Hi and welcome to module two of the this course on rabbits. Following on from module one, where we looked at the normal rabbit and its biological needs and transferring to its welfare needs, we're now gonna use some of that information to basically make those rabbit consultations, make the veterinary surgery more friendly to the pet rabbits we see. So, firstly, do rabbits have special needs?

The answer very simple is yes, as we've discovered last time, these are prey species, they can mask their signs, they're social animals, they really hate unfamiliar places and situations. Relevantly for, animals who we examine on a consultation table, they actually live at ground level, . They often are not used to regular handling, they're often untrained, they're often unsocialized er to people, and of course, we're put in a situation where they cannot escape.

The result is, of course, many of our patients are very stressed, and many of our patients are very fearful. This does not lead to better results from examination, and does result in potential suffering to some of our patients. And the vet trip is exactly when all this comes to the fore.

So, what does this lead to? Could this be a bad day, you know. It's something that has to happen, and whatever you do, it's gonna be a bad day.

Perhaps we should look at making it better. But we definitely have reduced clinical findings, clinical effectiveness, and definitely reduced clinical compliance, as owners are worried about the effects of treatments, the effects of coming to a vet it's gonna have on their pet. We see increased anaesthetic risks, as we see increased levels of adrenaline inside them, and when combined with particularly alphats, this can be quite a potent mix and can have really bad effects on a myocardial circulation.

And we'll also see increased recovery times and increased levels of gut stasis post-operatively. So, we kind of need to look at the rabbit's needs in the clinic and the preventive care required to reduce those, the number of trips, first of all, and also preventive care to help make the trip to the vet much less stressful in the first place. So, the basics, hopefully module one will have answered much of this, but we'll need to ref we'll be doing refresher bits as we go through some of the key points.

And we need to remember those five pet welfare needs, because this actually forms that framework we can work with for our patients. So biology behaviour, we base this on the biology, we need to be looking at, potentially reducing light levels to make these crepuscular species more comfortable. We need to be avoiding open spaces unless they can, .

Actually go and hide somewhere, and get get out of those open spaces easily, feel more secure in those, we provide those hiding things, and even in a clinic, we can do that with simple things like tubes to live in and boxes to live in, while they're in hospitalisation areas. We know a companionship, they live in small groups, they use visual signals a lot, and only when those fail, do they resort to physical aggression. So one question from this is how do you actually mix rabbits?

And this is one of the things that causes a lot of problems, especially when you have a single animal that needs to be mixed. And it can be very difficult. But if you remember in fact from the first time we talked about this is where do these these interactions occur?

And they, rabbits are territorial, they resource guard, so what we need to do is to reduce that territoriality, so we can look at Mixing rabbits away from one animal's particular territory, so do it on neutral ground. And we need to reduce competition of resources, so we need to make sure there are plenty of hiding places, we need to make sure there are plenty of food resources, plenty of water resources, so the animals don't have to share and don't have to compete, and one animal in particular cannot guard those and keep the other one off it, so that there's no drive to physical aggression, and we can reduce that a lot, much the same way as we can reduce that for any reducing any other form of aggression. Now, is a clinic the right place to do this?

Being in a place of mutual fear and being in a place is definitely neutral territory. Then this would seem quite a good place. The problem we have as veterinary surgeons and nurses is that this can still be aggressive intervals.

There's often very little space for animals to get away from each other. And therefore, you know, we may end up with harm being done to a patient and potential litigations and problems from that, so it can be very tricky to do it. So on balance, probably the veterinary clinic is not the right place to be doing the mixing, but we do need to have an understanding of the basics, and the ideal thing for a clinic is to know there's people in the area who do do rabbit, mixing, who do do rabbit bonding, and can assist the owner with this.

And as repeated from last time, very important, though, is that bonding is different to just being together. There are many rabbits who are just put together, they're simply rabbits, and their situation is not that great, but they are together because they need another rabbit with them. A truly bonded rabbit is what we're we're a bonded pair, a bonded group is what we're really after, and it's very different.

So, one thing we can do though, is we can appreciate rabbits on our social animals. We can never have rabbits brought in on their own. And we can always ask the owners to bring in the companions, so they come in in a pair, usually, or if a whole group, if there's a whole group, but they're, they're they're not separated for that trip.

And that's going to obviously make them more secure when they're in the clinic, and also reduce those problems of remixing when they go back home, especially when smelling of a veterinary surgery. And in addition to, we may have situations where we have to treat all the group. And definitely situations where stress relief is important.

Is there a time to separate them? Well, obviously you have to do this during the surgery and. Sometimes for a period post-surgery.

We might be worried about wound interference from one rabbit to another, though this can usually be overcome with some sympathetic suturing techniques, and actually, for many cases, The peck of a bonded pet can really be helpful. So for example, dental abscesses where we leave an open marsupialized hole, is the bonded the the the partner will often lick this and groom this and clean this, seen this happen too with chronic dacrocystitis and tear staining, and the the grooming from the other one really helps and really speeds up recovery, so it can actually be a positive in this sense too. Drips are a definite case in point, if you've got an intravenous dripping, it's really hard to protect that drip from the rabbit itself, it's near enough impossible to protect it from a partner.

So in those cases, yep, we do have to separate for that. May have separate for observation, for example, faecal output after gut stasis, but most of the veterinary nurses I've worked with have been absolutely brilliant at assessing not only two different types of feasts in the same enclosure, but also how much is being produced, how much a healthy rabbit should produce, and whether it's the right the right things are happening. So it can be done with just really good observation too.

Certainly if you've got a stressed companion, we don't want to harm that companion, so there are situations too where, you know, you don't want to say, induce gut stasis in a healthy rabbit because you're bringing that one into into into a surgery situation, so that can be a potential problem, that requires assessment of that individual and good communication with the owner about about that. If you do have to bring in, and you do have to separate temporarily, for example, surgery, you can keep the rabbits within sight of each other, and smell of each other, and even in just in two runs or cages next to each other, so they can really be as close as they possibly can without physical contact. And sometimes you can amend treatments to allow pair keeping, so for example, with fluids, you might want to come off intravenous as quickly as you can, move on, let's say, subcutaneous fluids, where you're not actually you don't have to separate them to protect the drip line.

And if you do separate, mixing again afterwards is really important, and that again does have to be done in the clinic, before you send them home, and it's good to know that they're back in back in together, and usually that sort of short-term mixing works quite well in a clinic. Handling, and again, many of our rabbits don't want to be handled, and this may be due to fear, certainly due to the fact that we may be aware of us as predators, and handling stress can be a long-term stressor to them, especially when we're doing a type of invasive handling if you like, for clinical examination. And in many cases, this is because they're not well socialised, they can maybe be happier being kept away from people in the first place, and so really probably does depend on that animal and again should be discussed with the owner, and even get the owners to to do some of that handling, especially if they're more secure with them than they are with the vet.

