Hello everyone, Anthony Chadwick from the webinar vet. Welcoming you to one of our monthly nursing webinars, which is currently being sponsored by JHP recruitment. We're very fortunate today to have Joe Hind, who's gonna be speaking to us about that horrible condition that er.

You know, it's always one of the dreads that you see, obviously in the summer months. Joe is the director of LIGO Learn. I saw her winning the inaugural RCBS VN Innovation winner in 2017, in, in, the autumn.

She's also an IE4 Animal advocate of the Year, also in 2017 and obviously not happy with that. She also was Blue Crossett Nurse of the Year in 2014, so obviously, Joe, you're, you, you collect awards. Yeah, my mantelpiece is getting quite full, which is very humbling, really.

No, but well done, thank you so much for doing this, really looking forward to hearing you on, you know, your specialist subject rabbits, but particularly that horrible condition of fly strikes, so over to you. Great, thank you very much, Antony. OK, thank you everybody for, for joining in for this webinar, as Anthony said, it's kindly sponsored by JHP recruitment.

I'm gonna take you through a few things. I've just a conflict of interest for us to get out of the way, but obviously my company is Lego Learn, and as such we have Supreme Pet Foods as our sponsor, and we'll be talking about a little bit of diet a little bit later on, and the Rabbit Welfare Association and fund, I'm a volunteer for them as well, and I've used quite a lot of their posters in the talk, which you can get directly from them as well to help with awareness. So we're gonna talk about fly strike, myiasis, as Antony said, it's an absolutely horrible thing.

I've seen RTA cats with this as well, and dogs, and, these flies just get everywhere. And if we're looking at the black's veterinary dictionary, then we can see that it is described as the presence of larvae of Dipterus flies in tissues and organs of the living animal and the tissue destruction and disorders resulting therefrom. So, what is the problem with flies?

Well, Diptera basically covers over a million different types of flies, and in the UK we're mainly concentrating on the green bottles and the blue bottles. So the Lucilia are the green bottles and the Califara are the blue ones. Now, majority of about 80% of what we have over here are the green flies.

As such, you can see from the photos, they are naturally, they've got that green colour across their abdomen and across their shoulders. Now the problem with these guys is they come out, they have a moochy round, and they can smell from a really extraordinary, distance, something like 180 yards away, they will be able to smell faeces or a wound or urine. So they'll come across and they can lay up to 180 eggs in one go.

. Which in itself, you know, that's a huge problem. These eggs are being laid usually around wounds. If the rabbit's got a sticky bottom or dirty or a dirty litter tray, they can be laying the eggs inside the litter tray as well, and then they can crawl onto the, the animal, but, but a lot of, a lot of eggs in one go.

And that's just the one fly, so if you get another fly come along, she's then gonna deposit her 180 eggs as well. Now these eggs will hatch into L1 larvae in approximately 12 to 24 hours. The eggs are tiny, they're like little tiny grains of rice, literally just a couple of millimetres long, they're not very big at all.

So they're quite easily missed, and the flies are very clever. They lay them very deep in the fur, close on the skin surface as they can. They don't tend to lay directly onto a wound, they're slightly on the edges, and you'll find them in clumps in there.

So you're literally talking hours before these eggs are hatching out. Now the L1 larvae. Don't actually cause too much of a problem, they're not, they're not actually harming the rabbit at that stage apart from any sort of excretions that they're.

That they're giving off. However, in just 2 to 3 days they hatch into the L2 and L3 larvae. Now these are the ones that are really causing the problems.

So not only are these guys, hanging around and having a munch on whatever wound or poo or, you know, the problem that has attracted the mother fly to the rabbit. When they've run out of this this necrotic tissue, they're then gonna move on to sound tissue and that's where we have a problem because they're gonna move on through, tunnel on through this through this living tissue. Now they can do this very, very quickly, and cause devastation within hours.

So when we're recommending to clients that they're checking their rabbits' bottoms 3 times a day, it really is imperative that this is done because the morning check to the lunchtime check, that could be enough time for these eggs to have hatched that have been led the day before, and then we've got severe damage going on. Now these guys will stay as maggots for up to 10 days there or thereabouts, tuning around and having a good old munch on the poor old bunny, after which they're gonna dig down and they'll pukate, and they pupate for about 2 weeks. After this, they then emerge out as they're overfly and off they go.

And this life cycle can be as little as just 1 month, depending on the external temperature. If it's colder then things take longer for these larvae to moult and hatch into the into the L2 and L3 stage. And if it's warmer and the temperatures that they prefer, then this is gonna go a lot quicker.

So it's a really quick problem on a day to day, hour to hour basis, but also the life cycle of the fly is something we need to think about. And if we haven't got these enclosures really clean, we could end up with almost a systemic fly strike problem. So we need to understand that fly strike is not a primary cause, very, very rarely, although the green bottle can actually lay on sound tissue and immediately eat sound tissue when it gets to the L2 stage, but there is usually an underlying cause.

Now the most common cause is the fur matting and faecal contamination going around that that rabbit. So, you know, poopy but when it comes in and it's got all this poo stuck around its bottom. This can actually be a myriad of reasons as to what, why it's got in this state.

It could just be a long fur animal that isn't kept very well. However, we need to look at diet, which is the most key reason for this, this sticky bottom syndrome, and we'll come to that at the end of the webinar we'll go through. What dietary, things we can, we can look at to, to make sure they don't get this.

Dental disease can also be a reason for having this fur matting. If they've got a sore mouth, they're not gonna want to wash themselves. So, you know, this can be a reason for, for not grooming themselves and then the fur's getting matted, the skin's getting sore, and that's attracting the flies across.

