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Veterinarian Articles on Rabbit Care Popular Rabbit Beliefs: Debunking the Myths By Jeffrey R. Jenkins, DVM
As with most things in our lives, there is a wealth of mysticism surroundings rabbit care and health. Let's look at some of those truisms, aphorisms and platitudes that surround our dear rabbit friends.
"You will break a rabbit's back if you pick it up incorrectly!"
There is some truth to this statement. Rabbits have powerful back and leg muscles that they use for both running and jumping. These muscles are literally more powerful than the bones of their spine. The force of a rabbit's kicks may fracture vertebral processes where lumbar muscles attach, articular processes that act as the joints of the spine, or the entire body of the vertebrae. When lifting or holding a rabbit, especially one that is frightened or one that you may not know well, you should lift and hold it with one hand placed under it's chest and the other under its pelvis, supporting it's weight. The feet and legs should be directed away from your chest. Do not place your hand under the feet of the rabbit. This way, if the rabbit should kick, its legs cannot push against you, thus preventing the rabbit from propelling itself through the air and from fracturing its back with the sudden force of the kick. The greatest risk of a rabbit breaking its back, or other bones, occurs when it is fearful. If you must lift a frightened rabbit, lift it by the scruff of skin at the back of it's neck and support it's weight by placing a hand under its rump. Most importantly, get it back on the ground as soon as you can.
"Like a cat, rabbits get hair-balls that can be prevented by giving cat hair-ball lubricant products."
Rabbits do have a problem that is referred to as a "hair-ball" that may be caused to some extent by the ingestion of hair. The cat forms a ball of hair in its stomach that blocks outflow from the stomach. The problem in the rabbit, more correctly named "gastric stasis," is a functional problem where normal stomach motility and secretion of stomach acid and digestive enzymes cease. This leads to a loss of fluid in the stomach and a dehydration of the contents of the stomach. This situation may be induced by the presence of a large amount of hair in the stomach, but is not caused by a blockage to stomach outflow as is the situation in the cat. The situation in the cat may respond to lubricant products by aiding in the passing of the hair-ball. This is not the case, however in the rabbit. Research has shown that these products have no effect on the rabbit with this problem.
"Pineapple juice, papaya and/or enzyme products are helpful in treating hair-balls in the rabbit."
Because the rabbit can not spit, it ingests a lot of hair when grooming. It is commonly thought that this ingested hair leads to gastric hair-balls ("gastric stasis," see above). For at least three decades rabbit owners have treated this problem with a host of digestive enzyme products including pineapple juice, papaya, or papaya tablets (all of which contain the digestive enzyme papain), or a number of pharmaceutical enzyme products including Prozyme, Viokase and many more. Several well performed scientific studies have shown that these products neither correct nor prevent the accumulation of hair, nor will they dissolve the accumulation of food and hair that forms in the stomach of the rabbit. We have found, however, that pineapple juice may have some positive effect in the rehydration and return of normal stomach acid levels in the stomach contents of rabbits with gastric stasis. "Any product "OK" to use on a kitten is "OK" to use on a rabbit."
This statement is made most often in regards to shampoos and flea products. Although kittens are delicate and most of the products approved for use on a kitten would be safe for any animal, there are some notable exceptions. The citric insecticides, especially the insecticide "Linalool," are very safe when used on dogs or cats, but highly toxic to rabbits. The spot-on flea and tick product "FRONTLINE" is also toxic to rabbits. "Rabbits need to chew on wood to wear off their teeth," and "Rabbits need to have their teeth trimmed as they grow older."
The teeth of rabbits do grow throughout life. The incisor (front) teeth grow an average of 5 inches a year while the premolars and molars (cheek teeth) grow 3 to 4 inches a year. Not wearing off teeth can cause real problems to the rabbit. Under normal conditions, the rabbit's teeth wear off as a result of their normal occlusion with the opposing teeth. Rabbits with a recessive genetic trait known as "brachiognathia" (shortness of the lower jaw) have incisor teeth that do not meet and, hence, do not wear properly. These rabbits must have these teeth trimmed regularly or, preferably, removed. If trimmed, the rabbit's teeth should be cut by a veterinarian using a dental burr. Cutting rabbit's teeth with nail trimmers may result in tooth root abscesses. Rabbits do well without incisors and this is often a more humane solution to this problem. Since the late 1980s, we have successfully removed the incisors from hundreds of rabbits. Complications to the procedure are rare, less common than complications to tooth cutting. Back to other Veterinarian Articles on Rabbit Care Successful Eradication of Severe Abscesses in Rabbits with Long- Term Administration of Penicillin G Benzathine / Penicillin G Procaine by Marcy E. Rosenfield (Moore) Copyright 2000, revised
2001. All rights reserved. No part of this document may be reproduced without
the expressed, written consent of the author. I was introduced to Bicillin C-R (150K penicillin G benzathine & 150K penicillin G procaine, 300,000 units/ ml, Wyeth- Ayerst) by Dr. Theodore Vonieda in November 1986 at the Society of Neuroscience convention (Dept. of Neurobiology at Northeastern Ohio Universities) who had used the "human" brand of this antibiotic for treating postoperative infection in rabbits. There are many veterinary pharmaceutical companies that make this antibiotic for use in animals. The more commonly known "brand" names are Pen PB- 48, Pen- Ben 48, Dura- Pen, Flo- cillin, Combicillin- AG and Durabiotic. Because there is no standard name for this antibiotic cocktail, I will use the name "bicillin" (small "b") for simplicity's sake. In the 1980's, the our laboratory's
research centered on single cell unit recording. Postoperative infection was common
in rabbits who had undergone the surgical procedure for electrophysiogical recording,
which involved building and cementing a recording pedestal used to hold and stabilize
the rabbit's head in the proper stereotaxic plane during these recording sessions.
