It's a great honour to be invited to speak at the Virtual Congress. Thank you very much indeed. This is the first talk I'm doing from its current location and, my broadband, whatever it's called, has, has just gone orange.
So, but it seems to be working still, so hopefully we'll just keep everything cross and hopefully it'll be all right. So, guinea pig diseases tonight, . And I'm trying to move it there.
So what I'm gonna try and do tonight is, really just go through a few common diseases. I'm hoping we're also gonna, because I can't cover all the guinea pig medicine, in, in, in, in, in just a short space of time. There's a lot more known about it, which is fantastic.
But it does make the job of this, this talk quite difficult. And, and the spoiler alert is, is such is a textbook on guinea pig medicine on its way, hopefully later this year. .
At the end of the year, but, just watch out for that and that'll be really exciting as well. There's so much more coming through about these guys and they're brilliant pats. So tonight I'm just gonna do a few different diseases, .
And hopefully have some time at the end for questions if you want to introduce any areas you don't feel I've covered or we were hoping I'd cover but haven't done. So we'll see what happens. So everything starts with biology, and I was like linking back .
To the biology of these species, and also how we then keep them as a result of not knowing about their biology. So let's have a look at, guinea pigs. These are wild caves.
There's several species actually, but, fundament they're South American. They have this lifespan of 5 to 10 years, and that must be one of the things I've always felt with these, these, these guinea pigs is they don't live as long as I think an animal that size ought to live. And then, and then very interesting the wildlife span of 5, 10 years is very similar to a captive lifespan of about 5 to 10 years.
Tennis being exceptional. They are hystriomorph from rodents that refers to a type of dentition, and they live in small groups, generally family units. they're certainly not solitary.
They don't live in vast sort of small family units and come feeding and stuff. And they live in dense cover. These are not open areas, so one of the differences with them in rabbits is that rabbits, you know, have have burrows and stuff, and that they then .
Come out in the open and feed, whereas guinea pigs tend to just live in dense cover and occasionally pop outfit if they have to. And they feed on coarse vegetation areas. One thing you do have in common with rabbits are they are coprophagic, this is very, very poor standard of nutrition, and they, they've got a hindgut ferments as well, so they, they, they reingest this this digestible faeces, and they have the same sort of me, not quite the same as rabbits, but sort of mechanism where they have digestible and indigestible faeces.
And so keeping them. You know, really, we want to replicate the wild, but can we? And how do we do that and how similarly can we get to that?
Because that's really what we want to try and do. We want to try and fit what we're, how we're keeping them with, with their, their biology. And yes, guinea pigs have been domesticated, if you like, for a long time, generally, in roles that have quite a short lifespan, but, .
You know, that domestication does not overcome basic biology. So They have needs. And whether you keep them indoor or outdoor, and there are good ways of keeping them in both situations, they have those needs and those need to be fulfilled.
So always, whenever you set up a husbandry system for any animal, you know, look at those five freedoms, look at those things you need to fulfil to keep the animal happy. And that's not just always just the basic, you know, . Diet things is not the basic, shelter needs, we've gotta think about, you know, reducing fear and distress, we've gotta think about providing for their biological needs and what they want to do, within that.
For guinea pigs in particular, we've got to remember they are a prey species, you know, they're fed on by a lot of predators in the wild and they they they they they're adapted accordingly. And again, don't forget they live in groups. These are not paired animals, these are not solitary animals, they live in groups.
And. Sometimes we keep them mixed species, and we've got to remember that group living animals want to live with the same species. They don't, you know, living with a single guinea pig living with a person, very close or whatever else is not quite the same.
Living with a rabbit is definitely not quite the same as well. So, you know, we want to live in groups of the same species there. They also live in deep cover, they need that cover and hiding in the captive situation.
And stuff like just very, very similar to rabbits in some ways is that actually if you do provide a lot of cover, and a lot of hiding areas, they will probably come out more, you'll probably see a bit more of them. You've seen everything dive back in very quickly. But fundamentally they do need to have that that little shelter, and that ability to get out of the way from the predators all around them, being a dog, cat, or person.
They are also reasonably territorial in the world. So again, they need to have sort of like familiar surroundings, and they will form these territories or these areas where they are, will become their territory, and keeping shifting about will actually cause some stress and and and what have you, because they they won't be able to set those territory up, they won't get familiar with it. So again, once you set things up for these guinea pigs, keep it reasonably similar all the time.
One important part of keeping them is, of course, as well as providing the husbandry is is is providing their diet. And this is what I like in life, I like keeping it simple, grass and hay. These are real fibivores, they like a lot of fibre in there, grass and hay.
And that should make up 85 to 90% of their diet. And it should make up 85 to 90% of your diet in terms of calories. So if you look in terms of volume, that's not gonna quite work because grass can really poor in calories, so you know, we want a lot of volume and that's why I quite like the, the sort of UK pet food, .
Posters and give you an idea of, you know, how much of each to give in terms of proportion. And you can give a lot, you can't really overfeed the fibre, element of a diet. And so if you're ever going to increase the amount you're giving, then, you know, you, you increase that fibre side rather than the other parts of a diet because they're the ones that might actually lead to over calorifying the diet.
There's a note also put this post up too, so I was like this one about the feeding enrichment and don't forget that feeding enrichment's quite important too. You know, all these animals do forage and their ways of making it a bit more exciting, very simple things like even putting food in tubes, making them work for that. But they're nice sort of forage toys and things about now, which is lovely, and give us all more options to make their lives a bit more interesting.
So don't forget to enrich as well as just providing the basic, nutritional needs. Now, as well as the fibre, we also give them fresh food. And fresh food does add some of that interest and enrichment, you know, a little bit of, bit of variety, not too much, but a little bit of variety that's good, it's just different flavours, different things, they do have their favourites.
This is my herd of, sows. I'm feeding on some, spare cabbage leaves. I do like that, as you see I keep mine outside, .
They also give them different micronutrients and that can be important, as well as the macros coming from a basic fibre, and it provides them with a lot of a good source of water, and water as we're gonna do at the moment, is a really quite important part of that diet for these guys. So again how much be careful the volume of . Of the fresh food, because too much you're gonna start reducing, that fibre intake, because you may end up with selective feeding.
The other thing too, we can look at at the moment as well is, you know, just not overwhelming with one particular type of fresh veg every single day and things, and if in doubt feed a mixture. And we're also gonna talk a little bit about the simple sugars you're gonna find in some of these as well, which may also cause some degree of issues, maybe bloating, maybe other other things as well. So If we're doing fresh food, what do we provide?
We get another poster some PDSA one, it's really nice. We normally, well, actually things like weeds are really good too, so, you know, good old dandelions, dark green leaves you find, find, out in the garden and stuff are really good as well, and there's information available on what's toxic to what you want to avoid. So, you know, otherwise you're gonna, you know.
Good good good safe way you see you see you see things you give you rabbits and give you guinea pigs as well. You give him some veg. Again, some examples on there.
You can add some fruit in too, but I would be very careful with that. Again, these simple sugars, an overwhelming amount of fruit, you might end up with some bloating issues, and also you may even end up with some dental issues, with, with the simple. Sugars involved as well, and that can be a problem.
And now I also add in things like root veg, and I do love things like carrots and stuff. But, you know, just be careful on those. There's a lot of change now that, the commercial, vegetables, root vegetables especially become much sweeter, to what it used to be.
And, you know, nutritionally for the animals, they should almost be regarded as fruits rather than than than vegetables with that. So you know, like a wild carrot is a very different creature to a commercial carrot you're gonna get from the supermarkets and stuff. And these compositions are changing all the time with the breeding with human if you like, human selective nutrition.
So just be a little careful on that too. And also, you notice this post everything's in moderation and that's really important. So, you know, if you're gonna give fresh food, you know, do 2 or 3 a day, you know, make it a bit of a mix, and, you know, give, give them some some some choice, a bit of this and a bit of that, and you're gonna get a better range of micronutrients coming through too, and not, you know, cause these potential dietary issues from having too much of one thing.
And what Mike Cotri we really do know about guinea pigs, it's about vitamin C. This is a classic vi vitamin deficiency in these guys, and they're unusual in that they don't, they're a bit like people, they don't produce their own vitamin C in the gut. So we need to provide them 10 to 30 milligramme per kilogramme body weight per day.
That's quite a lot. And, and we can get that from fresh foods, the big one being red pepper, and that, that's, that a little bit of that can be really helpful with that too. But things like, you know, if a lot of fresh stuff we have it too, grass and all the rest of it, you can get some vitamin C from all of these, and we can do that.
The pellets, would also provide this, but what is really important with this is that it will. Oxidise very, very quickly indeed. So you've gotta be really careful with open dates of packets.
So if it's more than 3 months after a packet's open, some of these, pellets we have lost over 50% of their vitamin C content is through natural oxidation. If you store it badly, if you keep it badly, then it's gonna be much more rapid, and it's gonna break down that much more quickly. And so basically like all these things is you've gotta look at the quality of not just the actual initial product, but what, how you, the quality of how you've kept it as well.
And then manufacturing is a really good product, but if it's stored badly, kept badly, then that, that's a problem. One thing to always say to people is, look, when you buy your pallets things, make sure you buy sealed packets, don't, don't buy sort of, you know, like hand dispensed stuff because you don't get sure how old that can be. You can supplements, generally we say don't add this to water, it'll break down in sunlight, it's a very, very fragile substance.
And also it will break down in contact with, zinc. So if you've got a drinker with a galvanised spout. Then you're gonna find that it starts to, to break down with that as well, so probably try and avoid water just doing and generally I'll get people to use the the sort of chew human chew tabs solid supplements and sprinkled over the food, as a much more stable way of doing it.
Hard to overdose vitamin C, that's the other good thing too, so you can give quite a lot, because it just generally comes out of the urine afterwards and that's absolutely fine. And a brief note to avoid, citrus, because that can be a acidity of citrus fruit can cause mouth problems and can cause some ulceration around the mouth, that, that, that despite direct contact. The other big nutritional problem is obesity.
This is really common. I love this guinea pig seizeometer from the UK Pet Foods again, and, you know, I look at my guinea pigs, and they're 3, 4-ish, and they're to size, so I must be feeding them a lot. But a lot of guinea pigs we see in practises are up in the 5.
It's very common indeed. How do we avoid that? Well, we avoid that with obviously feeding less, feeding more fibre and more exercise and more doing things, more enrichment in their lives, so it's really helpful.
Well, the consequences of obesity, well, same as everything else, really. We do see musculoskeletal disease or worse than that, so a lot of arthritis and guinea pigs and stuff. We do see cardiorespiratory disease, and that can be a big problem, and we'll also see, things like, hepatic lipidosis.
That is a cause of sudden death in guinea pigs, as the liver becomes very friable, very fragile, people pick them up by the middles, and that can actually rupture your liver if you're not careful you got very friable liver. And they also get these amazing, fatty depositor eyes, and we'll see that with, with fat guinea pigs as well. A very particular problem linked into dietary calorie is, pregnancy toxaemia.
Great link between diet and demand is easy to be, and they've got a, typically, you know, beef guinea pig, typically being fed so we like high calorie, easy carbohydrate foods, and, you know, we have the demands from. The, the, the growing foetuses, in later pregnancy will, will, will result in this pregnancy toxaemia. And guinea pigs of course have it very long gestation, 63 days, and they produce these very precrocial young, and, so they know this is really is quite a demand on, on the sow, at this stage.
And many of these do die from preemia, it's very hard to treat it, . But what do we see, we typically see a guinea pig who's just plain unwell, very late stage pregnancy, you can palpate the the the the kits quite sim quite easily, you typical your history anyway, if you want, . To do some testing, you should be able to pick up ketones in the urine or in the bloods, high levels and that's pretty it's gonna be diagnostic treatment, you know, supportive care, a lot of fluid, get some nutrition into them.