Pain, which can be arthritis, that often causes a big problem with these guys as well, if they're too fat to to clean themselves, so if they're obese. And also if there's some sort of post-antibiotic dysbiosis, so they could have been treated for something else, been on their antibiotics, which has upset their tummy, stripped away their flora, intestinal flora, and left them with a bit of a, a runny tummy or excess sarose. These excess stos aren't gonna taste very nice because they've got the medication in them.

The rabbits don't eat as many as normal and then stand them and get them brought around their bottom. Other causes we've got urine scald. Usually this is picked up quicker than faecal contamination.

However, we've still got to look at those underlying causes. Now these can be things like ekiculi, which can cause problems, kidney problems and urinary problems. They could be central nervous system lesions, kidney failure for other reasons.

First will damage, which means they can't actually position themselves correctly to pee. Therefore, they're peeing down their legs, urologist, cystitis, and also inactivity, which is something that I think we miss off quite a lot with rabbits. If they're in a suboptimal enclosure, these guys aren't moving around.

And if they're not moving around, even in the cleanest of environments, their, their bladders aren't working properly, that, you know, everything isn't being, the big particles aren't being suspended through the urine. And they, this can cause problems, they start getting sludge, and again, if they start to have problems with that sort of thing, this is gonna alert the flies and they're gonna smell it from very far away and off they come. Obviously abscessation and wounds, if there are any wounds going on, maybe you've got a bonded pair that have had a bit of a fallout and a fight, maybe they've caught themselves on a on a bit of wire in their enclosure and you haven't noticed this wound.

As you know, rabbit skin is very, very thin, and the smallest cut can really turn into the largest tear, and hide under that very dense fur. Ocular discharge is another reason for fly strike, which again is kind of overlooked. So if you've got rabbits with pastureella, dental disease, trauma around the eyes, or even just these brachycephalic rabbits, these, you know, these Netherlands that are really, really flat faced and do have problems in this area, flies can and will lay their eggs around the face because of that, they're attracted to that ocular discharge.

And skinfold dermatitis, we're looking in that perineal area around the scent glands, around the genitals, around the folds and creases of the back legs, which can get a bit hot and sweaty and not very nice down there. Again, sounds like a perfect area for a green fighter to look up. So if we're looking at detection then what are we actually gonna see?

So if you look at the top right screen, you can see the fly eggs there, you can see how tiny they are, and they really do bury down into that skin. Now if the owners are bedding these rabbits down on sawdust, then it may, it's very easy to look and think there's little flecks and grains of sawdust in the fur. So it's really important that we know what we're looking for, but also that we educate our owners so that they know what they're looking for as well.

These fly eggs obviously go through to the L2, L3 stage, down the bottom you can see the maggots there, and they're usually what we see when we are presented the case in clinic. There will be a mixture of eggs somewhere on the body that are still hatching out at different rates and also. With these lava running around and and having a munch.

Sadly, the bottom left hand picture is how these rabbits tend to present in an absolute mess, as well. However, the first detection stage that we really want to be key and and get our owners. Clued up on is the top left pitcher.

OK, so this is Piping one of my bunnies, and this is when he didn't feel very well. Luckily he didn't have 5 strike, but he had stasis. And this is a typical pose of some of a bunny that's sat there, it's hunched up, the eyes are a bit.

You know, a bit closed, the whiskers are held a bit back, the ears are held down, they're just not very happy, and this is key to to understand what's going on with these guys because the sooner owners can pick up on it, the better and the more we can get the jump on it. And these clinical clinical signs are coming through and it can take up to 4 days for owners to even notice that something's going on. As I say, initially the rabbits will be quite restless, maybe a bit scratchy, looking like they're zooming and binking around, but they're not actually in a good way.

They just can't get comfortable and settle. And if you think about that, that's because the eggs have been laid, possibly started to hatch, and it's uncomfortable and it and it's distressing for the rabbit, and they can't quite get to it. Following on from that, once these have got to the L2 stage, we've got an inappotent bunny, we've got someone who's lethargic, doesn't want to do anything.

The temperature's starting to increase at this stage. They're really not feeling very well at all. This moves on through, you wanna get that odour, that real anaemia smell from the waste products of these of these maggots.

And again, this is one of the key signs that attracts the owners to see that something's going wrong, it's this horrible smell. You're gonna see faecal soiling and urine scalled, however, bear in mind these are also reasons as well as clinical signs. So we've got the cause and the clinical signer on this kind of loop cycle going on here as well.

And as it gets more severe down the list, we've got the skin lesions and the alopecia. So as these maggots are eating away at the skin, the wounds are getting larger, the furs dropping out, and things are all going very, very badly. Things that we can check for in practise, we can do some biochemistry if you've got it on site, it can be very helpful.

You're likely to see decreased albumin and decreased globulin. It's very common in these cases, and the urea is going to be increased as well. So don't be surprised if you are running bloods, these are the sorts of things you're gonna look at.

Now with regards to glucose, I don't know how many of you are already testing glucose on the bunnies that come in. I do strongly recommend that you do start doing trends of blood glucose on all rabbits that that come into your practise. It can, for many reasons, it can be very helpful to ascertain how severe they are, how much pain they're in, how much stress they're in.

And if you do this for your elective procedures, it can give you a nice baseline and see if you can change your protocols to make things better. If you do it in your emergency cases, in your stasis cases, it can give you an idea along with other parameters as to what's going on. So anything under 15 MMOL is kind of standard for, for a rabbit really.

When we get to the 15 to 20s, then that's they're showing an increased sign of stress. Now this could be due to pain, this could be due to just being in the surgery, but usually up to kind of 1215 is just anecdotal kind of surgery stress over that we're we're getting worried. If we're getting 20 to 25, then we know there's some severe pain and stress going on, and 25 and above, then, then things are really bad and that's usually attributed to a gut blockage that you're looking at going in surgically.

