Rabbit Medicine

There is something particularly endearing about rabbits, something that moves me to continue learning as much as I can about them, so that I can provide them with the best medical care that I am able. Maybe it is the soulful eyes, the twitching nose or those silky ears that enamors me so. Maybe it is their large back feet covered with a plush fur that I love to stroke. Maybe it's the whole package: a beautiful animal that exudes vulnerability. While domesticated pet rabbits usually don't need to worry about being chased by predators, as their wild cousins might, their instinct is still centered on being alert, suspicious and ready for flight. I think this vulnerability and wariness is what makes me want to protect and care for these gentle, beautiful animals.

Rabbits are members of the order Lagomorpha, commonly called lagomorphs. The domestic rabbit, Oryctolagus cuniculus, is descended from wild rabbits of Europe and northwestern Africa. There are many different breeds of domestic rabbits, ranging from the diminutive Dutch and Polish breeds weighing from two to four pounds to the large breeds like the Giant Chinchilla and Flemish Giant, weighing up to 14-16 pounds. Rabbits make good pets and can be house trained. Females are called does and males are referred to as bucks.

Older bucks and some does that have given birth to a litter of kits (baby bunnies) develop strong territorial instincts and may bite people, but usually only if provoked. Rabbits can also inflict painful scratches if improperly restrained or if naturally aggressive. Some breeds are more aggressive than others, with Dutch rabbits being more aggressive than New Zealand Whites and Lops. Rabbits thump using both hind limbs as an isolated response to a fearful or painful situation. Rabbits begin approaching sexual maturation when older than three months (depending on the breed, nutritional status and health) and at that time, they may begin attacking each other. So, once they reach that age, they should usually be housed individually. In some circumstances, female groups established before sexual activity begins may be housed together. Mature rabbits should only be paired at mating. Neutering will usually decrease aggression.

Rabbits have an average lifespan of 5-8 years, with some rabbits living for up to 15 years. With good, preventative veterinary care, good husbandry, a clean environment and a healthy diet, a rabbit should live for many years. Rabbits are increasing in popularity, and fortunately, there has been an explosion of information concerning rabbit veterinary medicine over the last ten years. Many veterinary conferences are devoting more lecture time to rabbit topics. This should make it easier for you to find a veterinarian who is skilled in rabbit medicine.

If possible, you should seek out potential rabbit vets prior to actually requiring their services. You may want to ask other rabbit owners which veterinarian they use, or ask a pet retailer who deals with rabbits. Rabbit rescue organizations are also a good source of information as are local rabbit societies and clubs. Different veterinarians have varying levels of experience with rabbits, so don't be hesitant to interview prospective vets prior to choosing one. As a courtesy, it is best to schedule an appointment with a rabbit vet, stating specifically that you are interested in touring the facility and discussing the vet's experience with rabbits. Most vets are proud to show you their facility and specialized equipment for rabbit medicine. They should also be happy to discuss their experience with rabbits and continuing education courses that they have attended to learn more about rabbits.

A competent rabbit veterinarian should be able to accurately weigh your bunny (preferably in grams, to be the most precise), provide you with information about diet for your rabbit, perform a complete physical exam and any necessary lab tests, and be able to neuter (spay or castrate) your rabbit, as well as being able to perform routine procedures (such as dentistry to correct tooth problems). It is important to discuss emergency care with your veterinarian. Find out if your vet sees emergencies, and if not, ascertain where they send emergencies. You should feel comfortable asking your veterinarian questions, and your veterinarian should either be able to answer your questions or be willing to research your query.

Bucks are usually able to breed when they are 6-10 months old. Does are able to breed when they are between 4 and 9 months of age. Age at breeding depends somewhat on how old a rabbit is, but this is also a function of body weight. Small breeds develop more rapidly and are mature at 4-5 months of age. Medium sized breeds are mature at 4-6 months of age, and large breeds reach maturity at 5-8 months of age. Generally, does mature earlier than bucks. Bucks do not achieve optimal sperm production and reserves until they are 40-70 days of age. The reproductive life of a rabbit depends on the breed, but usually is between 5-6 years for a buck, and up to three years for a doe. The testicles of a buck usually descend at about 12 weeks of age, but the inguinal rings remain open for the life of the rabbit. Does have 8-10 mammary glands and nipples, however bucks do not possess nipples.

