Hi everyone, welcome to this webinar on reducing stress in the rabbit patient. This has kindly been sponsored by the Rabbit Welfare Association and fund and hopefully during this lecture you will get lots of ideas and suggestions on how to reduce stress in your rabbit patients. So firstly, I do just need to declare a conflict of interest.

So I would like to say that I do have a financial interest and an affiliation with the following organisation in relation to the content that's provided in this presentation, and that is to the Rabbit Welfare Association and fund, and I am their current editor of the Rabbiting on magazine and also their rabbiting on advertising sales manager. So we'll just have touch quickly on the learning outcomes of this lecture. So we will look at why stress is detrimental to rabbits and some of the signs that they may show.

The causes of stress in a veterinary environment, and there are many, many causes of potential stresses to rabbits in a veterinary environment. Some of the advice that we can give to clients prior to their appointments, which is gonna help reduce the stress for the rabbits before they arrive into the practise. Tips on how to make our rabbit consultations less stressful, and that's not only for the rabbits, but also for us as vets and as nurses, and how to reduce stress that rabbits may feel when they're hospitalised.

So the domestication of rabbits, so rabbits are descended from the European wild rabbits. They are a strictly herbivorous species, so they consume a wide variety of different plant matter and material in the wild. In their native environment they do form more than half though of the diet for over 30 different predators, and we do also need to remember that one of those is actually humans, so we are a predator to rabbits, so everything we tend to do to them is going to cause them some elements of stress.

Now when we look at the timescales of domestication, now dogs were domesticated somewhere between 40,000 and 100,000 years ago. Cats were around about 10,000 years ago, but rabbits have only been domesticated for less than 1500 years. So when we're looking at how rabbits interact with us and the stresses that they feel, not only are they a prey species as opposed to a cat and a dog, who are a predator species, their domestication and living alongside humans is far shorter than what it is for dogs and cats.

Now the stress that we feel in our everyday life compared to the stresses that rabbits feel is vastly different. So with us, we often feel very, very stressed when we are overworked, and we've got lots of different things going on at any one time and we're trying to work out how to actually go about getting all of those things done. Certainly now there might be some financial worries with the cost of living crisis that we're certainly going through, and those are often compounded as well when we're feeling overworked.

We might have worries about friends or family members, we might have sort of health worries about ourselves. We're often feeling tired as well, we're often working extra hours, we're staying late, we're going in early and often, you know, complaints as well. They're a big thing certainly in the veterinary profession.

If you're ever unfortunate enough to have a complaint against you, then it does cause you a huge amount of stress and there are lots and lots of other reasons that we feel stressed in our everyday lives. Now with rabbits, the stresses that they feel are slightly different. So if they're placed in any form of an unfamiliar environment, that is stressful for them.

It is a wild instinct of rabbits to understand their environment and know potential escape routes. So if they don't have that idea of a map of their environment, how they can potentially escape any form of predation, then that causes them undue stress. If they're around unfamiliar rabbits or unfamiliar people, and when we have them in the veterinary environment, we see these rabbits for a very, very short snapshot of their lives.

They're not familiar with us as people, they're not familiar with the sounds, they're not familiar with the scent. If they're placed near predator species, and this doesn't necessarily have to be directly next to them, it just means that they're in an area that they can smell them, they can see them, or that they can actually sense that they're there. Any strange smells or strange noises and certainly in a veterinary environment, there are lots of different smells, there are lots of different noises that are going off at any one time.

The feeling of travelling and of motion is going to cause them stress and only many years ago it was a way of trying to bond rabbits that you would place them in a carrier together, you would take them for a car ride, and that's placing them under undue stress in an attempt to try to get them to bond, and it's the same thing when they're just going to a veterinary appointment in the car. If they unfortunately go through the loss of a companion, that's gonna upset them, and some rabbits do go through certainly near a grieving stage. Any change in diet doesn't necessarily just potentially upset their digestive system, but it can put undue stress on themselves as well.

And mostly all of these things when we look at them either singularly or together are things that happen when rabbits go into the vets. And there's lots of detrimental effects that stress causes rabbits. So to some degree it's certainly going to slow down their gastrointestinal tract.

And when our GI tract starts to slow down, we start to worry about GI stasis, and that can therefore be a precursor to hepatic lipidosis as well. We get immune suppression and there's lots of potential subclinical diseases and conditions that rabbits can carry. They may carry these conditions for many weeks, months, years, or potentially throughout their whole life, and they never cause a problem until that rabbit is placed under undue stress.

So we can get Euniculi, we can get respiratory disease, kylitiella outbreaks. Any of these problems can start showing clinical signs when the rabbits are unduly stressed. We may see that there's some aggression to the rabbit's bonded companion, that may form therefore a bond breakdown.

There may also be some aggression towards humans and therefore we get this lack of human rabbit bond and trust breakdown as well. And we can unfortunately sometimes see fatal cardiac attacks in rabbits as well. These are normally the ones that are highly, highly stressed.

