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In this photograph generic azithromycin 250mg with amex, a lid retractor is being used to maintain an opening in the left abdomi- three centimeters of the catheter order azithromycin 250 mg line. The seventh rib (r) has been isolated and cut ventrally to fenestrations cheap azithromycin 500mg mastercard, the suction force is distributed among facilitate its removal for better access to the proventriculus cheap 250mg azithromycin otc. Addi- eral rents can be seen in the relatively clear caudal abdominal air sac (arrow) just to the left of the rib. The proventriculus (p) and tionally, if some of the holes are occluded by tissue, ventriculus (v) can be seen deep to the surgical site. Multiple-sized clips should be available to ad- A one- to three-millimeter rigid endoscope is helpful dress varied-sized patients and different surgical for visualizing areas that the surgeon may not be needs. The major expense is encountered in purchas- able to access with the operating microscope (eg, ing the applier, as the clips themselves are relatively lumen of hollow viscera). The appliers are available either propriate for small avian patients should maintain straight or with a 45° bend. The bent-tipped applier retraction but not have blades that extend deep into is useful for deep clip placement; however, the bent- the body cavity. Mini-Balfour retractors are useful in tipped instruments are about twice the size of the large patients such as macaws and cockatoos, Alm equivalent straight-tipped applier, making them retractors are appropriate for medium-sized patients more cumbersome to use. Generally, the small and like Amazons and conures, and Heiss retractors work medium clips are used most frequently. Small gauze pads (2 x 2) and In many situations, the placement of ligatures in sterile cotton-tipped applicators should also be avail- deep surgical sites is unachievable or results in un- able (see Figure 40. Surgical spearsj are small, acceptable tissue damage due to the relative inacces- wedge-shaped, highly absorbent, synthetic sponges sibility and delicate nature of avian tissues. The point of the spear provides static clipsh,i are best for controlling bleeding in these critical control when working under magnification. Radiosurgery (Electrosurgery) Radiosurgery employs high frequency (two to four mHz), alternating current to generate energy waves, which create vibration and molecular heat inside individual cells, causing water to vaporize and the cells to rupture while the active electrode remains cool (Figure 40. The frequency can be varied to achieve either cutting of tissues or coagulation of vessels. An anesthetized cockatiel hen has been taped to a surgical board in preparation for a hysterectomy. When set for monopolar operation, a radiosurgery unit employs two electrodes (an active electrode and an indifferent electrode or ground plate), which con- Absorbable gelatin spongesk are valuable for control- centrate the current density at the tip of the smaller ling hemorrhage, as is oxidized regenerated cellulose. Monopolar radiosurgical tech- niques are acceptable for gross tissue manipulations With avian patients it is best to place the patient on in avian patients weighing more than two kilograms. This allows the surgical assistant to move electrode) and a receiving antenna (indifferent elec- the patient intraoperatively to acheive proper visu- trode) for radio transmission. This is especially important ent electrode) should be large and placed as close as when using the operating microscope as it is much possible to the surgical area, and the contact with the easier to move the patient than to move and refocus patient should be improved using an electrode paste. Such boards are com- It is important to keep the active electrode clean and mercially availablem or can be easily constructed free of char and debris. A dirty electrode will drag from a plastic container lid, a piece of styrofoam or a section of cardboard. Tape restraints are pre- ferred over velcro restraints because they are dispos- able and minimize the risk of disease transmission. An ideal