Vaccination of rabbits without clinical exam

Re: Vaccination of rabbits without clinical exam

Mark Rowland — Sat, 01 Jun 2013 16:36:22 GMT

Fine. ave atque vale

Re: Vaccination of rabbits without clinical exam

Evelyn Barbour-Hill — Sat, 01 Jun 2013 16:25:15 GMT

[quote user="Mark Rowland"]Have this free of charge from a couple of years ago. Back to Rabbits Clinical Examination of the Rabbit [/quote]

Apart from taking the temperature, he did all that

Re: Vaccination of rabbits without clinical exam

Stephen Courtney — Sat, 01 Jun 2013 16:13:30 GMT

thanks Mark - I do take your point. Would still think that 'normal' is a lot quicker to appreciate than abnormal - therefore it is quicker to decide there is no problem that than to decide what a problem is. Your list shows a lot of problems one might find - I would argue many of these are not subtle, but i think i need to pay more attention to auscultation and palpation based on this information.

i like your comments about pre- exam observation - not really possible on a clinic vaccination visit - but i will work it into the shelter visits. Normally the bunnies are brought to me at a central exam table.

I also appreciate that if you don't know about something you will never diagnose it - if your only tool is a hammer, every problem looks like a nail etc - and i'm always happy to learn more. I actually feel my bunny medicine is reasonably up to date and i work with people who would be quick to pull me up if I was being careless. but equally thanks for this and I will look out for your next CPD day.

