Rabbit Emergencies

I was reminded again this week how important it is to have your rabbit examined at the first sign of it being unwell.

Rabbits are a prey species, and as such WILL NOT show signs of illness until they can't cope any more and often are about to die. If a prey species shows signs of weakness in the wild, they are more likely to be picked up by a predator, so those who can be stoic in the face of pain have a greater chance of survival.

The rabbit patient of note this week had been fine the previous morning. The previous afternoon it was "resting" in it's cubby and didn't eat its dinner. That was the point at which it needed to be examined. Unfortunately it didn't come in until the next morning by which time it was going into shock and died before lunch despite treatment for the shock.

Before he died, we had gotten as far as taking some radiographs and had identified a problem in the region of the liver/stomach. Fortunately the owners gave us permission to perform a necropsy (post-mortem examination) to find out what was going on. It turned out that this very-well cared for and well-loved pet had a torsed liver lobe: one of the lobes of the liver had twisted, cutting off its blood supply, and then ruptured, sending blood pouring into the abdomen and causing the shock.

I had never run into this condition before in rabbits, but an online literature search revealed it is "not uncommon" and often is identified in well-cared-for rabbit pets, often house rabbits. Those who survived had been given fluids and supportive care early and the condition had been diagnosed with blood tests (raised liver enzymes indicating damage to the liver) and ultrasound as well as radiographs. One even got as far as surgery in which the offending lobe was removed. Unfortunately our patient didn't live long enough for us to get to that point.

So the lesson for the week is to get your rabbit down to the vet's the minute it refuses food or behaves oddly, and be prepared financially if they ask you to allow some diagnostics - radiographs, ultrasound, blood tests - along with hospitalisation and fluid support. It may be a matter of life or death.

Healthy,well pets and preventative screening, oh my!

I was reminded a couple days ago of the importance of regular check-ups for pets who otherwise seem healthy. A rabbit came in with "diarrhea" and with feces clagged around her back end. As I reviewed her records, I noted that 6 months previously I had had extensive discussions with the owner about diet and how to prevent loose feces such as this (the official diagnosis is cecal dysbiosis, but that's a different story!). I wondered what had happened such that the rabbit had gotten into such a state. It turned out the family had just slipped a little in their feeding regime - feeding more pellets than the rabbit needed, not enough hay or grass and a few too many of the wrong type of vegetables. This left their beloved pet with a sore and gassy tummy and unable to recycle her cecotrophs causing them to stick to her back end! By simply having a physical exam and discussing the daily feeding we were able to overcome a problem which, if left, could have escalated into a problem requiring costly hospitalization and danger to the pet's life.

As vets we like to see our young healthy pets once a year and older pets every 6 months (or more often for animals with certain conditions). This helps us do our job of looking after the health of the pet and allows us to build a relationship with the pet and the owners. In many countries, annual vaccinations give us a good excuse to do this. The 6-monthly myxomatosis vaccine for rabbits in England was very useful for regular discussions of diets and teeth checks. In the US, though, the distemper/parvo vaccine and the rabies vaccine for dogs are now able to be given every 3 years. If these are the only vaccines your pet has, should they only see the vet every 3 years? Certainly not!

Annual check-ups go by many names: wellness exams, preventative medicine screens, healthy pet exams, etc. They enable your vet to check teeth, listen to the heart and lungs, feel the abdomen, and weigh your pet. Many owners can't do this for themselves, or don't know what they're looking for. You can discuss diet and subtle changes in your pet's behavior. Many vets are starting to incorporate blood screening into these annual exams. This gives them one more tool to diagnose conditions early while they can be easily treated and before they become a real problem for your pet.

In our practice, for dogs and cats, we recommend a pre-operative blood test prior to spaying or neutering a pet -- even those that are only a couple months old. This allows us to check that the kidneys and liver are able to handle the anesthetic, to check that there aren't any clotting problems in the pet, and to be sure they aren't anemic or harboring an infection that should be treated before "stressing" the body any further. After this we recommend a similar blood test (without the clotting profile) annually along with an annual fecal exam until the pet is 7 years old (5 for giant dog breeds). After age 7 we like to do a more comprehensive blood test that includes thyroid levels and a urine screening in addition to the regular fecal test.

