Good evening, everybody, and welcome to tonight's webinar. My name is Bruce Stevenson and I have the honour and privilege of chairing tonight's webinar. For those of you that are reading the screen and thinking, what, where, why am I in the wrong place?
No, you're not. You are with the one and only John Chitty, and regardless of what he talks about, he will always be one of my favourite speakers. Before I introduce John, I just want to thank our sponsors, Burgess.
Really, really appreciate Burgess stepping up as always when it comes to our small furry friends, and we will be hearing from Ellie Parks, who is the nutritional and scientific communications Officer after John's presentation before we get to any, questions that we may be able to squeeze in at the end. A little bit of housekeeping for those of you that haven't joined us before. If you have a question for John, please pop it into the Q&A box, and we will hold us, hold those over to the end, and we will get through as many of those as we can.
The Q&A box, you can find by just moving your mouse over the screen. The control bar pops up. It's usually a black bar at the bottom, and you just click on the Q&A box and then you can type away in there.
So our speaker tonight is Doctor John Chitty. John is an RCVS advanced practitioner in zoological medicine. He qualified from the Royal Veterinary College in 1990 and gained his RCVS certificate in zoological medicine in 2000.
Until recently, he was employed in small animal exotic practise in Andover with a 100% avian, exotic and small mammal caseload, both referral and first opinion. As well as consulting to various zoos and reintroduction projects. Now, John provides a consultancy and advisory service for zoos, local authority, and vets.
He is the co-editor of 3 texts on avian medicine, 1 on rabbit surgery, and co-author of textbook of Tortoise medicine. Author, author of various book chapters and papers on a range of species, president of the European Association of Avian Veterinarians from 2015 to 2017, and on an editorial board of the Journal of Exotic Pet Medicine, the veterinary Record, as well as the veterinary evidence. John was the past president of the British Veterinary, Small Animal Veterinary Association in 2017 to 2018.
And I know one of his favourite and most trusted, things that he gets up to is that he is a trustee and honorary secretary for VetLife. John, welcome back to the webinar, Vet, and over to you. Thanks, Bruce, and, Yeah, as you pointed out, this talk is not quite as advertised, .
Correct, so what I was asked to do was to . Do a talk on top 10 tips for small mammals, and I've restricted us to rabbits on the grounds that, well, as you'll see, I might not have stuck in many places to a script, but certainly I was really struggling to bring that down to for all small mammals down to 10, so I thought I'd stick to rabbits and go from there. If you have questions about any other small mammal species, again, pop them in the chat, we'll see if we can answer those at the end too.
So, keep me on my toes that way. So yeah, so I was asked to do these top 10 tips and based on, you know, for a new graduate. So it makes you really think about what you knew and what you felt you needed to know when you when you graduated yourself.
Now for me that was in the last millennium, it's a fair old while ago, so you know, it just goes into the old man reminiscing really, but. I don't have my notes anymore from college, but I do remember we didn't exactly have much in the way of rabbits and things. So I was trying to remember what I actually came out of college knowing.
So these are some of the facts we were sort of told about rabbits, and obviously the first thing was that, you know, they they die if they even look at an anaesthetic, but they didn't live long anyway. They had muesli, the teeth overgrow, so you clip them, sometimes prophylactically. They don't feel pain, they get myxomatosis.
Now when I graduated, we didn't even know about echiiculi, that seemed to come along later. They get a fly strike, they jump around, so you really hold them tight. They don't cost much, so no one will pay for them, and in short, you draw them a short straw if you see a rabbit in the evening clinic.
Not very positive, and in many cases not at all accurate. In some cases still are, and there's one we'll talk about tonight which is still relevant. So, first couple there will probably feel are still relevant.
But this is really reflecting how things have changed about 36 years now, so things have progressed, thank goodness. So, yeah, that's good news. However, I also thought I'd add in a few extras because I couldn't quite keep this to 10, and this is rule zero, and this is one of the things I did have when I had a clinic, which was the phrase only a or just a was absolutely banned.
Rabbits are. To their owners are as important as any other pet. There is a strong bond very often between rabbits and their owners, and besides which they are living creatures and sentient creatures, and therefore their welfare is very, very important.
So we never have only a So rule one, and that is that rabbits are a prey species. Which I think we never really took full account of before. So what do prey species have, they have these enhanced senses for detecting predators.
They stick together, that, that's really important, this group thing. They want to have an escape plan. So wherever they are, they want to know if they can get away in case a predator comes into view if it's not ready.
This means they don't have it. They can be aggressive. They also alternatively have a tonic immobility response, which is quite dramatic if it goes, if it happens, and a sign of severe anxiety.
And basically when they don't have the ability to escape, they'll become very, very anxious, and that will include being in things like unfamiliar settings and stuff. Also, the prey species, they show minimal clinical signs, but what signs they do show generally relate to pain or anxiety. So here's our two most common presentations.
On the left hand side here we have the unkempt hunched rabbit with some faeces stuck to the back end, rabbit with back pain, rabbit in pain. This is one that's just basically not able to physically move and look after itself. And on the right hand side we have the rabbit in the corner, head up, quite alert, airway as straight as possible, ears back, and this is an anxious, frightened rabbit which we hope we never do see in our clinics.
So the argument against this is that rabbits are pretty well long term domesticated, but domestication does not overcome biology. So it hasn't replaced their biological needs. It hasn't replaced their biological role in the food chain.
They are still prey species and they still have the mechanisms to deal with that and the senses to try and cope with it. So obviously really different to dogs and cats. And of course these rabbits will be affected by dogs and cats and other predators as well, for ferrets, and of course us.
And if they haven't been socialised properly, we are most definitely on that list as predators. And because they have really enhanced senses, they can detect us from quite a long way away and may be feeling fearful for a long time before we actually think we're doing something to them, which is going to cause some problems. So can we get them less fearful, which is one of the big things to try and do.
Now that has lots of advantages. One, not least in fact is that if we are dealing with a very stressed, very fearful animal, we are not going to get very good clinical findings, and that's going to mean that we don't get very good results either in terms of getting diagnosed diagnoses or in terms of getting good, successful treatments. So it's kind of in our interest as well.