Re: Vaccination of rabbits without clinical exam

Mark Rowland — Sat, 01 Jun 2013 16:01:18 GMT

Have this free of charge from a couple of years ago. Back to Rabbits Clinical Examination of the Rabbit British Small Animal Veterinary Congress 2006 M.L. Ward, BSc, BVSc(Hons), CertZooMed, MRCVS Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, Easter Bush Veterinary Centre, University of Edinburgh Roslin, Midlothian 18283602 Introduction The clinical examination is the single most important diagnostic tool available to the veterinary surgeon. Given that rabbits tend to mask signs of pain and disease, the relevance of the examination in this species is often overlooked. A wealth of invaluable information can be ascertained from a thorough, methodical approach and an understanding of normal lapine anatomy, physiology and behaviour. Rabbits and Stress Rabbits are prey animals, so their innate response to handling and examination is often one of fear. This must be a primary consideration in the consultation room and efforts made to minimise stress. Loud noises should be avoided and the smell of predators eliminated. The veterinary surgeon's approach must be calm and quiet yet confident. The behavioural and physiological effects of stress must be taken into account when interpreting the clinical examination findings. When to Perform an Examination Rabbits should be thoroughly examined not only at times of injury and illness, but also when presented for routine vaccination or elective surgery. A familiarity with the normal rabbit is essential to interpret abnormal clinical findings. Of equal importance, many subclinical diseases (e.g., early dental disease, cardiac disease) may be detected during routine checks and measures taken or advice given to minimise their impact on the rabbit's long-term health. Examination from a Distance Rabbits should always be assessed from a distance prior to handling. General demeanour, mentation and posture should be noted, as well as resting respiratory rate and rhythm. These may all alter once the rabbit is restrained. If a group of rabbits (e.g., a litter of juveniles) is to be examined, their behaviour as a group should also be noted. Healthy rabbits tend to huddle close to one another. Vital Parameters Respiratory rate, heart rate and rectal temperature should be determined early in the examination process. Normal values are as follows: Respiratory rate: 30-60 breaths per minute Heart rate: 180-300 beats per minute Rectal temperature: 38.5-40°C All will tend to rise with the stress of handling. A depressed body temperature is a more common finding in ill pet rabbits than pyrexia. Condition and Hydration Status The patient's body condition score (1-5) should be determined by both visual assessment and palpation of the soft tissues overlying the ribs, the dorsal spinous processes and the limb musculature. Obesity is an increasingly common and clinically important finding in pet rabbits. It may alert the clinician to consider husbandry issues (diet, enclosure design, ability to exercise freely) or medical/ behavioural problems that may be limiting the rabbit's activity levels (e.g., chronic stress, musculoskeletal pain). Similarly, low body condition scores may be associated with malnutrition or chronic disease. Hydration status can be estimated by evaluating skin elasticity in the inguinal/scrotal region and on the inside of the pinnae. Examination of Body Systems Following initial assessment, a standardised examination should be undertaken, evaluating each of the major body systems. The lecture will illustrate one approach which aims to minimise stress for the rabbit, maximise the clinical data acquired and yet is practical given the time constraints faced by most practitioners. Assessment is undertaken from nose to tail along the dorsum, then nose to tail along the ventrum, followed by a precursory examination of the oral cavity. The order of the examination is not fixed and practitioners are encouraged to develop a technique that suits them. Figure 1 highlights some of the most common abnormalities to note when performing a clinical examination of a pet rabbit. More detailed examination of certain body systems may be indicated depending on the initial findings (e.g., a neurological examination or measurement of intraocular pressure). Figure 1. Abnormalities of importance that may be detected during routine clinical examination of pet rabbits. Body system Feature of the examination Abnormalities Integument Fur (note breed differences) Matting, wetness, alopecia, discoloration, adherent faecal material, presence of ectoparasites Skin Wounds, erythema, bruising, ulceration, crusting, scaling, wetness, malodour, discoloration, urine scalding, myiasis, presence of macules/papules/comedones/pustules, cutaneous masses, subcutaneous masses, heat/swelling/discharge associated with the mammary glands Respiratory system Respiratory rate and rhythm Dypsnoea, tachypnoea, sneezing Nares Unilateral or bilateral discharge, stenosis Palpation of larynx/ trachea Swelling, pain Thoracic cavity auscultation Wheezes, crackles, absence of normal sounds Cardiovascular system Mucous membrane colour Pallor, cyanosis (Note: rabbit mucous membrane colour is normally light pink, paler than that observed in healthy dogs and cats) Auscultation of heart Tachycardia, bradycardia, cardiac murmur, arrhythmia Pulse rate and quality Pulse deficit, weak/thready pulses, arrhythmia Urogenital system Abdominal palpation Kidneys: renomegaly, asymmetry, pain, reduced size (Note: rabbit kidneys are normally very mobile and located in a more cranial position than in dogs and cats) Bladder: distension, pain, uroliths (take care as is very thin-walled) External genitalia Male: firm, swollen or painful testes (note: open inguinal canal so testes not always immediately evident in normal bucks), ulcerated/ inflamed prepuce, trauma to penis Female: vulval discharge, inflammation Alimentary tract Incisor teeth Discoloration, tooth fracture, abnormal wear, loose teeth, infection, malocclusion +/-associated soft tissue trauma Cheek teeth (via otoscope) Crown elongation, malocclusion, spike formation, tooth loss, infection, discoloration Oral cavity (via otoscope) Soft tissue trauma (often associated with dental disease), haemorrhage, presence of purulent material Facial palpation Asymmetry, swelling, painful foci, masses Abdominal palpation Generalised abdominal distension, tympanic/distended stomach, firm impacted accumulations of ingesta within the large intestine, lack of palpable faecal pellets in caudal abdomen, painful foci, masses, presence of a 'fluid wave' Abdominal auscultation Increased or decreased gut sounds, 'tinkling' Abdominal percussion Detection of large accumulations of gas Anus Evidence of diarrhoea, bleeding, presence of rectoanal papilloma Musculoskeletal system Observing ambulation Lameness, abnormal limb position, ataxia Palpation/manipulation of muscles and joints Pain, swelling, asymmetry, restricted range of motion, muscle atrophy Ears Pinnae As for skin (see above) Otoscopic examination Inflammation, abnormal exudates, ectoparasites, presence of a mass or foreign body, ruptured/thickened tympanic membrane (note: a small amount of wax is a normal finding) Eyes Periocular skin Wetness, alopecia, crusting, presence of ocular discharge Eye position Nystagmus, exophthalmos, sunken position Lacrimal punctum Discharge Eyelids Blepharospasm, asymmetry, oedema, irregularities, swellings along margins, aberrant eyelashes, entropion, ectropion Cornea Neovascularisation, oedema, ulceration Conjunctiva, sclera and nictitating membrane Inflammation, haemorrhage, presence of foreign body Anterior chamber, iris, lens, posterior chamber Inflammation, haemorrhage, presence of purulent material, opacity Peripheral lymph nodes Palpation of superficial lymph nodes Localised or generalised lymphadenomegaly (Note: other than popliteal lymph nodes, superficial lymph nodes are rarely palpable in the healthy rabbit) Improving Standards In the last decade or so, as the popularity of the pet rabbit has soared, public education has resulted in rabbit owners seeking advice from veterinary surgeons on a more regular basis and at earlier stages of disease. Clients are expecting higher standards of care and so the exciting, expanding field of rabbit medicine must become more sophisticated. The starting point for such an improvement in standards is to perform clinical examinations at a more advanced level. The potential benefits include an increase in our understanding of the rabbit in health and disease and more rapid and accurate diagnoses. Both of these factors directly impact positively on patient welfare, professional development and client satisfaction. References 1. Antinoff, N. Physical examination and preventive care of rabbits. Veterinary Clinics of North America--Exotic Animal Practice 1999; 2(2): 405-427. 2. Harcourt-Brown, F. Textbook of Rabbit Medicine. Edinburgh: Butterworth Heinemann, 2002. 3. Mader, DR. Rabbits: basic approach to veterinary care. In: Quesenberry, KE; Carpenter, JW. eds. Ferrets, Rabbits and Rodents--Clinical Medicine and Surgery (second edition). St Louis: Saunders, 2004; 147-154. 4. Manning, PJ; Ringler, DH; Newcomer, CE. Biology of the Laboratory Rabbit (second edition). San Diego: Academic Press, 1994. 5. Ward, ML. The physical examination and clinical techniques. In: Flecknell, P; Meredith, A. eds. Manual of Rabbit Medicine and Surgery (second edition). Gloucester: BSAVA Publications (in press). Author Information (click the author's name to view other papers and abstracts submitted by this author) M.L. Ward, BSc BVSc(Hons) CertZooMed MRCVS University of Edinburgh Roslin, Midlothian,

