Thanks ever so much. And, thank you to those who have endured all four in this session. I hope everybody's surviving the heat wave.

This is definitely not the weather to be a rabbit, I'm afraid. OK, so we're going to talk tonight about arthritic rabbits. This is probably one of the most common things we come across, and if you like the root cause of many of the issues we see with rabbits, and so a lot of our time is spent managing, these guys.

So So with what we mean by old rabbits and things like that, because most people consider arthritis to be an old age disease. We think about us as we get older, everything aches, everything hurts. And so therefore we expect to see this older age disease in dogs and cats, and probably in rabbits too.

So it is relevant to how old old animals are. And, and again, importantly, it will surprised me when I asked my clients is what answer they give me, but very few actually consider rabbits should get to 10 to 12 years old. .

But, and many don't get that far because dental disease and stuff, but certainly we can run older animals from 7 years in dwarf or giant breeds from much younger than that, so probably about 4 or 5 years and some of those to start seeing these wear and tear problems. But also don't forget, you know, if you've got chronic illness that may have effects too and like prematurely age, if you excuse the phrase, and also from, from some younger age, injuries and things will also induce arthritis at a much earlier age. .

And so therefore we can see arthritis. Yeah, obviously in older animals, but we will see it in the younger ones as well, and sometimes in very young animals, when we see this. And that is important that very often in our veterinary teaching we get very, very strung up on, you know, this is a young animal that we see these diseases, this is an older and we see these diseases, but some disease will affect all ages and certainly the rabbit, I would consider arthritis to be in any age disease and should always be considered.

So what do we see with that? Well, most of the issues arthritis relate to pain. If anybody's got some arthritis, they will know it hurts.

It's a funny sort of pain too, because, you know, you talk to people about it and say, oh, no, my animal isn't showing pain, doesn't vocalise or anything. And they say, Well, have you got, you know, do you have arthritis? They say, Well, yeah, it's just, do you vocalise it?

Well, no, it just aches the whole time. So it gets chronic, like grinding type of pain going on with that. And so these are sort of signs of pain we've really got to be aware of, and rabbits aren't very good at showing pain.

They're really good at suppressing it, which makes it a real good survival instinct for a prey species. So you've got to be aware of these signs you're looking out for, which may be reduced activity. That may be a hard one to pick up because, you know, we don't always do a lot anyway.

You may see al ability to move or to climb, and again, be very careful people say, oh, it's only running back yesterday. Well, yeah. It doesn't stop you running about, but it may stop you running back for longer, or it may affect your recovery from that.

So you may run about today, and maybe a couple of days to recover from that. So just because the rabbit is running around does not mean it's not arthritic. May very often see weight loss and chronic pain will, will, will, will, will, will result in weight loss very often and certainly muscle loss over affected areas.

So alter temperament, you know, some of these, these, these bad-tempered rabbits may, may be in pain. Sometimes they may be a lot quieter, sometimes they may be much hyperex excited but they think something can touch them they shouldn't. We can see reduced appetite, depending on what's affected and increased drinking, polydipsy associated with pain is really common.

And for polydipsy rabbit, you should always be thinking what's hurting, what's going on there. And of course, we see faecal and urinary changes just a little bit more in a moment, where we may see reduced faecal output or very small faecal pellets, and of course in urine so we mostly as urine stasis syndrome. So basically in a rabbit we may see almost anything and when in doubt in a rabbit, think pain and think about sorting it out there.

So arthritis common or rabbits, especially in giant breeds, in different parts, we got increased strain on the spine of the stifles, and they get changes very early on indeed. And those are typical areas affected the spine, the stifles, the hips, and also, don't forget the temporomandibular joint, we do see a fair bit of this and here's a scanner that showing a fairly normal, joint on the side, and we can see an arthritic change in this side. And for, for joint that's very labile, that's constantly used, having that degree of change in there is going to affect appetite quite profoundly, and cause a lot of pain while eating.

So we're talking about arthritis too. I should address this sooner. Joint inflammation, what arthritis means and the various sorts.