Just to get something just to start stopping using the fat their own fat deposits, get food going through, and then you've got to really reduce the demand, and this may occasionally be things like trying to induce, if you're close enough to birth, you can induce with steroids, but otherwise it can often be the emerging caesarean, and these are, these can be quite tricky at that time and obviously a very high risk operation at that stage. The other thing that traditionally linked to diet a lot is cystitis and neolithiasis and this is a really common package of diseases we'll see in guinea pigs, . A lot of myths them up, they've always missed with the exotic animals, but first of all is that it's often described as bacterial cystitis.
It's common, it's linked to a shortness of the urethra, especially in the females. And this one, if you think about it, doesn't make a lot of sense because these animals have evolved over millions of years, they've got a short urethra, yes, it's close to the ground, yes, so have lots of animals, and if it was that big a problem, they've they've gone a long way down the line, evolving to still have that. And the big deal is that actually not many of these cystoetis are actually bacterial.
They're actually probably more like cats, it's more it'd be like idiopathic sociis there various different factors, but bacterial sociis really is kind of not a big deal. It happens occasionally, of course, and it can be often secondary to other issues as well, but there's a primary problem, really unusual in my experience. So, you know, just just bear that one in mind and inflammatory changes is not necessarily call infectious changes.
And very difficult getting urine samples, we'll just cover that in a moment, but difficult getting urine samples of these guys, without getting a voided sample, and a voided sample is gonna be packed with bacteria every single time because they go out through this like this singular, not quite a vent, not quite a single opening, but they do have, you know, there's this area where urine enters and it's faecal contamination's really common. The other thing too is it's really common, it's linked to calcium oxidate crystals produced due to excess calcium in the diet, or calcium carbonate crystals, both are found in in cystitis. And again, we're gonna try and explore that one and try and hopefully just try and move away from that theory, because actually the natural guinea pig diet's got quite a lot of calcium in it and they're designed to really move that through like most herbivores.
We're gonna try and explore that a bit more depth. Now what I'm gonna try and propose is that actually most of the cystitis, as mentioned, is idiopathic. And actually we, we see there's a continuum of signs leading to urethiasis.
So in other words, stones are not a separate condition for cystitis. They're if you like the end stage of it, and in the middle of that you've got things like sludging and and and and crystal urea. Underlying causes will include things like reduced urination or reduced water, intake, or both.
And very much, I would see this as a disease of indoor caves, occasionally outdoor, a few people report this. I've never seen one myself, but some people report this. But basically indoor caves with like potentially stressful situations and low grade dehydration from living in like modern heated houses, which often have a hot, dry atmosphere.
So society itself, it's very common, clinical signs, typically things like vocalisation on urination. I'll also mention things like vocalisation on defecation is common as well. And, and that's that's that that can be quite confusing.
You will see hematuria in places and sometimes you'll see urine staining on the back end of a guinea pig as well. And in terms of diagnosis, yeah, that's pretty much it, clinical science and history is gonna give you that basic diagnosis before you move on to refine what else might be going on, what may be causing it. One big thing is, can you distinguish stones from cystitis?
Well, you can, if it's, completely blocked, if they've collapsed with that, you know, it's pretty obviously can. Sometimes you can palpate them, but it's unusual. So basically if you get a guinea pig show these sides, those are exactly the same sides you're gonna see with with stones half the time, so you know, it's worth X-raying and seeing what it all looks like.
But I'm gonna start with talking about the end stage, which is unusual with these, we when we start beginning and move to the end, but we're gonna start with the end stage to about stones because in some ways decision making can be a bit easier, well, possibly. So if we have stones, we always think about doing surgical therapy. The surgery is just like dogs and cats, but it's smaller.
We open up a guinea pig, we open up a bladder, we take things out, we close it up again, very simple. There are problems with that. And recurrence is really, really common, and, really rapid.
So it's not unusual to do a cystotomy, to take stones out and have stones back again within a month. And it's really important if you do go ahead with this, that, you know, you need to talk to the owners and say what's gonna happen, because there's a big op for you getting people to go through and obviously expense and things as well, and you know, just tell them that this is going to be. We might be seeing him again for the same problem quite soon, it doesn't mean we left one behind, but you know, this, this, this happens, and this could be a problem.
So. You know, we can reduce that to some extent. We'll talk about mo with things like fluids, with analgesia, with diuresis, to, to try and reduce that, get a lot of urine going through and try and flush things through them.
And, but to be honest, very often we'll be looking at surgical therapies being almost like salvage. These are guinea pigs who are blocked, these are guinea pigs who are gonna die if you don't operate. You've see running out of options, so you do need to go in there and get the stone out to save his life and give yourself a future and give yourself a chance.
But if there are other options, maybe they're better to take at the time. Is a recurrence, is it interesting? This is one where I did, which we did recur.
This is the X-rays I hope you can see the calcium there in the bed and you can see this line as well, and that's the incision line. And basically we've created inflammation and the calcium's sticking to it. We'll look at why that happens in a man.
Which is because idiopathic exercise is a vicious cycle. So you got this thicken lining, calcification, get inflammatory reproduced. Then you get further irritation, from the stone sticking to this, or from the crystal sticking to this in cord.
I mean nasty sharp crystals thing got cloaked and stuff, irritating lining, so you get further, inflammatory debris, further stone sticking and build up, build up, so it just is, is, is a vicious cycle. So why doesn't surgery help? Because you're creating more inflammation.
You're making a hole in that, you're creating more inflammation, therefore more inflammatory debris, therefore more crystals sticking to it and more more quickly are you to get the the stones forming. So that's why. So basically what's all illustrated is that stones are a consequence, they're not diagnosed saying right.
Your surgery might buy you some time. But primarily it's a salvage. So you've got to manage these medically as well, you can't shortcut, sorry surgeons, you can't short this, you've got to do medicine as well.
And you really got to manage those underlying causes or you're gonna have a very, very short lived success on this. So, in terms of medical therapy of stone, sludge, cystitis syndromes, what are you gonna do? Well, we're gonna talk about analgesia in a moment, we're gonna talk about nutraceuticals.
Big things control underlying problems. You know, these guys are not urinating enough or we're not drinking enough. So we're gonna look at managing things like inflammatory disease, so arthritis, really common underlying cause.
Why? Because they're not moving around very much, they're not going to get their food because everything hurts, we're getting water, everything hurts. Guinea pigs urinate, lift up their back ends and inject the urine.
Well, do you know if your back end hurts your arthritis or spine, you're not gonna do that, so you're gonna hold the urine in for longer, which means the crystals stay in contact bladder wall for longer, which means you're getting more irritation. Stress is gonna do the same thing, you know, we put drinkers and things, you know, typically we'll put them on the front of the . Of, of the cage because it's easier for us to change, so we're going to, you know, we, we, we we're gonna ask guinea pig to come in the open, out of shelters to do that, we may not want to do it.
So, you know, you may be too stressed and maybe too worried by not having enough cover and not having enough hiding to to to actually come and and and and come and come and drink. And we want to increase the movement. So again, if they're painful, anything like that too, then we're gonna want to want to do something to improve that.
They also urinate more if they move more, which helps too. So we might look at vitamin C levels, vitamin C we know is involved in joints. Vitamin C deficiency results in arthritis of hips and stifles and stuff, and so that's important.
It also involved in membrane stability, and that might be important in our bladder lining as well. So vitamin C is useful, when in doubt, put vitamin C in. We've talked about diet, not necessarily a big thing in terms of calcium content, but maybe diet is a big thing if we're looking at how much water's going through.
And a bit like rabbits, there is some evidence of beginning to build that actually if you feed a high calcium up, we need to drink more, as long as they drink more, it's absolutely fine to give that calcium. If they're not drinking, there's a reason why they don't, there's a problem with that, then maybe you need to cut back the calcium at that point. But basically you're balancing calcium intake with, with, with water intake.
But fundamentally you can cure all these ills by making sure they drink more and encourage them to do that. The size itself is causing stress, it's causing pain, they don't like that. So again, relieving that pain, inflammation is really good.
Potassium citrates up there as being a potential help. I would use this myself in terms of post-surgical management. I don't use it all the time.
Simply because of a nice iron exchange mechanism. We want potassium and the, the calcium to exchange, so we're getting more soluble salts coming through in the urine and getting rid of the calcium that way rather than do it. But as a general management tool, I'd probably avoid it, .
But I would use it post-surgically and it did seem to help quite a lot. In terms of diuresis again, post surgery, avoid furosemide, it does increase calcium excretion. Although it's not a direct problem, it just makes life more difficult, so, you know, probably not one to use.
Fluozides are great if you can get them they're always available. And in the very short term, good old dandelion is a diuretic. It's a very short-lived diuretic, so, but it, it's post-surgery, it's really good for the short term.
So in diet Away, again, not calcium overdose. They're designed to eat calcium, salts, they're designed to excrete it. But the prolonged crystal contact time is a problem.
So that's gonna lead to inflammation and so this vicious circle, the inflammation and sludge stone formation from there. So we've gotta keep urinating. And they've gotta keep drinking because less reduced drinking is less urine.
So this is a big thing, it's about balance, balance, balance, calcium that balance that calcium with drinking. So you know, if you drop the calcium with diet, yeah, fine, don't drink as much, but actually we're gonna have other effects from that lack of calcium. We want to maintain a decent calcium level going through, we cope with that, but we want them to drink more to help them with that.
Terms of drugs, you know, analgesia are really helpful, you know, it is painful. But really concentrate on that pain relief coming from anti-inflammatories because typically we're gonna look at inflammatory disorders, underlying arthritis or inflammatory disorders within the urinary system. So we're gonna be using meloxicam as our principal agents that you to use a really good anti-inflammatory and these guys, lot of data coming through about how to use it as well, which is really good, so that's fantastic.
Typically quite high doses too, the licence dose is very low, but the ones that show my PK are actually quite high, and I'll generally use 1.5 MB per gig twice a day orally. Meropotent may also be an adjunct, there's little data on how effective this is, but, you know, it may be useful.
Things like opiates and gabapentin, very little data on just how effective they are. Opiates seem to be effective in my hands, but again, not so much data on these. And of course, you're not really getting to, the underlying cause of the inflammatory causes using these, but you may buy yourself some short term relief and help the guinea pig just over that short term effects and get it functioning better.
Better in the meantime, just be careful, some sedation occasionally, particularly gabapentin. And of course, things like opiates have resigned, you know, we, for acute pain as much as more than chronic, and we're often dealing here with more chronic situations, so it's really important too. The big deal is, whatever you're using is make a plan and start off with a plan and discuss that with the owners, discuss all involve with the care of the guinea pig, and make sure you know what you're gonna do.
It's very easy to take acute drugs and turn them into chronic drugs just because you haven't got an exit strategy. So that's really important, and some of these cases don't always go well if you're very long term, it's very difficult to control that pain. So you want an exit strategy within this.
So you do your plan, you work out when you can use your drugs, which are short-term drugs, which are long-term drugs, when are you gonna leave them, what the triggers are to do that. So always forms analgesia plans, that's really useful. Use tools will be quite helpful.
I've typically used calming agents to just relax them a bit and get them not worried so much about life. And I also use a lot of bladder anti-inflammatories, typically marketed for cats and stuff. I think they help.
I've had some cases I've actually managed only with these and husbandry changes seem to be just enough for that. So most of them I've had to use with other drugs as well. I've typically used a combination of Nutrisys and NutraCalm.
I don't normally like using brands, but they're the best combination worked best for me compared to others, and I did try a few. But you know, it it it is an option there too in the long term they may help reduce the levels of other drugs and so they had some cases I managed on their own with them, which is quite good. Husbanbury changes are, I think the most important thing too.
