by Robert Clipsham, D. V.M.Simi Valley, California

AnatomyofaSurgical Sexing

Clinic

The primary advantage that surgi­cal sexing holds over the other off­site lab methods is that, in addition toaccurately identifying the bird's sex,it also provides for an immediate andfairly accurate evaluation of the bird'sstate of sexual activity, generalvisceral health and, in some cases, anestimate of relative age. These factorshave become increasingly moreimportant as bird import inventoriescontinue to dwindle and bird whole-ale prices have climbed steadily

upward (Don't think so? Compare theprice of blue and gold macaws whichhave jumped from S195 for six ormore in 1983, to 2,000 a pair in1988.)

The penalty for paying standardwholesale prices to set up an im­mature macaw hen which may sit upto five years without returning a centtoward the investment of food, careor cage wire has gone up a bit. Thecurrent evaluation of bird operationsin California shows that for everydollar of bird owned, aviculturistswill spend an equal dollar the firstyear for bird purchase, wire, food,housing, care, etc. A nanday conurewith scarred or disfigured gonads orabcessed air sacs is just as non­profitable as non-producing macaws,and aviculturists need to know whereto invest their dollars more now thanat any other time.

The routine office appointment­type surgical sexing has traditionallybeen apprOXimately 535 per bird insouthern California. During the lastten years, some veterinarians havecharged upwards of $75, plus anadditional fee for prerequisite labtests and examinations. The total costper bird, regardless of the speciesinvolved, could run as high as 5300each. This has been done for the pur­pose of enhancing patient safety, andto increase client awareness of abird's health status. This program caninclude certain standard and/oroptional medical work-ups as isagreed upon. This program is agreedupon by each client and the particularveterinarian involved.

The requirments that my clientswere presenting to me did not allowfor the above-mentioned criteria, asmany of the species they desired toproperly pair and breed fall into therange of under a one hundred dollarvalue, or the number of pairs to besexed did not allow for any extensivetesting of all birds.

I was approached by several com­mercial breeding operations, several

propagation.Dr. McDonald was concluding his

residency at the University of Cali­fornia at Davis at the time I wasbeginning my own, and his approachto the problems of aviculture as aveterinarian was both unique andeffective in northern California at thetime. The other major factors thatpresented themselves in the 1980swere the reality that foreign birdimportation had begun to show signsof decreasing. Aviculturists werebeginning to realize that domesticpropagation could be simultaneouslyenvironmentally important and finan­cially rewarding, and that surgicalsexing offered some distinct advan­tages over the techniques of fecalsteroid analysis or feather cytologicalsexing.

Dionics endoscope, an importantpiece ofequipmentfor surgical sexingprocedure.

The subject of surgery seems, atfirst glance, to be strongly out of con­text with the directives of domesticpropagation and endangered speciessurvival. The purpose of this presen­tation is to accurately identify theinter-dependency of these twosubjects, as well as to promote theconcepts of conservation for avianspecies which are in danger of, orbeing added to, the list of endangeredbirds already documented at thistime.

The idea of surgical sexing clinicscame about as a result of severalconcepts that came together coinci­dentally several years ago. The fore­most influence came about in theform of Dr. Scott McDonald, who iswell-known for his efforts to promoteavicultural medicine and domestic

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16 April/May 1989

Quick and careful surgical sexing with skilled hands andfiber optic endoscope.

import station owners, and the localavian society groups to considerestablishing a cost-effective means ofdetermining sex identification, as noother similar alternative was avail­able. Dr. McDonald advised that Iconsider a more extensive program toinclude flock health analysis and anepidemilogical survey analysisservice, and so the avicultural surgicalsexing clinic was created as part ofour In Flight avicultural service.

Certain economic factors also cameinto play, which were necessary to berecognized as within any business. Astatistical analysis indicated that if aminimum of forty birds per clinicwere sexed at a cost of S15, the cliniccould minimize its overhead, reducethe instance of clinic traffic, recoverthe initial investment cost (approxi­mately 10,000) for surgical equip­ment, and still assist in the efforts ofdomestic propagation.

