Hi. And, welcome to this, webinar on cardiorespiratory cases, in small animal, small mammal medicine. Glad to be presenting us with Aidan Raftery, a colleague, from Manchester.
And, we have, fortunately, been able to collaborate on many cases over the years and hopefully provide our different perspectives on many of these. Our aim during this webinar is to present various, sore mammal cardiorespiratory cases. Hopefully quite vary in species and in type.
And what we're trying to do is let's create a puzzle to solve each time, but more illustrate how we, came to different diagnoses. How we use different diagnostic techniques or some of the unusual or different underlying causes. Inter mammals and also some of the therapeutic options that are out there, which we can use.
It's not just giving a set of antibiotics often so in summary. Basically what is actually possible to be done for these cases? Rather than I said, just dispense some antibiotic.
So let's start with Case one, which is a six year old female neuter rabbit. She was presented in respiratory distress. Extreme distress.
And bear in mind rabbits. We could not. Well, I can't, breathe through her mouth very easily if they do start mouth breathing.
That shows absolutely severe, problems. And this was the sort of state she was in. So we did a base examination.
I think it's really important to emphasise for these cases where they are in extreme distress. A detailed examination is often not possible. And something, does need to be done either in terms of, sedation, which doesn't compromise respiratory system.
Or just a minimal examination just to reduce the problems and reduce things getting worse during that time. That's quite important. I went to stabilisation, so she received oxygen.
We gave a very short acting corticosteroid in her case. Because signs were so severe, antibiosis and some fluids. We did not immediately start feeding, because again, if they are really, great distress, it is very difficult, to, feed safely without inhalation.
Next day we perform radiography. She was fit to be, sedated for this. And we got this sort of picture.
We've got leafing of the lungs. We've got a clear, obvious amount of fluid present. So what do we do in these cases?
This is one thing we can do exactly what we would do with whether, say, a cat or a dog. And that is we can, prepare the, the thoracic cavity. And we can perform thoraco andis and we were able to withdraw some fluid.
This can be analysed in exactly the same way as you would for a dog or a cat. So we include with til we can look at a basic colour of it. We can see it's quite cloudy there, So something's happening inside that, and that means it's a good one to do some cytology on.
And these are the type of cells we're getting. And as you can see, there's a really ruptures of, you know, blood cells are quite sparse, and the cells that are coming out are really quite unusual looking. And that makes you worry.
So we drained off a quantity of fluid. I don't remember quite how much. But a reasonable quantity and re X rayed and we can see that we've got expansion of her lungs.
We've got a bit more air in there. She was breathing better and CIA at that point too. But we do have some consolidation, especially obscuring the heart.
Shadow. So next at this stage was to, perform an ultrasound. And this did reveal a mass, and given the bizarre cells and, pres, and her her signa, we really felt this was most likely to represent a tumour.
And at this point, we only elected for euthanasia. The actual tumours was, not, diagnosed, but was probably felt it was going to be a primary tumour in that region. So what lessons did we get from this?
Well, first of all, probably the timing of the we use of the corticoid. Small mammals are pretty, sensitive to the effects of corticosteroid. So we very, very rarely use them.
In this instance, we felt that with this respiratory stress and with inflammatory disease being so common in rabbits that this was a time we could use, use one, but kept it ultra short acting so that we weren't We were able to switch therapy if we needed to afterwards. Using it for a tumour might be deemed to be a be a good thing. But whether that tumour would have responded to longer term corticosteroid is unlikely.
And we're not sure. The other thing, too. This is this case from a few years ago before, things like TF, were really well known.
And I think probably one of the options we'd have these days is to, do the ultrasound before the, radiography. And doing that would have I would have identified the fluid a lot earlier and might have enabled, drainage using local anaesthesia. Before we moved on to, radiography and sedation.
So things change as they go along, too. And I think ultrasound for chest cases is really quite a good model to be considering using in many of these cases. One thing I will draw up before moving on from the section is that, this is actually, the case I illustrated was was, a female neuter.
This is a female entire rabbit. Also, presented in respiratory distress. And these, as you can see, we've got some, interesting cannibal metastases, and I think when you're dealing with an older female, entire rabbit do always bear in mind that uterine adenocarcinoma is very common.
As a cause of many different problems, it will metastasize, all over the body, particularly the lungs. And I think that's saying should be bore in mind. So these older rabbits.
So thank you for listening to that. And I'll hand you over to Aidan for the next case. Right?
So we're on to a different species moving away from rabbits. This is a debut. I'm not sure how commonly they're seen in practise, but we see lots of them, life, just a few, facts very quickly about them.
The life expectancy 6 to 7. But we often see much older ones. They are hindgut fermenters, so they shouldn't be fed the same diet as gerbils or hamsters.