Why do we want so much blood year after year? Pets are very good at hiding when they are a bit under the weather (or we humans aren't as good at noticing!). It is easy to see that your 10 year old cat is a bit sluggish and just attribute it to getting older. In reality she may be a bit sore with arthritis or feeling a bit nauseated from kidney disease. By the time a cat shows the typical signs associated with kidney disease of drinking too much and losing weight (similar to signs of thyroid disease and diabetes) 75% of their kidney function has been lost and cannot be recovered. If, however, at age 9 that cat had had a screening and the vet had seen that her kidney values were up from the previous year's test and the urine was more dilute, he could have put her on a special diet that would slow down the progression of the disease and help her feel better for longer.

This all becomes much more important with flock and prey species. With birds we rely heavily on our annual blood and fecal screenings - once a bird starts showing clinical signs it's nearly too late! We can pick up things like subclinical respiratory infections or early liver disease from an inappropriate diet. Rabbits also often harbor subclinical infections that can only be detected with a CBC (complete blood count - a count of the red and white blood cells in the blood).

So work an annual exam into your calendar - ask your vet to send you a reminder if you aren't sure how long ago you were last there. Be prepared with a list of questions/topics to discuss and be ready to have that blood sample taken - it may improve your pet's life and give you more time together to enjoy each other's company!

New Country, New Challenges

Soon after posting the last message I learned our family would have the opportuntiy to move to the Seattle area of Washington State, USA. The last couple months have been full of packing, selling belongings, moving and getting settled. I'm now in the process of becoming licenced to practice veterinary medicine in the State of Washington. I hope to start re-posting useful information and commentary soon.
I already miss my clients and colleagues in Leigh-on-Sea, but am excited for the new challenges that I'm sure are just around the corner.

A Plea...

I had a very distressing night on call last night.
I received a phone call from some clients saying their cat had just been hit by a car and was not in a good way; could they bring her down? Fortunately I was able to see her immediately, but that didn't change the outcome. Soon after arriving at the surgery she became unable to breathe and the owners had to watch helplessly as I attempted to CPR their sweet pet back into the land of the living.
I lost the battle. The owners were devastated, understandably.
As I made my way home, I discovered a fox on the road in front of my house freshly dead from having been hit by a car. I scooped him up to take to the morgue at the surgery so he could be cremated with some dignity.
My colleague who had been on call the night before had attended 3 cats who had been hit by cars. Each of these cats required emergency treatment, and then further investigations and treatments in the form of xrays and surgery to repair broken bones or wounds.
My plea is two fold: to everyone who operates a motor vehicle, please be careful! It is so easy to get complacent on roads that we drive down each day. These animals nip out into the road with no warning and may be dazzled by your headlamps or confused by noise or running from a predator. Please decrease your speed and increase your awareness of what is in front of you on the road. Just think how you would feel if it were your own animal... or a child.
Secondly, to everyone who owns a cat, please make every effort to enclose them indoors at night. Most of these accidents happen in the dark when visibility is reduced and the humans are tired! If they insist on going out, please make every effort to have them wear a reflective collar. Many of these accidents are preventable, and they are devastating for all involved.

Not to Be a Stick in the Mud, But…

I was at the park the other day and a lady arrived with a bouncy Cocker Spaniel. My heart sank as she picked up a stick and threw it for her beloved pooch to retrieve. You may think this is the best way to spend an afternoon – throwing a stick for your dog – but I can only see it as a potential road to disaster.

Stick injuries to the mouths and throats of dogs are a nightmare for the dog, for the vet and for the owner. The most basic and common injury is getting the stick caught on the roof of the mouth, between the upper teeth. This happens if the stick isn’t longer than the dog’s mouth or, more often, if the dog bites down too hard and breaks the stick, lodging the broken piece at the top of the mouth. A more serious injury occurs when the stick goes into the back of the mouth and the sharp end penetrates the lining of the pharynx. Often, even once the stick is removed, bits of bark or other foreign material can be left behind. It is extremely difficult to clean these wounds, even with the animal under anaesthetic and if any material is left behind it can cause inflammation (aka a foreign body reaction) or abscessation.

I treated one patient while at university whose oesophagus had been penetrated by the stick. It had to be referred to us at the university hospital for specialist surgery and ICU care during his recovery.

