What Is Gout?

Gout occurs in your bird when urates accumulate in its blood stream. Urates are formed when your bird processes the proteins in food. If urate levels get too high in your pet, the material will form clumps of crystals. Sometimes these crystals form around the joints, and sometimes they form in the pet's internal organs. The first form is called articular gout and the second, visceral gout.

Any type of bird can develop gout. But when veterinarians see the problem, it is most often in a budgie, cockatiel, finch or canary. We see it in larger parrots - but less frequently.

How Does Gout In Birds Differ From Gout In People?

It differs primarily in the underlying cause. In people, gout is usually caused by obesity, consuming too much alcohol and eating foods too rich in purines which are later converted into urates.

Birds metabolism is quite different from human metabolism. In birds, ordinary protein as well as purines result in uric acid waste. Uric acid forms the building blocks of gout crystals.

Is There More Than One Cause Of Gout In Birds?

We think that the majority of cases of gout in pet birds are due to feeding them foods they are not designed for. Particularly foods too high in protein and too low in beta-carotine. But because bird's kidneys are very different from human kidneys, anything that harms the pet' kidney can also cause them to develop gout.

All Birds With Gout Have Kidney Damage:

When your pet's kidneys no longer work properly, uric acid in its blood will rise above normal. Uric acid is normally flushed out of the bird's system in its urine. The urine is the whitish material in its stool. It is composed primarily of uric acid crystals. When the uric acid can not leave in this normal way, it will form crystals in other parts of your bird's body.

Gout Caused By Diet:

Smaller pets, such as budgies (parakeets) and cockatiels that develop gout, usually are not eating a good diet.

Because they are finicky eaters, even if you provide a balanced diet, they may pick through it, eating only the ingredients that catch their eye.

In the wild, these birds cover large areas, feeding on whatever happens to be in season and available. Their diet is rich in unmodified wild grass seeds when they can find them. But they also eat the flowers and buds of prairie plants (forbs) in large quantities. These green foods have nutrients that are not found in seeds. They never eat the yellow proso millet, sun flower or safflower seeds that form the bulk of pet store parakeet and cockatiel food. Safflower and sunflower seeds are grown to supply the cooking oil industry. They are a horrible source of nutrition. When pets are feed ordinary seed diets, they receive too much fat and inadequate amounts of vitamins and minerals. Fortified seed mixes have vitamins glued to the seed husk - the part that the bird discards.

Pelleted diets are better, but they are often formulated with too high a protein level for these small birds. Robert Stroud, The Bird Man of Alcatraz, noted in his 1933 book that when he gave his canaries a diet too rich in protein, they all developed gout as they aged.

Gout Caused By Primary Kidney Disease:

Any disease that damages your bird's kidneys can result in gout. Polyomavirus infection in larger parrots can be the cause, as can a number of other viral conditions.

When the pet has a systemic bacterial infection, the kidneys are often a site of infection. Even when these infections are cured with antibiotics, the kidneys may be permanently scared.

Gout Caused By Toxic substances:

Your bird needs vitamin D. But too much vitamin D added to it's diet can damage its kidneys. There is a fine line between enough vitamin D and too much vitamin D. The vitamin D in bird vitamins is D3 - much more powerful than the D2 in human vitamins which birds can not use. Rather than giving a D3 product to your pet, it is much safer to rely on the natural precursors of vitamin D3 in a balanced diet and expose your pet to an hour of direct sunshine a day - longer if the sunshine passes through glass.

Exposure to zinc and lead can also cause kidney damage. Exposure is usually due to galvanized cages or toys and trinkets hanging in the bird's cage.

Gout Caused By Inactivity:

It is hard to separate inactivity from other factors. But we do know that birds kept in small cages where flight is impossible develop gout much more frequently than birds kept in flight aviaries.

Gout Caused By Certain Antibiotics:

Gentamycin, and antibiotics related to it can cause kidney damage leading to gout when they are given in too high a dose or over too long a period.

Lack Of Vitamin A:

Probably the most common cause of kidney damage in pet birds is inadequate sources of vitamin A in their diet. Many birds are not equipped to handle ready-made vitamin A artificially added to their diets. But they are all designed to produce their own vitamin A from compounds called beta-carotenes that are found in certain foods. If they do not receive these foods, they can develop a vitamin A deficiency. Vitamin A deficiency causes many diseases in birds - one of which is kidney damage. Like vitamin D, too much vitamin A is also toxic. So it is much better to provide the non-toxic beta-carotenes in your bird's diet an let the bird decide how much vitamin A to produce than to give vitamin A supplements.

Also, at least some pet birds can not use the vitamin a that is in bird vitamin supplements or pelleted diets. Green plants are the source of beta-carotenes. Mr. Stroud also noticed that gout developed in his birds when they received no greens.

What Are The Signs Of Gout In My Bird?

There are three common signs you might see if your pet is developing gout.

The first is an increase in the white (urate) portion of his stool. This also occurs when the bird is not eating. So your veterinarian will confirm that the pet's blood urate level is also elevated. These birds are usually also drinking more than usual.

The second sign is difficulty walking. This is due to the joint pain and joint immobility that urate deposits cause. Pet birds that are developing gout may spent more or all of their time on the cage floor.

The third are shiny, raised, whitish deposits under the pet's skin. These are found around joints. We find them on the bird's limbs because in the articular form of gout, crystals tend to accumulate where the bird's body temperature is lowest.

Other signs of gout are internal and can not be seen by the owner.

What Kind Of Birds Get Gout?

Generally, birds that develop gout are mature. They are usually pet birds that are eating an inexpensive seed diet that only has a few common seed ingredients - primarily yellow, red and white proso millet, safflower seeds and canary grass seed.

Some breeders of large parrots and macaws experience gout in their hand-raised baby birds. When this occurs, it is associated with diets too high in vitamin D, calcium and protein. Some breeders also associate it with dehydration. But it is unclear if the dehydration precedes the gout or vice versa.

Gout is very rare in wild birds. When gout develops in birds that roam free, it is usually the internal (visceral) form and there is usually something toxic in there diet or environment that has damaged their kidneys.

What Tests Will My Veterinarian Run?

The best indicator of gout in pet birds is their blood uric acid level. To determine this, the veterinarian needs to send a blood sample to a laboratory. This is not a difficult procedure in larger birds, but it is in parakeets and other small pets. If blood is collected from the pet's toenail, the nail must cleaned well first.

Generally, we run a complete "avian panel" in which we check for a variety of problems. When the amount of blood is limited, the veterinarian can request the tests in order of priority until the sample has been used up.

Microscopic analysis of the bird's urine is also a worthwhile test. Sometimes bacteria are seen that indicate a kidney infection. In large, expensive parrots, a laparascopic examination can help evaluate the condition of the pet's kidneys.

Some birds with typical signs of gout do not have elevated uric acid levels. We do not know why this is.

Radiographs can also be helpful in evaluating the pet's kidneys. In one form of gout due to overdoses of vitamin D, nodules of calcium can be seen in x-rays of the pet's kidneys.

What Treatments Are There For Gout In My Bird?

Increase The Bird's Fluid Intake:

If the pet is debilitated when it is first brought to a veterinarian, giving it subcutaneous fluids often perk it up. These fluids also help flush out some of the urates. Some pets are helped by these fluids whenever they have a relapse.

Getting your pet to drink more is not easy. But if the bird is fed fruit, vegetables and sprouts, it's total water intake will be greatly increased. Add an additional water container to its cage. Some birds with gout have difficulty moving about, so water sources should be as close to the bird as possible. Try containers of different shapes and colors.

Modify The Bird's Diet:

Although most kidney damage is permanent, modifying your bird's diet can help preserve your birds remaining kidney function and, perhaps, help reabsorb some of the gouty plaques. Changing an ill bird's eating habits can be very difficult or nearly impossible. Birds that have been eating a seed diet can be very resistant to eating fresh foods. But it is very much worth the effort to try.

The goal is to get your pet to eat a diet that is rich in vitamin A and D precursors and low in protein. Many pelleted diets have crude protein levels of 10 - 15%. This is much too high for birds suffering from gout. You should attempt to provide a diet with no more than half this amount of protein by diluting the pellets with food items that are lower in protein. A good no-nonsense pelleted diet is sold by Mazuri .

Any diet change you make need to be done gradually. Start by adding appropriately sized pellets to the seed cup. You can place some on the floor of your cage also, if your pet is still able to walk.

At the same time, add diced fresh produce to the food dish. Cut it small for small birds because they are intimidated by large objects in the dish. You can try: collard greens, mango, papaya, sweet potato, yellow squash, pumpkin, yam, zucchini, cantaloupe, dandelion, red chili pepper, and leaves from the stem of broccoli and cauliflower, cabbage and turnips. Remove stale vegetables at the end of the day. Be sure to wash all produce well before giving it to your bird and do not provide a very large amount of any one item. The color and consistency of the stool of your bird changes rapidly depending on the color and consistancy of what they are eating. Do not be frightened by this. Limit these fresh greens and vegies to 30% of the bird's diet.

In addition - offer your pet sprouts. Any edible small seed from a health food store can be sprouted. Seeds designed for gardeners and farmers have toxic products added to them.

Some birds will eat oatmeal. If they accept it, oatmeal is another good way to lower the protein content of pelleted diets.

Medications That May Help:

Your veterinarian may prescribe several medications for your bird.

Most are sold in large tablets designed for humans to swallow whole. If you add the tablet to the bird's water, the medication will dissolve in the water and the bird will receive it when it drinks. These tablets contain a lot of starch and talc to bind the medicine together. This is the white residue at the bottom of the bird's water bowl. Do not be concerned about it.

Subcutaneous Fluids:

When your bird is in a gout crisis, giving fluids by injection may help it recover. This is usually done subcutaneously or intraosseously in the bones of the wing. This causes the pet to urinate in large amounts, flushing its kidneys of urates. In later crises, the bird may feel better when the procedure is repeated.