They're coro just like rabbits and guinea pigs. Chinchillas. They are social.
They need to live in social groups. Sticks. So one important thing about handling them is don't pick them up by the tail because they tend to twirl around and the degloving of the tail is very common.
Skip them up in a towel, and they are much more difficult to restrain than unexamined than guinea pigs or chinchillas. So it's it's good to have an experienced assistant to help you, so onto the case. Jinx, a five year old neutered male, lives in a large sort of very nice avery type of enclosure with large branches for climbing it with a group of five is fed de you palates at lib, with hay and water, always available.
Also, substrate is sort of wood shavings and sand, and never treated for parasites. But we don't really see parasites as a problem with them. Jinx had a history of chronic dental disease when he came to us, and there was a vague history of having had a few dentals.
But there wasn't any detail of what was actually done at each time. Two others of the same group also have ongoing dental disease. And currently, jinx was on, enri, fluoxetine and meloxicam, so meloxicam at 0.3 milligrammes per kilo once every 48 hours.
So he was referred because of respiratory sign signs, which started about nine weeks earlier and were slowly progressive with no response to the medication. These were exacerbated by exercise. There was no nasal discharge, but there were bouts of sneezing.
So on clinical exam, listening to the chest, they were referred. Respiratory sounds from the, from the upper airways, on, on palpation, the ventral cortex of the mandible. Was had areas of remodelling.
That was the sort of thing that's pretty common with chronic dental disease in these guys. Intra oral exam, the incisors, the the crowns of the, the incisor crowns were elongated. And the cheek teeth, we had sort of fairly severe signs of a chronic dental disease.
Here is a radiograph. It's actually not the same debut. But, you can see, severe dental disease.
In this case, you can see where this elongation of the, apical areas of the cheek teeth This would be causing remodelling. You'll feel this is bumps on the ventral, ventral cortex of the mandible. Just an interesting point about rodents.
The the apex of the mandibular incisor is all the way back here. That's why we don't remove. It's not possible to remove these.
Here. There is a bony structure here in in this debut. And that is in, adon Toma.
Quite commonly, in the case, we're talking about the, the the, apical areas of the maxillary incisors. maxillary cheek teeth, elongate and and cause problems in the, in the nasal cavities and obstruct the breathing. In this particular case, it was the adon toma.
So how do we treat this? We try and and, manage to maintain Clearer Airways. And the airways are partially blocked partially by, inflammation of of the soft tissues there.
Cause by this, these structures growing. So if we can use anti inflammatories to reduce the inflammation of the, of the lining of the nasal cavities, that will have an impact. If we can also use something to try to clear away excess secretions and that will also open up the airways a bit more and, and help with breathing.
And we do that by nebuli, hypertonic airline is is, is very effective. And at, cleaning the the nasal cavities. We try to manage the dental disease, by correct diet pellets are are not the correct diet.
Then just like sort of rabbits and guinea pigs. They need to be, using their teeth to grind up the food. Otherwise, they they overgrow, nonsteroidals meloxicam D is the one that we tend to use.
We don't have any data on on, dose or frequency of dose in, in day use. But in guinea pigs, which are the closest animal that we have data on, we need to use, a milligramme per kilo at least and every 12 hours. Analgesics gabapentin.
Some of these guys are are in discomfort and and analgesics would help, and gabapentin would be the drug that we would use. The Edon toma management. Medical as above are surgical.
There are surgical, treatments. Reported, you've got a a procedure called stent rhinoscopy. Where you you basically make an opening into the nasal cavity.
Just posterior to the, EOD onto that. These are usually, in most cases, around the incisors. Extraction of the teeth and removal of the Yoon toma is also described, But these surgeries are more commonly described in prairie dogs, which are slightly bigger animals and would be much easier to do the surgery.
So back to John for the next case. So second case is, back to rabbit. Another female neuter rabbit.
Five years old. It's very quiet. And we're showing weight loss in spite of, eating.
Although eating was slightly reduced, we did basic initial work cup, including taking history, examination and nothing too remarkable on those now. Normally, we'll radiograph these, as part of my main work up for rabbits of weight loss. And this is what we found, on the thoracic view.
And, I can see here that the heart is appearing very rounded. And, is elevating the trachea, so it's actually, parallel with the spine. And that's a pretty good clue that there's something going on in that region.
It certainly looked a bit large from that view. Now, we can do vertebra heart scores, and measure in the same way. As for dogs and cats.
This is the same rabbit with a slightly cleared image. And we can we can take those measurements now. The trouble with this rabbit, and with many of them, it's actually, it's very hard to find the right place on the thoracic vertebrae to actually measure from.
And if you have a look at this Rabb, you can see there's quite a deviation there. And these chronic subluxations around the thoracic and sometimes lumbar spine are quite common, probably following, handling issues when very, very young indeed. But it does mean it's very, very hard to measure unless you get that that that vital heart score properly.
