Originally published in the July 2015 issue of Veterinary Practice News. Love this article? Then subscribe today!
If a rabbit hasn’t had something going in one end and out the other in as little as half a day, it’s time to get the patient in for a visit right away, said Nicole Wyre, DVM, Dipl. ABVP (avian).
“They should be eating and pooping all the day,” said Dr. Wyre, who specializes in exotics at the University of Pennsylvania’s Ryan Veterinary Hospital. “If it’s been more than six to eight hours, it’s an emergency.”
This may be a sign of gastrointestinal stasis and a signal that treatment is urgently needed, Wyre added.
She and other veterinarians who specialize in treating rabbits said “eating and pooping” are easy and critical signs that general practitioners can cue in on.
Sari Kanfer, DVM, owner of Exotic Animal Care Center in Pasadena, Calif., noted that GI stasis can range from mild cases, in which the GI tract slows down, to severe, when there is an intestinal blockage and the rabbit is hypothermic and in shock.
“The cause may be stress, any other illness, some medications and ingestion of too much fur,” Dr. Kanfer said. “When rabbits have problems with fur ingestion, it is usually a small, dense piece that gets stuck in their small intestine. It is rarely from formation of a large hairball in the stomach.”
Kanfer echoed Wyre’s emphasis that at the first sign a rabbit stops eating, clients should be urged to get their rabbit into the veterinarian right away.
“Experienced rabbit vets realize the emergency nature and will get the rabbits seen right away,” she said.
GI stasis tops a list of common bunny ailments, but other problems are common. Kanfer’s most-common list includes dental malocclusion and abscess formation in adult rabbits, while older rabbits can develop arthritis and weakness, heart disease, kidney disease and also cancer.
“Baby bunnies frequently get coccidia, an intestinal parasite that causes acute, severe life-threatening diarrhea,” she added.
Because of the risk of coccidia, baby bunnies should be examined by an experienced rabbit veterinarian as soon as they are obtained, Kanfer advised.
“The coccidia can be found on a routine fecal test and can be treated with a sulfa medicine or ponazuril,” Kanfer said.
Bianca Zaffarano, DVM, who is in primary care and a section leader in veterinary clinical sciences at Lloyd Veterinary Medical Center College of Veterinary Medicine at Iowa State University, offered a to-do list for use when practitioners suspect dental disease.
“Sedation, oral examination under sedation, radiographs, CT scan, then blood work, anesthesia with intubation, dentistry – as guided by the aforementioned imaging – extractions, supragingival crown planing, etc.,” Dr. Zaffarano said. “Pain control. Recheck in six weeks.”
Preventive medicine by ensuring owners give their rabbits plenty of opportunities to exercise is favored by Dan H. Johnson, DVM, Dipl. ABVP (Exotic Companion Mammal practice specialty). Dr. Johnson is president of the Association of Exotic Mammal Veterinarians.
“As pet rabbits age, they tend to become obese,” said Johnson, owner of Avian and Exotic Animal Care in Raleigh, N.C. “Clients can prevent obesity by restricting pelleted feed, providing more hay and fresh leafy greens, and getting their rabbit out of its cage to exercise.”
Rabbits also often incur eye injuries, Johnson said.
“Rabbits have prominent eyes and exhibit a reduced or absent menace reflex,” he said. “They frequently present with eye injuries as a result. Rabbits are also prone to a number of infections that can manifest as conjunctivitis, epiphora, corneal opacity, cataracts and/or uveitis. Exophthalmos is commonly the caused by a retrobulbar abscess, frequently the result of a dental abscess.”
Despite what some literature proposes, Wyre advised in most instances against using a prokinetic, which forces the GI tract to start moving.
“We don’t use that because it can have some pretty powerful side effects,” she said.
She noted that cisapride has been tied to cardiac arrhythmias. Another medication that’s used often, Reglan, can force the stomach to start contracting and push out dehydrated materials when they are not ready to be moved out and cause an obstruction, Wyre said.
AEMV’s Johnson stressed weight control and exercise when listing his top treatment.
“Obesity in rabbits is treated by restricting calories – fewer treats, less pellets, more hay, more greens – and increasing activity,” Johnson said. “Letting a rabbit out of its cage to exercise in a rabbit-proofed indoor area is recommended, and supervised time outdoors in a fenced enclosure is also acceptable.”
For another common ailment, uterine disease, he suggested an ovariohysterectomy.
“Uterine neoplasia is slow to metastasize, and surgery should be considered even in does 10 years and older,” Johnson said.
Rabbit eye problems, another common ailment in bunnies, are treated similar to those in other species with a few exceptions, Johnson said.