So one thing we can do is we can remove predators, we can make prey-only spaces that can be consulting rooms, that can be waiting areas, hospitalisation areas, all that kind of stuff. So somewhere where there's no smell or sound or sight of things that may frighten them. We can socialise them again, we're just going right back in the sort of pet keeping.
So as what do we do as vets, we can actually reach out to the breeders, we can reach out to the pet shops, and we can ensure that before these rabbits are sold, before their socialisation windows close, is that they are being introduced to strange things. They're being handled. They are getting used to people and maybe having things looked at and stuff.
By the time they're sold, their socialisation windows are long closed. So it's really unusual for them to to learn at that point. This is often about the first time they're really held by anybody.
So this is one of the reasons why we do see these, these rabbits, very young rabbits who have these long term back problems and things, because they haven't been held before. They're suddenly about 8 weeks old, start being held. They've still got very soft, I mean immature bones, and of course they kick out and they damage themselves.
And of course we can, well the other reason for making us fearful is we make our clinics a better place to be for us, for the rabbits, for the owners, for everybody else, and that's got to be a good thing really. So in the clinic we want to reduce their stress. It's kind of what we do, it's sort of in our job title really.
I said this makes examination easier, makes it more meaningful, and it really does facilitate recovery. Stressed animals don't recover well, just like we know that stressed people don't recover well either. So this all starts with reception again.
Don't get the idea that this is purely on the clinical side of things. This is purely vets, purely nurses. This is everybody in the practise involved.
We're making sort of life better for for our pet animals. So reception needs to obviously know what emergencies are. Rabbit emergencies are not necessarily the same as dog and cat ones, so they need to know really what, what, what needs to come in now, what can wait.
These are who sees the rabbits in the practise. Not everybody does. That may seem strange to all of us on this sort of webinar that there are, there are people who don't want to see pet rabbits, but there are.
So, you know, receptional ones who need to basically sort them into the right place to see the right people at the right time, and they're going to have to advise on how to transport. And this is a bit different to dogs and cats very often that people kind of know how to move their dog and cat into the vet. They may not know how to transport their rabbit.
So they want to have ideally a top opening box, but it needs to be a dark box. It needs to have a lot of bedding to hide down into and of course always bring the companions, even for routine appointments unless there's a good reason not to. For example, the other companion may have a problem that's exacerbated by stress or some issue that means it medically shouldn't be moved, but basically, ideally always bring companions.
A lone rabbit is a very stressed, frightened rabbit. So we can reduce some of the stress too beforehand. Again, don't forget the importance of those first few appointments when you really are trying to teach people and don't forget also the value of having things on your website.
For new owners or prospective owners to get, to get used to things as well. So you can train the rabbit into the box. For many of them, the only time we ever go in that box is to go to the vets and have a bad experience.
This is negative reinforcement. We want to positive reinforce that. So why not train them into their travelling box a lot of the time, feed them in there, so most of the time we go in there, it's actually a good thing to do.
Put plenty of bedding in there so they can really hunker down, really hide in there. Yeah, we all have a lot of fun rushing out of our consulting rooms after, after a concert with 4 tonnes of hay that's decanted from a box into the room, but actually that's a good thing for the rabbit to have brought all that in there too. Again, don't bring our own, always bring with a companion.
And sometimes you've got rabbits in a group, bring in the whole group, and just occasionally there are times we actually need to treat them all, for example, let's say a mic problem or something like that. We can use things like pheromones, essential oils, we can get inventive with that, we can use, aerosols and plug-ins and things, we can put, we can soak cloths and things and put those, tie them onto the boxes in here, and we can try and get some of these calming agents into the rabbit as well. Once in the waiting room, again, try and keep them away from the sight, smell, and sound of predators.
They use all these senses, and they really are very, very sensitive to them, so try and get away from that. Ideally separate areas, but if we haven't got separate waiting rooms, what can we do? Well, we can have people into consulting rooms who've got they've got a spare one not being used.
We can ask them to wait in the car. But one of the important things is that we often see practises who have all these, you know, great lovely waiting areas, but then they all come out to the same desk. So the rabbit's in a box, the owner's paying, and there's the dog sniffing at the front of a box, or, you know, the rabbit's looking straight at something quite scary while popped on a desk or something.
So, you know, try and avoid those mixing areas and just occasionally it's worth having a separate exit. So they can go out, take the rabbit to the car, and then come back into the desk to do the paying, make the next appointment, that kind of thing too. Well, so again, we mentioned two before already about reception triage and stuff, but also reception are going to be helped help in reducing those waiting times.
The longer that poor rabbit's waiting, the longer it's going to get stressful. So you know, make sure everybody knows something's arriving, especially emergencies, and wait times are kept to an absolute minimum. We can talk about handling later on, but of course synthetic handling is a good way of reducing that fear.
And if you're going to hospitalise again, what do these rabbits need? Well, they're gonna need, first of all, they don't like hot conditions, they're not good with that. They will often need warm conditions, if they're, if they're they're sick, or around about the sort of 2022 marks.
They want them somewhere at hospitalised where they're quiet, away from predators, away from smells and everything with, with dogs and cats and things and the ferrets, . They want to be somewhere where you can observe them, of course, because you need to watch what they're doing, what they're up to, but you need to balance that with the fact that they don't like being in the wide open being watched. So privacy boxes, and here we show these feline forts, which are really very useful for that, and light levels are important too.
Rabbits in the wild are crepuscular, they come out at dawn and dusk. So really reducing the light levels, I mean we're used to clinical setting where we have lots of bright light, we can see loads of things and then everything's really reflective as well, so we like white, you know, clean surfaces, but they really just seem to have light from everywhere, which is not what these guys like. So a good dimmer switch on the rabbit ward and just try and reduce those levels to make them a little bit calmer while still having enough and you can see what they're up to as well.
I enough to, if you have a right of privacy levels, things to hide in, they often come out anyway because they can know they can safely run back in if they want to. So often you see them better. And of course, company, really important.
So you know, got companion rabbits in with them, so they they're never on their own, unless there are certain circum, for example, an intravenous drip is quite a good time to separate because you virtually can't protect it, but that's about the only time you're going to do that. And to have more than one rabbit, you need enough space, so roomy, large cages or runs or something where they can move about and just do rabbity things. Don't forget as well, always important that not all rabbits use drinkers.
