Category: Rabbit

Laser Surgery

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We have been using the carbon dioxide laser at the Long Beach Animal Hospital for over 20 years.  We are one of only a handful of animal hospitals in California that have this capability. It is a highly advanced and technical piece of equipment that we never dreamed about having while we were training to be veterinarians. Its one of the ways we offer state-of-the-art care at Long Beach Animal Hospital.

The laser is a high precision instrument 

It is carefully calibrated for each individual surgery

This video shows how we set up one for a dog neuter, and how the laser checks its circuits and calibrates itself.

You get to wear these cool glasses when the laser is on

Dr.P has taught many surgeons how to use the laser. Here he is teaching one of our externs.

GPig-EyeSx-11

Dr. Ridgeway is using the laser on a guinea pig for eye surgery.  He is using magnifying glasses due to the small size of his patient. Small patients cannot tolerate blood loss, so the laser has been a tremendous tool for surgery in animals that only have a few drops of blood in them to begin with.

Laser-Tortoise

Here he is teaching one of our externs on the use of laser in a tortoise. Veterinary students do not get exposed to the laser routinely while in veterinary school, which is one of the reasons they do an externship at our hospital. Our goal is to impart all of our knowledge to them as they start their careers.

Laser Theory

A carbon dioxide laser emits a high energy beam of infrared (invisible to the human eye) radiation in the form of light waves that has many veterinary applications. If you would like to learn more about the mechanics of lasers in general, including safety procedures, how they work, and why we use the carbon dioxide laser as opposed to other lasers, click here.

Graphic photos on this page.

Advantages

There are several advantages to the COlaser surgery:

  1. Pain Reduction

    Your pet will experience significantly less post operative pain in almost every instance. As a matter of fact, the pain reduction is so great that we perform declaws on cats only with a laser beam. This reduction in pain is a result of the unique characteristics of the laser beam as it cuts nerve endings, preventing the raw ends that are characteristic of scalpel blades.

  2. Swelling Reduction

    Whenever an incision is made in tissue with either a scalpel blade or scissors, inflammation is started in the affected tissue. This inflammation is a result of interaction with the circulatory and lymphatic systems. Because the laser beam effectively cauterizes the lymphatic system, there is much less post operative swelling. This makes your pet much more comfortable while it is convalescing from surgery.

  3. Control of Infection

    The laser beam operates at a temperature of over 200 degrees Fahrenheit. This makes it highly effective at killing bacteria that have the potential to cause an infection. This is particularly important in areas where it is difficult to prevent bacteria from contaminating the surgical site. Examples include abscesses and cat declaws.

  4. Minimal Surgical Bleeding

    When an incision is made with a scalpel blade, small blood vessels are cut in the skin and the layer of tissue just under the skin. These blood vessels can ooze throughout the surgery and even postoperatively. Traditionally they are taken care of by clamping them with hemostats, cauterizing, or holding gauze sponges on them until they stop. All of these procedures take time, which means the surgery takes longer and there is more post operative swelling. The laser beam is a highly effective coagulator of small blood vessels. Less bleeding during surgery means less anesthetic time and faster recovery time.

    Even though lasers are used effectively in many surgical procedures they are not used in every surgery. They are especially useful in oral surgery, neuters, growth removals, and amputations of small extremities. We also use it in small animals, especially birds, because of the laser’s great effectiveness at minimizing bleeding.

    The following sections give specific examples of the use of the carbon dioxide laser in our hospital.

    Neuter

    The laser is particularly advantageous in this surgery. Prior to using the laser we used a scalpel blade to make the scrotal incision and throughout the whole procedure. When using the scalpel like this, the scrotum would swell over several days post operatively as small blood vessels oozed. This was obviously very uncomfortable in such a sensitive area. The laser has eliminated this completely.

    Canine-neuter6

The laser is being use to cut through the outer layer of the testicle, called the tunica vaginalis

Canine-neuter7

The testicle is exposed, along with the epididymis and blood supply. Notice the lack of bleeding.

We neuter a wide variety of animal:

Cats

Rabbits

Dogs

Rats

Bladder Surgery

Bladder stones are not uncommon in animals. The bladder is usually inflamed and highly vascular, causing significant bleeding when we incise the bladder to remove a stone. The laser has revolutionized this surgery. This is a very sensitive internal organ, and anytime we can make an incision in such an organ without any bleeding, the healing period is much faster and less painful.

Surgery-CatLaserBladder

Here is the initial incision in a cat with no bleeding from the bladder

Laser-cystotomystone

This is a dog with the stone being removed from the bladder after the laser incision

Our bladder stone page has much more detail, including a movie of removing bladder stones from a dog. We also have pages that show removal of bladder stones in Iguanas and tortoises (you don’t want to miss this tortoise bladder stone page)!

Feline Mammary Tumor

These tend to be malignant and highly vascular, causing substantial time during surgery controlling bleeding, along with considerable bruising after surgery. The laser has revolutionized this surgery.