If you look on this rabbit, which doesn't have that Lation different rabbit again, you can see we can actually add those up together and we can get results. And there's some papers aren't showing that this can be useful. Others show it can be breed dependent.
However, in this case, I think we have enough evidence the heart was rounded, the trachea was elevated and we were looking very much at looking at cardiomegaly. And heart disease, in my experience, is quite, a common cause of, just not gaining weight or failing to thrive. Part of our thinking is because of that, enlarged heart, pressing on the oesophagus, and difficult getting food past there and possibly part just due to general efficiency of metabolism.
We did further. diagnostics ultrasonography did confirm we we actually had, a dilated, cardiomyopathy going on. And, we Then, we took some bloods, too.
And other than showing elevated, urea with pre renal disease, we didn't see too much on the Bloods. So we started, with rest. And again, I think this is one of those issue we should do with, heart disease in many species is just rest them.
Give a heart a chance to give a bit of a break. So restricted the environment for a short period. While everything or medication got going, We use an ace inhibitor.
In this case, we used, I metoprolol, which is came in liquid form of, formation and sadly, not available anymore. These days, we'd probably go straight to using, benazepril and crushing tablets and and syringing in, crushed tablet. We also for the bank added in, Met aam and tramadol, to, control, the the pain issues from that because it's hard to believe that's not actually quite painful.
Six months later, we've been doing reviews. In the meantime, everything will be going fine. They'd been rather to gain weight.
And, was actually a bit more active, which was great. And I was very happy. However, six months later, that was recurrence, resigned and very lethargic again, and had had some funny turns where she suddenly fainted, and done some peculiar things.
Especially while being active and on osculation. We picked up a dysrhythmia on this occasion. So dysrhythmia will be a good indication for, an ECG.
And to do this, you do need a really sensitive monitor. Rabbit heart rates are very very, high. And also, the complexes are not very large.
So you do need a sensitive monitor. Digital monitors now are absolutely fantastic and really help. And the other thing that helps a rabbit is use of a traumatic clips.
The old fashioned croco clips are very fierce, and rabbits are very sensitive to them, and the skin is quite delicate and we would normally attach some, put one onto each ear, and then another interview, Precor or fold. And that seems to be well tolerated by by most rabbits. So again, shame with prec curl fold.
That's a difficult one to place. Pluck a bit of hair, a little bit of the spirit, and we can attach those quite easily. And these the result gained.
from that because we have got an ECG reading. If we go into interpreting it, the heart rate is around about 350 a minute, which even for a rabbit, is quite fast. It was irregularly, irregular.
As you can see from there, the the Q RSS are all over the place, different in spacing there, too. A little hard to calculate the axis. And that's often the case of rabbits.
I the the Axis is quite hard to measure, but then again, it hasn't been thoroughly evaluated, as it would be in, say, people or in dogs. So I wouldn't use ECGS on a regular basis to determine heart size. What you can see, there is a no clear P waves, and you have got possibly some F waves as you get sort of fluttering along that baseline.
So this is really good definition for atrial fibrillation, which is what we diagnosed in this rabbit. So what we did to that? We continued with the ace inhibitor.
And we had it in atenolol at 2.5 milligrammes a day and, pentad, using a quarter of a 1.25 milligramme tablet daily.
Formally again. Pim used to come in non flavoured form, which was actually much better tolerated for rabbits than than the current liver flavour, Which is probably not surprising, but, but it was easy to give. And this is what we got.
A FA week or two later, and again, I think we can see it as much more recognisable as an ECG. So it's about a week after the heart rate's now down to 240 so that's quite a good reduction. It's not perfectly regular, but this was only a week in there too.
What we have got are clearly identifiable P waves, which is what we're really after in in treating of Feb in the longer term. She's survived another two years. And she was in normal size rhythm throughout at this time, and she was also so bright.
Had a good active life, which is fantastic. And actually, when she finally declined, it was very, very rapid, and she completely stopped eating. But again, the show that we can, treat some of these conditions, we can work them up and investigate in just the same way as it would for a dog or cat.
And I would, honestly, move that, ECG is probably under utilised a lot of exotic animal medicine. Probably because a lot of the older, units are find it very difficult to assess the the the the very small complexes. But thank you for listening.
I'll hand back to Aden. OK, so we're now moving on to another case. This is a rabbit case.
A rabbit called Jenny. Nine years of age, female neutered, presented to us. Having been on luxin for six days, her weight had dropped in that period with reduced droppings, and she had quite a severe exercise intolerance and was breathing with, her head raised, as you can see in the last image.
There was no nasal discharge. An increased respiratory effort. And there were, referred sounds from the upper airways on chest auscultation.
And there was a very abnormal breathing sound. So our plan was, radiology, rhinoscopy to have a look up the nose. Examine this sort of a gel area, check down the trachea and do a biochemistry haematology screen.
But initially, we just needed some, support for her, supplementary oxygen. So, even if we go to sort of 40 60% oxygen, that's gonna make a huge difference. Nebuli if it doesn't cause her any distress to try to help clear the airways.
Again, hypertonic airline. Nutritional support. And obviously, a rabbit like this needs monitoring.
24 hours. So what we saw on the on the radiology? Skull and chest?
There were no changes at all that could explain the symptoms. There were There were some changes, but they were not significant on rhinoscopy again. That was all normal and passing the, the scope through the nasal cavities and going right back into the nasopharyngeal area.
Nothing abnormal scene. The tracheoscopy scope down the trachea. There was increased secretions there, sort of mucoid secretions, but no actual Other abnormalities of the trachea and no sort of lesions were seen by a chemistry.
Haematology was all normal. However, on the oropharyngeal exam, the larynx was grossly abnormal. This isn't the picture of the same case, but it's a similar case.
So what we saw was the the, rim of the ery theno cartilages were were thickened with a lot of mucus. They weren't moving as they normally. They just sort of fluttering.
And the whole area was very, hyperemic. Very red inflamed. So basically, this is a case of laryngeal paralysis.
We we probably see about two or three of these a year, between us so that not very common, in, in most cases, the the ehe cartilages are are are about 70% open. They're unable to respond if any sort of anything comes in contact. So aspiration pneumonia is a high risk.
If they are, they can be asymptomatic for quite a long time. If if the as long as the eno cartilages don't become inflamed, then then the rabbits will be symptom free. So, treatment wise?
Well, there's no cure. Unfortunately, the aim of treatment is to try and settle that inflammation down, and reduce the secretions. The rabbit would be is usually they're usually very uncomfortable.
Trying to breathe. So supplementary oxygen. We often advise owners, of of these rabbits to have an oxygen concentrator at home, which they can buy on the Internet for quite relatively cheaply.
In case there's a flare up because that's the That's the big thing they can do initially, and they can start Some anti inflammatories usually met to, straight away. If there's a if they notice a flare up, avoiding to starting to happen, try to avoid any competition for food. We don't want the rabbit feeling that it has to gobble its food down.
And that would increase the risk of, of of, food. Going near the the larynx, causing causing inflammation or possibly aspiration pneumonia. Avoid dusty foods, dusty environments.
Nebulization may help. It might not do, and basically try and keep the the rabbit's life as stress free as possible. That's that case.
Thank you. Welcome back to John. The next case, actually going to go back to, hearts and ECGS again?
I said I do like EC ging. And, do you find it very useful? And this is a case of a ferret.
Just for change of species. When chris had been referred and was arrived semi collapsed very, very weak and had a long history of breathing problems and, unusual ferret had a very, very slow heart rate. But it was interesting.
Also had a really interesting double beat sound. And it just sounded very, very weird indeed. And, not the usual nice rapid heart.
A ferret heart regular sound. So again into ECG. Ok, I would suggest with these guys a traumatic tips are are, are useful, but, what I would also say with, with the ferret.
Don't forget the benefit of, of holding them. So they're vertical. Some will stay very still without scuffing.
Chris didn't, some will stay very still without scruff. And then get very bored after a short period of time. And then you have to be a little bit, keeping a little bit, Stiller Because one thing ECGS don't tolerate is is movement.
So this is Chris, and, this is him being held. And the nice thing is, we can take an ECG very quickly in a and it need to be in a conscious animal and without too, any real invasion. And this is the ECG produced from him.
And as you can see, it is quite a remarkable, trace and nothing. I've really seen like it before. So the nice thing about it is you can go through a ruler and a and a and a pen and a few sets of rules, and, and and and find what you got.
So, we did then go through ultras. Excuse the slide. And as is unusual, we can we can do ultrasound.
Conscious and ferrets are really pretty well behaved. And again see this very dilated heart. We got a lot of turbulence of a colour Doppler as well.
Showing this was really not flowing particularly well. So back to our ECG. That's so interesting.
What we're seeing is we had this, BGE There were occasional normal complexes. And the, but P waves are not associated with the QR S, and we had totally different rates. So we had a P wave rate of around about 100 and 10 a minute, which is really approaching normal.
Possibly a little bit slow for a ferret, but approaching normal and a QR S about 50 which is way, way low, for ferrets. So we had that, too. So this is what we diagnosed.
We diagnosed third degree heart block, with a ventricular by Gemini. As we were getting these two distinctive, forms there, showing that we had, you know, origin of, of the electro imp, impulses from two different places. So what can we use here?
And more importantly, what can't we use? Because most of our things, which we have, available tend to reduce heart rate. So if you like, think of our pendants and stuff, they give creased force contraction, but they might actually have a have a negative chroma, Cono.
Tropic effect. Which is what? Something we really did not want in this case is heart did not need slowing.
He did have some fluid in the abdomen. We'd have some ascites present. So we did put on some diuresis.
As as felt, this might be useful. Obviously, one thing with diuresis do worry about is any effects on, on electrolytes might affect heart rate. So we didn't use a potassium sparing one.
We used furosemide, on the grounds that, you know, we didn't want to build up of potassium. We potentially slow heart again. What we did use, we used Theophile.
And I was very grateful for, for the help of, a local cardiologist. And the reason for this is, the often it's very old fashioned, treatment for heart disease. We used to use it a lot in in dogs and cats.
And it's caffeine related, but it's a stimulant, and it does have a mild stimulant effect on on on the heart rate, just like caffeine does. And the idea being is we're trying to stimulate the atrium to go, as fast as possible. To get through eight or beats going faster, get more P waves, and hopefully a few more of those will get through to the, ventricles and speed up with the ventricular rate.
So a month later, we had this instead, again, we've got, aberrant beat. More like AAA ventricular. Premature contraction.
But we've got actually, Really, what mainly is a regular heart rate? And we're seeing, will be a negative P wave. But we are seeing more match up in those, I in those waves, so there's no direct associated with those.
We're getting more of them. We've got ventricular rate up to 80. There were still occasional episodes of weakness, but many fewer.
And chris continued in that fashion for about another four months. And then, arrived completely collapsed. And we we did perform euthanasia at that point.
So it's really a case then, of what more could we have done? And fundamentally, you'll look into what would be done with, with people and with with dogs and cats at this stage. And probably this is one where where the only real option would be something like pacemaking, and actually implanting a pacemaker in into the ferret.
Now, theoretically, that's possible with his state of health. And, ability to withstand therapy. I was suspecting Chris's cases were absolutely not possible.
And would would probably not have been a successful procedure. So, like, all these things is, you know, So you gotta look at the the animal, how well they are, what they can tolerate and what you can, what you can do for them at that point and modify your your expectations from there. But that probably was about it in terms of being able to treat that.
So thank you. And, over to a So this is a This is a case of, Toffy six year old male neutered, been treated for dental disease for several years. But recently some scabs had started appearing just on the side of the face, just anterior to the eye.
The referring vets cleaned the scabs and described a white material. That, that was consistent with inflammatory exo stroke puss, and they sort of flushed out. And it had been on Enrile for the last six weeks.
Here's a image when we, Tuffy asleep. So you can see the the area here. This is where there were scabs present.
So here is a skull just to show you where that area is. It's just here, and it's called the perforate area of the maxillary bone. And it's It's an area of the skull where you have, like, a It's a lace like structure, a mixture of sort of, bone and cartilage.
And it's this weaker area. OK, here is a cross section of the skull. And this this is the ventral recess of the maxillary Sinus.
This is the, dorsal, part of the maxillary Sinus. And that's the dorsal nasal con. So this this section is where there's a large opening from the dorsal nasal conca into the, maxillary sin.
There is an opening from the from the dorsal part of the mail. Sinus. The adventure part.
But it's further back. And this is the nasal nasal duct in its bony canal. So So, basically what we had going on is we had an abscess.
We had infection We had a sinusitis, in the maxillary Sinus that was, eroding through the bone here and and we were getting an oxidate on the surface of the skin, and that's what the scabs were. So, Sinus disease is actually quite common, but presenting in this format is not that common. It's it's quite rare, but it But it should be your top differential if you see scabs in this area in a rabbit.
Sometimes there'll be a nasal discharge. Some, quite often unilateral. There might be sneezing.
Occasion. There might be a head tilt more to do with pain from the, sinusitis, but you can get overflow of tears if the nasal aal duct is, is affected. Skull deformity.
It bleeds. Sometimes. I, sometimes breathing problems.
Sometimes the it ex oth. There's only a very thin plate of bone between the, the Sinus and the bony orbit. And so it it's it's a common cause of, a retro bobal abscess.
So diagnostics, radiology rhinoscopy. They're the primary diagnostics that we use to investigate these symptoms. Samples.
If we suspect a Sinus infection, we will pop a needle through that, perforated part of the maxillary bone in the skull into the Sinus, to get a sample from there, you can just use a hypodermic needle for that. The nasal A doctor should also be investigating if there's a possible sinusitis. Because that bony canal can be damaged.
And of course, culture and sensitivity of those samples will be really important, because treatment is not going to be a simple case of a few days course of antibiotics in this case, the Sinus was actually filled with granulation tissue. We sort of opened up the area marsupialized it, and, this is a very recent case, so we don't have a culture and sensitivity back yet. But our, antimicrobial treatment would be based on that, it it depends on on the presentation for the, of the sinusitis.
What you need to do. In this case, the Sinus was filled with granulation tissue. So the outcome may well be quite good in this case.
Eventually, that granulation tissue may well be, mineralized. And you may get that, bony. Inflammatory response that you often see in rabbits.
But in in the more common case, you still have a, a Sinus, a cavity there which should be filled with air, But, it is often filled with pus. And it's lined by, by a ciliary epithelial lining, which will usually be destroyed by the sinusitis. So it means that the the way of removing mucus and oxidate, is destroyed, so they tend to build up in their, the obvious thing would be to create a new drain in so that they can drain out.
But, experimentally that's been found not to work. This, textbook has got a section on Sinuses, but it's unfortunately, it's buried in the ear. The ear surgery section, and in there you find more detail on the sort of physiology of the Sinuses and the surgical approaches and and the puncture points for, collecting samples.
So back to you, John. Thank you. Aidan.
So moving on to back to rabbits for this case, and this is one really showing, aerosolization therapy. And, how we can use that, in these so isolation therapy will again. Why do it?
And there are many sort of reasons proposed for this, some of it to propose a safety that you can use potentially more dangerous drugs. Some of that may be felt to be allow direct application of drugs into lesions. Those who are probably a little bit disingenuous because to an extent, you know, you're often there's gonna be surf.
Drugs will go onto the surface of the animal and actually a lot more absorbed from respiratory membranes than people think. In terms of direct application again, concentration with these drugs will arrive is often very uncertain and and very often not tested and will vary throughout respiratory. But not there may be some some ability to do that occasionally, expression in effect, most definitely does help and suddenly, you know, saying we've got colds and then sorry, I'm a bit a bit like that today, and you know, sometimes it just steam and things that will also help shift some discharge, which can make things much better.
And sun mucus membrane is quite a beneficial effect, as somebody who's got a cold has been on a plane will notice the membranes dry out. But again, looking at this again, we look at what sort of spiritual these two rabbits actually get and how many times it's gonna be applicable. So generally, if we're gonna do this in animals and in rabbits, we're going to use Neb as our form of aerosolization.
Now, the reason we do it is because it's so easy to use. And, the other techniques generally are gonna require a lot of active, assistance from the animal. But it's very easy to nebulize.
I mean, a chamber you need, a nebulizer. You you need, a pot with a drug in it. Big problems with that is it's impossible to me to do, so you know, you you've got a measure amount in there, but you can't say how much of that drug is actually gonna get into the animal.
And you've gotta be careful what you use. So, and particularly with the fact that you know, if you do net ization, those drugs can go up in the air. We're gonna land on the rabbit, and the rabbit is going to groom afterwards.
So the thing about using less safe drugs is gonna be relevant here because, anything you nebulize is gonna be taken orally by by the rabbit, and that could lead to further issues with antibiotics. And then so you can be very, very careful what you use so very often with nebuliser, we're often using things like saline even. Very dilute F 10.
Something like that. Just so we get, much of the expectorant effect and everything else rather than a pure antimicrobial effect. In people, however, we know we don't nebulize very often nebulizations really reserved for young Children.
And for, very old people who can't, coordinate breathing rather when they can use a puffer instead. And these, meted, dosing devices are really the most common way to go. Everybody has people with either has them or uses them, for treating with asthma and and various other conditions.
And it relies on coordinating with breathing with being able to, take in that much of a metered dose. And that's exactly what they're for. They're for metering a dose for giving a specific dose into the nose.
So get a fixed control dose, and it is that thing, But you need to coordinate that puff with the inhaling. And that's the big problem we use in animals. So is it possible?
And the answer is yes. And this is where the spacer devices come in. So what you do is you puff into a spacer.
So you end up with saying halfway between, puffing and halfway between, nebuli. So essentially the, the drug, a fixed amount of drug is aerosolized into the spacer, and the animal will breathe in via the face mask. There This means they'd probably like to get all of it, but they are probably gonna get the majority of it.
And again, it's not gonna go all over them. So just around the nasal area, so it's it's not gonna be quite so many effects from that. So the case I have here is smudged literally with a two year old male neutered rabbit, presented tachy, dyne and not quite mouth breathing, but not very happy about life.
Had received antibiotic at a previous vet, and had no response auscultation of a chest really noisy. Lots of respiratory noises. Now, the good thing about that is so we haven't really probably got consolidation because, consolidations Very quiet, normally a bit like normal lungs.
But we So we had lots going on there, too. Mu memory is fine. We didn't have any any CYO.
And we're still in good body condition, Which is again, a good, good sign. For for, for prognosis. And usually he started to cough.
And I've had very few rabbits, actually, actually cough, before so usual thing we did take radiographs, and I think we see why we've got coughing. See, this really marked bronchial pattern. O on this X ray.
Some of calcification, which again is a mark of a chronicity of the problem. Lateral view? No, you not very well centred, I'm afraid this X ray, But, on lateral view again, we can see that bronchial pattern.
Quite clearly. So what do we do this? We, we did take some blood, so we want to look for any background disease and things we could or couldn't use.
And bloods were fine. We did an endoscopy. We, put a very small, flexible endoscope down the trachea and had a look around.
No picture, I'm afraid, is very, very difficult to get images from from It's a two millimetre endoscope. But also, it was just so inflamed that every time we touched the wall, we got some bleeding. So it was just remarkably inflamed.
Before we put the endoscope down. We did do a lung wash. Lung washing is really a good technique in these guys.
You can put an endo tracheal tube down and do a basic BAL, by just flushing saline through. And I'd recommend that in all sort of like diffuse, lung disease cases. So on lung wash, you had no bacterial or fungal growth.
Very important when you do lung was you do cytology as well. We have a mixed inflammatory response and respiratory epithelial hyperplasia. So what this really looked like was, rather than being an infectious pneumonia, and this backed up the lack of response to antibiosis before, this looked very much like, a primary inflammatory disease.
And so what do we want to treat this with? Well, you know, again, back to our human medicine stuff. Back to other species.
We're probably looking to use some corticosteroids, but we do know that corticosteroids are quite difficult in in rabbits. They are a bit sensitive to them. And how are we gonna do that?
So, you know, again, What way can we get the the right drug in at the right dose? So what we did we We opted for systemic antibiosis. And the reason for that is because we want to use some aerosolized steroid.
So on clinical appearance, there's no real indication for it. But we do know that steroids are going to, cause some immunosuppression. And we wanted to guard against getting a secondary pneumonia on top of what we had already.
So we, used, fluticasone, aerosolized there, too. We did warn the owner about side effects. And again, if you're gonna use, off li of drugs, if you're gonna, use things, potential side effects.
And things are a little bit, on the unusual side that you really do have to get good buy in from the owners and talk about it now, aeroscience we couldn't really use nebulization here. We just saying we want to control dose we don't want We don't want to. Just generally know realise we certainly don't want the rabbit.
Licking and grooming. Steroid. So we so we use a spacer.
Now, it's meant we didn't start therapy for, for a a week or two after diagnosis. And the reason being is, we really wanted to train the rabbit into the spacer and very important in doing something like this. Now, rabbits don't take kindly to having objects put over, their faces very much.
If you look at the P saw a picture beforehand to examination, you'd notice that, that he was, towel wrapped, because he was slightly flighty. So we got the owners to introduce, the the the spacer very gradually, to get used to handling him in a very gentle fashion. But we don't want the treatment to cause more distress.
And also rabbits, because when they get upset, they tend to to to do his apnea thing where it's really just to stop breathing now for an aerosol therapy. We do not want that to happen. That's the last response we need.
We need them to actually take this drug in. So we also introduced positive reinforcement training where we we identify what his favourite, treat was. And, no matter how bad it was, we let we let the games, right?
Just have that available. Show him that, and he can have that during his aeration or straight afterwards. And this worked really well.
He calmed down very quickly. He he took to his space quite nicely. And then we introduced the drug as well.
And started using that, and it worked really well, we did also make some change as well to environment. It's very important with with rabbits in particular with, ventilation. Often if you look at the sleeping compartments where hutches and whatever housed in they're often quite closes often very little air movement.
And this is where they're gonna see over all kinds of things. Too often you get a build up of some irritant substances, and especially when you think about down at rabbit nose level, which is quite low compared to where we're often, smelling the air. So, we we introduced more ventilation to his sleeping compartments.
We we got them to increase ventilation of the house cos a house rabbit. And we also got them to put him on to paper bedding, much less dust and feed. Hay wetted down to stop dust going up and the edge really try and reduce any irritation that might be, causing a problem.
And he wanted to really rapidly, he improved his demeanour. His breathing improved, the lung sound improved. His cough became occasional, but but, but but much less frequent.
So that was quite useful. And actually, the cough was was absolutely, a great sign to use. So instead of we start off with Aerosolization at, twice a day and we gradually reduced this to once a day and then we actually were able to reduce this into being when he coughed that the owners would would then would then, aerosolize him.
So we've really got those steroid doses down and down and down and down. And that was really nice that he tolerated this well, and they can actually use a clinical site to guide. When he needed a little bit more help, he came with antibiosis quite soon after, starting the, starting the aerosolization.
Apparently, he wasn't having any side effects from it, so we could wean him off that as quickly as possible. So, take a message out. Well, really, as we can be inventive with how we give these drugs, we can use drugs that may be a little bit less safe.
Systemically, we can use it in a more, topical fashion. And that opens up other avenues of, of treatment. Especially when we get some diagnoses that aren't necessarily straight out of the, book and over to Aidan.
OK, so this is, tco, 18 month old male rat. Been with the current owner for the last six months. It was a rescue.
So the age is a bit unreliable. It lives with two others in apparent peaceful harmony. When it came to us, poor body condition, poor coat, there was weight loss.
It was lethargic. And there were episodes of dyspnea with the head held upwards. And these were lasting sometimes up to five minutes.
This was the main reason that they presented that Go. There was no visible nasal or ocular discharge. On chest auscultation, we could hear crackles and clicks.
There was a lot of weight loss. There was a, increased, effort on breathing with abdominal breathing and on handling. Taco's breathing deteriorated, so the initial plan was, supportive.
We wanted to, give some oxygen. We wanted some anti inflammatories on board. So we started using meloxicam at half a milligramme per kilo every 12 hours.
We wanted some antibacterials, and we started, nebuli, with hypertonic saline. The being just to clean the nasal cavities and remove any biofilms that were present that would allow our antimicrobials to have better effect and to the plan was to take some radiographs when he was a bit more stable. Hopefully, quite quickly.
So here's the ready graph that we got. And we can see that, there's a lung lobe, that is Let's see. Can I get a pointer that is collapsed just here?
and this this is something we see quite common in in rats. Secondary to chronic respiratory disease. Probably collapsed due to, secretions in the in the airways, and the the plan is, to manage.
These cases, they they do tend to do quite well. And sometimes we find these, collapsed lung lobes. Incidentally, nebuli may not get down deep into the lungs.
We tend to use it more for upper airway problems. Often, it's streptococcus. Pneumonia.
Is is, is a common cause of chronic respiratory disease in, in rats, usually secondary to mycoplasma. Mycoplasma is usually the main player. But Enrile is not very good against streptococcal.
So it's not going to be a good choice. And, bronchodilators may help. And the, long term treatment would be to try and keep stress levels low.
Try and by keeping him on a good diet and have a stimulating environment. And a, the social group that he's with making sure there's no no bullies in there. So So, yeah, basically, that was a a short, short course.
So so these. Yeah. These rats need long term management, and in this particular case, we use potentiated amoxicillin and and we did get a good response.
OK, that's, tackle, Thank you very much. Back to John. So yeah.
So final. My final case is ready to look at, noses, in rabbits and really what CT can do for us. So I'm sorry about that.
CT, though, is becoming much more available. And it's good to know what it can do and what it can really add into a case. Even you haven't got directly available to you at the time.
So certainly what it's great for is things like heart tissues. It's very good where there's a lot of air about too. So things like Sinuses and nasal nasal cavities where it's, bone plus air is great.
We can also tell some stuff about heart size and chests as well, which is really quite good. So this is Suki, whose five year old female neutered rabbit, had ocular, discharged bilaterally very softly and sneezing and had no response to antibiotics or NSAID or tear duct flushing at referring vets. They had taken an x-ray.
We can see there is some degree of consolidation in the Sinus region just here. But, it's hard to see it. See exactly how extensive this is.
So we we did it, Actually. First response. We went to CT.
And what we can see here is, actually we can see some really big, big lesion in here. We can see some broken down bone we can see in the, coronal sections as well. We can see those.
We've got bone involvement. Section has been destroyed. And we can see the lack of bone has been, we've been taken out as well.
We have this large soft tissue mass, again, slightly different, section through there, too. And again, we can see the extent of the soft tissue lesion. And some bits of residues of what?
Were, nasal bones within there. So the anaesthetic was not easy to do this, which is very difficult breathing. That's why we didn't we we didn't sample it.
However, this was a presumed, tumour, based on the degree of destruction, lacks responses therapies, and, sheer extent of it, too. And nasal tumours are reported. Reasonably commonly in rabbits, with a couple of papers from around the world.
We treated with Dex methane again. Another steroid. use, in this case, we're looking for longer acting use, and for a way of avoiding we used injectables.
We want to avoid oral drugs because she found most things quite distressing. And again, with the provisor, this could could be, very difficult. But might just take down some peripheral reaction around the of a tumour.
make it regress a bit and might just give her a bit more time. With more breathing space. And this went went absolutely fine.
She did improve. Things Did. Did get better.
But two months later did come back again. So we didn't buy much time. We did manage to buy a bit so slightly depressing case to finish on, but again, we can at least see just somewhere differences where some of these imaging techniques, can give different information.
And different amounts of information. So thank you very much for listening to that
