lecture 1 exotics

academy of veterinary zoological medicine technicians

History is very important Exams will take longer Restraint can be complicated Bad information - HUSBANDRY, habitat and diet Bad websites Know the good ones! Stay up on state regs and CE

Summary of Law: No person may possess bears, cougars, or non-human primates as "pets." If you possessed one of these animals prior to the passage of the regulation you are grandfathered in. No person may possess venomous or large constricting snakes (defined as more than 12 feet long) without first obtaining a permit.

On dorsal surface at upper base of the tail Preening stimulates secretion of an oily, fatty substance Bird uses beak to spread the oil throughout its feathers to clean and waterproof them

Grow continuously at the base Disintegrate at their tip Create waxy powder that spreads throughout the rest of the plumage Birds without a uropygial gland have abundant powder down feathers

originates from the wrist and carries the alula feathers (steering feathers)

join with the second and third fingers near the distal end of the wing Help support the primary flight feathers

is a simple surgical that involves removing the end of the wing to render the bird incapable flight permanently.

Ears are located behind and slightly below the eyes Columella: single bone in middle ear External ear is often bordered with auricular feathers

Thin walled, lightly vascularized membranes Paired - cranial thoracic, caudal thoracic, cervical, and abdominal air sacs Unpaired - interclavicular air sac Reservoirs for air Provide warmth and moisture to facilitate diffusion of air through capillaries Aid in thermoregulation Help provide buoyancy

Trachea: cartilaginous rings. Can be long and coiled in few species Syrinx: enlargement of trachea above lungs Muscles, air sacs, and vibrating membranes Vocalization complexity depends on number of muscles present in syrinx

left male right female

Canaries The canary — among the most popular and varied pet birds in the world — is well known for his vocal talents and vibrant color. Canaries are actually finches, and they can be green or yellow, bright orange, or even brown. Still, when folks think of them today, they most often conjure up a brilliantly colored yellow bird, thanks to the Sylvester-outsmarting Tweety Bird. If you want a singer, make sure your new bird is a male — female canaries don't sing. This bird is perfect for beginners who aren't sure they want as much interaction as some other species require. The canary is happy to hang out in a cage and entertain you with beauty and song. In fact, they'd rather not be handled. Because they don't desire handling, the canary is a good children's pet, providing song and beauty and allowing youngsters to observe the wonder of birds close up. Finches The finch is another hands-off bird, a little charmer who embodies the word "vivacious." Finches are flashy, fast moving, and fun to watch, with a lively, constant twittering that's considerably below the decibel level parrots are capable of attaining. Finches do better in a social situation, so plan on buying two or more and giving them a cage with plenty of space to exercise their wings — these birds get around by flying and they don't climb for exercise. Also remember that when they're too crowded, territorial cage battles between cage mates will erupt. And Because they're perfectly content to live without handling, finches make good caged birds for an older child's room.

Budgies (Parakeets) Because of their small price tag and easy availability, budgerigars (or parakeets) are often treated as a throwaway bird — easily purchased, easily disposed of, easily replaced. This deplorable attitude keeps people from valuing these birds for their affectionate personality — some budgies even become very good talkers, albeit with tiny little voices. Colors now reach far beyond the green or blue you remember from the pet department at the dime store. They're usually timid, at first, but budgies can be tamed by gentle, patient handling and can bond closely to their human companions. For a very gentle child, budgies are ideal pets. Choosing a good pet store is important when buying any pet, but especially important for buying budgies. Mass-produced birds are harder to tame because they haven't been socialized, and they're more prone to life-threatening diseases.

Cockatiels are an exceptionally popular bird, and justifiably so. These small parrots are flat-out loving, and they live to snuggle and be petted. If you only recognize the gray bird with orange patches, you may be surprised at how many colors are available, thanks to the work of some energetic breeders. Some cockatiels learn to talk, but many are better at whistling. This bird is another who's a good choice for children as long as they understand the need for careful handling.