So we may have septic arthritis, may have rheumatoid arthritis. of course, we really are thinking mainly about osteoarthritis. We can use cytology to distinguish between them if you've got a, a, a change in the joint, but say primarily for purpose this talk, we're going to osteoarthritis.

So these are, if you like, more wear and tear, type of inflammations, and these can be affected by posture, by injury, by ageing and chronic use of those joints too. And as I mentioned before, don't forget these are going to be associated with chronic grinding pain as opposed to acute sudden pain. So how do we diagnose it?

Well, in the early stages after injury you may see swollen joints. We may just say do joint cytology there and we may do some imaging or advanced imaging to it. Again, we're gonna talk more tonight about the, the chronic problems, the later stage of this too.

And there we may see muscle wastage. We may see chronic joint thickening, rather than swelling acute soft swelling. We'll see radiographic changes reflecting the body's response.

Well, maybe a radiography, maybe advanced imaging, whatever, we see a response to that. And those can, you know, help localise what's going on there. One thing you may see occasion in rabbits is rabbits is a great ability.

They're not, we, we know all animals, if they're going to, we get muscle waste, you're resting that part of the body which the joint hurts. Rabbits are not using part of the skeleton will, will decalcify it. So some of you looking at an overall image of a rabbit, if you see a part of a skeleton that is less well calcified, look for joint lesions around there because they may very well reflect a part of what is being rested.

And of course, the other thing diagnosing suggestive clinical signs, but actually, we discussed earlier on too that almost anything is suggestive clinical signs. So basically, you diagnose arthritis because rabbit's got something wrong with it. So what are these signs?

Well generalised pain signs mentioned. Recurrent gutta another potential issue, and the reason for that is, is that the fuss coli, the pacemaker region of the gut, is influenced by external factors, including prostaglandins and inflammatory mediators. So if we have an underlying inflammatory cause, we may see recurring gut because something hurts.

We'll see urinary stasis problems, and this is a rabbit see here we got this beautiful, pelvic, calculate, renal pelvic calculate forming both sides there, quite a swollen kidney too. We can see we really have got a chicane in the spine to long term wear and tear on the joints in there and long term pain with that. And these rabbits very often don't urinate as often as they should do.

And you think about how a rabbit urinates, you know, lifts it back in and squirts out there, that takes a bit of spinal movement. If your spine hurts, you're not going to do that very often. So they often get a stay, they get these stones with sludging build up there, look for this underlying lesion about what happens.

If we get spinal lesion of the thoracic spine, we may well see breathing changes because they feel reluctant to expand their chest completely get very short, rapid breaths, we will be a factor too. We may see what PP neurological signs where we will get entrapment of nerves which again spinal again too. And again, of course, don't forget you're going to get dirty ears because a rabbit uses the back leg to clean the ears out.

So again, if you're a rabbit with a lot of debris building up in the external ear canal, particularly around the pinna stuff too, especially on one side, start looking for what's affecting the hind legs and the spine, about why it can't clean its ears completely. And here is a rabbit where, we, we, we with a generalised pain signs. We can what we can see on this, we can see the fact it's very unkempt.

It's not really turning and grooming very much. It's got a nice hunched back. In fact, the spinal lesion back there we can see the hunching.

And we've also got to build up a seeker trope that's not turning and taking seeotrophs properly. All these are sign that rabbit is not a very happy rabbit. It's not turning around properly.

It's hurting to a large extent. And that's a rabbit say with spinal arthritis. And here's a big thing.

The rabbit with a weak wobbly back end and muscle weight is more like to have spinal arthritis and be in pain than to have echiiculi. We see a lot of rabbits we get in as 1st 2nd opinion where people thought, well, you know, it's echiiculi because it's wobbling on the back end it's neurological. Always do your neurological tests, you'll very often find they're weak rather than having neuroscis.

And again, bear in mind what you can it does, it doesn't tend to cause lesions within that within that spinal cord. So these are much like a spinal arthritis. We often get some really good lesions on there.

