, fertile eggs, infertile eggs, and so forth. Evaluating production records allows avian veterinarians and aviculturist together to evaluate birds individually, by groups, and throughout the entire aviary. Establishing a record system has been discussed elsewhere.[2,13] Evaluating established records can become very useful during an emergency but can also be very time consuming if not already created. For those aviaries already on an established flock health program with evaluated production records, avian veterinarians can look for trends in production deficits that might help pinpoint a disease source.
By reviewing production records during most flock emergencies, avian veterinarians can key in on birds with poor or rapidly decreasing production. Disease outbreaks can sometimes be traced back to birds with subclinical illness whose reproductive performance has been poor. Sometimes the chicks carry the legacy (pathogens, genetic disease, and so forth) of their parents, and chicks that re doing poorly can also point to the source. If available, production records can hold valuable information capable of characterizing the true breadth, scope, and effect of underlying causes concerning flock emergency situations. If record systems re not yet established, aviculturists should be encouraged to maintain records and have flock profiles performed regularly.
The history, aviary physical examination findings, and individual bird diagnoses (past and present) are used to build an accurate flock differential diagnosis list. For clients who do not have an established flock health program, production records, and so forth, an attending veterinarian should at least understand the client's mission statement and obtain a copy of the aviary and the traffic flow map. Consider reviewing medical records, laboratory data and necropsy reports from the aviary's past as an additional tool with which to help characterize or better delineate problems within the aviary.
Whether presented with a live bird or a necropsy specimen from the flock, attempt to obtain a definitive diagnosis when relevant to the client's mission statement. Avicultural clients who limit the ability to definitively diagnose an individual bird's problem only make it more difficult to evaluate and treat the flock. It is extremely important to keep in mind that one bird does not necessarily characterize or define the health status or disease process(es) of the flock.
Use the aviary map to map out disease locations (Fig. 4).
In other words, by reviewing medical histories, pathology reports, and current physical examination or necropsy findings, mark sick-bird locations on the aviary map and the approximate dates of morbidity and mortality. Also define the disease process as best as it is known. Very quickly, any potentially relevant or significant disease patterns can be identified if present.
Disease occurs as a result of imbalances between potential pathogens (agents), the animal itself (host), and the surroundings (environment). For example, healthy birds are constantly exposed to viruses, bacteria, and fungi because these organisms are present in the environment. A nutritionally compromised bird is farm more likely to develop respiratory mycoses than is a healthy bird.[4,7,15] Occasionally exposing hand-feeding psittacine chicks in a closed facility and nursery to low numbers of infectious agents may not result in significant disease problems. Take the same facility and add nutritional, temperature, humidity, and other stresses to the chicks, and the probability of disease outbreaks becomes more likely. These examples are very simplistic but the concept is very important: pathogens create disease based on their interaction with host and environmental factors and not necessarily by themselves. As a result, testing and treating for the disease-associated agents may well be incomplete or inappropriate flock management in some settings.
Primary flock diseases, when present, are responsible for the bulk of flock morbidity or mortality. Examples of primary diseases, which may cause a flock emergency, include Polyoma viral disease in the nursery, starvation when feeding a novel medicated food that is poorly accepted, stray voltage from an improperly grounded wire, and nutritional stunting in psittacine chicks. Primary flock diseases may manifest or present differently in individual species and age groups; however, by themselves, they are capable of causing disease.
When multiple diseases are involved in an aviary emergency, the organisms involved are best viewed as secondary to an unhealthy aviary with other underlying problems. These secondary invaders, when present, take advantage of the aviary's compromised health. Poor traffic flow, nutrition, aviary design, extreme environmental conditions, and owner fatigue are underlying disease issues that can weaken the aviary's health. Even organisms that would be considered primary invaders in a healthy aviary can be one of many secondary pathogens in an overall improperly managed or unhealthy aviary.
