Think Rabbit. Virtual Manual 2014

Transcription

1 Thik Rabbit Virtual Maual 2014

2 Cotets Itroductio Thik Rabbit i the waitig room Thik Rabbit i the cosultig room Thik Rabbit i the operatig room Thik Rabbit durig hospitalisatio The Commercial View The Owers View

3 The Thik Rabbit! campaig aims to help Based o the pet populatio statistics, for every eight cats ad dogs you see i practice, you should see at least oe small furry. The chaces are that you see owhere ear that umber. Supreme Petfoods is sposorig the Thik Rabbit campaig to ecourage rabbit owers to visit their local veteriary practices to seek advice o carig for their pet ad to brig their pet forward for treatmet whe there are health problems. As we all kow, ot all rabbits are kept i ideal coditios. Vets ad urses ca make a big cotributio by providig advice about hutch size, correct feedig ad husbadry. I this maual we have icluded some hits ad tips o esurig the practice is well prepared to treat rabbits ad also a few ideas o appealig to rabbit owers. There s results from a survey of rabbit owers that explais their perspective ad ideas for makig improvemets. The commercial ratioale has bee catered for too, with a article o the impact small furries ca make o practice profits. I m ecouragig all practices to take part i Thik Rabbit Fortight to help improve the health ad welfare of the atio s rabbits. Molly Varga BVetMed DZooMed(Mammalia) MRCVS RCVS Exotics Specialist Yours sicerely To fid out more or sig up for the campaig visit Claire Hamblio Marketig Maager, Supreme Petfoods

4 Thik Rabbit..I the waitig room Travellig i a ofte ufamiliar pet carrier ad the waitig i a room where the sight, smell ad soud of predators prevails, leaves may rabbits feelig stressed before they eter the cosultig room. Cosider producig cliet guidelies o accustomig rabbits to their carrier ad travellig with rabbits Ca you create a dedicated waitig area for small furries or would it be suitable for owers to wait i their cars with their pet before beig called for their appoitmet? Cosider small furries oly cliics or sessios Take the Small Furry Promise at ad dowload a certificate showig the practice is iterested i small furries Display high quality products suitable for rabbits Use rabbit images ad iclude rabbit magazies for cliets. Implemet a best practice guide for cliets usig the waitig rooms. Thik Rabbit I the cosultig room While takig a history, cover the cage with a towel ad allow a few miutes for the patiet to become calm before assessig. Esure you have weigh scales suitable for small furries. Allow those who have most experiece with small furries to hadle those patiets

5 Hadlig techiques Take home message (mai aims) = 1. Cover eyes to reduce visual stimulatio 2. Support the back to prevet ijury Rabbits eyes are i a lateral positio which is ideal for prey (grazig)-species ad this meas they have a extesive circular field of visio, but there are blid-spots at the rostral (especially uder the chi) ad caudal aspects of the head ad if the rabbit is touched i these regios without warig it will be startled. * Methods: Adapted from; ill_rabbit_fieldofvisio httpwww.peteducatio.comarticle.cfmc=2+2083&aid=159 - Rabbit sadwich ; The rabbit is positioed at waist height across the hadler s body 1. Approach 2. Lift 3. Secure ito sadwich positio 4. Retur 5. Reacclimatise 1. Approach; calmly ad cofidetly, depedig o the method, either scoop up the rabbit from groud or table ad put a had over the eyes immediately, or pick up the rabbit with both hads aroud its middle ad with it facig towards you (because if its istict is to jump at least it is towards you ad is more cotrolled). 2. Lift; Quickly draw it ito the cetre of your body i order to get it i a secure hold before movig away. Do ot dagle the rabbit i mid-air or move away from the groud util it is securely held.

6 Admiistratio of medicatio (P/O, S/C, I/V, I/O, I/P) - Subcutaeous (S/C); The rabbit should be secured as much as possible potetially with a extra hadler, a portio of loose ski should be getly elevated away from the rabbit s body slightly ad the uused eedle (e.g. ot previously used to draw up medicatio) should be iserted i a cotrolled maer ito the subcutaeous layer of ski at a agle parallel to the rabbit s body. The syrige should be draw back to esure o blood (pucture of a vessel) or air (ot i the subcutaeous layer) is achieved ad the a small amout of the medicatio ca be admiistered but by feelig either side of the eedle-tip/isertio site. If the ski develops a hard swellig ad the rabbit shows discomfort this could idicate ijectig ito the itradermal layer for which there is ot sufficiet space for the volume beig ijected ad the eedle should be carefully advaced, the syrige draw back to check positio ad admiistratio ca cotiue. Most rabbit breeds will tolerate 20mls of fluids beig admiistered ito oe site ad as few as possible ijectios should be admiistered. Subcutaeous fluids i large volumes may also be give via a butterfly catheter especially if the rabbit is movig about a lot. By K.Eatwell