I mean, one is remove people from their lives. You know, we're not, most of these guys are not very happy about being handled all the time. They may go still, but that's not necessarily a good sign in a small mammal.
And they're not often very well socialised. Think howcoal they are. Their socialisation windows are very, very short indeed, and very few of these guinea pigs are actually handled a lot within the first couple of days of their life, which is probably when you're looking at needing to socialise these in that first week.
So you know, they're, they're not always quite as well adapted as we think they are. So we gotta be careful, make back of bet. And one thing I've often introduced is deep litter.
So 6 to 8 inches of hay and then sort of in a small close space inside or outside, so they just tunnel through it, they burrow through it. You actually do again, so you do see them quite a lot, they come up for air quite a lot there and put lots of bowls, lots of food all interspersed around the place, they can find it all over the place there, and they really like that. And give them a amount of hay, they'll tend to jump into it.
Give them a deep litter of hay, they'll tend to tunnel through that and they really enjoy that, and they really do move a lot more and do a lot more rather than sit in the back of the hutches worried about life. We'll increase drinking, urine flow, there's the other things we've got to, so any issues in getting to drinkers. Basic thing is, give them lots of drinkers.
Give them lots of bowls, put them all over the place, back of a hatch, front of a hatch, everywhere through the litter, everything like that too, just lots of them, so there's no no issue getting them, especially for older arthritic animals. In rabbits, there's data showing they for bowls of drinkers, not there for guinea pigs. In fact, what it's really shown is some guinea pigs for a drinker, some for bowls, and it really depends on what they had in the formative stage of their life, and they tend to prefer that.
So, try it, try whatever you want to, that's really good. Flavour the water, things like very dilute juices and things really can be helpful too. And when you're feeding fresh food, wet it, put it under the tap, wet it through it.
Just feed it sopping wet and get more water going through that way too. Increase movement, lots of cover, improve analgesic for arthritis are really helpful too, and in terms of diuresis, you know, dandelions, longer term can be more difficult, but hopefully we get enough water through the water will diurese them as well. In terms of prevention, well, maybe keeping outside's the answer because that is so, so much less common there, maybe it's the way you keep them outside is what way is better there too.
Certainly better socialisation, handy with getting breeders to handle these in the first week of life. Definitely, definitely a big thing. If they haven't been, maybe we need to reduce the handling afterwards.
Lots of bedding, lots of hiding places, lots of fresh wet food, vitamin C for sure. And if you keep them indoors, try and reduce those light levels, try and reduce those try and increase the humidity levels and try and reduce the background temperature. All very good for our fuel bills in this current day and age, but also reduces those guinea pigs becoming slightly dehydrated from that general keeping.
You onto another old thorny issue of ovarian cysts, again, these are very, very common, they they range from little tiny ones up to huge, huge set of 7 centimetres cysts, so, you know, they're absolutely enormous sometimes. There's studies showing there's very little in relation to anything really, what it shows is the older the so the more they have and the more likely they are to have them, . I would you know move in maybe the outside keeping there's less of them, but might be again related group size we'll talk about in a moment.
But certainly around about 80% of sows over 18 months of age will have a cyst or more, and the older they are, the more they'll have. We do see follicular sis, I put the question marks might be unusual. I think these are more common than we think they are.
There are, these are secondary follicles that don't, trees, and secret oestrogen we get signs relating to persistent irregulars and infertility and things to be breeding. And they are just very, very aggressive, guinea pigs, and if that's typical way people notice it that, you know, the, the, the older sows begin to attack all the others and it's really just plain grumpy. And so, you know, the, the, the that that can be a problem within that.
The Most common ones would be cystic retivai. These are more developmental, cysts and, should be non-hormone producing, but I do wonder, given how these are because typically over 80% of the cyst should be retti, cysts. But you know, I've found quite a few, the more I looked, the more we're actually showing behavioural signs of problems.
Causes again, it's all mut, it's so common, these are normal. You know, 80% of them must be normal. Well, really, it doesn't seem very right.
Potentially lack of breeding, but, you know, they, they don't, you know, we, we haven't, most of these guinea pigs haven't bred, that might be a problem. That's been proposed but not proven. Group structure two has been proposed, not proven with, very small, numbers that are kept in singly or they're kept, in a, a simple pair with no other females, that seems to predispose been proposed as predisposing.
There have been some thought about fight estrogens in the diet, but they're not definitely not proven and and kind of going out. But obesity certainly does seem to have a link to this as well, and maybe just overabundance of calorie might be overly stimulating the ovaries within that, that might be an issue as well, because many of these rodents are, if you like, calorie based breeders. Common signs, well, we don't see all these guinea pigs, so the most common sign is probably no clinical sign, and they carry on the cyst quite happily.
But we will see infertility certain ones there, sexual behaviours mentioned, vaginal bleeding with the, hormone production as well. But we may also see anorexia, hair loss particularly, or just a guinea pig who is just not quite happy and not just not doing well with a big space occupying lesion in the abdomen. Terms of diagnosis, well dead easy, we can feel them very often, we palpate them, we can sort of see on radiographs, but ultrasound is really great, we can measure them and and check them and assess progress, that's really good.
Terms of treatment, well, if his sister's there, we've got no clinical signs attached to it, well, we do have the option of doing nothing and that might be perfectly valid for most of these guinea pigs. If we have pain related signs, then we can give analgesia. And here's the big thing too, over 80% of females over 18 months will have these cysts.
It's very easy to ascribe any clinical sign we see in those guinea pigs as being cyst related, but actually, are they? You know, are they just coincidental? And we don't know that.
So don't just take a look at a cyst and say, hey, well that's what it is, it's got a cyst, it's got a sign, that's it. We've gotta really go into what is this cyst likely to be causing that sign, if not, let's investigate, let's make sure there aren't any other diseases going on at the same time. Or we can treat that, or we treat the cyst and say let's keep an open mind on this.
We use a lot of human chorionic gonadotrophin, 1000 units a week on 3 occasions, nasty painful injection, but does seem quite effective, but they will and do recur. So be careful there too. The really big ones, we can release some of the signs, rose or stretch signs, some are pain signs by by draining them, and we do that percutaneously, but I mean it's only a very short-lived effect.
And otherwise we might be into things like like removing the ovaries, and typically ovarectomy as much as ovarian hysterectomy too. In terms of prevention, well, that's a difficult one. We can certainly look at spaying them early, that's gonna remove the ovaries, remove the problem, but is it, it's a big up in guinea pigs we'll talk about at the moment, and is it actually are enough guinea pigs effect to justify that level of surgery?
And of course we have anaesthetize them. What we found, we kept SA survey, which was the last big multicentric, study, over 3% of guinea pigs died under anaesthetic or died within 40 hours of anaesthesia. Mostly pictured operatively, mainly because there's a lot of problems with underlying disease, and that led to problems with evaluation, preparation, choice of anaesthetic and maintenance.
So in terms of preparing, you know, always make sure you're treating all the potential underlying problems, a lot of underlying respiratory disease. So antibiosis, analgesia, anti-inflammatory are very useful. If you're anorexic, you know, feed them, fluids, you know, also very ill as well, make sure you get the the fluid balance right before you in these sides where if you possibly can.
Some people immediately beforehand like to clean their mouths to avoid them inhaling, a lot of the grot they have the back of their mouth, it's, and some people don't, that's an individual choice. Per anaesthetic, again, keep them warm, lots of fluids, you know, think about gut motility, which again, fluids and analgesia are probably gonna be major tools with that as much as giving gut motility drugs. But again, just make sure you look after the guinea pig during it.
I would also stress use a lot of local anaesthetic for analgesia. Basically take a guinea pig, weigh it, work out the maximum dose, and use that maximum dose in certain places. We can do it in terms of specific blocks, we can do it regionally, we can infiltrate incisional blocks, we can do intraabdominal, we can do splash blocks.
All of these are really good and valid ways of going. How to anise, what recipe to use, well, do you know, there are options there. We can use it all injectable, we can use all gas, we use a pre-med and gas.
You know, you find a technique that works in your situation, and make sure you evaluate it, and you're actually monitoring what your problem rate is, what your near miss rate is, that kind of stuff, and do it from there. I don't think there's a single way of recommending this, so I tend not to. But just make sure you, once you find things successful, make sure success is really what you're getting.
To the intubation, again, I mentioned it as material at the back of my mouth, it's nice to clean it out there, either beforehand or afterwards. And then, you know, if you intubate you don't want to be pushing a tube through that. Push your block, secondly, because you will take that down into the airways and you will potentially get postoperative pneumonia.
I've rarely intubated, I tend to use a masks for that, because I don't worry about this pneumonia risk when I have done. I've cleaned after I've anaesthetized and I've used endoscopic guidance to place that tube to try and minimise that contamination, but. It's still a problem.
I would always use post-op antibiotics if I do use an ET tube. But it's quite controversial to do it and it can be quite difficult. If you're not, then be careful for passive regurgitation, so make sure the head is always raised throughout the, the, the procedure, and make sure it doesn't move because it will be very easy to pull the head away from there and listen for any potential gurgling send.
Mess a bit late if you do, but you know, be careful. Post-op, you know, warmth, lots of security, post-op feeding, get some critical care into them as quickly as possible. Get those guts moving, get, get them feeling better about life.
And I must say, again, not great with product placement, but hey, this birds Xcel dual kit is fantastic, and the guinea pigs absolutely love it. And they often take this first step, so I'd always keep a bit of this handy and try that as well. We talk about surgical nutrients, one amazing really wanna do this.
A lot of males that are castrated for obviously birth control reasons too, but don't get things like, you know, single sex groups do work well, potentially there have benefits for females. Guinea pigs are nowhere near as aggressive as, as rabbits, so actually all male single sex groups can be quite good. What I would say is though, be careful with the scrotal approach.
There are issues with herniation, a big issue, whatever you take with herniation because they've got such opening or canals, so watch out for hernias at the time you're operating. Make sure you're closing your canal. But certainly with scrotal approaches because it's so low to the ground, it seems to scrape.
Of course you do end up with lots of problems with infection, foreign bodies, sometimes suture material, but very often hay. So therefore, one paper does recommend abdominal approach. Firstly, I've found moving to a pre-scrotal approach gets away from most of those problems, and it still makes it quite an easy job.
So I tend to recommend pre-scrotal approach to guinea pigs where I wouldn't others. And I also recommend closing the skin with sutures, whereas I wouldn't in most, most other, small mammals, I'd use glue only, but I would, these guys are closed with sutures. Terms of spaying, again, you have a debate ovarectomy versus ovarian hysterectomy, and, you know, they have, I, I find it really difficult to spay.
I, they've got very short ovarian pedicals, they've got the very short vaginas, and the cervix bay goes to the bladder, and certainly older pigs, often a lot of adhesion between bladder and and cervix, I mean really hard to like get under that too. So if I'm doing this for cys or whatever else I'd probably favour ovarectomy. I've never really been that keen on doing prophylactic spaying and young pigs or whatever, mainly so I just don't like the operation so much, but lots of people do and there are ways around it.
I think ovarectomy is probably the way to go, within that too. And if in doubt, what you can do as well, if you're in real trouble getting the say a cystic ovary up, you can do a bilateral flank approach as well as a midline approach that can be quite, quite quite useful. In terms of doing it, so this is how I tend to do those, open midline, you know, exteriorize everything.
I use like hema clips a lot, and what I basically do is just locate the ovary. Here's a cystic ovary here, and I'm just hemaclipping all around and it's clip and cuts and clip and cut, and basically gradually remove that, remove that ovary. And I found it much simpler than using pseudom material to liate.