monitor for the surgical patient would be easy to apply, unaffected by the surgical environ- ment, economically priced and provide data on the patient’s heart rate, respiration, body temperature and hemoglobin oxygen saturation. The high heart rate and small tidal volume of small avian patients are not easily detected by traditional monitors. Pulse oximeters have become standard in human anesthe- sia but may be unable to detect the high pulse rate of some smaller patients. Ball-type electrodes create a lot of tissue ceps are slightly wider than is ideal for avian surgery. Loop electrodes are used to avian surgery by using a fine sharpening stone to contour tisses, obtain organ biopsies and remove reduce the width of the tips. Skin incisions active electrode tip slightly narrower than the indif- and incisions into other fine tissues are best accom- ferent tip. A lower lar forceps in patients weighing less than two kilo- energy setting can be used with these forceps. With the Surgitron,q the fully filtered wave pattern of the grams and when manipulating tissues in the realm of microsurgery. The unit is is not needed as one of the tips serves as the active set at 1 for vessel coagulation, 2 for muscle transec- electrode and the other as the indifferent electrode tion, and 3 for incision of dry skin. Compared with the fine-needle or wire are difficult to coagulate, the cutting/coagulation monopolar electrodes, the tips of the bipolar forceps settings may occasionally be indicated. The coagula- are broader, allowing the current to be dispersed just tion setting is used primarily for tissue fulguration enough to accomplish the tissue welding that is criti- (such as the destruction of cloacal papillomas). The current passes from one tip Incision Techniques (active electrode), through the contacted tissue and The Harrison modified bipolar forcepsp may be used to the other electrode (indifferent) without passing through the entire patient. In avian patients, bipolar to make primary skin incisions, coagulate cutaneous forceps induce less reflex hemorrhage and provide vessels prior to blade incision and coagulate individ- improved tissue control. These forceps may also be used with or such close proximity, the transmitted wave currents without current for tissue dissection. Skin incisions are different from those generated with the monopo- should be planned in a manner to minimize the effect on feathers and feather tracts and to avoid the major blood supply to feathers. The skin is tented with thumb forceps and grasped with the bipolar forceps at the location of the proposed incision (Figure 40. The current is activated (using a foot switch) pre- cisely as the grasp on the tissue is relaxed slightly, and with a smooth, rapid motion, the forceps are pulled off the tissue. This will create a small incision in the tissue that may then be parted to allow introduction of the indifferent electrode of the bipolar forceps (non-bent tip). The electrode is in- serted subcutaneously to the extent of the proposed incision. The electrodes of the bipolar forceps are lightly apposed, the current is activated and the forceps withdrawn. The top should remain a normal color except immediately one has been specifically designed for avian microsurgical applica- tion. These tips are thinner than normal bipolar tips and the active adjacent to the incision (which should be white), and electrode has a 45° bend to facilitate cutting of avian tissues there should be no hemorrhage. This proc- ess is repeated until the tissue is completely tran- sected, stroke by stroke. Coagulation Techniques If hemorrhage is encountered, a sterile cotton-tipped applicator is used to dry the area for radiocoagula- tion, which cannot be achieved in a wet field. The swab is rolled toward the source of blood flow with gentle pressure to serve as a tourniquet (Figure 40. Once the vessel is identified, the slightly broader, flat indifferent electrode is placed under the vessel, and the bent-tipped, active electrode is loosely apposed to occlude the vessel. At high current or coagulation set- tings, the vessel frequently retracts within the tissue due to vasospasm.

