So, hello everyone. My name's Fabian Rivers. I'm an exotics, and small animal vet, in Birmingham, and I've been graduated for the best part of 3.5 years now.

And I've done a variety of different things, with regards to exotics and also some TV work as well. And so today, my aim at least is to. Try and dispel some of the confusion and frustration around exotics.

I think we're in a world where er people are buying exotics at such a fast rate that being an exotics vet isn't quite enough and. So I'm, today is, is the main aim is so that your smallies or your large animal or whatever background, you feel a little bit more armed and prepared to deal with some of the more common things that may not need to be referred to a certificate holder or a specialist. And so this presentation is very aptly named.

Sorry, we don't see exotics here. And this is something that I, I, I hear very, very often, when I'm being referred cases from a variety of different clinics and. It's, it's, it's so important that we begin to try and dispel some of the fears because there's so much, there's so much crossover between a variety of different fields.

So panic, . Why is there so much fear around zoological medicine or or exotics as a group? Well, there's an element of the unknown, we, we often feel we're very unfamiliar with the techniques.

We haven't studied it for a while, maybe we've been, practising for many, many years, and the standards have improved, or. Even at university, there is a, a definitely a field for improvement with the level of of teaching that we often get for exotics unless you have a particular interest in it, of course. And also that things change exceptionally quickly within this field.

You know, 3 years, and from being practising for 3.5 years now, I can tell you now for free, some of the things that, I was, expected to know have changed quite significantly, especially when it comes to things like analgesia, anaesthetic techniques, and things of that nature and that. Things are, are moving very quickly.

And also, one that we can't always account for is we're scared. I would say this normally, normally is related to, and my, my personal favourites are all the ones that people are most scared of normally is, snakes. It's definitely up there.

Rats, sometimes spiders, and, and also birds as well, but not because they're scared of the birds, but because they're scared of the flapping. But yes. I'm trying to do the opposite and and there's some reasons why we shouldn't fear.

Well, the unknown is nothing new for the veterinary community, we're always dealing with the unknown. And that element of, of involvement, just because it's new, shouldn't be a blocking, factor, or a factor that we don't, address, . And so I, I think it's so important that we as vets and, and this comes on to the second point, realise how many transferable skills we have every single day between, you know, different animals, because the basics of, of, particularly mammalian physiology, but the, the roots of physiology is often very, very similar, and sometimes, we as, as exotics vets often are, are extrapolating quite a bit from, from, you know, different types of, different species of animals quite a lot.

We haven't studied it, so I'm saying this is why I'm saying welcome to the presentation. This is why you're here. And again, things change very quickly.

Welcome to the presentation. You know, it's my job to try and, take away some of the mythos of exotics. And you're scared of animals, well, a bit like anything.

I currently have a new grad with me, at my practise and. It's always that one case of that big burly dog, and, or that, that strange looking gecko that will bite you. And I think, you know, sometimes we, we can be very aware that, you know, the practise of getting better at handling these animals is, is just takes time and confidence and, and some courage as well.

. And, you know, when I first started, I was completely scared of, of handling the calls, and now, you know, it, it seems second nature. But again, I do appreciate I see these animals much more regularly than you, most of you will probably see them. So, the famous case, and this is what we're going to spend most of our time focusing on, my rabbit slash guinea pig has stopped eating.

Now, rabbits and guinea pigs are different. But we often approach them very similarly, and I felt that if I could make some key distinctions between the two, we could cover a lot of ground, because I'm being sent so many cases recently, of guinea pigs and rabbits. Who are on a variety of different presentations.

And we, we tend to, especially in companion animal, ubiquitously chuck some, metoclopramide, or some, some loxicon and say we've done all we can, you need to go see an exotic vet. And I feel that so much more can be done at so many first opinion practises, first opinion practises. I feel this is a really good, really good start point.

So to be able to start this debate about what we do, we have to know what's normal. So we have to start with the physiology. And so let's talk about rabbit physiology very, very quickly, and just some fun facts for you to, to start this presentation.

So, they cannot vomit, very, very important, and it helps us get a, a good distinction on why it's not eating and motility disorders in a kind of wider sense, and obstructive disorders which will come on to come onto in come onto into it in a second. It's so important because when there's a buildup, whatever that buildup is, it can't come back up. When a rabbit eats something, it does swish around in that stomach, for at least 3 to 6 hours.

And so again, if we're talking about something that we've eaten, it helps give us an idea of how long it will be there, and, you know, at the point of when, rabbits have stopped eating and what things, medications and things we've given, and it helps us characterise what the progression may or may not be time wise. Small intestinal transit time, exceptionally quick. They have very, very, highly absorbable, highly er er er efficient, small intestines.

And the secum as well, very, very important. It's on the right hand side, so if you're taking those X-rays, something to be aware of. It's, it's a huge, huge part of the gastrointestinal tracts, 50% of the whole volume.

And so often you're seeing X-rays which may seem like huge impactions and actually it's just a, it's just a really, really large structure there. They have hard faeces, and this usually happens in tow with eating. And they also have secret troughs.

And ika troughs are, are actually this, this not the same thing as such, and there's something that, rabbits will, digest, and they normally pass them, you know, usually a couple of hours after not eating, usually when it's quiet. And it's really just to make sure that they're being efficient with digestion of, of all those valuable nutrients that they haven't, been able to make use of the first time. So when things are quiet or they've got reduced food intake, they will eat their own weird looking secret trucks.

They are, they are on a high fibre diet, and so they, there's this kind of low value hay, they is a very important part of, of, of their, er, digestion. And so what we normally say anecdotally is that every rabbit, loosely speaking at least, should be eating 85% in its in in in a day or at any time, should be eating 85% hay, 10% veg, and 5% pellet. Guinea pig physiology, very similar, cannot vomit as well.

Gastric 10 times 2 hours, so, a little bit shorter. The total GI transit time can be very varied, and these are all 8 to 30 hours can be completely normal. You see you can even larger organ in these guys, but it's on the left, it kind of, well, it's on the left side, but it, it sometimes extends into the, the that centre line as well, .

Hard faeces, up until recently, we, we used to think that they were also seotrophic, so they would eat their own scattross, but they are not. They are coprophagic, so what this means is that they eat their own faeces, and it, even though we, we, it looks very similar, and the principle is very much the same of, you know, making use of a variety of different nutrients that they may have not digested the first time. They are not Zika troughs, they are eating their own pure faecal matter, as it were.

And again, very loose rule of thumb, high fibre diet, the exact same balance is, is, is a very good, easy guideline to tell your clients, about if they are, are questioning it. I mean, there's a rule of thumb as well, that 25 grammes per kilogramme per day of, of food, of pellets, sorry, should be given to, to your rabbits. So for example, a guinea pig usually.

You know, on average will weigh around 1 kilogramme, so no more than 25 grammes a day for a guinea pig of pellets. Sorry, got faces. Well, it's important that we characterise what gut stasis is.

And the reason why it's so important we we characterise it, because it's such a common. Common way to, to respond to a rabbit that's not eating, or a guinea pig that's not eating. It's not eating, it's got gut stasis.