Quaker Parakeets Green and silvery Quakers are active and upbeat, and they like to vocalize. Some learn to talk, while others love to whistle. They can all be loving if they're socialized when young and given consistent, respectful handling. Note that these birds are illegal in a handful of states because they are considered a threat to native agriculture. (For information on restrictions where you live, check with your nearest Department of Agriculture or fish and game authorities.) Still, the Quaker is well worth considering if you live in places where they are legal. Poicephalus Parrots and Parrotlets The small African parrots known collectively as poicephalus are an easy-going bunch. Senegals are probably the most common, a handsome little bird with a gray head, green back and wings, and yellow-orange underside. Other species in the group include the Meyer's, Jardine, cape, red belly, and brown head — all known for their small size (a little bigger than a cockatiel) and affectionate personalities. They aren't the best talkers here, but their noise level is pretty low. After they decide you're trustworthy, these birds are especially fond of having their heads and necks scratched — in fact, they beg for it, tipping their heads and leaning over to expose their necks for a good scratch. Don't let the small size of the Parrotlet fool you; these 5-inch dynamos are all parrot — active, inquisitive, loving, and demanding. Apple-green or blue in hue, parrotlets are more quiet than some of their larger relatives, but some do develop the gift of gab.

Pionus Parrots Pionus are sometimes overlooked because they're not as flashy as other parrots. But what they lack in bright colors they make up for with winning personalities. These are slightly larger than the poicephalus, but still small enough to be easy to keep and handle. Their personalities are more sedate, and they're not excessively loud. (Nor are they considered fantastic talkers, although they're certainly capable of learning a few phrases.) The word most connected with the pionus is "sweet," and it fits. And when you're in love with one, you can appreciate the subtle beauty of these birds — the plumage of a healthy pionus has an almost iridescent quality about it. Pyrrhura Conures As pets, you've got about a dozen varieties of conures to choose from. The best bet for new owners is the green-cheeked or maroon-bellied conures, which are both much, much quieter than the more popular sun conure (but then, so are some rock bands). They are affectionate and playful. Some may even grace you with a few acquired phrases.

Amazon Parrots The Amazons are a little bigger and more expensive than many of the other birds on this list, but they're just too darn appealing to leave off it. Amazons are among the best talkers around, especially the yellow-naped species. They are also beautiful, brilliant, and love to clown around. They love to be in the limelight, and they seem to feed off the attention they attract. Some Amazon species are easier to live with than others. For beginners, the lilac-crowns, blue-fronted, red-lored, and white-fronted are good choices. These are less demanding, quieter, and all around are easy to handle. The problem for beginners: Amazons can be too smart. As with any parrot, you need to be sure you're giving your bird lots of structured socialization, a fair share of toys, and plenty of exercise

1. Blue Fronted Amazon Parrots 2. Red Lored Amazon Parrots 3. Orange-Winged Amazon Parrots 4. Yellow-Naped Amazon Parrots 5. Double Yellow Headed Amazon Parrots 6. Lilac-Crowned Amazon Parrots 7. Mealy Amazon Parrots 8. Green Cheeked Amazon Parrots 9. White Fronted (Spectacled) Amazon Parrots

Peach-Faced Lovebirds Peach-faced lovebirds are beautiful, active, and playful. A well-socialized peach-faced can be your best pal for years, if you don't leave him to waste away alone in a cage. When hand-raised and socialized with humans, these little guys love to be handled, carried around in your shirt pocket or on your collar. They're very affectionate, not overly loud, and capable of picking up a few phrases.

Complete Physical Exam Ophtho, Aural, Oral Feather check Abnormal Molting Development Damage or stress bars Ectoparasites Feather loss Body weight (usually in grams) Check Keel for muscle mass, to thin or too fat Fecal testing (Gram stain, direct smear, float) Routine screening bloodwork (CBC, Chemistry Profile) Client education & counseling Behavior Nutrition Husbandry Quarantine (when applicable) Annual veterinary health exam

Large and concave Site of origin of flight muscles In some species, muscles attach to large bony ridge or keel In flightless birds sternum lacks a keel

How much blood can I safely withdraw from a healthy avian patient? 1% of a patients body weight in blood can be safely withdrawn for diagnostic testing. Example: 30g Budgerigar, 0.3mls of blood can be safely withdrawn in a healthy patient. 1kg Blue & Gold Macaw, 10mls of blood can be safely withdrawn. In the larger birds, although you may be able to take 10mls of blood, one should only withdraw the amount needed for testing. Always be sure to gather your required tubes and sampling supplies prior to venipuncture to avoid clotting. What are suitable venipuncture sites in the bird? --Jugluar vein (right is generally larger than the left) --Basilic vein (wing vein) --Medial metatarsal vein (inner distal leg)