7 Thik Rabbit I the operatig room Cosider usig v-gel supraglottic airway devices specifically for rabbits for easy itubatio ( EXOTIC AND WILDLIFE ANAESTHESIA RECORD Date: / / Case umber:. Species: Procedure: Aimal s ame: Ower s ame: Body Weight:. Sex: M / F / N / E. Age: (years) (moths) Vet & VN: Drug ame Pharmaceuticals (Iductio, Aalgesia, Maiteace &Recovery) Dose rate Total Time give Effects time ad commets mg/kg or % dose (ml) Route (i/v, i/m, s/c, i/o, i/p) Drug ame Adrealie Atropie Diazepam Doxapram Glycopyrrolate Emergecy drugs (pre-calculate maximum safe dose for idividual patiet) Dose rate mg/kg or % Total dose (ml) Route (i/v, i/m, s/c, i/o, i/p) Time give Effects time ad commets Fluid therapy ml/kg/hr. Total/hr:. Bolus amout ( ml) ad frequecy ( ) RECOVERY MONITORING (Commece whe gas tured off ad/or reversible drugs admiistered) Mi Actual time Heart rate Respiratory rate Temperature Head lift Coordiated movemet Fluid therapy Other evets or treatmets

8 CARDIOPULMONARY RESUSCITATION IN RABBITS AIM: Maitai life util spotaeous breathig ad circulatio ca be restored AIRWAY Esure patet airway Itubate immediately or check for kiks/blockages May require larygoscope ad suctio of blood/fluid Tie firmly i place Cofirmatio -visualisatio, palpatio, chest wall movemet, capography What if I ca t itubate? Supraglottic airway tube Emergecy tracheotomy if Upper Respiratory Tract pathology Try tight fittig facemask with oxyge (but may ed up iflatig stomach) Do ot itubate if respiratory obstructio CNS stimulatio e.g. toe piches BREATHING Positive pressure vetilatio 100% oxyge breaths per miute Breaths should achieve ormal chest wall expasio Ambu bag coected to ET tube Breathig system circuit with a re-breathig bag attached for compressios Rapid abdomial elevatio (1 secod duratio) at regular itervals (~every 5 secods) the weight of the abdomial cotets pushig briefly agaist the diaphragm getly forces expiratio, ad ca stimulate volutary breathig. CIRCULATION Must achieve adequate myocardial ad cerebral blood flow Exteral chest compressios - aimal i lateral recumbecy circumferetial cardiac compressios per miute - compress chest wall by 25-33% Iteral cardiac massage Evaluatig basic life support Feel for pulses - doppler check mucous membrae colour ad CRT, (oxyge saturatio - pulse oximeter) check for aimals ow efforts check respiratory efficiecy (capography) Aaesthetic related arrest - call for help! switch off volatile check patecy of ET tube check flowmeters check breathig system give several breaths of 100% O 2 atagoize if possible (atipamezole for alpha-2s, aloxoe for opioids, flumazeil for bezodiazepies, o-specific reversal with doxapram)

9 Thik Rabbit durig hospitalisatio Keep i mid that differet temperature zoes may be required warmer for post-op rabbits ad cooler for hospitalised, o debilitated rabbits that are accustomed to outdoor livig. Watch out for gastric stasis o-productio of droppigs or iappetace for 12 hours or more. Use Selective Recovery or Recovery Plus as eeded. Always stock good quality hay for rabbit ipatiets. Provide water i a bowl to ecourage fluid itake.

10 RABBIT HOSPITALISATION FORM ANIMAL'S DETAILS CLIENT'S DETAILS Case o.: Name: Miss/Mrs/Mr Esure patet airway Name: Address: Species: Breed: Post code: Sex: MALE /FEMALE.ENTIRE /NEUTERED Primary telephoe o.: CNS stimulatio e.g. toe piches Age: Y...M Other cotact o.: Date: DD/MM/YY Case cliicia: Belogigs descriptios: Positive pressure vetilatio Hospitalised diet: Food Amout Frequecy Ow Food PELLETS MIX VEG Procedure/reaso for hospitalisatio: RR (b/m) Norm 30-60b/m HR (b/m) Norm b/m Temp ( C) Norm C Admissio Date: DD/MM/YY Breaths should achieve ormal chest wall expasio Ambu bag coected to ET tube Admissio weight: Kg TODAY'S WEIGHT: Kg Warigs/Cliical sigs: Gut souds preset Food Eate e.g 20g pellets/day (Hay to be give adlib) Bowl /Bottle Left Right Eate (g+?/10) Give (g) Drak(mls) Give (mls) CARDIOPULMONARY RESUSCITATION IN RABBITS AIM: Maitai life util spotaeous breathig ad circulatio ca be restored Procedure date: DD/MM/YY Faecal pellets (Approx. No. & form) Medicatio/Procedure Drug/Procedure Dose Total dose mg/kg ml Freq Route Drug/Procedure Dose Total dose mg/kg ml Freq Route Drug/Procedure Dose Total dose mg/kg ml Freq Route Drug/Procedure Dose Total dose mg/kg ml Freq Route Drug/Procedure Dose Total dose mg/kg ml Freq Route Drug/Procedure Dose Total dose mg/kg ml Freq Route Drug/Procedure Dose Total dose mg/kg ml Freq Route Drug/Procedure Dose Total dose mg/kg ml Freq Route Drug/Procedure Dose Total dose mg/kg ml Freq Route I/V Catheter maiteace: Rate: /hr Flush Locatio: L R Freq: Redress Procedures plaed/ Istructios for the day Phoe ower Bloods Urie Sample Charged Diagostic Imagig: Rads U/S C/T Edoscopy Vet iitials:. GA +/or Surgery Sedatio Other: PTO FOR NOTES AIRWAY Itubate immediately or check for kiks/blockages May require larygoscope ad suctio of blood/fluid Tie firmly i place Cofirmatio -visualisatio, palpatio, chest wall movemet, capography What if I ca t itubate? Supraglottic airway tube Emergecy tracheotomy if Upper Respiratory Tract pathology Try tight fittig facemask with oxyge (but may ed up iflatig stomach) Do ot itubate if respiratory obstructio 100% oxyge breaths per miute BREATHING Breathig system circuit with a re-breathig bag attached for compressios Rapid abdomial elevatio (1 secod duratio) at regular itervals (~every 5 secods) the weight of the abdomial cotets pushig briefly agaist the diaphragm getly forces expiratio, ad ca stimulate volutary breathig. CIRCULATION Must achieve adequate myocardial ad cerebral blood flow Exteral chest compressios - aimal i lateral recumbecy circumferetial cardiac compressios per miute Drikig(mls) - compress e.g. 300ml/day chest wall by 25 - Urie 33% Iteral cardiac massage Evaluatig basic life support Feel for pulses - doppler check mucous membrae colour ad CRT, (oxyge saturatio - pulse oximeter) check for aimals ow efforts check respiratory efficiecy (capography) Aaesthetic related arrest - call for help! switch off volatile check patecy of ET tube check flowmeters check breathig system give several breaths of 100% O 2 atagoize if possible (atipamezole for alpha-2s, aloxoe for opioids, flumazeil for bezodiazepies, o-specific reversal with doxapram)