And gut stasis itself is not a, a diagnosis, it is a clinical sign of a whole variety of different things, and. What we are are need to characterise is, is how to tell a difference. And gut stasis er is often called gastrointestinal stasis syndrome.

And so we have this lovely er er word art here, and the reason why I've done it in this way is because I want to make people let people know that it is multifactorial and it is, is something that plays into itself, and it, it's almost self-propagating as far as I'm concerned. And so there are a variety of different things that can cause gut stasis, as a clinical sign. I would say, number one, inappropriate diet.

I see that, so often. maybe, maybe 5 to 10 years ago, the amount of, of, of rabbits that were being fed usually, it's a big no no, was probably a little bit larger. I would say personally, in my experience now.

I don't, I very rarely seemly fed to, to rabbits, which is a really, really good sign that we're moving in the right direction. However, what I do see is, is, a large amount of, of rabbits being fed, inappropriate amounts of high carb, low fibre, and high fed diets. So inappropriate diet is definitely a, a, a big one.

Fibre is a really, really important part, as we all, we all will be patently aware of, . With regards to gastrointestinal motility. So if we have an inappropriate diet, things will slow down, gut stasis, definitely.

Stress. Well, I'm gonna come onto this in a second because they can be stressed about anything. Pain also very important and and concurrent disease, which is something we should be aware of.

But what are we comparing this to? Well, gastrointestinal obstructive disorders, and that is something that is so hard to differentiate and I see it relatively often that I get a preferred a case from another practise. And the kind of loose suggestion is, is that we've got gut stasis, it's a rat's not eating.

Giving it Emiprid, I'll give it metocloprobid, sorry, give it meloxicam, you know, I might have given it a little bit of, of, of buprenorphine. It's not eating, that's your problem. Well, Just because a rabbit is not eating doesn't mean that it's something that will spontaneously fix itself and.

I would say obstructive disorders, gastrointestinal obstructive disorders are, are very much underdiagnosed because we have this kind of one and done approach to any, any rabbit or guinea pig that's not eating. And so. These particular two species will eat a variety of different things by accident, you know, carpet, plastic can tell you, you know, their own hair, so much, so many different things that can, that can add to that.

And this is not to take away from the fact that the. Presence of plastic or carpet or, or hair may also be tied to other clinical conditions, for example, dehydration or or kidney disease or so on and so forth. So it's really important that we, we differentiate between the two, as quickly as possible because they are very different.

And I've, I've seen on, on many occasions that they've been called gut stasis cases in reality, they've been obstructive disorders, and this is something that helps characterise the speed at which we need to respond. So, questions to ask. So you have the rabbit, come straight through, come through to your practise, er, er, what questions are you going to ask?

Well, you'll, you'll, you'll ask your general questions, you know, how long and what has anything changed, but really, I, I tend to, to remember things in this particular er er approach. So diet. I'm seeing it so often, as I mentioned earlier, that, high pellet diets and, and, you know, having hay around the house or outside in the garden is, is, is always fed in the same area, but a lot of, of, of the clients that come through the door have no idea how much of the hay is being eaten.

And we're we're using very strange doses and amounts for, for pellets. You know, I give a handful, I give a mug. Regardless of whether we're eating them or not, and, and we're seeing that so much more now.

I have no issue with pellets, it's the balance that is definitely, an issue. Stressful, stressful events, as we know, rabbits are absolutely scared of everything. Anything odd, it's really important to ask.

dribbling, sniffling, urinating. You name it, any, a rabbit or a guinea pig will stop wanting to, to eat for variety of different, reasons. And also it may give us an indication of, of, of what other concurrent diseases or conditions may be occurring, which may help us, at the end, try and fix that and also fix the, the response to that in the clinical science.

Exercise. I will tell you now for free that many a a guinea pig and a rabbit that has a gut stasis at least often doesn't have a a great exercise regime. And also characterising, as mentioned earlier, the, the time, has it been a few hours or has it been a few days?

And this is just to expand on, on what I mentioned, earlier, effectively. Just coming to the bottom right where it says acute, and this is really for the things that you need to see as a clinician, that if you are barely looking into your clinical exam, and it's less, less an absent, punched. And is not really responding to you.

Your initial thoughts are, this might be, a little bit more problematic. However, if the owner is cleared to say, well, it's happened over a couple of days, we ate a little bit less, there's a little bit of pellets, we're running around a little bit less, then you can already start, working yourself towards the possibility it may be something more likely to be, like hyper motility of the gastrointestinal tract, so gut stasis as opposed to an obstructive disorder. For example.

A physical exam. Now you'll do your normal physical exam, and everyone has their own process, so I'm not gonna go through er er all of that, but what I will say is that, On presentation, the way that I want to be able to characterise the importance of how I approach this is again coming back to whether it's been an acute issue or a chronic issue. Because ultimately, gut stasis is a chronic issue, usually.

Whereas the obstructive disorders are often acute, and we need to approach them very differently. So with acute, despite the mentioning also being listless and things of that, that ilk and nature, we are looking for bloating. A quite profound tympanic stomach, and I can tell you now for free, if you feel a stomach, it's really, really, it's, it's, it needs to be addressed very, very soon.

Borborygy, so a lot of gas, in that, those intestines, also is, is important. But also borborygme itself, is, is an indication of, of hyper motility. And this is something that you often will see with obstructive disorders.

So what we, when we say gut stasis, we normally sort of think, oh, OK, hypomotility, everything's slowing down, you don't hear any gut sounds. Actually, with obstructive disorders, if you're hearing lots of noises, despite the fact that the stomach, for example, is large or we're listless or hunched, then you're already thinking, well, the intestines are working overtime. This is unlikely to be gut stasis, it may be something else.

If you have one of these acute patients where the temperature is below 37, you've got to get going. It's probably not very good when the temperature's that, that low. You need to, you need to start escalating this very quickly.

I've put tacky and bradycardic, tacky or Brady clinic, . The reason why I've mentioned this is because when it's an acute issue, they tends to be tachycardic and tachypic, to begin with. However, if you've got anything which is, got the prefix Braddy in these particular cases, you're, you're really pushing it for time, ultimately, and, and you have to factor in the prognosis is getting worse when things start to slow down.

Alongside the other things as well. Whereas with chronic on your basic clinical exam, again, you'll do all the basics, you know, TPR yada yada yada, but often with a true gut stasis case. You often will find, excuse me, the stomach feels like a, a bag full of, of faeces, basically.

It's it's usually this has this spongy or almost like a play doughy consistency. You're in the intestines, you won't really hear any gut sounds. But quite often as well, the, the clinic rest of the clinical exam would be fine, will be absolutely OK .

You know, a relatively, can be sometimes inquisitive, and, and it sometimes will have you questioning whether this, this, this poor rabbit or guinea pig is, is ill at all, to be honest with you. And so that helps characterise things now. We've got this huge bully's face on the screen.

The reason why this is important is because it's something that often is missed. You've got to check the teeth. You have to check the teeth, and I would say anecdotally at least, this comes to, comes back to the idea that there is a variety of different conditions and issues that may be going on.