Put bird down if getting to stressed Losing grip, panting, eyes close, if you/vet are worried

Wing clipping Owner Choice and some times for safety or medically warranted Finches and canaries are always flighted - these are "watching only" birds that most people don't handle. Other small birds that live in an aviary setting are often also left flighted, including budgies, cockatiels, and lovebirds. Parrots that are "hands on" companions often have their wing feathers clipped so that they can't fly away. Clipping doesn't hurt the bird - only the lower half of 7 to 10 mature flight feathers on the wing are clipped, and these don't have a blood supply or nerve endings - it's like a haircut. However, flying does psychologically benefit a bird, so you can keep a hands-on companion flighted if you're very careful about windows and doors, and you parrot-proof your home, removing all of the dangers that a roaming bird can find. All birds left outside of the cage should be closely supervised. Proper Wing Clipping should be comfortable to the bird and the owner

Quickly stop behavior Use pool noddle Bubble collars Disc collars

Nail and beak trimming Birds need very little actual grooming - they do most of the grooming themselves. They bathe themselves and they preen their feathers into perfection. When people say, "bird grooming," they are referring to clipping the wings, clipping the nails, and conditioning/trimming the beak. A professional should do all of these grooming chores until you know how to do them, with the exception of the beak - only an avian veterinarian should tend to your bird's beak. You can seriously injure the beak if you do something wrong, and the beak is very sensitive. Nail trimming can be traumatic for a bird, especially if it has to be restrained to have it done. Also, the nail has a blood supply, called the "quick," and if you cut into it the nail will bleed. You can stop the bleeding with styptic powder or flour. A really great, non-traumatic way to clip nails is the "sneak up" method. Hold your bird on your hand and talk to him in an animated way to distract him. Then, sneak up on the very tip of one nail and clip it off quickly and then turn around or do something to distract the bird from the fact that you just did that. You can do one nail a day, and in 8 days you'll have all of them done. Remember to only clip the very tip of the nail. Don't try to get too ambitious with this method! A bird's beak can get flaky and overgrown, often due to a poor diet, but sometimes just because the beak is built that way. The beak is made of keratin, the same material as our own nails. An avian vet can "condition" the beak using a file to smooth and shape it, and then oil it to keep it from drying. Don't do this yourself!

Beak trim - be careful with Chipped beaks can cause inappetance

Most are seenon outdoor birds/wildlife Can be treated with Ivermectin Knemidokoptes spp. - inhabits the featherless areas of birds, typically seen in Budgies

Giardia and Trichomonas - Rx Flagyl Coccidian Species - Rx SMZ Nematodes - Rx Praziquantel

Due to items found in and around caging Hard to determine Lead and Zinc are top 2 to test for

You'll often hear that birds hide the signs of illness until it's too late, and the illness is either too far advanced to be cured, or the bird is belly up in the cage. The truth is, if you know your bird really well, you can easily notice the subtle signs of something being "not quite right." Here are some signs of avian illness: Change of attitude. A typically active, playful bird that becomes listless and withdrawn may be feeling ill. Sleeping too much. A change in your bird's sleeping habits can indicate illness, especially if the bird is sleeping on two feet with its feathers fluffed up to keep it warm. Sometimes an ill bird will crouch on the bottom of the cage. Discharge from nares: The nares are your bird's nostrils and are found at the base of the beak. Discharge or bubbles from the beak: This is indicative of a respiratory infection. Clicking from the beak: A clicking sound that happens as your bird breathes indicates air sac mites - these usually occur in finches and canaries. Tail bobbing: A bird whose tail is bobbing (going back and forth) noticeably while at rest usually has labored breathing. Don't mistake this kind of tail bobbing for the kind that accompanies singing or breathing heavy after exercise. Vomiting: Vomiting is different from regurgitating, which is what a bird does when courting another bird (or you!) or to feed young. Vomit usually sticks to the feathers around the face and the chest. Lack of upkeep: An ill bird will usually look unkempt and ratty because it isn't preening as much. Being picked on by cage mates: Birds will pick on other birds that are ill, and may even kill the weakened one. If you notice any of these signs, take your bird to your avian vet right away.

Traveling with your bird is easy if you take some precautions and steps to make it as stress-free as possible. Here are some important travel tips: If you're traveling by air, make sure that you have an airline-approved carrier that will fit under your seat. Do not put your bird into cargo! Call your airline when you book your ticket and ask about their bird policy. Some airlines are no longer accepting birds in the cabin, so don't get stuck at the airport! Book your bird onto the flight when you make your reservation. Most airlines have limit on how many pets they take per flight, so make sure that your bird has its flying papers. Make sure that you take your bird's health certificate with you. You will not be allowed on the plane without it. If you're traveling by car, your bird should always be in a carrier. If you can't get the safety belt around the carrier, use bungee cords to secure it to the seat. It's very dangerous to allow your bird to ride freely in the car. If you have to leave the car, always take your bird with you - the car may become overheated, or a thief may spot your bird and steal it. Birds are not allowed on Amtrak, but they are allowed on some local trains - call to be sure and always have your bird in a carrier. The same applies for busses. In case of an emergency, write your bird's name and species, your phone number, and your veterinarian's phone number in permanent ink on the bird's carrier, and draw an arrow on each side to indicate which way is "up." Most birds are fairly calm inside the carrier, but some may panic. If you have a panicky bird, line the entire carrier with soft towels to avoid any injury from thrashing. Line the carrier with paper towels. Put your bird's favorite food inside the carrier along with a shallow dish of water or a water bottle (if your bird knows how to use one). Or, you can include a dish of cut fruit, like apples and oranges, so that your bird can get moisture from them. If the trip is long, check on his water often to make sure that it hasn't spilled. It's a good idea to clip your bird's wing feathers before the trip in case the carrier opens

It's a tragic moment for any bird keeper to watch a beloved bird fly away - and it happens quite often. Flying away isn't just a result of not having the wing feathers properly clipped. It's also a result of a carelessly opened window or door, and sometimes it's a matter of misjudging the bird, thinking that it will always stay on your shoulder, or that its wing feathers haven't grown in yet. Here's what to do if your bird flies away: Try to keep an eye on the bird and call for it to come down from wherever it has perched, usually a tree or other high spot. If you can, call someone to come outside and bring you the bird's food container, or something else the bird likes. If you have to get it yourself, move quickly. Try to call the bird down using the food. If that doesn't work (and most of the time it doesn't because the bird is scared or distracted), go inside quickly and get the bird's cage, or any cage, and the bird's friend (another bird) if it has one. The other bird will call to its friend to come back. Prop the empty cage door open and put food and water inside, then sit back a few feet (maybe out of sight) and wait for the bird to come back. If it does, rush over and shut the door. If your bird is friendly, try climbing a ladder as close to it as possible and lure it down with food. If you can't get your bird to come down, wait until nighttime when the bird will have to find a roost. If you know where the bird is when darkness falls, then you can use a ladder to reach him - grab him very quickly or use a net so that he doesn't go flying off into the darkness. If your bird has flown out of sight, get in your car and drive around looking for it. Do anything possible to locate it in the daylight hours. If you can't find your bird, immediately call all of the local animal shelters, veterinary offices, and pet stores and inform them about your lost bird. Someone may find your bird and take it to one of these places. Make up flyers with your bird's photo, a brief description of your bird, and offer a reward (but don't say how much the reward is). Post the flyers in high traffic areas within a 10-mile radius of where the bird was lost. As a preventative measure, if your bird can talk, try to teach it your phone number - it's a long shot, but it may help to bring the bird home if it is lost. You can also make a recording of your bird's vocalizations and play it outside if your bird is lost - the sound may bring it back. Make sure that your larger bird is micro chipped and that the chip's number is registered in a database.

Seeds vs pelleted diet-seeded diet best for smaller birds Peanuts..or no peanuts ( can be fatty) Fruit, Veggies, whatever you are eating NO Avocado or Chocolate-TOXIC

