Welcome to S a webinar on respirations. This is in small mammals, but we can specifically look at rabbits, rats and, guinea pigs. As, these are most commonly presented species with this sort of problem.
So while we're covering those, well, they've got much in common. We see a lot of respiration, which is a big reason for this. They're often kept in similar ways, especially inside the house.
And some of the issues, that, relate to respirations may affect all of them. However, some differences and in particular with guinea pigs, there's a bigger emphasis on infectious disease. With rabbits, a big emphasis on anatomy.
And rats a lot on social structure and and, immunity relating to that. There's some source information to have a look at if you want. BS.
A E manuals are all really good and contain lots on this. It can be useful. And just to let you know, there's, a new one on the way Very soon, specifically on guinea pigs, which does have respiratory, of course.
So we gonna start with rabbit anatomy and the majority of this talk will be on rabbits with. So if you like, diversions into the other species simply because we will see and probably do a lot more work with the rabbits and with the with the others. So rabbit anatomy?
Well, upper spirit tract. They have a very complicated system. The nostrils are really narrow.
They're really sensitive. And then they go on to these very narrow, complicated, nasal passages, as you can see from his cutaway. Dissections.
They produce a large amount of secretions. And this is one of the things with this sort of system it can get gummed up quite easily and can cause real problems. So it doesn't take a lot to get real, issues with, Wi wi wi wi with within nasal pastures.
Especially. Is that the fact that, the, rabbit can't easily mouth breeze? We'll talk about that more, more as we go along.
But, they can't easily mouth breathe. So therefore signs of respiratory disease can be quite easily in Y. They do actually have quite a cool breathing system, and that is that they have diversion of airflow on the inspiration and exploration.
And again, this will come in relevant later on too. So on inspiration, the, air is diverted more laterally into more complicated part of the conca and the, and the Sinuses. And on exploration, it's more through these central, larger passageways, through and this is gonna become relevant.
We can use that, when we get, which we'll talk about later in this talk. So, going off for a tract and rabbit, it's got very narrow oropharynx very, very large base of tongue. And this is why they've got real problems with breathing.
Cos you've got to dislocate the, glottis. And it really is quite difficult to do. We can make that worse, and we have, and we get a lot of brachycephalic now, so we squash a nose, we get it.
Dental compression. So we get the nasal passages are shorter and narrower. That means an areas of a na a a nasal passage are more likely blocked by the secretions.
And we get, more tortuous tear ducts and again more more issues. From there, the tear ducts run through the Sinuses. So when you see something like dacryocystitis, that may well not be just a tear duct problem or an eye problem that's more likely to be a dental problem.
Or, a Sinus problem because of where the tear ducts are running through those areas moving on to a lower respiratory tract. We'll see, a very narrow larynx. We have incomplete tracheal rings, and then going to the thoracic cavity, as you can see from its dissection.
Very, very narrow inlet. It's a very small, cavity. Basically, we've got a very large abdomen, and a very small cavity here, and we have a fat individual like this.
Then we end up with a lot more compression of her lungs than we would have otherwise. And if we have disease and again in this case, we can see an area of congestion. You know, it's very easy to lose an awful lot of functional capacity of the lungs.
Very quickly. The lungs themselves are very similar structure of the mammals, but they are really, really compressed in comparison. And that sort of fits with how rabbits, if you like, exercise you know, they they don't do a lot apart from when they're running away.
So they do very short bursts of anaerobic, exercise. But very, very rarely do they do. Sort of like long spells of, of aerobic rats and guinea pigs.
Do we see similar? Well, guinea pig? Yeah, we're gonna We speak of very large fermenting gut.
We do see, we do see some, some sort of like chest compression, As you can see on the right hand side here, the rat, though again does have a large abdomen. But again, we're getting looking more normal, sort of, lung capacity compared to, the, the CC compared to a rabbit and a guinea pig. So we're investigating respiratory.
Our first question was me. Is it respiratory? Because it may not be.
And some things do mimic it between rabbits. When you get anything blocking me area because they can't mouth breathe, they're gonna look very. We're getting difficulty very, very easily indeed.
Picture here is a rabbit with Trane with rabbit syphilis. And you can see a scabbing across there. Is blocking the block in area and, this rabbit presented as a case of open mouth breathing and severe respiratory distress.
We'll see extra respiratory abscesses and masses in all these three species, and they can all compressed lungs quite easily. We'll look at one particular syndrome in guinea pigs later on. And we'll see, compression of the lungs due to things like, gut Stasis in both rabbits and guinea pigs.
which can again I mean, some of these cases will prevent a as respiratory disease. And if nothing else, it will mean they're severely compromised. If we ever do have to go to anaesthesia.
For issues like blockages, we see cardiac disease. So with the remit of his talk today, but we are doing a future webinar on that, and, we also see, see a heat stroke and all these three species are pretty sensitive to overheating. And in a high situation, that can happen in summer sometimes.
So how do we distinguish the upper and lower? It's not always easy. Generally the upper switch track.
We hope we'll see nasal discharges. We may get some snorting sounds. We may get sneezing.
And and generally discharge is probably more of a giveaway than most. And it's most common in the in the in the rabbit in the rat. We'll get, some porphyrins.
We get poor friends, often with any type of spirits disease. And, sometimes even with rough handling or or stress. So again, it's not guaranteed.
Sign of of upper respiratory for lower respiratory tract disease. Major See weight loss? We do see in guinea pigs, occasional cases where they cough.
I was quite surprised by especially the first case I saw was during covid. Which is quite alarming. But it's, I give people sometimes cough and it's worth paying attention to, and it can be a sign of quite a severe pneumonia.
