26 Jan 2015
Elisabetta Mancinelli
Job Title
ELISABETTA MANCINELLI DVM, CertZooMed, DipECZM(Small Mammal), MRCVS exotic encounters
HEALTH and welfare need to be a priority in the veterinary surgeon’s everyday work. This applies to any aspect – from receiving clients and their pets and making sure the trip to the vet is the least stressful experience possible, through to keeping rabbits in the hospital in a way that is suitable to treat their condition to the best standard possible, to discharging the animal and making sure its return into the home environment is smooth.
Rabbits are notoriously prey species and masters at disguising signs of disease. They are stressed very easily and even the simplest disruption to their routine can result in significant stress.
Often pet owners feel their rabbit fears the car ride, the veterinary waiting room, reception, consult room and even the veterinary staff. This is one of the most common reasons for why asking advice from pet shops, groomers or breeders is preferred before even thinking of considering a trip to the vets. However, it is important to reverse this trend as vets can be a precious source of information to owners and their pets. It is therefore essential to address this anxiety/stress factor.
The first impression is usually the most important. The first contact the rabbit owner has with a veterinary practice starts with the reception area and the staff. Training in answering basic rabbit-related enquiries and recognising emergencies is essential for whoever is answering the phone.
Common questions a receptionist should ask include: is the rabbit eating? Is the rabbit passing faeces? For how long has it not been eating and/or passing faeces? Is the rabbit showing any of the following: diarrhoea, bloated abdomen, respiratory signs, head tilt, seizures, paresis/paralysis, collapse, bleeding or trauma?
Depending on the answers the rabbit may need to be booked in immediately and the receptionist must be able to recognise when this is the case. Furthermore, owners may telephone to ask if the rabbit needs to be starved overnight before a surgical procedure or if it needs routine vaccinations and/or worming. Receptionists should be trained to be able to answer these simple questions.
Advice on how to safely take the rabbit to the vet surgery so stress is reduced to a minimum needs to be provided (secure carrier with hay at the bottom, ideally with some of the rabbit’s own faeces; food; water; companion if present; care of heat stress in warm weather conditions).
The receptionist may suggest the owner covers the carrier with a towel during the journey to the clinic or ask the owner to do so during the wait in the sitting area. A dedicated area where rabbits and other exotic pets can sit away from cats or barking dogs (even simply using different sides of the waiting area may help) should be used in the waiting room (Figure 1).
Scheduling appointments (if at all possible) so the rabbit does not have to wait long in the waiting area may be required. Some owners are aware the visit can be stressful to their pets, but they do appreciate if the veterinary staff acknowledges this and everything possible is done to minimise their stress. Keeping a selection of high-quality rabbit food (hay, pellets and high fibre treats) and other products (magazines, books, posters and leaflets) in the waiting room is a way of demonstrating to rabbit owners the care and interest the practice is willing to show towards them (Figures 2 and 3). Many practices now have websites and/or a Facebook page with a dedicated section for rabbits. This may be a further incentive for pet owners to seek specific advice on transport, surgery, first aid or general care. It is obviously essential to make sure the page is scientifically correct, but at the same time is appealing and easy to understand for owners.
The nursing staff needs to be trained on the basics of rabbit husbandry, diet, medical care and neutering, as well as being able to triage if required and support the veterinary staff. Nurses working with these pets must be able to correctly and safely handle and restrain rabbits. A qualification in nursing exotic pets is available if nurses want to seek further training on these matters.
Of course, vets dealing with rabbits must keep themselves up to date with basic rabbit medicine and surgery matters, nutrition, reproduction and other facts. A large array of information can be found on the internet. Dedicated rabbit textbooks are also widely available, as well as webinars, CPD and lectures specifically targeted for the general practitioner. In the past decade, peer-reviewed publications have exponentially increased, demonstrating the effort and interest the veterinary profession is putting into understanding this unique species.
A room should be specifically available for rabbits to be seen (Figure 4). If this is not possible, an effort to avoid examining a prey species immediately after a predator species has been in the room (especially ferrets and birds of prey) should be made.
Washing hands after having handled a predator species and cleaning the room before allowing in and touching a rabbit is mandatory. Changing the scrub top may be necessary in some cases.
Specific posters and/or skull radiographs may be displayed in the room or a board with some more in-depth rabbit info may be placed on the wall.