And you may feel quite. Or learned enough to, to work up er yourself, but checking the teeth is a really common issue, or dental disease is a really common issue, and checking the teeth is really, really straightforward and I, I, I think a lot of, of, of my referral cases sometimes. We check the incisors and, and that's it.

And actually, this is a really straightforward thing to do, and it helps to give you an idea, very quickly. I would implore you, to, you know, do a little bit of research into what spurs look like. It's pretty self-explanatory.

There's a slight difference between how it looks between guinea pigs and rabbits, just based on their, their dentition. But, it's something really easy to do. Now, I will say anecdotally, guinea pigs are much harder to look, look at, usually because they tend to, have a lot more food in the back of their mouths.

But, you know, if you get a cotton bud and put that into the recess into the buckle cavity, sometimes you can just pull it out, at least have a, a good idea and see their, their first, you know, pre-molars, pretty well. Rabbits. If their gut status, they tend to not eating anyway, so you're usually able to visualise it.

Get your otoscope, make sure it's nice and warm, and the reason why I've got this big arrow is that's the, that's, this is my normal process of checking the teeth. Ultimately. You get what your client to hold, you know, the rabbit or the guinea pig either side, with just very light, a restraint on either side.

And then with your less dominant hand, I usually put my hand just over, the, the eyes, very, very lightly, and then use my index finger and my thumb to lift, the, the front of the mouth. It shows me the incisors very quickly. And then, With my otoscope, which makes sure I again it's warm.

I use my hand to warm it up. I will put it into this, left, or this, or the rabbit's right, or the guinea pig's right buckle cavity first. And the reason why I do this is because I get to see the first premolars.

And then, straight after, I will twist in the same position, just rotate my otoscope, and then over the tongue, have a look at the, dentition of the other teeth, basically. . Across the, across the mandible.

And by going over the tongue, I can use the otoscope to, to move the tongue out of the way and have a better look at, at the, the inside of the, that, that lingual side of teeth, which is often where the spurs, pop up. And then again, in the left buckle cavity, again, I can sometimes, process or push the ostoscope a little bit further into the recess of the buckle cavity on the left side. To have an idea of, of, of the maxillary teeth and then back over to the other side for the same thing as mentioned earlier.

So this is my normal process. It is important to say, it's important to say that this is not a complete dental exam by NHS of the imagination, and it is, it, it will give you some information, but it, it, you'll still can and are likely to miss things. But, in these emergency cases, all the information you can get as quickly as possible is obviously extremely, extremely important.

So, diagnostics, radiographs. And the reason why radiographs are, are, are so, so important is because you can get so much information so quickly and it helps you characterise what you're dealing with. Often, it's often the key, the key part of this process of diagnostics.

You can also do, blood glucose. And if you feel confident, CBC biochemistry for hyperglycemia, it's a bit of a spelling mistake there. but also, if you have a hyperglycemic, rabbit or guinea pig, or is it toxic, or you noticed lipemia, then you have to.

There is a, a poor, prognosis, unfortunately. So, again, hyperglycemia, profound hyperglycemia, particularly in rabbits, ataxia and lipemia, on your, your samples are suggestive of, of poorer prognosis. So these values are for rabbits in particular, and there was a a a nice little bit of research done, I believe by Molly Varga, and I think it was in 2012.

And this particular study, was done to help correlate what particular, biochemical values, in particularly glucose, could help give us an idea of, of, of, you know, whether we've got gut stasis or whether we've got an obstructive, issue, for example. And I find that there was a a huge misinterpretation of the, the study because the, the real interpretation is that. Glucose increases in rabbits because they're related to stress, right?

Stress, er er reactive stress, hyperglycemia, we see in cats, er, particularly as well. And what often people misinterpret from that study is that if you have a glucose over X, therefore you have an obstructive disorder and it's a bit of an oversimplification. What was found is that there was a much greater possibility of obstructive disorders if the glucose was over 25 millimo per litre.

But actually we're talking more about stress and pain. So if you have a glucose over 20 or 25, particularly 25, you're, you're thinking more profound pain, and that obviously at that particular point, increases the chance of it being an acute issue you need to fix very, very soon. I would say that if you have a glucose around, 12+, then, you know, you can have gut stasis in those situations, but it doesn't necessarily mean you don't have an obstructive disorder as well, or a partial obstructive disorder, .

But also it's important to consider er er biochemistry as well. In both of these cases, er if you have, you know, creatinine, urea and all sorts of other values, kidney values that are shooting through the roof. I mean, a lot of these guys are, are, are dehydrated.

Because of accumulation of fluid, often in the stomach as well, particularly for obstructive disorders, then, you know, you've got to consider, how you would approach that, with, you know, fluid therapy and things of that nature and that, that, that, that ilk. But also, and this is, this goes more for rabbits in particular, but also could go for guinea pigs, is that if you have liver enzymes which are climbing. Then it's important not just to say, well, the liver is involved, but that could be, a bit of a spontaneous response.

Rabbits will often get relative often will get a liver lobe torsion. So if you have liver if you have liver values going through the roof, then it's important not to rule out that as well as a profound source of pain. And one of the ways you can, you know, expand on that, which we won't touch on this presentation, is, is via ultrasound, or possibly, free food or, or, or, a haemorrhage into the abdomen as well.

But again that's a slightly different topic. Profound pain increases glucose and profound pain can be caused by a variety of different things. That's the main takeaway.

So, one thing I would like to say is that I, I, I get this relatively often. Now this is quite clearly a rat's tail, but the principle, lots of people, different people have different ways of collecting blood, in a, in a, stressful emergency situation, especially from a rabbit that's already stressed out. And I would say that I find a particular technique very similar to this one is something I, I, I prefer, but everyone has their own different er approach.

As we know, we can get blood samples from the marginal ear vein, er the sofina, and a variety of different places, jugular. But ultimately when we're stressed out and possibly, you know, going through shock, getting blood samples can be er er and kind of handling rabbits and guinea pigs can be quite stressful. For rabbits in particular, one way I really like to, approach it, unless it's, you know, you know, a rabbit, breed that's got very small ears at least, is that I tend to stay away from the, you know, jugular, and if I can, excuse me, I sometimes will stay away from, the Sefinus as well.

The Cepheuss is a really great blood vessel, but again, sometimes it, it, you know, a stressed rabbit, I don't want to stress out anymore. So I tend to personally go for the marginal ear vein as long as er our, our, our, we're not going into too much shock. Well our blood pressure is, is absolutely diabolical.

And what I tend to do is, here we have a rat's tail with a a a a needle and a hub. What I tend to do is take the hub entirely off the needle and. With that, just that needle, I will use, pop it into the marginal ear vein and let it drip through that.

And the reason why I love that is because it tends to be such a non upsetting way to get your blood sample relatively quickly. And, and, you know, we often use the 25 gauge needles and things of that nature, but, anecdotally I've used anything. As large as 21 gauge needles in marginal ear veins in, in hyper perfused, and, you know, going through shock rabbits, and I'm able to get, to get a relatively quick samples just from a 21 gauge needle or a 23 gauge needle.