And so rather than give panica, start thinking about diagnosing and finding that arthritic lesions are giving anti-inflammatory before you do that. Then we also do some marker signs or something else going on there too. An example I use here is poto dermatitis.

And again, another thing we see very commonly in rabbits. Well, there's lots of facts of poto dermatitis and some may be non-related to, to arthritis and pain. So maybe we see husbandry things.

So we we'll do things like look at substrate, we'll look at the hygiene within the, within the hutch and things, make sure you're not standing on soggy water, soggy, bedding. We also look for urine reactions, which may be going on that we may be reacting with sawdust, that type of stuff too. And also we saw like polyuric and things that may, may, may, may affect how much urine is being produced.

We look how much space they've got because that again may affect how much they can move around, how much they can get the weight of those hocks at various times. So husbandry is really important in this, but also they will have other issues too, so maybe localised. So these may affect how the weight bearing and stuff you can consider four limbs and stuff too, so it can happen on those as well, because we don't use potos on the back end.

So we look at all feet and we have localizations on there. And we may have things like arthritis of hock, within the the toe joints and stuff, and they may be important. If we see a unilateral case.

Look at what's on the good side, if you like, what's, what's affecting that to throw the weight onto the other foot. And we're often see an underlying osteomyelitis, and very rarely we've seen tumours and stuff affected area too, and that can be quite important. And here is a podermato rabbit you can see the soft tissue swelling here we can see some underlying burning reaction.

If you have a look on here, some very subtle signs of, of hock arthritis, which is what the real fundamental problem with this rabbit is as to why it sat there on its hocks and having a problem. We'll also see generalised issues. And if a rabbit is immobile and sat too long in one spot, then we start getting pressure sores developing and stuff.

So that may come from spinal issues and spinal arthritis. It may come from abdominal pain too. So some of our female rabbits with, with uterine endocarcinoma and long-term, abdominal pain may may sit sit and not do anything.

We may see from dental pain, middle ear disease, all these things that just cause rabbit sit there and hunker down and go quiet and not move enough. They may also see from urine issues too, so renal disease with polyuria, urthiasis, that kind of stuff too, we may get leakage and blockage and things too, and not urinate properly to those things will all have effects as well. But fundamentally, what we do thing that we know is underlying pain issue, we start looking and we're again, these may be signs of an underlying chronic painful arthritic condition.

This is a rabbit who did have, front leg problems. We can see here, hopefully you can see some, very cool back part of brachial plexus emerging. We can see some sort of lesions and bridging across the vertebrae here.

And that was a rabbit where we, we did have a nerve entrapment and neurological signs resolved that all rotated feet. It puts weight on the wrong part of the feet and we start getting poly dermati developing from that. So in short, with all these cases, radiography is really useful that any of our cases got rabbit showing generalised non-sick signs is radiograph them and radiograph them and radiograph them and look for where these lesions may be and what might be hurting that rabbit because you can pick up a lot more that way than for some of the things we may classly do and say a dog or a cat like take bloods and do things like that.

So what else may be affected, but we can see all kinds of places too. So this is a rabbit where we actually had stifle arthritis. There's not too many advanced changes on here.

We've also got some remodelling in the hips. He's had a degree of hip dysplasia, see this is not a round, hip joint here. We've got a slight bit of remodelling on the edges.

Here, as we do see some hips with giant braces what was most important, if you see the angle of the legs, we very often get these valgus some deformities and the stress that's putting on the stifles we see a little bit hoping to see the the joint ma there. This will cause, cause long term problems from on the stifles. Again, another hiptoplastic one, a bit a little bit more severe.

Again, we can see start we asked tabulum changes in this side in particular. And this side here, we can see a very, very small, femoral head there. Again, this side with this X-ray here too.

Again, we got, we got more hip changes, and also we can start seeing some of the, changes within the, stifles. You see, sometimes you get these calcifications along the collateral ligaments. Again, just like in other species, we'll start seeing this change and some roughening along, along the joint surfaces.

Again, we can see it's probably slightly better up here where they got like an exostosis forming. And you know, these rabbits have long term problems, real difficulty moving, . Again, we can predict pretty much that it's going to be painful.

