DR. SOPHIE JENKINS B.VET.MED PGCEAS CERTGPEXAP MRCVS. ADVANCED PRACTITIONER IN ZOOLOGICAL MEDICINE, ORIGIN VETS. www.originvetsclinic.co.uk
Sophie graduated from the RVC in 2008 and had very clear career objectives from the outset. Just three years later she obtained a general practitioner certificate in exotic animal practice, and then in 2016, she became an advanced practitioner in zoological medicine. She owns Origin Vets Clinic in South Wales, where she treats an amazing array of exotic species. Added to this she has 25 years of experience in keeping and breeding exotic animals. Her up-to-date knowledge shines through this veterinary webinar and includes cases that she has seen the day before speaking- I always find that particularly impressive.
The outline key objectives in her presentation are: –
· Understand why prey species show subtle pain responses
· Recognise the signs of pain in rabbits
· Interpretation of the pain signs to locate the pain
· Medications that can be used, routes and doses
· Adaptation of environments for chronic pain bunnies
After revising the five freedoms and a reminder that the owner or carer must adhere to these, she defines a prey species as –‘An animal that is hunted or killed (prey) by another animal (predator) for food’
It is important to be aware of this, as prey species will often hide signs of pain and illness, and because rabbits are crepuscular, pain signs will be more difficult compared to dogs and cats. Uncontrolled pain can lead to gut stasis and death quite quickly. The pathogenesis of this summarised with death being due to sepsis and shock.
The signs of pain are recognised by:
· Facial features
· Posture
· Activity
· Eating habits
· Drinking
· Demeanour
The grimace scale is very interesting and there is a link to the Newcastle University Rabbit Grimace Scale, which shows five areas for pain assessment. These are the ear, orbital tightening, cheek flattening, nostril shape and position of the whiskers-excellent information to pass on to owners. A list of 13 conditions demonstrates the wide variety of possible causes of pain. Dental pain is an important problem and we are given an additional 14 causes that could be associated with this. Some clinical illustrations from Sophie’s extensive library follow. Diarrhoea in weanings is painful, often caused by overfeeding pellets, and a general incorrect diet, associated stress and coccidia.
For pain investigation a full investigation is necessary with: –
· Full physical examination-always
· Bloods GHP and E.cuniculi
· Imaging –x-rays/ US scan/CT/scoping
· Urinalysis
· Abdominocentesis
Some brilliant x –rays of the whole body and head show various aspects of dental disease, along with a startling case of gut stasis (look carefully before moving on to the next one as there is something else on this radiograph that could be easily missed).
General comments on the management of pain are listed in the next slide including keeping with bonded partner, pain scoring and getting permission from the owner for analgesics, which are mainly off license. We are reminded to accurately weigh the rabbit before prescribing medicines.
The following analgesics are listed in a table, which Sophie is happy for you to photograph as a handy reference.
· Meloxicam
· Buprenorphine
· Methadone
· Morphine
· Fentanyl-Fluanisone
· Tramadol
· Gabapentin
· Paracetamol
· Maropitant
· Lidocaine
· Prednisolone
The drugs in the above list have their advised dose in mg/kg, route and frequency all conveniently in one table for easy reference.
The next part of the webinar summarises the uses of each drug, mode of action with lots of clinical tips and possible side effects. The amount of detail and work that has gone into preparing this information is quite extraordinary and very useful for first opinion practitioners. It is followed by emphasis on the need to feed anorexic rabbits to avoid hepatic lipidosis and ketoacidosis.
We move on from the detailed science to practical tips on environmental adaptations/adjuncts to analgesia, (eight in total), aiming to prevent problems from excessive cold or heat and flystrike protection. I liked the methods used to encourage foraging, which have the additional benefit of promoting exercise such as ‘yoga stretching’. Some general advice on housing contains more practical information and Sophie lists some of the uses of K laser, a class 4 therapeutic laser, which has benefits in wound healing/dental pain/arthritis/cystitis/ fractures and pododermatitis.
A clinical case of a rabbit with a distal femur fracture concludes the webinar. It brings together all the aspects discussed in the webinar, before Sophie’s summary slide.
· Prey species can mask pain well
· Full investigation required
· If in doubt analgesia!
· Multimodal is best
· Local where suitable
· Pain scoring important
· Don’t forget adjunctive therapy
Sophie spoke clearly and never seemed to be in a hurry throughout the presentation. Your attention is assured and there was even time for ten minutes of questions at the end. Sophie is clearly very much on top of her specialty. This webinar a real pleasure to watch.