11 Esurig your practice is small furry friedly: The Ward The duty of care that vets have for their patiets exteds beyod simple medical or surgical treatmet. For small furry patiets such as rabbits, guiea pigs ad rodets, husbadry ad hadlig cosideratios are ofte paramout for the success of treatmet, particularly as these species are proe to becomig stressed. Esurig small furries are t housed close to predator species whe hospitalised is oe way to promote exotic patiet s o-medical eeds, which ca be achieved by creatig a separate ward for small mammals. Here are a few other strategies to keep stress to a miimum ad ecourage a swift recovery: Cosider the species atural behaviours There will be some ievitable iterruptio of ormal restig patters for octural species udergoig treatmet. It is therefore extremely importat to make sure that treatmet ad moitorig check times are structured to be as ifrequet as possible ad that the eviromet promotes rest i the periods betwee disturbaces. Low lightig, quiet surroudigs ad ot beig housed i a thoroughfare ca all help. Keep hadlig to a miimum, especially whe aimals are likely to be stressed (e.g. whe uused to hadlig or pregat/ursig). The use of tubes or boxes to reduce direct cotact (particularly with very small species such as rodets) ca help with this. Also, makig sure all equipmet/ drugs etc. are to had whe admiisterig treatmet/performig checks will reduce hadlig time sigificatly. Beig prey aimals, may small furry species are shy, so a hide should always be provided. A cardboard box will usually suffice. Low level cages are also a good idea for ervous patiets that may ijure themselves if they dart or jump out of the cage whe it is opeed. Maitai familiarity Miimisig huma to patiet scet trasfer ca be achieved by wearig examiatio gloves whe hadlig the aimal or its beddig. However, thick gloves should be avoided to reduce the risk of crush ijury because of reduced dexterity ad touch/pressure feedback. Where possible, use the patiet s ow cage or cage furiture ad retai some old beddig at each beddig chage. Patiets that are used to beig kept i pairs or groups should be hospitalised with compaios where possible. Ofte, physical separatio is ievitable durig treatmet ad moitorig but housig cage mates i adjacet cages that allow through-bar physical ad scet cotact ca vastly help to reduce stress. Maitai diet It is importat to maitai a appropriate ad cosistet diet, eve if it meas feedig a less tha ideal igrediet. Aorexia ca quickly become a life or death sceario for these species. Provide water both from a bottle ad a bowl, irrespective of how it is ormally preseted to the aimal at home. Make sure bowls ca t easily be tipped ad do ot preset a drowig/chillig risk (especially to potetially weakeed patiets) by usig marbles or clea pebbles to prevet small species immersig themselves accidetally.