Re: Vaccination of rabbits without clinical exam

Stephen Courtney — Sat, 01 Jun 2013 15:20:13 GMT

[quote user="Mark Rowland"]Oh and btw, that's not a complete examination IMO. ;-)

[/quote]

OK Mark you win. I've totalled my CPD leave for the time being, but I'll look out for your next course

Re: Vaccination of rabbits without clinical exam

Mark Rowland — Sat, 01 Jun 2013 13:06:41 GMT

Oh and btw, that's not a complete examination IMO. ;-)

Re: Vaccination of rabbits without clinical exam

Mark Rowland — Fri, 31 May 2013 23:48:39 GMT

Not me, Central CPD :-)

Re: Vaccination of rabbits without clinical exam

Michael Woodhouse — Fri, 31 May 2013 23:40:07 GMT

[quote user="Stephen Courtney"]so what did i miss out, that people got so sniffy about before?[/quote]

It's a secret. The only way to find out is to pay Mark Rowland £285.

Re: Vaccination of rabbits without clinical exam

Stephen Courtney — Fri, 31 May 2013 21:04:02 GMT

OK, on my RSPCA visit today I times myself - examined a new arrival, also vaccinated her. young femal lop, weighing 1.5kg, already been spayed.

I looked in each eye with the auroscope head and magnifier, both eyes clear, i looked down each ear, both clear, examined nose, clear, incisors, normal and in good apposition. examined molars with the middle sized auroscope speculum, no spurs, everything looks fine. palpated the ventral mandible, dewlap area, forelimbs, checked claws. All fine. listened to heart and chest. resps normal, no dyspnoea, no rales wheezes or crackles. Heart sounds normal.

Palpated abdomen, normal, mammaries normal, no lumps or bumps. External genitalia normal, rear claws normal. Gait / mobility normal, and her bum is clean. coat in good condition, no evidence of parasites.

The people looking after her are knowledgeable and feed rabbits properly. I have nothing to tell them about rabbit husbandry - they know what I know. ?no chit chat needed, no advice needed, just a thorough health check.

It took me 2 minutes, and i believe I looked at everything.Not quite the minute I said before, but never the less, fast and i believe thorough.

so what did i miss out, that people got so sniffy about before? she is a healthy rabbit, it takes little time to confirm that. if there had been issues, no doubt it would have taken longer.

Remember the folk looking after her don't need the kind of advice i have to provide for a novice rabbit owner laden down with 10kg of pet shop meusli.

Re: Vaccination of rabbits without clinical exam

Thomas Johnson — Thu, 30 May 2013 09:21:55 GMT

[quote user="Hannah Wynne Richards"]

Is there an excuse with farm animals Isn't the basic problem food's far far too cheap-and should be realistically priced so farm animals get the proper veterinary input

[/quote]

True, but in a world market this isn't going to change, whatever consumers say about choosing food on animal welfare grounds the majority will buy the cheapest option on the supermarket shelf. We may wish it were different, and as individuals we can choose to support our local producers, but I can't see any big changes happening.

Re: Vaccination of rabbits without clinical exam

Hannah Wynne Richards — Wed, 29 May 2013 17:36:09 GMT

Is there an excuse with farm animals Isn't the basic problem food's far far too cheap-and should be realistically priced so farm animals get the proper veterinary input

Wynne

Re: Vaccination of rabbits without clinical exam

James Laidlaw — Wed, 29 May 2013 17:23:01 GMT

[quote user="Michael Woodhouse"]

[quote user="James Laidlaw"]What happens with adverse reaction reporting if they are taken out of the professional's domain?[/quote]

You'll hear about those, don't worry.

Love the way farmers are perfectly happy to get their vaccine or wormer from the merchants, but as soon as something untoward happens it is the vet they ring. I deal with far more adverse reaction stuff from stuff bought from other sources than things I sell.

[/quote] I remember those days! More often dirty needles or non sterile application suspected than actually a problem with the vaccine itself. I just don't think we can relate herd health to small animals. I know it happens, I know there are parallels, but I think it's only done to cut costs and corners for farm animals and there's no real excuse for that in small animal practice.

Re: Vaccination of rabbits without clinical exam

Michael Woodhouse — Wed, 29 May 2013 16:32:28 GMT

[quote user="James Laidlaw"]What happens with adverse reaction reporting if they are taken out of the professional's domain?[/quote]

You'll hear about those, don't worry.

Re: Vaccination of rabbits without clinical exam

Stephen Courtney — Wed, 29 May 2013 16:18:14 GMT

It looks like i need to take one on the chin - I do look at rabbits thoroughly, from one end to the other, including molars, and feel their tummies and inspect their backsides and claws etc. And it probably does take more than a minute - certainly in a consultation setting it takes much longer. i would not dream of hauling any animal out of its carrier and jabbing it and then handing the owner a bill.

BUT - it does not need to take long, in my opinion anyway, to be happy that an animal is well. If any abnormalities are detected then obviously they get looked at more closely. Vaccine exams are most useful for reinforcing your appreciation of normal - so the abnormal really sticks out when the cases turn up.

the shelter bunnies get examined very carefully before rehoming, and no new owner is conned into taking on a rabbit with bad teeth because no one bothered to look. Remember this is a small shelter, with a very dedicated/ OCD type 'owner'

My point was that when you are there to vaccinate a large number of animals, you can perform an adequate examination pretty quickly.

spending an inordinate amount of time over a vaccination in order make the owner feel you are 'worth it' seems wrong to me.

Re: Vaccination of rabbits without clinical exam

James Laidlaw — Wed, 29 May 2013 15:04:03 GMT

What happens with adverse reaction reporting if they are taken out of the professional's domain? Granted they are rare, but I have seen maybe 3 or 4 relatively severe post vaccination reactions (all reported to VMD) in the last 8 years, and invariably within 5-15 minutes of administration. Microchipping isn't in our sole domain either, but I've yet to hear of a vet implanting one into a dog's spine...

Re: Vaccination of rabbits without clinical exam

Malcolm Ness — Wed, 29 May 2013 14:57:18 GMT

[quote user="James Laidlaw"]Surely the comparison for ruling out intracranial disease in a young dog with signs of seizuring is a good case for a scan? [/quote]

Possibly, (but only possibly) and only ever after the patient has had a detailed neurological examination and review by a competent neurologist.

Getting back "on thread" - I think it almost inevitable that we will lose our effective monopoly to sell/administer SA vaccines. The vaccines are very safe and very easy to administer; the need for genuine veterinary involvement in their use is debatable (that is what this thread is about) and finally, while the potential benefits of a full annual health exam are indisputable, they are not well recognised by the pet owning public and any campaign to right this shortcoming is undermined on one hand by the sixty second examination and on the other by the relentless pressure felt by too many vets to do things on the cheap.