Just take it off the hub, so, because the blood pressure, often causes an issue there. And you'd be surprised about how quickly you can get a blood sample, from these, from these guys. So, yeah, if you can take the needle off the hub, marginal ear veins is something that, I.

Really, really do like, especially in rabbits. Again, for Zafina, in the, or in guinea pig, you know, you might want to go for a jugular, because, again, marginal ear veins are, are very, very different set of anatomy. But a, a, a jugular is important.

Sofinas, again, is really, really great. And again, I, I tend to stay away from the cephalic. But there are a variety of different ways, and many people will tell you different.

The radiogra. So here we have a very interesting and a perfect example of, of, of a way to differentiate between obstructive and non-obstructive or hypermotile, so er er a gut stasis, a true gut stasis and an obstructive disorder. And so this was a study done by Devon and Metau what 3 years ago.

Wow, that's gone quickly. And the paper is called Radio Radiographic Diagnosis of Small Intestinal obstruction in Pet Rabbits. Now what we have here is, is, is a.

The length and the width of a stomach, and a bit like a, for example, a vertebra heart score, we're going to put those two line lengths together and then measure also the relative length between L1 and the sacrum basically. If. And this is a rule of thumb, if the combined length of your, your stomacher is as long, if not greater than that, that there's lumbar vertebrae in that that that sacrum there.

The results showed, so the gastric length and the width greater than equal length to L1 to coxofemoral joint, to be more exact, there was a 98% chance of obstruction. That is a really, really, and it's super helpful point. Because at least if you're able to do this, if you're able to get a, you know, under a a a quick sedation, .

And you're able to get this lateral X-ray, and to be honest with you, it doesn't even have to be on sedation, sometimes you're able to get this particular value from a a DV. If you have this, that you have a real strong suspicion. That you've got an obstruction.

And so your approach is, is very different. If it's liquid. With a gas cap, so what we have here below, 92% chance of obstruction.

Direct contact between the gastric wall and the central abdomen as you again again you can see here, 92% chance of obstruction. And so having this. Plan, you don't even need to get an X-ray.

If you look at and you do your clinical exam and you see a rabbit where there is a bulging just by that, that xyphoid region. A bulging where the stomach is, you have already a strong suspicion that you have an obstruction. This doesn't er apply so much for for guinea pigs.

Not in the same way because we don't have the studies. However, what I will say is that, it's, it's, it, it's similar to an extent. And so what you're looking at is, is if you see an X-ray like this, you have, now this is a perfect example of something that you may see.

So you have a stomach which is enlarged, most definitely. But if you look at that, that, that, that, that rest of that GI it's, it's completely, completely, completely, completely, filled with gas. And this here is a, a relatively typical example of a gut stasis, which has continued to progress.

And so what we're looking at is a, a, a, a, a relatively gas-filled stomach, but really the main issue is that we've got those really full intestines. And so this is, is something that might, we might characterise it as, but we are, need to be careful because guinea pigs are, are much more likely to get GDV and I will tell you that, based off of the. Relative size of the stomach, and I honestly mean that the stomach here could be almost twice the size of the GDV.

You will be almost to the same rules that you would with the the previous study for rabbits. You will almost always know that you've got a GDV or, or similar, that the stomach really can probably almost be 75% larger than it is in this particular, radiograph. If you do get a GDP or you think it is that, just be aware that the prognosis is particularly bad, but the principle of how we fix it is, is the same as you would in a, a dog, and so ultimately a gastropexxy at the end of that is, is, is a common technique, but again.

The success rate is pretty poor. For treatment, so a true gut stasis, what are we looking for in particular? Well.

We find that these guys are not eating, so we need to correct appetite. Electrolyte imbalances, again, that's why it's so important. If you can get a blood test, to correct those, I would implore you to to to as as at all costs, but again we know costs can be a limiting factor.

Return ourselves back to normal motility because it's hypo motility which we're facing. Dehydration, exceptionally common. Soften the ingestor, er, so things move a little bit quicker.

Again, it ties into the whole dehydration idea as well. Sought pain can be very, very painful. And also making sure that we're, we're in a quiet and, you know, dark environment.

And there was a study, that I remember reading that said that a rabbit refused to eat for, I believe it was, maybe 12 or 24 hours, purely by virtue of the fact that it was in light. It may have been even longer. And so something as small as turning the lights off or making the room dark and quiet could be the game changer that you thought you never had in your arsenal.

Gastrointestinal obstructive disorders, however, . An obstructive disorder in a rabbit can kill a rabbit within. 6 hours.

And this comes back to the idea of transit time. It's so, so important that if you have any indication. That we have an obstruction, that your decision and timing should be really proactive, with a gut stasis, you can normally send them home with a variety of things, which we'll come on to in a second.

And but if, if you have an obstructive disorder, it's, it's imperative that you explain to the client the timeline for this. Temperature correction, as mentioned, you often will have a very, very low temperature, 37 °C or below. Fluid correction, as expected, usually IV we're not gonna send them home with, with, fluids, or, or liquid food.

Pain, again, same thing, just a little bit more proactive electro imbalance, of course. And also, and this is a, a slight difference between rabbits and guinea pigs and rabbits, for obstructive disorder, if we have gas or a huge amount of fluid, decompressing via gastric tube, you know, you can give them a little bit of midazolam to sedate them. But decompressing via a gastric tube, is, is, is often recommended, unless you feel that the obstruction is, is completely unable to be blocked otherwise.

As, as you would measure out the length of your tube, I think it's 18, French catheter would be a relatively good size and make some extra holes in the bottom. And if it gets blocked, take it out, flush it, and put it back in. And try and take out as much as you can.

But also, something to be, aware of, like I said, with, with, this is in rabbits, in guinea pigs, it's often very unfruitful to decompress, via a gastric tube. And I don't think there's been, been any research into this, but personally, if you have an obstructive disorder with a guinea pig, you're either hoping and wishing it, it manages itself. Or it's likely you'll have to go to surgery, and again, you need to make that eminently clear to the client that the the response to, to, to surgery can often be quite poor, especially when you've got so many other issues to fix.

So surgery, If you can, And you say, with an obstruction, there are two types of instructions. There is a proximal small intestinal obstruction and often a distal, small intestinal, obstruction. The proximal one, as you imagine, would, would be is, is the more common, however, it is the more dangerous.

But if you know where this obstruction is and you go into theatre and it's an emergency and you, you have this full stomach, it's full of gas, or it's full of, full of fluid. If you can feel where that obstruction is in the proximal small intestine, push it back into the stomach if you can, and if you feel it's safe. The reason why I say this is because enterotomy er er er response in rabbits and guinea pigs is particularly poor.

So if it's in the distal small intestine, see if you can kind of push it forward gently into the secum. And if it's the proximal, see if you can push it directly into the, the, the, the stomach. And, and at that point you can go via the stomachs to do a gastrotomy, and remove all that, that, that material.