Get used to this glucose guide, getting used to using it can be really helpful. And as I say, it's a trend like blood pressure would be. So you'll keep checking it to make sure it's decreasing, and that's the goal with the glucose is it should be decreasing.

Now with these fly strike, guys, you'll probably find they could sometimes be under 7 MMOL, and that's because they haven't been eating properly for a couple of days. So therefore we need to look at their nutrition, and see what we need to do to help them with that as well. We can also get secondary complications arise with Flystrike, and you know, quite often we think, oh it's fine, we've got all the maggots off, that's all we need to think about, however, we do need to look deeper into this and treat the whole rabbit, and the whole system.

So if we're looking at shock, these guys usually present with decompensatory and progressive shock. It's usually hypovolemic that they're showing. So.

Different clinical signs to cats and dogs insomuch that these guys have bradycardia, not tachycardia, but they'll also present being hypothermic and hypotensive. So we want to monitor these guys really, really closely, and obviously address these things as much as we can. Dehydration is a big issue with these, especially if they have got large wound areas then that have been weeping and seeping.

We want to check their PCV against the normal parameters and then we know that anything that's approximately 45 to 50% is . Is going to be dehydrated and we want to be giving IVFT to, to offset that. Enzymatic burns.

Now the larvae of these guys excrete proteolytic enzymes, and these cause cell death and decomposition, which is very great for the maggots because they can just excrete this stuff out and then gobble up the the decomposed cells that have gone on, so it makes life easier for them. However, that is obviously causes a lot of problems with rabbits, so they're getting these skin burns as well as these, these wounds, that we need to treat. So we need to make sure that we're not, we're looking beyond the maggots and we're not saying, OK, that's it, job done.

However, sometimes we do just need to understand that we can't save them all, and sometimes these guys come in in such a state that there's nothing can be done. So if they're completely moribund, you know, anything with fire strike, you need to sedate or anaesthetize them, and we're gonna come on to that. And if they're not well enough to, to.

To take that anaesthesia when you do your ASA grading, if you can't get that grading better very quickly, then you need to look at actually what's best for the rabbit in this case. If they have extensive soft tissue damage, so if these larvae are entering the body cavity, if there's excessive necrotic tissue and very large wounds extending beyond the dermis, then these are cases again that we would probably opt to euthanize instead. You have aberrant migration which brings the maggots deep from under the under the skin, and it can also infiltrate the organs and even if the rabbit's airway in some of the severe cases.

So sometimes these guys really are just beyond help, unfortunately, and we need to, to do the kindest thing. So what can we do? Well, as soon as the case arrives, really you're looking at this 10 point plan and what you want to do, this is in order of how I would recommend you, you, you do this and follow it through.

So the first thing these guys are in shock as we've said, so we wanna be doing our IVFT making sure we've got the fluids balance, checking their blood pressure, and working through that. It's extremely painful for these guys. Rabbits is a prey species anyway, every time they come into a clinic, unless they're coming for a vaccination or they've got mites, pretty much they need some sort of analgesia.

So real hot potato, really important that we get that done. As I mentioned briefly, we need to look at nutrition status. We also need to look at antibiosis and get that on board nice and early for these guys.

We are gonna have to sedate or anaesthetize them, again, being prey animals, having things picked off your bottom, washed and shaved and clipped and things like this is very stressful. Adding to that the fact of the pain, the stress of it all, it's all too much for these guys. We wouldn't do it to a cat or a dog without sedation or anaesthesia, so we need to be doing the same with our rabbits.

We need to prioritise the removal. So we want to remove the L2 and L3 larvas first, so the active would be ones that are chomping down on the rabbit cos they're doing the most damage. Next we move down to the L1s and the eggs because they're not currently doing any damage, and then we look at killing and halting any remaining activity going on with dressing wounds and looking at our underlying cause.

So working through the 10 points individually then. We're looking at intravenous fluid therapy. Now we want to avoid subcutaneous fluids with these guys because again, we've said they're in shock.

If they're in shock, the circulatory system isn't gonna be working as well as it should be. So if we just give them a big camel hump of fluids, it's not actually gonna move around the body and it's not gonna help them at all. It's not gonna help their blood pressure, so we want to be putting that cannula into the either the marginal vein and giving bonuses, slow bonuses when we can, have them hooked up to the grip set whilst they're anaesthetized so that you can, keep that going quite nicely.

You can also use the other veins, you can use the cephalic and other bits and pieces if you need to. There's always intraosseous if you're really, really struggling, but usually the marginal vein will tolerate it quite well. For the 1st 2 hours, we are looking at giving 25 mL per kg per hour.

However, this is we don't use shock res anymore, but this is kind of where that comes from. And moving on from that, we've got the general day total of 100 mL per kg per day, so make sure you take that 1st 2 hours calculation out of that 100 mil when you move on to to stabilise this patient. In general, we're giving Hartmans or lactated ringers, they, we have them in practise, everybody usually has them in practise, they're nice and easy to go in and don't cause any problems.

As I say, we wanna monitor these guys closely. We wanna check their blood pressure to make sure that our IVFT is working and doing what we expect it to do. We can do the same with our blood glucose as well to see how that's going.

If you have a lactate monitor as well, you can monitor the lactate, to see that actually the fusion is working nicely. So back to the nutrition stage. We've done the rabbits come in, the first thing we've done is the IVFT we've got that sorted.

At the same time, we want to be thinking about nutrition. We need to know when was the last time this rabbit ate properly. OK, so we need to get a good history from that owner.

And that often is better taken by a nur a separate nurse that isn't working on the rabbit to stabilise it at that time because they've got the time to go through all the questions you need to know to, to help you guys out. What we can do is we can give some parental glucose, but only in the very early stages, otherwise, you know, we have problems with the triglycerides and that exasperates the hepatic lipidosis, which is something that is a complication of a fly strike and stasis and things like that. Rabbits go into hepatic lipiddosis very, very easily actually, so we need to keep an eye on that.