And going round again, so we're doing that. And another big thing too, I always liked abdominal fluids with these, they are prone to adhesions, not quite as bad as rabbits, they are prone to adhesions, and so a lot of fluid in there for fluid therapy obviously, but just to wash out and dilute any, any, any of any debris there. One thing to mention is that the desert implants, things do not seem to be effective in guinea pigs, so chemical neuturing probably less of an option these in other species.
We do see dental disease, sorry it's gonna be a bit of a fly through. You know, again, bear in mind what's normal. They do have these much longer, lower incisor.
They do not meet with the upper in normal life. And when you look at the molars, they are at 45 degrees, that's quite normal. What is not normal is when we start getting very slanted inside.
There's a big clue we've got a problem going on, we start getting the meeting of the molars over top of the tongue, often trapping, that's why we get the anorexia. And those are the guinea pigs who've got problems. To have a look and see, we use, we do use, we use the same sort of tools we do for rabbits with the cheek bo dilators, with the, with the, with the, gags and things.
Be very careful not to over gag the guinea pig. They do get temporomandibular joint problems a lot, and I think some of those do stem from from over enthusiastic opening of a mouth and be careful with that too. It's a very difficult area to get to.
There are a lot of talk to about conscious dentals I'm not trying to cover too much on that tonight. Firstly, I've always favour anaesthetic because I find it difficult to see anyway. I worry a lot about putting things like clippers or or burling there without without being able to see properly.
And again, that, that, that overarching in my mouth with a gag, I think it's gonna be much easier to do when they, when they're when they're conscious. So I avoid that, I do like an anaesthetic with these. It is also worth sending your first few dentals things.
Taking some images, whether X-ray or CT but looking to see what the prognosis is on these roots can be overgrown. Often the roots are in far worse state than the crowns, and that's a big point and this is what resets the prognosis, so always do some imaging and see what's going on there. Terms of therapy, you know, clip and file, but whichever whichever you fancy, both are very effective, both can be done very well.
Pain relief, very important, because there's root disease, you know it's gonna be root disease, and they're gonna have problems eating, you want meat, fibre, you want to keep those teeth down as best you can. They're not gonna do that if their roots hurt, so pain relief, long term, really, really important, and back to good old meloxicam again generally. Antibiosis, if there's infection with his abscess, possibly, we'll talk about in just 2 seconds.
Diet again, back onto a fibre if you possibly can, if they'll tolerate it. But overall, once you've got dental root disease in these guys, the prognosis is pretty guarded, so you know, you're often fighting and losing battle. They do get abscesses, much less commonly than rabbits, but they're much more difficult to treat, or we say much more chronic.
Really difficult to remove the teeth from these guys. You you're gonna have to drill the teeth out, the, the rodent jaw rather than the rabbit jaw. So it's much more difficult to do.
So the overall dental prognosis is much poorer. And the other thing too is bear in mind the longevity of these guys, you know, living typically 5 to 8 years in captivity. Often we're seeing a 5 year old, 6 year old guinea pig with an abscess, you know what, What are we giving them?
We're going through huge, huge surgery, taking, you know, large parts of of of of the skullar part to get the teeth out, it can be difficult. So there's a lot more emphasis here on palliative care, so lancing and flushing abscesses, analgesia of course, and eventually euthanasia when it gets too much for them. And these are conversations you need to have with the owner before you really start going into them.
And that's important. Breed mention hyperthyroidism, which is still kicking around there in sort of low levels, but a few KCE will come through there. It is relatively common, but you know, it's it's just, it's not increasing, thank goodness.
Typically signs of cats, so you've got weight loss, very rapid heart rate, and if you do get a thin, older guinea pig, do start thinking about this because you can treat it. Typically take a, you know, you can feel the goitre there, you can feel, you know, there are things that can be there, but take a blood sample and the thyroid levels are very similar to cat level, so you can use those sort of numbers to, to, to judge it by. And in terms of treatment, typically I'd stabilise these with flimazole, methimazole, and then go on to surgery and remove the thyroid gland, which is nice and simple, just like in cats.
A few cases coming through of radioactive iodine therapy which seems to be effective as well, which is really cool if you have access. Brief mention of hay pokes. I've mentioned a lot about putting these guys in deep bits of hay, and the usual question comes up as being, oh my God, we've got a lot of hey cap pokes.
It can happen for sure. And we do see quite a lot. We get this really amazing UVitis or amazing corneal abrasions from there too.
They treat really well, remove the hay, anti-inflammatory drops, antibiotic drops, they look a million dollars for a couple of days, even the really deep ulcerated cases. So it does treat nicely to long to remove them. The problem is that with this is not the hay itself, getting back to quality and things as well.
So you know, if you're going to put the hay through there, make sure it's nice hay. Because when you look at the old, you know, nasty old old hay, it's all bitty, you know, it breaks off easily. Nice fresh hay doesn't do that.
So it's really is a disease of old, poor quality hay. And if you see this one, you know, don't, you know, advise a change by getting something better. And if you're gonna use some deeply to hay, make sure it's good quality hay, make sure you're advising that as well.
So in summary, so it's a bit of a run through, but these are just a few of the common syndromes we see. They're not the easiest patients, but we do see a lot of them now, an awful lot of them, and the real big growth area with that too. And we often see some very committed owners, with them, which is fantastic, for the guinea pigs, but it does mean we've really got to work at that too.
And I will just, my last thing says, look, you know, we're talking about making their lives less stressful at home. Don't forget, we can make that vet trip less, less stressful too. So do get people to bring them in, in, you know, nice cupboard containers, a lot of of hayle or straw in there too, to hideaway, lots of blankets to hide away in there too, and nice and dark, so that's gonna make you feel better there too.
If they've got companions, they should have companions, please bring companions with them, they'll feel much better than that too. Handle them very carefully and gently. Be very quiet, nice, quiet over practise too, and things like .
And these pheromone products can be really helpful as well, pet remedies, that sort of thing, really helpful as well, just try and reduce overall stress levels within this sort of, whole environment there too, because examining a stressed up guinea pig is not a rewarding experience for anybody, particularly not a guinea pig, and that is our job after all. So thank you for listening. I hope you have got a few minutes now just to, do a few questions and things.
Again, sorry, it's such a quick run through, there's a lot of diseases to cover. Thank you, John, that was excellent. Just seeing what we've got question wise.
We've got quite a few in there. So let me just see what What's on, Emily's saying, do you sedate when you're doing radiographs and if so, what's your drug protocol? I would typically give them a whiff of isofluorane and do it just under isoflurane.
Right, OK, thank you. I agree, I would always sedate them. It's very hard to do conscious, guinea pig, X-rays.
But even though they're actually easier to CT conscious, you know, these little mouse trap devices, they're brilliant for guinea pigs, they just tend to freeze. They just sat there and they're quite good with that. Fantastic.
We've also got what's your dose of oral meloxicamin, guinea pigs. I use 1.5 mg per gig, twice a day orally.
It's a PK paper in the vet record of 3 or 4 years ago now. And that was the dose they came up with. And 1.5 migs per kg or twice a day.
Once a day subcutaneously, but twice a day orally. So that's what I tended to use. Kirsty says, is there a recommended a milligramme per kilogramme for vitamin C?
And she said she saw something suggesting too much vitamin C. I think you mentioned this. Yeah, I think I calcium phosphate ratio.
I'm now having to remember the dose I actually wrote on the sli so it's 30 to 150 mg per gig per day. It's very hard to overdose vitamin C. It is simply urinated out, it doesn't change too much now.
It's very hard to really overdose it. I'm sure you can if you really try, but you know, I've, I've often got a whole human dose into guinea pigs each day and they're absolutely fine. What's your opinion, there's a question from Petra on, feeding cranberries, or cranberry supplements as prevention of cystitis.
Don't particularly prevent on its own, but if the guinea pig likes the flavour of cranberry juice. Flavour the water with it, it's very dilute, you know, cranberry juice as their general water. I've done that quite a lot.
If that's what they like, and I'll generally get people to do like bowls of different flavoured juices, see what they like. And if you get some drinking more, fantastic, it's great. Somebody else has asked for, what do you use for premedication, but it sounds like you just use ISO to put them down.
Generally ISO, but you know, you can pre-med, there's a lot of regimes out there, so, you know, midazolam combinations, opiate combination, there, there are lots available. I think it's one of those things where, you know, see what you need, work out a sort of regime for what what your situation is as well. Because we all know it's different combinations work in different people's hands differently.
And find out what's working, the big deal is whatever you do. Evaluate it and make sure your results really are looking like they are. And we both ends of the spectrum, so some people who think, oh, everything's going great, and we look at the numbers, actually, you know, there's a few problems going on.
And other people say, I've got a terrible guinea pig that has died. You look at it and thinking, well, they've done loads of guinea pig anaesthetics and they've had really great success for the last 18 months, 2 years and things, so there's not a big problem going on there, but it's nice to think about it and see what you can, what you can learn from that. So it's that thing about.
You know, have a problem, reflect on it, see what's going on, but above all, just maintain good records, keep a, you know, keeping out, monitoring of anaesthetic problems and not just the deaths but the near misses, because they're the ones you really want to get a handle on before you have disaster. That vitamin C dose again was that 30 milligrammes, 30 to 50 mg per kilogramme per day. Once a day, yeah, so I can remember it's on the slide there, but I'm trying to remember it myself right now.
Great, if people want to tell us where they're listening in from, it's always nice to, to see where people are listening in from, if you want to put that into the chat as we go into more questions, . Views on water intake for rescue guinea pigs who have never had water bottles or bowls if prone to bladder sludge, is regular syringe feeding of water an option? Yes, it is, and I will post ops certainly get people to do that occasionally.
It's a bit of a wrestle because it's gonna be stressful to them. It's a problem. Is it causing more problems it's worth?
You really got to see what what it's like there. And again, don't forget that root by by by wetting the vegetables, you know, get dark green, wet them down there. It's a really easy way of getting a lot of water in, and you don't have to hand, you don't have to do much to it, so I find that probably my, that's probably my favourite method of getting water in.
You even wet hay down, you know, you. You know, we can paper bed them for about, you know, get their feeding hay, wet that and feed that that wet as well, you know, there's any way you can get water in. Yeah.
Great, OK. Nicola just missed the statement on, male groups, good or bad, I think you said they were potentially good. They're much more stable than raps.
They don't, they're nowhere near as aggressive. I've maintained, I, I, I made, I've, my, my group now is solely so, but I have maintained males in the past and been absolutely fine. I've seen lots of boars come in they live together fine.
And it's one of those things where you can castrate them later if they are a problem. So, you know, it is potentially one of those things you can do, keep all male or female groups. And Mark's saying brilliant overview, really good for general practise, thank you.
Robin is saying, your antibiotic of choice. None If possible. For antibiotic choice depends on what you're using, what it's for.
And I think you can actually, the nice thing is, you know, we've got things like protect and stuff for rabbits and what have you. You do one for guinea pigs as well. It's really good.
They are sensitive, and there are quite a few antibiotics that they don't like very much at all. So you'll be a little bit careful on that. They're more sensitive than, than probably rabbits are.
But you know, there, there are a few, there are a few more choices than you'd think there may be sometimes. But it, like all these things depends on what it's for and what else is going on. I suppose culture and sensitivity is more and more important now, so it's.
Yeah, absolutely, always that thing about make sure you sample the right dates and make sure you sample them male and stuff, which can be tricky occasionally, but, you know, again, it depends what you're dealing with a respiratory problem, we're dealing with the, you know, like a true urinary infection, whether you're dealing with skin problems, you know, there are different antibiotics, different things really. So yeah, difficult one, but if in doubt, make sure it really doesn't need it. I mean, cystine's a great example of that.
So few of them are true bacterial cystitis, you know, yeah, antibiotics are very rarely indicated. Yes, exactly. Somebody else is asking about V gel.