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Pickering buy cheap azithromycin 100mg on-line, Ontario buy discount azithromycin 500mg on-line, Canada discount azithromycin 500 mg free shipping, Silvio and Conservation of the Puerto Rican Press generic 500mg azithromycin with amex, 1987. This feeding “art” has evolved out of necessity brought about by a lack of valid scientific information on the nutritional needs of these birds. Most current nutritional beliefs stem from years of “trial and error” feeding practices that are perceived as successful for the individual. A number of these practices have gradually been passed on, modified 3 and eventually accepted as status quo by avicultur- ists. Their endorsement has come through the reali- zation of certain improvements over previous feeding standards (such as the addition of fruits and vegeta- bles to an all-seed diet), with the conclusion being that this small degree of improvement represents an end. There is often a belief that nothing can be too good for the bird, and it is provided with an incredible variety of often not-so- nutritious foods. Theory in companion bird nutrition has also been inundated with self-proclaimed ex- perts, trying to achieve personal gain or recognition through their emphatic and frequently unsupported recommendations of certain feeding programs. Brue As aviculture has advanced over the past decade through the efforts of truly dedicated aviculturists, sound feeding practices that are based on the eating habits of long-lived birds or on sustained reproduc- tive successes have begun to emerge. Although most of this information is still anecdotal, there appear to be valid principles to support many of these prac- tices. Some of these dietary theories are based on what a particular species of bird is perceived to eat in the wild. There is only a moderate under- standing of what free-ranging birds eat, partly be- cause their diets vary widely with the seasons. The majority of companion and aviary birds are consid- ered opportunistic omnivores; that is, they will eat a large number of the foods that are available to them at any specific time. In most cases, this includes a wide array of vegetative material and a variety of animal products, as well as the consumption of soil and mineral deposits. Additionally, Current nutrient recommendations for companion most free-ranging birds do not live to their full ge- birds are derived from an extrapolation of the nutri- netic potential. This is due not only to predation and tional requirements for commercial poultry, the ap- disease exposure, but also to the frequency of malnu- plication of general nutritional principles that are trition caused by seasonally insufficient supplies of fairly constant among all vertebrates, an evaluation nutrient-adequate foods. The culmination of this multifaceted ap- historic perception that the diets available were not proach has resulted in a general estimation of the nutrient-deficient. The lack of financial incentives for nutrient needs for companion birds that can be either university or industry to employ nutritionists shown to be successful in growth studies and long- to study these species, and the expense and difficulty term feeding trials. It does not, however, determine of studying nutrient requirements in a variety of the specific requirement of an individual nutrient or species and metabolic conditions have further de- necessarily produce a diet that is totally optimized. It is doubtful that the nutri- however, general nutritional principles apply to tional needs of either the Psittaciformes or nearly all vertebrates, with a few notable exceptions. Passeriformes, not to mention of a specific individual Additionally, the most studied living species from a species, will ever be fully known. Even today, after nutritional standpoint has been the domestic almost a century of research in chickens and rats, the chicken. Although they are obviously not identical to entire nutritional picture has not been completely each other in all ways, the domestic chicken does elucidated for these species. There are substantial share similar physiologic parameters with popular data on the nutrient requirements for the growing companion Psittaciformes and Passeriformes. The animal, but there are still many questions as to the greatest difference among these species is the fact requirements for optimal reproduction, optimal that Galliformes are precocial (the neonate is mobile health and maximal longevity. The latter tends to be and generally self-sufficient at only a few hours of of little concern in any commercial species, but does age). In addition, domestic poultry have been geneti- have eminent importance for companion animals. Although research in this area involves poultry provide a starting point for the study of com- only two species and is strongly supported by univer- panion bird nutrition. It is at this point that the sities and hundreds of competitive manufacturers, anecdotal nutritional information that pervades the science of canine and feline nutrition is still aviculture becomes of great significance. These observations suggest that species- specific nutritional requirements exist, but because Nutrition itself is a critical link between the manage- many species of a genus or family perform similarly on ment practices provided for a bird and the bird’s good a certain diet, it can be assumed that the variations health. It can also predispose the individual The quality of water provided to companion birds to health