12 Have the right equipmet Beddig must be dust-free, absorbet, warm, o-abrasive ad allow for burrowig. Supreme s Natural Tumbefresh Beddig is dust extracted ad is ideal for the recoverig patiet. Food. Nutritio is paramout i the recovery of small mammals. Supreme s Sciece Selective meets the complete utritioal eeds of recoverig small mammals, whilst combiig high fibre with palatability. Always have fresh hay o site or rapidly available. Supreme s Fibafirst is aother alterative ad the log chai fibres will exted chewig times to provide evirometal erichmet Always have fresh food for temptig iappetat patiets. A few plat pots with some grass ad/or dadelios i them provide a space-savig ad readily available solutio. Critical care formulas. Rehydratable liquid feeds ot oly provide utritio, but also help to achieve rehydratio. Supreme s Recovery ad Recovery Plus products are ideal for the critical care of small mammals. Bottle warmers for warmig syriges of fluids ad Hyaluroidase additive for S/C fluids are extremely useful ad ca be purchased from most veteriary drug compaies. Portable icubators, appropriately sized oxyge tets ad humidifiers help to miimise chages i eviromet for the critically ill. Scales appropriate for size are vitally importat for moitorig. Scales must measure at least to the earest gram ad also be accurate below 50g. Appropriate moitorig sheets that allow ad prompt the recordig of thigs like droppig cosistecy ad umber, ad abdomial palpatio fidigs etc. will esure cosistet moitorig of importat parameters that may ot be icluded o a ormal hospitalisatio form suitable for cats ad dogs. Visit exotics-resources-zoe/ to dowload free moitorig ad iformatio sheets. Compilig specialist equipmet commoly used for small furry species i oe place, such as catheters, feedig syriges ad small volume syriges for example, helps vastly whe items are eeded quickly i a emergecy ad also for moitorig stock. This discussio is by o meas exhaustive but illustrates the eed to cosider more tha just the medical ad immediate husbadry eeds of small furry species whe hospitalised, to esure that stress is miimised ad recovery speed maximised. For further readig please refer to the followig geeral texts: Girlig S (2003) Veteriary Nursig of Exotic Species. Blackwell Publishig, Oxford BSAVA Maual of Exotic Pet ad Wildlife Nursig. BSAVA 304pp Exotic Pet Behaviour: Birds, Reptiles ad Small Mammals. Bradley Bays, T., Lightfoot, T. & Mayer, J Sauders.

13 To access more protocols, pro forma documets ad tips o carig for rabbits go to

14 The Commercial View Small Furries, Big Profits A recet survey of vets ad urses idetified that eve i the face of a major recessio, a massive 70 per cet of respodets felt that small furries/exotics had made a growig cotributio to their busiess profits over the last five years. 1 More excitig still is the ews that 90 per cet felt that there was potetial for small furries to make a eve bigger cotributio to practice profits i the future. The Profit Potetial While most vets ad urses have a gut feel that there is potetial here, ca we quatify the opportuity? Accordig to the Pet Food Maufacturer s Associatio most recet survey, there are a estimated 16 millio cats ad dogs, 1 millio rabbits ad 1 millio guiea pigs kept as pets i the UK. 2 That meas, very approximately, that for every eight cats ad dogs you see i small aimal practice, you should see a small furry. Supreme has estimated that the average practice has just 50 rabbits registered. Although it s highly variable, a practice should expect to have aroud active cliets per vet. 3 The frequecy of visits, efficiecy ad productivity of the vet will all ifluece this figure. The pet ower statistics suggest that those cliets should iclude 85 rabbit owig cliets registered per vet (based o the pool of available aimals). Takig six vets as beig average, this meas that the average practice should have 510 rabbit owig cliets registered. Keepig it Curret For those curretly sittig happily with their 50 rabbits, the a examiatio of the figures shows that there is already a substatial profit to be had from acillary retail sales aloe. Sales of cocetrate foods to those owers could geerate early 1,500 profit per aum. Cocetrate food the Profit Potetial Cost of 1.5kg Sciece Selective 3.99 (3 weeks feedig) Feedig cost per day 19p Purchases per year per rabbit Miimum of 17 Sales per year per rabbit, or from 50 rabbits per year. Approximate profit 1500

15 Hay ad beddig, usig similar calculatios, could geerate 1200 ad 1300 per year respectively ad hygiee products aother 500. Additioally, at each repeat visit there is a opportuity to build loyalty, develop relatioships ad promote wellbeig checks ad other services ot just for rabbits but for other pets the cliet may ow. To coclude, practices could be lookig at geeratig 10,000 additioal turover ad aroud 4,000 additioal profit, simply by stockig products for their curret rabbit owers. Cater for other existig small furry cliets ad most practices should be lookig at brigig the profit level up to per aum. Whe it comes to services, a PDSA report 4 foud that oly 46 per cet of owers have had their rabbit vacciated with a primary course, oly 37 per cet of rabbits are eutered ad a estimated 730,000 rabbits are ot registered with a vet at all. * Corer the Market For most practices growig the cliet base relies o marketig efforts ad word of mouth. Advertisig, leaflet drops, direct mail or promotioal evets are usually directed at all pet owers (or more ofte at all idividuals i a geographic area of whom aroud per cet are likely to be pet owers). Aother strategy that gets away from this blaket approach is to grow a iche. So, could you grow your practice through developig a more small furry friedly approach? We ve addressed the opportuities; where are the obstacles? Well, may people i the professio feel that cost of treatmet relative to the cost of the pet is the biggest barrier to growig this segmet, accoutig for 55 per cet of poll respodets, 1 while aother 45 per cet felt that lack of educatio ad a iability to recogise illess were the mai factors. Cost Issues There are a umber of ways to address fears over cost, but survey after survey shows that the biggest barrier is ofte i the cliicia s mid ad that most cliets wat to be offered the best treatmet for their pet regardless of cost. The recet PDSA Aimal Wellbeig Report cofirmed that 94 per cet of pet rabbits are ot isured. 4 The actual perceptio of the aticipated cost may be a barrier to owers brigig their pet forward for treatmet. Oe approach could be to survey cliets ad prospective cliets to fid out what their expectatios are of what they would have to pay for a basic cosultatio. It may be that the perceptio is greater tha the actual cost i which case there is a commuicatio exercise to carry out to allay fears. By askig pet owers what they would be prepared to pay for a cosultatio ad offerig price bads to select from, it may also be possible to idetify the poit at which cost becomes a deal-breaker ad to set the price at a realistic level. Upgrade the Offer While cost might be uppermost i your mid, there are cliets who wat the best ad with the icreasig popularity of idoor rabbits with youg urba professioals, there is a steady demad for premium products ad services. The perceptio of small furries as low moetary value pets has to some extet iflueced how may rabbit owers receive a expert dietary recommedatio. There is still a sigificat gap betwee low quality o-braded small pet foods ad higher quality sciece-based species specific foods. These higher quality foods that offer health beefits also have a much better fit with veteriary practices where the aim is to sell products that ehace well-beig.