Most rabbits (two out of three) developed infection either around the periphery
of the recording pedestal or contracted septicemia through the introduction of
bacteria during the recording procedure itself. These complications usually surfaced
a week or more after the surgical procedure. The post operative infection that
began around the periphery of the recording pedestal would over time, penetrate
and eat away at the bone, turning it to mush. Administering 0.25 cc of bicillin
(approximately 75,000 units) every three days eradicated the infection after only
one week of treatment. Slowly, the damaged bone regrew and was replaced by healthy
bone. Not one rabbit experienced side effects, no disturbance of the gut flora
was noted with bicillin usage, even at higher doses (1.0 cc, 300,000 units per
dose). From then on, the use of bicillin became an integral part of the laboratory's
surgical / postoperative protocol. All standard treatments begin with the removal of the abscess and debriding the area. The more popular surgical options used are removal of the eye, removal of molar spurs or sometimes the tooth or teeth and then packing the abscessed cavity with calcium hydroxide, which has been reported to cause serious tissue damage and necrosis at the affected site, or packing the cavity with 50% dextrose, or packing the affected area with antibiotic impregnated polymethyl methacrylate beads (AIPMMA), a technique analagous to radioactive seeding used in treating prostate cancer in humans. Beads impregnated with an antibiotic indicated by culture and sensitivity are implanted in affected areas, allowing the slow release of the chosen antibiotic. Because the pus in rabbits is thick, almost the same consistency of mayonnaise and does not drain, residual "fingers" of infection are usually left behind. These pockets of infection can lead to the formation of secondary abscesses from residual bacteria left in the vicinity of the main abscess, allowing infection to continue to spread. As systemic antibiotics go, the most frequently and perhaps overprescribed drug used in treating infection in rabbits today is enrofloxacin (*Baytril, Bayer Co.), oral and injectable. It is well- documented that abscesses contain a host of different bacteria, both aerobic and anaerobic. Enrofloxacin is not active against anaerobic bacteria, so administering this antibiotic as a standard treatment for abscesses may allow the proliferation of these anaerobes. Therefore it was imperative to find a safe, effective antibiotic that does not cause side- effects in the patient. Other advantages of bicillin are that bicillin injections do not cause skin irritation or sores at the injection site and administering one injection every other day is easier on rabbit owners, most of whom have little or no experience with injections. Protocol, Doses and Schedule of Administration I had such success using bicillin for postoperative infection that I began to experiment with it for other causes of infection, such as wounds caused by a bunny- bite. It wasn't until my own pet rabbit at age seven, developed a severe abscess, caused by a scratch to the upper eyelid by his "mate". This infection innovated most of the right side of his face, coming to a head as 15 cc of pus located just above his right eye. Because of the limited options and Pal's age, I felt that draining the abscess and administering bicillin on a long- term basis was the best initial approach for us. The other treatment options could always be employed later. After removing as much pus and infection as possible using a solution of sterile saline + hydrogen peroxide. The incision was closed using New Skin ( liquid bandage, Medtech*). Pal then received 0.50 cc (150,000 units) of Bicillin C - R administered by deep IM injection every other day for eight weeks, and then reduced to every third day for another four weeks. After three months of continuous bicillin administration, Pal was declared abscess- free, suffered no relapse (2.5 years) during his lifetime and best of all, kept his eye and his vision. The bicillin protocol and accompanying
dosing schedule was based on Pal's experience, a seven year old New Zealand. Because
most rabbits with infections and accompanying pain lose weight during their bout,
and bunny owners do not have scales that are sufficient to carefully monitor small
increments of weight gain (grams), the dose of bicillin has been divided into
two groups for administration purposes: The length of treatment depends on (a) the age and health of the patient (b) how long the rabbit has been ill (c) and how many different treatments were used, and (d) how well the infection responds to bicillin. At this point in time, rabbits treated with bicillin are on the same dosage schedule as Pal, eight weeks of bicillin given every other day, followed by four weeks of administration every third day. Some rabbits responded immediately to bicillin (n = 7), while others who had been chronically ill for some time (n = 3) took six to eight weeks of injections before any results were seen. Therefore it is imperative to continue the bicillin therapy and not give up too soon. In conclusion, the use of penicillin
G benzathine/ procaine used as a systemic antibiotic has successfully eradicated
abscess and infection in rabbits without causing debilitating side effects that
other treatments tend to do. Perhaps bicillin administered as a primary antibiotic
can prevent a small infection from becoming a life- threatening situation, making
abscess treatment easier all around. A successful surgical preparation
is based on the recovery of the subject, that is how long it takes to recover
after the surgical procedure back to pre- surgical condition and behavior. The
most important aspect when dealing with rabbits is controlling postoperative pain.