The results have overwhelminglyjustified our original assumptions,and the program seems to have beenbeneficial for all those involved. Thereduced cost per patient has allowedfor llanday conures to be sexed withthe same effort as triton cockatoos,and the clinic has been able to meetits financial obligations. Theincreased volume of patients has beenshifted to weekends to both accom­modate the work schedules of clientsand the traffic pattern of the veterin­ary clinic.

A great deal of this success is due to

several recent advances in medicaltechnology. In particular, the adventof isoflorane gas anesthesia (AeraneT\\by Anaquest) and the fiberopticendoscope. Without these two piecesof equipment, the degree of riskwould be greatly increased, alongwith the additional surgical timenecessary for each patient. We havesuccessfully anesthetized, sexed andrecovered as many as 140 avianpatients per day, without a singlefatality, using this technique. Conver­sations with the Department of Anes­thesiology at U.C.L.A. indicate that anew, injectable anesthesia withreversible potential under the name ofDitomidineT" may be the next step forpatient safety at some point in thefuture, but for the present its use isrestricted by law to portions ofEurope only. Our clinic is lookingfoward to the possibility of addingthis updated technology to our medi­cal assets.

Isoflorane patients typicallyachieve a full anesthesia plane withinapproximately 60 seconds afteradministration is begun, and recoverwithin 60 to 90 seconds to a fullystanding and/or perching positionwith the ability to eat without a post­anesthesia hangover, regurgitation orincoordination, as soon as the birddesires food. This is an immenseimprovement over the prolonged andstormy recovery period seen with thecurrently available injectables such asketamine.

The immediate post-isofloranerecovery period has not produced asingle fatality in over 3,000 sexings todate, although I have been advised ofa few patients expiring two to sevendays after sex analysis has beenperformed. Due to the nature of theanesthesia, and discussions with themanufacturer, I cannot identify anyconclusive link for these deaths to theanesthesia.

I suspect that these patients weretypical of the phenomena of hiddenor occult disease, as is so commonlydocumented in avian practice, andthe mortalities were a result of theirinternal disease conditions. Necrop­sies are always offered in these casesand all of the patients that have beennecropsied were confirmed forhaVing medical conditions that pre­existed the event of the surgicalsexing, or were fed immediately priorto sexing contrary to medical advice.Our clinic acknowledges the pres­ence of the additional stress thatsurgical sexing can potentially placeupon a patient, and in an attempt tofully inform bird owners that this riskdoes exist, our clinic requires that allclients presenting a patient for sexanalysis must read, understand andconsent to a standard ane the iarelease form for the use of isoflorane,which includes the option of post­poning anesthesia until other exten­sive diagnostic testing can be done ata later date.

Given that our clinic is heavilyinvolved with the aviculturist, theobvious cost advantage and the statis­tically low incidence of post-surgicalpatient complication leads me to theconclusion that the criteria for a sur­gical sexing clinic is both reasonableand justified for aviculture. The samecriteria many times will not apply tothe hobbyist, and should not beapplied to a pet bird. Cost concernsshould not be given the same priorityhere. The numbers of pet clientsrequesting surgical sexing alsohappens to be very low so that thisquestion is not frequently presentedto us. I actively discourage sex deter­mination for curiosity's sake despitethe low complication rate, as this is anelective procedure and not to be per­formed casually. Many pet owners arenot fully aware of the details of theprocess when asking and usuallyagree that curiosity does not justifythe answers they are seeking.

I am ardently aware that a balancehas been achieved here between thepotential risk of a diagnostiC proce-

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Tattooing the sex identity ofa caique after surgical sexing, right wingfor male.

dure and that of cost considerationsversus the ultimate in patient safety.Having authored a number of articleson avian anesthesia and patient safety,these factors are not strangers to me.The bottom line analysis still existsfor a majority of commercial avianclients, in that even with the use ofevery possible pre-anesthesia testavailable, I still cannot guarantee thelife of a patient under a generalanesthetic anymore than a humananesthesiologist can, including evenisoflorane. There are situations wheresex determination must be accom­panied with a zero risk factor, as is thecase with very rare or endangeredspecies, or for a valued bird kept formany years by an aviculturist. Inthese instances, owners are urged toconsider other alternatives such asfeather pulp cytological analysis (Le.,Vivagen Corp. of Santa Fe, M) wherethe increase in cost and waitingperiod may well be justified in theopinion of both myself and theowner.