16 Growig Small So, what about those issues relatig to the fact that may pet owers just do t kow whe their pet is ill, or whether their vet ca actually do aythig about it? There s also the thory issue of how to raise levels of awareess i parets as well as childre, where the child is the actual pet ower. Educatio is oe way forward, either through hostig rabbit health classes i the practice or goig out ito the commuity ad offerig hadlig ad health sessios i schools or at breakfast, after school ad holiday clubs. It s possible to raise your rabbit profile i other ways by active commuicatio with local ewspapers ad pet owers (through practice ewsletters ad websites) about key issues such as fly strike or vacciatio. Visible remiders such as we welcome buies sigage ad beig aware of the eed to esure that small furries are always represeted i your practice literature, help build your case. Build o Potetial There is obviously little room to be complacet i ecoomic terms ad it makes sese to maximise every uexplored opportuity. Grow the small furry segmet of your busiess, icrease the cliet base ad boost associated retail sales ad the beefits are clear to see. Refereces 1. A survey by the webiar vet, of 246 vets ad urses ad studets attedig a luch ad lear webiar o 15th September PFMA Pet populatio statistics Blackwell s Five-Miute Veteriary Practice Maagemet Cosult, Lowell Ackerma 4. PDSA Aimal Wellbeig Report 2011 ( This article was previously published i Veteriary Marketig, 2011 ad is reproduced i abbreviated form with their permissio. *Prelimiary data from the Better for Buies, Better for Busiess programme shows that participatig practices saw a huge uplift i uptake of vacciatio of rabbits, i most cases more tha doublig the previous level.

17 Rabbit Ower Survey We asked 100 rabbit owers about their experieces with veteriary practices. The results, o the whole, provide extremely positive feedback for the professio but there are some learig poits too. Backgroud The owers that completed the survey were recruited via the Supreme Petfoods website ad Facebook page, ad therefore the respodets may be skewed towards beig very carig ad educated owers with a elevated level of iterest i their pets. They were also specifically respodig to a survey that asked about their experiece with vets, which may have attracted those who felt they had a specific experiece i this area. Cosequetly, as with ay survey, the results should be iterpreted with some cautio. Scee Settig Sigle rabbit owership accouted for more tha a fifth of respodets ad a quarter owed two rabbits. Oe third of respodets owed 3-5 rabbits suggestig that multiple rabbit owership may be more widespread tha might be commoly assumed. Visits to the Vets A majority of 57% of respodets visited their vet more tha three times i the last year, early oe third (31%) had visited their vet 2-3 times with their rabbit ad oe had failed to visit the vet withi the last year. Agai this may reflect the character of the respodets but oetheless it is a impressive level of attedace. Level of Service The good ews is that 57% felt they received a excellet level of service from their vet ad a further 33% rated the service as good. Oly 3% felt they had experieced a bad level of service. This was reiforced by additioal commets: My vets are brilliat with rabbits My vet is fab with my bus ad that s why I use her. Fully trust my vet with all thigs rabbit They deserve a award for beig awesome. The vet urses I see totally adore my rabbits. They ever seem stressed with the urses hadlig them ad the advice they give me is very good.