They're not often used to being handled, and they're placed in this very, very stressful environment and unfortunately we do get sort of cardiac attacks from that. Now we're commonly looking at fear reduction and fear free in cats and in dogs, and that's certainly becoming much more common practise these days in veterinary practises. And rabbits do need and certainly deserve the same considerations, and again, being a prey species, you could certainly argue that they're going to be more stressed in this environment and actually reducing sort of fear in them is more important.

So what signs of stress the rabbit's gonna show? Well, there's some things that we can certainly see and there's other things that we can't outwardly see that are actually going to be going on. So we often get an increased respiratory rate and the rabbits will often be, their respiratory rate will be absolutely through the roof.

We do sometimes see this though certainly when rabbits are in pain, so just because we're getting an increased respiratory rate doesn't necessarily mean the rabbits stress if there are potentially other signs going on as well. We get these really big wide eyes, you could often see the whites of their eyes. They're going to a freeze position and this will be where they're trying to make themselves as small as possible, as flat on the floor as possible, and their ears will be flat against their back.

This is only in up-eared rabbits. So if you've got a lock-eared rabbit, then they're not going to have the same position for their ears. They may initially attempt to run away, and this is a common thing that we see in rabbits, not just in a veterinary environment, but certainly in a home environment when people try and pick them up.

Their first response is to always try to run away. So when you approach the rabbit, the rabbit backs off, it tries to run away, tries to hide in a corner or hides within a hide that it might have within its environment. Certainly they can start to reduce their appetite, and they can become completely anorexic, and this goes hand in hand with what we've just said about a detrimental effect being GMI stasis in our stressed bunnies.

But like I said, there are things that we can't see that are often going on as well. Now what we can't see is tachycardia, so increased heart rate in our rabbits. Rabbits have a variable heart rate, so their heart rates can certainly vary from the low 100s up into the 300s plus, and it's normally in our small breeds of rabbits that we see these really, really, really quick heart rates, and that can certainly be normal for the rabbit, but often when they're stressed, their heart rates will increase.

We'll get potentially increased cortisols and adrenaline levels as well. And as I said, we'll get a slowdown of the GI tract, and we can't see that happening until the rabbit's appetite starts to lessen and we start to get fewer droppings being produced at the same time as well. We can have an increase and a release of catecholamines as well, and this is sometimes a reason that we get these fatal heart attacks, these spikes in adrenaline, spikes in catecholamines, and we get adrenaline releases in rabbits and therefore we potentially get these fatal heart attacks.

Their blood pressure will increase as well, and we all know that you know, increased blood pressure isn't an ideal situation, and we get the immunosuppression problems. However, the signs that we see in rabbits don't necessarily correlate to the level of stress that the rabbit is under. So certainly some rabbits are much, much more easily stressed than others.

That's not necessarily breed or age dependent, neutered status, anything. Like that, most rabbits who are very, very used to human company, they're very used to being handled, are often far less stressed when placed in a veterinary environment. Those rabbits who are not used to being handled, they're not used to people, are likely to be more stressed.

So the world is a really scary place if you're a rabbit. So as we've already ascertained, rabbits are on the lunch menu to lots of different species. They're making up half of the food source for sort of over 30 species of rabbit of predators.

They're always alert to potential dangers, so they have an acute sense of smell, they have a very, very heightened sense of hearing, so their ears act as a funnel, so they're funnelling sounds down those ears, but they're able to move independently of one another. Lots do have a reduced sense of hearing. They're not able to move them as much as up-eared rabbits are.

Their eyes are naturally placed, which is as you would expect for any prey species. They are large and they do have a near 360 degree field of vision. They do have a blind spot in front of their nose and also just behind their head.

So if you are a rabbit, the world is really scary. Going to a vet is scary. So if you imagine yourself being forcefully placed within a box, you're potentially separated from your family, from your friends, you're taking away from the only place you've ever known as being safe.

You're driven to an unknown place, but you're able to still see, hear, and smell dangers, but you're unable to escape those. You're handled by potential strangers. You would be stressed and you would be worried, but this is the experience that many rabbits undertake when they're actually taken to the vets.

So how do we go about, therefore reducing stress? Well first of all, we need to start to think like a rabbit would. We need to see the world from their point of view.

So we always need to remember that, as we said, we are a potential predator to rabbits. We need to be able to advise clients on what they can do before they bring their rabbits into us. Try to alter our behaviour around them, so we're not quite as big, we're not quite as scary to them.

But simple changes make a really big difference. So most things in this lecture are not going to be any form of large monetary outlet to anyone or really big changes that you need to make in practise. They're very, very simple changes to do.

So client advice, so when they're travelling to the practise, ideally they need to familiarise their rabbits with the carrier that they're going to be travelling in, and ideally this needs to be done at least several days if not several weeks beforehand. So owners can place the carrier within the rabbit's environment, they can place some hay in there, some of their food in there, some of their tasty treats in there, so that the rabbits are happily going in and out of the carrier. Make sure that the carrier is a comfortable size for them, so it's not too big, they're not likely to be slipping and sliding around during the journey, but equally they're not really crammed in there and they can't turn around.

