OK, so really what are we talking about with gut stasis. Essentially reduction or absence of faecal palates, which sounds fairly obvious really, but that's what we're, we're kind of doing with rabbits. Some people refer to this as a bloat, and it's not a special form of gut stasis or part and parcel of the same syndrome, really.
I hopefully get To me, when I've I've been listening to talks on this and and been taking CPD, I've understood it best when I've thought about this as colic and having vowed when I qualified never to do horsework, I found myself working extensively now with mini horses, both in terms of dentistry. And now I find in terms of of their, of their gut problems, and it's very much like a colic. It is very much like the decision making often between surgical and medical colleagues, and we'll go through that through this webinar.
So, the big thing is the rabbit's gut, which is horrendously complicated, and well worth having a revision on, at, at length, with a textbook and a large glass of wine. But it's really pretty complicated, but that is probably the root of why they have so many gut problems because of the way they do these things. The proximal testing is the easy bit, and this functions very much in a dog or a cat.
Similar action mechanism of action motility, similar influences on what makes it move. Food stays in the stomach 6 to 8 hours, then comes through. One just dogs and cats are not discreet eaters eat continuously.
So stomach has food in it all the time and it releases slowly all the time as well. This turns over. And if you have nothing going in, you tend to have nothing going out.
So obviously you starve rabbit, there'll be nothing coming through the gut. The small intestine is again pretty quick, just like in carnivores, 4 to 8, 80 minute transit time. And this is the area that's not really responsible for setting the overall gut the gut speed.
So the whole time within the gut. The big area for that is, of course, the large intestine, and the proximal colon with the secu is redesigned for the mixing and separating a fibre, etc. And it has different motilities, different speeds, if it's producing the see trope or it's producing the undigestible palate and heavy cycles of action to do that.
And pretty complicated, we probably do the whole webinar on that if we really put our minds to it. Has 3, parts to it, as, as on the slide here, and this illustration one of Nigel Harcourt Brown's, pictures, . But the important part we're gonna be talking about is the fuss coli part before it enters the distal colon.
And the fus coli is what really sets the motility. This is the pacemaker for the gut. There is some effect of fibre on the ileocholic valves on the entry to this area, but the big, big thing is the fuss coli, really highly innovated, very rich blood supply, and alters it's also rated the large intestine between production of hard and soft faeces.
So it sets the phases, it sets the whole, whole tone of things. It is influenced by hormones. Prostaglandins, aldosterone particularly.
And this is a leading to what can cause these gut stasis problems. So prostaglandins, we know inflammatory conditions can do this. We, we know that things like stress and stuff will have effects on the man prostaglandins floating around.
Aldosterone, we know some minerocorticoid. This is going to be affected by electrolyte, concentrations. Therefore, it's gonna be affected by hydration.
It's going to be affected by overall health things. This is one reason why we're very, very common time to get a gut status outbreak, if you like, if you have a sudden hot spell or a sudden very cold spell. And very often 2 or 3 days later, we'll see an influx of cases.
Winter snow is a big one. Simply because you've got rabbits who have Or to their feeding, or to their drinking, and therefore have an altered hydration status, and as such are are going to have altered minimal corticoid levels and that can affect the gut. So the gut set by all sorts of things here.
So dietary intake, yeah, fibre levels to some extent, yeah, but not so much. But big ones being systemic effects of hormones, metabolites, hydration status. That's a big deal.
So we deal with gut, we're not just looking at the gut problem. We're looking at a whole rabbit problem. Let's take back this phrase of holistic medicine.
This is what applies to all medicine. So what causes gastasis? Let's look a bit more about this so that helps us if we know what caused it, we know a little bit more about curing it as well.
We're gonna look at chronic versus acute cases and most of the time we're gonna be talking about acute cases today. So brief info about chronic ones. These are the ones we grew at chronic ones about the periodic colics, and rabbits who just occasionally have these problems, and, you know, keep coming back and getting into another like episode of problems that sometimes associated moults and stuff, but they've just got these, you know, they may have small pellets, reduced pellets, they may have a secotrope problems, they fail to take the yo trope, but really this chronic grumbling, malfunctioning gut.
So what causes, these, well again, diet influence there to fibre and stuff. The big deal is pain. This is what's gonna affect the pros.
It can affect the, the, the, the way the guts move in there. So spinal pain, dental pain, ear pain, orthopaedic pain, abdominal pain. So you can look for the source of pain in these, and these can be effects on acute, phases, but for chronic ones, we're really looking at what is hurting that rabbit and what's making his gut malfunction there too.
We may well have dental issues as well, and this could also be things not just about root pain, but about things like hooks and stuff, and a failure to prehend properly. So let's go back to acute ones. So that's really what we've got time to deal with today.
OK. Again, we may have painful cases again too, maybe sudden onset. Again, we may have relapsing acute.
I'm talking about chronic case, we have periodic colics and things, but the acute ones may be a relapsing acute, acute condition too. And of course, we have surgical cases too with obstructions on foreign bodies and things. Again, diet may play a role with that too, where they stop feeding or changes and things like that can affect too.
A lot of people will say about about feeding grass, and that can, and that will induce things. Again, probably much lot of fallacy there, but like all things, if you suddenly change diet, if you give a very rich diet or something along those lines, you are going to affect the gut, you are going to affect the whole rabbit that way. Just as you would if you, if you really really sort of like heifers or whatever else onto spring grass, you can get these untoward effects.
So you can rabbits too if you suddenly give a load of stuff they're not used to. So changes should be gradual. Climate, as far as mentioned before, sudden hot spells, and cold spells can, can do things.
Husbandry change as well. Again, stress, you know, rabbits are very easily stressed. And I'm talking to this week about, you know, about stress things.
Oh, my rabbit's really, really chilled, he's really relaxed. They're not. They're kind of stressed up.
They're prey species. They, they may look quite, quite relaxed, but rabbits looking stressed, and rabbits not looking stressed look remarkably similar to us. And so moving a hutch around, putting in a strange place there, putting the cat next to it, all those things will.
Stress them in ways you may not realise and it's amazing how often you get a gutta episode after saying it seems quite minor. Stress is the deal. Al was think stress.
But foreign bodies happen too, and this is the art of dealing with the acute case is have you got one of these medical colleagues or have you got a surgical one that requires you to intervene quite quickly? Cause foreign body gut stasis is an emergency. So how do you distinguish these non-obstructive from partially obstructive, if you like, colleagues?
Can you use, clinical appearance, can use diagnostic investigations. Are they any help? OK, let's start with history.
OK. Technically, it should be an acute versus chronic onset. The medical one should be much more chronic.
The gut the foreign bodies should be pretty acute. There should be a different degree of anorexia. The the foreign body should be much more severe.
They should be much more anorexia, if you like. Again, the, the, the, the, medical ones should have at least bit of appetite and should gradually die away, whereas the foreign bodies are very, very acute indeed. Faecal output 2 for body should just stop, medical colleagues should, should die off gradually, should happen.
Will people have noticed, and that's the problem. There are a lot of rabbits there who really are not observed 24/7. Our owners may be absent, the rabbit may be in a place where it can't be observed.
And that's really. Meaning those histories that almost all of them present acutely. Very rarely do you get that intimation of of any chronicity at all.
So history doesn't always helped with that. And the other factor too is a lot of rabbits live with other rabbits. We tell people to have them together, and we all know from hospitalising rabbits together, it's really, really hard to tell which one is producing the pellet.
