The Gloved One: Talks Openly About the Hidden Risks of Pododermatitis

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Selecting a Qualified
House Rabbit Veterinarian

As a rabbit rescuer, I find the most challenging aspect of rabbit adoption to be convincing the new rabbit caretaker to take their rabbit to a qualified rabbit veterinarian.

I always hear in response, "Oh I have a wonderful veterinarian 3 blocks from my house and he's great with my cat, I really feel very comfortable with him." Well, folks, that's great for your cat! It's great that you don't have to drive very far either, but most responsible rabbit caretakers find themselves with a long drive to find the very best and most qualified exotic veterinarian and are glad to do so.

If you are to be a successful, responsible, and caring house rabbit caretaker, you must research and select a veterinarian for your rabbit just as carefully as you would do to find a specialist for your child.

Jar Jar Binks was neutered by a 'country' vet (or a farmer perhaps) using a staple gun and no painkiller prior to my adopting him. He had xrays later in life which revealed the staples still in his scrotum.

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What's The Fuss All About?

So what is the big deal about rabbit medicine? Why can't just regular, every day dog and cat vets treat your rabbit? Well, the answer is they haven't had any training! How can that be, they went to vet school right? Yes, we hope so, but the problem is that in vet school, the curriculum does not include companion rabbit medicine.

Oh, well, actually it does include an afternoon's lecture on treating rabbits who are being raised for meat or fur and how to keep sick ones from infecting a healthy herd. How is that done? The traditional method of keeping sick rabbits from infecting a healthy herd is to 'cull' them. That's a handy little euphemism for 'kill' that sounds just slightly different. Cull, kill, same thing. Not much of a treatment is it? If you have maybe one or two hutch rabbits in your backyard and you want to keep them breathing a little longer, maybe your cat and dog vet might be able to do that, keep them breathing a little bit longer. They do this by keeping the Merck Manual of Veterinary Medicine around the office. It has a short section on rabbit care that was written many, many years ago before it was even safe to spay and neuter bunnies.

So if this is your intention, just to keep them breathing a little longer, you don't need to finish reading this article. But if you want to know more, then read on, dear reader. I will impart to you the secrets of exotic rabbit medicine and how to select and build a team relationship with your qualified rabbit veterinarian.

Rebecca, once paralyzed due to e. cuniculi, made a full recovery
and goes to her exotics vet for an annual wellness exam.
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The Birth of a Great Rabbit Vet

A rabbit specialist is born after they finish vet school. He or she decides they want to specialize in exotics which include not only rabbits, but guinea pigs, birds, small and large rodents, reptiles, and fish. Among these many exotic species, there are those vets who choose one or two of these species to specialize in but for the most part, any exotic vet will help you far more than a cat and dog veterinarian. So now your vet has decided to become a rabbit specialist; at this point, he usually will then work as an intern with an established top exotics vet for several years.

During this time, the intern learns the tricky art of anesthetizing a rabbit without killing them. This is the real acid test of a rabbit vet; do they know how to spay a rabbit successfully by anesthetizing them with either isofluorane or sevofluorane gas? Isofluorane, or 'laughing gas,' is the most commonly used anesthesia for rabbits although it is thought the more expensive sevofluorane offers the patient a quicker recovery time.

By the way, I should quickly note that some cat and dog vets are actually able to neuter rabbits but are not confident in spaying them. They usually do this with injectable anesthesia which is very risky but some of them have become proficient at it. These vets, in particular, are probably ones who have been in practice long enough to remember when male rabbits, or 'bucks,' were neutered with staples (chop! Can you say 'OUCH!'?) and wanted to experiment with something a little less crude. So a handful of 'country' vets here and there may be able to neuter a male this way but that is the extent of their rabbit experience.

In The Doctor's Bag

He or she will also learn about the special drugs which exotic vets keep around the office which are not commonly used on cats and dogs and so there you have yet another reason not to expect a cat/dog vet to be able to treat your rabbit. Special antibiotics such as liquid Baytril (only the pill form is used for cats and dogs) which can be compounded into a tasty mixture in an exotic pharmacy to entice your rabbit to look forward to getting his medicine; trimethsulfate, fenbendazole, and analgesics (painkillers) such as liquid metacam (also called meloxicam) are extremely important for your little rabbit's medical treatment. And it is most certain that your rabbit specialist will carry a good and steady selection of Critical Care for Herbivores by Oxbow Hay Company which is used for assist feeding rabbits, guinea pigs, and other exotics after surgery or during other types of convalescence. If your vet doesn't carry this prescription formula food, they are not a practicing rabbit vet, period.