And back to this association, or that first, consultation, really get the handing down earlier, and even better still, work with the breeders, work with the pet shops, so that before they hit that, er, that, that selling age, that weaning age, they can be socialised and handled and get used to it. So in terms of examination, again prepare that consult room, make sure your kit's all ready, so you're reducing time, you're making sure that everything's easy to hand, that you can reach your stethoscope, you can reach your ophthalmoscope, horoscope, whatever, and do that. You can also reduce the predator smell, so if you can, .

You have a have a like a predator free room that only is dealt with only is used for like herbivores, say rabbits and rodents and stuff, so reduce that smell from there, and if you do have what we use occasionally, a clean down a deodorising between patients it does no harm at all. We want to reduce risk of injury as well, so if we have rabbits who aren't used to being handled, then, you know, we do one thing in particular is we don't want to, to jump off the table and onto onto the floor because rabbits do jump. So we can examine them on the floor, or we can make sure if we do we can't do that, we can alway we always do it over the table with rabbits not being held over empty spaces and things, which doesn't do them any favours in terms of security, and of course increase the risk they do fall, we've got further to go, and we might see broken bones and stuff.

And, but also we can do a lot in the box, so as we've got set up here, take the top of a box, the grills in place, there's no easy route forward, and although you can see you've got rabbit's a little bit hyper, a little bit, excitable from the look of that too, there's an awful lot we can do. In that situation, so before we, take the top off, we could actually watch to the front, we could have watched the breathing, pattern, breathing patterns from that, we could have watched its demeanour, we could do things like that too. Once we've got top off, we can do an external examination, we can look at the ears, we can look at the skin, we can have a brief look at the eyes and stuff.

We can certainly auscultate and we can certainly palpate the abdomen in that position without actually restraining the rabbit at all, or only minimal restraint. If we do need to, to restraint, things like ocular examination, oral examination, dental examination stuff, although incisor pretty easy without full full restraint, then, We can do that with this typical burrito type system with a with a towel wrap and security, and that's quite useful as well because we can also do things like put essential oils or pheromones onto those to to to to calm them down a bit. And again stressing that those essentials can be really useful in the consult room as well, again, just to try and reduce anything to to reduce some of those stress levels.

But here's the big thing is too, I've mentioned it a couple of times already, speak to the owner. They know their pet better than we do. We might know about rabbits, but they know their pet, so find out what their pet likes.

For if I if they if they do hold them. If a pet really like is is OK with that, calms with that, and therefore if a pet's OK with them, will they do the holding? Now, probably best not to have too many painful things because, you know, they may not be surprised by some of the reactions, but for non-painful examination stuff, it's amazing what you can do with the animal in the owner's arms and stuff too.

And part of that too, if the assessment of that too is again we're watching the animal but while we're taking history and stuff, is we can see how the owner and the rabbit are interacting to some extent, we can see the rabbit's reaction to the voices and things around them. Again, mentioned about towels, don't forget slippage, and so non-slip surfaces on tables and on scales are really important because rabbit starts to slip and slide, they become insecure, they're more likely to panic and do something really dumb, . Towels provide a bit of comfort, they provide a non-slip surface, and of course you can put pheromone or essential oils onto them too, and er and hopefully calm them down a bit too, and if you're already standing on a towel, it's much simpler to wrap them and burrito them when or if you have to do that.

For you as a as a as the exam examining person. Need to be calm. There's not time to be excitable, if, if you're panicking, everybody's panicking, including the rabbit.

So be calm, and again, what what I do in particular is I move my hands a lot if I'm talking, I'm really, 00, I'm doing it now, you wave your hand, you're expressive, but that's not very security giving to the rabbit because they're just seeing with these wildly waving hands at them, and that can also lead to to potential problems. So just try and keep your hands still, try and keep them even out of view if you really can't do that too. Quiet room, we don't wanna hear dogs barking, we don't wanna hear lots of noise, and lots of things that may make them panic, and again, try and reduce their smells, so if you've seen a predator before the rabbit, you know, change kit if you can, but otherwise, don't wash your hands, .

Try and get rid of as much of that smell as possible, and you can put things like essential oils and stuff on your, consulting jacket, on on your hands and things too, and again, try try and reduce that stress if possible. Light or dark's an interesting one, because the rabbits are are crepuscular, they do like dim light, but of course we wanna examine, we're gonna need, we we're we're with creatures of light and we want to see bright lights in there too, so you have to play this a little bit by ear. So there are things you can do with subdued lighting, but there are times you are gonna have to put lights on, just going to cope with that with things from there.

Not a bad idea to have a dimmer switch in your concert rooms, so you can try and vary those light levels depending on what you're actually doing. So the console itself, again, start with the history, and this is one of those things where, how much history do you wanna take for these? There's often a lot of husbandry required and stuff, so you probably do need to take a a pretty full history, at least on the first time you see these animals, and after that you can maybe go for more focused history on what's changing, what's different, and more focused on on on the disease process from there.

Definite things you need to know are things like signalment, obviously, time that the animal's been owned, if it's recently owned, the source is really good, vaccine and drug history is also very relevant. You want to know a lot about husbandry, and this is one area where modern multimedia's really help a lot, so videos and pictures of a husbandry setup, of a diet, of, you know, poos at home, that kind of stuff, really, really helpful. And these can be submitted before the consultation, so again, no, problems, and be much more efficient if you can get the owner to fill in a history form, send the pictures and videos before the consultation, so you've seen them and prepared for them, or they can show you on their phones during the consultation, but really helpful, really useful, they say a picture paints 1000 words, it saves a lot of explaining, especially when you come to those, husbandry things too.

And also, you may want to do some of the clinical signs too, so for example, if you've got a rabbit who's got a potential lameness problem, they're never gonna move that console, they just, just don't move, they just sit there, and the more stressed they are, the less they're going to move, so it's really difficult to see that, but hopping around at home, moving at home, the owner can take a video of that. Better still, if you're doing this form, if you give them a list of what videos and pictures you want, and how to get those, you're gonna get much more standardised results, which really helps too. Diet, obviously you need to know about that, and not just what's given, given, but I mean recent changes and which parts of the diet are eaten and which in preference to others, that's quite good too.

Previous problems always useful, does a rabbit eat strange things also good too. Any secretary problems, any management changes recently too? And the moulting one's really, really relevant as well, so especially when you get to gut problems, you know, is that rabbit moulting or very relevantly, are any of the other rabbits moulting at the same time, we might be looking at at hairballs building up and that kind of hairless forming.

So that that's quite useful as well too. And again, thinking of gut things is it's it's useful knowing, especially rabbits coming to you from a long from a bit of a distance, is we do have microclimates in the UK so . And climate change, I'm not thinking about global things at the moment, but you may have somebody who's had a bit of a cold snap, or a bit of a a real warm spell in one particular place, and that is going very frequent, we will see .

Gut stasis problems a few days after that, linked into behaviours and potential dehydrations and things. And if the kids come to, listen to the kids, sometimes people, parents don't always want you to hear everything and sometimes the kids will tell you some really good information that mum and dad aren't necessarily going to going to give up very easily. So it's always good to have the kids there and listen to what they're saying too.