18 Services The most popular services that 91% of rabbit owers said they would use were vacciatio ad euterig. There are some very specific opportuities too: 82% said they would use regular detal checks, 71% would use geriatric rabbit checks (with a further 19% sayig they might use this service) ad 60% would use their vet for parasite cotrol advice. The opportuity for welless services is sigificat with 50% of respodets sayig they would use rabbit healthcare educatio if it was offered, while a additioal 38% said they might use such a service. Choosig a Vet The most importat factor idetified i choosig a vet practice was a apparet iterest i rabbits i the practice cited by 99% of owers as beig very importat or importat (95% ad 4% respectively). Similarly rated was the importace of havig facilities for rabbits at the practice rated by 87% as very importat ad 12% as importat. My vet is excellet but as it is a small practice there is a mixed waitig area ad mixed keels would be much better if rabbits could be kept separate ad stress-free My vets are excellet ad have two rabbit specialist vets but still do ot have a special waitig room or separate facilities at back for rabbits, which is a shame. Havig vets ad urses with additioal traiig or qualificatios i dealig with rabbits was said to be very importat by 81% of owers ad importat by aother 16%. O the subject of cost, it is otoriously difficult to evaluate how hoest respodets are o this issue, but i this survey 31% said cost was very importat, 38% felt it was importat ad 11% said that is was uimportat. Perceptio We asked the respodets to agree or disagree with certai statemets. Although 94% felt that their vet took their rabbit s healthcare seriously, 91% felt the vet ad vet urse kew how to hadle rabbits ad 90% had o worries about takig their rabbit for routie appoitmets, it was slightly disappoitig that ot quite that umber felt that their vet geuiely liked or was iterested i rabbits (82%). Of course, 82% is still a impressive figure but it suggests that the professio is demostratig good levels of competece ad could perhaps work harder at establishig a rapport with rabbits ad their owers. Asked about who they would ask first if they eeded advice about the feedig or care or their rabbit, 61% said they would ask their vet or vet urse agai suggestig that more could be doe to promote welless through practices. Lack of Care Asked to rate the reasos why rabbit owers would ot take their rabbit to the vet, most people felt that ot kowig eough about rabbit healthcare or beig uable to recogise illess would be more importat factors tha the cost of treatmet although cost was still cited as a importat reaso why some owers might ot wat to visit the vets.

19 Ecouragig Rabbit Owers We suggested some iitiatives that vet practices might itroduce ad asked owers which of those would make them feel more willig to take their pet to a practice. Rather surprisigly the most highly rated was the provisio of regular updates from their vet about rabbit care i the form of letters or ewsletters, with 82% ratig this as very importat or importat. I order of importace the ext most popular iitiatives were special offers o rabbit products ad services (80%), a dedicated area o the practice website for rabbit owers (79%), fixed price cosultatios for rabbits (75%), ope day/behid the scees tour (73%), dedicated waitig area for rabbits (63%), rabbits welcome sigage (63%) ad rabbit oly cliic times (55%). Most practices would agree that the most popular ideas are simple marketig iitiatives that could be put i place very easily. Learig Poits Although most commets were overwhelmigly positive there are, however, always lessos to be leared: My rabbit was due to be castrated ad I received a text tellig me to starve my pets before surgery. I kew this was wrog I have Belgia hares ad my vets seem to be very worried about hadlig them.. Geerally lackig i kowledge ad iterest. Have o literature at all i the waitig areas. Vets i geeral do ot get eough stadard traiig o rabbits. I am pleased that my vet is geuiely tryig to improve their rabbit kowledge ad procedures by attedig workshops ad cofereces ad actually makig chages i the practice afterwards. I should t have to ask to get pai relief to take home to admiister to a recetly eutered/ spayed rabbit, it should be give as a matter of course. Kowledge o HOUSE rabbits! Some vets still fid this odd I have foud.. I geeral, may owers said they thought their vets were lovely, fatastic ad great The word brilliat cropped up repeatedly. Rabbit owers are obviously discerig cliets ad are makig some very astute observatios. Eve simple chages are likely to be oticed ad viewed positively. Supreme Petfoods would like to thak Wedy Bamet, Exotics Veteriary Nurse ad the Royal Dick School of Veteriary Studies for the use of the ursig plas ad protocols i this documet.

20 Thik Rabbit Nutritio Diet is probably the most importat factor i maitaiig rabbit health Aatomy ad physiology of the gut Dietary fibre Dietary carbohydrate Calcium The ideal diet Muesli ad pellets Trasitio betwee differet diets Dietary decisio tree Ifographic o obesity DUODENUM ILEO-COECAL VALVE OESOPHAGUS PYLORUS BILE CAECUM ANTRUM PANCREAS CAECAL APPENDIX FUNDUS ILEUM STOMACH JEJUNUM PROXIMAL COLON SMALL INTESTINE Aatomy ad physiology of the rabbit gastroitestial tract GIT Rabbits are hidgut fermeters ad to uderstad the dietary requiremets of rabbits it s useful to kow how their gastroitestial system fuctios. Neoatal rabbits have a relatively high stomach ph of 5 to 6.5, to allow bacteria to pass through ad coloise the caecum. After weaig, food is effectively sterilised i the stomach where the ormal ph is aroud 1 to 2, before it passes ito the small itestie. The stomach should always cotai igesta ad has a trasit time of three to six hours. The jejuum is log ad covoluted ad occupies the dorsal left flak; the ileum is similarly shaped ad forms a ileocaecocolic complex that eds i the sacculus rotudus. The sacculus rotudus is uique to rabbits ad has a thick wall cotaiig may macrophages ad lymphoid tissue. A ileocolic valve cotrols the etry of gut cotets ito the sacculus rotudus, whilst also prevetig reflux back ito the small itestie, see Fig 1. FUSIS COLI RECTUM DISTAL COLON ANUS The rabbits proximal colo is able to mix ad separate gut cotets. Large idigestible fibre particles, >0.5mm are separated out from igesta ad set distally ito the colo. Smaller digestible fibre particles ad fluid are set via reverse peristalsis ito the caecum where they udergo bacterial fermetatio. This releases essetial utriets for absorptio such as volatile fatty acids ad microbial proteis. The caecum comprises almost a fifth of a rabbit s total bodyweight ad is the largest of ay mammal relative to their size.