Place some hay and some healthy treats within the box for the journey as well, and if the rabbits have become familiarised and acclimatised to that in the weeks beforehand, then this is something they're gonna hopefully be used to. Make sure it's safely secured in the car, so again we don't want them, you know, potentially tipping over and moving around when they're in the car. We want them placed, ideally on a backseat with the seat belts around them so they can't move around.

Ideally advise that they always travel with their companion, and I'll just touch on that shortly, but there are certainly pros and there are, you know, a couple of cons to that as well, but by and large, ideally rabbits should always travel with their companion. Careful driving from the owner's point of view, we don't want the box as I said, being forcefully moved around in the car, potentially injuring and potentially stressing the rabbits out. And ideally we don't want any form of dietary or environmental changes before appointments, so we don't want owners deciding that they're gonna change the diet a week or so before they're potentially coming in to be neutered.

We don't want them placing them in different environments beforehand either. The rabbits are gonna be under undue stress before they even come into us. So looking at keeping them with their companions, so this does help to reduce the stress of both rabbits.

So even if one rabbit doesn't actually need to come into the practise, it might only be one rabbit that's poorly or one rabbit that actually needs a vaccination, ideally advised that both come in. Having your companion with you is going to offer both rabbits familiar support, and it's also going to help to prevent potential bonds breakdowns. The rabbits are very scent orientated animals, so if one rabbit smells slightly different and, you know, coming into a vets is going to have that effect on them, they're likely to potentially not recognise that rabbit when they go back again.

Now unfortunately, if we are taking along one rabbit who doesn't necessarily need to go to the vets, there may be some increased and unnecessary stress to that well rabbit, and it can be that if that rabbit was harbouring any form of subclinical disease, they may then start to show sort of clinical signs. So by and large we should always, always advise that rabbits travel with their companion, but we do have to be mindful that there is the possibility that the companion could therefore suffer some undue stress as well. Selecting a suitable carrier and there's lots and lots of different potential carriers on the market.

So ideally what we want is one that opens from the top and one that opens from the front as well. This therefore gives the rabbit the opportunity to come out of the carrier of their own free will, but it also means that we can access the carrier without having to take it to pieces, without having to take several minutes for us to get into it. We want it to be sturdy and secure, so we don't want it to be a cardboard box, we don't want it to be something the rabbit can actually chew or escape out of.

And again we want it to be non-porous, so if the rabbit does pass urine in there, then it's not going to be soaking in. And these are all potentially good examples of cages that we can therefore recommend for rabbits when they're coming in to travel with us. If they do use one of these wire baskets, it is advisable that they place a towel or something over it so that the rabbit therefore can hide away.

But these carriers are all easy access for us to get into the rabbit and potentially the rabbit can get out. Unfortunately, there are potentially unsuitable carriers on the market as well. These are ones that are going to soak or leak urine, so cardboard boxes, ones that can certainly be chewed, and the rabbit therefore can potentially escape out of them.

If they only have a front opening, we have to rely on the rabbit being able and wanting to come out of their own free will, or we have to take the carrier to pieces. We don't want them too big so they slip and slide around in there. And we don't want large gaps between the wires so that rabbits can potentially get their legs or their toes or their nails caught and cause them injuries.

And these are all examples of carriers that potentially are therefore unsuitable for rabbits, so wicker ones, the material ones that we see, ones that have large gaps in between the bars and ones that only open from the front. Ideally we want double opening, top and front, safe, sturdy and secure. So what can we do in practise for our rabbits?

Well, we can be looking at our reception and our waiting area to see what changes we can therefore potentially make. The consulting room as well. When we hospitalise our rabbits, what we can do to help reduce their stresses.

When we're performing our clinical examination. How to handle and medicate them to reduce stress. Any calming aids that we can use as well, so that's gonna be natural calming aids.

What surgical stresses we place rabbits under and what we can do therefore to reduce them. When we're giving fluid therapy, how we can reduce stress, and unfortunately when we're doing euthanasias as well, we still need to remember that we must reduce stress for our euthanasias. So let's look at our reception and waiting area.

So does this picture look familiar? So it's a very busy environment, it's often a noisy environment as well, but what we have here is cat, dog, and rabbits and furry all placed together in very, very close proximity with the rabbit placed on the bottom, you know, next to two dogs with people towering above it. This is a very common sight that we see in our waiting rooms.

We get predators sniffing in the carriers, which is common with dogs, you know, they're looking at a prey species, they want to be sniffing it out to see what's going on. Lots of different scents. We've got children in there as well, potentially looking in, asking if they can look at the rabbits, etc.

So this all increases their their stress levels. So they're already scared, they were already fearful before we've even placed any form of hands on these rabbits at all. So there are simple changes that we can make.