And if mum and dad are trying to shut them up very quickly, it's really interesting stuff to hear. So very, very important to, well, how did that problem start and how it is now, especially if you see anything on referral level, that's very relevant, but even if it's if it's just on first opinion that it's a more chronic problem, very often these syndromes have changed, and the clues you're gonna get from history are about how it first started, rather than what you see now, which may be secondary problems, maybe perpetuating problems, swamping that original problem. We know what's normal as well, and very often we have owners phoning up because they're worried about what's coming out there, and they don't really, often don't get the fact that normal rabbits do pass things like brown urine, red urine, orange urine.

What they don't normally pass is blood, and we can often get them to send pictures of what's coming out there, and in this picture on the right there, you can see that there's there's blood clots, and this is more hematuria than the others which are pigmented. Now, the key thing with all many exotic things, including rabbits is, you know, when do you take that history. And this is relevant when you're dealing with a particularly emergency situation.

Where very often you need to stabilise first of all, so that first look into the holder and see what the rabbit's demeanour is, is really important, and if a rabbit is in great distress, for example, open mouth breathing, or if the if it's just collapsed, then you know, get stabilising first all and take a history after that. Above all, remember they're prey species, they're gonna be very anxious, they're gonna show minimal clinical signs to you because you really are not somebody you may know. And a lot of those clinical signs relate to pain or anxiety.

So this rabbit here is, a rabbit in pain, got lots of signs, see that, so we can we can see the cecotroph buildup on its back end because it's very unkempt and very, very matted, so this is again, showing it's not grooming properly, and we can see there's a bit of a hunch in the back here, so it's not comfortable. And it's no great surprise that rabbit's got a spinal arthritic lesion, and, you know, that that's what we're seeing we're with that those those signs. This rabbit, on the other hand, is a very stressed rabbit, .

It's sitting in the corner there, you can see the different head posture, you can see the ears back, and a really different look to it, and again, well worth noting, especially before you go in and start handling and doing things to it. So signs of pain, we're looking for, this is typical things we're we're after and very often miss in rabbits, so reduced activity, often just freeze. We may see layman or gait changes, but as I said, you're probably do it from home.

Weight or muscle loss, which may indicate lack of use of a limb or part of the body. But basically it alter mood, that may be, more lethargic, maybe be quieter, maybe more aggressive, more excitable, anything happening to, may see altered appetite, and maybe eating different things, so, for example, in dental disease or root pain, you may be seeing less eating of fibre and more of simple, chewable stuff. Or you may see going off food altogether, and we may see change in faeces, smaller faeces, fewer faeces, we may see urinary changes where they're not urinating in the same way or little and often as opposed to frequently.

So of dental diagnosis, again, clinical signs are often a real giveaway for this, so the rabbit that's dropping food or is trying to eat but not eating very much or just suddenly gone off its food, very much we're looking often at dental disease for those, and that means we need to have a look at a bit of a look at the teeth there. Now the teeth are not easy to examine, you know, we, what can we do with conscious. So classically we'll look with the oroscope, and we'll see this sort of picture up here on the top left.

He's taken the endoscope, by the way, and we can see which was pretty difficult we've got because we've got the cheek kind of falling across, and this is why some of we do see more just a simple examination under sedation. Just move that cheek out away and we still start seeing a, a, not only a a hook there, but we can see the reddening just inside the cheek there, which shows it's rubbing on there and causing a problem. Now we can certainly have a look better at the bottom teeth, we can see them, we'll see a few more of those, and we can see, often see the ulceration of the tongue very clearly.

But I think the big deal is that on a standard examination in a conscious rabbit, we won't see all the molars, we won't see all the hook areas, we won't see all the ulceration, so you cannot rule out dental disease from that that that that examination. Add further to that is that you can't rule it out, even if you don't see lesions under under sedation or under anaesthesia, is imaging is essential, because we will see pain signs linked into root disease, sometimes without major signs in the mouth, and, you know, where we've got suggestive clinical signs, we do need to do full examination under anaesthesia and we also need to do imaging. If we haven't got suggested signs of rabbit is healthy, then at least we've ruled out major problems or undetected problems by a basic examination that was conscious.

So it does have a place, it is essential to do, and very often we can rule in dental disease on that, but we can't fully exclude it without the full exam under anaesthesia and imaging. Auscultation is very, very, often unrewarding in rabbits, and it's a difficult thing to do. First thing first is when you're looking at the rabbit in the box, is watch his patterns of breathing.

Typically, rabbits show very minimal chest movements, often you can barely detect it. Don't mistake the whiffling of a nose for a respiratory er rate, you can actually watch your chest walls move, and so it can be quite tricky to do, but watch them, and if they are showing obvious respiratory movement, or if they are Obviously showing open mouth breathing, we know we've got problems going on there are often quite severe problems. So watch those patterns first of all, and again do that before you handle because obviously after you handle the rabbit's wound up, we're gonna see very obvious breeding with that.

When you do have a listen, you use a small stethoscope head, and then you can pinpoint problems much more easily. And the problem we have with rabbits is that most of the respiratory diseases tend to cause congestion of all or part of the lung. So What does that sound like?

Well, we don't hear anything, if they're congested, there's no air movement, so we won't hear anything moving through there. Similarly, if a rat a lung is totally healthy, there's such minimal respiratory movements in a rabbit that actually we don't hear very much, so no sounds often link into either severe disease or no disease, and hard to tell apart. Where we do hear some sounds, we know we've got disease.

Probably not as severe as it could be, we've got disease there, so any sounds we're hearing on, through the lungs is probably significant. Heart also difficult to auscultate, the heart rate's very rapid, often too rapid to manually count, and that makes picking up things like dysrhythmias and murmurs much harder, especially as generally in rabbits we're looking at muscle disease, myopathies in the heart, so we often don't get significant murmurs till we've got a considerable stretch, and, and valves not meeting at that point. So moving on to diet, again, we talked about this last time too, please don't forget the importance of having lots of bowls and drinkers, er most rabbits prefer bowls to drinkers, but lots of those, depending on preference, throughout the enclosure, including hiding places, so you don't have to move very far for this.

There's plenty of for all rabbits and no competition, and less need to come in the open, less competition, less resource guarding. And don't forget, I mean, I don't think I mentioned this in the last module, but actually one way round, some of the resource garden guarding for food is not just to have lots of different food bowls, but to scatter feed, and that partly is enriching, we seem to, we actually do some active foraging, but also is reduce the ability of one rabbit to guard it all. And the other way of getting water in, of course, is to wet hay or wet greens, so they can get more water in as they eat those.

In the clinic, we were found to feed critical cases, . We can ask owners to bring their own food in, that's always a good idea. The familiar foods, I mean we've all been ill, we, we like to eat our familiar foods, it makes us feel better, and that's a really good place to start from.

Natural food's also important to be able to get hold of as well, so it's nice to know local grass areas where it's safe to go and forage and and get the grass, pick that local dandelions also really good there, you know, if they're contaminated, you need to be washed and and try and pick the least contaminated places, and it's amazing how often even indoor-based rabbits will, will seize those natural foods first of all, as what they want to eat first, it's really great. Otherwise it's well worth keeping a range of different foods in and trying them all. It's worth getting them in very small quantities because you may not be using them every day, and so we don't want to see spoilage.