problems and may even have implications should be of utmost concern to both the client and the for management techniques. Water and “soft foods” (foods containing ists and veterinarians seldom have any impact on high moisture content over 20%) are frequently im- genetic background because it is predetermined at plicated in exposures to high concentrations of bacte- conception. An open water container that becomes contami- area through selection of breeding stock. Regrettably nated with fecal material or food will promote rapid (especially in larger birds), the genetically poorer bacterial proliferation. These in- vitamins, there can be a 100-fold increase in the dividuals may be physically, emotionally or behavior- bacterial count in 24 hours. Changing the water and ally abnormal and are abandoned as companion birds rinsing the container will obviously decrease the bac- and relegated to breeding. This is a counterproduc- terial load, but an active biofilm remains on the tive process, because the breeder may unknowingly container walls unless it is disinfected or washed be selecting for undesirable traits. Contamination in the water container, in certain unusual traits or the practice of heavy breed- addition to the aqueous medium and compatible en- ing within a very small gene pool will ultimately vironmental temperatures, provide all the require- accentuate both desirable and undesirable charac- ments for microorganisms to thrive. This moisture foods such as egg foods, nestling foods, has created considerable problems in budgerigars, cooked foods, sprouts, fruits and vegetables provide cockatiels, canaries and finches. At warm environmental temperatures, these types of foods Without good, sound management techniques (see can become contaminated in as little as four hours. Chapter 2), an otherwise genetically strong and nu- tritionally sound bird will not maintain its good Water intake will be greatly influenced by the type of health. Most birds can derive the majority of sionally administered health care program must be their water requirement from foodstuffs when the provided to ensure the long-term health of a bird. Processed diets tend to increase the bird’s Just as providing complete, thorough veterinary care water intake over that typical for a seed diet because is impossible without proper training, so is the for- they generally are dry, lower in fat and tend to have mulation of a properly balanced, complete diet. Slightly moister feces formulation, development and production of a diet is are often observed in birds on a formulated diet. A well formulated, properly balanced diet represents a precise combination of over 40 nu- trients, sometimes provided by just as many different ingredients. It is critical to go beyond this quantitative protein and calcium is identical with respect to the approach and evaluate both the quality of the nutri- energy content of the diet. A illustrates how some seemingly dramatic differences simplistic example of nutrient intake miscalculation in nutrient levels can actually give very similar re- is the baby bird being hand-fed recommended vol- sults in the animal. In this situation, the Mineral Interrelationships nutrient uptake is insufficient to support growth. There are a vast number of different mineral interre- lationships, with every mineral affected by at least The Effective Energy Content of Food one other. The most critical in companion bird nutri- It is important that the individual nutrient levels be tion, and in most species, is the relation between balanced with respect to the energy content of the calcium and phosphorous.

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Philosopher and mathematician Bertrand Russell tells of a technique which he used on himself to good advan- tage in toning down excessive excitement: "When some misfortune threatens purchase 100 mg azithromycin with amex, consider seriously and deliberately what is the very worst that could possibly happen discount azithromycin 250mg with visa. Hav- ing looked this possible misfortune in the face order azithromycin 100mg with visa, give your- self sound reasons for thinking that after all it would be no such terrible disaster order azithromycin 500mg overnight delivery. Such reasons always exist, since at the worst nothing that happens to oneself has any cosmic importance. The universe was one huge, dead, immeasur- able steam engine, rolling on, in its dead indifference, to grind me limb from limb. Wherefore, like a coward, dost thou forever pip and whimper, and go cowering and trembling. Well, Death: and say the pangs of Tophet too and all that the Devil and Man may, will or can do against thee! Hast thou not a heart; canst thou not suffer whatso it be: and, as a Child of Freedom, though outcast, trample Tophet itself under thy feet, while it consumes thee? Ever from that time, the temper of my misery was changed: not Fear or whining Sorrow was it, but In- dignation and grim fire-eyed Defiance. Someone has said that the greatest cause of ulcers is mountain-climbing over molehills! A salesman calling upon an important prospect may act as if it were a matter of life or death. A debutante facing her first ball may act as if she were going on trial for her life. Many people going to be interviewed about a job act as if they were "scared to death," and so on. I Perhaps this "life-or-death" feeling that many people experience in any sort of crisis situation, is a heritage from our dim and distant past, when "failure" to primitive man usually was synonymous