We started to hear crackling sounds, without a stethoscope and with more auscultation later, and we may well see increased respiratory effort, so it's always worth just watching the animal and watching how it breathes. But with either upper or lower, we may see more rapid respiratory rate. We may see ocular discharges.
We may get extended neck or open mouth breathing, especially in rabbits, but many times, there's nothing obvious. You know, this is one of the things they're just not doing well, they're They're a bit quiet. They're not eating so well.
Losing weight. And it could just be one of those things you find on investigation of this type of generalised presentation. If you are seeing a respiratory tract disease, do think teeth.
In guinea pigs, as here, generally linked into motor disease. And that's the most frequent in rabbits. Although occasionally you'll get nasal discharge with insides disease and in rats, it's normally inside these and very rarely motor disease on history.
What we get, what are we going to get and what what might give us clues? Well, want to know about signal? You know how old you know, the sex of the animal?
That type of thing when it was purchased, always useful. Especially when we think about, infectious diseases. And especially we're thinking about obviously rats and guinea pigs with that, we don't have an onset aside.
So how long has it been going on for, and and what did it start like? Did it look like the to start differently on occasion. That can happen, and it's always nice to talk Chinese management changes that might or might have happened around that time.
We without previous disease history, if I had this before, have other problems before what's relevant and again other pets, you know. Have you got guinea pigs and rabbits kept together? Do you have different, group structures?
You know what? What's rat set up like, and, you know, for rabbits, vaccination is really important because both my miosis and RHD may present with some respiratory signs, husbandry really, really important, even. And things like bedding and substrate for litter trays because with with with urine anaesthesia, sometimes we'll get some interesting reactions.
We'll get some irritants produced, and that's really relevant. So that's an area two where we can really get people engaged. It's well worth asking them to bring photographs or videos.
Either send them along before the consult or bring them to the consultation really helps a lot with seeing how everything's set up and try and get them to lift lids on on, on on the on the hutches and and and and housing to have a look in at the sleeping compartment that's often an area where you get very poor ventilation. So do do get them to try and do that and also bring samples of bedding and samples of litter. Most people have forgotten the names of them.
It's quite remarkable that one. But most people have forgotten the names of what's coming in there. So, you know, do ask and bring stuff along so you can judge and see what it is and and look at it, and that's really helpful.
But get people doing the worst stuff there, and you get some really good results. And they say they're very, very happy to do that. May or may never.
But any exercise, like, can we rather think of rats and wheels? Can we be, you know, losing that ability to exercise very hard to Jud with rabbits and guinea pigs, But it's always worth asking, and again, we wanna go into the diet about about about issues from that, too, especially while we worry about dental disease issues. We do a lot of examination before handling.
Once you handle the animal stress, it's gonna change how it breeds anyway, it's it's gonna be really affected. So it's one of the things where see rabbits. You can normally see them in the carrier while you're doing the history.
Rats and guinea pigs come with a lot of, cover, which is great for them, but it does make it difficult to do. But if you can possibly do this, watch the animal before you handle. So you see his attitude.
How is it you know, Is it really lying on its side, breathing? He very, very heavily. Then, in which case, you know, you probably better do some stabilisation.
First of all, what's the head position held up? Is it held straight? Is the mouth open?
What's respiratory rate? What's respiratory effort? And most of the animals.
You really shouldn't see too much respiratory effort. You see any at all is a problem. And if you can hear it breathing, there's definitely a problem.
And again, you get some clue about discharges and stuff. Before you, you even pick the animal up and, like, just rabbit here, you can see if there's a left sided nasal discharge. You know, there, there you can see that without without handling.
And the other thing to look at in rabbits is they do have a thing called a carpal handkerchief, where they wipe their noses with with their their their wrists, which is very naughty. But they do it, and its rest is really useful because although the nasal, discharge may give you some idea of what's happening in the last 24 hours just to give you some idea about what's been discharged last 48 and again, rel you look at both pores, see which pore has got, got the discharge on it, and that's a really good thing to look for. So our actual clinical examination obviously relates to severity.
Signs of the animal is collapse and really struggling, you know, don't do too much, and if you have got scabbing over the nostrils, pick that up. First of all, first thing you do is clear those nostrils, especially a rabbit in distress. You'd be amazed at how what a different demeanour is once you give it a chance to breathe through its nose.
That's really, really, really important in terms of handling, you know, if it's in distress, minimal handling distress to keep a good close eye on it and probably have some, oxygen close by. And don't forget, with some anest a little anaesthesia, a little bit of sedation might really help with, facilitating that examination. One important thing to do when you do handle is palpate the chest.
So just basically, lightly compress it and, you know, your chest should be quite springy, so you go in nicely and to come out again. If you've got very congested lungs, like in this rat and this is a dissection of rat afterwards, then you know you're gonna get, really solid feel. It's not gonna compress easily.
And that's quite clear. You've got some some considerable gum consolidation going on in terms of osculation. It's a bit of a debate about how rewarding it is.
It's I think it's worth doing. I say, Listen, I try and pick a a nice little infant stethoscope, too, for very small creatures. But it can sometimes be very difficult, and particularly in rats, which can get quite dis, distressed with even having set to get put on them.
Which case? If if it's they are becoming distressed, you know, Just back off. It's You're not gonna get any meaningful results from it.
Especially start vocalising. But have a listen. See what you can do.
And the problem is is that sometimes you hear sounds and his sounds are important, but there shouldn't be many real thing. Is is significant. No sounds because a normal animal should have very little, respiratory sound through.
They should be almost silent. But so too is the consolidated chest. And you've got consolidate areas.
They will be silent, too. So you're never quite sure what what the significance of absolutely no sound is. So we wanna do some tests, we see what we can do.