We don't see rabbits to put off their food by about you feed they're getting old food that's gone slightly off or that the food's, deteriorated and lost some of its nutrient content. And fundamentally though, the right food is gonna be the one the rabbit rabbit wants to eat. Many of our diseases we'll see will be based in dietary issues, this is probably not the place to really convert them onto a full forage ration and everything, because they're under enough stress already, but certainly get them eating, if they've been inhapotent, and then send them home to change diet is not a bad approach.

In terms of critical nutrition, we can do a cyst feeding, so we were syringing, burritoing, syringing, that kind of thing, we don't particularly need vitamin C in rabbits, it probably does no harm, but we don't particularly need it, they do still function on their own. Whether some of the vitamin supplements are more and more necessary, whether they have something like gut stasis or major disruption to their gut biome, is another question, but nothing proven as yet. How often we feed and and and and and how we And and and how much we feed each time really varies with the patient and its needs, because They are different characters, so for a very nervous rabbit, it may be better to feed more in each feed, but do it less often, and for a very confident rabbit who takes the feed very easily and is used to being syringe fed, then little and often may work better for them.

Really important though to weigh the rabbit, a couple of times a day, make sure we're not, we're getting weight stabilising or gaining if we want to do that, and we're getting the right effect of our nutrition. What do we use? Well, we're really lucky these days, there are a lot of really good products on the market.

When I first started there were virtually none, and now we've got a real range of some very nice high quality feeds, and I think that goes really with personal preference, or even try, try, different ones. Try offering them without syringing as well becausema Heras will actually take critical cares without being syringe-fed, and that saves a lot of stress for everybody concerned, including the patient. And you do this for, for as long as you need to.

And probably no longer, so really trying to assess it, when's the rabbit starting to eat again, matching that with weight loss or gain and seeing what we, we actually balancing that with what we need to syringe feed. One important thing too is to make sure it's always reported how well the animal has taken that feed, and animals who really sort of stop swallowing very often can be a very poor prognostic sign, and it was well worth noting how easily that that that that's happening. Terms of hospitalisation, again, what do we need to be doing this, well, we need rooms that are basically warm but not hot, don't forget rabbits do not like excessive heat, but for sick animals, they do want to be warmer than normal.

Needs to be somewhere that's quiet, we wanna keep them well away from dogs and cats, and barking things and and and and lots of human noise as well, because that may be causing stress, and we want to be able to observe them clearly, but of course, again, back to our light levels, really worth having dimmer switches in, in your rabbit ward, because you want to be able to dim the lights, and. Get them to imagine it's dusk, for as much as possible, rather than brightly lit, and stressful rooms. We need to balance the need for, observation with that of privacy.

So don't, please don't throw away boxes and stuff, because they're a really good place for rabbits to hide, and they often come out more there. And of course you need to have enough space for them to move around and do stuff, especially I think like guts say it's really good for rabbits to move around, and also enough space they can have their companion with them, and they can have have company in there rather than just, just on their own. I was like these, we, we had these runs made, my old clinic and found them absolutely effective, rabbits moved around well, we often got good recoveries after gut stasis, and it's really nice seeing a patient to start to binky and look better in there.

In terms of proceeds mentioned a cardboard boxes, but these feline forts, or cat cat homes are absolutely fantastic. Katie rats actually sit on top of them, but normally they, they'll go and hide inside, and again, once they've got a hiding place, they're much more open about coming out, and, and, and exploring the rest of their run and and being more active. And don't forget to do things like observe urine and faeces, amounts of urine, colour, that sort of thing, any change in that too, and the faeces, are we getting faecal output, is it, the right amount, the right sizes, are we this healthy amounts there too, where you can watch them, again, it's difficult watching, the rabbit patients.

If you sit and stare at them, they really get nervous, because you're behaving like a like a predator, so you've got to kind of observe them secretly. Maybe this is a place for using, video, but, you know, just somewhere where you can be slightly, slightly, unobtrusive. But watch your breathing patterns too, and don't forget to put bowls in as well as drinkers, if you're not sure what a rabbit takes, put both in there, and also, as in this picture here, which is admittedly a guinea pig rather than a rabbit.

But, you know, don't put the bowls and the food in the front of a cage, make sure you move to the back, put it, put them behind the hide, so the animal doesn't have to come out there, and with guinea pig, we're actually using a big bundle of hay to act as cover, so that so the animal can come out and get its food and drink without really crossing open ground. So very important too, and we might want to use enrichment, so we're actually making devices for the animal to sort of seek in there, and often they will Work hard to get food, they wouldn't necessarily do so otherwise, so these, these hanging tubes with food sticking out is quite good, just box holes cut in them so they can go and get it, that seems to provide some amusement and seems to be quite a, quite a good way of doing it, and they give us a really nice fact sheet from UK Pet Food, about, feeding enrichment for rabbits and, and, and, and rodents at home. It's really cool, set of information.

Really important to to let everyone know what you're doing, have standard protocols, have setups and things, and one of our nurses did a beautiful job of producing these, and not only was there was a written list of what to do to set up, but also it's all in pictures as well, so it's really clear what to do. For, for these situations and what to put in there and then where, where, where to, where to go from there too. So for new staff in particular, this is really invaluable, so when we had patients coming in, we'd have all this set up ready to go before they arrived, and it was, was was just what we needed.

The thing with hospitalised animals is do they need sleep and I think this is quite an important area. Become more recod in people, and I think in animals too, patients need sleep. There are times you have to treat through the night, but there are also a lot of times where it's not a bad idea to tell your treatment, they finish late evening, they start again early morning, and of course they need to be observed, but you can do that as basically uninvasively as possible.

And give them time to get that rest and recuperation time, and not to have no bright lights on all through the night and disturbance, because that will slow recovery. So in terms of health and stuff, with our, we're back to our our welfare needs again too, first thing about maintaining health and things is getting husbandry and diet right, and that's gonna prevent a lot of things too. Pain relief also important, so recognising pain is a good thing to be teaching the owners and therefore and therefore hopefully getting we animals onto the necessary pain relief as quickly as possible.

Instead of reducing stress, we can do that with clinic as well, so it's not just the husbandry at home, it's husbandry with clinic too, so bring companions, do all that too, we've been talking about that just now. So what are we gonna do in the clinic too, so we're rooting stress, and the big reason we're doing this is fundamentally what we should be doing, and again, mentioned earlier, reducing that stress level is gonna make our examination easier, make it more meaningful, and it's going to facilitate recovery. And this starts on reception.

And it's not just the vet and the consultant, it's not just the nurse doing procedures and hospitalising, it's the whole clinic, and reception needs to be involved with this too, and they set the tone, and they're gonna give you important information so the right stuff happens when they come in. So first of all, teaching about recognising emergencies, because they are different to dogs and cats, they do need to understand what is considered an emergency and to get them in quickly. If I had a dog or cat off its food for maybe 12 hours, I maybe wouldn't panic.