with "death. Close scrutiny will show that most of these everyday so-called "crisis situations" are not life-or-death matters at all, but opportunities to either advance, or stay where you are. He will either get an order and come out better off than he was—or he will not get the order and be no worse off than before he made the call. One salesman I know doubled his income after he was able to change his attitude from a scary, panicky, "Everything depends upon this" out- look, to the attitude, "I have everything to gain and noth- ing to lose. Practice and learn the simple techniques of this chapter, and you, like hundreds of others before you, can learn to make crisis work for you by making crisis a creative opportunity. Once you give it a definite goal to achieve you can depend upon its automatic guidance-system to take you to that goal much better than "you" ever could by conscious thought. Think in Terms of Possibilities But to accomplish this—"You" must supply the goal. And to supply a goal capable of activating your creative mechanism, you must think of the end result in terms of a present possibility. The possibility of the goal must be seen so clearly that it becomes "real" to your brain and nervous system. So real, in fact, that the same feelings are evoked as would be present if the goal were already achieved. What, for example, is worry about possible unfavorable future re- sults, accompanied by feelings of anxiety, inadequacy, or perhaps humiliation? For all practical purposes we experi- ence the very same emotions in advance, that would be appropriate if we had already failed. We picture failure to ourselves, not vaguely, or in general terms—but vividly and in great detail. Remember what has been emphasized earlier: our brain and nervous system cannot tell the difference between a "real" experience, and one which is vividly imagined. Our automatic creative mechanism always acts and reacts appropriately to the environment, circumstance or situa- tion. The only information concerning the environment, circumstance or situation available to it is what you be- lieve to be true concerning them. On the other hand, if we keep our positive goal in mind, and picture it to ourselves so vividly as to make it "real," and think of it in terms of an accomplished fact, we will also experience "whining feelings": self-confidence, cour- age, and faith that the outcome will be desirable. We cannot consciously peek into our creative mecha- nism and see whether it is geared for success or failure. The "winning feeling" itself does not cause you to oper- ate successfully, but it is more in the nature of a sign or symptom that we are geared for success. It is more like a thermometer, which does not cause the heat in the room but measures it. Remember: When you experience that winning feeling, your internal machinery is set for success. Too much effort to consciously bring about spontaneity is likely to destroy spontaneous action. Then simply capture the feeling you would experience if the desirable goal were already an accomplished fact. Then your internal machinery is geared for success: To guide you in making the correct muscular motions and adjustments; to supply you with creative ideas, and to do whatever else is neces- sary in order to make the goal an accomplished fact. Cary Middlecoff, writing in the April, 1956 issue of Esquire magazine, said that "the Winning Feeling" is the real secret of championship golf. But there was some- thing about the way I felt that gave me a line to the cup just as clearly as if it had been tattooed on my brain. With that feeling all I had to do was swing the clubs and let nature take its course. Several years ago sports pages all over the country headlined the sensational play of Johnny Menger, ban- tam-sized half-back from Georgia Tech, in a post-season bowl game. Pen- ney tells how he heard his father say on his death-bed, "I know Jim will make it. Penney stores was built upon many impossible cir- cumstances and discouraging moments. Whenever Pen- ney would get discouraged, however, he would remember the prediction of his father, and he would "feel" that somehow he could whip the problem facing him. But again he remembered the words of his father, and soon recaptured the winning feel- ing, which had now become habitual with him. He had done some public relations work, and had gained some degree of reputation as an expert in the field of human relations. His big interest was people, and after years of study, both theoretical and practical, he thought he had some answers to the problems people often have with other people. Lying there in bed, I recaptured in memory the feeling of success and confidence I had had in talking to these small groups. I remembered all the little incidental details that had accompanied my feeling of poise. Then, in my imagina- tion I pictured myself standing before a huge audience and making a talk on human relations—and at the same time having the same feeling of poise and self-confidence I had had with smaller groups. I had welded the feeling of confidence and success from the past to the picture in my imagination of my career in the future. Although there seemed to be no door open to me at the time, and the dream seemed impossible, in less than three years time I saw my dream come true—almost in exact detail as I had imagined it and felt it. Because of the fact that I was relatively unknown and because of my lack of ex- perience, no major booking agency wanted me.

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