Is that appropriate in guinea pigs? No. They have been working on it.
I know from talking to them, they've been working on a guinea pig one for a few years, and hopefully it will come out one day. Guinea pigs have a really unusual, throat anatomy. And I think it's really caused the VTL people a lot of, a lot of problems.
And hopefully, the guy who does this is actually listening. Bobby's a nice guy, and also because he might be able to answer his bet again. But I wouldn't put a rabbit one in there, no, I wouldn't.
And you're still gonna have the same problems with the, with the muck at the back of the throat and stuff. It's a really difficult one about cleaning that, about when you do it, and it's, it's, it's quite controversial, but, you know, you can. Have, have a read through some of your opinions there and and see whether you want to do that or not.
So, Henriette is asking the question on, is, . Clipping teeth. She thought it was an absolute no go, but I think you were saying that it is possible to do.
I clip and farm. I always clipped and fart. Can be do it care, try and put too pressure.
I wouldn't want to shorten the crowns too much with, with clipping, but certainly taking the hooks off, you know, I found no problems with that at all. Conscious clipping is a different thing altogether, and I think that we haven't got the whole hour on that unfortunately, because it's quite a debate within the guinea pig world. And that's something I personally would avoid.
But once you're in East sides I've clipped and filed and finally work just as well . As as boring, but method of choice, I think it's fine to do both as long as you're careful, do, do, do, do, do it properly, don't know which one to use. Fantastic, we've got Susan listening in from a dark Tuesday morning in Melbourne.
In in Australia, Carlos in Porto in Portugal. We've got Lindsey in Galway, Patty in Michigan, Anna just the road from me in Saint Saint Ellen's, as they say. If you're from that neck of the woods, anybody else want to put anything, different from that, please feel free.
Let's go back, see if we can get one or two more questions in. There are a lot of questions come through, obviously we can't get to, to all of them, but let's see if we've got . A couple more that we can.
Peromones for guinea pigs, are there such things on the market, that's from Sylvia. Specific ones, but certainly the things like pet remedies and stuff do seem to be effective in reducing stress and certainly for the vetinary visits and stuff. I'd certainly recommend that, but in general pheromone use for specifically for them, but I'm not sure there is that, you know, but the pet remedy does seem to be quite helpful to them.
So look out for some of the pet remedy ones, that's great. . Let me see, is there anything else?
What about cats, Mirtazapine, miratazin, guinea pigs. Any experience on that? Never used it.
But, if I had, I had a really blocked one, I might, might be very tempted to get these things out. Actually, let's see the opposite, isn't it? Sorry.
So, I'm not a cat vet. I'm not smi vet anymore. So no, I haven't, I haven't used that one, particularly, so, but please ignore the last comment.
But yeah, I, I wouldn't, I haven't used it, so I wouldn't like to comment. With hyperthyroidism in guinea pigs, is that usually bilateral, John, and what sort of heart rate are you seeing in, in these animals? Oh, right, OK, great question.
Right, normally the case has seen to be be unilateral, but the second side has, has, has come up a couple of years later. So a year or two later, so that, that does happen. So, bit like cats in many ways, .
In terms of heart rate, that's a really hard one to answer because you've got a really rapid heart rate anyway. And I think once you're into the real hyperthyroid levels, you know, 250, 300 or, or, you know, a minute, it's really hard to say accurately that's exactly what. So, you know, and, and can't count that quickly, can we, John?
For an old man like me, it's really hard to do, you know, it's put it this way, it's more rapidly than Manchester United can concede a goal these days. Absolutely. Thanks so much John for that session, but we're gonna move on in this second session, which was recorded earlier by Emma, Keeble, specifically for the virtual congress.
It's gonna be about diagnosis and treatment of urinary tract disease in pet rabbits. Hello and welcome to this lecture on diagnosis and treatment of urinary tract disease in pet rabbits. My name's Emma Keeble, and I work as a at the Edinburgh vet school.
We have a small animal practise that is exotic based and we also see wildlife cases and as well as zoo cases. So today I'm actually focusing just on on rabbits and urinary tract disease. And this is something we do see an awful lot in practise and many cases present with urine, just urine staining of the back end.
So I thought this would be a useful and helpful topic for vets in practise, to review and go over. So what are we going to learn today? Well, hopefully by the end of this talk, you will, have a basic understanding of what's normal for rabbits, urinary tract anatomy, what's normal for rabbit urinalysis results as well.
And hopefully be able to recognise the sort of clinical manifestations and signs that you will see with urinary tract disease, both upper and lower in pet rabbits. Moving on from that, I would like for you to be able to list the sort of diagnostic tests that you will be using to get a good diagnosis and then thinking about any treatment options, as well as advice that we might be giving to the owner for long term care and management. So hopefully those will be your sort of take home bullet points from this talk.
So let's have a little think about how the rabbit urinary tract is slightly different, perhaps, to other mammalian urinary tracts. I mean, rabbit kidneys are fairly standard. They are round, sort of bean shaped.
Very smooth normally and situated in a retroperitoneal place. I find them very easy to palpate. The exception to this would be in really obese animals, and unfortunately we do have a few of those at our vet practise.
And that can make it obviously, you know, technically harder just because the amount of fat, that's intraabdominal. The right kidney is usually situated more cranially than the left, and this one is actually in very close contact with the liver. The kidneys themselves have a very distinct outer cortical area and an inner medullary area.
And you can see from the pictures here, and we have a postmortem example showing the kidneys, the right kidney at the top picture, and the left kidney at the bottom. And we also have some anatomical drawings just to help you visualise where those kidneys lie in the rabbit. Thinking more about the lower urinary tract, which involves the bladder and the urethra, the bladder in rabbits is very thin walled, so you do have to be quite careful when you're palpating this structure because, if you're overzealous and the bladder's inflamed and perhaps overstretched, there is a very small potential of rupture.
And, and bruising also to the bladder. I have seen that on postmortem from overzealous handling of the bladder on, on clinical exams. So just be cautious with it.
Often rabbits will react to palpation if they are uncomfortable. And the bladder itself lies ventral to the colon, and in females it's ventral to the reproductive tract. So if you've got the animal sitting in sternal recumbency, you should be palpating in the sort of cordal ventral abdomen.
Female rabbits have a much shorter urethra, and this actually exits into, the proximal vagina. So you do at this point get mixing with any fluids that have come from the reproductive tract. So if you had blood, from the reproductive tract, it could mix with urine at this point and then be urinated out.
This is very different to rodents who have separate urethral and vaginal orifices. So in the rabbits, they are joined and the urethra empties into the proximal vagina. Males have a much longer urethra, and there are two points where it sort of narrows a little bit.
The first is along the pelvic floor as it extends sort of over the pelvic brim, and the other point is right at the very end at the external urethral orifice. So these are the two sites that you might find, sludge accumulating or potentially stones, becoming blocked. And just as a recap, I had to sort of remind myself this the upper urinary tract, obviously the kidneys, the renal pelvis and calluses and the ureters, the lower urinary tracts, mainly the bladder and the urethra.
And we're going to look at the different conditions that occur, according to lower urinary tract disease and upper urinary tract disease. Wanted also to have a little chat about urine, and urine collection in, in rabbits. This can be.
It can be quite a challenge, and we often have animals that owners can't collect samples at home from. So we get them in perhaps for a day's hospitalisation, and we'll make up a little sort of what the nurses term a pea pod. We'll have, as you can see in the picture at the bottom here, an empty litter tray, and we'll use an incontinence pad that we've turned upside down.
So we've got shiny side up, so it's non-absorbent. And we'll remove everything from that cage except some water, and we'll usually put hay. In a rack that's attached to the front of the cage so that the hay isn't spread within the environment.
And the hope is that this rabbit will eventually use that litter tray, and we can get a relatively clean sample. Obviously, it's not ideal. There are some problems with this, you know, we might get bacterial contamination.
Well, we will get bacterial contamination, which could affect our sample. We might also get droppings, faeces sort of mixing with the urine as well. So really, that's the sort of very initial basic way of collecting urine, but probably better than that is perhaps to try and just gently express the bladder, as you can see in the top picture here, into a kidney dish or a clean, sterile kidney, kidney dish or tray.
And that's just very gentle paish. I mentioned earlier, you're not putting excessive force on this animal, you're supporting the back, as you can see from the picture there. If there is excessive force needed, you, you, you need to stop.
You shouldn't really be, applying that because there's a risk of rupture of bladder. But as I mentioned before, most animals that have urinary tract issues are quite sensitive and urinate quite freely on, on gentle palpation of the bladder. So I always have a kidney dish ready actually if we've got a suspicion that this might be a urinary problem.
Because as soon as you go to palpate the bladder, they may urinate on the table or all over you as well, depending on how you're holding your animal. So have one ready is quite a good tip, in your consulting room. Failing that, obviously, if we, we're wanting to get a sample there and then or we perhaps want to do some further tests, we might consider, sedating or anaesthetizing this animal and passing a catheter, and I'll talk a wee bit more about that later on.
And then really getting a clean sample that we want to send off for bacterial culture and sensitivity, we need to be probably, doing this via sedation. And then ultrasound guided cystocentesis. And this will give us a, a fairly sterile, clean sample that we can then send off to culture.
Rabbit urine is very different, so, to dog and cats, and, and I think this is quite important just to talk about here because we need to understand what is normal in our pet rabbits, and it can be very normal to have quite a thick, creamy sort of Texture to the urine and as you can see in the picture at the bottom here, that can sediment out as a sort of thick layer. And this is probably due to the presence of calcium carbonate crystals. These are the most predominant crystals that we find in rabbit urine.
The other thing that's different about rabbit urine is that it is quite varied in colour. So I often get owners coming in really worrying that they've got very dark urine that has, they think, blood in it, but this can just be due to dietary porphy and pigments. So it depends what the rabbit eats, but it can affect the colour of the urine.
What is good is that, using just a reagent stick analysis, we can be quite accurate with rabbit urine looking at the changes for the colour changes for glucose, ketones, and pH. But unfortunately for other parameters, multi-sticks analysis is not that accurate. Unfortunately, because of these porphyrins, it can affect the colour change.
So I think that's quite important to know when you're doing your, your dipstick analysis on rabbit urine. Also, classically, because they're herbivores, rabbit urine is alkaline, so that's very different to our dogs and cats, you know, being carnivorous. They tend to have more acidic urine, and normal rabbit urine is quite dilute, so I've popped the specific gravity of 1.015 up there for you as a normal value.
It's also normal to find small amounts of protein in rabbit urine, and particularly in young animals, this can be a little bit higher as well. But if we're having quite dilute urine that's containing protein, this probably is abnormal, and the worry with that is it could be an early indicator of renal disease. And something I use a lot in rabbits is the urine protein creatinine ratio.
And this can predict quite early on whether you have got, renal issues starting. And we have a normal range that's been evaluated in rabbits of 0.1 to 0.4.
So above this, I would be concerned. The only thing is you have got to be careful of how your sample's been obtained. If you have bacterial contamination, if you have ongoing cystitis, this could affect protein in the urine and give you false positives.
So do bear in mind what your sediment analysis is as well of the sample. When we're looking at sediment, it's normal to see some crystals there. Sometimes you'll see a few white cells as well as normal.
So don't worry about that. But, obviously, if you're seeing a lot of red blood cells, that is abnormal. And if you're seeing perhaps lots of bacteria and you've got a fairly sterile sample, that's abnormal too.
Just thinking about changes you might see on dipstick analysis, you know, glucose, urea, high levels of glucose can occur in rabbits just through stress. So a stress hyperglycemia can occur. So do bear that in mind if the animals come into you, it's been transported, it's been sort of perhaps handled a lot, it could elevate the glucose levels, blood glucose, and correspondingly, the glucose levels in the urine.