If the rabbit, I wouldn't, there's very few times when a fly strike case would come in and I would syringe feed it before starting to GA and do everything else. So it would be better to get some parental glucose on board so you can spike the bag and get that in. Alternatively you can use a nasal gastric tube, and that can be a very Very nice way actually in these collapsed patients of putting that tube in quickly, checking it's in the right place, and then putting something like the MRA by LaFerber in, which is a non-fiber product.

So we need to remember that actually we need to put fibre back through when this rabbit is recovering. But to get that immediate energy on board and try and, Help balance them out a little bit whilst they're going through just before the anaesthetic and whilst they're going through their anaesthetic, it can be a really nice easy way that the nurse can, you know, have a nurse just feeding through the tube whilst you've got the fluids on and whilst you're, you're going through the the procedures. So as I mentioned, analgesia really is important.

This is an excruciatingly painful procedure for these guys, or disease problem for these guys. And multimodal analgesia really should be used at all times with rabbits regardless of what's going on. We should be looking at why wouldn't we use analgesia rather than thinking, well, why should I?

OK, so again, think of cats and dogs. If this was something like that, if this is an RTA come in or just a cat with fire strike coming in, you didn't know why, again, you'd be putting that analgesia on board. We have quite a lot of options now with the rabbits.

Obviously we need to be aware of what's licence, and we need to be aware of the cascade, but you use that with your own judgement. So opiates, you're looking at your buprenorphine. Now b is very good, however, you've got to be careful with the dose rates.

A lot of practises that I've, I've been to tend to use quite heavy dose rates of you, and then that means the rabbits are quite sleepy, and take a while to recover, which obviously we want to get them up and their gut stimulated and everything quite quickly, so. You're looking at 0.01 to 0.05 Migs per gig on the view, and that's every 6 to 12 hours usually for for rabbits.

Now all of the doses that I do give you for your presentation have been taken from the textbook of public medicine by Molly Varga, the second edition released in 2013. I've stuck with the, with the, . So published doses, even though anecdotally she uses slightly different ones and and lots of us in practise can use slightly different ones as things have gone on, but these are the published ones, they're definitely .

Seen as safe to be used. So morphine, if you guys are using morphine in practise, again we're looking at 0.5 to 2 gigs per gig and every 4 hours, can work very nicely in rabbits actually.

Fentanyl, we're looking at 0.05 to 0.03 mL per gig.

So you can use that as part of your analgesia and anaesthesia plan. NSAIDs, rabbits do tolerate NSAIDs very, very well. Meloxicam is the drug of choice, and it's very well tolerated with mineral side effects.

However, if we think back to the fact that these guys are in shock, then do we want to be putting an NSAID on, on board straight away? Well, if they, if you get that hydration status fixed straight away, and you're avoiding going PO with this, so you're not using that intestinal tract, you know, you're going parentally. Then yes, it can be safely used.

Again, it's about monitoring it, getting the status right, and seeing whether it's appropriate to use the NSAID at the start of the procedure, or if you want to do it towards the end, or the end of the day when things are, are, are improving. And don't forget your locals as well. So local anaesthesia is really underused in rabbits, yeah, it's fabulous.

You can splash block, ring block, you know, you can put this stuff everywhere. And what I tend to recommend is draw up half of the total dose that can be given to your patients, in a syringe, and then you know you cannot overdose. On this.

So you can literally put it around the wounds, any suture lines, muscle lines, anything like that. You can, it's just gonna really help these guys deal with the pain. And the biggest problem with rabbits going into stasis is pain.

So if we can keep on top of that, we can keep the guts working and that really helps to improve their chance of recovery. Alongside this we want to be looking at antibiosis, and as I say, we wanna get this started relatively quickly actually. So we know these guys are gonna need antibiosis, it's not a case of .

Of using it without good cause, excuse me. We want to be looking at a broad spectrum, so you're looking at your refluxin beta or something like that, is good for your first line antibiosis. And we want something with good skin penetration as well, so if you've got the larger wounds going on rather than the smaller ones, you want to be looking at adding in some trimethoprine, sulfonamides, sulfitrim, something like that, and use the two together so that you've got that good, skin penetration as well as that broad coverage.

These guys often get a lot of secondary bacterial infection, which is usually clostridial. So in that case we would then be looking at adding in penicillin, especially when you've got these deep wound pockets, these tracks that these larvae have made during their aberrant migration through through. The skin layers, and if there's infection present down in the deep pockets, then you wanna be looking at putting some, some penicillin going on there.

Now with rabbits, it's one indicator to use penicillin, orally, so make sure that is in an injectable form. With regards to sedation anaesthesia itself, I'm not gonna go through all the different types of, of anaesthesia that you can induce. We would be here all evening, that's a whole another lecture.

However, this is just one protocol. What I will say is the safest anaesthesia is the protocol that you are most comfortable with. OK, so really stick with that.

If you've got something that works very well, and you're not having problems in recovery and you're not having problems on the table, then stick with it. Look at the doses, look at your protocols frequently to make sure that you're within current guidelines and thinking. However, these guys, these fire strike guys are not the time to say, oh, OK, well I have this webinar and it said use this protocol, so I'll use it.

It's just an example of what can be done, and there's plenty of examples out there. Now we do have our Fasan which is licenced for using rabbits, so under the scale we should really be using that. Again, my note of caution is just to say if you haven't used it before, this isn't the case to to rock it out and have a code.

So let's think, let's recap where we are with our bunny. It's come in, we've got the fluid therapy going on, we've got the nutrition going in by the NG tube, we've got the analgesia started on board, we've got the antibiosis sorted out as to when and how we're gonna use that. Now we've knocked it down and we're gonna get on with the parasite removal.