And this is what we're gonna go through and discuss a few of There's quite a few we can have a play with, and and we can We can see what we can get from there so we can go through a few of these and see, see what they give us. Now, to do these, you're probably gonna need to anaesthetize our sedate at the very least, so you know what? What do we do about this?
Well, I think first and foremost it it's gonna be a risk. If you've got severe Respi disease doing this sort of thing, it is gonna be risky anaesthesia or sedation. So discuss those risks with the owner.
Make sure you really understand. Make sure that that the that they appreciate just how severe the problems are. But why you need to do it, and it can be necessary, as we mentioned before for examination.
Certainly it can be necessary for some tests, particularly on radiography. But don't forget, it's also a very good means delivering oxygen. And that's gonna be helpful because animals may very often need that and reducing stress.
So if you deliver oxygen, reduce adrenaline, that's a good combination. In terms of preparation, you know, if there's any therapy you can do beforehand. If it's not a mad rush to find out what's going on there, then do it.
You know, it may be some, anti-inflammatory, maybe antibiosis. That may be just simple things like cleaning the nostrils, and getting the animals comfortable as possible, maybe giving some fluids, giving some food because some of these animals won't eat too well. Dental related, maybe even just the fact that it's very hard to eat when you can't breathe properly.
But, you know, supportive care like that's really important. And that might help you a lot. So again, if we're gonna do this, how do we do it?
This may range depending on the civic casement. What you have available. It can be for anything from a quick, you know, light, acebo fluorine or ISO fluorine anaesthesia.
Or you may choose to go down the route of, whichever injectable sedative regime you want, and again based that on, O on what the need is what risk is. So personally, I would probably try and avoid alpha twos, but I would certainly use a lot of midazolam, so blood work. Probably less relevant than most things.
In these cases, so haematology by chemistry might give you some ideas about underlying disease. Might give, you know, as many secondary disease might give you some idea about prognosis. There are certain concurrent issues, but you know, it's not gonna give you too much.
Maybe apart from the nature of immune response going on there. And that's particularly true in rabbits who don't produce a brain marked inflammatory response to their blood cells. In terms of serology, you can do that for E canica.
And that might be a concern, although very, very, very rare to get direct respiratory sites from E canica pasture again, probably less relevant because some of your normal rabbits are positive for this and do carry it. Even, it might might be what you culture from things. It's not a direct pathogen.
It may be older, pet rabbits. You might do blood work if you're looking at rat respiratory viruses, and we'll probably discuss a little bit about that later on about. But again, relevant to that at that time is probably not very important unless you're dealing with, a group situation.
Radiography, though, is to my mind essential. In terms of respiratory, we might be looking at dental assessment, looking at Sinuses, looking in the osteo. I like those areas.
Two gives us some ideas on the middle ear disease, and, identification of abscesses and stuff for lower respiratory. Well, we can look at identity abscesses we can look at, the fusions masses organically. Any concurrence diseases too, which are really important and might give you some clues about how much of a lung is affected, which is gonna be very important.
Prognostically, TV is a minimum. You want to do C lateral lateral and you want to do a dose of RU. It does require immobilisation anaesthesia term type.
Putting the animal on a plate or putting the, animal in a box to an east side is highly unlikely to give you a well positioned view. And unless it's well positioned, you're gonna struggle to really interpret these. So personally, I'd rather not do this than than do that type of technique.
But no, because to mobilise some way but getting positioned correctly, you can get some amazing information out of this, so it's really worth the risk in. In almost all cases, some issue might be insensitive. You know, you're gonna have to have obviously changes to lower respiratory, especially where to actually be able to see this.
But again often does provide a very big amount of, information. So upper respiratory again we can see this when we got marked dental disease on this, this is what we did present with a nasal, discharge And reason is because the Sinus here we can see outlined in white, is affected by both the molar and the molar and the incisor roots. So this is basically typically I spoke, but it gives you a good idea of what the overall outlook is here when we're doing lungs again.
I mentioned that tongue. Two views, you know, do position correctly. So lateral view.
Make sure those legs are really pulled forward away from a chest, especially in animals like rabbits and guinea pigs, which does such a compressed area of chest is very little to view. And legs line can be a problem. For the Dorsa ventral view again, pull the legs forward and outward slightly and again.
This will get as much chest clear as you possibly can. So this is what you can get. This looks like basically, it's one where it just look like, cardiomegaly.
But actually, a problem here is the legs are backwards, and so we can see if you look at the endos scapula we can have muscle overlying this entire area, and that's going to affect our interpretation. So we want a little bit more further forward if we possibly can try and avoid rotation. You see, I have rotated this one.
But, do do try and avoid that if you if you possibly can. But you can at least get a clearer view of the lung fields. This way we can see, through, like pneumonia patterns, we can see sort of soft tissue, densities through here and and just general fluffiness.
And that's probably the most common thing we're going to see. And we'll see some of the time if we do get bad news. Knees are uterine adenocarcinoma, metastases and very important to, if you have got a suspected case of do radiography before going into, T ovary hysterectomy because we will see mets in all kinds of places, including bone and especially the chest.
Otherwise, we see, different bits and pieces. We some see the bronchial patterns that's here. And we'll also get, much more marked consolidation of lung lobes.
As in this case here and sometimes we'll see some, changes within the bones. That's particularly true in guinea pigs, where we may see vitamin C changes within the, ribs of the Costa Contra junctions. Rats.
Again, Ready off is really helpful. In this case. We're gonna get respiratory for a bit of a double whammy here.
