So hello and welcome to this webinar on exotic small mammal emergencies. Today we're gonna cover how to triage the exotic small mammal patient when they present to the clinic, discuss the basics of emergency care, and look at some of the common emergencies affecting exotic small mammals that you may see in practise. Do know that a lot of the medications mentioned in this webinar are off licenced.

So, and so we do use those under the cascade. I just wanted to start out with outlining what species we'll be looking at today. There is a huge variety of different exotic small mammals that are kept in the UK and I think the easiest way to navigate these different species is to think about what they eat.

This then helps you to think about their anatomy and can guide you when it comes to triaging and treating these patients. The first group to consider is the herbivorera species. On the left-hand side of the screen, you'll see the guinea pigs, daegus and chinchillas.

These are all hindgut fermenters, which have large segus and eat primarily a diet of hay, vegetables and other roughage. They cannot vomit and they've got continuously growing incisors and molars. The next group are the omnivoreous species in the centre of the screen, which includes things like hamsters, rats, gerbils and mice.

They eat a diet of seeds, nuts, fruits, plants, and some meats, including insects. These species have continuously growing in sizesors, but their molars only have a limited period of growth, so they do stop growing once the tooth is mature. They also cannot vomit.

And then the last group are the more carnivorous species on the right hand side of the screen. The ferret is an obligate carnivore, whereas the African pygmy hedgehog is technically an omnivore, but they have similar anatomy to other carnivorous species. So they have teeth similar to a cat, and both of these species can vomit.

Before we look at triaging these patients, there was a few points I wanted to make. So first off, I always think it's important to remember that although these patients are small in size, there is still a range of different diagnostics and treatment options we can offer them. You may find it helpful on occasion to take a step back and just think, how would I treat this patient if it was a dog or a cat with these clinical signs?

As I think this can sometimes help us think a bit more logically about how we approach the case in terms of potential diagnostics and treatment. Also remember that a lot of these exotic small mammals are prey species, so they do hide signs of pain and disease very well. This means owners may not present them until they're at the end stage of their disease or illness.

A lot of these species are very fragile and so they can deteriorate rapidly. Therefore, it is important that if the owner says the pet is not eating or toileting normally, that they, or that they say the pet is not quite right, they should be seen as soon as possible. Finally, I just wanted to point out that when these animals are unwell, it can take a lot of commitment from the owner, both in time and money to treat them.

Therefore, it is important to make sure the owner is aware of this commitment and that their expectations are managed from the outset. So we're now gonna have a look at the first step in triaging these patients, which is taking a history. First off, do not panic.

All the species we're discussing today are mammals. So just think of them as little cats, dogs or horses. Many of the questions you need to ask are similar to what you would ask an owner about their dog or cat, but there is just a couple of extra things to consider.

So do make sure you ask about the environment the pet is kept in at home. Does it live on its own or with companions? Are the companions also showing the same clinical signs?

What is the enclosure like? Is it indoor or outdoor? And what substrate do they use?

These questions are important because poor husbandry can result in poor health. If you're seeing a ferret, it's important to ask about vaccination, as some people will vaccinate them against distemper and rabies. Guinea pigs and rats are sometimes neutered, as are some ferrets.

Although do note that with ferrets, routine neutering is not generally recommended, as adrenal disease commonly develops in neutered animals. And therefore we do usually recommend giving superlorin implants control breeding instead. Make sure you ask about the animals eating and drinking.

Sometimes these species will stop eating just a particular part of their diet. For example, a guinea pig may stop eating hay, which could be a sign of dental disease. Some of them will also be litter trained or only use a certain corner of the cage to toilet in.

And a loss of this litter training can be a subtle sign that something is just not quite right. Be sure to ask about subtle changes in behaviour, such as being less active or avoiding interaction with the owner or cage mates. And if it's an African pigggy hedgehog or a ferret, remember to ask if there's been any vomiting.

And then finally, ask other standard questions about previous health issues, trauma and exposure to toxins. When it comes to performing a clinical exam on an exotic small mammal, there's just a couple of tips I wanted to discuss. First off, always take a small towel into the consult room with you.

This offers the animal somewhere to hide and can reduce the chance of you getting bitten. Another good tip would be to grab the gas box or a clear plastic tub. So you can put the small exotic pet in the tub and then lift them up to eye level, which will allow you to have a closer examination of them and have a good look at their ventrum and their feet.