“Epiphora due to nasolacrimal duct obstruction may require intermittent flushing and/or treatment with saline, mucolytics and antibiotics,” he said.
He added that practitioners should be aware that dental disease, specifically apical abscesses, can lead to epiphora, conjunctivitis, pain and exophthalmos in rabbits.
All experts spoken with highlighted loss of appetite as a top concern. Treatment is another matter.
Kanfer said the next step upon discovering an inappetent bunny is to call for radiographs to see how bad the condition is.
“Basic, mild GI stasis can be treated with subcutaneous fluid injections, pain medicine, intestinal stimulants and syringe feeding,” Kanfer said.
“Severe cases, when there is an intestinal blockage, require radiographs, blood work, hospitalization on intravenous fluids, IV pain meds and supplemental heat. If the gut does not start to move within a few hours, and the rabbit is not producing urine, there is a guarded prognosis and the rabbit likely needs emergency surgery to remove the blockage.”
Pain medications, joint supplements and physical therapy are good treatments for arthritis and weakness, Kanfer said.
“Rabbits with heart disease respond well to the heart medicines commonly used for dogs and cats,” she added. “Rabbits with kidney disease require subcutaneous fluid injections to help their kidneys function better.”
Beyond basic treatments, these veterinarians agreed that dental disease is a good reason for a general practitioner to consider a referral.
Often, problems with a rabbit’s jaw leads to abscesses that behave like cancer in other animals, she said. They have a heterophile that doesn’t create pus like in dogs and cats, but appears as more of a “cottage cheese material,” she said.
These do not drain, and veterinarians must surgically debride, because this problem tends to eat away at their bone and cause destruction, she said.
“The surgeries can be pretty invasive,” Wyre said.
Wyre said cancer may be another cause for referral to a specialist, and that it’s a wrong assumption that a rabbit with cancer cannot be treated with chemotherapy or radiation.
With modern advances, they can be treated, she said.
She noted that she’s used melanoma vaccine for rabbits, and has used radiation therapy for rabbits with problems like a thymoma.
“I just want to make sure people know there’s an option out there,” Wyre added.
Zaffarano, with Iowa State, said the time to refer is standard regardless of the species.
“When they are not offering or providing for the animal the same diagnostic intensity and treatment that they would a dog or cat,” is when it’s time to find a specialist for a rabbit patient, Zaffarano said.
Johnson believes it’s time to refer to a specialist whenever practitioners feel they may be endangering a patient or practicing below accepted standards of care.
“Inexperienced practitioners should seek out rabbit/rodent continuing education before attempting complicated or risky procedures,” he said.
Kanfer recommends that if your treatment isn't working within a few days or a week, contact someone more experienced, or refer.
“It is our responsibility as veterinarians to offer the client and the patient the best care possible,” Kanfer said. “If a veterinarian cannot provide that, they should offer the owner the option of referral or consultation. Clients often gain respect for veterinarians who know their limitations but seek help to increase their knowledge and help a patient.”
It may be good to get up to speed on rabbits, or participate in some continuing education, according to Johnson, who noted that house rabbits have become one of the most popular pets in the United States.
“Rabbit owners are generally aware that they need to carefully select a rabbit-savvy veterinarian, because most veterinarians do not know much about rabbits,” Johnson said. “Pet rabbits are a good area for practicing veterinarians to devote time and energy to. Attend rabbit continuing education, get the necessary textbooks and it will pay off in the end.”
RACE to Treat Rabbits is Good to Remember
RACE: That mnemonic acronym is one Wyre likes to offer veterinary students to help them remember treatment steps for rabbits.
Rehydration. This is an important first step. Putting fluids under the skin or into vessels via a catheter and rehydrating the intestinal tract.
Analgesia. “These rabbits are not going to recover if they’re in pain,” Wyre said. Dealing with NASIDs or opioids has plusses and minuses, she said. For opioids, Wyre prefers buprenorphine, because it tends not to cause ileus constipation. If NASIDs are used, she advises checking kidney and liver values and making sure the patient is well hydrated first.
Cause. Figure out what caused it and try to resolve it. Another, although silent “C,” in Wyre’s mnemonic is what she calls “critical care feeding.” She suggests a product made by Oxbow, Critical Care for Herbivores, which is a ground-up hay feed that delivers needed fiber content to a rabbit’s GI tract. “I would recommend that every clinic that sees rabbits have that in stock,” Wyre said.
Exercise. Rabbits can be thought of as small horses, Wyre said. It’s important to make sure they’re moving, and moving their back legs in particular, as this helps the GI tract get moving as well, she said.