Most actually prefer bowls, even those who are drinker fed, so always put bowls and drinkers in there so you can get encouraged to take as much water and always put the water bowls and the food. And everything near their house. And so we don't have to go very far for it.
We don't have to step into the wide open, if at all possible. And bottom left here is a picture of a guinea pig in a box just as a cheat slide, but also to keep Bruce happy for we're actually doing more than one type of small mammal. And of course things like enrichment too, so, you know those tubes with vegetables and things, scatter feeding, all that kind of stuff just to keep them active, keep their minds active, and that helps take their mind off other stuff as well.
So that's. 1. Now 0.1.5, again I said slip a few more in here.
Please bear in mind that I didn't do just pure maths, I did statistics. So therefore always approximate, I think I can think 12 is approximately 10, which is what we're gonna do. And mix into this because so we hide signs is spotting pain.
And you remember back I learned that rabbits didn't really feel pain, we didn't show it. But actually they do, they feel quite a lot of pain, they just don't show really obvious signs, and these signs may be things like reduced activity, lameness or gait changes, muscle loss, altered moods, altered appetites, faecal urinary change, almost anything really, and if it's different to what they're normally doing, it's probably a pain sign. Sometimes we don't automatically see that, we're doing testing for non-specific illness, which again is often pain related, we often take a blood sample, well actually pain does show on bloods in rabbits, and we often get these low grade non-regenerative anemias, low white cells, often with a reversed heteropphil lymphocyte ratio.
We may see low protein, we'll we'll very often see raised glucose, so you'll know from dealing with our gut stasis cases. So we can see those signs, we start getting that sort of pattern, we can automatically think, hang on, there's something inflammatory, something painful happening inside this rabbit. So if in doubt, assume it's painful.
And here's another little tip as well, meloxicam dose, 1 mg per kg, there are a lot of doses below this, but if you go up a bit, the PK work shows this is probably the right sort of dose to be using, between once a day to twice a day depending, and, you get a lot better effect from it. Other pain relief is available, . But much less is known about it.
And there are remarkably few studies that show . Safety, efficacy, and certainly long term usage of many of these drugs, and that does actually include meloxicam as well, and many of these drugs we're using don't really have even well studied initial dose rates either. They are there.
There are things you can use. There are guidances in formularies. I think the important thing is to remember first of all, there are non-drug methods of pain relief which do include things like environmental enrichment, feeding enrichment, taking everything's mind off it, because many of these drugs simply modulate the perception of pain rather than actually kill pain.
So we can do that with behavioural and husbandry methods as well. And always, always observe and assess the effects you're getting from a drug. It's very easy to give a drug, assume it's going to work, but actually when we've got species where we don't automatically know that.
Then we have to really do some, some assessing. Now this is where things like pain scoring come in useful to assess before and after giving a drug and see what that shows, but again it's a tool, it doesn't show everything. Things like qualitative behavioural assessment, a really nice quantum way of sort of really sort of doing a more formal assessment of how that rabbit appears to be feeling, which is quite good too.
And also when you do start doing a pain plan, a chronic pain, pain plan, don't forget to have an exit plan. It's really easy to start adding in and adding in and adding in, and in many cases I've looked back on a case and thought, hang on, what am I doing here? What are we giving?
Why are we giving that? How many drugs do we need to give? And you need to have that idea of when things aren't working, what do we do next and where do we go.
And above all within this to help you with that exit plan is quality of life scoring. I really can't speak too much, too highly about doing this. There are some very simple, easy to use ones out on the web.
You can adapt them into each case because each case can have a slightly different way, different need, or simply different source of pain. So really useful to do that. And again gives everybody.
A big helping hand in making difficult decisions. So 0.2 is handling.
So eventually we got earlier on it's part of the stress control and things, but again, we're taught to hold them tight, they jump and do all sorts of things. But what we know from other species, the tighter we hold things, the more frightened they get, the tighter we need to hold them, and it's difficult. Big things we now know not to do, holding by the ears, scruffing them, turning them upside down.
Now, is there ever a time you need to do these? Well, certainly holding by the ears really there is never a time you need to do that. For the other methods, there might be, certainly, examining a ventrum is very difficult without turning, .
Some things you're doing may be really quite painful and quite difficult, but. Try and keep those times you need to do firm handling to a minimum, and really think about what the alternatives are, and very often we might be better off sedating, and or just even giving something like midazolam to calm an animal rather than simply try and hold it tighter. If you do have to do one of these handling methods, do talk to the owners first of all.
Many people are very switched on to what are good and bad methods of handling, and if you do this wrong, they'll get very, very upset indeed, and probably quite rightly so. So talk to them first of all before you do something. It's always better to ask them first than try and beg forgiveness afterwards in this case.
Back to a little bit again, winding back a bit about handling in general, and again this is back to about socialisation, is many of these rabbits don't want to be handled in the first place. They may be, if they haven't been socialised properly, then they may be very fearful of people holding them, and if they've had a bad experience for those first few handlings, then actually they're going to be terrified about being handled again. Don't forget we are predators, and don't forget many of these rabbits have got long term stressors by being being near people.
And some cases actually, do you know, they may be happier kept well away from them too. Really stress the fact is that we need to be working as a profession with the breeders, with the pet shops to get these rabbits socialised and handled very, very early in life, because if nothing else, it's in our interest to have these rabbits much more easy to deal with in the clinic. So back to speaking to the owner of clinical situation.
Before we really start doing a consult again, really worth talking to about what is a pet like? How do they hold them? And also, will they hold them very often because they know the smell of their owners, they know what their owner feels like, they know their owner.
They're going to be much, much calmer if they can be held by somebody who's familiar. Now if you've got somebody who really does know how to do this properly, that's not helpful, but most owners do know how to do it properly, and they want to be there and be helpful. And again, you can judge this as you go along before you get to the handling stage of how they appear to be interacting as well.
It seems to be quite a good idea. But you know, this is one of those situations where we really get the owners on board, really get them helping out there, and again, you'd be amazed just how easy this makes things. The extreme example, again to go into different small animal species, is with rats, and rats really, really are so much better.
