Good evening everyone and welcome to tonight's member webinar titled Respiratory Disease in Rabbits and Rodents. We're delighted to have Molly Varga hosting, tonight's, presentation for us. For those of you who, are new to the webinar vet, we'll go through a little bit of housekeeping quickly.

I'm sure most of you are aware of our procedures by now. If you have any questions, if you hover your, mouse over the presentation screen, a little black box should appear with a Q&A icon. Submit your questions in there and we will collate them for Molly towards the end of the presentation.

If you have any technical issues, myself and my colleague Anna are on hand to try and help out with those, and if you again, submit them into the Q&A box, we'll do our best to help you out. Just before we go into tonight's, webinar, we do have our annual feedback survey coming shortly. So you'll see an email, coming soon in the next few days.

So if you have any feedback, any, topics or subjects that you would like to see more of, and so forth, please do, log in, let us know. We'll try to use all feedback, to plan the, the schedule moving forward. So on to tonight's webinar, we have Molly Molly Varga joining us.

Molly gained her RCVS certificate in zoological medicine in 2001, and her diploma, mammalian in 2007. Her special interests are rabbit medicine and surgery. Molly has contributed to several books including the BSAVA manual of reptiles, Nursing exotic pets and Wildlife, rabbit medicine and rabbit Surgery, and volumes on rodent and rabbit medicine and surgery.

Molly's update on the textbook of rabbit medicine has recently been published. Molly also reviews articles for other authors and journals and has been involved in reviewing the wild pro volume on lagomorphs. She is an examiner for the RCVS Diploma in Zoological medicine, and Molly heads the exotics referral service at Rutland House, veterinary referrals in Saint Helens, Merseyside.

So it gives me great pleasure now to hand over to Molly. Thank you very much, Paul, and thank you very much everybody for Listen about respiratory disease in rabbits and rodents. So, after that introduction, I wanted to just say that actually we see a fair amount of question mark respiratory disease in rabbits and rodents, and I think all of us to some extent, are a little bit conscious of saying, OK, we're just gonna do the obvious thing, which is.

To give antibiotics and nothing else. So what I wanted to do was to prompt a little bit more of a conversation, whether it's between yourself and the clients, yourself and perhaps pet shop owners, maybe just in your head about actually what we're doing and how we treat these animals, in a very welfare-driven way, ideally. So what I wanted to do is to just very briefly review respiratory anatomy and to just look, again, quite briefly at how it differs between species.

So between the more familiar species, cats and dogs, and also between rabbits and rodents, I want to go a little bit into the clinical relevance of these differences. And then I just want to talk about some of the very common. Clinical signs, so coughing, dyspnea, exercise intolerance, and then have a little bit of a consideration of the less common or much more subtle clinical signs that actually, if you have the time and you know that they may be present, you may well pick up on either in the consultation or through perhaps a little bit more of an evolved history taking.

And then I want to look at appropriate diagnostics and talk through how we get to the most specific diagnosis that we can so that we can then give the best and most appropriate treatment ideally. I also want to talk about stabilisation and examination of the respiratory patient, simply because, actually, just like with the very dissonant cats, we can't be that gung ho about it. Some of these animals are both fragile and precarious.

So in terms of that, again, thinking about how and when we do some of the things that we need to do to them. Then I'm going to hit on some common conditions. I've got 3 or 4 that are very common and very important, and depending on time, we'll briefly go through, some other organisms that are worth knowing about.

If we have to rush through them, they'll be available through the webinar, because I'm conscious about how long this might be. And then finally, I want to talk about therapeutics, what we do. To a cure these animals, but much more importantly, make them feel better, and that's not always the same thing.

So let's get going. So firstly, anatomy. And we have here 5 very beautiful illustrations from the Czech version of Poppesco.

So the rabbit and rodent versions. The picture on the upper left hand side is a mouse. And I think the first thing that you will notice that it is quite common among all of these species.

So we have, going from the left to the right, a mouse, a rat, a hamster, and at the bottom, from the left, a guinea pig, and on the right, a rabbit. All of these animals have a much smaller thoracic space than you would expect in comparison to a cat or a dog. So they are all a little bit more respiratorily compromised than perhaps other species.

And they have evolved to deal with this behaviorally in different ways. These animals are not built for speed. OK.

But when we're talking about respiratory disease, that does mean that they become compromised very, very rapidly. The second thing to say is that certainly in the rat, the hamster, and certainly the rabbit, we have very, very obvious and quite large thymus glands anterior to the heart, meaning that sometimes if we're looking at these animals radiographically, it can be very difficult to see the anterior edge of the heart. In the mouse, actually, you can see that the heart is right almost in the thoracic inlet because there's so little space.

Certainly in the guinea pig, the thymus actually unusually is almost looped around the trachea. So again, a little bit of a different, geographical position than one might think. And all of these animals, are very much really dependent on the diaphragm, more than the intercostal muscles in order to be able to breathe.

So again, that's something to consider when you're restraining them and certainly when you're examining them. So there are some very relevant differences in terms of anatomy, and the key thing, if you remember one thing, is that all rodents and rabbits are obligate nasal breathers. That means that either in the rabbit, the soft palate is engaged with the glottis so that the gastrointestinal and the respiratory tract are completely separate.

In rodents, the soft palate will very often have a small hole in it called the palatal osteum, and that connects directly to the trachea. And again, giving a degree of separation, not as complete, but a degree of separation of the respiratory and the gastrointestinal tarts. So what that means is that if you see a rabbit or a rodent breathing with its mouth open.

That animal is massively compromised. It has stopped coping. It's river reserve capacity is gone.

So again, that's a very clear and very important and key clinical sign. Other things to consider are the differences in terms of things, physiologically as well as anatomically within the lungs. So the first thing to say is that rats in particular have a different type of secretion within the lungs.

It tends to be a lot more liquid, and a lot less, viscous and other species. They have clara cells, which Also, contribute to the mucociliary elevator. So it's a little bit of a, a two-pronged difference within the, the physiology and the capability of the lung.

All rodents have a higher chest compliance in the species that we are more used to, more familiar with, and, as I said, a reduced functional residual capacity compared to other species. So again, you can see that both of these, all of these factors are making them a lot more. To respiratory disease, we might expect.

However, on the other side, with most species, and particularly things like mice and the smaller hamsters, the airways, particularly the larger airways are proportionally much wider than you would expect for the size of the animal. So in some ways, some things can work in our favour. So as I said, rats have a different type of respiratory secretion.

And this in part, is modulated by the fact that actually, in addition to mucus secreting goblet cells within the respiratory empathy. They also have serous cells, and this changes the viscosity of the respiratory secretions. So they're less viscous, maybe it's almost like having your very own internal spectrum.

Maybe it's easier to get rid of these. Maybe this is an evolutionary advantage and added to that the clara cells, which again, impact on the, efficiency of the newcociliary elevator, then actually maybe we have a few things that are helping us rather than confounding us. And there are other things that I did want to mention, and again, certainly, with the histamine activity, if we think about that, rats in particular have been studied for histamine activity within the lungs, looking at inhaled allergies.

When we start to think about some of the animals we're treating, And we're sort of saying, oh, it's probably hay fever. Again, maybe let's have a think about that and sort of have a look at the evidence that we have in terms of perhaps my old physiological studies say actually, is this likely or could it be something, a little bit different. And then finally, and sadly, what I would also highlight is that particularly, In some of the smaller rodent species that were perhaps certainly all bred from a certain limited number of founder genetic members, the lack of genetic diversity certainly does increase the vulnerability of species to disease.

And sometimes it works in our favour and sometimes it makes things resistant, but sometimes it doesn't. And to remember that certain With many rat strains, a lot of the rats that we see within, the pet shop trade in particular are not very far genetically removed from some of those that have been bred to have specific genetic vulnerabilities. So again, we're having a little bit of a, a double whammy there in terms of whether these animals are likely or less likely to get disease.

So I wanted to talk through briefly some of the clinical signs. Coughing very obvious, so forced expulsion of discharges from the nasopharynx or potentially the upper trachea and bronchi. There are many other causes of cough, and we know that there are probably Between 2 or 300 causes of that within dogs.

And there's certainly is likely to be as many causes, within the rodent and rabbit population. We just may not have been able to delineate them as, as precisely. This is quite a non-specific sign, and what I would say is that in many cases, You won't hear it.

Most rabbits don't cough, you know, that it would be quite a rare thing to have happen. You might sort of see a sneeze, cough type of combination in some rodents, but just because it isn't present doesn't mean that there isn't disease. Dyspnea.

Now I said earlier that any rabbit or rodent with open mouth breathing is definitely dyspneic, it's not coping. And difficult or laboured breathing puts any rabbit or rodent into a very precarious and fragile position, and I would highlight that and say, yeah, that's absolutely an emergent case that we need to treat very, very carefully indeed. What I would say is that always with all of these animals these days, what I do is while I'm talking to the owner and we're getting a history, I observe the animals.

At rest, before we touch it, before we do anything else. With rabbits, I'll often let them hop around the floor if they, if they'd like to. With rodents, I think I'm a little bit more, reluctant to let them get into my hidy holes in the, in the consult room.

But I watch for the rate of respiration. I watch for the rhythm of it, and I watch for the depth, just so that we can actually have an appreciation of how much this animal is struggling. So I put up this infographic here.

This is a little bit of an algorithm that is used quite commonly in the US for dogs that are coming in with difficult or rapid respiration. And again, I think a lot of these things are very much . Things that we possibly do very automatically, but also these are very, very applicable to the species we see.

So an inspiratory dyspnea will likely be upper respiratory, an expiratory one will likely be lower respiratory. You know, if you have, the opportunity with some of these animals to perhaps do a little bit more radiography than you thought you would like to, all of those little bits of additional information can be very helpful. But to look at this kind of, an algorithm and think, actually, this is a much more defined way of looking at our patients.

And they may be a little bit less well defined in our heads, but actually they can and will get the same range of conditions that many other species get. So exercise intolerance, again, this one can be an interesting one. Now it's not consistently displayed.

But this is one of those things whereby if you ask the you know the right questions, they might sort of say, oh, actually, yes, he used to jump in and out of the hutch a lot, but he doesn't bother now, or he used to go on the wheel a lot, but you know what, he's, he's stopped doing it and he. Yawnspits, all of those different things. I think that what a lot of these species do is that they control their levels of activity to fit their perceived capability.

And that's one of the ways that they survive in the wild. You know, you don't run around like a maniac if you think you can get caught by a fox if you get out of breath, you hide. So in terms of that evolutionarily, these animals are very much still relatively wild, and as far as that goes, they will hide their distress and they will manipulate their activity levels so that they don't display it.

You may see it much more clearly, perhaps on examination, but again, this might well be the key question that you ask the owner and they say, oh, actually. So the other sorts of very sort of subtle things you might notice are changes in body posture. So a lifted head with an extended nose, you might see a slight abduction of the elbows and a crouch posture rather than a relaxed down, lying, flopped out posture.

And again, those are quite typical for Neo postures and you can tell again that behaviorally, the animal is letting you know it's starting to struggle. And these are important but very subtle things. And the less common signs, again, weight loss.

Absolutely, unexplained weight loss. You know, it's breathing rather than eating. And a lot of these signs are not necessarily directly related to the respiratory system.

Second thing is yawning. Indicating I'm not getting enough air, air hunger can be stress, can be other factors, but absolutely, as soon as an animal is yawning regularly and more commonly than you would have thought, again, I would say air hunger is a concern. And sort of hiding, not grooming, being less mobile, being less sociable, all of those things can certainly be factors.

Just want to highlight one thing though, that with a lot of these animals, particularly things like, for example, guinea pigs, chinchillas and rabbits, so the hindgut fermenters, you may not notice a difference in weight necessarily if it's happening, you know, over a period of time, but what you might notice is a change in body condition score, and the weight may remain consistent because. Of the amount of food within gut, but the body condition score is, is, is reducing potentially. So that's certainly something to consider body condition scoring as well as weighing when you have a look at these animals.

And then other factors that, you know, may denote a generally unwell animal are things like porphyrin production in rats. So the porphyrin will be produced in the tears and in the nasal secretions, certainly, you might well see pinkish brownish discharge around. And the eyes and the mouth, and the owners may feel that these things are bleeding.

In general terms, it's not bleeding, it is the production of porphyrin, but that indicates stress and an unwell animal will certainly display those signs. So again, that's worth highlighting. Now, initially, before we get onto this journey of how we do this and what we do, I want to step back and have a little bit of a think about exactly what we're trying to deal with here.

And to just look back to our roots in pathology. When I was at uni, they used to say that the pathology was the whole tree that veterinary medicine was hung on, it was the core of everything. And I hate to say, maybe they might be right.

So in terms of that, if we think about the sorts of things that we see, we might see rhinitis, inflammation of any part of the respiratory tract. So bronchitis, tracheitis, bronchiolitis. So from the very tip of the nose to the very bottom of the alveoli, any or all of those parts can become inflamed.

And what inflammation causes is sort of, you know, thickening of the tissue, inflammatory exudates mucus. I always associate mucus with inflammation. And if you think about that and you think about that in the context of respiratory disease, absolutely.

So inflammation is one of the key things that we need to think about dealing with for the welfare of our patients, OK? Tissue damage. So this inflammation, this, this inflammation that has been prompted by an organism, a bacteria, a virus, a fungus, won't necessarily heal back into perfect respiratory tissue.

So we might get an animal that is clinically very much better, that is still compromised. OK, because we've healed by scarring or tissue that is less functional than the original, type of tissue. So potentially, you know, the alveoli are collapsed or perhaps they have expanded into bully or something like that.

And while the organism that's causing it is under control, the secondary effects perhaps are not. Cellular responses. So again, the immune system is an amazing thing.

It sends a lot of these cells to the points of infection and or inflammation in order to do a job. But there's a tipping point in which that job, that functionality of the immune system can compromise the functionality of, for example, the respiratory system. So things like peribronchial cuffing, that type of thing, makes those structures less functional to that animal.

And the clinical signs separate from the respiratory tract cannot be forgotten. So we need to address these as well. So things like conjunctivitis, which is very common in some of the viruses, adenovirus, for example, will very commonly have a very, sore scleritis and conjunctivitis, vestibular signs where perhaps bacteria have tracked up these station tubes from a lower respiratory tract infection into the inner ear.

Dacryoinitis, swollen, sore lymph nodes, and certainly abscesses, potentially in locations distant from the respiratory tract, and all of those are things that surround respiratory disease in all of these species. And a lot of these changes will negatively impact that animal's basic ability to breathe. Less functional.

So I want to start with having a look at some environmental factors because I think quite often as small animal vets, we try and think about these in very specific cases, and I think I would encourage people to think about them very generally, particularly in rodents, particularly if they have been recently acquired, and particularly if they're kept as a colony. So I think that things like stocking density, how many animals are being kept in what sort of a space, is this Current Oracle because that's also important because the likelihood of firstly stress, competition for resource competition for space, competition for mates, and also, animal to animal transmission. The more animals you meet, the more likelihood there is of you getting something from one of them.

The method of housing, and again, is this socially acceptable for the species? Most hamsters like to live alone, apart from very tiny sort of Russian or Roberovskis. So a big Syrian hamster would prefer to be on its own, whereas the small ones wouldn't.

Mice can be colonial, rats are typically kept in packs of males or females. Gerbils and things like that tend to be kept in pairs. Chinchillas, and guinea pigs and rabbits, often in pairs, but are they actually sort of mixed?

Is there a room full of rodents? Is there a rodent, rodentarium in the house? Is the rabbit kept with a guinea pig?

So all of these are relatively useful to know. And also the . Certainly if you're looking at pet shops, what the policy is in for restocking, is it all in, all out?

Do they, destock if they have an issue, or do they have a drip feeding new animals coming in all the time? And if they do, is there a quarantine? And is it just days in a different room, is there testing, etc.

Etc. Cleaning methods are also very important and making certain that people do understand the difference between cleaning and disinfecting and the fact that you actually can't disinfect something that isn't already clean to start with. So getting rid of, you know, the, the biological waste properly and making certain that they're using the correct type of disinfectant and having the correct concentration and contact times.

And then coming to some of the things that we might think are more obvious, looking at the substrate and the bedding. So is it an aromatic? Is it something that is likely to be irritant?

Is it dusty? Is it clean? You know, are we using something that is appropriate for the species?

Food storage, again, very important. Have you got a massive bag of food that you're keeping for a year on the shelf in the bag? Or are you buying small packs of food that are sealed regularly and keeping them in airtight boxes?

All of these are useful to know. And then thinking back to some of our farm animal type thoughts, what about ventilation and air changes? If you have a rodent or a rabbit come in and you can smell that animal's cage and its environment, it isn't clean enough and there isn't sufficient ventilation.

OK. With reptiles, we certainly think about temperature and humidity. However, we shouldn't ignore these in rabbits and rodents either.

So most rodents are good up to about 26 degrees, chinchillas and guinea pigs and rabbits maybe they're up to about 22 degrees. Above that, they start to become a little bit heat stressed. As soon as the humidity is high, they become quite heat stressed.

And in the wild, they would control this behaviorally. So by, you know, blocking themselves away from the sun, seeking crevices or rocks or going into burrows, and we actually take that ability away from them. So we're so focused on reptiles doing this and yet we forget some of the more common species.

Genetics I've mentioned, but again, the final thing to consider is what about the wild animals in the environment as well. So certainly with our owners and for example, pet shops where there are potentially quite a few specimens in the same area, then rodent control of external pests may well be needed. And it's worthwhile thinking about that because actually what you don't want is, you know, wild rats bringing something in, for example.

So, physical examination, once we've looked at the history and we've looked at the signs and we've looked at the environment, we need to decide how and when we're going to examine this animal and particularly if it's very dystonic, actually I wouldn't, I would pre-oxygenate it. Give it a little bit of time to relax in an oxygen enriched environment. If you can get it into an oxygen tent that doesn't get too hot, absolutely brilliant, ideal.

And give that animal the ability to have a bit more reserved capacity, that's all we're doing is we're improving the likelihood that this animal can cope with what we are going to do. It is important that they don't get too hot. And I would also say that certainly.

If you bury what saying that you have your emergency equipment to hand. Try and do as much of everything as you can before you do a lot of handling. So I, as I say, I observe the respiratory rates and effort first.

And then my first parameter that I check is the heart rate so that although it won't be normal, it will be as near to baseline for that animal as I can get it because I haven't spent 5 minutes examining everything else. Look at the rhythm and the heart rates and whether there is a murmur and whether there's a pulse deficit because actually on first presentation, we can't discriminate between respiratory and cardiac all the time unless there's a massively obvious nasal discharge. And then do your normal things.

If you do think there's a murmur, where is it during what part of the beat is it? You know, is it consistent? How loud is it?

OK. And then once we've done that and got this animal examined, then potentially we can think about appropriate diagnostics. Obviously auscultation, but in some animals, and certainly I had one today, you can't examine this 35 gramme hamster conscious, it's evil.

So we had to sedate it to examine it and consider that. And with a lot of these tiny ones, again, we sedate them, quite often using Sio or ISO. I do think that that is quite a negative experience for them.

So if you can get an accurate weight and perhaps, you know, you can safely inject, then a tiny wee bit of something like an opiate or midazolam can be so helpful in making everything. A less stressful and less negative for your patient. And it's certainly coming in through the fear-free movement in the US that they're starting very much to not mask down anything at all and certainly try and avoid it without some kind of pre-medication.

And so I think we need to be thinking about getting towards that a little bit. Makes it safer for everybody. Another thing that I'd like to highlight, and again I think this is something that can be quite useful, and I can certainly point you in the right direction for a reference, is using your catnograph.

On your awake animal. So if you put it sort of, over the animal's mouth via a mask, perhaps, you can see if that animal is reading relatively normally or quite abnormally. And certainly, Mike Stanford and John Chitty have Documented, how to use kenograph, in exotics, and B, how to use it to assess the success or failure of treatment of respiratory diseases in rabbits.

So again, it's a bit of lateral thinking in how to use things that you already have. And again, that can be really quite useful. You may not hear very obvious long sounds.

But if you put the camera graph on and go, oh, this is not good, then you know perhaps you're in more trouble than you think you are. In terms of actual physical diagnostic samples that we may wish to take, then again, we need to think about doing these appropriately. And quite often, certainly with animals with nasal discharge, the temptation is to do a nasal swab, brilliant, absolutely, but we have to remember that all of these species, either they eat yotrophs or they A coprophagic, so their nose is definitely in and amongst faecal matter.

So actually what we don't want is a sample, certainly from the external portion of the nose. So what we want to do is a deep nasal swab that is taken via the nays that have been cleaned so that we don't get faecal contaminants. And that's why we do deep nasal swabs, so that we get something that is relative to the disease of the animal.

You might want to do lung washes, and they're certainly perfectly possible, but remember the lung volume is much smaller, so the volume of wash you would introduce would therefore be significantly smaller. With some of the smaller rodents these are very technically difficult or impossible, but again, certainly with things like guinea pigs and chinchillas and rabbits, they are perfectly possible, as long as you're careful. You might wish to just get a tracheal swab.

And again, if you can visualise the glottis then absolutely. But radiography, perhaps advanced imaging are gonna be your key things with things like serology or PCR exams to back up your clinical diagnosis. CT now is certainly coming down in price and certainly many places are attempting to do rabbit CTs conscious.

So it's becoming a lot more accessible for many more species. MRI is always going to be a little bit more expensive and more difficult, although we certainly do do that on rabbits and certainly guinea pigs, if we, if we need to. Serology is available to a greater or lesser extent for a lot of the organisms that we are looking at, but whether it's always available commercially is certainly questionable, and you may well need to go to specialist labs to have a look at some of the serological levels and also PCRs for some of the organisms as well.

So it may not be easily available from your regular lab. But again, it's worthwhile sort of seeking out . People that will provide these services should you need them.

And sadly what we may need to do is to consider postmortem examination, whether it is of an in contact or one of a group that is potentially suffering. And certainly where we're dealing with groups of animals, I think that's a very viable proposition. So, we've got this patient, we've examined it, we've decided on diagnosis.

We may well need to stabilise it. And again, it's coming back to our first principles, oxygen, warmth, if it's required, minimum of disturbance. So making certain that anything that you're medicating it with, try and get the minimum amount of issue for that patient and consider whether oral or parental medication is better.

Because the stress of being handled is, is always going to be a difficult one. And then consider whether you need medical support at this point. So things like bronchodilators, things like nebulization, again to help clear the airways, to moisturise and that type of thing.

And remember that fluid balance and nutritional support are really, really important. If that animal is breathing so hard, it's not eating, then it's definitely dehydrated and it's definitely in the negative nutritional balance. So we need to set those things right as well as everything else.

So I want to go on to some of the specific conditions, and the first and most obvious one is snuffles in rabbits, and very typically thought of as only pasturella, pasturerella maltocida. That isn't always the case. And to remember that snuffles, while you certainly see it at the nasal, entrance.

Will not necessarily end there. And a lot of these rabbits will have a significant amount of Nasal discharge and you know, issues with breathing, but they may also have, for example, abscesses throughout the lung, they can have a pyometra, they can certainly have an orchitis, all sorts of other things, and certainly many middle ear and inner ear infections that we identify are pastureella. This does need to be identified properly using a deep nasal swab.

But again, to remember that actually pasturella can be carried in the nasopharynx by quite normal rabbits in a similar way to the fact that 1 in 4 of us carry MRSA. So let's really sort of have a little bit of a think about it. And I think we need to confirm the diagnosis.

And ideally do a culture because in the age where in many countries in Europe, you cannot prescribe a fluoroquinolone as a first line treatment, period. And in many states in the US this is also becoming standard. Unless you have a culture that backs it up, we are going to need to start to change that paradigm fairly soon.

And we all know that one of the first things that all of us will reach for is the fluoroquinolone because it's authorised. So if we have the data and we have the backup, then in order to protect our ability to to prescribe, then absolutely we are gonna need to do this. And so we need to think about suitable culture samples.

We need to remember, certainly with rabbits, with snuffles that actually we need to evaluate the whole rabbits and to remember that even if it sounds good on auscultation, that lung is likely to be a little bit more compromised than we think. One of the key things that I find with snuffles rabbits is that they get a lot better in themselves, but they're still sneezing, they're still snuffling. And so I do think that reviewing the husbandry and the environment is really important.

No, I don't think they're allergic to hay, because we, you know, just think about it, but they may well be sensitive and sensitised to dust in the environment, particular issues. So again, let's look at that. Let's reduce.

The stress, because the less stressed any animal is, the better its immunity is. So again, look at that and sort of say, OK, well it might seem to like the dog, but perhaps maybe just for a little while, the dog could be somewhere else just so that we can get things a little bit more under control. If we have a culture, then we can think about appropriate doses and durations of antibiotics.

And I do think that we are going to need to use antibiotics, but I think you probably have all got by now the fact that actually I'm trying to get everybody to think about not only using antibiotics, but everything else surrounding those so that we can make that animal feel better. Antibiotics will make the animal feel better in a week. If your little boy has a cold or a pneumonia today, he wouldn't only get antibiotics.

He would get Calpol and he would get Brufen, and he would get all of the other things surrounding that. And our patients deserve that kind of care as well. And then to remember that for some of these cases, so some of the very severe rhinitises or sinusitis, surgery may well be, a significant requirement eventually.

So for pastorella, the key points are the environmental factors. So the cleanliness, the particulates, the exposure to other things. Pathogenicity of the isolate.

So in some cases, pastorella will produce both endo and exotoxins, and they also produce something called adhesin, which again affects how that bacteria binds to the respiratory epithelium. And to remember actually in many cases there are comorbidities. So things like ciliary associated respiratory bacillus, we'll come to that.

Things like borderella definitely causes damage in the turbinates. Things like Moroilla as well. And as we look at other diseases, you'll see that we're gonna kind of come towards a common theme here.

So mycoplasmosis in rats, again, absolutely a common thing, but it is not the only cause of respiratory disease in rats. And mycoplasmosis certainly is related to the genetic makeup of the animal, as many are bred to be susceptible, can develop very early and it is really hard or impossible to completely clear. So these animals may require either long-term or pulse antibiotics with other supportive elements in their care plan.

So, it's mycoplasma pulmonous, and it can cause both acute and chronic disease in rats, mice and actually in other species as well. Usually, it's spread by direct contact or aerosol, so aerosol of sort of sneezed out particles or dried up respiratory secretions that have become dusty, can be spread, via the uterus. But in this disease, stress is also a key factor.

So again, we're getting to a theme and immunosuppression due to comorbidities is also significant. Environmental conditions are also contributory to the to the disease. So it goes back to getting all of this information up front.

There are various different treatment options and if you can get the most specific diagnosis, then brilliant. There are various diagnostic tests available. These can be a little bit difficult.

Culture is, is problematic. So serology or PCR are certainly available. With this disease, fluroquinolones are effective, but just remember that you may very well see this presenting in rats that are 6 or 8 weeks old.

And do we definitely, are we certain we want to give fluoroquinolones to animals of that age? So we should perhaps in terms of antibiotic stewardship, be looking at other options as well. But again, we really need to be thinking about the adjunctive treatments.

Rats will get a hypersecretion of mucus, and they will get reduced clearance from the epithelial cells. So the, the mucociliary elevator is knackered, sadly. So you've got a lot of Discharge, perhaps it's a little bit more fluid, perhaps it's sitting there pooling in the lungs.

So you may very well need to have other things such as nuclelytics or decongestants. You may wish to attempt a cuppa and a lot of. Ratt owners you might wish to use bronchodilators, and again, we do use things like salbutamol inhalers in small enclosed boxes quite often for these guys, and we may wish to nebulize them.

So the features of mycoplasmosis, environments, comorbidity, again, the hyper secretory syndrome is very specific to rats. So it's rarely seen in other species, but we need to remember that. And as I said, the clara cells within the rats respiratory system help the mucus through the elevator.

This disease takes them out. And this disease heals by scarring, not by normal lung tissue production. So again, these animals are compromised.

Borderella, very common, we see it in a range of species, common in guinea pigs and just to remember that it's zoonotic. It can be down to stress, poor husbandry, that type of thing. You may well see it in guinea pigs that are kept with rabbits because it's often thought of as a normal commence in rabbits, but it isn't it's, significant pathogen in guinea pigs.

But remembering that other animals within the same environment may be asymptomatic at this time. And again, it depends what the animal's immune system does with this. It's a round and about in the environment, so fomites, direct contact, but again, aerosols.

So aerosolization of respiratory secretions or dried respiratory secretions in the environment. And remember that some of these bacteria and Bollerase one produce biofilms that will protect the bacteria from host defences, and we'll talk more about those in a minute. Chlamydia cavii.

Again, other types of chlamydia as well, upper respiratory disease, conjunctivitis, can be a venereal infection, but quite often, is respiratory in rodents. And again, you may well see other sort of aspects. So you might just see rhinitisis, but there may well be a pneumonia.

And again, stress can certainly be a trigger. Cila associated respiratory bacillus or CARB, and again, this is really, really common. It is a round and about in many rodents and it is likely mostly to be a co-morbidity.

But again, to just remember that this type of bacteria, it's around and about, it's affected by, a reduction in immunity. It's affected by, things like pasturella or Bella supervening, but it can be anywhere within the respiratory tract. So again, if you see an infection behaving not as you would expect, think perhaps there's a comorbidity there.

And I'm gonna go briefly through the rest of these bacteria. So chinny bacteriumccheri again causes pseudo TB. We see it on occasion.

Clasella pneumonia, again, we see that sort of fairly regularly. It can be part of the normal intestinal flora. It generally causes low level disease.

Adenovirus, increasingly recognised in guinea pigs, particularly young ones. Not as common, but the mortality rate is relatively high. And again, you'll see these animals actually really quite acutely ill with what seems to be a pneumonia and quite often, a sort of a scleritis and conjunctivitis.

And then other causes of disease that are not what we think. So fungal disease, we might well see histoplasma, we will certainly see in some of these guys aspergillosis. I think things like AD spiomycosis and pneumocystis are relatively rare.

And again, if you find it, then, you know, brilliant diagnostics, but not perhaps on the top of the diagnostic list. And then things like Sendai virus and silodacryo adenitis virus, both of these, Sendivirus in particular, are related to other more commonly known viruses. So Sendiviruses related to human power influenza and will cause quite significant disease outbreaks in lab rats, but it certainly will be seen in, pet shops on occasion.

And yodacyadinitis virus, coronavirus. So we know about coronavirus, we know that those can act in certain ways and we'll certainly see issues in mice and rats, certainly from shops where we've had perhaps a lot of mixing going on. And to touch on very non-infectious respiratory diseases, allergies I've touched on.

We have very little evidence for inhaled allergies at the moment, which doesn't mean that they don't happen. It means that we don't have the evidence. So all of us, every time we treat and diagnose one of these, diseases, creates a data point.

Which means that actually we should record some of these things that we diagnose and then eventually we can get some of this evidence a little bit together and some of it is going to be anecdotal. What about things like fibrosis? And again, so we see that certainly in Westies.

We think that we will see that in some of these species as well. And certainly pathologically it's found. What we don't know always is the cause.

Foreign body inhalation can happen, anything. And other things, so, you know, pressure trauma, infection from within the hospital, aspiration, heat stroke, very topical at the moment, and actually misdiagnosing respiratory disease where you actually have a cardiovascular disease. And then finally neoplasia, and again we see primary and secondary tumours associated with the respiratory tract.

Not commonly but certainly regularly. So what are we gonna do? Ideally, primarily diagnose and treat the underlying cause.

But for the welfare of that individual animal in particular, just giving the specific treatment, the antibiotic might well not be enough. So let's think about the respiratory functionality. Let's think about pain and discomfort.

Let's address that inflammation. And let's have in our hands things like rabbit puss because actually pus in the lungs is the same as passing an abscess. So let's think about that because that's difficult to clear.

And let's think about things like biofilm. So I'm going to put up one side of suggested antibiotics. And again, these doses are safe generally for rodents and rabbits.

There are a range of doses published relatively widely. But all of these are safe, within all of the species. And these are things that are very commonly used.

So N refluxes and ferocriolin at the top, sulphur for, tramethrin sulphur second, both of which have authorised preparations. I very commonly use doxycycline. I use an oral preparation, called Carryox.

I very commonly use marbafloxacin. And also, azithromycin as well, or with good effects as long as they're used appropriately. What about the other medications?

So I mentioned bronchodilators. Some of these doses are relatively specific, and some of them aren't. Salbutamol, this dose is a specific rat dose.

Theophylin again, very useful on occasions, just make certain, that you know the baseline heart rates, because obviously it will alter that. Definitely remember your analgesics and your NSAIDs. So I use meloxicam very commonly because it's a liquid formulation, so I can dose it accurately.

And again, the the dose range is relatively wide. I do go, these days for a probably a more moderate dose and add an additional analgesic if I need it, rather than going perhaps to a very high dosage. But with many of these animals, giving it twice a day will work clinically a lot better.

I am starting to use paracetamol, certainly in rabbits, and it can be used alongside meloxicam because it's not a non-steroidal. So in terms of that, it works in COX1A or a COX 3 pathway, and it, we don't yet know. So it doesn't work in the same way and the enzymes that degrade it are different.

So in terms of that, 20 mg per gig is a very low dose for a rabbit. We can go very much higher, but we're getting a good clinical response to that. I do use tramadol, and again, rabbits and rodents seem to have the enzyme that transforms it into the active form.

And again, we're getting good success. I tend not to use steroids unless the animal is very much end stage and that the owner has had wide counselling in terms of the fact that we may make things worse. Cos most of these species are very steroid sensitive.

So, I said I would have a quick word about biofilms and then talk about things surrounding that a little bit. Biofilms are becoming more and more important, I think, in veterinary practise in the next 10 years, biofilms. Antibiome are gonna be the big watchwords.

And we certainly know that many of the bacteria, for example, Pasorella, Pseudomonas in particular, will produce biofilms in, in vivo. And what this means is that bacteria that colonise very particularly surfaces, so for example, the surface of the epithelium and the respiratory tract will Genetically change their behaviour so that they produce something called a biofilm, which is essentially similar sort of mucopolysaccharide film and they behave quite differently from the same bacteria in their mobile form. And what that means is that they can be difficult to culture.

The biofilms with the bacteria will damage the underlying epithelium and remove the cilia and remove the goblet cells they take them out. They certainly My Have subtherapeutic doses of antibiotics can almost induce biofilm formation. And the biofilm itself protects the bacterial colony from the host defences and sometimes to a certain extent, antibiotics and drug therapies.

So they're really important things to consider, but the biggest thing to consider is actually there might be things there that you can't culture. So what do we do about that? So actually in humans with cystic fibrosis, things like acetylcysteine and wanesin are quite often used in order to try and break up the mucus within the lungs, but also hopefully within the biofilm.

So we certainly would suggest considering using these medications. I tend to use acetylcysteine. It can be given orally.

It is a sort of a protein. It is sort of an amino acid, it's not, but it's that kind of a structure. It can be very safely given orally to, any species and for those owners that are difficult about using flavoured.

Types of acetylcysteine, there is actually a vegan formulation available at a high street, health food store. So I do use that kind of thing. I will use a decongestant.

So quite often I will use things like phenylaphrine, but again, remembering that actually that will dry the mucous membranes and that lack the mucuscillary elevator. So it may not be as helpful as we think, and certainly in rabbits, it's not massively helpful. What about mucokinetics?

Yeah, get the saline in there, get the mucociliary elevator working better. Maybe nebulize them with it. And consider things like rohexane, which is, you know, somewhat mucolytic and also an expectorant so it makes respiratory secretions much more liquid, but also, allows them to come out more easily.

Which brings me to nebulization. It's applying, medication through the airway, so directly to where it needs to be. Certainly there are a lot of recipes for this available for birds, but it's hard to find doses for rodents and rabbits.

So the yardstick that I go with, and again, many of my colleagues do too, is that actually we use doses similar to the oral or parental rule doses given over sort of 25 minutes or so with saline as your carrier. And there are a lot of very good, nebulizers. The one that's there, to advertise it somewhat is, is silent and very easy to use and actually relatively, inexpensive.

You can put things like melytics and acetty cysteine through this. So again, it can all be very, very useful. So I'm going to stop talking and hope that we've started a conversation and hope right now that actually you're thinking about the things that surround everything that we're doing with our rodent and rabbit patients so that we can certainly sort of ramp up the welfare, but also ramp up your good outcomes, for, for these little guys.

So yeah, thank you very much for listening. Thank you very much, Molly. That was, an extremely detailed and informative talk.

I'm sure, everyone will agree. You're asleep probably. Nonsense.

To everyone who's, listening, if you do have any questions for Molly, Molly's agreed to stick around for a little bit, and answer any that she can. So if you submit them into the Q&A box, we'll go through a few now. So we have, one question that's coming in from Jill already.

What dose of, midazolam is safe in respiratory compromised rodents? What I tend to use is 0.05 mL per kilo.

And so it will just, it's just anxiolytic. It won't sedate them massively, but it's usually enough to stop them stressing and you can give it to up because because it's water solu, you don't get the inflammatory effect that you get with diazepam. So it's much more predictable as well.

Wonderful. Thank you very much. We don't seem to have any more at the moment.

I hear that start to come in now. Excellent. So, Maria is asking, what dose of acetylcysteine do you use?

So currently there is not a specific dose. There isn't in humans either. So depending on the size of the animal, I usually get owners to buy the capsules themselves, and then we divide the capsules up and, you know, give what appears to be an appropriate in inverted commas amount, because it's not a drug and It is sort of essentially similar to an amino acid, then there aren't side effects or negative effects associated with it.

But also it does mean that we don't know what the effective level is. And, and that tends to be the same in, in those people that are using it for dermatological reasons as well. We're sort of giving a, a sort of one size fits all until we know better.

OK, perfect. Thank you. Do you know if there are any those sort of looking into that at the moment?

Yeah, there, there is actually. I happen to know one at the moment, so watch this space. Excellent, thanks.

Lauren's asked, how often would you recommend nebulizing rabbit with the likes of F10? I probably do it twice a day for 15 and 30 minutes, and I, what I tend to find is you kind of have to increase the time, as you go along, as the animal sort of gets a little bit used to it. And you do need to train them and get them comfortable.

Of it as well. So I usually nebulize them in quite a familiar place, potentially, for example, you know, their travelling cage that's covered in towels or covered in plastic bags or something like that. And certainly makes sense they have food and treats and stuff in there.

But yeah, sort of up to 30 minutes twice a day. Perfect. Thank you very much.

Maria is asking, do you run any viral diagnostics routinely on rats? I always offer them, but very rarely do I get much pickup of it, sadly. Yeah.

I, I, I, I do tend to find, and I, I know how, where everybody's coming from, it's very difficult sometimes to get a lot of these guys to, to put their resources in that direction. Mm. OK.

Yeah, I mean, it, it's an awful lot of X-rays if you're spending 150 quid on viral diagnostics. So, yeah. No problem.

And, we've also got a question. If an owner declines cultures or PCR, would you use empiric antibiotics? Yes, I would.

And I, I do get to that point where I, I feel like we almost, tie our hands behind our backs if we can't do diagnostics. And sometimes, actually, somebody has to say, look, let's do something to make this animal better. So yes, I would, and I would never criticise for it.

But as long as we've got a good clinical pathway and we've got, you know, Relatively clear, sort of diagnostic, pathway that we've gone through and sort of said, OK, we're not doing that and we can't do that. I suspect this, and therefore I'm going to do that. Absolutely.

And again, I think that would be very, very, justifiable because I do have the range of clients from, I will spend anything to I've got 5 pounds. And I, I totally get it, yeah. And then do you have any advice for, sort of what to say to the clients who perhaps a lesser, Oh.

I usually, I usually say that if, you know. It, it's their animal, it's absolutely their decision how they want it to be treated. Just because we can't buy a Cadillac doesn't mean you can't buy a great secondhandini.

So we can do a good job, and that's where looking at all of the peripheral stuff comes in. So it's, it's about making, doing something to make that animal feel better. So we might not know the direct specific antibiotic, but actually if we've given it pain relief and we've nebulized it and all the mucus is gone and it's eating and it's fluid balance is OK, you know what, it's immune system may kick in and up.

Yeah. So it's, it's about looking at all of the little factors and doing all the, all of these little bits extra that will make you, you're a lot more effective. Wonderful, thank you.

How many, rodents do you see in practise out of interest? I don't do cats and dogs at all. So, currently, I've today done surgery on, a rabbit.

I've done surgery on a 30 gramme hamster. I've got 2 guinea pigs in hospital. I've also seen a dogue, I've seen two rabbits, so I see loads.

And again, it's absolutely the massive variety from people that are totally willing to do. What should be done. I don't do stuff for the sake of it to people that really are, are, are strapped and really thinking about just getting a new one.

So, you know, just try and do the best you can. Yeah. What, what's the insurance situation generally like in, in rodents and rabbits compared to the more popular small animals?

Yeah, so rabbits are very commonly insured now or much more commonly insured, but the, the insurance levels are lower in general, although that is likely to change. You can certainly insure guinea pigs and chinchillas. Some of the smaller specialist rodents are insured as well.

But again, that tends to be relatively rare. And again, you need to go through a specialist company for that. Yeah.

We have another question that's coming from Maria. What would you consider as better practise? Floroquine loans or azithromycin without culture and rats?

Owners tend to ask for azithromycin more and more usually through forums. Yeah, no, absolutely, because there's somebody called the Rat lady that published a dose about 10 years ago in a nice big rat sort of formulary. And again, if you look at how azithromycin is used in humans, it is not used twice a day at all, and it's certainly not used for any length of time.

I think that's a really hard question actually, and I'd probably to be down your sort of cascade route, you'd have to use fluroquinolone first. But, you know, at that point it's difficult if it's already, if it's come to me, it's already had a fluroquinolone and it's struggling. And I'm quite happy to go to something different, although I, I tend to go with doxycycline actually, but .

Now, I do have those people that come in and they now want. Yeah. And do you know of any good, resources for pet owners, perhaps to keep them informed as well.

Hm, I think that's quite a difficult one. The Association of Exotic Mammal Veterinarians has a website, so that's actually usually quite useful in terms of finding a suitable vet, but also care sheets. The Lefeba website, they're a food company from the US, but again, they have a brilliant website.

Both Supreme and Burgess, pet food companies have some information on their websites, although it's less about medical stuff. A lot of, veterinary clinics and stuff have again owners that, owners access, Veterinary Information Network, so Vin has, known as Portal as well. So there are a lot of things around that.

I just don't tell people not to go on forums because you don't know who's on them and you don't know the qualifications, and they may well have some kind of maps to grind. Yeah, I. Yeah, of course.

Very, suspicious of those. Absolutely, got another question here. Would you recommend vaccinating a rabbit while suspecting an active pasturella infection?

I think it depends how worried you are, actually. But certainly with the RHD2 vaccine, they're one of the brands I think you can use, unless the rabbit is really, really unwell, that it's actually safer to vaccinate and risk getting the infection. But in general, I would try and get the animal as well as possible so that you actually get a good response to the vaccine.

But all of the vaccines at the moment are sort of antiviral, they're not bacterial. So although they rely on a good immune response, hopefully, you wouldn't set an animal back too much. But right at the moment where I work, we're getting a lot of rabbits dying from RHD2 and I had a suspect one today.

It is definitely round and about. Would I vaccinate a rabbit that's on antibiotics for that? Yes, I would.

As long as it's not massively ill, yeah. Perfect. Thank you very much, Molly.

I think that that seems to have answered everyone's questions very nicely. As I said, it was a very informative, talk, and we do really appreciate that. Thank you very much for joining us and, for answering the questions there.

OK, thank you very much, Paul, and thank you everybody for attending. Yes, thank you, everyone, and we'll see you on another webinar soon.