So if space permits and you do have the room, have a separate waiting area for your rabbit only clients, although this isn't always possible if you're in a practise that doesn't necessarily have the space. If not, try and segregate a small area off the rabbits or for small furries where they can wait so they're away from all potential predators. You can also encourage your owners to place their carrier on a chair or have towels that you have behind reception that you can place over the carriers, and as I said, this is especially important if the owners have used a wire or exposed carrier just so that the rabbits have somewhere to hide away from.

Have owners placing their carrier facing a wall or the back of the chair, so the rabbit isn't physically looking out and staring at other animals and they therefore also can't look in and stare at the rabbits. Just pop a polite notice up in your waiting room so that you're asking owners not to allow their dogs to sniff in carriers. You can offer pet remedy wipes to clients and they can therefore wipe those on the rabbit's carrier or on the bedding, and we will touch a little bit on the natural calming age shortly as well.

If you don't have access to have a separate rabbit waiting area, you don't have access to segregate off an area just for rabbits or small furries, allow rabbit clients to wait in their car so they can come in, they can tell you that they're there, but they can therefore wait in their car for their appointments. It's really hot outside, unfortunately that sometimes isn't possible. And also think about having rabbit only clinics as well so that you're minimising the amount of dogs and cats that are in the waiting area.

You're not going to be able to plan for emergencies, the cats and dogs that might turn up, but you're gonna, you are going to lessen the amount of predators that are gonna be around at that specific time. So even if you have an hour or 2 hours a week where you just dedicate that to having rabbits, and guinea pigs, small furries coming in for routine appointments, then you are therefore going to have less predator species around. And always try and use disinfectants that have a minimal aroma, so certainly if we can smell something, that's gonna be heightened the rabbits.

So our consulting rooms and examination rooms, so the majority of rabbits don't like being handled, they find the experience extremely stressful, they may not be used to being handled, this is especially true of rescue rabbits whose history may completely be unknown. Most also don't enjoy clinical examinations and that's especially true when we're trying to examine their mouths and do a dental examination. So if we can try and do that dental exam at the end of the examination.

When they panic and in an attempt to try to escape, they will kick out, they will lash out, especially with their hind limbs, and they can cause themselves serious injuries. They'll always try to make sure that if they do potentially panic, they're lower to the ground and on the floor. Now different scents will linger from animals that may have been in that environment, so if we've had cats and dogs within that examination room, even if we've cleaned that down, the potential is that actually the rabbits are still gonna smell those.

Now slippery tables potentially make the rabbit panic even more, so place a rubber mat on there or a towel, just something so that if they do panic, then they're not actually going to slip and slide around. I always try to take things at the rabbit's pace, so take things slowly. If the rabbit is really beginning to get stressed, is trying to hide away, is really panicking, then stop, do something else and go back to whatever we're trying to do.

So with our examinations, so do try to allow the rabbits to come out of their carrier of their own accord, and this is where it's beneficial to have that front opening of the carrier. So place the carrier on the floor, open it up, and whilst we're chatting to the owner to decipher what's going on, why they're here, then allow that rabbit to try to come out of their own accord. Where it possible and if it's certainly suitable, do an examination sitting on the floor with the rabbit.

Therefore, if they do panic, they haven't got far to go with they're less likely to injure themselves. Wrap them up in a towel if that's also gonna help. That makes the examination feel safer, again, it means that that rabbit isn't gonna necessarily panic and if they do, they're less likely to injure themselves.

As I said, take the examination at the rabbit's speed. If you can, if you work in a large hospital, there is the potential to have a dedicated rabbit consulting only room if this is possible, or you can have it as a rabbit small furry room, just where, you know, potential predators aren't going to be. Always remember that it's not just cats and dogs that are predators to rabbits, so you wouldn't be allowing ferrets, some types of birds of prey in there, and some reptiles either.

And some rabbits do respond better to their owner restraining, others don't, so not, it's not always the case that it's better to get owners to actually restrain the rabbit when we're doing something to them. If it's safe to do so, the owner's happy to do it, and they feel that their rabbit will be happier if they're restraining, and certainly it's potentially worth giving that a go. Now what we don't want to do is to forcefully pull or take the rabbit out of the carrier.

Now in emergency situations where we need to get rabbits out of their carriers quickly, that's not necessarily the case. We need to actually get into the carrier and get the rabbit out. But ideally if they're coming in for something routine, then we want them to be able to come out of their own free will.

Don't examine a really flighty rabbit on the table. They are likely to take off over your shoulder and they potentially will therefore really injure themselves. So again, always do something on the floor, preferably with them wrapped in a towel.

Don't rush the examination either. Don't continue to do something if the rabbit really dislikes it and starts to panic. So hospitalisation.

So we want to place them away from birds of prey, certainly some reptiles and ferrets. They're all, as I said, potential predators. So sometimes improvation is the key when we're looking at where we can actually safely house rabbits when they're in for hospitalisation.

If possible, place them in a rabbit or a small furry ward or an area certainly where you don't have any predators that are going to be around for those rabbits. It doesn't necessarily necessarily mean where they can see potential predators. It also means where they can potentially smell them as well, or even hear them.