We also get some really quite severe things. And this is a rabbit who is about 78 years old, came in just showing weakness on the back end. What you can see here is, I think very clearly, is at some point in his life, I had a dislocated spine.

And it's now set in completely wrong position, and they had no record. They'd had rabbits about a year old. They had no record of having any injury at all.

So it's likely this injury predated that. And a typical rabbit, it's covered up, it's shown, it, it, it's shown no no pain signs, it's covered up for many years and probably why I had muscling over that area. Then it wouldn't, everything stayed roughly in the same place.

As the lesion got over the artery change developed and got more painful, so the muscle disappeared and became less stable and made things worse. We'll see more subtle signs more often. And again, if you look along the spine, you see a nice straight line as soon as you see one vertebra is slightly out of kilter with all the others.

And again, a bit of a pointer that may have have some degree of, of, of arthritic disease there. It's always worth doing two views and doing, a DV as well as a lateral. The reason that is particularly on a lumbar sacral joint was very subtle lesions.

And this rabbit had signs more relating to the right leg and the left. We can see the difference. Here's a fairly normal, if you like, lumbar sacral joint.

And here you can see the reaction on the other side there, which is leading to nerve entrapment and problems down that whole, whole hind leg. We'll see disc disease too resulting in long term sequels. Again, we're looking occasion a width of a disc width of a joint.

So you've got a wide joint, you've got wide joint, here we've got narrowing of a disc space, and sometimes we're actually very rarely we actually see calcification, of a disc space that that really is quite unusual, but you will see them from time to time. Again, advice always used to be, while I was looking at these cases, I would say to people, OK, X-ray of the lumbar spines where you find most of the lesions actually, as I think put small rabbits on the plates and I get more spine and I lesion of the thoracic area. Here's another one here.

We can see these change up around the back of a brachial plexus emergence again, another lesion there. And also we start seeing cervical lesions to the more your X-rays. So that's now my advice is, if you have these sorts of rabbits, X-rays and from top to toe, you want to see the skull anyway for dental problems, for ear problems, but it's really good to, start getting some of those cervical spinal lesions too.

And we do see a few of those too. And it's another, again, narrowing of this space in the cervical area is a very hard area to image, for cervical thoracic, boundaries, . But then we move up into these areas, up into the main part of the neck, and we can start seeing again more reactions along the base of the spine.

These can be quite subtle, so again use for having digital where you can actually enhance and blur your images slightly. Or we're using advanced imaging, which could show them much more clearly. And this is, obviously a rabbit with severe spinal problems.

We can see within the, thoracic area, we can see just how clearly those are showing now. And if we go back into the lumbar area again, we can start seeing these major, major, spondylitis reactions along the spine there. Again, it doesn't take a lot of imagining that this is going to be a very, very painful, rabbit.

So, OK, we're gonna diagnose it. What can we actually do about it? It's really important to remember that arthritis fundamentally, or sorry, arthritis, chronic arthritis is incurable.

We're not going to make it go away, and we have to manage those expectations. So we really have to get the owner to understand those pain implications. That's really tricky because you're already telling them they've probably missed this for quite a long time, and the rabbits have these problems building up for a long time, which they haven't seen at all.

The rabbit's not vocalising. It's not doing things they understand as being painful in a dog or a cat or them. We've got to try and educate them through that too, and understand what they're doing.

We can, once we do that, we, we can do some has been change and get people to understand that too. So things like flooring are important. So we don't want rabbits on, not on, on sort of non-slip or slippery floorings and stuff can like we were a dog or whatever else there, we want to have some grip and things.

It's also important in regards to the feet. There's a very good paper in the vet record a few years ago showing the only thing that really stopped polar dermatis developing was to keep on to grass or hay. And so actually having a more limited area sometimes for most we're living in a deep litter hay bedding might be really useful.