We've got a bit of a a gassy gut here, which is gonna be compressing the chest. And we're also gonna get it marked area of consolidation within the chest as well. And if you have got it available, CT is incredibly useful for upper and lower respiratory disease.
So if you have access to that too, that's brilliant. Now, the one advantage you might get with CT is that you can sometimes do this conscious, by, popping away with sort of like a trap devices. And sometimes you'll get a sudden you get a conscious chest view.
From those and some of those head as well, depending on what type of CT unit you have, we do sometimes do, ultras, grey. Air is obviously a problem to ultrasound because it bounces up. But the good thing is Fortunately, a lot of our, disease is very advanced.
We have a lot of consolidation, which means we can ultrasound it. And that's especially true in rats. And I found that really useful because actually, what it does, it does enable you to do some percutaneous sampling so you can locate a consolidated lesion.
You can stick a needle in it, and you can aspirate material for cytology, and culture. And that's really helpful. And, of course, you know, cardiac disease can look very, very similar to respiratory disease, so it does enable you to assess the heart at the same time.
So we mentioned about taking material for culture. This is one of our problems we sometimes get is, you know, we we get issues with, you know, what's being produced and where it's really helping and very commonly get curious about. You got this case taking a swab, grew this, given the antibiotic, it hasn't worked.
So why doesn't it? You know, what are the problems with it? Well, first of all, I would like to find pathogens, and that can be tricky.
And and one important thing with that is actually where are you sampling? So if we have upper diseases, you know, can we actually sample within the area? Because if we've got an abscess up inside the, caudal part of the nostrils, we can do a deep nasal swab.
Yeah, but are we gonna get into that area to get it? If we sample the VVV VA, we're very unlikely to be getting much apart from. We normally find that.
So we may not find those pathogens if we have lung disease. There's absolutely no point at all taking, nasal oral swabs because we're looking in the wrong place, so we may not find those pathogens. And in some cases, we haven't really got pathogens.
You know, there is. It is due to other issues. So a rabbit with aper asper disease is the problem is a dental disease allowing things getting into the nose That shouldn't be there.
We are like you find commensalism. And the good thing with that is is what happens if we find pasture? You know, when we discuss that later on, so if you do find it commencing, how significant is it?
We are gonna contamination. And again if you do need nasal orbit. It's very hard to guard it, to go deep and get sample only deep nasal areas.
And not to get, superficial areas contaminating that and very often we're not gonna find a thing. So we have a very pussy case. Puss contains many inhibitory factors, and we'll very often get absolutely no culture from that.
So it can be very unrewarding indeed. Where we are attempting to, you know, always do Aero, anaerobic as well as aerobic area is often a bit shut off from oxygen. And of course, we got any abscess situation anaerobes really come to the fore.
And we have an issue too, about with it culture, both rats and guinea pigs. Mycoplasma is a serious issue and one of the major, respiratory pathogens around there, but it won't culture routinely. You've gotta do some special stuff to get to do that.
And whether that's worth the effort with it's worth, the cost of it is is of due significance. But send your routine. Bac won't pick this up, and therefore, all this adds up to what results you get.
How significant are they? So you need to be able to really, know you're sampling in the right place. Hence the imaging.
And then then then make sure you're sampling in the right place. Get right. We can maximising that chance.
So I mentioned about P culture and past. So if you have a healthy rabbit, it's of absolutely no sign at all, because it is a commence. So it's pretty normal there.
Don't use prophylactic antibiotics. You might wanna cons consider other rabbits, especially if you're like a colony situation. And more rabbits being introduced That might be important, and especially if this is in, quarantine going into a large pasture free area.
But they're unusual if we have a diseased rabbit. Now, if we have a young or a rabbit in a breeding colony or whatever, then it may be very significant at that point. And there are more pathogenic strains that might be might be quite useful, and again, recently purchased could be important.
So you gotta look at health safe to the others, see what significance is. And hopefully it is a colony situation. The the breeder is, quarantining.
And so hopefully it's not gonna be a complete disaster. If it is an older individual rabbit against significance probably quite minor. You gotta consider the underlying causes of what else might be causing respiratory in those cases.
In terms of guinea pigs, we do see a bigger range of bacteria, and we do find those are, certainly a lot more significant, within that one. And one example of that is border teller. Now this again is carried by both healthy rabbits and guinea pigs.
But it's much more pathogenic in guinea pigs, and we generally get lung disease. But we mic up respiratory science as well, and it's pretty parallel. These are lungs from a border.
Tell a a guinea pig. Obviously that one didn't make it because it's really pussy. Abso areas, but And, you know it's not nice and again because you get a lot of lung and solidity.
You might get more things like weight loss and non-specific illness before you get over respiratory signs. So you know it's a difficult one, and this bacteria may spread. They can.
They go septicaemic with border teller so we might get generalised seps seia, and obviously that's a pretty severe case. So we do see that quite a lot. And there's a good reason for not, housing guinea pigs and rabbits together.
We rabbits tolerate it pretty well. The other big, respiratory problem I get is cervical lymph itis, also called lumps, which is a lovely name. This actually is a is a strange one.
I debated where they put this in respiratory talk. Most of the time we get the lumps in the ventral. Neck is here and that the owners very often worry about this causing respiratory problems and pressing the windpipe.
Actually, it rarely does tend to, pull downwards, pull vally with gravity, and so we don't often see that. But we will get cases in the nasal area. We'll get cases that may actually burst inward.
We may get some respiratory issues from that issue, tore it at zoos. Don't think it does have potential to be zoonotic. So with Children around stuff you want to be a little bit careful on that, too.
Can be found commenced, but can spread quite rapidly. Amongst a group, especially a stress group. So stress is really an important underlying problem.