Now kennels really must be as large as possible so that we're allowing rabbits to move around. Rabbits need to move around that their GI tract keeps moving, so we don't want to be placing them in really small cat kennels, we want to be placing them in the biggest possible kennel that we have available. Try not to place rabbits in kennels whereby they've got another animal walking above them.

So either place them in a kennel that's on a lower tier and therefore leave that upper kennel empty or place them in the upper kennel, but take care so that that rabbit isn't gonna fall out or jump out when the kennel's opened. Try and keep your environmental temperature a comfortable level for them, so somewhere between sort of 18 to 21 degrees. Rabbits are crepuscular animals, so they are most active in twilight hours, so they're active mostly at dawn and dusk.

They're not naturally active during the day. So if you have the sort of dimmer switches on your lights, then dim the lights or even switch them off for them. Offer somewhere for rabbits to hide.

So this in this photo here, this is a really nice plastic enclosure. It's wiped down, so therefore easy to use between patients as well. However, it doesn't necessarily have to be something like this.

So you can always use their own carrier if that's suitable for them to go in and out of. Again, it has the benefit of having their scent on it, so it's gonna help them feel a little bit more secure. But something just as a cardboard box, it's suitable as long as the rabbits aren't gonna chew it, if they are chewing it and potentially ingesting that, and that needs taking away.

But otherwise some plastic box of some sort is all equally fine. Always provide a litter tray, especially true for house rabbits, so lots and lots of fresh hay in there, some tasty, healthy cheeks for them as well. It's gonna help to encourage the rabbit to go into the litter tray and also to eat the hay.

We can line our cages with blankets, newspapers, towels, anything sort of along those lines can be used, but whatever it is, again, it's really important that none of it is ingested, and if rabbits are trying to dig at it and actually ingest it, then just lying in the kennel with some hay may be the only option. Try and allow rabbits to exercise in a safe environment, so we want to be giving them a kennel that's as big as possible, but we also want to be allowing them to get out of that kennel during the day, even if it's just a half an hour or 1 hour at a time, so they can physically move around and hop around. Again, it needs to be somewhere that's safe, so it needs to be somewhere where there's no potential risk of chewing through electrical cables or doors being opened on them, and it needs to be somewhere that can be cleaned down properly in between rabbit patients.

These are really good examples of potential options for housing rabbits and sort of giving them mental stimulation. So we can provide enrichment for them and sometimes we again, we have to be creative, so just some simple cardboard tubes that can be filled with hay, filled with pellets and vegetables so that the rabbits can therefore spend time trying to get to the food. Again, that's the same with empty tissue boxes, they're a good size to be just stuffing some hay and vegetables in for them.

Different balls to roll around, but lots of different places to hide in. When we're looking at natural calming age, so one of the first ones that we can certainly look at is . Pet remedy and this works pretty instantly.

So it's available as a plug-in diffuser, so you can have it running all the time where you've got rabbits. It works also on dogs and on cats, so there's no worry that it has to be in any form of species specific hospitalisation areas. Also comes as a spray or as wipes as well, so you can leave it, as I said, plugged into your rabbit kennels or even just in your prep room, wherever you like.

You can use the spray on towels that you might be using to handle rabbits, or you can use the spray on different towels that you're giving out to clients to carry a cover over their boxes with in the waiting area. You can use wipes on carriers as well and on kennels. So the Gabba mimics a natural calming aid, which is present in all different mammals, all different reptiles and birds as well, and it is predominantly Valerian oil based as well.

It has a very low concentration though of the valerian, so it isn't capable and potent enough to cause sedative effects. The diffuser delivers this constant slow release, but it's really kind, really gentle on its effects on the metabolism as well, and it's exactly the same for calming sprays and wipes. So potentially if you contact pet remedy, they certainly may be able to send you out some samples to potentially try and practise.

The other option that we have is Nutraal, and this is manufactured by Nutrivets. This is fast acting, so it works in around about 1 to 2 hours. And it is herbivorous friendly, so these are sprinkle capsules, so we can open them up, they can be added into syringe feeds that we're giving to hospitalised rabbits if we're needing to syringe feed them once daily, or we can sprinkle them onto some wet vegetables if they're eating their own free will.

And it can be used short or longer term, so owners can certainly be using it at home if they need to. It's also potentially an option to be using for rabbits in and around firework time as well, but certainly for when rabbits are coming to the vet, it can be used short term for that use. It has no sedation effects, so like pet remedy, it's not going to cause a sedative effect, and it has several different active ingredients that act as synergistically effective.

So we have the L tryptophan, which is a natural amino acid, and it's found in different proteins, and that's involved in the production of the hormone serotonin, and that certainly has been shown to help reduce stress. We have the L-theanine, which is an amino acid component of green tea, and that's involved in the dopamine neurotransmitter function. We have the Paiflora in Cannata, which is from the passion flower, and that helps relax and reduce tension.