Most likely, your rabbit-specialist-in-training will also be getting training in treating large birds (parrots) and reptiles too. These drugs are also used for those species and there is debate even among rabbit specialists about the proper dosage or safe length of time to use these drugs for rabbits and other exotics. None of this will be the least bit familiar to a vet whose entire practice is cats and dogs.

After your rabbit specialist is fully trained, he or she should have at least a 99% success rate spaying rabbits; 99.99% is preferable.

Birds and Bunnies

Many wonderful rabbit vets are also avian (bird) vets and may even be a board certified avian vet (ABVP) or maybe even a diplomate certified avian vet (DABVP) which means they did especially well on their board certification exam. Although there is no board certification for rabbit vets yet, it is a general rule of thumb that a good avian vet is also a good bunny vet. This is, for one reason, because birds and bunnies are very similar in their fragile systems and the drugs they can tolerate.

Another important aspect of being an exotic specialist is they can offer your rabbit a quiet, low-stress hospital in which to recover from surgery or other treatment during their stay. Housing a newly spayed rabbit next to a coonhound is a disastrous idea and I have known rabbit caretakers who have lost beloved bunnies because of just this. Rabbit specialists should also subscribe to Exotic DVM magazine in order to stay current with the latest discoveries and treatments. It was in this magazine only as little as 4 years ago that tremendous breakthroughs in treating e. cuniculi, a prevalent blood parasite of rabbits, was reported. If your vet is telling you that e. cuniculi is a death sentence, or that neurological symptoms from it, such as partial paralysis or head tilt, are untreatable or not worth treating, then they are at least five years behind the times or that was probably the last time they attended an exotics conference or rubbed shoulders with a real exotics vet.

Horatio, a little Netherland dwarf, required about fifty stitches during his abscess surgery following his ill-fated attack on a cockatoo. Only a very skilled rabbit vet could have performed this operation.

Horatio's incision not only went up and down his chest (see previous photo) but around his front legs as well. He required the use of anitbiotic bead implants which only qualified rabbit vets have in house.

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Upon Re-examination

So by now, you should have a solid understanding of the difference between rabbit vets and cat and dog vets and why it is so important to take your rabbit to a rabbit veterinary specialist. And it doesn't stop there. Even among the specialists, there will be the good ones, the bad ones and everything in between. I personally drive and hour and a half to the best exotic hospital in three states, and so now you know why I cringe when I hear a prospective adopter tell me, "Oh I have a vet 3 blocks from my house and he's just great with my cat. I feel very comfortable with him." What is your goal? Feeling comfortable with a vet or getting your sick rabbit qualified care? Medicine of any kind is not about getting a warm fuzzy or social interaction. It is a matter of life and death and if the best rabbit vet on Earth has a boorish personality, then grin and bear it. It's worth it.

Your role in your rabbit's medical care is not to have a warm fuzzy from your vet or save on gas money. It's to be as informed as the vet! You should be aware of the latest treatments and understand what is going on in that sophisticated little European sports car called a rabbit. Make sure you get your homework done by picking up a copy of Kathy Smith's Rabbit Health in the 21st Century and make sure you pick a vet for your rabbit who also recommends this book or keep looking. Exotic medicine will cost you more but you will get your money's worth; your rabbit will get well.


 -Thumper S. Thompson
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Splash of Buns 'N Noses

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Does Your Rabbit Have
e. Cuniculi,
Pasteurella, or just a cold?

If you don't know the answer, your vet should be able to tell you right away which is the likely culprit.

Over and over, I'm explaining to people why you can't just take your rabbit to just any veterinarian. In a sentence (the title of this little article, above), I've summed it up. If your veterinarian doesn't know what e. cuniculi or pasteurella are, and why they're so deadly to rabbits, and the latest treatments for them, then you shouldn't be going to that vet with your rabbit. You might as well just throw your money out the window. You don't take a Saab or an Audi to your local Shell station for repair do you? (If you had one, that is, I don't either but in a parallell universe, I'm wealthy and have great cars.) Well you have to take that Rabbit to an imported car specialist, too. The point I'm trying to make is, your rabbit veterinarian has to have had special training to treat rabbits.

I remember my very first adopter calling me to 'blame' me for his newly adopted rabbit having developed a jaw abscess. A jaw abscess is a terrible thing, but it is also not a predictable thing. There was no way I could have known that poor little rabbit would have developed an abscess. She needed immediate surgery and her prognosis would have been good. But the adopter, who could have easily afforded the treatment, refused to take the little bunny to a real rabbit vet even when I offered to pay for it! He said, "I'm comfortable with Dr. (Blah blah blah dum dum)." That is no qualification! He also relayed to me, "Dr. (Dum Dum) said it is major surgery and even minor surgery is very risky for rabbits and she doesn't feel comfortable doing it."