Rabbits off its food for 12 hours, I'm starting to worry quite a lot. They also know you need to know who sees a rabbit within the clinic. If you're trying to build up a caseload of that too, you know, not every vet wants to see all the rabbits, lots of vets do, hopefully, but not everyone does, so who sees them, who's the one who's interested, who who's the one to go to first of all?

I need to advise on how to transport, they're the ones who need to be telling the owners to bring in the companions, to keep them dark, to have lots of bedding, and ideally a top opening box rather than a side opening one. So, about, this is where things start from, this is what the, again, what the reception need to be giving out and talking to people because they can ask questions. Can we make that transport better?

Now I mentioned in the previous module that we can train rabbits, we can train them into boxes, so we're not having to do a stressful capture. So rabbits are used to being fed into the box, that's great. We can extend that by meaning if they go into the box, you can shut them up there too, we can take them to a different room maybe and do something nice with them.

So we're not always used to the fact that every time we go out of boxes to a vet, and it's gonna be a bad, bad day, so the box is associated immediately with a bad time. We need to keep them quiet, we need to keep them warm, we need to keep them dark. These are recurring themes throughout all this, quiet, warm, dark is a great waste to do.

And of course, companionship. A very much recurring theme is make sure that the box is big enough for all the rabbits to come in in, and they they always come in with a companion. Make sure deep litter.

Yeah, we've all had those consultations where we've taken the rabbit out and there's hay all over our rooms and it's like it's like a like an absolute explosion in a barn in there, but that's great, because that's what they're hiding in, that's what they're they're they're providing them with security and stuff, so it's really useful for them too. If it's more cage type cat cage type carrier, cover it with a blankets even easier too. But bring in two, you know, use your toys, the usual treats, the usual foods, and bring them in for almost anything, because, you know, you, it's hard to tell often how sick they are they're going to be, when you're gonna need to hospitalise, if the owner's got those already, it's going to make life much easier to take them in too.

When they arrive, again, reception needs to know where to put them. You don't want them in the general waiting with noisy dogs and noisy people and all the kerfuffle of veterinary surgery going on there too, so. You don't wanna have the smell of cats and ferrets and things about too.

So ideally, we may need to see them quickly, so the receptionist doing that initial triage, they're looking in the box thinking, gosh, that doesn't look great, I think I might get something for you quite quickly. Need to direct them, ideally to a a a a prey species waiting area, or even a room that's only used for that and away from the waiting area, or you can do it with in-car waiting, when it comes in, they're they're aware, and as long as the weather's not too extreme, too cold or too hot, in-car waiting's a very good way round, er not mixing with with with with predators, er while they're waiting for the appointment, and even better than that is it gets away from the potential issues of smell of of these predators as well. We can be using a lot of these pheromones, essential oils and things too, like maybe with a plug-in, diffuser, these can be waiting areas, in concert rooms, everywhere you like.

We can soak bits of cloth, and tie those into the box, so if the owners haven't done this, again, this can be available at reception and just tie it into the box while they're waiting. Quick mention about infectious disease control, especially admitting, you know, don't forget that for some things we may want to be doing some screening, if there's we we we're worried about certain problems, we will want to be doing some quarantine for admitting, so it's a good idea to keep our vaccinated and our unvaccinated separate from each other, and potential infectious disease is not a great idea to to to mix them in the same ward as those who haven't got infectious disease. Between the patients, cleaning and disinfection, don't forget cleaning's probably much more important.

Disinfection certainly doesn't work unless you've cleaned thoroughly between them. And barrier nursing, and I would really advise, we don't really know how common RHG2 carriage is, it's almost untestable, . So really regard every patient potentially infectious and a good idea to to bury bury nurse every single patient, so we're using different gear between the between the runs or between the the the the cages and we're using PPE relevant PPE and stuff.

Another issue obviously these is is of course they die under anaesthetic, everybody's worried about doing anaesthetics, and to be honest, in the CESA survey, a number of years ago now, but still the most relevant multicentric survey we have, 0.76% of young healthy rabbits admitted for neutering were dead within 48 hours of anaesthesia, which is a pretty shocking figure. Now this happened because, mostly post-operatively, and this happened really because of issues within evaluation.

And, and preparation, of underlying disease that wasn't detected at those times, and that affected choice of anaesthetic and of course the maintenance and perioperative support. So really important to prepare the patients for the anaesthesia, so, examine, identify those underlying problems, Look not just a problem to but potentially related issues, so for example, let's say we had a polio dermatitis case, we're pretty sure it's probably arthritic issues, there's probably lots of other things going on as well, and You know, we may want to address those, we may be looking at potential respiratory problems, from that, and we may want to, Therefore, treat those before we anaesthetize and operate. Frail animals, we'll probably want to give them fluids and feed them, .

We may want to clean mouths as well, we're, and this is particularly relevant if we've got to say something like a dental disease case, rabbit hasn't been eating for a while, it's thin, maybe a little dehydrated, and . And we we don't need to rush into that anaesthesia. Much better if we actually spend hours to days, stabilising a patient, feeding them, building them up before we do anything.

Peri-anesthetically, again, fluid's important, maintain warmth, rabbits are tubular animals, so we have a big surface surface area to volume ratio, and therefore they tend to lose heat quite rapidly under anaesthesia. So don't get wet them down, don't use too much spirit, keep them as warm as possible, and things like these bear huggers things are really useful for that. We want to look at after gut motility, we mentioned in a previous module that issue of gut motility be related into inflammation, stress, fluid balance, hydration, that sort of thing.

So perioperative prokinetics probably don't do very much at all, and certainly after I stopped using them, we, we noticed absolutely no difference at all incidence of gut stasis in surgery. Far more relevantly, get the analgesia right, analgesia, anti-inflammatories, fluid balance, are gonna do much more good in preventing gut stasis than prokinetic. So, this is a mixed slide, as you can tell, I think it's always worth bringing guinea pigs in as well with these things too, .

But it's really difficult telling how these animals are in pain. I bring guinea pigs in as well because we're using more grimmer scales, we're using more facial expressions in rabbits, and obviously things like guinea pigs, you can't use this for, they don't really show facial expressions, but I think it's worth questioning slightly how effective they are in rabbits. They are not telling you the whole story.

There can be a disease that may affect them too, and, certainly we've had one case with a which had a facial palsy which you obviously you simply couldn't score. They are very, very good though, at being, if you like, tiebreakers, at being a potential indicator, but only within that whole clinical picture, and if in doubt, give pain relief, I wouldn't use a grimmer score to say, no, I don't need pain relief on that too. I'd probably be looking much more at how that whole rabbit's behaving.

They are a tool, they are part of a part of the toolbox, but not the entire story. What is difficult with analgesia in all these animals. Is that We don't know a lot about the drugs we're using.

Very few have dose rates that have been well evaluated and well studied. We might have some PK work done in some, but very few. We certainly don't have very many, if any, safety efficacy studies in those, and that's a real problem.

Example here would be meloxicam in guinea pigs, it is under cascade, we should be using a licenced dose there, but that licenced dose is very, very different to those evaluated on pharmacokinetic studies. Which is the overriding factor here, because the pharmacokine studies don't look at efficacy, and they don't look at safety. This is where a discussion with the owners really, really comes in.