Distinguishing between primary and secondary diseases becomes important in managing the disease. Primary disease processes may actually be easier to control because usually one deals with only the causative organisms or process. Secondary diseases point to underlying aviary imbalances and require that the present pathogens or disease processes, as well as the aviary's overall health and homeostasis, must be managed.
Until such time that the contagious and the infectious character or population effect of the flock emergency is understood, containment policies are key to protection of the flock at risk. Moving birds within the aviary should be very specific and planned carefully so as not to further disseminate the disease process or expose at-risk birds. Aviary disease outbreaks are not limited to infectious disease because starvation, extreme environmental conditions, mass exposure to toxins, and other hazards can result in flock emergencies. Appropriate isolation is used in conjunction with characterization and identification of the problem(s) presented and underlying in the facility.
Updated aviary maps, with the disease and its locations depicted, may reveal where the problems lie. Traffic flow maps may help define potential routes of the pathogen, toxin, and so forth as well as the transmission and the dissemination. These two maps are used together to set up functional roadblocks. Isolate areas with affected individuals and establish an orderly traffic flow in a manner that does not allow additional subpopulations of birds within the aviary to be placed at risk (Fig. 5). Directing traffic flow is not limited to the birds and owner, but also includes any other possible fomites like food and water bowls and air that may also have a role in the pathogenesis of the flock disease. During the movement process, do not break closed aviary rules in an effort to control the aviary's disease.
If one large room is involved and it is not possible to establish barriers (i.e., walls, doors, and so forth), consider moving unaffected individuals outdoors (weather permitting) or to another building or house (preferably with no other birds), or evacuate all of the affected birds (if only a few are involved). Be careful not to expose additional avian species by moving unaffected birds (which may be subclinical carriers) into a healthy aviary.
These basic containment principles apply to a house, a pet store, a nursery, or a large aviary and can be instituted before a definitive diagnosis is made. In many cases, the emergency is corrected at this point as deficits in the traffic flow and bird locations within the aviary may be the direct cause of the emergency.
Pet stores typically serve as outlets for multiple sources of birds and in essence can easily and repeatedly violate closed aviary rules. These factors can make infectious disease outbreaks difficult to manage in pet stores. If a pet store has a breeding facility on-site, the aviary should be managed as discussed throughout this article. Non-infectious pet-store emergencies are also managed similarly as with other aviaries.
The difference in managing the pet shop as a flock is with the birds brought in from the wholesale market to be sold (retail) to the public at the store. Even well managed pet stores have occasional infectious disease outbreaks owing to the nature of the business.
When an infectious agent is identified within the store, traffic flow should be immediately corrected with the intent to isolate affected individuals and suspected subclinically afflicted (carrier) birds. The source of the affected birds and suspected carriers should be contacted and notified of the concerns present, particularly if disease is noted comparatively shortly after the birds were acquired. This may open more opportunity for emergency and standard flock health management. Antibiotic use is discussed below and follows the same rules as with other aviaries. The authors recommend keeping affected birds isolated from the public and restricting their sale until the outbreak and the disease concerns have passed.
If a large area that is readily visible must be treated and quarantined, as with a chlamydia outbreak, it is best to divert attention away from the public's concern and keep business going as smoothly as possible. Zoonotic disease outbreaks must be treated and reported as is standard per local, state, and federal laws for both legal and publish health concerns. Inappropriate recommendations or breaches in client confidentiality may significantly damage a pet store's finances and reputation. If possible, cover quarantined areas with dark paper or some other opaque material to eliminate the public's viewing of the area. The authors do not recommend encouraging shop employees to discuss ongoing pet-store disease processes with the customer base. Consider placing a sign such as "Construction in Progress" or "Remodeling Bird Room," and so forth to help explain the diversion. Of course, the pet store should follow through with the stated change.
Most important, shop owners should work with an attending veterinarian to understand how and from what source the infectious agent came and how to prevent a reoccurrence. This is usually most effectively accomplished by carefully and more critically evaluating the quality of the sources from which birds are acquired. This should be established as an effort to build an open and effective long-term relationship between the veterinarian, the pet store, and the wholesale sources. Open communication and sharing goals is key to the viability of both the pet store and the wholesaler through continued bird sales. Ultimately, pathogen or sentinel-type management protocols within the pet shops can or should be eliminated, as the overall incidence of infectious disease is reduced drastically with good management and a healthy relationship with suppliers.
Mass medication or vaccination is not necessarily appropriate for all flock medical emergencies — including those centered around individual pathogens and their disease processes. Certain infectious diseases may require group treatment and can be summarized into select groups. These groupings include (1)when a single agent that is susceptible to appropriate antibiotics is disseminated throughout the aviary, (2)when zoonotic disease is present and its locations within the aviary are uncertain, and (3)when definitive diagnosis or aviary management are not permitted and shot-gun antibiotic therapy is requested.
Ideally, antibiotic treatment is limited to affected individuals and populations of birds suspected to be subclinical carriers within the aviary. Antibiotics should ideally be chosen according to susceptibility patterns from cultured organisms. If culture and sensitivities are not available as with most viral, fungal, and parasitic diseases, antibiotic choices are based on available literature, if possible, and previous experience. For example, and initial antibiotic for a herpes or virus, Candida albicans and Sternostoma tracheacolum infections, may include acyclovir, ketoconazole, and ivermectin, respectively.[3,8-11]
The principles of vaccination imply that a vaccine serves to induce antibody production that the clinician hopes will be protective for the individual bird as well as the overall population at a later date. When considering flock vaccination during an emergency, even the most appropriate vaccine will most likely not prevent disease in an exposed na´ve population, but it may serve to protect an unexposed group or a previously vaccinated group of birds and prevent further dissemination of the agent in uestion. Before vaccinating, understand the biology of the organism being vaccinated against, the cost of vaccination (including monetary costs and the effect of handling individual birds), and what the anticipated effect is for the flock. Vaccines should be used as management tools rather than specific disease treatments. In short, specific vaccination protocols do not substitute for complete flock management.
In the authors' experiences, primary infectious pathogens are the least common cause of aviary disease. Most aviary diseases are attributable to traffic flow or financial, production, and environmental-related diseases. Infectious diseases tend to occur secondarily to the above-listed problems. All aviaries have infectious disease present, as various bacteria, fungi, and virus particles are ubiquitous, but not all aviaries have potentially infectious agents causing clinical disease associated from the presence of these agents. When pathogen hunting, an avian veterinarian is likely to find some infectious or even contagious organisms and possibly even one or two that are causing disease in individual birds or selected groups. Unless specifically guarded against, recognition of infectious agents can easily lead veterinarians into pathogen management or detection protocols being forwarded alone, without discussing and explaining to the avicultural client the pathogenesis behind the disease process. There is usually a reason for the disease, and it is often a combination of problems rather than an infectious agent alone.
Most traffic flow issues are related to breaking closed aviary concepts. An infectious agent is brought in and disseminated through improper trafficking of animals, people, and fomites. Managing diseased traffic flow requires first locating known and potential sites of infectious disease and then identifying possible routes that could aid dissemination. Simply set an organized traffic flow intended to divert movement away from disease-process locations. Ideally, the traffic movements should end with areas considered diseased. By putting diseased birds last on the daily route, there is less chance for other birds to become exposed to a disease process.
"Financial disease," in the authors' experiences, is more commonly subclinical. Subclinical factors include insufficient funds for the proper nutritional support of the birds, appropriate veterinary care, proper cleaning materials, and facility maintenance. These factors often directly create or feed increased owner and caregiver stress, which also contributes to the pathogenesis of aviary disease. It is not uncommon for a stressed or fatigued caretaker to make careless mistakes such as breaking closed aviary traffic rules; feeding chicks with overheated formula (resulting in crop burns); forgetting to feed, clean, or treat individual birds, and so forth. These stresses may in part result from financial disease, but nevertheless, affect the aviary as a whole.