In the video note how diseased the subcutaneous tissue looks and the total lack of bleeding in this highly vascular area. Also notice as milk is excreted from the gland as the surgery progresses

Our web site has a detailed page on mammary tumors in animals.

Rat Mammary Tumor

Rats get a mammary tumor under the skin very commonly. The laser is huge when it comes to removing them with minimal bleeding, which is important in a small animal.

Surgery-RatMammary-3

Surgery-RatMammary-4

Click here to see the full surgery

Oral Tumor

A tumor that can be encountered in dogs and cats is called sqamous cell carcinoma. These pictures are of a dog that had one on its left jaw, called the mandible. The only way to completely cure this tumor is to remove the jaw on that side, a surgery called a hemimandibulectomy. In this case the owner decided against it, and will have the growth removed as much as possible with the laser, following up with radiation therapy.

The tumor is identified by the white arrow. It had been removed 1 year earlier, but as expected with this type of tumor, has recurred. This time the surgery will be with the laser for maximum comfort for Jackey.

The post operative appearance immediately after it has been removed by the laser. Minimal bleeding and swelling are apparent.

We were able to suture gum tissue over the defect left by the surgery. It is hard to tell in this picture that any surgery was performed at all.

This tumor is in a Tegu

LaserSurgery-IggieJaw

The arrow points to the tumor

LaserSurgery-IggieJaw-2

No sutures, no bleeding, no pain, and no inflammation

Declaws

This is a request from people that want to keep their cats indoors. Prior to a declaw, we advise keeping the nails trimmed short or the administration of Soft Paws on the nails, along with a scratching post. One of our nurses will gladly give you a demonstration of these options.

We prefer you use other options before thinking about laser declaw, and will show you how to gently trim the nails

If this does not work you need to make an appointment to have your cat examined by one of our doctors and determine if it is a candidate for the surgery. We do not do this surgery routinely.

Prior to the introduction of the carbon dioxide laser all declaws were done with a scalpel blade. It is a very precise surgical procedure that our doctors have performed thousands of times. Unfortunately, the post operative period was painful, the feet were bandaged, and most cats had to stay in the hospital for several days. On older cats this surgery was even harder on the pet.

The advent of declaws with the laser surgery has substantially minimized these drawbacks. There is usually no bleeding during the surgery so a tourniquet is no longer used. Most of them can even go home the day of surgery but we prefer to keep them for observation for 1-2 days. Most cats have so little pain or discomfort they are jumping and running before nature has had time to complete the healing process. Always restrict their activity at home for the first few days to prevent this problem.

This cat’s nails have grown into its pads due to the owner’s inability to care for it properly. This is a painful situation and makes him a candidate for a front declaw.

Feline-NecroticNail

Sometimes the problem is even more severe, and the severely infected toe (on the right) needs amputation. This is where the laser shines.

The following pictures are from an actual declaw that we performed at our hospital.

Surgery-CatLaserDeclaw

The nail is gently pulled forward prior to surgery to open up the area behind the nail where the incision with the laser will be. Bone is not cut during the procedure at any time, only tendons and ligaments are cut.

Surgery-CatLaserDeclaw-4

The laser beam (it is invisible to the naked eye) has started the incision at the top of the toe. It will cut through skin and tendons along with ligaments in between the digits.  The nail, with its attached bone (called phalanx 3), is removed.

The surgery is complete with no bleeding, swelling,  or trauma to any bone. The top arrow in this picture points to the bone at the joint of the 2nd knuckle. The bottom arrow points to the intact pad that has not been touched either. A drop of surgical tissue glue will be put on the pad to cover the end of the bone.

The foot immediately after surgery. There is no need for a bandage.

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Fluid Therapy

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Fluid therapy might just be the most important medical therapy we perform on sick animals. Dehydrated pets feel ill, cannot fight disease, do not eat well, and cannot metabolize drugs efficiently. Dehydration decreases the circulation to two very important organs, the liver and the kidney. These organs are then unable to perform vital functions, some of which include detoxifying drugs and removing waste products.

We give fluids to a wide variety of species in addition to dogs and cats. They can be ill, and need fluids for many different reasons.

This guinea pig being examined by one of our externs has a problem with overgrown teeth and cannot eat well. This has caused him to become dehydrated, and in need of supplemental fluids.

Before coming in for treatment this rabbit was painful from a broken leg and not eating well, so it became dehydrated. Supplemental fluids to correct the dehydration, and a splint to take away the bone pain and allow the healing, were needed to get him back to being a normal bunny again. You can see how we treated his fracture here

Yup, we even give fluids to 120 pythons when they are ill or dehydrated. This is probably not something you want to try at home!

Fun Facts

Before we get started on the specifics, lets go over a little background on fluids.

The body weight of a normal dog or cat is about 60% water, puppies and kittens are up to 80% water. These numbers show the importance of a proper fluid balance for normal physiology, especially in puppies and kittens when these animals become dehydrated.