Very young animals, too. Very common indeed to see in terms of therapy, typically antibiosis, and, rarely do you get resistance issues with this. So things like trims.
Trims suon can be very good, or Lansing and flushing can be useful, but it can be a real grumbling problem. And, it can keep recurring, and it can be very difficult to clear from some individuals, and it can also spread down with the sort of chain of lymph loads. And again, we can get chest involvement with that in terms of control.
Again, this is one where if you're moving guinea pigs between groups, it is important to get a quarantine period, especially young animals getting into that and that that's very useful indeed. Now, rat inflations are is quite a cornucopia. They, the big one is mycoplasma, but there's an awful lot of others, and all these may be found in our cases.
May be found, within the the pet animals. So you gotta consider them all. But mycoplasma is probably We'll start therapy against in in in the initial stage.
Do we need to specific diagnostics for these. Well, this is a tricky one. Because some of the virus in particular, you can only really get from very specialist labs.
They're pretty expensive. And of course, viruses aren't directly treatable anyway, so is it worth doing? It's really debatable.
And personally, I very rarely have. What I would say is I would, probably treat for mycoplasma first, and then would look to culture looking for the other bacteria if I'm getting treatment failure, But again, make sure you're sampling in the right areas. Try and get direct lung samples if you can.
I would very rarely, if ever do. Respiratory, virus serology. Simply because, for, you know, you know, an individual pet rat that's probably not gonna be ov overly clinically helpful for the cost involved.
So generally, we are going to, be giving antibiotics to a lot of these cases. Especially in in rats and guinea pigs. Which one do we use?
Ideally, culture and sensitivity. But again, we may very often said have cost issues, and also we may have severe disease, but that delay in getting results for for several days may mean we have to do a first guess. We have what to do.
And the other thing too. Don't forget is we'll talk about this later on this. Adjunctive therapy and physical therapies may be really helpful in reducing the amount of time we have to give antibiotics, and in some cases, may may even replace it all together.
But we can do that. So again, mentioned about bacterial sensitivity again. When?
When I would do this, I would certainly consider an antibiotic failure. And I would certainly consider it if you like. Colony outbreaks.
There. So again, where to? How to do thinking about where the problem is.
So it is just a a respiratory disease without being associated with a physical problem, like dental disease or whatever. Then deep nasal swab. Probably a way to go there.
We're looking at lung disease. Then I'll be looking at lung washes and aspirate, depending on whether they've got consolidated lesion. A generalised issue.
Which species? That sort of thing. So I mentioned about antibiotic failure again.
Why do we see those meant already about failures with culture and sensitivity? But don't forget things like dose rates may be not known particularly well for a certain drug. We may have drugs that don't penetrate.
Well, so a good example that would be aflac great drugs for fluoroquin lines. Very good and respiratory situation. But if we're dealing with an abscess, they're very poor at entering anaerobic, acidic areas.
And dealing with things there. We may have drug activity that doesn't work in that particular, S against that particular agent. So we might be trying to treat, mycoplasma with something like, Try meth sulfonamide.
And again, we've got underlying causes, which keep driving us on. So pasture is a good example of that, too. If these respiratory that were generally due to solely to pasture, we would treat it quite easily.
It's very rarely resistant so we can get rid of it. But being driven by dental disease or sinusitis or or or other issues in that area, then it's really hard to clear and chronicity, and we have to be honest here. But a lot of these diseases, especially look on imaging, have been there for months and building up for a long, long time.
Five days of antibiotic is not gonna touch that is not gonna change anything or or S and see much difference with it. So again, we have to be honest about what kind of effect we're gonna see quickly and again manage our expectations and manage your expectations of the owner. Now again, what we use.
We have issues with safety and stuff, and a particularly in guinea pigs. Guinea pigs are a pro worst lot. So here's a list if you like safe or not safe, you know, got question marks there.
Why question marks is actually look down these columns you actually see there's some crossover and some, and people aren't, you know, really aren't sure which ones are always safe in there. And so there's no there's there's reduction in choice because of that, my guinea pigs more sensitive. Well, just like rabbits.
They will get this if you like dysp OSIs type of thing, where you can clear the wrong bacteria from the gut and end up with, say, like clostridium or EEEEE. Coli left behind, which can be really quite dangerous. But they have worsen rabbits, and the difference is because you you can, and some of these get a very direct toxicity.
The bottom slide, which I've borrowed is, showing the sort of edoema you'll get in in in the gut, in some cases with a direct antibiotic toxicity. So generally we recommend is look, stick to the safe column, stick to that. And if you can prepare the patient, you can't always.
But if you can get them onto a decent high fibre diet, get the gut at least in more alkaline, get it more and more functioning better it it does seem to help protect, with a better flora. It helps you to help protect against these problems. Certainly, if in doubt, use parenteral roots rather than oral roots.
Obviously more direct effect or orally. And that's why in rabbits you can often use penicillins inject toly, which I certainly would not recommend giving by mouth. And some people think the probiotics may be helpful with this, and they're certainly gonna do no harm at all to do that.
What can help us, too, with our bacteriological interpretation, and it's a lot of it comes down to. That is, to, to back it up with some cytology. So when you take a swab, just put someone on the slide, have a look at it, and we take our to do the same thing.
And it's great, cos it's, faster, and you're gonna get a result straight away. And certainly you don't want to be doing, you know, waiting four or five days before you or two or three days before you. You you start treating, so you get a first guess.
Use something based on what a psychological appearance of the organisms is, and it's gonna show you a cell responsive bacteria. So if you see cocky being engulfed by white blood cells, that's a pretty good clue. The body thinks that these cockle bacteria are quite significant.