Re: Vaccination of rabbits without clinical exam

James Laidlaw — Wed, 29 May 2013 14:37:18 GMT

I will preface this by saying I don't have an MRI scanner. Surely the comparison for ruling out intracranial disease in a young dog with signs of seizuring is a good case for a scan? Not a "compulsory" scan, but where the patient is able to have this done, is it not better to rule out congenital or unusual mass lesions in the brain, rather than treating without knowing what is going on under the surface? I don't see the comparison of this to suggesting annual vaccination or rabbit clinical exam time.

Secondly, I seriously doubt annual blood sampling for titre checks would be more accepted than annual vaccinations, and unless the manufacturers change their licensing I find it unlikely that our advice can change unless you discuss this with clients. I have had a handful of clients over the years having 2 year or 3 year intervals for their cats' vaccinations, and our dog vaccines are only every 3 years for DHP once the puppy course and first booster is done. I still feel there is immeasurable value to an annual health check, and while every client may not want to carry out suggestions for clinical work/surgical work/medical investigations, I find it important to let them know what we find and what options they may have for monitoring, treatment or management.

Re: Vaccination of rabbits without clinical exam

Malcolm Ness — Wed, 29 May 2013 14:05:53 GMT

[quote user="Mark Holmes"]I have observed those who coincidentally have an MRI scanner and hold steadfastly to the opinion that 2 yo epilepsy patients need an MRI scan [/quote]

As one of the "early adopters" of MRI in this country, I still use the technology when clinically appropriate. However, I would agree completely with the implication that MRI is massively over-used. Exactly why this might be is a moot point but certainly the money to be earned must be an important factor, added to which is the perception that MRI is invariably "gold standard" along with the widespread use of MR in vet schools where it is rarely made completely clear to students ( and/or clients) that the use of the technology is more speculative/academic rather than case-management led. In fact, the diagnostic yield is often poor and very many times does not reflect the money spent. For example, MRI has not been shown to produce consistently clinically useful information in the investigation of joint disease in dogs and cats, nor does it add much clinically useful information to the majority of disc-related myelopathies providing they have been competently examined. Similarly, the diagnostic yield with MRI in a young dog with all the signs (or lack of them) and history suggestive of idiopathic epilepsy is remarkably low

Re: Vaccination of rabbits without clinical exam

Mark Holmes — Wed, 29 May 2013 13:40:37 GMT

It was not directed at anyone especially just an indirect observation. If vaccines were deregulated I suspect that with in a few years more vets would be questioning the need for annual vaccines and inviting people for a health check and serology testing. I don't question the value of an annual health check or it being done thoroughly. I have observed those who coincidentally have an MRI scanner and hold steadfastly to the opinion that 2 yo epilepsy patients need an MRI scan or more regularly layering service upon service upon service onto clients and scoffing at people who chose not to partake.

Re: Vaccination of rabbits without clinical exam

Michael Woodhouse — Wed, 29 May 2013 10:19:41 GMT

[quote user="Martin Atkinson"] I would hope Mark that you would be amongst those who would raise an eyebrow at a client bringing in a pet with a neglected condition that could have been detected at an early stage with a routine examination.[/quote]

Martin, your clients are maybe awfully well trained, but I find loads of neglected problems at vaccination - sometimes not very subtle.

I have also tried stopping vaccinations in some cases (older dogs that don't mix) but on 2 occasions lost touch with old dogs, explained the examination was more important than the booster, but then you see them 2 years later to PTS a wreck of a dog. Unless the dog is sick and needs treatment now I have changed my approach and now tend to carry on boosting older dogs. People like it because they have come and got something for their money. Dog gets followed up in a year automatically by the PMS. It's not about the money.

I tried a reminder on the system for a yearly healthcheck without the booster but compliance was awful (20% versus 75% for boosters).

Honestly if the examination part takes 1-2 minutes you can be in there for well over 10 discussing problems, looking further into issues. etc etc. You can't get them out the door in 60 seconds.

Re: Vaccination of rabbits without clinical exam

Mark Rowland — Wed, 29 May 2013 10:03:04 GMT

[quote user="Michael Woodhouse"]

Keen to learn - what more should I de doing?

[/quote]

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Re: Vaccination of rabbits without clinical exam

Martin Atkinson — Wed, 29 May 2013 09:57:41 GMT

[quote user="Mark Holmes"][quote user="bob lehner"]

[quote user="Martin Atkinson"] I feel the average pet owner/charity rescue organisation does not. The reason we will now go round in circles Michael is because you invariably have a totally different and intransigent point of view which quite frankly is sometimes at the limit of acceptable practice[/quote]

Well personally I find Michael's viewpoint frequently refreshingly sensible and down to earth...!

[/quote] Likewise, I find that many of the views dearly held with regards to animal care happen coincidentally to support our own financial interests. Michael's posts generally don't do this. They are invariably pragmatic and reflect a certain reality. Surely it is better to see the world as it is than how we would like it to be. I wonder if vaccines did become down graded so that any SQP could sell and administer them how long would the profession take before annual vaccination became a less dearly held necessity?

[/quote]This sort of reply sorely tests my faith in the veterinary profession. I don't perform an annual vaccination I perform an annual health check at which the pet's vaccine requirements are discussed, they may require an annual booster or they may not. I would hope Mark that you would be amongst those who would raise an eyebrow at a client bringing in a pet with a neglected condition that could have been detected at an early stage with a routine examination. It beggars belief that there are those who believe that the one who spends 10-20 minutes on a full health check and charges little more is the one who is motivated by their financial interests but the ones who are getting patients through in 5 minutes or less and are prepared to sell vaccines/medication to all and sundry without proper care are not. You've got your thinking cap on backwards. My God if this is the attitude of the majority I'm glad I can retire anytime soon.

Re: Vaccination of rabbits without clinical exam

Michael Woodhouse — Wed, 29 May 2013 09:45:26 GMT

[quote user="Mark Rowland"]Thanks for that pearl of wisdom Michael but I dont think Ill be taking advice on rabbit consultations from one whos usual reply is "Wheres the seasoning".[/quote]

mmm, rabbit pie.

What would be your routine for a bunny examination at vacc?

I tend to look at whole bunny on the table, check ears, eyes, nose. Feel jaw, part lips and look at incisors. Feel round neck for LNs. Run my hands over the bunny to feel body and coat condition and check for lumps, bumps etc. I then palpate the abdomen, pick bunny up and look at underside, check for lumps and bumps and nail length. Check no faecal matting/scalding etc. Then listen with stethoscope L, R and over sternum. Even with a little paeds steth I tend not to move it around in a bunny as they don't have huge lung fields.

If I find anything odd, then spend more time on it. A 10 second listen to chest is usually enough to categorise as normal or abnormal.

I don't use the ophalmoscope on every booster, nor do I routinely do temperatures. If it was a bunny to re-home I would look in its mouth to see molars with the otoscope. I don't routinely do so in a good condition bunny the owners report is well and is in clearly good condition. If it had runny eyes, matted faeces then I most certainly would.

Same idea with a dog or cat, do so whilst questioning. It's only if I find something abnormal I dig further.

Keen to learn - what more should I de doing?

Re: Vaccination of rabbits without clinical exam

Mark Rowland — Wed, 29 May 2013 09:40:10 GMT

Another point to make is that when we are asked "Why are vaccines so expensive" our reply is usually the provision of a full clinical examination. I wonder if this was over in a minute what our clients would think of our pricing strategy. They may as well go down to the local vaccination clinic where the examination may take longer!

Re: Vaccination of rabbits without clinical exam

Mark Rowland — Wed, 29 May 2013 09:33:04 GMT

[quote user="Michael Woodhouse"]

[In a dog or cat it's not the examination that takes the time, more the history and any recommendations.]

[/quote]

Thanks for that pearl of wisdom Michael but I dont think Ill be taking advice on rabbit consultations from one whos usual reply is "Wheres the seasoning".

I too usually find your replies quite refreshing in most cases.

To think any clinical examination can take less than a minute is just cras in my opinion, especially in a rescue situation where these animals with no history are going to new homes. I think its unfair to send a rabbit to a new home carrying a subclinical problem which the new client is then going to have to pay for. Would not the vet who missed that condition be liable in some way?