Without pain relief, many rabbits stop eating, raising the spector of gastrointestinal
stasis and other complications. A small amount (0.20 cc - 0.50 cc) of lidocaine
HCl, 1% (*Xylocaine, Astra) injected at the area of the incision dramatically
decreases postoperative pain caused by edema and swelling which interrupts the
cascade effect caused by trauma to the affected area. Lidocaine applied before
or during any surgical procedure anaesthetises the area for up to four hours from
injection. Adding a local anaesthetic to any pre- surgical preparation is an inexpensive
and simple way to help alleviate or eliminate postoperative pain. First and foremost I must thank Pat Franklin. Pat not only helped keep me focused on our quest during some pretty strenuous times and was instrumental in helping others whose bunnies were in dire straits. I also want to thank Dr. Anita Sabellico at the Suffield Veterinary Hospital in Suffield Connecticut, the first vet willing to try bicillin on a "last chance" bunny, Pat's Londo, instead of undergoing more surgery. I also want to thank Marti Veneziale and her bunny Bubby, the second successful story, and Rhonda Rice whose keen instinct helped us all in more ways than one can imagine. I also must thank Dr. Ted Vonieda for introducing me to the antibiotic Bicillin C-R. My goal is to create a database of
case studies, written in the bunny owner's "own words". This page will
be updated as cases are reported and data is gathered from other bunnies who,
at this time, are being treated using bicillin as a systemic antibiotic. Hopefully
these cases, and the data and subsequent results gathered can be used as a guide
for veterinarians interested in using penicillin G benzathine/ procaine on their
patients, and for rabbit owners as reassurance that an abscess no longer means
chronic illness, debilitation, or death. Back to other Veterinarian Articles on Rabbit Care By Jeffrey R. Jenkins, DVM Rabbits have a number of problems involving their eyes, the most common of which is tearing or discharge from the eye which we call "epiphora." Epiphora is a symptom, not a disease in itself, a sign that the rabbit's eye is not able to drain tears. Most often epiphora is seen when the drainage system is not working correctly, typically when the tear duct is blocked by debris, such as mucous from the tears, or by discharge and swelling caused by infection in the duct. Less commonly, epiphora occurs when too many tears are produced for the system to handle (as when a person cries). The rabbit's tears drain from the eye through a single opening in the lower eyelid called a punctum or plural puncta, located in the medial (nose) side of the eye, nestled in an indentation in the lacrimal bone. The upper portion of this duct forms a funnel-shaped chamber called the lacrimal sac. The lacrimal sac collects tears and directs them down the curving course of the lacrimal or tear duct, through the bones of the rabbit's skull. There are two locations where the duct narrows or flattens: at the maxilla bone the diameter narrows, and as it passes over the roots of the upper incisor teeth the duct is significantly flattened. The duct opens at a nasal punctum, depositing tears just inside the nostril. The narrow and small diameter sections of the duct may become clogged with normal mucous discharges from the eye or debris that has accumulated in the eye. Other causes may include trauma to the lacrimal or maxillary bones of the face and impaction or abscesses of the upper incisor teeth which further constricts the lacrimal duct. Disease of the lacrimal sac and duct is called dacryocystitis. Dacryocystitis is most often secondary to bacterial infections occurring within the duct. Surprisingly, most of these rabbits do not have infections of their eyes. Pasteurella multocida bacteria is the most common cause (making dacryocystitis part of the "snuffles complex" of upper respiratory disease seen in the rabbit). Staphylococcus sp. and Streptococcus sp. are also commonly found. Diagnosis of dacryocystitis is based on clinical signs, cultures of the lacrimal duct and on cultures and cytology (microscopic examination) of material flushed from the duct. Radiographs (X-rays) of the rabbit's teeth and facial bones may also be indicated. The importance of performing diagnostic tests varies with the severity of the case. A rabbit who has no prior history of tearing problems and has no pain, swelling or redness of its eye or area over the lacrimal sac, and no signs of infection of its eye, very often will respond to flushing of the lacrimal duct and topical medications. Rabbits with a history of repeated problems with tearing should have a more thorough set of diagnostic tests performed. Treatment of dacryocystitis is aimed at opening the lacrimal duct and correction the underlying cause. Typically this includes both oral and topical antibiotics (eye ointment or drops). If the eye is infected, that problem must be addressed as well. Rabbits with dacryocystitis often have tear scald (much like diaper rash) caused by tear draining onto their face. Correction of the tearing helps to correct this problem. However, many rabbits will benefit from shaving the hair over the affected area and application of a topical medication to reduce the inflammation and aid in healing. It is difficult to correct dacryocystitis in rabbits with underlying changes of their facial bones and/or abscesses of their cheek teeth. Palliative measures may need to be initiated to make the situation bearable during the long course of treatment to correct the problem or, in some cases, for the rest of the rabbit's life. These may include treatments aimed at preventing tear scalding of the face or even medications or surgery to reduce the amount of tears the eye produces. Back to other
Veterinarian Articles on Rabbit Care THE IMPORTANCE OF ANALGESIA FOR PET RABBITS Susan A. Brown, DVM, Midwest Bird & Exotic Animal Hospital,Westchester, IL 60154
