Episode 10 - Rabbiting on about rabbit skin

In this episode Sue, John & Paul invite Molly Varga to chat with them about a non-traditional companion animal - the rabbit. Molly heads up the exciting new specialist exotic pets service at Rutlland House Referral Hospital in St Helens, Merseyside.

 

Log this CPD with 1CPD here

 

SHOW NOTES:

 

INTRO

(00:00) John, Sue and Paul introduce the podcast the guest, Molly Varga (diploma in zoological medicine).

 

 

Chapter 1 – Rabbit Owners

 

(02:13) Sue asks Molly to introduce herself and Molly shares that she works in a multidiscipline referral hospital practice in the northwest seeing everything that isn’t a dog or cat and she has lectured and written on the subjects.

 

(03:46) Sue asks whether the popularity of rabbits has grown, Molly says they are the third most popular pet after cats and dogs and over lockdown there has been a disproportionate growth in the ownership of rabbits.

 

(04:31) Sue asks what the advantages are with having a rabbit, and Molly says that the unique nature of rabbits, and the higher need for care mean people engage with them as pets with their personalities - with more people keeping them as house pets, with them being less independent than cats. They are often seen as a precursor to children or a pet people have instead of having children.

 

(05:46) John asks where the best source of information for rabbit ownership could be found and Molly says the vets unfortunately may not always be the best source of information, so she would advise the Rabbit Welfare Association as the best source, with the PDSA, the RSPCA and the Blue Cross also have good information as well as some pet food companies. For more advanced information The Veterinary information Network.

 

(07:52) Sue asks if inappropriate diet and husbandry is indeed the main cause of issues with rabbits and Molly agrees with this, saying they are shifting to more rabbits being kept indoors and this can help with companionship but cause some issues with their legs from a different use of those indoors. She also says there are fewer dental issues from poor diet than there used to be.

 

(09:21) John asks if dental issues are the most common problem with rabbits, and Molly confirms that this and gut stasis are the most common presentations, both of which are interlinked and can be a primary issue or most commonly a consequence of something else which has reduced the appetite such as pain. It is important we remember that often the symptoms we are presented with a part of a bigger picture.

 

Chapter 2 - Rabbit Skin

 

(11:02) John asks about if the underlying cause is ever a skin issue and Molly says they are presented with a lot of skin problem because the owners can see it, but again this is often part of a larger picture, so they see ectoparasites and ear based swellings, and alopecia, wounds and abscesses are very common.

 

(12:13) Sue asks if there are things owners can do at home or whether they should go straight to the vet when faced with a skin problem and Molly says there are things owners can do at home and there are over the counter preparations they can use – but this does often miss the bigger picture mentioned, and so an assessment can pick up these interrelated issues – such as a lack of grooming because of other factors leading to a mite infestation. So if something isn’t working it isn’t worth persisting but would be better to seek professional advice.

 

(13:41) Sue asks about the over-the-counter preparations, and whether there are any of these owners should avoid and Molly concurs and says fipronil as a red flag product which should never be used in rabbits. She advises a permethrin based antiseptic spray is very useful as long as there are no cats in the household – But for more specific products it would be better to reach for license products, authorise products or products used under the cascade.

 

(15:03) Sue asks for other ingredients useful for treating skin problems in rabbits and Molly advises imidacloprid as generally safe and authorised for fleas, whilst fleas are not typically the main problem for rabbits. Another is cyromazine – but increasingly we are moving towards products like selamectin, moxidectin and milbemycin being used under the cascade, which means they are safe and evidence based but are just not authorised at the current time for use on rabbits in this country. So this then comes back to a vet having a look at the patients and doing tape strips or swab tests and seeing what is happening to select the appropriate product.

 

(16:50) Sue summarises and asks what are the clinical signs seen with rabbit skin disease and if this can be a zoonosis – where the condition can be passed to humans. Molly says the white flaky dandruff is quite typical with rabbits and these are mostly rabbit fur mites but can be Cheyletiella and this can be transferred to people. Most of the other parasites seen are not zoonotic – and Sue clarifies it would be seen as an itchy rash.