And then, if you do a GM culture staphylococcus, that really does back it up quite nicely. So you'd be much more sure that your results are giving a relevant answer. Probably less use in up respiratory disease.
But Katie might We might get some interesting results from there, too. But certainly lower respiratory disease is really helpful. That's particularly true because we often get non infectious diagnoses as well.
So aspirates and lung washers do those cytologies lung wash is actually fairly simple. I will exclude the rat from this because that's downright tricky. But in, both rabbits and guinea pigs, this can be done, rabbits especially.
So, I would do this in cases where I have got, confirmed low res respiratory disease. And certainly, if I'm, not getting good response to treatment. Always anaesthetized, and always intubate.
Feed a urine catheter into the tube, just feed it down towards relevant area. If you have got your lateral disease, make sure that that, affected lung is lower. Most, and then for a rabbit sounds like a 2 kg rabbit.
I'd use 2 to 5 mils of saline and basically titrate the volume of, based on that. And just insert that with draw and just flush it about a bit, and you'll get a very poor harvest picture on the top right here. You can see we've got a harvest there.
It's about 0.4 of a mil. That's a really good harvest from about 2 to 3 mils.
So, you know, you don't expect masses there, too. And that's quite important let's see, Wrong cos that went, So, the other way you can make that easier sometimes is to do endoscopy. This is possible.
We've got a one millimetre, 1.6 millimetre or a two millimetre metre flexible endoscope. You can get diametric, especially in larger rabbits.
And that can enable a direct wash. Some of the direct sampling as well. For up respiratory, it's easier.
Still, we can use rscos, and certainly a two millimetre ryos cope would do. It will be really will be effective in most size rabbits. And that lets them look at a lot more areas.
Also even, diagnose things like foreign bodies. We'll see from time to time in rabbit noses. Two millimetre scope will also just about going into a larger guinea pig nose as well, by the way, so that that can be quite useful.
The other test, which we really developed, found very helpful is cat grey. And this is a rabbit one. So we're not gonna exclude rat rats and guinea pigs for this because it's gonna really, I think size the way it precludes this, but Caty really assesses lung perfusion and therefore gives you an idea of a spiritual performance and ability.
And best of all, with this, it lets you do a conscious rabbit. And this is great for things like pre anaesthetic assessment, where you're not sure what you're going into with it. And the big thing to remember is don't forget the normal expired card oxide that was around about 4% or 49 of mercury.
And you can relate this to the wave form. That's quite important. I'm sure many will be using, a cat in routine anaesthesia anyway, and hopefully Well, this is what Caty does.
It's an early warning system of hypoxia, and it tells you it's breathing and also is breathing pretty well. Hopefully And you get this Cato gramme, which is just showing they will rise in carbon dioxide when you may breathe out. And then the slower the breathing rate the longer than that plateau normally is, and the faster as you get a very short plateau.
That's what we're normally gonna see. This is how we do it. This is its ni size rabbit for showing, but, you can do this quite as unconscious rabbit.
I would not use an end on one as end sampler here, but I would use a sidestream sampler as in there. And this is just a an ET tube connector that got continue airflow through them. And this is where it comes really useful.
The rabbits, exhale through one part of the, the nostril, nasal cavity. And it's even more useful. It have even wider, less complicated parts.
So it's so it's where really the end of that. ET connector tends to default to now you can to get to It's better by putting a little bit of local anaesthetic in the nose. First of all, and generally, most rabbits will tolerate this pretty well.
So we did a a bit of a small study in 11 healthy rabbits in a pet shop. We got actually, 34 of these gave really nice, normal breathing pattern. We got some huffing breasts.
You know a thing where rabbits do where these guys use the very light. Very quick, huffing, breathing. We've got a couple of breath holds, as well.
But for normal breath, I can see where it comes. Useful Being able to see the wave form. We can see all this is, you know, usually look quite pointy.
They are basically right. Waveform. They're not going back down to zero, and they're not plateauing properly because it's got, a respirator of 49.
So it's breathing quite fast, but it's there, but we can again see it's got 4.2% cover, so it's quite good. And anyway, we got really results are really fitted with what we expected at that sort of level.
And interestingly enough, not too much difference between whether which way we held them upside down or sternal, which was quite intriguing. We did see a cup of huffing breath, and, these you see, as you can see, but it looks like a waveform. So again, you can pick it really easily.
And I'm surprised you've got very low carbon dioxide levels. So you're getting this sort of really low level and you see a sort of pattern that, you know, this is not irrelevant. This is not a useful diagnostic recording that's quite useful, too.
So we can do that and we can get an idea when we've had disease. We're seeing very high carbon dioxide levels. And that's, and that that that's, quite useful as a diagnostic parameter.
We can actually watch at full with therapy. So very useful with someone had postponed ops because, we're we're not sure about respiratory exchange ability. Based on those and that a useful technique.
So what other therapies can you do apart from antibiotics? Well, one of them is nebuli and particularly rats and stuff. People.
The owners are very switched on to this. I think one of the important things is it's not a magic answer. It's a really useful thing to do, but it's not a magic answer.
Legalisation could be as simple as steaming. So putting an animal in a steamy bathroom just like we would do with, with our prosperity, we we know we we we we put our head over a bowl of steaming water, and it really acts as a as a good expectorate. It's helpful, something like aromatics.
I would really caution against this because, these are very small creatures. There are toxic doses. Some of these two and very, very poorly studied so personal I would use a straight W, steaming water rather than adding an aromatic to it.
So just be careful with those you can nebulize antimicrobials And that plenty that can be useful again. Little evaluation. But again, don't regard as a bypass for about how toxic a, an antibiotic you can use because, of course, it will go over the animal as well, and it's gonna groom it off, but it's gonna do some good things, too.