And and have we really got both the rabbits or whatever, producing the right number of pellets? That's difficult. Now, the longer you live with them, the easier it is to tell what you should have each day, but it's quite difficult to then notice, is that a chronic onset or an acute onset.
And above all, rabbits don't always read textbooks. So therefore, they, they, they ought to know how they should present with a different type of colic, but they don't always. And not all foreign bodies will present so acutely and not all medical ones will present so chronically.
And again, situations change. And we'll see a situation where we have like small bits of fur coming out of the stomach, where we almost have like partial foreign bodies that clear and then stick again, clear and stick. So you may have like an acute relapsing within the same day.
So, you know, maybe you're OK with one minute, not OK the next, and that can really alter things too. So, the history. Above all, remember houses Maxim, everybody lies.
You need to know about signalling that's useful. Time is useful too, diet's useful. Previous problems is a relapsing or has it pro problems before is great.
Again, what diets changed recently. Above all, all these things can be summed up as have we seen this before? And have, you know, Has anything changed recently?
Moulting another thing too, long head rabbits, again, that can be not the cause of it the stasis, but certainly a factor in in producing a foreign body and things like that too. And again, knowing the local weather patterns is quite useful too. And if somebody's came to you a long way away, you actually have to ask them this too.
When in doubt, always talked to kids, . Sometimes they're the ones who, who know more and if you have a 7 year old who's desperately trying to get mum to pay to, to, to let them speak, something's worth listening to them as well because you know one or two little details that mum may not want to be revealed. So when you get an examination again, can we distinguish just by examining, which is what we really want to do as clinicians?
OK, well, basically they all look the same unless they really collapse, that's the big deal. It referred to Americans as bunny brick, I personally prefer calling rabbit rocks, for various reasons. .
They're often very still, they're very quiet, they don't move. They have this tense and large abdomen. Some people use gut sounds.
I must, I don't find that very useful and lots of normal rabbits. I don't hear much in way of gut sounds, but an absence of gut sounds can be a factor in this, if you work out what's an absence from. Whatever you do when you examine, whatever rights and wrongs are turning upside down to examine, don't do it with these ones, because that's when you could start flipping gas field this guy around.
And I personally, I wouldn't do that. OK, body temperature is also used, we'll touch on that in a moment as a prognostic aid, and that can be quite useful one here too. So can you identify the bad ones on examination?
Well, the answer is not really. The bad ones do look very bad. The good ones, can also look bad too.
What is very bad is things like temperature being less than 92 °F. Sorry, an old fashioned boy, I like Fahrenheit. .
If you got sinus or respiratory patterns to pressure on, on the lungs, if you got really tended gassy viscous on palpation, be very delicate with that too, or we start getting distressed and you handle them. Those are really, really bad signs. And so temperature less than 92, the prognosis almost extremely guarded to hopeless.
So in these cases, discuss the outlook. If you've got a really bad one, discuss the outlook we own it, let make decisions for you. Do give them oxygen, and always, if possible, radiograph before you go any further.
So you want to know whether you've got like in this case you've got your gassy viscouss being with stomach or in this case your gassy viscous being with secu, it does make a difference. Because you can decompress. And you can do that with a needle.
You can do that with the stomach. You cannot do that with a sea cum. Whatever you do, don't put a needle in a sea cum, it doesn't like it, and you tend to get all kinds of problems there too.
You can in those cases deflate with a tube and you've got a really collapsed rabbit do it conscious, otherwise recommend you anaesthetize or sedate. You introduce a lubricated red rubber tube into either the stomach or into the vent. And then you, once you've passed it to a place where it needs to be pre-measure it where it needs to go, either a see or into the stomach, then you can gently massage and deflate that organ.
Once you've got some gas out, you can choose some warm saline and wash it through. They also insert drugs whether they be prokinetics, probiotics, antibiotics, absorbents, that type of thing, which we'll discuss later on. That can be a good emergency procedure, usually when desperate.
Don't do this blind. Otherwise you are saying, do I feel lucky today? Because if you put in the wrong end, you're gonna have a problem.
If you don't know how extensive the gas is, you're gonna have a problem. If you put a needle in blind, you really don't know what you're putting that needle into. You can only do that in the stomach.
So always, always X-ray if we do anything like that. OK, you can also take a blood sample. And the things we always measure a PCV obvious reason again, hemo concentration, that type of thing.
Blood smear can be quite useful those this situation. You've got a very anaemic rabbit. Nicely your ear creatinine, see how the kidneys are bearing up under the strain, often get raised your ear creatinine can be quite insensitive, it can be useful.
We're checking electrolytes, reason stated before, and of course these rabbits are gonna have veryal electrolytes in situations, and we measure glucose, and glucose in every situation. So why do we do that? Rabbits do get stress hyperglycemia.
The more severe the gut problem, the more the pain. The more the pain, the more the stress, and therefore the more stress, the higher the glucose. In other words, your glucose is a good measure of the severity of the gut problem.
And the higher it is, the more likely to be obstructive colic. So it's a prognostic and a diagnostic indicator in one go, which is always useful, we like those. OK, so what levels do we use?
Well, you do get some very low, and these are cases with chronic malnutrition cases. In the average one or slightly raised, you're looking at normal or averagely stressed rabbits. Once you've got 1520, then we're monitoring those, we're kind of see what's happening because it could go either way.
2025 these are probably surgical, could be medical, over 25, basically those are usually surgical. There are exceptions, and there definitely are exception this one too. And you've got to take these into account with respect to rabbit's character.
So for example, we had a very stressed up rabbit the other day, which was actually flying around and not wanting handling at all. It looked almost too well to be an obstructive colic. And it had a glucose about 35.
Now, normally that would say that goes along with obstructive. We gave it some anxiolytic and within about half an hour, that was down to about 15. So it can be affected by other factors too.
So never ever take any parameter as the only thing you use. But you can use this as, as a, as a guide, so as a tiebreaker you're not sure whether it's surgical or not. This is a good one to be using just check things out on.
It's very easy to monitor. And that's a big deal. If you're not sure, reassess it.
Take another blood glucose in half an hour. Take another in 1 hour's time. If you give the drugs, reassess that glucose.
It's so easy to do, it's not expensive. You can do that quite simply. It's not sufficient on its own.
As I said, there are exceptions. There are reasons why saying it's really high, maybe a high be falsely high. There's sometimes times when, when the glucose is falsely low.
So like any parameter, it's not the B or end or it's not the only thing you can be using. We'll go on to this moment. The next deal is once you're sort of fairly hopeful that this is not going to be an obstructive colic, you need to make that rabbit feel better.
So we can talk about hospitalisation needs of things destressing rabbits probably them for another day. Axiolytics are probably the mainstay what I use. These rabbits are really scared, their abdomen hurts.
They don't, . The, the, the, the more the abdomen hurts, the more stress they get, more friendly, the worse the problem gets, it's the vicious circle. Antics really help.
We use a lot of midazolam in these cases, 0.25 me per cake as needed, and we find that really helps a lot. You want to get some fluids into these.
Now, What type of fluid hopefully is going to be decided by the electrolyte measurements. You put fluid subcutaneous, intravenous intrasseous depending on needs, depending on, on, on, on the severity of the problem at that stage, and the rabbit can tolerate intervention. I mentioned rocius, I prefer prefer this in many cases to intravenous, particularly for dwarf rabbits, which I find absolutely hellish to get an intravenous catheter into.