So we've got limited movements, so you'd be less likely to get pressure sores developing. We try and reduce their need to climb, you know, we try and stop people having rabbit climbing up the stairs, jumping on to furniture and stuff, to reduce that stress on the back and things got spinal problems can be helpful. And the use of ramps is really useful, so low, shallow ramps to get onto things they need to, they can carry around when they want to.

If they've got these really amazingly tiered hutches, again, make sure the ramps between the different tierage are nice and shallow, but not too steep, that can be important too. Handling is also important, and we can talk a little bit at the moment about how some of these lesions develop, but A lot of the behavioural problems we see forgotten say an aggressive rabbit is upset about people coming to pick it up because it back hurts or its hips hurt or something like that and people pick them up there, it's uncertain and it may actually hurt it more that way. And so it's really important to teach owners again good.

Handling, even though they may seem to know whatever just run through things, synthetic handling methods, make sure that back into it was supported, how they carry right with A to B and stuff so we don't make things worse as a rabbit feels reassured and doesn't get leery about being picked up or handled by, by people. And again, really important in the surgery too, certainly if you're dealing with some older animals and stuff and care, we're supporting the spine at all times moving around there. We did have a case recently where we had a rabbit virtually go off its legs after castration.

And we, we only came to a second opinion because she thought the vets had done something to it under anaesthesia. We x-rayed, we found a major spinal lesion. Which have been going on for a very, very long time.

We can say, OK, fine, let me do spondylosis and stuff. This didn't happen. This is not over.

This is a rabbit who's got severe spine problems, you know, probably by laying out on the table for castration and things, probably just, just tilt to the spine a bit and just stress the joints, and we just got a breakdown there. We put on to on to on to anti-inflammatories, the rabbit did really, really well. So, you know, again, be, be aware of these things too, and synthetic handling within the surgery, and, and positioning and stuff really helps a lot too.

We look at diet as well, and again, really important that these rabbits with arthritis don't get fat. They load the joints too much and put too much stress with them as well. You mentioned about some of the cervical spinal lesions tonight.

Food position is really important. If rabbit's got a sore neck, putting the food down on the floor is not a nice thing to do to it. So put food up a little bit higher, put it onto a platform and stuff like you would with the dog, and make it easy to get there too.

Again, exercise is important too. You don't want to arrest these animals absolutely completely or lose even more muscle, bulk, and that will destabilise the joints even more and worse the problem. You do want them moving.

You won't be able to choose to do reasonable level of exercise on the flat to get around and do stuff. You don't want them to stay totally static. Similarly, you don't want to overdo it, and if they start hanging around doing far too much and and overstressing, a problem, that can make things worse too.

So exercise and moderation is a really good thing to do. What can we do as that? We, we, well, we like using drugs, and we obviously want to use pain relief.

And that is the mainstay of treatment. We, we basically, we, we, we, we take away the inflammation, we take away the pain, we help that rabbit move around more. That's going to help it muscle up, and that's going to stabilise the joint more and then we, we, we, we, we will hopefully got a more, more stable, longer term situation.

What we can't do is let the surgeons leave the animal in pain. Now, maintain this is non-steroidals. Very few have much data in rabbits apart from meloxicam.

This is the, pharmacokinetic dose rate, which is 1 milligramme per kilogramme. Really importantly, use that, that dose. It's not a high dose.

It's a herbivore thing. If you look at a dose in cattle and horses, it's really high, about 2 to 3 milligrammes per kilogramme. So carnivores have different protein bind, different absorption rates, so they have to, they will have a much lower dose than the herbivores.

So bear in mind, you need to have a high dose. Various papers mention this being once a day or twice a day. Personal I tend to start it twice a day and try and come down to once a day.

To get once I got the loading done, I tend to stick around the 1 milligramme per kilogramme. I do worry about this reduction in pain relief. I guess I want to reduce, reduced dose, at least that temptation, where you're actually finding the highest dose of anti-inflammatory that doesn't work.

And then when pain relief is king, if that rabbit is happy about relief having a good dose of getting good quality pain relief, leave it there. When that doesn't work, we can use opiates. There's very little, known really with these for longer term use.

OK. Short-term use, a lot of testing done. But for longer term use, not much known.

