Gizzard impaction - X-ray confirmed. How to proceed?

Have you tried the Moro carrot soup? It works wonders restoring the gut balance and even catches bacteria resistant to antibiotics.

https://www.backyardchickens.com/threads/ascites-not-eating-scaly-leg-mites.1441960/post-23973664

Other than that, you could still try the rather drastic method of giving her Coca Cola, as it is known to dissolve almost everything. I use it for crop impaction treatment and it works just fine.
It’s so odd that you mention Coca Cola! At the start when I was under the impression it was packed full of grit I ran some experiments on shell grit in citric acid at different concentrations with the amount of grit I guessed would be in her system. I tied the top of the jars off with an elastic band and a glove and waited to see what happened. They produced so much gas - it inflated the glove!! It worked at dissolving the grit though - it became fine and easily crushable after 20 minutes. I was still contemplating giving it a go in hopes she could expel the gas but ultimately decided against it because I did not know how her body would process all the liquid calcium it produced. It also created a plaque around the bottom of the jars that needed to be scraped off so I decided it may do more harm than good for her (probably would give her a heart attack knowing my luck). Great idea though :)
 
Day 10 - oh my gosh it was on today! Little Moe (don’t think I have actually mentioned her name yet lol) got booted out of her pen at dawn before she could eat the bedding and everything overnight looked the same - I was tossing up the idea that euthanasia may be a better way for her to go instead of dragging whatever this is out any longer. I left her in the kitchen area with her egg yolk for breakfast and left to run some errands... I came home to a poop catastrophe! I don’t mind when hospital chickens poop in the kitchen/family area, I developed a very strict disinfecting routine after my last girl that was ill long term but this definitely triggered me. There was poop everywhere - I was gone for all of 30 minutes and she would have gone around 20+ times. Shortly after I got back she started pooping larger volumes, slightly larger than the good one she did last night. These ones had green urates/fluid in them and then her little tail stayed up like she was trying to push out an egg. I did a vent exam and saw that she had prolapsed - so put that back in and felt around for any large object that may be sitting there but found nothing. Her abdomen was also very warm to touch today where it wasn’t yesterday. I put her on painkillers/anti inflammatories for the prolapse and antibiotics for whatever was causing her to be warm. I did a smear of the green watery substance around the large poops thinking an abscess or something had ruptured but found nothing unusual. The day progressed well, she was much more alert and wanted to roam everywhere and was not as slow as she had been. She did keep prolapsing during the morning but it seemed to stop after lunch. Her poops were 60% large and full looking with watery urates and 40% were small and thin like they had been previously. She is still on liquid foods and hand watered electrolyte water. Tonight her gizzard is now much smaller and her abdomen is starting to feel soft to the touch again (where before it was rock hard) so she is expelling. Most poops contain grasses and grit still so once again not all digestive enzymes. Just before I put her to bed she passed this amazing poop - I was so excited I called my daughter in and we did a little happy dance :). She also seems to be regaining function in her crop as it is forming then normal crop shape and holding tension better (where before it was easily manipulated and distended). She is still at risk of sudden death though as she is skin and bone - I would be surprised if she weighted more than 600 grams with all the impactions cleared. That’s pretty much it for today and hopefully tomorrow brings more good news.
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Next update - day 12. She has been a lot more lively and wanting to move around more but does still have the odd period where she fluffs up and stays still for a while. Poops are more ‘normal looking’ although they are a very dark green. I have noticed that to get her pooping she has to be moving so she gets patted a bit when she is staying still so she starts wandering again. The poops still are not as thick as a normal so something is still constricting them. When I look at a poop smear under the microscope it’s clearly all plant material so not too concerning. She is still passing a few urate only droppings but nowhere near as many as she use to. More oocysts were found in larger numbers than I would like on tonight’s smear so she is having another 2 days of baycox starting tonight (I am so sick of battling this - nothing seems to knock it out) her poops are also a little more mucous covered today which makes sense considering. She gained 22 grams over 24 hours which is promising and she is eating and drinking on her own again. Diet is 3 eggs (yolk and white) per day, some mashed pellets, apple mash (won’t eat apple sauce anymore) and anything she finds in the patio when I’m not looking. Her gizzard has retracted further up again today but is still larger than normal (yes I have poked many other chickens to draw comparisons lol) her abdomen is also feeling softer again today but given the weight gain and her problems I can’t rule out fluid. The warmth of the area seems to have faded to normal range today too. Crop massages are backing off as it’s holding a good position and shape (still not fully emptying overnight though) and abdominal massages are only when I am doing my daily checks. She is off the anti inflammatories today as I am worried about organ damage and the prolapses have finished but will resume if they start again. She had multivitamins in her water today for an extra boost. Although she is in hospital she has been visiting the flock daily so they don’t forget about her - today she decided to have a dustbath. That’s pretty much all the news for today :).
 