It might live a drug to affect area, but definitely it's gonna act as an expectorant. And for a lot of these animals living in hot, dry houses, gonna act as, hydrating mucus membranes and so you can use it both upper and lower spirit disease as an adjunctive treatment and can be really good. Other things we can do, we can give immunos stimulants.
There are quite a few people who like propolis and things like that, too. And I've seen some reasonable results of that, too. And that's no, no bad thing, especially again thinking about rats where we're we're, looking at, social stress.
And and also really are quite run down Men, aromatics again, often heard of, Please be careful with those. We can use bronchodilators and very often we we're using Coplin, especially in rats. And that's quite useful.
In some cases, one thing is very useful is NSAID. And once upon a time, I was a farm that I remember Carly. Maybe you got much better results using anti inflammatories, getting some reactions out of her lungs.
And again, especially with things like rats and where we might be dealing with viral disease, That's really what we've got. But with all of them, it's gonna be considerable reaction. And getting that down is going to make their lives much, much easier and much better.
I would avoid steroids. Apart from the extremists. There's really very few indications for this and a report where most of these animals are quite sensitive to it.
And we have got any question marks over immunity. Then we've got to be careful over that. So mentioned rats quite a lot.
What we do with these Well, in terms of acute, the presentation I'll be looking for the underline causes so things like stressors. What's the colony like, Really useful again to have pictures of a case set up. You know, have you got one rat dominating things and especially if you're looking at a rat respiratory, it's quite old in a stable group.
And it's the only one affected. You can be pretty sure that's the bottom of the pile. And there's some other issues going on within that, also, we look for irritants and stuff, and again, these things, like what subs you use what litters used are.
You know how closed off is the area, and even ventilation levels, both of the room and of the housing they're using. And you get some good idea of that from just looking at a set up, looking at where the airflow might be. So general self and trial therapy, I'd probably aim at anti mycoplasma.
First of all, doxycycline's my favourite, but I might end up with, Fluoroquin Lane as well. Instead of depending on what's available, anti inflammatories alongside. Take good old meloxicam normally, and nebulization potentially, in certain cases, so if there's no improvement relapse, I probably would change the antibiotic from where those initial ones onto azithromycin or I had azithromycin as well.
And the beauty of that one is that, is it penetrates consolidated areas because it enters into monocytes and enters them that way. Otherwise might try a Penis. They might try.
Try, try me sulfonamide if I was worried about one of the other bacteria involved or if I culture and found that maybe add in, Theophile if I'm thinking about congestion. But really, as I say, I'm thinking about diagnostics doing some radiography again to get sedate them for this and looking to see if I have got consolidation like it on the right side of his, chest of this rat. Then I'll be taking an aspirate from that and seeing what's going on there.
Other things you might find too, is this case is actually, collapsed right lung. And Atal Lata, we've got a very hyper expanded left lung in this case here. This is pretty obviously why antibiotics didn't work in this case because that right lungs just just disappeared.
So it's unlikely to get totally right. So again, mention two. Don't forget.
Look at stressors. Don't forget group structure. Don't forget two.
If a rabbit rat is the bottom apart, it's gonna stay that way. And sometimes one of the big therapies you're gonna do is actually split that off that rat off with a friend. And try and break that colony up and sort of do that too.
So also important to know how long we've had them for any mixing any M AC structure really important. And all those cater multilevels look brilliant. They've often got one ladder between each level and a dominant rat can really control movement between the levels and for food and water.
Or or hiding areas are in one particular area. They can really exclude other rats from that and again, husband issues like, you know, airborne irritants, ventilation issues, irritants from from litter and stuff and airborne irritants are quite important because a lot of these species all living inside the house are can be exposed to be like the hot, dry atmosphere of a centrally heated house, and that can drive membranes a bit, reduce ventilation, and really be a good drive of respiratory, just as it is in people sleeping compartments. All spaces, too.
You know, they're often closed off areas, where the animals are a lot often very crowded because they're all going in there in a group. Not necessarily a problem. But if there's no airflow through there, that's a good way to get build ups from there.
Sometimes you lift up the lid of some of these things like you smell inside it. It gets quite nasty. We're talking about substrate again.
Don't forget. Also, of course, just how close grannies are and where do you smell it? Where do you check it?
There's no good smelling where we are no feet above it. Sometimes those animals are often millimetres above the substrate, so that's where the problem is. It really is like a micro environment microclimate down at that level.
That's important. And of course, they may live in different rooms of a house. And, you know, is this a room where people spray stuff?
Is this in, You know, teenager's bedroom, where all kinds of things get sprayed in teenagers' bedrooms So you know, it's important to know, understand those sort of issues, too. And if you want to Certainly if if you if you want a an environment that is badly ventilated and potentially full of pathogens you know, a teenager's bedroom is a place to be, really? Because they're not well ventilated from past experience.
So, nasal flushes another therapy might wanna do. They say we've done up respiratory infections. Where we're having, you know, other sort of treatments.
Things too. And they say we've ever done a very simple nasal flush again, a conscious rabbit, and simply just squirting, if you like a very small volume of very dilute F 10 We normally use, through the nasal pastures. They don't like it very much, but it's a really effective way of clearing out some of these sticky discharges in the short term, especially if they are in some degree of breathing distress and making that much easier.
Now we're gonna finish your rabbits Sinuses, and this scenario where flushing can come in as well. Because we're seeing more and more of these problems with with the Sinus areas. They do have quite a complicated system.
The important ones we're gonna have are the maxillary Sinus, which dorsal mental assessors and the dorsal Conor. And these open together into the nasal cavity. There is an internal one called a sphenoid case that I have to say it's unusual, but you're gonna need advanced imaging to really pick that one up, and it's quite a tough one to deal with.