21 The proximal colo eds i a highly muscular sectio of gut called the fusis coli. I here water is squeezed out of the cotets ad hard faecal pellets are formed, which are the moved o ad stored i the distal colo before beig expelled. A differet set of caecal ad proximal colo cotractios are required to move caecal cotets ito the fusis coli, where soft mucous covered caecotrophs are formed. These the pass ito the distal colo where they trigger igestio by the rabbit, directly from the aus. Whe food is scarce all caecotrophs are eate, however where food is i abudace they ca build up ad cause soilig aroud the aus. Caecotrophs slowly dissolve i the stomach ad their utriets absorbed i the small itestie. Dietary Fibre It is importat that a diet cotais a high proportio of fermetable (isoluble, large) fibre as well as a variety of differet sized soluble fibre particles, as both are required for stimulatig ad maitaiig ormal gut fuctio, prevetig ileus ad maitaiig ormal detitio. A high fibre diet is essetial for Stimulatig ormal gastroitestial fuctio Maitaiig detitio Dietary fibre plays a essetial role i GIT fuctio because: Fibre stimulates caeco-colic motility ad helps prevet caecal impactio Fibre stimulates the productio of motili, a prokietic ezyme secreted i the small itestie Fibre icreases overall food itake, resultig i loger gut-trasit time ad better food coversio efficiecy Fibre particles over 0.5mm i legth are required to stimulate the fusis coli I additio: Dietary fibre has bee show to decrease hair accumulatio i the gut ad help prevet formatio of hair balls Fibre is required to help iduce the drive to eat caecotrophs Rabbits i the wild sped a high proportio of the day eatig. Diets that are low i fibre are eate too quickly, leadig to boredom ad vices such as fur chewig ad barberig.

22 A high fibre diet is also essetial to maitai ormal detitio: O average icisors grow at 2mm per week whilst cheek teeth grow o average at 2mm per moth. A high amout of dietary fibre is therefore required to provide eough abrasio to wear dow teeth sufficietly to avoid overgrowth ad malocclusio (which predispose to ifectio ad facial abscesses). Prologed periods of gridig fibrous food also provides mechaical stresses required for the maiteace of good madible ad maxilla boe quality. Pet rabbits should always have access to ad lib hay (fibre) ad fresh water Dietary Carbohydrate Ideally rabbit diets should be both high i fibre, low i carbohydrate ad without added sugar. Sugar is added to some commercial rabbit food i the form of fruit pulp, syrups ad molasses a practice that Supreme has campaiged agaist. Carbohydrates are digested ad absorbed primarily i the stomach ad small itestie; they ted to have a rapid gut trasit time, especially if there is little accompayig fibre. A overload of carbohydrates ca result i icomplete digestio ad ay residual starch is passed ito the caecum ad becomes a substrate for caecal bacteria. This ca the lead to a rapid bacterial overgrowth, diarrhoea ad eterotoxaemia. Newly weaed rabbits are particularly susceptible to this whe they are moved (e.g. from breeder to pet shop) ad they have a diet chage with little hay available. High carbohydrate, low fibre diets ca cause the followig problems: Predispositio to detal caries Disruptio of ormal caecal bacteria required for fermetatio Predispositio to over-eatig ad obesity Dietary Calcium The mai pathway that rabbits acquire calcium is by passive absorptio across the itestial mucosa, which is poorly cotrolled. Therefore the total serum calcium levels of rabbits usually reflect dietary itake. However whe the diet cotais low levels of calcium the rabbit ca also actively uptake it from the gut usig activated vitami D3 ad ultraviolet light, as i other mammals. Excess calcium is excreted by the kideys, which is why rabbit urie is ofte cloudy due to the presece of precipitated calcium carboate. Excessive dietary calcium must be avoided as high calcium levels i urie ca cause irritatio ad ski scaldig or urolithiasis. The dietary requiremet for calcium is 0.6 to 1%. Calcium ad vitami D deficiecy have bee implicated i detal disease, by causig uderlyig metabolic boe disease. The alveolar boe surroudig teeth ca demieralise, allowig apical elogatio ad wideig of periodotal spaces which ca lead to tooth rotatio ad ifectio. The theory is that rabbits fed icorrectly o muesli type diets ca selectively feed, leavig the compoets rich i calcium, resultig i a overall deficiecy. I additio it s kow that the calcium cotet of grass ad hay ca be highly variable. Calcium deficiecy may be more likely to occur if the rabbit is also deficiet i vitami D due to a lack of exposure to sulight. I such cases the active uptake of calcium may be isufficiet to compesate for the lack of dietary calcium. Good quality cocetrate igrediets ad a balaced diet should provide optimal levels of calcium. It is also importat to provide a suitable ratio of calcium to phosphorus i the diet. A ratio of 1.5 :1, or 2:1 is recommeded. Rabbits are more tolerat of high calcium to phosphorus ratios tha low oes. Excess dietary calcium ca cause urolithiasis Low dietary calcium ad lack of sulight may cause - metabolic boe disease - detal disease