We use a proximal femur, and you do need a syringe pump for this. But it's like putting fluid into a hard walled vein, using circulation very quickly, and it's a very easy place and very easy to maintain. This next slice of cheat, this is clearly a ferret, I'm afraid, but the anatomy is roughly the same.
And we're looking here, this is the ileum here and the crane land of ileum, and it's the point of the issuum back here, and this is the, proximal femur. And the needle is entering basically, Into the femur through the greatest sort of behind the greater recanter. And it's very, very easy place.
You can do a contra, you put a lab of local in there, and you basically to hold the femur and just, just screw the needle into it. Stan hypodermic needle as you can see, you feel it crunchy goes and then you can feel the, the, the, the needle with within the femur, and then you can touch your syringe pump. OK.
In the very collapsed animal, the other thing I do apart from temperature is also to measure blood pressure, just the same with sort of cats and stuff. And if it's under 90, then we'll start trying to use colloid. Now, accepting it it's very hard to get hold of colloids at the moment.
And for this, if you haven't got a colloid available, then use high dose of crystalloid. But really as you would in in sort of a shocked dog or cat. It is worth when you're doing either collage or high or high rate crystalloids of assessing the blood pressure every 30 minutes and basically you reduce the speed of crystalloid or stop the colloid when the blood pressure is restored.
And that way you can avoid circulatory overload, which can, is quite easy to do in a rabbit. We also give analgesia. I tend to use non-steroidals, but you got to be a little bit careful renal function, hence the reason you're measuring your creatinine if you can.
Sometimes you might have gastric ulceration being a feature of a gut problem too. So sometimes you might want to combine with coating agents occasionally. And we may use opiates depending on the severity of things.
If you're using the dazolam, sometimes get sedation, and that can be something we want to avoid. So part of decision making is again how where the rabbit is. We will radiograph as soon as practicable.
If we haven't already done it in the initial collapse stage, we want to decompress, we'll do this as soon as we can. Major on sedation tend to do it consciously all possible, . We might use a little bit of Siva flu rain sometimes, but normally we're trying to use a quick conscious view.
Always do a DV and if we're able to tolerate it, we'll do a lateral as well, if at all possible. And we're looking to see really what the gas patterns are inside there. So fairly normal type of thing here, we're looking for lots of little bits of gas all the way through the gut.
And again, here as well, we can see we've got, we've got a very large stomach. We've got lots of little bits of gas through there. Again, this is fairly normal medical colic type of picture.
Doesn't have to be a beautiful view. It just has to be good enough to see those gas patterns. And the DV view of the same rabbit, again, we can see these bits of gas all the way through large and small intestine.
And can see this mixing the gas in with the stomach contents is like a mottled pattern. Something a bit confusing too. Here we got gas building up in this large straight thing down the right side is the duodenum.
It's quite important to see. And this could be forgiven being mistaken for a foreign body. Got gas and the pyloris, we've got gas coming through the duodenum here, but we have got this mottling through the rest of small intestines.
We have got passage stuff through there, and that would tend to move us away from that. This is a case where, again, the lateral view, saying it shows similar sort of picture to. This is a case where we would be using the glucose to help guide us with, is this surgical, is this not?
I see from this case is somewhere about 18, 19-ish. So again, we'll be thinking that's probably not a surgical case. So we see calcified stuff there too.
This is obviously sludging in the bladder. Another sign of an underlying pain source again. So again, we may be looking at chronic onset with this type of thing.
This is a renolith. Again, another clue that we might well have, a chronic pain sources, and that might be again a factor in, in assessing whether it's a medical thing or likely surgical thing. This case it was a more interesting one.
This is actually a lipoma the cancer and we had 2 or 3 of these now, and they seem to be forming, in castrated rabbits on the end of the, tunic, on the end of the blood vessels. And it gets very pedunculated, lipoma. And both the cases we've seen it now, so 3 cases seen now too, we, we had these presenting as relapsing colics.
And what seems to happen is that the, pedunculated mass seems to get wrapped around the gut and affected that way. And when we've calmed them down and gone and removed these lumps, we've actually found everything sorted out and we don't have relapses again. This is a weird case that a rabbit was eating some concrete, again.
Showing this rabbit's got all eating and stuff and again a factor in getting this massive aus forming. And so this is a big question. I obstruction, really.
Again, you know, the clue you've got too, although the stomach is very large. We've got a lot of gas in there in strange places, is obstructed, almost certainly not because whatever's causing it has gone through. This is a sum blown up.
They say it's gone through the secu, and that's dilated, it almost can't be obstructed because that's, it's got that far. It's now the big stuff. Again, side view of that, just looks spectacular.
But again, this is saying we're looking at overall Ilias we've got the cica large, you've got small intestine enlarged, you've got stomach enlarged, so the whole gutter stopped working. Same again too, more spectacular again. Again, this is one way you're X-raying before you put needles in things.
If nothing else, well, I probably wouldn't put a needle on decompress from both ends with the tube for simple reason. You've got, you've got seecum overlying stomach, really hard to access them without damaging the scum. Again, you see why was respiratory stress, you see the compression of the lung fields, hardly lung space available one does seem a little bit of cardiogaly as well.
So this is rabbit in deep, deep trouble. Another case, sort of similar, where we've got enlarged stomach and enlarged secu again a sort of full blown gut aus. We do DBs is more standard, what you're gonna do when you sort of emerge situations put the rabbit on a plate and things again, here we go, got a nice, large intestinal problem.
This really is point out. This is not an obstruction. You know, this is a, a, a medical colleague case too.
This is a case of the stomach enlarged. In this case, again, almost certainly medical, you've got just a big pocket of gas rather than the picture you get with, with an obstructive situation. And again, very little gas and through in small intestine, what is is modelled around.
So what are surgical indication? What is a surgical case look like on X-ray? Well, this is one of them, and this thing here is the duodenum when he gets large straight piece of gut, and that's all very dilate indeed.
These are the ones you have really thinking of obstruction. From the dorsoventral view again, we see down the right side here, like the pre when I showed previously with the in with the inflated pyloris. This is a typical surgical presentation.
Similarly here too, we've got gas in the stomach and the gas is forming this ring, this halo around the contents running so model through its halo forming around there. And again, this is where we're looking at obstruction. This case was it was a pyloric foreign body.
And again, side view, we can see that halo much more clearly. And OK, well we got some gas coming through to the large intestine, this is, is, is, is the pyloric foreign body. This is where we're looking at things like abdominal disaster.
First it was a hazing through the gut, not just movement blur. We're getting fluid, free fluid, but also we look at the gas here, it's outside of the stomach. And what this is showing is we have, we have actually have rupture.
In this case, again, a micro rupture in the pyloric region. Very, very, very poor prognosis. Now, what you can do if you suspect such a situation is abdominal wash, and this can be quite useful.
And can you sedate the animal, you have a dorsal recumbency, very carefully rotating in case anything like the worst happens. We'll insert warm saline at 150 mL per kg into the caudal abdominal quadrants like we're doing in intraslamic or into into abdominal fluids, and then we'll rock gently and mix that fluid around a bit, and then we'll remove a small portion of cytology. Very quick, very easy, and gives you some clue what's going on there.
This is the case that we had in the last few months. You see the acitic fluid, you see the sort of haze through here, and then this came back as showing sort of plant material and quite a grotty reaction and that surgery, this is what we found. .