The fluid in the bodies of normal animals resides in 3 areas:

Inside the cells of an individual organ, called the intracellular space. 65% of the total fluid in the body resides in this intracellular space.

In the bloodstream, called the intravascular space. 25% of the total fluid in the body resides in bloodstream.

In the tissue surround the cells, called the interstitial space. 10% of the total fluid in the body resides in the interstitial space.

When the intravascular fluid is low hypovolemia results. Hypovolemia means the body cannot deliver adequate oxygen to the cells, and a pet can go into shock. If not treated death can ensue. We assess this low oxygen problem with an instrument called a Pulse Oximeter, which measures the oxygen saturation of the hemoglobin molecule in the red blood cells. It should be in the 90 percent range.

This pot-bellied pig, with a 92 % oxygen saturation, and a heart rate of 82 beats per minute, is normal

Pets with hypovolemia are very ill and can exhibit some of the follow symptoms:

Elevated heart rate, called tachycardia.

Slow heart rate, called bradycardia. This occurs when your pet is in the act of dying.

Weak peripheral pulses. We detect this on an exam by palpating the femoral pulses while simultaneously listening to the heart.

Prolonged capillary refill time (CRT). For a normal animal this should be under 2 seconds.

This is how we check the CRT. This pet is under anesthesia, a time when we carefully monitor this parameter

Cold extremities

Low blood pressure (hypotension).

Hypothermia (low body temperature)

When the interstitial fluid is low dehydration results. This is not usually life threatening until the dehydration progresses to around 10%, which now causes hypovolemia. Dehydration is detected during an exam when any of the following occurs:

Tacky or dry mucous membranes (the gums)

Skin tenting

Sunken eyes

Elevated BUN or Creatinine on a blood panel

Elevated hematocrit and total protein

blood sample will also give clues to dehydration, especially the total protein level and the hematocrit.

This is the hematocrit test, checking the percentage of red blood cells in the serum, giving us information on the state of your pet’s hydration

After the hematocrit is measured we break the tube in the middle and place the serum on an instrument called a refractometer to check the protein level. In conjunction with the history, exam findings, and hematocrit level, the protein level helps us determine the degree of dehydration.

Hypovolemia and dehydration can occur independently. A dehydrated patient might not be hypovolemic, and a hypovolemic patient might not be dehydrated.

Our doctors decide on how much fluid to give your ill pet based on the following:

The normal (called maintenance) amount of fluid your pet needs every 24 hours to maintain normal physiology (called homeostasis).

For a dog this is 60 ml for each kg of body weight. For a 20 pound dog this is 545 ml (1/2 of a liter, or 30 ounces) per 24 hours.

For a cat this is 45 ml for each kg of body weight. For a 10 pound cat this is 204 ml (0.2 liters or 7 ounces) per 24 hours.

The degree of dehydration of your pet

A 20 pound pet that is 7% dehydrated needs 600ml to correct this dehydration. This is more than pet owners realize, and why proper fluid therapy is so important when we hospitalize your pet.

Ongoing fluid losses like vomiting or diarrhea. As pet that has been burned has tremendous fluid losses due to seepage of serum at the burned skin area. This ongoing loss is subjective, but it needs to be added to the calculation above if your pet continues to have these fluid losses.

Symptoms of Dehydration

Signs of dehydration include lethargy, anorexia (poor appetite), sunken eyes, sticky gums, constipation, and a general feeling of malaise. It is diagnosed based on a history of anorexia, vomiting, diarrhea, or extra fluid loss, in combination with a physical exam and diagnostic tests. During an exam a dehydrated pet will shows signs of dehydration when the problem is greater than 5 %. The page talks about the two primary methods used to give fluids to pets. The first is intravenous, and is performed only by us in the hospital. This is not a treatment method you will do at home.

Types of Fluids

The type of fluids we will be describing are called crystalloids. This are the kinds most people are used to, and are usually lactated ringers solution (LRS) or sodium chloride (NaCL), and variations thereof that we might use in specific situations.

These are some of the ingredients in LRS

Another type of fluid is called a colloid (hetastarch or hydroxyethyl starch). Colloids are used only in specific situations, which are not common. For the remainder of this page we will be referring to crystalloids.

Intravenous (IV) Fluids

I.V. (intravenous) catheters are used extensively in pets that are sick or those pets that are about to be anesthetized. These catheters allow us to administer medication directly into the venous system for rapid distribution to the whole body. Medication given this way acts faster and is more controllable, a significant advantage for an ill pet or in an emergency. IV administration of fluids is critical in pets that are hypovolemic.

Intravenous fluids are important during surgery. We monitor this closely in many ways, especially with the blood pressure.

If your pet is ill and staying in the hospital, or about to undergo anesthesia for any reason, an I.V. catheter to allow fluid administration is one of the most important therapies we can institute, and can literally be life saving.

This dog getting his teeth cleaned was put on IV fluids before the procedure to stabilize the kidneys for the anesthesia. The fluids are continued for the duration of the procedure, and will be administered until this pet is fully awake and its owner is picking it up.  

The placement of the catheter requires technical skill and knowledge, particularly in small or dehydrated pets (the veins in these pets are small and damage easily). Improper placement of the catheter can literally cause more harm than good. Our nurses excel at placing I.V. catheters in all species.

Because the catheter is introduced directly into the venous system, it must be placed in an aseptic (sterile) manner. The hair over the vein is shaved, and special tape is placed over the catheter. 

Comfort is also important when placing the catheter due to the small nature of some of our patients, and the duration the catheter must stay in the vein. This tape and catheter is constantly monitored by our staff for comfort and sterility. After 3-5 days we usually replace the catheter in order to minimize the chance of the catheter causing an infection. 

I.V. catheters are usually placed in one of three veins:

Cephalic Vein-This is by far the most common vein to use. It runs along the top of the foreleg of dogs and cats. The illustration below shows the placement of this catheter in a large dog.

Jugular vein-This vein is in the neck. A catheter placed in this vein allows longer term use and the ability to give larger volumes of medication with different viscosity’s.

Saphenous-This vein is on one of the back legs. It is mostly used when the cephalic vein is unusable, but can be used at any time.

Various other veins are sometimes used, by they are reserved for some of the more unusual species of animals we deal with. In some of these pets like birds, that have minuscule seized veins, we cannot give the necessary emergency fluids intravenously. In these cases we use what is called an intraosseous catheter. This catheter goes directly into the bone marrow, and allows us to give the necessary fluids to a small creature rapidly and effectively. In birds it is put in what is called the tibia tarsal (tiboitarsus) bone. This is equivalent to our tibia or shinbone. It is put in at the knee joint.

This radiograph shows the placement of an intraosseous catheter. It is going down the shaft of the tibiotarsal bone in this bird that came in collapsed and in shock. The bird responded and recovered completely after we administered fluids through this catheter. 

Your pet’s catheter will stay in for the duration of its hospitalization or procedure, and will not be removed until you return to pick up your pet. Your pet may go home with a small piece of tape and cotton where the catheter was. It can be removed several hours later after you return home.

We use many different types of fluids, the most common one being Lactated Ringer’s Solution. The amount of fluids given are calculated and  monitored carefully.  We use a special fluid pump that gives a consistent amount of a period of time.

Each patient receiving fluids has a custom fluid chart outside its cage for close and constant monitoring of the fluids. Our doctors make adjustments in the type and amount of fluids as diagnostic tests like blood panels, and your pet’s response to treatment, are analyzed. 

Subcutaneous (SQ) Fluids

The second method used to administer fluids is subcutaneously (under the skin) between the shoulder blades. The administered fluid slowly absorbs over several hours. In this hospital and on an out-patient basis, this method is used for pets that are not seriously ill, but just need some additional fluids to maintain hydration, fight a fever, or stimulate the appetite.

If your pet needs to be on SQ fluids on a long term basis due to a chronic disease, think of it as bonding time and make it a positive experience

This section on SQ fluids contains  detailed step-by-step descriptions on how to give fluids at home on an ill pet, an older pet, or a pet with kidney disease. When you first read it you might think there is no way I can do all of that. Once you observe us do it in front of you, and then do it yourself, you will realize it is not anywhere is difficult as you think when you read about it the first time.

This video is how we give sq fluids at our hospital. Notice how calm this dog is.

SQ fluids are of special benefit for pets that need long term fluid administration at home, usually older (geriatric) cats or those with kidney disease. This is the animal version of dialysis in people, and it works extremely well. These fluids at home are highly beneficial, and have had cats with chronic kidney disease do well for years with this treatment at home.

If your doctor feels your pet needs SQ fluids at home you will be taught how to administer them by our nursing staff. At first it might seem an impossible notion to give your pet fluids at home. Not only is there the psychological fear of using a needle, or worry about hurting your pet, there is also a worry that your pet will not stay cooperative long enough for the few minutes it takes to give the fluids.

Rest assured that you will not be forced into giving these fluids if you feel uncomfortable, although we have yet to encounter a client that was not able to perform this procedure at home. This is because we have extensive experience in this area, and we teach you at your own individual pace. Only when you feel you are ready will you proceed on your own.

You will be given as many personal demonstrations as necessary, and can return to the hospital at any time for further demonstrations or to make sure you are performing the procedure properly. You are welcome to bring your pet in at any time for assistance in giving the fluids, so do not feel you are on your own. If you are out of town, your house sitter can bring your pet in for these fluids. We consider you part of our nursing team and are willing to give any assistance needed. Before you are given a live demonstration the following basics will help prepare you.

The scariest part of the whole procedure for most people is the actual insertion of the needle into the skin so that the fluids flow under the skin (SQ). You will watch us do this as many times as you need to overcome any fear you might have. When you realize it is not all that difficult by watching us do it, we will hold your hands when it is your turn if needed.