We found this out during COVID, when they're taken away from owners, handled by by by by vets and nurses, consults were almost valueless. When you have the owner in there holding them, you can get so much more out of them because they're so much less frightened. So examination itself too, we can also try and minimise that that that handling because they don't like it.
They also don't forget they when they're frightened, they do things like jump around a bit. They they they can they can jump off. So we got on surfaces like we normally do ease their likely to damage themselves.
So we can handle rabbits on the floor. We can get down there with them and we can do, do a consult sitting down on the floor, very friendly, very sociable, for me, very difficult with my knees and back, but there we go. Sometimes it's better doing that than other things.
Whatever happens, they don't like being held up in the air. So if you are holding them up, up, up high, then at least make sure there's a surface just beneath them because obviously it does go quite easily wrong. But there's an awful lot you can do just by taking the top off the box and doing it without picking them up.
The first thing you can do is watch them, just see what they're doing, see how their their demeanour, see their breathing patterns, . See if there's any obvious discharge things, again like the rabbit we saw earlier with a posture, obvious signs of of pain or lack of grooming or anything like that too, really important. We can do an external exam, we can palpate over the skin, we can we can look at the skin, we can look at the fur, we can auscultate, we can palpate the abdomen, we can compress the chest, all those things without even vaguely lifting or holding the animal.
We will need to handle things like ocular exams, oral exams, and dental exams, . And we can, we'll need to restrain them for those, but keep it simple, and these things like bunny burritos are really helpful to wrap them in a nice towel, they're there, they're nicely enclosed. They do seem to have a sort of burrow response where if they feel something along their flanks, they feel much more comfortable and much more calm.
And again, towels are also useful, put them on the table, put them on scales, they're non-slip, they're made more comfortable and also easy to wrap around the rabbit if they're already sat on there. And you can also cover them with pheromones and essential oils, and that seems to comfort them as well. So golden rules of handling really, handle lit as you need to.
Put your hands and arms under the body if you're carrying around, always support the back, keep, don't keep them too high off the ground if at all possible. Always use two hands, not one. Be steady and quiet and for old rabbits really double down on all those rules because they very often have arthritis, very often have dodgy backs, and bad handling is a very good way of having problems.
And I should add to that too in eastide rabbit, because again, what these rabbits with spinal problems is it's really not that rare to have a problem afterwards where you've an eastside rabbit routine, nothing's happened, been no incidents, and yet that rabbit can't use its back end afterwards. And very often on X-ray you find they've got preexisting spinal disease. The muscles have relaxed under anaesthesia and everything has destabilised, so really be extra careful with those anaesthetized rabbits.
So number 3, echiiculi always used to be so easy. Every rabbit had echiiculi, but actually not all neurosease is echiiculi. Not all weakness is neurosease, and certainly not all head tilt is echiiculi.
In fact, most of it isn't, and they don't suffer from phenbendazole deficiency, and we do need to diagnose it if we suspect it. So how do we do that? It's really difficult because we can't really use clinical signs because there are no really obvious signs of them.
The only one I would honestly say is a good, a real marker sign probably EC is when you get these really fine tremors, and you get sort of just just rabbit is just very quiet and slightly slightly twitchy and we've got almost like cerebral signs, much more like EC than anything else. We can try and rule out everything else, but that's not easy because if we want to rule out ear disease properly, we've got really gotta be doing CTs to get that inner ear disease ruled out. We should be able to biopsy, it'd be really nice if we could, but bear in mind it's the brain and the kidneys affected and those don't respond well to being biopsied.
There are PCRs available now for urine and faeces, but very often when they're showing clinical signs, they're not shedding, the organism at all, . And we can use things like cut phase proteins, electrophoresis to try and look at the immune response that can be helpful and elevated levels of these can be indicative certainly of an inflammatory response there, but not necessarily guarantee of the EC but can be a good addition to that smoking gun evidence. So we're generally left with a serology of IgG and IgM, and this is our general set of rules.
So if you've got negative IgG, IgM, and clinical signs. Then we can probably rule this out because the clinical signs are due to be immune response to EC. So therefore if we haven't got an immune response, we shouldn't have signs linked to it.
IgG positive, IgM negative should be background antibody, and even if it's varied, you do paired, you'll find it fluctuates wildly. That's not reliable in a rabbit, they, they just kind of don't have stable antibody levels, so don't feel that a rise or a fall in teta indicates active infection, it doesn't. Ig negative, IgM positive kind of shows recent infection, which may or may not be linked to signs.
They're both positive and you've got the right signs, that should be diagnostic, but still with a question mark. Big question though is how common is it actually? Serology in normal rabbits is around about 50 to 70% of rabbits depending on on the studies you're looking at.
But actually 50 to 70% of rabbits don't come in with EC. They're actually, in my experience, really rare cases. We'd probably see about 2 or 3 a year.
And so not very many at all. And again, back to saying most common sign we got of that was a fine tremor, not head tilt, not renal disease, but just a fine tremor. So 4 about teeth, yeah, this is our original things I learned about which yep we still see a lot of dental disease, it's still there.
Do we see less than we did? Not really sure. I think we do see different because we had a lot of work done on calcium levels in diet linked to this.
Calcium levels really were raised in diets and I think we see much less bone density issues than with skulls. Same with skull x-rays I've taken in recent years have been very different to those I took probably about 20 years ago. I think we see a lot linked into brachycephalism, and I think probably a head shape now is one of the more dominant causes, but still fundamentally comes down to diet, which we'll talk about in a moment.
So clinical signs, again, use anything that any rabbit that's not eating properly or losing weight, really we start thinking about dental disease. Don't forget that dentist cannot be ruled out without a full examination under anaesthesia and skull imaging. If you can see it obviously fine.
If you can't see it obviously don't rule it out till you've done all those. Well, here, here's the reason why for the anaesthesia. Here's a rabbit, this is an endoscopic views, but not a sized animal.
We've got this really nice diastema, we've got these really good sort of cheek pouches almost. You need to move them out of the way and when you move them away you start seeing some of these little hooks that go into the into a soft mucosa. So you're not going to see those very easily in a conscious rabbit.