Glucosuria, other than that, usually indicates an altered energy metabolism. So this is sometimes seen with hepatic lipiddosis, and very rarely diabetes mellitus is diagnosed in pet rabbits. It's not a common differential, diagnosis.
If you get a ketonuria, that is abnormal and usually can be related to periods of anorexia. It could be related to hepatic lipiddosis, perhaps pregnancy toxaemia or diabetes mellitus. If your urine is acidic, as I mentioned, it shouldn't be, and that could be because you've got a, a, an acidosis.
This could be secondary to anorexia. Again, hepatic lippidosus, pyrexia, pregnancy toxaemia, these sorts of differentials. And if you've got blood in the urine, I'd mentioned earlier, this can also be from the reproductive tract because of this mixing within the vagina of, of urine and and reproductive .
Discharges. So it could be that you've got a, a genital tract bleed, so something like a venous endometrial aneurysm or perhaps even uterine adenocarcinoma, or it could be urinary tract, secondary to cystitis, urolithiasis, or renal infarcts, for example. So there's lots of things that rabbit urine can tell us, and this is something I use a lot of in clinical practise.
You know, if we've got an animal, we're not too sure what's going on, they've not been eating very well. There's no real, obvious causes, then, you know, do, do a urinalysis is a fairly simple, straightforward, sample to collect and, and quite a good indicator of animal health. So now I wanted to just consider really the clinical signs of urinary tract disease.
I'm also gonna just generally discuss the sort of diagnostics and, and treatment and then we'll go on to look at specific conditions of the lower urinary tract, and, and, you know, investigate them in more detail. So the sort of clinical signs we'll see with urinary tract disease in pet rabbits really depends on whether it's upper or lower. But they're the sort of signs we'd expect to see, I think, in any animal, that's got an, an issue perhaps with the bladder or, or with renal disease.
So, increased thirst, increased urination or difficulties with urination as well, or changes in urinary patterning are very common. And particularly in rabbits, we tend to see this urine scalding of the perineum, and you can see the picture below on, on, below the picture with the rabbit in the, the litter tray. This is a chronic urine scald that has caused excoriation, dermatitis, there's been alopecia and scarring around that area, so this has been ongoing for quite some time.
And some owners seem to think this is normal, it isn't. So if you're seeing anything, you know, even just staining of the fur at the back end with urine, it's, it's not a normal finding and it's worth investigating that further. So if we see these sorts of signs, obviously we want a really good clinical history.
We want to be doing a full physical exam. And as I mentioned before, feeling the, the kidneys is quite straightforward, and I do, commonly get animals reacting. Consistently actually to palpation of one or, or both kidneys, particularly with things like renalists or pyelonephritis.
Sometimes we can feel that a kidney's bigger than another. You might feel very small kidneys that are quite sort of knob knobby and, and have got sort of bumpy. Sort of edge to them, so irregularities.
Obviously, I mentioned the bladder as well if you're kind of feeling in that sort of cord or ventral area of the abdomen and you get a pain response that's repeatable, that could well be because you've got inflammation of the bladder or perhaps a bladder stone. And certainly in some rabbits you'll actually be able to palpate or see small euroliths. So in, in male rabbits I mentioned at the pelvic brim or at the actual urethral orifice, you may see a bladder stone or feel one there.
And the same actually in females. I've had bladder stones lodged, right at the sort of exit, if you like, of the urethra. So it's always worth as part of your clinical exam, having a little look there and checking for any stones.
So how are we going to diagnose urinary tract disease? Well, we've got obviously a, a whole array of diagnostics we can use. Certainly.
Going back to basics, thinking of our clinical history, our physical exam, I would generally also run a, a full blood profile and we talk about why that's important in a bit. I mentioned how useful I find your analysis, and if you're not sort of regularly doing this in pet rabbits, do please consider, you know, it's fairly inexpensive to run. We can do a re.
Strip analysis, you know, obviously taking into account the pros and cons and you know, how sensitive that test is. We can certainly do specific gravity, and I always try and do sediment analysis as well, because that will really tell you, you know, what's present in that urine. Have you got red cells?
Is that abnormal? And we might consider also the urine culture we talked about with a a sample from cystocentesis. And I also mentioned how useful I find the urine protein creatinine ratio, that's the UPC there abbreviated.
Thinking about our diagnostics, well, we can actually determine quite a lot with radiography. Quite commonly on rabbit, plane abdominal radiographs, lateral views, you will see, sediment within the bladder. And I've got some pic.
Is there of radiographs showing this, that can be normal. So it's important to determine whether this is an overly full bladder with a lot of sort of calcium carbonate sludge, or whether this is just a small amount and it's normal for that individual. This also could potentially be a bladder stone, and there are ways of determining that that we'll come to talk about later.
I also really do like using ultrasonography, and we can do this conscious, in most rabbits, if they're well behaved. And certainly we get nice images of the kidneys, depending on your, Images skill and and depending on your machine, you might also get some really nice images of the ureters, and sometimes you can follow these all the way down to the bladder. We can look at the bladder and bladder wall thickness as well.
So it's a really nice modality for that. And you can see the ultrasound image here we have . A nephrolith, so it's casting an acoustic shadow below it, and these are quite easy to pick up, on ultrasound.
Other things we could consider, certainly we could think about CT, we often do this with intravenous contrast as well. We might consider intravenous pyelography to assess how well the, the kidneys are actually functioning, but you have got to be very careful with that if you're worried about the animal being in renal failure. And then we can look endoscopically at the distal urethra, particularly in females because they've got a slightly wider urethra, if we were worried potentially about a stone blockage.
Thinking about treatment of urinary tract disease, well, I think very importantly, pain relief is one of the key treatments that we should be giving. A lot of these animals are really in a lot of discomfort. And so thinking straight away about giving analgesia.
And I tend to, go for perhaps the opioids in the first instance, just because I'm not always sure, whether we've got kidney issues as well. And, and some of the non-steroidal. Would be contraindicated if there's azotemia or dehydration or, or GI effects as well.
So, I tend to avoid the non-steroidal anti-inflammatory drugs initially, although they are very good once you've ruled out any underlying issues. They are very good at reducing inflammation within the bladder, but I wouldn't give them in the first instance until I'm happy that the kidneys are functioning normally. I put some other ideas up there as well, and we do send some of these patients home with tramadol.
Seems to work quite nicely in rabbits, although some owners do, report that rabbits can be a little bit more, dopey perhaps, or, or less alert than normal, but it seems to be very sort of case dependent. We're probably going to give this animal some fluids depending on how we want to do that, whether it's subcutaneously or via an indwelling catheter and admitting the animal, and depending on whether we think there's underlying infections present, we might consider some systemic antibiotics. These cases often do need nutritional support.
They might have stopped, stopped eating properly. They might have secondary, gut stasis, and so often prokinetics and, and nutritional supports needed as well. And then just put at the end some sort of extra things that sometimes help in these, in these cases and you know, people have talked about these supplements, whether they really do have much effect, we, we don't know for sure, but we, we probably should think about whether we give glucosamine, vitamin C, and with the 3 fatty acid supplements as well, particularly in these sort of chronic cases, they might be helpful in the management of those.
So now we're gonna consider lower urinary tract disease and what sort of things happen with this, what causes there are of lower urinary tract disease. And I think one of the top reasons we see rabbits is with cystitis. So this is inflammation of the bladder.
And this is common, particularly, I think, in female rabbits because of ascending infections, but it can also be secondary to a crystal urea, so excessive buildup of crystals and irritation of, of the bladder, and it could potentially be secondary to a bladder stone. The type of signs that we're going to see, are very classic really for, for any, any animal with cystitis. We might get teeth grinding as well because of the pain, and we might actually get an animal presenting with gut stasis, but they've actually got a urinary tract infection.
So do bear this in mind as another differential. So we're going to basically, get a urine sample from this individual because we're suspicious, and when we look at the urine sample, we're probably going to see lots of inflammatory cells, red blood cells. We might see lots of clumps of bacteria, and usually there are quite a few crystals present as well.
At this stage, we can decide whether we just treat the animals symptomatically or whether we want to do further diagnostics, and I guess it depends on each case and how long these, these have been going on for. But certainly, the ideal and, and what we're we're trying to do to get away from, you know, antibiotic resistance is to do cultures and sensitivities in these cases. And certainly animals that have been previously on antibiotics, we are seeing resistant infections in the bladder.
So do consider this in in your refractive cases. Treatment wise, I mentioned analgesia as, as most important. We want to do lots of supportive care as well, and we are likely to start some systemic antibiotics.
And one that's particularly concentrated in the urine are the, sulfonamides. So this is perhaps one that I would go for in the first instance, and I've given you some dose doses there. I probably would do that and then obviously if treatment's not, working, we would take the rabbit off antibiotics and get a sample for culture and sensitivity perhaps a week later.
Do be aware that Pseudomonas and E. Coli have, have been identified as causing cystitis in rabbits. And generally, treatment wise, I tend to do quite a long treatment course, sometimes as much as 4 to 6 weeks, in refractive cases to really get on top of these infections.
But again, you know, you need to assess that on a case by case basis. Moving on from cystitis, I think one of the, the second most common things we see in pet rabbits is this condition called, I call hypercalciuria, as well as uroethiasis. So urolethiasis, meaning stones anywhere along the urinary tract.
Hypercalciuria tends to be a concentration of these calcium carbonate crystals within the bladder. And this can build up to a point where it's just thick sludge, and it's very difficult for the animal to void. The, the reason why this happens in rabbits is they're quite unique in that the dietary calcium, so everything they eat is exactly related really to the amount of calcium they excrete in the urine.
So the more calcium in the diet, the more they excrete in the urine. And most rabbits are OK, you know, they're adapted physiologically to this, and, you know, it, it doesn't cause a problem. And so it's normal for, for rabbit urine to contain the calcium carbonate crystals.
But metabolism of calcium is under renal regulation, and this fractional excretion is 45 to 60% in rabbits, and in most other mammals, it's only 2%. So this is where if something else goes wrong, and there's another, another factor affecting it, this, this excessive, amount of calcium in the urine can become an issue. And I think this is, you know, there's lots of reasons why that might be.
So we talk about underlying predisposing factors. Certainly if you have a very high calcium diet, then obviously that's gonna put extra stress on the kidneys and, and the excretion of calcium. If we have a lowered water intake, we're not gonna get that flush through happening.
If we have reduced activity, it might be that the animal's less inclined to urinate. It has limited exercise, it's perhaps a wee bit obese as well. Excuse me.
We might have underlying bacterial infection. We could have, echiicular infection, and this can cause neurological atony of the bladder. So you get urine retention.
And obviously, there could be other things, obstruction to urine flow as well. So just showing you this video here of this little bunny, it's very obvious that it's got locomotives issues, but as it falls over there, you see how urine stained the back end is. So that's a secondary problem to .
It's obvious locomotor issues, but it's something we need to be aware of and we need to be concerned that it could have an underlying cystitis developed there. So what are we going to see? Very similar signs to our cystitis.
We're going to get sort of pain from, from this . And, and, you know, we might get stretching out of the abdomen, we might have difficulty passing urine as well. And when we examine, usually the bladder is painful, and is resented being palpated.
As I mentioned before, you might be able to feel an actual stone somewhere along, the urethra in males, and this picture at the bottom here, the, this stone was literally at the very end of the urethra, the ele orifice, and you can see the radiograph above, from this individual. So we're going to try and diagnose, obviously, we can be suspicious on our clinical exam, but it's very similar to cystitis. So we need to rule out that there isn't excessive calcium in the bladder or a stone somewhere along the urinary tract.
So actually, plain radiography is pretty good for this, so we can usually have a look and see whereabouts we think the stone might be. Where this can be difficult is if you've got tiny little stones within the ureters. And I find ultrasound really helpful, for this, to actually perhaps follow the ureters I mentioned.