And then we also have our B vitamins added into that which helps to optimise the integrity and function of neurotransmitters within the brain. So certainly consider using either Nutrial or Pet Remedy or potentially both as well and we can also consider using these at home prior to appointments, so recommending them before the rabbits even come into practise to owners. Gentle handling is really, really important.

So as I said, not that many rabbits are used to being handled, that may come down to potential early life experiences, it may be that they weren't handled when they were very small, they may have suffered from previous rough handling and had. Poor experiences of being handled and therefore be fearful of people and being handled, maybe that they're a rescue and they have an unknown history. So again, you know, a lot of rescue rabbits don't necessarily like being picked up because they potentially had previous rough handling.

They may be unfamiliar with people, smells, and different environments, and that can panhandling therefore compounds that. They'll always be very slow, very quiet, and very gentle. Again, wrap them up in a town if they're likely to struggle, sit on the floor when we're handling them.

Now prep is often a very, very busy area, but it is often the area that we do clinical examinations in. So if your prep room is really busy, you've got lots of different things going on, it might be better to move to a quieter area such as a consulting room and actually do an examination in there. Most rabbits will always try to hide when you approach them and some certainly do try to panic.

They certainly stop if you safely can if that does happen. Now medicating rabbit, so certainly my preference when we're doing different routes of medication, and certainly I find that the least stressful is going to be intravenous. If you've already got an IV catheter in, then it's gonna be less stressful for you, therefore, to give intravenous medications.

Therefore, tend to find that subcutaneous medications are therefore the next least stressful, followed by oral and then intramuscular medications. So always try to go least to most stressful. Always have everything ready that you need and that's gonna include any spares or syringes, needles, catheters, whatever, just in case you actually need them.

Now if you've already got an IV catheter in and in some cases subcutaneous medications can certainly be given with the rabbit in their kennel, you don't always need to get them out to actually give these medications to them. The rabbit may want to hide in a towel, so if you do need to get them out, you do need to handle them to actually give them their medications. Have a towel and just have the part of the rabbit that you need exposed so that they therefore can hide away in that towel.

Always follow gentle restraints, and again, always make sure that you are in a safe and quiet area. So our syringe feeding, so this can certainly be very, very time consuming and it can also get quite messy as well, and certainly patience is needed when we're syringe feeding rabbits. So to reduce stress, wrap them up in a towel, use a bib or paper towel sort of around the chin area just to keep them nice and clean.

And there's a different variety of specially formulated herbivore syringe foods available. Many, many rabbits have different preferences, so sometimes you do have to try more than one before rabbits will willingly take their syringe feeds. They're all high in fibre and they're all there to encourage the gastrointestinal ability, so they all contain lots of indigestible fibre, and they help to return to normal function, certainly during periods of anorexia or wherefore rabbits do have a reduced appetite.

We do certainly have rabbits who will refuse to swallow their syringe feed, so no matter how much you're putting in, they just allow that feed to dribble out of their mouth, and if this is the case, then certainly stop. Leave that rabbit and try again another half an hour or 1 hour later. Now what timings we use, really depends on how well the rabbit is taking that food.

So it tends to be less stressful to give fewer feeds throughout the course of the day, but to give more of the food per time if the rabbit will therefore accept it. If the rabbit gets to a point, unfort. And it isn't swallowing the food and we have to stop, then it may be that we need to give more syringe feeds throughout the course of the day, but actually give less per time.

But if you can, if the rabbit will willingly accept the food, give it fewer feeds throughout the course of the day, but try and get more food into it each sitting. The use of ELA and Eyal, so Ela cream, should ideally be used before we're inserting intravenous catheters or before we're taking blood samples, can't ideally be used certainly in an emergency situation because it does take between 30 to 60 minutes to take full effect, and you do have to be patient, certainly to make sure that you wait that long. Now FBalm though is the one that we can use in potentially emergency situations and when we need urgent IV access, it does work almost instantly.

And certainly having the skin numbed and the veins certainly slightly dilated, which EmLA does tend to do, will increase your likelihood of successful catheterization or blood collection on your first attempt, which again is going to be a lot less stressful for the rabbit, and certainly a rabbit who is really, really fractious and who actually doesn't really want us placing a catheter or taking a blood sample from them. So always try and make your life as easy as possible. So if you know you've got a rabbit coming in that's gonna need an IV catheter, that's gonna need potentially blood, then pop some in the cream on their ear vein or on their apin vein, whichever, vein you're likely to use a cannulation or for taking your blood sample.

If you've got a rabbit coming in who you need to get a catheter into straight away, then look to use your EPal instead. When rabbits coming in for surgery, we are placing them under lots of different stresses. So we often have admit times from sort of 8 o'clock in the morning, 8:30 in the morning, and we have every single admit coming in at that same time.

But do we necessarily need our rabbits to be coming in at that time? Potentially could they come in slightly later? So.