If you do see problems, what are you gonna do? Well, always that debate about whether the de Bur or whether the clip and file really kind of . Kind of rages on.
Everybody has a different opinion and really, as long as it's done sympathetically reducing iatrogenic damage, then it probably doesn't matter which one you do particularly. For my particular taste, I always use burrs for trimming incisors before actually reducing coronal height, which is relatively unusual and sometimes hook reduction linked to that. But if I just had hooks reduced, I tend to just clip and file.
And I had gone from burring. And then changed to clip and file and noticed absolutely no difference in success rate, both in terms of owner feedback to how the rabbits were afterwards, also in repeat dental timings, the interval between them, they seemed exactly the same whichever I did. Prevention obviously is key, as I said, we talk about calcium now, but the big dietary thing which is still ongoing to that extent is fibre, and lack of that, but again, genetics I think plays a big role in these guys, and we've got really short nosed rabbits, really a lot of dental compression is you're gonna have to be a lot keener on a diet to help keep those teeth down.
So mention about fibre, this is obviously the key bit for all all rabbit nutrition, they are real fibervores, and of course high fibre helps reduce obesity which is one of those other big problems in rabbits we see, . And don't forget that neither calcium nor fibre is really provided by a muesli diet, but both are provided by grass and hay. So grass and hay really are the fundamentals of rabbit feeding, and this would seem like a very basic biological fact, but it's something certainly when I graduated was never really thought about, and now we still need to emphasise it again and again and again.
The grass and hay are the fundamentals. And the other thing that is important too is prognosis, if we diagnose dental disease soon enough and we can control it well enough with diet and things, we can get a reasonable prognosis of that, it will never go away, but control is fairly easy. But we have advanced dental disease with prognosis always guarded at best.
What has changed a lot too is better success rate for abscesses, still very guarded if you do get one, but nonetheless, we do have much better success rates dealing with them. Imaging, better imaging techniques give us better prognostics, which is really helpful before we do surgery. We're better at doing removal of teeth so we can actually get the knives of infection out of the way.
We've kind of all moved on now to marsupialization techniques, packing techniques. And the nice thing is we have a lot more people with a lot more owners with a lot more patience, a lot more resources to really deal with these long term complicated cases. They don't get better in one surgery, don't get better in one go, they don't get better by next week.
So really people have to have that patience to deal with it. And one of the big ones is of course retro bulbs, and in days of yore we used to head straight to nucleation, take the eye out, and just deal with a pus-filled eye socket instead. Now we very rarely do that, and we could deal with that by removing the affected teeth, by Marsupializing the abscess to to the the ventral to skin ventral to the eye, and really nucleation is almost, almost never needed these days.
So. 5 is again, while we're thinking about teeth, these are small horses, so basically if it's not the teeth, it's the gut, and gut stasis is probably our most well is our most common emergency. But the big nice thing now is we don't just get these as sudden death cases.
We, we do have better success rates both for medical and surgical cases, and in fact we probably now have fewer surgical cases now. We've got things like lidocaine CRIs being used, a lot more fluid therapy in general, and a lot better techniques for reducing spasm in the gut. So all these cases where the gut is just sort of spasming over a potential foreign body are often relieved by medical therapy.
For medical cases which are the general, we've really got to think about our fuse as coli. Things that make it stop it working more relevantly, so inflammatory substances, fluid electrolyte balance being wrong, stress, pain, all of those will stop that fuses coli working properly and causes the gut stasis. We know much better how to help these, so we use anti-inflammatories, analgesia, we use fluids, we use good old midazolam, and above all, this is not prokinetic deficiency because it's not.
There is a cause for it, and it's not the fact the rabbit has an inherent need for having metoclopramide. It needs to have the actual root cause treated rather than relying on some of those drugs, and a good reason for not relying on those drugs is actually we don't know how well they work or if they work at all. So really tricky.
And we get much less post-op gut stasis these days because we recognise those causes. Why do we get post-op gut stasis? Because we've got inflammatory reaction because we've done some cutting.
We've got fluid balance changes because we've had blood pressure changes through the kidneys and stuff. And with fluid balance has gone out tilt, we have a stressed animal, we may have a painful animal, but we're much better now at dealing with post-op pain, postoperative fluids, postoperative stress. We deal with those things and therefore we get much less in the way of gut stasis afterwards.
And one thing which really helps that too to get that post-op pain better is use local anaesthesia during the surgery as well and really get funky with this. So be aware of those maximum doses, dilute that down because it's about spread, it's not about concentration, and use that maximum dose all over the place, so specific blocks, regional blocks, infiltration, incisional intraabdominal blocks, splash blocks, all those things we can use several different ways in any one case. And that's really gonna help the local anaesthesia.
As we said earlier, you know, different things we don't know about analgesia and rabbits, but we do know is that local anaesthetic blocks nerve endings and therefore we block the transmission of pain, and these are the only true analgesics. These will work and they really help a lot in reducing stasis. So his gut stasis surgery where you've got obstruction, is it more or less successful?
This is a big debating point. It's more successful on the grounds we're kind of better at operating rabbits these days, but actually it's less successful in some cases because we actually operate on so many fewer and only the very worst cases go to surgery. But hopefully we're better at stabilising them now.
I was always taught to go straight and operate as soon as possible. I think most of us now would actually really hold back, really spend much more time preparing a rabbit, stabilising, getting a bit of lidocaine, CRI and that kind of stuff too. And we also know now try and avoid cutting the gut, milk the foreign body through to the large intestine if at all possible, or empty the stomach via sort of gastric tube, rather than actually opening and cutting it.
And above all, really important we audit our cases, we audit those success rates. Like everything else, rabbit medicine's full of myth and magic, and it's really worth just checking out those those numbers and make sure it's actually working. Quick practical one, clipping fur.
Don't forget rabbit fur is very fine. Dog and cat hair is not. Rabbit fur does not gum up gum up the the dog cum clippers, it's the fact that clippers are blunted by dog and cat hair.
So the important thing is you have a pair of dedicated rabbit clippers in your surgery, you sharpen them regularly, and you do not, do not use them on dog and cat fur. So why do you often clip the fur, it's to get blood and sometimes it's actually like getting blood out of a stone, quite frankly. They are tough to bleed.