4 key bits of kit that will be needed for this task. Firstly, are the tweezers. If you remember the priority that I said, we want to look at those L2 and L3 larvae first, so these maggots that are really causing you the damage, and we want to tweeze these guys off one by one.

We don't want to squish them too much, that's why we don't go straight in the clippers because all of those prosolytic enzymes that they're that they've got inside that they're excreting out is then going onto the skin and we're just gonna have to lavar even more. So it's a bit painstaking, not the quickest thing in the world, you know, you've really got to kick back and go right, OK, I'm gonna work quickly and methodically, but it's gonna take you some time, so you're literally tweezing these guys off. And also be careful where you tweeze them off too, because you, you can get kind of caught up in in picking them off and then they're escaping outside of the kidney dish and, and going over to, to the other side of the prep room.

So make sure you're putting these guys in some sort of solution, or a closed tub or something that is, that they, they're not then getting out and infecting the rest of practise. You want to move on to, after the tweezers, then you can do some combing with a flea comb to get rid of eggs. It's really good, really easy and quick way it picks those eggs up nicely and you can do that.

And then you're gonna move on to shaving them. So it's up to you if you use a 40 blade or a 10 blade, whatever you prefer, just be careful, be slow. You don't want to get these guys wet first off the bat.

Some people will will plunge them and try and wash them. It's not a good thing to do. Not only are you gonna cause problems with these guys because they're already hypothermic due to the hypothic shock, you're then gonna.

Give yourself a load of rabbit fur that can't be brushed and combed and clipped and things in a wild mess. So the tweezer, then we go, then we look at clipping and give yourself some decent margins around because you may have to follow these, these, these migration tracks up through the skin, so you know, make sure you have a good exploration going on. After this, we will then, lavage them, which I'll go through when we get to the wound stage, but you're basically, flushing through cleaning.

You're not only cleaning these, these wounds in the skin, but you're also cleaning the fur of any, urine stains or faecal contamination. Anything that the fly was attracted to in the first place, we wanna clean. That up as well.

So if it was around the eyes, we wanna make sure we're getting that discharge off them and getting them nice and clean as we possibly can. And then we want to use the hairdryer on them, OK? So now only just get them really nicely dry, but it also changes the humidity, so it, it lowers the humidity within the fur and close to the skin.

And by doing that, this will halt and really slow down the, the hatching and and the the stages of these lava going from eggs to L1s, from L1s to L2s and L3s. So by heating them up and making sure the rabbit's nice and dry and that humidity is low, it makes it really does help, get on top of things. We want to look at .

Medical parasite removal as well. So we've got cypermethrin, which we can use at this stage. So F10, do an antiseptic wash, which is very good at this stage when you've done the tweezing and the combing and the clipping, you can then use the F10 antiseptic wash to go over the areas and clean these guys down.

You can also use the F10 germicidal wound spray with insecticide, which we will come on to a bit later, but that's just cypermethrin and that's kind of a real widely used option for these cases. We also want to look at ivermectinellamectin as well. Now, ivermectin injections are, I believe, no longer licenced.

They may or may not be, but I, I, I'll have to check on that, but I'm not sure they are. However, they are widely used and I certainly, you know, have . Be in practises that we used them for years and they work very, very well.

Theirme injection is distributed well throughout the whole of the body as well, it's not localised as some of the others can be, can be quite localised. So, you know, giving them a shot of ivermectin that's gonna help kill off any. Residual L2s, L3s, that are lurking that maybe you haven't found.

You do need to be slightly careful in that, we wanna get as many maggots off as we can because if we're killing them and they are under the skin, then we're gonna have necrosis going on and we're gonna have break down those proteic enzymes again that I mentioned are oozing out through, and we're gonna have all sorts of infection problems by having these dead bodies under the skin of the rabbit. Permethriins can be used. There's actually a Xanax Ultra, topical treatment, which is good, but doesn't penetrate beyond the sebaceous layer.

So again, I would personally pick Ivermectin injections over permethrin spot on treatments. When you send a rabbit home, this could be something that you, that you recommend to to continue with the Xanax Ultra or something else. And rimazine is something that we had licenced for, for many, many years and it was our only treatment for a good few years, so basically rear guard.

And it used to be standard to, to be using rear guard in these cases. However, it's not for use in broken skin, so I wouldn't actually use it in surgery for a case that has already got fly. So we're looking at our wound management then, we've cleaned everything up as much as we can.

The rabbit's still nicely anaesthetized. We want to be lavaging all of these wounds out, so we really wanna check that all these tracks we've got to the end of them, we, we haven't got infection down the bottom of them or maggots down the bottom of them, and poverty and iodine is really good for your vaging out these wounds and literally. Quash, squash, rush, squash.

At the same time making sure that you, you know, the fluid therapy is OK, the blood pressure's OK, and the heat for these guys, you know, this is quite a difficult thing for them, for you to keep them warm enough, so you need to look at your heating methods, especially once you've shaved a lot of the hair off and you're flushing, then these guys can lose their temperatures really quickly to be on top of that one. We wanted to bride these wounds as well, it's really important, obviously from from normal wound care, but also if we have got any L1s lurking around that are gonna mol into L2s and L3s, they're gonna go in and have a chomp on on that . On that dead skin, so we want to be surgically debriding, and also you can choose to use a product like dermisol or or something like that to to help debride after you've covered over the wound.

I've mentioned it before and I'll mention it again. The F10 wound spray also comes in a wound cream, both of which have this insecticide inside them. So these can be very good.

The F10 spray can be used directly onto broken skin. I'll go on to that in a minute, but this would be used at this stage before any sort of dressings. So that would be a mild kind of cases for your, for your medium cases you're looking at using hydrogels.