The number of rabbits kept as pets has increased dramatically over the last decade. The veterinary profession has made huge strides in knowledge over this same period of time and now rabbit medicine and surgery is taught in an increasing number of veterinary schools and there is an abundance of published and lecture material available to the practitioner. We now have veterinarians who have established themselves as "rabbit specialists" (although they may still be few and far between). However there still exists some considerable confusion on the use of analgesia (pain relief) in the rabbit amongst a number of veterinarians who see rabbits. Some practitioners still do not use pain-relieving medications in their rabbit patients even though they routinely use these drugs in dogs and cats and surely even themselves! I would like to look at why this situation might exist, why analgesia is very important to our rabbit patients and what types analgesic agents are safe and appropriate. The vast majority of veterinarians are caring professionals that are truly concerned about the health and welfare of their patients. Veterinarians commonly use analgesic agents in dogs and cats, but the same is not always true for other species including the rabbit. Why might this be? There are three main reasons that I would like to examine: THE PRESENCE OF PAIN IS NOT RECOGNIZED The signs of pain are well established in the dog and cat, however until recently, signs of pain were frequently not recognized in rabbits. If a veterinarian or caretaker doesn’t suspect an animal is in pain, they may not consider using any pain relief. Rabbits are "prey animals" meaning that their place in nature is as a food source for predators. Prey animals often become immobile when they are frightened, this being a natural protection to avoid detection by a predator. Prey animals also tend to hide any discomfort (again a protection against predators) unless they are in familiar surroundings. A visit to a veterinary office or an examination by a veterinarian can represent a frightening experience and the rabbit may remain immobile and not give an obvious response to a painful touch. Often it is necessary to detect pain through observation when rabbits are moving about their own familiar environment where they feel comfortable enough to show their "true nature". In the veterinary office, the rabbit may not show painful signs until it has been in its cage for a while and calmed down. This is not to say that rabbits can’t show signs of pain when handled, but that they are more likely to mask pain then a more familiar species such as a dog, and therefore pain may be missed. As you can see it is VITALLY important for you to be familiar with your pet and observe his or her actions daily so you can detect changes in behavior. Your observations will become an important part of the history you give your veterinarian. The history is a vital part of the diagnostic process. We know for a fact that rabbits have the same neurophysiological mechanisms as humans to produce pain and therefore have the capacity to feel pain in the same manner as us. The following are signs that have been associated with pain in the rabbit. Remember that not all these signs are SPECIFIC for pain and may also occur with nonpainful conditions. However, all these signs are abnormal and should be cause for further investigation. Abnormal "hunched" appearance when sitting Alert but reluctant to move Moves slowly or with effort Depression/lethargy Limping Unusual or sudden aggression Loss or decrease in appetite or water consumption Tooth grinding Hiding (when it is not usual behavior)/facing the corner Shows no interest in his/her surroundings (loss of curiosity) Crying or "grunting" when moving/defecating/urinating or being handled/examined Coat is unkempt due to loss of interest in grooming Taking a long time to eat/dropping food out of the mouth
In addition to the signs of pain, ACUTE severe pain or stress or moderate to severe CHRONIC pain or stress can lead to these internal problems: Gastric ulcers Cardiomyopathy (heart muscle disease) Alterations in the gastrointestinal (GI) flora (which may lead to ileus (a shut down of the GI tract) or other disease) Drop in body temperature Renal ischemia (areas of damage to kidney tissue) PAIN IS "PROTECTIVE" There was a theory among veterinarians (and years ago with human doctors as well) that pain is "protective", meaning that the natural function of pain is to keep the area that is painful from being used thus allowing it to heal. People that follow this line of thought don’t believe in using pain relief because the animal wouldn't’t heal properly. For instance, if a bone is broken, the pain will keep the animal from using that bone until it heals. However, we certainly know that in humans moderate to severe pain can cause depression, loss of appetite, atrophy of muscles and pressure sores (from non-use of the area), and a resultant poor quality of life. All these conditions also occur in rabbits that experience moderate to severe pain. In addition, a rabbit may develop severe skin irritation from urine and stool because he or she doesn’t want to groom or move about. Rabbits may experience a lowered body temperature and may eat poorly under the stress of moderate to severe pain. Rabbits can also develop gastrointestinal (GI) ileus (where the GI tract "shuts down") and gastric ulcers in response to pain, both conditions being potentially life-threatening. All of these conditions can seriously delay healing and threaten the overall health of the rabbit. In my own experience as well as that of other published veterinarians, there is no evidence to indicate that analgesia will delay healing. In fact, since we have been more liberal with the use of analgesia in the past decade, we have seen a dramatic INCREASE in the success of treatment of rabbits in pain, particularly in the management of post surgical or post-traumatic pain. Rabbits generally recover more rapidly; they eat sooner, become more active and have less GI problems when pain is managed. We have not found that rabbits will chew their stitches or pull off bandages more readily when analgesics are used. If bandages or sutures need to be protected, there are more imaginative and less cruel ways to accomplish this then leaving the animal in pain! Moderate to severe pain is not "protective" but rather destructive to the rabbit’s overall well being. Pain management is crucial to treatment success in many cases. ANALGESICS ARE "DANGEROUS" TO USE IN RABBITS Veterinarians for years have been afraid to use a number of medications in rabbits because they were thought to be "fragile" animals. I used to feel the same way when I started seeing rabbits 23 years ago, but these ideas were based on ignorance of the physiology and behavior of this species. Once one learns how rabbits "tick" one can avoid many pitfalls. In addition, there is now a wealth of information on safe and appropriate drugs to use in rabbits for a