And, and, and certainly one thing that is for sure is that, oral buprenorphine doesn't tend to work very well. It's that much this absorption you get to save the cat. Main one must use most often is tramadol.

Tramadol being a funny drug, and that probably not like dogs, like people, not all rabbits are going to be tramadol converters. So do warn people this may not work, or it may work very well, you don't know. And the other thing with rabbits as well is that the only real serious trial done in them.

All that showed was that 11 milligramme per kilogramme did not reach therapeutic drug levels in the blood. So as we, what we know is that the drug dose in rabbit is going to be higher than 11 milligramme per kilogramme, which isn't particularly helpful. I think most people about 15 meg per kg, but you can probably get higher and we need more data before we really know much more about that.

Gabapentins begin to be used a bit in them, and again, there's some anecdotal doses kicking around there too. Again, bear in mind that gabapentin takes a long time to kick in and work. It's not an instant effect, and you may have to be careful that too.

And in some cases when you're desperate, you know, you may want to move on to steroid use, because you use information to and we make sure you got a suitable wash out of any any NSAID before you do that. Steroids can be used in rabbits. They are sensitive to steroid side effects, but used with care they can be quite useful.

There are other therapies too, . So nutraceuticals do get used so glucosamine preparations, and some of those can be, can be very good indeed. Lots of others like, turmeric and whatever else have got very limited data in rabbits, but there are some trials out there with some of the others.

There are some reasonable preparations too. If you're going to use them, use whatever evidence base you can, use the best quality products you can, and that hopefully will guarantee you actually getting that compound into that animal. We've used a little bit of PS gags, so using Cartraphan.

Again, we may get some effect in some of those rabbits with that and as well as those adjunct therapies, but certainly there's no harm at all and can be really helpful. And what we do have a lot of spinal rubs we are putting a few of those through laser and acupuncture now, and we're getting some really nice responses from, from those. And so the owners reporting much better activity, much better ease, especially immediately afterwards too.

And very often we'll start with laser and move on to acupuncture once once a pain to ease a bit too, and that does seem to be helpful. So fundamentally non-steroidals are a mainstay. What are the effects of these?

Well, you know, they are, they can get gastric ulceration. If you have suspicion that then faecal occult blood is a way of testing for that. They can get renal problems, just like in dogs and cats, it's not common, but it can occur.

So watch out for drinking, watch out for activity, watch out for weight loss, which are typical signs of renal disease too. That may mean it's worth doing some monitoring. If you're gonna do that, I'd probably recommend you use, urine sampling and looking for protein levels in the blood, urine, sorry, and also looking for, possibly, for looking at specific gravity, although there's some complication with that, but gravity and that's quite good.

Blood monitoring is very difficult because rabbits are not protein feeders primarily. Urea and creatinine, urea is quite, can go up with any form of renal effect or with pre-renal effects too, and creatinine is very, very, insensitive. So blood urine creatinine is not going to often be very helpful unless they've already got disease and already shown a rise in those.

So what happens, we do have renal failure too. Well, don't forget in the Bentley world pain control is king. We can't deny pain relief because we've got renal failure.

So we have to look at this, this equation of quality of life versus longevity, and which is most important what we're going to do about it. And really, our job is quality of life. It's not whatever else there.

So what we can do around that, we, we, we, we can't just plough on. We've got to do something. Well, we can reduce non-steroidal, we can take that dose down a bit, see if that helps at all.

We'll probably be unable to get rid of it totally. We can increase other drugs. We can start bringing opiates in, maybe gabapentin, maybe something that's less renooxic can help.

For a lot of our rabbits, we've used Benazepril. That's been really helpful when we have had, an anti-inflammatory case with renal disease. Benazr with increased glomera filtration rate really does seem to help a lot in rabbits.

We have some really excellent results we've been able to monitor through that too. In the shorter term fluids. And the other thing to bear in mind too, we're talking quality of life.