23 The Ideal Diet: The ideal diet should mimic the atural grass-based diet as close as possible. Grass is approximately 20-25% crude fibre, 15% crude protei ad 2-3% fat. Therefore the bulk of the diet should be grass (fresh or freeze-dried NOT law mower clippigs) ad/or hay (good quality meadow hay or Timothy Hay) available at all times. Hay ca be fed from ets or racks to miimise cotamiatio ad icrease time spet feedig. A high fibre, o added sugar cocetrate food should also be provided, alog with fresh vegetables. A variety of gree vegetables ca be fed to rabbits of all ages, (washed before had) although they eed to be itroduced gradually to ewly weaed oes. Ufortuately, a recet UK survey of 52 ew rabbit owers (JL Edgar ad SM Mulle 2011) foud that oly 40% iteded to feed hay or grass, whilst 100% iteded to feed cocetrate. This highlights the eed to reiforce the beefits of hay to rabbit owers ad also supports the recommedatio of cocetrate with a higher fibre, low carbohydrate cotet such as Supreme Selective. Supreme Selective has a fibre cotet of 25%, closely reflectig the fibre cotet of rabbits mai atural diet, grass. I additio it has o added sugar. Further advaces i maufacturig techology have recetly bee made ad ow Supreme Fibafirst ad VetCarePlus rages offer Mooforage ad cotai 34% fibre. It is always worth checkig the compositio label of commercial diets to check the cotet of these two key utriets ad to watch out for hidde sugars. Rabbit cocetrate should be HIGH FIBRE with NO added sugar A greater amout of cocetrates are idicated i sick, debilitated, pregat ad lactatig rabbits to esure a adequate eergy supply. Supreme Selective rage provides specific diets for growig, pregat ad lactatig rabbits ad older oes (4+ years). The Supreme Vetcare Plus rage for specific health problems are detailed earlier i the maual (see page 11). Other additios to the diet ca iclude the followig: Do NOT feed Commercial treats which are high i sugar ad fat, so should oly be fed very occasioally Favourite herbs or high fibre treats (istead of high sugar/fat oes) Twigs or braches from edible fruit trees with bark attached, to provide tooth wear ad metal stimulatio Law clippigs Frosted vegetables Mouldy food As they ca all lead to severe digestive disturbace.

24 Muesli ad Pellets I the mid 1990 s it was discovered that muesli type diets fed to rabbits could lead to calcium deficiecy ad poor calcificatio of the skull ad teeth, predisposig to advaced detal disease (FM Harcourt- Brow 1996). This was because rabbits were foud to be selective feeders, most commoly rejectig whole grai ad pellets withi a muesli mix, leadig to a less tha miimal requiremet of dietary calcium beig igested. However, these days there are some very good muesli mixes cotaiig pellets with higher levels of palatability, added fibre to provide chewig opportuities ad much better quality igrediets, such as Supreme s Russell Rabbit. Iterestigly a sigificat umber of owers prefer a muesli mix, 29% i the recet survey of 52 ew owers (JL Edgar ad SM Mulla 2011), particularly those who attribute more secodary or huma emotios to their pet. This may be because muesli type diets are perceived as providig more evirometal erichmet, with more opportuity to forage. If this type of cocetrate is preferred by owers they may feel quite strogly about it. Therefore it is better to esure they are well educated about avoidig selective feedig, by oly toppig up food bowls whe all the muesli is goe (as well as feedig ulimited hay). Extruded cocetrates such as Supreme s Selective Sciece, ad Mooforage brads Fibafirst ad VetCarePlus, cotai the same balaced utriets i every piece, avoidig ay selective feedig cocers. Trasitio betwee diets Sudde chages i diet ca disrupt the ormal caecal bacteria ad cause a serious GI upset. Therefore diets eed to be chaged gradually over several days or weeks. Ad lib hay ad water should always remai available. The proportio of old food should be reduced by a small amout each day, whilst the proportio of ew food icreased correspodigly ad both mixed together i the same bowl. See suggested timetable below: Day % Old diet % New diet Fresh hay ad water should always be available. Whe chagig a diet it is prudet to suggest the ower does the followig ad cotact the practice if they spot a problem: Moitor droppigs loose droppigs, reduced umber of droppigs or o droppigs ca be sigificat Weigh the rabbit at the same time each day, weight should remai stable, ay persistet treds (up or dow) suggests there may be a problem Carefully moitor the rabbit s behaviour for ay sigs of lethargy or other abormalities

25 The Dietary Decisio Tree This decisio tree has bee put together by Supreme Petfoods with small aimal veteriary experts ad provides a tool for choosig the optimal diet for each idividual rabbit patiet. Refereces ad Further Readig Meredith A. The importace of Diet i Rabbits. The British Rabbit Coucil Sayers I. Approach to prevetative health care ad welfare i rabbits. I Practice 2010;32: Edgar JL, Mulla SM. Kowledge ad attitudes of 52 UK pet rabbit owers at the poit of sale. Vet Record 2011; March 21st Hamli J. The importace of fibre i rabbit health. The Veteriary Nurse 2012;3(7): Harcourt-Brow FM. Calcium deficiecy, diet ad detal disease i pet rabbits. Vet Record 1996;139: Harcourt-Brow FM. Detal disease i pet rabbits:1. Normal detitio, pathogeesis ad aetiology. I Practice 2009;31: