terbutaline

In L&D again. Around 10am I started having contractions 5 minutes apart. Came in around noon, was hooked up to the monitor and they started an IV and began to push fluids. I then got a terbutaline injection, which didn’t help, so then I got 2 more (which is max). After that when the contractions weren’t stopping they gave me procardia which slowed them down a lot. Then the NP who is taking care of me ordered an ultrasound because I’m so big and Mason is weighing in at 4 lbs 11 oz!! Ultrasound tech said that I’m measuring about a week and a half ahead.
Waiting on the doctor now. Hoping to go home!!

Respiratory Diseases in Birds

Most common causes of respiratory disease

  1. Aspergillosis
  2. Chlamydia psittaci
  3. Airborne intoxications

Dyspnoea - emergency treatment required!

  • Warm incubator with oxygen flow at 5 L/min, in a dark quiet area
  • Bronchodilators (terbutaline) - 0.01 mg/kg IM
  • Analgesia/sedation/anti-anxiety (butorphanol) - 1-2 mg/kg IM
  • Fluids if needed
  • Then get history and regularly monitor bird from a distance
  • Treat (suspected) disease

Respiratory system can be divided into five sections

  1. Upper airway
  2. Large airway - trachea and mainstem bronchi
  3. Small airway - branches of mainstem bronchi
  4. Parenchyma - lung tissue
  5. Coelom - concurrent problem in coelom compressing respiratory system

Upper airway disease

  • Clinical signs: soft nasal sound, open mouth breathing, nasal discharge (w/ rhinolith), tachypnoea, no dyspnoea, sneezing, periorbital swelling
  • Differentials: Mycoplasma, Mycobacterium, Chlamydia, Aspergillus, Candida, Avipox virus, parasites, toxins, allergins, foreign bodies
  • Diagnosis
    • Flush nares and collect sample from choana for culture and sensitivity, cytology and PCR
    • Endoscopy (through choana) and biopsy
    • Gold standard = CT scan
  • Treatment
    • Treat underlying cause
    • Flush nares
    • Tylosin (if Mycoplasma), antibiotics, antifungals
    • NSAIDs
    • Only change diet once bird is feeling better

Large airway disease

  • Clinical signs: stridor, open mouth breathing, gasping, tachypnoea, dyspnoea, voice choice, lethargy, anorexia
  • Differentials
    • Post-intubation necrosis
    • Aspergilloma (fungal granuloma) - in macaws and owls
    • Foreign bodies - cockatiels aspirate seed husks
    • Mass - goitres (in budgies), neoplasms, oropharyngeal granulomas (Mycobacteria)
  • Diagnosis
    • Clinical signs 
    • Radiography
    • Tracheoscopy and tracheal wash
    • Foreign bodies - shine bright light at apteria (featherless part of neck) to identify FB in trachea
  • Treatment
    • Foreign bodies - stick needle attached to syringe through trachea below FB and expel air to blow FB up
    • Aspergilloma - surgery needed, stabilise with air sac breathing tube beforehand

Small airway disease

  • Clinical signs: soft wheezing sound, severe respiratory distress, open mouth breathing, gasping, abdominal effort
  • Differentials: toxins, allergens, granulomas (Aspergillus, Mycobacteria)
    • Macaw Hypersensitivity - allergy to feather dander of cockatiels
  • Diagnosis
    • History
    • Radiography –> to identify soft tissue infiltrate
    • Coelomic endoscopy via abdominal cavity
    • Blood test
      • If acute: heterophils
      • If chronic: monocytes
      • If Macaw Hypersensitivity: possibly eosinophilia
  • Treatment
    • Bronchodilators (IM or nebulised)
    • Antibiotics, antifungals
    • NSAIDs

Parenchymal disease

  • Clinical signs: no sounds, tachypnoea, severe dyspnoea, poor BCS, lethargy, anorexia
  • Differentials
    • Toxins - teflon, cigarette smoke, etc.
    • Cardiogenic pulmonary oedema –> increased hydrostatic pressure –> ascites
    • Aspiration pneumonia - due to crop feeding
  • Diagnosis:
    • Blood test
    • Radiography
    • Heart pressure monitor - from brachial artery on wing protagium
    • Echocardiography
  • Treatment
    • Oxygen therapy
    • Antibiotics, antifungals
    • NSAIDs
    • If pulmonary oedema: furosemide, 2-4 mg/kg IV

Intracoelomic disease

  • Clinical signs: no sounds, open mouth breathing, tachypnoea, dyspnoea, respiratory distress, distended coelomic cavity, systemically ill (nesting, laying, lethargy, anorexia)
  • Differentials: heart/liver disease, hypoalbuminaemia, peritonitis, neoplasia
  • Diagnosis
    • Radiography, ultrasound, CT scan
    • Coelomocentesis - from midline just below liver/umbilicus
    • Blood test
    • Endoscopy (not if fluid-filled coelomic cavity - fluid will enter air sacs)
  • Treatment
    • Treat underlying cause
    • Drain fluid

Docs did an Ffn test which was negative but the nifedipine didn’t stop the contractions so they gave me an injection of terbutaline because the contractions aren’t stopping and they’re 3-6 minutes apart. Hurt like a bitch but it worked.

They sent me home after my iv emptied with instructions to rest ire and stay hydrated. I feel like shit right now. Hopefully I can make it to 37 weeks. I’m a centimeter dilated as of now.