Allopurinol (Zyloprim):

Allopurinol is used to reduce uric acid level in the bird's blood. The abnormally high blood uric acid level is the cause of the gout. Blood uric acid level need to be monitored periodically to determine if the medicine is working. Change the water and medication twice a day.

Colchicine and Probenecid (Benemid):

In Humans, probenecid enhances uric acid excretion by the kidneys and colchicine seems to decrease the pain of gout and the frequency of attacks. Veterinarians use it, hoping for the same effect. I know of no scientific studies that have documented that it is effective in birds, but when allopurinol alone is not sufficient to bring your bird's blood uric acid levels to normal, one of these medications may be added.

Metacam (meloxicam):

Birds with articular gout can be in considerable pain and reluctant to move. Some veterinarians give this medication or a similar one to reduce this pain.

Pantothentic acid (Vitamin B5):

Some studies indicate that supplements of Vitamin B5 help in lowering blood uric acid levels.

Sodium Bicarbonate:

The normal pH (acidity) of bird urine is 6.5-8, depending on diet and other factors. We know that uric acid crystallizes more at lower pH. So some veterinarians suggest that birds with gout receive sodium bicarbonate to maintain a more neutral urine pH. However, altering blood pH to a significant extent can be fatal. And it is normal for urates to form crystals in your pet's urine.

Experimental Drugs:

There are several promising new drugs being developed for use in humans with gout. I am sure that veterinarians are already using them in birds somewhere :

Febuxostat:

Febuxostat appears to be superior to allopurinol in reducing serum urate levels. The drug was approved by the European Medicines Agency in 2008 and recommended for approval by the U.S.Food and Drug Administration on November 26, 2008.

PEG-uricase:

PEG-uricase is a recombinant urate oxidase, which breaks down the uric acid deposits. It is being studied in Phase III clinical trials for the treatment of refractory gout in the United States. It appears effective in lowering blood uric acid levels.

Physical Treatment:

Some cases of articular gout are accompanied by itching an pain - particularly in cockatiels when the wing joints are affected. When this occurs, a restraining elizabethan collar might help the bird from causing further chewing injury to itself.

Some birds appreciate added heat and humidity. You can supply a heat lamp - but be sure that the bird can move away from it if it becomes too hot.

Because many birds with gout have difficulty using their feet, replace their standard perches with perches that are wider in diameter. Add additional water containers so the bird does not have to travel far to drink.

Natural Remedies:

Some owners feel that feeding cherries or cherry juice helps their pets. Cherries contain anthocyanins which are thought to reduce inflammation. Some people with gout find it helps them. So some bird owners give their pets cherries or cherry juice.

If you use natural remedies, use them in very small amounts.

What Is The Outlook For My Bird?

With diet modification, medications and some of the steps I have outlined, it may be possible to preserve the kidney function that your bird has left. The best way to gauge the effect of treatment and make modifications when they are required is by periodically monitoring uric acid level in your bird' blood. There is no treatment that will restore damaged kidney tissue. In most cases , birds must remain on medications indefinitely.

How Can I Prevent Another Pet From Developing The Same Problem?

Buy An Immature Pet:

When you buy your next pet, try to purchase a bird shortly after it has been weaned. Birds develop their food preferences very young and it is very difficult to change these preferences once they have been established. Pet stores usually sell birds after they have already developed a taste for things they are fed at the pet store. And pet stores tend to feed cheap, and common diets. So purchase your bird young from a breeder if at all possible - before all its feathers have fully formed.

If your new pet is older, try a diet change technique I suggest .

Feed Variety:

Feed a variety of foods. Feeding a monotonous diet of limited ingredients is not wise. The birds becomes bored and the chances for dietary imbalances become greater. The more different foods a bird eats, the healthier it will be and the longer it will live.

Encourage Exercise:

Encourage your bird to exercise. Most commercial cockatiel, parrot and parakeet cages are much too small. Birds were not designed by God to walk from place to place. For their circulatory system to function well, they need to fly - or at least flap. Letting your bird fly loose in the house is very dangerous. But you can build a flight cage. The cage must be long, but it does not have to be wide or deep. Birds do not like to fly if they think their wing tips might brush up against objects.

Flighted birds are always in danger of escaping or crashing into windows, fans and mirrors. But clipping enough of the secondary wing feathers so the bird can only fly a few feet solves this problem. Do not clip only one wing as this gives the bird a tendency to roll.

Natural Sunlight:

Expose your bird to natural sunlight for at least one hour a day. If the light passes through window glass, the time must be longer. This allows the bird to re-establish it's normal body rhythms and produce adequate amounts of vitamin D3.

Encourage Water Consumption:

Encourage extra water intake by having multiple water containers of different color and shape. Feed fun fruits and vegetables that are high in water.

Avoid Easy Fixes And Miracle Cures:

Do not give vitamin supplements and remedies as a substitute for good nutrition. With proper diet, these supplements are unnecessary and sometimes harmful to your bird's health.