wide range of conditions, including pain relief. The excuse that analgesics are dangerous is no longer acceptable. We have used a variety of analgesics in rabbits for over a decade with very rare side effects. However, the potential danger of not using analgesia, are much more serious (loss of appetite, GI disease, depression, poor healing, etc.). I would be remiss if I did not tell you that ANY drug or "foreign substance" introduced into a living being can have side effects, so there are always risks. However, the analgesics used today in rabbits have been tested thousands of time at many dose levels and are safe alternatives to the agony and dangers of moderate to severe pain. Today there are many analgesic choices ranging from mild to potent and your veterinarian will determine which is best based on your rabbit’s needs and condition. Now let us summarize WHY pain relief is important in the rabbit. A REVIEW OF THE IMPORTANCE OF ANALGESIA IN THE RABBIT Domestic rabbits maintain the physiology and behavior of a prey species. Even though a pet may be handled frequently, it will respond to pain and stress in the same manner as its wild ancestors. Serious side effects of moderate to severe pain or fear in a rabbit include a drop in body temperature, loss of appetite, lethargy, GI disturbances, kidney damage, heart muscle disease, prolonged recovery time from anesthesia or surgery and prolonged healing time. Death can be the ultimate result of prolonged severe pain or stress. Therefore it is ESSENTIAL that pain relief be used appropriately in the rabbit in order in improve the quality of the pet’s life and the treatment success. In my opinion, (and I feel very strongly about this), there is no excuse to withhold analgesia from a rabbit (or any pet for that matter) when it may be experiencing moderate to severe pain. There is currently a wide range of analgesic agents available. I wonder how many humans would go without pain relief if given the choice! Once a veterinarian is educated on the importance of pain relief in the rabbit and the analgesic agents available, there should be no reason not to use them appropriately. HOW ANALGESIA IS USED There are many situations where analgesia may be used. I will list a few of the more common conditions here. Analgesia is commonly used in surgical cases. Minor skin surgeries often don’t need extended pain relief, but invasive surgeries and orthopedics, for example, can result in serious postoperative pain. Analgesics can be given before, during and/or after surgery depending on the rabbit and the procedure. Some rabbits only require pain relief for 24 hours postoperatively, whereas others may require analgesia for several days. GI disease can be a painful condition in rabbits because often there is painful gas distention of the GI tract. The use of analgesia can help the rabbit regain its appetite more quickly thus stimulating GI tract motility and relieving the gas distention more rapidly. Pain relief may only be needed until the pet is defecating normally. Dental disease can be painful when overgrown teeth cause mouth and tongue ulcers and abscesses. Using analgesics can help the pet continue to eat while the dental condition is being treated. Pain relief is used in trauma cases based on the severity of the injuries. Rabbits that have been terribly frightened with or without other injuries can benefit from short-term analgesia particularly if it has a sedative action. Rabbits with serious inflammatory disease such as pododermatitis (sore hock), severe urine or chemical burns and acute inner or middle ear infections often benefit greatly from pain relief until the area heals. Abdominal disease including some cancers, bladder stones, ovarian disease and liver disease can be painful and analgesics should be considered for use. Certainly a great many disorders do NOT require pain relief and the inappropriate use of these drugs is to be avoided. You and your veterinarian can determine if your pet’s condition warrants the use of pain relief. ANALGESIC CHOICES In this section I will give a brief overview of different types of analgesics used in rabbits. I will not be discussing specific dosages because dosages for analgesics can vary greatly and depend on the health of the patient and the condition being treated. Your veterinarian can find appropriate doses in the references at the end of this article as well as a number of drug formularies that include rabbits. OPIOID ANALGESICS These are pain relievers that are opiate derivatives. The one you may have heard most about from this group is morphine. Opiods are very effective pain relievers and may also produce a sedative effect Mild sedation can be beneficial in situations where it is important to keep the patient calm and confined such as post surgically and after severe trauma. Opioids are generally given by injection in the rabbit, either subcutaneous, intramuscular or intravenous. The one drawback to opioids is that most of them have a short duration of action (only 2 to 4 hours) with the exception of buprenorphine, which is effective up to 12 hours. Opioids would most likely be given in the hospital before, during or after surgery, or after a serious trauma. The medications most often used in this group include buprenorphine (the most commonly used), butorphanol, morphine, nalbuphine, pentazocine, meperidine, nalozone, and oxymorphone. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) NSAIDs are agents that both control inflammation and are analgesic. They vary greatly in potency from the weakest, aspirin, to the a stronger drug such as carprofen. To date there are no documented reports of serious side effects with these drugs, however it is known in other species (horses, dogs, humans) that long term use at the upper end of the dosage range may result in gastric ulcers. In particular, corticosteroids should NOT be given at the same time as NSAIDs because the potential for gastric ulcers is greatly increased. In addition, these drugs should probably not be used 24 to 48 hours prior to surgery due to potential renal (kidney) complications. NSAIDs can be given either orally or by injection. They have an apparent long duration action, ranging from 12 to 24 hours for most agents. NSAIDS are commonly used to control pain in GI disease and for at home postsurgical care. These agents are also useful for chronic pain particularly if it is caused by inflammatory disease such as arthritis, acute ear infection and abscesses. If