I shot him down immediately, "But Fluffy has already had major surgery! She's been spayed! And she recovered just fine!" Yea, Dr. So-and-So, that's pretty major surgery and if you don't feel comfortable doing elective surgery on rabbits, then you should refer your client to someone who does, or to a group like the rabbit rescue who pays for more surgeries on rabbits than you'll ever hope to perform on them, for a referral.

Remember, any vet will gladly take your money and break up their day from seeing cats and dogs, but if they're a responsible vet, they'll tell you the extent of their experience with exotics and whether they are really qualified to help a sick rabbit. Ask them, 'do you think it's e. cuniculi, pasteurella, or just a cold' and if they look taken aback, go somewhere else.

In conclusion, your rabbit's ace in the (rabbit) hole is going to be you carefully choosing a vet for them and trying to stay on top of rabbit medicine yourself as your vet. For more in-depth information on this topic, see my article, Selecting A Qualified House Rabbit Veterinarian. And I highly recommend the book Rabbit Health in the 21st Century by Kathy Smith.

 -Thumper S. Thompson
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The Truth About Vitamin D

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Is it the answer to rabbit dental disease?

Frances Harcourt-Brown publishes a new paper on acquired dental disease in house rabbits

Frances Harcourt-Brown is considered by many to be the world's leading rabbit researcher. She is the author of the seminal Textbook of Rabbit Medicine. Although there are many wonderful rabbit medicine practitioners and researchers in this and other countries, Harcourt-Brown, a 1973 graduate of Liverpool University, is generally considered at the forefront of rabbit medicine for a couple of reasons. One reason is that she has espoused rabbit medicine enthusiastically and her practice in the UK is approximately 85% rabbits whereas here in the US, there probably aren't any practices having as high a rate as that of rabbits being seen. The vets that BES bunnies most often go to, SEAVS, is about 65% rabbits and that's the highest we've heard of in this country. Arguably also, there is a higher concentration of rabbit owners per capita in the UK than the US.

That might be because rabbits are a native species in the UK and are not in the US - there are no American rabbits (well, except for the highly endangered tiny pygmy rabbit), there are only hares (cottontails) in the US. So Harcourt-Brown also has access to a large population of wild rabbits to study.

Harcourt-Brown is particularly interested in rabbit dentistry although she has published many peer-reviewed scientific articles on rabbit medicine. The latest of her works is titled, The Progressive Syndrome of Acquired Dental Disease in Rabbits. and was published in the July 2007 Journal of Exotic Pet Medicine. Intriguing article title, isn't it? We thought so, so I bought it and now I can relay to you the most important parts of the article for rabbit owners.

For the past year or so, Vitamin D has enjoyed a lot of publicity. If you're like me and stay on top of medical and health news, you've heard a lot of hub-bub about Vitamin D. Certain media outlets, like Life Extension Foundation, are usually years ahead of the rest of the media in reporting on what will soon be hot topics. That's where we read about the Vitamin D 'epidemic' four years ago and have watched with interest as medical media and general media outlets around the country have finally caught up. Not only are people not getting enough Vitamin D, but neither are house rabbits! And, according to Harcourt-Brown and other rabbit researchers, that could be a key cause of rabbit dental disease.

My first rabbit, Darth, didn't wake up from his last molar trim. He was an 11 year old little 2 lb. Netherlands dwarf, a darling little fellow much like Spike. His teeth were particularly bad. His trim frequency had gone from every two months to every two weeks. I ended up driving all over Kingdom Come trying to find the best price on his trims. I ended back at the place where I started though with his final trim because all that driving was wearing us both down. For his last trim, he was dehydrated from drooling with pain and he didn't wake up. We were very sad but we also couldn't afford that anymore. Still, he lived a long, dignified life. Really, we should have thrown in the towel earlier, but it is very hard to know when it's time to do that.

Not all rabbit dental disease is this bad. But what happens is, your rabbit's molars, which are supposed to have a flat surface, grow pointy and sharp and pierce the tongue, or roof and/or sides of the mouth causing pain and infection. And they can't eat. The vet puts him under anaesthesia and trims the points down with a Dremel-like tool.

Harcourt-Brown's new article discusses not only appropriate treatment, which has changed in the past several years, but also things like exposure to sunlight, the lack of which may be a key cause of this syndrome.