Practicing by inserting a needle into an orange or similar fruit can be helpful. Different sized needles, ranging from 22 gauge to 18 gauge, are used to give SQ fluids. During the demonstration we will show you which one works best for your pet.

The 18 gauge needle, at the top, has the largest diameter. Fluids flow fast through this needle, taking less time to give them. If this size needle is uncomfortable for your pet, we will try the 20 gauge next because it is smaller, although the fluids will flow more slowly. On small pets we might even use the 22 gauge needle. 

During this demonstration you will be told exactly how much fluids to give. For most cats with chronic kidney disease, this is 100ml once or twice daily. The fluid bag has 1000ml (1 liter), so for the average cat you will be able to give these fluids for ten days. This might vary depending on many factors, and your doctor will determine the amount and frequency. Do not change this unless instructed to.

Keep children and other pets away if they are disruptive during the process of giving the SQ fluids at home. Have all of your equipment readily available, usually on the same table as your pet. Depending on the size of your pet, the table should be around waist to chest high. It is helpful to set up one area of your house to give the fluids. Hang the fluid bottle in this room for easy access. It should be at least a few feet above the table for optimum flow. You will be shown how to set this up by one of our staff.

Store the fluid bag at room temperature and cover the bag so no light hits it. We sometimes add medications like vitamins and electrolytes to the bag, and light can affect them.

When you purchase a fluid bag from us it needs to be set up with the IV line. We will show you how to do this in person. You only need to set it up when you purchase a new bag. After that, you give the fluids with a new needle each time, keeping the IV set attached, until the bag is empty.

Never use the needles more than once since they are sterile and very sharp when first opened. Repeated use could cause an infection in your pet, and makes the needles dull, causing discomfort on administration. Needles are inexpensive, so don’t take the chance by re-using them.

When you purchase the bag it comes wrapped in a plastic wrapping. Remove the wrapping at home when you are ready to set it up to give fluids to your pet. After you remove the outer wrapping lay the bag on your table or hang it from a coat hanger. 

Open the sterile IV set and lay it on the table


These are the components of the IV set

The large white end with clear receptacle goes into the fluid bag once the white cap is removed. The clear container above will be filled part way with fluid once attached. 

 At the opposite end of the IV line is a small blue cap. You remove this blue cap when you attach a needle, which you will learn about later. 

The large blue plastic piece in the center allows you to turn the flow on and off, and also adjusts the rate of flow. Make sure the white wheel is in the off position like this when first setting it up. 


Remove the white plug from the bottom of the bag. The cap is in solidly, so you will need to pull hard to remove it.

 You can do this while the bag is hanging, or while it is laying on the table. Discard the white cap, it will not be used again. 

Remove the white cover from the IV set receptacle. It is sterile, so do not touch it to anything at this point. 

Hold the hanging bag steady, or lay it flat while doing this, so you can put it straight in without touching anything else. 

Insert it all of the way into the fluid bag 

Hang the bag, then squeeze the receptacle until the fluid fills half of the receptacle

It should look like this when you are done

Lay the needle next to the end of the IV set that has the blue cap

Remove the clear plastic at the base of the needle by twisting it either direction. The open base of this needle is sterile, so do not touch it to anything until you insert it into the IV line. 

Remove the blue cover at the end of the IV set. Turn the fluids on and let a few seconds of fluids flow through the IV line to remove the air. Let these few drops flow into a small bowel or on to a towel. Do not touch the end of this line to anything. 

A few air bubbles left inside the IV line will not cause any problems 

Insert the needle straight into the opening. Hold you left hand still as you twist clockwise with your right hand to lock it tight

Hang the IV set over the fluid bag. You are now set to give the fluids. 

Every pet reacts differently to the actual giving of the fluids, and they feed off of your emotions, so cool and calm usually works best. If either one of your gets worked up, stop and try again later.

Make sure the location to give the fluids is subdued and calm, with no excessive lighting or noise to alarm your pet. Take your time by bringing your pet to the table and interacting with it by petting it and holding it. You can even feed it while giving the fluids. A towel for restraint, or another person holding the head, might even be appropriate.

Hold your pet to the side, make a small tent of the skin between the shoulder blades, remove the cap over the needle, and rapidly insert the needle between the shoulder blades in one motion.

Insert it all of the way in until the hub touches the skin. Turn on the fluids completely on by moving the white wheel all the way to the top, and give the prescribed amount of fluids. For most pets, this takes only a few minutes of your time daily, a few minutes of your time that will be highly advantageous to your pet. 

When you are finished giving the fluids remove the needle from your pet and cap it. Remove the used needle and place a new sterile needle at the end of the IV set, and hang the IV set over the bag as before. You are now ready to give the fluids again the next time one of our doctors prescribes.

Finally, pat yourself on the back for a job well done, have a seat, and breathe deeply (or get a stiff drink if needed to calm your shaking hands).

Place all used needles in a safe place with no access to children or pets. A sharps container to hold these needles is the best place to put them until disposal. Dispose them according to the guidelines in your community. Here are some local disposal centers for needles. If you are not near one of these areas call us at 562-434-9966 for other locations:

EDCO Recycling and Transfer Center

2755 California Ave.

Signal Hill, CA 90755

562-597-0608

L.A. County Sheriff- Lakewood Station

5130 N. Clarke Ave.

Lakewood, CA 90712

Huntington Beach Collection Center

17121 Nichols Lane

Huntington Beach, CA 92647

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Front Leg fracture

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This bunny was presented to us unable to use his left front leg. After an exam by one of our doctors it was determined that the leg might be broken.  A radiograph revealed the extent of the injury.

Our friend is nice and cozy just before his radiograph

You can see his fracture/dislocation near the L marker 

A special lightweight but strong plastic splint with foam padding is custom sized for his leg


Several layers of cotton padding are used to hold the leg stable yet keep him comfortable 

It looks heavy but it is actually light. This much cotton is needed to stabilize the fracture.

Once the final cotton wrap is applied and checked for comfort an outside wrap is applied to keep the cotton in place and also keep it clean

Looks like we ran out of “bunny” wrap and had to use “rooster” wrap for the outside bandage

Our friend is good to go and feeling much less pain now that the fracture has been stabilized and the leg is comfortably in the splint

This bunny will need up to 2 months of healing for the fracture to heal. It needs to rest during that time and use the leg sparingly so the fracture can heal. The splint lets him walk on it comfortably, which is an important part of the healing process. Without using the leg slightly the bone has less of a tendency to heal due to the effectiveness of the splint. If this does not heal surgery might be needed. We will keep you posted.

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Urinary Stones and Sludge (hypercalciuria)

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Rabbits make wonderful pets, that need special attention from everyone in your family regarding their health 

Rabbits are prone to problems of the urinary tract.  These problems range from irritating sludge in the bladder, to kidney problems,  to the formation of a bladder stone that needs surgical removal. Sludge is urine thickened by calcium salts to the point of being chalky and thick in consistency, sometimes as thick as toothpaste. This causes problems in the urinary bladder usually, although it can occur in the kidneys or ureters. There are many factors why a rabbit might get this problem, so it is important to address all of them.

Rabbits need routine exams to ensure their health

Graphic photos on this page

Underlying Problem

As opposed to most other animals, rabbits absorb almost all the calcium in their food into their bloodstream. This causes a higher than normal blood calcium level relative to other animals. If an individual rabbit is not efficient at utilizing and eliminating any excess calcium through the urinary tract, a sludge or bladder stone problem might present itself.  Some of the factors we know about that might predispose a rabbit to a urinary problem with calcium include:

Genetics- Some rabbits are not as efficient at eliminating any excess calcium

Rabbits that are not good drinkers

Obesity

Sedentary lifestyle- rabbits that stay in a cage all day

A diet with excess calcium

Soiled litter pan area in a fastidious rabbit

Diseases elsewhere in the body can have an effect on a rabbit’s normal physiology, disrupting it to the point that they can stop eating and get dehydrated, leading to decreased kidney function and sludge or stones in the urinary bladder. You can learn more about them in our Rabbit Diseases section. The more common ones are:

GI Stasis

The dark round area in the center is a greatly distended stomach due to GI stasis

E. Cuniculi

The severe head tilt in this rabbit could be a sign of Encephalitozoon Cuniculi

Teeth Conditions

The point on this molar tooth could cause an inability to eat well over a period of time

Pasteurella

This conjunctivitis could be an indication of Pasteurella

Reproductive Disease

This is the radiograph of a rabbit with a uterus that is greatly distended. That large whitish area in the center of this abdomen is the uterus.

This is that fluid filled and greatly enlarged uterus during the surgery to remove this uterus

This male rabbit has a very large tumor in its left testicle. The surgeon is pointing to a normal sized testicle on the other side. The cancer was removed in a neuter surgery.

Urine that contains excess calcium will have the consistency of sludge. This irritates the bladder and urethra, causing significant inflammation and pain. If the problem persists long enough, a bladder stone (urolithiasis) might form.

In order to make a diagnosis of the problem in rabbits, we follow the tenets of the Diagnostic Process. This is a methodical and detailed way to approach diseases that ensures an accurate diagnosis. It includes:

Signalment- age, breed, and gender of an animal

History- what an owner has noticed at home about a pet’s specific behavior

Physical Exam- the findings from an exam by one of our veterinarians

Diagnostic Tests- What tests are used to make a diagnosis

Response to treatment- if the diagnosis is correct the pet should get better

Signalment

Urinary problems in rabbits can occur in all breeds of any age or gender. Young or old, large or small, male or female, it doesn’t matter.

History

Symptoms are variable, depending on the duration and degree of the problem, along with the individual rabbit’s tolerance for pain and discomfort. Some of the symptoms to watch for include the following:

Lethargy

Poor appetite

Diminished droppings

Urinating more than usual (pollakiuria)

Straining to urinate (stranguria)

Unable to urinate

Blood in urine

Chalky deposits on the fur in the perineal area

Moist or damp rear quarters from urine dribbling

Licking at rear quarters

Rubbing rear quarters

Skin rash in inside of rear legs or perineal area

Grinding teeth (a sign of pain)

Odor to urine

These are also the symptoms of other diseases in rabbits, so at the first sign of any of these problem you should bring your rabbit in for an exam with one of our veterinarians.

Physical Exam

Any sick rabbit gets a thorough physical exam by one of our veterinarians. It starts with body weight and temperature, and progresses to checking your rabbit from nose to tail for any physical abnormalities. Typical findings might include:

Low body temperature (hypothermia)

Underweight (low body condition score)

High heart rate (tachycardia)

Dehydration

Irritation to the perineal area

Neurologic deficits

Painful abdomen upon palpation

Small kidneys upon abdominal palpation

Distended bladder upon abdominal palpation

Bladder stone palpable upon abdominal palpation

Excess amounts of chalky or bloody urine when the bladder is expressed

Diagnostic Tests

Over the decades our body of knowledge regarding normal and abnormal values in diagnostic tests of rabbits has increased to the point that they are crucial for a proper diagnosis.

Blood panel

This test should be performed on all sick rabbits irregardless of the symptoms. It should also be performed yearly as part of the Wellness Exam on rabbits. These animals age rapidly, and oftentimes hide their symptoms, so it is important to have baseline normals on an individual rabbit, and to catch problems before they become entrenched and untreatable.

The blood panel in rabbits checks for a wide array of problems. It starts with a check of the red blood cells for anemia or infection. There are tests of the kidneys and liver, important organs to assess when we suspect a urinary or kidney problem in rabbits. We also check the electrolytes, and especially the calcium level.

This rabbit has blood abnormalities that can happen with a sludge problem, and also many other problems

Urinalysis

This will check for white blood cells, red blood cells, and crystals in the urine. We also assess the specific gravity and the protein and glucose levels, in addition to looking for signs of bacterial infection.

Urine Culture and Sensitivity

If we suspect a urinary tract infection (cystitis) we will take a sterile sample of urine directly from the bladder and attempt to grow out any pathogenic bacteria. If they do group out, we will check many different antibiotics to find out what antibiotic that particular bacteria is sensitive to and will kill it. This report takes 2-3 days.

This pet has a Staph. infection, that is sensitive to several different antiboitics

Radiography (X-rays)

It is important to radiograph any sick rabbit. There are a multitude of problems that can occur on the inside that are not apparent externally during our physical exam.

This is what a radiograph of a rabbit looks like. The important abdominal structures are labeled:

K- kidney

B- urinary bladder

Cecum- our appendix

Did you notice the spinal fracture? Without this radiograph, we would not have known this.

This rabbit is laying on its back for a radiograph. The arrow points to the left kidney because this rabbit has significant sludge in its bladder, and we wanted to assess the kidneys. Do you notice anything else?

The two lower arrows point to the different appearance of the wings of the ileum of the pelvis, which could indicate bone cancer. We would never had known this if we had not taken a radiograph. 

The sludge that occurs in the bladder, and the stones that also might occur, have a large amount of calcium carbonate in them. This means that they are radiopaque, and show up vividly on an abdominal radiograph.

The small whitish area in the center of this radiograph is some sludge in the urinary bladder of this rabbit. This small amount is of no significance in a rabbit with no symptoms of disease.

This rabbit has more sludge in its urinary bladder. This amount may or may not be of significance, depending on how this rabbit is doing, other diagnostic tests, and follow up radiographs.

S- stomach

K- kidneys

This rabbit is not eating well, is lethargic, and has an odor to its urine with urine scalding on the perineum. It needs to be treated for sludge in its bladder. Can you identify other organs besides the sludge in the urinary bladder? The radiograph below labels the organs. 

H- heart

L-liver

S-stomach

The cecum and sludge are obvious. In the radiograph above, did you notice the calcifications in the kidneys, circled in red?

Same rabbit as above, this time laying on its back. The large amount of sludge in the urinary bladder is even more apparent in this view.

You can see the calcification of the kidneys in this view also

This is what a distended bladder looks like at necropsy

In addition to sludge, rabbits with urinary problems can get bladder stones. Other names for bladder stones are urolithiasis and cystic calculi. These stones also occur in dogs and cats. They are handled differently in the rabbit though.

Click here to see how we take care of bladder stones in dogs and cats.

Click here to learn more about how we do surgery at the Long Beach Animal Hospital in a wide variety of animals.

These are bladder stones in the urinary bladder

Bladder stones in rabbits are removed surgically. We take special precautions in all rabbits when anesthetizing them. Our Anesthesia page has more details on anesthesia.

We have a team of people present when we anesthetize a rabbit

They are closely monitored while under anesthesia 

We approach rabbit surgery like any other surgery using aseptic surgical techniques.