The veins are very fragile, they've got blood that clots up and hemolys easily, so what tips have we got for that too? Well, practise, it's a big thing. You know, the better you do, the better you'll get at it, it's quite important.
Also, stress, it's one of the things you find as you get older, a lot of light really helps, so you get good visualisation of those veins, . Choice a site too, don't be too fixed in that, it does vary a bit, bear in mind, things like ear veins really shut down quickly in stressed out rabbits, in cold rabbits. So if you've got a rabbit who's just come in off a street on a cold winter's day, the chances of you being able to get anything out of its ear veins are very, very slim indeed.
So you can, wait, warm the ear. But even just putting a rabbit somewhere quiet and warm and comfortable for a while, putting some amyla cream on that ear, and those veins will just di dilate out as as the rabbit gets happier, and sometimes using a bit of midazolam to calm things down really helps too. Mention about using Emla cream, if you haven't got quite the time to wait for that, a little bit of Ethiccalm can of course sometimes just give you a little bit of instant skin anaesthesia to help stop them jump and stuff.
But above all, take your time if possible. Be quiet and calm, avoid shock factors, it really helps you, it helps the rabbit. And time is one of those really real things that makes us have problems with techniques like blood taking, .
If we try and rush, we lose that calm, we lose that ability to think, so we've got to reduce that rush, reduce that panic, and you need to plan. So very often, you know, there's a rabbit on the way, you've got some rough idea of what's wrong with it. You know you're probably going to take a blood sample, so have everything ready, have it all set up somewhere nice and quiet, have somewhere a rabbit can sit for a bit.
You don't need to react immediately when you're 10 minutes behind already and try and do that in a panic. But here's the other thing too, tip 8, why get blood? Take some pictures instead.
Blood results from rabbits are often disappointing. Many rills are non-specific, and they do confusing things. Inflammatory reactions in rabbits, they normally drop their white blood cell count.
They do all kinds of things with a diurnal rhythm, so, so different levels be high at different times of the day. And very often what we find is that rabbit bloods are also are actually not that helpful always. Part of that too is the fact we're applying tests to them of things we use for us, things we use for dogs and cats.
It may also just be that those are not the right tests for rabbits and for prey species. So, you know, some of there are bits we can get out of this, but often things we can't. And actually, as we said already for this this webinar, most non-specific rabbit cases are pain related, dental, orthopaedic ears.
So take a picture instead, here's a gut stasis case. We can see you've got lots of gas throughout the gut and lots of stomach. It's not an obstruction, we can know from a pattern, but if we have a look here, we can see it's really nice set of bony spurs along the spine here.
This is a rabbit with a really bad back. Why has it got bad guts? Because it's its back's bad.
Say 0.9, why don't they die under anaesthesia? Let's reverse that question, and why don't they die?
Well, Think back to a KESA survey, which is the last multicentric study done, a little bit aged now, but it's still a very good survey. Most die due to underlying disease, undetected disease beforehand. There are some cases where a cold will kill them during the anaesthetic, and if you use that heady combination of alpha-twos with adrenaline and stress, we get some really interesting effects on the myocardial circulation.
So using a standard rabbit mix, which is designed for a nice young healthy rabbit and an old rabbit might be a prob might be a problem as well. But we can improve these, and we have improved these by better evaluation of rabbits before anaesthesia, better control of those underlying diseases, so in other words, if we have a case where, Dental disease is a great example. We've got a rabbit with bad teeth.
It's thin, it's a bit dehydrated, it hasn't been eating properly for a week or two, it's not a happy rabbit. Do we really need to rush in and anaesthetize it and do the dentistry there and then? Probably not.
We can give it fluids, we can feed it, we can give it some analgesia, we can make it feel better, but the midazolam takes that stress away while we're doing that, and we can really get the rabbit in a much better position to take the anaesthetic when we have to do it. So stress levels down, don't rush, life is better. So stress relief too, and again, you know, what are we doing for even basic stuff that comes in as day patients, sometimes elective things.
We want to really try and reduce that waiting time, reduced time rabbit can really wind up there, . We want to do those pre-op checks properly, we want to make sure that there's no underlying disease and in some cases it might be better doing a few days before or even a week before your surgery so you can really get a handle on what the what the underlying factors might be rather than take rabbit in and have sent home again. When we hospitalise, we're gonna do, we talked about already, you know, we wanna be in a low stress situation apart from predators and all the other things, of course we want to have a companion as well.
Midazolam I find really helpful in these cases. It's anxiolytic, it's amnesiac, it has lots of great things about it, and these are things we need to do. One of the big nos is it's great to have a catheter in place in the ear vein, but if a rabbit comes in, it's immediately jumped on by 2 or 3 people to place a catheter, that stress to put that in there is probably going to undermine the advantage of having it there in the first place, so.
Get the rabbit in there, let it calm down, give the anti-stress drugs, let them work, and then put the catheter in at that place at that time, so it's not really getting too many bad effects from that too. And afterwards, after the procedure, feeding, you get that gut moving again, companionship, so back with its companion as quickly as possible and do the best you can. And all throughout this, just take the time to let rabbits acclimatise, let them destress, and don't just rush, rush, rush and keep those levels high.
Our 10th 1 here Is that this is probably the depressing one to end on really, is that fly strike isn't about flies. They still get this. This is the bit that really makes me a bit sad really, but this is a disease which, do you know, I, you see your first one and you never want to see it again.
And when you see it again and again and again, it's just a bit depressing sometimes. They still get this. And yet we know what the causes are and things, and there are many underlying reasons for this.
They can often orthopaedic. These are rabbits who can't take their seeker tracks because they physically can't turn. If they've got spinal arthritis, they've got hip arthritis, something along those lines too.
That mean it's generally debilitated. They're too weak to turn. They have dental problems where they've got hooks in the tongue, so they can't turn around and take it.
Secotropes are disgusting things. One of the things that I found which really cheered me up about rabbits was I couldn't believe that something as nice as a rabbit actually ate this disgusting see a trope, and they don't want to. They don't find it tasty.
They have to do it as a reflex. It has to happen immediately. And if anything interrupts that, then they won't do it.