When examining a ferret, if you scruff them gently, then they will often yawn, and this can allow you to have a really good look in that mouth. They can also be easily distracted with more paste, which can help reduce the chance of you getting bitten. Guinea pigs will always have food in their mouth.

So if the mouth is empty, then I would worry that they're not eating as they should do. And then don't be afraid to sedate a hedgehog with IO or CO to allow you to examine them. A curled up hedgehog that is half.

In and puffing away can be impossible to examine, and you'll be able to perform a much more useful exam if you can just get them to relax using a little bit of gas. Also, do take care of your exam in a chinchilla. If they are handled roughly, then they can shed large portions of their hair coat, which the owner will not thank you for.

With gerbils and agus, remember they can deglove their tails. So if you are supporting them by holding the tail, always hold that tail at the base, nearer to the pet's bottom and never hold them by the tip of the tail. When it comes to performing a clinical exam, remember that, remember that a lot of it will be very similar to when you examine a dog or a cat, but again, there's just a few extra things to remember.

So first of all, do make sure to you always assess that hydration. These small mammals dehydrate super quickly and it's important that we try to correct any dehydration as part of their treatment plan. With rats, you will sometimes see them present with red tears or bleeding from the eyes.

This is not blood, but it is porphyn pigments that are naturally released from the lacrimal glands, and a buildup of these red tears can be seen when the rats are ill or stressed. Hamsters have large cheek pouches which extend down to the level of their shoulders. When examining a hamster.

Do have a really good look and a feel of that pouch area to look for any abnormalities such as an impaction or swelling. And then dental disease is very common in exotic small mammals, and you should always look in that mouth as part of your clinical exam. Checking sizes for signs of overgrowth or uneven wear, remembering that the herbivores and the small rodents do have those continuously growing in scisors.

In some of the larger species, you may also be able to use an otoscope to have a look at the molar teeth. But remember, a GA or a sedation is required to perform that full oral exam. Do have a feel along the mandible and maxilla for any lumps and bumps.

And then hypersalivation is also a key sign that there may be a problem in the mouth. So also do make sure you look out for that. Many of these animals will wipe their nose on their forearms to remove any nasal discharge.

So do keep a lookout for any wet sleeves. With herbivores, it's important to listen for gut sounds, just as you would do in a bunny rabbit. And normal gut sound is about 1 to 2 episodes of boring me per minute.

Do be aware of normal scent glands. In Syrian hamsters, they have scent glands on their hip and flank area, and sometimes owners will worry that these are bald patches, as they can look really obvious and a little bit oily, particularly when that hamster first wakes up. Do have a good look at those glands, but if they do look uniform and they're not inflamed, then you can reassure the owner that they are a normal feature.

With gerbils, they have a ventral scent gland, like you can see at the picture in the bottom of the screen. The gerbils will sometimes get tumours growing from these scent glands, and they can also get infections here as well. So it's important to examine that gland as part of your clinical exam.

With ferrets, you may feel a large spleen on abdominal palpation. This can be a normal finding in older patients due to extra medullary erythroparesis, but it's definitely worth investigating the spleen if you are worried it's abnormal. An ultrasound can be a useful tool for this.

Another interesting point to note is that African pygmy hedgehogs do this really weird behaviour where they cover their spines in frothy saliva. The first time an owner sees it happen, they can be quite worried and confuse it with vomiting. With vomiting, it would obviously tend to contain food content, but self anointing is purely just the saliva.

Hedgehogs will self annoint for numerous various different reasons, including as a sexual behaviour and in response to new smells or stresses in their environment. Small exotic pets can also be prone to developing feet and hock sores. So do make sure you check their feet, as as the Zaws can become so painful that the pet stops eating.

Make sure you check that genital area and double check the sex of the animal, as sometimes pet shops obviously can get it wrong. And then with chinchillas, also check the penis for signs of fur rings, which is when fur gets trapped around the penis and it can cut off the blood supply. Avoid rectal temperatures unless it's completely necessary, as it can be very stressful for these pets, and you can cause damage to them as they're so small in relation to the size of that thermometer.