This is potentially too where pain scoring comes in as well, having said it's not the be all end all, it's a tool, it can help a bit. So when we use a drug, We have to admit to ourselves we are not necessarily knowing what it's going to do. And we don't necessarily know how effective it's going to be in that species, and a dose rate and a formulary doesn't always tell you everything you need.

So this is where you need to be evaluating the pain levels before, and evaluating them afterwards and how effective is it, and you do need to be also evaluating whether we're seeing pain relief, or sedation, and how many other effects we're seeing. And this is where certainly with chronic pain and stuff, is we need to be talking to the owners, getting them on board, getting them to be scoring and understanding how to look at things, and then to be evaluating what's been given, because the worst outcome is that we give a drug, we mask the signs, and we don't kill the pain, and that would be a bit disastrous. What we do know within pain relief is that local anaesthesia does stop pain, as one of it's probably our only real true analgesic we use.

Easy to use as well, and probably underused, so be aware of maximum doses, they're they're well written up. You can weigh the rabbit, we can work out what that maximum dose is. We can draw that up, we can dilute its saline because like I said, you all about spread rather than concentration.

And then we can use that full dose, and we can put it in all sorts of different places. So we can do specific blocks, we can do regional blocks, we do infiltration, we can do incisional blocks, we can do intra-abdominal blocks, we can do splash blocks. So for example, for a rabbit spray, I would be doing an incisional block.

I would then be, after the uterus is removed, I'll then do local anaesthetic into the abdomen and use saline to spread that round, and then at the end, do some stitching up, I'd put a final splash block in place. Adds greater adds greatly to the effects, for dental abscesses you can do with specific blocks, and also, when you're flushing out and cleaning, really great idea, just a quick flush around with some dilute local anaesthetic, and my goodness me, they do eat a lot better when you flush the abscess with a bit of local. So preventive medicine, as we mentioned before, involves dietary, diet and husbandry, of course what we always switch on to things like vaccination, parasite control, but don't forget things like regular checks, finding things else going on there, not all disease infectious, and we're gonna mention neutering as well.

So worming and things, intestinal nematodes really are not a cause of disease in rabbits. Very rarely will you see some, some issues. One of Boys is Pasilurus, by the way, this is the pinworm, very, very common.

Suspected might even be, commensal or possibly even symbiotic in these, probably commence as more and more relevant. But unlikely to be pathogenic. I've seen two or three cases where I've had rabbits in huge groups, in zoos.

There have been some, the area I've been in has also been had wild rabbits come into it, but they've been there for a long time, so the grass is very short. There's very little forage there and the. Very contaminated with faeces, so we're getting a big amplification and build-up of of of nematodes in in there, and they've got enormous loads, that has caused problems, but really unusual, really different.

So in general, you can say rabbit intestinal nematodes are not a big problem, but be aware of them, if in doubt i with signs. The intestinal parasite that may cause problems is coccidiosis, and we'll see that in young rabbits now. A big one is Erasteia, which is the hepatic form er cos hepatic neosis wasting and death, but in some rabbits you'll even see er the gut forms cause problems as well with a high enough load.

And one thing I, you may see is that apart from just failure to thrive and things, there's even things like generalised hair loss, that sort of thing, just thin rabbits, it's well worth doing a faecal check for this if they're young. Stress that because the therapy is really to knock back the numbers to allow the immunity to develop, and many adult rabbits will carry these coccidia in low numbers, and finding some ooassis in a in a healthy older rabbit is not necessarily an abnormal finding. It's really difficult too, we're used to a nematodes to doing eggs per gramme and doing things on numbers, so we can assess, you know, how many worms we've got, what kind of bird we got based on the number of eggs, not so easy with coccidiosis, because the coccidia do a sort of implant, Reproduce, implant reproduce cycle, so you can have an awful lot of coccidia in implantation phase not producing many oocysts, or you can have a reproductive phase where not many coccidia are producing a lot of oocysts, so the exact numbers don't really tally too much, so when you're evaluating, you've got to see, are they there?

What are the clinical signs and what age or immune status rabbit do we have, and I will stress, I've said not adult rabbits, if they're really immune suppressed, you may yet see this, but it's really unusual. And therapy, we've got some, we've got sulphur drugs, we've got potentially you've got things like Amprodium. Which are effective and knocking back the numbers, but the idea is not to eradicate.

So if at the end of a course of treatment you've still got cirrhosis coming through, that is not a treatment failure, that may be absolutely perfect, again, can't do it on numbers, but to see it there, and how is the animal doing, is it gaining weight, are the clinical signs reversed? And within this comes Echiiculi, which is technically like a parasite, it's more of a fungus. It's a difficult one, this one, disease prevalence is quite low, .

It's often difficult to diagnose and it's often over-diagnosed bizarrely, but many of the things put down to are often other things altogether, it's quite difficult to tell, and diagnosing it is really hard because, Serology can help, clinical sciences don't help, there's lots of, it's very difficult to get to. Parasite prevalence, though, is very high, and different studies show between 50 and 70% of UK rabbits are serro positive, so that number do not get disease from it. Therapy, the only one that's been shown to work in any form at all is phenbendazole, and yet phenbendazole is a drug that's out there to use for prophylaxis.

This is difficult because we don't know prophylaxis works, there's no data showing what effect it has on reducing incidence of disease in a high prevalence, low, morbidity disease, that's quite difficult to show. We also only have one drug, so we want to be, we don't want to be really inducing resistance to that by overusing potentially. So, you've gotta ask really whether it is justified in doing these routine uses, and whether we're not better off doing focused prophylactic treatment, which may be a longer course, but maybe only used say for mixing or for for definite risk periods, rather than doing a fixed time automatic dosing.

Bear in mind with Echiiculi, . The following sort of rules, if there are any, that not all neurological disease is echiicula. Knottal weakness is neurological disease, and that's much more common than neurologicals anyway.

Head tilt is actually more usually ear disease rather than echiiculae. And the predilection site for the parasite is the cerebrum. So it's more likely you're going to see.

Generalised cerebral signs, then you're going to see head tilt, based on that, and certainly the majority of my cases where I had raised IGM and IgG were rabbits with fine tremors and with a more definite, Cerebral changes rather than head tilts, it's really quite unusual to get those come IGM positive. In short, rabbits don't suffer from phenbendazole deficiency, and it's really important to try and diagnose it. Now, just to illustrate the point how difficult a caniculi is, I've put a picture up here of a lens.

This is the caniculi cataract. This is really hard to diagnose, because the lens infection is in utero. So the parasite enters from a dam, it enters the lens, which is an Amina privileged site.

The young rabbit in the uterus is not going to form an immune response to it, so therefore these rabbits are generally going to be seronegative to echiiculi, even with an echiiculi, cataract. If they are positive, it represents coincidental post-birth, postnatal infection. Does it matter?

And the answer is no, because this is also a site where panicure's not going to get in, it's not going to make much difference. If you are going to treat it, generally it's going to be cataract surgery, it's going to be va emulsification, removal of cataract, and if you really want to diagnose it, you can then do PCR on that, remove cataract, and you can find the parasite that way, but it doesn't really affect the treatment in knowing about it beforehand. In terms of vaccination, we vaccinate against myxomatosis, RHD1 and RHD 2.