Proper Caging Proper perches Proper Substrate

Common household dangers Birds are sensitive creatures that are prone to injury or illness from common household items. Things we don't often see as dangerous can be deadly for birds. Here are a few: Standing water. Birds have been found drowned in water glasses and even dog bowls. Keep toilet lids down, Jacuzzi tubs and fish tanks/bowls covered, and don't let dishes soak in the sink while your bird is out of its cage. Ceiling fans: Take down your ceiling fans or make absolutely sure that they're off when your bird is out of the cage. You may think that he can't fly that high, but you'd be surprised! Lead: Stained glass, fishing weights, and old, chipping paint contains lead, which is as deadly for your bird as it is for you. Keep these items far from your bird's reach. Scented candles, potpourri, and air fresheners: Anything that scents the air using chemicals is very dangerous for your bird. You can get the same effect by boiling cinnamon sticks and scented teas - just don't leave them on the stove when your bird is loose! Nonstick surfaces: Nonstick surfaces found in cookware, space heaters, popcorn makers, and various other appliances, emit toxic fumes when heated that actually kill birds without warning. Hot pots and pans: A pot full of boiling water might look like a great bathing spot for your bird - very bad! And worse, the pot may be full of hot oil or sauce. Keep your bird away from the kitchen when you're cooking. Glass and mirrors: A flighted bird may think that clean glass and mirrors are empty space and can be seriously injured or killed by flying into them. Sticker your glass and mirrors, or keep them dirty! Open windows and doors: Many birds fly away and are never recovered. Keep your window screens intact and be careful when you go in and out of the house. Wires: Wrap and put away all wires - your bird may become curious and chew on them. New carpeting: New carpet emits fumes that are deadly to birds

Occasionally, an "incident" will happen that doesn't necessarily require an immediate trip to the veterinarian, or perhaps your vet is closed when you have a problem and have to deal with it yourself. Here are three problems that can befall companion birds: Fumes: Sometimes you are unaware of fumes in the air, but may notice your bird acting strangely - perhaps you're using your fireplace for the first time that season (in which case the bird should be out of the room!). The bird may become woozy, have a seizure, or even lose consciousness. Remove the bird from the area immediately and ventilate the room. Removing the bird from the source of the fumes may be enough to bring him around. If not, take him to the avian vet immediately. Oil on the feathers. It happens sometimes that birds will accidentally get into household oil, which is actually incredibly hazardous because oil prevents the feathers from insulating the bird. If your bird does get into oil, the first thing to do is dust him thoroughly with baking flour and then gently wipe it off. Next, fill a bowl or the sink with enough lukewarm water to cover him up to the neck, and add some grease fighting dish soap - just enough to make the water sudsy. Dunk the bird and very gently rub the feathers - do not dunk its head! Then dry the bird with paper towels and put it in a warm place to continue drying. Hopefully these two steps should be enough to remove the majority of oil on the feathers - if not, seek professional medical help. Birds can overheat easily if left in a hot area or put into the sun without a shady spot where it can retreat. An overheating bird will pant with its beak open and hold its wings slightly away from its body, and will be standing on two feet. Take the bird to a cool area right away and mist it with cool water. Place a few drops of cool water into its beak (without distressing it further). Watch to make sure that the bird regains its normal activity.

Avian Polyomavirus (Papovavirus, Budgerigar fledgling disease, Psittacine polyomavirus) Avian polyomavirus (AVP) primarily affects young birds. It is a primary infectious cause of nestling psittacine mortality, especially in mixed collections and open aviaries. The typical presentation is a well-fleshed juvenile, just prior to fledgling age, with acute onset of lethargy, crop stasis, and death within 24-48 hr. Subcutaneous hemorrhages are often noted when injections are administered. Asymptomatic adults may be carriers. Gross necropsy : pale skeletal musculature and subcutaneous ecchymotic hemorrhages,kidneys and liver are enlarged and may be pale, congested, and mottled, or have pinpoint, white foci, petechial or ecchymotic hemorrhages may also be present on viscera, particularly the heart which may be enlarged and may show hydropericardium. Aviary control methods include avoiding the housing of budgerigars or lovebirds on premises where other species are bred, adhering to standard hygiene procedures, preventing access to the nursery by visitors, and not introducing birds into the aviary without 90 days quarantine and testing. Testing: involves collection of cloacal and choanal swabs for PCR testing for viral shedding and blood for virus-neutralizing antibody to identify birds with previous viral exposure. Vaccine: For breeding birds, 2 doses of the vaccine are administered at a 2-wk interval; this should be done off-season. The manufacturer recommends administration of the first dose to neonates when the chick is ;35 days of age, with a booster vaccination in 2-3 wk.