 

Chapter 3 - Rabbit Ears

 

(18:20) John asks about the problem Molly mentioned earlier about swelling at the ear base and asks if rabbits typically get ear problems. Molly confirms these are regular and in her experience there is less otitis externa (outer ear infection) and more commonly either ear mites (presenting as red, sore, itchy (pruritic) ears) or ear base swellings. Molly talks about the layout of a rabbits ear describing the diverticulum (outpouching of a hollow (or a fluid-filled) structure in the body) and this will often become be filled with either waxy debris or pus, particularly in lop eared rabbits.

 

(19:30) John asks how you would approach this in terms of diagnosing it and whether a vet would approach this the same way as they were a dog or a cat. Molly would mention additional challenges in treating rabbits, the L shaped ear canal makes it harder to see down the ear and check the tympanic membrane (ear drum) – so she would look at cytology (microscopic examination) of any discharge to see if there is any inflammatory response to see what the issue is. John confirms this would be looking at a swab taken from the air and rolled on a slide and stained and view done a microscope, and Molly says yes this will be the same for rabbits.

 

(21:02) John goes on to ask but rabbit pus looks like and Molly says rabbit pus is creamy, yellowy, thick toothpaste like material and the ceruminous (waxy, so more normal) discharge that is not yet dry can look very similar – so all the more reason to check this down the microscope.

 

(22:11) Sue does clarify that the bacteria found in a rabbits ear is different than the bacteria a vet would see down a dog or cats ear and Molly says the culture down a rabbits ear will not match up well with what the ear looks like – so a very dramatic culture could be found in a very normal here, but equally a very abnormal looking ear could present a very normal looking culture. So Molly advises doing cytology in the practice (vets) in order to see if there are inflammatory cells and would advise against jumping towards using steroids or antibiotics in the ear without confirming this.

 

(23:34)  Sue asks what Molly would reach for in cleaning a rabbits ear and molly advises Tris-EDTA products, with something that dissolves the waxy material, so she uses Tris-NAC in practice and also flushes the ear with Hyaluronidase in saline as pus lacks the Myeloperoxidase needed to make it liquid so if you put another enzyme in the ear, and people have tried trypsin historically but she uses Hyaluronidase – this then disperses the pus and removes the pus from the ear.

 

(24:49) Sue asks about chlorhexidine and Molly tends to avoid this as she prefers other products as it can sometimes cause reactions in the ear – Sue likes cleaners with salicylic acid in and low doses of squalene for rabbits ears. Sue asks if molly has used hypochlorous acid in the ear and Molly has not yet tried this (see our previous podcast episode).

 

Chapter 4 - Rabbit pain

 

(26:24) Sue asks about recognising and managing pain and rabbits and Molly says it very difficult to recognise pain in rabbits and this then makes the pain difficult to manage. She discusses the Rabbit Grimace Scale as a method of identifying pain with the help of the owners, as other indicators normally used in pets do not work so well in rabbits. She also uses other indicative pain behaviours such as flinching or belly pressing which can indicate pain and adds these together to give an impression of the pain but there is currently no validated pain score for rabbits. All rabbit vets used meloxicam, but also things like gabapentin and tramadol and even paracetamol.

 

(29:14) John asks how easy is it to medicate rabbits and are there risks which should be considered with how regularly we medicate rabbits. Molly points out the importance of considering the balance of stress and pain management in rabbits, which are a prey species; she points out as a prey species they have a wide range of vision and the medication is going somewhere they feel vulnerable – so training the owners to positively reinforce this with using something the rabbit likes the taste of.

 

(31:37) John asks if Molly would use antibiotics and she confirms there are safe options, but she is cautious of the effect on the population on the flora in the gut, and so actually broad-spectrum antibiotics are generally safer and the gram positive spectrum antibiotics are not so idea. So there are potentiated Sulphonamide as well as a enrofloxacin authorised for rabbits in the UK as well as known to be safe drugs such as doxycycline and azithromycin which have been given long term to rabbits with little or no side effects.

 

(33:04) Sue says farewell to Molly and they clarify the term for rabbits is non traditional companion animals, no longer ‘exotics’.

 

Outro

(34:35) John Sue and Paul wrap up the conversation discussing who their favourite famous rabbits are.