The average body temperature of a rabbit is between 99.1 and 102.9 degrees F. Rabbits have a well-developed third eyelid, also called the nictitating membrane, which covers the eye during sleep or anesthesia. Rabbits have a wide field of vision that reaches 190 degrees for each eyeball. A rabbit's eye is eight times more sensitive to light than a human eye. Rabbit eyes possess both rods and cones in the retina, indicating that they can see color, and are sensitive to the blues and greens present at twilight. Rabbit ears contain an intricate blood vessel system that you can see through the skin. The ears are involved in heat regulation and sound gathering. A rabbit should never be picked up by its fragile and sensitive ears, nor should the ears be used as a method of restraining a rabbit. Veterinarians often use the veins in the ears for drawing blood for testing and for administering intravenous injections. Rabbit teeth grow throughout its life. The skeleton comprises only 8% of a rabbit's body weight, whereas a cat's skeleton is 13% of its body weight.

Rabbits are fairly hardy animals, and many health problems are the result of poor diet, lack of cleanliness or improper handling (which may result in injuries). While we will examine some common rabbit medical problems, this article is not meant to replace proper veterinary care. If it is apparent that your rabbit is ill, you must take your rabbit immediately to a veterinarian for diagnosis and treatment.

Alfalfa-based rabbit diets were originally developed for meat animals and not for rabbits intended to be pets. These pellets were not meant to be fed long-term, because meat rabbits usually only lived for one or two years. Therefore, rabbits that consume too many alfalfa pellets or hay will often become obese and develop problems with high blood calcium (hypercalcemia).

High blood calcium can eventually lead to other problems. For example, the calcium will be excreted by the kidneys and may result in a type of calcium-based "sand" that forms in the urinary bladder (called bladder sludge). Rabbits with too much calcium in the urine (hypercalciuria) usually have thick, creamy urine.

Some rabbits develop stones that could cause obstructions in the ureter (the tube that transports urine from the kidney to the bladder) or urethra (the tube that drains urine from the bladder out of the body). Obstructions can be very dangerous. Radiographs (x-rays) or ultrasound may be necessary to diagnose stones in the urinary tract. Bacterial bladder infections can also occur.

Once diagnosed, surgery may be necessary to remove stones. Shock wave lithotripsy has been experimentally applied, but this is not commonly available. If the stones are not obstructing urine flow, medical treatment may be attempted prior to surgery. This may include daily manual expression of the bladder and intravenous or subcutaneous fluids to increase the flushing action, and to dilute the urine.

Dietary changes are an important part of hypercalcemia treatment, and changes are necessary to prevent future problems. It is necessary to decrease the amount of dietary calcium, which will directly lower the amount of calcium circulating in the rabbit's bloodstream. This will also lower the amount of calcium excreted in the urine. Feeding primarily timothy grass hay or timothy hay-based pellets, and green vegetables will lower the amount of calcium in the diet. If the rabbit is overweight (and many hypercalcemic rabbits are), then it should be placed on a restricted calorie diet (as directed by your rabbit vet) and the rabbit should be encouraged to exercise more frequently.

Rabbits may occasionally excrete red urine. This is usually not caused by blood but rather from pigments in plants that are excreted in the urine. Pigmented urine may be intermittent and may last for just a few days. True blood in a rabbit's urine is usually serious and requires veterinary assistance. If possible, bring a urine sample to your vet when you have a rabbit evaluated for urinary problems.

Rabbits are herbivores, meaning that they eat only vegetation, and they do well on high fiber diets. Since their teeth grow throughout their lives, if malocclusion (misaligned bite) occurs, overgrown teeth may result. Rabbits should be provided with safe wood, such as untreated pine, to chew to help keep the teeth ground down.

Rabbits possess a cecum, which is involved with digestion and are hindgut fermenters. At night the cecal contents of a healthy rabbit move rapidly through the large bowel and are excreted from the anus. These "cecotrophes" are also known as soft feces or night feces, and are then consumed by the rabbit, usually directly from the anus. The consumption of feces, called coprophagy and practiced by rabbits, most rodents and a variety of other animals, is normal and usually begins between the second and third week of age, when young rabbits begin consuming solid food.

Normal fecal pellets are hard, round and excreted during the day. Cecotrophes are usually produced in the early morning hours and are small, soft, sweet-swelling and about the size of the pea. They contain high levels of B vitamins and vitamin K, and twice the protein and half the fiber of standard feces. Their redigestion after being eaten by the rabbit helps absorb previously undigested nutrients and reinoculates the rabbit's gut with essential nutrients and beneficial microbes. While coprophagy seems unsavory to us, it is a normal and necessary behavior of healthy rabbits.