That has a separate opening so separate to the other one. So with an auxiliary, which is the most commonly affected Sinus, the premotor create these impressions of ventral floor. We've got a nasal aqua duct in there as well.
And these recesses connect with a large opening, and they go then into the dorsal coccal Sinus. So back to your sinusitis, common the system doesn't help, but and underlying causes can be a big problem there, too. So this is what it should look out and cut away.
There we can see the dorsal assessor. We can see the ventral assess. We can see the proximity of the, molar teeth here.
This is immediately behind, the cord to the, incisor root, which is basically opening into this area as well. So it's quite they're quite big in comparison to the nasal cavity. They're very large indeed.
And this is what they look like when they're filled with discharge and F one CT. And we can we can see the ventral recess here. We can see the dorsal recess here.
We can see the material in their little air gap there just to show that it shouldn't normally be like that. So we can have problems with that. So clinical signs, nasal discharge often difficulty breathing.
That's clogging everything up. We may see that concurrently, with dental problems, we usually see that concurrent dental problems. It may present its tac cystitis.
We can endoscope. We know. So this week, actually, we sort of see the, discharge coming from, the actual opening.
But the the caveats that is very often there's a lot of discharges very hard for the scope to see past that. But basically it looks like any other respiratory on first. Presentation.
We can X Ray. We can sort of see it too. And here's our typical presentation Ventral recess here.
We can see if we got a grey stripe in the blackened area here, too. We can actually, see, again confirm a associated with teeth. But we can see the discharge within that, And again here, here, we can see on our pocket there.
We can see some more, material there. And this is what happens when you put some contrast into the tear duct. This one was the one that actually presented as dacryocystitis.
We put some contrast in there. We can see that that area which you see before delineated, actually look, we can see it's got a wall around it. It's actually the it's blocking.
And actually, that would be an airfield, cavity airfield, abscess, probably with a wall around there. And we can see how basically it's blocked the tear duct. What's happened then, is the tear duct is dilated and what we're doing with the materials dilating through there so that duct is actually filling the Sinus.
CT is more sensitive, for looking at these, and is the way to go. If you're really suspicious and with more people having access to it now, I can't really push it hard enough for that. But again, we'll often get these.
Sinusitis will extend into the nasal cavity. Yeah, they may get some, turbinate bone inflammation as well. We may get osteomyelitis on the lateral wall as well.
That's quite common. And here on these sort of, coronal sections, we can see again these of these changes to the lateral wall and the loss of bone density around there. That's quite a problem.
So therapy. Well, we can do open surgery. I'll show you that in a moment.
We can scrape things out. However, what would get people to consider when looking at these decisions with the alternative one is, try and flush material out. By going through the skin is there's a micro environment in here, too.
The bigger hole you make, the more you break that micro environment down, and that does affect how they work. And it also affects what the likelihood of recurrence is. So the more of a mess you make in there, the more likely I get future problems.
Sometimes you have to. So initial therapy might very well do antibiosis, might very well do anti-inflammatory. Sometimes your nasal flush is to clear things that way to buy some time to give you, drugs, time to work, but otherwise might try direct flush.
Just very simple technique. And essentially, what we do is we need size a a it clip up between the eye and the nose. And if you look on a rabbit's skull, you'll see there's like a cri preform area on on this sort of lateral, surface O of the skull that goes into the, Sinus area, and we basically just pop a needle through there.
We can see we're aspirating first of all, which is very good for culture and cytology. We can see a bit of material in the syringe, and then we'll simply flush some saline through, just to clear some of that out of the way, and that can be really quite effective. In some cases, we can make the hole a little bit bigger, and we can actually do so, like implant something like an ear wick.
A a sort of dry sponge in there and feel antibiotic. Leave that for a few days, then withdraw it, and that can make make your life a little bit easier for dorsal silencing. We're gonna do the same again, positioning just obviously on the dorsal surface, head again.
Research in May use the imaging to guide that that that that that needle insertion that's quite useful. This slide from Aidan Raftery, which I'm very grateful for. And again, give me some more idea about roughly where you're going with that so I can line draw across the, medial, canvas of the eyes down the dorsal midline and then halfway between the dorsal midline and the, nose, we've got a little spot just there to go into the dorsal area and that that can be quite effective Guide and again if you go and go into, ventr as access of a sign again, aid and side again.
These are the sort of areas you're looking at, but really good to have access to a rabbit's skull, and get access to imaging that's gonna help you guide things much more accurately. And in very focal lesions. When we're operating again, we'll use those landmarks.
We'll also use imaging, and this is what we do if we open surgery. So basically what we'll do is to treat it with, like a dental abscess. So essentially open.
The area I will very often just use a skin biopsy punch to do that. They do bleed. So be be prepared for that.
And, Then we can just cure it out, and then marsupialize the, abscess, just like we would for a dental abscess, too. And finally, the thing, that's all. Rabbit problem.
Actually, we are seeing some Sinus problems emerging in guinea pigs as well. Now, too, they they have maxillary Sinuses and guinea. See problems there, too.
And this is a recent guinea pig with, pretty intractable upper respiratory disease. And again, we've got, Mark's marked filling of of the the maxillary Sinus here. We can see it through here as well.
So thank you for listening. Respiratory is very common. And just empirical empirical treatments very rarely work for very long because there's so many underlying issues.
So you really do have to address those. And the other important thing, too, is lower respiratory may usually be medical and managed medically, But don't forget for upper upper upper respiratory disease is that it's gonna require surgical intervention at some point. Thank you for listening.