The anesthesiology department atU.C.L.A. has reported to me that thestatistical incidence of anesthesiadeath in human patients is aroundone in 20,000 patients. I believe thatour incidence rate is comparablyfavorable, especially under the finan­cial conditions that veterinary medi­cine must function with, as opposedto the extensive resources that humaninsurance policies provide for.

This is an example of the rule ofmedical epidemiological statistics,where dollars are forced to be com­pared to life. I do not believe that a20-fold increase in cost for pre­anesthetic evaluation can bring about20-fold reduction in the incidence ofpatient mortality for this procedure.The comments I have received fromavian clients support this conclusionvery firmly, as do the experiences ofother avian vets I have spoken withwho are involved in providing thisprogram.

The other side of medical statis­tics is the perceived reality of anaviculturist, which does not gounnoticed in my practice. I was therecipient of a comment several yearsago by an avicultural client whom Ihad assisted for several years. I hadsexed two or three of his birds overtwo year's time under the traditionalformat. Once the surgical sexing clin­ics were initiated, I would routinelysex up to 20 birds at each clinic forthis aviculturist. In amazement, Iasked this aviculturist why he hadn't

18 April/Mayl989

pursued proper mate assignmentyears earlier. He answered, "It justcost too much to do it before;' yet,this same aviculturist was now spend­ing up to 5300 at each clinic asopposed to only 75 during theentire two years prior for the verysame aviary. This demonstrated to methe need to offer aviculturists animmediate benefit, in the form of anincentive, to correctly sex and pairbirds. This is necessary if domesticbreeding programs are ever to have areasonable opportunity to succeed.Proper mate pairing is not a guaranteefor good propagation, but homosex­ually paired birds are certainlyguaranteed to prevent one.

The efforts to make this programavailable for all aviculturists haveproven to be rewarding for both theclinic and our clients. We have experi­enced a substantial increase in ourpediatric case load and have gainedinvaluable insight into the care andmedicine for infants from these addi­tional patient cases. Our long termgoal is to gradually change our workload from a surgical one to that of apediatric discipline. Our patientnumbers for surgical sexing willbecome domestically raised offspringinstead of the imported birds, whichwill soon be less available and thedecreased patient load unable tofinancially support the high techequipment required for this task. Ihave witnessed a strong growth ratein our local bird society as the newbabies find their way into homes ofpeople not previously involved withbirds. This serves to strengthen thesupport of aviculture in the commun­ity and these new converts can act asinvaluable resources when state orlocal governments move to legallyrestrict bird ownership or breedingefforts by private citizens.

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I have found the sexing clinics alsoact as a form of introduction toaviculturists who have been unawareof the other services that an avianveterinarian can provide. A successfulsexing for a new client often leads toa long standing relationship whereother birds benefit from better qualitycare and client education programs.Surgical sexing traditionally has beensought after even by those avicultur­ists who do not realize the extensiveevolution that has occurred withinavian medicine over the past twodecades. I believe avian veterinariansshould utilize this opportunity toassist the uninformed bird ownerwhen it presents itself.

The sexing clinic itself has under­gone some evolution. For reasons ofpracticality, a person outside of theclinic such as a bird club member orbreeder is assigned the task of com­piling a patient schedule. Patients arescheduled every five to ten minuteswith a morning and afternoon breakof thirty minutes to allow for unfore­seen scheduling problems and latearrivals. Clients are requested toarrive alone and to keep their birds inisolated groups in boxes or cages toprevent contact between birds fromdifferent sources. A recent study inthe A.M.A. Journal of pediatric prac­tices about the degree of infectiousdisease spread among children incrowded waiting rooms revealed thefollowing results. For all the infec­tious diseases monitored in childrenboth during and for an extendedperiod of time after the clinic visit,only one virus (measles) showed anypotential for infection. This examplecan only stand as a model, as I knowof no similar studies for avianmedical clinics. However, most of thediseases of children have a compar­able organism (respiratory bacteria,

Quarantine impor·t station holding cages. An increasingly rare sight - banks ofcageshousing singles and pairs ofmacaws.

diarrheal agent, herpes virus, etc.) inavian species. I suspect the actualdegree of contact is substantially lessbetween bird patients than betweenchildren with their natural curiositylevels and busy, probing fingers. Thisstudy compares very closely with ourown experience.