Rabbits may suffer from a variety of gastrointestinal ailments. Signs range from soft stool and diarrhea to enterotoxemia (toxins in the bloodstream from bacteria originating in the gut), bacteria in the bloodstream and even death. Pathogenic (disease-causing) bacteria and other factors that allow toxins to proliferate are the usual causes. Dietary changes, antibiotic therapy causing dysbiosis, stress, and in some cases, genetic predisposition may lead to GI problems.

Ileus, which is a cessation of the normal waves of contractions that move food through the gastrointestinal tract, is a common problem in rabbits. It is usually not a primary problem, but occurs secondary to stress, systemic disease, infections, inappropriate diet or pain.

Rabbits, like horses, cannot vomit. Rabbits can ingest too much hair when grooming, and since they cannot expel a hairball (as a cat can), this can result in development of trichobezoars (hairballs) in the stomach under certain circumstances. Hairballs, in themselves, usually will not pose a problem to a rabbit that is healthy, well hydrated and on a proper diet. To prevent hairball problems, it is best to groom your pet rabbit regularly to remove loose hair. Rabbits with gastrointestinal problems related to a hairball may lose their appetite and water consumption may be decreased. Weight loss may be apparent. The number of fecal pellets may be significantly reduced. Abdominal palpation may reveal a doughy mass in the abdomen, which may be painful. It should be noted that rabbits can and do ingest hair, and usually it will pass without problems. However, if a rabbit is suffering from GI tract problems, and becomes dehydrated, the hairball can cause a partial obstruction and exacerbate other GI problems.

If ileus, a trichobezoar causing a partial blockage, or other GI symptoms are diagnosed through radiographs, ultrasound, palpation, physical examination, fecal testing, blood tests and history, it is very important that the rabbit be given support care by your rabbit veterinarian. This usually includes parenteral fluids (subcutaneous, intravenous, intraosseous), syringe-feeding fluids and a special formula for ill rabbits, pain medications, drugs to stimulate intestinal motility (if there is no blockage) and antibiotics (if indicated to prevent overgrowth of dangerous bacteria or if there is clear evidence of bacterial infection).

Rabbits that don't eat will rapidly develop hepatic lipidosis, a condition that occurs when a rabbit is not taking in enough calories or nutrients to meet its metabolic needs. When a rabbit stops eating, as it commonly will when it is sick, triglycerides are mobilized to the liver from stored body fat elsewhere in the rabbit's body. This sets off a chain of complex metabolic processes that cause liver enzymes to elevate in the rabbit's bloodstream, which can then rapidly lead to potentially life-threatening liver disease.

Ketosis usually occurs in a rabbit when its body fat is being utilized for metabolic needs, which is what happens when a rabbit cannot or will not eat. Ketones are produced by exaggerated and incomplete oxidation of fatty acids brought about by starvation. These ketones are not normally found in the urine of a healthy rabbit, therefore a urine test strip can screen for ketosis in an anorectic rabbit. Ketones have an odor similar to acetone (a component of nail polish remover), and it is sometimes possible to smell this volatile compound on the breath of an affected animal.

Antibiotic therapy can cause a dangerous shift in the bacterial organisms normally found in the rabbit's gut. This is referred to as dysbiosis. In fact, almost all of the important GI problems in rabbits are, directly or indirectly, related to disruption of the rabbit's hindgut bacterial flora. Spore-forming anaerobes, consisting mostly of Clostridium spp. and coliform bacterial species such as Escherichia coli, increase as the population of normal organisms decreases. This can occur with antibiotic therapy, reduction of fiber in the diet, increased carbohydrates and with disruption of the normal GI motility. Changes in the pH of the cecal contents can also support the growth of pathogenic bacteria. Enterotoxemia can occur from Clostridium spiroforme, and enteritis may occur from E. coli, Salmonella, Pseudomonas and Campylobacter-like bacteria.

Rabbits can get GI related problems from coccidia, a type of protozoa that can reproduce in the GI tract or liver of rabbits. Repeated fecal parasite exams may be needed to identify the hepatic form of coccidia. Coccidia can cause diarrhea or soft stools.

Other parasitic organisms may cause digestive problems in rabbits. Cryptosporidium, Giardia, tapeworms, flukes and pinworms can all occur. Although pinworms are fairly common, even if present in large numbers, they usually do not cause illness in rabbits. These pinworms are not contagious to humans.

The other big group of medical problems in rabbits is related to the bacterial organism, Pasteurella multocida. The group of diseases caused by this organism is called pasteurellosis. This bacterium can cause "snuffles," an upper respiratory disease that not only results in nasal discharge, but may also infect and erode the bones and structures of the rabbit's head. Pasteurella multocida may also cause abscesses in various areas of the body, lung and heart (specifically, pericarditis) problems.