How do I triage a bird emergency? Do not touch the bird! Be calm and quiet, as the less panicked you are, the less stress the patient (and the owner) will feel. Escort owners and pet to quiet exam room, if not already done. Observe the bird for obvious signs of respiratory distress: i. Open beak pantingii. Tail bobbing/pumpingiii. Wide leg stance If bird is in respiratory distress, inform the veterinarian and request permission from them and the owner to place the bird in oxygen before any handling. Ideally, keep the bird in it's travel carrier and put it into an oxygen chamber without handling the bird. If the bird is bleeding, try to assess where the blood is coming from without handling the bird. Inform the veterinarian and obtain appropriate cautery tools which the veterinarian may need to stop the bleeding: Electrocautery, styptic powder, gauze, silver nitrate sticks, or even some suture material and a laceration pack. Be prepared! Obtain a brief history from the client. Some questions may help the veterinarian before they are able to get in the room: How long have they noticed the problem, have they seen any bleeding, irregular feces, regurgitating/vomiting, seizures? Inform the veterinarian of your observations and history.

Some hens (female birds) will lay eggs with or without a mate present, and some will even lay them without a nest present. Cockatiels and lovebirds are notorious for this behavior. Seeing an egg on the bottom of the cage can be distressing for a bird's guardian. What do you do about the egg? It seems cruel to take it away, but actually, if the egg is infertile (which it is if there's no male present, and often even if there is a male present), then it's not so nice to allow the bird to sit on the egg for weeks in attempt to hatch it. Also, the presence of one egg will prompt the bird to lay others to create a "clutch." You can allow the "mom" to sit on it for a few days, but then you should remove the egg and all traces of a nest that she may have tried to build. Egg laying is a perfectly normal behavior, but it's not to be encouraged simply because it takes a large toll on the body. Eggs leach calcium from the bones, and egg-laying hens need a lot more nutrition - especially calcium and protein - than non-laying hens. You can discourage egg-laying by decreasing the amount of light your bird gets a day to less than 12 hours and by removing all "nesting" material, including paper. To stop egg laying: Move bird Make sure they have toys Supplements Implant

Sometimes, if a bird isn't in her prime or if she has recently had too many eggs, she can become "egg bound." This is when an egg is stuck inside of her, usually because it is malformed, soft, or because she's too weak to pass it. You may notice that her abdomen is distended and that she's on the bottom of the cage, fluffed up and possibly distressed. Her droppings may be large and watery, or she may not have droppings at all. Egg binding is a potentially deadly condition that requires immediate veterinary care. If you can't get her to the vet right away, place her in a warm hospital cage and give her two drops of olive oil in her beak and several drops in her vent (where the egg comes out). Be very gentle and be careful not to aspirate (choke) her with the oil. The oil may lubricate the egg and allow it to pass - heat is also critical to this process, so make sure that the hospital cage is around 98 to 99 degrees Fahrenheit, and that it's well ventilated. Moisture is important too, so place a dish of water in the hospital cage as well. Keep an eye on her to make sure she's okay, but don't disturb her too much. Give her a chance to pass the egg.

Feather mites and other external parasites can chew and consume parts of the feather vanes Daily wear and tear: lighter tips of flight and tail feathers can be worn off Fault bar (stress bar): weakened area on the feather vane where barbs lack barbules Results from stress that interrupts blood flow during feather growth Common stressor: poor diet

Process of feather replacement Occurs once to several times a year, depending on species In most species, feather replacement is symmetrical One or two pairs of flight feathers molted at a time Many species of waterfowl molt all flight feathers at once after the breeding season

red tail feathers, grey main feathers

typically green main feathers with multi-colored feathers depending on type of amazon

small solid colored birds

usually has a long feather on top of head

white feathers, but head feather lift up and will have colorful feathers on top

multi-colored

remember the beak is almost a triangle

comes in a variety of colors blue and gold and scarlet

has a peach face

has a masked face

remember mindy at all pets

notice the ring around the neck

mostly red

multi-colored

30 or more minutes

8500 species of birds and 29 orders of birds

Psittaciformes (parrots) and Passeriformes (canaries and finches)

1-10 are the primary feathers and the 10th feather is the last feather on the wing

PTFE fumes from teflon pans

a healthy bird can lose up to 10% of its blood volume ( or 1% of BW body weight)

most sick birds are 5% to 10% severely dehydrated is ;10%

depression, reduced skin elasticity over digits, sunken eyes, cool digits, and decreased refill time of the basilic (cutaneous ulnar) vein