With the rupture from Maseka. More on that case in a moment about why this is quite a difficult one. So why, why, why, why would you go sooner.
So basically decide this obstructive or non-obstructive based on history, on the examination, blood glucose, radiographs, and sometimes these abdominal wash to just how much emergency we got what we're going into. Big deal is do not use your prokinetics until you're absolutely sure that is not obstructive, or you will have an emergency on your hands quite quickly. So This thing doesn't work so well on the webinar as face to face, but we can little pauses and decide whether what we're going to do in these cases and really odd ones.
So this is a rather represented typical thing, acute onset, gut stasis, taking this X-ray on a straight view. We can see it's very interesting back here again, got a source of pain, which is quite intriguing. We have this picture here is very dilated to testing.
So now got about 5 seconds while I take a swig of coffee, and you can think about what you would do and whether, whether you your initial gut reaction, boom boom is right. This to me, first of all, a small intestine looks very, very much like an obstructive pattern. And again, this very big dilation.
Again this would suggest you've got an obstruction, in the small intestine. So weird things rabbit, this is when I had quite a high glucose. It was about 25.
And about 15 minutes later when we retest it, because it just did not look like construction. It was down to about 11 and we re-X-rayed, this area here had gone. We had a bit more gas in the, in the small intestine.
What we think is happening here is this is roughly where it's entering the large intestine. We actually have a foreign body or a partial obstruction about to enter the the, the, the large large intestine into, into the secu. I got a little bit of hair or something coming through there.
This is what will happen there too. It's why he gets relapsing pain episode, passing through the stomach with the small intestine doesn't like it very much at all, because that stomach and small intestine, and then it pops into the large intestine and everything passes. Next the hair comes along, same thing happens.
So he gets relapsing colics over a day or two. So this is a non-surgical, but really could be forgiven thinking this was surgical. And again for this one here too, again, I'm gonna take for your coffee while you sum up very similar sort of history, similar sort of glucose range, odd pattern on, on, on, on the X-ray.
This area here is quite weird. A very odd shape of gut and very hard to decide exactly which part piece of gut is, is, is affected. The small intestine is very thickened, it looks really solid, .
Something in here, and a lot of gas in the rectum. And this probably is a clue that this is almost certainly not obstructive. The fact the rectum is blown up with gas would indicate this that something is passing through it, and it's probably more of an illitic pattern than it is of of obstruction.
And again, this is one which with anxlytics and stuff, the glucose levels fell, and we rex-rayed, we saw this gas pattern here move. If it stayed the same, we might be more inclined to go in and operate. So, Not so easy to to evaluate all the time.
OK, let's say we have decided it is surgical, we have to go in there. The big deal is you have to be pretty decisive. These are emergencies.
These are not things to defer for a while. These are, you have to be fairly decisive about going in there. You need to get your fluid therapy, aggressive, and sorted out quickly.
You need to be in, in as fast as you can go. O techniques very much the same for a dog or cat, and, and small surgeons will probably know a lot more about gut surgeon than I will. Always check pyloris carefully.
So it's not always easy to find a problem there too. And just check around there because we've had several where we're just obstructing at the entrance to the small intestine, often with mats of fur and things. So well worth checking that really, really carefully.
If it isn't a small intestine, try not to open the intestine. Try to milk these through to, to the large intestine again, pop them through just like we saw in the X-ray. Very it with fluid therapy, and again, be very careful abdominal adhesions.
More on that in just a moment, but rabbits do like forming adhesion. So again, firstly, no powder gloves. Secondly, always, always wash everything out really carefully afterwards.
So, solution to pollution is dilution, get rid of everything as much as you can. So here we have an obstructive colic. You can see the actual obstruction here, see the difference in two parts of the gut.
And essentially what we're gonna do is gonna milk that through the small intestine and into into the large intestine there too. So just using fingers, just milking through, and milking through and eventually we get to the entrance to the secu. And we gonna pop that into feel it pop and you do see the gut really suddenly change shape.
And if you're monitoring glucose through this, which is quite fun, you actually will see that drop within 2 or 3 minutes and come right down. What you do need to go through is not to say, oh, that's it, we go back through the gut where this has been. This is that same case.
And here we can see there is damage to the small intestines right up in the duodenum right near the stomach. That was quite an abrasive piece of material coming through. And you can see it's just obviously lodged there for a period, and there's a bit of necrosis in that part of the gut, which obviously affects the prognosis quite severely.
Now, we've mentioned quite a lot of rules and things about using do things. They don't always follow the rules. It's wheredes come in.
And in my experience, I've seen a few cases where I've had ones that look sort of very obstructive on, on, X-ray, have pretty low glucoses, initially respond quite nicely to medical therapy and to calming down, but just keep relaxing, never quite get right, and then suddenly get worse. And this similar case is the one that had the ruptured sum in the end, which I showed earlier. And when we did go in, surgically, here you can see why the problems are occurring, and just have the abdomen is just full of adhesions, and you can see constriction across various parts of the gut where the adhesions are forming.
As abscess material formula as well. And ultimate, the problem was it had had a rupture some time previously. The owners had no idea.
They hadn't this rescue rabbit, they had it for a year or two, and they'd never seen a gut episode before. So these have probably been grumbling on for, 2 or 3 years, just forming ades waiting for the disaster to happen. So sometimes you get these problems, and, and they're just waiting to get you.
In this case, is really inoperable. You're not going to be able to make this better. Here's the, material from the Cer entering the abdomen to picking up on the wash.
So, so it's medical colic, it's not surgical. We're gonna go ahead with those. We're gonna do again, we're gonna monitor the glucose.
We're gonna repeat radiographs. Really important to. And see what effect your treatment's having.
We started analgesia, we started anxiety, we started fluids when we first assessed the rabbit, uses whatever. So John, your, your sound has just gone down there. I don't know whether you've just moved your mic.
Sorry about that, Antony, is that better? Yeah, that sounds great. Excellent.
Good to know you're still listening, which is good. Somebody's out there. Excellent, so, you're gonna continue those, .
As before, again, root of fluids, choosing on, on way where we maintain the rabbits and things, and obviously rabbits is that joy of maintaining a drip. Any secrets on that, I'd be very grateful to hear them, especially with hospitalising with its companion, really difficult to guard that drip, and so I think you're more in danger of getting a plastic foreign body, than providing good fluid therapy. Always offer food to these rabbits.
Always get a favourite foods, doesn't matter how bad a diet is there. If it's a favourite food you want these guys eating, we can amend diet later. Hay's always good to offer because it should have it, grass as well, dandelions too.
Amazing how many rabbits like fresh food first of all. So give them that choice and amazing how fast they're gonna eat just so they've got something they want to eat there too. We offer water in bowls and drinkers.
Lots of drivers prefer bowls, even, even the ones that we have drinkers, they feel that's given choice again. Make sure you know that too. Provide syringe feed.
There are a variety about now too. I've mentioned, mentioned Supreme. The Burgess, one is also very good, really nice.
We've got choices now too, we've used all of them at various stages, and we get on well with all of those, and they all seem to work really well. High fibre feeds going in there. Absolutely love them.
Sometimes we might use liquidised pellets, we're used to that. Sometimes use better art critical care if we're finding problems getting more solid, material into, into rabbit, and we might want a high glucose, electrolyte, ease to feed liquid food, but usually using these high fibre, recovery diets. And that's made a big, big difference to rabbit medicine.