NSAIDs are used for extended periods of time, they should be used at the lower end of the dosage range and the rabbit should be monitored to prevent potential gastric ulcers. However, neither our clinical experience nor that of others I have spoken to indicate that gastric ulcers are a problem in rabbits given long term NSAIDs. Common NSAIDs that are used include; aspirin, carprofen, diclofenac, flunixin, ibuprofen, indomethacin, ketoprofen, acetominophen and piroxicam. Local Anesthetics Local anesthetics can be administered in the form of topical creams or drops or by superficial injection into the skin. The most common use of local anesthetics in the rabbit include minor skin procedures (skin biopsies, small tumor removals, IV catheter placement), ophthalmic procedures (tear duct flushing and thorough eye exam) and nasoesophageal tube placement (the drops are put in the nose so the small tube can be placed in the awake patient without discomfort). Local anesthetics are not meant to be used for long term analgesia and their duration of action is fairly short. Epidural (Spinal) Anesthesia Although epidural anesthesia has been described and can be quite successful in the rabbit for some surgical procedures, it is rarely used. This is probably due to the fact that the average veterinary practitioner is unfamiliar with the techniques of administering this type of anesthesia in the rabbit which requires more skill than a simple injection. However, this form of anesthesia/analgesia may find increased use in the future. Epidural anesthesia/analgesia might be most useful to control postoperative after an abdominal exploratory, particularly GI surgery. This would be a short-term anesthesia and would have to be administered and monitored in a veterinary clinic. CONCLUSION Rabbit patients definitely benefit from the use of analgesia in a variety of situations. The humane choice is to use analgesia in the painful rabbit. In addition to pain relief it is essential to manage the rabbit in all other aspects of care including environment (quiet recovery area, appropriate temperature, clean), diet, and other medical or surgical therapy. Please work with your veterinarian to provide the most comfortable environment for your pet’s recovery. Your pet deserves the same humane care we would expect for ourselves! NOTE ON REFERENCES: I encourage your veterinarian to read more about analgesia in rabbits. The references listed below all contain information on the use and importance of pain relief in the rabbit. These articles represent only a tiny fragment of the information available this subject, but these were selected because they are current and were written with the practitioner in mind. They also contain current dosages for appropriate analgesics for rabbits. A great deal of the information in this article was gleaned from reference #2, an excellent, concise article on small mammal analgesia as well as my own 23 years of experience with many hundreds of rabbits. References: 1. Brown SA. Clinical Techniques in Rabbits. Seminars in Avian and Exotic Pet Medicine, Vol 6, No 2, 1997; pp 86-95. 2. Flecknell PA. Analgesia in Small Mammals. Seminars in Avian and Exotic Pet Medicine, Vol 7, No 1, 1998; pp 41-47. 3. Laber-Laird K, Swindle MM, Flecknell PA. Handbook of Rodent and Rabbit Medicine. Pergamon Press 1996; pp 234-237. 4. Ramer JC, Paul-Murphy J, Benson KG. Evaluating and Stabilizing Critically Ill Rabbits – Part II. Compendium on Continuing Education for the Practicing Veterinarian, Vol 21 (2), 1999, 116-125. Back to other
Veterinarian Articles on Rabbit Care Update on Testing and Treatment of Rabbits with E. Cuniculi By Jeffrey R. Jenkins, DVM In a previous article, I wrote about testing rabbits for Encephalitozoon cuniculi (E. cuniculi). The greater availability of tests along with possible new treatments made testing rabbits more advantageous. Since that time we have tested a number of clinically normal rabbits, tested several rabbits with specific neurological signs and treated several E. cuniculi-positive rabbits with albendazole (Valbazen, SmithKline Beecham Animal Health, West Chester, PA), a drug used to treat parasites in cattle and E. cuniculi in humans with severe immunosuppressive diseases such as AIDS. The results of our efforts have been interesting and have led us to some preliminary but optimistic conclusions. Of the "clinically normal" (healthy) rabbits tested (whose results have returned), 11 of 25 rabbits (44%) had significantly high titers. This tells us that they have or have had the parasite. We also found several rabbits with neurological abnormalities, ranging from vestibular disease (torticollis/head tilt) to paralysis or paresis (loss of neurological function), with positive titers. The encouraging finding is that we have also had rabbits with clinical signs and positive E. cuniculi titers who have shown improvement in their clinical signs when treated with albendazole. It is important to keep in mind that the above findings are only preliminary and still must be considered anecdotal at this time. We can draw some early conclusions from them. First, that E. cuniculi is ubiquitous in the San Diego area. I'm not certain if any other population of "pet" or "house" rabbits has been examined for E. cuniculi, so it's hard to say if the disease is more or less common here than in other areas. Second, we have a stronger suspicion that some of the neurological disease we see in our rabbits is related to E. cuniculi infection. This confirms post-mortem findings. We have known all along that some of the vestibular cases we see are the result of E. cuniculi infections, but for many of the other "vague" central nervous system problems it is much more difficult to diagnose a cause. Last, and most important, we feel that we now have a promising treatment for the rabbits who are infected with this disease. One rabbit owner who's rabbit was treated with albendazole reported "slight improvement (immediately upon starting treatment) and definite improvement in motor skills and emotional status including increased appetite from the fifth day of treatment." Our recommendations at this time are that all rabbits with signs of neurological disease be tested for E. cuniculi. Treatment with albendazole should be considered in any rabbit with neurological signs that are in a high risk group (such as young rabbits with vestibular disease) and/or that have a positive titer. We will continue to recommend that new rabbits be tested and will follow serologically positive rabbits for symptoms. Whether serologically positive rabbits with out signs of disease should be treated is controversial. At this time we are recommending that these rabbits be tested periodically. Rabbits with a rising titer or those that develop clinical signs (head tilt, etc.) we will recommend treatment. Back to other
