Lecture 5 Welle

Medical Therapy for Feather Picking Disorders

Presenting Author: Kenneth R. Welle, DVM, Dipl ACVP(Avian)

All Creatures Animal Hospital, Urbana, IL and University of Illinois, College of Vet Medicine

Interpretive Review and comments by Dr. Nemetz:

We have learned from Dr. Rosenthal's paper (click here) that feather picking is a complex, multifactorial problem. Dr. Welle presented a paper illustrating that in our search for a cause, sometimes the patient need assistance to control the pruritis, pain, secondary infection, and protecting the skin. Additional medical therapy can be used to assist with behavioral modification and to regulate hormonal activity.

The overall challenge in a patient that is feather picking/mutilating is to identify and control ALL the possible contributory factors. These will fall into several categories:

Controlling Pruritis (itching)

These patients will be seen interrupting normal behavior to pick at the skin. Little is known about the chemical mediators of pruritis in birds so it is difficult to choose a specific therapy. Dr. Welle has used antigen-restricted diets by Hills Corporation with mild success. Antihistamines, Non-steroidal anti-inflammatories (NSAID), and steroids were discussed, all with limited success and in the case of steroids possible severe side-effects.

Controlling Pain

Veterinarians know through anatomy the pain involved when a feather is removed from a bird, but unfortunately this pain does not deter these birds from self-plucking. Pain relief starts with the prevention of further injury. Reorganizing the cage, lowering perches, and protecting the feathers in other ways is important to prevent falling and further feather injury. Analgesic drugs can be used but only have a short-term effect. Also NSAID can be used when appropriate. Omega-3 fatty acids (flaxseed oil) may be of benefit as well, but no studies have verified its efficacy.

Controlling infection

Infections are often involved in feather picking birds either as a potential cause or as a secondary sequela (consequence). If an owner notices skin ulcers, exudate, or odor, these are the hallmarks of an infection. From there, cultures can be performed with antibiotic sensitivity to discover the most therapeutic medication to prescribe.

Treating Concurrent Conditions

Concurrent conditions are common in feather pickers. Poor nutrition, liver disorders, aspergillosis, elevated heavy metal blood levels, and trauma can contribute to the problem. The key to any medical therapy is to correct the "known" problems, resolve the bird's discomfort, and then possibly the feather picking will resolve.

Protection of Skin and Feathers

In the short term we must protect the bird against itself. Collars, bandages, T-shirts, jackets, or combinations of these may be necessary to accomplish this goal.

Psychotropic Drugs

Psychotropic drugs have a low success rate if the diagnosis of systemic disease is not fully explored, treated and ruled out. Dr. Welle's opinion is that this type of therapy is best used in birds with severe fear or anxiety, birds whose owners are having difficulty applying behavior modification instructions, and those unresponsive to other therapy. He prescribes mostly Clomipramine and Haloperidol. These are used as last resort therapies, not as a first choice. Dr. Nemetz has seen many examples, as stated by Dr. Welle, of birds with severe fear or anxiety without systemic disease. Haloperidol as well as other psychotropic drugs has produced excellent results in specific cases.

Hormone Therapy

Reproductive hormones sometimes have a significant influence on parrot behavior, however hormone therapy in not appropriate in many cases. If the picking coincides with the onset of breeding, hormone therapy can be effective. Lupron (leuprolide acetate) is used to suppress reproductive hormones without having its own hormonal effects. In 1994 Lupron was shown to be effective in cockatiels but was cost prohibitive. In 2000 Dr. Don Zantop demonstrated Lupron's effectiveness in other psittacine species and how to make it cost effective for clients. Depo-Provera (Medroxyprogesterone) has been used successfully in males and females, however with side effects including obesity, liver disease, and diabetes mellitus, Dr. Nemetz finds this hormone rarely indicated. Hypothyroidism has been in the literature for years but as of 2003, only two such cases have been reported that failed a two-fold response to thyroid stimulating hormone (TSH) and responded to appropriate therapy. Dr. Nemetz still has doubts regarding even these cases based on today's therapeutic options and diagnostics.

Conclusion:

Dr. Welle's paper emphasis was that we must thoroughly work-up the feather picker/mutilator in the goal of a long time resolution, but we should also assist the patient to prevent further feather/skin damage as well as reduce its discomfort.