LET THE SUNSHINE IN

Many people don't understand what Vitamin D and sunshine have to do with rabbit's teeth. Good question! Sunlight or sunshine allows your body to synthesize, or build, Vitamin D. Vitamin D allows your rabbit's body to metabolize, or utilize, calcium. Calcium is needed by the teeth and bones. In rabbits, teeth grow perpetually, so they need to be able to effectively metabolize calcium all their life. Yes, you can get Vitamin D from other sources than sunlight, like fish and algae, and a few other plant sources [editor's note: supplementing Vitamin D in the diet is dangerous and can be toxic if not supervised by a medical professional, sunlight or artificial lighting simulating sunlight cannot be toxic as the body simply stops synthesizing Vitamin D from these sources when sufficient levels are reached]. But those sources got their Vitamin D by synthesizing it from the UV in sunlight. And not just any sunlight, it has to be a certain wave-length of sunlight which is most accessible around high noon.

I talked to a few vets about Vitamin D lately and its possible relation to this rabbit dental problem. They had varying opinions on whether increased sunlight exposure would be useful, but that's all they were, opinions. It is not really known right now just how this would affect the new syndrome Harcourt-Brown describes in her paper. But she does make some interesting conclusions. "Most pet rabbits are housed indoors or in hutches and are proteccted from sunlight, so they are unable to synthesize Vitamin D," she says. If that is so, then a little sunlight could go a long way toward helping ease not only dental issues, but bladder sludge, bladder stones, and the like. Leading US rabbit advocate (and Chapter Manager of the Florida House Rabbit Society) Dana Krempels, PhD, seems to agree about the sunlight factor and dental disease (see link for comment).

Let the Sunlight Pour Down

It should be noted though that the sunlight must fall directly on the animal. Sunlight coming through a glass window has the UV filtered out by the glass and is of no use in the context we are discussing here. For people who keep parrots and reptiles, we have long known that this a vital part of those animals' living requirements. Parrot people who live in climates where it is too cold most of the year to take their birds outside, purchase special full spectrum lights which simulate the sunlight spectrum and these have been proven to be beneficial to the birds, and people as well (who suffer from SAD). There is no possibility of a toxic amount of of this light as the body simply stops synthesizing Vitamin D once it has enough. And, your body (and also your rabbit's) can store Vitamin D for later use. So if a rabbit's required 'photoperiod' is 5 minutes a day, and he gets 35 minutes of noonday sun in one day, that's enough for that week.

There are risks, though, in taking your rabbit outside. Predators, escape, pathogens, pesticides, and other dangers lurk about. If you do take your rabbits outside regularly to munch on some grass in the noonday sun, be sure that the grass is pesticide-free and that it's a dry day. More humid days make for more pathogens swimming about in the air and on the ground. Harcourt-Brown also says, "Significantly higher PTH and lower blood calcium levels have been found in rabbits without dental disease and living outside in natural conditions." Finally, an interesting note Harcourt-Brown makes, "Despite its prevalence in the pet rabbit population, PSADD is not documented in laboratory rabbits, even though the majority of these animals are not provided with twigs, grass, hay, or any other abrasive diet."

In Conclusion

She goes on to include, "Similar (dental) radiological changes to those that occur in rabbits with PSADD have been recorded in the incisors of genetically obese laboratory mice. In the mouse study, restricting the food intake prevented the (dental) changes taking place, which is the opposite expected result if the dental pathology was due to insufficient chewing." These two observations, that lab rabbits do not develop PSADD, and that elimination of obesity in lab mice eliminates PSADD in mice, are packed with potentialities. And more research I'm sure will be done on these two topics by Harcourt-Brown.

In the meantime, it is certainly a good idea to look into making sure your rabbit gets their true 'photoperiod' each day, or the amount of time required by a certain animal to obtain their needed amount of sunlight. And also to keep them slim and trim. An aside, cats are the only animals that, other than invertebrates who manufacture their own Vitamin D, do not require sunlight in order to synthesize the Vitamin D hormone.

One final note on this article by Harcourt-Brown, she clearly opines that doing a minimal trim on maloccluded teeth is preferable over the now 'old school' approach, which is to trim them down to the base of the gum line. Doing this, she notes, only causes the tooth to grow back faster and more deformed and destroys enamel of which rabbits have a finite amount during their lifetimes. This would be a good thing to discuss with your vet if your rabbit is going in for regular trims. I personally, will request this in the future, although it won't be necessary really since this is already how my vets are doing it. But I will still double check just to be sure.

 -Thumper S. Thompson

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