Poor production simply results in fewer viable chicks. Whether it is regarding raising ostriches for meat, Nene geese for display, or budgerigars for the pet trade, aviculture exists because new birds are produced. It is the production of birds, particularly for the pet trade, that feeds birds to the public and patients to the avian veterinarian's office. Record review is the key to assessing an aviary's production. Without an accurate record system and a careful review, an aviary's production statistics are anecdotal, and true understanding of the effect of production losses is difficult. Production may be poor because of inappropriate diet, over-crowding and stress, chronic infectious disease, and so forth. Treatment for decreased production is obviously based upon the definitive diagnosis, but an attending veterinarian and aviculturist must first recognize that production deficits exist.
The environment plays a large role in aviary health. Everything from changes with the seasons, weather conditions, environmental toxins, wild animals, and many more factors can directly affect aviary health or homeostasis. The overheated Teflon-coated pan can be just as devastating to chicks in the kitchen as are the opossum and the cockroaches disseminating Sarcocystis spp. oocysts in an African Grey aviary's food supply. Both situations, though technically preventable, still occur. When assessing aviary health, consider the role of the environment.
Managing the underlying disease processes, in fact, becomes the basis of flock health management. Many flock emergencies present the opportunity to offer and deliver the initial steps toward developing an organized flock health program, especially with new clients. Even established clients who have occasional disease outbreaks offer perfect opportunity to explore aviary management as opposed to pathogen-oriented and crisis intervention approaches, as has been the traditionally accepted norm in most private avicultural and veterinary circles in the past.
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2. Echols MS, Speer BL: "A comprehensive plan for managing flock reproductive performance." Seminars in Avian and Exotic Pet Medicine 5:4, 1996.
3. Flammer K: "Fluconazole in psittacine birds" in Proceedings of the Annual Conference and Expo Association of Avian Veterinarians, Tampa, 1996, p 203.
4. Macwhirter P: "Malnutrition" in Ritchie BW, Harrison GJ, Harrison LR (eds): Avian Medicine: Principles and Application Lake Worth, FL, Wingers Publishing, Inc., 1994, p 849.
5. Morris W: The American Heritage Dictionary of the English Language Atlanta, Houghton Mifflin Co., 1981, p 91.
6. Morris W: The American Heritage Dictionary of the English Language Atlanta, Houghton Mifflin Co., 1981, p 503.
7. Oglesbee BL: "Mycotic diseases" on Altman RB, et al (eds): Avian Medicine and Surgery Philadelphia, WB Saunders, 1997, p 323.
8. Orosz SE, Frazier DL: "Antifungal agents: A review of their pharmacology and therapeutic indications" J Avian Med and Surgery 9:1, 1995.
9. Phalen DN: "Viruses" in Altman, RB, et al (eds): Avian Medicine and Surgery. Philadelphia, WB Saunders, 1997, p 298.
10. Ritchie BW: "Select diseases of the alimentary tract" in Association of Avian Veterinarians Main Conference Proceedings Annual Conference and Expo, Philadelphia, 1995, p 425.
11. Rupley AE: "Respiratory bacterial, fungal, and parasitic diseases" in Proceedings Avian Specialty Advanced Program and Small Mammal and Reptile Medicine and Surgery — Association of Avian Veterinarians, Reno, NV, 1997, pp 37, 41.
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14. Speer BL: "Closed aviary concepts" in The Large Macaws: Their Care Breeding and Conservation, Fort Bragg, CA, Raintree Publications, 1995, pp 267-271.
15. Spira A: "Disorders of the respiratory system" in Rosskopt WJ, Woerpel RW (eds): Diseases of Cage and Aviary Birds, ed 3, Baltimore, Williams and Wilkins, 1996, p 423.
16. Taylor EJ: Dorland's Illustrated Medical Dictionary, ed 27. Philadelphia, WB Saunders, 1988, p 481.
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