Another dog we treated at the local surgery had to have multiple anaesthetics to remove all of the bark that had become imbedded in his pharynx.

May I suggest rather than a stick, that a Frisbee, a bit of thick rope, or a sturdy rubber toy be employed to exercise your dog and that you leave the sticks for some one else.

The Cost of Animal Health

In the UK, we are blessed (or cursed depending on how you look at it) with a National Health Service. As a result, the humans rarely have any idea what it costs for them to see the doctor or spend a night in hospital. It comes as a bit of a shock when they come to the vet's and are asked to pay sometimes hundreds of pounds for treatment. There are three aspects of the price of veterinary medicine that I'd like to discuss:
(1) Getting an Estimate
(2) Insurance
(3) Prevention is Cheaper than Cure

(1) Before you even make your appointment you can get an idea of what it is going to cost you. Receptionists are used to people phoning up to find out the cost of a consultation (remember to ask how long the time-slot is -- a vet who does 20 minute consults may not be twice as expensive as one who does 10 minute ones so you may get more for your money). They will also give you an idea of costs for routine procedures like neutering and dental work. Once you have seen the vet and s/he has told you what is wrong and what needs to happen to fix it, it is a good idea to ask for an estimate. This gives you an idea of what kind of money you will be expected to hand over at the end of treatment and may help you make decisions as to which procedures to accept or decline. The estimate may be verbal or written. I prefer to give written estimates (I print out a copy for my clients to take home with them) so if there is a discrepancy at the end we can explain why it is different. If I do give a verbal estimate, I always make a note in the record. This reminds me to let the client know if the treatment is going to exceed what I initially thought. If your vet gives you a verbal estimate, I suggest you write it down yourself and make sure you have heard him correctly (50 rather than 15 for example). Please also realise that an estimate is only that. Once the vet is able to see the results of tests or the way your animal responds to treatment, the course of further treatment may change.

(2) I am always relieved when a client tells me they have insured their animal. I don't view this as a green light to spend lots of money on unnecessary tests, but rather as an equaliser. It allows me and the owners to do what is right for the individual patient rather than what the owner can afford (which may not be appropriate for the pet). Many people are sceptical of insurance companies, having found them unwilling to pay out for problems with their home or car. We have found them very accommodating so far and have had very few problems. For people who don't want their money to go to some large corporation, perhaps never to be seen again, I suggest opening a savings account just for the pet. I suggest finding out what the insurance premiums for your area are and saving that as a minimum amount. I do often suggest to clients who bring me new puppies/kittens for vaccination that they start a savings account, but take out insurance for the first couple years since this is when animals tend to be the most accident-prone and when the savings account will still be too small to cover the cost of a broken leg or retrieval of a swallowed toy.

(3) Please, please, please vaccinate your pets. If you decide you don't want them vaccinated, for whatever reason, at least bring them for an annual check up -- especially once they enter their geriatric years (over 8 years old for dogs and cats, over 5 for rabbits). Your vet can pick up subtle changes in your pet and can help curb problems before they become expensive. A toothbrush and tube of doggy toothpaste along with a demonstration of teeth brushing by the nurse is a lot cheaper than an anaesthetic for dental cleaning and extractions of rotten teeth. Kidney disease can be managed just with diet in the early stages, but may require multiple blood tests, blood pressure tests, fluids, tablets and hospital stays if not diagnosed until it is advanced.

Finally, when you are thinking of bringing a new pet into your home, please remember there is more than just the purchase price to factor in. A £2.00 hamster can ultimately cost £200-300 with the cage, food, toys and veterinary care.

My Claim to Fame... or Not!

A different kind of post today: one of a more personal nature...

A new series started tonight on ITV (Channel 3 in the UK). It is called Prehistoric Park and is on Saturdays at 6:50pm. I imagine in a couple months it will air in the US on the Discovery Channel or Animal Planet or some similar channel.
(See the ITV website for more details)

My claim to fame, however, is that I auditioned for it, believe it or not. They had advertised in one of the vet mags for a female vet with acting experience. That's me, so I sent in an audition DVD. Unfortunately I wasn't chosen, so you can imagaine the eagerness with which I watched tonight's opening episode. The vet they've chosen is a woman named Suzanne and I don't know anything else about her. She only had a few short scenes in tonight's episode, so we'll see if she plays more of a role in the future ones.