If we can't maintain that in a safe way, we do have to offer euthanasia, and it's not an invalid thing to do because it's about quality of life is about animal not suffering, and we have to be aware that is an option and something to bring into discussions, especially if our control of kidney disease is not that successful. So again, let's look at the brighter side of things. How do we monitor the effect of our arthritis drugs?

Well, we can look at the activity levels and, and we can even teach our, our owner some degree of pain scoring that type of thing too. We can monitor body weight, get a little bit careful, we got to combine that body condition and make sure we're not just getting a fat rabbit who who who's inactive. We can look at muscle gain, we can palpate, we can see, we can also see that we see the mobility in the joints here we can move things around there too.

And they obviously they were. Clinical signs associated with that, arthritis, then we can monitor how they're responding. Do we have fewer gut, gut episodes?

Is the urine flow better? We're getting less sludging with the urine and that kind of thing? And if we get that, should we reduce drug doses again, I would caution care with that, the good quality response, maybe maintain those doses, they're doing something positive.

And back to saying we all we need to consider quality of life. This is not a curable condition. Pain will increase as the condition worsens.

So we have to be accurate with our prognosis. They really know, this is something that's going to be be potentially life-limiting, unless we can control the pain. We have to be prepared to be evaluating the whole time and changing that too.

Again, owner perceptions too, and just so many owners don't perceive that the painful condition be a type of problem going on there. Sometimes they've known a relative or themselves being really bad pain from arthritis, and that means their ability to cope is really quite poor. And therefore they often may like euthaity much earlier than others.

Remember our veterinary surgeon's oath versus Hippocratic Oath. We are not sworn to to life at all costs. We we're, we're not sworn to longevity.

We are sworn to quality of life, and that's really important as if you like a core value to fall back on in these cases. And so we do have to discuss euthanasia. We do have to discuss end of life sometimes, and that's really important.

And this is the thing too, if you're already offering these questions too, you know, I've got a rabbit with arthritis. I'm giving anoxicam at 1 mg per gig twice a day. I'm giving Tramadol at say 20 mg per gig twice a day.

I'm giving gabapentin, and it's still not working. It's still having problems, still can't move. Do you know there's not many places to go with this.

And you really have to say what's the welfare for the animal? What are we doing this for? Why are we doing this still?

So we really want to prevent it. We know it's difficult to treat, whatever, so how do we prevent this too? Many of these injuries occur at a very early age.

And rabbits. Begin to socialise and learn when they first emerged from the nest about 2 weeks old. And yet, very few rabbits are actually handled and socialised that age.

And this is again probably getting potentially worse at the moment where the new animal welfare regulations, say you can't sell a rabbit before 8 weeks old. To be honest, very much on the breeders, very much on the pet shops to really get handling those rabbits from a very, very early age indeed, because very often by the time we buy at 8 weeks old, we're not learning much. So they're, they're very likely to be very fearful.

The initial handling episodes can be quite traumatic, and this is a common time for low grade injuries to occur, especially in young, soft, developing bones. And this one I think most of these, these, these spinal problems occur when, I mean that's why where most owners are very accurately saying, I don't recall there being injury, and you're looking at a subluxated spine. So how do we change this?

We change by educating people, by going to the pet shops, by encouraging very early handling, and they're going to develop this by having rabbits who when they sell them, are really much more relaxed, much easier to handle, and much nicer to handle, animals. We're going to teach the owners when they come in. For their first consultation, OK, maybe a bit late, but better then than never, how to handle the rabbit, how to do it safely, how to support the back, how to move the rabbit around there, how not to pick it up from midriff and stuff and do that so that they can learn how not to cause problems with the backs and stuff.

Much easier when somebody's already had a problem with that too. And we're gonna do some weight management too. We're gonna teach them good quality, diet, so a high fibre diet, good activity levels.

Because of rabbit is good activity levels can have a much more better calcified spine, especially goes outside as well, get some vitamin D on into it as well. High fibre diet, we're gonna have less fat rabbit, less weight on the joints. Don't forget too, the fat is an active substance and in many other species you'll see that large quantity of fat will actually increase pain and pain perception in non-weight bearing joints.