How much do you, how often do these, again, we'll base this on the rabbit, how easy they're taking it all. We'll often just give them a bowl of it and see how, how they take these, and, . And if they're willing to take them from a bowl, that's a really nice one.
We know problems sort of sorting itself. We don't need syringe feed them then too. They're getting really stressed with it.
We may cut down the frequency with which we syringe feed. Some rabbits take little enough and much better. We vary according to how that rabbit's going, what it's doing, and what we perceive it needs to be.
We always weigh the rabbits, 2 or 3 times a day while they're hospitalised again and get an assessment of what we're doing with that. The big deal is many rabbits are quite fat, and we do have a potential issue with hepatoidosis. So you do need to have material going into that stomach, to guard against hepatodosis secondary problem.
Sometimes we consider a nasogastric tube. I find it difficult high fibre food as we very rarely use it, but in a stressed rabbit, that might be 11 option to take. Again, these fine grind type things can be quite useful there too, or really liquidised to the higher fibre foods.
Parts of tube, much the same as for a cat. Big deal is always a radioa tube because if it goes in the lung field, they won't show you. You put a saline down, they won't show you by coughing and things like that.
So you got X-ray and make sure it really is in the stomach. OK, the other thing we often use now is, is antitoxins, particularly choostyramine, which is marked quest strand. We use it as a toxin absorbent, and we use that because we see a lot of rabbits, we think, where once the gut gets going, they've had a build up of toxins of the stomach which suddenly gets released into the small intestine.
And we see rabbits who so hypofeis, we saw, yeah, it's a yippee, it's fantastic, and they just die a few hours later. And maybe that's due to the drugs they've had by mouth before they come to us. Maybe that's because, here's a bit of a tip, always give you drugs by injection, at least they've got a gut stasis, they ain't going to absorb them very quickly from the stomach.
So, we use these antitoxins, and we think that's improved our success rate in that respect, just so we've got something going in there. So when it does, start moving material does enter the, small intestine, hopefully those toxins are absorbed and not going to be absorbable by the rabbit. Antibiotics have been indicated, certainly we've got peritonitis, certainly we've got post-operative, we'll use those two.
If you're worried about, toxin reduction, maybe maybe about some sort of gas forming, clostridium, maybe you might use them, there, there, but overall, probably very rarely, indicated in these cases. Something like probiotics, there's very little data on what these actually do. They'll certainly do no harm, but it's not one I'd use the mainstay.
Now, once we've done these, and we're still not getting the gut movement, this is when we reach for pro kinetics. Basically after stabilisation. If they're not improving or on point of improving, they maybe do then, but after reassessment, we're really sure this is not going to be obstructive, they, they're not progressing quite as quickly wanted to.
That's why I in pro kinetics. Lots of these rabbits do not need them, and we don't use prokinetics in, we probably are using in less than half the cases we see. Most of them started moving before they get to this phase.
What do we use? Well, coin for books things on pro we'll get you've got a choice of metoclopramide Reistine or this got Si Pride and Don Periddone. .
Of ones we effectively use most of our use metoclopramide. I do like metoclopramide by intravenous infusion. We've got intravenous going, we'll often have metoclop to that, rate being about 4 MB per kg over 24 hours.
And that, that seems to work much better than metoclop given by discrete subcutaneous injections. Cisapride is very effective on distal gut, but again, of course, being orally, you have to make sure the stomach has got at least some movement to it before you can use that. Oral drugs may not work.
Bear in mind they're not improving. This can take days. So this may be a chronic and serious situation may have underlying factors.
It can take days to get right. So keep reassessing the critical parameters, keep reassessing glucose, keep X-raying, see what's happened. So at least you can keep the faith and know that it should work if you're just patient enough and keep moving.
If it's not going again according to plan, always consider the underlying reasons, maybe you have got adhesions. But I wouldn't necessarily rush into exploratory unless it really does start to, to worsen after a phase of of improving. So when it's better and improved, that's when you look at your underlying factors, particularly recurrent comic.
So it's no good really just sending these home to relapse at leisure. You really do want to find out why and see if you can stop this happening, because one day it will be the bad one. And the investigation really very similar for chronic cases.
So we're really looking for what is the source of pain. So X-rays are your friend. So you've done your basically your plunkograms, you plunk right the plate, taking your assessments of gut, of gut, gas.
You're now looking for the source of pain, whether it be dental, oral, spinal, and the more parts of spine we actually more we find lesions. I've left that cervical there. We're seeing a lot of cervical lesions to we X-ray of the neck and things.
Look at the hips, looking at the stifles, . Again, look through the abdomen. And one source of pain, for example, in an entire female rabbit can be uterine adenocarcinoma.
So if in doubt, you can always just scan and just check out that that uterus and see whether that's got any weird changes going on there too. So you're looking for the source of, sort of pain and you're looking for what you're trying to control. In essence, you're trying to diagnose your meloxicam deficiency, and then work out why you're gonna use that too.
In some cases we do bloods. I find haematology quite useful and see how depressed that is usually is in these cases. And if you haven't assessed kidney parameters before, I'd like to do that too.
If I'm worried about hepatic lipidosis, it's great to assess liver. It's not easy in rabbits, and liver enzymes, they say all raised and all quite significant. It's very hard to say that they're that that important.
And bile acids, sometimes you get very high level, but they can be really, really hard to evaluate. We might do echiiculi serology, but it's not really very important in these cases, and doesn't really seem to have an involvement, although you will hear from time to time icula can be a cause of these things. So the haematology, we'll often see the typical signs to be like chronic illness, chronic disease, which case we get a mild non-regenerative anaemia.
Remember that rabbits tend to have, fairly low, PCV anyway. So we talk about anaemia sort of range but talking about 25 to 32ish. The non-regenerative, and again, bear in mind rabbits usually have a very highly regenerative picture.
So when we're looking at just less regeneration than normal, and we often see very low white cell counts. It doesn't necessarily mean it's not inflammatory, but we'll often see these these low white cell count with stress and things. If we see regenerative anaemia, so again, much more strongly than normal, we're looking for blood loss.
And really one of the big places that we've got gut problems is through the gut lining. And gastric ulceration is not rare in rabbits. So if in doubt, run a faecal occult blood, that test does seem to work in these guys, and then you will quite surprisingly often get, get, get positives, and that's when you can use urranistidines, that's where it does really come in useful.
And, and other anti-ulcer treatments can be used for that point too. So we get inflammatory signs again, we may see increased white blood cells, may increased heterophil counts. They also he lymphocyte ratio, some toxic stem cells.
So we also look, I like to look at proteins do electrophoresis and these guys, so looking at inflammatory proteins, see what goes, and electro is nice where often in rabbits they respond to inflammation by by lowering their cell counts. And, and to proteins will often show acute phase protein changes, when the cell counts are quite, are quite low. So I find it quite useful tiebreaker again.
OK, you can I mentioned earlier on that. Whatever is written, it's very unlikely to be a primary factor. It's not really a predilection site for canicular satellite in the gut.
It tends like neuro tissue. It tends to, tends to like like going to kidneys and stuff. So it's unlikely to be a primary factor in this.
What might be, it might be a secondary factor. And so you've got a chronically stressed rundown rabbit, then recrudescence can be a big deal with this. .
So we might see it rearing ahead at that point too. Whatever happens, do, run double serology. Do run IgG and IGM.
Paired serology every a couple of weeks is pretty useless, unfortunately, but you need IGG and IGM. IgG for background level, CSS has been, exposed IGM, see whether you've got, acute, reaction and acute, onset there too. Unless you got your IGM raised, it's unlikely to be a factor at that time.