It'll just sit there. So all these things are things that make you think twice. So if you turn around and your back hurts and spasms, you're going to stop doing it.
That moment for eating a secret trove is broken and gone, just like we would think twice about then bending down and picking up a paper clip. So debilitating too obesity can do the same thing as well, you know, it's just physically hard to turn around and sadly we still see husbandry situations where where they are is so small that they can't physically turn around and take the secret trophy easily, and that's a problem. And if you combine it with bad hygiene, so it striking onto faeces in the general environment, that can be a problem.
So prevention should be easy because we should be able to treat, recognise those causes, should have this cause it under control. And we have great drugs for dealing with this. We have some a couple of really good prophylactic agents to to provide to these, and we can even better now because we know the causes, we should be able to identify the causes.
We can do targeted prophylaxis so we can give it just to at-risk rabbits, and yet it still doesn't happen. So this is a bit from 36 years ago we still don't always get right, and it's just sad, especially when it's a narciss disease of a lot really. So summary of my not quite 10 points on not quite all small mammals is that rabbits are prey species.
They have massive stress issues, and we need to reduce that stress. We need to recognise their pain. We need to control that pain, and we don't need to panic when we see a rabbit.
So thank you. John, as always, that was amazing. Thank you so much.
Some great insights there into incorrectly and, and long-held beliefs. And as you correctly said, a lot of us were taught these things, when we, when we studied, and, it just shows the importance of CPD. So thank you for spending your time with us and sharing all your knowledge with us.
Folks, we've had a couple of questions about, going back on slides and things like that. I probably should've, mentioned this in the beginning, but we do tape all our webinars, and the recording from this will be up on the webinarvet website, in the next 24 or 36 hours. So if you want to go back and re-look at something and, Take, make notes or take a screenshot or whatever you want to do, the recording will be available there.
Before we jump into questions, we are just going to hear from Ellie Parks, the nutritional and scientific communications Officer for our wonderful sponsors, Burgess. So, Ellie, over to you. Thank you very much, and thank you very much, John.
I'm sure everyone can agree that it was a great talk. I love listening to everything you've got to say, especially about bunnies as a bunny fan myself. So I'm just gonna go through a few points about, Burgess and what's, what's coming up, with our small animals, in the next couple of months.
So I want to start off with Guinea Pig Awareness Week. So Guinea Pig Awareness Week returns in October, and it's the 7th year, for this, this event, this campaign. The the theme this year is centred around guinea pig health, hence the little guinea pigs, going to visit their vet on the screen.
So resources and assets, to use in practise, will be available in a few weeks' time. However, that QR code on the screen, I will show it again later in case you don't get a chance to scan it just now, . It will take you to our website which is where you can sign up for reminders and as soon as the assets and the packs are available for you to download, you'll get an email and you can er print out or digitally see all the the great content we have for Guinea Pig Awareness Week.
Another thing that is probably really helpful in practise is our Excel dual care, which is our version of a critical care product. It's a must have in practise er when seeing rabbits, guinea pigs, chinchillas, herbivores in general. And our critical care can be fed as a nugget.
Er so if you do have a patient that is well enough to eat, it might be unlikely but it can happen. Or it can be fed in a syringe feed. You just add water to the nuggets, er, the nuggets will absorb the water.
And then you give it a good mix, you then syringe feed it with the syringe that you can see on screen. The key to getting as much fibre into the, the animals, as possible is to have it quite thick, so you want it quite thick, the paste that you make, which is why you need a syringe that has quite a wide, wide tip end, so you can get behind them front teeth and that wide tip of the syringe will allow for a thick paste to get through, so they can have a little chew and swallow that food down. So it's suitable for rabbits and guinea pigs, because it has high levels of protective vitamin C in there.
So we wouldn't usually say, nuggets can be fed to both rabbit and guinea pigs, they do need separate ones, but in this case, because of the vitamin C in there, that's protected, from manufacturing processes. You can feed to both. It's got probiotics in there to support the digestive tract.
It also contains tryptophan, which is there to support at times of stress. Magnesium will also support the immune system, and it is high fibre and that will support gastrointestinal function and get that gut moving again if it's slowing down. It is a key product to help support during times of illness and recovery.
You can also, suggest to feed this if an animal is coming in for a routine, surgery, so a dental or, a neuter. They can feed these nuggets before they come to you, and then when they're in your care, they can eat this nugget or they can have itsringe fed, and then it can work as a transition, process from this nugget back to their original nugget when they get home. So it's a really handy little nugget to have in practise.
And then finally I want to talk to you about our vet portal. So it's a dedicated hub to find resources, nutritional support and extra CPD, which everyone is always keen to do. You can download species specific leaflets, care guides, posters, access welfare campaign packs, for Rabbit Awareness Week and, Guinea Pig Awareness Week for example.
You can watch exclusive webinars and read about blogs that are written by industry experts, and it's all free to access. So again, another QR code, but the assets that you can see on the screen, the little orange, pink and blue booklets, they're care guides, so there's one on guinea pigs and it goes through quite in detail the five we venues of guinea pigs. The blue one is for rabbits, and the pink one is focused solely on rabbit nutrition and the importance of, high fibre diets and, good quality nuggets.
So scan that QR code and you can download all our assets. And that's it from me, so I try to get through that as quick as possible because I know we have a lot of questions, but if you do have any questions relating to, small animal nutrition, or any questions regarding our products, please do get in touch with me. That email on the screen is the best one to, to reach out on.
And then you've got your two QR codes there that I mentioned earlier, one for the vet portal and one for the guinea pig Awareness Week reminder. Thank you, Ellie. Please leave that slide up so that people can make a note of that and scan those while we are chatting, if you wouldn't mind.
A big thank you to our sponsors, Burgess, and also to Ellie for running through that, information for us. They really are a great company and, you know, if they are supporting us, my, feeling is that I should urge you to support them. So thank you again to Burgess and specifically Ellie.
John, we have no doubt, loads of questions for you. One that we, often chat about on almost every presentation that we do together is about doses. And I know that you don't like specific doses and that, but lots of people are asking about the use of midazolam and the dose.
Do you want to give us your broad picture of doses of drugs, please? I'm gonna surprise you tonight, Bruce. Are you?