And take out that obstruction. However, if you have to, then, you know, I've seen it quite often that people will go into these testing, and there's similar principles for a cat or a dog, you know, making sure there's some mucosa is in, in, in your position, when you close it up, and things of that nature, the smallest decision possible, without, you know, causing further damage to the mucosa. What you sometimes may find as well is, as you'd expect, strictures, and very sad looking intestines, and again, making a, a, a, an informed decision about what you think the prognosis will be, is, is something that is, is relatively transferable between companion animal work and as well as, as, as large animal work as well.

So I've, I've, this is a, a slightly amended version of something that Molly Varga had has done back in 2014. I think it was her textbook of rabbit medicine. So I've, I've tried to, adapt her version here, and add some updates to, to what I'm aware of.

So I'm gonna go through it very quickly. So this is particularly for rabbits, so, take a picture or make your own version. And, and you can use this as a guideline about how you approach the different, gastrointestinal stasis or obstructive disorders, and this is a really, really, you know, balanced way to approach this.

So we're still using, metoclopramide. The actual licence values are 0.2 to 11 MB per gig every 8 to 12 hours.

However, I don't tend to use lower than, 0.5, . One thing to be made to to make eminently clear is that I tend to give Emiprid or metoclopramide as an initial injection.

The reason why I use this is because it, it gets things started, but it tends to, and from what we understand, only works in the fore gut, and often gut status, as we know. Is is something that is a hindgut issue. And so, yes, moving the material, and the ingestor from the stomach into the intestines is helpful, so it doesn't just sit there, but in the grand scheme of things, it's important to, to characterise why this may help, but may not fix the, the origin of the issue.

Alongside that, now this is something that is has been also up for is controversial debate now. Says of pride. Now C of Pride is supposed to, supposed to work on the fore and the hindgu, and so for the last 5, maybe even as as close as 10 years now, Si Pride has been given.

Via the mouth, as, as being the, the, the thing, the game changer, of, of, of, of prokinetics. And, but there was a little bit of research that came out, in New Zealand, rabbits, I think they were lab, they were lab tested, . And this particular research showed in healthy rabbits, at least, that ya pride had no effect on, on, on motility, gastrointestinal motility.

And so there's a little bit of a er er a question or controversy about its efficacy. The research did actually use 0.5 mix per kick.

I believe it was every 12 hours. And so even though the dose ranges are suggested 0.5 or anything to 1, very similar to metoclopramide, some people use it, some people don't.

I can and still do use it because I, I find that. Maybe it's a little bit of confirmation bias, but also I do think Si Pride does work well. but also I've updated some of the protocols for the rest of, of my clinic, and so maybe the response or the higher, response to, gut stasis has been because of some other, medicaments that I've been giving as well.

But I, I go, because of this research, instead of going from 0.5, I go all the way up to 1 big kick. I, I, it, I haven't seen any issues of harm, as a result.

And it's either not gonna do anything, or it's going to do a little bit of something. And that's my current reasoning. And there's, again, like I said, there's controversy between, exotics vets, around the world who feel whether or not they use it, you know, and so we can do that.

But also, moving on to, opioids and local anaesthetics. Something that people will be very familiar with is buprenorphine, every 6 to 12 hours. You can give it via the mouth, you can give it IV, you can give it, intramuscically or subcutaneously.

However, I will mention that some of the older doses of 0.03 mg per gig, have been suggested to have sedative effect, but limited analgesic effect. But again, that, that's always something that may change.

There was some study, about, lidocaine, CRI, IV. And I think this is probably what we're currently saying is the gold standard for treating gut stasis now. This particular bit of research showed that if you gave, I think it was easy the rabbits as well, you gave 2 mg per gigs a loading dose IV, slowly, of course, and then the CRI IV of 100 mcg per kilogramme, per minute, .

You had an increase of, of faecal output and signs of pain and so on and so forth. And so if you can hospitalise a gut stasis rabbit or need to, then, then leave a can see your IV if you have a a a a needle, . Yes, you have a L K CRI available basically your practise.

Then, then this is a really, really great place to, to start your workup. Anecdotally, I've heard of people using ketamine now. I wouldn't like to vouch for that cause I haven't tried it myself.

But lidocaine, fentanyl, and I believe ketamine to your eye, has also been used as well. But not just for gut stasis. It might be a little bit of overkill, but for a variety of different, anaesthetic protocols.

No steroidals, meloxicam, we used to, use as doses as low as 0.3. However, there's been some research suggests.

Also there's a suggestion that anything lower than 0.6 mix perk, may or may not have value. This is twice daily as opposed to the once daily that we normally, or historically have gone for.

however, I have used, occasionally, for to get this one, to get rabbits, and, rabbits in particular started is 1.5 gigs per gig as high as that as an injection. And I found actually that, I have a quite good response to relate to that.

Of course, these are, are outside the licence dose as well. But it, it sometimes you, you'll, you'll have to, you know, consider the options and consider your case by case and if it's suitable or not. .

Anti-ulid drugs, now ranitidine is something that I give regardless or all at all costs. Reason one, because it's, it's suggested as a prokinetic. But also number two, because I've seen so many postmortems of, of, of, rabbits with profound gastric ulceration.

So even though there's no suggestion that giving higher meloxicam doses increases the chance of, of gastric ulceration, I would really, really, really, implore people to use ranitidine. I, I believe, you know, even though you can't get Zantac anymore, or the injectable, I, you can get it from, I believe it's from, Summit. Yes, I believe it's from Summit, and get these tablets, and I, I, anecdotally, if you can put them in something and.

Some, fibre plex or and push it into, you know, this, this, poor rabbit or guinea pig's mouth, or sometimes crush it, put a little bit of water. I think it tastes quite bitter, but if you can get it in, I really recommend it. Antibiotics we've got stasis, not indicated.

Probiotics, again, fiberplex or similar, maybe useful. Fluids. Sometimes you get away with oral fluids, sometimes IV, sometimes, you know, subcutaneous.

All of those will have value. And then syringe feeding most definitely is, is something that I, I tend to do, especially if I send home, send them home with a variety of other things as well, depending on how severe it is, or it's not eating. Whereas obstructive disorders, No, do not give prokinetics.

It's contraindicated for obvious reasons. Opioids, like I said, there's so many different protocols of pain. The only one I tend to stay away from is borphenol.

But methadone, I think is, is fantastic. It's what I normally reach for buprenorphine at higher doses again, and lidocaine COI IV as well alongside if, if I have that option available to me. Now steroidals, .

But again I, I, if I, if I will give it, if I have a feeling that our kidneys are doing OK, if I've got a biochemer, a biochemistry. I'm a lots of chem mentioned before. Vanitidine, post-op, because I'm probably going to give this one some meloxicam to go home with, usually a high dose.

Antibiotics, most definitely, especially if we're, if we're, if we're, you know, taking out, things from the abdomen. The reason why I would say this is because quite often, I find that we have, some. If we have, if we're doing a gastrtomy in particular, we try to be as clean as possible in trying to make sure the contents of the, of, of, of the stomacher are removed, but I have found er anecdotally at least that.