So something like intrasy gel, so it's gonna absorb that bacteria and also keep the wound nicely hydrated at the same time. And if you cover that over with a nice permeable dressing, something like oxite, so that that's gonna keep everything nice, and moist inside underneath that dressing, you're gonna need to be checking this frequently, changing this frequently. And making sure what's going on.

Some people use Manuka honey medical grade, again, that's another option, depending on how severe, these wounds are. When we get to severe cases, so if we have got very large dressings, very large wounds and skin deficits, then you're looking at, we need to base down, something to, to promote granulation. So you're looking at something like glot, or you can, you know, back in.

The day you'd suture in place some some granuflex across there. So whatever dressing you have of choice, but what we need to do is make sure that we're, we're putting down a nice layer to promote that granulation and give this wound the best chance of healing that we can. So that's pretty much what we're doing as our first line of defence in practise.

They're coming in, we're putting them on the fluids, we're looking at nutritional status, we are anaesthetizing them. Making sure that's going smoothly and then doing this tedious process of getting rid of all these maggots, both by hand and by giving them some sort of, medical treatment as well. I, I'm injections or something like that to, to get rid and kill and halt the spread of these maggots.

But we also need to look at the underlying causes. So once the rabbit's off the table and nicely recovering, we need to spend a little bit of time just looking at their history and looking at what maybe caused this before we go on and carry on with our cases for the day. As we mentioned before, all these things here are underlying causes, and some of them may have another underlying cause going on.

You can see on the top picture there, that's an image of not very nice seek trophs, so. Tropes are supposed to look like very, very small, shiny little balls in little clumps often looks like little blackberries in the tray if they've left them. If the diet's too rich or post antibiotic therapy.

And they're eating them, then they can get this kind of cow pat appearance, and they're really, really sticky, so they easily stick around bottoms and legs and things and and it's just a real treat for the flies. A picture of the urine sold down the bottom there, it's a typical presentation I'm sure we've all seen rabbits like this. So again, we're gonna be doing a, a urine workup, we wanna be looking at what's going on with this.

Is this a problem with the urine, is there a problem with the with the kidneys, is it a skeletal back problem? Is it an enclosure problem, what's going on? With these guys, however, majority of the time it does come down to diet, and you'll be pleased to know that's the end of the, the gory photos.

Now this slide, if you've seen any of my talks before, comes up quite a lot. It's one of my favourite posters that really demonstrates very nicely what an adult rabbit's diet should be. And it's a nice one to share with owners because they can grasp the concept because 80% here and 10% there, oh, that's a bit wishy-washy.

Whereas if we think that a rabbit, an adult rabbit should eat a ball of hay at least the same size of its body every single day, we can understand that concept. And it really is vital for the teeth and the tummy that hay is the main part of their diet, that's what they were set up to eat. The whole digestion is set up for a very poor diet, but in very large quantities.

OK, so that's what you need to feed them. Next important thing is they do need some pellets. So think about 5% of pellets here, which is usually 1 to 2 tablespoons of adult pellets per rabbit per day.

That's all they need for for medium sized rabbits. When you get into the giant category, you're looking at roughly 1 tablespoon per kilo, but that makes sure that is on the weight that they should be, not the weight that they are, otherwise they'll just keep getting bigger and bigger. Now with this, it's roughly about the size of a rabbit's ear, unless you've got an English lock, in which case you'll be feeding a dog bowlful to try and match their ears, and that's not where we want to go with this.

Veggies, there's quite a lot of misconception going on out there. It has been for a while that we have the hay and hay and veggie diet for a while. It's not good.

They do need their pellets and they need a good quality extruded pellets with a really high crude fibre, . And basically this, this keeps them going. It has all of their nutritional content in it.

If we're feeding hay and veggies alone, not only do we need to know the nutritional needs of that rabbit, we need to know the nutritional value of every single thing we put in front of it. So that piece of cabbage, exactly how much protein and ash and calcium and phosphorus and the and the and the . Calcium phosphorus ratio and magnesium, and what percentages has that piece of vegetable got in it, and we need to compare that to how much that rabbit needs and do the math and work it all out and nobody's got time for that.

OK, so the pellets give the nutrients, the hay gives the bulk and the fibre to work the teeth and the tummy, and the veg basically is enrichment. OK, it's there as a treat and a small handful no bigger than the rabbit's own head every day is more than enough for these guys. So quite often owners are feeding a very high veg diet, and maybe pellets, maybe not pellets, maybe too many pellets, but the rabbit's only eating about 20% hay because it's eating lots and lots and lots of veg.

It's a big bowl of deep green veg twice a day. And it's just too rich for the rabbit's digestive system, so they're overproducing their seotropes, they're not eating them, so they're squishing them and they're getting caught around the bottom, and this is the main reason where the, the sticky bottom's coming from. Either that or they are giving them a dog bowl of pellets every day, or muesli mix and .

And again, it's, it's tipping the balance of that diet and making it too rich. So if we strip it back to what it needs to be and keep it really strict, then that works really well. These guys don't need fruits in their diets at all.

We don't get rabbits in the wild climbing trees to find bananas, so even though they love them, they don't need them, and if we don't feed fruit, then, then they, they don't expect it. Treats are a human concept, not an animal one. OK, you've got a rabbit on a strict diet and you offer it one extra pellet randomly out of the box, it will go nuts for it.

The same as if you gave it a piece of banana. So getting this across to our owners to make this rabbit the healthier, healthiest it can be. Is the best way forward.

We want to look at prevention from enclosure point of view as well. So if we think about that small tiny hutch with the rabbit in it, if it does have a dirty area, it can't move away from it. If it's not moving very much because the hutch is too small.

Then, as I say, it, it's digestion slowing down, the large particles in his bladder are falling to the floor, it's causing some sludgy bladder problems, might get some urine leak, in general, it's not gonna be a healthy specimen, and that's gonna make it, . More of a risk for fly strike. We want to make owners aware that when they need to look at temperature, these green flies come about when it gets 9 °C or warmer.