Nine years of avian practice alsosupports our conclusions from apractical experience standpoint.Clients are allowed to watch theprocedure and 1 encourage clients toview the gonads of their birds for tworeason: I firmly believe that a bettereducated client is a better aviculturist,and sharing new knowledge is benefi­cial to us both. The second reason isto eliminate any later misgivingsabout the actual sex of the gonad orits state of health should a breedingprogram suffer a setback in the future,or should a potential buyer question asel1er's information.

A certificate is issued with eachbird, testifying to its sex, with theveterinarian's signature on eachcertificate. A breed registry book isalso maintained with the owner'sname and address, species of bird,sex, estimated level of sexual activity,tattoo markings and/or bird bandnumber, and any special notationsrequired such as unusual markings,health status, etc. This book is veryvaluable should a mate be needed fora particular bird in the future, or if aquestion arises upon purchase of abird that was previously sexed by ourclinic. The client names and numbersare held confidentially in order to

maintain aviary security, unless specifi­cally released by the owner.

Sanitation and disease transmissionhas always been a recurring questionamong our clients and ourselves. Inorder to reduce the risk of passingmicrobial agents between birdgroups, I disinfect the fiber opticequipment and surgical blades in glut­eraldehyde (Wavicide-OP") solution.Sterile, autoclaved gauze is used forfluid removal present on any bird andclean towels are changed betweeneach group of birds to prevent featherdust or fecal contamination fromoccurring. The surgeon's and techni­cian's hands are disinfected withchlorhexidine or alcohol praybetween patient groups. The facemasks and anesthetic hardware is alsocleaned with Wavicide-OF" spraybetween groups. I have not had anypatients returned to me with an infec­tious disease or an internal infectionto date following approximately5,000 sexings. Discussions with threeother avicultural vets with an accu­mulated total of about 40,000 surgicalsexing patients also report the sameresults.

I am pleased to note that two otherveterinary clinics in our practiceradius have begun to offer surgicalsexing clinics as well. I personallybelieve that this increase in servicefor aviculturists and the increasedcontact between avian vets and breed­ers is necessary if we are going tochange the current predictions foraviculture. The requirements foroffering such clinics can be great as

the equipment costs are high, theformat is not one taught in veterinaryschools, and the veterinarian musthave already achieved a certain levelof acceptance with the local avicul­tural community. It is also quitedifferent for most veterinarians topractice a skill in such intimatecontact with clients that is general1yreserved for the strictly off-limits areaof the clinic. Forethought and thor­ough planning is necessary to preventclient congestion and confusion fromturning a sexing clinic into a cauldronof chaos.

1 still find some resistance to thisconcept among a few professionals,although I fail to see the wisdom insuch a position. I fully agree that notal1 veterinarians should attempt thisundertaking, as it requires a high levelof confidence in one's skills andpeople management. Not everyone ismade for riding broncos either, andpersonal preference still counts for agreat deal. This is a specialty serviceand if a veterinary clinic is offeringservice for aviculturists, I think thisone is of great value for its clientele.

1 also believe just as firmly that thisservice probably is not appropriatefor a strictly pet bird clientele whereother priorities present themselves asa reflection of the client's needs. Ithink rather than attempting to assesshow the process is done correctly,each person should consider howthings should be done correctly foryou and the client's birds.

The final evaluation as to whethersurgical sexing clinics are necessaryor not will be long in coming. If thepredictions of the major bird impor­ters and conservationists are accurate,we should see some major trendsemerging in about three years.Hopefully, the aviculturists we areassisting now will have an adequatesupply of replacement stock andproven breeders for trade purposeswhen the traditional commercialsources are largely gone. Consideringthat many doemstically bred psitta­cine species become sexually active ataround three years of age, this givesus just about the right amount of timeto fill an otherwise unmanageabletime gap.

I would rather be in a position tohave an abundance of clients withproven breeders at a time of limitedimport stock and prove myself incor­rect, than to wish I had listened moreclosely to what many veteran avicul­turists have repeated to me moretimes than I can remember. •

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