And this is like to be the same case in rabbits as well. So again, we don't want rabbit's fat. We want a good high-quality fibre diet.

And guess what? That's gonna help them with things like dental disease stuff too. It's no coincidence that rabbits evolved with grass and hay, and this is exactly where we're going to for all these things to get your rabbit as healthy as possible.

So in summary, all paper rabbit should be radiographed. Arthritis is painful. It doesn't get better, but it can be prevented if we stop thinking about arthritis and old age disease and think about it as being a disease from basically the moment that rabbit's born and moving and stuff, then it's actually a young age disease and prevention has to occur in that period there too with good quality education about handling, socialising, diet, and we can reduce these cases by, by a long way.

Thank you. John, that was absolutely fascinating. I, I have never thought of arthritis in young animals and, and the fact that we could prevent it so relatively easily with education.

Not to eradicate but hopefully reduce the case would be really good, yeah, yeah. So yeah, fabulous. .

We do have some questions that have come through to us. Caroline wants to know which nutraceuticals would you recommend for rabbits with OA? Right.

This is not my, my, I'm not very good on these things. I would tend to, we use the Ox Bay Joint supplement quite a lot. And otherwise, I direct people to get a really good quality, veterinary grade glucosamine supplement, whatever, whatever site they're using.

So I talk to my colleagues and to find out what the latest flavour month is there. And actually, a lot of, a lot of people actually have, around here seem to have horses too, and many of those seem to be on glucosamines we use some of these really good quality equine supplements. The important thing is I do get to use a vet quality one, and one that's gone through testing and quality and quality control.

Yeah, I think that's important especially with things like glucosamine and all the problems. Exactly. And also I think also trying to avoid it from, you know, from things like, you know, sensitive sources, some, some shellfish or stuff like that too.

One we seems wrong feeding rat that sort of things rabbits, but also because you got to look at the environmental sustainability of that. Absolutely, absolutely, I agree. Another good question come through.

Can you use paracetamol in rabbits? And if yes, what dose? OK.

I've never used it. And I don't know. There will be some doses published, how well they've been worked out, whether anecdotal dose, I really couldn't tell you, but you can, you probably can.

Again, maybe as a short-term rescue, it's saying we should consider. But again, don't. Look at that being a mainstay drug.

Go back, it was important to use drugs, go back to the drugs got most data on them, and use them first of all. So that really brings us to naloxicam nearly every single time. But that's the one where most data has got really well worked out.

There are some, even some loading studies, joint loading studies coming through now too. So just be a little bit, be careful where we, where were some of the new ideas, you know, go back to try and trusted in the first place. Yeah.

Yeah, sometimes, as you say, the, the ones with the most data are there for a reason. It's really weird with paracetamol at the moment because it's a separate brand altogether. But there's some data to paracetamol, Ibuprofen in human medicine are almost being rated or a little better than placebo effect.

And yet, inventing medicine, we're seeing genuine effects from, from, from paracetamol. Would not use ibuprofen, by the way, don't use ibuprofen. That's true.

But it may also be we're looking at different people, different animals responding to different drugs and different needs that too. So again, what we need fundamentally here is more data. So we can look to rotate and do things.

I think the other thing too, which we haven't really considered much in rabbits is washout periods. And whether we, if we are changing those drugs, how long we have to leave between them because I don't think that's been studied at all, really. Right, it's just a, a best guess.

Best guess, absolutely. Yeah. John, we've got loads of comments coming through about how fabulous it's been, how much people have enjoyed the series.

Thank you. It really has been great. And folks, if I can just remind you, in your chat box, Dawn has put a message and a link there.

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And if you don't feed back to us on topics that you want and short courses like this with Fabulous, knowledgeable colleagues like Johnny. We don't know, so please use that surveyMonkey or quite simply drop Dawn a line, Dawn at the webinar vet.com and she really is open to listening and listening to ideas.

So for all of you for attending, thank you very much, John, for tonight and also the whole series. Thank you for sharing your knowledge with us. It's always a pleasure to listen to you.

Thank you for the opportunity and thank you for listening.