And then finally, always make sure you weigh the pair and monitor their body condition score every single time you see them. So you can look for any trends. With the herbivores, do note that their weight can fluctuate massively depending on how much they've eaten that day.

But looking at trends and assessing that gut feel and body condition score can help to guide you as to whether they're experiencing a true weight loss or a true weight gain. Next up, we're gonna look at the basics of emergency care, and the first thing we will look at is analgesia. Non-steroidals are commonly used in these patients, with meloxicam often being a first line choice, as that liquid formulation can allow for much more accurate dosing than having to divide tablets into tiny doses.

Do know the dose range from meloxicam is often at a much higher per kid rate compared to what we would use in a dog or a cat. And then remember as well that Metacam cat suspension has now been licenced for use in guinea pigs in recent years. With ferrets, they can be really prone to developing GI ulceration.

So you may want to consider using a concurrent H2 blocker if you're gonna be given an NSAID. With opioids, the drug I tend to use most for these patients is buprenorphine as it appears to be effective and well tolerated. Fentanyl is also often used in ferrets, and we do have some dose rates for the tramadol in rats, ferrets and mice.

Remember, we don't have a lot of data available to us currently around efficacy of these products in these species. So it's important to pain assess the pet regularly to make sure the analgesia you've provided is sufficient. Don't forget that alpha 2 agonist drugs also have a degree of analgesic effect.

However, in the emergency situation, I do tend to avoid these due to a risk due to the risk of cardiovascular depression in a patient that's already compromised. Local anaesthesia can also be considered, but do be careful with the risk of overdose and always calculate the maximum dose you can give, so you know, know that you can't exceed that. And then ketamine can obviously also be considered as part of a multimodal approach.

Dehydration occurs commonly in sick exotic small mammals, so it's important to consider whether fluid therapy is required as part of your treatment plan. The maintenance fluid rate is higher than that of a dog or cat, so in so in exotic small mammals, it's usually quoted as 75 to 100 mL per kg per day. If I need to give a bolus of fluids, I will usually give 10 mL per kilo over a 20 minute period, and then I'll reassess to see if any more fluids needed.

And the fluid type I most commonly use is Hartman's. When we're thinking about which route to give fluids, there obviously are multiple routes that we could consider. You may be able to place an IV in the cephalic sinus or femoral vein.

Subcut fluids could also be considered, and they're really easy to give. However, their absorption can be very slow, especially if the animal was collapsed and hypothermic. Intraperitoneal fluids can be given, but you do need to be very careful as there is a risk of causing damage to the internal organs with the needle.

IO catheters can be considered. Again, be really careful when you're placing these to reduce the risk of actually fracturing the bones. And then finally, or fluids obviously could also be used, providing the animal is well enough to take fluids from a bottle, a bowl or a syringe.

When it comes to feeding these patients, it is vital that you do consider nutrition immediately. And don't wait until days 2 or 3 of hospitalisation as you may do in a dog or a cat. If a patient is being admitted to the hospital, I will often ask the owner to bring in a lunchbox for the pet, containing their favourite foods, so that they are being presented with foods they are used to, to hopefully stimulate them to start eating a bit sooner.

Drastic diet changes should not be performed when a patient is unwell, unless obviously the food they're being offered is harmful or toxic. The key thing always is to get the meat in ASAP so we can always discuss improvements to the diet once the animal is feeling better. If you are worried that an animal isn't eaten enough, do sit down and do the calculations to work out how much food they need to eat in a day to reach their calorie requirement, so you know exactly how much they should eat.

There is a range of different diets available for syringing to these pets, including the oxbow critical care range for herbivores and carnivores, the recovery plus sachets for herbivores, and the critical care formula from Vett Arc, which is a white powder that you can mix with water. A favourite of mine has to be the Emirade range, and on their website they have a really useful feeding guide. So for example, if you search for a hamster, it will tell you how much of each powder to mix, mix together with how much water to create the perfect formulation for the species in front of you.

And it will also guide you on the volume of food to feed to that pet to reach their daily calorie requirement. These small mammals do lose heat very quickly, especially when they're unwell. So do consider whether you need to supply them with an additional heat source, like a snuggle safe.

It is important, however, to ensure that the animal is able to move away from that heat source if they're getting too hot. You should also consider whether the patient would benefit from oxygen therapy. Remember, the only contrary indication to oxygen is fire.

I love that expression. So giving oxygen via chamber, flow by, or mask may well be of benefit and would rarely be of any harm at all. Always consider giving oxygen if the patient is stressed, is sick, or collapsed.

And remember that many of these exotic small mammals suffer with some degree of underlying respiratory disease. So, they will likely benefit from being given a little bit of supplemental oxygen prior to the stress of handling for a clinical exam. When it comes to diagnostics, although many of these patients are small, we can still get a usable blood sample from them.

The average blood volume in these patients is 7% of body weight, and if they're healthy, we can take up to 10% of this blood volume. So even with a 25 gramme mouse, we can still get a few drops of blood, which can be enough to run a couple of tests. Blood collection sites will vary obviously depending on the species.

If it is that you just want a glucose reading, you could consider a foot prick. In larger mammals, consider the jugular, femoral vein, cephalic, and sinus. For rats and mice, they have this really great tail vein that runs down either side of the tail, which is fairly easy to get a decent size decent size sample from.

And then with guinea pigs, we tend to collect samples from the cranial vena cava, as illustrated in this photo. I prefer to have them sedated or under a GA for this and then lay the guinea pig on its back. You then go cranially to the first rib and aim down towards the opposite hip, and you should be able to hit the vessel that way.

When measuring glucose, we can use those handheld glucometers that we use for a dog or a cat. Do remember, however, that these are not calibrated for exotic species, so it can be more useful to look for trends rather than exact values for some species. Hyperglycemia can be seen fairly commonly in the clinic environment due to stress, but we can also see it due to diabetes in hamsters, gerbils, guinea pigs, chinchillas, and degus.

We can also perform epochs, ISAs, or, you know, emergency databases and run a full haematology and biochemistry if it's indicated. If I do want a full blood panel, I will usually send the sample off externally to an exotics lab, as their machines can get results on much smaller samples than we can run inhouse. And do ask for the reference ranges from the lab or consult a textbook.

We can also perform endocrine testing in ferrets and other species when it's indicated. With ferrets, we can run an adrenal profile, if we're worried about adrenal disease and look at insulin levels in relation to glucose levels if we're worried about insulinoma. Don't forget, we can also really easily image these patients.

X-rays can be performed, and with a guinea pig, I'll often just sort of wrap them up in a towel to keep them still. With smaller mammals, you may want to place them in a box or a chamber whilst they're being X-rayed to avoid them running off if they start to come round from that sedation. Ultrasound is also a really useful tool, whether you're performing a full ultrasound or just a basic pocus or fast scan.

To look for some free fluid and obvious abnormalities. With herbivores, they do tend to have a lot of gas in the intestine. Which sometimes can make the ultrasound a little bit more limited, but you can still get some really great images of the major organs like the liver, kidneys and bladder.

So it's still well well worth doing the ultrasound. Next up, I wanted to give you a quick rundown of anaesthesia in these patients with a few helpful tips. Because small rodents cannot vomit, you do not need to starve them before a GA.

But with a guinea pig, you may just want to withhold food for an hour or so before the procedure. This is to hopefully reduce the volume of food the guinea pig has in its mouth. And once they're sedated or anaesthetized, I will use a cotton bud and a otoscope to remove as much of the food from the mouth as possible so that I reduce the risk of that food being inhaled.

As ferrets and pygmy, African pygmy hedgehogs can vomit, they should be fasted for 1 to 4 hours before sedation or GA. All small mammals will benefit from pre-oxygenation prior to surgery, as I've already mentioned, because a lot of them will have some degree of underlying respiratory disease. And then, as hypothermia happens rapidly, do take steps to keep them warm before, during, and after that GA.

And if you need to clip their hair, then just make sure you minimise the size of the clip, and also don't saturate them with hippy or spirit, because obviously you'll make them even colder. Also make sure you have everything ready that you may need to hand prior to starting the sedation or GA so you can minimise the time that they're under the sedation. Multiple drug combinations for general anaesthesia are possible, and the key is to find a combination you are comfortable with.

As I already mentioned, I do tend to avoid alpha2s due to the risk of cardiovascular depression if my patient is sick. Always consider analgesia, and I will often give buprenorphine to these patients. There's obviously other drugs you may want to add in as well, such as ketamine and midazolam.

With ferrets, I would always recommend you do give some sort of pre-med, as they can really panic if you just attempt to gas induce them. For induction, if you have got an IV, in some species, you may wanna consider using propofol or alfaxan. But for most of the smaller species, I do tend to just gas induce them in the chamber.

For the larger species, definitely consider taking control of that airway with an ET tube. With ferrets and African pygmy hedgehogs, it's, it is easy to place an ET tube and it's much the same as you would do for a puppy, a cat or a kitten. With guinea pigs, intubation can be achieved using a blind technique or by using an endoscope or otoscope for guidance.

Monitoring your patient whilst they're under general anaesthesia or sedation is obviously vital. I love using Dopplers to monitor their heart rates, as it can be really comforting to hear that little heartbeat beat racing along, whilst you're completing your surgery or procedure. You can also keep an eye on their temperature, blood pressure, and use your pulse ox as well.

And then if they're intubated, you could also use the catnograph. Wouldn't are asleep, we need to keep an eye on the depth of anaesthesia. Once the patient has reached the surgical plane of of a GA, there will be a lack of response to a tail or toe pinch.

They should maintain a sluggish repeal reflex at surgical depths of GA. And the eye position will tend to be fixed in rodents. You can also assess your tone, the same as you would do for a dog or a cat.

However, this may be fairly limited in the herbivores because they've got such a small gape. And then on recovery, I tend to continue offering oxygen and make sure that I keep them warm. Obviously we will also see patients that have crashed and we will need to attempt CPR.

Remember your basics here, thinking about airways, breathing and circulation. You can either use a tight fitting face mask or you can intubate the pear if it's one of those larger species to take control of that airway and to deliver breaths. And we're usually aiming for a breathing rate of 20 breaths per minute.

Cardiac compression should be performed at around 100 beats per minute, and you will need to adjust the way you perform the compressions, depending on the size of the patient. So for example, with a gerbil, we will compress the heart gently by having a forefinger and a thumb on either side of the chest wall. With larger species like the guinea pig, you may be able to compress the heart between the thumb and all four fingers.

The compression rate of 100 beats per minute may seem a little bit slow for some of these animals, but we do need to make sure we are performing effective compressions and allowing that chest to recoil and draw blood into the heart before we compress it again. Reverse any drugs you've given wherever possible and check the glucose as hyperglycemia can be a really common cause of arrest. And when it comes to CPR drugs, we are using the same ones we use for dogs and cats.

But dose ranges do vary quite a bit depending on the species in front of you. So if you do have a sick patient that is at risk of arrest, do take a moment to sort of have a look in your formulary and calculate their emergency drugs. So that if they're admitted to the hospital and they do crash, then at least you've been prepared if the worst was to happen.

The last thing I want to discuss is the basic of emergency care is euthanasia. We all prefer to give that lethal injection via an IV if we can in a dog or a cat. But with these little patients, we should consider the animal's stress level when we are placed in an IV.

Obviously in a collapsed patient, they may well tolerate, you know, an IV absolutely fine, but do just weigh this up depending on the case in front of you. For the smaller patients, if I'm honest, I will just tend to gas them down with or without giving an injectable analgesia or sedation beforehand. And then I would just give that pentobarb intracardiac.

If I could, and if I can't get the heart, then I'll give it in intrahepatic instead. We're now gonna move on to look at some common emergency presentations that you may see in practise. So dental disease is very common in exotic small mammals, and so I did wanna mention it in this lecture.

If you're working as an emergency vet overnight, it will obviously be really unlikely that you'd need to perform a dental in the middle of the night. However, I do still think it's important that you're comfortable diagnosing dental issues and stabilising these patients so that they can have those dental treatments in the days that follow. Clinical signs of dental disease include weight loss, grinding of the teeth, known as braxy, hyper salivation, and facial masses and abscesses.

You may also note that the pet has a poor poor coat quality because it stops grooming itself like it should. And the owner obviously may report that the animal has stopped eating a particular part of their diet or has just stopped eating altogether. On occasions, you may have an owner present an animal thinking they've got respiratory disease, when in fact it is dental disease.

I have seen this happen most commonly with daily goose, as they make funny noises, they hyper salivate and they hold their mouth slightly open when they have got dental disease. And it can look a lot like respiratory disease when you first look at them. But obviously, when you do a bit more of a detailed clinical exam, you'll then realise it's dental disease instead.

You may also have a patient that's patients that sort of present completely collapsed as they become hyperglycemic due to prolonged anorexia. And with these patients, it's vital that they are stabilised before any dental treatment is tempted. When stabilising a patient prior to a dental, there are quite a few things to consider.

So fluids, analgesia, feeding and warmth are the key things to consider. And you may also want to consider prokinetics, depending on your clinical exam findings and the species you are treating. Exercise can also be very beneficial at stimulating the gas stimulating the gastrointestinal tract to start moving again in patients with ileus.

So do encourage them to move around. To perform a full oral exam, you either need to sedate the animal or anaesthetize it. And obviously remember you could also consider taking some dental X-rays to cons to assist in your treatment plan.

Species that have incisors that continually grow, remember, we should be bearing down these teeth and not just clipping them, as clipping can lead to tooth fractures. With dental disease in African, African pygmy hedgehogs and our ferrets, their dentition is similar to that of a dog or a cat. So you can approach their teeth in the same way you would treat dental disease in a canine or feline patient.

Also remember that diet is an important part of long-term management. So it will be important to correct any dietary issues once that animal has recovered. This could include things like making sure degus or guinea pigs are eating enough hay to keep those teeth under control.

Hamsters can prolapse their cheek pouches. So they will sometimes show it show up to your practise with a large pink mass hanging out of their mouth that the owner says has suddenly appeared. This can also occur due to them, sorry, it most often occurs due to them getting large or sticky food stuck in the pouch.

But pouches can also prolapse due to neoplasia, cysts, inflammation or infection of that pouch. And the hamster sort of pushes the pouch out because they feel that there's just something that's not quite right in there. Therefore, it's always important to properly examine that pouch, to look for any abnormalities and see if you can identify and treat the underlying cause.

In order to replace the pouch, you need to sedate or anaesthetize the hamster, and then replace that pouch using a cotton bud to ensure the pouch is fully replaced back to its normal position. I would then pass my needle and suture material through the cheek wall into the cotton bud, and then out of the cheek wall again. I then pull the cotton bud out of the pouch, tease the suture material away from the tip of the cotton bud, then pull the suture material tight and place a knot on the outside of the cheek.

Using this technique and going through that cotton bud gives you the reassurance that you've passed through all the tissues in the in the wall of the cheek and into the wall of the pouch so that hopefully your, with your sutures, the pouch does then stay in place. If you do find that this technique fails, then the other option is incising over the cheek and placing some internal sutures to attach the pouch to the subcut tissues. Wet tail is a condition that is commonly seen in hamsters between 3 and 10 weeks of age.

The most common cause of this bacteria is called Lawsonia intracellularis, but other causes of diarrhoea include other bacterias, viruses, stress and dietary indiscretion. Clinical signs that you may see include the hamster being really wet around its back end with foul smelling diarrhoea. It's important to remember that wet tail is diarrhoea rather than urinary tract disease.

The hamsters are often anorexic and dehydrated, and when you feel the abdomen, they're usually in quite a degree of abdominal pain, and you can sometimes feel some really big gassy distended gas er distended bowel loops as well. The most important part of treatment with wet tail is the correction of the dehydration and managing any electrolyte disturbances and hyperglycemia. Other parts of the treatment plan include giving analgesia, appropriate antibiotics, Pepto-Bismol, and also probiotics as well.

There's a couple of other GI diseases that I also wanted to briefly mention. The first is choke in chinchillas. Chinchillas can occasionally get things like treats lodged in their oesophagus, and so they will present choking, hypersalivating, wretching, not eating, and they can also appear dysneic as well.

The best way to treat them is to pass a stomach tube to hopefully dislodge that tree and push it down into the stomach where it'll be digested. You may also need to consider giving them analgesia, fluid therapy, and other supportive care as required. Ferrets are very, very inquisitive creatures, so gastrointestinal foreign bodies are fairly common in this species.