Have to admit, a lot of rabbits don't eat, they potentially don't drink as well before they have their surgery. So we're not going to be operating on these rabbit patients until later in the day, potentially 1112, 1 o'clock, potentially therefore, a later admit with less time in practise is going to reduce the stress and the time that that rabbit goes without food and water prior to their surgery. Ask owners to bring in some of their familiar foods, so some of the hay that they really like, some of their treats that they like the most, or if they're particularly fond of certain fresh vegetables, then ask owners to bring some of that in.

It may be that they bring in a particular towel or soft toy or something with a familiar scent on as well for those rabbits. Never mask rabbits down for general anaesthesia, so this is a really highly stressful thing for rabbits to go through, and it is completely unnecessary, so we don't ever need to be forcefully gasping them down for anaesthesia. Try and aim to operate on your rabbit patients as early in the day as possible, so again that's less time for them to stress and sit in their kennel beforehand, but it's also longer for them to recover, it gives more opportunity to painschool them, top up their analgesia prior to them going home later in the day.

Our Elizabethans are buster collars, so we really shouldn't ever be using these on rabbits, and most rabbits totally despise them. So as a prey animal, they don't like the sensation of anything being physically around their neck. It also stops them from eating their secret trove droppings.

It also inhibits their grooming and also means that they can't graze effectively either. So Buster collars, Elizabethan collars are not designed, therefore to be on rabbits. Rabbits normally interfere with wounds if their analgesia isn't sufficient, so if they've got sutures that are potentially too tight or potentially skin glue as well, which is going to be pulling in and around the wound.

So reassess your analgesia. Does that rabbit need higher doses? Does it need multimodal and analgesia?

So something else introducing, look at your sutures, do they look too tight? It is a possibility that rabbit has referred pain, so it physically can't get to an area that actually hurts it, so it's just trying to chew the area that it can actually get to. Sometimes the pet medical t-shirts do work OK on rabbits, but they are easily soiled, so it may be that owners do need more than one of those that they can frequently change them so the rabbit actually isn't sitting in close proximity to droppings or to urine near to skin or near to their wound.

But we shouldn't tend to ever need to use Elizabethan and buster collars on rabbits. Fluid therapy. So the placement of our intravenous catheters doesn't need to be stressful, and that's not only for rabbits, it's also for us as veterinary professionals as well.

So as I said, always use a quiet area, a very calm area as well, numb that skin, so wait if you've used Ela cream for about 30 to 60 minutes. If you've use Epicom, then you're good to go pretty much straight away. Use quiet clippers and if you're going for a marginal ear vein and you've got really noisy clippers up near their ears, they've got a heightened sense of hearing that's really going to be quite fearful and stressful for them.

Make sure that your blade doesn't have any teeth missing and therefore you're not likely to actually cut the rabbit when you're clipping them. Once you have placed an IV catheter, it's far less stressful to be giving medication via that route than it is to be giving them subcutaneously. So it's far stressful to be giving them IV medication and IV fluid than it is to continually have to give them subcutaneously.

So subcutaneous fluids, certainly in large amounts can be really uncomfortable. So again, if you can place an IV catheter. Always keep your bandages as light as possible, so they will always want to try to shake their head, to get the bandages off, so always try to keep them as light as you possibly can.

So with IV access in your marginal ear vein, again, handling isn't necessarily necessary when you're giving fluids or when you're giving medication. You can simply do that with the rabbit in their kennel. So you are stopping the rabbit from having to come in and out of their kennel for every time they need fluids and every time that they need any form of medication.

And as I said, large quantities of subcutaneous fluids are uncomfortable, especially when they're repeated at frequent intervals. So we know that rabbits have higher fluid rates than what dogs and cats need. So it is a case of that we're constantly having to give them fluids, you know, every hour or every couple of hours, and that's gonna not and that's gonna not only be stressful for rabbits, but also uncomfortable for them.

Whether you decide to allow owners to visit may be down to your practise protocols, but it certainly may be beneficial to some rabbits to allow their owners to come in and spend some time with them. The certainly the opposite is also true for some rabbits. So owners can come in, they can potentially look to be encouraging anorexic rabbits to start eating.

It's often likely that they will have more time to be able to spend with rabbits than what we can with the best one in the world. The owners are more likely to be able to come in and be able to spend longer with them to try to get them to eat. Certainly some rabbits can be comforted by their owner's voice, and familiarity to scent as well.

The flip of that is also true, and that may be more stressful for other rabbits for the owner to come in and then to go again. So whether or not owners do visit does need to be on a case by case basis depending on the rabbit and also depending on the owner's viewpoint as well. Ah, rabbit weight clinics.

Now there are lots and lots of rabbits that are unfortunately overweight, and many of those do benefit from weight loss programmes. However, having rabbits coming in every sort of couple of weeks, every month or so for veterinary visits is going to be stressful to the vast majority. Of them, but we can get around that problem.

So after they've had their initial consultation, we have devised a suitable weight loss plan for that rabbit. The owner is on board. We can therefore consider different ways of actually ascertaining whether or not that rabbit is losing weight.