Everyone in the surgical suite practices aseptic surgical techniques

We use the laser to make an incision into the bladder and remove the stone. Note the lack of bleeding on this highly vascular urinary bladder when using the laser. 

After any anesthetic procedure we closely monitor our patients until full recovery

Ultrasound

This is a precise and highly accurate way to assess the kidneys and urinary bladder, and it complements radiography. We also check the other organs in the abdomen carefully with ultrasound.

This is an ultrasound of the urinary bladder with a bladder stone

In this ultrasound the kidney it is being measured

Treatment

In the acute phase sludge is removed with gentle manual expression. If your pet has a chronic problem with sludge in the bladder we can teach you how to do this at home. Flushing the bladder, after manually expressing most of the sludge, helps complete the process. We might sedate your rabbit if we need to pass a urinary catheter to flush out of the sludge.

We might need to hospitalize to provide intravenous (IV) fluids in a dehydrated rabbit and to help support the internal organs like the kidneys. Pain medication is commonly used, along with assist feeding for those rabbits not eating.

If a bladder stone is present we will remove it surgically.

Once your rabbit is stabilized our goal is to help prevent recurrence of  the stone. This is done by you at home in many ways:

Adding water to the food if your rabbit is not a good drinker

Giving supplemental (SQ) fluids under the scruff of the skin to increase urine output

Showing you how to express the bladder

Show you how to assist feed

Keeping the litter box clean

Decrease the weight if obese by feeding less, and increase activity

Using medications as prescribed by us if one of our doctors think it is indicated. This could include:

Pain medication

Antibiotics

Cranberry juice

Vitamin C (ascorbic acid)

Using food that does not have an excess of calcium might be helpful. This means no pellets or alfalfa hay.

Feed only Timothy, Oat, or Orchard Grass hay. A small amount of fruits, and grass hay based pellets can be fed

Also feed fresh leafy green vegetables like kale, mustard greens, dandelion parsley, broccoli leaves and romaine lettuce.

If your water is hard (lots of minerals in it like calcium) you might want to get a water softener.

Follow Up

Any rabbit that has a sludge or bladder stone problem is susceptible to recurrence. Routine monitoring by physical exam, blood panels, and radiographs every 3-6 months is needed to catch the problem early.

Our Rabbit Diseases section has  more information on rabbits, including how we surgically repaired the fractured femur in the radiograph below. This is put here as a reminder that rabbits have powerful back legs in relation to their spine and long bones. If not restrained or held properly they can easily fracture these bones. A femur can be repaired, a fractured spine cannot.

This is called a mid shaft transverse fracture of the femur

Don’t forget to give your bunny lots of TLC, like Dr. Kennedy is doing here on one of her patients

 









 

 

 

 

 

 

 

 

 

 

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Symptoms of Diseases

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It is sometimes difficult to determine if your pet is ill, especially since many pets have subtle signs of illness that they easily hide from owners. Here are 7 basic areas you should observe on a daily basis to help determine if your pet needs an exam by one of our doctors.

Eating

Watch your pets daily eating habits for :

  • difficulty chewing
  • odor
  • swelling
  • pawing at its muzzle

Since dental disease is so prevalent please follow the link to learn how this can affect your pet’s eating.

Breathing

When your pet is at rest count the number of times it breathes per minute (watch it for 15 seconds and multiply that number by 4). A typical dog or cat breathes 30-40 times per minute, although this can be variable based on breed and external temperature. The important thing to watch for is an increase in its respiratory rate over a period of time. Trend this on a piece of paper weekly so you can see this trend as it gets going. This can be a subtle but very important parameter to measure since an increase here can be for many serious reasons.

Urination

Look for any changes in the following:

  • Urinating more often or in greater amounts than normal
  • Urinating small amounts frequently
  • Straining to urinate
  • Inability to urinate
  • Licking at genitals

In female dogs it can be difficult to assess some of these parameters, so try to pay close attention when she squats to urinate.

Defecation

Any significant change here is important:

  • Continual diarrhea of any type
  • Straining to defecate
  • Licking at anus
  • Scooting
  • Any blood on feces

Walking

Obvious lameness is readily noticed. Also look for a pet that is leaning more towards one leg or the other, tires easily after walking or playing, is slow at getting up after resting, or is reluctant to go up or down any type of elevation like stairs or jumping into a vehicle.

Mental Status

  • Lethargic for more than a few hours
  • Depressed
  • Aggression
  • Crying, moaning, or vocalizing
  • Disorientation (ataxia)
  • Walking in circles
  • Pressing head against the wall
  • Gazing up at the sky
  • Tremors
  • Seizures
  • Coma
  • XS salivation

Miscellaneous

  • Sore skin
  • Bleeding from an unknown source
  • Bleeding from the nose, mouth, ears, penis, vagina, or anus
  • Vomiting
  • Distended abdomen
  • Swelling anywhere
  • Redness patch on skin that comes and goes

Now that you have observed your pets daily habits lets look at how you can perform a basic exam at home by going to our In Home Exam page.

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