If it's dilated, it's much more easy to see as well. So I would usually try and combine both radiography and ultrasound, just for, for absolute sort of certainty that we're picking up where these, these issues are. We might consider doing CT and urinary contrast studies as well.
I would also definitely recommend that we run haematology and biochemistry to see whether we've got any azotemia or any changes to electrolytes. And I mentioned echiiculi, so echiiculi serology is probably important as well. And then obviously all our full urinalysis.
So treatment of this, well, usually, it depends on where these euroliths are, but they tend to require surgical intervention. You might have heard of extracorporeal shock wave lithotripsy, which they use, I think, in people and, and it has been trialled in other animals, but it is contraindicated in rabbits because, it's been shown to cause significant renal, liver and lung pathology. So we tend to be going surgically.
To remove these. However, we've had a couple of cases that we have, we've written up of medically managing urethral obstructions in rabbits, and this was with fluid therapy, analgesia, and sort of serial monitoring ultrasonographically of the, the blockage. And this was actually a partial blockage.
Sometimes you'll get a discrete stone, sometimes you'll get a sort of build up of sludge in the ureters, and this can cause problems. If you've got renal lists, you might consider actually removing them. Unilateral cases, that is a consideration, but obviously you need to be aware that what's happening with the other kidney, is it normal?
Is it able to function on its own before you remove the, the abnormal one? If you've got bilateral renalists, that's more of a concern. Animals often are in pain, I feel, with these, they're often losing weight, they're often going into kidney failure as well, and that can be a much worse, prognosis, and these tend to be palliative care only, and close monitoring.
I don't like to just send these home. It's important for them to keep coming back in, and checking to see if there's any underlying things developing. So we have some ultrasound pictures on the right here, just showing a fairly dilated pelvic area in the, the top picture.
And actually in the bottom pitch, that is a very dilated ureter and we can see between the two little crosses the, the eurolith that's blocking there. So you can get some quite nice images. If you have large stones in the bladder, then you're probably looking at a cystoomy.
And this is quite standard. It's really the same, as for other species. What you can do is pass a urinary catheter while you're in there, down the urethra just to check that there aren't any further calculi, in the urethra itself.
And if you do go into the bladder, I think taking samples for calculus analysis and perhaps a, a sample of the bladder wall for culture, could be quite important for your case management long term. Smaller bladder calculus, are often less than 5 millimetres, might be voided by the urethra. So if you've got a tiny one, then you could consider trying medical management with pain relief and fluid therapy and really close monitoring to see if this is passed naturally.
But obviously at any point, if the animal looks to be blocked and not unable to urinate, you know, you need to warn owners that this is, this is crucial and, and an emergency. Other times you could actually anaesthetize the animal and catheterize the bladder and gently flush and see if you can remove smaller stones this way, but there is a risk they could become blocked. And obviously that could lead to obstruction, of, of urine flow.
With the hypercalciuria, what we're going to try and do is increase fluid intake, so that we're gonna flush these crystals out of the bladder. We're gonna give them an antibiotics if, if there's a secondary infection as well as pain relief. But I do find in very severe cases, such as the pitch you can see here, that's not contrast, that's all build up of sludge in the bladder.
And you can see the, the surgical picture below of how thick and cozus this material was. Then I think you might have to sedate, or anaesthetize your rabbits, pass a catheter and try and flush. And often these take kind of repeated warm saline flushes, copious amounts to get all those crystals out.
And usually I would radiograph them after to check that we've removed most of the crystals. And what we then need to do is keep them hospitalised to check that they're able to urinate normally, but as I mentioned, in really severe cases such as this one, we might have to go in surgically and actually remove that material. And you can see how thick and sort of inflamed the bladder looks there as well.
This is just to show you catheterization, so it's quite nice. You can see the catheter there having been placed and what you could do is a contrast study and just to see if, you know, there's normal bladder fill in this animal. So how are we going to treat these stones and sludge build up?
Well, we do need to think about underlying causes and certainly thinking about the diet and reducing the amount of ingested calcium is quite important. . It is common for these stones and crystals to recur, so we need to have ongoing monitoring of these cases.
I've given a list of, of, different diets that we should be avoiding there for you, and a big cross against the curly kale, cause that's something that can contain broccoli and curly kale can contain quite high levels of calcium, so we need to be taking those out of the diet. So, we also want to increase the water intake, and it's been shown that rabbits will drink much more from a bowl, 50% more water from a bowl than a bottle. So I always say to owners, offer both, so they've got the option.
We want to think about their, their exercise levels, how often they urinate. And with these, I do get them back in regularly, usually about every 3 months, to recheck urinalysis. And sometimes we take radiographs as well to monitor how things are doing.
If we have an obstruction, this is an emergency, so you can see in the radiograph there, we've got a grossly distended bladder and a huge calculus right at the bladder neck. And this is something we, we need to be, getting in there very quickly as an emergency to sort out. It is more common in, in males because the urethra tends to be narrower.
And quite often you'll just feel this hugely descended bladder on palpation. And you might want to take a radiograph just to confirm or, or, perform an ultrasound. And usually you can see these in the bladder neck.
You might not be able to see if the stone has blocked in the intra pelvic area. You won't be able to follow that with an ultrasound. It might be more difficult to see radiographically as well, because you've got superimposition of the pelvis.
Often, biochemistry will be elevated, so you'll have an azotemia as well. What I tend to do in these cases, if, if you're really worried, it's, it's been blocked for some time is to do cystocentesis just to aspirate some of that, urine off and to provide some temporary relief. But what we need then to do, and I said we come on to talk about catheterization, is we need to try and, and remove this blockage.
And I tend to sedate these animals with some midazolam, which is quite nice because it relaxes the urethral sphincter as well and helps you catheterize them. And we usually sit the rabbit in sternal, and slowly feed the, the, catheter into the urethral opening. Females are actually quite easy to catheterize, but it's blind.
So as you're going in, I tend to have the back legs raised on a sandbag and you're directing your, your, catheter ventrally. And you'll find that the urethral opening is about half the length of the vagina along. And as long as you place it ventrally, you will go in and you'll know you're in when you get aspiration of urine.
So you can gently flush with saline and see if you can get the calculus flashed back into the bladder and then obviously you can do a cystootomy to, to sort that and retrieve it. This was just to show you. When you open up rabbits' abdomens, you do get this enormous seum that appears first thing.
So just be very careful when you're going into that very thin walled abdomen. That's the first thing you'll hit, and you do not want to be nicking it. And if you've got a very enlarged bladder, that's a higher risk as well.
Everything tends to sort of, you know, bulge out as you go in. So, moving on from that, urinary incontinence is something I wanted to consider. Urine retention and overflow issues do occur in rabbits.
We often don't think about this, but it's quite important. And often, this is actually a secondary issue. It's not a true incontinence.
We need to be able to distinguish these from behavioural issues because I get a lot of owners coming in, and talking about aberrant sort of urination, and it's actually spraying and marking behaviour. So we really need to get to the bottom of whether this is increased urine production or a frequency, and this can in itself lead to a secondary urine scold and staining. So I've just done a, a little table there with some of the most common reasons for urinary incontinence, but true incontinence is quite rare in, in rabbits.
Usually it's, urine retention and overflow issues. So these can be secondary to obstructive or infectious or or neurological causes. So for example, if you had spinal issues, or disc disease, echiiculi, these might lead to increased fluid buildup in the bladder, and a big intraabdominal, sort of atonic bladder occurring.
We do also see obstruction from outflow, which will then cause the bladder to become enlarged and atonic due to ongoing inflammation, prostatitis or accessory sex gland disease in male rabbits as well. More rarely incompetence of the urethral sphincter can occur, in female rabbits, and these are spayed animals, but I think this is, is pretty rare. It's not like in dogs where perhaps you see it more commonly.
But it interestingly has been shown that lower oestrogen levels in neutered female rabbits, increase the risk, of effects on the bladder mucosa and muscle wall and predisposed to incontinence and cystitis. So perhaps neutered female rabbits are more likely to get this. What are we going to see?
Well, we often get that sort of smelling of urine at the back end. We might get urine staining at the back end. Owners might report sort of spotting around the house.
We need to do a full neurological assessment. So, if you have any of these cases, think about doing some X-rays, and looking at the spine for osteoarthritis or spondylosis. And what we'll see on those X-rays is that the bladder is quite enlarged and often very intraabdominal.
You do want to be considering serology for echiiculi as well. So we need to address the underlying cause, and we'll talk about treatment for urine staining scald in a minute. But when we're looking at these cases, we should probably consider whether this has happened since neuterring the animal and whether this is relevant because we could consider some hormonal treatment if we felt that that was important in the clinical history.
So moving on, finally, with the lower urinary tract disease, before we get onto upper urinary tract disease, urine staining and urine scald. I mentioned this is quite a common condition, and I'll just play this video here for you. This individual rabbit, it's a giant breed rabbit, is basically taking very .
Restricted hops, it's pivoting. It's not sitting upright like it's, it's companion. And this animal had urine staining at the back end.
So this is important to look at gait analysis, and I often get owners to take videos at home. I always put the rabbits down on the consulting room floor and see how they're actually moving. And hopefully you can see the real difference between the two rabbits as they move there.
And what we need to do if we get in urine stain at the back end, we need to check that it's not faecal staining. So it's important just to differentiate between those two. And it can be a primary urinary tract issue, so it could be cystitis or all the things we've discussed, or it could be secondary.
It could be a problem with posturing to actually void the urine. It could be a tonic bladder, secondary to E caniculi. It could be that the rabbit's very obese and therefore not able to sort of lift and toilet, away from those excessive skin folds.
So it's really important to think about all the possible causes. Diagnostics wise, again, we're really going to run all the diagnostics we've been talking about for all these lower urinary tract diseases, and I think urinalysis is top up there as well. But I think perhaps doing, if we're concerned about gait issues, some underlying assessment of the musculoskeletal system, that's really quite important as well.
The top radiograph is showing you that we've got some spondylosis, it's just a tiny little bit of bridging of the vertebral bodies, . And the CT scan, which is taken at the level of the stifle to the right of the screen, you see really severe stifle arthritis in this individual, and we're seeing a lot of elderly rabbits with osteoarthritis of the stifles. So when we move on to treatment, we can get these really sort of nasty, dirty back ends that are really quite a focus for, for fly strike in the summer months.
So we want to be cleaning all of this up. We want to think about pain relief, some topical barrier creams, perhaps. And obviously, if we address the underlying cause, then hopefully this doesn't continue to occur.
One thing that we might want to consider talking to owners about is weight reduction in obese animals, perhaps encouraging, extra exercise. So we could do scattered feeding. We can offer sort of hay stations around the environment as well.
And we want to make sure these animals can actually get to a litter tray easily. It might be a problem with that. And I mentioned fly strike in the summer months.
We can cyromazine is an insect growth inhibitors, so it prevents maggots from developing and we also have wound sprays that we can use as well. These contain insecticides too. Also just mention these are quite rare things that can happen with the lower urinary tract, but something I have certainly seen in practise, you know, probably only a few cases, but you can get prolapses of the bladder, and the bladder can prolapse via the urethra.
It can, it can herniate as well. And this has been seen in both male and female individuals. And often what you see is an animal that's collapsed, it's in a lot of pain, and you get this swelling around the inguinal area, and you can't palpate the bladder on clinical exam.
On radiography or ultrasound, you'll, you'll often not be able to find the bladder in the normal place, but you'll be able to find the bladder in a subcutaneous position. And if you, ultrasound guide aspirate this, you'll get urine from it. Most, well, these basically need surgical correction and, you know, obviously it, it's quite a major operation, so you need to talk through prognosis with the owner as well.
Tumours of the lower urinary tracts are quite rare in rabbits. We have had a transitional carcinoma, diagnosed bladder liyoma as well, but not as common perhaps as we see in dogs and cats. Also wanted to just have a quick thinking about increased urine output and what causes there might be for this.
Often you get a more dilute urine, and obviously we'll come on to talk about renal disease in just a minute, but, there are some potential hormonal reasons for this as well. And it could be related to treatments too, so corticosteroids or diuretics obviously can increase the urine output. So now coming on to just discuss the upper urinary tract and disease.
So by this, we're really meaning really basically kidney disease, and, and the principles of kidney disease are, are very similar to other mammal species, and then you're all very aware of acute and chronic renal failure, and I'll try and just talk away through these a little bit, you know, at the end of this lecture. . It can be reversible if it's acute renal disease, and obviously trying to figure out what's going on is quite important in these cases.
And we classically divide acute renal failure into three possible scenarios. So you can have pre-renal and intrinsic renal disease or post renal courses, and I have Seen certainly we've been having some quite warm summers recently. We've had a couple of cases where water bottle sippers have become blocked and the animal's been water depraved for a period of time, and there's no alternative water source available.
And in these cases we can see pretty acute renal failure developing. With chronic renal failure, this is more over a longer period of time. Usually the lesions are progressive, irreversible, they require long term management, not there's no cure, and we do give a much more guarded prognosis.
We often don't know what the initial cause was, and quite, later in the disease, we, we tend to see the azotemia, but we might see owners reporting an increased thirst and increased urination. What I tend to see in rabbits, the first thing is really a a slightly reduced appetite and weight loss. And these are the sort of key things rather than the increased thirst that we, we see.
And I pop the normal sort of daily water intakes for rabbits and average urine output up there just so that you're aware of what's normal and then can, you know, sometimes we get owners to record how much they're drinking in 24 hours, and, and then we can see whether that's normal for that size of rabbit. So how are we're gonna differentiate the two. It is important because acute renal failure, we can treat and chronic re renal failure is best managed.
So what we're going to see with acute renal failure, we tend to get, a hypophosphattemia, whereas with chronic renal failure, we get a hypophosphattemia. Chronic renal failure is usually associated with polydips and polyurea, but more commonly I see weight loss and, and condition loss, and we can see chronic anaemia. So this is really clinically evident.
You can see there, looking at the mucous membranes of the eye, very pale, mucous membrane. You can also look at the vulval or urethral opening, mucous membrane colour as well, and perhaps the lips if you've got a, a nice rabbit that's not going to bite you. Often the kidneys themselves are quite small with chronic renal failure as well and irregular.
So I just put on there, you, you know, I talked about the three different causes of acute renal failure, the pre-renal, intrinsic, and post renal. And these are very similar really for other mammal species with the exception perhaps that echiiculi and pet rabbits is one of the main, most common reasons, I think. For intrinsic renal disease and chronic renal failure in pet rabbits.
So I think that that is quite a key thing. And often, you know, you might not have positive serology. It might be that this happened a long time ago and has been a progressive damage to the kidneys over time.
So this is looking at causes of chronic renal failure in the rabbit, and I mentioned there E caniculi. It, it probably is the top one up there. We can get, you know, nephroliths, we can get amyloidosis and fibrosis.
So this is Quite common, I think. These are, these are common reasons in in other mammals as well. So I've just put those up there just so that you can have a an awareness, but often we don't, by the time we're diagnosed in chronic renal failure, we don't know what the initiating cause was.
What sort of signs will we see with kidney diseases? Well, quite similar I guess to . You know, that, that sort of painful teeth grinding, weight loss, depression, and we might see a bit of you in school.
We tend not to see the sort of difficulty urinating. But the weight loss, I think, and body condition loss is, is key. Usually the kidneys can be palpated and they might feel smaller and more irregular.
And certainly also you can get enlarged kidneys with things like pyelonephritis or nephroliths as well. Looking at the blood work, again, this is quite similar, I guess, to, to other mammals. We want to look at, creatinine and blood urea nitrogen.
So those are indicators of vasotemia. We might get glucoseura as well. And we might get changes in, in electrolyte levels.
With chronic disease, we will potentially see anemias, and these can be pretty severe. The problem is, like with other animals, that we have to have a severe loss of renal function before we get elevations. And so, this is not particularly sensitive.
So you can get animals that look clinically like they might have renal problems, and they really don't have very elevated, serum creatinine or blood, urine nitrogen levels. So this is where your urine protein creatinine ratio is really important to look at. How we're going to diagnose this?
Well, we obviously take our bloods. We might then consider some imaging, and we've got normal values that have been reported for both ultrasonography size and radio radiography size of kidneys, and I've given you those there, which hopefully are good. So you can compare whether the kidneys smaller or bigger than you would expect.
I do like ultrasonography for evaluating kidneys in, in rabbits. They're really, it's really easy. Even I can do it.
I can place a probe and get a kidney. They're quite nice to visualise, but certainly also radiographic. You can see from the image there that that you do get a nice image of the kidneys.
Just also to show that sometimes you'll get this, this, bladder sludge that's built up again on radiography. And this is just showing a cross sectional view, ultrasound view of the kidneys, and we've got a slightly dilated pelvic area there. Our good old urinalysis is very, very important as well, and we mentioned earlier about the high levels of protein being a concern and our UPC ratios being important.
Another thing I try and do as well in pet rabbits is, recording systolic blood pressure. It can be difficult to measure in rabbits cause it tends to go up quite quickly with stress, but we have got anatomical sites and normal reference intervals, evaluated. So I've given you the, the normal systolic pressures for rabbits there.
And, and that's quite important to, to consider as well in these chronic renal failure cases. How are we going to treat them? Well, we're going to consider rehydrating this animal, correcting any perfusion abnormalities, correcting any electrolyte imbalances, stopping any predisposing, perhaps nephrotoxic medications, giving nutritional support, and this might be just syringe feeding if the animal will, or we might even place a nasogastric tube.
And I've just got a little video here. This little animal has a nasogastric tube. It wasn't eating and .
Rightly or wrongly, enjoyed a tiny bit of banana, but this then got at eating other things that were much better for it. We wouldn't normally be feeding banana routinely to to rabbits. But sometimes if you want to just get their appetite back, you know, trying something treat wise, and then, once that's been eaten, sort of, starting to feed sort of more, more normal sort of leafy greens can be very helpful.
We might consider oral phosphate binders. I don't find that these are are regularly needed, but if you had a really hypophosphatemic case, you could, initially, you might want to consider crystalloid bolus. Obviously, if we've got really moribund animals, then we might be thinking about oxyglobin.
And often these animals have secondary gut stasis and need that treated as well. Recovery is possible, with acute renal failure cases. I have had, you know, some amazing, cases that have responded really, really well.
But we always give a sort of, you know, poorer prognosis to the owner, and it can take up to 3 days for tubular regeneration. So do, do keep going as long as things aren't, aren't getting worse and worse and worse. Then it's worth persevering for these three days.
In mild cases, I'd probably start with 0.9% saline or or Hartman's, but in severe cases, Hartman's is contraindicated because it can exacerbate the hyperkalemia and hypercalcemia. And while we're doing this, we want to monitor urine production, and I say measure output, but I mean, you can estimate output as well.
With acute renal failure, when we're trying to work out our fluid volumes, I thought this would be quite helpful. We are going to assume a 3 to 5% dehydration, and we'll add that to our maintenance requirements. And so we can work out our deficit and give that over the first sort of 6 to 8 hours.
And it's important to weigh your animal twice a day, and we do this routinely. So if the animal's maintaining weight, we know that our fluid therapy is effective. If it's losing weight, it's not.
I tend to then repeat the biochemistry values once rehydrated. So, you know, sometimes I'll do these daily, sometimes I'll do them every other day just to see how things are going. And once that's happened, we want to change the fluids to a lower sodium content fluid, and basically start to reduce our fluid therapy so we don't get medullary washout.
We might need antibiotics if we've got severe kidney disease and the CT image above shows a huge urolith kidney stone, we might consider having to remove the kidney in those cases. But as I'm As I mentioned before, you have to be careful. You need to be sure that the, the, the other kidney is functioning normally before you do this.
So the pictures here show a renal tumour, and it's just to show that the other kidney is looking fairly normal and healthy. How are we going to manage longer term? Well, we can do dietary management, so talking to owners about avoiding high calcium and phosphorus feeds.
We want to think about perhaps in anaemia cases, giving injections of erythro protein, and this can really help, I found, in some cases. We might want to think about. Treating caniculi as well.
And if you have got a hypertensive rabbit, then considering ACE inhibitors, you know, again, it's not common that we put rabbits on these, but they can reduce the glomera filtration rates, so they can exacerbate renal disease as well. So you just have to be careful and ensure that they are definitely indicated before you start them. With chronic renal failure, really, it's going to progress.
So we need to have a long chat with the owner in these cases and decide is this the right thing for this individual, and review the case regularly, have regular checkup appointments where you clinically assess, you record body weight and condition, you perhaps repeat the blood profiles and your analysis, and you monitor the blood pressure. So I've just got a little video here to show you of us doing blood pressure. It's on a hind limb.
Distal tibial area. We've got the pulse oxometer, sorry, excuse me. You've got the Doppler there attached.
We've put a little cuff over and we're having a listen, to find when we can hear that pulse again. And often these are quite low, and we do repeat them and try and do sort of best of 5. But you can use other, blood pressure machines as well for this, process.
So just to really finish up a couple of brief slides on causes of, of renal failure in rabbits, and I'd mentioned about eu canicula, so I thought I should probably have a, a slide up there just to remind you about this particular parasite. It is excreted in the urine and then spores are ingested or inhaled, and the kidneys are one of the target organs as well as the central nervous system. So we get this inflammatory response, and that can be a common cause of kidney problems and kidney failure in pet rabbits.
Another thing that we quite commonly see is hydronephrosis, and this is where we have that blockage and basically and causes a back pressure, and enlargement of the kidney. And you can see this on, on X-ray or ultrasound scan. If we remove the obstruction, sometimes this can correct, but most cases that we diagnose are more chronic, and, and these associated weight loss and abdominal pain.
And it might be that we have to remove the kidney in these cases. Tumours of the kidneys have also been reported. The most common are benign embryonal nephromas, but you can see a list of other tumours that have been reported here as well, and you can see radiographically there's a very enlarged kidney, and which we have removed and then sent for histology.
Pyelonephritis is also something that we do see in rabbits, and this is often secondary to staph infections or pasturella infections. It's basically diagnosed on clinical signs, urinalysis, and blood work, and also, ultrasound can be very helpful to see an enlarged kidney, and these respond quite well to systemic antibiotics. We can get calcification of the kidneys.
This is quite an end stage occurrence usually secondary to chronic renal failure, and you might see these radiographically, as, you know, topic calcification of the cortices and renal tubules. Not much you can do about that. We do see cysts.
These tend to be incidental. You'll see them on ultrasound. Often they're multiple and they're small.
I wouldn't worry too much about them. There has been an inherited condition, diagnosed in some rabbits and polycystic kidney syndrome, but I've never seen this. It's very rare.
So thank you so much for listening. I've got a, a big list there of, useful references that you might find helpful if you, thought about these, these cases and want to read up a little bit more about them. And I also just wanted to quickly acknowledge my colleagues at the, Dick Vet School of Veterinary Studies, as well as all our lovely owners who've given us permission to use all these pictures for this talk.
Thank you so much for listening. I hope you found it helpful. Thanks very much everyone for listening, that was Emma Keeble, Emma isn't actually on she has recorded that, but it is .
We'll be OK to pass those questions that you've asked over to her and we'll hopefully get her to, to do a blog and we'll let you all know. When, that's actually been, put through.