Quite often, some of the ingestor may get into the, intestines, and the last thing you want to do is to cause a, you know, septic peritonitis, for the sake of, of, of a, you know, a, a couple of days antibiotics post-op, for example. But, it's, I, I think it's important that we make clear that if we feel we've done a completely clean up and there's no indication until we've flushed the abdomen, then by all means, withholding antibiotics is really, really a, a positive, approach as well. Probiotics may be useful.

IV fluids, most definitely. We're not going to get around it with, with, with really, with all, with oral, fluids, and even so of fluids can be a little bit, slow. And again, again, with nutrition, you know, tempting foods, curly kale, so on and so forth, might be really helpful.

Guinea pigs, very much similar, I would, you know, take notice of the buprenorphine doses, they pretty much triple or quadruple. So 0.2 migs per gig every 4 hours.

Methadone, increases, but again, it's pretty much a very similar, breakdown, of, of what we mentioned earlier, but I, I'll hold it up for just a couple of seconds so you guys can, take a picture or make a note of it. But by all means, it's just, it's more, changing the doses, . So, also, something to mention is that with meloxicam.

I've actually put, it's licenced to 0.2, it's not, it's 0.02 mg per gig, like 0.2 mg per gig.

But there's a suggestion at least that, anything from, the higher doses, could be something of, of, of value. So we're looking at, you know, 1.5 migs per gig of, of, of, meloxicam.

No, sorry, 0.2 mgs is correct, but doses as high as 1.5 mg per gig, have been given in some research once daily.

But again, it's not licenced for that. So, it's something to be, to be aware of. You always have to go with the licence dose first.

But again, you might find that you need to increase, your meloxicam doses, to make your, your. Your, case, improve its current situation. What I will, what I will say is that with gut stasis or obstructive disorder, that meloxicam by itself in guinea pigs doesn't tend to work.

I would always, always, always, always for a gut stasis, guinea pig gives some type of opioid, alongside that. But again, there, there are 1000 different things that people suggest, and, and, like, So, I'm gonna move on to something else. So chesty rat.

So a, a rat that has got some type of respiratory issue. I see this so often, and it's so easy to see, kind of ubiquitous breathing rat signs, and say, you know, it's, I'm gonna try get some antibiotics and hope for the best. And the reason why I think I want to mention this is because there's, there's, yes, respiratory issues in rats is very common, and is often, very hard to get into control or nigh impossible.

But, there's often much more we can do, er, er, at our first opinion practises, without having to do all sorts of fancy diagnostics, and are able to improve the current situation outside of, you know, here's what Arifloxacin. Of you pop. So, the main culprit, and there's a variety, the reason why we call it chronic respiratory disease is because they're a bit like how we have, what we ubiquitously call kennel cough, in, in, in dogs.

There are many different factors, that can cause er er chronic respiratory disease in rats. The main culprit is Mycoplasma hormonas, and there's been research that suggests that, pretty much every rat, you know, by the age of 4 months will have mycoplasma, but just because mycoplasma is there, does not mean it's, it's a clinical manifestation and, you know, streptococcus and, and a variety of other viruses and, and so on and so forth, which can cause exact same presentations. It's multifactorial, so again, younger rats don't tend to be, don't tend to struggle.

In the same way that, you would expect, them to, whereas, you know, over a year old, maybe, you know, 18 months, that's when you tend to see the manifestations of, of issues. Husbandry, again, if they're not cleaned up very regularly, the, the ammonia, crowding, stress, all those things are really important. We tend to like, recycled.

Recycle paper as a bedding, so you know, things which are very dusty tend to be also. A, a confounding reason of why we have a chronic respiratory disease. So husbandry in the environment.

And also the strains of the bacteria or or virus that we're afflicted by can also change the current complexion. It is often a cyclical disease and so you never really get over it, and it's mainly due to the fact that if you have an infection, a bit like you would, in, in many other, species, is that when it causes a profound reaction, you get all these, these, these proteases and these enzymes that will end up, end up causing alveolar damage. Well, what you often see in rats is almost like little granulomas quite often in the lungs, which even with a CT scan, you may, you may miss.

And so what happens is, is that you, you, the, the capacity for, you know, oxygen exchange in the lungs is, is, is, can struggle as a result. And so you will see relatively ubiquitous, common clinical signs of, of dysplanic er rats. And I'll show you this in this slide.

So here we have a a nice YouTube clip of a perfect example of a rat that is dysmic. It's important to also characterise that just because we have an, a bit like a, like a cat or a dog or any other animal, just because we're looking like this does not mean, I'll play it again, does not mean that we are struggling, . Struggling only because we have a chronic respiratory issue.

There could be a variety of different issues that are at play here. So, What we have is. Presents, you have dyspne?

We have the whiskers are pulled back, the orbits are smaller, and you may or may not be able to see, but the corner of the mouth is also pulled back, and this is an indication of pain. And what I tend to phrase as under the umbrella of suffering, and so this is a rat that is suffering, . Respiratory issues, especially profound ones, can cause er er stress, but also a huge amount of pain and discomfort.

And so this right here has a pretty poor prognosis for variety of different reasons. But again, I, I, just because we look like this does not mean that this is the only issue is at play, so make sure you do your workup and your diagnostics. So, my rat is struggling to breathe.

What do you do? Well, you, you get your history. Remember to focus on the environment, you know, er, er, where do we stay, what's the bedding, you know, do we, how often do we clean, clean these ones out, how many, how many rats are in a set space?

I think environment is something that's really high on the agenda of making sure is, is, is looked after, and the flare-ups of these are often related to poor environment, to be honest with you. Clinical signs, as mentioned, it can be dysmetic, but you can also see nasal discharge, weight loss, hunched, red tears, and these tears are, are, is a, is a normal response to stress and pain and discomfort. So red tears doesn't mean that necessarily got conjunctivitis, as often a lot of clients think.

It's more of a, physiological, pathological, physiological manifestation of pain and stress. Mycoplasm itself. Also has been isolated in the inner ear, inner ear, and so you will see sometimes a lot of, of rats with head tilts, and, and effectively, you know, torticollis, secondary to vestibular disease.

So if you see head tilt and breathing concern, you you've got a decent, decent-ish indication that's gonna be neoplas a point on this that's at least part of the issue here. However, what you will do is make a presumptive diagnosis, quite early based on this. so many cases, the overwhelming cases with these, these clinical signs will have at least, to a large extent, a respiratory issue.

But it doesn't stop you from from doing the doing further diagnostics as we always implore you to if you feel that way, if you feel that way and kind of comfortable, radiography. I often personally find unless a, insipid or consolidated lung is, is there on an X-ray, I, I find it very difficult myself still, to be able to interpret a rodent or particularly a rat, a chest X-ray. I would say anecdotally, unless it's a very, very clear, I wouldn't read too much into it.

So I would say per from personal experience it's often and fruitful, but it doesn't stop you from doing it. You should still do it. CT scan if you have one handy, but again, I, most of the clients that come and see me do not, fancy doing a CT scan for their pet, for their pet rat.

Trachea wash can be extremely helpful, and the principle is pretty much the same. I would usually put maybe, you know, 0 0.5 mLs of, of saline, and kind of put it into the trachea, flush it in and, and, and take it out, send it off to the lab for cytology and culture sensitivity.