So we need to keep an eye on the temperatures and see what's going on, because as soon as that, we haven't got the seasons that we used to have, so we can't say, oh, fly strike is a summer problem because it's not anymore. Literally anytime those temperatures spike or if you've got a really good outside enclosure, avery shed style thing that's really well in. The temperature may already be above 9 degrees.

So that's something to be aware of. And the humidity as well, so if we can can, if the humidity goes 60 degrees or above, again, this is what these flies love. So there's something to be kept an eye on there.

We want to make sure the enclosures are very well ventilated to to reduce those smells that are gonna hygiene is gonna be kept good to again reduce those smells, . And make sure everything is circulating through really nicely. And we can make environmental adaptations as well, so we can put fly netting across the hutches and the aviaries and the windows in the house, if you don't want to buy mosquito nets, you can go to the local charity shop and pick up some some neck curtains and make your own.

It'll work just as well. You can get electronic zappers to go in your house or in your enclosures. Obviously leads well away from those nibbly teeth that rabbits have, but just some bug zappers that can stop them if they do get into their enclosure, they'll be attracted to that.

Brief warning about flypaper, flypaper is OK. Personally, I think it's a bit of a nasty death for the flies if we care about such things. But I've also seen rabbits that have been caught in flypaper and it literally skins them alive when you're trying to take it off.

So if you are using it, never use it in the rabbit's enclosure itself, use it on the outside, and definitely wear no. Rabbit can get to and also yourself because one thing that I have done is I thought oh I've been very clever and I've put it on the outside and then I've bent over and stood up and pulled my hair and then I'm attached to the flypaper. So be really careful about where you're putting this stuff to make sure you're not gonna catch something that you don't want to catch.

And there's also some plants, so you can grow lavender in your garden, and put tubs of it around the rabbit's enclosure. It's a natural repellent for for these flies, and also the rabbits quite like to munch it as well. So there's things like that we can use.

Be careful with. Oils and peppermint oils, never get them anywhere near the rabbits, and they can be a bit too strong smelling to have in the rabbit's enclosures as well, so again in the house or in the in the garden may be OK, but not too much in their actual enclosures. So the two products we've spoke about, the primazine is the rearguard, has been the market leader because it was the only one for many, many years.

It's an insect growth inhibitor. It doesn't actually kill flies. One application lasts for up to 10 weeks, and it works on the, the L1 larvae.

It does not repel flies, which is one thing about this, but it is a bit of a misconception. So, people think, oh, I've put it on there, therefore they won't come on. It's not.

What it does is the flies come on, they lay their eggs, but because of the growth inhibitor, the eggs don't hatch. And if the eggs are already on there and they've got to the L1 stage, they don't then mould through into the L2 and L3 that do the damage. Now the thing with rear guard, as I mentioned before, is you must not use it on broken or sore skin.

So when you've got rabbits that are high risk, so elderly patients with some disability or deformity, if they've got urine stools for other other problems that they have been treated, then we don't want to be using rear guard, because it's going near the sore skin and if it's not going near the sore skin, it's going somewhere else and the sore skin is left unprotected. It's also a nightmare to apply. I don't know if you've tried, but it's got this sponge applicator and it seems to have really sharp prong in the middle, so I always cut the top of the bottle off, put my gloves on, apply the rear guard to my gloves, and then massage it through the fur on the rabbit if that's what I'm using.

If you do have a rabbit that's got a poopy bum or, or urine sold or problems that it is having to be bathed relatively frequently for, even though we, we don't naturally want to do that. Again, rear guard, the efficacy, isn't quite sure whether it's still gonna be working quite as well if, if you're constantly washing off of the fur. So I'd say if your average rabbit that's well and dandy and got no problems, he's an adult, nice and clean, clean closures, then rear guard's great as a preventative.

The alternative is the F10 germicidal wound spray with insecticide. Now the reason I keep banging on about that it's the wound spray is because sadly I have seen cases where people have used the F10 floor cleaner on the patients in wounds and to prevent wounds, and of course it causes an awful lot of damage and skin stuffing, and it's not a nice place to be. So they've got a range of products, make sure you're using the right product for the right reason.

It's a cypermethrin, which is antiseptic and antimicrobial, and it actually repels and kills the flies and larvae. So it's one step further than the than the rear guard. But it's also safe for use on sore skin, so it's a treatment and a prevention.

You apply it once a week to these guys, you just spray it around the bottom, it's easy to use, and certainly if you've had a fly strike case come in, you can treat with the F10 and then send them home with the rest of the bottle to continue to use it as a, as a prevention and treatment as well. Just be aware, it is a permethrin, so it is very, very toxic to cats. So if you are using it, be careful if there's cats in click and be careful when you send it home with owners as well, to make them aware of the risks associated if there's cats around.

So to summary then, to bring it all together, we're looking at prevention is best thing cure. So we wanna get these guys on a good diet, in a good enclosure, get these owners clued up as to what fire strike looks like and how much of an emergency is, so that you're not seeing the fire strike cases. And then when you do see them, it's important the reception staff know that it is an emergency, we need to see these guys as soon as possible.

And that these guys are gonna be in hypovolemic shock and we need to combat that with IVFT analgesia, analgesia, analgesia. And we've got both the mechanical, and the medical and sometimes surgical removal of these, these L2 and L3 larvae, to make sure that they're fully clear. And this may need to be repeated a couple of times as well, so you may need to keep the rabbit in and then repeat the anaesthesia and repeat the flushing again and, and deal with those, those wounds, and the underlying causes.

And that's all from me, thank you very much. Happy to take any questions. Thanks very much, Joe.