Pasteurella can be serotyped to further identify the bacterium; different strains have different abilities to cause disease. They may produce endotoxins (poisons contained within the bacterial cells) that cause fever, depression and shock. Pasteurellosis can be diagnosed by a combination of the history, clinical signs, radiographs and perhaps other tests. While it is possible to culture the bacterium and perform antibiotic sensitivities, this organism can be fussy and hard to grow in a lab, and may not survive transfer from the rabbit to the lab. Other rests include a Pasteurella titer, which may be difficult to interpret, as one positive test only shows that the rabbit has been exposed to the organism. It usually takes a second titer, run two to three weeks after the first, to show if the rabbit has an active infection. A newer test is called a DNA PCR, and this test is very accurate. A swab is taken of a suspected pasteurellosis lesion, and sent to a lab where they will amplify a portion of the DNA of the organism, and then identify it. Since it doesn't require live organisms to grow, it can pick up cases that cultures can miss.

Pasteurellosis in rabbits may present as upper respiratory disease (inflamed nostrils, sinusitis, tear duct infection, inflammation of the conjunctiva of the eye), ear infections, pneumonia, bacteria in the bloodstream, abscesses in the subcutaneous tissues, internal organs, bones, joints or genitalia.

Pasteurella is easily transmitted by aerosol (sneezing) from infected rabbits, direct contact or by infected objects (such as toys, food and water dishes, etc.) The bacteria may also be transmitted from a doe to her kits at birth. Primarily, Pasteurella enters the rabbit's body through the nares or through wounds. Once established in the nasal passages, the bacteria can spread to other organs through the bloodstream.

If the organism spreads to the middle ear, inner ear or brain, it can cause a head tilt, walking difficulty and other signs of dizziness. Treat may be attempted, based on culturing and sensitivity, or by PCR testing. Antibiotic treatment may eliminate the infection in some cases, but in most cases, medication may only control the disease, but not eliminate it. Controlling the infections may also require adjunct therapy, such as eye drops.

A rabbit with pasteurellosis should be kept on a good diet and remain free from stress or extreme changes in temperature. Affected bunnies should also be kept very clean, and housed in well-ventilated quarters.

Other organisms can also cause respiratory disease in rabbits, including Bordetella bronchiseptica. This bacterium is quite common in guinea pigs, dogs, cats and pigs. For this reason, rabbits should not come in contact with these species. Bordetella may also be involved with pasteurellosis. Mycoplasma and Chlamydia infections are two other organisms that can cause respiratory disease in rabbits.

Rabbits may suffer chronic rhinitis and bronchitis due to exposure to allergens in their environment. If your rabbit suffers from either of these ailments, try to determine the cause and remove the offending allergens from your bunny's environment. Discuss this with your rabbit veterinarian. Using an air filter with a HEPA filter may help reduce dust and allergens. It may also help to use a box fan with an air conditioner filter attached to the back side, so that as the fan blows, it traps dust and dander in the fibers.

Reproductive system disease can occur in unspayed or non-castrated rabbits. Rabbits should be neutered before they reach two years of age, preferably between six and 12 months of age.

Rabbits occasionally fracture the seventh lumbar vertebra (one of the backbones) as a result of improper handling, but this can also occur in caged rabbits that are startled or frightened. If a rabbit kicks and twists while being held, it can fracture its back, which will usually result in hind-leg paralysis.

Rabbits are very susceptible to heat-stroke or heat stress. Signs include weakness, depression, incoordination, seizures and coma. Extreme care must be taken to prevent rabbits from being overheated; temperatures of 85 degrees F and above can be dangerous, especially to rabbits not acclimated to warmer temperatures. Rabbits housed outdoors during the summer must have shade, good ventilation and cool, fresh drinking water.

Lead poisoning may occur in rabbits that are allowed freedom to roam around a house and also may occur in rabbits housed in galvanized-after-welding cages (these have about 1% lead and 1% zinc). They may chew on painted surfaces containing lead paint, or they could chew on other objects that contain lead or zinc. A rabbit suffering from lead toxicosis may show subtle neurological signs, depression and lethargy, and most will show decreased appetite and weight loss. Most are anemic and may have other changes in the blood.

Rabbits may develop sore hocks, a chronic problem in which ulcers and infection occur on the bottoms of the feet. The proper name of this condition is ulcerative pododermatitis. Occasionally, the ulcers may extend down to the bone. This problem usually begins because of trauma to the skin, such as may result from abrasions caused by rough, irregular or poor-quality cage flooring, frequent thumping (which bruises the feet), confinement to a small cage, excessive weight, soiled cages or thinning fur on the feet.