These are routine vaccines, and we have really good effective vaccines available to us, which are great. The problem within this is, the two couple of problems really. One, we may see, I'll show a picture of skin myxomatosis here, we may see this in a in a vaccinated animal.

This is actually, I, I always felt was a bit of a sign of success really, that we had a good immune response, to a very, very, virulent strain, and that actually probably if you hadn't been vaccinated, that would probably have been a fatal infection. So I always found that quite a reassuring thing to see. RHG 2 is a difficult one, there's the vaccine, the mixed vaccine that's available, it's very good and been very effective, but the other strains do pop up from now and then, of varying severities and varying types, and there are specific RHG2 vaccines available.

Now from RWA the current advice is that we, use both. The mixed vaccine, the mixed and host RHG 1 and 2 vaccine, and use a separate RHG 2 vaccine. Because they've been tested against different strains, and we may, Again, no work done to prove, we may see increased protection against a bigger range of strains from that.

Certainly does no harm to use both vaccines, remembering that you've got to leave at least two weeks between them. So, neutering, again, why do we do it, in females, we we do this obviously stop breeding, I stop things like forced pregnancies where the induced ovulation hasn't worked. And also because of uterine adenocarcinoma.

In that is an interesting one, in lab rabbits, it can be very, very high indeed, which reflects the genetic lines, it may be used for specific investigations in, in lab rabbits, but, it's still nonetheless, in pet rabbits maybe not quite as high an incident rate, but still high enough that it's well worth doing something to try and prevent it, as it is malignant and it does cause a lot of deaths. So spaying is the only way to go. Typically, we will do this, .

When they are around about 4 to 6 months old, it's kind of balancing between the uterus being big enough to detect and fine and easy to remove, with not being or not becoming overweight and making the operation much more difficult, and the weight thing is really quite important. Because, obesity is linked into neutered females, and it's really important to give out dietary advice, at the time of neutering to try and reduce this and prevent this. Castration, again we'll do this to prevent breeding, we do see issues with male rabbits together, and although we can prevent a lot of aggression problems with, with where we provide enough resource, we provide enough space for hiding place things too, this can be very difficult, especially as a as a female within scent, which is really quite a common thing to have, and they will fight, they will try and castrate themselves, to be honest, it can be quite difficult too.

We can see testicular tumours, but rarely, but in uncastrated rabbits, I say fight damage is a major problem. So if you're keeping males together, generally the advice is to, to castrate them. And obviously they have retained testes, then they definitely do need to be castrated, because we do become much more likely to become tumours.

Do see these from time to time, it's probably worth acting sooner rather than later. I've very rarely seen one come in for a vaccination check with, only one testis down and seen that that second testis descend, so generally my feeling has been to, to not wait too long, but to go in and castrate them relatively quickly. However, For my personal advice to people doing these things, the most common way of keeping rabbits is to have a male and a female.

The female, I think it is absolutely essential, they get spayed because of the risk of a uterine adenocarcinoma, but if we have that situation, generally I recommended waiting on the castration. Because quite a lot of these rabbits were absolutely fine, as a as an entire male with a spayed female, we didn't see many problems, and the nice thing about rabbits compared to say, dogs, dogs who wait too long in castration have a big memory of being male, and, They, you know, if you wait too long to castrate, you didn't lose all the male behaviours. With rabbits, they do stop, and it doesn't almost doesn't matter when you castrate them, they, they, they do loads of those quite quickly, so you can afford to wait and just see whether there's potentially any, any negative interactions, but again, always be careful, making sure you reduce these competition areas and making sure you reduce the likelihood of there being aggressive, interactions, so basically, spay all females, castrate some males, and.

Yep, we, we know there's been a problem reported in the past about anaesthetic risk, but actually do an evaluation of the anaesthetic of the anaesthetic risk before you do the neutering and treat those and make sure they're they're well, you know, we're in healthy a condition as possible for you for surgery, and you will reduce those problems with the anaesthesia. Again, preventive medicine, we talked about pain a lot, it's great to teach owners about how to do pain scoring and to evaluate them and to really look at the whole rabbit and evaluate the whole rabbit in terms of the pain, especially if they're on long-term analgesia. And the other thing to teach owners about is quality of life scoring, and this thing's really effective for the older rabbit, for the rabbit with a chronic problem, .

Often in making that decision about when it's time for to consider euthanasia. So quality of life scoring's really good, there's some great websites out there. One I used to like was called Laoflove.com for a very simple, easy to use QRL scoresheet and really effective at showing people one of treatment's working, or two, when things are not working so well.

And I think that's really a really good thing to be doing, certainly when we start going to be looking at more geriatric cases. Obviously we want to get good compliance if we want to achieve good, good, good results, so we need to be able to give drugs and firstly I think it's really great that we've sort of basically moved away now from from giving drugs in water, which is very ineffective. And direct oral dosing is actually really simple in rabbits, even with, with, with, with, with tablets you can give the pen giver, and if necessary, then we can teach the owners how to do the rabbit wraps and bunny burritos, to give those, a syringe into the mouth directly, which is really great.

In my surgery, again, I probably shied away, I really can't remember the last time I gave it, I gave an intramuscular injection. It can be very painful, muscle rabbit's muscles are very low bulk, get a lot of membrane stretch around them, and that can be a big problem. So subcutaneous, dosing, much more effective, much less painful, and seems to be better tolerated.

We can give fluids as part of our stabilisation, we've got lots of routes to do for that, so intravenous, intraosseous, subcutaneous, intraperitoneal, I'm gonna be careful with that because of course a large gut, easy to hit, and so you wanna be be carefully evaluate that, but nonetheless, it can be a very effective route to give as well. Types of fluid, rates and things, ideally, measurement of electrolytes, gives a good idea of what's required, and we can maintain these, With some degree of ease in them, but of course not with a companion present because it can be quite difficult to use intravenous, but back to the stress on a patient is balance all your treatments with how much stress you're causing, so if you are giving longer term fluids over a few days, sometimes it's better to be switching on to the subcutaneous route where we can keep rabbits together. I mentioned about intraosseous.

This is a route I really like, especially in dwarf rabbits, intravenous really hard in these, catheterizing and maintaining those in dwarf rabbits can be really tricky, especially if you are dehydrated and really great to be able to pop this in. You can pop these in in seconds, . And this is basically a needle placed into the crate into the proximal femur and we're going into round with the greater trochanter.

This is a cheetah, this is a ferret. So here we can see the ileum, we can see the ischium. This is the greater trochanter, and we're basically drilling a needle.

And we can do this, in, in a conscious rabbit, with a blur of local we can anesterize or sedate for it. We basically drill a needle into there. What we do need is we need a syringe pump, it won't passively drip into there, but with the syringe pump we can use this and.