The exact same principle you would do in a, a dog or a cat. However, mycoplasma itself is extremely hard, extremely hard to, to cultivate. So again, if you have the, if your lab has the option for serology for mycoplasma, then brilliant.

But you know, just because they don't come back with your, from your, cultural sensitivity with mycoplasma doesn't mean that it's, it's not, it's not there. 3 options. Well, and this is the thing I really want everyone to take away, today, is that for, for this particular case is that there is a lot more than than Beitrill basically, .

Nebulation is something that in severe cases, and even in maintenance cases, I would definitely recommend. You you'd be surprised about how many rat owners are so devoted to their rats that they will go and buy a, you know, a, a, you know, middle, middle, you know, go onto Amazon and buy a a a a a nebulizer and set up a little thing, and I think it's quite a nice . Quite a nice touch for them to do to show how how involved they are, and I think people don't tend to have on rap.

They tend to have 2 or 10. And if you have 10 at least, it, it's a forward investment to get a nebulizer, and it's so easy to do, to be honest with you. Antibiotics, again, something that they'll likely have to be circularly on, and again, if you can do, culture sensitivity testing, as always would be recommended, .

You know, whether or not from nasal discharge or from track or wash, be brilliant. Steroids, I will talk about, talk, talk to you about these in a second because there's a little bit of a, a slightly controversial topic again, especially if you've got a repeated, respiratory infection. I know they are bronchodilator and so on and so forth.

The key thing here, as mentioned already, is long term success is rare to to to to futile, basically. What you are doing is, is managing. And also to characterise how well you're going to manage, it is always worthwhile to do further work up and further diagnostics.

So do your bloods. I'll do an X-ray, I'll do a trachea wash. And that will help you characterise, but it's very important you tell your clients very early when you believe this is the, the, the case, that, you know, long term success is, is rare, and this is likely to be an affliction that comes back, more often than not.

And so again, here is a setup of a a . A, a place for the rats to be nebulized and again something like this is something that we have in our own practise. It, you know, you can have all sorts of, of 1015 minutes, in there with some, with, with, with your products, whatever you're going to use, and I'll come on to it in a second.

And twice a day, it's just really helpful for, for clearing the airways and sometimes getting antibiotics there as well. And then again, here's a, you know, making sure we can get those beds in as well. So nebulization, just expand them a little bit.

We use a product called F10. F10 is, is fantastic, it's great for cleaning wounds. It's, it's the exotics version of almost of, of hippie scrub, shall we say.

But I, I, I really, really, I think most exotic practises use a lot of F10, I'm sure whoever, I think if whoever produces F10 are very wealthy from exotic. Practises, but the idea is that you can use it by a concentrate form or it's a complete and ready to use form, and they have other products as well for, you know, insecticides and, and things of that, that nature. But F10, if you make it into a 1 to 250 ratio, you can put it straight into your nebulizer.

Leave it on for 1020 minutes, and it really has, if I'm, say, anti, antibacterial, anti-fungal, and also helps kind of, lubricate the airways where there's kind of a mucus in the upper airways as well. So it kind of does two or three different things at the same time. So this is kind of the, the, the, the standard for many, nebulized rodents, particularly rats.

You can also, nebuli gentamicin, and these are some of the suggested doses, I believe, from, a variety of texts. Amifloxin's obviously licence, so Aryl, but there's other products here which, Based on culture sensitivity testing, that you may want to use, in a variety of different upper respiratory and lower respiratory tract issues instead of, for example, or, or alongside giving oral antibiotics. Antibiotics, now this is not, this is an inexhaustive list again, culture sensitivity testing, so important.

But, yeah, Beittra, I'm sure many of you will be very comfortable with that. But, in research, at least, in research, a lot of exotic vets, love doxycycling for this particular issue, . Like cycling tends to work very relatively well er for Mica Pas and Pomonnis, just by its mechanism of action.

And so, here is an example. I personally, where, where, Beittrol has been, not really had the response I wanted it to, and I, I find this sadly quite often. I personally like azithromycin.

You can get paediatric, forms of it, so, 150Bigs per gig tends to, for, you know, tends to be a relatively large amount, but, it tends to be relatively palatable. And you know, I, I, I, I think azithromycin or doxycycline, depending on how you administer it, can, can work really well. If I'm not mistaken, azithromycin, has a greater chance of, of resistance.

But again, this is all related to culture and sensitivity, sensitivity testing, as much as you can. If you find you have streptococcus, actually what you should be using is a completely different antibiotic, which is mola. And again, there is that, that dose, but it is for streptococcus pneumonia, it tends to be the, the best option available for that.

Options two, so, steroids. Now steroids is something that I personally find is, is helpful in similar cases where it's either this, when they, we have this severely dyspic rat. really profoundly severely dyspneic.

I would normally give just one off injection, 0.3 mL per gig, of dexamethasone. I didn't mention that there.

So Dexad dressing, for example, do for, and, that tends to be it alongside starting antibiotic treatment, and that's what they normally start with, and it's just really to give a little bit of respite in the immediate future, just to open those airways up basically. I do find that, that I've had slightly more success rate with profoundly dyspneic, rats alongside hospitalisation, oxygen therapy, so on and so forth. Some of my colleagues have mentioned that they sometimes give them, prednisolone.

I haven't, I haven't written this down because. I'm not a big fan of it, to be honest with you. I think, the quickest we can use or stay away from, or the, the sooner we can stay away from steroids, the better.

And I find a very small amount of dexamethasone, is, is the furthest I will go personally. But, you know, it's, it's, it's trial and error, and sometimes I'm sure, prednisolone may have had some positive effects as well. And then other er er here we have some bronchodilators and a, always gets wrong, it's muscarinic.

No that's, it's a beta 2 adrenergic product salbutamol basically. I think salbutamol is fantastic. It's something that you can, you can order in, I'm very familiar with, and I've, I've seen it used and I've had moderate to very positive responses with it.

It's something that . You don't need to be a a an exotic expect to get. And you know, when your first round of antibiotics and your first round of nebuli hasn't really, it's improved it but not really done it, salbutamol or a bronchodilator or both, can be the game changer.

And, and so again something that I would highly recommend . You know, again, would be great. Again, if they're not up for buying salbutamol, cos I know it can be a little bit expensive, then, you know, a bronchodilator, is, is really, really, really something easy to, to give them, to be honest with you.

So let's go on to the last, last, last part of this presentation. Emergency avian care, now. Again, something I've referred referred to a lot of the time, I can't tell you the amount of times that people have rung me, said, I've rung 6 practises all near me, and they say they don't see birds.

And I know that a lot of people know it's completely, I, I, I completely understand why it was so we don't see birds, there's no point in you coming here. But I, I think for emergency care, personally, I think. So especially with birds, so much can be done, which does not need to be specialist at all.

Doesn't need to be a certificate holder doesn't need someone to be interested in exotics. It's, it's, it's the basics, as mentioned, the basics of the physiology of a, of a, a profoundly, you know, ill bird is, is pretty, is pretty common, across the board with, with other emergency cases. There are some, it's very common, and often that's related to the fact that.