Yeah, but to keep, keep the anticipation going. First of all, I'm really remiss. Once again, I've forgotten to thank the sponsors at either the beginning or the end of the talk where I put the.
So thank you, thank you, Burgess, again for sponsoring the talk, Burgess, I've been fantastic. Sponsor these talks for a long, long time and I know Ellie's one of our amazing trustees for Guinea Pig Welfare UK and I know I'm in so much trouble the next time we meet. So I'll let you off, John, don't worry.
Anyway, thank you very much indeed, I'm sorry about that. So to surprise you, Bruce, the only dose rate I ever really remember and like to like to remind people of is midazolam. And I use 0.25 mg per kg subq.
And that'll be 2 to 3 times a day depending on need. It's not the full sedative dose. It is just something to just take the edge off just to make them just de-stress them a bit, and you very rarely get very obvious sedation from it, which is what I really liked about it.
That is the only dose I'll be drawn on. Apart from the meloxicam, won't make the cake. Partly right.
No, you're absolutely correct, but I can be contrary to the end on this one, so sorry, Ben. No, that's very helpful because it is a question that you and I both know comes up really often, about doses and everything else. Maybe you'd just like to guide people through what they should be doing when they're working out doses in general.
Absolutely, yeah, and in general this is true, and actually this is the other good thing too, I must say that's the dose I like. But. The worst thing you can do with most of these days is remember them because you stop looking for them.
And things are changing quite a lot, hopefully the theme of the talk very much is how much has changed, . And new stuff comes out all the time and it takes a long time to hit with formularies and it takes a long time to hit with textbooks, so. You really want to be almost scanning the peer reviewed literature a lot for this, so I would recommend that you do kind of get updates from Royal College Library or you.
Just go through every sort of quarter and just just check out any new new small mammal doses that are out there, and just really keep a review or if you've got an unusual drug you're doing, just do a Google Scholar, do a Vin search, do some kind of search to see whether any new peer reviewed doses out there for it. A great example that's Moropotent, where there's new work coming through every single year on that one. This is the drug's really got a lot of excitement going for it, .
Nebulous results but a lot of excitement going for it. So you see new dose new dosage advice coming through the whole time, so always look things up, because it's just changing so much. Yeah, yeah.
And that's, that's great. I'll, I'll give you this, John, you haven't changed that story since you and I started many years ago together, so, yeah there we go. We're familiar ground.
We're happy. I'm going to paraphrase cause we've had a whole lot of questions come through that cover these two topics. The first one is, when you hospitalise, a patient and their mate together, how do you monitor things like faecal production and know who's doing what?
Right, there's one piece of essential stuff for surgery that I never actually really mentioned properly. One thing that really makes the whole thing tick, and that's the amazing veterinary nurse. And they were fantastic at knowing one, how much faeces a rabbit should produce, therefore how much faeces two rabbits should produce, but working out that very often two different rabbits defecate in different places, so just watching and observing and seeing what they did.
And of course if you've got one with gut stasis very often they'll be coming out different sizes for a few days, so you can really follow from that. So it really is a case of watching. And having a few basics and then just observing those individual patients.
And having that essential creature in the practise that makes every practise successful, our wonderful vet nurses. They were absolutely brilliant at counting faecal pellets and knowing what should be coming out of them and what was happening. Really, really great.
Absolutely reliant on them. Yeah, they are amazing. I, I am a big fan of vet nurses.
The other, question that has come through in a lot of different forms, John, is you mentioned the use of, pheromones and essential oils and that to try and de-stress them. Do you have ones that you feel work better than general, or do you just reach for general ones? There are some data about, stress effects of pheromones in consultations.
They're quite hard to get hold of in the UK, but they are around. And those have got some data to them about showing better effects from, from clinical procedures. What we do have easily obviously essentials like pet remedy and stuff, and anecdotally they do seem to help a lot.
I don't have the data to actually back it up like you do with the pheromones. So that's why I tend to put both of them on the same slide there, but, and I certainly think with pet remedy and stuff there's a lot of good, you know, anecdotal responses to to to just everything being a lot calmer around it. And it can be really again you could say you get funky with it, you can put it on your hands, on your, on your arms, consulting jacket, everything else there's just so hopefully to a rabbit you smell better.
Yeah. Always a good thing. Always a good thing.
Michelle has asked, do you ever use lactulose as a gut softener? Together with all the other fluids and analgesics and everything. No, I haven't, .
Really because the issue is not like pure constipation type thing, so you're not trying to . Get more fluid in there and trying to break things down from there because usually it's not just, it's not interspassated solid material going through, it's in fact the gutters just stopped, so almost like a different, different problem. However, there are rabbits where we do and especially.
Again, anecdotally, and beginning some information coming through there that obese rabbits do seem to suffer more from this. So therefore hepatic lipidosis is a bit of an issue potentially, and I would probably think about using some electroos and things as they begin to the gut begins to work because you may get some hepatic lipidosis, you may get some some encephalopathy effects and things like that from a faulty liver. Fantastic.
Last question and then we've run out of time, I'm afraid. What is the optimum socialisation window time for rabbits? As I said it, I thought, please don't ask that question.
Basically they emerge from a burrow around about 2 weeks of age, and when the sort of eyes are opening and stuff, and that's when they're really learning fast. So I would be looking at 2 to 4 weeks. Basically, and my rule of thumb is, once those rabbits have eyes open, they're starting to explore, that's when they're learning.
That's when you pick them up, that's when you do things with them, that's when you teach them. Excellent. John, as always, that was amazing.
You haven't disappointed. I, you are still my favourite presenter of all time, so a big thank you for coming on tonight and sharing your knowledge with us, and, I look forward to having you back again. Thank you, and thanks everybody for listening.
To Ellie, from Burgess, thank you very much for coming on and thank you for Burgess for the great sponsorship, and, we hope it continues well into the future. To all of you for attending tonight, thank you so much for your time. I hope you have enjoyed this and have learned as much as I have.
And last but definitely not least, my pres co-host in the background, Dawn, who has made everything run smoothly. Like a good vet nurse, we couldn't do without Dawn, so thanks, Dawn. From myself, Bruce Stevenson, it's good night.