You may feel the foreign body on abdominal palpation or see it on an x-ray or ultrasound. And you just need to treat these ferrets in the same way you would manage a foreign body in a dog. Gastric dilatation and GDVs can occur in guinea pigs, and it's important to establish whether you have just got a dilation of the stomach or if the stomach is twisted.

A GDV can be rapidly fatal in this species due to shock and respiratory impairment, as a large stomach can compress the lungs. If a GDV is suspected, you will need to act fast if the owner wants to treat them and just approach the case in the same way you would do if it was a dog that was presented with a GDV. Respiratory disease is really common in rats, and there's a variety of different causes, including different viruses, bacteria such as mycoplasma and allergies to things in the environment such as sawdust.

Clinical signs do include things like nasal discharge, sneezing, dyspnea, weight loss, and you can also see head tilt because mycoplasma pomonas can cause otitis media as well. Treatment includes providing oxygen if they're acutely dysic, giving appropriate antibiotics, mucolytics, meloxicam, nebulization, and correcting any dehydration with fluids. It's also important to look at reducing stress and making any necessary husbandry improvements as well.

When I do think about respiratory disease in rats, the picture on this slide, which I've taken from the BSAVA manual, always comes to mind. When rats get these severe infections, they can have permanent and really quite drastic changes to the lung structure as shown in this picture. And it's no wonder why these animals come back again and again with recurrent respiratory signs when the lungs have been damaged to this extent.

I do think it's important that we have this conversation with the owner and make them aware of the situation, so that they understand that with the rat with respiratory disease, we cannot always cure them. And the best we may be able to achieve is just to manage the problem as best as we possibly can. Guinea pigs can be fairly prone to developing cardiac disease, and they will often present with signs such as lethargy, anorexia, weight loss, dyspnea, coughing, and pale or blue mucous membranes.

To diagnose cardiac disease, we use the same tests we were doing, a dog or a cat. So we're looking at things like radiography, thoracic ultrasound, and echoes as well. And then to manage cardiac disease, we use rosemide and potentially immaendin and benazapril as well.

There's a couple of diseases that affect ferrets that I wanted to discuss next. The first one is insulinoma in ferrets, and the most common sign we tend to see these presenting with is pouring out their mouths and increased salivation. Some owners will present the ferret thinking that they've got something stuck in their mouths.

So if you check the mouth and there's nothing there, then do remember to have insulinnoma on your differential diagnosis list, as it is fairly common in this species. Other clinical signs include ataxia, weight loss, weakness, and seizures if the animal becomes hyperglycemic. We can diagnose an insulinnoma by being able to demonstrate a low blood glucose level of less than 3.4 alongside these other characteristic clinical signs.

Collecting blood for an insulin reading at the same time as hyperglycemia can also help you to confirm your diagnosis. And if you do think a ferret has an insulinoma, but your glucose level is over 4.2, then you may want to withhold food for a couple of hours and then recheck it to be able to demonstrate that the glucose level drops below that reference range.

With ferrets, you do tend to get, you do tend to get sort of small ins insulinoma tumours. So they may only be 1 millimetre or so in size. And they can also get multiple tiny tumours throughout that pancreas.

It can be impossible to visualise these tumours on imaging, so surgery may be a challenge if you cannot find an obvious tumour or tumours to remove. Other options for treatment include prednisolone, dioxide, and managing their diet to reduce the frequency of those hypoglycemic episodes. Next up, I'll briefly discuss adrenal disease in ferrets.

It's important to note that this is an excess of sex hormones in ferrets rather than an overproduction of glucocorticoids that we see in dogs with Cushing's. It's very common in neutered ferrets due to the loss of their feedback mechanism from the gonads. And the reason we no longer recommend the routine neutering of ferrets is because adrenal disease occurs so commonly post neutering.

So instead, we usually advise that ferrets are given Desloelian implants to manage their breeding cycles instead. Clinical signs we often see include alopecia, increased sexual behaviour, and in females, we can also see the swelling. The main reason though, for mentioning this disease today in a lecture about emergencies, is because we can see male ferrets presenting with urinary obstruction due to prostatic enlargement and cysts.

And so with these guys, it's really important that they're seen quickly to relieve those obstructions. To diagnose the disease, we will often run adrenal profiles on bloods, and ultrasound can also be helpful. In terms of treatment, the most common treatment is placement of a Deslaelian implant, but surgery is also sometimes performed to remove an abnormal adrenal gland.