13. Poor Moe, she’s not doing too good today. Her condition has deteriorated and she is staying still and open beak breathing (no gasping though). I got the stethoscope out and had a listen to her air sacks and fluid is in the abdominal one, you can clearly hear it - the lungs themselves sound good though. Her heart rate is through the roof too - to compensate for the lack of oxygen perhaps? I know nothing about how fast their hearts are meant to beat but it is much faster than the other hens I compared to. I think her little body is starting to give out so the next 24 hours will be important. To be honest I don’t know how she made it this far - I have had hens look off one day end be dead the next, she is on day 13. If I had to guess what is going on with her knowing what I do now (and boy have I done some research other the last couple of weeks) I would say her impacted gizzard and slow doughy crop is secondary to something very sinister. The droppings are still covered with mucous and the high oocyst numbers keep coming back. I did another gram stain and am also wondering if it is necrotic enteritis from CP. I was under the impression the first ones results were bacillus but cannot figure out the cause of the narrow, mucous covered poops besides coccidiosis or that - I guess only a necropsy will tell me for sure. She is still passing plant material in her droppings so the gizzard is still clearing (had no access to grass for a while). As a last ditch attempt to save her I have got her on doxycycline and metronidazole - one for respiratory and the other for possible CP. The combination of drugs in themselves may prove too much for her system though (don’t have many other options - I have had mg in my flock and it doesn’t respond to anything else other than doxy) I researched and found no drug interactions between the two so hopefully they will be ok. Unfortunately I don’t have anything else to offer than that - it’s impossible to get medications here. She still wants to eat and is drinking on her own and is still keen to beat up her broody friend - she’s a little fighter. Unfortunately if I don’t see an improvement over the next couple of days I will have to get her put to sleep - she looked like she was starting to suffer today and I don’t want that for her, but will give her a chance to respond to treatment. She’s being spoilt, fussed over and pampered so may be feeling off, but is happy with her hospital arrangements :). I’m not confident she will make it through the night, but have thought that many times - we will see.
 
13. Poor Moe, she’s not doing too good today. Her condition has deteriorated and she is staying still and open beak breathing (no gasping though). I got the stethoscope out and had a listen to her air sacks and fluid is in the abdominal one, you can clearly hear it - the lungs themselves sound good though. Her heart rate is through the roof too - to compensate for the lack of oxygen perhaps? I know nothing about how fast their hearts are meant to beat but it is much faster than the other hens I compared to. I think her little body is starting to give out so the next 24 hours will be important. To be honest I don’t know how she made it this far - I have had hens look off one day end be dead the next, she is on day 13. If I had to guess what is going on with her knowing what I do now (and boy have I done some research other the last couple of weeks) I would say her impacted gizzard and slow doughy crop is secondary to something very sinister. The droppings are still covered with mucous and the high oocyst numbers keep coming back. I did another gram stain and am also wondering if it is necrotic enteritis from CP. I was under the impression the first ones results were bacillus but cannot figure out the cause of the narrow, mucous covered poops besides coccidiosis or that - I guess only a necropsy will tell me for sure. She is still passing plant material in her droppings so the gizzard is still clearing (had no access to grass for a while). As a last ditch attempt to save her I have got her on doxycycline and metronidazole - one for respiratory and the other for possible CP. The combination of drugs in themselves may prove too much for her system though (don’t have many other options - I have had mg in my flock and it doesn’t respond to anything else other than doxy) I researched and found no drug interactions between the two so hopefully they will be ok. Unfortunately I don’t have anything else to offer than that - it’s impossible to get medications here. She still wants to eat and is drinking on her own and is still keen to beat up her broody friend - she’s a little fighter. Unfortunately if I don’t see an improvement over the next couple of days I will have to get her put to sleep - she looked like she was starting to suffer today and I don’t want that for her, but will give her a chance to respond to treatment. She’s being spoilt, fussed over and pampered so may be feeling off, but is happy with her hospital arrangements :). I’m not confident she will make it through the night, but have thought that many times - we will see.
Her feeling sickly might well be the side effect of all the medication.

Instead of mixing doxycycline and metronidazole you might want to try sulfadimethoxine to get rid of the coccidia and it might even help with some of her other problems (enteric/soft tissue infections).

And try the Moro carrot soup to help with restoring gut balance : https://www.backyardchickens.com/threads/ascites-not-eating-scaly-leg-mites.1441960/post-23973664
 
Day 15. Moe’s still going... somehow. Did a complete turn around the day after my last post and seemed to be having the best day yet, also improved today. Poops are now either solid with a good white cap (though still completely green and full of plant material) or she has the odd poop that is watery urates with a tiny bit of faecal material in it. Air sacks are much better though not 100% - there is still a slight rattle. Breathing is also more normal and nowhere near as laboured as day 13. Her temperature is down to normal ranges (going by feel - thermometer does not get high enough to measure them).
The impactions are improving - the crop is emptying more and more each morning - though there is still an accumulation of grit in there that I can feel (had absolutely no access to any for weeks) so I have started giving her oil again and upping the massages to help things along. The gizzard unfortunately does not seem like as much good news. It is definitely smaller, but has somehow shifted to a more medial position pointing and encroaching towards the vent. Palpating it you can feel that it is bulbous in some areas which could perhaps be abscesses, cancer, etc or just it trying to move into a more normal shape with obstructions present. It was hugely distended so i imagine full recovery (if possible) will be a long process. I also can’t rule out another organ like the liver pushing it in this direction. She will be going back to the vet in a couple of days for another X-ray to see how things are going so hopefully have more information then. She is still on her medications and a liquid diet - she would probably kill for a mealworm right now lol.
 

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