I've generally found these to be better tolerated too because they're more out of range, whereas instead of having a drip line floating around my head, so they tend to be not chewed out quite so quickly. In terms of general drug therapy and choosing drugs, I've been talking about pain relief earlier on, and the importance of discussing with owners about what we're looking for, what how to evaluate what effects and things too. Again, really important with this, About using the right drugs, so obviously ideally diagnose, get, we get our accurate diagnosis we can get with drugs more and more likely, really important things like antimicrobials where we're doing not just culture, but potentially cytology as well, showing those ways, bacteria are the relevant ones, in fact, it is even a bacterial infection in the first place, and hopefully everybody's using the rabbit protect post poster and got clinic protocols there too.

And RWA and BSAVA drew up together a set of guidelines as to which drugs may be most effective and those based on the published evidence, so please use those, hopefully it'll help inform getting those protocols right, and then we can get better antimicrobial stewardship, because a lot of situations where we used antibiotics traditionally aren't actually bacterial, we don't need them, which is great. So diagnosed, I also had talked to the owners, and I mentioned here about Cascade, we do have some licenced drugs, which under the Cascade system we should use, but clinical judgement can mean you can use different drugs too. But certainly if we're off licence, we do need only consent, which can be the majority of our drugs, but off-license or on licence, we need to discuss with them what the benefits of the drugs we're using are, what the potential dosing issues are, what the potential side effects are, so they are fully informed, understanding what's happening, can report problems quickly if they need to, but also are appreciative and are in agreement with what we're actually doing, and that's very, very important for ensuring correct compliance.

Again, antibiotic failure, I've mentioned that too, mentioned the Protec poster, and this is the link, by the way, to the, to the guidance, if you want that too, but again, don't forget why we get antibiotic failures. And that may be down to again back to these drugs, we don't always have dose rates, we're often maybe using a drug with the wrong penetration, so for example, we have an abscess, we're not going to get great penetration with any antibiotic, it's gonna take a long time to get antibiotic to the centre of abscess and get any effect at all, and even then we're probably gonna end up with a sterile abscess left behind. We may not have activity, so if we're using a fluoroquinolone, it's not gonna penetrate into an acidic environment anaerobic abscess, because it's not gonna work in there too.

Fake culture sensitivity, it doesn't always give us the right results, hence the use of cytology alongside, because we may be sampling the wrong place at the wrong time. I've seen a lot of cases of pneumonia where people have taken nasal swabs, this is not going to be effective, and even if we have got an upper respiratory disease, if we've got a sinusitis, again, it's not gonna help sampling from the nasal cavity, we need to go into a sinus, take our sample. So really important again, back up cytology, make sure we're getting, we're understanding the results better too.

Similarly, we may not be addressing the underlying causes, so we may have let's say sinusitis, but if we don't address the underlying dental issues or underlying cause of that sinusitis, we're not gonna control it just with antibiotics. And of course, sometimes it's just very chronic, so it takes a long time to get results, we need to be realistic, if we do have a bacterial infection, how long we have to use those drugs for, and what effect we're gonna get from that too, and manage our expectations as the owners. And of course the big one is, some of these cases, we don't need antibiotics, they're not primarily bacterial, it's much better to treat the non-bacterial parts of it, and the bacteria will kind of sort themselves out, and that's where we came from with the guidance, and I do hope you find it useful.

And cytology, I love the cytology too, I think it's often more useful in bacteriology too, faster, it shows that cellular response too, it shows the morphology of bacteria, and again it shows it's not always bacterial, and the bacteria, this is ear disease, this is currumen, it looks like past but actually it's currumen, and you can take a sample of that very quickly, look at it on a slide, see it's pretty acellular, see there's see if there's no cellular response bacteria in there too, and you can know it's not really appropriate to give antibiotics then. Blood taking, again, we do quite a lot on these guys, there's plenty of er there's places to, there's places to use, so we can use the ear, we might use the jugular, might use lateral cephenous er vein, for these, big thing is, it can be tricky, especially in a stressed rabbit who's maybe vasoconstricted, especially on a cold day, especially after after after a stressful trip in, and a and a consultation. And the other thing that's stressing there is often the vet and the nurse doing this.

So really importantly you have the time put aside. Don't rush this, the more you rush, the more panicky everybody gets, the more panicky rabbits gets, the vasoconstriction gets worse, the more difficult the better the venno puncture gets too, so really make sure you have time set aside, really make sure you de-stress, and if you are bleeding, a patient, take them in for a bit. Put them somewhere basically warm, dark and quiet, settle them down, and let those those those peripheral circulation come back up again, and much better success rates from that too.

So in terms of the ear vein, this is our easiest one to access, but it's quite a weak vein. And again, it really does rely on good peripheral circulation, and this is the one where really it's worth waiting for. And Emla cream's very, very useful to put on there.

Two reasons, one is, of course, it's a, it's a sensitive area and a bit of low cloud sitting on the skin, really reduced chance of a rabbit jumping off the needle, and you're losing that vein we've worked so hard to get. And the second thing is, it takes 20 to 40 minutes to really work. So you do put it on there, put the rabbit, somewhere nice and calm and quiet and let everything just vasodilate for you, and it makes life much easier from there as well.

Use a small needle and syringe, don't put too much negative pressure on there, or the vein will collapse, and you'll get even less of a sample. Smaller samples, really effective route to take. Jugular's quite difficult to get, but it's, it's a good vein if you can.

Females are really difficult got a dewlap, so very often hard to find the the the jugular, area. It's a bit more lateral compared to positioning a dog or or a cat, but it is a good vein there too, and if in doubt, a bit of sedation or anaesthesia will, will help access it too. You can use a cranial vena cava, the same way as you would for a guinea pig, but hemostasis can be quite difficult afterwards, putting pressure on it as well, so, but nonetheless, it can be an effective vein to use.

Most commonplace I tend to use was the lateral cephenus, er, showing a shaved area on the back of a leg, and even in stressed rabbits, it wasn't too bad and didn't tend to constrict too much, and we get quite good samples from that too. Relatively easy to get to, so just rabbit restrained. Head in a nice dark place in somebody's armpit, and a leg over the side of a table and raised around the stifle, and, you know, we can get to that usually kneeling on the floor.

Sometimes we only get a small sample, and some of that can be deemed a bit of a problem, but don't forget you do a lot with that too, so for a blood smear, one drop of blood's enough. We can do a PCV tube, you get obviously a PCV, but we can look at a buffy coat, we're we're into that, and some of those total solids, if we think that might be a good marker, but these can be done. And sometimes we can just look at the sample, so this is bottom right shows a lipidotic sample, and this is really quite a useful thing to see, and that gives us quite a few clues about what might be going on with that rabbit, if we can see that.

But the nice thing too now, we get more critical care machines coming up through like being available, biochemistry machines available that work on very, very small volumes of blood, and 0.1 of a mil of blood can get you quite a good profile on some of these machines. So in summary, rabbits do have their own unique points, you can't quite manage them like dogs and cats.

They're prey species, that, is what really dictates our responses, and probably what makes the most difficult is that we do get stressed. But if you care for those needs, and look after them and appreciate those, you can reduce their stress, reduce your stress, you can make the owners much happier, which is what again gets their stress levels down to, and above all, get much better clinical results for your patient. Thank you for listening.