So not because of these. So it's probably just background at that stage too. Whatever happens, I do not give panicure on spec, partly is probably not absorbing too well.
Also it's like these rabbits to have low cell count. One thingen benzo can do is cause radio memetic effects and affect the the blood counts. So in summary, guts, some is mild and some is life threatening.
It's really difficult to tell which one it is without full assessment. Examination won't give us those clues, history won't give us those clues always, or it can be very, very misleading. So unless you actually run some tests and things, you're ultimately just going to be guessing.
You do need to do this quite quickly. Because if you do go for the, I'll treat for a bit and see what happens. Then this is where we end up with the absolute disasters on our hands.
So all these assessments are done really very quickly indeed. These are emergencies, we do need these two quite fast. What it's not, it's not beryl deficiency.
It is also not metoclopramide deficiency. There are cases, at least for Batra, is it's not actually contraindicated. It may not be needy, it's not contraindicated.
Metoclopramide is downright contraindicated in some of these cases. So you really do need to evaluate before you start putting pro kinetics in there and be absolutely sure it's not an obstructive one, or you're gonna find out in an awful hurry, and those ones that do tend to die. It's also not panicure deficiency.
Again, I like to have any acute effects, but unlikely to do any good and may do some underlying harms as well. So assess, find out what you need to and then treat. Sometimes you do have to take shortcuts.
Sometimes you may have an unwilling to spend and unwilling to do things there. You have to take shortcuts to use best guess. In relapsing cases, you may decide to shortcut in those ones too.
But always do those with good communication with the owner, explaining what the situation might be, why you're having problems there too. And if you can do one thing and one thing only, blood glucose is very quick and very cheap. Thank you.
Thanks, John. That was excellent. Really interesting about the glucose, I didn't realise that it could be as sensitive to that and as labour moving up and down and things.
Ah, it's, it's lightning fast. And it's quite neat to see how quickly that changes, which what makes it really effective in doing serial monitoring when you're not sure how, how long you've got, you can, you can, you can really see those changes fast and get and get in there quickly if you, if you've maybe made the wrong decision to start with, or hey bet to start with. There are times that it doesn't work.
It's not, so you, you've got to be, I think sometimes you can then have the tendency of thinking it's the holy grail, which, you know, clearly it isn't, so we've just got to remember that as well. But interesting. Yeah, we've now got Karen Smith from Burgess who's gonna talk to us.
I'm just checking that Karen can get her screen up. So Karen, if you just share your screen now and show us your slides, that would be great. And I'll also, just check that you've, you've been unmuted.
As well. Can you see me? Yeah, that's great.
That looks great, Karen. So just before Karen starts, Karen's recently started working for Burgess as the nutritional advisor. Previously, she is a registered veterinary nurse.
She was the course manager for the veterinary nurse course at Ashcombe Bryan College. She, has a menagerie of creatures at home. Do you, do you have any rabbits yet?
I don't actually have rabbits at the moment, building up on rabbits, I think, but you have. Res, did I, did I see and and wallabies, yeah. So it is quite a little menagerie you've got there, but I think you do need a couple of rabbits now.
Agreed. Just to tell a little bit, Burgess, of course, well known to everyone as a rabbit food maker. It started making rabbit food in the 1960s, but actually, was founded as a flour miller back in the 1700s, 17th century, so, so 1600, so a really, really old company that's been producing food for pets and for people for, for centuries now, but is not happy just with doing the easy sort of traditional things, is also involved in mobile MRIs, so from the past very much up to the present as well.
So, over to you, Karen, and looking forward to the talk. Well, hello everybody, and, thank you to Antony and thank you very much to John for that really interesting talk. And, just a little bit of background adding on to what Antony was saying.
Burgess is a British family company, and we've got very strong family values and traditions which are the core of our business. For generations, we've produced fine quality food for people. As well as pets and animals, and we've got a 200 year heritage in agriculture, which has helped forge strong relationships with the farming community, and our ingredients for our recipes are sourced locally wherever we can.
We pride ourselves in being experts in animal nutrition. The health and happiness of pets is our number one goal and our expert knowledge helps us to achieve this. And we firmly believe that good nutrition is the number one preventative care.
So I just want to talk to you about a couple of our products which may interest you today. The first that I wanted to mention is Excel Duel Care, which is our recovery diet for rabbits and guinea pigs. It is a nugget-based recovery diet, and unlike other products, it has a dual function because it can be fed as a paste dissolved in warm water and stringe fed as other diets are, but it can also be fed as a nugget for long-term recovery and hospitalisation.
It comes in a 700 gramme box, so it'll be, it'll feed the average animal for about 10 to 14 days. So it's ideal for perioperative feeding, and this means that the animal can be sent home with the food for the owner to feed. So it supports the animal back through the transition back onto its usual food, and it allows time for proper recovery without any abrupt changes in the in the feeding and in the diet.
It's a fully nutritionally balanced food so it's suitable for long-term feeding as well. And it can also be fed to the patient's companion at the same time, which is really convenient for the owner as well. It's got very high levels of protected vitamin C, and this provides for the increased vitamin C requirements of sick and stressed rabbits and guinea pigs.
It has high levels of long fibre, and these are purposely not finely ground to make sure that they support gut mortality. They stimulate the appetite and help prevent gut stasis throughout the recovery period, while the animal might have a reduced hay intake. To support the gastrointestinal system, we've also added something called pro feed.
And this is, contains rapidly accessible short shortchange fructo oligosaccharides, and these are for prebiotic growth and activity of sequel micro microorganisms to support the immune system and to maintain mucosal health by increasing the colonic blood flow and mucosal cell size and efficiency. Carnitine works alongside this to prevent, to promote fat metabolism, and this is particularly important because of the risks of hepatic lipidosis, in anorexic animals. As well as after illness or surgery, dual care is suitable for feeding at times of stress because of high levels of vitamin C, as well as a tryptophan and a balance of B vitamins and magnesium.
And that's available for all your veterinary wholesalers at only 1 pound 90 plus VAT. So it's quite commonly incorporated into surgical costs or hospitalisation fees to make sure that all animals are supported throughout that perioperative period. The second thing I wanted to mention today was our new XL Nature's blend diet.
This is a unique formulation in the nugget market. It's a high fibre blend of nutritious grasses, and it's mixed with vitamin rich hedge row ingredients including dandelion, nettle, and lemon balm. We've spent the last 18 months developing this diet with, leading agricultural colleges, agronomists, and specialised farmers, to produce the perfect blend for rabbits.
It's closer to the rabbit's natural wild diet, mimicking the foraging choices that it would naturally make. This unique blend, provides variety and it's also extremely palatable. And the natural, herbs all have, have been selected for invaluable health benefits.
For example, dandelion promotes digestion as well as urinary tract health, and nettle also supports the urinary tract. Lemon balm has calming properties and it increases mood state, calmness and alertness whilst reducing anxiety. Prebiotics have been added in the form of short chain fructologous saccharides, which are in the most accessible form, and so they're rapidly fermented, and this results in increased production and activity of the cecal microorganisms and increased production of volatile fatty acids as a result.
It promotes epithelial integrity, supports the immune system and helps to modulate those blood glucose levels. We've also added lucerne extract, which is a natural and balanced source of antioxidants to support the cells in the immune system. And Lucerne extract is very high in lutin, which is an antioxidant, which is known to support eye health.