A tailored rabbit history form is useful as a guide for the important questions that cannot be missed. These history sheets are widely available from the internet or they can be personalised to the clinician’s choices. Getting everything ready before the physical examination is even started is important so handling of the rabbit is reduced to a minimum (Figure 5).
Of course, a correct and safe handling technique is essential (Figure 6). There are still too many reports of spinal fractures/luxations in rabbits resulting from improper handling during the visit to the vet. Vets have a central role in preventing disease, treating illnesses and enhancing the quality of life and welfare of these animals, but vets also define our future and profession during each consultation.
Animals respond to stress by activating a wide array of behavioural and physiological responses that are collectively referred to as the stress response. In response to stress, a cascade of events culminates in the release of glucocorticoids from the adrenal cortex (Smith and Vale, 2006).
If exposure to glucocorticoids is prolonged, a variety of pathological outcomes becomes more likely and adverse effects may result, such as altered physiological and endocrinological function, immune system suppression, reproductive impairment, hyperglycaemia, insulin resistance, altered carbohydrate metabolism eventually leading to hepatic lipidosis, hypertension, reduced renal blood flow, cardiac failure, and even pathological lesions (Goldkuhl et al, 2010).
Furthermore, stress is a common cause of reduced gut motility, eventually leading to altered gut function and stasis (Varga, 2014a). All these issues may be potentially life-threatening to the rabbit. Rabbits are considered catecholamine-driven animals, very prone to stress and with a high metabolic demand. If handled too roughly, stressinduced catecholamine and endogenous corticosteroid release can result in tachycardia, hypertension, reduced renal perfusion and hyperglycaemia. If a rabbit is already ill, this process can worsen dramatically its clinical conditions, resulting, in extreme cases, in cardiac failure and death due to stimulation of the sympathetic nervous system.
Therefore, every attempt must be made to reduce stress, including providing adequate pain relief at an appropriate time – pre-emptive analgesia may help reduce pain and postoperative stress (Page et al, 1998).
Rabbits have a relatively delicate skeleton that accounts for seven to eight per cent of their total bodyweight, but they have strong and well-developed muscles. Correct, gentle and calm handling is extremely important to avoid spinal and long bones injuries. The rabbit should be examined on a skid-free surface, wrapped in a towel when too panicky and always with a hand used to support the back. If allowed free in the room, placing towels on the floor may help the rabbit to hop without slipping.
Always remember rabbits have prominent eyes positioned laterally. This feature gives them a field of vision close to 360° for quick and effective detection of predators coming from any direction around the entire horizon, but with a blind spot beneath their eyes and caudal aspect of the head (Williams, 2012). When the rabbit is approached around these areas with no warning, it may be startled. Different handling techniques may be adopted, depending on the situation or procedure performed. Rabbits should never be scruffed or picked up by their ears. Covering the eyes with a hand may be useful to calm the rabbit.
In many cases, rabbits need to be admitted to hospital to be able to perform a thorough diagnostic plan and to receive appropriate treatment. Remember very few drugs are licensed for use in exotic species and, therefore, the use of drugs licensed for other veterinary species or humans may be required. Owner informed consent for the off-label use of drugs in an exotic species must be obtained.
Ideally, prey species should be hospitalised in a stressfree environment (Figure 7). Predators should be kept away from the sight, smell and auditory field of rabbits. Common rabbit predators include dogs, cats, ferrets and birds of prey. Often, this is not practical, therefore a quiet corner or simply covering the rabbit’s cage with a towel may be a short-term solution.
A basic cage set-up would include newspaper at the bottom of the cage and a large amount of hay/straw as bedding material (Figure 8). Blankets, towels or soft bedding may be required in specific cases, such as when a rabbit is presented with head tilt, to avoid trauma if it is unable to maintain its balance, or to avoid soiling a wound (Figure 9).
Be warned some rabbits tend to chew newspaper and blankets. A hide box should be provided for the rabbit to have a secure place to sit comfortably and undisturbed (its carrier box may be more familiar, but a cardboard box of adequate size can be used). A litter tray may be placed in the opposite corner. Hay and/or a combination of shredded paper or recycled paper pellets may be used and changed when soaked. Some rabbits like to eat while in the litter tray so a hay rack can be placed close to this. Rabbits are prone to heat stress when the environmental temperature rises above 22°C. Ideally, temperature should be maintained between 17°C and 22°C.
Always consider the possibility of having a rabbit’s bonded companion hospitalised at the same time. This reduces stress, helps with recovery and avoids fighting when the rabbit is reintroduced in the home environment. Rabbits can become bored and frustrated if they have nothing to do. Especially when the hospital stay is long, safe rabbit toys and other objects can be used to enrich their environment. Always have a selection of common rabbit food in the hospital to avoid changing diet while the animal is hospitalised. Alternatively, just ask the owner to bring a rabbit’s lunch box. Fresh food needs to be always available, even if the rabbit is not eating on its own, as it can stimulate appetite. Make sure to ask whether the rabbit is drinking from a bowl or a bottle. It has been shown that, given the option, rabbits prefer drinking from large open dishes (Tschudin et al, 2011). Many rabbits, not used to bottles at home, may not drink if not given an alternative while in the hospital.
Exercise outside the cage may help in some cases. It can stimulate gut motility and relieve boredom. If a small and secure garden is not available in the hospital, a short and supervised period outside the cage into the ward may be provided daily. Make sure the rabbit does not chew on cables. During the hospital stay, rabbits should be assessed daily (or more frequently in critical cases) and food and water intake, faecal and urinary output and the bodyweight should be recorded daily. A specific hospital sheet may be used for this purpose.
Many rabbits are admitted to the hospital to receive medical treatment or to undergo a surgical or other procedure. Planning surgeries early during the day is useful to reduce stress and allow plenty of time for the rabbit to recover from an anaesthetic and to be monitored. It is essential to be prepared and have all the equipment laid out and ready before taking the rabbit out of its cage to reduce handling and stress. If the rabbit is going to be anaesthetised it should be weighed and the correct dose calculated for every drug to be administered in the peri-operative period. Emergency drug doses should be calculated and the drugs should be kept close to avoid wasting time in case of an emergency. A study found the majority of rabbit deaths occur within three hours post-anaesthesia (Brodbelt at al, 2008). Close postoperative monitoring is therefore essential to avoid complications.
The discharge appointment should be considered as an opportunity to discuss with the rabbit’s owner the findings of the diagnostic procedures performed, to show x-rays or other images, or to discuss the surgery.
It is important to explain everything correctly and to show how to administer all the medication prescribed as this strengthens the trust the owner has with the vet. If supportive feeding is required at home, showing clearly the quantity of feeding formula the rabbit will need and waiting to administer the final feed in front of the owner is often much appreciated. Writing instructions on a discharge sheet and explaining it step by step is usually very helpful. An emergency number should be provided for any concern and a recheck appointment scheduled if required.
Referrals may be considered when a procedure or the care of a rabbit is out of the practice area of competence. This should not be considered as a failure. On the contrary, it demonstrates provision of the best care possible for the rabbit patient. Having a contact number readily available is always useful and asking advice at any time should not be feared. This is always the best choice when there are doubts.
Good communication with other members of staff and owners is always key to success. Explain what procedures are going to be performed and why these are going to be done.
Always keep owners updated rather than expecting them to understand. Many owners are emotionally very attached to their pets and may be very pleased to have updates and information about their pets while in hospital.
Figure 1. A dedicated area where rabbits and other exotic pets can sit away from cats or barking dogs should be available in the waiting room. However, if space is limited, simply using different sides of the waiting area may help.
Figure 2 (right). Keeping a selection of magazines, books, posters and leaflets in the waiting room demonstrates to rabbit owners the practice’s care and interest in their pets.
Figure 3. Owners can read through the posters and leaflets while they wait and gain useful information.
Figure 4. A room should be specifically available for rabbit consults. Specific posters and/or skull radiographs may be displayed in the room or a board with some more in-depth rabbit information may be placed on the wall. This often facilitates discussions with owners where images can be readily shown.
Figure 5 (inset). Rabbits are very easily stressed so getting everything ready before the history is taken and the physical examination is started is important. A precision scale to record the rabbit’s weight, a stethoscope, an otoscope with different sized cones, a thermometer, nail clippers and a towel are the tools required that should be laid out ready to be used during the rabbit physical examination. A tailored rabbit history form can be a useful guide for important questions.
Figure 6. Correct, gentle and calm handling is extremely important to avoid spinal and long bones injuries.
Figure 7. Ideally, a dedicated rabbit/exotic ward should be available for prey species to be hospitalised.
Figure 8. A basic cage set-up would include newspaper at the bottom of the cage and a large amount of hay/straw as bedding material. A litter tray and a hide box should be provided. Food and water should be measured and easily available.
Elisabetta Mancinelli
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