Veterinarian Articles on Rabbit Care Joanne Paul Murphy, DVM
Once you live with a rabbit, you realize just how far off the mark are the generally accepted notions of them. Why would anyone consign these sensitive, subtle creatures to life in a classroom? Even in those rare situations where (unlike the animals described below) the rabbits' short-term physical requirements are met, social, emotional, and psychological needs are impossible to provide for. Nor are the students coming away with the intended lessons. They may hear about "respect and responsibility," but they see a rabbit who is being used and who in most cases is disposed of when her usefulness ends. Doc and Winnie were of the few lucky ones. Hopefully their story will inspire others to act as Carol McCall did. Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is not well understood either in humans or other animals. Since it is complex and cannot be measured directly, pain is very subjective. I'm sure you can think of two people who might undergo the same unpleasant experience, but each will have a different description of the pain. We assume that as each person interprets pain differently, each individual animal also experiences pain differently. Animals cannot communicate with us verbally, making it especially difficult to identify, classify and quantify their pain. Yet the anatomic and chemical pathways of pain and its perception are probably similar in all animals. Therefore we work with the premise that conditions that are painful to a human are also painful to animals, such as our rabbits. Attitudes are changing about pain Because rabbits can't talk to us, caregivers and veterinarians have traditionally relied on the observation of pain-induced behaviors to decide when it is time to intervene. We have used pain to indicate that there is an underlying problem, and in the past, the approach was to correct the problem and assume that the pain would then resolve. The current thinking is that we want to be sensitive to the subtle signs of pain, because the treatment of pain itself can aid healing. It is not only rabbit owners and veterinarians who are changing their attitudes. Human infants are similar to rabbits in many ways, because they also communicate in ways that can be obscure and challenging for parents and doctors to understand. Both pediatric and veterinary medicine are learning that subtle changes in behavior may be the only indication that an animal or child in discomfort. The study of pain has been very active in both human and veterinary medicine over the past 10-15 years. Veterinary medicine is asking questions such as 1) how can we recognize signs of pain in our patients 2) what types of benefits are associated with adequate pain control 3) how can we differentiate pain from anxiety 4) what types of drugs are effective in alleviating pain 5) how do different types of animals respond to different treatments. How can we recognize pain in rabbits? When working with rabbits the presence of pain must be inferred by the observation of change from normal behavior. A normal rabbit is bright, alert, active, inquisitive, has a smooth coat and good body condition. Pain may be evident as a limp or a change in gait, withdrawal or protection of an injured part, awkward or abnormal postures, licking, rubbing or scratching at an area or decreased food and water intake. Rabbits are unique from most of the other companion animals, because they are adapted as a prey species, an animal that normally needs to hide any handicap in order to escape predation. Signs of pain may be subtle such as a change in respiration, reluctance to move, apprehension, sudden aggression, inability to rest or sleep normally, or a worried or anxious statement. A rabbit with abdominal pain or sore feet may lie stretched out or sit in a hunched position. Grinding of the teeth is a sign of severe pain. It is unusual for rabbits to vocalize but when they experience sudden pain or anxiety they may give a high pitched squeal, quite unnerving to any person hearing it. Very often the presence of pain in rabbits is under diagnosed by both caregivers and veterinarians, and when it is recognized it is often underestimated. It is very difficult to differentiate pain from anxiety in rabbits, especially since they are often combined and may be manifested by similar changes in behavior. It may be simplified by a basic acceptance that rabbits will be anxious whenever they are placed in an unfamiliar environment. Is it useful for an animal to feel pain? It used to be thought that pain was a protective mechanism that helped animals decrease their activity and thereby decrease any damage to an injured body part or surgical site. However, this same adaptation can be detrimental when a rabbit is under veterinary care. Current medical thinking has tried to understand and minimize the detrimental effects of pain. Pain is stressful and can prolong recovery. Rabbits will often stop eating when they are painful or frightened and a change in gastrointestinal motility can be very harmful to a rabbit. Therefore treatment should be directed at decreasing pain and anxiety. What benefits are associated with pain control? We still have a long way to go in both evaluating pain in rabbits and effectively managing it for their benefit. Human medicine has tried to document the benefits of pain control. Most of the veterinary studies have looked at dogs and cats because these are the most common animals brought to veterinary practices. Some of these benefits include improved breathing functions, decreasing stress responses surrounding surgery, decreased length of hospitalization, faster recovery to normal mobility, improved rates of healing and even decreasing the spread of cancer after surgery. Almost all studies show people and animals return to normal eating and drinking habits sooner when given relief from pain. Therefore prevention, early recognition and aggressive management of pain and anxiety should be essential to veterinary care of rabbits. Rabbit owners are justified to request support from their veterinarian on this issue. It