Nature's blender is high in beneficial fibre, and when fed alongside good quality forage, as Xcel, the 5-step feeding plan that we recommend, it ensures rabbits get the right level of fibre and nutrients that they need to maintain their all-round health. For those of you who haven't already registered, Rabbit Awareness Week this year is between the 18th and the 26th of June. It's a well established and successful annual campaign which was created by Burgess Healthcare, Burgess Pet Care, should I say, and it's supported by MSD Animal Health.
They're RSPCA, the PDSA, Wood Green, RAF, that's really, really well supported. We all work together through this dedicated week, educating rabbit owners about proper rabbit care and welfare. Vets and nurses help to help this campaign by holding free, rabbit health checks to educate and inform owners.
And this is the 10 year anniversary of Rabbit Awareness Week, and each year, we focus on a different aspect of rabbit welfare in terms of the five welfare needs. In 2016, we're focusing on companionship. Because more than 57% of UK rabbits live alone, which obviously causes distress and suffering.
So we want to change this. The main objective of this year's campaign will be the Buddies for Bunnies pledge, and this is inspiring rabbit owners to consider suitable friends for the rabbits by encouraging rehoming from welfare centres. We've got a dedicated website with information, as well as an extensive PR and social media campaign.
And we want to encourage pet industry retailers, vets, rescue centres and schools to sign up to raw, giving them the tools that they need to drive this awareness. So you can register for your vet raw pack at the website shown on the screen, which is www.raittawareness Week.co.uk.
And this pack includes posters, health check certificate, information on rabbit welfare needs, leaflet on vaccination, and also the AWA rabbiting on magazine. So if you haven't already, can I ask you to register and get on board with that. That'd be brilliant.
Just to mention, a lot of vets and nurses aren't aware that Burgess also does some really, really good dog and cat feeds that are very high quality. These provide an excellent option that you could stock for clients who perhaps don't want to pay the well-known premium brand prices, which are often stocked in veterinary practise. So for dogs, we have our sensitive range, which is an affordable hypoallergenic food.
For example, this is 30% more affordable than the James Well Welllo brand. It's got a simple fixed formulation. And it's got great functional benefits, including heart, digestive, skin and coat, joints and bones and stool formation benefits.
The cat range is an affordable but premium life stage range with kitten, adult and mature variants. The cat range has a unique dental health claim as well. It's high in British protein sources using locally sourced ingredients, and it's got an, an improved resealable packaging now for freshness and palatability.
We are just introducing our new grain-free well-being ranges for dogs and cats. In the dog range, these benefits, include dental. The dental range contains our unique dental ingredients, which reduce plaque and tartar buildup.
We have a digestive, diet, which contains prebiotics and beat pulp for digestive health and function. And a skin and coat range which contains fish and linseed oils, biotin and coated zinc to help maintain, the skin and coat condition. The cat well-being range has 3 variants.
We've got slender, skin and coat, and sensitive. And these are all grain-free diets, and they all contain the unique dental health claim and ingredients. Both ranges are premium quality nutritionally, but they are at an affordable price compared to other comparable products.
Now it's competition time. So, what we'd like to do is, give away, 3 sacks of Xcel Nature's lend to the 1st 20 correct answers to the following question. The question is, as well as L tryptophan, magnesium, and a balanced vitamin profile, which ingredient in Excel dual care is needed in increased amounts at times of stress?
And we'd like you to send your answers into the email address at the bottom, which is webinar at urgesspetcare.co.uk.
So good luck with that. We're sending out 2 free bags. And that's it for me.
So I could just remind you all to get on board with your registering for Rabbit Awareness Week and thank you very much for your time. That's great, Karen. I think a couple of those slides, certainly for me, we're just, edging off the bottom, so it might just be worth re-reminding us of that email address again.
Can you see the one that's on the screen at the moment, Anthony? No, no, I don't know if that's just me, but it's just cutting out at the very bottom of the screen. OK.
The email is www.rabbitawareness Week.co.uk.
And for the competition, it was webinar at urgespetcare.co.uk.
Webinar at Burgess petcare.co.uk.
So perhaps, if you could put that in the chat box for, or in fact, let me do that and then everybody can can see it just in case that's that's not been. Visible. So, we'll put that in again.
So if you all look in the chat box, that will be their webinar. At Burgess pet care.co.uk.
That's right, yeah. And then Rabbit Awareness Week is. That's www.
Yeah. Rabbit Awareness Week. That's nice and easy, isn't it?
Dot co.uk. Rabbit Awareness Week.
Dot co.uk. So they're both there and I think, you know, great .
A great week to follow. It's amazing how many, you know, rabbits are increasing all the time. We've had over 500 people on this webinar.
There's clearly, you know, an interest for us all to know more and, you know, obviously, thank you, John, for, for some of the, you know, the great comments that we're getting through and for the great webinar that you did. I'm, I'm conscious that it is just on 2 o'clock now, and I know people may need to slink out. So if you do need to slink out, that's one of the benefits of webinars, you will not be seen, so you can, slink away.
But, I think if we could have 5 or 10 minutes of questions, and obviously people can always pick up these questions later on, recording should be up, you know, within the next 48 hours. So if they're not up by tomorrow, certainly by Friday. So, let me see if we've got, I, I, I know we have questions, there've been a lot coming through.
Just the, the, the first one was one from, Henrietta, who was just asking about your, your, diet, Karen, that you can, you know, obviously sludge up a bit. Do you provide a syringe in there or do we have to do the syringe bit? Karen, can you hear me there?
Can you hear me? Yes, sorry about that. Yes, it doesn't currently have a tringe that comes with it, but we're currently redoing the packaging and we will be including, a shringe, due for re-release when we re-release it for BVNA in October.
Currently, we recommend that you use a wide bar syringe because we've purposely kept the long fibres in there to prevent gut stasis. So, a wide bar syringe in the meantime, but We re-release the new packaging but we will provide ranges with those, yeah. There you go, Henrietta.
How about that for quick customer service. You can't get much better than that, can you? So is that a 20 mil syringe that you're suggesting, or is it a special syringe with an even wider bore than that?
And it's just needs to have a wider ball than than they would take a normal hypodermic needle. Yeah, you can get them from your wholesaler still, but we will be providing them to make sure you're on the right one. That's fantastic.
Thank you very much. Another question, let me just see that there are a lot of questions that have come through, John. It's, provoked a lot of interest.
So Emily has said, what is your recommended sedation protocol for decompression? Generally, I will, . Use midazolam, yes, combined with opiate.
So typically in that probably use butterphenol. I do have to look at doses the whole time, so I'm not going to quote numbers because I'll probably just get them wrong. I will use, the time I just see the fluorine by mask.
Now, I know there's been a question come up about using that and the stress that can cause. Yes, it can do. At this stage, we want a very quick onset anaesthetic with a very quick recovery.
And little other problems. I think rabbits are quite stressed already. We do understand that we do try and keep stress to a minimum, but sometimes we're after sheer safety at times.
So, you know, that can be very useful, especially we want a quick anaesthesia decompress, and we are working desperately harder than. I, I think he's always good with those rates, not to quote if you're not sure. I mean, are you just that's coming because of old age, John, or well, partly partly how much you're changing, and that is you know, the days when you and I qualified when there's probably about one sedative anyway.
If you look at the doses, they're really high, really, really high. I mean, hypnolm's a great example is how high that was, you know, back in the 90s with. Mainly because these came from lab rabbit protocols, where admittedly the safety wasn't quite the same, but also you're looking at young, good condition rabbits.
And if you know through modern textbooks where people are dealing more with lesser condition or with ill rabbits, pet situation, those dose rates are falling and falling and falling. So essentially you basically go through almost as new as you can and go as low as you can with them. It's easier top up is to take out.
So yeah, that's the main reason I, I would look them up all the time because they are changing. And the problem, of course, you know, when, when we were lads, John, was that, You, you, or certainly I, probably you didn't, but I would positively dissuade any rabbit owner from having any sort of anaesthetic procedure because they either seemed to be very, very light, or they died on you, and they didn't seem to be, especially with halothane and. And such like like about it wasn't the greatest anaesthetic, was it?
No, absolutely not. I mean, it actually it's a very good anaesthetic thing, but no, in terms of exotics and stuff, I mean, the main problems that you had your cardiac depression, your respiratory depression occurring simultaneously, so you found it as a problem when it's too late. And that's one of the great things that ISO is actually respiratory depression happens first.
The problem with IO in rabbits is, of course, is that very distinctive smell. They don't like it. Sivo is much better.
And we're often induce with Sio because you don't get anything like the apnea with it. It doesn't have the same smell. It doesn't certainly it's not irritant, and we get some really nice results that sometime because they just don't have the same stress levels with it.
Yeah, brilliant. We've got a, a comment or a question from Rebecca saying, could you remind us what the toxin absorber generic name was Quest, Q U E S T R A N. It's actually available over the counter in chemists, we're desperate, but, as you get from wholesalers and stuff, and we'll typically add a 2 or 3 meals into each feed, 5 meals for giant rabbits, just in with the food and stuff.
It comes a really nice orange flavour, does smell lovely. And Hazeltons, what, what is your favourite anxiolytic? Is that midazolam?
Midazolam, yeah, we use lots and lots of midazolam. And, yeah, . Yeah, it's really useful and it's not, it doesn't appear to be very sedative.
Us, I've used Valium a bit too, and it's really sedative in rabbits and they do go very sleepy and I don't want that at that stage. I want to so I want them eating. Yeah, great.
Alina is asking on the blood glucose question, can we use Alphatra? Yeah, I tend to use Alphatrack, . We've been doing some mucking around with some machines really and using different machines, you get very different answers.
None of these are really evaluated for rabbits. And we make sure we stick to the same machine, of that animal. So whatever we start with, we, we stick with it.
And that gets away from the problems because we said two different machines and the same right at the same time, we'll get usually stress usually within the same ballpark area answer, but they will be slightly variable. So if we're looking for changes, we look, we use the same machines, we can see those changes more accurately. It's brilliant.
I think we're gonna get a bit involved in practise politics here, John, which will be more up your street than mine, but we'll, we'll attempt to answer this one. My practise will use barium to to determine if a rabbit has a foreign body as opposed to an ileus. Is this OK to do, as it is a bit of a touchy subject between staff members.
Some agree with it and some don't, but what's your thought? OK, I'm not gonna touch on what practise policies are. There are reasons for, for it too.
Anti barium is a fascinating in rabbits, and the reason is, is because what you can use it for beautifully is to assess whether they are producing seeker tropes, and, and actually eating them because what they'll do is they'll pass the barium and then they'll retake it back in again, so you just double pass. And that's something which you can't always observe. So, Yeah, it's, it's nice for that.
In terms of assessing whether saying stuck or not, it's gonna take too long. Yeah, because by the time you watch for, for the transit time through there, I mean, what I can't remember the figures were from, for me they're looking at some transit time with the, the, the, small intestinal transit time. It's gonna take a long time in a normal rabbit.
Now, if you've got a gastric stasis, that could just sit in there for as long as it takes to do so. So I wouldn't use that on its own. I think barium studies have have a use, I have used them, in that immediate assessment, I think there's things you do quite quickly.
If you've got a foreign body, you do need to get in there fast. And would the barium cause a problem if it leaked out of the intestine into the abdomen? Yes, yes, that would be, I suppose the other worry, wouldn't it?
Yeah, that would be if you got, at the same time, if you have a gut perforation, you've got other problems. The prognosis very, very great. Another question is just, with regard to Rabbit's Awareness Week, which obviously coming up on us within the next 2 or 3 weeks.
And Henry is saying, can a school obtain the rabbit pack independently? There are some schools near my home that are in the Bermuda Triangle with respect to small fairy animals. Yes, if they go on the website that there's a special school section, where schools can get a pack sent to them as well.
That's great. I think we'll do one more. The, the other thing I, I love the sound of the new Burgess diet with all those calming ingredients, and I'm, I'm just a little bit tempted to have it myself as a little snack.
I mean, is it, you know, it looks good and all, all the, dandelion and nettle, John, it did sound rather tasty, didn't it? Yeah, actually, I'll tell you what, it's really good for, and we use this for, we use it for guinea pigs, and it's absolutely fantastic for those. I'm not mean to plug Burgess and I hope, but if they would like to pay me, I'll be very, very happy.
It is absolutely brilliant for guinea pigs, and we've had a lot of anorexia guinea pigs who just start eating it. One of my colleagues got into practise and I said, yeah, yeah, it won't work, and it did, and it has done every time since, so it's quite irritating, really. But no, it's absolutely, it is super for guinea pigs.
I love it for that. Fantastic. Nola's saying, just I think the last question.
I know that there's been lots of questions, so. Apologies if, if yours hasn't been answered, but Nola is asking in cases with foreign body necrosis in the small intestine, do you perform end to end anastomosis and what suture material do you recommend if so? OK.
Yes, I have done. Those results have been brilliant. It is very fiddly surgery and by that stage, that they are desperately in trouble rabbits.
I would use something like a 5 knot polysor my my my normal for that. Yeah, so very fine, and I would recommend, especially when you get old like Anthony and me, of using head loops, because they make life so much easier, and I just wish I'd, I'd had the lack of pride to, to use them a lot earlier than I do now. So you, you've got one of them on now, not now, but you, yeah, exactly.
Yeah, that's all good. Well, listen, thank you again, John, always entertaining when we have you on, but not only entertaining, also very informative and educational. I know that this is an area that just we, we grow in our knowledge almost exponentially on rabbits.
Obviously I also want to thank Karen and, you know, on her behalf on, on Burgess as well for making this possible. As I say, over 500 vets and nurses on. If you can tick on where you're listening in from, just so that we've got an idea where everybody's been listening from.
I know. Some people get together and listen in, staff rooms with vets and nurses together to discuss. I know some of you may be listening to this in other parts of the world, so it may be an evening meeting rather than a lunchtime one.
But it's always fascinating to know where people are listening from, so do stick that in the chat box. And, There we go, we've got Deirdre in Australia, so that, that's very much an evening webinar and Jose in Portugal and in Suffolk. So people are listening from all over the world, John, you know, you know now that webinars, You don't always get a lot of love back.
You don't get the tumultuous applause, but I think people have been really enjoying it from the comments that we're seeing. Got somebody listening in from Budapest there as well. I'm sorry, the sound seems to be quite a problem with this.
So my apologies about that. It could well be saying I've done. No, it was really, really good job.
Thank you so much, and again, thank you, to Karen and to Burgess for making it all possible as well. I'm looking forward to seeing you on a webinar very soon. Thanks again, bye bye everyone.