We don't often, these guys are stoic, they are usually prey, they usually hide all their clinical signs to the, to the very last minute. And so having an emergency bird situation, avian situation is, is very, very common. Common signs, er, sleeping a lot, er, fluffed up, regurgitating, diarrhoea, collapsing, seizures, can't walk.

But I something that I think is really important is, is. Often, if a client rings the practise and says. I have a bird and, I have a cockatiel, for example, we've got here on the bottom left, and it's fluffed up, sleeping lots.

But I don't think he's that bad. I, I tell my receptionist to overstate an, an emergency in, in, in birds because so often they're so much worse, than we give them credit for. And so, A lot of the time, a lot of my referrals are, well they, the owner or the client said, we, we, we have a bird here that has collapsed, but he or she, looks OK, can we come to you?

And at that point, because. We have been told that it's not that bad, we automatically default to the idea, well actually you can go somewhere else, you can go to someone who has an interest in birds, etc. Etc.

And actually the reality is, it's much worse than that, so . Something to be aware of, er, er, any of these signs could be a profound emergency, which, which, you know, going, travelling large distances for, for example, if you, if you don't live near an exotic threat, may not be the wisest thing. And so this is where, you know, your first opinion practise comes in.

So what to remember, handle as little as possible, if at all. AKA if you feel that you're going to stress this bird anymore. There's no point happening.

I do the bare minimum. And stabilisation is the is the key of of this. A lot of birds that come in are are extremely hypothermic and so especially if fluffed up, because as we know, fluffing up birds is a is a is is is based on thermal regulation.

And so, you know, making sure we've got a nice warm room, . Rehydration, again, there will be intra osseous catheters, IV catheters, I think in first opinion practise that has not got an exotics background. We're often talking about, so got fluids, maybe a little bit of a vitamin prep.

I do feel like, for example, just spike it with a little bit of that. Option therapy, very, very important. And we'll talk about this in a second.

Nutritional therapy, safe cage, making sure you have something suitable. So we need to have a perch, but maybe some towels, make sure the head is above the bum, because again, if they, if they're lying flat, sometimes, crop er er er crop fluid, or the contents of the crop will, will, will kind of come out of the crop and go, up into the, the, the, the mouth, and then be inhaled. So again, keeping that head nice and high, and then just be pragmatic about what you see in front of you, basically.

And, and be aware that you are will be limited in most of these emergency cases about what you can do because you can't handle these birds without, you know, often, putting them at, quite a profound level of risk. So, what we have here is a, a few techniques, and things to be aware of. So fluid therapy as mentioned, subcutaneously.

So if you look at the top right, here is a rock dove, and the idea at least is if you can see, that just above. That femur It's a nice big juicy skin flap, and the idea at least is that if you lift that skin flap, you can, it's, it's it's a, it's usually quite a a large space. And so in there, you can deposit a certain amount of fluids.

Again, it's usually the, the, the, from severe emergency cases, the chosen place to get fluids in, mainly because restraining a profoundly ill bird for an IV or an IO catheter is, is nigh on impossible. So, you know, this is a really safe option for, for limited handling. We normally say very loosely for, for these situations, you know, 2 mLs, per 100 grammes, you can do this, and it says a day, but really it's actually 2 mLs maybe and, 2 mLs every couple of hours.

So every 4 hours, you could probably give 2 mLs. But again, I tend to go for, for my initial fluids, 2 mLs per 100 grammes. He.

Make sure, again, birds have internal temperatures around 40 °C, so if you want to get it, if you can get a temperature and it's around 36 °C, for example, that's for pretty much every pretty much every bird that's, that's quite hypothermic. And so having a nice warm room around 29 °C, it's great. Oil heaters or radiator heaters again.

Again, because they exude a nice, a nice slow heat. You don't want to use anything that's, that's gonna pollute the air. Again, you know, gas heaters and things like that, are, are problematic and shouldn't be used.

Nutritional therapy. So in the bottom right, we have an example, and this is actually not a tube feed as such, but it's, it's the, it's the localization. Of how you should put your syringe into the mouth of the bird.

And so it's sometimes hard to say that, well, on the right side of the, the, the, the neck and not all birds, but many of them, they have a crop, and that they also have a very prominent opening to their, their, their trachea. And we're trying to avoid that. And so if you are able to, to get your syringe or your tube basically into the dorsal right side cavity of, of, of, you know, a, a bird's mouth and slowly slide that tube down, down into, the oesophagus down into the crop.

And you're able to, you're usually able to. Be sure that you're not going to go into the, windpipe. But again, this is a really good visualisation of the structures.

Again, you can see the, the syringe is going into the dorsal right side, not dorsal left, the dorsal right side in particular, because the crop is on the right side as well. And if you put your, your tube or your syringe into that, that, that recess, then you're usually jobs are good at. Safe page as mentioned before, antibiotics.

Now this is a a a a tempting one, again, it's the idea of being pragmatic, I think. You have to be aware that if we have an open wound, for example, it's very plausible. I mean, birds have really clean skin, but it's plausible at least that, we've got some bacterial colonisation.

So you may elect to give some, some antibiotics at that particular point, but I think we need to express a little bit of restrict restraint, sorry, about just giving antibiotics blankly and hoping for the best and pulling out the baitrel yet again, you know, make a decision. You know, if, if, if we think it's a respiratory issue, then by all means, but again, if we, if we want to do further tests, then it, it, you know, for example, if we're taking samples from a, a nasal cavity or nasal sinus, then having antibiotics may, obstruct, a, a, a suitable, a suitable diagnosis about the origins of the issue. But again, quite, quite a few of these cases will have secondary infection.

And so again, you know, it's kind of a judicious use, and proactive use based on what you feel is, is necessary. Option therapy, you know, an enclosed space, a bit like your nebulizer, . 100% oxygen for most birds is sometimes related to oxygen toxicosis.

And so 1 to 2 hours tops of pure oxygen, you know, whether it's in a gas, in, in a kind of a cage, which is closed up with some cling film on it, or, kept in a, a very large gas mask for your smaller birds. No longer really than an hour or two, and then basically we, we, we take them off oxygen, see how they respond. If they still need the oxygen to keep going, then we'll repeat that for another hour, then we'll take the gas mask off, we'll take them out of their, their, their, their little setup, and then review.

And, but again, maintain what we really want is a 40 to 50%, per% oxygen situation, because that's more of an ideal one for a, severely dyspneic, bird, for example. OK, and that, and that is it, and that is it. The, the main takeaway from all of this is that you can do so much at first opinion practise and I, I, you know, I, I, it's, it's so important that we continue, .

We continue to, to improve the way that first opinion practises have an option for er treating exotics. And by all means, you know, you refer where you are unsure like you would with any other particular field, but I feel so much. Passionate about the fact that small animal vets, large animal vets, equine vets, er have the skill set, they are so so competent when it comes to doing exotics, and it's a little bit of confidence, a little bit of courage, and up to date information which can be the game changer, and that's all for me.