Rabbits require periodic grooming. Longhaired breeds need to be frequently brushed. Nails may become fairly sharp and long if not trimmed regularly. Nails should be periodically clipped. Rabbits tend to keep themselves very clean and do not usually require periodic bathing. Occasionally, a vet may prescribe medicated baths or dips to treat certain skin conditions.

Rabbits may develop abscesses, generally associated with Staphylococcus or Pasteurella bacteria. Abscesses can occur anywhere on a rabbit's body, but are usually found on the head and limbs. Swellings may develop after a day or several days. Usually, these lumps are not painful to the rabbit. The abscess may be cultured by a vet, who will drain a small amount of the material using a fine needle, or just a swab if the abscess is already open to the outside. Other tests may need to be performed to identify the severity of the problem. Radiographs may be needed to diagnose if bone involvement has occurred. Ultrasound and CT scans may prove helpful. Treatment usually requires surgery to completely remove the infected material followed by antibiotic therapy or the insertion of antibiotic impregnated beads at the infection site, as well. Unfortunately, abscesses are likely to recur and may require repeated treatments.

Ringworm is a fungal infection of the skin that is not uncommon in rabbits. Lesions appear as dry, crusty, hairless patches that may or may not be itchy. Treatment should be prescribed by your veterinarian. It may be contagious to humans and other pets.

Ear mites, caused by Psoroptes cuniculi, can cause serious problems if left untreated. They cause inflammation and crusting in the external ear canals, and the crusts can become very thick. Affected rabbits often scratch their ears and shake their heads. This can lead to more severe infection. Rarely the mites can infest the legs, feet and skin of the perineum in debilitated rabbits.

Treatment should be instituted by your veterinarian. Usually injections of ivermectin are given throughout the mite's life cycle (three weeks). It is best to not clean the ears of an infested rabbit, as this can cause severe pain and often causes the ears to bleed. Once the mites are gone, the ears can then safely be cleaned out. The rabbit's environment and any rabbits it has been in contact with must be treated.

Occasionally, a rabbit may become infested with a rabbit fur mite, Cheyletiella parasitovorax. It is potentially contagious to both humans and other animals, including dogs and cats. Rabbits with this mite often have dandruff or dry skin. The mite's life cycle is approximately five weeks.

Rabbits may become infested with fleas, especially if they share a home with dogs and cats that are permitted to go outside. Treat a rabbit as you would a cat. And of course, the environment must also be treated.

Timid rabbits may be subjected to barbering by more dominant bunnies. Usually the hairs are broken or plucked on the head and back. Does in heat may barber and pull their own hair. Pregnant does near the end of their term will usually pull hair from the forelegs, ventral chest and hips to help line the nest. Rabbits on a poor diet, low in fiber, may also pull their own hair out.

Rabbits with dental disease may drool excessively and develop dermatitis. Rabbits with a dewlap that drink from bowls may develop an infection there due to the skin being constantly wet. The same can occur in rabbits that dribble urine, or those living in unsanitary conditions, resulting in urine scald of the rear ends.

Rabbit syphilis (venereal spirochetosis) can cause crusting and ulcerations around a rabbit's nostrils, lips, eyelids, chin, external genitalia and perineum.

One disease, encephalitozoon nosematosis, is a common disease among rabbits caused by Encephalitozoon cuniculi, a microsporidian protozoan. It is transmitted by the urine/oral route, usually from doe to kit. Spores tend to inhabit the brain and kidney tissues. Clinical signs are usually slight, subclinical and chronic. Damage to the kidneys may occur over time and incontinence may result. A diagnostic test is available. A positive titer indicates that the rabbit has been exposed to the disease, but it cannot distinguish between active infection and previous exposure. Obtaining a titer is helpful, but a second titer may be needed to ascertain if the infection is current. There is no specific treatment for this disease, but many rabbits recover with out therapy.

When you are ready to obtain a new pet rabbit, make sure that you acquire it from a clean facility. Find out if the breeder or pet store works with a veterinarian to keep their stock healthy. Closely examine any rabbit that you are considering adopting. While baby bunnies are adorable, consider looking into adopting an older pet rabbit from a rescue facility. Many rabbits are given up as pets when owners lose interest, or have trouble dealing with behavior or medical problems.

Regardless of the source of your new rabbit, take it immediately to a rabbit-friendly veterinarian for an exam. Your rabbit can live for five to six years or longer, and you can get off to a good start by having your bunny assessed by a vet who can make dietary, husbandry and medical recommendations for you and your new pet.

Copyright 2006 Margaret A. Wissman, D.V.M., D.A.B.V.P.
All Rights Reserved

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