The final ferret condition I wanted to mention is persistent res in ferrets. As ferrets are induced ovulators, they will remain in ouas until they're mated or have medications to bring them out to heat. If a ferret remains in oestrus, they will have a sustained high level of oestradiol, which can lead to bone marrow suppression and pancytopenia.

As a result of this, we will see clinical signs such as pale mucous membranes due to anaemia, petechiation and ecchymosis due to thrombocytopenia, and signs consistent with them being in heat, such as a swollen vulva. The treatment for this condition may well involve giving them a blood transfusion, and if they, if they're very anaemic. And no blood groups have been identified in ferrets, so you don't need to cross-match them.

So, therefore, as long as the owner's got another ferret at home or they know of another, you know, a friend with a ferret, as long as that ferret's big enough to donate, then they can supply that blood donation to the affected animal. Alongside transfusions, we also need to consider supportive care and H HCG injections as well. With prevention, it all comes down to managing those reproductive cycles, and the most common thing we recommend these days is that Deslorein implant.

Urinary disease is a fairly, is fairly common in our guinea pigs. And, we can see them presenting with urinary urinary tract infections, with the clinical signs, usually being bloody urine, vocalising, when they urinate, and also having some abdominal pain as well. To treat the infection, obviously give appropriate antibiotics, and then the discomfort, we usually manage that with meloxicam.

Urinary tract stones are also a common occurrence with guinea pigs, and the stones tend to be calcium carbonate. These stones are usually easy to diagnose on x-rays, but it is important to make sure that you do X-ray the whole perineum so you can see if there's any stones trapped in your distal urinary tract or vagina. In the X-ray on this slide, you can see a large calculus, which is lodged in the vagina, and this was causing this guinea pig a huge amount of pain.

I usually take a DV X-ray and then two lateral x-rays. One with the hind legs held cranially and one with the legs pulled distally, so that I can reduce the risk that I miss a stone hiding under the bones of the legs. To manage the stones, we do need to make sure we adjust that diet to reduce calcium and oxalate and remove any stones that are causing an obstruction or pain.

We do know that some guinea pigs are really prone to developing stones, and so if they do have a cystoomy, they may well develop more stones in just a couple of months. In these cases, I think at some point we do need to sit and consider the welfare of that patient and really potentially only remove any stones if they're causing a blockage or causing them a lot of pain. And otherwise look to manage the diet and, sort of give painkillers to help control this problem instead.

Pituitary tumours can commonly be seen in rats, particularly in older female rats. And these rats often will present with a head tilt, ataxia, and circling. It's important to note that there are obviously other differentials to head tilts, including ear infections, trauma and stroke-like events.

But as pituitary tumours are fairly common in rats, make sure those tumours are also on your list. To manage the clinical signs, you can try a Gallaok, which has been shown to help in some patients by temporarily reducing the clinical signs and reducing that tumour size as well for a period of time. Depending on the severity of the clinical signs, you may also need to provide supportive care such as fluids and syringe feeding, if they're struggling to eat and drink on their own.

Early neutering of rats has also been shown to reduce the risk of pituitary tumours developing. And then the last condition I wanted to mention today is hibernation in hamsters. So hamsters can enter a state of hibernation if the temperature in their environment drops below 5 degrees.

In practise, I would often have owners calling in, unsure whether their hamster had died or was just hibernating. As a quick Google search often gives owners that glimpse of hope that maybe their pet is just hibernating and it hasn't passed away. I will explain to the owners on the phone that they do only hibernate if the temperature drops below 5 degrees.

So if they have kept the hamster in a warmer area of the house, like the living room, then it's unlikely that they, they are hibernating, it's more likely that they've died. But I would always obviously offer the owner, to bring the hamster down to the clinic so that we can check the signs of life on clinical exam and use a Doppler to check for a heartbeat. If you are presented with a hibernating hamster, then you just need to gently warm them up and they should come out of hibernation quickly.

It's important that you then discuss with the owner about where they're keeping that hamster in the home and explain that they need to move them to a warmer location to avoid them going into hibernation again. So thanks very much for listening to my talk today. I do hope it's been helpful and there's been some useful tips you can take away from this presentation.

So thanks again, and goodbye.