So owners can weigh the rabbit at home, they can do measurements at home as well, so if we have measured that rabbit in practise, we can be showing the owners where they need to be doing their measurements at home as well. They can send photos via email, so side views, top views as well, so that we can see the difference in the rabbit's physical appearance. We can have conversations with them via the phone or via video as to how the rabbit is doing, and this is all going to reduce the amount of visits and therefore stress that rabbits need to actually come in.

So with our weight loss plans, rabbits need to lose weight very, very slowly over a longer period of time. If we're seeing them every 2 to 4 weeks, that means that that rabbit might have 6 to 9 months or even more of, every other week or monthly visits to the practise, which we really want to try to avoid. We can potentially see them once every 3 months or once every couple of months, but in between that, if we can reduce the visits, we're going to be reducing their stress.

So the PDSA 2022 animal wellbeing pool report showed some quite interesting statistics on rabbit weights and how owners perceive their rabbits to be. So of those surveyed, 87% of rabbit owners say that their rabbit was at an ideal weight. Only 1% of rabbit owners described their rabbit as being obese.

And 28% of rabbit owners knew the current weight of their rabbits. Unfortunately, I think what we see in practise is that a lot of rabbits are overweight to some degree, but how owners perceive their rabbits to be overweight or certainly obese is quite different. When we're performing euthanasias for rabbits, again, we never ever want to mask them down, so this is unnecessary, it's highly stressful, and that's just putting aside all the potential health and safety risks as well.

So there is never a need to mask down rabbits. Ideally place an IV catheter, so our marginal air vein, potentially or cephalic or cephalus, they're all suitable for IV catheter placement. We wrap them up in a towel, we only have to have their head and their ear exposed for a marginal air vein to insert them.

If they are really stressed, if they are really fractious and it's very, very difficult to get a catheter in, they're panicking, then give them a light sedation first of all. The owners may want to take that rabbit's body home so that if that rabbit does have a companion, they therefore can spend some time with them and actually accept the loss as well. I would encourage everyone to join the Rabbit Welfare Association and fund.

So it is the UK's leading rabbit welfare charity. So there are lots of different links on there as to what you can look at, the information that they have to hand. They do produce this.

On the hot booklet, it's now on version 6, I believe, and this is a booklet that you can give out to your clients. It goes over feeding, neutering, vaccination advice, environmental advice, all different aspects that they're likely to need during sort of rabbit care. And that's just a link therefore on their rabbit friendly as well, so you can apply to be a rabbit friendly practise.

It is a fairly lengthy questionnaire that you'll need to fill out, that will be analysed by their veterinary experts, and they will therefore award you silver if you meet that criteria or gold if you meet that one. If you don't meet either silver or gold, they will therefore give you advice on what improvements you could make to look to actually meet those. I would encourage everyone to take a look around your practise.

So go into work, look at what you do and potentially what you can change. So can you change the times that you admit your rabbit patients? If you don't operate on them routinely until later in the day, can you make sure that your admits are done slightly later on?

What pre-op and appointment advice do you give or do your receptionists give to your rabbit clients? Is there anything in the reception and waiting area that you can change? Can you segregate a small area off for just rabbits or small varies?

Is it better to ask clients to wait in their car if they're coming in? Anything you can do in your examination and consulting rooms. Do you have anti-slip tables?

Do you have towels? Can you examine rabbits on the floor instead? What's your kenneling like for your rabbits, and do you advise that companions are admitted?

If you don't advise that companions are admitted, potentially that's something that you should therefore look to change. When you're handling rabbits, can you move them into a different area of the practise so that they're away from the hustle and bustle of veterinary practise life? Placing your IV catheters, do you use ELA or Epial?

Can you look to use that? When you're medicating or syringe feeding or giving fluid therapy, do you need to get the rabbit out of the kennel? Is it better to do the, if you're giving intravenous medications or fluids, is it better to just do that with a rabbit in the kennel rather than picking them up, getting them out, doing what needs to be done and then putting them back in?

They're different surgical stresses that you can look at. As I said, can you admit them later in the day, if you are admitting them early in the morning still, can you do your rabbits, general anesthesias earlier on in the day? What's your euthanasia protocol?

Do you place IV catheters in rabbits again? Do you use ELA or Ethical? There's going to be lots and lots of others that haven't, you know, been touched on, and things that, you know, this might sort of trigger and you might think that there's something therefore that you can change.

A different take home messages, so everything that we do induces some stress to rabbits. We can never have completely stress free. Everything that we do is gonna be stressful to some degree.

We can look though to minimise it as much as we possibly can. So stress does have lots of different detrimental effects on rabbits, some of that we can see and some of that we can't see. Some rabbits will cope better with stress than others, sometimes that's because of previous experience that they've had, or it may just be that that rabbit is more laid back.

But simple changes and certainly small changes and they don't need to be expensive, make a big difference to our rabbit patients. So I'd just like to thank everybody for listening, and I'd just like to thank a few people for allowing me to use their images in this lecture. If anyone does have any questions that they would like to ask, then I'm more than happy for emails to be sent to me and I will try to get back to you as soon as I possibly can.

Thank you very much.