is a good idea to assume that any invasive surgery can potentially be painful for a rabbit. Rabbits tend to return to eating and recover faster following spay and neutering surgeries when provided a narcotic to relieve pain during the surgery and for 1218 hours following the surgery. What can we do to reduce pain? Pain is only one of many stress factors that sick rabbits must face. Sick rabbits need to cope with their disease or injury in addition to stressful changes that come with the problem. A sick rabbit usually has to leave his familiar surroundings and travel to the veterinary hospital, a strange environment with threatening noises and smells. He may also be separated from his human and/or rabbit friends. The veterinarian (usually a stranger to the rabbit ) palpates, pokes and moves painful parts of the rabbits body. The doctor may need to restrain him and take blood or perform other diagnostic procedures. We need to try to see it from the rabbit's perspective. We can reduce frightening and/or painful aspects of a procedure by petting the rabbit, speaking in soft tones, using good nursing practices and providing a home and hospital environment that is conducive to rest. Rabbits respond better and may recover faster if returned to their familiar home environment as soon as possible. It is a strongly held belief by many rabbit owners that rabbits are comforted by being with a familiar companion rabbit whenever possible. However, caregivers must also listen to the veterinarian's decision because there are occasions that warrant keeping the rabbit alone for observation. What is analgesia? Analgesia literally means absence of pain sensation. The realistic use of analgesia tries to relieve pain and discomfort through the use of medication. There is not one drug that abolishes pain without complete anesthesia or loss of consciousness. Unfortunately, not all medications work exactly the same in every animal or human. This makes it difficult for the veterinarian to determine how effective or even how long a treatment may be effective in an individual. Treatment may involve many different levels of providing comfort. What types of medication can control pain? When a rabbit needs to be hospitalized, the veterinarian may choose to give medication to reduce anxiety, such as diazepam (Valium). Rabbits require high dosages of this type of drug and may appear quite drowsy, yet when they are moved or examined, they become very alert. Your veterinarian will assess your rabbit and his disorder prior to prescribing any medication. There are no drugs developed specifically for rabbits, but many analgesics have been evaluated for rabbits, and dosages are available. There are several different categories of medication to control pain, and these will be briefly described: 1) Local anesthetics such as lidocaine, provide excellent analgesia provided that the local block is given over the entire surgical area. Veterinarians use local anesthetics for minor surgical procedures such as skin biopsies, or they can be used in the immediate period following surgery as a supplement to general analgesia. 2) Non-steroidal anti-inflammatory drugs (NSAIDS), such as aspirin or Carprofen, are able to decrease swelling and inflammation. The potency of different NSAIDS vary with each drug, dose and type of pain. Rabbits require high dosages of aspirin but it can be a very effective analgesic. It can be administered at home but should only be used under veterinary supervision. NSAIDS cannot be given for very long time periods because they have side effects on the gastrointestinal tract and the kidneys. 3) Alfa-2-Agonists, such as xylazine, are powerful analgesics especially for the treatment of abdominal organ pain. But these drugs also produce deep sedation and depression of the heart rate and blood pressure. Therefore this type of drug is not used very often for relief of pain after surgery although it can be used as part of the surgical anesthesia drug combination. 4) Narcotics include a diverse group of drugs in the opiod family. A common example of an opiod drug used for rabbits is butorphanol. Opiods are the most effective analgesics for the treatment of pain but there are well known side effects and disadvantages. Veterinarians often use narcotics for rabbits just prior or during surgery and immediately following surgery. Some opiods are controlled by the Federal Drug Administration and can be difficult for veterinarians to prescribe for home use. I have been testing the use of a narcotic patch that can be applied to the skin and left in place at home for 3-4 days. Because it does not need to be injected, it may be a good alternative to most other forms of narcotics. Your veterinarian should be able to recommend an appropriate plan to alleviate your rabbit's pain once a diagnosis has been made. Do not try to develop your own home remedies for pain relief. Each medication has side effects that could be very dangerous for your rabbit. Caregivers can do a number of things to minimize their rabbits discomfort such as careful handling of the sick rabbit, prompt communication with your veterinarian, gentle nursing care and rest to improve his comfort, access to food and water and a palatable diet to keep the rabbit eating. It is important to prevent changes in the gastrointestinal motility especially when the rabbit is already stressed by disease. References Baumans, V., Brain, P.F.; Brugere, H.; Clausing, P.; Jeneskog, T. and Perretta, G. 1994. Pain and distress in laboratory rodents and lagomorphs: Report of the Federation of European Laboratory Animal Science Associations (FELASA) Working Group on Pain and Distress accepted by the FELASA Board of Management. Laboratory Animals. 28: 97-112. Eisele, P.H. 1997. Analgesia in small animals. Veterinary Proceedings. 11:796-799. Eisele, P.H. 1997. Signs of pain in small mammals. Veterinary Proceedings. 11: 795 -796. Hansen, B.D. 1994 Therapeutics in practice: analgesic therapy. The Compendium. July : 868-875. Hellebrekers, L.J. Treatment of perioperative pain in dogs, cats and rabbits. Surgery. Liles, J.H. and Flecknell, P.A. 1992. The use of non-steroidal anti-inflammatory drugs for the relief of pain in laboratory rodents and rabbits. Laboratory Animals. 26: 241-255. Sackman, J.E. 1991. Pain. Part II. Control of pain in animals. The Compendium. 13: 181-192. Short, C.E. and Van Poznak,A. (ed) Animal Pain. 1992. Churchill Livingstone, N.Y. |
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