So yeah, happy for people to ask questions. Before you do, it looks like we've got a lot of vets on today, so perhaps if you can just put in the chat box, whether you're a vet or a nurse, the reason I'm saying this is obviously this fine for the vets to come on it if you are coming on this, you know, do make sure that you get your nurses to look at it either by doing it as a lunch and learn so you can just watch the recording with them. Or, you know, obviously look to get some of the nurses in the practise onto membership as well.

So, if you can just start putting in, if you're a vet or a nurse. Just so we know, so we've got. People putting that in, we've got Dominic's a vet, Stefan's a vet, Emma's a vet, Diana's a vet, Lisa Ann is a nurse, .

We've got Ollie as a vet, Gordon as a vet, Mark is a vet. Gay and Christina as nurses. Oh, it's good to have so many vets.

David is a vet, Mark is a vet. But it'd be lovely to have some more nurses, so do share this, you know, as members, I have no problem with you, you know, doing this as a lunch and learn. I mean this is a, I think an ideal area, obviously Joe, you know, there's a lot of nursing care involved in these cases, isn't it?

So it's very important that nurses are, you know, today some basic stuff like the . You know, the disinfectant that you showed at the end, I mean, use the wound one rather than the floor floor cleaner sounds very sensible, we really need to talk about it, but obviously people do it. You know, similarly with the cyromazine, you know, don't be putting that onto damaged skin, it's a preventative, that's what it's there for.

It's, it's getting some of those messages over, you know, particularly maybe, younger nurses, obviously, I'm sure some of the vets, you know, we wouldn't know everything about that as well. But I think it's so important to . To get the nurses onto these, I, I'm conscious that our platinum, you know, we have a lot of nurses who join because they want to be stretched by the veterinary stuff.

But we're also making sure that the nursing programme is, is really good, because the feedback I get sometimes from nurses is there's a lot of CPD out there, but if you're 3 or 4 years qualified, there's a lot of stuff that's a bit too basic. I mean, is that fair, Bev, do you think? Is it hard for nurses to get that kind of next level stuff?

Are you there, there's a lot of noise with you, Bev, but I don't know, can you hear me there? Sorry, do you mean me? Yeah, sorry, Joe, I've seen I've I've got Bev on the mind at the moment cos I've been talking to Bev Panto as well, who's also obviously.

Sorry, you confused me there. Yeah, absolutely, and fly strike, I think, fly strike cases in clinic is, a perfect example of where nurses can really shine. Because they can do a lot of this stuff, without needing direct supervision from, from the vet.

So the vet can agree the treatment plan, they can look at, you know, what drugs are going to be used and how they're gonna use it. But with regards to whether that rabbit is under anaesthesia, and the, the look, the exploring of the wounds and the flushing and the picking of the maggots, that's something that could really be championed by the nursing team. And of course the recovery, as with all rabbits, is highly nursing intensive.

So this, this isn't a quick fix. This is a one or two dedicated members of staff for for potentially a couple of days just on this one case alone. So it's definitely something that, that is very, very applicable to, to the, to the nursing staff.

No, that's right. David is, is just saying what nasogastric nutrition do you use in these cases? OK, so what I would use in the first instance when we are getting these back to to stabilisation is I would use Emirate by LeFerber.

Now it's a non-fiber product so it goes in very syringes very, very easily and. Works very nicely to stabilise these guys out and then as soon as they are the other side of anaesthetic, I would then switch to using something like the critical care fine rind. So again, that's gonna go down your 5 French nasal gastric tube, but then that's got the fibre in it that that that that really, really needs.

That's great. Leavre are, you know, very, reputable company as well, an American company who, are often at BSAVA and things, so. You always look out for them when you're one of the conferences.

Are there any other questions? Anything that people would like to ask before we, we close the day. Obviously, again, thank you, Joe, so much for all your help with the webinar.

I think it's a fascinating subject, and it's just great to just, you know, look at it in, in, from the start to the finish. So really, really good. Obviously Lego learn, great stuff that you're doing there, do go over and have a look at the website.

And obviously thanks to JHP for the sponsorship of the, of the webinar. So we've got another question, I think. Gordon has said any problems using pineapple juice to help with diet digestion?

Yes, OK, so we're on a, a myth, myth busting, evening this evening. So pineapple juice used to be used, because it was thought to break down the hair inside the gut if there is a drug of error or some sort of impaction. However, it doesn't work that way.

It may possibly fresh pineapple juice from the core that's very heavy in the enzymes, and and papya as well, so papa and bromine enzymes can break down the mucus that is holding in patches together. So if we're looking at stasis cases with a, a possible partial obstruction. This is when it was kind of indicated anecdotally to be using the pineapple juice.

However, it, it's been kind of blown apart and shown that it, it really doesn't do anything. It's nothing more than than a sugary treat really. And we don't want to put too much in because then we're worrying about changing that flora and ending up with more sort of propsidosis and things like that.

If we, if we're putting too much sugar into the gut. So, I certainly wouldn't use it in a, in a fly strike case, even with stasis as a, as a secondary, symptom. I think we, we've very much moved away from that now and we're sticking with good fiber-based foods to get them eating.

Brilliant. OK, that's great. .

Ooh, now have we got, no, I don't think there are any more questions. So again, thank you so much, Joe. Thank you to JHP.

Obviously, great stuff that you're doing at Lego Learn, so do go over and have a look at the website, everyone. As I say, please do let the nurses look at this. And, you know, if your nurses aren't already members, I think nurse membership is something silly like about 20 pounds a month, so it's extremely cheap.

You know, do feel free to, to speak to any of the team in Liverpool, if you want to look at that as an option for other members of the team. Thanks everyone, good night, and we'll see you on another webinar very soon. In fact, just as a, as a final one, protecting, we're doing a webinar tomorrow on the need for cobalamine.

So do come along to that one as well. If you haven't registered, I'm sure you can find that fairly easily on the website. Thanks very much, everyone, bye bye.